Pyelonephritis

Question 1

Urinary tract infections can spread through the kidney either ?

Answer 1

hematogenously by the blood stream or by ascending infection from the urethra or bladder

Question 2

Hematogenous spread of UTIs is more common in instances of (1) or in (2) patients

Answer 2

1. ureteral obstruction 2. immunocompromised

Question 3

Immunocompromised patients can have renal infections from a variety of viruses including (1) whereas (2) is the most common cause of urinary tract infections in adults with an intact immune system

Answer 3

1. polyomavirus, cytomegalovirus (CMV) or adenovirus 2. E coli

Question 4

Acute pyelonephritis is most commonly caused by (1) and consist of collections of (2) within the kidney (3)

Answer 4

1. ascending acute cystitis or urethritis 2. neutrophils (micro or macroabcesses) 3. collecting system or the interstitium surrounding the renal tubules

Question 5

Where do micro or macroabcesses occur in acute pyelonephritis?

Answer 5

kidney collecting system or the interstitium surrounding the renal tubules

Question 6

Acute pyelonephritis most commonly occurs after ?

Answer 6

obstruction of the urinary tract or after catheterization or other instrumentation of the bladder, urethra, or ureters.

Question 7

(1) can cause urinary tract infections as well as acute pyelonephritis.

Answer 7

1. Pregnancy

Question 8

Because the ureters are generally closed during micturition (urination), there should be little reflux into the ureters unless there is some sort of malformation such as (1). These individuals can develop reflux, and will thus transmit bacteria from bladder or urethral infections directly to the kidney

Answer 8

1. a short intravesicle segment of the ureter

Question 9

Clinically, patients can present with the distal signs of urinary tract infection (1), constitutional signs of infection (2), and signs of the renal infection including (3)

Answer 9

1. dysuria, frequency, anemia 2. fever and malaise 3. posterior costovertebral angle flank pain (known as CVA tenderness).

Question 10

Urinalysis for a urinary tract infection has (1)

Answer 10

1. white blood cells in urine (pyuria) and bacteriuria.

Question 11

Why are UTIs more common in women than men?

Answer 11

Urinary tract infections tend to be more common in women than men because estrogen increases adherence of bacteria to transitional cells, women have shorter urethras, and women lack the antibacterial prostatic secretions of men

Question 12

When the infection ascends to the kidney and becomes pyelonephritis, there are (1) because the (2) in the kidney are present in the (3) and move downstream into the urine. So the classical diagnostic feature for acute pyelonephritis is (1).

Answer 12

1. white blood cell casts 2. neutrophils 3. interstitium and tubules

Question 13

Urinary tract infections generally do not progress to acute pyelonephritis and are generally confined to the urethra and bladder because of the defense against (1) from the bladder into the ureter

Answer 13

1. reflux

Question 14

In individuals that have a short (1) of the ureter, there can be reflux into the ureter with urination because the (2) doesn’t completely block the (3) as it does in most people with longer (1).

Answer 14

1. intravesical (within the bladder) segment 2. bladder contraction 3. ureter

Question 15

In cases of intravesicle reflux, the acute pyelonephritis tends to occur in the (1) at the superior and inferior pole which tend to be blunter and easier for bacteria to access

Answer 15

1. renal papillae

Question 16

Because acute pyelonephritis consists of (1) within the kidney (2), there are a number of acute complications which can arise, including (3), in which the renal papillae become necrotic and can be sloughed into the ureter causing (4)

Answer 16

1. neutrophils 2. collecting system and interstitium 3. papillary necrosis 4. obstruction

Question 17

Papillary necrosis is more common in (1) and is often (2)

Answer 17

1. diabetes 2. bilateral

Question 18

Grossly, there is (1) and degeneration of the renal papillae while (2) and (3) are seen microscopically.

Answer 18

1. yellowish necrosis 2. neutrophils and coagulative necrosis 3. conserved outlines of tubules

Question 19

Another acute complication of pyelonephritis is (1), in which neutrophils fill the (2) causing acute inflammation of the entire renal collection system

Answer 19

1. pyonephrosis 2. renal pelvis, calyces, and ureter

Question 20

If pyonephrosis extends through the (1) into the perinephric fat, then it becomes a (2)

Answer 20

1. renal capsule 2. perinephric abscess

Question 21

Generally, an abscess (which is a collection of (1) develops a (2) wall as a result of the inflammation process, which stops the spread of the inflammatory process, but can make it difficult to (3)

Answer 21

1. neutrophils 2. fibrous 3. treat with antibiotics

Question 22

Chronic pyelonephritis is generally believed to be the result of multiple recurrent (1) infections which lead to fibrosis (scaring) of the (2)

Answer 22

1. ascending 2. renal cortex

Question 23

This results in an abnormal bumpy kidney shape inside the usual rounded border.

