#Gross
#Cut_section

#Diagnosis 👉🏻  Normal kidney


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Renal pyramid

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Pelvis

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Medulla

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Cortex

NORMAL KIDNEYS

✫The distal tubules
- wall: thin
- lumen: broad

✫The proximal tubules
- wall: thick and reddish
- lumen: narrow

NORMAL KIDNEYS
at medium power 

NORMAL KIDNEY
The normal distal & proximal tubules at high power 

NORMAL KIDNEY
The normal glomerulus of the kidney at high power 

#Electron_microscopic
NORMAL KIDNEY

ACUTE PYELONEPHRITIS

✫Definition
Suppurative bacterial infection of tubules and interstitial.
The most common disease caused renal disease and Renal failure

E. coli is the most common uropathogen

✫Predisposing factors
-  female due to  short urethra and urethra close to anal
-  Pregnancy due to hormonal relaxation to muscle 
فماعاد يحصل construction فيحصل stasis of urine
والحمل ايضاً يعمل compression on bladder فتسبب stasis of urine
- Obstruction due to tumor or prostatic hyperplasia
وسببه هو هرموني ، والذي يكون بسبب dihydroteststeron وهو non precancerous
- catheters


✫ Routes of infection
- Ascending infection
مثلاً من المثانه بسبب كان فيها cystitis
- Haematogenous ( blood borne infection)
مثلاً في حالة endocarditis
- Or from Adjacent organs

✫More common in
women and in patients with diabetes


✫Gross description
- Multiples microabscesses or suppurative patch in cortex and medulla
-  Renal capsule is detached (non adherant) and filled with blood clots
- The pelvis and calyx has congestive blood vessels and pus
- The kidney is normal in size or enlarged
- The cortex and medulla can be differentiated


✫Microscopic description
- Glomerulus normal
- Neutrophils in tubular lumina
التي تجمعت على شكل casts
- Neutrophils in interstitium
التي بتعمل degeneration of tubules والتي اصبحت eosinophilic
و الـ degeneration هنا reversible
- Congestive blood vessels

✫The results
- complet recovery
OR
- perinephric abscess : extension of pus through renal capsule into adjacent tissue
الذي يسبب septicemia
- papillary necrosis (gray-white to yellow areas)
الذي يسبب بدوره acute renal failure
ويحدث بشكل خاص في الاشخاص يلي عندهم diabetes, urinary tract obstruction
- Chronic pyelonephritis

..

#MICROSCOPIC

#Diagnosis 👉🏻 Acute pyelonephritis

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Congestive blood vessels

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Degeneration of tubules

#The_orange_areas
Cell without nucleus
حصلها degeneration

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Normal cell
ما حصل لهاش degeneration

#The_red_areas
White blood cell casts

#The_green_area
Normal glomerulus

Casts of neutrophils in the urine

#GROSS

#Diagnosis 👉🏻 Papillary necrosis


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Necrosis
ونوع الـ necrosis هو coagulative necrosis

CHRONIC PYELONEPHRITIS

✫divided into two forms:
- chronic obstructive pyelonephritis
يسبب dilatation of the pelvis and calyx with pus and inflammatory cell
وتسمى Pyonephrosis
- chronic non obstructive pyelonephritis
وتسمى pyelonephritis


✫Gross description
- The kidney is atrophy
وبسبب هذا تكون كمية fat التي حول الكلى اكثر من الطبيعي.
- irregular in the surface
- Thickening and adherant of capsule
- hemorrhage and scarring in the cortical
In the cut section
The cortex and medulla indifferentiated due to fibrosis.


✫Microscopic description
- Perglomerular fibrosis ( pink and thick)
- Glomerular sclerosis
وهذا العلامتين توجد ايضاً في حالة focal & segmental glomerulonephritis
وأيضاً في حالة membranous nephropathy
- Interstitium ➪increase in stroma or fibrosis in the stroma
وبسبب هذا عمل compression on tubules التي اصبحت atrophy
- tubules atrophy
بيحصل فيها compensation بيحصل dilation of tubules والخلايا تصبح flattening و داخلها hyaline cast (pink secretion) وتسمى (thyroidisation)
- Chronic Inflammatory cells (lymphocytes)
- hyaline arteriosclerosis may be caused by hypertension

..

#GROSS

#Diagnosis 👉🏻 Chronic pyelonephritis

#The_blue_arrows
Irregular in the surface and atrophic kidney

#GROSS

#Diagnosis 👉🏻 Chronic pyelonephritis

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Fibrosis
Brown to white in the color

#MICROSCOPIC

#Diagnosis 👉🏻 Chronic pyelonephritis

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Thyroidisation

#MICROSCOPIC

#Diagnosis 👉🏻 Chronic pyelonephritis

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Atrophied tubules

#MICROSCOPIC
CHRONIC PYELONEPHRITIS

#صورة_لتوضيح Atrophied tubules

#MICROSCOPIC
#Diagnosis 👉🏻 Chronic pyelonephritis

#The_black_arrows
Atrophied tubules

#GROSS
#Diagnosis 👉🏻 cystitis


#The_features
Signs of inflammation
- Hyperemia (Erythema)
- Thickening
- swelling

Route of infection
From descending as from pelvis & ureter