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PubMed2001

Transient renal glycosuria in a patient with acute pyelonephritis.

Glycosuria was detected in a 37-year-old Chinese woman by a urinary examination in a local clinic with clinical evidence of acute pyelonephritis (APN). Transient glycosuria is an unusual complication of acute pyelonephritis in non-diabetic patients. As there is growing prevalence of type 2 diabetes in the population worldwide, it must be recognized that mistaken diagnosis of diabetes mellitus by glycosuria may predispose patients to an unfavorable hypoglycemic episode. Thus definite diagnosis of diabetes mellitus should be made only after recovery of APN by means of urinalysis or by simultaneous blood glucose concentration analysis.

Acute Disease↗

PubMed2003

A patient with E. coli-induced pyelonephritis and sepsis who transiently exhibited symptoms associated with primary biliary cirrhosis.

A 28-year-old woman had chief complaints of headache and a 40 degrees C fever. At this time, findings indicative of inflammation including elevated CRP and increased WBC were observed, and E. coli was detected on blood and urine culture. As a result, the patient was diagnosed with pyelonephritis and sepsis. Furthermore, markedly increased hepatobiliary enzymes and elevated anti-mitochondrial antibody were confirmed. The administration of antimicrobial agents resulted in improvement of the pyelonephritis and sepsis and normalization of hepatobiliary enzyme and anti-mitochondrial antibody levels. It has been documented that the incidence of urinary tract infection is high among patients with primary biliary cirrhosis (PBC). The findings obtained from the present patient are of considerable interest in elucidating the mechanism of onset in PBC.

Adult↗

PubMed1979

Ultrasonic characteristics of chronic atrophic pyelonephritis.

Six cases of chronic atrophic pyelonephritis were studied with gray scale ultrasound. The findings are analogous to those seen pathologically, namely a focal or multifocal process with loss of renal parenchyma, retraction of one or more calyces, decrease in renal size, and increased echoes from fibrosis. In the proper clinical setting, the diagnosis of chronic atrophic pyelonephritis can be made using ultrasound technique.

Adolescent↗

PubMed1980

Gallium-67 radionuclide imaging in acute pyelonephritis.

The symptoms and clinical course of patients with acute pyelonephritis are variable; likewise, urinalysis, blood cultures, and excretory urography may be normal or equivocal. The ability of gallium-67 to accumulate in areas of active inflammation was useful in the diagnosis of acute pyelonephritis in 12 cases. A multiplane tomographic scanner was used for imaging four of these patients. Initial experience with this scanner is also discussed.

Acute Disease↗

PubMed1980

Sonographic features of xanthogranulomatous pyelonephritis.

The ultrasonic findings of three patients with surgically confirmed xanthogranulomatous pyelonephritis are presented. All of the involved kidneys were markedly enlarged, had a large central echogenic area, and demonstrated an increased parenchymal anechoic pattern. The appearance correlated well with the other radiographic and gross pathologic findings. While this appearance was fairly distinctive, it is anticipated that there will be some difficulty in distinguishing this entity from simple hydronephorsis, especially in conjunction with staghorn calculus. It is also anticipated that focal xanthogranulomatous pyelonephritis will have an atypical appearance.

Adolescent↗

PubMed1991

Xanthogranulomatous pyelonephritis, perinephric type--a case report.

A 46 year-old woman with perinephric type of xanthogranulomatous pyelonephritis is described. She had a fever and pain with a palpable mass in her right flank. The blood analysis revealed anemia, leucocytosis, gamma-globulinemia, but no hyperlipidemia. The urine analysis showed nothing abnormal, but enterobacter was present in the urine. An intravenous pyelogram demonstrated a right non-functioning kidney. The diagnosis of a perinephric abscess was made from the x-ray and ultrasonogram, and a right nephrectomy was performed. The resected kidney had a tumor-like lump covered with Gerota's fascia at the postero-lateral side of the kidney. The cut surface of the kidney revealed an area of hemorrhage, blood clotting, abscess and a brownish yellow area in the perinephric fat tissue. The calyx and pelvis were normal. Histologically, the brownish yellow area was a granuloma with foam cell infiltration. The foam cells contained lipids. The renal parenchyma showed a non-specific chronic pyelonephritis.

