Segmental Atrophic Pyelonephritis in Renal Reduplication: Preservation of Smaller Upper Pole Segment by Partial Nephrectomy

Harvard, B. Marvin

doi:10.1016/s0022-5347(17)63318-4

Cited by 2 publications

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“…When the focus of pyelonephritis was associated with duplication of the renal pelvis, however, some patients were improved by the operation, which removed the diseased renal parenchyma along with its pelvis and ureter. This agrees with observations by earlier writers (Abrahamsen & Christoffersen, 1954;Harvard, 1966;Sinner & Wilhelm, 1968).…”

Section: Scand J Urol Nephrol6 Scand J Urol Nephrol Downloaded From Isupporting

confidence: 93%

Conservative Renal Surgery in Pyelonephritis: A Follow-up Study

Myrvold

Fritjofsson

1972

Scandinavian Journal of Urology and Nephrology

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Thirteen patients with localized pyelonephritis in an otherwise apparently normal kidney and 22 patients with atrophic pyelonephritis, and sometimes also dysplasia, in one segment of a duplex kidney underwent partial nephrectomy. The indication for operation in both groups was recurrent urinary infection with or without refractory hypertension.Twenty-nine of the patients were followed up 5 to 21 years after the operation. Recurrent urinary infection was present postoperatively in 10 of the 12 re-examined patients who had had focal inflammation in an otherwise normal kidney and in 8 of the 17 with duplex kidney. No favourable effect of surgery on hypertension was demonstrated.In recurrent urinary infection and localized pyelonephritis, partial nephrectomy is indicated if the operation can also eradicate a cause of the infection. Renal hypertension per se does not constitute an indication for partial nephrectomy in adult patients.Partial nephrectomy has become a relatively common operation for renal lithiasis, tuberculosis, hydrocalycosis, trauma, tumours of a solitary kidney, etc. Localized chronic pyelonephritis has also been suggested as an indication for partial nephrectomy (Christoffersen, 1957;Poutasse, 1962;Semb, 1964). The rationale then was to clear the kidney, improve the prospects for effective chemotherapy and, in some cases, to reduce refractory intractable hypertension.We have followed up a series of patients who underwent partial nephrectomy for pyelonephritis. The long-term results of the operation were judged with regard to urinatry-tract infection and/or hypertension. 1 Present address: Urological Clinic, Regionsjukhuset, tirebro, Sweden. Scand J Urol Nephrol6 MATERIAL AND METHODSDuring the period 1947-1962, partial nephrectomy was performed on 13 patients at Sahlgrenska Sjukhuset's Surgical Clinic I in order to eradicate an apparently well demarcated focus of pyelonephritis in an otherwise healthy kidney. All of the patients were women. The upper renal pole was extirpated in 10 cases and the lower pole in 3. Minor resection which could be described as biopsies were not included in the series. The resected tissue was histologically examined in 11 of the 13 cases, and in all of them showed chronic pyelonephritis.In the same period 22 patients (17 of them women) with duplex kidney and atrophic pyelonephritis in one of the renal segments underwent 23 heminephrectomies. The upper part of a kidney was excised in 18 operations and the lower part in five. Histologic study was made of 21 resected specimens. In all of them a picture of chronic pyelonephritis was found and in ten specimens there were also changes coexistent with renal dysplasia.The indication for operation in both groups of patients was recurrent urinary infection, sometimes associated with refractory hypertension. Roentgenograms showed well-defined foci of pyelonephritis. In no case were calculi present at the primary operation.The age distribution of the patients is illustrated in Fig. 1.Twenty-nine of the 35 patients were followed up 5 t...

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Section: Scand J Urol Nephrol6 Scand J Urol Nephrol Downloaded From Isupporting

confidence: 93%