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PubMedDate not supplied

Mucor pyelonephritis. Report of a case diagnosed by urine cytology, with diagnostic considerations in the workup of funguria.

BACKGROUND: Isolated renal mucormycosis is an uncommon kidney infection affecting patients with underlying systemic diseases and intravenous (IV) drug abuse. We report a unique case in the cytologic literature in which urine cytology provided insight into the diagnosis, renal mucormycosis. CASE: The patient, a diabetic and IV drug abuser, presented with complaints of left flank pain, fever and dysuria. All urine cultures were negative. A computed tomography (CT) scan showed changes consistent with left acute pyelonephritis, and the patient was treated for a presumed diagnosis of bacterial pyelonephritis. Late in the hospital stay, the cytology laboratory diagnosed Mucor in a single urine specimen, but the patient had already been discharged. The patient was never treated for funguria, only to present again with left flank pain 13 months later. An abdominopelvic CT scan showed progression to left chronic pyelonephritis. The patient, however, left the hospital against medical advice before any further workup could be completed. CONCLUSION: Renal mucormycosis should be considered part of the differential diagnosis in patients with underlying diseases or IV drug abuse who present with symptoms of acute pyelonephritis. The differential diagnosis of Mucor funguria should also include fungal ball in the renal pelvis or urinary bladder and fungal cystitis.

Adult↗

PubMed1970

Water, acidosis, and experimental pyelonephritis.

The effect of water restriction and ammonium chloride acidosis on the course of Escherichia coli pyelonephritis was determined in the nonobstructed kidney of the rat. To alter the chemical composition of the renal medulla, water intake was reduced in rats to one-half the normal daily intake. Water restriction increased the incidence of coliform pyelonephritis. Systemic acidosis, produced by giving a 300 mM solution of ammonium chloride, increased urinary osmolality to values comparable to water restriction and also predisposed to pyelonephritis. However, when rats were fed the same solution of ammonium chloride but were allowed access to tap water ad lib., urinary osmolality values were comparable to those observed in normal animals, and susceptibility to pyelonephritis was reduced or eliminated despite a degree of systemic acidosis similar to that observed in rats fed ammonium chloride solution without access to tap water. These results suggest that water diuresis may overcome the inactivation of complement produced by ammonium chloride acidosis and that renal medullary hypertonicity, produced by either water restriction or ammonium chloride acidosis, is a major determinant of this tissue's unique susceptibility to infection.

Acidosis↗

PubMed1988

A shift from acute to chronic spontaneous pyelonephritis in male MM mice associated with a change in the causal micro-organisms.

Proteus mirabilis was the predominant cause of acute diabetes-associated pyelonephritis occurring spontaneously in male MM mice until they were segregated in a new environment. Thereafter Pasteurella pneumotropica and Streptococcus faecalis emerged collectively as the most common causal organisms, the pyelonephritis became more chronic and Proteus mirabilis isolates from faeces and urine produced atypical non-swarming colonies on blood agar plates. This did not account for the reduced pathogenicity of Proteus mirabilis; when MM males were returned to the original environment the pyelonephritis again became acute but was associated with the atypical type of Proteus mirabilis although the normal type was abundant in the environment. The MM mice were Caesarean-derived and cross-fostered shortly before their transfer to the second environment, which probably accounts for their changed microbial status, but the reason for the emergence of the atypical type of Proteus mirabilis is not understood. The acute nature of the male MM pyelonephritis when caused by Proteus mirabilis parallels the situation described in other animals and humans.

Acute Disease↗

PubMed1983

Lack of significance of pili in experimental ascending Escherichia coli pyelonephritis.

The role of pili as a bacterial virulence factor has been studied. The model used was acute ascending Escherichia coli pyelonephritis in the mouse. Three strains of E. coli were injected in lightly or more heavily piliated phases into 15 mice each. At sacrifice of 13-15 animals 2 weeks later, no significant difference in severity of pyelonephritis was found as judged by numbers of bacteria in the kidney, nor intensity or frequency of gross abscesses. 27 strains of E. coli were order ranked for severity of pyelonephritis produced and compared with intensity of piliation in vitro under conditions designed to maximize pilus formation. No significant difference was found. 15 strains derived from patients in whom infections were confined to the bladder were compared for degree of piliation with 12 strains infecting the kidney. No significant difference was found. These studies do not support a significant role for the degree of piliation as a virulence factor in pyelonephritis.

