Experimental Pyelonephritis and Hypertension

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Abstract
Hypertensive vascular disease and chronic pyelonephritis are related clinically but the precise nature of this relationship is difficult to establish from patient material. In a series of studies in rats with an experimental model of pyelonephritis a number of alternative explanations for the relationship between the two diseases have been examined. These possibilities are: (1) chronic pyelonephritis directly causes hypertensive disease; (2) chronic pyelonephritis makes the subject more prone to hypertensive disease; (3) pyelonephritis aggravates pre-existing hypertension; and (4) hypertensive subjects are more susceptible to pyelonephritis. The results of these studies indicate that in the rat chronic pyelonephritis does not usually cause hypertension, but will aggravate pre-existing hypertension and make the nonhypertensive rat more vulnerable to other hypertensive influences. In particular, an increased susceptibility to pyelonephritis can be demonstrated in the rat with both acute and chronic elevation of blood pressure. Thus, the latter three alternatives provide a better explanation of the relationship between pyelonephritis and hypertensive disease in the rat than does a direct etiologic linkage. From these findings, certain clinical implications are suggested, with particular emphasis on the possibility that increased susceptibility to renal infection may exist in hypertensive subjects. The importance of these considerations in further research and in clinical diagnosis and management are discussed.