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PubMed1993

Asymptomatic acute pyelonephritis as a cause of acute renal failure in the elderly.

Urinary tract infections in the elderly are common, often asymptomatic and usually benign. We report three patients who presented with acute renal failure due to acute pyelonephritis in the absence of clinical findings of infection or urinary tract obstruction. Blood and urine cultures grew Escherichia coli in two of the patients and in two patients renal biopsy confirmed acute pyogenic pyelonephritis. Antimicrobial therapy and haemodialysis led to improvement, though one patient subsequently died from an unrelated cause. We suggest that acute bacterial pyelonephritis should be considered as a cause of acute renal failure in the elderly. Clinical features of infection may be absent despite bacteraemia. Prompt diagnosis and intervention may avoid chronic renal failure in a group that has a less favourable outcome with long-term dialysis.

Acute Disease↗

PubMed1993

Bacterial flora of the urinary tract of pigs associated with cystitis and pyelonephritis.

Twenty-three cases of porcine cystitis and pyelonephritis were examined bacteriologically. Eubacterium suis was found in 21 cases. The isolation of large numbers of Escherichia coli in the upper urinary tract was associated with linear renal scarring. An unidentifiable streptococcus and Enterococcus faecalis were isolated from a case of purulent ureteritis, pyelitis and pyelonephritis. The bacterial flora from cases of cystitis and pyelonephritis was different from that isolated from sows with asymptomatic bacteriuria.

Animals↗

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↗

PubMed1986

Lack of protection against ascending Escherichia coli pyelonephritis in diabetic rats following immunization with purified lipopolysaccharide.

Purified lipopolysaccharide of Escherichia coli produced specific antibody when injected intraperitoneally or given to rats orally. Either route of immunization did not prevent ascending pyelonephritis in a diabetic rat model. The use of purified LPS excludes the potential contribution of other virulence factors of E. coli as protective antigens in the prevention of ascending pyelonephritis and confirms that anti-lipopolysaccharide antibody is not protective for ascending pyelonephritis.

Administration, Oral↗

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↗

PubMed2006

[Amyloidosis secondary to xanthogranulomatous pyelonephritis: a case report and review of the literature].

Xanthogranulomatous pyelonephritis (XGP) is a rare entity characterized by the formation of inflammatory renal masses rich in macrophages loaded with lipids. It is usually secondary to repeated urinary infections and urinary obstruction due to stones, which produce slow destruction of the renal parenchyma, requiring nephrectomy. It may sometimes be associated to secondary amyloidosis that leads to the appearance of a nephrotic syndrome. We have conducted a search in the Medline database between the years 1967 and 2003 and we only found 6 cases in adults and 3 cases in pediatric patients with amyloidosis secondary to xanthogranulomatous pyelonephritis. During this same period, there are more than 570 citations that include more than 1,000 patients with isolated XGP, so that we estimate that amyloidosis that complicates a XGP should be less than 1% of all the XGP cases. We present a case of XGP in a 51 year old female patient associated to amyloidosis that initiated with nephrotic syndrome, analyzing the clinical characteristics of the 9 previous cases. We compared their clinical characteristics with those of 51 patients with xanthogranulomatous pyelonephritis without amyloidosis of a large classical series in order to characterize this clinical picture better.

Amyloidosis↗

PubMed2006

[Acute pyelonephritis treated under "home hospitalization." Ten years' experience].

INTRODUCTION: We present the experience of the Vitoria-Gasteiz Hospital at Home Unit in the treatment of acute pyelonephritis, including an analysis of potential predictors of failure. PATIENTS AND METHODS: A total of 369 episodes of acute pyelonephritis without septic shock or renoureteral obstruction are described. After initiating intravenous antibiotic therapy in the hospital emergency department, all patients were referred to the HH. We analyzed the characteristics of the cases and the relationship between several clinical factors and failure of HH care, defined as the need to readmit the patient to conventional hospitalization. RESULTS: During the study period, 280 women and 89 men (age 16-88 years) met the inclusion criteria. Mean length of HH stay was 5 days and duration of intravenous therapy was 3 days. Sixteen of the 369 cases (4%) had to be readmitted to the hospital because of hypotension, vomiting, pain, fever, or signs of obstruction on ultrasound or because they requested it (four patients). Patients who were readmitted had a higher maximum temperature (mean 39.4 vs. 38.7 degrees C; p = 0.006) than those who remained at the HH. There were no differences between the groups with respect to the other clinical variables studied. The evolution of all 16 hospitalized patients was favorable; only one required a urological intervention. CONCLUSIONS: Hospital at home care was an effective alternative for managing acute pyelonephritis without shock in 96% of cases referred by the emergency department, and obviated conventional hospital admission, which is usually indicated for this disease.

