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Results for “Pyelonephritis”

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PubMed1997

[Emphysematous pyelonephritis].

OBJECTIVE: To present an uncommon but startling case of a urinary tract infectious disease such as renal emphysematous pyelonephritis. METHOD/RESULTS: We report the case of a decompensated diabetic female patient who presented an intrarenal infectious picture with gas formation compatible with emphysematous pyelonephritis that showed good evolution following medical treatment and simple nephrectomy surgery. CONCLUSIONS: Emphysematous pyelonephritis is a serious infective disease that occurs almost exclusively in diabetic patients and requires a fast and correct diagnosis differentiating between diffuse from focused processes in order to advise conservative or aggressive therapy on the renal unit (percutaneous drainage/nephrectomy), based on immediate hemodynamic and antibiotic medical support, due to its serious prognosis such as is described in the literature.

Emphysema↗

PubMed1997

Cytokine gene expression during experimental Escherichia coli pyelonephritis in mice.

PURPOSE: We studied nine inflammatory and immunoregulatory cytokines in acute pyelonephritis and urethral obstruction in mice to better understand the processes underlying kidney inflammation and scarring. MATERIALS AND METHODS: Experimental acute pyelonephritis was established in Bki NMRI outbred mice by bladder inoculation of Escherichia coli, followed by 6 h urethral obstruction. The numbers of cytokine mRNA expressing cells for interleukin-1 (IL-1), IL-4, IL-6, IL-10, IL-12, tumor necrosis factor alpha (TNF-alpha), TNF-beta, transforming growth factor beta (TGF-beta) and interferon gamma (IFN-gamma) were determined in the kidneys and spleens from the infected, non-infected but obstructed and untouched mice using in situ hybridization with radio-labelled oligonucleotide probes at 12 h, 48 h and 6 d after release of the urethral obstruction. RESULTS: Kidney cell expression of IL-1, IL-6 and TNF-alpha mRNA was observed already at 12 h and persisted on day 6 in the infected animals. A significant proinflammatory cytokine response occurred also in the non-infected obstructed animals, albeit later and at lower levels. A marked increase of IL-4, IL-10, TGF-beta and IFN-gamma mRNA producing cells was also found in the kidneys of these two groups again with higher levels in the infected animals. Very high numbers of splenocytes expressing mRNA for IL-1 were observed especially in the infected animals. A high proportion of splenocytes further expressed mRNA for IL-6, TNF-alpha, IL-4, IL-10, IFN-gamma and TGF-beta, again with highest numbers in the infected group of animals. CONCLUSIONS: The present study extends previous knowledge about the local and systemic cytokine expression profiles during acute pyelonephritis and after urethral obstruction. Of particular interest was the marked kidney cell expression of mRNA for TGF-beta, presumed to be important both for obstructive and post-infectious renal scarring.

Acute Disease↗

PubMedDate not supplied

[The role of the persistence characteristics of microflora in the etiological diagnosis and determination of the sources of the infection of the urinary system organs in pyelonephritis in infants in the first year of life].

The microbiological status of 63 infants with pyelonephritis was determined. The importance of bacterial persistence factors for the identification of the infective agent and the detection of the source of infection of the urinary tracts was evaluated. The intestinal reservoir was shown to be the source of persistent microflora causing the formation of pyelonephritis, the change of the pathogenic species and the development of isolated bacteriuria at the end of the acute stage of pyelonephritis in children under 1 year of age.

Anti-Bacterial Agents↗

PubMed1997

[Circadian hydroxyprolinuria in the early diagnosis of nephrosclerosis in patients with chronic pyelonephritis].

The time course of daily urinary excretion of hydroxyproline (HOP) was followed up in patients with chronic pyelonephritis. Manifest hyperhydroxyprolinuria was observed in these patients at the earliest stages of nephrosclerosis, and it augmented with development of renal insufficiency. Measurements of HOP in the urine of patients with chronic pyelonephritis is proposed as an indicator reflecting the metabolic status of renal connective tissue at the early stages of nephrosclerosis. It can be used to assess the activity of the sclerotic process in the kidneys of patients with chronic pyelonephritis, predict the disease course and outcome, and, probably, to develop methods of adequate pathogenetic therapy with biochemical monitoring. The method is not invasive, sufficiently informative, and available for clinical diagnostic laboratories.

Chronic Disease↗

PubMed1997

[Hydrocortisol, parathyroid hormone and calcitonin in blood of patients with chronic pyelonephritis and nephrosclesosis].

