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PubMed1992

Renal ultrasonographic correlates of acute pyelonephritis.

To determine the frequency and clinical significance of ultrasonographically detectable alterations in renal volume and anatomy that are associated with acute pyelonephritis, 25 women underwent renal ultrasonography during the acute phase of their illness, and 21 of these patients underwent the procedure after receiving antimicrobial therapy. One patient had a predisposing anatomic abnormality (4%; 95% confidence interval, 0-12%), and one patient each (8%; 95% confidence interval, 0-19%) experienced focal complications (an intrarenal mass and perinephric fluid collection). The kidneys of the 21 evaluable patients were acutely swollen (mean, 20%; P = .0001); one or both kidneys were enlarged by greater than or equal to 15% in 17 (81%). Acute renal enlargement was associated with protracted pretherapy symptoms (P less than .01), leukocytosis (P less than .01), focal infectious complications (P less than .01), and prolonged hospitalization (P less than .05). Thus, ultrasonographically demonstrable renal swelling characteristically occurs in women with acute pyelonephritis but is usually apparent only in retrospect. The degree of swelling correlates with selected clinical parameters, and the frequency of underlying anatomic abnormalities and focal infectious complications is low.

Acute Disease↗

PubMed1993

Virulence factors and pap genotype in Escherichia coli isolates from women with acute pyelonephritis, with or without bacteremia.

Bacteremia develops in a subgroup of patients with acute pyelonephritis. This study examined isolates of Escherichia coli from the urine and the blood of 25 bacteremic and 67 nonbacteremic women with this acute disease. P-fimbriated strains were found in 100% of bacteremic patients without complicating factors but in only 71% of nonbacteremic patients without complications (P < .05). Non-P-fimbriated strains were only found to cause bacteremia in three patients with compromising host factors. Strains from the bacteremic group and those from the nonbacteremic group did not differ significantly in terms of hemolysin or aerobactin production or of serum resistance. The P-fimbriated strains from both groups of patients carried pap DNA sequences of the papGIA2 adhesin type; prsGJ96 homologous DNA sequences were rare. The results suggested that P fimbriae and compromising host conditions independently increase the risk for bacteremia during acute pyelonephritis.

Acute Disease↗

PubMed1975

Antibody-coated bacteria in the urine of obstetrical patients with acute pyelonephritis.

The direct immunofluorescence method for the detection of antibody-coated bacteria in urine sediments was used to test urine samples from obstetrical patients with the clinical diagnosis of acute pyelonephritis or cystitis. Antibody-coated bacteria were present in the urine from 12 of 15 patients with acute pyelonephritis, but they were not observed in the urine from 13 patients with cystitis. The clases of antibody coating the bacteria were IgG, IgA, and, in some cases, IgM. A correlation between a high titer of antibody in serum and the presence of antibody-coated bacteria in the urine was noted. These results confirm that the immunofluorescence test can be useful, as previously reported, in distinguishing infection of the kidney from infection of the bladder.

Adolescent↗

PubMed1981

Bacteria-specific antibody in the urine of patients with acute pyelonephritis and cystitis.

Urine specimens from 65 adult patients with symptomatic urinary tract infections that involved 91 episodes of well-defined acute pyelonephritis or cystitis were tested for antibody-coated bacteria (ACB) by a fluorescent antibody assay, unbound bacteria-specific antibody by radioimmunoassay (RIA), and levels of total protein and IgG. Acute pyelonephritis was associated with positive tests for ACB (22 [69%] of 32), elevated levels of unbound antibody (28 [88%] of 32), and a mean RIA binding ratio of 9.4. Cystitis was associated with negative tests for ACB (56 [95%] of 59), low levels of antibody in urine (38 [64%] of 59), and a mean RIA binding ratio of 3.2. The results showed that a negative test for ACB may occur with elevated levels of unbound antibody in the urine because, although elevated, levels were still too low to result in detectable antibody coating of the bacteria. There was often, but not always, a correlation between RIA binding ratios and levels of urinary protein and IgG.

Acute Disease↗

PubMed1982

Significance of intrarenal concentrations of gentamicin for the outcome of experimental pyelonephritis in rats.

The significance of continuous intrarenal levels of gentamicin in the treatment of acute pyelonephritis due to Echerichia coli was investigated in rats. Treatment was started 24 hr after E. coli was injected into the left kidney. A single dose or three successive doses (10 mg/kg of body weight) of gentamicin administered ip every 8 hr could not sterilize the kidneys. Injections of gentamicin (10 mg/kg) every 12 hr for seven or 14 days resulted in continuous levels of the drug in the medulla that persisted above the minimal inhibitory concentration for E. coli (1.6 microgram/ml) for six months or more. Whereas greater than or equal to 73% of the right kidneys or urine specimens were found to be sterile up to six months following a week of therapy, only 23% of the left kidneys were sterile. Two weeks of treatment sterilized greater than or equal to 86% of the left kidneys, right kidneys, and urine specimens. Concentrations of drug in serum and urine were poor predictors of both the intrarenal distribution of drug and the outcome of pyelonephritis.

