Figure 632

Schematic representation of the forms and course of renal involvement by malacoplakia: 1, normal kidney; 2, enlarged kidney resulting from interstitial nephritis without nodularity; 3, unifocal nodular involvement; 4, multifocal nodular involvement; 5, abscess formation with perinephric spread of malacoplakia; 6, cystic lesions; and 7, atrophic multinodular kidney after treatment. Interstitial granulomatous reactions are a rare but characteristic hallmark of certain forms of tubulointerstitial disease. The best-known form is that of sarcoidosis. Interstitial granulomatous reactions also have been noted in renal tuberculosis, xanthogranulomatous pyelonephritis, renal malacoplakia, Wegener's granulo-matosis, renal candidiasis, heroin abuse, hyperoxaluria after jejunoileal bypass surgery, and an idiopathic form in association with anterior uveitis.

The inflammatory lesions of malacoplakia principally affect the urinary bladder but may involve other organs, most notably the kidneys. The kidney lesions may be limited to one focus or may be multifocal. In three fourths of cases the renal involvement is multifocal, and in one third of cases both kidneys are involved. The lesions are nodular, well-demarcated, and variable in size. They may coalesce, developing foci of suppuration that may become cystic or calcified. The lesions usually are located in the cortex but may be medullary and result in papillary necrosis. (From Dobyan and coworkers [7]; with permission.)

├Ąg^^H Tubulointerstitial Disease

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