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PubMed1975

Single nephron study of intrarenal urea handling in experimental pyelonephritis.

Micropuncture experiments were carried out in 20 rats with bilat. experimental chronic pyelonephritis. Inulin and urea concentrations were estimated in the late proximal, early distal and latte distal nephron segment. Proximal urea reabsorption did not differ from that in control animals. Fractional amount of filtered urea in the early distal segment was significantly lower in the pyelonephritic rats, urea reabsorption in the distal tubule approcimated zero. The data indicate that intrarenal urea recirculation is abolished by the experimental lesion, thus determining maximal urine urea concentration. It is suggested that the concentrating defect of experimental pyelonephritis is not only a result of an adaptational increase in individual nephron GFR; an additional intrinsic lesion seems to be present, located in the renal medulla.

Animals↗

PubMed1990

Randomised double-blind study of norfloxacin and cefadroxil in the treatment of acute pyelonephritis.

In a coordinated, double-blind multi-centre trial, adults with symptoms of acute pyelonephritis were randomly assigned to receive a two-week course of oral treatment with either 400 mg norfloxacin twice daily or 1 g cefadroxil twice daily. Of 197 patients enrolled in the study, 140 could be evaluated for drug efficacy and 193 for drug safety. Norfloxacin gave a significantly higher bacteriological cure rate than cefadroxil, both at 3 to 10 days (98% versus 65%; p less than 0.0001; 95% confidence interval (CI) for difference in proportions 21-46%) and up to eight weeks (87% versus 48%; p less than 0.0001; 95% CI 25-54%) after cessation of treatment. The differences between the two regimens were most pronounced in men and in patients with complicating factors such as diabetes mellitus and urinary tract abnormalities. The clinical response during treatment did not differ between the two groups, but symptomatic recurrences at follow-up were more common in the cefadroxil group (28% versus 3%; p less than 0.0001; 95% CI 14-36%). Adverse events were more often reported by patients receiving cefadroxil (39% versus 22%; p = 0.011; 95% CI 4-30%) and consisted mainly of gastrointestinal disturbances and vulvo-vaginitis. In terms of bacteriological and clinical efficacy and safety, a two-week course of norfloxacin was superior to a two-week course of cefadroxil for oral treatment of community-acquired acute pyelonephritis.

Acute Disease↗

PubMed1995

Hyponatraemia and hyperkalaemia in acute pyelonephritis without urinary tract anomalies.

UNLABELLED: Three children with severe hyponatraemia and hyperkalaemia associated with acute pyelonephritis are reported. All were very young male infants in a poor general condition and seriously dehydrated. Diagnostic procedures did not detect obstructive uropathy or vesico-ureteric reflux. CONCLUSION: Hyponatraemia and hyperkalaemia occurs in young infants with severe acute pyelonephritis in the absence of obstructive uropathy or vesico-ureteric reflux. The severe inflammation of the kidney itself may explain the electrolyte disturbance by a transient resistance of the distal tubule to aldosterone.

Acute Disease↗

PubMed1987

Comparative activities of five antimicrobial agents in experimental Proteus pyelonephritis in mice.

Five antimicrobial agents, ciprofloxacin, ticarcillin, piperacillin, aztreonam and gentamicin, were compared both in vitro (MIC's, time-kill studies) and in vivo, in the treatment of experimental Proteus mirabilis pyelonephritis in mice. In the treatment of the pyelonephritis, ciprofloxacin was clearly superior to the other agents, both with respect to the percentage of sterile kidneys after treatment as with respect to the mean numbers of bacteria per kidney. The results can only be partially explained by the in vitro activities of the different antibiotics.

Animals↗

PubMed1976

Diagnostic value of ceruloplasmin, haptoglobin and sialic acid in chronic pyelonephritis.

