M.A. Dovbysh, N.A.Voloshin, A.A. Gubar, А.В. Unguryan, I.M. Dovbysh

Pathogenetic condition of kidney’s lymphodynamics in the development of pyelonephritis

In the experiment, 75 rabbits Chinchilla studied changes in the kidney in violation of lymphatic drainage. In the 1st group of animals (26 rabbits) was ligated at the gates of the lymphatic vessels of the left kidney. In the 2nd group (8 rabbits) - 2 days after ligation of lymphatic vessels were injected intravenously with the culture E.coly. In the 3rd (15 rabbits) - 60 hours lymphostasis intravenously injecting culture E.coly. In the 4th group of animals (9 rabbits) with early (2 days) and late (60 days) was administered intravenously period lymphostasis culture E.coly and ligated into the ureter upper third.Animals were removed from the experiment 3, 7, 14, 30 and 60 hours.

After violations of the outflow of lymph from the kidney to the 1st group of animals on day 3 there is swelling of the fibrous capsule, renal parenchyma and perirenal fat, disturbed microcirculation and lymphatic vessels dilate, there is degeneration of the tubular epithelium, interstitium is saturated with protein and lymphocytes.30-60 days increases the synthesis of connective tissue around blood vessels, glomeruli, tubules between the gate and the kidneys. In the 2nd and 3rd groups on the border of the cortex and medulla in the renal papilla appear leuco lymphocytic infiltration in the stroma of the gate - eosinophils. Leukocyte-lymphocytic infiltrates were paravesselslocated, between the tubules. Their sizes are increased at the border cortex and medulla. In 80% of cases there is necrosis of the renal papilla (necropapillitis). With the simultaneous ligation of the ureter in animals 4th group develops purulent destructive process in the kidney - pyonephrosis.

The scheme of the pathogenesis of pyelonephritis according to which violation of lymphatic drainage from the kidney degrades the microcirculation, resulting in edema of the parenchyma, the fibrous capsule and perirenal tissue, development of tissue hypoxia. The protein accumulates in interstitium, there are degenerative changes in the tubular epithelium, found lymphocytic infiltration. Around the arteries between the glomerulus and tubules in the sinus found connective tissue, which leads to the obliteration of intrarenal and extrarenal lymphatic vessels. In the context of infection on the background of impaired kidney lymphodynamics enhanced microcirculation disturbance, increased edema Pokey and the load on the lymphatic vessels. In contrast to the aseptic inflammation due to ligation of lymphatic vessels of kidneys after infection in the parenchyma formed leukocyte-lymphocytic infiltrates, there is necrotizing papillitis. If you violate the passage of urine in these conditions develops pyonephrosis. A vicious circle of pathological. One of the features of its elimination, according to the diagram of the pathogenesis of pyelonephritis, there is an improvement of kidney’slymphodynamics.