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PubMed1989

[A case of emphysematous pyelonephritis--review of 32 cases in Japanese literature].

A case of emphysematous pyelonephritis is presented. A 66-year-old woman with diabetes mellitus was hospitalized for sudden pyrexia and left abdominal pain on January 13, 1987. She had shown preshock, pre-disseminated intravascular coagulation, hyperglycemia and renal dysfunction. Plain X-ray films of the abdomen and abdominal computer tomographic scanning showed a gas shadow in the left kidney. Retrograde pyelography demonstrated the left complete ureteral obstruction. A diagnosis was made of emphysematous pyelonephritis associated with diabetes mellitus and ureteral obstruction. Left nephrectomy was performed on January 17, 1987, and the pus obtained from the kidney yielded E. coli. After the operation, she has been doing well with diabetes mellitus under good control without insulin therapy. Thirty two cases of emphysematous pyelonephritis in the Japanese literature including our case are reviewed.

Aged↗

PubMedDate not supplied

[Function of the kallikrein-kinin and prostaglandin systems of the kidneys in patients with chronic pyelonephritis].

The activity of the kallikrein-kinin, prostaglandin and cyclase systems was assessed in 117 patients with chronic pyelonephritis with and without arterial hypertension. Pyelonephritis is shown to be associated with a dysfunction of the pressor-depressor mechanisms examined, featuring a depression of vasodepressor reactions. Patients with normal, increased and depressed humoral parameters could be found in each study group, the changes being particularly marked in patients with chronic pyelonephritis, combined with arterial hypertension.

Adolescent↗

PubMedDate not supplied

[New methods in the laboratory diagnosis of chronic glomerulonephritis and chronic pyelonephritis].

Two new laboratory diagnostic tests for chronic glomerulonephritis and pyelonephritis have been developed. The first one is based on electrophoretic mobility of urinary lysozyme under certain conditions, such as the use of 12% polyacrylamide gel with pH of 4.3 and acid electrode buffer with pH of 4.0. After electrophoresis was discontinued, lysozyme position was determined by lysis of Micrococcus lysodeikticus, used as test agents and added to the gel as a suspension prior to polymerization. Urinary lysozyme was found to be in the anode area of the gel in 95% of patients with chronic pyelonephritis, and in its cathode area in 92% of patients with chronic glomerulonephritis. There was no lysozyme in the urine of normal subjects. The other laboratory technique, the ethanol test, is based on comparative assessment of the degree of urinary opacification after ethanol is added in conditions of neutral reaction (following the addition of physiologic saline) and marked alkaline reaction (following the addition of sodium hydroxide solution). The ratio of optic density of the alkaline specimen to that of the neutral specimen was above 1 in patients with chronic glomerulonephritis, and below 1 in patients with chronic pyelonephritis and normal subjects. Examination of biochemical mechanisms of the proposed tests has demonstrated that the pattern of proteinuria is the most important factor affecting the results.

Adolescent↗

PubMed1989

[Use of plasmapheresis in multimodality correction of hemostasis disorders in patients with calculous pyelonephritis].

As many as 142 patients with calculous pyelonephritis were examined for the system of hemostasis. It is shown that pyelonephritis is characterized by hypercoagulation shifts according to the echitox test, by the high content of fibrinogen and its degradation products, thrombinemia, a decrease of the antithrombin III level, and by high heparin resistance of plasma. At the same time there was a reduction of fibrinolysis. Thirty-six patients with the most pronounced disorders of hemostasis underwent multimodality treatment including plasmapheresis which favoured an improvement of the patients' status. The body temperature declined, the signs of intoxication disappeared, and the well-being improved. Hypercoagulation tended to disappearance, whereas the content of fibrinogen and its degradation products decreased. The level of antithrombin III rose and plasma resistance to heparin disappeared. At the same time the characteristics of the paracoagulation tests identifying thrombinemia remained unchanged. No noticeable changes in fibrinolysis were recorded. It is suggested that plasmapheresis should be widely used in multimodality treatment of pyelonephritis.

Adult↗

PubMedDate not supplied

[Pseudotumor focal xanthogranulomatous pyelonephritis in adults. Role of imaging technics in the diagnosis].

