Summary: Systemic Pathology

Read the summary and the most important questions on Systemic Pathology

• 1 Renal System Pthologies

• 1.1 Tubulointestitial Diseases

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• What are the clinical features of chronic pyelonephritis?

  Chronic pyelonephritis features include:
  

  • Chronic renal failure: Proteinuria, hypertension, azotemia - Elevation of BUN and creatinine levels, reduced GFR.

  • Hyposthenuria: Inability to concentrate urine manifested as polyuria, nocturia.

  • Radiological findings: Asymmetrically contracted kidneys, caliectasis.

• What is the purpose of imaging in data investigations?

  Imaging is utilized to look for what is causing urine stasis. It helps identify underlying issues that may be contributing to the condition. Imaging is a crucial step in diagnosing and understanding the cause of urinary problems. It provides visual evidence to guide further treatment and management.

• What causes drug-induced TIN and what are the pathogenic events?

  Drug-induced TIN is caused by:
  

  • Adverse drug reactions: Penicillins, antibiotics, diuretics, proton pump inhibitors, NSAIDs.

  Pathogenic events:
  

  1. Drugs act as haptens.
  2. During secretion, drugs bind to tubular cell components.
  3. Becomes immunogenic.
  4. Tubulointerstitial injury from T cell-mediated immune response or IgE.

• What are the key factors involved in ascending infection and its epidemiology?

  Ascending infection involves adhesion to mucosal surfaces, reaching the bladder. Key factors:
  

  • Flagella and cilia help movement.
  • Toxins reduce peristalsis, allowing less flushing.
  • Epidemiology includes:
    • Vesicoureteral reflux (VUR)
    • More common in females (shorter urethra)
    • Males (complicated UTI)
    • Highly virulent bacteria cause damage.

• List the complications associated with urinary issues.

  Complications include:
  

  • Sepsis
  • Perinephric abscesses
  • Renal dysfunction and failure
  • Cause pre-term labour
  • Uterine growth retardation
  • Urethral narrowing (stricture)

  Treatment of UTI is given with PID (pelvic inflammatory disease), and menstrual changes due to PID may occur.

• Describe the morphology and clinical features of drug-induced TIN.

  Morphology includes:
  

  • Pronounced edema.
  • Infiltration by mononuclear cells: Lymphocytes, macrophages.
  • Eosinophils and neutrophils often present in large number.

  Clinical features:
  

  • Fever, eosinophilia, rash, renal abnormalities.
  • Nonselective proteinuria, leukocyturia.
  • Serum creatinine rise in 50% of cases in older patients.
  • Acute kidney injury with oliguria 50% of cases in older patients.

• What are tubular and interstitial diseases, and how are they characterized?

  Tubular and interstitial diseases almost always occur together and are known as tubulo-interstitial nephritis (TIN). They are characterized by:
  

  • TIN (tubulointerstitial nephritis): inflammatory
  • obstructive/ischemic or toxic tubular injury

• Describe the characteristics of chronic pyelonephritis.

  Chronic pyelonephritis involves:
  

  • Blockage to urine flow (chronic obstructive pyelonephritis)
  • Chronic reflux-associated pyelonephritis (reflux nephropathy)

  Morphology:
  

  • Gross: Shrunken kidneys, necrosis of renal tubules
  • Renal papillae & calyces are always affected (scarring)
  • Patchy or diffuse fibrosis

  Microscopically:
  

  • Multifocal (macrophages)
  • Acute on chronic infiltrated due to exacerbation (neutrophils)
  • Scarring of the pelvis or calyces

• Describe the morphology of Acute Pyelonephritis, both macroscopically and microscopically.

  Morphology of ascending infection:
  

  • Macroscopically:
    • Mucosa is mottled.
    • Swollen, congested, and smudgy.
    • Abscesses due to liquefactive necrosis
    • Unilateral or bilateral
  • Microscopically:
    • Hypercellularity.
    • Neutrophil infiltrates.
    • Liquefactive necrosis.

• What are the clinical features of ascending infection, including LUTS and bleeding patterns?

  Clinical features include:
  

  • LUTS (Lower urinary tract symptoms):
    • Dysuria, frequency, urgency.
    • Hematuria (RBCs without casts and WBCs casts in urine).
  • Bleeding patterns:
    • Bladder: Blood in entire urine.
    • Urethra: Blood at start, then normal.
    • Ureter: Blood in entire urine, clean after void, blood at end.