A Contribution to the Etiology of Calcareous Pyelonephritis

Abstract

Hager reports a case of classical exstrophy of the bladder with rudimentary penis, complete epispadias, absence of symphysis pubes, and a calcareous pyelonephritis from which Salmonella ammoniae was isolated. The findings agree with the chemical and experimental data obtained in a study of incrusted cystitis with alkaline urine. The mechanism of the production of alkaline urine with a precipitation of the alkaline inorganic salts in the renal pelvis and calyces is similar to the production of incrusted cystitis with free floating stones in the bladder by the action of S. ammoniae. In a previous publication Hager and Magath showed that incrusted cystitis with alkaline urine results from implantation of S. ammoniae on an already existing cystitis and that the condition can be produced experimentally in animals. The mechanism by which calcareous deposits and free calcareous masses are formed in the bladder is similar to that of the formation of renal calculi in certain cases of calcareous pyelonephritis. Hager states that S. ammoniae may invade a kidney pelvis and under favorable conditions produce calcareous pyelonephritis.