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

#The_black_arrow
Congestive blood vessels

#The_yellow_arrows
Degeneration of tubules

#The_orange_areas
Cell without nucleus
حصلها degeneration

#The_blue_areas
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


#The_white_arrows
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

#The_black_arrow
Fibrosis
Brown to white in the color

#MICROSCOPIC

#Diagnosis 👉🏻 Chronic pyelonephritis

#The_black_arrows
Thyroidisation

#MICROSCOPIC

#Diagnosis 👉🏻 Chronic pyelonephritis

#The_black_arrows
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

#MICROSCOPIC

#Diagnosis 👉🏻 cystitis


#The_black_arrow
Transitional epithelium

#The_blue_arrows
Inflammatory cells

#The_features
Increase inflammatory cells in submucosa
Neutrophils (acute cystitis)
Lymphocytes (chronic cystitis)

The Causes
Bacterial
Or Schtosoma hematobium

#MICROSCOPIC

#Diagnosis 👉🏻 Eosinophilic cystitis (Schistosomiasis)


#The_blue_arrow
Transitional epithelium

#The_black_arrows
Schistosoma eggs

#The_yellow_arrows
Eosinophilic lesion

Schistosoma eggs in muscles layer

Schistosoma eggs in urine

#The_black_arrows
RBCs
Due to hematuria

BRUNN'S NESTS
benign bladder lesions similar in appearance

تحدث هذه الحالة بسبب irritation للـ transitional epithelium التي تسببه Schistosoma
وبسبب irritation بيحصل hyperplasia of transitional فلما تعمل المثانه contraction و hyperplasia قده thick بتضغط على transitional  وتدخله الى submucosa  مكونه nests


هذا Neste يلي تكونت فيما بعد يحصل انه الدم ما يوصلش للـ central تبعها فتموت الخلايا مكونه فراغ يمسى cystica
Cystica: spaces filled with clear fluid lined by flattened urothelium
وهذه الحالة تسمى CYSTITES CYSTICA


او Nests هذه الخلايا تبعها يلي في central تتمايز إلى cuboidal or columnar cell (columnar metaplasia) وتكون gland like lumens
وتسمى CYSTITES GLANDULARIS


THE CAUSES
- Schistosoma
- Cancer
..