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PubMed2001

Oral ceftibuten switch therapy for acute pyelonephritis in children.

The available oral third generation of cephalosporin, "ceftibuten" was used to substitute the intravenous drug after defervescence in acute pyelonephritis in children. This randomized controlled study compared the efficacy of an oral ceftibuten switch therapy with a ceftriaxone in both short-term and long-term outcomes. 36 99mTc-dimercaptosuccinic acid (DMSA) scan proved pyelonephritis patients were randomized into the study group, "ceftibuten" (N=18) and the control group, "ceftriaxone" (N=18). Ceftriaxone (75 mg/kg/day) was the initial antibiotic in both groups. After defervescence for 24-48 hours, oral ceftibuten (9 mg/kg/day) was substituted in the study group and continued for 10 days. The subject characteristics and laboratory data were not different between the two groups. The urine culture at D14 was sterilized in both groups. The incidence of renal scarring was 66.6 per cent and 61.1 per cent in the study group and the control group respectively. The rate of recurrent infection showed no statistical significance. The duration of hospitalization was shorter in the study group than in the control. In conclusion, oral ceftibuten switch therapy can be recommended as a safe and effective treatment for acute pyelonephritis in children. The use of oral therapy may result in a significant reduction of health care expenditure.

Acute Disease↗
PubMedDate not supplied

[Systemic amyloidosis secondary to xanthogranulomatous pyelonephritis].

Secondary amyloidosis is a relatively common pathology in which chronic infectious diseases are common causes, especially infected bronchiectasis, osteomyelitis or chronic ulcers. The association of xanthogranulomatous pyelonephritis and systemic amyloidosis is extremely rare. To our knowledge, despite innumerable cases of xanthogranulomatous pyelonephritis reported in the literature, this association has been reported in only 8 previous cases. Patients usually complain of fever, back or flank pain and urinary tract symptoms. A long lasting evolution of the process is frequent. We report a 70 year old patient who developed amyloidosis secondary to xanthogranulomatous pyelonephritis. As well as the rarity of this association, this case is exceptional in its clinical presentation, without any urinary tract symptoms that could suggest the diagnosis.

Aged↗
PubMed2002

Color and power Doppler sonography versus DMSA scintigraphy in acute pyelonephritis and in prediction of renal scarring.

UNLABELLED: Capabilities of color and power Doppler sonography (DS) were prospectively evaluated for diagnosis of acute pyelonephritis and for prediction of scarring by comparison with 99mTc-dimercaptosuccinic acid scintigraphy (DMSA). METHODS: Fifty-seven children (mean age, 5 +/- 3 y) with acute pyelonephritis were investigated by biologic testing, DS (DS 1), and DMSA (DMSA 1). Patients who were <6 mo old or had high-grade reflux or obstruction were excluded. Forty-five children had a clinical follow-up examination, biologic testing, DS (DS 2), and DMSA (DMSA 2) at a mean of 7 +/- 2 mo after acute infection. Sonography (gray-scale and DS) was performed by 1 experienced radiologist who was unaware of patient data. DMSA studies were interpreted by 2 physicians who were unaware of patient data. RESULTS: Temperature, neutrophil count, and C-reactive protein value were significantly higher in patients with abnormal DMSA 1 findings than in those with abnormal DS 1 findings (P < 0.05). When compared with DMSA 1, DS 1 had a sensitivity and specificity of 80% and 81%, respectively. At follow-up, all clinical and biologic data had normalized. Scarring after infection occurred in 51% of children. When compared with DMSA 2, DS 1 had positive and negative predictive values of 57% and 75%, respectively, and DMSA 1 had respective values of 62% and 100%. Reflux was not considered a good predictor of scarring. CONCLUSION: DS and DMSA results were concordant in 81% of kidneys with acute pyelonephritis. The predictive value of DS for renal scarring was not considered sufficiently high for DS to be used in routine practice.

Acute Disease↗
PubMedDate not supplied

[Stage II focal xanthogranulomatous pyelonephritis].

