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PubMed1978

[Pathologic features in diagnosis and differential diagnosis of pyelonephritis (author's transl)].

Morphological diagnosis and differential diagnosis of pyelonephritis are discussed particularily considering macroscopic features. A special form with radiological significance is ncrotizing "emphysematous" pyelonephritis. Chronic non-obstructive pyelonephritis is rarer than formerly thought if strict morphological criteria are applied. It should be differentiated from nephropathy caused by analgetics. In analgesic nephropathy bilateral papillary necrosis is the earliest and most characteristic alteration. Differentiation between chronic pyelonephritis and analgesic nephropathy is possible in most cases but may be difficult if analgesic nephropathy is complicated by bacterial infection. A classification of "unilateral small kidney" is presented. Unilateral acquired "renal shrinkage" should be differentiated from congenital "unilateral hypoplasia". It remains to be discussed whether the so-called "Ask-Upmark-Kidney" is a malformation or the result of chronic pyelonephritis.

Acute Disease↗

PubMed1977

Experimental model of corynebacterium renale pyelonephritis produced in mice.

Corynebacterium renale type I (strain 115), 1.7 X 10(7) to 4.5 X 10(7) organisms, introduced intravenously into mice disappeared from the blood less than 24 h after inoculation and did not produce pyelonephritis. The same strain, 1 X 10(7) to 5 X 10(7) organisms, inoculated into the urinary bladder of mice was not recovered from the blood in any of the mice, but caused pyelonephritis accompanied by ureteritis and cystitis in 16 of 21 (76%) mice. Pyelonephritis and cystitis in mice were histopathologically similar to those found in cows. The antibody response was observed only in the mice with pyelonephritis or pyelitis, but not in those with only cystitis or in those without lesions, as found in cows. Similar diseases were produced in mice by C. renale types II and III but less frequently than by type I. It is suggested, therefore, that mice may be useful in the study of bovine C. renale infection.

Animals↗

PubMed1978

Interaction of human serum and neutrophils with Escherichia coli strains: differences between strains isolated from urine of patients with pyelonephritis or asymptomatic bacteriuria.

Strains of Escherichia coli isolated from the urine of children with pyelonephritis (n = 18) or asymptomatic bacteriuria (ABU) (n = 20) were serotyped and compared with respect to opsonic requirements, sensitivity to serum, amount of chemiluminescence produced by normal neutrophils during phagocytosis of the various strains, and amount of capsular antigen. Strains isolated from cases of ABU more often had the capacity to activate the alternative complement pathway than had strains causing pyelonephritis. The ABU strains were also better opsonized in fresh human serum and were more often serum sensitive than the pyelonephritic strains. There were individual variations in neutrophil chemiluminescence during phagocytosis of the various strains, but the two groups of strains did not differ significantly. The strains from pyelonephritis cases produced a greater amount of capsular antigens than the ABU strains. There was no correlation between presence of a particular O or K antigen and capacity to activate the alternative complement pathway. The observed differences between strains isolated from patients with ABU and those isolated from patients with pyelonephritis may be relevant for further studies on differences in bacterial virulence or host defense factors.

Antigens, Bacterial↗

PubMed1976

Hypertension and plasma renin activity in experimentally induced chronic pyelonephritis.

The present authors conducted a series of experiments with mongrel dogs, in which unilateral chronic pyelonephritis was induced and postoperative changes in blood pressure and plasma renin activity were observed over a period of 3 months. The pyelonephritis infection was brought about by a method involving vesicoureteral reflux and ureteral dysfunction, as described in a previous paper. Pre- and postoperative levels of systolic pressure were compared, but no definite trends were found for the first 3 weeks after operation. At 30, 60 and 90 days the pressures were found to have risen by 21.2 +/- 14.6 and 17.1 +/- 16.7 mm Hg, respectively. No appreciable change in the plasma renin activity was found, however, at any stage. From these results it was concluded that experimentally induced chronic pyelonephritis in dogs caused a rise in blood pressure. No connection between the pyelonephritis and the renin angiotensin system was found.

Animals↗

PubMed1979

[Significance of the ability of E. coli to alter capillary permeability for the reproduction of pyelonephritis in mice].

Experiments in a number of biological models showed that the cultures of E. coli isolated from the urine of children with pyelonephritis had a varied spectrum of pathogenic properties. Histologically confirmed pyelonephritis induced by intravenous infection in CBA mice, treated with 5% glucose by the method of Montgomerie et al., correlated with the bacterial adhesiveness to the epithelium and the interference with capillary permeability, registered in experiments on the pulmonary model with Evans blue used for control. The criterion for the development of pyelonephritis in mice, which was based, in the opinion of Mintogemerie et al., on the positive results, indicating the presence of the infecting agent in the culture obtained by inoculation with the samples of urine and kidney tissue, was found to be insufficient, as only 28 out of 45 cultures of E. coli isolated from the kidneys coincided with histologically confirmed cases of pyelonephritis.

Animals↗

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↗

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↗

PubMed1977

Cancer of the urinary bladder and pyelonephritis.