Acute Disease↗

PubMed2006

Acute pyelonephritis associated with transudative pleural effusion in a middle-aged woman without urinary tract obstruction.

OBJECTIVE: To describe a case of acute pyelonephritis associated with pleural effusion. CLINICAL PRESENTATION AND INTERVENTION: A 39-year-old female non-smoker who had Escherichia coli bacteremia due to acute pyelonephritis, developed bilateral transudative pleural effusions during hospitalization. She was successfully treated with intravenous antibiotic therapy. Follow-up chest radiographs revealed complete resolution of the bilateral pleural effusions. CONCLUSION: Though quite rare, pleural effusion is a potential complication of acute pyelonephritis. The exact pathogenesis of transudative pleural effusion is unknown, but the effusion may resolve spontaneously when infection is adequately controlled.

Acute Disease↗

PubMed1989

Pyelonephritis complicating relapsing acute pancreatitis.

A case of right pyelonephritis with hydronephrosis complicating relapsing acute pancreatitis and right pararenal phlegmon formation is presented. Hydronephrosis is a reportedly rare complication of extrapancreatic inflammation; the only 6 previous cases involving the right side are reviewed. The present case report, to our knowledge, is the first to describe clinical and laboratory evidence of pyelonephritis secondary to partial obstruction of the right upper renal tract by an extrapancreatic phlegmon. The clinician caring for patients with acute pancreatitis should be aware of this important complication, since the presentation of pyelonephritis-flank pain and fever--could erroneously be attributable solely to the pancreatitis.

Acute Disease↗

PubMed1975

A new method for producing a chronic E. coli pyelonephritis in rabbits.

Chronic pyelonephritis, especially that caused by the most common invader E. coli, corresponding satisfactorily to the pathophysiology of the human disease is difficult to reproduce. We have developed a pattern of infection with which we succeeded reliably in producing a chronic E. coli pyelonephritis. This was achieved by inserting a plastic catheter into the renal pelvis. A suspension of E. coli was injected via the catheter into the renal pelvis of 32 rabbits. This pattern of infection takes a chronic progressive course and, in all cases, results in typical macroscopic and histological changes in the kidney. The bacterial excretion in the urine remains unchanged over a period of months. With the experimental procedure described, the pathogenesis and pathophysiology of chronic E. coli pyelonephritis can be clearly studied. Drugs currently used on patients can be tested for their effectiveness in long-term application.

Animals↗

PubMed1982

Prevention of scarring in experimental pyelonephritis in the rat by early antibiotic therapy.

Experimental pyelonephritis was produced by either retrograde or direct infection of rat kidneys by Escherichia coli 078. Combined antibiotic therapy with amoxycillin and gentamicin, commenced within 23 h of direct infection, prevented acute suppuration and subsequent scarring. The same antibiotics combination commenced 24 h after both retrograde and direct infection did not significantly reduce acute suppuration but did reduce scarring. Treatment begun later than 24 h after infection had no effect on the outcome of pyelonephritis induced by either route. Significantly lower peak levels of serum antibody to the O antigen of E. coli 078 were obtained in rats treated at 24 h after retrograde pyelonephritis than in those in which treatment was started later. Kidney scarring could not be prevented if antibiotic therapy was commenced after the appearance of mononuclear cells in the inflammatory lesion.

Animals↗

PubMed1984

Morphologic and immunohistologic study of pyelonephritis in rats by various bacteria and fungi. Special reference to inflammatory changes and localization of antigen.

