There is considerable divergence of opinion as to the surgical indication in cases of unilateral pyelonephritis. Recently the pendulum of opinion has swung toward conservation of the diseased kidney, decapsulation and nephrotomy being advocated as the procedures of choice. Some have taken a middle ground and are guided by the bacteriology of the urine obtained from the involved organ by means of the ureteral catheter. They choose nephrotomy for bacillary infections (such as B. coli and B. pyocyaneus), and reserve nephrectomy for coccus infections (such as staphylococci and streptococci). If it is remembered that in any infection the reaction of the human organism to the invading bacteria has an importance at least equal to that of the type of micro-organism, it follows that no hard and fast rule of this kind is to be relied on.
The decision must be made, rather, on the basis of the patient's clinical condition,
ASCHNER PW. TWO UNUSUAL CASES OF PYELONEPHRITIS. JAMA. 1920;74(5):320-322. doi:10.1001/jama.1920.02620050028011