Adhesiveness↗

PubMed2004

Ultrasonographic features of focal xanthogranulomatous pyelonephritis.

OBJECTIVE: To analyze the ultrasonographic features of focal xanthogranulomatous pyelonephritis. METHODS: Ultrasonographic features of 15 patients with pathologically proved focal xanthogranulomatous pyelonephritis were retrospectively analyzed by 2 radiologists who reached a consensus, in terms of the location, margin, size, and echo texture of the mass, associated calculi, lymphadenopathy, or local extension, in comparison with computed tomographic and clinical findings. RESULTS: At ultrasonography, 12 (80%) of 15 masses were well circumscribed. The maximal sizes of the masses ranged from 2.5 to 5.8 (mean, 3.8) cm. Thirteen solid masses (87%) were hyperechoic (n = 7), hypoechoic (n = 4), or isoechoic (n = 4) to the renal cortex, and the preoperative diagnosis was either renal cell carcinoma (n = 11) or Wilms tumor (n = 2). The preoperative diagnosis of the other 2 cystic lesions (13%) was renal abscess. Renal calculi were found in 1 case, but lymphadenopathy or local extension was not depicted. Clinical inflammatory signs were found in 11 of 15 patients. CONCLUSIONS: There were no specific ultrasonographic features that allow for the distinction between focal xanthogranulomatous pyelonephritis and renal tumors or abscesses. Focal xanthogranulomatous pyelonephritis should be considered when there are clinical signs of infection or inflammation and a focal solid mass is seen on ultrasonography.

Abscess↗

PubMed1999

[Emphysematous pyelonephritis: apropos of 4 cases].

PURPOSE: The propose of this study was to describe the imaging findings in four patients with emphysematous pyelonephritis and to perform a review of the literature. MATERIAL AND METHODS: Four cases of emphysematous pyelonephritis are presented. US and CT examinations were available for all patients. RESULTS: Gas within the kidney may be diagnosed by plain film or rarely by ultrasound, but its location and its extent are best evaluated by CT. A review of the literature shows that emphysematous pyelonephritis is a rare and life-threatening infection typically occurring in diabetic patients. CONCLUSION: CT is useful for diagnosing emphysematous pyelonephritis, especially when symptoms fail to resolve promptly with medical therapy.

Adult↗

PubMed1998

PCR studies on the presence of Chlamydia trachomatis in the upper urinary tract of patients with obstructive pyelonephritis.

Chlamydia trachomatis infections are among the most common sexually transmitted diseases in the world and it is only logical to hypothesize that it alone or in association with mycoplasmas can participate in the initiation and persistence of upper urinary tract infections. Having in mind the inconclusive evidence regarding the role of C. trachomatis in upper urinary tract infections we decided to study the presence of C. trachomatis in the upper urinary tract of patients with obstructive pyelonephritis using the polymerase chain reaction. We studied 20 patients (12 female and 8 male, aged 20-60 years) with symptoms and signs of acute pyelonephritis in accordance with Kunin's criteria (1997). Samples were taken during surgery of the upper urinary tract by aspirating urine from the renal pelvis or the ureter above the level of the obstruction and analyzed for the presence of bacterial pathogens using routine microbiological techniques and employing the "AMPLICOR CT/NG" test (Roche Diagnostic Systems, Branchburg, NJ, USA) for the presence of C. trachomatis. Chlamydia trachomatis was found in the aspirated urine of 5 patients (25%). In 3 of the patients the microbiological tests of the aspirated urine did not establish any other microbial agent. In the other two Escherichia coli and Proteus mirabilis were cultured. The analysis of the clinical and laboratory findings in the patients with Chlamydia trachomatis infection alone and those with an associated bacterial pathogen failed to reach statistical significance. Following the operation all of the patients received treatment with Ofloxacin 200 mg bid for 7 days with a favorable clinical and laboratory outcome. In our opinion, the AMPLICOR CT/NG test is a sensitive and specific method for diagnosing low-number Chlamydia trachomatis infections of the upper urinary tract in patients with obstructive pyelonephritis. Chlamydia trachomatis should be considered as a possible etiologic agent in acute pyelonephritis and the therapeutic regimen in such patients should be targeted at its possible underlying presence.

