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PubMed2004

Secondary pseudohypoaldosteronism in an infant with pyelonephritis.

BACKGROUND: Urinary tract infections and/or urinary tract anomalies are very frequent among children. Especially in newborns/infants they represent additional factors in the development of secondary pseudohypoaldosteronism. CASE HISTORY: We present an 8-week-old infant who developed hyponatremia and hyperkalemia secondary to acute pyelonephritis. The boy presented with non-specific signs, including poor appetite, lethargy, and hypotonia. An extended evaluation led to the diagnosis of pseudohypoaldosteronism (PHA). PHA was transient and during therapy of pyelonephritis all of abnormal laboratory parameters returned to normal. The patient had vesico-ureteric reflux grade IV. CONCLUSION: Secondary/transient/reversible PHA occurs in patients with immature renal tubular responsiveness to aldosterone due to infancy when they have urinary tract anomalies and/or urinary tract infection. (Tab. 1, Ref. 7.)

Acute Disease↗

PubMed1992

[Emphysematous pyelonephritis. A serious complication of diabetes mellitus].

Pyelonephritis emphysematous (PE) is a life threatening renal infection which is observed practically exclusively as a serious complication of diabetes mellitus. 95% of the 73 cases which have been reviewed were found in diabetic patients. The symptomatology resembles that of severe acute pyelonephritis but the disease differs from this in that, in PE, emphysema develops in the actual renal parenchyma and/or in the perirenal tissues. The most important single factor in the etiology appears to be ischaemia of the tissues which are employed as growth media for the microorganisms involved. Infections with E. coli, Klebsiella pneumoniae, Aerobacter and Proteus are the most commonly found. Isolated cases with Candida and Cryptococcus neoformans have been observed. The mortality in untreated cases of PE is 100%. With medical treatment alone, the mortality decreases to 73% while, when combined medical and surgical intervention is employed, the mortality can be reduced to 30%.

Diabetes Complications↗

PubMed1992

[Emphysematous pyelonephritis].

A case of emphysematous pyelonephritis (EPN) is described. EPN is a severe suppurative infection of the renal parenchyma and the perirenal tissue, characterized by intra-renal, and possibly perirenal, gas formation. This is a rare form of acute pyelonephritis. The condition is associated with a high mortality. Diabetic patients are particularly prone to the disease. The diagnosis is established with great certainty by computed tomography of the kidneys. The condition should be treated with an intensive combined medical-urological regimen with percutaneous nephrostomy guided by computed tomography or ultrasound should be performed. If no therapeutic response occurs, surgical incision and drainage or nephrectomy are recommended. In the present case of EPN, the medical treatment proved adequate.

Emphysema↗

PubMed2005

[A case of microscopic polyangitis with sepsis due to pyelonephritis].

A 69-year-old woman, who had been diagnosed with interstitial pneumonia at 66 years of age, was admitted to our hospital because of high fever, purpura occurring on her arms and legs, and renal dysfunction. At the time of admission, her renal function had severely deteriorated (sCr 8.2 mg/dl, 24 h Ccr 6 ml/min), she had a severe high fever (BT 39.5 degrees C), back pain, a white blood cell count of 19,540/,microl, and a CRP level of 26.7 mg/dl. Blood and urine cultures yielded identical strains of E. coli. We diagnosed sepsis caused by pyelonephritis, and started intravenous meropenem trihydrate(MEPM) at 0.5 g/day. Her renal dysfunction was severe, so we started hemodialysis therapy. Immunological examination revealed the presence of ANCA-associated glomerulonephritis. Renal biopsy before steroid therapy confirmed the diagnosis of pauci-immune-type crescentic glomerulonephritis. Based on purpura and interstitial pneumonia, along with rapidly MPO-ANCA-positive progressive glomerulonephritis (RPGN) with acute renal failure, we diagnosed microscopic polyangitis (MPA). To treat sepsis and severe pyelonephritis, we started intravenous immunoglobulin 5 g (100 mg/kg)/day for 5 days before starting immunosuppressive steroid therapy (m-PSL 1 g/day, PSL 20 mg/day) for 3 days. These treatments improved her general condition and immediately improved her renal function. It is important to prevent infection during treatment using conventional immunosuppressive therapy. These findings suggest immunoglobulin therapy to be a safe immuno-suppressive treatment that is efficacious against ANCA-associated glomerulonephritis.

Aged↗

PubMed2006

[Pharmacodynamic study of Relinqing granules on bacterial pyelonephritis model in rats].

OBJECTIVE: To observe the effects of Relinqing granules (powder of Polygonum capitatum extract) on the bacterial pyelonephritis model in rats. METHOD: The rat bacterial pyelonephritis model was induced by injecting the escherichia coli ATCC-25922 into kidney parenchyma. The rats were divided ramdamly into Relinqing groups(52.32, 26.16 g x kg(-1)), norflorin group (0.03 g x kg(-1)), model group and normal control group, and were given experimental drugs by gastrogavage. The contents of leucocytes (WBC), occult bloo (BLD), glucose (GLU), protein (PRO), ketones, bilirubin and urobilinagen in urine were determined. RESULT: As compared with the model group, Relinqing granules 6.0 g x kg(-1) (crude drug 52.32 g x kg(-1)) could decrease significantly the contents of WBC and BLD in urine and, however, had no markedly effects on the other biochemical parameters of urine. CONCLUSION: Relinqqing granule has significant effects of decreasing urine WBC and BLD on the bacterial pyolonephritis in rats.

