Pyelonephritis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Pathophysiology
- Pyelonephritis results mostly from an ascending infection, from the urethral (when colonised by organisms) to bladder and then through the ureters to the renal parenchyma or from a descending infection from the blood itself.
- Acute pyelonephritis is an exudative purulent localized inflammation of the renal pelvis (collecting system) and kidney.
- The renal parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting of purulent exudate (pus): neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils).
- Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, glomeruli and vessels are normal.
- Gross pathology often reveals pathognomonic radiations of hemorrhage and suppuration through the renal pelvis to the renal cortex. Chronic infections can result in fibrosis and scarring.
Xanthogranulomatous Pyelonephritis
Xanthogranulomatous Pyelonephritis is a rare disease. It is associated with nephrolithiasis. Many kidney stones are seen and stag horn calculi can also be noticed. Xanthogranulomatous pyelonephritis is usually confused due to its appearance, with a malignancy and aggressive management requiring a surgical resection is done. The histopathology of the specimen confirms xanthogranulomatous pyelonephritis rather than a tumour. The initial presentation can be abdominal distention owing to the formation of a peritoneal abscess. Proteus is the most common organism involved in case of a peritoneal abscess associated with xanthogranulomatous pyelonephritis.[1]
Microscopic Pathology
=Gross Pathology
Gross pathology often reveals pathognomonic radiations of hemorrhage and suppuration through the renal pelvis to the renal cortex. Chronic infections can result in fibrosis and scarring.
Acute pyelonephritis
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Chronic pyelonephritis
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References
- ↑ Yeow Y, Chong YL (2016). "Xanthogranulomatous pyelonephritis presenting as Proteus preperitoneal abscess". J Surg Case Rep. 2016 (12). doi:10.1093/jscr/rjw211. PMC 5159021. PMID 27915241.