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Chronic Pyelonephritis

  • Anil K. Mandal

Abstract

Chronic pyelonephritis is one of the most perplexing subjects encountered in the practice of nephrology. The confusion is caused by ambiguous ideas concerning pathogenesis, a lack of absolute histopathological features, and sampling errors in the biopsy specimens used to diagnose the condition in the living individual. In general, chronic pyelonephritis may be defined as a pathological state of one or both kidneys as a result of infection by bacteria or other microorganisms, or injuries caused by noninfectious agents such as chemicals. There is much debate over whether chronic pyelonephritis is a separate entity or a variant of chronic interstitial nephritis. This is not a result of the similarities in histological appearances so much as the failure to document bacterial infection as the cause of chronic pyelonephritis in the vast majority of cases. Bacterial infection is always suspected but seldom has it been confirmed in the renal tissue. Many investigators have begun to believe that factors other than infection alone cause chronic pyelonephritis. Therefore, it has been proposed and accepted by many individuals that chronic interstitial nephritis rather than chronic pyelonephritis is a more appropriate term. Since in many cases no identifiable cause is found to account for the renal histopathology, it seems logical to substitute the term idiopathic chronic pyelonephritis for bacterial chronic pyelonephritis.

Keywords

Urinary Tract Infection Renal Tissue Vesicoureteral Reflux Renal Scarring Acute Pyelonephritis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Reference

  1. Andres, G. A., and McCluskey, R. T.: Tubular and interstitial renal disease due to immunologic mechanism. Kidney Int. 7: 271, 1975.PubMedCrossRefGoogle Scholar
  2. Aoki, S., Imamura, S., Aoki, M., and McCabe, W. R.: A bacterial and bacterial pyelonephritis. N. Engl. J. Med. 281: 1375, 1969.PubMedCrossRefGoogle Scholar
  3. Barnes, B., Gergan, J.. and Braun, W.: The tenth report of the human renal transplant registry. J. Am. Med. Assoc. 221: 1945, 1972.CrossRefGoogle Scholar
  4. Bengtsson, V., Hogdahl, A., and Hood, B.: Chronic non-obstructive pyelonephritis and hypertension: A long-term study. Q. J. Med. 37: 301, 1968.Google Scholar
  5. Douglas, A. P., and Kerr, D. N. S.: Infection and the kidney. In Short Textbook of Kidney Disease. Lippincott, Philadelphia, 1971, p. 170.Google Scholar
  6. Dublin, M., and Shimamura, T.: An ultrastructural study of the renal medulla in experimental acute pyelonephritis. Yale J. Biol. Med. 48: 211, 1975.PubMedGoogle Scholar
  7. Freeman, R.: Does bacteria lead to renal failure?, Clin. Nephrol. 1: 61, 1973.Google Scholar
  8. Heptinstall, R. H.: Pyelonephritis. In Pathology of the Kidney, 2nd ed. Little, Brown, Boston, 1974, p. 877.Google Scholar
  9. Heptinstall, R. H.: Interstitial nephritis. A brief review. Am. J. Pathol. 83: 214, 1976.Google Scholar
  10. Kalmanson, G. M., Sommers, S. C., and Guze, L. B.: Pyelonephritis. VII. Experimental ascending infection with progression of lesions in the absence of bacteria. Arch. Pathol. 80: 509, 1965.PubMedGoogle Scholar
  11. Kass, E. H., and Zinner, S. H.: Bacteriuria and renal disease. J. Infect. Dis. 120: 27, 1969.Google Scholar
  12. Kimmelstiel, P., Kim, O. J., and Beres, J. A.: Chronic pyelonephritis. Am. J. Med. 30: 589, 1961.PubMedCrossRefGoogle Scholar
  13. Kleeman, C. R., Hewitt, W. L., and Guze, L. B.: Pyelonephritis. Medicine (Baltimore) 39: 3, 1960.Google Scholar
  14. Mandai, A. K.: An etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis). Am. J. Med. Sci. 274: 317, 1977.CrossRefGoogle Scholar
  15. McDonald, R. H., Levitin, H., Mallory, G. K., and Kass, E. H.: Relation between pyelonephritis and bacterial counts in the urine: An autopsy study. N. Engl. J. Med. 256: 915, 1957.CrossRefGoogle Scholar
  16. Murray, T., and Goldberg, M.: Chronic interstitial nephritis. Ann. Intern. Med. 82: 453, 1975.PubMedGoogle Scholar
  17. Nimmich, W., Budde, E., Naumann, G., and Klinkmann, H.: Long-term study of humoral immune response in patients with chronic pyelonephritis. Clin. Nephrol. 6: 428, 1976.PubMedGoogle Scholar
  18. Prakash, C., Verma, P. S., and Puri, D.: Chronic pyelonephritis. J. Assoc. Physicians India 10: 405, 1962.PubMedGoogle Scholar
  19. Raaschou, F.: Studies of chronic pyelonephritis with special reference to kidney function. Munksgaard, Copenhagen, 1948.Google Scholar
  20. Ransley, P. G., and Risdon, R. A.: Renal papillae and intrarenal reflux in the pig. Lancet 2: 1114, 1974.PubMedCrossRefGoogle Scholar
  21. Reiman, A. S.: Pyelonephritis. In Renal Disease ( Sir D. A. J. Black, ed.). Blackwell, Oxford, 1972, p. 399.Google Scholar
  22. Risdon, R. A., Sloper, J. C., and deWardener, H. E.: Relationship between renal function and histological changes found in renal biopsy specimens. Lancet 2: 363, 1968.PubMedCrossRefGoogle Scholar
  23. Smellie, J. M., and Normand, I. C. S.: Bacteriuria, reflux and renal scarring. An annotation. Arch. Dis. Child. 50: 581, 1975.PubMedCrossRefGoogle Scholar
  24. Sommers, S. C.: Chronic pyelonephritis. Personal communication, 1977.Google Scholar
  25. Sommers, S. C., Robbins, G. G., Babin, D. S., and Knaack, C. T.: Chronic pyelonephritis, renal tubular atrophy, and hypertension. Arch. Intern. Med. 110: 151, 1962.CrossRefGoogle Scholar
  26. Sommers, S. C., Gonick, H. C., Kalmanson, G. M., and Guze, L. B.: Pathogenesis of chronic pyelonephritis II. Effect of repetitive infection. Am. J. Pathol. 45: 729, 1964.PubMedGoogle Scholar
  27. Stamey, T. A., Govan, D. E., and Palmer, T. M.: The localization and treatment of urinary tract infections: The role of bactericidal urine levels opposed to serum levels. Medicine (Baltimore) 44: 1, 1965.CrossRefGoogle Scholar
  28. Steblay, R. W., and Rudofsky, U.: Renal tubular disease and autoantibodies against tubular basement membrane induced in guinea pigs. J. Immunol. 107: 589, 1971.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1979

Authors and Affiliations

  • Anil K. Mandal
    • 1
  1. 1.Renal Electron Microscopy Laboratory and Staff Physician, Medical Service Veterans Administration HospitalUniversity of Oklahoma College of MedicineOklahoma CityUSA

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