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Auto-antibody to kidney tubular cells during retrograde chronic pyelonephritis in rats.

Retrograde pyelonephritis was induced in inbred Fischer rat kidneys with Proteus mirabilis (1 X 10(8) organisms/ml). Sera from pyelonephritic animals sacrificed at 4 and 6 weeks contained cytotoxic antibodies to cultured syngeneic 51Cr-labeled kidney tubular cells (p less than 0.02 and p less than 0.05, respectively) which could be absorbed with plasma membranes. Immune sera from 4- and 6-week pyelonephritic animals also displayed a granular fluorescent pattern along the surface of cultured kidney tubular cells. Quick-frozen syngeneic rat kidney sections stained positively with fluorescent antibody on the intraluminal side of kidney tubular cells. The results suggest that during chronic phases of pyelonephritis, auto-antibodies to kidney tubular cells are induced.

Animals↗

Acute renal failure due to pyelonephritis.

Acute renal failure developed in a 3-year-old boy with acute pyelonephritis. Renal biopsy showed acute interstitial infiltration of neutrophils and macrophages. There were also glomerulitis and capillary tuft thrombosis. He required peritoneal dialysis, but subsequently recovered renal function. Prompt antimicrobial therapy is crucial to insure a favorable outcome. Pyelonephritis is an unusual cause of acute renal failure in infants and children.

Acute Disease↗

Chronic granulomatous interstitial nephritis: unusual complication of acute pyelonephritis.

We describe an unusual complication of acute pyelonephritis in a 45-year-old diabetic female. She was admitted to our hospital due to fever and flank pain which had developed 10 days earlier. Urinalysis showed many WBC and urine culture revealed Escherichia coli. After adequate antibiotic treatment, clinical symptoms abated but renal failure and leukocyturia persisted. Abdominal CT showed bilateral focal bacterial nephritis and renal biopsy disclosed chronic granulomatous interstitial nephritis. On the 80th hospital day she was discharged with a serum creatinine of 299 mumol/l. In the outpatient clinic, renal dysfunction and leukocyturia persisted up to 1 year. In conclusion, this case raises the possibility of a chronic interstitial process of acute pyelonephritis.

Acute Disease↗

Intravenous co-trimoxazole ("Bactrim") in the treatment of acute pyelonephritis.

Patients with acute pyelonephritis may be extremely ill and have a complicating septicaemia. This may necessitate the parenteral administration of an appropriate antibacterial agent. This paper reports the use of intravenous co-trimoxazole in two young women with severe acute pyelonephritis. 101 ml of co-trimoxazole (800 mg sulphamethoxazole and 160 mg trimethoprim) was added to 500 ml of 5% dextrose in water and infused over a 90-min period. This treatment was given every 12 h for five doses, before switching to oral co-trimoxazole. The treatment was clinically and bacteriologically successful and no side effects were noted.

Acute Disease↗

Treatment of experimental ascending Escherichia coli pyelonephritis with ceftriaxone alone and in combination with gentamicin.

We have tested the effectiveness of several antibiotic regimens, using a rat model of Escherichia coli experimental pyelonephritis that mimics the conditions of severe renal infections in man because the infection is acquired by the ascending route. We found that ceftriaxone, when given for 5 days to rats with severe exudative pyelonephritis, was as effective as the combination ceftriaxone + gentamicin or the reference combination ampicillin + gentamicin. This effectiveness in vivo of the antibiotic alone was achieved despite a marked synergism between the combinations of antibiotics in vitro. This observation suggests that a new and extremely active cephalosporin is as effective in vivo when used alone as when given in combination with an aminoglucoside and provides rationale for testing the use of single antibiotic therapy for clinical situations for which combinations of antibiotics are currently recommended.

Ampicillin↗

Treatment of acute pyelonephritis in women with intramuscular ceftriaxone: an out-patient study.

Ceftriaxone, a third-generation cephalosporin with a long half-life, was administered intramuscularly to 30 adult women suffering from acute pyelonephritis. Standard bacteriologic methods were used to identify the pathogens and their susceptibilities before treatment and at intervals during and after treatment. Overall cure was achieved in 25 (85%) of the patients 6 weeks after completion of therapy. The results demonstrate that ceftriaxone is an effective drug when given once a day intramuscularly to out-patients with acute pyelonephritis.

Acute Disease↗

Xanthogranulomatous pyelonephritis. A review with 2 case reports.

Xanthogranulomatous pyelonephritis is a rather peculiar and rare form of chronic pyelonephritis and is usually caused by calculous urinary tract obstruction. The characteristic pathological finding is the presence of foam cells. We present 2 cases and give special attention to the clinical diagnosis and the phenomenon of nephrogenic hepatic dysfunction. A new series of 200 cases has been analyzed, and the most typical features of this inflammatory condition are compared with the findings in earlier series from the world literature.

Adult↗

Emphysematous pyelonephritis with pneumocystitis.