Based on 8 personal cases, pseudo-tumoral xanthogranulomatous pyelonephritis is reviewed with emphasis on diagnosis. The condition is a particular form of chronic renal suppuration of histologic definition (combined lesions of chronic pyelonephritis and xanthogranulomatous foam cells). Two forms are recognized: one diffuse, fairly frequent form corresponding to a pyonephrosis, and a pseudo tumoral focal form, the only type discussed in this report, which raises the problem of diagnosis of a renal mass that requires the application of all currently available exploration means to define its true nature. Intravenous urography, ultrasound and CT scan imaging show a non-specific mass of variable character. Selective renal arteriography sometimes shows inflammatory type vascularization, a valuable aid but again non-specific. Puncture biopsy has been used by few authors. However, the presence of a renal mass associated with a chronic pyelonephritis, lithiasis and recurrent episodes of urinary infection should suggest the diagnosis and make use of imaging techniques to detect the affection and adapt therapy, major oncologic surgery being of no utility. Perhaps NMR imaging will provide a step forward in tissue characterization, but it is too early to say.

Adult↗

PubMed1988

[A case of xanthogranulomatous pyelonephritis--an experience of echo-guided aspiration biopsy for the diagnosis].

Xanthogranulomatous pyelonephritis is a rare disease of the kidney. The pre-operative diagnosis of this disease is usually very difficult. Recently, echo-guided aspiration biopsy has been suggested for the differential diagnosis of the renal mass. We experienced a case of xanthogranulomatous pyelonephritis and performed echo-guided aspiration biopsy. A 57-year-old female was admitted to our hospital with complaints of upper abdominal pain and right lumbago. Judging from the findings obtained by intravenous pyelography, computed tomographic scan, ultrasonography and angiography, the lesion was a right renal inflammatory mass but renal tumor could not be denied. Because clear cell carcinoma was suspected from the results of echo-guided aspiration biopsy, right radical nephrectomy was performed. However, the resected kidney was diagnosed to be xanthogranulomatous pyelonephritis. Post-operative course was uneventful.

Adenocarcinoma↗

PubMed1986

[Immunoglobulins in the serum of chronic pyelonephritis patients].

The authors studied the serum levels of immunoglobulins G, A and M in 72 patients with chronic pyelonephritis and 77 clinically healthy subjects. In spite of the high biological variability of the indices studied, high serum levels of IgG and IgA were established in the patients with active urologic infection and with advanced renal insufficiency. Significantly higher values of IgG were established in active pyelonephritis, caused by E. coli and Proteus and of all immunoglobulins--in infection with Enterococcus. The serum level of immunoglobulins in chronic pyelonephritis should be complexly interpreted, together with the other clinical and laboratory data.

Adult↗

PubMed1987

[Emphysematous pyelonephritis complicated by liver cirrhosis and diabetes mellitus: a case report and a review of the literature].

A case of emphysematous pyelonephritis is presented and a review of literatures is made. A 67-years-old woman with diabetes mellitus, complained of severe left flank pain and high fever and was referred from the department of gastroenterology. A computed tomography film demonstrated gas in the left renal parenchyma and a diagnosis of emphysematous pyelonephritis was made. She was in a state of shock and died after 4 days of conservative treatment. Emphysematous pyelonephritis is a rare, life-threatening disorder and 85 cases in the world have been reported to date. Our case is the 18th one in Japan. Its etiology, symptomatology, treatment and prognosis are discussed.

Aged↗

PubMed1986

Cellular basis of host defence in pyelonephritis. II. Acute infection.

We have investigated the cellular basis of host defence mechanisms in experimental pyelonephritis. Cellular components of the host defence system were depleted using cyclophosphamide, methylprednisolone or radiation. Depletion of cellular competence did not affect the course of infection during the first 16 h after challenge with Escherichia coli, but after 96 h up to a 1000-fold increase in bacterial numbers in the kidneys of cytodepleted animals was demonstrable. When quantitative aspects of the relationship between cellular competence and host defence were studied, it was found that severe depletion of cellular components was necessary before host defence mechanisms were adversely affected. Thus while cellular mechanisms are quantitatively adequate and contribute to host defence in pyelonephritis they have little impact on the immediate post-infection phase. Non-cellular factors however, do limit bacterial proliferation in the acute phase and may be important determinants in the biology of pyelonephritis.

Acute Disease↗

PubMed1986

Sodium and potassium concentrations of red blood cells and plasma in children with nephrotic syndrome, uraemia and pyelonephritis.

