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PubMed2000

[Emphysematous pyelonephritis in lithiasic kidney caused by acinetobacter].

Emphysematous pyelonephritis is rare. It is exceptionally associated with urolithiasis with obstruction of the collecting system. It is generally observed in female diabetic patients. It is caused by gas-producing bacteria. We report a case in which emphysematous pyelonephritis was caused by an acinetobacter, associated with pelvic ureteral junction lithiasis. Drainage and nephrectomy were necessary to overcome this life threatening situation.

Acinetobacter Infections↗

PubMed1975

Local immune response in experimental pyelonephritis in the rabbit. I. Morphological and functional features of the lymphocytic infiltrate.

The cellular activity of circulating lymphocytes and lymphocytes isolated from the infected kidney of animals with experimental haematogenous pyelonephritis was evaluated. The incorporation of [3H-methyl]thymidine into DNA by lymphocytes was studied with mitogens such as phytohaemagglutinin (PHA), pokeweek mitogen (PWM) and goat anti-rabbit IgG (GARIG). Lymphocytes from infected kidney had a high baseline DNA synthesis compared to circulating lymphocytes from days 5 to 27 of infection. Infected kidney lymphocytes failed to respond to PHA, PWM, or GARIG, whereas circulating lymphocytes did respond to these mitogens. Uropod-bearing lymphocytes, which were shown to be T lymphocytes, were present from days 5 to 77 of infection. B lymphocytes, as determined by surface immunofluorescent technique, were present by day 12, coincident with the onset of local synthesis of antibody. These studies reveal that in pyelonephritis, the cellular response goes through sequential changes and indicate a dynamic interrelationship between T and B lymphocytes at an infected site.

Animals↗

PubMed2000

Angiotensin II type 1 receptor antagonist (losartan) down-regulates transforming growth factor-beta in experimental acute pyelonephritis.

PURPOSE: To study the effect of an angiotensin II type 1 receptor antagonist, losartan, on cytokine expression, kidney growth and renal scarring in experimental acute pyelonephritis. MATERIALS AND METHODS: Female Bki NMRI mice, 8 weeks old were infected with E. coli CFT 073 via the urethra. Mice were divided into four groups; either left untreated; or treated with NaCl 0.9%; or an angiotensin II type 1 receptor antagonist, losartan, in doses of 1 mg. or 40 mg. /kg. body weight. The treatment was given daily i.p. for 48 hours, 3 weeks or 8 weeks respectively. Kidneys were weighed and sectioned for histo-pathology and in situ hybridization for mRNA of IL-1beta, TNF-alpha, IL-4, IL-6, IL-10, IL-12, TGF-beta and IFN-gamma. Homogenized kidneys were used for EIA of TGF-beta and bacterial growth. RESULTS: The mRNA expression of the studied cytokines generally peaked at 48 hours in all four groups. In animals treated with losartan, kidney TGF-beta, IFN-gamma and IL-6 decreased significantly at 3 and 8 weeks as compared with controls, untreated or those treated with NaCl, (p <0.005 respectively). Infection was associated with a declining kidney weight, also in the presence of losartan. A 50% reduction of the spread of renal scarring was observed in the losartan treated group, but this did however not reach significance. The proportion of kidneys showing bacterial growth was not influenced by losartan although in these kidneys the mean bacterial counts at 3 weeks were significantly higher in the losartan treated mice (p <0.006). CONCLUSIONS: Losartan is associated with downregulation of TGF-beta, IFN-gamma and IL-6 and may, in combination with antimicrobial therapy, reduce the risk of cortical renal scarring in recurrent acute pyelonephritis in infants.

Acute Disease↗

PubMedDate not supplied

Emphysematous pyelonephritis: a rare presentation.

Emphysematous pyelonephritis is a rare life threatening infection in diabetes characterised by suppurative infection of renal parenchyma and perirenal tissues. It usually presents with fever, nausea, vomiting, abdominal pain, shock, lethargy, and confusion. Diabetic ketoacidosis is an uncommon presentation. In the present case, an elderly female presented with abdominal pain, fever, vomiting, and altered sensorium. She was diagnosed to have diabetic ketoacidosis with metabolic encephalopathy with right emphysematous pyelonephritis. She had an excellent response to medical treatment alone and was later discharged on oral hypoglycaemic agents.

