Pyelonephritis: Pathogenesis and Unsolved Problems

  • W. R. McCabe


Ten to fifteen years ago, little difficulty would have been encountered in describing the pathogenesis of pyelonephritis. At that time, the recent renaissance of interest in pyelonephritis had convinced most physicians that pyelonephritis was extremely prevalent, was the most common cause of renal insufficiency, and that persistent bacteriuria and chronic pyelonephritis were practically synonymous. Subsequent studies have suggested that our original estimates of the prevalence of pyelonephritis were excessive and that persistent bacteriuria cannot be equated with chronic pyelonephritis. Indeed, most evidence indicates that in adults, without urinary tract obstruction, progression of bacteriuria or acute pyelonephritis to renal insufficiency is either infrequent or only occurs over a very protracted period of time. The relative infrequency of renal insufficiency resulting from urinary tract infection becomes quite apparent when the prevalence of bacteriuria is compared with the number of annual fatalities from renal disease, as shown in Table I. This presents estimates, derived by Kass, of the prevalence of bacteriuria in the United States in 1960 (1), with reported deaths from renal disease, Nephritis and Nephrosis and Infections of the Kidney (2). Thus, even if the assumption is made that all reported deaths from renal disease are actually due to pyelonephritis, only 0.5 % per year or 5 % per 10 years of bacteriurics develop fatal renal insufficiency. Similar reexaminations of many of our concepts of pyelonephritis have resulted in several major controversies concerning basic aspects of this disease. These have even extended to questioning whether chronic pyelonephritis has a bacterial etiology (3).