Emphysematous pyelonephritis is an acute infectious process mostly associated with diabetes and obstruction. It is a life-threatening illness and treatment generally involves antibiotic therapy, surgical drainage and nephrectomy. The prognosis is poor regardless of therapy. Herein, we present a case with pneumocystitis. To our knowledge, there have been 54 cases previously reported. There is no doubt that emphysematous pyelonephritis with pneumocystitis as in our case is less frequent.

Air↗

Association of xanthogranulomatous pyelonephritis with small renal cell carcinoma. Case report and review of the literature.

A case of xanthogranulomatous pyelonephritis associated with 'small' renal carcinoma is presented. The urinary sediment showed atypical cells, suspect of malignancy. The renal neoplasm measured only 1.5 cm, had the typical papillary configuration of a 'small' renal carcinoma and was composed of atypical cells with finely granular cytoplasm and hyperchromatic nuclei. The xanthogranulomatous pyelonephritis was a primary lesion, spacially separate one from the other. The clinicopathological features of reported examples of coexistence of these diseases have been reviewed.

Adenocarcinoma↗

Microvascular changes in the early stage of reflux pyelonephritis. An experimental study in the pig kidney.

Renal microvascular changes were studied in the pig kidney during the initial stage of reflux pyelonephritis. In 10 piglets vesicoureteric reflux was surgically induced. The animals were then infected with a strain of Escherichia coli and sacrificed 2 weeks following the initiation of infection. Following injection of the kidneys with Microfil, microvascular changes were investigated by a combined stereomicroscopic, microradiographic and histological technique. Renal microcirculation was found to be impaired in the areas involved in the acute inflammatory process, owing to the compression of glomeruli, small peritubular capillaries and vasa rectae by the ensuing interstitial oedema. These findings indicate that acute focal ischaemia caused by microvascular obstruction could be an important factor in the mechanism of renal damage in reflux pyelonephritis.

Angiography↗

Local immune response in experimental pyelonephritis.

Experiments using an in vitro method of assessing protein synthesis by (14)C amino acid incorporation were designed to determine whether pyelonephritic kidneys were capable of local antibody production. Unilateral pyelonephritis was produced in rabbits by intravenous injection of E. coli 0-75 while one ureter was transiently occluded. The capability of protein and immunoglobulin synthesis by pyelonephritic kidneys, contralateral kidneys, normal kidneys, and spleens from normal and pyelonephritic animals was measured. Enhanced protein and immunoglobulin syntheses by pyelonephritic kidneys were first detected by the 11th day after infection and persisted through day 120. In individual experiments the pyelonephritic kidney produced 6-170 times more soluble protein than did the contralateral, uninfected kidney. In seven experiments, IgG comprised a mean of 72% of the total protein synthesized by the pyelonephritic kidney, compared with a mean of 19% in the contralateral kidney. IgA accounted for 10 and 9%, respectively. In these experiments 0.6-17% of the synthesized IgG was precipitable by somatic antigen of the E. coli 0-75. The capability of the pyelonephritic kidney to synthesize soluble protein was quantitatively similar to that of spleens from infected animals. The proportion of synthesized protein which was immunoglobulin G, however, was greater in the pyelonephritic kidney than in the spleen. Furthermore, specific antibody synthesis by the pyelonephritic kidney persisted longer than did synthesis by the spleen of the same animal. These studies provide evidence that in experimental pyelonephritis a significant local immune response occurs which is represented primarily by the production of IgG. Local immunoglobulin formation and specific antibody synthesis may be important factors in determining patterns of host resistance.

Amino Acids↗

The local immune response to Escherichia coli O and K antigen in experimental pyelonephritis.

Although the systemic and local immune response to the O antigen of Escherichia coli has been well characterized, little information is available on the immune response to K anigen. Experimental hematogenous pyelonephritis was produced with Escherichia coli 06 K13 H1 and the serum and local (intrarenal) antibody response to O and K antigens was determined with the enzyme-linked immunosorbent assay. Both local and serum antibody responses to the K antigen were significantly less than that to the O antigen. The K antigen induced low titer IgM and IgG antibody responses in fewer than one-half of the animals and did not induce a local IgA response in any animal. In contrast, the O antigen induced local antibody responses in each of the immunoglobulin classes in all animals from day 9 of infection. Similarly, the serum IgM and IgG antibody titers to the K antigen were significantly less than those evoked in response to the O component of the Escherichia coli. No serum IgA anti-K antibodies were detected. These observations helf clarify the roles of these two antigens in pyelonephritis. Although the K antigen of Escherichia coli functions as a virulence factor in upper urinary tract infections, this antigen does not elicit a significant immune response, whereas the O antigen does induce a significant antibody response which could be of protective or diagnostic benefit.

ABO Blood-Group System↗

Salmonella enteritidis. A rare cause of pyelonephritis in children.

