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PubMedDate not supplied

[The surgical treatment of suppurative destructive forms of acute pyelonephritis in pregnant women].

The paper presents the results of surgical treatment of pyodestructive pyelonephritis diagnosed in 111 puerperae and gravidae. Suppurative nephritis, carbuncle and abscess of the kidney ran as unilateral (94 patients, 84.7%) or bilateral (16 patients, 14.4%) process. The diagnosis of pyodestructive pyelonephritis of the solitary kidney was made in 1 gravida. The outcomes of pyodestructive pyelonephritis in puerperae and gravidae depend primarily on individual approach to therapy. Different operative interventions warranted a complete response in 97.3% of the gravidae. 96 of 108 gravidae operated on the kidneys delivered viable neonates. Early operative interventions in many cases preserved the kidney and prevented septic complications. Pyodestructive changes restricted to 1-2 segments of the kidney were effectively treated by nephrostomy. Bilateral pyodestructive pyelonephritis should be managed step-by-step starting at the side of the most evident symptoms. Two-stage bilateral lumbotomy with nephrostomy in combination with antibacterial therapy and plasmapheresis eliminated septic complications thus allowing normal development of the fetus. Nephrectomy is the best treatment in advanced pyodestructive lesion with severe life-threatening septic intoxication.

Acute Disease↗

PubMed1997

Pyelonephritis and vesicoureteral reflux after renal transplantation in young children.

PURPOSE: We assessed morbidity and risk factors of pyelonephritis in children after renal transplantation. MATERIALS AND METHODS: Between 1986 and 1995, 41 children underwent transplantation and all who had documented pyelonephritis were evaluated. RESULTS: Six children who underwent transplantation before age 7 years had 1 to 3 episodes of pyelonephritis with significant renal dysfunction and vesicoureteral reflux into the grafted system. An antireflux reimplantation procedure in 5 children was complicated by temporary functional obstruction in 3. No further infection occurred after correction of vesicoureteral reflux. After a median of 4.5 years post-transplantation all patients have a functioning graft. CONCLUSIONS: After renal transplantation vesicoureteral reflux and young recipient age are major risk factors for pyelonephritis with subsequent graft dysfunction.

Adolescent↗

PubMedDate not supplied

[New data on the etiological factors in acute pyelonephritis].

Spectrum of microbe agents of acute pyelonephritis has been studied. It is shown that Mycoplasma hominis plays an important role in etiology of acute pyelonephritis besides the already known enterobacteria and Gram-positive cocci. It is also established that mycoplasmal pyelonephritis more often develops in patients with the diseases of urinary blade (cystitis) and genital organs. Results of serological investigations which confirm etiological role of isolated microorganisms in the initiation of acute pyelonephritis are presented.

Acute Disease↗

PubMed1976

[Roentgen diagnosis of pyelonephritis].

With the help of special literature and the results of own investigations the usability and evidence of radiological examination methods in the diagnosis of pyelonephritis are described. The high value of urography in the ascertainment of predisposing factors for pyelonephritis is emphasized. Subject of nearer considerations is the characteristic radiological feature of chronic pyelonephritis in its different developmental stages. Especially in connection with the decent radiological changes in the early forms of chronical pyelonephritis is referred to the necessity of an optimal collaboration between clinician and radiologist.

Acute Disease↗

PubMed1976

[Chemotherapy in pyelonephritis].

In the present paper the most important general directions of the chemotherapy of the acute as well as the chronic pyelonephritis are explained. In adult age actual acute pyelonephritides are rare. In most cases acute attacks of chronic pyelonephritides are in question. Also in the acute pyelonephritides for the initial therapy the application of highly effective chemotherapeutics is recommended which lead to high tissue and serum levels. The exclusive application of nitrofurantoin or an only symptomatic therapy is not indicated in acute pyelonephritis. Only a consequent therapy of the acute form of the course gives the possibility to reduce the number of chronic pyelonephritides. The most favourable conditions for the treatment of chronic pyelonephritis with the aim of stopping the chronic process or eventually even a cure are given by the long-term therapy. For the initial therapy according to the antibiogramme a tissue effective chemotherapeutic remedy is administered. This was followed by a long-term prophylaxis of about 6 months. Taking into consideration the therapeutic mechanisms of the preparations and the severity of the clinical picture always the least toxical antibacterial remedies should be administered. The most important chemotherapeutics for the therapy of pyelonephritis, their side-effects and the peculiarities of their use in renal insufficiency are discussed.

Acute Disease↗

PubMed1998

[Emphysematous pyelonephritis].

