Pyelonephritis and End-Stage Renal Disease (ESRD)

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Unit V – Problem 11 – Pathology: Pyelonephritis and End-Stage Renal Disease (ESRD) - Urinary Tract Infection (UTI): presence of bacteria and leukocytes (pyuria) in the urine. - What are the causative organisms of (UTI) and pyelonephritis? E. coli. Species of Klebsiella, Enterobacter, Proteus and Pseudomonas. In immunocompromised patient (especially those with transplanted organs): polyomavirus, cytomegalovirus and adenovirus. - Pyelonephritis: Definition: it is a renal disorder affecting tubules, interstitium and renal pelvis. Routes of infection: Hematogenous: It is less common. From distant foci: septicemia or infective endocarditis. From the lower urinary tract (ascending infection): Colonization of dsital urethra and then: Spread to urinary bladder: in females it is due to short urethra or catheterization Multiplication in urinary bladder. Spread to ureters and renal pelvis via vesicoureteral reflux. Spread to renal parenchyma: intrarenal reflux. Acute pyelonehpritis: Morphology: Gross (image-1): discrete focal abscesses in one or both kidneys which can extend to large wedge-shaped areas; hyperemia. Histologic features (image-2): patchy interstitial supparative inflammation; intratubular aggregates of neutrophils and tubular necrosis. 1 2 Complications of acute pyelonephritis: Pyonephrosis: ureter, calyces and renal pelvis filled with pus. Perinephric abscess. Papillary necrosis (image-3): it is seen also in analgesic abuse, sickle- cell disease, obstruction and diabetes. 3 Natural course of acute pyelonephritis: Healing. Irregular scars: cortical surface with fibrous depressions. Pelonephritic scar: deformation of the underlying calyx and pelvis. Urinalysis in acute pyelonephritis: Pyuria. Bacteruria. WBC casts. Chronic pyelonephritis: Definition: It is a chronic tubule-interstitial inflammation + renal scarring + pathologic involvement of the calyces and pelvis. It is an important cause of End-Stage Renal Disease (ESRD). It can be divided into two forms: Chronic reflux-associated: A more common form of chronic pyelonephritic scarring. Early in childhood → urinary infection on congenital vesicoureteral reflux and intrarenal reflux. Reflux may be unilateral or bilateral: scarring and atrophy of one kidney or involving both kidneys, leading to chronic renal insufficiency. Chronic obstructive: Obstruction predisposes the kidney to infection. Recurrent infections superimposed on obstructive lesions → recurrent bouts of renal inflammation and scarring → chronic pyelonephritis → parenchymal atrophy. Morphology: Gross (image-4): irregular scared asymmetric contracted kidney with blunted, deformed calyces. The scars vary from one to several in one or both kidneys. Histologic features (image-5): chronic tubulointerstitial nephritis + thyroidization ± periglomerular fibrosis 4 5 - End-Stage Renal Disease (ESRD): Causes: Diabetic glomerulosclerosis. Glomerulonephritis. Chronic pyelonephritis. Obstructive uropathy. Hypertensive nephrosclerosis. Polycystic kidneys. Drugs and toxins. Morphology: Gross (image-6): shrunk kidneys; diffusely granular cortical surfaces. Histologic features (image-7): Tubules are atrophic with casts. Sclerotic glomeruli. Thick-walled arteries. Chronic inflammation and fibrosis. 6 7 .

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Diagnosis and Primary Care Management of Focal Segmental Glomerulosclerosis in Children
1.5 CONTACTCOCONOONNTATACACACT HOURSHOUROURRS 1.5 CONTACT HOURS Monkey Business Images / Thinkstock Diagnosis and primary care management of focal segmental glomerulosclerosis in children Abstract: Focal segmental glomerulosclerosis (FSGS) is a pattern of kidney damage that can occur in individuals at any age, including children. Pediatric patients with FSGS require medication monitoring, growth, and psychological health. This article discusses the NP’s role in the clinical presentation, diagnostic workup, and treatment of FSGS in pediatric patients. By Angela Y. Wong, MS, CPNP-PC and Rita Marie John, DNP, EdD, CPNP-PC, FAANP P, a 10-year-old girl, told her parents several This article discusses the pathophysiology, epide- times, “I feel puffy,” before the family sought miology, clinical presentation, and treatment options J medical attention. This complaint could in- for FSGS. In addition, the article elucidates the role dicate a myriad of issues ranging from sudden weight of the NP in managing this disease when it occurs gain to simple abdominal gas. For this child, “puffy” during childhood. depicted her progressive edema—the only overt symp- tom of her diagnosis of focal segmental glomerulo- ■ Overview sclerosis (FSGS). Although some children with FSGS FSGS is a pattern of kidney damage involving scarring may only present with asymptomatic proteinuria at of glomeruli in the kidney. This pattern of glomerulo- a routine physical, FSGS can affect individuals of all sclerosis is focal and segmental, meaning not all glom- ages, and is a common cause of end-stage renal disease eruli are affected and only parts of the glomeruli are (ESRD) in children.1 damaged, respectively.2 FSGS is the most common Keywords: end-stage renal disease, focal segmental glomerulosclerosis, kidney transplant, nephrotic syndrome, pediatrics 28 The Nurse Practitioner • Vol.
