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PubMedDate not supplied

[The characteristics of the treatment procedure in acute suppurative pyelonephritis in diabetic patients].

From 1986 to 1992 the authors treated 160 patients with acute purulent pyelonephritis (APP) associated with diabetes mellitus (DM). 100 patients were diagnosed to have diffuse-purulent pyelonephritis (DPP), 60 patients (37.5%) had purulent-destructive pyelonephritis (PDP). The authors carried on two different surgical policies: in 1986-1988 a conservative approach was followed (7 out of 21 patients underwent nephrectomy, 14 underwent nephrostomy and other organ-sparing operations), in 1989-1992 a radical approach was used. After the nephrostomy there were 7 lethal outcomes (53.8%) and 6 cures. Histological examination of the kidneys from the latter patients revealed DPP with major renal pelvic involvement. Lethal outcomes were caused by intoxication resultant from progressive purulent destruction in the operated on kidney in the presence of uncorrectable hyperglycemia with ketoacidosis. In view of mutual aggravation observed in APP and DM and ineffectiveness of nephrostomy in PDP, indications to radical removal of the inflammation focus (nephrectomy) are of vital character. This explains why the conservative approach was changed for the radical one according to which nephrectomy was conducted in 37 (94.8%) of the surgical patients. Lethal outcomes of nephrectomy under the radical approach reached 27%. The employment of active radical policy reduced postoperative lethality by 26.8%. It is inferred that in DPP conservative methods including nephrostomy are valid. IN PDP primary nephrectomy in justified. Overall positive results were achieved in 80% of the patients. A 20% lethality was due to severe DM, APP form and imperfect therapeutic policy.

Acute Disease↗

PubMed1993

Xanthogranulomatous pyelonephritis in a child.

Xanthogranulomatous pyelonephritis is an uncommon form of chronic aggressive infection of the kidney and surrounding tissues usually affecting middle aged women. It is rarely seen in childhood. We report the case of a female child with a history of fatigue, progressive anorexia, and fever in whom a diagnosis of pyelonephritis on a predisposing factor of lithiasis was suggested. After initial antibiotic treatment, nephrectomy was needed for an acute general deterioration. Pathology demonstrated xanthogranulomatous pyelonephritis.

Child, Preschool↗

PubMed1993

[Pyelonephritis in pregnancy].

This article on pyelonephritis of pregnancy is based on data from the literature and on a retrospective study of 64 patients followed up from 1987 to 1991. Pregnancy is the cause of a more frequent progression from lower urinary tract infection to pyelonephritis. The clinical features and course of the disease are not specific of pregnancy. Cure is the rule in young pregnant or non-pregnant women, provided the urinary tract itself is healthy. Repercussions on the foetus (weight and size retardation or prematurity) seem to have been overestimated; they are very light when pyelonephritis is successfully treated. Studies in neonates have shown no increase in the infection rate. Treatment is based on a 3-week course of antibiotics, the nature and use of which are discussed here. Prevention relies on detection and treatment of lower urinary tract infections which are known to respond readily.

Female↗

PubMed1993

[Acute pyelonephritis in diabetic patients].

Urinary tract infections rank first among the infections of patients with diabetes mellitus. They are encouraged by chronic hyperglycaemia and occur more frequently in diabetic women aged over 50 who suffer from disorders of the autonomic nervous system responsible for disturbances of bladder voiding. Another facilitating factor in younger women is pregnancy. Acute pyelonephritis is more dangerous than in non-diabetic populations, being often painless and therefore neglected. An unexplained blood glucose imbalance may be the only manifestation of acute pyelonephritis. In these patients, pyelonephritis is more frequently complicated by pyonephritis or papillary necrosis, both capable of threatening the patient's life or renal function. Moreover, since the diabetic kidney is exposed to a specific glomerulopathy with nephroangiosclerosis and interstitial lesions, all infections may aggravate these lesions, and they must be treated vigorously. Antibiotics may be less effective due to reduction of their tissue levels, and relapses, more frequent and resistant to treatment, may call for prophylactic treatment in certain patients. This is why urinary tract infections must be detected systematically and with a frequency which depends on the presence or absence of facilitating factors: female sex, age, neuropathy, mechanical causes and pregnancy. Using dipsticks that detect urinary leucocytes and nitrates makes detection easier and less costly.

