CASE HISTORY

For a year had had occasional haematuria, and was unable to concentrate on his work as a clerk. His appetite had been poor and he was often sick after eating. He had become increasingly constipated. For a month before admission he had been confined to bed and for a week had been delirious with much vomiting. His bowels had not been opened for 4-5 days, and he had lost a good deal of weight. On examination; BP 150/90. Breath was foul, tongue dirty and coated brown. Bladder 1" above umbilicus. Catheter "tied in". Grossly infected urine with quantities of pus and some blood. PR: considerable uniform enlargement of prostate, about 2 1/2 finger widths, elastic, and regarded as probably "simple". Blood urea 435mg/100cc. NPN 250mg/100cc. Creatinine 5.6%. Died in uraemia.

PATHOLOGY

Kidney 210mmx205mmx80mm. The pelvis of the ureter is greatly dilated, with a congested mucosa. It was distended with turbid urine. The tips of the medullary pyramids are flattened or even concave, and both outer and cut surfaces of the kidney show innumerable abscesses, tending, on the outer surface especially, to cluster and coalesce. There are also depressed scars of old infarcts.