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tension is a rare exception in these patients. Bors & Comarr (1970) found an incidence of
8-2 per cent of renal death with hypertension in their own cases. A more detailed analysis
on hypertension in relationship to pyelonephritis and amyloidosis was given by Talbot
(1965). Out of 43 paraplegics and tetraplegics upon whom autopsies were done, 35 had
renal disease: 19 pyelonephritis, 3 amyloidosis only, 13 both. Of the 19 pyelonephritis
cases 9, of the 3 amyloidosis only one, and of the 13 combined pyelonephritis and
amyloidosis cases 6 had hypertension. Talbot's definition of hyerptension was systolic
blood pressure of 150 mmHg and/or 100 mmHg diastolic blood pressure.
In our paper on comparative studies on endogenous creatinine and urea clearances
in paraplegics and tetraplegics (Doggart, Guttmann & Silver, 1966) 18 out of 28 patients
were suffering from chronic pyelonephritis. Table 22 gives the details of the clinical
findings, from which it would appear that in n cases out of the 18 the pyelonephritis
was associated with amyloidosis, and these patients had pressure sores, some associated
with osteomyelitis. In the n cases amyloidosis was discovered by rectal biopsy, of these
in one as early as 19 months after injury, in two patients it was found at
post-mortem.
Death occurred after 1-3 years in 4 cases after the diagnosis of amyloidosis had been
made.
Hypertension was found in 8 of the 18 patients (44-4 per cent), in 5 of them diastolic
pressure varied between 100 and 150 mmHg. Although, in the 3 additional patients who
were of young age, the diastolic pressure was only 90 mmHg, this is considered as
pathological in accordance with Fishberg's views (1954). One of these 3 (aged 32) had a
systolic pressure of 150 mmHg, the second (aged 31) had a hypertensive retinopathy
and the third (aged 27) with a blood pressure of 130/90 was oedematous with a proteinuria
of 13-6 g/24 hr and a serum albumin of 0-4/100 ml. These high incidences of hyper
tension in pyelonephritis and pyelonephritis associated with amyloidosis are in accordance
with the results found by Tribe and Silver in their larger series.
In discussing the underlying histopathology of renal hypertension in pyelonephritis
and amyloidosis, it would appear from all histological data available so far, that no clear
relationship exists between the disturbances of the glomerulo-tubular system. There
is general agreement amongst pathologists about the outstanding histopathological
findings in chronic pyelonephritis and amyloidosis, associated with hypertension, such as
endarteritis fibrosa with or without reduplication of the internal elastic laminae in arteries,
proliferative glomerulitis, glomerular sclerosis, glomerular tuft necrosis and amyloid
replacement of surviving glomerular tufts, etc. However, the same alterations of the
renal tissues have also been found in chronic pyelonephritis and/or amyloidosis without
hypertension. It remains, therefore, to be seen whether the solution of this problem will
be found in refinement of histopathological techniques or by further elaboration of
biochemical, perhaps immunobiological research.
(8) Cancer of the urinary tract
In the past this complication following spinal cord injuries was practically unknown
because of the short duration of life of these patients. However, it has become a reality in
recent years owing to the greatly increased life-span of paraplegics and tetraplegics after
