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PubMed1956

The diminutive kidney; congenital hypoplasia and atrophic pyelonephritis.

Diminutive kidney, hypoplasia or atrophic pyelonephritis, may be the cause of hypertension, lumbar or abdominal pain, obscure gastrointestinal symptoms or chronic urinary infection accompanied by chills and fever. A hypoplastic kidney is prone to infection and stone formation.Diagnosis includes meticulous x-ray examination and renal function studies employing the more accurate quantitative phenolsulfonphthalein test of each kidney. Nephrectomy is the treatment for unilateral disease causing symptoms; localized atrophic pyelonephritis is amenable to partial resection. Since urinary stasis invites infection, obstructing ureteral strictures should be dilated. Pyelectasis, secondary to ptosis, and ureteropelvic obstruction should be corrected by nephropexy or plastic repair. These conservative measures may prevent renal destruction.SIXTEEN PATIENTS WERE SUBJECTED TO NEPHRECTOMY: Six because of persistent pain and chronic infection and ten because of hypertension. The six with pain and chronic urinary infection were relieved. In six of the ten with hypertension, the disease recurred within six months to seven years.

Atrophy↗
PubMed1999

Oral vs intravenous ciprofloxacin in the initial empirical management of severe pyelonephritis or complicated urinary tract infections: a prospective randomized clinical trial.

BACKGROUND: There are few data on the efficacy of oral antibiotics in the initial empirical management of severe forms of urinary tract infection (UTI). METHODS: In a multicenter, prospective, randomized trial we compared oral (500 mg twice daily) vs intravenous ciprofloxacin (200 mg twice daily) in the initial empirical management of hospitalized patients with serious forms of UTI. Exclusion criteria were severe sepsis, inability to take oral medication, or the presence of obstruction or renal foci of suppuration. The study population included 66 women with pyelonephritis, 43 patients with community-acquired UTIs, and 32 patients with hospital-acquired UTIs. The frequency of bacteremia was 28 (42%) of 66 in the patients with pyelonephritis and 25 (33%) of 75 in those with complicated UTIs. Seventy-two patients were randomized to treatment with oral and 69 to intravenous ciprofloxacin. RESULTS: There were no infection-related deaths and no patients required an early change of antibiotics because of worsening clinical status during the initial empirical phase of treatment. The mean duration of fever was 1.7 days in patients treated by the oral vs 1.9 days in patients treated by the intravenous route (P = .15). The rates of microbiological failure (3% in the oral vs 2% in the intravenous treatment group) and of unsatisfactory clinical response (4% oral vs 3% intravenous) were low. A treatment change was eventually required in 14% of the patients assigned to the oral and 7% of the patients assigned to the intravenous regimen, mainly because of the isolation of enterococci or ciprofloxacin-resistant organisms in pretherapy urine specimens. CONCLUSIONS: In the hospital setting, oral ciprofloxacin is as effective as the intravenous regimen in the initial empirical management of serious UTIs, including bacteremic forms, in patients without severe sepsis, obstruction, or renal foci of suppuration. The efficacy of the oral regimen indicates a potential use for ciprofloxacin in outpatient treatment of a subset of patients currently hospitalized on account of disease severity.

Administration, Oral↗
PubMed1988

Emphysematous pyelonephritis in a xanthogranulomatous kidney. An unusual cause of pneumoperitoneum.

Emphysematous pyelonephritis is a rare, life-threatening suppurative infection of the renal parenchyma and perinephric tissues. The disease is encountered primarily in patients with diabetes mellitus or ureteral obstruction associated with perinephric and intrarenal gas. Causative organisms are those normally found in the urinary and gastrointestinal tracts; however, anaerobic bacteria have been demonstrated in only 1% of cases. We describe a case of emphysematous pyelonephritis, which presented as an acute abdomen with pneumoperitoneum in a nondiabetic patient. No visceral injury was found at laparotomy. Multiple gas-producing organisms, including Clostridium ramosum (not previously reported, to our knowledge), were the cause of the free intraperitoneal and perinephric air. Subsequent radical nephrectomy revealed a xanthogranulomatous kidney. An aggressive surgical approach combined with intensive antibiotic therapy, after aerobic and anaerobic culture of excised tissue, is lifesaving.

Adult↗
PubMed2001

Sonographic features of xanthogranulomatous pyelonephritis.