Urinary Tract Infection Interstitial Nephritis Acute Pyelonephritis Renal Medulla Bacterial Antigen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kass, E.H.: Trans. Assoc. Amer. Phys. 69: 56 (1956).Google Scholar
  2. 2.
    U. S. Public Health Service. Vital Statistics of the United States. Monthly Vital Statistics Report. (September 1971).Google Scholar
  3. 3.
    Angell, M. E., Relman, A. S., Robbins, S. L.: New Engl. J. Med. 278: 1303 (1968).PubMedCrossRefGoogle Scholar
  4. 4.
    Barrington, F. J. F., Wright, H D.: J. Path. Bact. 38: 871 (1930).CrossRefGoogle Scholar
  5. 5.
    MacDonald, R. A., Levitin, H., Mallory, G. K., Kass, E. H.: New Engl. J. Med. 256: 915 (1957).PubMedCrossRefGoogle Scholar
  6. 6.
    Kass, E.H.: The role of asymptomatic bacteriuria in the pathogenesis of pyelonephritis. In: Quinn, E.L., Kass, E.H.: Biology of Pyelonephritis. (Little, Brown and Co., Boston, Mass. 1960 ).Google Scholar
  7. 7.
    Aascher, A. W. Sussman, M., Waters, W. E., Evans, J. A. S., Campbell, H., Evans, K. T., Williams, J. E.: J. infect. Dis. 120: 17 (1969).CrossRefGoogle Scholar
  8. 8.
    Freedman, L.R.: Prolonged observations on a group of patients with acute urinary tract infection. In: Quinn, E.L., Kass, E.H.: Biology of Pyelonephritis (Little, Brown and Co., Boston, Mass. 1960 ).Google Scholar
  9. 9.
    Kunin, C.M., Deutscher, R., Paquin, A., Jr.: Medicine 43: 91 (1964).PubMedGoogle Scholar
  10. 10.
    Stamey, T.A., Pfau, A.: Calif. Med. 113: 16 (1970).PubMedGoogle Scholar
  11. 11.
    Stamey, T.A., Govan, D.E., Palmer, J.M.: Medicine 44: 1 (1965).PubMedCrossRefGoogle Scholar
  12. 12.
    Fairley, K. F., Carson, N. E., Gutch, R. C., Leighton, P., Grounds, A. D., O’Keefe, C.M.: Lancet II: 616 (1971).Google Scholar
  13. 13.
    Fairley, K. F.: The routine determination of the site of infection in the investigation of patients with urinary tract infection. In: Kincaid-Smith, P., Fairley, K. F.: Renal Infection and Renal Scarring ( Mercedes Publishing Service, Melbourne 1970 ).Google Scholar
  14. 14.
    Kaitz, A.L.: J. clin. Invest. 40: 1331 (1961).PubMedCrossRefGoogle Scholar
  15. 15.
    Clark, H., Ronald, A. R., Cutler, R. E., Turck, M.: J. invest. Dis. 120: 47 (1969).CrossRefGoogle Scholar
  16. 16.
    Vosti, K. L., Goldberg, L. M., Monto, A. S., Rantz, L.A.: J. clin. Invest. 43: 2377 (1964).PubMedCrossRefGoogle Scholar
  17. 17.
    Turck, M., Petersdorf, R.G.: J. clin. Invest. 41: 1760 (1972).CrossRefGoogle Scholar
  18. 18.
    Stamey, T.A., Timothy, M. T., Millar, M., Mibara, G.: Calif. Med. 115: 1 (1971).PubMedGoogle Scholar
  19. 19.
    Bran, J.L., Levinson, M. E., Kaye, D.: New Engl. J. Med. 286: 626 (1972).PubMedCrossRefGoogle Scholar
  20. 20.
    Cox, C. E., Hinman, F., Jr.: Factors in resistance to infection in the bladder. I. The eradication of bacteria by vesical emptying and intrinsic defense mechanisms. In: Kass, E.H.: Progress in Pyelonephritis (F. A. Davis Co., Philadelphia 1965 ).Google Scholar
  21. 21.
    Vivaldi, E., Munoz, J., Cotran, R., Kass, E.H.: Factors affecting the clearance of bacteria within the urinary tract. In: Kass, E.H.: Progress in Pyelonephritis (F. A. Davis Co., Philadelphia 1965 ).Google Scholar
  22. 22.
    Kaye, D.: J. clin. Invest. 47: 2374 (1968).PubMedCrossRefGoogle Scholar
  23. 23.
    McCabe, W.R., Jackson, G. G.: New Engl. J. Med. 272: 1037 (1965).CrossRefGoogle Scholar
  24. 24.
    Teague, N., Boyarsky, S.: Invest. Urol. 5: 423 (1968).Google Scholar
  25. 25.
    Govan, D.E., Palmer, J.M.: Pediatrics 44: 677 (1969).PubMedGoogle Scholar
  26. 26.
    Weyrauch, H.M., Bassett, J. B.: Standford Med. Bull. 9: 25 (1951).Google Scholar
  27. 27.
    Glynn, A.A., Brumfitt, W., Howard, C. J.: Lancet I: 514 (1971).Google Scholar
  28. 28.
    Kaijser, B.: J. infect. Dis. 127: 670 (1973).PubMedCrossRefGoogle Scholar
  29. 29.
    Beeson, P. B., Rowley, D.: J. exp. Med. 110: 685 (1959).PubMedCrossRefGoogle Scholar
  30. 30.
    Rocha, H., Fekety, F. R., Jr.: Delayed granulocyte mobilization in the renal medulla. In: Kass, E.H.: Progress in Pyelonephritis (F. A. Davis Co., Philadelphia 1965 ).Google Scholar
  31. 31.
    Chernew, I., Braude, A.I.: J. clin. Invest. 41: 1945 (1962).PubMedCrossRefGoogle Scholar
  32. 32.
    Sanford, J., Jr., Hunter, B. W., Sonda, I.K.: J. exp. Med. 115: 383 (1962).PubMedCrossRefGoogle Scholar
  33. 33.
    Williamson, J., Brainerd, H., Scaparone, M., Chuck, S. P.: Arch. intern. Med. 114: 222 (1964).PubMedCrossRefGoogle Scholar
  34. 34.
    Vosti, K. L., Monto, A.S., Rantz, L.A.: J. Lab. clin. Med. 66: 613 (1965).PubMedGoogle Scholar
  35. 35.
    Sanford, J. P., Hunter, B. W., Donaldson, P.: J. exp. Med. 116: 285 (1962).PubMedCrossRefGoogle Scholar
  36. 36.
    Cotran, R.S.: J. exp. Med. 117: 813 (1963).PubMedCrossRefGoogle Scholar
  37. 37.
    Aoki, S., Merkel, M., Aoki, M., McCabe, W.R.: J. Lab. clin. Med. 70: 204 (1967).PubMedGoogle Scholar
  38. 38.
    Aoki, S., Imamura, S., Aoki, M., McCabe, W.R.: New Engl. J. Med. 281: 1375 (1969).PubMedCrossRefGoogle Scholar
  39. 39.
    Kalmanson, G., Glasscock, R., Montgomerie, J., Guze, L.: Is chronic pyelonephritis an immunologic disease? Abstracts V International Congress of Nephrology, p. 107 (1972).Google Scholar
  40. 40.
    Gloor, F. J.: Some morphologic features of chronic interstitial nephritis (Chronic Pyelonephritis) in patients with analgesic abuse. In: Kass, E. H.: Progress in Pyelonephritis (F. A. Davis Co., Philadelphia 1965 ).Google Scholar
  41. 41.
    Hamburger, J., Richet, G., Crosnier, J., Funck-Bretano, J. L., Antoin, B., Ducrot, H., Mery, J. P., de Montera, H.: Nephrology, 2 vols. ( Saunders, Philadelphia 1968 ).Google Scholar
  42. 42.
    Freedman, L.R.: Ann. intern. Med. 66: 697 (1967).PubMedGoogle Scholar
  43. 43.
    Jackson, G. G., Dallenback, F. D., Kipnis, G. P.: Med. Clin. N. Amer. 39: 297 (1955).Google Scholar
  44. 44.
    Saphir, O., Taylor, B.: Pyelonephritis lenta. Ann intern. Med. 36: 1017 (1952).PubMedGoogle Scholar
  45. 45.
    Freedman, L.R.: Urinary tract infection, pyelonephritis, and other forms of chronic interstitial nephritis. In: Strauss, M.R., Welt, L.G.: Diseases of the Kidney (Little, Brown and Co., Boston 1971 ).Google Scholar

Copyright information

© Springer-Verlag/Wien 1975

Authors and Affiliations

  • W. R. McCabe

There are no affiliations available

Personalised recommendations