OBJECTIVE: To report a case of focalized stage II xanthogranulomatous pyelonephritis and the diagnostic difficulties encountered. METHODS: A 63-year-old female consulted at the emergency services for fever during the last two months and right lumbar pain. Urinary cultures were negative. A CT scan showed a poorly-defined heterogeneous mass in the lower pole of the right kidney. Fine needle punction-aspiration biopsy was compatible with renal cell carcinoma. The patient underwent radical nephrectomy. RESULTS: The histopathological study showed focalized stage II xanthogranulomatous pyelonephritis but no evidence of neoplasia. CONCLUSIONS: Xanthogranulomatous pyelonephritis can mimic the clinical, cytological and imaging features of renal neoplasia.

Biopsy, Needle↗
PubMedDate not supplied

[Structural-functional damage to cellular membranes in deficiency of vitamins A, E, B2, B6, PP in children with calculous pyelonephritis].

Lipids were studied in 150 patients with nephrolithiasis, calculous pyelonephritis; enzymes, LPO products, phospholipase in 111 patients; vitamins A and E in 136 patients, vitamins B2, B6 and PP in 146 patients in the course of the disease, at admission and after treatment. In acute purulent and aggravated chronic calculous pyelonephritis lysophospholipids levels rose manifolds. Activation of LPO products, phospholipase, organ-specific enzymes is closely associated with low provision of vitamins A, E, B2, B6, PP. Deficiency of these vitamins ranged from 76.8 to 94.6% in acute purulent calculous pyelonephritis in all the patients.

Adolescent↗
PubMed1976

[Serum antibodies in urinary infection in children. Significance and relation to pyelonephritis].

Serum antibodies were measured repeatedly in 176 cases of urinary tract infections in children. The method used, passive haemagglutination with the bacterial antigen of the patient's urinary infection, gives a positive reading from 1/160. Antibodies were found in 139 cases and the lower limit compatible with a diagnosis of pyelonephritis was 1/2560. The result may, however, be negative in infants of less than one year. As in the first publication, the authors describe three types of curves of progression. Analysis confirms the relationship between persistent antibodies and evolutive pyelonephritis. Experimental results and a comparison of clinical and pathological findings are discussed and support the notion of the value of a persistent high antibody level in the diagnosis of chronic pyelonephritis.

Adolescent↗
PubMedDate not supplied

[Dynamics of some characteristics of humoral immunity, vaginal interferon status in pregnant women with the relapse of chronic pyelonephritis].

65 pregnant women with the exacerbation of chronic pyelonephritis in the III trimester of gestation and 34 healthy pregnant women were examined. The quantitative content of immunoglobulins, the activity of interferon in cervico = vaginal washings and the composition of the vaginal microflora were determined. All patients with the relapse of chronic pyelonephritis exhibited disturbances in the normal microbiocenosis of the genitals and the dysfunction of the local immunity of the genital system, accompanied with a decrease in serum and secretory IgA, an increase in the amount of IgG and IgM, increased interferon activity. Pregnant women with the relapse of chronic pyelonephritis received, in addition to traditional therapy, local treatment with Kipferon suppositories, an immunomodulating preparation. The study revealed that the use of this preparation normalized the characteristics of local immunity, the composition of the microflora' of the genitals and led to the disappearance of the clinical symptoms of the disease.

Antibody Formation↗
PubMed2003

[Management of the emphysematous pyelonephritis].

We report two cases of emphysematous pyelonephritis in diabetic patients. The first suffered from emphysematous pyelonephritis and emergency nephrectomy was performed. The second patient suffered from emphysematous pyelitis and was successfully treated by nephrostomy. We present a comprehensive review of the literature on emphysematous pyelonephritis and discuss the indications and the results of treatments of this rare and severe infection.

Emphysema↗
PubMed2004

[Assessment of fructose-1,6-biphosphatase in urine of children with acute pyelonephritis].

UNLABELLED: We assessed the excretion of fructose-1,6-bisphosphatase (FBP) and N-acetyl-beta-D-glucosaminidase (NAG) in 52 children (aged 4.1 +/- 2.3): group I--26 children with acute pyelonephritis (APN), in whom the examination were carried out twice: A--before treatment, B--after 14-21 days of antibacterial treatment, group II--21 healthy children. Activity of FBP in urine was found in 80% children from group I and II, and activity of NAG was found in all children from both groups. In examination A mean excretion of FBP and NAG was higher than in healthy children (p < 0.05). After antibacterial treatment excretion of both enzymes decreased to values, which did not differ from control group (p > 0.05). High correlation between FBP and NAG (r = 0.9355; p = 0.00001) was shown only in 14 children, in whom the course of acute pyelonephritis was serious (CRP > 20 mg%, leucocytosis > 10 x 10(9), and renal swelling in ultrasonography). CONCLUSION: Increased excretion of FBP in urine is found mainly in children with severe course of acute pyelonephritis, in whom the correlation between NAG and FBP is observed.

