Histopathological and fluorescent microscopical observation have been made on the tissue reaction and the localization of tubercle bacilli in various stages and types of lesions in the kidneys removed from cases of renal tuberculosis.
(1) In the Gaseous cavity type numerous bacilli were demonstrated at the papillae of collapsed pelves, particularly in the Gaseous substance the constituting the cavity surface, often proliferating in profusion during the completed stage. However, they were generally few and difficult to be identified during the terminal stage.
(2) In the circumscribed and obstructive cavities, unconnected with the pelves, the bacilli. were hardly demonstrable.
(3) In the hydronephritic type, arising from ureteral stenosis or stricture, the bacilli were fewer than in the Gaseous cavity type, in spite of their outward structural resemblance.
(4) In the disseminated tubercular type, the organisms were difficult to be traced. Furthermore, in the fibrosclerotic type, only a few organisms could be identified in the submucous foci of the pelves.
(5) With the exception of cavity wall, the bacilli could be identified with difficulty in the tuberculous foci of the renal parenchyma, regardless of the types or stages of the disease. On the basis of tissue reaction, although the exudative lesions are full of the bacilli, the proliferative lesions contain only a few, while the fibrosclerotic lesion faild to show the presence of any organisms.
Summarizing the above observations, the following general statements may be made:
(a) The propagation of the tubercle bacilli is particularly active along the cavity wall opening into the renal pelvis which is constantly in contact with fresh urine.
(b) No causative relationships could be established with reference to the number of tubercle bacilli present in the cavity wall and that in the parenchymal foci. However, in one instance of initial stage, a linear extension of tubercle bacilli was noted from the collapsed lesion of the pelvic papilla down into the lumen of a urineferous tubule, a finding which confirms the theory of tubular dissemination in renal tuberculosis.
(c) As to the number of tubercle bacilli found along the cavity wall, no difference could be found whether streptomycin in doses of 40g was injected or not before the nephrectomy. Some atypical organisms were noted after streptomycin administration, but the same could be said of untreated instances, signifying that the presence of atypical tubercle bacilli is not brought about by the effect of streptomycin.

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