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PubMedDate not supplied

Emphysematous pyelonephritis: a consequence of adenocarcinoma of urinary bladder in a nondiabetic patient.

Emphysematous pyelonephritis (EP) is a life threatening condition of acute necrotising renal parenchymal infection that encompasses a much wider spectrum of complicated urinary tract infections such as renal abscesses, emphysematous pyelitis, pyelonephritis, acute renal papillary necrosis, and sepsis. We report an unusual case of adenocarcinoma bladder in a middle aged nondiabetic patient, presenting with EP. Emphysematous pyelonephritis was the initial symptom in this case with an underlying carcinoma of the bladder. The role of imaging is prime in management of such cases, if an early diagnosis is to be made and a potentially devastating outcome is to be avoided. The literature regarding EP has been reviewed and discussed. The goals of managing EP should be (1) early institution of parenteral antibiotics and a (2) a staged nephrectomy (preceded by a temporary percutaneous drainage particularly with antibiotic resistant septicemia) so as to maximize survival rather than proceeding directly to emergency nephrectomy.

Adenocarcinoma↗

PubMedDate not supplied

[Xanthogranulomatous pyelonephritis and renal carcinoma. Report of a clinical case and review of the literature].

Xanthogranulomatous pyelonephritis is a rare disease of the kidney; renal parenchyma is replaced by lesions radiologically simulating clear cell carcinoma. We present a case of a 62-year-old diabetic woman observed at our institution for the appearance of back pain and dysuria. A CT scan revealed a large lesion of left kidney with psoas muscle infiltration and the patient undrwent a nephrectomy. Histology surprisingly showed a xanthogranulomatous pyelonephritis. Though recent reports demonstrated the feasibility of conservative management of XGP with antibiotics, the use of pre-operative biopsy is still limited by the risk of seeding and the high false-negative results. How to distinguish xanthogranulomatous pyelonephritis from renal cancer?

Carcinoma, Renal Cell↗

PubMed1991

[Role of structuro-functional changes in cell membranes in the formation of the immune response in patients with chronic pyelonephritis].

The authors analyze the status of cationic transmembranous transport in leukocytes in patients with chronic secondary pyelonephritis (CPN) as related to the clinical manifestations of pathology and immune response. 117 patients with CPN were examined. In 58 patients, pyelonephritis was associated with nephrolithiasis, in 59 with different abnormalities of the kidneys and urinary tract. The immunity status was examined according to the content of IgA, IgG, IgM, T and B lymphocytes, complement (CH50), the phagocytic neutrophil test and secretory IgA in the urine. In white blood cells, a study was made of the activity of Mg(2+)-, Na(+)-K(+)-, Ca(2+)-ATPases. As a result of the studies the patients were found to have low functional activity of Ca(2+)-ATPase, Na(+)-K(+)-ATPase during the clinical manifestations of pyelonephritis. Analysis of the frequency of enzymatic activity values showed their nonuniformity. In some patients, it was lowered (less than X--1), whereas in others, it appeared increased (over X+1). Patients with an enzymatic activity below X--1 manifested a decrease of the content of IgA, IgG, IgM, T and B lymphocytes, and of phagocytic activity of neutrophils as compared to patients exhibiting a high enzymatic activity. The conclusion is made about the relationship between enzymatic function and immune response. It is recommended that drugs possessing membrane-protective and reparative pharmacological effects be included into multimodality therapy.

Adult↗

PubMed2006

[Xanthogranulomatous pyelonephritis in children].

OBJECTIVE: The authors report their experience of xanthogranulomatous pyelonephritis in children and emphasize the diagnostic and therapeutic difficulties supported by several published series. MATERIALS AND METHODS: This was a retrospective based on ten patients treated for xanthogranulomatous pyelonephritis. RESULTS: Treatment was surgical in 90% of patients. Total nephrectomy was performed in all diffuse forms (80%) and one of the 2 localized forms (10%). Treatment was exclusively medical in only one patient (10%). Five subcapsular nephrectomies, three total nephrectomies and one radical total nephrectomy were performed. The course after treatment was excellent in 100% of cases. CONCLUSION: The treatment of xanthogranulomatous pyelonephritis is surgical, although cure can sometimes be achieved by conservative treatment.

Adolescent↗

PubMed2006

Contribution of quorum-sensing systems to virulence of Pseudomonas aeruginosa in an experimental pyelonephritis model.

