Classification of Renal Diseases, Acute Tubular Necrosis, Acute Pyelonephritis, Chronic pyelonephritis - Pathology - RDT

Topics: Classification of Renal Diseases, Acute Tubular Necrosis, Acute Pyelonephritis, Chronic pyelonephritis
Subject: Pathology
Course: RDT IInd year

1. RENAL DISEASES Dr. Salman Ansari MBBS

2. List of topics Classification of renal diseases Acute Tubular Necrosis Acute Pyelonephritis Chronic Pyelonephritis

3. Classification of kidney disorders Congenital malformations : simple renal cyst, Adult polycystic kidney disease Tubulo-interstitial diseases : acute tubular necrosis(ATN), acute pyelonephritis, chronic pyelonephritis Glomerular diseases : different types of glomerulonephritis, nephrotic syndrome, nephritis syndrome Obstructive uropathy Renal vascular diseases Tumours of kidney

4. Anatomy Unit of kidney - nephron Nephron consists of glomerulus, tubule and collecting system Glomerulus is the filtering unit

5. Tubular and tubulointerstitial diseases Tubular disease: ATN Tubulointerstitial: acute pyelonephritis, chronic pyelonephritis

6. Acute Tubular Necrosis Definition Causes Pathogenesis Clinical course Prognosis

7. Acute Tubular Necrosis Also called Acute Kidney Injury(AKI), acute tubular injury(ATI) Destruction of tubular epithelial cells resulting in acute renal failure Most common cause of acute renal failure Rapid reduction in renal function with severe oliguria(less than 400 ml/day)

8. Etiology Ischemia(ischemic ATN) : due to blood loss, severe burns, septic shock Direct toxic injury(nephrotoxic ATN) : antibiotics, heavy metals(mercury, lead) Combination of ischemic and nephrotoxic AKI Acute tubulointerstitial nephritis Urinary obstruction: tumours

9. Pathogenesis Injury to tubule epithelial cells : due to ischemia or toxins Leads to backleak of fluid into interstitium ->obstruction of lumen by detached epithelial cells ->increased intratubular pressure ->decrease in GFR -> oliguria Disturbance in blood flow Ischemia causes vasoconstriction and reduced blood supply to tubules

10. Clinical course 1. Initiation phase : mild reduction of urine output and increase in BUN 2. Maintenance phase : sustained decrease in urine output in the range of 40 to 400 mL/day (oliguria), salt and water overload, rising BUN level, hyper kalemia, metabolic acidosis, and other features of uremia

11. 3. Recovery phase : steady increase in urine volume, which may reach up to 3 L/day Loss of large amounts of water, sodium and potassium (leading to hypo kalemia) in the urine. BUN and creatinine levels also start to return to normal.

12. Prognosis Can be reversed with treatment and most patients recover

13. ACUTE PYELONEPHRITIS

14. Acute Pyelonephritis Definition Etiology Pathogenesis Clinical features and Diagnosis

15. Definition Acute infection of the kidney affecting the tubules, interstitium, and renal pelvis. Can be acute or chronic Bacterial infection commonly

16. Etiology Causative organisms: Gram-negative bacilli E.coli, Klebsiella , Enterobacter Route of infection: ascending infection from lower urinary tract Less common: hematogenous spread

17. Risk factors

18. Pathogenesis Bacteria from perineum spread to lower urinary tract due to poor hygiene and colonise it spread from lower tract to upper tract via catheterisation/trauma/reflux Multiply in upper urinary tract and cause infection( acute pyelonephritis ) Leads to Acute kidney injury(AKI)

19. Clinical features Fever Sudden onset of pain in abdomen Dysuria, frequency and urgency

20. Lab findings Urine analysis: pus cells, WBC casts Bacterial C/S: to find out organism and which antibiotic it is sensitive to Treatment: Antibiotics - oral or intravenous Supportive measures

21. Complications

22. CHRONIC PYELONEPHRITIS

23. Chronic pyelonephritis C hronic inflammation of tubulointerstitial tissue leading to scarring of calyces, pelvis and renal parenchyma. important cause of end-stage renal disease

24. Types 2 types 1. Reflux nephropathy (chronic reflux-associated pyelonephritis) 2. Chronic obstructive pyelonephritis Develops due to recurrent infections superimposed on obstructive lesions, which lead to renal inflammation, parenchymal atrophy and scarring.

25. Morphology Kidney is shrunken and scarred

26. Clinical features B ack-pain Fever pyuria b acteriuria

27. Diagnosis Culture is usually sterile Intravenous pyelography(IVP) for diagnosis

28. Irregular scar Small contracted kidney

29. Sources: Ramadas Nayak - Undergraduate Prep Manual Harsh Mohan - Textbook of Pathology Questions : [email protected] For notes: