Chronic pyelonephritis

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Chronic pyelonephritis

Pathology

Renal and ureteral disorders

Renal agenesis

Horseshoe kidney

Potter sequence

Hyperphosphatemia

Hypophosphatemia

Hypernatremia

Hyponatremia

Hypermagnesemia

Hypomagnesemia

Hyperkalemia

Hypokalemia

Hypercalcemia

Hypocalcemia

Renal tubular acidosis

Minimal change disease

Diabetic nephropathy

Focal segmental glomerulosclerosis (NORD)

Amyloidosis

Membranous nephropathy

Lupus nephritis

Membranoproliferative glomerulonephritis

Poststreptococcal glomerulonephritis

Goodpasture syndrome

Rapidly progressive glomerulonephritis

IgA nephropathy (NORD)

Lupus nephritis

Alport syndrome

Kidney stones

Hydronephrosis

Acute pyelonephritis

Chronic pyelonephritis

Prerenal azotemia

Renal azotemia

Acute tubular necrosis

Postrenal azotemia

Renal papillary necrosis

Renal cortical necrosis

Chronic kidney disease

Polycystic kidney disease

Multicystic dysplastic kidney

Medullary cystic kidney disease

Medullary sponge kidney

Renal artery stenosis

Renal cell carcinoma

Angiomyolipoma

Nephroblastoma (Wilms tumor)

WAGR syndrome

Beckwith-Wiedemann syndrome

Bladder and urethral disorders

Posterior urethral valves

Hypospadias and epispadias

Vesicoureteral reflux

Bladder exstrophy

Urinary incontinence

Neurogenic bladder

Lower urinary tract infection

Transitional cell carcinoma

Non-urothelial bladder cancers

Renal system pathology review

Congenital renal disorders: Pathology review

Renal tubular defects: Pathology review

Renal tubular acidosis: Pathology review

Acid-base disturbances: Pathology review

Electrolyte disturbances: Pathology review

Renal failure: Pathology review

Nephrotic syndromes: Pathology review

Nephritic syndromes: Pathology review

Urinary incontinence: Pathology review

Urinary tract infections: Pathology review

Kidney stones: Pathology review

Renal and urinary tract masses: Pathology review

Assessments

Chronic pyelonephritis

USMLE® Step 1 questions

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High Yield Notes

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Questions

USMLE® Step 1 style questions USMLE

of complete

A 45-year-old woman presents to the clinic with flank pain, malaise, and weight loss over the past several weeks. She states, “I just have no appetite for anything these days.” She has a history of recurrent urinary tract infections and several episodes of nephrolithiasis. Her temperature is 38°C (100.4°F), pulse is 94/min and blood pressure is 154/62 mmHg. Physical examination shows a palpable left sided flank mass. She subsequently undergoes a biopsy of the mass with the following histologic finding demonstrated below:  



Reproduced from: Wikipedia

Which of the following pathogens is most commonly implicated in this disease process?  

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Transcript

Content Reviewers

Rishi Desai, MD, MPH

Contributors

Tanner Marshall, MS

With chronic pyelonephritis, pyelo- means pelvis, and -neph- refers to the kidney, so in this case it’s the renal pelvis, which is the funnel-like structure of the kidney that drains urine into the ureter, and -itis means inflammation. This inflammation is usually caused by bacterial infection of the kidney, which is called acute pyelonephritis.

When somebody has recurrent episodes of acute pyelonephritis, the kidney becomes visibly scarred, at which point it’s referred to as chronic pyelonephritis.

Now a urinary tract infection, or UTI, is any infection of the urinary tract, which includes the upper portion of the tract—the kidneys and the ureters, and the lower portion of the tract—the bladder and urethra.

So acute and chronic pyelonephritis are types of upper urinary tract infection.

Now, an episode of acute pyelonephritis often clears up without much complication. Certain people, though, are predisposed to having recurring bouts of acute pyelonephritis, which eventually leads to chronic pyelonephritis and permanent scarring of the renal tissue.

The most common risk factor for recurrent acute pyelonephritis and therefore chronic pyelonephritis, is vesicoureteral reflux, or VUR, which is where urine is allowed to move backward up the urinary tract, which can happen if the vesicoureteral orifice fails.

The vesicoureteral orifice is the one-way valve that allows urine to flow from each ureter into the bladder, but not in the reverse direction.

VUR can be the result of a primary congenital defect or it can be caused by bladder outlet obstruction, which increases pressure in the bladder and distorts the valve.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 7/E (ENHANCED EBOOK)" McGraw Hill Professional (2014)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Xanthogranulomatous Pyelonephritis: Clinical Experience with 41 Cases" Urology (2008)
  6. "Risk Factors Associated with Acute Pyelonephritis in Healthy Women" Annals of Internal Medicine (2005)
  7. "Diagnosis and Management of Acute Ureterolithiasis" American Journal of Roentgenology (2000)
  8. "Vesicoureteral Reflux, Reflux Nephropathy, and End-Stage Renal Disease" Advances in Urology (2008)
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