36 Questions
What is the main cause of pyelonephritis?
Bacterial infection
What is a predisposing factor for pyelonephritis in females?
Short and wide urethra
What is the term for inflammation of the renal pelvis?
Pyelitis
What is the route of infection in pyelonephritis through the urethra during endoscopy or catheterization?
Ascending infection
What is the term for inflammation of the interstitial tissue of the kidney?
Nephritis
What is a complication of pyelonephritis in pregnant women?
Urinary stasis
What is the typical clinical course of E/M in terms of response to corticosteroids?
Dramatic response to corticosteroids with recurrence
What is the most common cause of nephrotic syndrome in adults?
Membranous GN
What is the primary mechanism of idiopathic membranous GN?
Immune deposits against renal auto-antigen on the basal surface of visceral epithelial cells
What is a characteristic feature of membranous GN on electron microscopy?
Subepithelial deposits with spikes
What is the typical proteinuria pattern in membranous GN?
Non-selective proteinuria
What is the frequency of hypertension in membranous GN?
30%
What is the primary cause of minimal change glomerulonephritis (GN) in adults?
Idiopathic
What is the characteristic appearance of membrano-proliferative GN on PAS stain?
Tram track appearance
What is the type of proteinuria seen in minimal change GN?
Selective proteinuria
What is the prognosis of minimal change GN in response to cortisone?
Dramatic response to cortisone
What is the characteristic deposit seen in membrano-proliferative GN by EM?
Sub-endothelial deposits
What is the type of nephrotic syndrome seen in focal segmental GN?
Non-selective nephrotic syndrome
What is the characteristic feature of membrano-proliferative GN on light microscopy?
Bilateral enlarged kidneys
What is the fate of 2/3 of patients with membrano-proliferative GN?
Nephrotic syndrome
What is the primary difference in terms of age between MCG and MGN?
MCG is typically seen in adults, while MGN affects children
What is the difference in proteinuria between MCG and MGN?
MCG has selective proteinuria, while MGN has non-selective proteinuria
How do MCG and MGN respond to cortisone?
MCG responds dramatically to cortisone, while MGN is resistant
What is a characteristic of the electron microscopy picture in Type I MGN?
Subendothelial electron dense deposits are present
What is the pathogenesis of Type II MGN?
Activation of the alternative complement pathway
What is the typical prognosis of Type II MGN?
The disease recurs in transplantation
What is the typical gross picture of MGN?
Bilateral enlarged kidneys
What is the characteristic microscopic picture in MGN?
Glomeruli with hypercellularity and lobular accentuation
What is the characteristic feature of Acute Tubular Necrosis (ATN)?
Acute decline in renal function
What is the more common type of Acute Tubular Necrosis (ATN)?
Ischemic ATN
What is the effect of tubular damage on the rennin/angiotensin system in ATN?
Stimulates the rennin/angiotensin system
What is the effect of cast formation in ATN?
Increases intra-tubular pressure
What is the characteristic feature of the gross picture of Ischemic ATN?
Enlarged kidney, with pale cortex and congested medulla
What is the prognosis of Ischemic ATN?
Worse
What is the characteristic feature of the micro picture of tubules in Ischemic ATN?
Distal convoluted tubules are affected
What is the effect of back leak of tubular fluids in ATN?
Increases interstitial edema
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
This quiz covers the definition, causes, and predisposing factors of pyelonephritis and nephritis, including bacterial infections and urinary tract obstruction.
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