URINARY SYSTEM, DISEASES OF. Diseases of the Kidneys (see also BRIGHT'S DISEASE, volume i).
Pyelitis (Pyelonephritis; Pyonephro sis).
Definition.—Inflammation of the pel vis of the kidney. Concomitant inflam mation of the renal substance justifies the term pyelonephrilis; and intense and extensive purulent involvement, the term pyonephrosis.
Symptoms. — These are frequently overshadowed by those of the primary condition that causes the pyelitis;• they are varied, also, for the same reason. The simple catarrhal pyelitis may cause slight pain and tenderness in the region of the affected kidney or kidneys, mild fever, with a turbid urine of acid reaction, showing a few pus-cells, a little mucus, rarely some red corpuscles, and a trace of albumin, perhaps.
In the severer varieties, as in calculous pyelitis, the occasional concomitant at tacks of renal colic are attended with the presence of blood and pus in the urine, with some mucus, and the transitional caudate epithelial cells from the middle layers of the mucosa of the renal pelvis. The presence of the latter, however, is not constant; hence their absence does not exclude the existence of a pyelitis, since some of the most destructive forms of the affection, as the acute or chronic suppurative or the pyelonephritic may be unaccompanied by the presence of the pelvic epithelium in the urine. This holds true still more in the case of pvo nephrosis, in which the kidney often be comes one large abscess.
In severe pyelitis the pain is very acute, coursing down the ureters. The fever is moderate; and most of the symptoms common to nephrolithiasis are mani fested.
The symptom of a well-marked pyclitis is a. pain in the loins, with extension to the abdomen, to the groin, to the thigh, and to the testicles. There is also ten derness; urination is frequent, and very often painful. The urine is found to con tain albumin, mucous casts, epithelium, in the marked cases pus. W. M. Ord (Practitioner, Sept., '97).
In pyonephrosis and pyelonephrilis the fever is rather hectic or typhoid in type.
Paroxysms of rigors or chills. followed by a rapid rise of temperature to 104° or 105°, and ending in profuse and ex hausting sweat, may be observed; or there may be marked prostration. dryness of tongue and skin, feebleness of pulse, stupor, and delirium. Pvamic cases reveal a temperature-curve of irregular course, with marked remissions.
In obstructive pyelitis the urine sonic times flows freely and normally for awhile, until the increasing pain over the affected kidney ends in relief by the ex pulsion of the obstacle and the passage of purulent urine. This alternation of normal with purulent urine is indicative of a unilateral pyelitis.
The urine is =maniacal in cysto-pye litis. Albuminuria is shown according to the degree of pyuria, and associated nephritis.
In chronic suppurative pyelitis or pyelonephritis the pyuria is variable, both in quantity and constancy. Inter mittent pyuria may be due to the tem porary blocking of the ureter by a stone (obstructive pyelitis). The pus is seldom mixed with epithelium in chronic puru lent pyelitis. The associated intermit tent fever may be like that of tuberculous pyelitis, and marked prostration, anemia, and emaciation are concomitants. Evi dences of amyloid change may be re vealed in long-standing chronic cases.
The term ammonicemia has been ap plied to that complexes of nervous symp toms that is supposed to arise from the decomposition and absorption of urinary substances. These symptoms may be similar to the manifestations of diabetic coma.
Distinct enlargement and fluctuation in the lumbar region may be determined in many cases of pyonephrosis. This may also be intermittent, being detect able while there is obstruction to the flow of pus, and vice versa. According to A. II. Smith, at the menstrual periods pye litis may be subject to marked exacerba tions, simulating renal colic.
In chronic pyelitis with progressive atrophy of the kidney, uraimia is likely to terminate the case.