Hydrocortisole, parathyroid hormone (PTH), and calcitonin were radioimmunoassayed in the blood of patients with chronic pyelonephritis. Hydrocortisone content decreased at the early stages of nephrosclerosis before renal failure, and hypercalcitoninemia was developing. In chronic renal insufficiency hydrocortisone level normalized, hypercalcitoninemia augmented, and PTH level in the blood plasma increased. Disorders of these substances metabolism are believed to be one factor in the pathogenesis of pyelonephritic nephrosclerosis. Measurements of blood hydrocortisone and calcitonin in patients with chronic pyelonephritis can be used for early diagnosis of nephrosclerosis before its clinical manifestation as chronic pyelonephritis. Such measurements will help objectively assess the activity of the sclerotic process, timely begin proper treatment, and predict the disease course and outcome.

Adult↗

PubMedDate not supplied

Role of renal ultrasonography in the management of pyelonephritis in pregnant women.

OBJECTIVE: The objective of this study was to determine the usefulness of renal ultrasonography in pregnant women with pyelonephritis. STUDY DESIGN: A retrospective review was done of hospital records of 171 consecutive pregnant women admitted to the hospital over a 7-year period with the diagnosis of pyelonephritis. RESULTS: Urine cultures were positive in all but one of the women and intravenous antibiotics were administered in all cases. Renal ultrasonography was done in 75 (43.9%) of the women and results found to be normal in 26 (34.7%) of them. The renal pelvis was dilated mildly (6 to 10 mm) in 25 (33.3%), moderately (11 to 15 mm) in 16 (21.3%), and severely (> or = 16 mm) in 8 (10.7%) patients. Duplicated collecting systems and renal calculi were each found in 2 (2.7%) patients. All patients were treated conservatively with no need for ureteral stents. Three of the patients with severe hydronephrosis were first seen at term and delivery was therefore induced. There was no difference in maternal characteristics and outcome of pregnancy between women who underwent renal ultrasonography and those who did not. However, the duration of hospitalization was significantly longer (p < 0.02) for women in whom renal ultrasonography was performed (mean +/- SD, 5.8 +/- 1.7 vs 4.1 +/- 1.3 days). CONCLUSION: Renal ultrasonography is of limited benefit in pregnant women with pyelonephritis, because these imaging studies only rarely modify management and do not significantly affect pregnancy outcome.

Adult↗

PubMed1976

[Diabetes mellitus, hyperuricemia and pyelonephritis].

The following groups of patients are discussed. 1st group: 51 patients with diabetes mellitus and chronic pyelonephritis, 2nd group: 15 patients with diabetes, hyperuricaemia, adiposity and pyelonephritis. It was established that in the first group pyelonephritis was therapeutically well to be influenced by antiobiotics and chemotherapeutics after stopping of diabetes. In the second group the success was less satisfactory and it was also to be achieved retardedly on account of the massive renal lesion, by the combination of diabetes and uricopathy. The clinical syndrome of diabetes mellitus, hyperuricaemia and adiposity is discussed.

Adult↗

PubMed1998

Expression of intercellular adhesion molecule-1 in mice with Pseudomonas-induced pyelonephritis.

PURPOSE: To investigate the role of intercellular adhesion molecule-1 (ICAM-1) in the renal inflammatory process, we studied the time-course fluctuation of ICAM-1 expression on inflammatory lesions in mice with experimentally induced bacterial pyelonephritis and the effect of in vivo administration of an anti-ICAM-1 monoclonal antibody (mAb) on leukocytic migration. MATERIALS AND METHODS: Ascending pyelonephritis was induced by transurethral instillation of Pseudomonas aeruginosa, and the expression of ICAM-1 in the pyelonephritic lesions was studied by immunohistochemical methods. RESULTS: The expression of ICAM-1 on the pyelonephritic lesions closely paralleled the degree of infiltration of neutrophils and macrophages until 3 days after infection. At 7 days after infection, though the degree of infiltration of these cells was quite high, expression of ICAM-1 was reduced. Treatment with the anti-ICAM-1 mAb in mice with bacterial pyelonephritis resulted in suppression of influx of neutrophils and macrophages in the infected sites until 3 days after infection. However, at 7 days after infection inhibition of the influx of these cells was not seen. CONCLUSIONS: These results suggest that ICAM-1 expression is transient and plays a key role in the influx of neutrophils and macrophages associated with the early-phase response, and that in the late phase ICAM-1 independent adhesion molecules may be more predominant.

Animals↗

PubMed1998

[Pseudotumorous focal xanthogranulomatous pyelonephritis in children. Apropos of a case].