Animals↗

PubMed1989

Role of complement-derived and bacterial formylpeptide chemotactic factors in the in vivo migration of neutrophils in experimental Escherichia coli pyelonephritis in rats.

In experimental Escherichia coli pyelonephritis, the bacterial multiplication in the kidney parenchyma triggers a burst of neutrophil extravascular migration, as measured by the myeloperoxidase (MPO) activity in the kidney, a marker for tissue neutrophil infiltration. To test the mechanisms of in vivo neutrophil migration, pyelonephritis was surgically induced in rats that were then either complement-depleted with cobra venom factor (CVF), resulting in a profound hypocomplementemia for 72 h after inoculation, or treated with phenylbutazone (PB), a competitive antagonist of bacterial chemotactic formylpeptides. Compared to controls, CVF- and PB-treated animals killed when the neutrophil infiltration started (32 h) had a significantly reduced neutrophil infiltration, as measured by kidney MPO activity. This effect disappeared in animals killed 72 h after surgery, when neutrophil infiltration peaked. These data suggest that redundant chemotactic mechanisms triggered neutrophil migration. Inhibiting one of these mechanisms only transiently delayed neutrophil migration but did not affect the peak infiltration.

Animals↗

PubMed1987

The frequency of in-vitro resistance development to fluoroquinolones and the use of a murine pyelonephritis model to demonstrate selection of resistance in vivo.

The frequency of development of resistance to the fluoroquinolones in vitro was generally low with Escherichia coli (in the order of 10(-7) to less than 10(-9) and high with Pseudomonas aeruginosa (in the order of 10(-5) to 10(-7)). Susceptibility to the fluoroquinolones also decreased after serial transfer in increasing concentrations of the drug. Although the MICs for the resistant E. coli variants were higher than that of the parent organism, they were still susceptible to achievable serum concentrations of all the quinolones except nalidixic acid. On the other hand some of the P. aeruginosa variants selected for resistance were resistant to achievable serum concentrations of all the quinolones. When E. coli pyelonephritis in mice was treated with the fluoroquinolones, difloxacin, A-56620, and ciprofloxacin were more effective than norfloxacin and nalidixic acid in lowering viable bacterial counts in the kidneys. The susceptibility of E. coli isolated from kidneys of mice treated with the quinolones was the same as that of the parent strain. When P. aeruginosa pyelonephritis in mice was treated with the fluoroquinolones an initial reduction in the cell count was seen, followed by an increase in the number of resistant variants. The resistant variants differed in their colony morphology and cell envelope proteins. The levels of resistance for the P. aeruginosa variants ranged from a two- to a 64-fold increase in the MIC.

Animals↗

PubMed1990

Efficacy and tolerance of cefodizime in the treatment of acute pyelonephritis.

The efficacy and tolerance of cefodizime in the treatment of acute pyelonephritis were evaluated in an open, international, multicentre study. In total, 128 patients were treated with 1 g cefodizime bd iv or im for a mean of 8.3 days. Underlying urinary tract abnormalities were present in 35% of cases. The most frequently isolated bacteria were Escherichia coli (79/97 evaluable cases) and Proteus mirabilis (8/97 evaluable cases). The overall clinical and bacteriological success rate was 89.7% (87/97). The drug was well tolerated, with only a few mild and transitory adverse events. Tolerance at the site of injection was good in 97.5% (78/80) of those treated iv, and 79% (38/48) of those treated im. Three patients had skin reactions which were probably related to cefodizime. Alterations of laboratory parameters were seen transiently in five patients (3.9%). Cefodizime is effective and well tolerated in the treatment of acute pyelonephritis.

Acute Disease↗

PubMed1996

Efficacy of ABT-719, a 2-pyridone antimicrobial, against enterococci, Escherichia coli, and Pseudomonas aeruginosa in experimental murine pyelonephritis.