Female↗

PubMed1985

Experimental pyelonephritis and papillary necrosis in the Gunn rat.

Homozygous and heterozygous female Gunn rats show increased susceptibility to experimental urinary infection. The strain develops pyelonephritis after intravesical inoculation of Proteus mirabilis in numbers which fail to induce the lesion in albino rats, and severe pyelonephritis is frequently complicated by papillary necrosis. The basis for this enhanced susceptibility has not been defined, but the occurrence of the phenomenon in both homozygous and heterozygous rats indicates that it is not caused primarily by high plasma levels of unconjugated bilirubin or by the deposition of bilirubin in the tip of the renal papilla. The increased susceptibility of the homozygous Gunn rat to ascending urinary tract infection provides supporting evidence for the suggestion that infection may complicate the natural history of experimental analgesic nephropathy in this strain and is relevant to the clinical association of analgesic nephropathy and urinary infection.

Animals↗

PubMed1986

The combination of pivampicillin and pivmecillinam versus pivampicillin alone in the treatment of acute pyelonephritis.

96 patients with clinical symptoms of acute pyelonephritis were randomized to 2 weeks treatment with either a fixed combination of pivampicillin and pivmecillinam or to pivampicillin alone. If needed, treatment was first started with the respective parenteral equivalents of the drugs. Acute pyelonephritis was bacteriologically verified in 57 patients, in whom Escherichia coli was isolated in 80% of the cases, Klebsiella in 7% and Proteus mirabilis in 5%. 22 of the 39 patients excluded did not have significant bacteriuria (less than 10(8) c.f.u./l). Combination treatment was superior to pivampicillin/ampicillin alone, in terms of clinical effect, with successful treatment being noted in 93% in the combination group and in 53% in the ampicillin group (p = 0.002). The combination was also more effective bacteriologically and it did not select resistant strains in the urinary tract. Ampicillin treatment alone, was, however, associated with a significant increase in urinary strains resistant to ampicillin and to mecillinam. Unsuccessful responders had a significantly higher mean age (p less than 0.01) than successful responders. No serious side-effects were noted.

Acute Disease↗

PubMed1988

Efficacy and safety of once daily versus intermittent dosing of tobramycin in rabbits with acute pyelonephritis.

Unilateral pyelonephritis was induced in 50 rabbits by injecting Escherichia coli (minimum inhibitory concentration of tobramycin 0.25 mg/l) into the left kidney and by obstructing the ureter temporarily. Tobramycin treatment (daily dose 10 mg/kg) was started 4 days after surgery, either in a single daily dose or in 3 divided doses at 8 h intervals, for 2, 3, 5, 7 or 10 days. Comparison of bacteriology, renal morphology, and renal functions (BUN, serum creatinine, alanine aminopeptidase, N-acetyl-beta-D-glucosaminidase, cathepsin B, sphingomyelinase) suggests better efficacy and renal tolerance of the single daily dose regimen in the treatment of experimental acute pyelonephritis.

Acetylglucosaminidase↗

PubMed1988

Frequency of thromboembolic complications in patients with acute pneumonia and pyelonephritis.

Infectious complications increase the risk of postoperative thromboembolism. In order to assess the risk of deep vein thrombosis (DVT) in acute infections not associated with surgery, 36 patients with acute pneumonia or pyelonephritis were evaluated regarding development of DVT with the 125I-fibrinogen uptake test with confirmative phlebography. 1/15 patients with pyelonephritis and 1/21 patients with pneumonia developed DVT. No fatal pulmonary embolism was seen. The frequency of DVT was thus 6%. This low figure may be due to early mobilization of the patients and does not motivate routine anticoagulant prophylaxis against thromboembolic complications in patients with acute infections.

Acute Disease↗

PubMed1995

Ampicillin plus mecillinam vs. cefotaxime/cefadroxil treatment of patients with severe pneumonia or pyelonephritis: a double-blind multicentre study evaluated by intention-to-treat analysis.

