CLINICAL AND EXPERIMENTAL STUDIES ON RENAL ARTERIOGRAPHY IN PYELONEPHRITIS

Abstract

The purpose of the present report is to investigate the findings and the diagnostic value of renal arteriography in pyelonephritis.
1. By using the experimental pyelonephritis in dogs, the comparative study concerning arteriography in the living and removed kidney, microangiography and the histological findings was carried out, and the following results were obtained.
1) In the acute stage of pyelonephritis, the segmental and interlobar arteries were spread, elongated and separated from each other. The intensity of the nephrogram was diminished and the size was increased. In the chronic stage, the intrarenal arteries were tortuous. The size and the intensity of the nephrogram were diminished according to the localization or the extent of atrophy of the cortex in the affected kidney. In the last stage, the main renal artery was extremly diminished in caliber and ultimately the disappearance of the nephrogram was observed.
2) According to the findings on the postmortem renal arteriogram, the microangiogram and the histological sections, it is concluded that the arteriographic findings in pyelonephritis in vivo indicate the presence of lesion in periarterial tissue, which affects blood supply rather than artery itself, and reveal the localization and the extent of disturbance of renal function.
2. The findings on the renal arteriogram in clinical cases were elaborated and the following results were obtained.
1) In acute pyelonephritis, the segmental and interlobar arteries were spread, elongated and separated from each other, and contrast medium diffused into the branches of peripheral arteries with lack of uniformity. The size of the nephrogram was increased and the intensity was diminished, and the periphery of the nephrogram was indistinct and irregular. In chronic pyelonephritis, the main renal artery and the intrarenal arteries were diminished in caliber. The intrarenal arteries were closed each other and distributed with tortuous and uneven pattern. The size of the nephrogram and the thickness of the renal cortex were diminished.
The above mentioned findings and the inhomogenous nephrogram with areas of marked cortical atrophy were observed in the various extents in connection with the degree of parenchymal destruction.
2) In the cases with pyelonephritis, whose IVP did not reveal the particular findings, the arteriogram showed the distinct findings indicating the presence of acute or chronic parenchymal lesion.
3) The renal arteriogram manifested the presence of asymmetrical and localized lesion in pyelonephritis more than glomerulonephritis and nephrosclerosis. It is concluded that renal arteriography is a more useful diagnostic tool in chronic pyelonephritis, especially in determining the localization and the degree of lesion.