Summary
The role of the renal papillae in the pathogenesis of pyelonephritis and reflux nephroapthy was studied by endoscopy and histology in adult autopsy kidneys. Compound papillae with a concave area cribrosa of the “reflux type” were found in greater frequency in adults than in children. Acute purulent inflammation in the renal parenchyma or coarse pyelonephritic scars were seen almost always overlying “refluxing” papillae or overlying papillae altered by papillary necrosis, obstructive atrophy and other changes of papillary shape. Intrapapillary tubular obstruction in early analgesic nephropathy, gout, myeloma and medullary cystic disease is an other factor favouring bacterial infection to occur. Without an underlying renal papillary damage renal injury attributable to urinary infection seems to be rare.
Zusammenfassung
Die Nierenpapillen spielen in der Pathogenese der Pyelonephritis und der Refluxnephropathie eine wichtige Rolle. Physiologische Formvarianten, pathologische Formveränderungen und intramedulläre Prozesse begünstigen das Übergreifen von Harnwegsinfekten auf das Nierenparenchym. Zusammengesetzte konkave Papillen, die den Reflux ermöglichen, sind in Erwachsenennieren häufiger als bei Kleinkindern. Sektorförmige Entzündungszellinfiltrate bei eitriger Pyelonephritis und kortiko-medulläre Narben bei chronischer Pyelonephritis finden sich fast ausschließlich über konkaven oder pathologisch veränderten Papillen. Die intramedulläre Harnabflußbehinderung bei Analgetika-Nephropathien, Gicht, Plasmozytom oder Markschwammnieren fördert das Angehen bakterieller Infekte.
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Gloor, F., Bürgin, M. Die Bedeutung der Nierenpapillen in der Pathogenese von Pyelonephritis und Refluxnephropathie. Klin Wochenschr 63, 907–911 (1985). https://doi.org/10.1007/BF01738144
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DOI: https://doi.org/10.1007/BF01738144
Key words
- Renal papillae
- Morphology
- Pathogenesis of pyelonephritis
- Reflux
- Renal pelvic endoscopy
- Intramedullary changes