RE: ACUTE LOBULAR NEPHRONIA

J. D. Wegenke, G. H. Malek, A. J. Alter and J. G. Olson J. Urol., 135: 343-345, 1986 To the Editor. 1 read with interest the article describing 2 cases of acute focal bacterial nephritis. I object to the term acute lobular nephronia used in that title, which the authors define as "an acute, suppurative infection of an entire renal lobule analogous to segmental involvement of the lung in lobar pneumonia". Lobar pneumonia is defined as an acute inflammation of 1 or more lobes of the lung, together with consolidation. Lobular pneumonia is synonymous with bronchopneumonia, in which case inflammation is focal. In the kidney the cortex is composed of subunits of lobules and each lobule consists of glomeruli with their surrounding tubules, a medullary ray with its tubules arranged at right angles to the subcapsular surface, and a similar group of glomeruli and surrounding tubules on the other side of the ray.1 Should an entire lobule be inflamed acutely the lesion still is small and probably will not correspond to the wedge-shaped lucent areas (which appear to be larger than microscopic size) seen on a computerized tomography scan. I believe that in both cases a patchy or focal parenchyma! inflammation had occurred and not necessarily in any lobular distribution as has been interpreted by the authors. The discrete wedge-shaped areas of renal involvement with no spread of infection outside of them in cases of acute pyelonephritis, a feature seen in man and laboratory animals, were emphasized by Freedman and Beeson.2 What the authors have described as acute lobular nephronia is, in fact, an acute bacterial inflammation involving focal wedge-shaped areas of the kidney and should be called acute focal bacterial nephritis. The term nephronia is not defined in the standard medical dictionaries nor could I find it in large renal pathology references.li3>4However, there is a term oligomeganephronia, which describes a rare form of renal hypoplasia with reduced number of nephrons and enlargement of all elements of nephrons that are present.6 The authors do not describe anything related to a nephron. If they are describing an inflammation of a nephron, it should be called nephritis (nephron being the anatomical and functional unit of the kidney) and not nephronia. Respectfully, Deba P. Sarma Department of Pathology Louisiana State University Medical School and Veterans Administration Medical Center New Orleans, Louisiana 70146 1. Heptinstall, R. H.: Pathology of the Kidney, 2nd ed. Boston: Little, Brown & Co., vol. l,p. 1, 1974. 2. Freedman, L. R. and Beeson, P. B.: Experimental pyelonephritis. IV. Observations on infections resulting from direct inoculation of bacteria in different zones of the kidney. Yale J. Biol. Med., 30: 406, 1958. 3. Spargo, B. H., Seymour, A. E. and Ordonez, N. G.: Renal Biopsy Pathology. New York: John Wiley & Sons, 1980. 4. Antonovych, T. T. and Mostofi, F. K.: Atlas of Kidney Biopsies. Washington, D. C.: Armed Forces Institute of Pathology, 1980. 5. Carter, J. E. and Lirenman, D. S.: Bilateral renal hypoplasia with oligomeganephronia. Oligomeganephronic renal hypoplasia. Amer. J. Dis. Child., 120: 537, 1970

Sarma DP(1987): Acute lobular nephronia (letter). J Urol 137:1007-1008. PMID: 3573160 [PubMed indexed for MEDLINE]