. Surgery, its principles and practice . Fig, 124.—Tuberculosis of Kidney showing the Descending Process of the Infection (Lower). The pelvis and upper part of ureter contain many tuberculous ulcers which gradually become less, entirely disappearing in the lower portion of the ureter. ureter is involved. The process is most marked in the upper segmentin the primary form and appears as small tuberculous nodules and ulcera-tions (Fig. 124). The ureter may be greatly thickened and stenotic,thereby causing renal retention. The bladder wall about the ureteralorifice in most cases shows a tuberculou
. Surgery, its principles and practice . Fig, 124.—Tuberculosis of Kidney showing the Descending Process of the Infection (Lower). The pelvis and upper part of ureter contain many tuberculous ulcers which gradually become less, entirely disappearing in the lower portion of the ureter. ureter is involved. The process is most marked in the upper segmentin the primary form and appears as small tuberculous nodules and ulcera-tions (Fig. 124). The ureter may be greatly thickened and stenotic,thereby causing renal retention. The bladder wall about the ureteralorifice in most cases shows a tuberculous cystitis. Symptoms.—How long tuberculosis may remain latent in the kidneycannot be determined. Until a caseating focus breaks into the pelvisor until tension in the capsule gives rise to pain or tumor, there may be PLATE Tuberculosis of the Kidney. DISEASES OF THE KIDNEY. 231 nothing to indicate its presence. The earher symptoms are, as a rule,vesical. Thamuria, chiefly nocturnal, vesical tenesmus, and polyuria, inthe order named, are generally the early chnical signs. Micturition is,as a rule, not painful until the bladder wall has been seriously cystitis that is not gonorrheal, the result of instrumentation,trauma, or stone, must be looked upon with suspicion, especially in theyoung. The urine at an early stage is turbid and, as a rule, of hght specificgravit}^ Careful and repeated examination by centrifuging or seclimen-tation in conical glass will frequently demonstrate the bacillus. In nega-tive cases inoculation experiments may be made. Shreds of detrituswill often be found in the urine, in which the microscope may reveal con-nective-tissue fibers. Hematuria occurs often. Sometimes the diseaseis ushered in by hematuria, which rarely, however, is profuse as in neo-plasms. As a rule
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