[The pathogenesis of chronic pyelonephritis and its therapeutic consequences].

During the last 2 years we examined 186 patients with secondary and 42 patients with primary chronic pyelonephritis. In most cases the secondary pyelonephritis is the sequel of a urolithiasis, less frequently in congenital renal anomalies, adenomas of the prostatic gland and patients with superposed pyelonephritis in renal lesion on account of metabolic disturbances (diabetes, gout) or abuse of analgetics. The course of the disease as well as the results of the therapy show peculiarities in the two forms of pyelonephritis. Thus, for example, the recidivations are more frequently in the secondary pyelonephritis, in the urine culture other germs appear more frequently, and the disease shows a more rapid course. The bacterial sanation in patients with primary pyelonephritis remains stable in the course of one year, where as in the obstructive pyelonephritis (non-operated cases) in the same period all patients show recidivations. After operative treatment of the obstruction the conservative treatment leads to a bacterial sanation in about 70%. In patients with superposed pyelonephritis at first the basic disease is to be treated, i.e. the metabolic disturbances are to be compensated and at the same time an antibacterial therapy is to be performed.