BACKGROUND AND PURPOSE: Pseudomonas aeruginosa has been reported to monitor its cell density as well as expression of virulence determinants by quorum-sensing signal mechanisms operative through autoinducers. In the present investigation, we studied the contribution of quorum-sensing signals during the course of P. aeruginosa-induced pyelonephritis in mice. METHODS: The standard parent strain of P. aeruginosa (PAO1), possessing functional las and rhl quorum-sensing systems and its isogenic mutant strains, PAO-JP1 (single mutant), harboring a mutated lasI gene and PAO-JP3 (double mutant), harboring mutated lasI and rhlR genes were employed. One uroisolate of P. aeruginosa belonging to serotype O8 and deficient in production of quorum-sensing signals was also used. RESULTS: The parent strain of P. aeruginosa was significantly more virulent compared to its isogenic mutant strains and quorum-sensing negative clinical strain, as assessed by neutrophil influx, malondialdehyde production, renal bacterial load and pathology induced in experimental animals. CONCLUSIONS: Quorum-sensing systems play an important role in the pathogenicity of P. aeruginosa in pyelonephritis. Both the las and rhl quorum-sensing systems are important for the virulence of P. aeruginosa in the development of pyelonephritis.

Animals↗

PubMedDate not supplied

[Immunity and the possibilities for immunomodulation in acute pyelonephritis].

The paper presents evidence on dysfunction of natural killer cells and abnormal proliferative response of peripheral blood mononuclears to T- and B-cell mitogens (PHA, Phytolacca) in patients at varying stages of acute pyelonephritis. A number of immunomodulators (recombinant alpha 2-interferon, IL-2 and tactivin) produce different effects on natural killer activity and lymphocyte blast transformation in healthy donors and pyelonephritis patients. Immunotropic effects of immunopeptides depend on the drug dose, the response of various subpopulations of the immunocompetent cells being individual. It is suggested that immune system, natural killer activity in particular, plays an important part in pathogenesis of acute pyelonephritis. In vitro experiments demonstrate that there can be a positive clinical response to tactivin and recombinant alpha 2-interferon administered in doses activating the function of certain immunocompetent cells.

Acute Disease↗

PubMed1991

[Emphysematous pyelonephritis associated to urogenital tuberculosis].

Emphysematous pyelonephritis is a rare condition which in most cases occurs as a result of Escherichia coli infection of the urinary tract in patients known as being diabetic. The gas-filled abscesses carry a high mortality rate, especially when the antibiotic treatment is not combined with early surgery. We report a case where the failure of medical treatment led to curative nephrectomy. Unusually, diabetes was revealed by the pyelonephritis. Another particularity of this case was that the emphysematous pyelonephritis was associated with genitourinary tuberculosis. This association, of which no other example could be found in the literature, is discussed.

Adult↗

PubMed1991

Candida pyelonephritis complicating traumatic C5 quadriplegia: diagnosis and management.

We present the first reported case of Candida pyelonephritis in a spinal cord injured patient. In addition to multiple courses of empiric antibiotics, the neurogenic bladder and alteration in cell-mediated immunity found in spinal cord injured patients may have increased this patient's susceptibility to fungal disease. A 50-year-old patient with C5 motor functional quadriplegia developed Candid albicans pyelonephritis while undergoing rehabilitation. The patient had several surgical procedures and multiple courses of antibiotic therapy during acute hospitalization. He continued to have a hectic fever curve, leukocytosis with increased band forms, lethargy, and progressive uremia during rehabilitation. Successful investigation of the patient's condition included assessment of serologic tests for Candida precipitin antigen; multiple blood and urine cultures; exclusion of other causes of hectic fever; abdominal computerized tomogram, which revealed a left kidney hypodensity with irregular margins; and a retrograde pyelogram, which demonstrated multiple renal pelvic-filling defects. Cystoscopically placed ureteral stents, which relieved the genitourinary obstruction, drained gross pus from which Candida albicans was cultured; the patient was treated with amphotericin B and showed clinical improvement. Pathogenesis, presentation, diagnosis, and treatment of Candida pyelonephritis are reviewed.

Algorithms↗

PubMed1990

[Endoperoxides and the immunological indices of patients with chronic pyelonephritis].

In 31 patients with chronic active pyelonephritis and 10 clinically healthy controls the following indices were followed up: the serum level of the endoperoxides and several parameters of humoral and cell immunity (T-lymphocytes, active T-lymphocytes, T-helpers, T-suppressors, B-lymphocytes, NK-cells, immunoglobulins G, A and (M), as well as the lysing activity of the natural killers towards the cell line K-562. The patients with chronic pyelonephritis were classified into two groups: I group--patients examined for serum peroxides in the acute phase of the inflammatory process and II group--patients examined in the subacute phase. A statistically significant differences was found for the serum endoperoxides between the patients form the I group (in the acute phase of the disease) and the healthy controls (respectively) 52.0 +/- 17.3 nmol MDA and 9.0 +/- 6.9 nmol MDA, p less than 0.001). The difference between the patients in the subacute phase and the healthy controls was insignificant (p less than 0.1). No significant deviations were found in the immunologic indices studied. The findings show that the immunologic mechanisms probably do not play a leading role in the pathogenesis of chronic pyelonephritis. The endoperoxides level is an index of the activity of inflammatory process in this disease.