Adult↗

PubMed2000

[A case of xanthogranulomatous pyelonephritis presenting with the flank subcutaneous mass].

A 51-year-old female exhibited fever, left flank pain and left flank mass in March, 1993. Drip infusion pyelography (DIP) revealed a non-functioning left kidney with shadows of calculi, and abdominal computerized tomography (CT) showed renal calculi and multilocular cystic lesions in the left kidney extending through the perinephric space into the mass on the left flank. Percutaneous nephrostomy and percutaneous drainage were performed, followed by left nephrectomy. Histopathological findings revealed xanthogranulomatous pyelonephritis. There have been a few case reports of xanthogranulomatous pyelonephritis forming nephrocutaneous fistula in the back.

Cutaneous Fistula↗

PubMedDate not supplied

[The sensitivity of the urinary microbial flora in patients with different courses of pyelonephritis to well-known antibacterial agents and to the new preparation flurenizid].

Positive dynamics was observed in clinical picture and laboratory tests with sensitive to flureniside originators of pyelonephritis. No side effects were noted. The results obtained permit regarding flureniside as a drug of choice to be used for etiotropic treatment of patients with pyelonephritis caused by a sensitive to this chemotherapeutic agent microorganisms.

Acute Disease↗

PubMed2000

[Emphysematous pyelonephritis: a case report].

In this study, a case of emphysematous pyelonephritis has been reported in a 70-year old diabetic male with a non-functional contralateral kidney. In spite of appropriate medical treatment and surgical drainage, the outcome was negative. The case in question concerned a rare form of the disease, i.e., emphysematous pyelonephritis, a severe and necrotizing infection which is characterized by the presence of intraparenchymal gas produced by anaerobic bacteria, and the rapid development of acute sepsis or septic shock. Medical treatment alone is seldom sufficient, and surgical intervention, in most instances consisting of radical nephrectomy rather than surgical drainage, is advocated due to the extent of the necrotic lesions.

Aged↗

PubMed1975

Bacteriuria in the catheterized patient. Cystitis or pyelonephritis?

Seventy-two patients with indwelling urethral catheters had urine specimens cultured to detect bacteriuria. Bacterial sediments were examined to find the source of the bacteria, with use of an antibody immunofluorescence (IF) technique. Antibody coating demonstrated by fluorescence was considered evidence for pyelonephritis. In cystitis, the bacteria did not fluoresce. Repeat culture and immunofluorescence studies were done 3 to 18 week later. One third of the patients had a urinary infection. Two (13%) of the patients catheterized for one day and 17 (55%) catheterized four or more days had appreciable bacteriuria. One patient catheterized less than three days had positive IF, while 5 patients (16%) catheterized four or more days had positive IF. Only two of the ten patients observed, with an initial infection, had sterile urine on follow-up culture. On follow-up study, of the four patients with bacteriuria of renal origin, one showed a sterile urine, two had cystitis, and one still had pyelonephritis.

Adult↗

PubMed1975

An ultrastructural study of the renal medulla in experimental acute pyelonephritis.

Experimental acute pyelonephritis was produced in rats by a combination of intravenous administration of Escherichia coli, strain IMRU-54, and temporary unilateral mechanical ureteral obstruction. Structural alterations of the renal medulla were studied by light and electron microscopy. Major cellular alterations occurred in the vasa recta. Tubular and interstitial cells demonstrated minimal alterations after the brief period of acute inflammation. Polymorphonuclear leukocytes within tubular lumina contained structures resembling E. coli in nonprotoplasts-like form. Numerous protoplast-like organisms, to the exclusion of any other structural forms, were detected within the interstitium of the inner medulla. Nonprotoplast-like structures resembling E. coli were rarely observed in interstitium of the inner medulla. Following relief of ureteral obstruction, clearance of acute inflammation was rapid. In conclusion, hemoatogenous acute pyelonephritis induced by E. coli, IMRU-54, is able to inflict cytological and ultrastructural damage to structural elements of the inner and outer medulla of rats. Vasa recta incurred prominent alterations in endothelia and basement membranes, whereas tubular epithelia and interstitial cells had relatively good structural preservation. The data suggest that intravenously administered E. coli is capable to revert to a protoplast-like structure in the inner medulla.