Adult↗

PubMed2000

How accurate is dimercaptosuccinic acid scintigraphy for the diagnosis of acute pyelonephritis? A meta-analysis of experimental studies.

UNLABELLED: The purpose of this study was to evaluate the performance of dimercaptosuccinic acid (DMSA) scintigraphy in the diagnosis of acute pyelonephritis and to compare the test performance of the standard technique, planar DMSA, with the newly introduced technique, SPECT DMSA. METHODS: All published animal studies in which DMSA scintigraphy was compared with histopathology, the reference standard for acute pyelonephritis, were identified using a comprehensive search strategy with the MEDLINE and EMBASE databases. Test performances of all DMSA methods and SPECT versus planar DMSA were analyzed using summary receiver operating characteristic (sROC) curves. RESULTS: Seven studies were identified, including 2 of SPECT DMSA. Problems in study design or reporting were common, with numerical errors in 4 studies. Overall, at a sensitivity of 86%, specificity was estimated to be 91%. Detection of acute pyelonephritis was at a lower threshold for SPECT than for planar DMSA (sensitivity/specificity values of 97%0/66% compared with 82%/ 97%), and the overall test performance of SPECT was not demonstrably better than that of planar DMSA. When applied to a group of children with a prevalence of renal damage of 40%, this means that 98% of children with abnormal planar DMSA scans will have renal damage, whereas only 65% of those with abnormal SPECT scans will have renal damage. Planar and SPECT DMSA will miss 11% and 3% of children with renal damage, respectively. Out of 100 children in the hypothetical group with 40% experiencing renal damage, SPECT will identify 6 extra true cases of renal damage at the expense of 19 extra false positives, when compared with planar DMSA. CONCLUSION: Published studies of DMSA test performance are few in number and have significant methodologic problems that should be avoided in future studies. DMSA, particularly the planar technique, performs well for the diagnosis of acute pyelonephritis. Using test performance criteria, SPECT DMSA alone has not been shown to be preferable to the established planar method and will result in a small number of true-positives at the expense of a larger number of false-positives.

Acute Disease↗

PubMedDate not supplied

Bilateral emphysematous pyelonephritis with perirenal abscess cured by conservative therapy.

Emphysematous pyelonephritis is a rare life-threatening infection of the renal parenchyma. It usually affects unilateral kidney and occurs mostly in diabetic patients. It is characterized by the presence of gas within the renal parenchyma and requires prompt diagnosis and early aggressive therapy. Bilateral emphysematous pyelonephritis is even more rare and is associated with high mortality. We describe a case of a 62-year-old diabetic woman who presented with nonketotic hyperosmolar coma and bilateral emphysematous pyelonephritis caused by Klebsiella pneumoniae. Diagnosis of bilateral emphysematous pyelonephritis was confirmed by an abdominal computed tomographic scan and microbiologic studies. Our patient was successfully treated using percutaneous catheter drainage and long-term antibiotic therapy.

Abdominal Abscess↗

PubMed1975

Experimental pyelonephritis in the monkey. II. The prognostic value of radionuclide evaluation of the urinary tract.

The radionuclide scintiphoto study, a noninvasive technique, is abnormal in acute pyelonephritis. A delay in excretion of the isotope has also been observed in dehydrated studies in chronic pyelonephritis. To further elucidate this abnormal pattern in pyelonephritis, experimental renal infection was produced in monkeys. Dehydrated 131-I-hippuran scintiphoto studies were conducted weekly for 8 weeks after the initial infection. The scintiphoto studies showed significant delay in excretion of radionuclide in all bacteriuric monkeys at 1 week. After this time, delayed excretion was seen in only those monkeys later classified as having chronic pyelonephritis. This was statistically significant (P smaller than 0.01).

Acute Disease↗

PubMed2000

[Prospective, randomized, comparative study of the efficacy, safety and cost of cefuroxime versus cephradine in acute pyelonephritis during pregnancy].

