[Primary chronic pyelonephritis or diffuse kidney lesions? (critical comments on interpreting the data from a urologic x-ray examination)].

Abstract

Analyzing correlation of the results of excretory urography and histological findings (kidney biopsy) in 2852 nephrological patients the author has come to a conclusion that changes in the structure of the pelvicaliceal system (PCS) which are usually regarded as x-ray signs of primary chronic pyelonephritis (PCPN), are not typical of this disease and can be also observed in patients with diffuse renal lesions. PCS changes of "pyelonephritic" type were detected in 2470 patients, histologically in 698 (28.1%), in them PCPN morphological signs were detected, and 1772 patients (71.9%) had different diffuse renal lesions. In the author's opinion, PCS changes in such patients could result from an increase in the kidney mass caused by edema or sclerosis of morphological elements of the renal tissue. The absence of both in 382 patients with diffuse renal lesions was not accompanied by PCS changes. The author has been of opinion that identity of the pictures of PCS changes is in the unity of the existing process: compression of the PCS fragments as a result of edema or sclerosis. Therefore PCPN absolute x-ray criteria could be based on the histological confirmation of this disease and what is most important on the absence of morphological data in favor of any diffuse renal lesion or on the detection of the normal renal tissue. In the interpretation of changes in the PCS structure to avoid diagnostic errors the author insists upon the necessity of regarding these changes, first of all, as a result of renal lesion only with subsequent patient's examination to determine the true nature of renal lesion. A decisive point in this respect is a histological study.