75-year-old female with pyelonephrosis, status post ureteral stent.

Procedure: Left kidney and ureter, radical nephrectomy.

Gross: The specimen consists of a resected kidney with attached perirenal adipose tissue and proximal segment of the ureter, measuring 29 cm. from superior to inferior, 15 cm. from medial to lateral, and 6.5 cm. from anterior to posterior. The kidney is bivalved during intraoperative gross consultation. The renal pelvis and renal calices are slightly dilated. Two green-brown irregular renal stones are grossly identified in the renal pelvis and ureteral junctional area. The renal stones are about 1.4 and 2.2 cm. in greatest dimension. A portion of the thickened renal pelvis is used for intraoperative frozen section consultation. Further sections of the renal cortex reveal a few scattered white-tan soft areas, measuring up to 0.6 cm. The proximal ureter measures 11.5 cm. in length with a diameter of 1 cm. Opening the proximal ureter reveals intraluminal accumulation of blood. Representative sections are submitted.

Micro: Sections through the dilated and thickened renal pelvis show transitional urothelial mucosa with extensive mucosal and submucosal chronic inflammation with lymphoid aggregates and patchy fibrosis. Areas of edema and infiltrations of neutrophils are also noted. The ureteral resection margin exhibits edema and patchy chronic inflammation in the lamina propria. Sections through the renal cortex show extensive acute and chronic interstitial nephritis involving more than 50% of renal cortex. Areas of tissue disruption and microabscess formation are present. Scattered sclerotic glomeruli are also noted in the renal parenchyma. There is moderate arterial and arteriolar nephrosclerosis. H & E stain