Urinary tract infections can spread through the kidney either ?
hematogenously by the blood stream or by ascending infection from the urethra or bladder
Hematogenous spread of UTIs is more common in instances of (1) or in (2) patients
1. ureteral obstruction 2. immunocompromised
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
1. polyomavirus, cytomegalovirus (CMV) or adenovirus 2. E coli
Acute pyelonephritis is most commonly caused by (1) and consist of collections of (2) within the kidney (3)
1. ascending acute cystitis or urethritis 2. neutrophils (micro or macroabcesses) 3. collecting system or the interstitium surrounding the renal tubules
Where do micro or macroabcesses occur in acute pyelonephritis?
kidney collecting system or the interstitium surrounding the renal tubules
Acute pyelonephritis most commonly occurs after ?
obstruction of the urinary tract or after catheterization or other instrumentation of the bladder, urethra, or ureters.
(1) can cause urinary tract infections as well as acute pyelonephritis.
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
1. a short intravesicle segment of the ureter
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)
1. dysuria, frequency, anemia 2. fever and malaise 3. posterior costovertebral angle flank pain (known as CVA tenderness).
Urinalysis for a urinary tract infection has (1)
1. white blood cells in urine (pyuria) and bacteriuria.
Why are UTIs more common in women than men?
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
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).
1. white blood cell casts 2. neutrophils 3. interstitium and tubules
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
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).
1. intravesical (within the bladder) segment 2. bladder contraction 3. ureter
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
1. renal papillae
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)
1. neutrophils 2. collecting system and interstitium 3. papillary necrosis 4. obstruction
Papillary necrosis is more common in (1) and is often (2)
1. diabetes 2. bilateral
Grossly, there is (1) and degeneration of the renal papillae while (2) and (3) are seen microscopically.
1. yellowish necrosis 2. neutrophils and coagulative necrosis 3. conserved outlines of tubules
Another acute complication of pyelonephritis is (1), in which neutrophils fill the (2) causing acute inflammation of the entire renal collection system
1. pyonephrosis 2. renal pelvis, calyces, and ureter
If pyonephrosis extends through the (1) into the perinephric fat, then it becomes a (2)
1. renal capsule 2. perinephric abscess
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)
1. neutrophils 2. fibrous 3. treat with antibiotics
Chronic pyelonephritis is generally believed to be the result of multiple recurrent (1) infections which lead to fibrosis (scaring) of the (2)
1. ascending 2. renal cortex
This results in an abnormal bumpy kidney shape inside the usual rounded border.
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).
1. dilated and atrophic 2. eosinophilic hyaline casts 3. thyroid 4. thyroidization.
Microscopically, in chronic pyelonephritis, the interstititum is usually (1) with an infiltrate of (2) which represent the chronic inflammatory cells.
1. fibrotic 2. lymphocytes
One uncommon type of renal infection is (1) which usually presents as a unilateral yellow tumor mass
1. xanthogranulomatous pyelonephritis
The mass in xanthogranulomatous pyelonephritis consists of (1) and are most commonly a response to (2)
1. lipid filled macrophages 2. proteus infection
In xanthogranulomatous pyelonephritis, (1) can be present, which are composed of (2)
1. staghorn calculi 2. magnesium ammonium phosphate stones
Xanthogranolomatous pyelonephritis often forms (1) for reasons that are not well understood
Causes of UTIs and Pyelonephritis:
Escherichia coli, followed by Proteus, Klebsiella, and Enterobacter
IMMUNOCOMPROMISED (esp. w/ transplanted organs; RENAL ALLOGRAFTS): what viruses cause Acute pyelonephritis
Polyomavirus, CMV and adenovirus
Acute pyelonephritis Pus which are _____ are found where
neutrophils in collecting tubules and interstitial tissue
Polyomoavirus causes acute pyelonephritis in 1); what do you see on HandE and EM:
1)Immunocompromised; H&E-->nuclear enlargement and intranuclear inclusions; EM-->cystalline-like lattices on EM
Polyomoavirus H&E-->____and ____ inclusions; EM-->_____ lattices
nuclear enlargement; intranuclear; cystalline-like
Predisposing factors for acute pyelonephritis:
•Urinary tract obstruction
•Acquired e.g. _____
posterior urethral valves in males;
Pre-existing renal lesions may cause acute pyelo; how?
causing intrarenal scarring and obstruction
•Vesicoureteral reflux (VUR)
•Pregnancy (UTI and bacteriuria).
•Pre-existing renal lesions
Immunosuppression and immunodeficiency
Predisposing factors for acute pyelonephritis
Systemic signs seen in 1); NOT seen in 2)
1) Pyelonephritis; prostatitis
Cystitis distinguishable from pure urethritis by more ___ onset, more ___, pain and tenderness in ____region.
acute; severe symptoms; suprapubic
DRE--> prostate is ___ ___
BOGGY & TENDER
VUR--> Short intravesical ureter (which doesn’t close fully during micturition), thus urine goes up and bacteria enter _____
concave papilla at the POLES
Complications of acute pyelonephritis
1. Papillary necrosis
3. Perinephric abscess
Complications of acute pyelonephritis
Healing: neutrophils replaced by lymphs then irregular scars that can be seen on the cortical surface as ___
Indentations in kidney
Abnormal shape with loss of cortex
•Tubules have eosinophilic hyaline casts --> thyroidization.
chronic pyelonephritis histo:
•___ dilation, atrophy and loss of glomeruli.
•Tubules have _____ --> thyroidization.
Interstitium is scarred w/ chronic inflammatory cell infiltrate.
Tubular; eosinophilic hyaline casts
Inflammatory is ___
May cause ___
lipid-filled macrophages; fistulas