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Flashcards in Pyelonephritis Deck (47):

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.

1. Pregnancy


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

1. reflux


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.

Chronic pyelonephritis


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

1. fistulas


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

•Congenital e.g._____

•Acquired e.g. _____


posterior urethral valves in males;

prostatic hypertrophy


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


•Diabetes mellitus

Immunosuppression and immunodeficiency

Predisposing factors for acute pyelonephritis


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

1) Pyelonephritis; prostatitis

2) cystitis


Cystitis distinguishable from pure urethritis by more ___ onset, more ___, pain and tenderness in ____region.

acute; severe symptoms; suprapubic



DRE--> prostate is ___ ___



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

2. Pyonephrosis

3. Perinephric abscess

4. Healing


Complications of acute pyelonephritis

Healing: neutrophils replaced by lymphs then irregular scars that can be seen on the cortical surface as ___

fibrous depressions


Indentations in kidney
Abnormal shape with loss of cortex

Chronic Pyelonephritis


•Tubules have eosinophilic hyaline casts --> thyroidization.

chronic pyelonephritis


chronic pyelonephritis histo:

•___ dilation, atrophy and loss of glomeruli.

•Tubules have _____ --> thyroidization.

Interstitium is scarred w/ chronic inflammatory cell infiltrate.


Tubular; eosinophilic hyaline casts


Xanthogranulomatous Pyelonephritis

Inflammatory is ___

May cause ___

lipid-filled macrophages; fistulas