Page 493 - Concise Pathology for Exam Preparation ( PDFDrive )

478 SECTION II Diseases of Organ Systems

Q. Differentiate between acute and chronic pyelonephritis.

Ans. Differences between acute and chronic pyelonephritis are listed in Table 16.6.

TABLE 16.6. Differences between acute and chronic pyelonephritis
Features Acute pyelonephritis Chronic pyelonephritis
Definition Acute suppurative inflammation of Chronic tubulointerstitial disease showing tubu-
kidney caused by bacterial infection lar inflammation and renal scarring with
pathologic involvement of calyces and pelvis
Predisposing factors Urinary obstruction, instrumentation, Obstructive pathology, presence of reflux
catheterization, pregnancy, DM and
pre-existing renal lesions
Subtypes No subtypes Chronic obstructive pyelonephritis and
reflux-associated nephropathy
Gross Discrete yellow, raised abscesses are Coarse corticomedullary scars overlying blunted
seen on the renal surface or dilated calyces
Microscopy Tubules show suppurative necrosis • Tubules show atrophy in some areas and dila-
with preserved outline tation in others
• Dilated tubules filled with colloid-like casts
(thyroidization)
Clinical features Sudden onset with back pain, fever Insidious (silent) onset with progressive decline
and malaise in renal function

Q. Differentiate between chronic glomerulonephritis (CGN) and
chronic pyelonephritis (CPN).
Ans. Contrasting features of CGN and CPN are given in Table 16.7.

TABLE 16.7. Contrasting features of CGN and CPN
Features CGN CPN
Primary disease Glomerular, cortical Tubulointerstitial
Distribution Diffuse Patchy
Proteinuria Marked Mild or absent
Involvement Symmetrical Asymmetrical
Cortical scars Fine Coarse
Calyces Normal Distorted
Glomerulosclerosis .50% Occasional
Interstitial fibrosis Mild Marked
Periglomerular fibrosis Mild Marked
Tubular atrophy or loss Mild Marked
Thyroidization Absent Present

Q. Describe the Clinico morphological features and pathogenesis
of diabetic nephropathy.

Ans. Morphological Changes in Diabetic Glomerulosclerosis

Clinical Features of Diabetic Glomerulosclerosis
Patients may present with either of the three glomerular syndromes, namely, non-nephrotic
proteinuria, nephritic syndrome and chronic renal failure.
1. Capillary basement membrane thickening:
Widespread thickening of GBM with mesangial widening

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