Pyelonephritis is a frequent infection of variable severity. Mortality is low since the era of antibiotics. Emphysematous pyelonephritis is however a rare but life threatening form of kidney infection, which affect more frequently diabetic subjects, characterized by gas producing bacteria. These gaseous lesions can be localized in the renal parenchyma or in the perirenal or retroperitoneal space. Diagnosis became easier with the advent of CT scan. Treatment usually requires surgery and antibiotics. We report a case of emphysematous pyelonephritis in a diabetic patient. The CT scan strongly suggested the diagnosis which was confirmed per-operatively. Proteus mirabilis is exceptionally described in emphysematous pyelonephritis.

Aged↗

PubMed2000

Blood cultures in pyelonephritis: Do results change therapy?

OBJECTIVE: To determine how often blood culture results are instrumental in directing the therapy of patients with pyelonephritis. METHODS: Retrospective chart review of all patients admitted to Doctors Hospital with a diagnosis of pyelonephritis to ascertain whether the results of blood cultures were instrumental in the management of those patients. For study purposes, results of blood cultures were considered instrumental if the treatment regimen or diagnostic procedures were changed because of those results. RESULTS: 212 patients were admitted during the study period with a diagnosis of pyelonephritis. Of these, 105 (49.5%) had blood cultures ordered as part of their workup. Adult patients had at least 2 blood cultures ordered and some had as many as 4 or 6 sets ordered during hospitalization. Most pediatric patients had only a single blood culture ordered for diagnosis. Of the 105 patients, 88 (83.5%) had no growth on any of the tubes drawn. 17 patients had positive growth in at least one tube; however, 6 out of these 17 patients were judged by the treating physician to have contaminated cultures that were not diagnostically useful. Of the 105 patients, only 11 (10.4%) were considered to have positive culture results by their treating physician. The organism identified by blood culture was compared to that present in the patient's urine culture, and in only 2 patients did the results differ and were found to have a secondary site of infection. Only in these 2 cases were the antibiotic regimens changed because of the blood culture results. No patient without a second site of infection had a change in therapy based on the blood culture results. CONCLUSIONS: In patients admitted for pyelonephritis, blood cultures may not be needed.

Journal Article↗

PubMed1966

Pyelonephritis in the diabetic. Correlation of open renal biopsies and bacteriologic studies.

In a study of 80 juvenile diabetic patients, chronic pyelonephritis was found histologically in seven (9%) of open renal biopsies. Twelve patients (15%) had positive urine cultures. No patient had a positive renal-biopsysite culture. Three patients (4%) had positive renal-tissue cultures. There was essentially no correlation found between the presence of positive urine cultures, positive tissue cultures, and the histological diagnosis of chronic pyelonephritis. It is suggested that factors other than the continued presence of bacteria in the kidney may play a role in the pathogenesis of chronic pyelonephritis.

Bacteriuria↗

PubMed1981

Xanthogranulomatous pyelonephritis.

Thirty-eight nephrectomy specimens and two biopsies of perinephric abscesses from patients with xanthogranulomatous pyelonephritis have been examined. Twenty showed evidence of venous damage. This included organised thrombi in 12, intimal thickening in five and phlebitis in three. All specimens showed evidence of previous haemorrhage in the form of haemosiderin deposition. These findings differed significantly from a control series of chronic pyelonephritis. It is suggested that venous occlusion and haemorrhage are factors in the pathogenesis of the lipid accumulation in the kidney which is characteristic of this condition. The association of a papillary transitional cell carcinoma of the pelvis in a patient with xanthogranulomatous pyelonephritis is reported for the first time.

Adult↗

PubMed1996

Virulence factors and O groups of Escherichia coli isolates from patients with acute pyelonephritis, cystitis and asymptomatic bacteriuria.

