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Chronic pyelonephritis
Chronic pyelonephritis is a chronic inflammation of the renal tubules and interstitium that occurs due to recurrent urinary tract infections and scarring. It most commonly affects children with congenital anomalies or spinal cord injuries and is the leading cause of end-stage renal disease. It is typically caused by either chronic obstructive pyelonephritis due to obstruction of urine outflow, or reflux nephropathy caused by vesicoureteral reflux allowing urine to flow back into the kidneys. Symptoms may include fever, flank pain, and symptoms of chronic renal failure like hypertension. The condition can lead to complications like proteinuria, focal glomerulosclerosis, and papillary necrosis.
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Chronic pyelonephritis
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- 2. ▪ Chronic inflammationof the renal tubules and interstitium with scarring and deformity of the renal calyces and pelvis ▪ Occurs due recurrent attacks of inflammation and scarring ▪ It’s the commonest cause of end stage renal disease (ESRD) ▪ Nephron loss Introduction
- 3. Affects whom?? ▪ moreoften in infants and young children ▪ Children with congenital anomalies of urogenital system ▪ Person with flaccid bladder due to spinal cord injury
- 4. Based on thecause, it is of 2 types ▪ CHRONIC OBSTRUCTIVE PYELONEPHRITIS ▪ REFLUX NEPHROPATHY (chronic reflux-associated pyelonephritis)
- 5. CHRONIC OBSTRUCTIVE PYELONEPHRITIS Obstructionto outflow of urine @ diff levels predisposes the kidney to infection Recurrent episodes of such obstruction and infection result in renal damage and scarring Rarely recurrent attacks of acute pyelonephritis can lead to renal damage It can be B/L, as with congenital anomalies of urethra (posterior urethral valve) Or it can be U/L, as with calculi or tumors
- 6. Reflux nephropathy ▪ Commonestcause of chronic pyelonephritis ▪ Results from superimposition of UTI on congenital vesicoureteral reflux (VUR) and intrarenal reflux ▪ reflux of urine up into ureters during micturition ▪ Manifests in early childhood .The incidence of reflux according to sex is equal in infancy, but after infancy both pyelonephritic scarring and reflux are far more common in females. Infection is the likely cause of progressive scarring in females.
- 7. CONGENITAL ABSENCE ORSHORTENING OF INTRAVESICAL PORTION OF URETER URETER NOT COMPRESSED DURING MICTURITION REFLUX OF URINE INTO URETERS REFLUX RESULTS IN INCREASE IN PRESSURE IN PELVIS SOTHAT URINE IS FORCED INTOTUBULES DAMAGE OF KIDNEY AND SCAR FORMATION
- 9. Morphology of CP Gross: ▪Uneven scarring of kidneys unlike symmetrical as in the case of chr. GN ▪ Hallmark : scarring involvement in pelvis or calyces or both leading to papillary blunting and marked calyceal deformities M/E: ▪ Uneven interstitial fibrosis ▪ inflammatory infiltrate of lymphocytes and plasma cells ▪ Dilation or contraction of tubules with atrophy of lining epithelium ▪ Sclerosis of glomeruli ▪ Tubules may contain pink to blue glassy appearing PAS-positive casts known as colloid casts that suggest appearance of thyroid tissue hence descriptively called thyroidization
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- 13. Predisposing factors Factors thatmay affect the pathogenesis of chronic pyelonephritis are as follows: ▪ (1) the sex of the patient and his or her sexual activity; ▪ (2) pregnancy, which may lead to progression of renal injury with loss of renal function; ▪ (3) genetic factors; ▪ (4) chronic bladder infections ▪ (5) neurogenic bladder dysfunction. paralysis from spinal cord injury, or tumors ▪ (6) Catheters, tubes, or surgical procedures may also trigger a kidney infection. In cases with obstruction, the kidney may become filled with abscess cavities
- 14. CLINICAL FEATURES ▪ Maypresent with fever, flank pain ▪ Usually present with chronic renal failure or symptoms of hypertension ▪ frequency of micturition & dysuria
- 15. COMPLICATIONS ▪ Proteinuria ▪ Focalglomerulosclerosis ▪ Progressive renal scarring leading to end-stage renal disease ▪ Papillary necrosis ▪ Perinephric abscess
- 16. DIAGNOSIS • Urinalysis • Intravenouspyelography • ultrasound
- 17. TREATMENT ▪ Antibiotic therapy ▪Relieve obstruction ▪ Analgesics ▪ The role of surgical correction of vesicoureteric reflux remains uncertain, but meticulous control of infection appears to prevent progressive scarring.
- 18. • FLUID INTAKE •CRANBERRY JUICE • PAIN MANAGEMENT
- 19. VARIANT OF CP ▪xanthogranulomatous pyelonephritis (XGP) ▪ emphysematous pyelonephritis (EPN) due to diabetes mellitus
- 20. TUBERCULOUS PYELONEPHRITIS • Tuberculosisof kidney occurs due to haematogenous spread of infection from another site, most often from lungs. • Less commonly from ascending infection from the tuberculosis of genitourinary system such as from epididymis or fallopian tube. • The renal lesions in tuberculosis may be in the form of 1.tuberculous pyelonephritis or 2.multiple miliary tubercles
- 21. Morphological features GROSS: • Bilateral •Usually involving medulla with replacement of the papillae by caseous tissue • Huge number of small scattered granulomas seen M/E: • Typical caseating epitheloid cell granulomatous reaction is seen • Afb can be demonstrated
- 22. CLINICAL FEATURES • Persistentsterile pyouria • Microscopic haematuria DIAGNOSTICTEST • Identification of M. tuberculosis by repeated culture of urine on LJ media
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