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PubMed1988

Aerobactin-mediated uptake of iron by strains of Escherichia coli causing acute pyelonephritis and bacteraemia.

A total of 285 strains of Escherichia coli isolated from children and women with acute non-obstructive pyelonephritis and from patients with bacteraemia as well as 120 faecal strains of E. coli from healthy children and adults were examined for aerobactin-mediated uptake of iron. The incidence of aerobactin-positive strains was significantly more in isolates from children with acute pyelonephritis (81%) than in faecal isolates from healthy children (50%, P less than 0.01). It was also higher in isolates of E. coli from women with acute pyelonephritis (72%) compared with faecal isolates from healthy adults (42%, P less than 0.001). Of the E. coli strains causing bacteraemia, 55% were aerobactin-positive. A significant correlation was found between the presence of aerobactin and expression of P-fimbriae in strains of E. coli isolated from children with acute pyelonephritis (P less than 0.01) and in isolates from bacteraemic patients (P less than 0.001). These results indicate that the presence of an aerobactin-mediated system of iron uptake may be an important virulence factor in strains of E. coli that cause ascending pyelonephritis.

Acute Disease↗

PubMed1991

Management of acute pyelonephritis in an emergency department observation unit.

STUDY OBJECTIVES: To determine whether moderately to severely ill patients with acute pyelonephritis can be treated successfully on an outpatient basis, and whether any aspect of history, physical examination, or initial laboratory data predicts failure of outpatient therapy and the need for hospitalization. DESIGN: Retrospective chart review of all patients with a diagnosis of acute pyelonephritis seen during a three-year period. SETTING: Emergency department observation unit of an urban teaching hospital serving residents of the city and county of Denver. TYPE OF PARTICIPANTS: Women between the ages of 15 and 50 with symptoms, physical examination, and initial laboratory data consistent with a diagnosis of pyelonephritis. INTERVENTIONS: Patients received IV antibiotics, rehydration, analgesics, and antiemetics in an observation unit for up to 12 hours, when they were either admitted to the hospital or discharged home on oral antibiotics. MEASUREMENTS AND MAIN RESULTS: Sixty-three of 87 patients (72%) with acute pyelonephritis were managed successfully as outpatients, nine (22%) were hospitalized directly from the observation unit because they were considered to be too ill to go home, and five (6%) returned with persistent symptoms after ED therapy and were hospitalized. No clinical or laboratory variable predicted success or failure of ED observation unit therapy at the time of initial presentation. CONCLUSION: In selected patients, the observation unit may be used to initiate therapy for acute pyelonephritis. Those with an adequate clinical response to initial treatment may be discharged on oral antibiotic therapy with appropriate follow-up.

Adolescent↗

PubMed1992

Acute renal failure in adults with uncomplicated acute pyelonephritis: case reports and review.

Acute renal failure is a rare complication of acute pyelonephritis in patients who do not have urinary obstruction. Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure nor is renal failure considered a likely consequence of bacteriuria. In this review, the cases of acute renal failure caused by acute pyelonephritis that have been reported in the last quarter century are examined. Including two new cases reported, only 12 cases of acute pyelonephritis resulting in acute renal failure were found. Three of these occurred in patients with a solitary kidney. All cases occurred in individuals who had no history of urinary tract infections, and all were caused by Escherichia coli. In several cases, the administration of non-steroidal antiinflammatory drugs contributed to disease. Three cases occurred after catheter-acquired bacteriuria. Acute renal failure is an uncommon but serious consequence of uncomplicated acute pyelonephritis in adults.

Acute Disease↗

PubMed1992

Comparison of urine and serum concentrations of interleukin-6 in women with acute pyelonephritis or asymptomatic bacteriuria.

The mucosal and systemic interleukin-6 (IL-6) response to urinary tract infection was analyzed in women with acute pyelonephritis or asymptomatic bacteriuria. Urine and serum samples were obtained at diagnosis and after treatment. IL-6 activity was elevated in urine samples from most bacteriuric women, regardless of the severity of infection. Urinary levels greater than 20 units/mL occurred in 25 of 29 women with acute pyelonephritis and in 36 of 42 women with asymptomatic bacteriuria. Elevated serum IL-6 levels were found mainly in patients with acute pyelonephritis: Levels greater than 20 units/mL occurred in 14 of 28 women with acute pyelonephritis compared with 0 of 28 women with asymptomatic bacteriuria. These results suggest that bacteriuria is accompanied by elevated urinary IL-6 levels and that this IL-6 is locally produced. The spread of IL-6 to the circulation in patients with acute pyelonephritis may contribute to the elevation of fever and C-reactive protein characteristic of the disease.

Adult↗

PubMed1986

Influence of inflammation on the efficacy of antibiotic treatment of experimental pyelonephritis.