The relationship between the presence of bacterial virulence factors and the severity of urinary tract infection (UTI) was analized in this study. The production of alpha-hemolysin (Hly), the expression of P-fimbriae and the mannose-resistant hemagglutination (MRHA) type IVa (associated with the presence of P-fimbriae), were all detected more frequently in Escherichia coli strains from acute pyelonephritis than in strains isolated from cystitis and asymptomatic bacteriuria. In contrast, the production of cytotoxic necrotizing factor type 1 (CNF1) and the expression of MRHA types III and IVb were distributed uniformly between strains causing different clinical categories of UTI. Thus 88% of the E. coli strains from acute pyelonephritis showed some of the virulence factors investigated in this study, whereas only 60% (p < 0.01) and 56% (p < 0.01) repectively of the strains isolated from cystitis and asymptomatic bacteriuria possessed virulence factors. There were no significant differences in the prevalence of virulence properties between strains isolated from patients with or without complicating factors. Only 16% (p < 0.001) of the fecal isolates from healthy individuals showed virulence factors. The virulence factors were concentrated in strains belonging to 10 (O1, O2, O4, O6, O7, O14, O18, O22, O75 and O83) of the 12 serogroups most frequently detected in uropathogenic E. coli strains. The majority of uropathogenic O4, O6, O14, O22, O75 and O83 E.coli strains were Hly+CNF1+ and expressed P-fimbriae or MRHA type III, whereas the strains of serogroup O18 were Hly+CNF1- and P-fimbriated. Among O1 and O7 strains we found Hly-CNF1-strains that expressed P-fimbriae. Among O2 strains we found Hly+CNF1+ strains that expressed P-fimbriae or MRHA type III and other Hly-CNF1-strains that possessed P-fimbriae. We conclude that E.coli strains isolated from pyelonephritis show virulence factors more frequently than those from cystitis and asymptomatic bacteriuria, and that strains that cause urinary tract infections in Spain belong to the same serogroups as uropathogenic E.coli isolated in other areas of the world. Our results support the special pathogenicity theory and suggest that many cases of serious urogenital disease may be caused by a limited number of P-fimbriated E.coli strains that usually produce alpha-hemolysin.

Acute Disease↗

PubMed1980

Virulence of Escherichia coli in acute pyelonephritis, acute cystitis and asymptomatic bacteriuria.

E. coli strains were isolated from urine specimens of hospitalised patients with acute pyelonephritis, acute cystitis or asymptomatic bacteriuria (ABU), and tested for virulence in an experimental mouse model. Of 12 pyelonephritis-strains 11 were shown to be virulent and 1 avirulent; of 12 cystitis-strains 4 were virulent and 8 avirulent; of 12 ABU-strains 5 were virulent and 7 avirulent. It is concluded that, while no difference in virulence was found between cystitis- and ABU-strains, pyelonephritis-strains were more often virulent than cystitis- and ABU-strains. No associations could be shown between virulence of the isolated strains and the presence of antibody-coated bacteria in the urine. Common urinary O types were not more often virulent than other O types. No relationship was seen between virulence and the presence of K antigen or the presence of particular K types.

Acute Disease↗

PubMed1995

The possible role of granulocyte elastase in renal damage from acute pyelonephritis.

During acute inflammatory processes, extracellular release of granulocyte elastase can contribute to subsequent tissue damage. To test our hypothesis that extracellular elastase release during acute pyelonephritis may contribute to subsequent renal parenchymal damage, we compared the intracellular and extracellular activities of the lysozyme elastase of human polymorphonuclear cells (PMN) when incubated in vitro with bacterial strains causing renal infection that led to either renal damage or no damage. Urine bacterial cultures were obtained from patients with acute pyelonephritis (flank pain, costovertebral angle tenderness, fever > 38 degrees C, bacteriuria, pyuria, and leukocytosis). Renal damage was demonstrated by cortical scarring on followup intravenous pyelography and/or diminished function on 131iodine hippuran renal scan. Mean extracellular elastase activity (mu units/PMN) was 0.15 for unstimulated PMN, 0.07 for PMN stimulated by bacteria not associated with renal damage, and 1.20 for the PMN stimulated by strains associated with renal damage. Mean intracellular elastase activity (mu units/PMN) was 3.73 for unstimulated PMN, 3.48 for PMN stimulated by bacteria not associated with renal damage, and 3.31 for the PMN stimulated by strains associated with renal damage. Extracellular granulocyte elastase activity was thus significantly higher (P = 0.0001) in PMN stimulated by bacterial strains associated with renal damage. Extracellular release of elastase may contribute to the pathogenesis of renal damage in pyelonephritis.

Acute Disease↗

PubMed1976

[Antibody binding bacteria in the urine in chronic pyelonephritis].

Using the direct immunofluorescence technique antibody-coated bacteria were demonstrated in urine samples from 49 of 57 patients with the clinical diagnosis of chronic pyelonephritis, but were not observed in urines from 11 patients with cystitis. A correlation rate was found between the presence of antibody-coated bacteria in the urine seidment and elevated serum antibody titers in the pyelonephritis group as determined by the indirect immunofluorescence technique. Patients with elevated serum antibody titers without antibody-coated bacteria in the urine, and vice versa, were also found. Patients with cystitis did not have elevated serum antibody titers against the homologous strain isolated from the urine. The clinical diagnosis of chronic pyelonephritis could be confirmed in 86.5% of patients taking into account the presence of antibody-coated bacteria and/or elevated serum antibody titers.