BACKGROUND: Second generation cephalosporins (CFPs) are more active in the treatment of acute pyelonephritis during pregnancy but their cost is considerably higher than their predecessors. Cefuroxime, a second generation CFP with oral and parenteral presentations, might offer significant advantages and become a first choice antimicrobial in this setting. AIM: To compare the efficacy, safety and cost of cefuroxime and cephradine in the treatment of acute pyelonephritis in pregnancy. PATIENTS AND METHODS: Hospitalized women with 12 to 34 weeks of pregnancy, with clinical and bacteriological diagnosis of acute pyelonephritis, were randomly assigned to receive cefuroxime (Curocef(r), Glaxo Wellcome) 750 mg t.i.d, i.v. or cephradine 1 g q.i.d., i.v. If the isolated organism was resistant to the assigned drug the patient was excluded. Once patients were afebrile, they were switched to an oral form of the same antimicrobial. They were discharged according to the clinical status and treated for a total of 14 days. laboratory tests, including urine culture were requested during controls and at the end of follow-up at 28 days. RESULTS: One hundred and one patients were randomized: 49 to receive cephradine and 52 to receive cefuroxime. Patients in the cefuroxime group hed fewer febrile days (mean 1.7 vs 2.2, p < 0.05), faster clinical recovery (mean 2.7 vs 3.1 days, p < 0.05), a higher rate of bacteriological cure at 28 days (78.8% and 59.2%, p < 0.05) and lower rate of failure (21.2% vs 40.8% p < 0.05). The rate of resistance of isolated uropathogens was 14% to cephradine and 1% to cefuroxime. CONCLUSIONS: Cefuroxime can be considered as a first choice option in the treatment of acute pyelonephritis during pregnancy due to its tolerance, microbiological activity and efficacy.

Acute Disease↗

PubMed2000

[Characteristics of the diagnosis of purulent pyelonephritis].

Results of diagnosing pyelonephritis in 106 patients using ultrasonography, CT and thermovision were analyzed. Purulent pyelonephritis (PP) was diagnosed in 57 patients, serous pyelonephritis--in 49 patients. The sensitivity of ultrasonography in the diagnosing of PP was more than 80%, that of CT--90%. The methods used allowed the 100% improvement of the differential diagnosis of renal abscess, apostematous nephritis and pyonephrosis. The greatest problems were met in the diagnosis of renal carbuncle which was detected in 50% of cases by ultrasonography and in 54% of patients by CT. The minimum sizes of the destruction focus when the diagnosis could be reliable were 2 cm for ultrasonography and 1.5 cm for CT. Only using the findings of CT could diagnose emphysematous pyelonephritis. Thermovision could not find any definite criteria of PP. The timely diagnosis of PP allowed the organ-saving operations to be fulfilled in the overwhelming amount of the patients. Positive results of the treatment using the above mentioned diagnostic methods were obtained in 98.8% of the patients.

Adolescent↗

PubMed2000

[Acute pyelonephritis associated with intestinal dysbacteriosis: incidence and enhancement of efficiency of treatment].

A study was made on the incidence rate of acute pyelonephritis associated with intestinal dysbacteriosis in urological patients (n = 68). Prehospitalization and precombined-treatment duration of the illness came up to one to four days. It has been ascertained as a result of the conducted study that under present ecological conditions, acute pyelonephritis runs its course in the presence in patients of dysbacteriosis of the intestines even before the start of treatment in an urological clinic setting. Antibacterial treatment of patients with acute pyelonephritis without simultaneous action on the pathogenic intestinal microflora and normalization of colonizing normoflora was found to produce profound aggravation of dysbacteriosis and to result in the development of candidasis. Extermination with the aid of the intestinal antibiotic intetrix of the pathogenic microflora in the intestines together with achieving of normalization of intestinal normoflora by way of the enteral intake by patients with acute pyelonephritis of eubiotics permit the marked improvement to be achieved in results of combined treatment thereof.

Acute Disease↗

PubMed2001

[Pseudotumoral xanthogranulomatous pyelonephritis: diagnosis with percutaneous biopsy and success of conservative treatment].