Acute Disease↗

PubMed1993

[Antibiotic treatment of pyelonephritis in adults].

The diagnostic criteria of acute pyelonephritis are well determined, but this is not the case with the drugs used in the initial treatment and the duration of therapy, notably since not all cases of this disease have the same severity. The antibiotics which fulfill the requirements for effectiveness and good tolerance include aminopenicillins alone or combined with clavulanic acid, aminosides alone or combined with aminopenicillins, carbapenems, 2nd and 3rd generation cephalosporins, cotrimoxazole and fluoroquinolones. Patients with severe pyelonephritis should be hospitalized and treated initially by the parenteral route later followed by the oral route. Patients whose pyelonephritis shows no sign of severity can be treated at home by the oral route. The duration of treatment (10 to 20 days) depends on the initial severity and course of the disease, on laboratory reports and, sometimes, on urinary tract imaging.

Adult↗

PubMed1993

[The clinical significance of immunological indices in chronic pyelonephritis].

Humoral and cellular immunity and data on biopsy tissue inoculation were evaluated for 72 patients with morphologically confirmed pyelonephritis. Cellular immunity was judged by lymphocyte rosette-test. T-lymphocyte subpopulation was counted in absolute numbers. No case of the biopsy bacterial contamination was shown bacteriologically. A complement C3 component was obtained in amounts similar to those in the controls. In remission IgA tended to a significant increase which (in IgM fall) continues in the disease aggravation. T-lymphocytes (total, active and suppressors) reduced in number, the changes arising in the remission with further intensification in a pyelonephritis exacerbation. Basing on the evidence obtained it is inferred that a significant suppression of cellular immunity, particularly T-suppressors, agrees with the idea of pyelonephritis as genetically determined, infection-mediated immune inflammation initially involving the medullary layer and urinary mucosa. The disease is characterized by defects in local immunity and changes in the density of receptors to the agent antigens. The predisposition came to action in disorders of urodynamics consequent to obstruction or ureteral hypotonicity of nonobstructive nature.

Adolescent↗

PubMed1993

99mTc-MAG3 and 99mTc-DMSA in the detection and assessment of pyelonephritis.

In this report, we present the case of a patient suffering from recurrent acute pyelonephritis and who had a hypertrophic right kidney following left nephrectomy. 99mTc-dimercaptosuccinic acid (DMSA) scan is known to be of value in the diagnosis of pyelonephritis, based on the detection of parenchymal abnormalities. The kidney accumulation of 99mTc-mercaptoacetyl-glycylglycylglycine (MAG3) at 2-3 minutes also proves to supply useful information on cortical function. This case illustrates that 99mTc-MAG3 study may be an efficient complementary examination to 99mTc-DMSA scan in the detection and assessment of pyelonephritis.

Adult↗

PubMed1977

[The distribution of antibiotics in extravascular renal tissue during experimental pyelonephritis of dogs (author's transl)].

For the success of an antibiotic therapy in pyelonephritis the concentration of antibiotics attainable in the kidney tissue is of extreme importance. Therefore in dogs, besides serum level and urin level a tissue level was defined after a single dose of gentamycin and cefazolin. While gentamycin is highly concentrated in the kidney, which is indeed more in a state of shock than health, Cefalozin is being excreted, after initially high values, excreted in a course approximately parallel to the blood level curve, within 5 h down to concentrations between 1 mcg/ml and 4 mcg/ml. The level of the tissue in the cortex of healthy kidneys and infected kidneys without additional damage by a ureter ligature averaged about 40% less than the serum level. The tissue level of kidneys infected by the additional damage of a ureter ligature and with signs of a pyelonephritis was extremely lower and reached occasionally hardly 20% of the serum level. Attention is also called to the consequence of these results for the therapy of the pyelonephritis.

Animals↗

PubMed1977

[Diagnostic value of the 131 I-hippuran clearance in chronic pyelonephritis].