Adult↗

PubMedDate not supplied

Virulence properties of Escherichia coli strains in patients with chronic pyelonephritis.

In 50 Escherichia coli strains obtained from the bladder puncture urine of patients with chronic pyelonephritis, determinations of virulence properties were performed. All of the E. coli strains isolated from 26 acute episodes of pyelonephritis were found in the smooth form. 30% possessed K 1 antigen, 77% showed the ability to form hemolysin and 30% produced colicin V (aerobactin). Fimbriae (detected by mannose-resistant hemagglutination) were registered in 81%, and plasmids ranging between 50 and 70 Md were demonstrated in 70% of the bacteria. In contrast to this, only 70% of the E. coli strains isolated from 24 patients at an inactive stage of pyelonephritis were found in the smooth form; 10% of these encoded K 1 antigen, 20% hemolysin and 10% colicin V. Plasmids in the range 50 to 70 Md could be found in 30%. On the basis of multivariate analysis of variance and discriminant analysis, it was confirmed that uropathogenic strains possess several virulence properties, mannose-resistant hemagglutination being of particular importance.

Adult↗

PubMed1979

[Chronic pyelonephritis in adults (author's transl)].

The frequency of chronic pyelonephritis is often overestimated. Chronic pyelonephritis is probably always a secondary disease in cases with obstructive changes in the ureters or other primary renal damage. The influence of chronic infection on the progression of renal insufficiency is still not well understood today. Underlying disease and infection should always be taken into consideration in the treatment of chronic pyelonephritis.

Adult↗

PubMed1986

Fecal colonization with pyelonephritogenic Escherichia coli in neonates as a risk factor for pyelonephritis.

The aim of the study was to investigate the properties of fecal P-fimbriated Escherichia coli strains in neonates and to relate these characteristics to the later development of acute pyelonephritis. In a 2 1/2 year prospective study of the children admitted to a particular neonatal ward, 113 children were found to be fecally colonized with a P-fimbriated Escherichia coli strain. However, only one of these children developed pyelonephritis from this strain during the first year of life. The combined results of serotyping, biochemical phenotyping and determination of outer membrane protein pattern as clonal characterization suggested that only 26 of the P-fimbriated strains belonged to a pyelonephritogenic Escherichia coli clone. It is concluded that the risk of a child colonized with an Escherichia coli strain belonging to such a clone of developing pyelonephritis, as calculated in this study, is about 4%.

Acute Disease↗

PubMed1992

Color Doppler sonography in pyelonephritis.

Renal sonography detects abnormality in only 40% of pediatric pyelonephritis. In eight patients shown to have acute pyelonephritis by 99mTc DMSA renal cortical scintigraphy, five were found to have focal abnormalities of renal perfusion by color Doppler sonography in the same sites as the scintigraphic defects (sensitivity-63%). Two of the five patients had normal plain sonograms. False positive studies occurred in patients with documented chronic renal scarring. The specificity of vascular asymmetry was 70%. This preliminary report suggests that, particularly in the patient without pre-existing renal scarring, color Doppler evaluation of the renal vasculature may increase the sensitivity of sonography in the diagnosis of pyelonephritis in children.

Adolescent↗

PubMed1994

Urine interleukin-6 and interleukin-8 in children with acute pyelonephritis, in relation to DMSA scintigraphy in the acute phase and at 1-year follow-up.

The relationship between urine interleukin-6 (IL-6) and interleukin-8 (IL-8)/creatinine quotients and 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy, performed within 10 days of acute first-time pyelonephritis and after 1 year, was studied in 41 children. The urine IL-6 and IL-8/creatinine quotients were also related to the urine N-acetyl-beta-D-glucosaminidase (NAG) and albumin/creatinine quotients. Presence of DMSA uptake defects, reflecting local inflammation, in children in the acute phase of pyelonephritis, were associated with elevated urine IL-6/creatinine quotients (median 27 pg/mumol); in children without DMSA changes there was no increase in quotients (median non-detectable) (P < 0.05). Persistent DMSA changes at the 1-year follow-up, probably reflecting renal scarring, were only seen in children with increased urine IL-6/creatinine quotients in the acute phase (P < 0.01). No correlation was found between urine IL-8 and DMSA uptake defects. Vesicoureteral reflux (VUR) at 6-8 weeks did not correlate with the urine cytokine levels in the acute phase. The urine excretion of NAG and albumin, reflecting renal dysfunction, was associated with values of both urine IL-6 and IL-8/creatinine quotients, but not with DMSA defects or VUR. Thus, the initial urine IL-6/creatinine quotients might be used as an indicator of risk for persistent renal damage in acute pyelonephritis.

Acetylglucosaminidase↗