The sodium and potassium concentrations of the red blood cells and the plasma in 38 children with pyelonephritis (19 acute, 10 chronic and 9 healed), 5 children with uraemia, and 20 children with nephrotic syndrome were compared with those of control children. The red blood cell sodium concentration was lower in patients with acute pyelonephritis, uraemia, and steroid-treated nephrotic syndrome, and higher in those with chronic pyelonephritis and nephrotic syndrome not treated with steroids. Except in uraemic cases, these alterations were not accompanied by plasma sodium and potassium changes. The results might be explained by pathological Na+ and K+ transport processes in the red cell membrane. The possible role of extracellular fluid volume changes, sodium loss and water retention are discussed.

Child↗

PubMed1978

[Urgent problems in the study of pyelonephritis in children].

The literature data and own observations concerning the features of patho- and morphogenesis of pyelonephritis in children are presented. Particular attention is given to the importance of renal tissue and intrarenal blood vessels dysplasia in the genesis and development of pyelonephritis as well as to the pathogenetic role of inflammatory processes in urinary tract wall in obstructive uropathies. The importance of morphological studies in diagnosis, prophylaxis and treatment of pyelonephritis in children is emphasized.

Age Factors↗

PubMed1978

[Diagnostic value of determining urinary fibrin split products in glomerulonephritis, pyelonephritis and graft rejection].

On 112 patients with bioptically ascertained chronic proliferative glomerulonephritis, 94 with pyelonephritis and 23 patients with kidney transplantation altogether 1,050 times the fibrin fission products in the urine were estimated by the passive haemagglutination after Merskey. It was the aim of the investigation to test the diagnostic evidence described in literature concerning the floridity diagnostics in glomerulonephritis and the recognition of rejection in kidney transplantation as to its reproducibility. In comparison to the latent glomerulonephritis (0.3 microgram/ml) the florid glomerulonephritis (12.3 microgram/ml) as well as the acute pyelonephritis (9.2 microgram/ml) in comparison to the chronic pyelonephritis (1.3 microgram/ml) has significantly higher values. On account of the numerous "falsely positive" and "falsely negative" values in contrast to the data of other authors an activity diagnostics is not possible. Only in the glomerulonephritis with nephrotic syndrome a prognostic use is to be expected: Patients with steroid-sensitive nephrotic syndrome do not secrete any fibrin fission products in the urine and patients with steroid-resistant nephrotic syndrome secrete them in a large number. We could confirm that an increase of the fibrin fission products in the urine after kidney transplantation refers to an acute rejection crisis. Since 10 of 27 rejections were fibrin fission product-negative, in the lacking fibrin fission products in the urine a rejection is not be excluded, by which the diagnostic value is restricted.

Fibrin Fibrinogen Degradation Products↗

PubMed1979

[The clinical value of unspecific humoral immune parameters. Attempt at an immunogram. II. Quantitative determination of CH50E, CB50E, C3, C4 and lysozyme and measurement of indirect phagocytosis rate in the serum of patients with chronic pyelonephritis].

In 183 patients with chronic pyelonephritis as unspecific humoral immune parameters CH50E, CB50E, C3, C4 and lysozyme as well as the indirect phagocytosis against Staphylococcus aureus SG 511 and E. coli were tested. Clinically a differentiation according to 3 degrees of the renal function and 3 degrees of the activity of the disease was performed. The statistical analysis took into consideration mean and limit values. With the help of contingency tables tendency pictures were developed. C3, C4 and lysozyme proved as suitable for a humoral immunogramme in chronic pyelonephritis. C3 was increased in clear activity, C4 and lysozyme in restricted renal function and expressed activity. In view of the high biologic variation of humoral test parameters advantages and disadvantages of an immunogramme are discussed. But for patients with chronic pyelonephritis finally the estimations of IgM, IgG, IgD, C3, C4 and lysozyme are regarded as clinically useful. A feasable immunologic test set should be controlled, precised and completed.

Adult↗

PubMed1985

[Bacteriologic, histologic and functional studies of the kidney in 5 days' therapy of experimental E. coli pyelonephritis with gentamycin. Comparison with 9 days' therapy].

