Dystocia from congenital cystic kidney of the foetus : with report of a case from the Obstetrical Laboratory of the Johns Hopkins Hospital / by Frank W. Lynch.

  • Lynch, Frank W. (Frank Worthington), 1871-1945.
Date:
[1906]
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Credit: Dystocia from congenital cystic kidney of the foetus : with report of a case from the Obstetrical Laboratory of the Johns Hopkins Hospital / by Frank W. Lynch. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    cates of the obstruction theory. Virchow now claimed that the disease resulted from intrauter- ine inflammation of the papilla, and that the subsequent contraction of the newly formed in- terstitial tissue caused papillary atresia, so that communication no longer existed between the uriniferous tubules and the calyces of the kidney. Moreover, he concluded that the cysts might lose their connection with the tubules from which they started, during the progress of the disease. He adhered to this theory in later life, and made it hold good even for the cases in which there was obstruction in the ureters. Thorn, in 1882, carried the idea still further, and, in a case observed in an adult, showed that there had been extension of the inflam- mation from the kidney pelvis to the papillae, resulting in atresia of the uriniferous tubules. Leichenstern, in 1884, also noted a similar condition in the cystic kidneys of an adult, which he designated nephropapillitis fibrosa. He assumed that the inflammation originated in the walls of the arteriae rectae, and then passed out to the papillary ducts, causing stenosis and retention cysts. Durlach, in 1885, reports a case in an infant of six months. The kidneys were large and cystic, and the pelvis was the seat of fibrous pyelitis; bands of connective tissue passed to the kidney surface through the columns of Bertini, excess of connective tissue was also noted in the lateral portions of the pyramids, and above this retention cysts. Arnold, in 1890, reported a case in a syphilitic foetus, and demonstrated a nephropapillitis as the aetiological factor, holding that in the extension of the disease the tubules became constricted, with consequent alteration of the normal secretions. Among others who have favored this theory of intrauterine inflammation may be mentioned Stohr, Mackenzie, Smith, Schultz, and Bockenheimer. Others have taken the stand that a general interstitial new growth or cirrhosis has been the cause of the constriction of the tubules, and see in the congenital cystic kidney lesions anal- ogous to the cysts in chronic nephritis. Sabourin was an enthusiastic advocate of this view, and Cornil and Brault have described various con- ditions of the tubular epithelium, secondary to the retention and resulting from a primary kidney sclerosis. Ebstein, Palm, and Ruckert have reported cases in which the foetal kidneys shrunk to the size of a bean. Dunger notes a similar case in which the lesion was unilateral. The obstruction theory has not proven satis- factory to all observers. Some, after review- ing cases presented in support of this view, have adduced them as evidence for other theories. Thus, Mutach observed a case pre- senting the same features as one which Virchow thus described: ‘‘The ureters on both sides were open only to the level of the lower rim of the kidney, where they gradually became narrower and the lumen stopped entirely, while the wall became merged in the connective tissue which filled the region of the hilum.” “Atresia of the kidney pelvis therefore certainly existed on both sides.” Although Mutach was able to see no opening in his case, he found he could inject alcohol from the ureter into the tubules, and by cutting serial sections demon- strated communication to the papillary zone. He stated, therefore, that with the laboratory methods of recent time, Virchow might have found that the atresia was not absolute. Others have called attention to the fact that as yet there has been no satisfactory explanation of a peculiar localized inflammation of the papilla of each kidney (for the lesion is commonly bilateral) associated with defects admitted to be the result of error of development of the kidney, such as absence of the pelvis of the kidney, branching of the ureters, etc. 2. Many have taken the ground that the great frequency of deformities resulting from errors of development in cases presenting con- genital cysts of the kidney is of more than accidental relation. The probability of this view has been strengthened by the complexity of the process of development of the genito- urinary tract. Koster, in 1866, claimed that atresia of the papilla was more likely due to a primary defect of development than to an intra- uterine inflammation, and called attention to the frequency of congenital defects of the kidneys, as absence of the kidney pelvis or ureters, in cases of cyst kidneys. He evolved his theory on the basis of Kupffer’s conception of the development of the kidney; i.e., that the tubules develop independently of the pelvis, and fuse at a later period. Failure so to unite would cause this lesion. Koster advocated this