The present case of chronic pyelonephritis with renal acidosis due to failure of the renal tubules to reabsorb base carbonate is the first to come to my attention. In December 1939 Hartmann1 described the first case of primary renal acidosis with tubular insufficiency on record. His patient was a 4 month old infant with no history of renal infection. There was, however, severe, uncompensated renal acidosis with loss of base carbonate. Apparent complete recovery followed administration of excessively large doses (75 cc. daily) of molar sodium r-lactate for several months.
My patient was a 2 month old infant who was brought into the hospital with pyelonephritis and renal acidosis. I was unable to clear the renal infection or to produce complete compensation of the acidosis. After two months of intensive treatment the patient died. The renal lesions are described in the present report.
REPORT OF A CASE