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PubMed2005

Laparoscopic nephrectomy for emphysematous pyelonephritis.

Emphysematous pyelonephritis is a serious suppurative infection of the renal and extrarenal tissues. Controversies exist surrounding the appropriate management of this life-threatening condition with advocates for both medical management alone and percutaneous drainage combined with nephrectomy. The laparoscopic approach for nephrectomy is quickly becoming the standard of care for benign disease of the kidney and low-stage renal cancers. We report a case of a 60-year-old diabetic male undergoing successful laparoscopic nephrectomy for right emphysematous pyelonephritis, and our procedural technique. To our knowledge, this is the first report of laparoscopic nephrectomy in the setting of emphysematous pyelonephritis. Carefully selected patients with emphysematous pyelonephritis may benefit from the advantages of laparoscopic nephrectomy in centers with sufficient laparoscopic experience.

Diabetic Nephropathies↗

PubMedDate not supplied

[Anaerobic parasitocenoses of the urinary tracts as a risk factor of acute pyelonephritis].

We examined 86 patients with acute gestational pyelonephritis, 72 patients with acute pyelonephritis admitted to hospital, 63 control women with favourable obstetric anamnesis and physiological pregnancy which finished in birth of a healthy child and 57 women with favourable obstetric anamnesis undergoing pregravidal examination. Microbiological factors of acute pyelonephritis risk and acute gestation pyelonephritis were determined. These factors were the presence of anaerobic parasitocenosis in the urinary tracts represented with trichomonades, mycoplasms, ureaplasms, herpes viruses and cytomegaly in various combinations.

Acute Disease↗

PubMedDate not supplied

[Polyoxidonium in the treatment of calculous pyelonephritis].

Efficacy of polyoxidonium was studied in combined therapy of urolithiasis complicated with secondary pyelonephritis. Of 60 patients with secondary pyelonephritis in urolithiasis, 30 received adjuvant polyoxidonium. Phospholipids and cholesterol in cytomembranes were defined with thin-layer chromatography. Humoral immunity was evaluated by the levels of IgA, IgM, IgG, hemolytic activity of the compliment system, the level of circulating immune complexes, activity of lysozyme. Concentrations of IL-1beta, TNF, IL-4, IL-6 were also estimated. Subpopulations of immunocompetent cells were tested on flow cytofluorimeter by immunofluorescence with monoclonal antibodies. Phagocytic component of the immune system was assessed by phagocytic activity of neutrophils, phagocytic count, NBT test. The trial demonstrates that polyoxidonium has a positive action on the disease course, an antiinflammatory, immunomodulating properties, suppresses peroxidation, promotes recovery of structural-functional characteristics of cellular membranes in patients with urolithiasis and secondary pyelonephritis. Polyoxidonium is recommended in secondary pyelonephritis and urolithiasis as adjuvant to basic therapy for anti-inflammatory, detoxication and immunomodulating effect.

Adjuvants, Immunologic↗

PubMedDate not supplied

Nonsurgical treatment of bilateral emphysematous pyelonephritis in a diabetic patient.

Bilateral emphysematous pyelonephritis is a rare life-threatening condition affecting almost exclusively patients with diabetes mellitus. Symptoms, which include fever, chills, abdominal and flank pain, nausea, vomiting, dysuria and pyuria, usually mimic those of classic pyelonephritis, and thus clinical suspicion for this urgent condition should be raised in every diabetic patient with similar presentation. Computed tomography (CT) remains the gold standard for the diagnosis demonstrating gas in the renal parenchyma, collecting system or perinephric tissue. Treatment, which should be aggressive, is classically surgical, and early nephrectomy is recommended. Percutaneous drainage associated with medical treatment might be an alternative. Successful exclusively medical treatment has been described but is infrequent and is reserved as an alternative for patients in whom surgical intervention is contraindicated. We report a case of bilateral emphysematous pyelonephritis in an 82-year-old female diabetic patient who presented with symptoms of typical pyelonephritis. Diagnosis was confirmed by CT, and Escherichia coli was identified as the causative factor. The patient was successfully treated medically with intravenous administration of cefepime and amikacin for 14 days and recovered fully. The therapeutical options for this severe but rare condition are discussed.

Aged, 80 and over↗

PubMed1991

[Candida urinary tract infection with special reference to ascending pyelonephritis].