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Glomerulosclerosis in Reflux Nephropathy
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Kidney International, Vol. 21(1982), pp. 528—534 NEPHROLOGY FORUM Glomeruloscierosis in reflux nephropathy Principal discussant: RAMzI S. COTRAN Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts penis, testes, and urethral meatus were normal. The prostate was of normal size. Editors The BUN was 14 mg/dl; creatinine, 1.3 mg/dl (creatinine clearance, 113 mI/mm); blood chemistries were normal; the blood glucose was 93 JORDANJ. COHEN mg/dl; and the complement profile was normal. Serum protein was 7.5 JOHN 1. HARRINGTON gIdI with 4.3 g/dl albumin. Urinalysis showed a pH of 5; a specific JEROME P.KASSIRER gravity of 1.015; 4+ protein, no cells, and no bacteria. Urine culture was sterile. The 24-hour urine protein excretion was 2.4 g. Editor Chest x-ray showed borderline cardiomegaly with clear lungs. An Managing intravenous pyelogram revealed bilateral coarse scarring with caliecta- CHERYL J. ZUSMAN sis. The right kidney was smaller than the left. There was moderate ureterectasia extending down to the ureterovesical junction. A voiding cystourethrogram revealed a large-capacity bladder; the patient had no MichaelReese Hospital and Medical Center urge to void after almost 500 ml of contrast material was instilled. Bilateral reflux was greater and persistent on the left and was intermit- University of Chicago, tent on the right. The left ureter was dilated and tortuous. A left Pritzker School of Medicine ureterocele and right bladder diverticulum were visualized. and A biopsy of the left kidney showed focal scarring with interstitial New England Medical Center fibrosis and chronic inflammation, tubular atrophy, and dilation.
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Focal Segmental Glomerulosclerosis in Systemic Lupus Erythematosus
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Diagnosis and Management of Pyelonephritis
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Focal Segmental Glomerulosclerosis
some = Focal sections of = Segmental Focal Segmental kidney filters = Glomerulo FSGS Glomerulosclerosis = { are scarred Sclerosis How can research help? Research, which often requires patient participation, can lead to a better understanding of the causes, provide better diagnoses and more effective treatments, and ultimately help to find a cure. Be part of the discovery: By studying patients, researchers can more quickly unlock the mysteries of this disease. To get involved in research and stay informed, go to: Nephrotic Syndrome Study Network www.Nephrotic-Syndrome- NEPTUNE is a part of the NIH Rare Diseases Clinical Research Network (RDCRN). Funding and/or programmatic support for this project has been provided by U54 Studies.org DK083912 from the NIDDK and the NIH Office of Rare Diseases Research (ORDR), the NephCure Foundation and the University of Michigan. The views expressed in written materials of publications do not necessarily reflect the official policies of the or call 1-866-NephCure Department of Health and Human Services; nor does mention by trade names, commercial practices or organizations imply endorsement by the U.S. Government. What is Focal and Segmental Glomerulosclerosis? Symptoms, Diagnosis and Treatment Each person has Focal Segmental Glomerulosclerosis (FSGS) is a Your nephrologist may also recommend: two kidneys in rare disease that attacks the kidney’s filtering system • Diuretics and low salt diet help to control edema their lower back. (glomeruli) causing scarring of the filter. FSGS • A medication that blocks a hormone system called is one of the causes of a condition known as the renin angiotensin system (ACE inhibitor or ARB) Nephrotic Syndrome (NS).
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Path Renal Outline
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FSGS Fact Sheet 4.12.18
® Focal Segmental Glomerulosclerosis Focal Segmental Glomerulosclerosis (FSGS) is a rare kidney disease characterized by dysfunction in the part of the kidney that ﬁlters blood (glomeruli). Only some glomeruli are aected, but continued damage can lead to kidney failure. Focal = Some Segmental = Sections Glomerulo = of the Filtering Units Sclerosis = Are Scarred FSGS Symptoms The exact cause of primary Early symptoms of FSGS are the same as Nephrotic Syndrome. FSGS is unknown and not precisely understood. However, genetic and Common Symptoms: environmental factors may be associated - Protein in the urine, which can be foamy (called with the disease. proteinuria) - Low levels of protein in the blood With FSGS, many individuals - Swelling in parts of the body, most noticeably around experience cycles the eyes, hands, feet, and abdomen (called edema) of remission and relapse. - Weight gain due to extra ﬂuid building up in your body Remission means there - Can cause high blood pressure (called hypertension) is currently no and high fat levels in the blood (high cholesterol) protein spilling into the 50% of urine. patients with FSGS will Fast Facts progress to kidney failure. The only way to dierentiate FSGS from other primary Every FSGS Nephrotic Syndrome conditions is to have a kidney biopsy. patient follows a unique journey. FSGS in Adults FSGS in Children - FSGS occurs more - Focal Segmental frequently in adults than Glomerulosclerosis is one of in children and is most the leading causes of End Some patients prevalent in adults 45 Stage Renal Disease receive a kidney years or older. (ESRD) in children. transplant to treat their kidney failure due to FSGS, - African Americans are 5 - FSGS is associated with but FSGS comes back times more likely to get up to 20% of all new cases to attack the new FSGS in comparison with of Nephrotic Syndrome kidney 30-50% the general population.
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Renal Manifestations of Common Variable Immunodeficiency Tiffany
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Karyomegalic Interstitial Nephritis with Focal Segmental Glomerulosclerosis: a Rare Association
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Focal and Segmental Glomerulosclerosis (FSGS)
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