Pyelonephritis and Nephritis
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Questions and Answers

What is the main cause of pyelonephritis?

  • Fungal infection
  • Parasitic infection
  • Viral infection
  • Bacterial infection (correct)

    • What is a predisposing factor for pyelonephritis in females?

  • Short and wide urethra (correct)
  • Long and narrow urethra
  • Urinary tract obstruction
  • Diabetes mellitus

    • What is the term for inflammation of the renal pelvis?

  • Pyelonephritis
  • Pyelitis (correct)
  • Urinary tract infection
  • Nephritis

    • What is the route of infection in pyelonephritis through the urethra during endoscopy or catheterization?

    <p>Ascending infection</p> Signup and view all the answers

    What is the term for inflammation of the interstitial tissue of the kidney?

    <p>Nephritis</p> Signup and view all the answers

    What is a complication of pyelonephritis in pregnant women?

    <p>Urinary stasis</p> Signup and view all the answers

    What is the typical clinical course of E/M in terms of response to corticosteroids?

    <p>Dramatic response to corticosteroids with recurrence</p> Signup and view all the answers

    What is the most common cause of nephrotic syndrome in adults?

    <p>Membranous GN</p> Signup and view all the answers

    What is the primary mechanism of idiopathic membranous GN?

    <p>Immune deposits against renal auto-antigen on the basal surface of visceral epithelial cells</p> Signup and view all the answers

    What is a characteristic feature of membranous GN on electron microscopy?

    <p>Subepithelial deposits with spikes</p> Signup and view all the answers

    What is the typical proteinuria pattern in membranous GN?

    <p>Non-selective proteinuria</p> Signup and view all the answers

    What is the frequency of hypertension in membranous GN?

    <p>30%</p> Signup and view all the answers

    What is the primary cause of minimal change glomerulonephritis (GN) in adults?

    <p>Idiopathic</p> Signup and view all the answers

    What is the characteristic appearance of membrano-proliferative GN on PAS stain?

    <p>Tram track appearance</p> Signup and view all the answers

    What is the type of proteinuria seen in minimal change GN?

    <p>Selective proteinuria</p> Signup and view all the answers

    What is the prognosis of minimal change GN in response to cortisone?

    <p>Dramatic response to cortisone</p> Signup and view all the answers

    What is the characteristic deposit seen in membrano-proliferative GN by EM?

    <p>Sub-endothelial deposits</p> Signup and view all the answers

    What is the type of nephrotic syndrome seen in focal segmental GN?

    <p>Non-selective nephrotic syndrome</p> Signup and view all the answers

    What is the characteristic feature of membrano-proliferative GN on light microscopy?

    <p>Bilateral enlarged kidneys</p> Signup and view all the answers

    What is the fate of 2/3 of patients with membrano-proliferative GN?

    <p>Nephrotic syndrome</p> Signup and view all the answers

    What is the primary difference in terms of age between MCG and MGN?

    <p>MCG is typically seen in adults, while MGN affects children</p> Signup and view all the answers

    What is the difference in proteinuria between MCG and MGN?

    <p>MCG has selective proteinuria, while MGN has non-selective proteinuria</p> Signup and view all the answers

    How do MCG and MGN respond to cortisone?

    <p>MCG responds dramatically to cortisone, while MGN is resistant</p> Signup and view all the answers

    What is a characteristic of the electron microscopy picture in Type I MGN?

    <p>Subendothelial electron dense deposits are present</p> Signup and view all the answers

    What is the pathogenesis of Type II MGN?

    <p>Activation of the alternative complement pathway</p> Signup and view all the answers

    What is the typical prognosis of Type II MGN?

    <p>The disease recurs in transplantation</p> Signup and view all the answers

    What is the typical gross picture of MGN?

    <p>Bilateral enlarged kidneys</p> Signup and view all the answers

    What is the characteristic microscopic picture in MGN?

    <p>Glomeruli with hypercellularity and lobular accentuation</p> Signup and view all the answers

    What is the characteristic feature of Acute Tubular Necrosis (ATN)?

    <p>Acute decline in renal function</p> Signup and view all the answers

    What is the more common type of Acute Tubular Necrosis (ATN)?

    <p>Ischemic ATN</p> Signup and view all the answers

    What is the effect of tubular damage on the rennin/angiotensin system in ATN?

    <p>Stimulates the rennin/angiotensin system</p> Signup and view all the answers

    What is the effect of cast formation in ATN?

    <p>Increases intra-tubular pressure</p> Signup and view all the answers

    What is the characteristic feature of the gross picture of Ischemic ATN?

    <p>Enlarged kidney, with pale cortex and congested medulla</p> Signup and view all the answers

    What is the prognosis of Ischemic ATN?

