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The whole question of renal infection is complicated by confusing conditions in many phases of the process. The phase, however, that is most complicated and perhaps least understood is that which deals with the routes by which the infecting organisms reach the kidney. Evidence is presented that demonstrates the blood stream as undoubtedly the route of infection in some instances; again there are equally convincing clinical and experimental facts to favor the more or less direct transmission to the kidney through the lymph stream. During the earlier days, it was assumed that all renal infections were ascending directly from the lower urinary tract to the kidney pelvis and parenchyma by way of the lumen of the ureter. This route eventually acquired the disfavor of most of its supporters, who were drawn toward the more attractive hematogenous and lymphogenous theories. For some time the direct ureteral route was considered mechanically impossible
CULVER H, HERROLD RD, PHIFER FM. RENAL INFECTIONS: A CLINICAL AND BACTERIOLOGIC STUDY. JAMA. 1918;70(20):1444–1448. doi:https://doi.org/10.1001/jama.1918.02600200010004
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