Acute Pyelonephritis

1
Acute Pyelonephritis

• Affects cortex with sparing of glomeruli and
  vessels. White cell casts in urine are
  pathognomonic.
• Bacteria infection can result from hematogenous
  spread or from ascending infection (usually due
  to predisposing condition)
• Usually E. coli. Also Proteus, Klebsiella,
  and enterobacter.
• Presents with fever/CVA tenderness
• Its just a cute pyelonephritis (Not too bad)

2
Chronic Pyelonephritis

• Coarse, asymmetric corticomedullary scarring.
• Thyroidization of the Kidney
• Eosinophilic casts seen in tubules
• Chronic Pye
• T - Thyroidization
• E - Eosinophilic Casts
• A - Assymetric Scarring

3
Diffuse Cortical Necrosis

• Acute infarction of cortices of both kidneys.
• Likely due to vasospasm and DIC
• Often seen in obstetric catastrophes (abruptio
  placentae) and septic shock

4
Acute Tubular Necrosis

• Most common cause of acute renal failure.
• Reversible, but fatal if left untreated.
• Seen with ischemia (shock), crush injury
  (myoglobinuria), toxins.
• Death usually during oliguric phase.
• Recovery in 2-3 weeks.

5
Renal Papillary Necrosis

• Sharply defined gray-white to yellow necrosis of
  the apical two thirds of the pyramid.
• Associated with
• 1. Acute Pyelonephritis
• 2. Phenacetin (analgesic) use
• 3. Diabetes Mellitus
• Think Apical Pyramid Destruction

6
Acute Renal Failure

• Decline in renal function. See ? creatinine and
  ? BUN.
• Associated with Prerenal, Intrarenal, or
  Postrenal complications.

7
Acute Renal Failure

• 1. Prerenal Azotemia Decreased RBF ?
• ? GFR. Kidney retains sodium and water.
• 2. Intrinsic Renal Usually due to acute
  tubular necrosis or ischemia.
• 3. Postrenal Outflow obstruction (stones,
  BPH, etc.) Only seen if obstruction is bilateral.

8
Acute Renal Failure
9
Uremia Syndrome marked by ? BUN and ?
Creatinine.

• Consequences
• Anemia (failed erythropoietin production)
• Renal osteodystrophy (Vit. D not activated in
  kidneys)
• Hyperkalemia (possible arrhythmias)
• Metabolic acidosis (? acid secretion and ?
  generation of HCO3-.

10
Uremia Syndrome marked by ? BUN and ?
Creatinine.

• 5. Uremic encephalopathy
• 6. Sodium and H2O excess ? CHF and pulmonary
  edema
• 7. Chronic Pyelonephritis
• 8. Hypertension

11
Electrolyte Disturbances

• They exist and you should probably know about
  them.

12
Alcoholism

• Physiologic tolerance and dependence with
  symptoms of withdrawal when intake is inhibited.
• Treatment Options
• 1.Disulfiram inhibits acetaldehyde
  dehydrogenase ? accumulation of acetaldehyde ? ?
  Hangover symptoms (Take this and drink and you
  want to DIE!)
• 2. Supportive tx. of systemic manifestations
• 3. Alcoholic anonymous and other support groups.

13
Complications of Alcoholism

• Alcoholic hepaitis and cirrhosis, pancreatitis,
  dilated cardiomyopathy, peripheral neuropathy,
  cerebellar degenerations, Wernicke-Korsakoff
  syndrome, testicular atrophy and hyperestrinism,
  and Mallory-Weiss syndrome

14
Alcoholic cirrhosis

• Long term use leads to micronodular cirrhosis
• Symptoms jaundice, hypoalbuminemia, coagulation
  factor deficiencies, portal hypertension,
  peripheral edema, ascites, encephalopathy, and
  neurologic manifestations (asterixis hand
  flapping)
• Drink Alcohol - your liver looks like a
  basketball Micronodular cirrhosis

15
Wernicke-Korsakoff Syndrome

• Due to vitamin B1 (thiamine) deficiency in
  alcoholics.
• Classic Triad
• 1. Psychosis
• 2. Ophthalmoplegia
• 3. Ataxia (Wernickes encephalopathy)
• Can progress to memory loss, confabulation,
  confusion
• Treatment IV vitamin B1
• Note below characteristic lesion of mamillary
  bodies
• Wernickes affects the Mamillaries

16
Mallory-Weiss Syndrome

• Longitudinal lacerations of the gastroesophageal
  junction with failure of LES relaxation.
• Associated with pain in contrast to esophageal
  varices.
• Its not wise to drink till you throw-up.

17
Argyll Robertson Pupil

• Pupil contstricts with accommodation but is not
  reactive to light.
• Pathognomonic for tertiary syphilis.
• Prostitutes Pupil Accommodates but does not
  react, whatever that means

18
Amyloidosis

• Amyloid deposits show apple-green birefringence
  on Congo red stain.
• Systemic forms affect heart, kidneys, and other
  organs.

19
Amyloidosis

• AL Amyloid Light chain. Seen with plasma
  cell disorders (multiple myeloma,
  Waldenstroms). Often fatal.
• AA - From serum Amyloid-Associated protein,
  acquired secondary to chronic inflammatory
  disorder. Familial variants exist.

20
Amyloidosis

• ATTR - From TransThyRetin, a serum transport
  protein. Familial or acquired in elderly.
• Aß - Major component of Alzheimers Disease
• ?2 microglobulin - Deposits in tendons and
  joints of Dialysis Patients.

21
Aschoff Body Rheumatic Heart Disease

• Aschoff Body granuloma with giant cells
• Anitschkow Cells activated histiocytes
• Two RHussians with RHeumatic heart disease
  (Aschoff and Anitschkow)

22
Auer Bodies (Rods)

• Peroxidase-positive cytoplasmic inclusions in
  granulocytes and myeloblasts
• Primarily seen in acute promyelocytic leukemia
  (M3).
• Treatment of AML M3 with ATRA can release Auer
  rods ? DIC.
• AML M3 has Auer Body

23
Casts

• When seen in urine sample, casts indicate that
  hematuria/pyuria is of renal origin

24
Casts

• RBC casts glomerular inflammation (nephritic
  syndromes), ischemia, or malignant hypertension
• WBC casts inflammation in renal interstitium,
  tubules, and glomeruli
• Granular Casts - Acute Tubular Necrosis
• Sorry, Ive got nothing to remember this by

25
Casts

• Hyaline Casts Often seen in normal urine
• Waxy casts - Seen in chronic renal failure
• This problem has waxedon for a while now

26
Erythrocyte Sedimentation Rate (ESR)

• Nonspecific Test that measures acute-phase
  reactants. Any condition that elevates
  fibrinogen should elevate ESR.
• Dramatically ? with infection, malignancy,
  connective tissue disease. Also ? with
  pregnancy, inflammatory disease, and anemia.

27
Erythrocyte Sedimentation Rate (ESR)

• A ? ESR is associated with blood diseases in
  which red blood cells have an irregular or
  smaller shape that causes slower settling ie
  sickle cell anemia
• In patients with polycythemia, too many red blood
  cells decrease the compactness of the rouleau
  network and artifactually lower the ESR.
• Still a useful tool in diagnosis of temporal
  arteritis and polymyalgia rheumatica.

28
Ghon Complex

• TB granulomas with lobar and perihilar lymph node
  involvement
• Reflects 1º infection or exposure.