The pathogenesis of Candida urinary tract infection (UTI) has been investigated clinically and experimentally with special reference to ascending pyelonephritis in rats. Among the Candida species, Candida albicans was most frequently isolated from clinical specimens including urine in two medical centers, one in Japan and the other in the United States. The isolates of C. albicans serotype B showed a significantly lower susceptibility to 5-fluorocytosine compared to those of serotype A (p less than 0.01). The distribution pattern of the serum antibody titers against C. albicans in 20 candiduria patients (C. albicans 19 and Candida tropicalis 1) was similar to that in 23 bacterial complicated UTI patients. All patients with candiduria had underlying diseases of the urinary tract, such as neurogenic bladder, bladder cancer or benign prostatic hyperplasia: indwelling urinary catheters were present in 15 patients and all had received antimicrobial agents before the study. Ascending Candida pyelonephritis has been investigated in female rats which were transurethrally inoculated into the bladder with C. albicans ATCC 10259 strain. The incidence of Candida pyelonephritis was approximately 80% in rats treated with cyclophosphamide and more than 70% in rats with partial ureteral obstruction. There was a significant relationship between renal and urinary Candida cell populations (p less than 0.01). Furthermore, a significant relationship was revealed between renal Candida cell populations and histological grades of pyelonephritis (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

[Arterial hypertension in senile pyelonephritis: the renal hemodynamics].

Eighteen patients aged 60 to 80 years suffering from chronic pyelonephritis (CPN) and nephrogenous arterial hypertension (AH) were examined for intrarenal hemodynamics: effective renal blood flow (ERBF), glomerular filtration rate (GFR), filtration fraction (FF), renal vascular resistance (R). Renal hemodynamics in patients with senile pyelonephritis and AH was found to be characterized by a decrease of ERBF, GFR, FF, an increase of R (p less than 0.01), with the alterations being related to the AH intensity, mass of the functioning renal parenchyma (for GFR) and partly (for R) to the pyelonephritis and AH standing. R which is dependent on the duration and course (number of exacerbations) of CPN is one of the factors that determine the development and gravity of AH in senile pyelonephritis.

Aged↗

PubMed1990

[Clinico-pathogenetic substantiation of the immunocorrective treatment of pyelonephritis in infants].

The results of the treatment of 47 babies treated with the immunocorrecting drugs (t-activin, levamisole, sodium nucleinate, prodigiozan, lysozyme) together with antimicrobial remedies are described. The babies were selected from 120 patients suffering from pyelonephritis. Indications for use of the immunomodulators included the deficiency of the T component of immunity, of phagocytosis and, more rarely, of B lymphocytes, an unfavourable premorbed condition, severe lingering disease course as well as low efficacy of antibacterial therapy. Two control groups consisted of 120 patients who were not given the immunocorrecting remedies and 30 normal children of the first year of life. The immunostimulation therapy minimized the duration of the active phase of pyelonephritis, decreasing the rate of relapses and the probability that the disease may progress to a chronic course. The positive influence of the above drugs on the clinical picture of pyelonephritis enabled the duration of antibacterial therapy, the dosage and the frequency of antibiotic use to be reduced. The favourable outcome of pyelonephritis was followed by gradual normalization of the immunological parameters.

Adjuvants, Immunologic↗

PubMed1990

The effect of parenteral iron administration on the development of Staphylococcus aureus-induced experimental pyelonephritis in rats.

The first of the three groups of rats was taken as a control and the other two groups were injected with high (15 mg/kg) and low (5 mg/kg) doses of ferric ammonium citrate given intramuscularly twice daily for 5 days. Pyelonephritis was produced in all groups by intravenous inoculation with Staphylococcus aureus. Serum and urine of each rat was collected periodically and their iron content was determined. The severity of pyelonephritis was evaluated by determination of bacterial growth and pathological lesions in kidneys after 10 days of bacterial inoculation. The results showed that parenteral iron administration markedly aggravated pyelonephritis development in rats. But there was no significant difference in the severity of pyelonephritis between rats treated with high or low iron doses.

Animals↗

PubMedDate not supplied

The role of Tamm-Horsfall protein in the pathogenesis of reflux nephropathy and chronic pyelonephritis.

Recurrent bacterial infection of the kidney was previously thought to be responsible for the renal scarring typical of chronic pyelonephritis until recent studies suggested that recurrent bacteriuria rarely produces chronic pyelonephritis in the absence of obstructive uropathy. In contrast, the association between vesicoureteral reflux (VUR) and chronic pyelonephritis has been observed frequently in the absence of urinary infection. Although the mechanism by which VUR injures the kidney has not been defined, recent observations have suggested that some component of urine might serve as an antigenic determinant involved in the immunopathogenesis of renal scarring in VUR. Therefore, the present studies investigated the immunopathogenic role of Tamm-Horsfall protein (THP) in (1) a rabbit model of tubulointerstitial nephritis; (2) a swine model of reflux nephropathy; and (3) patients with recurrent nephrolithiasis. The antigenic similarities between THP and uropathic bacteria were also studied. Our observations indicate that autoimmune responses to THP may occur after exposure to THP by intravenous challenge in rabbits, by urinary reflux in pigs, and in recurrent nephrolithiasis in man. Also, extracts of uropathic coliforms competitively inhibit the binding of human THP to its antibody. These studies suggest that autoimmune responses to THP may be the pathogenetic mechanism by which these factors, including bacteriuria, contribute to "chronic pyelonephritis."

