CHRONIC

PYELONEPHRITIS
CHRONIC PYELONEPHRITIS

• Chronic pyelonephritis is a chronic tubulointerstitial disease resulting

from repeated attacks of inflammation and scarring due to infection.
• Important cause of end stage kidney disease.

• Can be divided into 2 forms:

- Reflux nephropathy.
- Chronic obstructive pyelonephritis
REFLUX NEPHROPATHY
- Early childhood
- Superimposition of urinary infection on congenital vesico- ureteral reflux.
- Causes scarring & atrophy- chronic renal insufficiency
CHRONIC OBSTRUCTIVE PYELONEPHRITIS
Obstruction predisposes to infection.

Recurrent infection + diffuse/ localized obstructive lesion

Recurrent bouts of renal inflammation & scarring

Chronic pyelonephritis
 MICROSCOPY
• Uneven interstitial fibrosis
• Inflammatory infiltrate of lymphocytes and plasma cells.
• Dilation or contraction of tubules with atrophy of lining epithelium
• Sclerosis of glomeruli
• Section from kidney shows atrophic and dilated tubules which are lined
by flattened epithelial cells filled with colloid like casts
( THYROIDIZATION )
• Interstitium is inflamed and fibrotic.
MICROSCOPY-2 points
Section from kidney shows atrophic and dilated tubules which are
lined by flattened epithelial cells filled with colloid like casts
( THYROIDIZATION )
Interstitium is inflammed and fibrotic.
ADULT POLYCYSTIC
KIDNEY DISEASE
• Autosomal dominant
• Multiple expanding cysts
• Bilateral
• Ultimately destroys the renal parenchyma
• Renal failure
PATHOGENESIS
• Mutation of PKD1(16p13.3) and PKD2(4q21)
GROSS
• B/L enlarged

• Externally –composed
of masses of cyst

• Fluid-serous,red –
brown

• Cysts arise from the

tubules
2 main gross features
• Specimen of kidney, which is markedly enlarged and has a bosselated
appearance.
• c/s shows multiple cysts filled with serous fluid.
RCC
• Tumor of adults

• Age at diagnosis :
• 6th to 7th decade;
• M:F=2:1

• Risk factors :
• tobacco, HTN, VHL syndrome

• Clinical features :
- hematuria
- flank pain
- abdominal mass
• Clear cell carcinoma (70 – 80%)
• Papillary carcinoma ( 10 – 15%)
• Chromophobe renal cell carcinoma ( 5%)
• Collecting duct (bellini duct) carcinoma (1%)
GROSS
• Specimen of kidney shows a growth which is well circumscribed ,
solitary and centered on the cortex.

• C/s shows a bright yellow-grey white variegated mass with areas of

hemorrhage and necrosis.

• Tumor separated from surrounding tissue by a fibrous pseudo capsule

and has a variegated appearance i.e. it shows hemorrhage , necrosis ,
calcification , cystic change.
Growth

Variegated
appearance
(hemorrhage,
Well necrosis, cystic
delineated change,
calcification)

normal (cortico
medullary
differentiation)
 MICROSCOPY

• Section studied shows large , polygonal cells arranged as solid sheets and as large
nests separated by stroma with sinusoid like vessels.

• Cells are large, polygonal with clear ( due to deposition of glycogen & fat) /
granular cytoplasm & centrally located nuclei.
TRANSITIONAL CELL CARCINOMA
• 90% of all bladder tumors

• Patients
• > 50yrs
• Males> females

• Most common form of presentation :

• hematuria

• Sites :
• lateral wall , posterior wall , trigone

• Bladder lesions can be papillary or flat and low grade or high grade
 Gross
• Proliferative growth in
trigone,obstructs urothelial
orifice
• Growth shows fine
papillary excrescences
 Microscopy

• Section shows tumor

composed of thin long
branching papillary (finger
like) projections of
multilayered epithelium with
central thin fibrovascular
core.

• Projections are lined by

plump large cells arranged in
groups of > 7 layers with
prominent hyperchromatic
nuclei & clear cytoplasm
 SEROUS CYSTADENOMA

• Multi cystic lesion in which papillary epithelium is contained within

fibrous walled cysts .
• Mass projecting from the ovarian surface.
• Benign tumors typically have a smooth glistening cyst wall
• with small papillary projections.
• Borderline tumors contain an increased number of papillary
projections . Larger areas of solid or papillary tumor growth, tumor
irregularity, and fixation or nodularity of the capsule are features
associated with malignancy.
• Demonstrates
multi loculations
• Inner surface is
smooth
• Single
pappilation
Thank you