Chronic Pyelonephritis at Autopsy

Abstract

A review of autopsies during 3 to 2-year intervals between 1957 and 1964 showed a progressive decline in the frequency of the pathological diagnosis of chronic pyelonephritis (excluding urinary obstruction, diabetes mellitus or blood stream infections arising in other organs). Chronic pyelonephritis was diagnosed in 2. 4% of autopsies during 1957-59 and in 0. 6% in 1962-64. This decline was greater in men than in women and was considered most likely due to a growing appreciation of the non-specificity of the pathological features of chronic pyelonephritis. This explanation was supported by the study of clinical and autopsy data from the 15 patients in the series who died of renal insufficiency. Whereas there was little to suggest that urinary infection played a significant role in the pathogenesis of the renal disease, there was a great deal of evidence to implicate hypertension, occlusive vascular disease, toxemia of pregnancy, hereditary abnormalities and nephrotaxic agents. The role of urinary infection in the pathogenesis of chronic renal disease can be defined only after thorough evaluation of the relation of bacterial infection to other factors capable of producing renal damage. The features of non-obstructive chronic pyelonephritis are not sufficiently specific to establish the role of bacterial infection on the basis of morphological criteria alone.