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Analysis of the data obtained during a comprehensive examination of a great number of nephrologic patients during 1964-1989 permitted the author to draw a conclusion that a considerable part of errors in the diagnosis of diffuse renal lesions (DRL) are primarily made as a result of inadequate choice of examination methods that might contribute to the solving of a diagnostic problem; an insufficiently clear idea of the resolving power of those methods, and violation of the succession of their use. Erroneous interpretation of the patient's complaints and disease history we face sometimes, inadequate competence in the assessment of the clinical symptoms and laboratory data are of no less importance. All these moments are supported by the author's own observations. Special emphasis is laid on the causes of diagnostic errors occurring in the diagnosis of primary chronic pyelonephritis (PCPN), especially of its latent form, renal amyloidosis, focal nephritis, toxic or toxico-infectious kidneys, concomitant diffuse renal lesions, and on the etiology of the nephrotic syndrome (NS). The author substantiates inaccuracy of the concept of a potential development of the NS in patients suffering from PCPN. The author holds that if PCPN patients manifest the NS, it means that PCPN may be coupled with certain DRL complicated by the NS.

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The author characterizes in detail 4340 patients with diffuse renal lesions (chronic glomerulonephritis, renal amyloidosis, lupoid nephritis, diabetic glomerulosclerosis and nephrosclerosis) coupled with different diseases of the urinary organs including urolithiasis, cancerous and tuberculous processes, purulent diseases of the kidneys and prostatic lesions. Stage III chronic renal failure (CRF) was revealed in 2073 (57.1%) out of the 4340 patients. All of them died because of uremia. The mean lifespan of the patients was 1.6 +/- 0.1 yr. since manifestation of the concomitant process. The shortest times of CRF onset, the highest frequency of stage III CRF and the least lifespan were noted in patients with double association, particularly in those suffering from associated chronic glomerulonephritis with renal amyloidosis and urinary bladder cancer in the stage of compression with tumor of the intramural parts of the ureters, namely they were 0.6 +/- 0.1, 100% and 1.0 +/- 0.1 yr., respectively. The author holds that the main reason for such an abrupt CRF onset in patients with concomitant renal lesions of any type lies in simultaneous combined influence on the kidneys of absolutely different diseases bearing in mind their etiology and pathogenesis. Besides, according to the author's data, considerable influences on the times of CRF onset and rates of its progress are produced by both the course and stage (phase) of the development of each of the coexistent diseases. Attention is drawn to the necessity of early participation of urologists in the solution of the problems concerned with the policy of managing nephrological patients with diseases of other organs of the urinary system as well as with permanent dynamic follow-up of all the patients with concomitant processes, especially with double ones.

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Analyzing correlation of the results of excretory urography and histological findings (kidney biopsy) in 2852 nephrological patients the author has come to a conclusion that changes in the structure of the pelvicaliceal system (PCS) which are usually regarded as x-ray signs of primary chronic pyelonephritis (PCPN), are not typical of this disease and can be also observed in patients with diffuse renal lesions. PCS changes of "pyelonephritic" type were detected in 2470 patients, histologically in 698 (28.1%), in them PCPN morphological signs were detected, and 1772 patients (71.9%) had different diffuse renal lesions. In the author's opinion, PCS changes in such patients could result from an increase in the kidney mass caused by edema or sclerosis of morphological elements of the renal tissue. The absence of both in 382 patients with diffuse renal lesions was not accompanied by PCS changes. The author has been of opinion that identity of the pictures of PCS changes is in the unity of the existing process: compression of the PCS fragments as a result of edema or sclerosis. Therefore PCPN absolute x-ray criteria could be based on the histological confirmation of this disease and what is most important on the absence of morphological data in favor of any diffuse renal lesion or on the detection of the normal renal tissue. In the interpretation of changes in the PCS structure to avoid diagnostic errors the author insists upon the necessity of regarding these changes, first of all, as a result of renal lesion only with subsequent patient's examination to determine the true nature of renal lesion. A decisive point in this respect is a histological study.

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Analyzing the data of a comprehensive examination of 372 patients admitted to hospital with a distinct clinical picture of acute pyelonephritis, the author shows that out of these patients' population, 278 (74.8%) had an active form of chronic disease running a latent course. At the same time 40.4% of cases were diagnosed to have chronic renal failure (CRF), stages IB-IIB. To determine the genuine character of renal injury, the author thinks it necessary to regard the symptom-complex of acute pyelonephritis as a consequence of the pyelonephritic process itself. In complicated cases of the diagnosis, biopsy of the kidney concerned is required. In 176 patients the final diagnosis was established by uroradiological examination, in 59 by means of the use of laboratory methods, and in 137 by biopsy of the involved kidney. It is recommended that patients with renal pathology should be kept under prolonged dispensary observation, particularly those with an initial stage of CRF.

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