Disorders of Urinary Tract
(In March 1949 the Frank E. Bunts Educational Institute presented a continuation course on Diabetes, the proceedings of which were later published in the Cleveland Clinic Quarterly. These proved so popular that it has been decided to publish the proceedings of the similar course on Medical and Surgical Disorders of the Urinary Tract held on November 17, 18, and 19, 1949.—Ed.)
PYELONEPHRITIS AND GLOMERULONEPHRITIS
Robert D. Taylor, M.D.
Both pyelonephritis and glomerulonephritis can cause proteinuria, pyuria, hematuria, cylindruria, and eventually hypertension and renal failure. Glomerulonephritis has been more widely studied and hence, in spite of an incidence of only 0.7 per cent, is a more common diagnosis in the presence of abnormal urinary findings than is pye-lonephritis which was observed in 5.6 per cent of 3607 postmortems. Glomerulone-phritis is a relentlessly progressive disease while pyelonephritis can be cured or controlled.
Clinical Differential Diagnosis
|A. Chronic Pyelonephritis||B. Chronic Glomerulonephritis|
|1. History||1. History|
|More common among women; often follows marriage or pregnancy. Recent or remote history of chills, fever with dysuria. Nocturia is more frequent during active phase. Edema is rare save in terminal state.||There is no sex predominance. There is sometimes history of acute hemorrhagic. glomerulonephritis More often proteinuria is discovered during routine examination. Edema is frequent. Nocturia gradually increases and becomes continuous.|
|2. Physical Findings||2. Physical Findings|
|Patients may appear acutely or chronically ill. Blood pressure is usually normal and becomes elevated only as renal failure supervenes; occasionally acute hypertension is present. Costovertebral angle. . .|