The authors report on their 9-year experience concerning the results of the determination of the effective plasma flow by means of the 131J-hippuran clearance in patients with chronic pyelonephritis. On account of the disagreements in literature it was our first task to establish the lower normal limit. Issuing form the parallel investigations with the classical PAH-clearance in 50 patients and in a control group of 71 patients with hearlhy kidneys 487 ml/min were taken into consideration as lower normal limit. The authors examine in 867 patients with chronic pyelonephritis whether it is possible to diagnose relatively early disturbances of the renal function in values of the hippuran clearance lower than 487. It was established that in 28.9% of these patients the ING was normal, in 45% the concentration power maintained and in 70% the rest nitrogen in the serum was not increased. These results allow the recommendation of a broader application of the hippuran clearance in patients with pyelonephritis, since by means of this method relatively earlier restrictions of the renal function can be established than by means of other functional tests (ING and Volhard's test).

Adolescent↗

PubMedDate not supplied

[Lipid peroxidation in the kidney tissue of patients with nephrolithiasis and chronic pyelonephritis].

Lipid peroxidation (LPO) activity has been analyzed in homogenates and microsomes of cortical samples obtained intraoperatively from the kidneys of 33 patients. Of them, 21 patients had mild, moderate or severe pyelonephritis or nephrolithiasis. Unaffected cortical tissue from renal carcinoma patients was used as control. LPO activity was judged by basal level of malonic dialdehyde (MDA) and MDA growth in the homogenate and microsomes following initiation of ascorbate-dependent LPO. Activation of LPO was registered in patients with moderate disease with active inflammation. They also exhibited greater MDA basal levels and rapid MDA increase in response to in vitro initiation of ascorbate-dependent LPO simultaneously with attenuation of endogenous antioxidant defense. In severe pyelonephritis and nephrolithiasis with drastic deficiency of renal function LPO activity was low and nonresponsive to stimulation either by ascorbate or Fe+2. This is probably due to lack of the substrate after massive death of renal cells. Enhancement of LPO activity in patients with pyelonephritis or nephrolithiasis against functioning kidneys may appear responsible for destruction of renal tissue.

Adolescent↗

PubMed1996

[Spontaneous renal rupture due to xanthogranulomatous pyelonephritis; a case report].

A 47-year-old female was admitted with colicky pain in the left flank. Ultrasonography and abdominal CT revealed left perirenal hematoma. Abdominal CT revealed a multilocular cystic lesion in the upper pole of the left kidney. Renal angiography revealed left renal cell carcinoma. Left nephrectomy was performed under a tentative diagnosis of left renal cell carcinoma. However, pathological diagnosis was xanthogranulomatous pyelonephritis. Xanthogranulomatous pyelonephritis is an atypical form of chronic renal parenchymal infection that can be classified as diffuse type or focal type. Preoperative diagnosis of focal xanthogranulomatous pyelonephritis is difficult because of clinical and radiological similarities to renal cell carcinoma. Our case is presented with a brief review of the literature.

Carcinoma, Renal Cell↗

PubMed1996

[Pseudotumor form of focal acute pyelonephritis].

Two cases of focal acute pyelonephritis presenting with an unusual pseudo-tumoral appearance on CT are reported. The lesions exhibited a focal intra-parenchymal homogeneous round-shape mass without any other parenchymal or perirenal fat CT abnormalities. The final diagnosis of focal acute pyelonephritis was confirmed on following CT scans which demonstrated the total disappearance of the lesions in both cases. This particular appearance of acute focal pyelonephritis which mimicked a renal tumor should be clearly individualized in the terminology based on CT findings.

Acute Disease↗

PubMedDate not supplied

[The information value of Escherichia coli persistence markers in the bacteriological diagnosis of chronic pyelonephritis in children].

In 181 E. coli strains isolated from sick children having chronic pyelonephritis and risk factors of its development, as well as from healthy children, the complex of phenotypic signs, and among them bacterial persistence markers (antilysozyme, anticomplementary and "anti-interferon" activity), adhesive capacity, antibiotic resistance and colicinogenicity, were analyzed. The specific bioprofiles of E. coli, the causative agents of pyelonephritis, were established. The most informative biological characteristics of E. coli were determined and used as the basis for the development of the algorithm for differentiating the causative agents of pyelonephritis from transitory and contaminating flora. The effectiveness of the proposed diagnostic algorithm was confirmed by clinical approbation.