Answer 23

Chronic pyelonephritis

Question 24

Microscopically, in chronic pyelonephritis, the tubules are (1), or they have (2). This makes the kidney look like (3) microscopically so it is called (4).

Answer 24

1. dilated and atrophic 2. eosinophilic hyaline casts 3. thyroid 4. thyroidization.

Question 25

Microscopically, in chronic pyelonephritis, the interstititum is usually (1) with an infiltrate of (2) which represent the chronic inflammatory cells.

Answer 25

1. fibrotic 2. lymphocytes

Question 26

One uncommon type of renal infection is (1) which usually presents as a unilateral yellow tumor mass

Answer 26

1. xanthogranulomatous pyelonephritis

Question 27

The mass in xanthogranulomatous pyelonephritis consists of (1) and are most commonly a response to (2)

Answer 27

1. lipid filled macrophages 2. proteus infection

Question 28

In xanthogranulomatous pyelonephritis, (1) can be present, which are composed of (2)

Answer 28

1. staghorn calculi 2. magnesium ammonium phosphate stones

Question 29

Xanthogranolomatous pyelonephritis often forms (1) for reasons that are not well understood

Answer 29

1. fistulas

Question 30

Causes of UTIs and Pyelonephritis:

Answer 30

Escherichia coli, followed by Proteus, Klebsiella, and Enterobacter

Question 31

IMMUNOCOMPROMISED (esp. w/ transplanted organs; RENAL ALLOGRAFTS): what viruses cause Acute pyelonephritis

Answer 31

Polyomavirus, CMV and adenovirus

Question 32

Acute pyelonephritis Pus which are _____ are found where

Answer 32

neutrophils in collecting tubules and interstitial tissue

Question 33

Polyomoavirus causes acute pyelonephritis in 1); what do you see on HandE and EM:

Answer 33

1)Immunocompromised; H&E--\>nuclear enlargement and intranuclear inclusions; EM--\>cystalline-like lattices on EM

Question 34

Polyomoavirus H&E--\>\_\_\_\_and ____ inclusions; EM--\>\_\_\_\_\_ lattices

Answer 34

nuclear enlargement; intranuclear; cystalline-like

Question 35

Predisposing factors for acute pyelonephritis: * Urinary tract obstruction * Congenital e.g.\_\_\_\_\_ * Acquired e.g. \_\_\_\_\_

Answer 35

posterior urethral valves in males; prostatic hypertrophy

Question 36

Pre-existing renal lesions may cause acute pyelo; how?

Answer 36

causing intrarenal scarring and obstruction

Question 37

* Vesicoureteral reflux (VUR) * Pregnancy (UTI and bacteriuria). * Pre-existing renal lesions * CATHETERIZATION * Diabetes mellitus Immunosuppression and immunodeficiency

Answer 37

Predisposing factors for acute pyelonephritis

Question 38

Systemic signs seen in 1); NOT seen in 2)

Answer 38

1) Pyelonephritis; prostatitis 2) cystitis

Question 39

Cystitis distinguishable from pure urethritis by more ___ onset, more \_\_\_, pain and tenderness in \_\_\_\_region.

Answer 39

acute; severe symptoms; suprapubic

Question 40

Prostatitis DRE--\> prostate is ___ \_\_\_

Answer 40

BOGGY & TENDER

Question 41

VUR--\> Short intravesical ureter (which doesn’t close fully during micturition), thus urine goes up and bacteria enter \_\_\_\_\_

Answer 41

concave papilla at the POLES

Question 42

Complications of acute pyelonephritis

Answer 42

1. Papillary necrosis 2. Pyonephrosis 3. Perinephric abscess 4. Healing

Question 43

Complications of acute pyelonephritis ## Footnote Healing: neutrophils replaced by lymphs then irregular scars that can be seen on the cortical surface as \_\_\_

Answer 43

fibrous depressions

Question 44

Indentations in kidney Abnormal shape with loss of cortex

Answer 44

Chronic Pyelonephritis

Question 45

•Tubules have eosinophilic hyaline casts --\> thyroidization.

Answer 45

chronic pyelonephritis

Question 46

chronic pyelonephritis histo: * \_\_\_ dilation, atrophy and loss of glomeruli. * Tubules have _____ --\> thyroidization. Interstitium is scarred w/ chronic inflammatory cell infiltrate.

Answer 46

Tubular; eosinophilic hyaline casts

Question 47

Xanthogranulomatous Pyelonephritis Inflammatory is \_\_\_ May cause \_\_\_

Answer 47

lipid-filled macrophages; fistulas