Diseases & Conditions Blog

In 1827, Richard Bright of London described a disease which thenceforward bore his name and is probably the best known of medical eponyms (diseases named for the discoverer). Bright’s disease is not a single entity. Several varieties are now recognized, and there is some confusion about definitions. In a very broad way, the group of diseases may be called nephritis inflammation of the kidney not resulting from infection in the kidney. Fine blood vessels of the glomeruli, the filtering units of the nephron, are commonly affected; hence the awkward term, glomerulonephritis.

Causes of Nephritis

Although germs are not a direct cause of nephritis, recent research has incriminated certain strains of germs as probable indirect causes. Acute glomerulo­nephritis may occur several days after a patient has suffered an infection caused by group A hemolytic streptococci, of the sort that often cause “strep throat” and scarlet fever. Delayed-action toxins produced by the germs are thought to be responsible.

Salts of mercury and some other metals can cause nephritis. The kidneys, guardians of the blood’s purity, filter and excrete innumerable kinds of harmful substances day and night. Metabolic diseases may produce scarring in the kidney and inflammatory reactions. And the very vascular kidneys are subject to sclerotic or artery-hardening processes. This form of nephritis is called nephrosclerosis.

Symptoms of Nephritis

Acute glomerulonephritis usually affects young people, but no age is exempt. Symptoms include loss of appetite, head­aches, nausea, vomiting, and scanty urine. There is puffy water logging of tissues. The urine contains much albumin (protein), evidence of kidney damage. Blood pressure usually rises. The patient is kept in bed and his diet carefully regulated with respect to intake of fluids, sodium, and other food elements. The great majority of patients recover completely and rarely have a second attack.

Chronic glomerulonephritis has a more serious outlook, though it is by no means to be regarded hopelessly. The condition may be latent for many years during which no active treatment is required. Dropsy is not quite so common a symptom of active disease as in acute glomerulonephritis. There is often anemia and a sallow complexion, and wastes tend to accumulate in the blood from diminished capacity of the kidneys to excrete them. There is albumin in the urine. Blood pressure rises. Although kidney impairment increases slowly, there may be a latent period, even of many years, during which the patient may feel quite well and be able to carryon an active life. Inflammatory reactions tend eventually to cause renal insufficiency, uremia, and there may be accompanying congestive heart failure. The chronic condition has many aspects of generalized vascular disease in which the kidneys are conspicuously involved.

The relationship between high blood pressure and vascular kidney disease is of great interest because of the general high incidence of hypertension. Special tests to uncover these relationships are now available, such as renal arteriography-x-ray films of kidney vessels. When high blood pressure is present, these special tests should be carried out by a team of urologists and internists to rule out or confirm renal causes of hypertensive disease. When renal artery obstruction is demonstrated, surgical correction is frequently possible, as by constructing a bypass of the affected artery.

What is this condition?

Pelvic inflammatory disease is any acute, subacute, recurrent, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement. It includes inflammation of the cervix, uterus, fallopian tubes, and ovaries, which can extend to the connective tissue lying between the broad ligaments.

Early diagnosis and treatment prevents damage to the reproductive system. Untreated, the disease may cause infertility and lead to potentially fatal blood infection, blood clots in the lungs, and shock.

What causes it?

Pelvic inflammatory disease can result from infection with bacteria, which invade the uterus when the defensive barrier formed by the cervical mucus is compromised. The breach may be caused by various procedures, such as insertion of an intrauterine device, biopsy instrument, or catheter. Other predisposing factors include abortion, pelvic surgery, and infection during or after pregnancy.

Bacteria may also enter the uterine cavity through the blood­stream or from drainage from a chronically infected fallopian tube, a pelvic abscess, a ruptured appendix, diverticulitis of the large intestine, or other infected areas.

The bacterium Neisseria gonorrhoeae most commonly causes pelvic inflammatory disease because it’s most able to cross the cervical mucus barrier. Other common bacteria found in cervical mucus are staphylococci, streptococci, diphtheroids, chlamydiae, and coli­forms, including Escherichia coli and Pseudomonas. Uterine infection can result from one or more of these bacteria, or it may follow over­growth of normally nonpathogenic bacteria in an altered endometrial environment, as occurs in childbirth.

What are the Symptoms of Pelvic Inflammatory Disease ?

Pelvic inflammatory disease symptoms vary with the affected area but generally include excessive pus discharge from the vagina, some­times accompanied by low-grade fever and malaise (particularly if gonorrhea is the cause). The woman experiences lower abdominal pain, and movement of the cervix or palpation of the fallopian tubes or ovaries may be extremely painful.

How is it diagnosed?

Diagnostic tests generally include:

• Gram staining of secretions from the endocervix or cul-de-sac to identifY the bacterial agent; culture and sensitivity testing aids selection of the appropriate antibiotic. (Urethral and rectal secretions may also be cultured.)
• ultrasound to identifY a tubal or uterine mass (simple X-rays seldom identifY pelvic masses)
• culdocentesis (aspiration) to obtain peritoneal fluid or pus for culture and sensitivity testing.
• In addition, the woman’s history is significant. Pelvic inflammatory disease is typically associated with recent sexual intercourse, intrauterine device insertion, childbirth, or abortion.

How is it treated?

To prevent progression of pelvic inflammatory disease, antibiotic drug therapy begins immediately after culture specimens are obtained. Infection may become chronic if treated inadequately.

The guidelines of the Centers for Disease Control and Prevention for at-home treatment include a single dose of Mefoxin given along with Benemid, or a single dose of Rocephin. Each of these regimens is given with Vibramycin for 14 days.

The official guidelines for hospital treatment include Vibramycin alone or a combination of Cleocin and Garamycin.

Development of a pelvic abscess necessitates adequate drainage. A ruptured abscess is life-threatening. If this complication develops, the woman may need a total removal of her uterus, fallopian tubes, and ovaries.