    <p>Worse</p> Signup and view all the answers

    What is the characteristic feature of the micro picture of tubules in Ischemic ATN?

    <p>Distal convoluted tubules are affected</p> Signup and view all the answers

    What is the effect of back leak of tubular fluids in ATN?

    <p>Increases interstitial edema</p> Signup and view all the answers

    Study Notes

    Inflammation of the Kidney

    • Pyogenic abscess: a type of infection of the kidney
    • Specific inflammation:
      • T.B. (Tuberculosis)
      • Bilharziasis
      • Hydatid disease
      • Pyelonephritis

    Pyelonephritis

    • Definition: inflammation of the interstitial tissue of the renal pelvis and kidney followed by affection of tubules and glomeruli
    • Causes:
      • Mainly bacterial infection (E.coli, Klebsiela, Proteus, Enterobacter, and Pseudomonas)
      • Predisposing factors:
        • Urinary tract obstruction (strictures, stone, tumors, enlarged prostate)
        • Diabetes mellitus
        • Females are commonly affected due to short and wide urethra and pregnancy-related urinary stasis
    • Routes of infection:
      • Hematogenous: the organism reaches the kidney from a distant focus (septicemia, pyemia)
      • Ascending infection: through urethra, bladder mucosal damage or urine retention, or bladder infection and atony with incompetent vesico-ureteral valve
      • Direct: from adjacent infected organ

    Nephritis

    • Nephritis: inflammation of the interstitial tissue of the kidney
    • Pyelitis: inflammation of the renal pelvis
    • Types of Nephritis:
      • Minimal change GN
      • Membranous GN
      • Focal segmental GN
      • Membrano-proliferative GN

    Minimal Change GN

    • Type: nephrotic syndrome in children
    • Causes:
      • URT infection
      • Auto-immune diseases
      • Atopy
    • Grossly: normal kidneys
    • LM: normal only lipid deposition in proximal convoluted tubules
    • EM: only effacement to foot process
    • I/F: no deposits
    • Fate: selective proteinuria, dramatic response to cortisone

    Membranous GN

    • Type: nephrotic syndrome in adults
    • Causes:
      • Primary: idiopathic
      • Secondary: autoimmune disease
    • Grossly: bilateral enlarged kidneys
    • LM: thick basement membrane
    • EM: sub-epithelial deposits, effacement to foot process
    • I/F: sub-epithelial deposits
    • Fate: non-selective proteinuria, resistance to cortisone, hematuria in 15%

    Focal Segmental GN

    • Type: nephrotic syndrome in children
    • Causes:
      • Auto-immune disease
      • Heroin
    • Grossly: bilateral enlarged kidneys
    • LM: some glomeruli normal others are fibrosed
    • EM: denuded basement membrane, effacement to foot process
    • I/F: sub-epithelial deposits
    • Fate: non-selective proteinuria, resistance to cortisone

    Membrano-proliferative GN

    • Type: mixed nephritic and nephrotic
    • Causes:
      • URT infection
      • Auto-immune diseases
      • Idiopathic
    • Grossly: enlarged kidneys
    • LM: "tram track appearance" by PAS stain
    • EM: type I: sub endothelial deposits, type II: intramembranous deposits (DDD)
    • I/F: according to its type deposits
    • Fate: 2/3 with nephrotic syndrome, 15% with hematuria, 1/3 mixed nephritic with nephrotic

    Mechanism of Nephrotic Syndrome

    • Massive and selective proteinuria
    • Dramatic response to corticosteroids
    • Recurrence is common with steroid dependence
    • Improve at puberty
    • May be associated with Hodgkin's disease and NSAID therapy

    Mechanism of Nephritic Syndrome

    • Type I: idiopathic, diffuse thickening of GBM by immune deposits
    • Type II: secondary, by circulating Ag-Ab complexes
    • Antibodies develop against renal auto-antigen on the basal surface of visceral epithelial cells

    Acute Tubular Necrosis (ATN)

    • Definition: a clinicopathological disease characterized by damage of tubular epithelial cells and acute decline in renal function
    • Types: ischemic or toxic
    • Reversible, but may pass to acute renal failure
    • Causes of oliguria in ATN:
      • Tubular damage
      • Glomerular damage by toxins

    Ischemic ATN

    • More common
    • Causes: arterial occlusion, shock, poisons, severe dehydration, sepsis, transfusion reactions
    • Gross picture: enlarged kidney, with pale cortex, congested medulla
    • Microscopic picture: distal convoluted tubules, focal, disrupted
    • Prognosis: worse

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    Description

    This quiz covers the definition, causes, and predisposing factors of pyelonephritis and nephritis, including bacterial infections and urinary tract obstruction.

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