In this double-blind multicentre study, using the intention-to-treat approach, a total of 293 patients with fever (> or = 38.5 degrees C), symptoms of sepsis and signs of pneumonia or pyelonephritis were randomly assigned to treatment with ampicillin and mecillinam (A+M) or cefotaxime followed by cefadroxil. In the febrile phase, treatment was given intravenously twice daily, either with 1,200 mg ampicillin together with 600 mg mecillinam or with 2 g cefotaxime alone. When the patients stayed afebrile, the intravenous administration was replaced by oral treatment twice daily for 14 days, either with 500 mg pivampicillin and 400 mg pivmecillinam or 1 g cefadroxil. In the A+M group, 33% (48/144) of the patients did not complete the full course of treatment as compared with 32% (47/149) in the cephalosporin group, the reasons being treatment failure in 27 and 29, respectively, or adverse effects (n = 16 in both groups). The median duration of fever was 47 h in the A + M group and 50 h in the cephalosporin group. Of 135 patients with pneumonia, 68% were completely cured in the A + M group, and 65% in the cephalosporin group, the main reasons for treatment failure being Mycoplasma pneumonia or ornithosis. Of 136 patients with pyelonephritis, 63% were cured in each group. The main reason for failure was bacteriological relapse. Side-effects were reported by 32 patients (22%) of the A+M group, as compared with 41 (28%) of the cephalosporin group. Epigastric complaints were equally frequent in both groups, but there was a tendency for a higher frequency of exanthema in the A+M group, and for antibiotic-associated diarrhoea and fungal superinfections in the cephalosporin group.

Amdinocillin↗

PubMed1997

Aminoglycosides do not improve the efficacy of cephalosporins for treatment of acute pyelonephritis in women.

A prospective, coordinated, randomized multicentre trial was conducted to determine whether tobramycin 160 mg intravenously (i.v.) once daily for 2 days would improve the efficacy of cefotaxime 1 g i.v. twice daily for 2 days followed by a 10-day course of oral cefadroxil 1 g twice daily, in the treatment of community-acquired acute pyelonephritis in women. Of 73 patients enrolled in the study, 51 could be evaluated according to the protocol. There were no significant differences in bacteriological cure rates between the combined treatment with tobramycin/cefotaxime and cefotaxime alone, either at short-term follow-up (63.0% vs 59.1%; 95% confidence interval (CI) for difference in proportions -23.4% to 31.2%), or up to 7 weeks after cessation of treatment (42.9% vs 52.2%; 95% CI, -18.0% to 36.6%). A modified intention-to-treat analysis showed no difference in clinical efficacy between the two regimens (68.6% vs 69.2%; 95% CI, -22.9% to 24.1%). Tobramycin seemed to enhance the resolution of inflammation by a more rapid decline in C-reactive protein levels. The high recurrence rates after treatment with beta-lactam antibiotics in this and previous studies of acute pyelonephritis may be explained by adverse ecological effects rather than failure to eradicate the infection.

Adult↗

PubMed1996

Focal xanthogranulomatous pyelonephritis presenting as renal tumour in children. Case report with a review of the literature.

Xanthogranulomatous pyelonephritis (XGP) is a specific form of chronic inflammatory kidney disease which may involve both sexes at any age. The disease presents either in the diffuse form or less commonly as a focal process which is almost impossible to differentiate from renal malignancy. XGP usually occurs in association with urinary tract obstruction, infection and/or renal stones. Symptoms are often vague and non-specific. The most common offending organisms are E. coli and Proteus mirabilis. In reviewing the literature we have found 197 cases in children during the last thirty years, and of these only 15 (7.6%) were of the focal form. A case of focal xanthogranulomatous pyelonephritis in a 6-year-old boy is reported which demonstrates the diagnostic difficulties encountered in this disease. We emphasize the importance of XGP in the differential diagnosis of renal tumours in children with recurrent or therapy-resistant urinary tract infection in spite of no evidence of renal stone, poorly or absent function in the kidney or urinary tract obstruction.

Child↗

PubMed1997

Successful conservative management of emphysematous pyelonephritis, bilateral or in a solitary kidney.