Successful treatment of cancer of the urinary bladder consists not only in elimination of the tumour process, but also in prophylaxis of various complications. Among complications caused by the tumour process as well as by the applied methods of its therapy a certain place belongs to pyelonephritis. Pyelonephritis develops in consequence of the disturbance of the function of the urinary bladder after hemicystectomy resulting from the change of the bladder's form. With the view of preserving the anatomo-physiological function of the urinary bladder and preventing complications the author suggests a method of reconstruction of the bladder consisting in shaping it in a spherical form after hemicystectomy. Such shape of the urinary bladder ensures nearly normal conditions for both urination act and urinary flow from the upper urinary pathways, this being the prophylaxis of pyelonephritis.

Humans↗

PubMed1979

Alanine-aminotransferase activities in the renal tissue during experimental and chronic human pyelonephritis.

In chronic experimental and human pyelonephritis (PN) simultaneously renal enzyme and phosphatide analyses and quantitative histological examinations were performed. The results reported in this study refer only to alanine-aminotransferase (AlAT) activities. 139 rabbits developed unilateral experimental pyelonephritis, in further 19 rabbits the experimental PN did not settle or "healed up spontaneously". 31 samples of human pyelonephritis nephrocirrhotic kidneys and 20 samples of healthy human kidneys were examined. Glomerular AlAT-activities increased initially up to the 31-days series, thereafter they decreased without any exception. In the cortical tubules of the rabbit kidneys the enzyme activities increased also up to the 31-days-series, later on they decreased extremely. The medullary AlAT-activities similarly showed increasing values till the 31-days-series, which were followed by sharply depressed data. In the "spontaneously healed up" tissue the glomerular AlAT was increased more than 100%, the cortico-tubular one nearly 100%, and the AlAT of the medulla paralleled the increased values of the 20-days series nearly. The human samples of pyelonephritic nephrocirrhosis showed in all 3 fractions (glomerula, cortical tubules and medulla) extremely depressed AlAT-activities. The significance calculations (universally applied t-test) showed an overhelming majority of the values with significance (p less than 0.001). The measured enzyme activities correlate well with the quantitative histological examinations.

Alanine Transaminase↗

PubMed1978

Xanthogranulomatous pyelonephritis: a critical analysis of 26 cases and of the literature.

Manifestations of xanthogranulomatous pyelonephritis in 26 patients closely mimicked those of neoplastic and other inflammatory renal parenchymal diseases. Middle-aged or older women were affected most often. Most patients presented with anemia, chronic febrile illness, a painful tender flank mass and recurrent urosepsis. Some features of nephrogenic hepatic dysfunction were present in 13 patients. Bacterial cultures of renal tissue were almost always positive but the spectrum differed considerably from that of the bladder urine. Urographically, a renal mass lesion was encountered in 62% of the patients, nephrolithiasis in 38% and a functionless kidney in 27%. Angiographically, none of the 4 mass lesions studied was distinguished from hypernephroma. Indeed, a correct preoperative diagnosis was made in only 1 instance. There were 3 stages of xanthogranulomatous pyelonephritis recognized. Treatment consisted of nephrectomy for diffuse or advanced stage disease or both (21 patients), excision of the diseased renal segment for localized and low stage disease (2 patients) and renal biopsy (3 patients). Xanthogranulomatous pyelonephritis did not recur but in some patients bacteriuria continued or hypertension developed.

Adolescent↗

PubMed1977

Diffuse xanthogranulomatous pyelonephritis in children: an unrecognized variant.

Xanthogranulomatous pyelonephritis in childhood has been thought to exist only in focal form. We encountered 2 cases of diffuse xanthogranulomatous pyelonephritis in children and have found 3 others reported in the literature, making it necessary to change this concept. The essential radiologic and pathologic differences between focal and diffuse xanthogranulomatous pyelonephritis are reviewed.

Child, Preschool↗

PubMed1977

Significance of antibody-coated bacteria in urinary sediment in experimental pyelonephritis.

The sequential appearance of antibody-coated bacteria in urinary sediment was followed in experimental pyelonephritis produced with Escherichia coli O6:K13:H1. It was possible to determine against which antigen of the organism this antibody was directed. Antibody-coated bacteria appeared by day 11 of infection, a time which coincided with the synthesis of local (intrarenal) antibody. Bacteria coated with antibody more than three days after serum antibody but four days before urinary antibody appeared. Antibody eluted from coated bacteria was directed against the O-antigen of the infecting organism but not the K-antigen. Newly synthesized intrarenal antibody and urinary antibody were directed only against O-antigen, but not against K-antigen; this finding would explain why the antibody that coated the bacteria was antibody to lipopolysaccharide. Thus, a positive test for antibody-coated bacteria indicates that a local immune response to O-antigen has occurred. It is postulated that this immune response could relate to the clinical symptomatology of acute symptomatic pyelonephritis since most patients presenting with acute pyelonephritis have bacteria coated with antibody.

Animals↗

PubMed1978

Reflux nephropathy and chronic atrophic pyelonephritis: a review.