An acute exudative Escherichia coli pyelonephritis rat model was used to study the influence of progressive pyelonephritis on the efficacy of antibiotic treatment. In this model, transient ureteral obstruction after E. coli bladder inoculation induces early bacterial multiplication in the kidney parenchyma, and the bacterial counts peak by 48 h. The inflammatory response (assessed by the increase in kidney weight) is somewhat delayed, starting 36 h after inoculation and peaking by 72 h. Groups of rats received 4 doses over 48 h of saline, ceftriaxone (100 mg/kg), or ceftriaxone (100 mg/kg) plus gentamicin (4 mg/kg). These treatments were initiated 24, 36, 48, or 72 h after bladder inoculation. Antibiotic treatment started at 24 h was significantly more effective in reducing bacterial counts in the kidney parenchyma than at any later therapy onset. Only when started 24 h after inoculation was the synergistic combination of ceftriaxone plus gentamicin more effective in reducing bacterial counts than ceftriaxone alone. Ceftriaxone and ceftriaxone plus gentamicin regimens started at 24 h reduced significantly (by 42 and 55%, respectively) the incidence of acute exudative pyelonephritis when compared with the incidence in saline-treated controls. Early therapy onset (24 h) strikingly reduced the development of the inflammatory response. This reduction was less marked when antibiotic therapy was started at 36 h and no longer apparent when therapy onset was delayed up to 48 or 72 h. In conclusion, the efficacy of antibiotics in eradicating bacteria from the kidney parenchyma and in preventing acute exudative pyelonephritis was markedly hampered by the development of pyelonephritis.

Animals↗

PubMed1991

Attenuation of antibody response to acute pyelonephritis by treatment with antibiotics.

While acute pyelonephritis is known to elicit an antibody response, it is also known that a patient who has had pyelonephritis once is susceptible to recurrent renal infection. Using our experimental model of pyelonephritis in the monkey, we tested whether antibiotic therapy of the acute disease would affect the antibody response. We found that it did, because antibiotic therapy beginning 72 h after bacterial inoculation attenuated the antibody response so that rechallenge 3 months later produced acute pyelonephritis and prolonged bacteriuria. The animals with untreated infection had an antibody response that lasted a sufficient period of time to prevent acute pyelonephritis after renal challenge. We have confirmed that antibody titers against P fimbriae are protective, and to a degree, this protective effect may be abrogated by antibiotic therapy.

Acute Disease↗

PubMed1990

Xanthogranulomatous pyelonephritis associated with renal cell carcinoma. Report on two cases and review of the literature.

Xanthogranulomatous pyelonephritis is a rare and particularly aggressive variant of chronic destructive pyelonephritis. Even when all modern diagnostic possibilities are exhausted, it is often not possible to distinguish xanthogranulomatous pyelonephritis from a renal cell carcinoma preoperatively. In clinical practice false diagnoses are therefore frequent. The coexistence of xanthogranulomatous pyelonephritis and renal cell carcinoma is extremely rare. We report 2 such cases. In 1 case surgery was performed on the kidney affected by xanthogranulomatous pyelonephritis using a renal sparing technique.

Aged↗

PubMed1988

Altered clinical and histological features of male MM mouse pyelonephritis associated with a change in its microbiology.

Radical changes in the clinical, microbiological and histological features of spontaneous pyelonephritis in MM male mice occurred when they were transferred to a new environment after Caesarean derivation. Although the incidence of pyelonephritis remained the same, the survival age was increased. The renal histology indicated a shift to a more chronic form of pyelonephritis with renal amyloidosis as a common feature. At autopsy much more renal scarring was seen, resulting in the 'shrunken' kidney typical of chronic pyelonephritis. Renal lymphocytic accumulations were commonly found in MM mice, but they were also seen frequently in C57BL mice and in germfree stocks of both strains: no association was found between these lesions and pyelonephritis.

Amyloidosis↗

PubMed1975

The relation between experimentally induced pyelonephritis and hypertension.

Hypertension resulting from chronic pyelonephritis has been shown in clinical as well as experimental cases, although some authors deny that there is a pathogenic relationship between the two. To throw light on this problem the present authors conducted a series of experiments with mongrel dogs, in which 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. Preoperative and postoperative levels of systolic pressure wer compared, but no definit 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 plus or minus 11.2 mmHg, 21.7 plus or minus 14.6 mmHg and 17.1 plus or minus 16.7 mmHg, respectively. Thus there was a significant elevation (p smaller than 0.01). 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↗

PubMed1978

Elevated plasma renin activity in patients with acute pyelonephritis.