Adult↗

PubMed1990

[Effect of interferon on the course of experimental E coli-induced pyelonephritis].

The effect of the type I interferon on the development and process of experimental pyelonephritis caused by E. coli was studied on mice weighing 12 to 14 g. Interferon was administered intraperitoneally in a dose of 1000 units on days 3 and 7 of the disease. It was shown that the administration of the type I interferon to the mice with experimental pyelonephritis promoted rapid elimination of bacteria from the kidneys, prevented their penetration to the contralateral (intact) kidney, prevented marked macro- and microscopic damages in the kidneys, lowered the intensity of the inflammatory reaction, and increased the phagocytic activity of neutrophils and the number of the E-rosette-forming lymphocytes in the thymus. The data provided experimental grounding for clinical trials of interferon preparations in treatment of bacterial pyelonephritis.

Adjuvants, Immunologic↗

PubMed1990

Coexisting bacterial pyelonephritis and bilateral ureteral fungus balls in a diabetic patient. Case report.

Bacterial pyelonephritis is a common precipitating factor in the development of diabetic ketoacidosis. Prompt diagnosis and appropriate antimicrobial therapy usually result in resolution of constitutional symptoms and adequate control of serum glucose. However, occasional cases of presumed bacterial pyelonephritis may not respond to appropriate empiric antibiotic therapy, then causes should be sought such as obstruction or untreated fungal infections of the urinary tract. In this case a diabetic patient with classical pyelonephritis was found to have bilateral ureteral fungus balls as the underlying cause of refractory infection.

Adult↗

PubMed1990

Effect of E. coli pyelonephritis on the intracortical accumulation kinetics of gentamicin and netilmicin in rats.

The role of serum levels on the intrarenal accumulation kinetics of gentamicin and netilmicin in normal and infected kidneys was evaluated in a short-term infusion model in conscious rats. Female Sprague-Dawley rats were infused over a period of 6 h with gentamicin and netilmicin achieving individual steady-state serum levels ranging from 0.5 to 120 micrograms/ml. The model of pyelonephritis used resulted in severe left pyelonephritis and mild right pyelonephritis. Only the right infected kidneys were studied. Gentamicin and netilmicin cortical concentrations were analysed as a function of serum levels by linear (least-squares regression analysis) and non-linear regression. For the non-linear regression analysis, the Michaelis-Menten kinetic was the best fitting curve. Steady-state elevation of serum concentrations of gentamicin and netilmicin was associated with a non-linear increase of cortical concentrations in normal kidneys, suggesting a saturable process. By contrast, in the mildly-infected right kidneys, the steady-state elevation of serum concentrations of gentamicin was associated with a linear increase of cortical concentrations while the accumulation kinetic of netilmicin showed a saturable process. At lower serum levels (therapeutic range, from 0.5 to 15 micrograms/ml) both gentamicin and netilmicin showed a first order kinetics of accumulation and netilmicin accumulated less than gentamicin in normal kidneys (p = 0.0004). By contrast, the uptake of netilmicin was higher in the right infected kidneys, as compared to the uptake of netilmicin in the normal kidneys, (p = 0.00005), and as compared to gentamicin in the respective kidneys. We conclude that renal infection modifies the intrarenal accumulation of aminoglycosides.

Animals↗

PubMed1990

[Emphysematous pyelonephritis. Apropos of a case].

Emphysematous pyelonephritis is a rare form of pyelonephritis that carries a very poor prognosis. This article reports a review of the literature on this condition and describes the clinical and roentgenographic criteria for diagnosis. Diagnosis rests on the presence of clinical manifestations of pyelonephritis with intrarenal air-filled images on the roentgenograms. Both the author's personal experience and the data from the literature confirm the need for urgent treatment combining antimicrobial agents effective against Escherichia coli, the most common causative agent, and surgery, which usually consists in a nephrectomy.

Emphysema↗

PubMedDate not supplied

[Shmakovka narzan mineral water in the treatment of chronic pyelonephritis in children].

