56 DISEASES OF THE PELVIS OF THE KIDNEYS AND URETERS. 

 CHAPTER II. 



INFLAMMATION OF THE PELVIS OF THE KIDNEY PYELTTIS. 



ETIOLOGY. In rare cases, the pelvis of the kidney is the seat of a 

 oroupous or of a diphtheritic inflammation. This is usually accompa- 

 nied by similar inflammation of other mucous membranes, and is usually 

 a concomitant of infectious disease. It is most commonly observed in 

 the typhoid stage of cholera, but may also proceed from catarrhal in- 

 flammation, especially that arising from calculous pyelitis. 



Catarrhal pyelitis, in the great majority of cases, is the result of 

 an irritation of the mucous membrane, induced by the presence of 

 calculi in the pelvis of the kidney. In similar manner, the ammonia 

 of stagnant and putrid urine may provoke a most intense catarrh of 

 this region. Much more rarely, catarrh of the urinary passages is 

 caused by acrid substances, such as cantharides, the balsams and resins, 

 which have been taken into the system, and excreted with the urine. 

 Again, we frequently find pyelitis as the result of severe gonorrhoea, 

 the inflammation having extended to the bladder and ureters. 



A mild form of catarrhal pyelitis is a common complication of 

 Bright's disease. It sometimes appears during pregnancy, and during 

 the later stages of typhus, as well as during the desquamative period 

 of the acute exanthemata. A hsemorrhagic form of this affection 

 sometimes accompanies scurvy, and the morbus maculosus of Werlhof. 



ANATOMICAL APPEARANCES. In croupous or diphtheritic inflam- 

 mation of the pelvis of the kidney, its mucous membrane is found 

 either to be covered by membranous exudation, or else is converted 

 into diphtheritic eschars, which, upon separation, produce irregular 

 losses of substance. 



In recent cases of catarrhal pyelitis, the mucous membrane is red- 

 dened by injection, and (especially in the scorbutic form) by ecchy- 

 mosis. At the same time, it is relaxed, and covered by purulent mucus. 

 When of longer standing the redness disappears, or becomes discol- 

 ored, the tissue of the mucous membrane is swollen, and, in some cases, 

 is incmsted with urates, or with salts of lime. The pelvis of the kidney 

 usually is dilated, and its walls are thickened. Not unfrequently, the 

 renal parenchyma has suffered atrophy, as in hydronephrosis. In cases 

 of long-continued mechanical irritation, there often is ulceration of the 

 mucous membrane, which may terminate in its perforation, followed by 

 infiltration of urine into the surrounding areolar tissue, with suppurative 

 destruction of the latter. The resulting abscesses may point in various 

 directions, as into the cavity of the peritonaeum, or externally, forming 

 long fistulous openings ; or, previously forming adhesion, it may bursl 