Acute Disease↗

PubMed2000

Emphysematous pyelonephritis.

Emphysematous pyelonephritis is a rare, severe, necrotizing form of renal infection characterized by the presence of gas within the renal parenchyma or perinephric space. In patients suspected of emphysematous pyelonephritis, computed tomography scan should be done promptly. Based on the available data and this case, surgical intervention appears to be the preferred treatment.

Blood Chemical Analysis↗

PubMed1975

Local immune response in experimental pyelonephritis in the rabbit. II. Lymphocyte stimulation by lipopolysaccharide of infecting organism.

The response of circulating and kidney lymphocytes from rabbits with experimental haematogenous pyelonephritis to somatic (O) antigen (lipopolysaccharide) from the infecting organism was evaluated. Lymphocytes were cultured for 3 days in the presence and absence of lipopolysaccharide from the infecting organism, Escherichia coli O75 and a heterologous organism. Circulating lymphocytes showed a significant response to the homologous lipopolysaccharide by day 5 of infection, and kidney lymphocytes responded by day 19 of infection but failed to respond after day 33. The lipid moiety of somatic antigen was required for the stimulation of lymphocytes since antigen preparations in which lipid was low or absent did not activate lymphocytes. B lymphocytes from kidney were stimulated by this antigen whereas both T and B circulating lymphocytes responded. Thus, pyelonephritis in rabbits is associated with the activation of a subpopulation of circulating cells which have specific receptors for the homologous antigen. B lymphocytes that are specifically activated by the homologous or O antigen then localize to the infected site.

Animals↗

PubMedDate not supplied

[Mineral water Volzhanka from Undorovskĭ spring in combined therapy of patients with nephrolithiasis and chronic pyelonephritis].

Water loading is an essential component in therapy of nephrolithiasis, especially in the presence of small ureteral concrements or fragments after extracorporeal shock-wave lithotripsy. Saluretics, furosemide in particular, cause side effects. One of these is dyselectrolytemia due to potassium loss. Mineral waters have advantages in the treatment of nephrolithiasis and pyelonephritis as their drinking does not lead to electrolyte loss. Low mineral waters are highly diuretic, e.g. after drinking 1 liter of Volzhanka day-time diuresis increases by 300-400 ml. This relieves ureteral and calyceal-pelvic tonicity stimulating elimination of the concrements or their fragments after lithotripsy. Intake of Volzhanka proved effective in combined therapy of nephrolithiasis, calculous pyelonephritis, urate nephrolithiasis.

Chronic Disease↗

PubMedDate not supplied

[Relationship between immunogenic markers with metabolic processes in chronic pyelonephritis].

Such HLA phenotypes as A3B35 and A9B35 occur most frequently in patients with chronic pyelonephritis (CP). In these phenotypes there are most pronounced changes in the lipid phase of red cell membranes and renal tissue. The above changes of blood cell cytomembranes and renal tissue can be used as diagnostic criteria of inflammation activity in pyelonephritis while the HLA antigens are helpful for detection of CP risk groups.

Adult↗

PubMed2000

[A case of effective endotoxin adsorption therapy for septic shock due to acute pyelonephritis].

Although septic shock has a high mortality rate of 43%, recently the endotoxin adsorption column was established and its efficacy is interesting. We report a very effective case of endotoxin adsorption the rapy for septic shock due to acute pyelonephritis. A 59-year-old man with chief complaints of pyrexia and right backache was referred to our hospital with a small right ureteral stone (4 mm) associated with a low degree of right hydronephrosis. Since it was diagnosed as right acute pyelonephritis, antibiotics were administered; and then septic shock occurred on the day of hospitalization. Endotoxin adsorption therapy was performed for two days and hemodynamic stability was achieved. The concentration of blood endotoxin was reduced remarkably and the efficacy of endotoxin adsorption therapy was suggested.

