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[Pathologic features in diagnosis and differential diagnosis of pyelonephritis (author's transl)]
Abstract:
Morphological diagnosis and differential diagnosis of pyelonephritis are discussed particularily considering macroscopic features. A special form with radiological significance is ncrotizing "emphysematous" pyelonephritis. Chronic non-obstructive pyelonephritis is rarer than formerly thought if strict morphological criteria are applied. It should be differentiated from nephropathy caused by analgetics. In analgesic nephropathy bilateral papillary necrosis is the earliest and most characteristic alteration. Differentiation between chronic pyelonephritis and analgesic nephropathy is possible in most cases but may be difficult if analgesic nephropathy is complicated by bacterial infection. A classification of "unilateral small kidney" is presented. Unilateral acquired "renal shrinkage" should be differentiated from congenital "unilateral hypoplasia". It remains to be discussed whether the so-called "Ask-Upmark-Kidney" is a malformation or the result of chronic pyelonephritis.
Insights
This study reviews the morphological diagnosis of pyelonephritis, emphasizing macroscopic features and differentiating it from analgesic nephropathy. It also addresses unilateral renal shrinkage and the Ask-Upmark kidney.
Area of Science:
- Nephrology
- Pathology
- Radiology
Context:
- Morphological diagnosis of pyelonephritis is crucial for accurate patient management.
- Distinguishing pyelonephritis from other renal conditions like analgesic nephropathy is clinically significant.
- Radiological features, such as in necrotizing emphysematous pyelonephritis, aid in diagnosis.
Purpose:
- To discuss the morphological diagnosis and differential diagnosis of pyelonephritis based on macroscopic features.
- To highlight necrotizing emphysematous pyelonephritis as a radiologically significant entity.
- To differentiate chronic pyelonephritis from analgesic nephropathy and congenital unilateral hypoplasia from acquired renal shrinkage.
Summary:
- The diagnosis of pyelonephritis relies on macroscopic features, with necrotizing emphysematous pyelonephritis being a notable variant.
- Chronic non-obstructive pyelonephritis is less common than previously believed when strict morphological criteria are used.
- Analgesic nephropathy, characterized by bilateral papillary necrosis, must be differentiated from pyelonephritis, though complications can make differentiation challenging.
- A classification for unilateral small kidney is proposed, distinguishing acquired renal shrinkage from congenital hypoplasia and discussing the etiology of the Ask-Upmark kidney.
Impact:
- Provides clear diagnostic criteria for pyelonephritis and related conditions.
- Improves the differentiation between similar-appearing renal pathologies.
- Contributes to a better understanding of unilateral renal abnormalities and their origins.