A previously healthy 2.5-year-old boy developed symptoms of acute pyelonephritis following an acute gastroenteritis. The patient received parenteral ampicillin and gentamicin for 72 hours and then ampicillin for an additional 11 days when the original urine and stool cultures grew Salmonella enteritidis, sensitive to ampicillin. The patient responded very well to treatment, but B-mode renal ultrasonogram revealed a left hydronephrosis and megaureter suggestive of longstanding obstruction of the ureterovesicular junction, later confirmed by other diagnostic studies and by surgical exploration and repair. Salmonella infection has been rarely documented to cause pyelonephritis in children. Obstructive uropathy appears to be a predisposing factor for this unusual complication of Salmonella enteritis.

Acute Disease↗

Pivmecillinam in the treatment of childhood pyelonephritis.

In a prospective study, twenty children with a mean age of 4 years were treated with pivmecillinam, 25 mg to 40 mg per kilogram body-weight and day, for acute pyelonephritis. Urine cultures yielded growth of E. coli in sixteen instances, Klebsiella spp. in two, S. saprophyticus in one and a mixed Gram-positive flora in one patient. All children fulfilled the diagnostic criteria for upper urinary tract infection. In all cases where Gram-negative pathogens were responsible, the infections were eradicated. One reinfection was registered in a child with a concomitantly discovered congenital urological malformation. Pivmecillinam also cured one patient infected with S. saprophyticus but was ineffective in the case of mixed Gram-positive flora. It is concluded that pivmecillinam is a valuable new drug for the management of pyelonephritis in children, as most of these infections are caused by Gram-negative organisms.

Adolescent↗

Acute bilateral emphysematous pyelonephritis successfully managed by medical therapy alone: a case report and review of the literature.

BACKGROUND: Bilateral emphysematous pyelonephritis is a life threatening condition usually occurring in diabetics. Management of this condition has traditionally been aggressive and surgery is considered mandatory. However, this is itself a hazardous intervention in a septic, unstable patient with circulatory or liver failure. When bilateral disease is present, the need for long-term dialysis is obviously unavoidable. CASE PRESENTATION: We herein report one of the few cases of bilateral emphysematous pyelonephritis successfully managed by non-surgical treatment.

Adult↗

Computed tomography evaluation of renal parenchymal volume in patients with chronic pyelonephritis and its relationship to glomerular filtration rate.

The measurement of renal parenchymal volume using a calibrated computed tomography image processing method has been evaluated clinically on a cohort of patients with chronic pyelonephritis. Comparison of renal volume with function as assessed by 99Tcm DTPA renography demonstrated a simple linear relationship in patients who were normotensive and aproteinuric. The implications of this result on the interpretation of prognostic factors determining declining renal function in chronic pyelonephritis are discussed.

Chronic Disease↗

Pyelonephritis and hypertension.

Blood pressure changes were followed up for 1-12 years (average; 3.8 years) in 46 cases of confirmed postoperative chronic pyelonephritis which had undergone ureterocutaneostomy, nephrostomy or other urologic operations. Diastolic blood pressure levels averaged 82 mmHg before operation, and 89 mmHg in the chronic stage after the operation. The incidence of hypertension (over 100 mmHg diastolic pressure) was 7% before the operation, but rose to 30% in the chronic stage. Application of an "age- and sex-adjusted score" also served to confirm a mean increase in blood pressure through the development of chronic pyelonephritis. No correlation was found between renal function and blood pressure. Nor was there any definite relationship between family history of hypertension and high blood pressure. In the 14 cases observed for plasma renin activity, values were found to be in the normal range.

Adolescent↗

Ciprofloxacin extended release: in the treatment of urinary tract infections and uncomplicated pyelonephritis.

Ciprofloxacin extended release (XR) is a new oral formulation of a fluoroquinolone that allows once-daily administration while maintaining therapeutic serum levels of the drug. The maximum plasma concentrations (Cmax) of once-daily ciprofloxacin XR 500 mg was higher than that of twice-daily ciprofloxacin immediate release 250 mg and the Cmax of once-daily ciproflocaxin XR 1000 mg was higher than that of twice-daily ciprofloxacin 500 mg. No accumulation of ciprofloxacin XR at steady state was observed in healthy men and all other pharmacokinetic parameters were similar to those of the immediate-release formulation. In patients with uncomplicated urinary tract infection (UTI), bacteriological eradication rates were similar in recipients of ciprofloxacin XR and immediate-release ciprofloxacin at the test-of-cure (TOC) visit, as were rates of persistence or new infection. Clinical cure rates were also similar in the two treatment groups. Bacteriological eradication occurred in 89% of ciprofloxacin XR and 85% of immediate-release ciprofloxacin recipients with complicated UTIs or acute uncomplicated pyelonephritis at the TOC visit. Clinical cure rates were also similar in the two treatment groups. black triangle Ciprofloxacin XR was generally well tolerated in patients with uncomplicated or complicated UTIs or acute uncomplicated pyelonephritis and showed similar tolerability to that of the immediate-release formulation.

Administration, Oral↗