Vesicoureteral reflux, chronic pyelonephritis and reflux nephropathy

on 6.1.09 with 0 comments

Know the conditions that cause vesicoureteral reflux

  • Maldevelopment – shortening of intramural portion of ureter due to abnormal embryologic development of an ectopically located ureteric bud with laterally displaced ureteric orifices.

  • Obstruction – causes increased pressure

    • Organic causes

      • Bladder tumor

      • Prostate tumor / hypertrophy

      • Stones

    • Functional causes

      • Spinal cord injury

  • Infection w/ mucosal edema

    • Intravesical ureter can’t function as an efficient valve

  • Genetic factors

    • Male:Female ratio 5:1

    • Primarily a disorder of whites

    • Autosomal dominant, familial

    • Multiple genes exert a cumulative effect to reach a critical threshold for manifestation of reflux disease

Know the causes of renal reflux and reflux nephropathy

  • Basically the same as (and including) VUR

What are the consequences of vesicoureteral reflux and urinary obstruction?
  • Allows spread of infection from lower urinary tract to kidney → pyelonephritis
  • Subsequent intrarenal reflux leads to inflammation, scarring, and pelvocalcyceal deformity

    • Sterile reflux may even cause damage – especially high-pressure VUR

Where are the potentially refluxing papillae in the kidneys?

  • Usually located at poles

  • Identified by concave surface and gaping orifices

Know the pathology of chronic pyelonephritis

    • Kidneys tend to be reduced in size – unequally if bilateral

    • With obstruction, there are scars with thinning of renal tissue overlying dilated calyces

    • Solidification and / or hyalinization of capillary tufts

    • Periglomerular fibrosis or deposition of collagen in Bowman’s capsule

    • Tubular atrophy w/ eosinophilic casts (thyroidinization)

    • Chronic inflammatory infiltrate in tubulointerstitium, pelvis, and calyces

    • Xanthogranulomatous pyelonephritis

  • Gross – Yellowish, nodular, and large lesions

  • Micro – Foamy histiocytes, other acute and / or chronic inflammatory cells

  • Usually associated w/ Proteus infection

Know the clinical manifestations of chronic pyelonephritis

  • Recognition of chronic pyelonephritis is w/ radiologic exam, NOT biopsy

  • Back pain, HTN, fever, bacteriuria, pyuria, proteinuria

  • X-ray – Kidneys asymmetrically smaller, coarse scars overlying blunted papillae, deformed and dilated calyces

Category: Pathology Notes



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