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PubMed2001

[Percutaneous nephrostomy in emergencies. Report of 42 cases].

PURPOSE: Through this work we are going to demonstrate the interest and the contribution of the percutaneous nephrostomy in obstructive anuria and in pyonephrosis. PATIENTS AND METHODS: It is a retrospective study concerning 42 cases. The average age of the patients is 50 years (19-80 years). The sex-ratio is 26 men for 16 women. The nephrostomy was realized in first intention or after failure of ascent stent on 33 patients for an obstructive anuria and nine patients for a pyonephrosis. RESULTS: Improvement of the renal function was noted in 100% of obstructive with anuria and apyrexy in every case of pyonephrosis. No major complication arose during the realization of the nephrostomy. The long-term prognostic depends on the etiology. CONCLUSION: The percutaneous nephrostomy constitutes a saving, effective and temporary solution in the strategy of the coverage of obstructive anuria and pyonephrosis.

Adult↗
PubMed2000

Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients.

STUDY DESIGN: A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms. OBJECTIVES: To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients. SETTING: Regional Spinal Injuries Centre, Southport, UK. METHODS: A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis. RESULTS: A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of flank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous inflammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi. CONCLUSIONS: The symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysreflexia. Physicians should be aware of the serious import of these symptoms in SCI patients.

Adult↗
PubMedDate not supplied

Percutaneous nephrostomy for nonoperative management of fungal urinary tract infections.

PURPOSE: Percutaneous nephrostomy has proved to be an important modality in the nonoperative treatment of bacterial pyonephrosis. The role of this technique in the management of fungal pyonephrosis continues to evolve. The authors retrospectively reviewed their experience with percutaneous nephrostomy in the management of fungal pyonephrosis. PATIENTS AND METHODS: Seven patients, two neonates and five adults, were identified with proved fungal infections. Eleven percutaneous nephrostomy tubes were placed, all with use of the Seldinger technique. RESULTS: Percutaneous nephrostomy allowed (a) prompt microbiologic diagnosis of fungal infection (Candida albicans in six patients, Torulopsis glabrata in one); (b) urinary diversion with subsequent improvement in renal function, enabling systemic administration of potentially toxic antifungal drugs 5-fluorocytosine and amphotericin B (four patients); (c) local irrigation with amphotericin B (four patients), (d) guidewire fragmentation of fungus balls (two patients); and (e) introduction of a Simpson atherectomy device to obtain biopsy specimens from an obstructing ureteral polypoid lesion (one patient). The funguria was successfully eradicated in six patients, one of whom died on the 39th hospital day of a pulmonary embolus and another of whom died of extensive small bowel infarction during hospitalization. The one patient whose outcome of antifungal treatment remains unknown died at home with a functioning percutaneous nephrostomy 23 days after the procedure. CONCLUSION: Percutaneous nephrostomy may play a role in the non-operative management of fungal urinary tract infection.

Aged↗
PubMed1978

The concentration of thiamphenicol in severely diseased human kidneys.

The concentration of thiamphenicol in serum and renal tissue was determined in 17 patients with severly diseased kidneys after an intravenous injection of 1000 mg of the drug. Two hours after the administration the renal tissue concentrations ranged in patients with hydronephrotic kidneys from 38.0-63.5 microgram/g, in patients with cirrhotic kidneys from 17.9-42.7 microgram/g, in patients with pyonephrosis from 9.8-17.6 microgram/g and in patients with renal carcinoma from 37.7-64.2 microgram/g. The patient with the renal sarcoma had a level of 138.7 microgram/g. At the same time the serum concentration ranged from 4.6-15.2 microgram/ml. The highest renal tissue/serum concentration ratios of thiamphenicol were observed in patients with hydronephrotic kidneys and renal tumours, the lowest in cases of pyonephrosis. The influence of severe renal disease on the renal tissue/serum concentration ratios of thiamphenicol is discussed. The high renal tissue levels of thiamphenicol in patients with severely diseased kidneys fulfill an important condition for the antibacterial chemotherapy of kidney infections.

Humans↗
PubMed1986

Renal candidiasis of the infant: ultrasound evaluation.

Sonographic diagnosis of 3 cases of renal candidiasis led to early diagnosis and treatment. Echogenic densities within a dilated pyelocalyceal system appeared to be the classic finding for obstructing candidal bezoars or candidal pyonephrosis in the premature neonate. Sonography was useful in guiding diagnostic and therapeutic percutaneous nephrostomies of very premature (900 and 750 g) infants. The ultrasonic findings of moderate echogenicity within dilated collecting systems in premature infants suggest pyonephrosis. Candidiasis should be considered as a prime cause.

Candidiasis↗