Thirty-three patients with acute pyelonephritis were studied with regard to the changes in plasma renin activity (PRA) along the clinical course of the disease. 1) Abnormally high PRA was found in 64% of patients in the active stage of acute pyelonephritis; they showed a decrease in urinary output of sodium, a reduction in creatinine clearance, and high indices of inflammatory activity. 2) The changes of PRA in the course of acute pyelonephritis were negatively correlated to the urinary sodium excretion and creatinine clearance, but positively to the activity of inflammation, serum sodium concentration and the number of E. coli in the urine. PRA returned to normal with the improvement of pyelonephritis. 3) Concerning the mechanism of hyperreninemia in the active stage of the disease, the following three factors may be considered; renal ischemia, negative sodium balance in the body, and inflammation. Of these, the negative sodium balance seems to be the most important. The patients could not take enough foods to maintain their energy and sodium balance because of fever and pain. 4) The significance of resting PRA in acute pyelonephritis might be to reflect the sodium status in the body, but not to be related to hypertension.

Acute Disease↗

PubMed1991

Diagnosis of acute pyelonephritis in children: comparison of sonography and 99mTc-DMSA scintigraphy.

Ninety-one children 1 week to 10 years old with culture-documented febrile urinary tract infection were evaluated with renal sonography and renal cortical scintigraphy by using 99mTc-labeled dimercaptosuccinic acid (DMSA). On the basis of previous experimental studies, DMSA scintigraphy was used as the standard of reference for the diagnosis of acute pyelonephritis. The DMSA scans showed changes consistent with acute pyelonephritis in 63% (57/91) of the patients. Sonograms showed changes consistent with acute pyelonephritis in 24% (22/91) of the whole group and in only 39% (22/57) of the patients with scintigraphically documented acute pyelonephritis. Pertinent sonographic findings were areas of increased cortical echogenicity in 14 patients and decreased echogenicity in eight, including three patients with renal abscesses. Dilatation of the renal collecting system was noted in nine patients and renal enlargement was noted in three. We conclude that renal sonography is a relatively insensitive test for the detection of acute inflammatory changes of renal cortex. Therefore, it should not be used as the primary imaging technique for the diagnosis of acute pyelonephritis. However, sonography is a useful technique in evaluating the nature of the defects seen on the DMSA scan and in detecting obstructive uropathies that may be associated with urinary tract infections.

Acute Disease↗

PubMedDate not supplied

[Activity of proteolytic enzymes and trypsin inhibitor in blood serum and kidney in pyelonephritis].

In 116 patients with acute and chronic pyelonephritis and in 66 healthy persons the total proteolytic, trypsin-like, catheptic, BAEE-esterase activities and the content of trypsin inhibitor were determined in blood serum and kidney tissue. The total proteolytic and catheptic activities were distinctly increased in blood serum and, especially, in kidney tissue under acute pyelonephritis. In chronic pyelonephritis the activity of cathepsins was decreased in blood serum. The trypsin-like activity tended to decrease both in blood serum and kidney. The BAEE-esterase activity was increased in kidney, particularly in acute pyelonephritis, but in blood serum it was decreased. The inhibitor of trypsin was not found in kidney; in blood serum its content was slightly increased in acute pyelonephritis but there were only slight alterations in the chronic disease.

Acute Disease↗

PubMed1990

[Echographic dynamic control of the urinary system and fetal development in pregnant women with acute pyelonephritis].

Ultrasonography in 52 pregnant women with acute pyelonephritis has been found to be a useful marker of efficacy of aggressive care. Reversal of inflammation in acute pyelonephritis without an associated disease reduced the kidney size and restored urine flow by the end of the 7-9th day of therapy. In pyelonephritis coexisting with nephrolithiasis, reversal of inflammation did not completely restore urine flow until a stone in the urinary tract was passed or surgically removed. The clinical patterns of pyelonephritis were elucidated in congenital renal malformations. The urine flow was completely restored and kidney sizes were maximally contracted postpartum. With an early therapy, the fetal development was appropriate for gestational age. Frequently relapsing pyelonephritis concomitant with toxemia or severe congenital renal disease led to intrauterine growth retardation.

Acute Disease↗

PubMed1990

[The quantitative analysis of the x-ray changes in the kidney calices in chronic pyelonephritis in children].

As many as 89 patients aged 6 months to 14 years with microbial inflammatory diseases of the urinary tract and 40 controls of the same age were examined. Of the patients, 55 had chronic pyelonephritis, 21 acute pyelonephritis, and 13 an infection of the urinary tract. For examination use was made of the planimetric method of measuring the width of the fornix and the cervix of the renal calyces on excretory urography. The fornicocervical index, product of the indicated parameters of the calyces, was computed. In health, that index did not exceed 24 units. In the majority of patients suffering from chronic pyelonephritis, it turned out higher. The false negative results were obtained in 7 cases. The fornicocervical index remained unchanged in patients with acute pyelonephritis and urinary tract infection. It is suggested that the fornicocervical index be computed for use as an objective criterion in the diagnosis of chronic pyelonephritis in children.

