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PubMed1999

Emphysematous pyelonephritis: case report and review of the literature.

Emphysematous pyelonephritis (EP), a rare necrotizing infection of the upper urinary tract, is a life-threatening complication of patients with diabetes mellitus. A case of EP is described where the diagnosis was delayed for 36 h and the patient died notwithstanding aggressive medical and surgical intervention. The demonstration of gas in the renal structures is pathognomonic of EP. Because early diagnosis and aggressive medical and surgical management is imperative for recovery, we recommend plain abdominal radiographs as a minimal screening tool for all diabetic patients who present to hospital with a presumptive pyelonephritis. The diagnosis should also be considered in patients who failed appropriate medical therapy.

Diabetes Mellitus, Type 2↗

PubMed1984

Standardization of a model of E. coli-pyelonephritis in rats.

The validity of preclinical testing of antibiotics in animal experiments is highly dependent on the quality and, especially, the standardizability of the infection model. Some of the factors associated with standardization of the acute phases of infection are demonstrated for experimental pyelonephritis in female albino Wistar rats after transuretheral infection. The renal bacterial count and infection rate are correlated to the volume and bacterial concentration of the instilled E. coli suspension. Strains of albino Wistar rats from different breeding institutions show differing resistance to the infection. E. coli pyelonephritis establishes more easily in female Wistar rats of strain Han: WIST than in strain Bor: WIST. Following dissection of the animals, the infected kidneys can be stored for at least 4 weeks at -30 degrees C or in liquid nitrogen, because the bacterial counts remain constant. However, in frozen renal homogenates the bacterial counts fall rapidly. During the first 4 post-infection days the bacterial content of the kidneys is relatively constant. The period 30-72 h post infection is especially suitable for therapeutic studies.

Animals↗

PubMed1991

Treatment of pyelonephritis in an observation unit.

STUDY OBJECTIVE: To determine the feasibility of managing patients with acute pyelonephritis as outpatients after initial treatment with IV antibiotics in an emergency department observation unit. DESIGN: Prospective and uncontrolled. SETTING: ED observation unit. TYPE OF PARTICIPANTS: Nonpregnant female patients 14 years old or older without immunocompromise or serious underlying disease and no evidence of septic shock. INTERVENTIONS: All patients received two IV doses of trimethoprim/sulfamethoxazole at a 12-hour dosing interval and promethazine and acetaminophen as needed for nausea and fever, respectively. Baseline laboratory data, urinalysis, and urine and blood cultures were obtained. MEASUREMENTS AND MAIN RESULTS: Patients were observed for signs of septic shock, nausea, vomiting, and the ability to tolerate an oral intake. At the end of the observation period, 43 of 44 patients were discharged on oral trimethoprim/sulfamethoxazole. One additional patient who was doing well clinically was recalled and admitted because of a positive blood culture. CONCLUSION: Patients with acute pyelonephritis, despite significant fever or nausea and vomiting, can be treated effectively as outpatients after a brief period of observation and IV antibiotics.

Adolescent↗

PubMed1988

Emphysematous pyelonephritis: an emergency indication for the plain abdominal radiograph.

We report the case of a 59-year-old diabetic woman with emphysematous pyelonephritis. The patient presented with nausea, vomiting, and right flank pain of three days duration. The diagnosis was established by a plain abdominal radiograph in the emergency department. Aggressive rehydration, control of diabetes, broad-spectrum antibiotic therapy, and early right nephrectomy resulted in rapid clinical improvement. Emphysematous pyelonephritis is rare and often fatal. Survival depends on early diagnosis and aggressive combined medical and surgical management.

Anti-Bacterial Agents↗

PubMed1981

Citrate-synthase activities in the renal tissue during experimental and chronic human pyelonephritis.

In chronic experimental and human pyelonephritis (PN) renal enzyme and phosphatide analyses and quantitative histological examinations were performed. The results reported in this study only refer to citrate-synthase activities (= condensing enzyme = CE). 139 rabbits developed unilateral experimental pyelonephritis, in further 19 rabbits the experimental PN did not settle or "healed up spontaneously". 31 samples of human pyelonephritic nephrocirrhotic kidneys and 20 samples of healthy human kidneys were examined in the same manner. The glomerular CE-activities in the rabbit increased steeply in the 20- and 31-days-series, remained at a high level up to the 100-days-series, showed normal values in the 213-days-series, and permitted a marked decrease to be seen in the 261-days-series only. The corticotubular CE-activities increased steeply in the 20- and 31-day-series, still being above the normal values in the 64-days-series. Thereafter, only reduced and strongly reduced values were observed. In the pyelonephritic medulla of rabbits the CE-activities increased very steeply during the 20-days-series, were still above the level of the normal values up to the 100-days-series, dropping then to pathologically reduced data in the 212-days-series. Thus the CE-activities showed a similar type of behaviour to that of the corresponding glomeruli. Chronically pyelonephritic contracted renal tissue in human beings also showed major reductions in CE-activities in all three tissue fractions studies. The significance calculations (universally applied t-test) showed an overwhelming majority of significant values (p less than 0.001).