Emphysematous pyelonephritis, bilateral or in a solitary kidney, is a life-threatening condition that requires prompt diagnosis and early intervention. Reported mortality is high, despite desperate surgical measures often ending in loss of renal unit, but medical management, possibly combined with percutaneous drainage, is sometimes successful. We report two cases of emphysematous pyelonephritis, one bilateral and one in a solitary kidney, with successful conservative management. Predisposing factors were insulin-dependent diabetes mellitus and micronodular cirrhosis secondary to chronic alcoholism. Prompt sonographic diagnosis determined the success of conservative management. Escherichia coli was identified as causal factor. In the bilateral case the clinical picture improved within 48 h after control of diabetes and broad-spectrum antibiotic treatment. For the affected solitary kidney, percutaneous drainage and ureteric catheterization were required.

Anti-Bacterial Agents↗

PubMed1989

[Emphysematous pyelonephritis a case report and review of the literature--comparative study with Japan and other countries].

A 36-year-old woman with diabetes mellitus complained of left flank pain and high fever. Drip infusion pyelogram (DIP) did not visualize the left kidney, but revealed crescent-shaped gas formation within the left renal shadow. Abdominal computerized tomography showed a subcapsular shadow in the left kidney. Because her symptoms was aggravated, left nephrectomy was performed under the diagnosis of emphysematous pyelonephritis. There was no manifestation of her prior symptoms after the operation, and she was discharged on the 19th postoperative day. In Japan, 43 cases of emphysematous pyelonephritis have been reported in the literature. These 43 cases were studied clinically and in comparison to the cases reported in Western countries. The male-to-female ratio was approximately 4 to 1, in contrast to the Western ratio of female preponderance. The age of the patients showed its peak at the 50-60's, the mean age being not significantly different from that of Western patients. 37% of the patients had the affected side on the right, 56% on the left, and 7% bilaterally. This was comparable to the results of Western countries. 93% of the subjects suffered from diabetes mellitus as the basal malady, which was comparable to that in Western studies. However, patients afflicted with urinary passage impairment accounted for 14%. This incidence was lower than that reported in Western studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1980

Pyelonephritis associated with Legionella pneumophila, serogroup 4.

A patient with bladder carcinoma metastatic to lung and brain died of pneumonia. Autopsy examination showed a confluent bronchopneumonia with several small abscesses and acute pyelonephritis with abscess formation. Legionella pneumophila, serogroup 4, was isolated in pure culture from lung tissue postmortem and was also shown by direct immunofluorescence in the kidney and spleen. In the kidney, the organism was noted in areas of acute pyelonephritis. This represents the first case of an extrathoracic inflammatory lesion associated with L. pneumophila.

Humans↗

PubMed1999

[Emphysematous pyelonephritis complicated with diabetes mellitus: a case report].

A 46-year-old woman with diabetes mellitus was admitted to our hospital due to lower right abdominal pain. Urinalysis did not show marked pyuria. Abdominal computed tomography showed an abnormal gas shadow in the right renal parenchyma. A diagnosis was made of right emphysematous pyelonephritis. Despite aggressive supportive therapy, the patient's condition worsened. Therefore, right nephrectomy was performed. The next day her general condition was markedly improved. We reviewed 122 cases of emphysematous pyelonephritis including our case in the Japanese literature, and discussed its etiology, symptomatology, choice of treatment and prognosis.

Diabetes Complications↗

PubMed1999

[A case of emphysematous pyelonephritis with emphysematous cystitis].

A 74-year-old woman with diabetes mellitus had a high fever, and was treated with antibiotics and insulin in another hospital. She was referred to our department, because CT scan showed the right hydronephrosis and the abnormal gas shadow in the right renal calyces. Ureteral catheterization was performed on the right side and cloudy urine was drained. Urine culture yielded E. coli. Since submucosal emphysematous changes were demonstrated in the bladder mucosa by cystoscopy, she was diagnosed with emphysematous pyelonephritis with emphysematous cystitis associated with diabetes mellitus. Administration of antibiotics and insulin and the ureteral catheter drainage improved her condition immediately. Abnormal gas shadow on CT scan and submucosal emphysema on cystoscopy disappeared. We reviewed 110 cases of emphysematous pyelonephritis and 23 cases of emphysematous cystitis including our case in Japan, and report their clinical characteristics.

Aged↗