=Pyelitis= is inflammation of the pelvis of the kidney. When a
suppurative inflammation extends into the interstitial tissue of the
organ, it produces a condition called pyelonephritis. The inflammation
usually starts in the pelvis of the kidney, the infection being
carried there either by the circulation or the urinary tract, but it
soon involves the rest of the kidney. Pyelitis is usually secondary
to some other conditions such as urethritis, cystitis, or ureteritis.
“Infection of the kidney rarely takes place through the blood and only
when the vital membrane of the kidney is impaired.” It may start from
within the organ in the interstitial tissue, caused by infectious
embolism or traumatism, or the tubules may become obstructed by
concretions.
=Osteopathic Etiology and Pathology.=—Retained decomposed urine due
to pressure upon the ureters by tumors or bladder disease; calculus
concretion, kinked ureter, displaced kidney, traumatic agencies,
as falls, blows, strains, kicks or penetrating wounds; nephritis,
pregnancy, cold and wet, are causes. Pyelitis may follow cystitis,
the inflammation extending up the ureters to the pelvis of the kidney
and thence to the substance of the organ, inducing pyelonephritis.
Tuberculosis, focal infections, and intestinal disorders (colon
bacillus), are other causes. Lesions from the ninth dorsal to second
lumbar or lower, and malnutrition are predisposing factors.
=Pathologically=, the mucous membrane of the pelvis is usually the
first affected, the inflammation generally extending from below upward.
It is swollen and sometimes visibly congested and of a gray color. The
pelvis and calyces are more or less dilated, while the papillæ are
flattened. There is a gradual dilatation of the calyces and atrophy of
the kidney substance, until the whole organ may be converted into a pus
sac. If complete obstruction occurs, the fluid portion may be absorbed
and the pus become inspissated and cheesy. The ureter is often dilated.
In tuberculous pyelitis the apices of the pyramids are also invaded,
the kidney substance is broken down and the result is the same. In the
pyelitis caused by cystitis, the infection passes up the tubules or is
carried by the lymphatics. The abscesses extend along the pyramids,
burst through the papillæ and calyx into the pelvis of the kidney, and
thus also the kidney becomes a purulent sac.
=Symptoms.=—Pain and tenderness over the region of the kidney first
appear. In a few cases cystitis will be the only symptom. The
suppurative stage is marked by high fever and a chill or a succession
of chills. The general condition of the patient denotes prolonged
suppuration. There is failure of health and more or less wasting
and anemia. The urine is characteristic, contains pus, which varies
in quantity greatly, and where only one kidney is affected, may be
suppressed for a time and there will be a sudden outflow of the pus,
due to the breaking of the sac. Blood is also very constant, but hardly
ever of sufficient quantity to be seen by the naked eye. The urine is
usually diminished in quantity and the color pale; the specific gravity
is low on account of the small amount of urea present. The reaction of
the urine is acid. Pus and blood render the urine slightly albuminous.
Casts from the kidney, and even portions of the kidney, may be present.
=Diagnosis.=—From =nephritis= by the absence of much albumin, tube
casts and dropsy. From cystitis, by the history, lumbar pains and acid
urine. =In cystitis the urine is always alkaline.= From =perinephritic
abscess=, by the absence of edema over the lumbar region. The urine may
be normal and there are lumbar pains and hectic fever. In =tuberculous
pyelitis= there is a history of tuberculosis in other organs and there
are tubercles in the urine. =Malaria= or =typhoid= may be suspected.
The X-ray and cystoscope should be employed. An exploratory incision
may be necessary.
=Prognosis.=—Depends altogether on the cause and extent of kidney
involvement. In simple cases and some tubercular, recovery may occur,
although there is a tendency in all cases for the disease to become
chronic.
=Treatment.=—Depends upon the cause, but thorough treatment along the
lower dorsal, the lumbar and sacral regions will be of considerable
benefit in controlling the catarrhal process in the kidney, its pelvis,
the ureter and the bladder. If pathology permits, gently raising the
kidneys, ureters and neighboring organs, knee-chest position, will
materially assist circulation and drainage. Fresh spring waters for
diluents and restricting the diet to light food, preferably milk,
are indicated. Rest is important and warm applications locally are
sometimes helpful. The general health must be carefully watched as
there is always considerable drain upon the system. A timely operation
may materially lengthen the life in many cases. Attention to the
bladder, urethra and prostate is necessary.