In a group of 84 patients with exacerbated chronic pyelonephritis the authors have determined the blood serum levels of ceruloplasmin, haptoglobin and sialic acid before, during and after antibacterial treatment. They have found a decrease in these levels following treatment. The results of ceruloplasmin, haptoglobin and sialic acid assays could be used as an index for the activity of the pathologic process, as well as in the differential diagnosis between pyelonephritis and glomerulonephritis.

Ceruloplasmin↗

PubMed1982

Impairment of cell-mediated immunity in Pseudomonas aeruginosa pyelonephritis: lack of suppressor cell activity in vivo.

Bacterial pyelonephritis was induced in mice by direct microinoculation of Pseudomonas aeruginosa in the kidney. In the acute phase of P. aeruginosa pyelonephritis, a state of cell-mediated immunity impairment, evaluated both in vitro as lymphocyte reactivity to concanavalin A and in vivo as host versus graft reaction has been observed. Furthermore, delayed-type hypersensitivity to specific bacterial antigen has been detected only when the kidney infection was subsiding, i.e., 3 weeks after bacteria inoculation. When investigating the mechanism of such T-cell impairment, we were unable to transfer the immunodepression, suggesting that suppressor cells are not involved in vivo. The role of P. aeruginosa inhibition of cell-mediated immunity in the pyelonephritic host is discussed.

Animals↗

PubMed1986

Generalized amyloidosis secondary to xanthogranulomatous pyelonephritis.

Unilateral nephrectomy in an 8-year-old male with chronic renal failure and urosepsis revealed a combined histologic lesion of xanthogranulomatous pyelonephritis and amyloidosis. Amyloid deposits were found also in the rectum and liver. On clinical grounds xanthogranulomatous pyelonephritis was also suspected in the remaining kidney. Common causes of systemic amyloidosis were excluded. After operation the signs of amyloidosis diminished, probably due to removal of the infected kidney, but renal function deteriorated rapidly.

Amyloidosis↗

PubMed1992

Calculous pyelonephritis.

The authors report on 48 patients with calculous pyelonephritis. Urinary obstruction was caused by renal calculi in 21 patients and ureteral calculi in 27. Urine cultures were positive in 87.5% and bacteremia was seen in 70%. The common organisms in urine and blood culture were E. coli, Proteus and Klebsiella. Septic shock occurred in 10 (20.8%) out of 48 patients. Calculous pyelonephritis with urinary obstruction is a very serious condition.

Female↗

PubMed1990

Synergistic effect of promethazine with gentamycin in frequently recurring pyelonephritis.

The effects of promethazine were studied in children with frequently recurring pyelonephritis which was not associated with urological abnormalities. The results of three methods of treatment were compared: 10 children were given a combination of gentamycin and promethazine for 7 days (Group 1), 11 received gentamycin treatment alone for 10 days (Group 2), and 19 (Group 3) were on long-term oral antibiotic prophylaxis (5.6 +/- 2.1 years) with episodes of intensive treatment of recurrences. In a 3-year follow-up period, the number of pyelonephritis recurrences was significantly lower in Group 1 than in Groups 2 and 3. Six out of 19 children in Group 3 had renal scarring. The authors suggest a synergistic effect between gentamycin and promethazine therapy. Promethazine increases antibiotic sensitivity, which could contribute to the elimination of recurring urinary tract infections.

Adolescent↗

PubMed1995

Acute renal failure due to acute pyelonephritis.

We report a case of acute renal failure due to acute pyelonephritis with microabscess formation. Despite antibiotic therapy renal function deteriorated, necessitating peritoneal dialysis. Although rare, acute pyelonephritis is an important consideration in the differential diagnosis of acute renal failure, and prompt antibiotic therapy is crucial to insure a favourable outcome.

Acute Disease↗

PubMed1979

Emphysematous pyelonephritis: optimal diagnosis and treatment.

A case of emphysematous pyelonephritis is presented in which computerized tomography (CT) both confirmed the diagnosis and demonstrated extension of the gas to the region of the adrenal glands and inferior cava. The etiology and pathogenesis of emphysematous pyelonephritis is discussed. Radiologic evaluation of this disease should be prompt and noninvasive. Plain films establish the diagnosis, isotope scanning assesses function of the opposite kidney, and CT demonstrates the full extent of the pathological process and confirms the diagnosis. Aggressive treatment is recommended.