Chronic atrophic pyelonephritis is associated with vesicoureteric reflux in infancy. Reflux disappears during childhood in 50% of cases. It is more commonly detected in infants (49%) and children (26%) with infection than in adults (4.4%). Severe reflux may persist in adults and is usually (94%) associated with scarring. Patients with end-stage renal failure due to pyelonephritis are much younger than patients with end-stage renal failure due to other causes. The incidence of reflux according to sex is equal in infancy, but after infancy both pyelonephritic scarring and reflux are far more common in females. Infection is the likely cause of progressive scarring in females. Hypertension is associated with chronic atrophic pyelonephritis. Proteinuria is the worst prognostic feature in patients with reflux nephropathy and pyelonephritic scarring. Intrarenal reflux determines the site of scarring. The role of surgical correction of vesicoureteric reflux remains uncertain, but meticulous control of infection appears to prevent progressive scarring.

Adolescent↗

PubMed1979

Synergism of ampicillin and gentamicin against obstructive pyelonephritis due to Escherichia coli in rats.

Rats with obstructive pyelonephritis due to Escherichia coli were treated for different intervals with ampicillin and gentamicin either alone or in combination. The combination of ampicillin and gentamicin was synergistic in vitro and significantly more effective in vivo than was either drug alone. After treatment for 10 days, the combination of ampicillin and gentamicin was the only regimen that sterilized all of the pyelonephritic kidneys. The importance of achieving sterility was illustrated by the observation that severe infection and acute pyelonephritis recurred after religation of the ureter in 12 (71%) of 17 ampicillin-treated animals that had harbored as few as 46 organisms per kidney before ligation. A synergistic combination of antibiotics rapidly sterilizes obstructed pyelonephritic kidneys. In view of the particular risk of renal infection in the presence of urinary obstruction in humans, synergistic antibiotic combinations may be useful in the treatment of obstructive pyelonephritis in humans.

Acute Disease↗

PubMed1979

Suppressed lymphocyte mitogen-responsiveness in urinary tract infections of children and its correlation to pyelonephritis.

Cell-mediated immunity (CMI) was studied in a group of 48 children with urinary tract infections (UTI) using a whole blood micromethod for lymphocyte stimulation in vitro. The patients were subdivided into pyelonephritis group (27 cases) and lower urinary tract infection (LUTI) group (21 cases) on the basis of fever, erythrocyte sedimentation rate, C-reative protein and renal concentration capacity. At the acute stage of infection the lymphocyte responsiveness to leucoagglutinin (LA) and concanavalin A (Con A) was suppressed in both groups, but the suppression was much greater in those with pyelonephritis. By 6 weeks after infection the lymphocyte responses were normal in most but not all cases. We conclude that an acute pyelonephritis is associated with marked suppression of CMI and that the latter can be used as an additional criterion for establishing the level of infection. Patients with UTI did not generally appear to have any primary defect of CMI but when suppression of CMI was present, it seemed secondary to an ongoing infection.

Agglutinins↗

PubMed1977

Influence of acetohydroxamic acid on experimental Corynebacterium renale pyelonephritis.

The role of Corynebacterium renale urease in the establishment of pyelonephritis was studied by the oral administration of acetohydroxamic acid (AHA), a urease inhibitor, to experimentally infected rats. The bacteria were introduced by surgical insertion of a zinc disc containing 1 X 10(6) colony-forming units of C-renale into the urinary bladder whereas sterile discs were implanted in the bladders of the control animals. Daily administration of AHA via the drinking water did not halt the development of pyelonephritis. Larger doses, given by gavage, did accomplish this goal; that is, the pH of the urine was lowered, the number of colony-forming units of C. renale in the kidney was reduced drastically, and pyelonephritic lesions were observed in the kidney by light-microscopic examination. All experimental rats developed cystitis in varying degrees of severity. About 70% of the intact AHA given by gavage was excreted in the urine 24 h after administration of this compound. Rats implanted with a urease-negative mutant of C. renale displayed no signs of pyelonephritis but did develop cystitis.

Animals↗

PubMed1979

The sonographic appearance of acute pyelonephritis.

Acute pyelonephritis and acute ureteral obstruction often present with similar clinical and urographic findings. Ultrasound, however, can easily detect the presence of obstruction as well as demonstrate characteristic findings suggestive of acute pyelonephritis, and thus allows differentiation. In two patients with acute pyelonephritis, the ultrasonic findings consisted of a large swollen kidney with an increased anechoic corticomedullary area, with multiple scattered low-level echoes. Each of the two cases is discussed in detail.

Acute Kidney Injury↗

PubMed1979

Immunological aspects of pyelonephritis.

Several virulence factors, such as O and K antigens and capacity to attach to uroepithelial cells, seem to be required for Escheria coli to cause acute pyelonephritis. These factors induce an immune response, however, which can modify the course and clinical expression of the infection. During acute pyelonephritis, autoantibodies to the Tamm-Horsfall protein increase. These antibodies, which probably are evoked by a cross-reaction noted between structures of E. coli LPS and the Tamm-Horsfall protein, may add to the renal tissue engagement in interstitial nephritis caused by bacterial pyelonephritis.

Acute Disease↗