Studies from the Institute of Pathology, Queen's University, Belfast

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Perinephritic abscess may be a sequel to a localization of organisms in the kidney parenchyma, with extensioni either by way (a) of the lymphatics whlichi pass through the fibrous capsule from the cortex of the kidney to the perinephritic fat or (b) by contiguity of infected tissues. For this reason a guarded prognosis should he given in all cascs of perillephritic abscess, and the possibility of future operative interference, i.e., nephrectomy, kept in mind. (3) Carbuncle of the kidney can only be treated satisfactorily by a neplhrectomy. (4) The meseinteric a(lenitis, which was the cause of this patient's attack of intestinal obstruction, is difficult to explain, but probably took place coincidenit with the renal infection. PATHOILOGIST's REPORT. Microscopical specimten: The specimen shows one-half of the removed kidney. Apart from its general contour, an(l the presenice of a relatively uninvolved pyramid, it is difficult to distinguish its naturc. Ihe renal tissue is replaced by a (lense hard whitish tissue. In areas small abscesses are found burrowing through this firm tissue. In other areas discrete yellowish nodules, measuriing from 1-3 mm. in diameter, are seen. Ihe pelvis is surroun(led by dense white tissue. Microscopical examination: Histologicall) the kidlney is founld to show the results of a long-contillue(d pyo-genic inflammatory process. Mluch of the renal parenchyma has beenl destroyed and replace(d by fibrous tissue. In areas the iniflammationi is still active, and there are inumIlerOuS abscesses of varying size, conitainiing nlumerous gram + ye. coccal organisms. In the older healed areas there are large collections of fat-conitaining largc mononuclears,. which probably represent the site of sterile abscesses. NIany of the surviving tubules are filled b) polymorphs. Surviving glomeruli show a variable picture. In some the pericapsular fibrous tissuc is greatly increased. In others the inflammatory process has invaded the glomerular tuft, leading to its partial destruction, repair by fibrous tissue, and the formation of capsular ad hesions. Diagnosis: Chronic staphylococcal infection of kidney (renal carbuncle).

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