Anatomical Changes, Symptoms. 1017 



kidney is transformed into a pus sac consisting of several 

 compartments, 4-16 kg. in weight (Pyonephrosis) (Kitt). 



The ureter is changed into a tube with thick walls, up 

 to two fingers in width, the mucosa may present similar changes 

 as that of the renal pelvis. The mucous memljrane of the 

 bladder also sometimes contains hemorrhages or a variable 

 inflammation which may even be diphtheritic. 



The microscopical examination of the affected kidney gives the following 

 result, according to Ernst : Cellular infiltration in the cortex, in places assuming the 

 form of small or large purulent infarcts, the dilated urinary tubules are filled with 

 anuclear epithelia, pus cells and casts, vascular thrombosis is frequent; in a more 

 advanced stage connective tissue proliferation, necrotic or purulent foci especially 

 in the papillae. Masses of bacteria are found in the small softened foci in the 

 cortex, in the capsules of Bowman and in the thrombi of the blood vessels, while the 

 collecting tubules appear as though filled up with bacteria. 



The fluid in the renal pelvis and the ureter contains much tissue detritus, 

 aumerous pus cells, some red blood corpuscles, fibrin threads, pavement and cylin- 

 irie epithelia and crystals of triple phosphates ; there are also found masses of 

 B. renalis, alone or more often associated with other bacteria. 



Symptoms. It is impossible to indicate a definite period 

 of incubation because the exact time of the bacterial invasion 

 3annot be ascertained. It appears from the observations made 

 ap to the present that pyelonephritis may become manifest 

 in from a few days to several months after the commencement 

 of the primary disease. 



In the more frequent chronic form the clinical symptoms 

 are diminished appetite, suppression of rumination, emaciation, 

 staggering gait, the urine is voided fairly easily. Pressure 

 upon the Imnbar region sometimes produces manifestations 

 of pain. On rectal exploration the bladder is found half filled, 

 sometimes the dilated ureter is felt above the pelvis, below 

 the vertebral column, on both sides or only one, it feels like 

 a firm rope passing to the kidneys and is usually thickened 

 in its anterior portion. Palpation of the kidneys may indicate 

 normal conditions or enlargement, sometimes fluctuation, or 

 sensitiveness to pressure in one or both kidneys. 



It is more frequent to find increased urination associated 

 with painful exertions. Pressure on the sacral region causes 

 pain, a thick purulent vaginal discharge soils the pubic region. 

 Eectal examination gives similar results as in the preceding 

 case, but on inspection catarrhal reddening or swelling of the 

 vaginal mucosa is seen, especially around the urethral opening, 

 and the mucosa may be covered with superficial ulcers. In 

 male animals the prepuce may be inflamed (Hess). At times 

 colicky symptoms appear, probably due to the temporary 

 occlusion of the ureters by masses of exudate, blood clots or 



sediment. . 



The urine is seldom clear and even then contams albumen, 

 and on microscopical examination cellular elements and tlie 

 bacillary clumps described above. In the great majority of 

 cases the urine is turbid, muddy, sometimes bloody, strongly 