Xanthogranulomatous pyelonephritis is a particular form of chronic pyelonephritis. It is observed less frequently in children and can sometimes present with a focal pseudoneoplastic appearance. An 11-year-old child was admitted with abdominal pain, alteration of the general state and weight loss without fever or palpable mass. Medical imaging was unable to distinguish between malignant renal tumour or tuberculosis. The diagnosis was confirmed by the inflammatory and purulent appearance of the mass and histopathological examination of the biopsy fragment. Percutaneous drainage of the abscess, combined with antibiotics provided marked improvement. Despite its rarity and its nonspecific clinical features, focal xanthogranulomatous pyelonephritis must be considered in order to propose conservative treatment.

Amoxicillin-Potassium Clavulanate Combination↗

PubMed2026

Emphysematous pyelonephritis in children: Lessons from a case report and systematic review.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a rare, life-threatening gas-producing renal infection. Literature on pediatric EPN remains scarce. OBJECTIVE: To describe a case of pediatric EPN and systematically review the data on clinical presentations, diagnostic modalities, management strategies, and prognosis in pediatric emphysematous pyelonephritis. METHODS: A comprehensive search in PubMed, Embase and Web of Science using defined search terms was done, along with the Joanna Briggs Institute (JBI) critical appraisal checklist for quality assessment. RESULTS: Of 100 records, 20 studies (n = 21) were included in the review. The median (IQR) age of presentation was 48 (8-138) months. The major risk factor was reflux/obstructive nephropathy (52.3 %), and E. coli was the common organism. Management included antibiotics (47.6 %), minimally invasive procedures (33.3 %), or nephrectomy (19 %). We additionally report an adolescent girl with Type 1 diabetes mellitus and class 3A right-sided EPN. She improved with antibiotics and percutaneous nephrostomy (PCN) insertion. CONCLUSION: Obstructive or reflux nephropathy is a major risk factor for pediatric EPN. Antibiotics are the mainstay for treatment with supportive management. Refractory cases may require percutaneous drainage or partial/total nephrectomy.

Humans↗

PubMed2004

[Nephrectomy in acute uncomplicated pyelonephritis].

BACKGROUND: Which complications can develop from uncomplicated pyelonephritis that may require nephrectomy? METHODS: From January 1999 to June 2003 we carried out nephrectomy in ten cases due to abscess formation after acute, uncomplicated pyelonephritis. The medical files were evaluated retrospectively. RESULTS: Nine women and one man were involved. The mean age was 36.2 years. Leading symptoms: flank pain, fever and chills. The mean symptom duration before admission was 14.6 days. Urinary tract infections were caused by Escherichia coli (six), E. coli and Enterococcus (once) and Klebsiella pneumoniae (once). Two cultures were sterile. Indications for nephrectomy were urosepsis (7 cases), anuria (once), increasing abscess formation under antibiotic therapy (once), drastic deterioration of general condition (once). CONCLUSIONS: Uncomplicated pyelonephritis is easy to treat under outpatient conditions with adequate oral antibiotic therapy. Close control must be ensured and clear recovery of symptoms should occur within 48 h. In the case of long duration of symptoms (>6-7 days) or lack of improvement of symptoms under calculated therapy in the first 2 days, inpatient therapy should be initiated because of the high risk of infectious complications. According to our experience, the following patient group is especially at risk: female, symptom duration of at least approximately 1 week, pre-treatment and transfer from another departments.

Abscess↗

PubMed2004

Antimicrobial Selection in the Treatment of Pyelonephritis.

Pyelonephritis is a common clinical entity, although accurate data regarding the true prevalence of this infection are lacking. Acute pyelonephritis is associated with significant morbidity and even mortality. There are very few randomized controlled clinical trials that have addressed the optimal management strategies and antimicrobial therapy for this infection. Increasing resistance among uropathogens, especially Escherichia coli, has impacted recommendations for empiric antimicrobial therapy, and fluoroquinolones have emerged as the empiric therapy of choice for individuals managed as outpatients; more options are available for empiric parenteral therapy for those who require hospitalization. Further study of the epidemiology of antimicrobial resistance among uropathogens and of alternative agents for the management of pyelonephritis is urgently needed.

Journal Article↗

PubMed1999

Pharmacologic Basis for the Treatment of Pyelonephritis.

Urinary tract infections (UTIs) are among the most common bacterial infections in humans. Even though physicians have been treating UTIs for 60 years, there has been no standardized approach regarding the rational choice of antimicrobial agents and optimal treatment duration for these infections. This review discusses the pharmacologic basis for the treatment of UTIs. Although most antibiotics concentrate well in the urine and can eradicate most of the sensitive uropathogens that cause lower UTI, antibiotics given for the treatment of pyelonephritis must concentrate and kill bacteria embedded within the renal parenchyma. Investigators once believed that antibiotics must concentrate in sufficient amounts in the urine of infected patients to be effective in treating pyelonephritis. In fact, the efficacy of an antibiotic in the treatment of pyelonephritis is proportional to its capacity to converge in high concentration not only in urine but also in the renal parenchyma because serum and urine levels of antibiotics are poor predictors of the intrarenal levels. Other factors should also be taken into consideration in the management of UTIs, such as the time of day antibiotics are given because significant time-dependent differences have been observed in the pharmacokinetics and rate of excretion in urine of several antibiotics. Finally, the authors review the recent development in the inflammatory response in the urinary tract that may explain the clinical features of UTI and may be useful in the diagnosis as well as better management of UTI.

