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.
KeywordsUrinary Tract Infection Renal Tissue Vesicoureteral Reflux Renal Scarring Acute Pyelonephritis
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