Pyelitis. Pyelonephritis. Inflammation of the Renal Pelvis. 233 



the tubules), may afford presumptive evidence of pyelitis. But 

 pyelitis is usually combined with nephritis or cystitis and the com- 

 plications 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 back- 

 ward . 



Diagnosis cannot often be certain. Purulent urine, with a 

 considerable number of the splieroidal 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 nuicosa of the pelvis is con- 

 gested, red, and .sometimes, with calculus, haemorrhagic. Later 

 it becomes thickened by exudate, which fills also the submucous 

 tissue. In some in.stauces 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 inflamma- 

 tory lesions of the kidney, ureter, or bladder are common. 



Prognosis is not hopeful. Where it has resulted as a de.scend- 

 ing infection from the kidney, the severit\' of the primary le.sion 

 renders the case a grave one, while if it has been an ascending in- 

 flammation from the bladder it is no le.ss .so. 



Treatment. Diluent (watery) diuretics are especiall}- indicated. 

 Pure water may be given ad libitim. 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. Tras- 

 bot 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. 



