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PYELONEPHRITIS For more information visit www.msd.com Pyelonephritis, or interstitial nephritis, is the predominantly interstitial inflammation with destruction of the renal parenchyma, organization, signs of fibrosis, and retraction and deformation of the renal calices and pelvis. At the beginning there is cell infiltration, to be followed by sclerosis and eventually atrophy and fibrosis. Pyelonephritides can be divided in acute and chronic. The most common etiology in the case of acute conditions has a bacterial origin. The most common bacterium is Escherichia coli, although others such as Streptococcus and Staphylococcus can also be held responsible. Among the etiologies acting as predisposing factors of the chronic condition, urine reflux and obstructive disease can be found. 1,3 Hematic pathway1 Staphylococcus Musculus detrusor urinae Tuberculosis Uterus Calculus Streptococcus Levator ani m. Escherichia coli Ascending infection References 1. Cotran RS, MD; Kumar V, MD, FRCPath. y Collins T,MD, PhD. El riñón. En: Robbins Patología Estructural y Funcional. McGraw-Hill. Interamericana, 2003. pp. 1014-1019. 3. Stephen A. Martin. Pyelonephritis. En The 5-Minute Clinical Consult 20Th. Edition. Lippincott Williams & Wilkins. 2012. pp: 1106-1107. 3 Urethra External (voluntary) sphincter m. For more information visit www.msd.com Reflux Ascending infection Cancer Imagen 4 Musculus detrusor urinae Fimbriae Kidney Fallopian tube Ovario Uterus Ureter Levator ani m. Escherichia coli Urethra M. esfínter externo (voluntario) Diabetes References 4. Modify from Frank H. Netter. In Atlas de Anatomía Humana. Elsevier Masson 2007, 4ta edición. Pp: 366 y 370 4 For more information visit www.msd.com A CUTE PYELONEPHRITIS1 Acute pyelonephritis is characterized by the infiltration of a purulent exudate in the renal parenchyma and most commonly has a bacterial origin. It is more frequent in children and adults older than 40, and has a higher incidence in women (because their urethra is shorter and therefore facilitates ascending bacterial infections). Pregnancies constitute a cause of pyelonephritis because they act as an obstructive agent. Small abscesses Etiology The most common etiologic agent depends on how the infection is acquired: - The most typical bacterium is Escherichia coli, which infects the kidney in an ascending way after having caused a urinary infection, or cystitis. - Staphylococci and Streptococci reach the kidney after infecting another localization, generally the skin or the heart (endocarditis). They find their way by means of an hematogenic pathway through bacteriemia. - Mycobacterium tuberculosis reaches the kidneys after its pulmonary primoinfection, producing the granulomas typical of this condition. Renal pelvis Clinical manifestation It presents suddenly with a high fever, accompanied by chills and tremor, and lumbar and abdominal pain. The skin becomes hot, reddish and wet. Patients experience a general discomfort, nausea, vomiting and fatigue. Urine is dark and turbid. There is dysuria, pollakiuria and vesical tenesmus. It respects the medulla-cortex relationship Ureter Renal calices Infection References 1. Cotran RS, MD; Kumar V, MD, FRCPath. y Collins T,MD, PhD. El riñón. En: Robbins Patología Estructural y Funcional. McGraw-Hill. Interamericana, 2003. pp. 1014-1019. 2. Ioanna Zarpada, Petros I. Rafailidis and Matthew E. Falagas. Pyelonephritis. In: Gorbach´s 5-Minute Infectious Diseases Consult. Wolters Kluwer. Lippincott Williams & Wilkins, 2012. pp.332-333. 3. Stephen A. Martin. Pyelonephritis. In The 5-Minute Clinical Consult 20Th. Edition. Lippincott Williams & Wilkins. 2012. pp: 1106-1107. 5 For more information visit www.msd.com Swollen capsule that adheres to it CHRONIC PYELONEPHRITIS 1 Chronic pyelonephritis presents as a complication of an acute pyelonephritis when there are predisposing factors. Chronic pyelonephritis leads to chronic renal failure. Granulation Calices and pelvis dilation Predisposing factors Obstructions: any injury or pathology causing an obstruction to the exit of urine will result in urine retention, involving subsequent renal damage. An obstruction can be caused by tumors in the urinary tract or the surrounding organs (prostate), as well as by renal lithiasis among other factors. Reflux: it results from a faulty vesicoureteral valve, in such a way that urine from the urinary bladder returns to the ureters and from there back to the kidneys, causing structural damage. Fibrosis Surgical factors: genitourinary tract surgeries can produce adhesions preventing urine from flowing normally. Metabolic factors: such severe diseases as diabetes mellitus, gout, and myeloma are the ones leading to renal system destruction. Renal medulla and cortex retraction Size reduction Referencias 1. Cotran RS, MD; Kumar V, MD, FRCPath. y Collins T,MD, PhD. El riñón. En: Robbins Patología Estructural y Funcional. McGraw-Hill. Interamericana, 2003. pp. 1014-1019. 6 For more information visit www.msd.com Copyright © 2014 Anejo Producciones S.A. www.Anejo.eu Director: Eduardo Requena. Buenos Aires, Argentina. Total or partial reproduction by any means prohibited unless written consent is given by the owner of the copyright.
