Figure 737

Urinary tract infection (UTI) in the immunocompromised host. UTI results from the encounter of a pathogen and a host. Natural defenses against UTI rest on both cellular and humoral defense mechanisms. These defense mechanisms are compromised by diabetes, pregnancy, and advanced age. Diabetic patients often harbor asymptomatic bac-teriuria and are prone to severe forms of pyelonephritis requiring immediate hospitalization and aggressive treatment in an intensive care unit.

A particular complication of upper renal infection in diabetes is papillary necrosis (see Fig. 7-32). The pathologic appearance of a sloughing renal papilla, A. The sloughed papilla is eliminated and can be recovered by sieving the urine, B. In other cases, the necrotic papilla obstructs the ureter, causing retention of infected urine and severely aggravating the pyelonephritis. C, It can lead to pyonephrosis (ie, complete destruction of the kidney), as shown on CT.

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