Definition. Causes: primary from vegetable irritants in food, toxins,
cryptogams, pelvic calculus, strongylus gigas; secondary from renal
calculus, parasite, tubular urethral or vesical infection, infecting
deposits, metastasis. Symptoms: as in nephritis, pus, blood, or
albumen in urine, tender, arched loins, purulent polyuria, with
spheroidal epithelium. Diagnosis. Lesions: inflammation, calculus,
etc., in pelvis. Treatment: pure water, sodium bicarbonate,
antiseptics, balsams, fomentations, piperazin, extraction of calculus.
Suppurative inflammation of the mucosa lining the renal pelvis may occur
in the acute or chronic form.
_Causes._ It may be either primary or secondary. As a =primary= disease
it may be the result of poisoning by irritant diuretics such as
cantharides, turpentine, colchicum or balsams, or shoots of the
coniferæ, it may be due to the passage of the irritant products of
cryptogams found in musty fodder or grain, or it may come from the
irritation caused by the toxins of bacteria developed in the system or
in food or drink. Cases that develop from the irritation of a pelvic
calculus or precipitate, and from the presence of the strongylus gigas
(in dogs) may also be placed in this class.
As =secondary= causes are those in which the inflammation starting in
the uriniferous tubes extends down to and implicates the pelvis, and the
still more frequent instances of extension of purulent infection upward
from the ureter, bladder or prostate, so as to involve the pelvis. So in
blocking of the urethra by strongylus, stricture, clot or calculus, and
in spasm of the sphincter vesicæ, the delayed urine is liable to undergo
fermentation with evolution of ammonia, and not only the bladder but the
ureter and renal pelvis may suffer. Again, the occurrence in the kidney
of the hyperplasia of cancer, glanders (horse) and tuberculosis (cow)
may be the direct cause of pyelitis. Similarly foci of infection in the
kidney may be found in distemper in the dog, and in the contagious
pneumonia and influenza of the horse. In man infection from the bowel
through the migration of the bacillus coli communis to the devitalized
kidney and contents in hydronephrosis, has been traced, and the
liability to this must be still greater after the surgical insertion of
the ureters in the rectum as a substitute for the obliterated bladder
and urethra. Again, in the intra-arterial migrations of the strongylus
(sclerostoma) armatus pus microbes may be carried to the kidney and
reach the pelvis.
_Symptoms._ These are in the main those of nephritis with marked rigors.
The presence of pus cells and albumen in the urine may come from
suppuration in the substance of the kidney itself, or sub-capsular
abscess opening into the pelvis, or it may come from cystitis,
prostatitis or urethritis. The special stiffness and tenderness of the
loins, polyuria in which the liquid is purulent, but free from
uriniferous casts, and in which it is charged with the spheroidal
epithelium of the pelvis (not the columnar of the tubules), may afford
presumptive evidence of pyelitis. But pyelitis is usually combined with
nephritis or cystitis and the complications prevent diagnosis. In some
cases the urine is scanty and strongly albuminous, and in others a round
calculus will block, at intervals, the opening of the ureter giving rise
to obstruction of the flow from that kidney and the occurrence of
violent renal colic lasting until the stone is again dislodged backward.
_Diagnosis_ cannot often be certain. Purulent urine, with a considerable
number of the spheroidal cells of the pelvis, and the general signs of
nephritis may be taken as diagnostic. A great excess of such epithelial
cells would on the contrary point to cystitis.
_Lesions._ In the early stages the mucosa of the pelvis is congested,
red, and sometimes, with calculus, hæmorrhagic. Later it becomes
thickened by exudate, which fills also the submucous tissue. In some
instances the pelvis is distended by an impacted calculus, in others the
obstruction of the ureter by an impacted calculus or a swelling has led
to overdistension of the pelvis, and ammoniacal fermentation of its
contents. Coincident inflammatory lesions of the kidney, ureter, or
bladder are common.
_Prognosis_ is not hopeful. Where it has resulted as a descending
infection from the kidney, the severity of the primary lesion renders
the case a grave one, while if it has been an ascending inflammation
from the bladder it is no less so.
_Treatment._ Diluent (watery) diuretics are especially indicated. Pure
water may be given _ad libitum_. To this may be added if necessary
moderate doses of bicarbonate of soda or potash with such non-irritating
antiseptics as salicylic acid, salicylate of soda, sulphite of soda,
sulphide of calcium, quinia or chamomile. Trasbot even recommends small
doses of vegetable astringents, balsam of Tolu, or Peru or of Copiaba,
or oil of turpentine or tar water. Apart from simple water, the diuretic
agents may be used with greater freedom if the solid parts of the kidney
are little or not at all involved and if the urine contains no casts of
the uriniferous tubes.
Benefit may also be obtained from fomentations, or cupping of the loins,
and even from the application of mustard and counter-irritants.
If the active symptoms subside the continued use of tonics would be
indicated, especially quinia, and also of the balsams with the view at
once of antisepsis and toning up of the mucous membrane.
In case of calculus of the pelvis surgical extraction is virtually the
only resort, though a very desperate one. Its increase may be retarded
or prevented by antisepsis, a liberal use of water, and the exhibition
of piperazin or some of the essential oils.