Acetylglucosaminidase↗
PubMed2003

[Renal and tissue fibrinolysis dysfunction in secondary pyelonephritis in children before and after the surgery].

Indexes of fibrinolytic and proteolytic blood and urine activity in secondary pyelonephritis in children up to and after operative treatment for obstructive pyelonephritis were studied. The simulating method of hydronephrosis and secondary pyelonephritis was elaborated, changes of the tissues fibrinolytic activity of pyelourethral segment region in conditions of experiment and in operated children were studied. After the operation the conditions for urodynamics disorder occurrence are creating, in particular, lowering of activity of urine urokinase, disorder of tissues enzymatic fibrinolysis of pyelourethral segment with activation of general hemocoagulative potential, what promotes the urolythic disease and hydronephrosis occurrence and necessity for according correction.

Animals↗
PubMedDate not supplied

Diffuse xanthogranulomatous pyelonephritis and staghorn calculus: report of one case.

Xanthogranulomatous pyelonephritis and staghorn calculus are rare in children. In this report, we describe a Chinese boy without history of urinary tract infection who developed insidious onset of left flank pain. Urine culture showed Proteus mirabilis infection. Sonography and computed tomography of the abdomen showed typical picture of xanthogranulomatous pyelonephritis and staghorn calculus. Photomicrography showed characteristic lipid-laden macrophage aggregates. After nephrectomy, he was symptom-free. In conclusion, xanthogranulomatous pyelonephritis should be considered in afebrile children with flank pain and staghorn calculus.

Adolescent↗
PubMedDate not supplied

[Xanthogranulomatous pyelonephritis: clinical, radiological and pathologic characteristics].

OBJECTIVES: Xanthogranulomatous pyelonephritis is an atypical chronic infection which simulates a malignant renal neoplasia, definitive diagnosis of which is obtained by pathologic study after surgical removal. In this paper we analyze our experience and compare it to that reported on the literature. METHODS: We performed a retrospective study of cases of xanthogranulomatous pyelonephritis diagnosed in the period from January 1945 to December 2000 at the Institute of Neoplastic Diseases, analyzing clinical, radiological, and surgical features documented in the medical records. RESULTS: There were 11 cases, 82% of them were females. The presence of signs and symptoms such as pain and abdominal mass appeared in 73%, accompanied by hematuria and fever. Most radiological tests showed destruction of the renal parenchyma with abnormalities in the collecting system and obstruction by lithiasis. 91% of the cases had positive urine cultures, being Escherichia coli, Proteus Mirabilis and Klebsiella the most frequent germs. Simple nephrectomy was the surgical treatment, and complications were minimal. CONCLUSIONS: Xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of renal cancer because of its clinical features.

Adult↗
PubMed2005

Diagnosis and management of acute pyelonephritis in adults.

There are approximately 250,000 cases of acute pyelonephritis each year, resulting in more than 100,000 hospitalizations. The most common etiologic cause is infection with Escherichia coli. The combination of the leukocyte esterase test and the nitrite test (with either test proving positive) has a sensitivity of 75 to 84 percent and a specificity of 82 to 98 percent for urinary tract infection. Urine cultures are positive in 90 percent of patients with acute pyelonephritis, and cultures should be obtained before antibiotic therapy is initiated. The use of blood cultures should be reserved for patients with an uncertain diagnosis, those who are immunocompromised, and those who are suspected of having hematogenous infections. Outpatient oral antibiotic therapy with a fluoroquinolone is successful in most patients with mild uncomplicated pyelonephritis. Other effective alternatives include extended-spectrum penicillins, amoxicillin-clavulanate potassium, cephalosporins, and trimethoprim-sulfamethoxazole. Indications for inpatient treatment include complicated infections, sepsis, persistent vomiting, failed outpatient treatment, or extremes of age. In hospitalized patients, intravenous treatment is recommended with a fluoroquinolone, aminoglycoside with or without ampicillin, or a third-generation cephalosporin. The standard duration of therapy is seven to 14 days. Urine culture should be repeated one to two weeks after completion of antibiotic therapy. Treatment failure may be caused by resistant organisms, underlying anatomic/functional abnormalities, or immunosuppressed states. Lack of response should prompt repeat blood and urine cultures and, possibly, imaging studies. A change in antibiotics or surgical intervention may be required.

