Infectious pyelitis may result from small-pox; diphtheria; typhus, scarlet, •. and typhoid fevers; and is probably pro duced by the toxic substances eliminated. _Nephritis is commonly associated with it (pyelonephritis). Parasites—such as the echinococcus, distoma, strongylus, and filaria—may give rise to pyelitis.
Cantharides, cubebs, copaiba, turpen tine, etc., and diabetic urine even may in rare instances excite this affection.
Pathology. — The morbid changes in the simple, catarrhal variety of pyelitis consist of a congested, swelled, and some times ecehymotic, mucous membrane cov ered with a viscid, smooth exudation of muco-pus and desquamated epithelium. The urine in the pelvis of the kidney is turbid from the admixture of pus-cor puscles and epithelium. In calculous pyelitis, owing to prolonged and severe irritation, purulent inflammation and ulceration prevail, and the renal struct ure is also involved by extension (pyelo nephritis). Renal abscesses are thus formed, and small dark calculi are found frequently, mingled with the pus in numerous small abscess-cavities; or, per haps, the destroyed renal parenchyma may be entirely replaced by one large abscess (pyonephrosis).
Case of pyonephrosis in which renal substance was found almost entirely de stroyed and replaced by large intercom municating cysts containing thin, turbid, fluid urine and some pus, besides eight to fifteen calculi. Loomis (Med. Record, Feb. 23, '95).
A diphtheritic inflammation, with the formation of a false membrane and sloughing of the pelvis, sometimes fol lows the severe infection of the specific fevers. Marked hemorrhagic areas may also be seen. In tuberculous pyelitis there is usually associated a nephritis with areas of tuberculous softening and ulceration, and later pyonephrosis. In certain chronic cases of pyelitis there may be cheesy masses of infiltration affecting the kidney-structure; calcification of these may ensue.
Persistent obstruction leading to pye litis is associated with dilatation of the pelvis from retention of urine or pus (pyonephrosis). This, in turn, from pro longed pressure, causes the marked atro phy of the secreting structure of the kid ney that is seen in such cases. There is also an increase in the interstitial tissue with secondary contraction.
Prognosis. — Renal complications al ways make the pyelitis a serious affection. Catarrhal cases recover. Calculous pye litis tends toward chronicity. Pyelo nephritis and pyonephrosis are likely to end fatally from exhaustion or uraemia.
Perforation and the discharge of pus into the peritoneal cavity, pleural sac, intes tine, and bronchi, even, may precede death. The gravity of all cases of pye litis depends upon the causes and upon the tendency to consecutive suppuration.
Treatment.—This varies according to the cause: the latter needs to be removed, its effects counteracted, and its return avoided. The treatment of calculous pyelitis is essentially that of nephro lithiasis. Primary inflammation of the lower portion of the urinary tract must be combated, causes of urinary retention and decomposition must be diminished, infectious fevers must be judiciously handled, and irritating diuretics with held.
In all forms of pyelitis local measures are useful, in the form of hot-water bags, fomentations, dry cupping, etc. Inter nally, the use of diluents is to be encour aged, especially the alkaline mineral waters, flaxseed- and moss- teas, barley water lemonade, skimmed and butter milk.
Among drugs selected for their sooth ing properties are the potassium citrate, uva ursi, buchu, and pareira brava. In the event of suppuration surgical inter vention is necessary. Irrigation by means of Kelly's ureteral catheter may be prac ticed with good results in females suf fering from purulent pyelitis. Operation through the Lack is usually indicated in pyelonephritis and pyonephrosis. In chronic pyelitis such stimulating and alterative drugs as salol, and the oils of turpentine, sandal-wood, juniper, co paiba, and erigeron, may be tried.
Bovet and Iluchard recommend the treatment of infectious pyelonephritis by the hypodermoclysis of chloride-of-so dium solution.
The first element of importance in pyclitis is diet. In the acute form the patient should be kept in bed till the urine be normal and micturition easy, with milk diet and lukewarm baths; every second day a good rubbing. In the summer months his residence should be at the sea-coast, with lukewarm sea water baths. In chronic cases the wells of Vichy, Carlsbad, and the different car bonic springs, as Wilmer Sauerbrunn, Prelauwasser, Krondorfer, etc., may be found beneficial. In place of those mineral waters, aqua calcis, 0I/, to 19 ounces several times a day, may be substituted. In the early stages of acute pyelitis, tannin, alum, and acetate of lead are often found useful; in chronic cases small doses of extract of secale cornutum have been adminis tered with advantage. Monti (Inter. klin. Rund., March, '93).