ACUTE AND CHRONIC

RENAL FAILURE
PYELONEPHRITIS

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 ACUTE RENAL FAILURE

 Acute renal failure is termed acute

suppression of renal function

 Morphological equivalent is tubular

necrosis

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 ACUTE RENAL FAILURE
 Etiology:
 1shock
 2 severe Glomerulonephritis
 3 incompatible blood transfusion
 4 crush-syndrome
 5 endogenic and exogenic intoxication
 6 acute drug-induced interstitial nephritis

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 ACUTE RENAL FAILURE
PATHOGENESIS
 Ischemic renal injury
 Cause reduction of GFR
 Tubular epithelium is
sensitive to hypoxia
 TE is vulnerable to
toxins
 Destruction of
membrane proteins &
 K-Na ATP
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 ACUTE RENAL FAILURE
PATHOGENESIS
 The distribution of
necrosis areas is
more segmental
with ischemic
injuries
 Tubulorhexis
 Casts in DCT
 Stromal edema
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 ACUTE RENAL FAILURE
PATHOGENESIS
 Toxic injuries
result in more
diffuse proximal
tubular injury as
necrosis.
 Stromal edema

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 ACUTE RENAL FAILURE

 Truet’ Shunt includes ischemia of the

cortex and arterial hyperemia of the
medulla as a reversed shunt

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 ACUTE RENAL FAILURE

 Necrosis of
proximal
convoluted duct
epithelium

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 ACUTE RENAL FAILURE

 CLINICAL STAGES
 1 INICIATION
 2 MAINTENANCE (OLIGURIA)
 3 POLYURIA
 4 RECOVERY

Patients with recovery are less then 30-10%

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 ACUTE RENAL FAILURE

 Clinical tests for acute renal failure

 Oliguria – urine mL/daily less then
400ml
 Blood urea more then 7,2-8,5 mkmol/L
 Potassium less then 3,6-4,6 mmol/L
 Sodium more then 13,4-21,7 mmol/L

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 CHRONIC RENAL FAILURE AS
UREMIA
 Chronic renal failure is the final
outcome of a variety of renal
diseases and is the major cause of
death in renal diseases.
 Morphologic equivalent is termed

nephrosclerosis or contracted kidney

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 CHRONIC RENAL FAILURE AS
UREMIA
 There are three stages of CRF

1 –st stage is termed diminished renal

reserve
 Glomerular renal filtrate (GRF) is 50%

of normal, blood urea nitrogen (BUN)

is normal,
 Creatinin value is normal

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 CHRONIC RENAL FAILURE AS
UREMIA
2 –st stage is termed renal insufficiency
 The GFR is 20% - 50% of normal
 Azotemia, polyuria, nocturia occur

 Azotemia is termed a biochemical

abnormality that refers to an elevation of
blood urea nitrogen (BUN) and Creatinin
levels.
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 CHRONIC RENAL FAILURE AS
UREMIA
3 –st stage is termed renal failure as uremia
 The GFR is less than 20% of normal

 Edema, metabolic acidosis, hypocalcaemia occur

 Uremia is termed Azotemia associated with a

constellation of clinical signs and symptoms
with
biochemical abnormalities including fibrinous
pericarditis, gastroenterocolitis and pneumonia

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 CHRONIC RENAL FAILURE AS
UREMIA
 MORPHOLOGIC EQUIVALENT IS
TERMED NEPHROSCLEROSIS OR
CONTRACTED KIDNEYS

 CONTRACTED KIDNEYS ARE THE

RESULT OF MANY RENAL DISEASE
AND CAUSE OF DEATH
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NEPHROSCLEROSIS OR
CONTRACTED KIDNEYS

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 NEPHROSCLEROSIS OR
CONTRACTED KIDNEYS
 Sclerosis and glomerulus
hyalinosis of the
glomeruli
 They don’t filtrate
the plasma

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CONTRACTED KIDNEYS MAY

BE PRIMARY OR SECONDARY

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 PRIMARY CONTRACTED
KIDNEYS
 Primary contracted kidneys are
 a result in nephrosclerosis of diseases

with renal vessel lesion first of all

 Atherosclerosis of renal large arteries

 Arterial hypertension with lesion of

renal small arteries and arterioles

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 SECONDARY CONTRACTED
KIDNEYS
 All Subacute and chronic renal diseases
result in secondary contracted kidneys or
nephrosclerosis
 Glomerulonephritis, pyelonephritis,

intersticial nephritis, cystic renal diseases,

amyloidosis, diabetes mellitus.

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 TUBULO-INTERSTICIAL
DISEASES OF THE KIDNEY
 All disease of the kidney may be
refered to

 Glomerulopathies or

 Tubulo-stromal pathies.
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 PYELONEPHRITIS
 Pyelonephritis is a disease with
inflammation involving the stroma, calyx,
and pelvis of the kidney.
 Pyelonephritis may be acute and chronic
forms according to clinical course.
 One or both kidney may be involved in
the disease.
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 ACUTE PYELONEPHRITIS
 Acute pyelonephritis is a common
suppurative (purulent) inflammation
of the kidney caused by bacterial
infection.

