KIDNEY

SECTION F
ACUTE
PYELONEPHRITIS
ACUTE PYELONEPHRITIS
• Suppurative inflammation
• Caused by bacterial or viral infection via hematogenous
spread
• 70-80% of the case – E. coli
• Others: Proteus mirabilis, Klebsiella pneumoniae,
Enterococcus faecalis, Staphylococcus
GROSS FEATURES
• Size of affected kidney is normal or slightly enlarged
• Surface exhibits grayish-white areas of inflammation and
abscess formation
GROSS FEATURES

Grayish-white areas of inflammation

and abscess formation

Photo Reference: Robbins and Cotran Pathologic Basis of Disease.

9th Edition, Chapter 20, page 932
MICROSCOPIC FEATURES
• Hallmarks:
• Patchy interstitial suppurative inflammation
• Intratubular aggregates of neutrophils
• Neutrophilic tubulitis
• In earlier stages, neutrophilic infiltrates are limited to tubules
• Tubular necrosis
 MICROSCOPIC FEATURES

Presence of abscesses (suppurative necrosis); Acute neutrophilic exudate within tubules

consisting of pus, neutrophils, cell debris, and interstitial inflammation
and central germ colonies
Photo Reference: Robbins and Cotran Pathologic Basis of Disease.
Photo Reference: Pathology Atlas online 9th Edition, Chapter 20, page 932
CLINICAL FEATURES
• MANIFESTATIONS:
• Sudden onset of pain at the costovertebral angle
• Systemic evidence of infection such as fever and malaise
• Indication of bladder and urethral irritation:
• Dysuria
• Frequency
• Urgency
CLINICAL FEATURES
• Acute Pyelonephritis is commonly associated with:
• Urinary tract obstruction
• Vesicoureteral reflux
• Bacteriuria in pregnant women (bet. 4-6%), may develop
to symptomatic urinary infection if not treated
• Diabetes Mellitus
• Immunosuppression and Immunodeficiency
RENAL CELL
CARCINOMA
RENAL CELL CARCINOMA
• May arise in any portion of the kidney, but more commonly
affects the poles
• Tumor occurs more often in older individuals (60-70) and
show a 2:1 male preponderance
CLASSIFICATION OF
RENAL CELL CARCINOMA
• Clear cell carcinoma
• Most common type (70-80%)
• Tumors are made up of cells with clear or granular cytoplasm
and are nonpapillary

• Papillary carcinoma
• Accounts for 10-15% of renal cell carcinoma
• Characterized by cuboidal or low columnar cells arranged in
papillary formation
 MICROSCOPIC FEATURES

Clear cell carcinoma – Papillary carcinoma –

with clear or granular cytoplasm with papillary growth pattern

Photo Reference: Robbins and Cotran Pathologic Basis of Disease.

9th Edition, Chapter 20, page 955
CLASSIFICATION OF
RENAL CELL CARCINOMA
• Chromophobe carcinoma
• Represents 5% of renal cell carcinoma
• Composed of cells with prominent cell membranes and pale
eosinophilic cytoplasm, usually with a halo around the nucleus

• Collecting duct carcinoma

• Accounts for 1% or less of renal epithelial neoplasms
• Arise from collecting duct in the medulla
• Characterized by malignant cells forming glands within a
prominent fibrotic stroma
MICROSCOPIC FEATURES
Chromophobe carcinoma –
prominent cell membranes
pale eosinophilic cytoplasm
with a halo around the nucleus

Photo Reference: Robbins and Cotran Pathologic Basis of Disease.

9th Edition, Chapter 20, page 955
GROSS FEATURES
• Usually solitary unilateral lesions
• Bright yellow-gray-white spherical masses of variable size
that distort renal outline
• Large areas of gray-white necrosis and foci of hemorrhagic
discoloration
• Margins are usually sharply defined and confined within
renal capsule
GROSS FEATURES

Typical cross-section of yellowish, spherical

neoplasm in one pole of the kidney

Photo Reference: Robbins and Cotran Pathologic Basis of Disease.

9th Edition, Chapter 20, page 954
CLINICAL FEATURES
• Diagnostic Triad
• Costovertebral pain
• Palpable mass
• Hematuria
• Usually asymptomatic – produce symptoms when tumor
attains a large size
• Tendency to metastasize widely before giving rise to any
local symptoms or signs (most common- lungs)
CLINICAL FEATURES
• Renal cell carcinoma is “One of the great mimics in
medicine”
• Tends to produce a diversity of systemic symptoms not related to
the kidney
• Produce syndromes ascribed to abnormal hormone production
such as polycythemia, hypercalcemia, hypertension, hepatic
dysfunction, eosinophilia
REFERENCES
Kumar, V., Abbas, A. K., Aster, J. C. (2015). Robbins and Cotran Pathologic Basis
of Disease. (9th Ed.) Elsevier Inc.: Philadelphia