Emphysema↗

PubMed1999

[Intra- and peri-renal gas formation. Bilateral emphysematous pyelonephritis].

Bilateral emphysematous pyelonephritis is an extremely rare, rapidly progressive and life-threatening intrarenal and perirenal infection. It is associated with diabetes mellitus, obstruction of the upper urinary tract and the presence of gas-forming coliform bacteria. As it presents as a severe acute pyelonephritis, a high index of suspicion and computer-tomographic imaging are essential to make the diagnosis. Only immediate combined medical and (bilateral) surgical therapy can reduce the high patient mortality. Postoperatively, computer-tomographic monitoring is recommended to follow the response to therapy.

Aged↗

PubMed2001

Transient urethral obstruction predisposes to ascending pyelonephritis and tubulo-interstitial disease: studies in rats.

Chronic tubulo-interstitial disease, an important cause of end-stage renal disease, often results from the combined effects of a disturbed urinary outflow tract and urinary tract infection. Acute unilateral ureteral obstruction in rats rapidly induces foci of medullary necrosis, confined to the region of the papilla and fornices. This injury may provide a nidus for bacterial invasion and may invoke reactive and regenerative changes, ultimately leading to chronic pyelonephritis and tubulo-interstitial nephropathy. To explore this possibility, adult rats underwent renal morphological evaluation 2-7 days following transient 24-h unilateral ureteral obstruction. In some experiments the bladder was inoculated with bacteria (10(8)-10(9) cfu/ml Escherichia coli in 0.5 ml) after release of ureteral obstruction, with subsequent cultures obtained from the pelvis of both kidneys and from the urinary bladder. Morphologic evaluation of perfusion-fixed kidneys, 2-7 days after the release of 24-h ureteral obstruction disclosed papillary necrosis, urothelial proliferation, marked inner-stripe interstitial expansion, and fibrosis and proximal tubular (S3) dilatation. The lateral (perihilar region) was predominantly affected, with lesions spreading from the fornices. There was some progression of interstitial fibrosis during the postobstructive time course or following more prolonged ureteral obstruction. By contrast, infection hardly contributed to the tubulointerstitial changes. In rats subjected to infection, cultures were positive in all 15 postobstructive kidneys, as opposed to five contralateral kidneys (P < 0.0001). Viable counts from the postobstructive kidney were also higher than those from the contralateral side (79,000 +/- 12,000 vs 2900 +/- 1600 cfu/ml, mean +/- SEM, P < 0.0001), and were comparable to those obtained from the bladder (77,000 +/- 13,000 cfu/ml). We conclude that transient ureteral obstruction predisposes to ascending pyelonephritis and to tubulointerstitial disease. This vulnerability may relate to altered urodynamics and medullary tissue destruction.

Animals↗

PubMed2006

Resolution of cortical lesions on serial renal scans in children with acute pyelonephritis.

BACKGROUND: The ideal time for distinguishing a renal scar from acute inflammatory lesions by renal DMSA scintigraphy remains controversial. OBJECTIVE: To determine the time needed for resolution of lesions after acute pyelonephritis. MATERIALS AND METHODS: A total of 105 children with acute pyelonephritis underwent renal sonography, voiding cystourethrography and baseline DMSA scintigraphy. Two subsequent scans were performed during the 6th and 12th months in patients with abnormal findings on the previous scan. RESULTS: The baseline DMSA scintigraphy revealed cortical lesions in 37 patients. At 6 months, 13 patients (38.2%) were found to have cortical lesions. At 12 months, 6 patients (17.6%) were found to have persistent renal cortical lesions. The resolution rates for lesions detected on the first scan were 61.8% and 82.4% on the 6- and 12-month scans, respectively. Vesicoureteric reflux, and bilaterality or multifocality were not relevant for resolution of lesions. Female gender seemed to be associated with a higher persistence rate. CONCLUSIONS: The renal cortical defects present at 6 months have a high rate of resolution later during follow-up. DMSA scintigraphy performed 12 months after the infection provides more reliable data regarding persistence of renal cortical lesions.