Journal Article↗

PubMed2005

[Emphysematous pyelonephritis with favourable outcome after conservative treatment].

Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis is responsible for a high mortality rate. We report the case of a woman, unknown diabetic, who presented with emphysematous pyelonephritis. Early diagnosis performed by CT-scan allowed effective and conservative surgical treatment and final positive outcome.

Amoxicillin-Potassium Clavulanate Combination↗

PubMed1970

Prevention of experimental hematogenous and retrograde pyelonephritis by antibodies against enterobacterial common antigen.

Rabbits were immunized with common antigen (CA) derived from Salmonella typhimurium. Animals with CA hemagglutinin titers of 1-320 to 1-81,920 were injected with 10(7) viable Proteus mirabilis via the retrograde and hematogenous routes. Nonimmune control groups were challenged similarly. From the retrogradely challenged groups sacrificed at 4 weeks, pyelonephritis was found in 89% of the control animals but not in those immunized. Bacteriuria was present in 89% of the controls but in only 61% of the immunized group. Hematogenously challenged, immune animals sacrificed at 6 weeks did not show histological evidence of renal pathology, and only 6% had bacteriuria. Eighty-six per cent of the nonimmune controls showed both pyelonephritis and bacteriuria. The protective effect is specific because of the following. (i) Active and passive CA immunization did not prevent pyelonephritis due to Pseudomonas aeruginosa which does not produce this antigen. (ii) Passive immunization with a CA antiserum conferred protection against a P. mirabilis challenge. (iii) Passive administration of an antiserum from which CA antibodies had been differentially absorbed abolished the protective activity.

Journal Article↗

PubMedDate not supplied

[Renal scintigraphy using technetium dimercaptosuccinic acid in the diagnosis of pyelonephritis in children: study of 17 cases]

OBJECTIVE: To determine whether the presence of abnormal results in DMSA renal scintigraphy indicates pyelonephritis. METHODS: We performed the washout test in 17 children with urinary tract infection, as a criterion standard, to locate the infection site. All the children underwent DMSA renal scintigraphy in the acute phase of the disease. The results were analyzed by the chi-square test or Fisher test. RESULTS: DMSA renal scintigraphy revealed changes in all five cases of pyelonephritis, suggesting acute kidney involvement. On the other hand, only one child with cystitis (total = 12 cases) had abnormal results in renal scintigraphy. Sensitivity and specificity were 100% and 92%, respectively. CONCLUSION: DMSA renal scintigraphy is a sensitive method for the diagnosis of pyelonephritis in children.

Journal Article↗

PubMed2005

[Diagnosis and conservative treatment of acute pyelonephritis in diabetes mellitus].

AIM: To raise efficacy of conservative treatment of patients with acute pyelonephritis (AP) which developed in the presence of diabetes mellitus (DM). MATERIAL AND METHODS: Elderly patients (n = 218, 182 females and 36 males) with DM and AP enered the study. DM type 1 and 2 were diagnosed in 41 and 177 of them. Pyelonephritis was diffuse-purulent, pyodestructive, calculous, pyocalculous. RESULTS: Conservative treatment was made in 160 patients, surgical treatment--in 58. Lethal outcomes (14 cases) were registered as a rule in patients with bilateral pyodestructive pyelonephritis. CONCLUSION: AP is a severe complication of DM. The severity of DM decompensation and metabolic disorders is proportional to AP severity. AP in diebetics runs often an asymptomatic course and the diagnosis is difficult. Therapeutic policy is individual with consideration of a clinical course. Positive results were achieved in 80% patients.

Aged↗

PubMed1964

THE ROLE OF IMMUNITY IN THE PATHOGENESIS OF EXPERIMENTAL RETROGRADE PYELONEPHRITIS.

Retrograde pyelonephritis was produced in rats by the intravesical injection of Proteus mirabilis. When animals were preimmunized against Proteus mirabilis by (a) prior infection, (b) administration of antigen, or (c) passively transferred antiserum, they were resistant to infection by proteus when challenged by the retrograde route. The protective effect of specific preimmunization in retrograde pyelonephritis indicates that a major site of action is retardation of bacterial growth within the parenchyma of the kidney.

Animals↗