Urographic findings in adults with chronic pyelonephritis.

The radiological findings in a cohort of 138 adults with chronic pyelonephritis are presented and the following conclusions made. Scarring is commoner in the right kidney than the left and is found in the upper, middle and lower poles with decreasing frequency from above down. Agreement between observers in the grading of scarring in urograms taken without standardisation or routine tomography, is sufficiently high to justify the continued use of the intravenous urogram as a screening test but is not high enough to detect any progression of scars in the group over a 6.5-year period. Repetition of urograms seldom reveals the development of calculi or other new abnormalities and is not justified as a clinical routine. The combination of extensive bilateral renal scarring and proteinuria is associated with the worst renal function.

Shunt nephritis: report of two cases and review of the literature.

We report two cases of glomerulonephritis associated with infection of cerebrospinal fluid shunts inserted for the treatment of hydrocephalus and comment an another 70 cases reported in the world literature. Although infection of CSF shunts is common, the development of glomerulonephritis is rare. Non-pathogenic bacteria are the commonest infecting organisms. Antibiotics are generally ineffective in eradicating the infection and the glomerulonephritis, but removal of the shunt is usually, though not always, associated with complete resolution of the renal disease.

Effect of aluminium hydroxide on serum ionised calcium, immunoreactive parathyroid hormone, and aluminium in chronic renal failure.

According to the Bricker-Slatopolsky theory, secretion of parathyroid hormone (PTH) is switched on in chronic renal failure by hypocalcaemia due to phosphate retention. In an attempt to reverse this process 20 patients in preterminal renal failure (plasma creatinine 569 +/- 195 mumol/l) were given aluminium hydroxide, 3.8 g daily. They were studied for four weeks and all measurements were made at the start and weekly, except measurements of serum aluminium concentration, which were made at the start and at the end of the fourth week. Mean serum phosphate fell from 1.89 to 1.47 mmol/l (5.9 to 4.6 mg/100), mean serum calcium rose from 2.07 to 2.24 mmol/l (8.3 to 9.0 mg/100 ml), and serum ionised calcium rose from 1.07 to 1.20 mmol/l (4.3 to 4.8 mg/100 ml), but serum immunoreactive PTH did not fall. Thirteen patients had initial serum immunoreactive PTH concentrations at or near to normal and 11 were taking beta-blockers but even in those with neither explanation, PTH concentrations did not fall. Serum aluminium concentrations rose from 0.4 to 1.02 mumol/l (10.9 to 27.4 microgram/l). Aluminium hydroxide corrects serum phosphate, total calcium, and ionised calcium at the price of a rise in serum aluminium concentration; in this study it did not affect serum immunoreactive PTH. The Bricker-Slatopolsky theory still needs verification in studies of patients with chronic renal failure.

The natural history of chronic pyelonephritis in the adult.

One hundred and thirty patients with primary chronic pyelonephritis diagnosed radiologically or by nephrectomy, 84 with unilateral and 46 with bilateral disease, have been followed for six to 240 months. The clinical and radiological features of the disease at presentation, together with its influence on pregnancy, have been analysed. Serial observations of bacteriuria, blood pressure and renal function have been made during follow up and the intravenous urogram (IVU) has been repeated after five years in most patients. Although the disease probably starts in early childhood it often presents to the nephrologist in young adults, mainly women, as symptomatic urinary tract infection, hypertension, renal insufficiency or a combination of these features. Though associated with increased morbidity in pregnancy it does not usually interfere with fertility and in this series it did not cause increased fetal loss. Repeated urinary tract infections and hypertension are common events. Proteinuria is usually minimal and when present is associated with hypertension. The disease in most patients with unilateral disease runs a benign course; a poorer prognosis is associated with bilateral disease, hypertension and proteinuria. Since we found no association between frequent urinary infections and declining renal function we suggest that only symptomatic urinary infection should be treated in adults with chronic pyelonephritis.