URETERIC CALCULI
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 |
|
| B |
Renal cell carcinoma |
|
| C |
Autosomal dominant polycystic kidney disease |
|
| D |
Cystic dysplastic kidney |
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 |
|
| B |
Renal cell carcinoma |
|
| C |
Autosomal dominant polycystic kidney disease |
|
| D |
Cystic dysplastic kidney |
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 involvOment 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 tutrules 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.