PURPOSE: The purpose of this study was to describe the various sonographic features of xanthogranulomatous pyelonephritis (XGP). METHODS: We retrospectively reviewed the CT, sonographic, and medical records of patients diagnosed with XGP from January 1981 to December 1998. Twenty-seven patients for whom XGP was histopathologically confirmed were included in the study. There were 12 men and 15 women, with an age range of 21-86 years (mean, 57 years). All patients had undergone sonography of the kidneys. The renal size, shape, and outline were recorded. The presence of perinephric fluid accumulation, of obstructive uropathy, or of internal echoes in the dilated collecting system and the echotexture of the renal parenchyma were documented. RESULTS: We categorized the XGP into 4 groups on the basis of the sonographic features: (1) diffuse hydronephrotic, 12 patients (44%); (2) diffuse parenchymal, 9 patients (33%); (3) diffuse contracted, 4 patients (15%); and (4) segmental or focal, 2 patients (7%). A localized perinephric fluid collection was present in 4 patients (15%). The preoperative sonographic diagnoses were pyonephrosis (n = 14, 52%), renal pelvic tumor with possible associated infection (n = 5, 19%), renal parenchymal mass (n = 2, 7%), hydronephrosis (n = 2, 7%), and chronic pyelonephritis with renal atrophy (n = 4, 15%). XGP was considered a possible diagnosis in only 11 patients (41%). CONCLUSIONS: XGP has no specific sonographic features but is suggested by parenchymal thinning and hydronephrosis, sonographic signs of chronic obstructive uropathy caused by stones; echoes in the dilated collecting system; and a perinephric fluid collection. CT, needle biopsy, or both are recommended to further evaluate and confirm sonographically suspected XGP.

Adult↗
PubMed1991

Chronic pyelonephritis: the significance of renal renin and the vascular changes in the human kidney.

Hypertension complicates chronic pyelonephritis. Since arterial narrowing is common in the damaged kidney, activation of the renin-angiotensin system due to renal ischaemia has been suggested as a pathogenetic mechanism. We used an antiserum to human renin and an immunoperoxidase technique to study the anatomy of renin-containing cells (RCC) in 18 kidneys removed for pyeloneophritis. We independently assessed the degree of arterial narrowing and correlated these variables with the clinical findings. There was histological evidence of hyperplasia of RCC in 5 of the 6 hypertensive patients and in 7 of the 12 non-hypertensive cases. There was no difference in the apparent number or distribution of RCC between the hypertensive and the non-hypertensive cases. Also, the degree of arterial narrowing did not correlate with either the hyperplasia of RCC or the blood pressure of the patients. Our results do not support the hypothesis that narrowing of the intrarenal arteries is important in the pathogenesis of hypertension in pyelonephritis. In our cases, the renal veins were more severely damaged than the arteries and their lumina were often obliterated by organized thrombus. We suggest that such widespread obliteration of the renal venous tree could impair blood flow and contribute to the tissue damage in the pyelonephritic kidney.

Adolescent↗
PubMed2004

Predictors of receipt of a fluoroquinolone versus trimethoprim-sulfamethoxazole for treatment of acute pyelonephritis in women in Manitoba, Canada.

PURPOSE: The increasing and comparatively high proportion of uropathogens in Canada resistant to trimethoprim-sulfamethoxazole (TMP-SMX) may be partially responsible for the increasing use of fluoroquinolones. A number of patient-specific variables have been identified as risk factors for infections caused by antibiotic-resistant pathogens. However, variables unrelated to need, have also been associated with receipt of broad-spectrum antibiotics. We identified patient variables associated with receipt of a fluoroquinolone versus TMP-SMX for treatment of acute pyelonephritis. METHODS: Healthcare claims from the province of Manitoba, Canada for the period February 1996 to March 1999 were examined to identify episodes of pyelonephritis in non-pregnant females between 18 and 65 years of age treated with TMP-SMX or a fluoroquinolone. Patient variables were identified based on healthcare claims review and data from Statistics Canada. Logistic regression was used to model the probability of receipt of a fluoroquinolone. RESULTS: A total of 1084 women met inclusion criteria; 653 treated with TMP-SMX and 431 treated with a fluoroquinolone. Age, income, rural residence, recent antibiotic use, recent hospitalization and presentation to an emergency room (ER) were positively associated with receipt of a fluoroquinolone. CONCLUSIONS: Patient variables reportedly associated with an increased probability of resistant organisms (e.g., age, recent antibiotic use and recent hospitalization) were significantly associated with an increased probability of receipt of fluoroquinolones. However, variables unrelated to antibiotic resistance (e.g., income, rural residence and presentation to an ER) were also significantly associated with receipt of a fluoroquinolone.

