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Intravenous pyelograms done before, during, and after an attack of acute pyelonephritis in a 41-year-old woman showed an increase in the size of both kidneys during the attack. The right kidney did not excrete the contrast medium during the acute episode. When function returned it became smaller, and three months after the attack of pyelonephritis this kidney was 1 cm. shorter than before it.
OBJECTIVE: Determination of the long term incidence of uraemia, hypertension, and toxaemia in pregnancy associated with non-obstructive focal renal scarring after pyelonephritis in childhood 25-35 years earlier. DESIGN: 27 Year follow up of patients with non-obstructive focal scarring identified from a retrospective review of intravenous urograms performed in childhood between 1951 and 1967. SETTING: Paediatric primary referral centre and urological clinic in tertiary referral centre. PATIENTS: 30 Patients (mean age 33 (range 22-41] with non-obstructive focal renal scarring first detected between 1951 and 1967 and a history of febrile urinary tract infection. MAIN OUTCOME MEASURE: Hypertension and complications of renal damage. RESULTS: Three patients had developed end stage renal disease, seven had developed hypertension, two of 16 women had a history of toxaemia during pregnancy, and seven patients had undergone renal surgery during follow up. Of the 20 patients who had neither had renal surgery nor had end stage renal disease, all had a significantly lower glomerular filtration rate and renal plasma flow and higher diastolic blood pressure, mean arterial blood pressure, plasma renin activity, and serum beta 2 microglobulin concentration than 13 healthy age matched controls. Diastolic blood pressure and plasma renin activity were positively correlated (r = 0.50, p less than 0.05) and so were fractional sodium excretion and both systolic and diastolic blood pressures (r = 0.54, p less than 0.01, r = 0.51, p less than 0.01 respectively). The progress of renal damage was unrelated to the incidence of recurrent infections. CONCLUSIONS: Children with focal renal scarring due to pyelonephritis are at high risk of serious long term consequences. It is essential that they are given adequate attention and care during adolescence and pregnancy.
The origin of the intracellular fat in human xanthogranulomatous pyelonephritis has been the centre of some discussion in the past. A report of a case in a domestic cat is of interest as normal feline renal epithelium is rich in stainable fat. A comparison of the human and feline varieties of xanthogranulomatous pyelonephritis reveals certain fundamental differences between the two and reinforces the view that the fat concerned in the human disease does not originate in the renal epithelium.
Experimental, ascending acute pyelonephritis in rats was produced by injecting 0 x 5 ml of 10(9) bacteria/ml into the urinary bladder via the urethra. No traumatic manipulation of the ureters of kidneys was necessary. A grading system for kidney lesions based on macro- and microscopical examination was used. The capacity of different Escherichia coli and proteus strains to induce acute pyelonephritis was tested, and the E. coli 06K13H1 strain and the Proteus mirabilis 03H1 strain were especially capable of causing urinary tract infection. For the P. mirabilis 03H1 strain, a dominance of right kidney lesions was noted in contrast to the E. coli 06K13H1 strain which did not show any side preference.
The AgNOR argyrophil technique was applied to clear cut examples of renal adenoma (n = 7), clear cell carcinoma (n = 9), and xanthogranulomatous pyelonephritis (n = 5). There was no significant difference between mean AgNOR counts per cell in adenomas and carcinomas, supporting the idea that there is a continuous spectrum of kidney tumours. Xanthogranulomatous pyelonephritis and clear cell carcinoma showed significant differences in mean AgNOR counts per cell, suggesting that the technique may be of use in distinguishing between these conditions, although further cases may need to be examined to confirm this.
We report the case of a 63 year old lady with xanthogranulomatous pyelonephritis. The treatment of choice is nephrectomy. At operation a fistula between large bowel and kidney was found requiring bowel resection. This is a rare complication of xanthogranulomatous pyelonephritis.
