Question
A 45-year-old male with history of recurrent ureteric calculi presented with fever. Right-sided nephrectomy was performed. Gross view and histology have been provided. What is your diagnosis?
| A. |
Chronic pyelonephritis with hydronephrosis
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| B. |
Renal cell carcinoma
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| C. |
Autosomal dominant polycystic kidney disease
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| D. |
Cystic dysplastic kidney
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Show Answer
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Correct Answer » A
Explanation
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Ans. a. Chronic pyelonephritis with hydronephrosis
Chronic Pyelonephritis
- . Insidious in onset, may present with clinical manifestations of acute recurrent pyelonephritis with back pain, fever, frequent pyuria, and bacteriuria.
- . Gross examination: Irregularly scarred kidney; if bilateral, the involvement is asymmetric.
- . Hallmark of chronic pyelonephritis: Coarse, discrete, corticomedullary scar overlying a dilated, blunted, or deformed calyx.
- . Most of the scars are in the upper and lower poles, consistent with the frequency of reflux in these sites.
- . Microscopic changes: Predominantly involve TUT (Transparent Ultrasound Transducer) rules and interstitium
- . Dilated tubules with flattened epithelium may be filled with colloid casts (thyroidization).
- . Glomeruli may appear normal except for periglomerular fibrosis, but a variety of glomerular changes may be present, including ischemic fibrous obliteration as well as secondary changes related to hypertension.