Animals↗

PubMed1986

Suppurative bacterial pyelonephritis as a cause of acute renal failure.

Acute oliguric renal failure associated with bacterial pyelonephritis is a rarely recognized clinical entity. We report a woman with an ectopic pregnancy who developed acute renal failure requiring dialytic support. The renal biopsy revealed focal microabscess formation and leukocyte interstitial infiltration compatible with suppurative pyelonephritis. Although her renal function improved gradually with antimicrobial treatment, the process was incomplete and renal dysfunction persisted at a 10-week follow-up, suggesting permanent renal damage.

Acute Kidney Injury↗

PubMed1997

Xanthogranulomatous pyelonephritis in a renal allograft recipient.

Xanthogranulomatous pyelonephritis rarely occurs in renal allografts. This is the fifth reported case. Diagnosis was made by renal biopsy, which is usually performed to evaluate an elevated serum creatinine. Associated patient symptomology is nonspecific, and graft imaging with ultrasonography and computed tomography was not helpful as it would be with native kidney xanthogranulomatous pyelonephritis. Successful treatment with antibiotics may depend on the serum creatinine at presentation. Prognosis, therefore, is guarded, with a common outcome of irreversible renal dysfunction.

Adult↗

PubMed1999

Bilateral emphysematous pyelonephritis caused by Candida infection.

Emphysematous pyelonephritis is a rare, often severe infection of one or both kidneys that is most often caused by bacterial infection. Surgical intervention is often necessary. We describe a case of a diabetic patient with bilateral emphysematous pyelonephritis caused by Candida infection that was treated conservatively. Renal function recovered almost completely in spite of giving a potential nephrotoxic drug for 6 weeks.

Aged↗

PubMed2000

Acute pyelonephritis: a cause of acute renal failure?

Two patients with acute renal failure due to acute pyelonephritis are described. Examination of the renal biopsy showed normal glomeruli, severe interstitial neutrophilic infiltration and edema with no signs of acute tubular necrosis. Until now, only twelve biopsy-proven proven cases have been reported. A review of the literature on acute renal failure due to acute pyelonephritis is presented.

Acute Disease↗

PubMed1983

Epithelial abnormalities in the renal pelvis in experimental hydronephrosis and pyelonephritis.

Unilateral hydronephrosis was induced by temporary ligature of the left ureter in 29 rabbits. In 21 animals so treated, chronic pyelonephritis was simultaneously induced by intravenous application of a suspension of E. coli. Histologic examination of renal pelvic epithelia in animals killed four weeks after the surgical intervention, revealed the following features: 1. Simple hyperplasia of urothelium in 12 cases, 2. atypical hyperplasia - (dysplasia) of urothelium in 10 cases, 3. v. Brunn's nests in 20 renal pelvises; 11 cases of cystic pyelitis, all combined with Brunn's nests, 4. metaplastic transformation of visceral mono- or bilayered epithelium into multi-layered urothelium-like structures in 19 renal pelvises. These changes are observed almost exclusively in the left renal pelvis of animals subjected to temporary ureteral ligature. Atypical urothelial hyperplasia is found only together with chronic pyelonephritis. Hyperplastic and dysplastic epithelial changes in the renal pelvis, the formation of Brunn's nests, and cystic pyelitis are interpreted as sequelae of postrenal obstruction or concomitant chronic inflammation.

Animals↗

PubMed1998

MRI and CT features in two unusual cases of xanthogranulomatous pyelonephritis.

Two unusual cases of xanthogranulomatous pyelonephritis studied by both magnetic resonance imaging and computed tomography, are presented. Extension of the disease depicted by both computed tomography and magnetic resonance imaging was compatible with the findings at surgery. Computed tomography seems to be sufficient for xanthogranulomatous pyelonephritis imaging evaluation, while magnetic resonance imaging is not recommended on a routine basis, since no additional valuable information is yielded.

Aged↗

PubMed1999

Rational diagnostic steps in acute pyelonephritis with special reference to ultrasonography and computed tomography scan.

Depending on the severity of the clinical syndrome, acute pyelonephritis may require more extensive imaging diagnostics. In the uncomplicated form of the disease, ultrasonography does not appear to be absolutely necessary. In clinically severe cases, however, which fail to respond to antibiotic therapy, ultrasound is the optimal procedure for ruling out urinary tract obstruction. Where there is clinical suspicion of complications proven risk factors, persistent fever and/or continuing pathological inflammation parameters (elevated C-reactive protein levels in serum)-ultrasonography is the primary imaging technique for the exclusion of pyonephrosis, as well as for other complicating factors such as calculi, etc. In cases of insufficient response to antibiotic therapy, we recommend performing a renal computed tomography scan with contrast medium, in order to rule out hypoenhancing zones as hints for severe tissue alterations. This procedure is in accordance with the suggestions of the Society for Uroradiology. In the future, DMSA scintigraphy might constitute an equivalent diagnostic method for the exclusion of these focal inflammatory changes. Above all, DMSA scintigraphy makes it possible to anticipate the development of scars following acute pyelonephritis.

