Kidney non-tumor - Chronic pyelonephritis

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Kidney non-tumor

Tubular and interstitial diseases

Chronic pyelonephritis

Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 24 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Chronic tubulointerstitial inflammation and renal scarring with severe involvement of calyces and pelvis
● Pyelocalyceal damage / blunting rules out other tubulointerstitial inflammation

Clinical features
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● Causes 10%-20% of end stage renal disease in transplant or dialysis units
● Associated with pyelitis and ureteritis cystica
● Some patients with pyelonephritic scars develop focal and segmental glomerulosclerosis with proteinuria in nephrotic range, perhaps due to renal ablation nephropathy

● Types: reflux (chronic reflux-associated pyelonephritis) and obstruction (chronic obstructive pyelonephritis)
● Reflux: more common, usually arises in childhood, unilateral or bilateral; damage often due to infection; associated with calyceal dilation (usually upper pole); see tubular atrophy and thyroidization, interstitial fibrosis
● Obstruction: associated with parenchymal scarring, usually not in children

Case reports
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● 68 year old woman with renal sinus mass by imaging (J Med Case Rep 2009;3:9054)

Gross description
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● Irregular scarred cortical surface usually at poles, dilated and blunted calyces
● Dilated ureter; retraction and destruction of papillae with “U” shaped scars

Gross images
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Dilated calyces, reduced renal parenchyma and scarring

Micro description
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● Tubular thyroidization (filled with colloid casts), tubular atrophy
● Interstitial fibrosis and inflammation (intense diffuse lymphoplasmacytic inflammatory infiltrate with germinal centers)
● Obliterative endarteritis of vessels, interstitial Tamm-Horsfall protein (amorphous, fibrillary, PAS+ material surrounded by inflammatory cells)
● Normal glomeruli early in disease course

Micro images
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Various images

Differential diagnosis
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● Chronic glomerulonephritis: diffusely scarred cortex
● Vascular disease: can cause wedge-shaped cortical scars, but underlying medullary and calyceal areas are normal

End of Kidney non-tumor > Tubular and interstitial diseases > Chronic pyelonephritis

Ref Updated: 8/17/12

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