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

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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

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Atrophied tubules

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#Diagnosis 👉🏻 cystitis


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

Route of infection
From descending as from pelvis & ureter

#MICROSCOPIC

#Diagnosis 👉🏻 cystitis


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Transitional epithelium

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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)


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Transitional epithelium

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Schistosoma eggs

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Eosinophilic lesion

Schistosoma eggs in muscles layer

Schistosoma eggs in urine

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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
..

#MICROSCOPIC

#Diagnosis 👉🏻 brunn's nests

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Nests

#MICROSCOPIC

#Diagnosis 👉🏻 cystitis cystica

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Cystica

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#Diagnosis 👉🏻 cystitis glandularis

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Columnar metaplasia

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#Diagnosis 👉🏻 kidney infrect


THE CAUSE
Necrosis due to Ischemia
هذه الـ ischemia حصلت بسبب Thromboemboli
ونوع الـ necrosis هو coagulative

#The_features
Necrosis like wedge shaped (the apex towards medulla) , pale in color and ringed by intense

#MICROSCOPIC

#Diagnosis 👉🏻 kidney infrect

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Necrosis

هنا ظهرة eosinophilic بسبب انه الوسط تحول إلى قاعدي نتجة denaturation of protein

A
#Diagnosis 👉🏻 Normal kidney

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Normal glomerulus and tubules


B
#Diagnosis 👉🏻 kidney infrect

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Necrosis glomerulus and tubules (coagulative)

بسبب necrosis الـ nucleus absent
And tubules filled with fibrin debris

#MICROSCOPIC

#Diagnosis 👉🏻 Acute tubular injury and necrosis (distal)

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Necrosis tubules

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Intratubular obstruction
Due to necrosis cells


THE CAUSES
الـ necrosis حصل بسبب الـ Ischemia فالدم وصل للـ proximal فقط و ما وصلش للـ distal
فالمتضرر الان distal حصله له necrosis و Necrotic cells انتقلت الى داخل tubules وسببت Obstruction فحصل عند الشخص oliguria قد تستمر هذه الحالة او يحصل regeneration للخلايا تبع tubules بس الخلايا تكون immature فما يحصلش reabsorption بشكل المطلوب فيحصل عند الشخص polyuria

#MICROSCOPIC

#Diagnosis 👉🏻 Acute tubular injury and necrosis (proximal)

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Tubular vacuolization

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Tubular dilation


THE CAUSES
الـ necrosis حصل بسبب الـ toxic فالدم وصل للـ proximal
فالمتضرر الان proximal حصله له necrosis و Necrotic cells انتقلت الى داخل tubules وسببت Obstruction فحصل عند الشخص oliguria قد تستمر هذه الحالة او يحصل regeneration للخلايا تبع tubules بس الخلايا تكون immature فما يحصلش reabsorption بشكل المطلوب فيحصل عند الشخص polyuria

#The_features
- Tubular dilation
- Tubular vacuolization
- destructions cells
- Absent nucleus