Focal xanthogranulomatous pyelonephritis is an unusual form of chronic renal infection that is difficult to diagnose prior to surgery. We report on a 19-year-old woman who presented with a renal mass that mimicked malignancy. The diagnosis of focal xanthogranulomatous pyelonephritis was first suspected by radiological findings and further confirmed by histopathologic examination of percutaneous biopsy specimens of the lesion. Successful treatment of the patient was achieved with antibiotic therapy alone. Maximal efforts, including percutaneous renal biopsy, should be made to establish the diagnosis of focal xanthogranulomatous pyelonephritis before a therapeutic decision is reached. We recommend the use of antibiotics as a first-line treatment for patients with focal xanthogranulomatous pyelonephritis.

Adult↗

PubMed1975

[Renal glutaminase I activities in experimental and human chronic pyelonephritis (author's transl)].

QUESTION: For more exact knowledge on the pathogenesis of pyelonephritis a series of large scale histochemical and biochemical investigations were performed. In this study the author reports his observations on the renal glutaminase I activities in experimental and human pyelonephritis. MATERIALS AND METHODS: Details on materials and methods were given in a recent paper [PHILIPPSON, Exp. Path. 8, 182-193 (1973)]. Glutaminase I activities (L-glutamine amidohydrolase, EC 3.5.1.2.) were quantitatively analyzed according to MATTENHEIMER and DEBRUIN (7) in which the reaction was not only produced by cooling but also by simultaneous inhibition by means of 15% trichloric acetic acid. Ammonia was released and determined by Berthelot's reaction as modified by WELLER (18). RESULTS: The results in rabbit kidneys are compiled in the tables 1-3, the observations on human kidneys are represented in table 4. 139 rabbits showed unilateral experimental pyelonephritis, in 19 rabbits pyelonephritis did not develop or "healed up spontaneously". 31 samples of pyelonephritic nephrocirrhotic human kidneys (obtained by surgical operations) and 20 samples of healthy human kidneys were investigated. After separation of renal cortex and medulla the cortex was separated into glomerula and renal tubules by differential centrifugation. Significance was tested by universal comparison of the group mean values by t-test (rabbit and human kidneys separately). 1. In the rabbit glomerula glutaminase I (glut I) activities were increased significantly from the beginning of the experiment up to 100 days. They decreased markedly in the subsequent nephrocirrhotic stage (fig. 1). 2. The glut I activities in the rabbit cortical tubules decreased immediately, intensively and succesively up to the late-chronic nephrocirrhotic stage. 3. The rabbit medullary glut I showed likewise intensive decrease in the acute and subacute phase progressing to very low activities in the nephrocirrhotic stages. 4. In all samples from human pyelonephritic nephrocirrhoses (glomerula, cortical tubules and medulla) extremely decreased glut I activities were demonstrated. 5. The enzyme activities observed and the results of the semiquantitative histological analysis [SORGER and co-workers, Exp. Path. 9, 280-287 (1974)] are closely correlated. 6. In the glomerula of the "spontaneously healed up" tissue the glut I activities were markedly increased whereas they were moderately decreased in the cortical tubules and in the medulla. 7. The dry weights and values of protein content were equal to those earlier reported (PHILIPPSON 1973). 8. In the significance test (universally applied t-test) the overwhelming majority of the values showed high significance (p less than or equal to 0.001). The results are correlated with the observations of the semiquantitative histological analysis (SORGER et al. 1974) and discussed on the basis of data reported in literature.

Animals↗

PubMedDate not supplied

[Pyelonephritis and bacterial tubulointerstitial nephritis].

With the purpose of establishing the clinicopathologic correlation in pyelonephritis and to discard other interstitial nephrites, with present day morphologic criteria we analysed 63 casos that had been diagnosed as pyelonephritis, following Weiss and Parker's histologic criterion. The clinicopathologic diagnosis of pyelonephritis was confirmed in 12 cases; all of them showed obstructive uropathy and in most of them, there was chronic renal failure. Interstitial nephritis was established in 27 cases, all of them showing septicemia and almost half of the cases showed acute renal failure. Other 20 cases showed tubulointerstitial nephritis secondary to different types of glomerulopathies, fetal glomerulosclerosis, dysplasias, nephrophthisis, radiation nephritis and renal infarct. In 4 cases, the study of sections finer than the original, showed absence of histopathologic lesions. The results of the present study point out the main causes of confusion with the pathological diagnosis of pyelonephritis, the necessity to investigate predisposing uropathy in patients with urinary infection and stresses the importance to establish correlation with clinical and laboratory findings in cases with tubulointerstitial lesions.

