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May 19, 1956


JAMA. 1956;161(3):210-214. doi:10.1001/jama.1956.02970030028007

• Among 1,130 women with suspected toxemia, 73 had persistent albuminuria in the absence of any genitourinary symptoms. Of the 73, 37 were antepartum and 36 were postpartum patients, and within these two groups there were, respectively, 20 and 14 with evidence of hypertensive vascular disease in addition to signs and symptoms of toxemia.

Each of the 73 patients showed at least two of the following three manifestations of pyelonephritis: (1) clumps of white blood cells in the urinary sediment, (2) pyelonephritis cells (glitter cells observed by supravital staining of sediment from freshly voided urine), and (3) positive urine culture.

Therapy with either sulfonamides or antibiotics caused disappearance of the clumps of white cells in all patients and either clearing or decrease in albuminuria; the urine culture became negative in all but three. Two cases are described in some detail to show how essential the urinary data were for correct diagnosis and how effective the treatment was when the diagnosis was clear. Ophthalmoscopic examination also contributed important information. If pyelonephritis is not to be overlooked, microscopic urinalysis must become standard procedure in antenatal and postpartum clinics.