Acute Disease↗
PubMed2004

Application of serum PSA to identify acute bacterial prostatitis in patients with fever of unknown origin or symptoms of acute pyelonephritis.

BACKGROUND: Exclusion of prostatitis in screening for prostate cancer (Cap) is a matter of concern in the prostate-specific antigen (PSA) era. Yet, the identification of acute bacterial prostatitis (ABP), intentionally utilizing PSA in patients with pyrexia has been scarcely reported. METHODS: In total, 39 men, who presented at our department with a fever higher than 38.3 degrees C, were randomly selected. We investigated the fraction of patients who had serum PSA levels higher than 4.0 ng/ml and categorized them according to an initial diagnosis of pyelonephritis, ABP, other urogenital infections, and fever of unknown origin (FUO). RESULTS: Six of nine cases initially diagnosed as pyelonephritis, presented with elevated PSA levels between 9.5 and 75.1 ng/ml. All six cases of clinically diagnosed prostatitis had PSA elevated between 4.1 and 13.6 ng/ml. In 8 of 18 FUO cases, PSA was elevated between 5.1 and 77.0 ng/ml. PSA levels significantly correlated with age (P < 0.005). All 20 patients with elevated PSA received antibiotics, and serum PSA was significantly reduced in all cases (P < 0.001) together with the alleviation of fever and normalization of CRP. CONCLUSIONS: PSA is a prompt and steady diagnostic tool for identifying ABP that might be missed or misdiagnosed. We recommend the measurement of PSA in cases not only with urologic infection but also puzzling pyrexia.

Acute Disease↗
PubMedDate not supplied

Focal xanthogranulomatous pyelonephritis simulating malignancy in children.

Xantogranulomatous pyelonephritis is a severe chronic form of renal parenquimal infection that usually results in diffuse renal destruction. An unusual case of xanthogranulomatous pyelonephritis in a child is reported which presented as a focal mass without calculus in a functioning kidney and was diagnosed as a renal tumor.

Child↗
PubMedDate not supplied

Emphysematous pyelonephritis with resultant emphysematous cholecystitis secondary to hematogenous dissemination.

Both emphysematous pyelonephritis and emphysematous cholecystitis are uncommon, but potentially fatal, clinical entities. The simultaneous diagnosis of these two entities in the same patient has not previously been reported. In this paper, we describe a 68-year-old diabetic male who presented acutely with emphysematous pyelonephritis and emphysematous cholecystitis. This case demonstrates several important diagnostic and treatment considerations. Additionally, the unique circumstances of this case offer support for the proposal that emphysematous cholecystitis may often be secondary to hematogenous seeding/embolic phenomena rather than obstruction of the cystic duct. Prompt diagnosis is essential, as prompt intervention can minimize mortality and morbidity.

Acute Disease↗
PubMed1986

Experimental haematogenous pyelonephritis in mice with uropathogenic, enteropathogenic and enterotoxigenic Escherichia coli.

Acute haematogenous pyelonephritis was produced with known uropathogenic (075), enteropathogenic (0111) and enterotoxigenic (H10407) Escherichia coli in mice. The enterotoxigenic E. coli showed the highest bacterial counts in kidney and urine and was found to have the same potential for causing pyelonephritis as a known pyelonephritogenic strain both in untreated and corticosteroid treated mice. Enteropathogenic E. coli was found to be less pyelonephritogenic in untreated mice, but under the effect of corticosteroids it showed similar pyelonephritogenic potential.

Animals↗
PubMed1987

Microvascular injury and repair in acute human bacterial pyelonephritis.