Acute Disease↗

PubMed2001

[Acute pyelonephritis. Randomized multicenter double-blind study comparing ciprofloxacin with combined ciprofloxacin and tobramycin].

OBJECTIVES: To investigate the effects of an intravenous injection of tobramycin (T) in female patients with acute uncomplicated pyelonephritis treated with ciprofloxacin (CIP) (500 mg bid per os). METHODS: It was a randomized, multicenter, double-blind study conducted in six departments of emergency medicine. The main exclusion criteria were: previous history of urinary tract malformation of lithiasis, a recent urological procedure, pregnancy, diabetes mellitus, immunodepression, or severe sepsis. The primary criteria for evaluation were: the percentage and rate of clinical recovery, as well as bacteriological efficacy. RESULTS: 118 women were enrolled, 60 in the tobramycin group and 58 in the placebo group. E. coli was the most commonly isolated organism; all organisms were susceptible to ciprofloxacin and tobramycin. Two women in the CIP + T group and four women in the CIP + P group failed to respond clinically. The recovery rate was similar in the two groups (96 and 93% respectively). CONCLUSION: Administration of a dose of tobramycin did not demonstrate its clinical benefit in treatment of acute uncomplicated pyelonephritis treated by oral ciprofloxacin.

Acute Disease↗

PubMed2000

[Papillary renal cell carcinoma complicated with emphysematous pyelonephritis: a case report].

A case of papillary renal cell carcinoma complicated with emphysematous pyelonephritis is reported. A 75-year-old woman with diabetes mellitus was admitted to our hospital with macroscopic hematuria and a child's head-sized firm mass in the left hypochondrium. Computed tomographic (CT) scanning revealed a huge left renal tumor with hydronephrosis. The patient had acute pyelonephritis and antibacterial therapy was initiated. Ten days later, conservative therapy was not effective and CT scan revealed emphysematous necrotic tissue in the tumor. We performed percutaneous drainage. Then dark red liquid and gas were discharged. Her general condition was improving. Left radical nephrectomy was performed. The mass was solid and pathological diagnosis was papillary renal cell carcinoma with necrotic tissue and coated by a thick pseudocapsule. She has remained free of disease for 27 months after operation.

Aged↗

PubMed1998

Emphysematous pyelonephritis.

Emphysematous pyelonephritis is a severe form of acute pyelonephritis, characterised by fever, abdominal pain, nausea and vomiting, associated with intraparenchymal and perirenal gas production. It is often diagnosed radiologically, by plain films of abdomen, ultrasonogram and/or CT scan and often needs surgical drainage. We report a case which could be diagnosed clinically because of extensive surgical emphysema in a diabetic patient which was successfully managed by a combined medical and surgical approach.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Surgical tactics in complicated forms of acute purulent pyelonephritis in pregnancy].

Out of 3000 pregnant women observed in 1986-1999, pyodestructive forms of pyelonephritis were diagnosed in 120 women. They were treated surgically. The policy of the treatment depended on the degree of pyoseptic intoxication, severity of toxic affection of the parenchymatous organs, severity of pyodestructive changes in the kidney. Plasmapheresis expanded indications to organ-saving operations, effectively and quickly arrested purulent intoxication. Various organ-saving operations have been successfully performed in 77(64.1%) pregnant women. In 12 patients nephrostomy was uneffective. In these patients a second nephrectomy was made. Primary nephrectomy was made in 37 cases of life-threatening pyoseptic intoxication. Hard to treat bilateral pyodestructive forms of pyelonephritis were detected in 15(12.5%) women. Bilateral nephrostomy with cleaning of purulent infection foci was effective in 9 patients. It is shown that early surgical detoxication of the most affected kidney prevents development of extended pyodestructive alterations in the contralateral kidney and avoid surgical intervention.

Acute Disease↗