Twenty-one rejected kidneys from 2426 slaughtered dairy cows (0.87 per cent) had gross signs of pyelonephritis that were confirmed by histopathology. In all the kidneys the findings were consistent with a chronic rather than an acute infection. One species of bacteria was cultured from 12 of the kidneys and two species of bacteria were cultured from six. The most commonly isolated bacteria were Escherichia coli, from eight kidneys, Arcanobacterium pyogenes, from seven kidneys and Corynebacterium renale, from five kidneys. The other bacteria cultured were Corynebacterium cystitidis, Corynebacterium species, Streptococcus species group G and Enterococcus faecalis. E. coli was cultured from all the kidneys from which two species were isolated; the accompanying bacteria were A. pyogenes in three kidneys, C. renale in two and C. cystitidis in one. No bacteria were cultured from two of the kidneys and no significant bacteria were cultured from another. The kidneys with pyelonephritis were slightly larger than a comparison group of 72 kidneys without nephritis.
Experimental pyelonephritis was produced in mice by the intravenous injection of Pseudomonas aeruginosa. Immune response to infection was studied by passive hemagglutination antibody titers. Vaccination of mice with live P. aeruginosa or culture filtrates (Pseudomonas antigen) induced antibodies and resulted in a high degree of protection against death and pyelonephritis following subsequent hematogenous challenge with the homologous strain. Transfer of immune serum protected mice against death following infection with the homologous strain and with a heterologous strain. However, immune serum failed to protect mice from kidney infection by the heterologous strain. These data indicate that immune serum seemed to protect against early, overwhelming bacteremia but did not prevent a chronic course of kidney infection by a heterologous strain.
Focal xanthogranulomatous pyelonephritis of the left lower pole was accidentally discovered in a 34-year-old woman at sonography. The patient had no history of stones and urinary tract infection and both conventional radiology and CT scan revealed radiated calcifications within a well-circumscribed mass. Surgical treatment consisted of enucleoresection of the lesion, and histopathology revealed a nucleus of bone metaplasia. To the best of our knowledge, metaplastic bone formation has never been documented before with xanthogranulomatous pyelonephritis.
The purpose of the study was to investigate the management of pyelonephritis in a large Italian pediatric population. A total of 1,333 patients (36% male) were considered. Escherichia coli was the most frequently isolated agent (89.9%), followed by Proteus mirabilis (3.6%) and Klebsiella oxytoca (2.1%). 27% of microorganisms were resistant to amoxicillin, 4% to amoxicillin/clavulanic acid, 11% to trimethoprim-sulfamethoxazole, 2.4% to gentamicin and less than 2% to ceftazidime. Despite this resistance pattern showing that oral antibiotics, such as amoxicillin/clavulanic acid, are effective in vitro as well as parenteral antimicrobials, a parenteral antibiotic was given initially to 756 (57.2%) children. A prophylactic regimen was started in 922 patients with a rate of reinfection during prophylaxis of 9.5%; a higher rate of reinfection was observed in patients with reflux (25%) compared to children without reflux (3%) (p < 0.0001). Vesicoureteral reflux was demonstrated in 30% of patients. The number of renal abnormalities detected by DMSA in patients with and without reflux was significantly different (p < 0.001). CRP was higher in patients with scars (p < 0.02). In conclusion, pyelonephritis represents a common disease with about 2,500 days of hospitalization per year in the Veneto Region where there is a pediatric population of about 800,000 under 15 years of age. The results of antimicrobial in vitro tests indicate that amoxillicin/clavulanic acid could represent the antibiotic of choice. The high frequency of malformations, observed even in children between 6 and 12 years of age, may suggest the need of an imaging study including DMSA scan and VCUG in all age groups.
A 72-year-old non-diabetic uremic woman underwent right nephrectomy for urolithiasis at the age of 50. Because pyuria, fever, chilliness and left flank pain developed during preparing for arteriovenous fistula, she was admitted to National Cheng Kung University Hospital. Renal cell carcinoma (RCC) complicated with emphysematous pyelonephritis (EPN) was diagnosed and immediately treated with antibiotics and CT-guided percutaneous catheter drainage. Cultures of pus and blood yielded Escherichia coli. She received left radical nephrectomy later for the control of persistent sepsis and removal of left renal tumor. The pathology of the tumor was composed of a glandular arrangement of granular cells with the occasional atypism, and renal parenchyma had been totally replaced by RCC. The non-tumor part of the kidney showed chronic pyelonephritis. Five months later, multiple metastases developed. We reported this first uremic case with EPN and RCC, but without diabetes mellitus and urinary tract obstruction. The gas formation may be due to large RCC, which caused impaired tissue perfusion and E. coli infection.