Acute Disease↗
PubMed2005

[A case of emphysematous pyelonephritis successfully treated by percutaneous drainage guided by CT and review of previous cases reported in Japan].

A 40-year-old woman with diabetes mellitus was admitted to our hospital for a high fever and left back pain. She was initially diagnosed with acute pyelonephritis by laboratory data and started with intravenous antibiotics. However, her general condition worsened. Computed tomography (CT) showed a gas shadow within the left renal parenchyma and we made a diagnosis of emphysematous pyelonephritis. Percutaneous drainage guided by CT was performed immediately. She recovered and was discharged. Cultures of the pus grew Escherichia coli. We review previous cases of emphysematous pyelonephritis reported in Japan, and discuss the etiology, treatment and prognosis of such cases.

Adult↗
PubMedDate not supplied

[Lipids content in renal tissue membranes in patients with urolithiasis and secondary pyelonephritis].

We studied cytomembranes of the interstitial tissue of renal medullary layer obtained by lifetime biopsy of renal tissue in the course of pyelolithotomy in 46 patients with urolithiasis and secondary pyelonephritis. Biopsy structure was controlled with histological methods using standard staining. Basic phospholipids and cholesterol fractions in renal tissue cytomembranes were assayed at thin layer chromatography. The findings show significant changes in a nephron cytomembrane lipid phase in patients with urolithiasis and secondary pyelonephritis. There was a structural rearrangement of lipid biolayer of renal tissue cell membranes in response to microbial inflammation. Thus, use of membrane-stabilising drugs are grounded in patients with secondary pyelonephritis and urolithiasis.

Humans↗
PubMed2005

Xanthogranulomatous pyelonephritis due to calculi: report of 63 cases and review of literature.

OBJECTIVE: To examine the relationship between clinical history and results of renal investigations in patients with xanthogranulomatous pyelonephritis. METHODS: A retrospective review was conducted on 63 cases presenting with histopathological diagnosis of xanthogranulomatous pyelonephritis between 1995 to 2002, at the department of Urology, Bolan Medical College and Sandeman Provincial Teaching Hospital Quetta. RESULTS: There were 26 males and 37 females having an average follow up of two years. Positive findings on examination and investigations at presentation were fever and flank pain in 59 (93.6%) patients and pyuria in 34 (53.9%) patients. All the patients had renal and ureteric calculi with no or severe reduction in the function of the affected kidney on DTPA scan. Hypertrophy of the contra lateral kidney was seen in 56 (88.8%) patients. CONCLUSION: Xanthogranulomatous pyelonephritis is a common entity in this part of the world. Late referral leads to loss of the kidney. Pre-operative diagnosis of the condition is desirable and if surgery is mandatory then all infected tissues have to be removed.

Adolescent↗
PubMed2005

[Correlational studies of urine interleukin 6, interleukin 8 and nitric oxide in the patients with pyelonephritis and hydronephrosis].

The urine concentration of IL-6, IL-8 and nitric oxide (NO) were determined in the patients with pyelonephritis and hydronephrosis. Correlations between urine levels of IL-6 and IL-8 and amount of nitric oxide in the hydronephrosis patients were not found. However, in the patients with both acute and chronic pyelonephritis the coefficient of correlation was high, r((IL-6/NO)) = 0,94 and r((IL-8/NO)) = 0,86 for acute and r((IL-6/NO)) = 0,72 and r((IL-8/NO)) = 0,40 for chronic forms, respectively. These data suggest that secretion of NO during hydronephrosis has a compensatory character and acted on renal microvascular tone, whereas during pyelonephritis NO produced inflammatory mediators by recruiting leukocytes and has pathogenic character.

Adult↗