Algorithms↗

PubMed1977

[Renal failure in an infant due to bilateral ureter obstruction by Candida albicans pyelonephritis (author's transl)].

In the course of Candida albicans pyelonephritis an infant devleoped acute renal failure as a result of bezoar production with bilateral obstruction of the ureters. As on the one hand "obstructive" Candida pyelonephritis is not a well-recognised cause of renal failure, and on the other a noticeable increase in the number of cases of serious Candida infection with pyelonephritis can be observed during antibiotic and immmunosuppressive therapy, it seems worthwhile to report this case.

Acute Kidney Injury↗

PubMedDate not supplied

[Lipid peroxidation and Ca-dependent ATPase activity in the microsomal fraction of renal tissue in patients with nephrolithiasis and chronic pyelonephritis].

The author has estimated levels of malonic dialdehyde (MDA) indicative of activity of membrane phospholipid peroxidation activity, basal and true (in incubation in the culture containing glomeruloform antibiotic alameticin) Ca-ATPase activity in microsomal fraction isolated from cortical tissue of functioning kidneys obtained intraoperatively from 26 patients. 12 samples of cortical tissue obtained from uninvolved parts of the kidneys affected with carcinoma served as control. 14 samples were obtained from the tissue of functioning kidneys affected with nephrolithiasis and active chronic pyelonephritis. The investigations show elevated MDA levels, enhanced basal in reduced true Ca-ATPase activity of microsomes from the kidneys of patients with nephrolithiasis and active chronic pyelonephritis compared to control. It is suggested that high basal against low true Ca-ATPase activity of renal microsomes may be explained by increased permeability of renal membranes for Ca2+ under activation of lipid peroxidation in active chronic pyelonephritis and nephrolithiasis.

Adolescent↗

PubMedDate not supplied

[Effect of a renal peptide complex on experimental acute pyelonephritis].

The purpose of the present study was to examine the effects of the animal renal peptide complex renaline obtained via acid extraction on the cause of acute pyelonephritis in the experiment. Renaline was found to be highly effective in treating experimental acute pyelonephritis in rats. This is manifested as improved changes in the parameters of leukocytosis, leukocyturia, rectal temperatures, and bacteriuria along with the regression of abnormal changes and the reduction in renal mass differences, as compared to the similar parameters in untreated animals. The findings indicate that the clinical use of renaline in the combined therapy for acute pyelonephritis.

Acute Disease↗

PubMed1977

Acute renal failure secondary to acute pyelonephritis.

A six year-old girl presented with acute oliguric renal failure, secondary to acute, non-obstructive pyelonephritis. Evidence for pyelonephritis as the cause of renal failure included: the evolution of typical changes on serial intravenous pyelograms, an acute interstitial inflammatory exudate on percutaneous renal biopsy, and gram-positive cocci on gram stain of the biopsy tissue. Although a specific causative organism was not conclusively identified, enterococcus was isolated from the initial catheterized urine specimen. The patient recovered from the acute illness but was left with impaired renal function, hypertension, and cortical scarring. Acute, non-obstructive pyelonephritis can produce acute renal failure in children and must be considered in the differential diagnosis of this syndrome.

Acute Disease↗

PubMed1997

Haemolytic Escherichia coli in etiopathogenesis of pyelonephritis in rats--an experimental study.

Of the 26 urinary E. coli strains employed in the present study, 16 were haemolytic and 10 were non haemolytic in character. Of the 16 haemolytic strains injected through the exposed femoral vein of the rats, 12 showed the lesions of pyelitis, pyelonephritis and proliferation of glomerular tuft while 2 showed only the lesions of pyelitis and pyelonephritis. It was interesting to note that none of the nonhaemolytic strains produced any lesion in the animal. The data demonstrated a positive correlationship between haemolytic activity of E. coli and pyelonephritis in rats.

Animals↗