A 62-year-old male diabetic presented with emphysematous pyelonephritis and contralateral atrophic kidney. He failed to improve with a supportive management, and we placed a double-J stent instead of performing percutaneous nephrostomy or nephrectomy with marked improvement. We report a case of emphysematous pyelonephritis recovered by ureteral stenting.
We report a case of biopsy-proved acute pyelonephritis which caused acute renal failure. Despite appropriate antibiotic therapy, recovery of renal function was slow and incomplete. Renal papillary necrosis was an apparent complication, which the patient may have been predisposed to by alcoholism. Although rare, acute pyelonephritis is an important consideration in the differential diagnosis of acute renal failure because of the need for specific therapy.
Bilateral emphysematous pyelonephritis is a rare condition, with only 14 cases reported in the English literature. It carries a bad prognosis, surgical management being the recommended mode of therapy. We report a case of bilateral emphysematous pyelonephritis in a 50-year-old diabetic lady which was successfully managed using antibiotics alone.
The causes of acute renal failure in bacterial allograft pyelonephritis were evaluated using abdominal CT and graft biopsy. Twenty-one recipients, who showed a poor response to antibiotic therapy, comprised this study group. The diagnostic approach taken with this poor responder group was first to perform abdominal CT. If a focal lesion was identified on abdominal CT, a diagnosis of acute focal bacterial nephritis or renal abscess was made. If no focal lesion was found, a graft biopsy was performed for diagnosis. Abdominal CT revealed focal lesions in 9 of the 21 recipients, and renal biopsy showed superimposed acute rejection in 8 of the 12 recipients biopsied. In conclusion, acute renal failure in allograft pyelonephritis is associated with not only severe infection but also a superimposed acute rejection process. Therefore, imaging study and graft biopsy are recommended in the poor responder group.
A history of phenacetin abuse has been found almost three times more frequently among subjects diagnosed on clinical and functional grounds as suffering from chronic pyelonephritis than among those suffering from other renal diseases or among non-renal controls. The chronic pyelonephritis in subjects admitting phenacetin abuse has been usually characterized by a more frequent intense bacteriuria and leucocyturia, by a slightly more frequent haematuria, history of renal colic, presence of stones and more rapid downhill course of glomerular filtration rate than in subjects without phenacetin abuse. A sterile lesion also without any past evidence of infection was observed only in subjects with the heaviest analgesic abuse. The discontinuation of the abuse in 5 subjects led to an improvement of the renal function.
The appearance of antibody-coated bacteria in urinary sediment has been evaluated in rats with experimental pyelonephritis. At day 7 after induction of pyelonephritis, 9 out of 11 rats demonstrated antibody-coated bacteria in the urinary sediment. The other 2 rats never had a positive urinary sediment. Following removal of the pyelonephritic kidneys, antibody-coated bacteria disappeared in 7 of 9 previously positive rats. In the 2 rats which continued to show antibody-coated bacteria, the infecting organisms were found in the remaining kidney. The 2 rats which never developed antibody-coated bacteria in urinary sediment had a higher then normal serum antibody titer, and 1 rat with antibody-coated bacteria showed a normal serum antibody titer. It is concluded that although the search for antibody-coated bacteria in urinary sediment is a very useful technique, its negativity does not exclude upper urinary tract involvement; in the case of renal parenchymal infection, immunity is not the same at the systemic and the local site.
Concentration and acidification capability was tested in 41 patients with chronic pyelonephritis (PN), 14 patients with chronic glomerulonephritis (GN), 16 patients with diabetic nephropathy (DNP) and 12 healthy controls. Significant differences appeared between PN and GN, PN and DNP comparing a quotient between percent of normal osmolarity and percent of normal creatinine clearance. Similar results were obtained using a quotient creatinine clearance/ammonia excretion, which enabled the differentiation of PN from the other groups. The tubular functions of concentration and ammonia excretion in relation to creatinine are clinically useful in the differentiation of pyelonephritis from glomerular kidney diseases.