Acute inflammatory cell-capillary endothelial cell interactions, related to injury and repair, were investigated light and electron microscopically in acute human bacterial pyelonephritis. In inflammatory infiltrate-adjacent microvessels, the small capillaries were completely occluded by leukocyte plugs and the large capillaries were densely filled with acute inflammatory cells adhering to the endothelium. Severe damage to small and large capillaries was observed around endothelium adherent, degranulated neutrophil granulocytes containing phagocytosed bacteria. There were spaces in the endothelium, degradation of the vascular basement membrane, of the perivascular interstitial matrix and of collagen fibrils, with fibrin deposition and vessel wall fragmentation. In the small capillaries relatively distant from the interstitial infiltrates, emigration of leukocytes was frequently seen. Around the escaping cells the endothelial lining displayed occasional discontinuities, allowing leakage of vascular fluid into the interstitial space. Some small capillaries not related to the infiltrate were occluded by fibrin thrombi with apparent damage to the endothelial cells and disruption of the capillary wall. Various reparative changes were noticed in association with this change including capillary neovascularization. The findings confirm the existence of polymorphonuclear leukocyte-mediated injury of capillaries during the development of inflammatory responses in acute pyelonephritis.

Acute Disease↗
PubMed1989

P-fimbriae vaccines. II. Cross reactive protection against pyelonephritis.

Protection against acute pyelonephritis was induced by immunization of baboons with purified P-fimbriae of Escherichia coli as vaccines. To test for cross-protective capacity of two different P-fimbriae vaccines we vaccinated baboons with P-fimbriae purified from either E. coli strain ER2 or strain JR1 and subsequently challenged the animals with E. coli strain JR1. All vaccinated animals showed elevated antibody titers to P-fimbriae from both of the E. coli strains used. Both vaccines tended to reduce the time of bacteriuria. They partially prevented pyelonephritis and protected against loss of renal function.

Animals↗
PubMed1975

Xanthogranulomatous pyelonephritis in childhood.

Urographic, arteriographic and B-mode echographic findings in a four-year-old girl with tumefactive xanthogranulomatous pyelonephritis are reported. Review of our case and those that preceded it illustrates that when a localized mass in a functioning kidney is encountered radiographically in a child, xanthogranulomatous pyelonephritis should be included in the preoperative differential diagnosis. Nephrectomy may then be avoided.

Child, Preschool↗
PubMed1997

Xanthogranulomatous pyelonephritis mimicking malignant disease: is preservation of the kidney possible?

Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of pyelonephritis rarely seen in children. It is characterized by destruction of the renal parenchyma and invasion of adjacent tissues, mimicking renal tumors. Preoperative diagnosis is very difficult. Two children with XGP are presented. One underwent nephrectomy and the other drainage of a renal abscess with kidney preservation. Although surgery is considered the only effective treatment, a high index of suspicion and renal biopsy may prevent radical nephrectomy.

Child↗
PubMed1988

Aggravation by morphine and D-aspartic acid of pyelonephritis induced by i.v. inoculation of Staphylococcus aureus in rats.

Experimental pyelonephritis was induced by intravenous inoculation of Staphylococcus aureus in homozygous Brattleboro diabetes insipidus (Hom Brattleboro DI), heterozygous Brattleboro (Het Brattleboro) and Wistar rats. One group of rats from each strain was implanted with morphine-containing pellet three days before inoculation. Another series of groups received D-aspartic acid (D-ASP) intraperitoneally, starting three days before inoculation throughout the experiments. Owing to the inhibition by morphine or D-ASP of food intake, another control group from each strain was subjected to food restriction. Pyelonephritis development on the tenth day of inoculation was evaluated by the determination of viable bacteria in urine and total kidney tissue, and pathomorphological lesions in kidney. Hom Brattleboro DI rats appeared more resistant. Morphine or D-ASP significantly increased the findings in three strains of rat.

Animals↗
PubMedDate not supplied

Comparison of the development of experimental pyelonephritis in homozygous brattleboro diabetes insipidus rats, heterozygous control rats and normal Wistar rats.

A comparative study was performed on haematogenous experimental pyelonephritis by injecting a Staphylococcus aureus suspension i.v. to homozygous and heterozygous Brattleboro and Wistar rats. The numbers of viable bacteria in blood, urine and kidney homogenates and the pathomorphological scores determined on the tenth day of infection were significantly lower in Brattleboro diabetes insipidus rats than in heterozygous Brattleboro and normal Wistar rats. The results suggest that homozygous Brattleboro rats are much more resistant to experimental pyelonephritis.

Animals↗