Short-term antibiotic treatment is recommended in infections of the lower urinary tract but its effectiveness is questioned in the upper urinary tract infections. We compared a 5 and a 9 day treatment of experimental E. coli 022 pyelonephritis after unilateral nephrectomy in 127 mal Wistar rats. We used 9 mg gentamycin per kg b.w. twice daily. I131 hippurat excretion was not decreased during the 5 day treatment but was only temporarily diminished during the 9 day treatment. Histologically the severe acute pyelonephritis was decreased after the 9 day treatment but not after 5 days of treatment. Bacteriologically almost all the kidneys were sterile after the 9 day treatment but the majority of the kidneys showed the injected strain of E. coli after the 5 day treatment. The results indicated that the shortened treatment was much less effective in our acute experimental pyelonephritis.

Animals↗

PubMed1985

[Pharmacokinetics of cefuroxime in pregnant women with acute pyelonephritis].

The pharmacokinetics of cefuroxime was studied in 40 pregnant women with acute pyelonephritis. The women were in the 2nd and 3rd terms of pregnancy. The antibiotic was injected in a dose of 500 mg. The antibiotic levels in the blood and urine were determined with the agar diffusion method. The pharmacokinetic parameters were measured in a one-compartmental model with regard to antibiotic absorption. The measurement was performed with the use of computer. The cefuroxime concentrations in the blood and urine were practically the same at all periods of the study and at different terms of pregnancy. In pregnant women with acute pyelonephritis, the volume of cefuroxime distribution and the time of a two-fold decrease in the blood antibiotic levels increased. The estimation of the optimal scheme of cefuroxime dosing by the Krueger-Timer principles provided treatment of acute pyelonephritis in pregnant women with intramuscular injections of the antibiotic in a dose of 500 mg every 8 hours for 7-8 days.

Acute Disease↗

PubMed1985

[Scintigraphic study of the kidneys with a 99m Tc-ascorbic complex in chronic pyelonephritis patients].

A scintigraphic study of the kidneys was carried out in 1780 patients with chronic pyelonephritis: 1308 with calculous and 472 with acalculous pyelonephritis. The scintigraphic finding was interpreted for each kidney separately. Diffuse damages of renal parenchyma was most often observed (47,6%), being, in the majority of the cases--bilateral. Disturbed drainage was established in 13,2%, dysfunction of one of the kidneys--in 18,8% and focal disturbed structure--in 5,4% of the kidneys studied. The results from the scintigraphic study were juxtaposed to the clinic of the disease and the data from laboratory and X-ray investigations. The scintigraphic study of the kidneys with 99m Tc-ascorbic complex is easy to perform, well tolerated by the patients, non-invasive method with no special risks, with minimal irradiation loading. Scintigraphy provides valuable information to the clinicians about the functional, structural and drainage disorders in the kidneys of patients with chronic pyelonephritis, allowing the control of the evolution of the disease and the effect of the treatment.

Ascorbic Acid↗

PubMed1979

[Chronic pyelonephritis of older and old patients--a diagnostic problem in general medical practice (author's transl)].

Chronic pyelonephritis is the most common renal disease of old age. The number of registered cases of this disease is below current diagnostic possibilities, since chronic urinary tract infection and chronic pyelonephritis still too rarely play a role in differential diagnostic considerations. Because of the insecure reliability of anamnesis and complaints reported by the patients the uroscopic examination of the urine and bacteriologic diagnostics are of special importance. These examinations can be carried out in general medical practice and they will lead to a diagnosis of chronic pyelonephritis with relatively high probability.

Aged↗

PubMed1979

[Xanthogranulomatous pyelonephritis in the infant. A report on 4 cases (author's transl)].

Four cases of xanthogranulomatous pyelonephritis in children are reported. In three cases, the disease took a diffuse form and in the fourth it was of a localised form. Around these cases, the authors review 39 case histories published between 1963 and 1978 and which involve only children. An over-all assessment of the 43 cases thus gathered together allows the general picture of xanthogranulomatous pyelonepn 9 cases, it was of the localised type; and in 4 cases, the pyelonephritis only involved one or another pyelon in patients with re-duplication. The diffuse type is more common in boys and the localised type in girls. Twenty-nine cases were found in children of less than five years. In 23 cases, there was a proteus infection. The etio-pathogenesis of xanthogranulomatous pyelonephritis remains obscure. The main clinical and therapeutic problems are dealt with.

Child↗