PYELITIS. PYELONEPHRITIS. INFLAMMATION OF THE RENAL PELVIS.
Definition. Causes: primary from vegetable irritants in food, toxins, cryptogams, pelvic calculus, strongylus gigas; secondary from renal calculus, parasite, tubular urethral or vesical infection, infecting deposits, metastasis. Symptoms: as in nephritis, pus, blood, or albumen in urine, tender, arched loins, purulent polyuria, with spheroidal epithelium. Diagnosis. Lesions: inflammation, calculus, etc., in pelvis. Treatment: pure water, sodium bicarbonate, antiseptics, balsams, fomentations, piperazin, extraction of calculus.
Suppurative inflammation of the mucosa lining the renal pelvis may occur in the acute or chronic form.
Causes. It may be either primary or secondary. As a primary disease it may be the result of poisoning by irritant diuretics such as cantharides, turpentine, colchicum or balsams, or shoots of the coniferæ, it may be due to the passage of the irritant products of cryptogams found in musty fodder or grain, or it may come from the irritation caused by the toxins of bacteria developed in the system or in food or drink. Cases that develop from the irritation of a pelvic calculus or precipitate, and from the presence of the strongylus gigas (in dogs) may also be placed in this class.
As secondary causes are those in which the inflammation starting in the uriniferous tubes extends down to and implicates the pelvis, and the still more frequent instances of extension of purulent infection upward from the ureter, bladder or prostate, so as to involve the pelvis. So in blocking of the urethra by strongylus, stricture, clot or calculus, and in spasm of the sphincter vesicæ, the delayed urine is liable to undergo fermentation with evolution of ammonia, and not only the bladder but the ureter and renal pelvis may suffer. Again, the occurrence in the kidney of the hyperplasia of cancer, glanders (horse) and tuberculosis (cow) may be the direct cause of pyelitis. Similarly foci of infection in the kidney may be found in distemper in the dog, and in the contagious pneumonia and influenza of the horse. In man infection from the bowel through the migration of the bacillus coli communis to the devitalized kidney and contents in hydronephrosis, has been traced, and the liability to this must be still greater after the surgical insertion of the ureters in the rectum as a substitute for the obliterated bladder and urethra. Again, in the intra-arterial migrations of the strongylus (sclerostoma) armatus pus microbes may be carried to the kidney and reach the pelvis.
Symptoms. These are in the main those of nephritis with marked rigors. The presence of pus cells and albumen in the urine may come from suppuration in the substance of the kidney itself, or sub-capsular abscess opening into the pelvis, or it may come from cystitis, prostatitis or urethritis. The special stiffness and tenderness of the loins, polyuria in which the liquid is purulent, but free from uriniferous casts, and in which it is charged with the spheroidal epithelium of the pelvis (not the columnar of the tubules), may afford presumptive evidence of pyelitis. But pyelitis is usually combined with nephritis or cystitis and the complications prevent diagnosis. In some cases the urine is scanty and strongly albuminous, and in others a round calculus will block, at intervals, the opening of the ureter giving rise to obstruction of the flow from that kidney and the occurrence of violent renal colic lasting until the stone is again dislodged backward.
Diagnosis cannot often be certain. Purulent urine, with a considerable number of the spheroidal cells of the pelvis, and the general signs of nephritis may be taken as diagnostic. A great excess of such epithelial cells would on the contrary point to cystitis.
Lesions. In the early stages the mucosa of the pelvis is congested, red, and sometimes, with calculus, hæmorrhagic. Later it becomes thickened by exudate, which fills also the submucous tissue. In some instances the pelvis is distended by an impacted calculus, in others the obstruction of the ureter by an impacted calculus or a swelling has led to overdistension of the pelvis, and ammoniacal fermentation of its contents. Coincident inflammatory lesions of the kidney, ureter, or bladder are common.
Prognosis is not hopeful. Where it has resulted as a descending infection from the kidney, the severity of the primary lesion renders the case a grave one, while if it has been an ascending inflammation from the bladder it is no less so.
Treatment. Diluent (watery) diuretics are especially indicated. Pure water may be given ad libitum. To this may be added if necessary moderate doses of bicarbonate of soda or potash with such non-irritating antiseptics as salicylic acid, salicylate of soda, sulphite of soda, sulphide of calcium, quinia or chamomile. Trasbot even recommends small doses of vegetable astringents, balsam of Tolu, or Peru or of Copiaba, or oil of turpentine or tar water. Apart from simple water, the diuretic agents may be used with greater freedom if the solid parts of the kidney are little or not at all involved and if the urine contains no casts of the uriniferous tubes.