STUDIES OF THE UROLITHIASIS (XVI REPORT)

URINARY INFECTION AND PRODUCTION OF URINARY CALCULI

Abstract

The relationship between infection and the formation of calculi has been mentioned by several authors. The author attempted some experiments on this subject.
1) The bacteriological examination of the urine of 61 patients suffering urinary calculi reveals that the incidence of urinary infection is 41 cases or 67.2%. The type of infection is as follows: Staphylococcus 48.8%, Echerichia coli 17.1%, Corynebacterium 2.4%, Proteus 4.9% and Pseudomonas 7.3%. The property of splitting urea is demonstrated in 34% of the isolated strains, of which Staphylococcus shows the highest frequency (50%). All the cultured strains have no faculty to produce mucoprotein in the test tube.
2) As to bacteriocidal activity examined by sensitive tablet, chloramphenicol is in most cases effective to these organisms. Other antibiotics as terramycin, strreptomycin and aureomycin are also available almost to the same extent.
3) The author followed Hryntschak and succeeded in producing renal calculi in 50% of rabbits after repeated intravenous injections of Staphylococci isolated from the urine of patients. Agreat deal of Koch's elements of calcific crisis appears in the urine of rabbit soon after injection. It is indispensable in, this experiment that the ureter of the same side be previously strictured.
4) The author succeeded in forming renal caculi in one third of the experimental rabbits, of which the paranasal cavity had been instilled with staphylococcal suspension fluid repeatedly so as to cause inflamation. In this case, too, the stasis of the upper urinary tract is necessary.
5) The principal pathological findings in the kidney of the above mentioned two experiments are slight circuratory disturbances associated with presence of Koch's elements of calculous crisis in the Bowman's capsules and renal tubuli.
6) The electromicroscopic examinations reveal in no case calculi, produced by above mentioned methods, presence of Staphylococci in the nucleus of the stone.
7) The author failed to confirm Boschamer's postulation that 5 to 10% solution of fibrinogen, if added with Staphylococci and incubated at 37°C for an hour, produces in the test tube dense aggromelate, which coincided with the nucleus of calculus in vivo.
8) Intravenous injection of staphylococcal toxin causes specific vascular spasm and distinct calculous crisis in the rabbit's kidney. Numerous spheroliths are found in the rabbit's urine soon after injection.
9) Under direct microscopic observation of the kidney of the Japanese frog (Rana nigromaculata) remarkable changes of glomerular circulation such as assest, pulsation and slowing of the blood stream can be seen after injection of staphylococcal toxin.
10) The author followed and failed Davolas's postulation that succeeded in producing vesical calculi by repeated instillation of Bac. proteus in the rabbit's bladder, which had been previously inflamed by salicylic-acid in alcohol. It seems to the author that the formation of experimental vesical calculus is more dependent upon the well prepared circumstance and good oppotunity than urinary infection.
In view of the author's experiments it can be concluded that bacteria or bacterial toxin exert an unfavourable influence upon the renal blood flow and there occurs in the nephoron the phenomenon of crisis, which can develop to concrement under favourable circumstances Koch's theory would apply itself well to explain the genesis of the renal calculi correlated to. infection.