MEDICAL BIOLOGY, HUMAN ANATOMY, PHYSIOLOGY AND PATHOLOGY - Ya.I. Fedoniuk 2010

ANATOMY, PHYSIOLOGY, PATHOLOGY

CHAPTER 8. THE PROCESS OF URINATION AND ITS PATHOLOGY

ANATOMY AND PHYSIOLOGY OF THE URINARY ORGANS

PATHOLOGY OF THE KIDNEYS AND URINARY BLADDER

FUNCTIONAL DISORDERS OF MICTURITION

KIDNEY DISEASES

3. PYELONEPHRITIS

Pyelonephritis is a non-specific infectious and inflammatory process characterized by simultaneous or sequential damage to the renal pelvis, calyces, and renal parenchyma, predominantly involving the interstitial tissue.

Women under the age of 40 are affected more frequently, particularly during Pregnancy. Pyelonephritis also commonly develops in childhood.

A key prerequisite for the onset and development of pyelonephritis is a compromised systemic host condition and lowered Immunity.

Pyelonephritis is classified into Primary and secondary forms. Primary pyelonephritis occurs without impaired urine outflow, whereas the secondary process develops in the presence of urodynamic obstruction (urostasis).

Contributing factors to pyelonephritis include Diabetes Mellitus, Gout, potassium deficiency, analgesic abuse, and extrarenal foci of infection.

Depending on the clinical course, acute and chronic forms of pyelonephritis are distinguished.

In acute pyelonephritis, pathomorphological changes depend on the stage of serous infiltration and suppuration. Stage I (serous pyelonephritis) presents with Kidney enlargement and edema of the surrounding adipose tissue. Cell/15.html">Microscopy reveals multiple inflammatory infiltrates. Stage II (Purulent Pyelonephritis) is characterized by The formation of multiple small purulent foci (microabscesses). Apostematous nephritis refers to the appearance of numerous tiny abscesses beneath the renal capsule in the cortical layer. Purulent infiltrates extend down to the renal papillae. The coalescence of small purulent foci leads either to necrosis, forming a renal carbuncle, or to the creation of a larger cavity, known as a Renal abscess. Carbuncle formation is associated with a septic embolus occluding a Blood vessel lumen.

Chronic Pyelonephritis is characterized by focality and a polymorphism of Changes in the renal tissue, presenting with varying degrees of Asymmetry in bilateral cases. This diversity is manifested by areas of active inflammation or tissue shrinkage interspersed directly alongside unaffected parenchymal zones. The affected areas undergo a healing process through replacement of the renal parenchyma with sclerotic Connective Tissue, ultimately resulting in a shrunken kidney (pyelonephrotic contracted kidney). In cases of bilateral renal contraction, Chronic Kidney Disease progresses.