Adolescent↗

PubMed1987

Cellular basis of host defence in pyelonephritis. III. Deletion of individual components.

Hosts were depleted of individual cellular components to determine the effects of these manipulations on cellular defence mechanisms in acute and chronic pyelonephritis. T-lymphocytes were found to have little or no involvement in host protection but cyclosporin A administration had a dramatic effect on the gross pathology and bacteriological status of experimentally induced pyelonephritis. This change represented a major depression of host defence status. Cyclosporin A also activated resolved lesions in chronic pyelonephritis, associated with an increase in bacterial numbers. Administration of antineutrophil serum also led to a 1000-fold increase in bacterial numbers in the acute phase but had little effect on the host-parasite balance in chronic pyelonephritis. Macrophage blockade, on the other hand, did not affect the course of either acute or chronic infection. These studies have provided additional information on the immunobiology of experimental pyelonephritis and have focussed attention on the role of neutrophils, and an unidentified mechanism, affected by cyclosporin A, in host defence to renal infection.

Animals↗

PubMed1988

[Effect of immunization with Escherichia coli J5 on the course of experimental pyelonephritis in rats].

Among the germs of urinary tract infections is a great heterogenicity. Therefore, in search of vaccine candidates of pyelonephritis such germs must be checked the antigens of which to be occurred as much in other pyelonephritis germs as possible. E. coli J5 as a re-mutante of E. coli O111 has a core-antigen which is found in the most enterobacteria. We have examined whether a pyelonephritis in rats was prevented by prophylactic use of a E. coli J5 vaccine and if the course of the disease was influenced by vaccine treatment of animals with pyelonephritis, respectively. Neither a pyelonephritis was prevented nor an existing infection was influenced favourable by the vaccine of E. coli J5.

Animals↗

PubMed1986

[Incidence of antibody-coated bacteria in patients with chronic pyelonephritis].

Of 168 urine sediments, which were obtained from 55 patients with chronic pyelonephritis in the course of 3 years when a significant bacteriuria with E. coli was present, we demonstrated antibody-loaded bacteria in 81 cases (48.21%). In the active stage of the disease with 54.10% were found significantly more than in the inactive with 32.61%. In obstructive chronic pyelonephritis the positive rate was 54.79% in contrast to 43.16% in non-obstructive chronic pyelonephritis. While in the active stage of the obstructive chronic pyelonephritis with 57.41% more antibody-containing bacteria were excreted than with 47.31% in the inactive stage, the positive rate in the active stage of the non-obstructive chronic pyelonephritis was with 54.47% significantly increased in contrast to 22.22% in the inactive stage. 25.71% of the patients excreted only ACB+-, 34.29% only ACB(-)- and 40% ACB+- and ACB(-)-germs in the course of the disease. The ACB-positive quote was in rough forms with 62.50% statistically significantly increased in contrast to 45.54% in O-typable and 42.86% in non-O-typable strains. In the ACB+- group the immunofluorescence titres to the homologous strain and the C3-activator in the serum as well as the urine lysozyme were significantly higher than in the ACB(-)-group.

Antibody-Coated Bacteria Test, Urinary↗

PubMed1986

[Defense mechanisms of the macro-organism in bacteriuria in chronic pyelonephritis].

In the course of 4 years we isolated 193 E. coli strains of 55 patients with chronic pyelonephritis. In patients with obstructive chronic pyelonephritis the mean value of the immunofluorescence titre (in the serum) to the E. coli strain excreted in the urine as well as the total complement were significantly increased, the serum lysozyme was significantly lower than in patients with non-obstructive chronic pyelonephritis. A relation to the activity of the disease was existing only in the non-obstructive chronic pyelonephritis, where in the active stage the total complement was significantly decreased, the complement factors C3 and C4 as well as the urine lysozyme were significantly increased in comparison to the inactive stage. 94.64% of all immunofluorescence titres obtained to the homologous strain in the patients' serum were above the border of the normal area of 1:40. A relation between level of the titre and activity of the disease could not be established. No significant differences could be proved between the titres taken to serum-sensitive and serum-resistant strains. In 32.73% of the patients we observed disturbances of the serum bactericidia against the homologous serum-sensitive E. coli urine strain at one or several points. They fall to equal shares to patients with obstructive and non-obstructive chronic pyelonephritis and were found at 66.67% in the active stage of the two forms of the disease. In patients with and without disturbances of bactericidia no significant differences in the total complement, in the complement factors C3 and C4, the C3-activator, the serum lysozyme and the immunofluorescence titres could be proved.

Antibody Formation↗