ABT-719 is a 2-pyridone antimicrobial which inhibits DNA gyrase activity. It has considerable subcutaneous (sc) and oral efficacy in the treatment of experimental pyelonephritis induced in carrageenan-treated mice by clinical isolates of Enterococcus faecalis, Enterococcus faecium, Escherichia coli, and Pseudomonas aeruginosa. Therapeutic ED50s, defined here as producing a 2 log10 reduction in kidney bacterial burden, provide a reliable end point for comparison of drug efficacy in this experimental infection. Therapeutic ED50s for ABT-719 against these infections were equal to or up to ten-fold lower than those for ciprofloxacin, used as a reference because of similarity in mode of action. Against E. faecalis, the therapeutic ED50s for ABT-719 were 4.5-13.6 mg/kg.day for sc administration and 6.8-8.9 mg/kg.day for oral administration. ABT-719 was more potent than ciprofloxacin and vancomycin against the E. faecalis strains, which showed ciprofloxacin and vancomycin resistance covering a range of MICs. Against E. faecium, the therapeutic ED50s for ABT-719 were 8.8 mg/kg.day (sc) and 9.4 mg/kg.day (oral). Against an isolate of E. faecium showing ciprofloxacin and vancomycin resistance the ED50 for ABT-719 to achieve a 1 log10 reduction in kidney bacterial burden was 17.9 mg/kg.day by sc administration. While ABT-719 had lower efficacy against this isolate than against others, ciprofloxacin and vancomycin failed to show efficacy. Against E. coli, the therapeutic ED50 for ABT-719 was 1.1 mg/kg.day (oral), and against P. aeruginosa, this value was 2.7 mg/kg.day (oral) with values against both of these pathogens similar to those for ciprofloxacin. ABT-719, which represents the new 2-pyridone compound class, has promise for the treatment of urinary tract infections, as suggested by the significant efficacy seen against experimental pyelonephritis caused by E. coli, P. aeruginosa and susceptible and resistant enterococci.

Animals↗

PubMedDate not supplied

An etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis); an electron microscopic study.

Renal tissues were studied using electron microscopy (EM) and immunofluorescence microscopy (IFM) from three patients who were found to have chronic interstitial nephritis (pyelonephritis) by light microscopy (LM). By LM, 90% of the glomeruli in two patients and all glomeruli in one patient were normal. By EM, glomerular capillaries in all patients revealed generalized fusion of epithelial foot processes. In two patients, IFM for immunoglobulins, third component of complement and fibrinogen were negative. These two patients received corticosteroids for 6 to 12 weeks. In one, proteinuria markedly decreased (from 17.9 to 1.1 gm) in four weeks and in the other follow-up studies of renal histology revealed normal glomeruli and partial restoration of foot processes by LM and EM respectively. Thus, this study offers evidence for lipoid nephrosis (or minimal lesion disease) as an etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis). The impaired renal function in these patients is attributed to tubulo-interstitial disease rather than glomerular pathology. It remains to be determined whether the two disparate pathological conditions have coexisted or chronic interstitial nephritis had led to the appearance of lipoid nephrosis through an unidentified mechanism.

Adult↗

PubMed1992

Pseudotuberculous pyelonephritis associated with nephrolithiasis.

This report describes a 40-year-old man with an unusual form of granulomatous pyelonephritis, associated with nephrolithiasis, resulting in end-stage kidney disease and right pretransplant nephrectomy. The kidney specimen contained a staghorn calculus and showed chronic inflammation with confluent caseating granulomas and multinucleated giant cells, resembling renal tuberculosis. However, neither tubercle bacilli nor other microorganisms were demonstrated in the renal tissue or in urine cultures. Because these findings do not support a tuberculous etiology of the granulomatous pyelonephritis, we conclude that this patient had a pseudotuberculous reaction as a consequence of nephrolithiasis.

Adult↗

PubMed1989

Medical histories of children with acute pyelonephritis compared with controls.

The medical history of infants and preschool children with their first known episode of pyelonephritis was obtained by questionnaire and compared with that of controls matched for age, sex and living area. Previous infection, medical consultation and antibiotic treatment were registered significantly more often in the patients. Furthermore a high proportion of cases had recently received antibiotic therapy, primarily penicillin V. Urinary tract infections were reported more often among first degree relatives of the cases. Exclusive breast-feeding was significantly shorter in the pyelonephritis patients, according both to the questionnaire and to the records from the Child Health Centers. The two populations were not shown to differ in birth weight or length, neonatal history, number of hospitalizations, previous episodes of fever or frequency of atopic disease in the families.

Acute Disease↗

PubMed1991

Emphysematous pyelitis and emphysematous pyelonephritis characterized by computerized tomography.

We report three cases of emphysematous pyelonephritis, all of them associated with perinephric emphysema, and one case of emphysematous pyelitis to demonstrate the value of computerized tomography (CT) in both diagnosis and patient management. The differentiation between air in the collecting system (emphysematous pyelitis), air within the parenchyma (emphysematous pyelonephritis), and air in the perinephric space (perinephric emphysema) may have significant prognostic (survival) and therapeutic (medical vs surgical) implications. Computerized tomography is currently the best method for demonstrating intrarenal air and for characterizing the location of that air (intracalyceal, intraparenchymal, perinephric, or pararenal).