Experimental pyelonephritis induced in rats by a single intrarenal injection of Pseudomonas aeruginosa, Serratia marcescens, Candida albicans, and Cryptococcus neoformans was studied pathologically and immunohistologically. The lesions which develop following intrarenal inoculation were similar to those seen during the course of pyelonephritis in man. Localization of the whole bacteria and the amorphous bacterial antigens and the whole fungi and the amorphous fungal antigens in the inflammatory lesions persisted up to 10-12 and 6-8 weeks, respectively. After that, continued inflammatory changes in progressive scarring can evolve in the absence of persistent bacterial or fungal antigens. Rat gamma globulin was localized in the plasma cells of the renal inflammatory infiltrates from 5-6 days to the end of the experiment (14th week). The incidence of progressive renal sclerosis was high in case of Candida pyelonephritis. The possible roles of progressive renal scarring by C. albicans are discussed.

Animals↗

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↗

PubMed1970

Urinary concentrating ability in early experimental pyelonephritis.

The effect of early bilateral pyelonephritis on urinary concentrating ability was studied in rats injected intravenously with enterococci or Staphylococcus aureus and in rats inoculated with Escherichia coli into the medullae of both kidneys. The mean maximum urinary osmolality of normal rats was 2352 mOsm/kg of water. Inoculation of E. coli caused reversible pyelonephritis with sterilization of the kidneys within 12 wk. By 1 day after injection the mean maximum urinary osmolality had decreased to about 1100 mOsm. remained at this level for 3 wk, and then rose to normal by 12 wk. After injection of enterococci and staphylococci, the mean maximum urine osmolality decreased over 3-4 days to about 1000 and 800 mOsm respectively. In the enterococcal infection (which is chronic) the maximum urine osmolality remained about 1200 mOsm for at least 12 wk whereas in the staphylococcal infection (which is reversible) the osmolality gradually rose. Antimicrobial therapy of E. coli renal infection with colistimethate sodium and S. aureus infection with ampicillin rapidly reduced bacterial titers in the kidneys with an associated rise in maximum urinary osmolality. Therapy of enterococcal renal infection with ampicillin produced less impressive decreases in bacterial titers in the kidneys and little or no improvement in urinary concentrating ability. With antimicrobial therapy or with the self-limited infections, the rate of increase in concentrating ability was directly correlated with the rate of decrease of bacterial titers. However, there was poor correlation between histological findings in the kidneys and urinary concentrating ability. These studies demonstrate that early experimental pyelonephritis is associated with a concentrating defect that can be rapidly reversed and therefore is not related to permanent renal damage.

Ampicillin↗

PubMed1997

Development of experimental model of chronic pyelonephritis with Escherichia coli O75:K5:H-bearing Dr fimbriae: mutation in the dra region prevented tubulointerstitial nephritis.

Escherichia coli that express Dr fimbriae and related adhesins recognize the common receptor decay accelerating factor. E. coli strains that express adhesins of the Dr family were postulated to be associated with cystitis (30-50%), pregnancy-associated pyelonephritis (30%), and chronic diarrhea (50%). In this study, we investigated the hypothesis that E. coli renal interstitial binding mediated by the Dr adhesin may be important for the development of chronic pyelonephritis. An insertional dra mutant, E. coli DR14, of the clinical E. coli isolate IH11128 bearing Dr fimbriae, was constructed and used to characterize persistence of infection and interstitial tropism in an experimental model of ascending pyelonephritis. Quantitative cultures of kidney homogenates indicated that Dr hemagglutinin positive (Dr+) E. coli IH11128 established a 1-yr colonization of renal tissue. In the Dr hemagglutinin negative (Dr-) group, 50% of animals cleared infection within 20 wk and 100% between 32 to 52 wk. Dr+ E. coli colonized the renal interstitium. Significant histological changes corresponding to tubulointerstitial nephritis including interstitial inflammation, fibrosis, and tubular atrophy were found in the kidney tissue of the Dr+ but not the Dr- group. A substantial amount of fimbrial antigen was detected in the parenchymal regions affected by interstitial inflammation and fibrosis. The obtained results are consistent with the hypothesis that mutation within the dra region, affecting E. coli binding to tubular basement membranes, prevented renal interstitial tropism and the development of the changes characteristically seen in tubulointerstitial nephritis.

Animals↗

PubMed1994

Antibodies to Tamm-Horsfall protein in patients with acute pyelonephritis.

