| Chronic Pyelonephritis
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Etiology
•Urine reflux
due to uretero-vesicle incompetence with or without superimposed
infection.
•Urine outflow obstruction of any kind (calculi, tumor,
prostatic hypertrophy) with superimposed ascending infection.
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Pathogenesis
•Obstructed
urine flow causes urinary stasis, providing a medium for bacterial replication.The
infection ascends to the renal parenchyma (often via vesicoureteral reflux) and causes inflammation and
fibrosis.,
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Epidemiology
•In general, any abnormality to the flow of urine from the
calyces to the urethra increases the risk for pyelonephritis.
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General Gross Description
•There is irregular loss of renal parenchyma with
scarring.
•There is distortion of the associated calyces which commonly
appear dilated because of the reduction in medullary and cortical
tissue.
•The disease process may be unilateral or bilateral and is seen
more frequently involving upper and lower poles of the kidney.
•Examples:
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General Microscopic Description
•The
affected areas may show dilated tubules filled with colloid-like hyaline
casts (thyroidization).
•The affected areas may show atrophic tubules
with interstitial fibrosis and chronic inflammation.
•The calyceal mucosa
shows chronic inflammation and fibrosis.
•Examples:
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References
• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 871-972.
• Harrison's Principles of Internal Medicine, 13th Ed: Isselbach et. al. (eds). New York, McGraw-Hill, 1994, pp.543.
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| Chronic Pyelonephritis
| | Synopsis by: Harold Yamase M.D. (T72000M43000)[443]
| |