Animals↗

PubMed1989

The rarity of chronic atrophic pyelonephritis in adults Nigerians.

A study was designed to investigate and define the true incidence of chronic atrophic pyelonephritis; its contributing role as a cause of chronic renal failure. The study was designed to investigate and define the true incidence of chronic disease in affected individuals in a hospital based population. We relied on radiological and postmortem histopathological evidences of the disease. The results showed that radiologically detectable unilateral chronic atrophic pyelonephritis was found in only 15 out of 391 intravenous pyelograms performed on patients referred to the renal clinic (3.8 per cent) during the five-year study period; bilateral disease was not found. Histopathological evidence from postmortem studies showed evidence of chronic atrophic pyelonephritis in 12 out of 250 autopsies (4.8%). In a short term follow up of women with unilateral pyelonephritic scars, it was found that antihypertensive treatment and meticulous treatment of urinary tract infection prevented a decline in renal function and the outcome of pregnancy was satisfactory. Chronic atrophic pyelonephritis is a rare disease in adult Nigerians and seems to be a benign disease. It may be indolent and unrecognised in many patients.

Adult↗

PubMed1989

[Aztreonam versus tobramycin in acute pyelonephritis. A comparative study].

We performed a comparative study between the monobactam antibiotic aztreonam and the aminoglycoside tobramycin in patients diagnosed as having acute pyelonephritis. The respective doses were 1 gr. IM daily for 7 days, and 100 mgr. IM q 12 h for the same period of time. Clinically, 100% of uncomplicated acute pyelonephritis and 87.5% of complicated infections cured with aztreonam. Tobramycin achieved an 80% cure rate for both types of infections. Microbiologically aztreonam was effective in all uncomplicated acute pyelonephritis, and in 69.56% of the complicated cases (overall microbiological cure rate = 78.7%). The therapeutic failures were ascribable to infections from S. faecalis, an organism naturally resistant to aztreonam. Thus, the microbiological cure rate was 84.2% in complicated pyelonephritis from organisms sensitive to this antimicrobial. The microbiological cure rate for tobramycin was 70% in acute uncomplicated, and 80% in complicated infections. We observed a good clinical and biological tolerance to both antimicrobials. No side effects were observed. Serum and blood biochemical analyses, and coagulation tests revealed no changes.

Acute Disease↗

PubMed1989

[Excretion of antibody-coated bacteria in chronic pyelonephritis].

Of 168 urine sediments, which were obtained from 55 patients with chronic pyelonephritis in the course of 3 years when a significant bacteriuria with E. coli was present, we demonstrated antibody-coated bacteria in 81 cases (48.21%). In the active stage of the disease with 54.10% were found significantly more than in the inactive with 32.61%. In obstructive chronic pyelonephritis the positive rate was 54.79% in contrast to 43.16% in non-obstructive chronic pyelonephritis. While in the active stage of the obstructive chronic pyelonephritis with 57.41% more antibody-coated bacteria were excreted only ACB+-, 34.29% only ACB-- and 40% ACB+- and ACB--germs in the course of the disease. The ACB-positive quote was in rough forms with 62.50% statistically significantly increased in contrast to 45.54% in O-typable and 42.86% in non-O-typable strains. In the ACB+-group the immunofluorescence titres to the homologous strain and the C3-activator in the serum as well as the urine lysozyme were significantly higher than in the ACB--group.

Antibody-Coated Bacteria Test, Urinary↗

PubMedDate not supplied

[A diagnostic method in acute pyelonephritis in pregnant women].

A radiothermometer has made it possible to take deep temperature directly from the kidney. Comparison of temperatures, obtained from normal nonpregnant women, normal pregnant women and pregnant patients with acute pyelonephritis has demonstrated a significant drop in renal temperature during pregnancy. In acute pyelonephritis, renal temperature drops still further, with the temperature difference between the affected kidney and the contralateral one ranging from 0.5 degrees to 1.5 degrees. Deep temperature measurements of each kidney are taken from several sites, selected at ultrasonic scanning, which makes it possible to calculate temperature variance for the kidney. Variance increases significantly (more than two-fold) in the inflamed kidney, as compared to the intact one. Therefore, the diagnosis of acute pyelonephritis can be made where deep temperature difference is between 0.5 degrees and 1.5 degrees and temperature variance is increased twofold or more in one kidney, as compared to the other, in a pregnant patient. The side of affection is also determined in this way. The proposed diagnostic method is perfectly safe for the mother and the fetus, and can be used for the diagnosis of acute pyelonephritis during pregnancy, along with other procedures.