The role of antibodies to Tamm-Horsfall protein in the diagnosis of acute pyelonephritis was studied. Antibodies to Tamm-Horsfall protein were also determined in a group of normal subjects. Patients with acute pyelonephritis were divided into subgroups according to the concurrent presence of vesicoureteral reflux or nephrolithiasis. No statistically significant differences (p > 0.05) were observed for any class of antibodies (IgG, IgA and IgM) between the groups of healthy subjects and patients with acute pyelonephritis, regardless of the presence or absence of vesicoureteral reflux or nephrolithiasis. Values for different antibody classes showed that IgM antibodies were the most abundant in all the groups examined. A difference in the values of IgM relative to IgA and IgG antibodies was found to be statistically significant in the patient group only (p < 0.05). In patients with vesicoureteral reflux, there was no statistically significant difference (p > 0.05) between the values of IgM and of other antibody classes. In these patients, however, the highest values of all the three antibody classes were obtained, although these differences were also not statistically significant (p > 0.05). The results pointed to the need of further studies of the role of antibodies to Tamm-Horsfall protein in the diagnosis and pathogenesis of tubulointerstitial nephritis.

Acute Disease↗

PubMed2003

Uterine contraction frequency during treatment of pyelonephritis in pregnancy and subsequent risk of preterm birth.

AIMS: To assess ceftriaxones effect on uterine contraction frequency and determine risk factors for subsequent preterm birth in women with pyelonephritis. METHODS: Seventy-one women with pyelonephritis at greater than 24 weeks' gestation with continuous external tocodynamometry after antibiotic administration were studied. Patients received 2 doses of ceftriaxone 1 gram intramuscularly at 24-hour intervals. Temperatures, timing of antibiotic administration, and gestational age at delivery were recorded. RESULTS: Uterine contraction frequency was measured for the hour prior to antibiotic administration, as well as the six hours after. Uterine activity steadily and significantly decreased from a mean of 5.1 +/- 7.3 at presentation to 2.0 +/- 2.9 uterine contractions per hour (P = .04, student t-test) six hours after ceftriaxone administration. The maximal number of contractions per hour each woman experienced did not correlate with temperature (r = .02, linear regression analysis). Uterine contractility and recurrent urinary tract infection were both associated with subsequent preterm birth (P = .004 and .016 respectively using nominal logistic regression analysis). CONCLUSIONS: (1) A significant decrease in uterine activity from baseline occurs after ceftriaxone administration for acute pyelonephritis in pregnancy. (2) Temperature elevations are not associated with increased uterine activity. (3) Patients with significant uterine activity or recurrent urinary tract infection are at risk for preterm birth.

Anti-Bacterial Agents↗

PubMed1998

Procalcitonin is a marker of severity of renal lesions in pyelonephritis.

OBJECTIVE: In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured serum procalcitonin levels, a recently described marker of infection. We compared it with other commonly used inflammatory markers and evaluated its ability to predict renal involvement as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. METHODS: Serum C-reactive protein, leukocyte counts, and procalcitonin levels were measured in 80 children, 1 month to 16 years of age, admitted for suspected pyelonephritis. Renal involvement was assessed by 99mTe-DMSA scintigraphy in the first 5 days after admission. The examination was repeated at least 3 months later if the first result was abnormal. RESULTS: In lower UTI, the mean procalcitonin (PCT) was 0.38 micrograms/L +/- 0.19 compared with 5.37 micrograms/L +/- 1.9 in pyelonephritis. In these two groups, respectively, leukocyte counts were 10939/mm3 +/- 834 and 17429/mm3 +/- 994, and C-reactive protein (CRP) levels were 30.3 mg/L +/- 7.6 and 120.8 mg/L +/- 8.9. When inflammatory markers were correlated to the severity of the renal lesion as ranked by DMSA scintigraphy, we found a highly significant correlation with plasma levels of PCT, but borderline significance with CRP and none with leukocyte counts. Patients without vesicoureteral reflux had a mean PCT of 5.16 micrograms/L +/- 2.33, which was not significantly different from that in patients with reflux who had a mean PCT of 5.76 micrograms/L +/- 3.49. For the prediction of renal lesions at admission, CRP had a sensitivity of 100% and a specificity of 26.1%. The sensitivity and specificity of PCT were 70.3% and 82.6%, respectively. CONCLUSION: We conclude that serum PCT levels were increased significantly in children with febrile UTI when renal parenchymal involvement (assessed by DMSA scintigraphy) was present and allowed for prediction of patients at risk of severe renal lesions.

Calcitonin↗