Acute Disease↗

PubMed2000

Isepamicin versus amikacin for the treatment of acute pyelonephritis in children.

In this study we compared the efficacy and safety of isepamicin versus amikacin at a dose of 7.5 mg/kg i.v. q12h for 10-14 days in children with pyelonephritis. Sixteen children were enrolled in the study; ten received isepamicin and six amikacin. Urine cultures grew Escherichia coli in all patients. All patients were treated successfully with either isepamicin or amikacin. Clinical and bacteriological response rates were 100% for both groups. No adverse events occurred. Peak serum levels ranged from 9.05 to 30.70 mg/l (median: 16.165) and from 12.20 to 25.90 mg/l (median: 19.05) for isepamicin and amikacin, respectively. Trough serum levels ranged from 0.11 to 3.20 mg/l (median: 0.75) and from 0.1 to 2.1 mg/l (median: 0.655), respectively. Isepamicin was shown to be as effective and safe as amikacin in the treatment of children with pyelonephritis and might prove an advantageous alternative in areas with high incidence of resistance to other aminoglycosides.

Amikacin↗

PubMed1997

[Acute pyelonephritis and subcapsular hematoma revealing nephroblastoma at the age of 15 years].

BACKGROUND: Nephroblastoma' the most common renal tumor in children between 1 and 5 years, occurs rarely in the oldest child. CASE REPORT: A 16-year-old teenager suffered from acute pyelonephritis caused by Klebsiella pneumoniae. Renal ultrasonography showed a left subcapsular hematoma; the CT scan confirmed the finding and also showed renal scarring. However, a second CT scan showed pulmonary nodules suggestive of metastasis, a diagnosis that was confirmed by needle biopsy of pulmonary lesions. Recovery was obtained after chemotherapy and nephrectomy with a 3-year-follow-up. CONCLUSION: This nephroblastoma was particular because its development in an adolescent, its association with acute pyelonephritis and subcapsular hemorrhage.

Adolescent↗

PubMed1991

Percutaneous management of localized emphysematous pyelonephritis.

The authors report a case of emphysematous pyelonephritis that was successfully treated with radiologically guided percutaneous drainage. This case illustrates that in certain patients with focal abnormalities, functioning renal tissue can be salvaged and emphysematous pyelonephritis can be eradicated with a combination of antibiotics and radiologically guided percutaneous drainage.

Aged↗

PubMed2003

[Once-daily gentamicin dosing versus thrice-daily dosing in infants with acute pyelonephritis].

BACKGROUND: Once-daily dosing (ODD) of gentamicin is advocated as an effective and safe treatment of Gram-negative bacterial infections in adults. There are insufficient data in the literature to justify its use in infants. OBJECTIVES: To compare the efficacy of ODD of gentamicin with that of classical thrice-daily (t.i.d.) administration in infants with acute pyelonephritis. METHODS: We performed a quasi-experimental study comparing 33 infants who received ODD of gentamicin with a historical control group of 25 infants treated with gentamicin t.i.d. Leukocytosis, C-reactive protein, creatinine, gentamicin dose, peak and trough values, time required for disappearance of fever, and outcome were analyzed. RESULTS: The mean doses of gentamicin (mg/kg/day) were higher in the t.i.d. group (6.4 1.14) than in the ODD group (5.06 0.22; p < 0.001). Peak serum gentamicin concentrations (micro g/ml) were significantly higher in the ODD group (9.32 1.4) than in the t.i.d. group (5.09 1.15; p < 0.001). Mean trough gentamicin concentrations (micro g/ml) were lower in the ODD group than in the t.i.d. group (0.23 0.26 vs 0.78 0.45; p 0.001). There were no significant differences in the duration of fever between the groups (30.64 32 hours in the t.i.d. group vs. 28.57 32 hours in the ODD group). Serum creatinine levels were normal during treatment in both groups. In all patients outcome was good and no adverse effects were noted. CONCLUSIONS: Treatment with ODD of gentamicin in our population of infants with acute pyelonephritis was as effective as traditional administration t.i.d. and possibly was equally safe or safer.

Acute Disease↗

PubMed2002

Acute pyelonephritis causing acute renal allograft dysfunction.

In renal transplant recipients, acute pyelonephritis may cause acute deterioration of renal function. We report a case with acute allograft failure due to acute pyelonephritis, which was confirmed by graft biopsy. After appropriate antimicrobial therapy, allograft function recovered.

Acute Disease↗

PubMed1975

Selective deficiency of thymus-derived lymphocytes in experimental pyelonephritis.

Pyelonephritis was induced in experimental animals derived of thymus-derived (T) lymphocytes by adult thymectomy and serial sublethal irradiation. In this model T lymphocytes were reduced to less than 1% of normal adjudged by the in vitro Phytohemagglutinin (PHA) responsiveness of lymphoid cells from deprived animals compared with control animals. Pathologic, bacteriologic and immunologic aspects of renal infection were studied in the T cell-deprived animals during the acute, resolving and chronic stages of pyelonephritis. The experiments have shown that the ablation of lymphocytes did not appreciably alter the course of the disease.

Animals↗