Acute Disease↗

PubMed1989

[Interferon in the modulation of the immune response in pyelonephritis caused by Staphylococci and Pseudomonas aeruginosa].

In experiments on mice the influence of mouse serum interferon, type I, on immune response in pyelonephritis caused by staphylococci and P. aeruginosa has been studied. The immunomodulating action of interferon and its therapeutic effectiveness have been shown to depend on the etiology of the disease. When injected intraperitoneally in a dose of 1,000 ED, interferon produces a pronounced therapeutic effect in pyelonephritis caused by P. aeruginosa and no effect in pyelonephritis of staphylococcal etiology. Type I interferon introduced in the dose used in this investigation has no influence on the killer activity of spleen lymphocytes, enhances the activity of the complement and the production of antibodies, produces a leukopenic effect and, depending on the etiology of pyelonephritis, exerts influence on the activity of dehydrogenases, the number of EAC- and E-rosette-forming cells, the oxidation metabolism of neutrophils and their phagocytic activity.

Animals↗

PubMed1986

[Ciprofloxacin and cefotaxim: pharmacokinetic and therapeutic effectiveness in E. coli pyelonephritis in rats].

Ciprofloxacin was tested in the acute and chronic experimental E.coli pyelonephritis in rats. Its therapeutic efficacy was compared with that of cefotaxime. In the acute pyelonephritis increasing doses resulted in increasing elimination of bacteria from the kidneys. Ciprofloxacin and cefotaxime showed no difference in the efficiency in therapy of the acute pyelonephritis. In chronic pyelonephritis ciprofloxacin proved to be more effective than cefotaxime in spite of identical in vitro activity. Pharmacokinetic data showed that ciprofloxacin was eliminated more slowly than cefotaxime. The long serum half-life and the high volume of distribution could be responsible for the high therapeutic efficacy and could outweigh the disadvantage of metabolic instability.

Acute Disease↗

PubMed1986

[Radionuclide diagnosis of acute pyelonephritis].

Nephroscintigraphy using a 67Ga-citrate complex and 99mTc-pyrophosphate was performed in 88 patients with acute pyelonephritis. Nuclide hyperfixation was revealed in 97.8% of the cases. Three groups of patients were singled out on the basis of the intensity of incorporation and nature of the distribution of the radiopharmaceuticals (RP) in the kidneys. In the 1st group the RP incorporation was insignificant but higher than normal values; the RP distribution in the affected kidney was diffuse-inhomogenous. These changes were considered to be typical of acute serous pyelonephritis. In the 2nd and 3rd groups a sharp rise of the RP accumulation was noted, being typical of acute purulent pyelonephritis. One could distinguish between diffuse and focal lesions by the picture of the RP distribution in the renal parenchyma. Diuresis stimulation made it possible to differentiate an actual nuclide fixation during inflammation from nuclide mechanical retention as a result of urine outflow disorder. According to the authors, both radiopharmaceuticals could be applied for the diagnosis of acute pyelonephritis as well as for differential diagnosis of various forms of the disease.

Acute Disease↗

PubMed1988

Xanthogranulomatous pyelonephritis. A reappraisal and immunohistochemical study.

The clinicopathologic features of 17 patients with xanthogranulomatous pyelonephritis are described, together with results on a number of histochemical and immunohistochemical techniques that were used to demonstrate the variety of cells involved. Based on our clinicopathologic data and review of the literature, we believe that xanthogranulomatous pyelonephritis should be regarded as a destructive, and, at times, tumefactive inflammatory process that may complicate chronic pyelonephritis. The initiation of this process remains an enigma. However, there appears to be three main features that are associated with xanthogranulomatous pyelonephritis: pelvicalyceal obstruction, ulceration of the pelvicalyceal urothelium, and bacterial infection.

Adult↗

PubMed1986

[Prevention of pyelonephritis].

The possibilities of the prophylaxis of pyelonephritis in the intrauterine life, in infancy and childhood, in internal medicine, gynaecology and urology are described. After explanation of the causes of pyelonephritis it is referred to the importance of the asymptomatic, significant bacteriuria and it is emphasized that there is no primary pyelonephritis, but every pyelonephritis is secondary.

Adolescent↗