Autopsy↗

PubMed2004

[Surgical policy in acute purulent pyelonephritis in patients with diabetes].

Efficacy of treatment of 208 diabetic patients with acute pyelonephritis was analyzed. Surgical treatment was performed in 58 patients (43 with insulin-non-depended and 15 with insulin-depended types). All the patients were divided into 4 groups depending on forms of pyelonephritis: non-destructive (116 patients), purulent-destructive (58), calcllious (34), purulent-calculous (10). Algorithm of differential diagnosis between non-destructive and purulent-destructive forms of acute pyelonephritis in diabetic patients are presented. It is demonstrated that surgical treatment is the main method in complex therapy of purulent-destructive forms. Rational surgical policy is substantiated. In patient with diabetes and purulent pyelonephritis nephrectomy is more expediently. Nephrostomy may be used only in light forms of diabetes with local destructive forms ofapostematosic nephritis. Radical surgical policy permitted to achieve positive result of treatment in majority of patients. Lethal outcomes were seen in two-sided lesion of kidneys with apostems, and carbuncles.

Acute Disease↗

PubMed2005

Challenges in preventing pyelonephritis in pregnant women in Indigenous communities.

INTRODUCTION AIM: To measure the quality of antenatal care in rural and remote regions of the Northern Territory, using asymptomatic bacteruria as an indicator. BACKGROUND: Indigenous Australian women and their babies have a greater frequency of adverse outcomes in pregnancy than their non-Indigenous counterparts. It is well established that asymptomatic bacteriuria may have serious outcomes in pregnancy, including an increased risk of pyelonephritis and a strong association with preterm and low birth weight delivery. Ensuring good quality antenatal care can reduce the individual risks of pregnancy for mothers and their babies. In the Northern Territory there are well established guidelines for antenatal care in rural and remote Indigenous communities. These are documented in the Women's Business Manual. Audit and feedback is one method that has been shown to have a small to moderate effect in changing clinician behaviour, in this case improving compliance with guidelines. METHODS: A retrospective chart audit of antenatal clients was conducted at 10 rural and remote primary health care clinics in the Northern Territory, Australia. The audit reviewed all the available charts (n = 268) of pregnant women, from the participating communities, who gave birth in 2002 or 2003. The diagnosis and management of asymptomatic bacteriuria was chosen as the indicator of quality antenatal care, as it is one of five areas of antenatal care where there is evidence that appropriate management improves outcomes. The quality of care was measured against the local guidelines, the Women's Business Manual. RESULTS: Women frequently had urine tests with where the dipstick showed an abnormal result, with 75% (95% CI [0.70,0.80]) of women having at least one episode of abnormal urinalysis during pregnancy. Six hundred and twenty episodes of abnormal urinalysis in pregnancy were identified. The incidence of bacteriuria at first visit was 16%, (95%-confidence interval = 95% CI [0.10, 0.21]). Compliance with the guidelines was poor. Fifty-six percent (95% CI [0.52,0.60]) of those samples testing positive on urinalysis were not sent to pathology for microscopy and culture, as recommended in the guidelines. Of those with a positive culture, 32% (95% CI 0.28,0.39) were appropriately treated with antibiotics. When antibiotics were given, good compliance of 82% (95% CI 0.76,0.87) with antibiotic guidelines was demonstrated. The positive predictive value of dipstick urinalysis in diagnosing asymptomatic bacteriuria was low in this study at 33.5%. There were 13 episodes of confirmed or probable pyelonephritis. No women with recurrent urinary tract infections were followed up according to protocol. CONCLUSION: Aboriginal women have worse pregnancy outcomes than the non-Indigenous population of Australia. Pyelonephritis is a preventable condition in pregnancy. In these rural and remote communities, pyelonephritis has not been prevented due, in part, to a failure to follow the local guidelines. Structural problems were identified and need to be addressed in order to improve compliance with guidelines and hence pregnancy outcomes for rural and remote Indigenous women.

Anti-Bacterial Agents↗