Adult↗

PubMed2002

Emphysematous pyelonephritis: no longer a surgical disease?

Emphysematous pyelonephritis is a rare, life-threatening infection of the kidney characterized by the presence of gas within the renal parenchyma, the renal collecting system and the perinephric tissue. It usually develops in diabetic patients and often presents abruptly with bacteraemia, septic shock and acute renal failure. Diagnosis can be delayed because the symptoms mimic a classical upper urinary tract infection. Aggressive management, including parenteral antibiotic therapy, treatment of septic shock and control of the glycaemia, is mandatory. Immediate nephrectomy has been considered to be essential to increase the chance of survival. Recently, percutaneous drainage has been reported as a kidney-saving and life-saving alternative to surgery. We present a case of severe emphysematous pyelonephritis in which there was full recovery after antibiotic treatment combined with temporary percutaneous drainage. The therapeutic options in this rare, life-threatening condition are discussed.

Adult↗

PubMed2006

Hand-assisted laparoscopic nephrectomy for xanthogranulomatous pyelonephritis with nephrocutaneous fistula after failed flank exploration.

Xanthogranulomatous pyelonephritis presenting with nephrocutaneous fistula is a rare condition, and its treatment of choice is nephrectomy. Laparoscopic management has been proved to be challenging in these inflammatory renal conditions. However, there was no previous report in the literature regarding laparoscopic treatment of nephrocutaneous fistula especially after previous operation. In this communication, we report the first case of hand-assisted laparoscopic nephrectomy for xanthogranulomatous pyelonephritis with nephrocutaneous fistula after previous failed flank exploration.

Cutaneous Fistula↗

PubMed2006

Accurate diagnosis of acute pyelonephritis: How helpful is procalcitonin?

AIM: This prospective study aimed to investigate the diagnostic value of serum procalcitonin levels in children with acute pyelonephritis documented by Tc-dimercaptosuccinic acid (DMSA) scintigraphy. METHODS: We compared the symptoms and laboratory findings of fever, vomiting, abdominal/flank pain, leukocyte count, serum C-reactive protein and procalcitonin levels with the results of the DMSA scan obtained within the first 72 h after referral in children who were diagnosed as having acute pyelonephritis. Thirty-three children (31 female and two male) aged 1-11 years (mean 4.42 years) were enrolled in this prospective study. RESULTS: Twenty-one of 33 patients (64%) had positive DMSA scans. On the scans obtained after 6 months, five of 21 patients (23.8%) had renal scars. No correlation was found between clinical and laboratory parameters, alone or combined with each other, and positive DMSA scans. Serum procalcitonin levels were 0.767+/-0.64 and 1.23+/-1.17 ng . ml in children with normal and positive DMSA scans, respectively. The cut-off value for procalcitonin using receiver operating characteristic analysis was 0.9605 ng . ml, while sensitivity and specificity were 86.4% and 36.4%, respectively. However, if the cut-off value was chosen as 2 ng . ml, the sensitivity increased to 100% while specificity did not change markedly. CONCLUSION: The serum procalcitonin test, like other commonly used laboratory parameters, e.g. serum C-reactive protein and white blood cell count, was inadequate in distinguishing renal parenchymal involvement in acute febrile urinary tract infections.

Acute Disease↗

PubMed1988

One or three weeks' treatment of acute pyelonephritis? A double-blind comparison, using a fixed combination of pivampicillin plus pivmecillinam.

The clinical and bacteriological effects of 1 and 3 weeks' pivampicillin plus pivmecillinam treatment were compared in a double-blind, randomized study of patients with acute pyelonephritis. Three weeks after the end of active treatment, clinical success was seen in 29 (91%) of the 32 patients on 1-week treatment, compared with 28 (97%) of the 29 patients treated for 3 weeks. Bacteriological success was seen in only nine (28%) patients in the 1-week group vs. 20 (69%) in the 3-week group (p = 0.004). This difference was mainly due to a large number of relapses of lower urinary tract infection in the 1-week group. Even in uncomplicated cases, the bacteriological result of the 1-week treatment was unsatisfactory. Side-effects were more common in the 3-week treatment group. In conclusion, 1-week treatment of patients with acute pyelonephritis is too short. Three weeks' treatment is effective in uncomplicated cases, but even longer treatment or low-dose prophylaxis is indicated in certain patients with predisposing factors.

Acute Disease↗

PubMed1992

Bilateral emphysematous pyelonephritis resolving to medical therapy.

We describe a case of bilateral emphysematous pyelonephritis, in a diabetic female, that responded to medical therapy alone. Her complete improvement is documented radiologically. Emphysematous pyelonephritis, as a cause of serious infection in diabetic patients, is briefly reviewed.

Cilastatin↗