The impact of "Pasechnyĭ" spa of the Shmakovka health resort on the circadian urinary output, renal excretion of magnesium, calcium, nonorganic phosphorus, oxalates, uric acid, phospholipids, acido- and ammoniogenases, daily fluctuations of urinary pH was studied for the first time in 65 children with chronic pyelonephritis. In the presence of spa treatment the authors revealed a 75-100 per cent increase in the circadian urinary output, urinary excretion of magnesium, uric acid, ammonia, titrated acids, a decrease in the levels of calcium, oxalates, nonorganic phosphorus and acidification of the urine at 9 o'clock in the morning mainly in children with primary pyelonephritis and at 9 and 6 o'clock in the morning in patients with concurrent uricosuria. Other parameters were not significantly different from those in the controls. Acidification of the urine in the presence of high uricosuria resulted in crystalluria of urates and oxalates in 26.31 per cent of patients with the concurrent urate diathesis. The water of Shmakovka mineral springs is recommended for patients with primary pyelonephritis, phosphaturia and calcium oxalate crystalluria with alkaline reaction of the urine and unjustified for those who suffered from urate diathesis.

Adolescent↗

PubMed1990

[Renocolic fistula caused by xanthogranulomatous pyelonephritis: a case report].

Renocolic fistulas caused by typical xanthogranulomatous pyelonephritis are rare. We present a case of renocolic fistula caused by xanthogranulomatous pyelonephritis. A 58-year-old woman was admitted to the Department of Urology, Sakata City Hospital, with the chief complaint of pain in the left flank region. The plain film showed no calculi. An intravenous pyelogram showed left non-functioning kidney. A left retrograde pyelogram demonstrated a communication between the left renal calyx and the descending colon. A computed tomography done after the retrograde pyelography revealed contrast medium in the descending colon and a heterogenous left renal mass and thickness of Gerota's fascia. On the basis of the radiologic studies a diagnosis of renocolic fistula was made. The patient underwent a nephrectomy with closure of the fistula of the colon. The pelvicaliceal system of the resected kidney was distended and contained yellow fatty like tissue. Histologically xanthogranulomatous pyelonephritis was confirmed. The patient made an uneventful recovery.

Colonic Diseases↗

PubMed1989

[Type 1 fimbriae, P fimbriae and X adhesins in Escherichia strains causing pyelonephritis, cystitis and recurrent urinary infections].

The presence of type 1 fimbriae, P fimbriae and X adhesins in 30 strains of Escherichia coli producing pyelonephritis, 30 strains producing cystitis, and 30 strains producing recurrent urinary infections are compared. All the strains were collected from adult women without risk factors for infections of the urinary tract. The presence of P fimbriae was 73% in strains producing pyelonephritis, 40% in strains producing cystitis and 20% in strains producing recurrent urinary infections; the presence of X adhesins was 3%, 0, and 17% respectively. There were, in consequence, significant differences between the groups studied; however, such differences were not observed with respect to the presence of type 1 fimbriae, which was 97%, 97% and 90%, respectively. We conclude that P fimbriae act as a factor of greater virulence in the strains of E. coli producing pyelonephritis and X adhesins are found almost exclusively in the strains producing recurrent urinary infections.

Adhesins, Escherichia coli↗

PubMed1989

[Value of the ultrasonic method of examining children under 1 year of age with pyelonephritis].

The paper treats the experience gained with the use of ultrasonography for investigation of the urinogenous organs in pyelonephritis children of the first year of life. The clinicolaboratory parameters as well as the data of the instrumental research methods including the roentgenourologic and echographic data were analyzed. This made it possible to define the importance of ultrasonography in these patients' examination and the examination routine. It is concluded that ultrasonography of the urinogenous organs in pyelonephritis children of the first year of life in one of the principal research methods, which should be performed before the use of other instrumental methods. Based on the echographic appearance approximately 1/3 of the children with pyelonephritis were suspected to have congenital developmental diseases of the urinogenous organs, whose nature was unraveled and specified by excretory urography. One should not exaggerate or underestimate the significance of each research method. Of importance are also the results of clinical, laboratory, echographic and x-ray studies.

Age Factors↗

PubMed1989

[Clinico-echographic parallels in patients with pyelonephritis and exacerbated chronic kidney failure].

24 patients with chronic renal failure due to chronic pyelonephritis were studied prospectively. In 18 of them (51%) the deterioration of the renal function was caused by obstruction, urinary infection, dehydration, etc. In 13 patients with chronic renal failure in exacerbation there were clinical data for activation of the pyelonephritis which was followed up dynamically. The ultrasound examination revealed enlarged kidneys with unclearly outlined renal structures. The changes were reversible and the pattern resembled that of acute renal failure. With the disappearance of the echographic data for interstitial renal edema an improvement of the renal function was established. The serum creatinine fell from 697.4 to 347.6 mumol/l (p less than 0.025) and plasma osmolality tell from 327.8 to 287 mOsm/l. No such changes were found in other II patients with chronic pyelonephritis and chronic renal failure without exacerbation.

Adolescent↗