 It can be unilateral or bilateral

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 Pathogenesis of acute pyelonephritis
 Hematogenous infection

apostematous nephritis

Ascending infection
urogenous pathway
Purulent cystoureteropyelitis

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 ACUTE PYELONEPHRITIS
 Etiology for hematogenous infection may be
 Staphylococcus, streptococcus
 It is starting from
apostematous nephritis
with numerous
abscesses abscesses

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 ACUTE PYELONEPHRITIS
 Formation of abscess

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 ACUTE PYELONEPHRITIS
 Etiology for ascending pyelonephritis is
Escherichia coli, Proteus, Enterobacter

 There is endogenic infection because the

same infective agents can be seen in colon

 Ascending pyelonephritis is more 85% of all

cases with acute pyelonephritis
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 ACUTE PYELONEPHRITIS
 Leukocyte infiltration within stroma, cup and
pelvis walls with neutrophils predominance

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 ACUTE PYELONEPHRITIS
 Ascending pyelonephritis is developed by
underground diseases as follow:
1 vesicoureteral and intrarenal reflux

2 chronic obstructive diseases of

urinary tract

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 ACUTE PYELONEPHRITIS
 COMPLICATIONS ARE:

 1 PAPILLARY NECROSIS
 2 PYONEPHROSIS
 3 PERINEPHRIC ABSCESS
 4 PURULENT PARANEPHRITIS
 5 UROSEPSIS

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 ACUTE PYELONEPHRITIS
 PAPILLONECROSIS WITH INFARCTION

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 ACUTE PYELONEPHRITIS
Results are in
 pyelonephritic scar and

 fibrosis

 with deformation of underlining

calyx and pelvis

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ACUTE PYELONEPHRITIS
 Results may be in
 Recovery

 Transformation in chronic
pyelonephritis

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CHRONIC PYELONEPHRITIS
 Chronic pyelonephritis is termed
chronic tubular and interstitial
inflammative disease with
compatibility of asymmetric irregular
sclerosis and deformation of calyxes
and adjacement parenchyma

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CHRONIC PYELONEPHRITIS
 There are two forms

 1 chronic obstructive pyelonephritis

 2 chronic reflux associated

pyelonephritis
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CHRONIC PYELONEPHRITIS
 Causes may be as follow:
 1 infection
 2 toxins
 3 metabolic diseases
 4 physical factors
 5 tumors
 6 immunologic reaction
 7 vascular diseases 36
CHRONIC PYELONEPHRITIS
 Reflux associated chronic pyelonephritis

Enlarged ureter

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CHRONIC PYELONEPHRITIS
 The result is in nephrosclerosis involving
 Stroma, calyces, pelvis, then vascular and
glomerular sclerosis joint to it.
 At last secondary contracted kidneys
 are formed
 With clinical picture chronic renal failure

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CHRONIC PYELONEPHRITIS
Enlarged tubules are like
thyroid follici
Phenomenon is termed
thyroidism
Delated tubules may be
filled with colloid protein
Casts.
Stroma is infiltrated by
lymphoid and
hystiocytoid cells 39
CHRONIC PYELONEPHRITIS
Stroma is
infiltrated by
lymphoid
plasma cells
and
hystiocytoid
cells
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 Xanthogranulomatous chronic
pyelonephritis
 It is unconventional and rare form

 Etiologic agent is Proteus and obstruction

of urinary channels of infection

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 Xanthogranulomatous chronic
pyelonephritis
 Gross picture can resemble in
appearance
nephrocellular carcinoma

Yellow-brown node

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 Xanthogranulomatous chronic
pyelonephritis

There are a lot of macrophages with

foamy cytoplasm,
plasma cells, lymphocytes, and granulocytes

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CHRONIC PYELONEPHRITIS
 CHRONIC PYELONEPHRITIS
MAY BE CALCULOUS OR
UNCALCULOUS

 WITH STONE FORMATION

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 UROLITHIASIS DISEASE

 There is a stone
formation disease within
the kidney, renal
calyces, pelvis, bladder.

Sites with narrowing

And lumen
obstruction

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 UROLITHIASIS DISEASE

 Stone is seen
within calyx

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 UROLITHIASIS DISEASE
Result of lumen obstruction
Is termed hydronephrosis
with enlarged pelvis and calyxes
filled with fluid and local atrophy
of the renal tissue.

The renal tissue

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 UROLITHIASIS DISEASE
There are two theories pathogenesis
of stone formation:
1 the theory is connected with
hypercalcemia state;
2 the theory is connected with a deficiency
in inhibitors of crystal formation in urine

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 UROLITHIASIS DISEASE
The stone with branches ahd formed
within calyxes and pelvis is termed
stag horn-like or coral-like stone
The radiopaque stones are uric acid and
cystine stones
The radiolucent are calcium salt stones
Other stones may be magnesium salts,
oxalate and phosphate salts. 49
 UROLITHIASIS DISEASE
 There are five types of diseases with
urolithiasis:
 Hydronephrosis
 Gout nephrosis
 Pyonephrosis
 Reflux nephrosis
 Calculus pyelonephritis
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 Xanthogranulomatous chronic
pyelonephritis

There are a lot of macrophages with foamy cytoplasm

plasma cells, lymphocytes, and granulocytes

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The end

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