Definition:

Chronic inflammation of the parenchyma and pelvis of the kidney.

Aetiology :

escherichia coil is mostly the causative organism.

Associated factors are

(l) Inadequately treated acute pylonephritis. (2) tertiary obstruction due to—(a) calculus. (b) stricture. (c) prostatic disease. (3) Statis in bladder due to-—(a) cystocele. (b) paraplegia, tabes dorsalis etc. (4) Renal tuberculosis (5) Prolonged ingestion of phenacetin.

Pathology

Pathology May be unilateral or bilateral. Macroscopically there would be scarring; of varying degree with reduction in size of kidney. Patchy fibrosis with lymphocytic infiltration, tubular atrophy, periglomerular fibrosis and disappearance of nephron are the microscopic picture.

Clinical features

(1 ) tiredness, lassitude, ill health. (2) Repeated attacks of fever with pain in lumbar region. (3) Dysuria may he present. 4) Sometimes malnutrition or uraemic symptoms may be present. (5) P/R— Prostatic obstruction and cystocele may be present. (6) In late stage, uremia may &ot in.

Investigations:

(1) Urine shows albuminuria and few pus cells, WBC, casts are pathognomic. On culture—may reveal organisms ( mostly E. cod). (2) Blood urea level may be high. (3) Kidney function test—impaired function. (4) Pyelography and cystoscopy o he dooc to find out any pathology in the kidney or bladder,

Complications :

(1) Hypertension. (2) Uraemia. (3) Pyelonephrosis, Renal stone.

Differential Diagnosis

(1) Renal tuberculosis (1) Chronic glomerulonephritis. (3) Neprerosis. (4) Analgesic nephropathy.

Prognosis: Good

Treatment:

(I) Rest in bed in warmth. (2) Control ef infection. (3) Increased fluid intake with moderate protein diet. (4) Obstruction or calculi, if present, are to be treated. (5) Treatment of complications, if present.