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Many varieties of changes are encountered at operation in chronically infected kidneys containing stones. There is ordinarily, however, a tendency to the eventual formation of only three pathologic types, and the great varieties of changes seen are usually stages in their development. They are: 1. A pyonephrotic, multilocular sac, with reduced blood supply, and more or less complete destruction of renal functions, and perirenal changes not as extensive as those encountered in the other two types. 2. An atrophic, almost functionless kidney with, usually, very dense and often very marked perirenal adhesions. 3. A generalized enlargement of the kidney as a result of an increase in the fibrous tissue, a large blood supply, impaired renal function, and very marked fibrolipomatous, perirenal changes.
The case reported here belongs in the third class, and illustrates (1) how painless an enormous enlargement of the kidney with very large calculi may be and (2)
Boyd ML. AN ENORMOUS CALCULOUS PYONEPHROSIS. JAMA. 1926;87(15):1214–1215. doi:10.1001/jama.1926.92680150004011d
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