RENAL PATHOLOGY 3 Flashcards Preview

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Flashcards in RENAL PATHOLOGY 3 Deck (41)
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1
Q

Urinary tract infections can spread through the kidney either ?

A

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

2
Q

Hematogenous spread of UTIs is more common in instances of 

A

 IE 

3
Q

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

A

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

4
Q

Where do micro or macroabcesses occur in acute pyelonephritis?

A

kidney collecting system or the interstitium surrounding the renal tubules

5
Q

Acute pyelonephritis most commonly occurs after?

A

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

6
Q

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

A

1. STONE, Pregnancy, BPH

7
Q

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 most likely develop reflux, and will thus transmit bacteria from bladder or urethral infections directly to the kidney

A

1. REC. STONE

8
Q

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

A

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

9
Q

Urinalysis for a urinary tract infection has (1)

A

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

10
Q

Why are UTIs more common in women than men?

A

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

11
Q

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).

A

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

12
Q

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

A

1. reflux

13
Q

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)

A

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

14
Q

Papillary necrosis is more common in (1) 

A

1. diabetes 

15
Q

PAPILLARY NECROSIS=Grossly, there is (1) and degeneration of the renal papillae while (2) and (3) are seen IN URINE.

A

1. yellowish necrosis 2. coagulative necrosis 3. hematuria

16
Q

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)

A

1. neutrophils 2. fibrous 3. treat with antibiotics

17
Q

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

A

1. ascending 2. renal cortex

18
Q

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

A

Chronic obstructive pyelonephritis

19
Q

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).

A

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

20
Q

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

A

1. fibrotic 2. lymphocytes

21
Q

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

A

1. xanthogranulomatous pyelonephritis

22
Q

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

A

1. lipid filled macrophages 2. proteus infection

23
Q

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

A

1. staghorn calculi 2. magnesium ammonium phosphate stones

24
Q

Causes of UTIs and Pyelonephritis:

A

Escherichia coli, followed by Proteus, Klebsiella, and Enterobacter

25
Q

Acute pyelonephritis Pus which are _____ are found where

A

neutrophils in collecting tubules and interstitial tissue

26
Q

Predisposing factors for acute pyelonephritis:

•Urinary tract obstruction

•Congenital e.g._____

•Acquired e.g. _____

 

A

posterior urethral valves in males neonate;

prostatic hypertrophy

27
Q

•Vesicoureteral reflux (VUR)

•Pregnancy (UTI and bacteriuria).

•CATHETERIZATION

•Diabetes mellitus

Immunosuppression and immunodeficiency

A

Predisposing factors for acute pyelonephritis

28
Q

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

A

1) Pyelonephritis; 

2) cystitis

29
Q

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

A

acute; severe symptoms; suprapubic

30
Q

septic shock

A

e.coli infection

31
Q

Complications of acute pyelonephritis

A

1. Papillary necrosis
2. Perinephric abscess

3. Healing

32
Q

Complications of acute pyelonephritis

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

A

fibrous depressions

33
Q

Abnormal shape, large scar with loss of cortex-KIDNEY

A

Chronic reflux associated Pyelonephritis

34
Q

•Tubules have eosinophilic hyaline casts --> thyroidization.

A

chronic pyelonephritis

35
Q

chronic pyelonephritis histo:

•___ dilation, atrophy and loss of glomeruli.

•Tubules have _____ --> thyroidization.

Interstitium is scarred w/ chronic inflammatory cell infiltrate.

 

A

Tubular; eosinophilic hyaline casts

36
Q

Xanthogranulomatous Pyelonephritis

Inflammatory is ___

May cause ___

A

lipid-filled macrophages; fistulas

37
Q

ca cervix

A

hydronephrosis

38
Q

dilated pelvis, dilated cayclycial  system

A

hydronephrosis

39
Q

unilateral- dilated pelvis, dilated cayclycial  system

A

stone, tcc

40
Q

risk factors- of chronic pyelonephritis

A

vesicourethral reflux, a source of infection

41
Q

Sickle cell anemia

Analgesic

Pyelonephritis with DM

 

These could produce_________

A

Acute papillary necrosis