PYELITIS AND PYELONEPHRITIS.
When inflammation of a suppurative type is confined to the pelvis of the kidney or the calyces, the term " pyelitis " is applied, hut more frequently the renal parenchyma is involved, this condition being recog nised in the term Pyelonephritis, and often both conditions exist together.
It may be accepted that all forms of pyelitis or of pyelonephritis must be regarded as of septic or infective origin, and this bears directly upon the treatment problem. The microbes may be deposited from the blood; this hzematogenous type really as regards treatment falls under the lines laid down in the immediately preceding article on Py;:emia, and in this variety of renal suppuration the pelvis of the kidney rarely suffers to any extent, unless some obstructive condition coexists with the infection.
The organisms, however, usually reach the kidney from the bladder or lower urinary tract, travelling along the lymphatics of the ureter and not mounting against the downward current of the urine unless there be almost complete obstruction to the free passage of the urine towards the bladder, as demonstrated by the experimental researches of Eisendrath and Schultz. It is with this latter or urogenous type, which always at first affects the pelvis and calyces of the kidney, that the present article mainly deals.
From the above considerations it becomes the first duty of the surgeon to make a search for the primary cause as soon as the characters of the urine and the symptoms demonstrate the advent of pyelitis, for until the source of infection has been dealt with little can he accomplished suc cessfully in the way of treatment. Thus calculi, enlarged prostate, growths in the bladder, urethral affections and suppurative conditions of the testicle must be dealt with when present. The most frequent of all causes is the use of a septic catheter for the relief of retention of urine, the pyogenic organisms being directly introduced into the bladder on the instrument: a cystiti: follows which eventuates in a suppurative pyelitis, and if neglected this is very liable to terminate in pyelonephritis with suppurative destruction of one or both kidneys.
The removal of the cause of the obstructed flow with free irrigation of the diseased bladder by saturated Boric Acid solution and the internal use of antiseptics afford the only chance of cutting short the suppurative inflammation of the renal pelvis.
A well-marked type of pyelitis is not uncommonly met with in which no breach of surface in the urinary tract is found. The form of Bacillus coli infection usually met with in children is the most important variety of this type. Without discussing the route by which the bacillus finds its way into the urinary system, whether by the blood or the urethra, the duty of the physician is to disinfect and flush out the urinary tract. Thomson has shown that the urine is always add in these cases, and by the administration of full doses of alkalies as the Citrate of Potassium (2o grs. ter die) the growth of the bacilli is rapidly inhibited, and the fever, in creased frequency of micturition, pus in the urine and other symptoms soon subside as the secretion becomes alkaline under the influence of the drug. Normal saline by the bowel or hypodermically further aids recovery by flushing the urinary tract.
Contrary to theoretical considerations, the writer has frequently found the combination of Hexamine with an alkali do well, where both had failed when used separately.
The pyelitis of pregnancy is of the same nature, but unlike the infection in children it often fails to respond to simple alkalies alone. Urotropine ro grs., or other urinary antiseptics as New Urotropine (Ilelmitol) 20 grs., Cystopurin 20 grs., Hetralin 20 grs. or Creosote 3 mins. should be employed. Hanna Thomson points out that Urotropine, if given in combination with Sodium Benzoate, never causes irritation about the neck of the bladder, and always proves effectual in ridding the urinary tract of the bacilli. Abundant demulcent draughts or copious libations of weak alkaline waters, as effervescing Potash Water or Vichy, and the free injection of Normal Saline solution should also be employed to wash out the genito-urinary system.