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This 30-year-old black male was born with a meningocele which was repaired in childhood. Despite repair of the meningocele, this patient continued to have a neurogenic bladder.
Six months previous to this admission, the patient passed a single renal calculus but intravenous pyelograph pyelogram (IVP) showed left nephrolithiasis (a 1 cm stone in the lower lobe). For 6 months the patient had to be catheterized each day for 6 hours. However, he continued to complain of hesitancy and urgency and suffered occasional urinary tract infections.
On this admission, a culture of the patient's urine specimen grew Gram-negative bacilli (Proteus species). Cystoscopy showed heavy trabeculation of the bladder with early diverticula and the left ureteral orifice showed squamous metaplasia. The lower pole of the left kidney was removed surgically, following which the patient recovered and was discharged on antibiotics.
File:IPLab2Metaplasia7.jpg|This is a photomicrograph of the trachea from a smoker. Note that the columnar ciliated epithelium has been replaced by squamous epithelium.
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== Virtual Microscopy ==
=== Kidney: Metaplasia ===
<peir-vm>IPLab2Metaplasia</peir-vm>
=== Normal Kidney ===
<peir-vm>UAB-Histology-00114</peir-vm>
== Study Questions ==
* <spoiler text="What is a neurogenic bladder and what complications may result from this condition?">A neurogenic bladder is any condition or dysfunction of the urinary bladder caused by a lesion of the central or peripheral nervous system. Complications primarily include stasis, infection, and stone formation.</spoiler>
* <spoiler text="What factors in this case predisposed to nephrolithiasis?">Stasis and infection.</spoiler>
* <spoiler text="Does this metaplastic process predispose to neoplasia?">No.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/437096-overview eMedicine Medical Library: Nephrolithiasis]
* [http://emedicine.medscape.com/article/453539-overview eMedicine Medical Library: Neurogenic Bladder]
* [http://www.merckmanuals.com/professional/genitourinary_disorders/urinary_calculi/urinary_calculi.html Merck Manual: Urinary Calculi]
* [http://www.merckmanuals.com/professional/genitourinary_disorders/voiding_disorders/neurogenic_bladder.html Merck Manual: Neurogenic Bladder]
* [http://www.merckmanuals.com/professional/genitourinary_disorders/approach_to_the_genitourinary_patient/evaluation_of_the_renal_patient.html Merck Manual: Approach to the Genitourinary Patient]
=== Journal Articles ===
* Barbera M, Fitzgerald RC. [http://www.sciencedirect.com/science/article/pii/S1055320709000180 Cellular Mechanisms of Barrett's Esophagus Development]. ''Surg Oncol Clin N Am '' 2009 18:393–410.
* Spechler SJ and Souza RF. [http://www.nejm.org/doi/full/10.1056/NEJMra1314704 Barrett’s Esophagus]. ''N Engl J Med'' 2014 371:836-45.
* Barbera M, Fitzgerald RC. [http://www.biochemsoctrans.org/content/38/2/370 Cellular origin of Barrett’s metaplasia and oesophageal stem cells]. ''Biochem. Soc. Trans'' 2010 38:370–373.
* Mills JC and Sansom OJ. [http://stke.sciencemag.org/content/8/385/re8.full Reserve stem cells: Differentiated cells reprogram to fuel repair, metaplasia, and neoplasia in the adult gastrointestinal tract]. ''Sci. Signal'' 2015 8(385):re8.
* Clouston B and Lawrentschuk N. [http://onlinelibrary.wiley.com/doi/10.1111/bju.12378/full Metaplastic conditions of the bladder]. ''BJU Int''2013 112(Suppl 2):27-31.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/148-bladder/11-urinary PEIR Digital Library: Bladder Images]
* [http://library.med.utah.edu/WebPath/RENAHTML/RENALIDX.html WebPath: Renal Pathology Images]
{{IPLab 2}}
[[Category: IPLab:Lab 2]]