Acute Disease↗

PubMed1997

Imaging of pyelonephritis.

OBJECTIVE: Accurate diagnosis of pyelonephritis using clinical and laboratory parameters is often difficult, especially in children. The main aims of this prospective study were to compare the value of different imaging techniques [renal sonography, cortical scintigraphy with technetium-99m dimercaptosuccinic acid (99mTc DMSA) and computed tomography (CT)] in detecting renal involvement in acute urinary tract infections and to determine the sensitivity of DMSA scans for permanent renal scars 6 months later. MATERIALS AND METHODS: Between February 1992 and January 1993, 55 children admitted to our pediatric unit with febrile symptomatic urinary tract infections were eligible for analysis. Ultrasonography (US), DMSA scanning and micturating cystourethrography were performed in every case. Only 18 children underwent CT. A second DMSA scan was performed in 48 children a mean of 7.5 months after the first. RESULTS: US abnormalities were found in 25 children (45 %). The first DMSA scan showed a parenchymal aspect suggestive of pyelonephritis in 51 patients (93 %). Among the 18 patients studied by CT, 14 had abnormalities. Normal US findings did not rule out renal parenchymal involvement. Scintigraphy appeared to be more sensitive than CT for renal involvement. The frequency and degree of initial renal parenchymal damage seemed to correlate with vesicoureteral reflux, but the most severe initial parenchymal defects were not associated with marked clinical or laboratory manifestations. Repeat DMSA scans, performed on 45 kidneys with abnormalities at the first examination, showed resolution in 19, improvement in 16, persistence in 8 and deterioration in 2. The prevalence of vesicoureteral reflux was not higher in patients with renal scarring on the second DMSA scan than in patients whose scans showed an improvement. CONCLUSION: DMSA scans should be considered as a reference in the detection and follow-up of renal scarring associated with acute urinary tract infection as this technique is more sensitive than US and CT, the latter being unsuitable because it entails radiation exposure and sedation of patients.

Acute Disease↗

PubMed2004

Pyelonephritis mimicking colitis on CT: case report.

We report a patient with acute pyelonephritis in whom the dominant computed tomographic findings were ascending colon and cecal wall thickening and pericolonic fat stranding, likely related to contiguous inflammation from the right kidney. To our knowledge, this is the first report of acute pyelonephritis affecting the right colon mimicking colitis on computed tomography.

Adult↗

PubMedDate not supplied

Hepatic periportal tracking associated with severe acute pyelonephritis.

The computed tomographic appearance of hepatic perivascular halos has been described in a variety of disorders. We observed three cases with sepsis due to acute pyelonephritis who presented with anasarca and had identical computed tomographic features of periportal edema associated with ascites, pleural effusion, a thickened gallbladder wall, and a dilated inferior vena cava. None of the three patients had an underlying disease process that was previously described as an etiology for an altered hepatic lymphatic dynamics. Acute severe pyelonephritis should be included in the differential diagnosis of extrahepatic diseases that cause hepatic perivascular lucencies.

Acute Disease↗

PubMed2002

Reversible secondary pseudohypoaldosteronism due to pyelonephritis.

We report a 5-week-old boy who developed severe hyponatremia and hyperkalemia secondary to acute pyelonephritis. The patient presented with non-specific signs, including poor appetite, failure to thrive, and dehydration. An endocrinological evaluation led to a diagnosis of pseudohypoaldosteronism. The patient had phimosis, but no congenital urinary tract malformations. Outflow obstruction secondary to the phimosis appears to have caused pyelonephritis, and renal inflammation decreased responsiveness to aldosterone transiently.

Acute Disease↗