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Acute Pyelonephritis

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Bacteria infection can result from hematogenous spread or from ascending ... Metabolic acidosis ( acid secretion and generation of HCO3 ... – PowerPoint PPT presentation

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Title: 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.
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