Home   Chapter Home   Jobs   Conferences   Fellowships   Books


Kidney non-tumor

Tubular and interstitial diseases

Chronic pyelonephritis

Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 24 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● Chronic tubulointerstitial inflammation and renal scarring with severe involvement of calyces and pelvis
● Pyelocalyceal damage / blunting rules out other tubulointerstitial inflammation

Clinical features

● Causes 10%-20% of end stage renal disease in transplant or dialysis units
● Associated with pyelitis and ureteritis cystica
● Some patients with pyelonephritic scars develop focal and segmental glomerulosclerosis with proteinuria in nephrotic range, perhaps due to renal ablation nephropathy

● Types: reflux (chronic reflux-associated pyelonephritis) and obstruction (chronic obstructive pyelonephritis)
Reflux: more common, usually arises in childhood, unilateral or bilateral; damage often due to infection; associated with calyceal dilation (usually upper pole); see tubular atrophy and thyroidization, interstitial fibrosis
Obstruction: associated with parenchymal scarring, usually not in children

Case reports

● 68 year old woman with renal sinus mass by imaging (J Med Case Rep 2009;3:9054)

Gross description

● Irregular scarred cortical surface usually at poles, dilated and blunted calyces
● Dilated ureter; retraction and destruction of papillae with U shaped scars

Gross images

Dilated calyces, reduced renal parenchyma and scarring

Micro description

● Tubular thyroidization (filled with colloid casts), tubular atrophy
● Interstitial fibrosis and inflammation (intense diffuse lymphoplasmacytic inflammatory infiltrate with germinal centers)
● Obliterative endarteritis of vessels, interstitial Tamm-Horsfall protein (amorphous, fibrillary, PAS+ material surrounded by inflammatory cells)
● Normal glomeruli early in disease course

Micro images

Various images

Differential diagnosis

Chronic glomerulonephritis: diffusely scarred cortex
● Vascular disease: can cause wedge-shaped cortical scars, but underlying medullary and calyceal areas are normal

End of Kidney non-tumor > Tubular and interstitial diseases > Chronic pyelonephritis

Ref Updated: 8/17/12

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).