Animals↗

PubMedDate not supplied

Xanthogranulomatous pyelonephritis and malacoplakia of the bladder in a middle aged female.

We describe the case of a female with xanthogranulomatous pyelonephritis and malacoplakia of the bladder, presenting with recurrent urinary tract infection and renal mass. The genitourinary tract should be explored to evaluate the coexistence of these two diseases. Nephrectomy and bladder mass resection is warranted to maintain sterile urine. This case represents an unusual instance of the synchronic appearance of xanthogranulomatous pyelonephritis and malacoplakia of the bladder, implying a common pathogenesis for two related diseases from a different histological spectrum, in which the urinary obstruction serves as a promoting factor for the stepwise transformation of morphogenesis.

Female↗

PubMedDate not supplied

[Combined rehabilitation of patients with chronic pyelonephritis].

A total of 47 patients with chronic pyelonephritis in remission were divided into two groups. Group 1 received balneotherapy with attenuated in both groups. In group 1 total cholesterol in blood lowered to normal values, LDLP cholesterol fell by 35.2%, VLDLP cholesterol rose by 17.7%. In group 2, urine Na decreased by 23.8% (p < 0.01), blood Na - by 52.9% (p < 0.01), HDLP cholesterol rose by cholesterol, VLDLP cholesterol, LDLP cholesterol normalized. Thus, it is recommended to include enterosorbents on the basis of alginic acid into therapy of pyelonephritis.

Alginates↗

PubMed2006

[Xanthogranulomatous pyelonephritis presenting a subcutaneous mass in the lower abdomen: a case report].

A 72-year-old female presented with the complaint of left lower abdominal swelling in May, 2005. Laboratory analysis revealed elevated white blood cell counts and C-reactive protein. Abdominal computed tomography showed left ureteral calculi, left hydronephrosis and a mass extending through the perinephric space, psoas major muscle into the left flank and lower abdomen. Echo-guided needle mass biopsy was performed. Histopathological findings revealed xanthogranulomatous changes. Under the diagnosis of diffuse xanthogranulomatous pyelonephritis extended into psoas muscle and subcutaneous tissue, antibiotic therapy was given for 5 months. After reduction of subcutaneous mass, left nephroureterectomy was performed. Histopathological findings revealed xanthogranulomatous pyelonephritis and ureteritis. Postoperative course was uneventful without any relapse of inflammation.

Abdomen↗

PubMed2006

Emphysematous pyelonephritis: report of 4 cases.

Emphysematous pyelonephritis is a rare, life endangering suppurative infection of the renal parenchyma and perirenal spaces. The disease is encountered mainly in patients with diabetes mellitus and is characterized by the production of intrarenal and, occasionally, perirenal gas. We present 4 cases of emphysematous pyelonephritis encountered in our hospital with review of the literature.

Aged↗

PubMed1991

[Acute pyelonephritis. Prospective analysis of 91 cases].

Ninety nine patients suffering of acute pyelonephritis are prospectively analyzed. Mean age was 39.8 +/- 18.2 (mean +/- DE), 72 of them were females and 19 were males. The most frequent clinical manifestations were fever and side pain in 97% of the cases and lower urinary syndrome in 78%. The duration of symptoms previous to the visit was 3.5 +/- 2.9 days. Bacteremia was confirmed in 99% of cases, it affected the oldest patients (p less than 0.001) and provoked the lasting of fever (p less than 0.05). E. coli was the most frequently isolated microorganism with an incidence of 91% in the isolated samples. Gentamicin was the initial treatment and the definitive treatment was prolonged to a total of 14 days. Fifteen percent of patients were classified after the evaluation as carriers of complicated pyelonephritis and had to undergo afterwards a urologic treatment. Follow up over a minimum of 6 weeks showed a treatment failure in 2% of cases and recurrency in 22%.

Acute Disease↗

PubMed1991

[Emphysematous pyelonephritis: 3 cases].

We report 3 patients who developed emphysematous pyelonephritis. All were diabetic females over 50 years of age with unilateral necrotizing pyelonephritis. Intra and perirenal gas was demonstrated and all patients had infection by E coli. X ray and ultrasound studies allowed the diagnosis. Antibiotic therapy was unsuccessful and all patients had to be operated on.

Aged↗

PubMedDate not supplied

[The enzyme function of cationic transmembrane transport and its relationship to the homeostatic indices of patients with chronic pyelonephritis].

The paper examines the relationship between the clinical manifestations of pyelonephritis and the functional activity of enzymes of cation transmembrane erythrocyte transport (Mg(2+)-, N(+)-K(+)-, Ca(2+)-ATPases). An individual analysis ascertained that the patients who showed a low Ca(2+)-ATPase activity had marked signs of inflammation in the body, as evidenced by ESR, seromucoid and fibrinogen concentrations. These patients had more significantly depressed immune defense mechanisms as reflected by the levels of immunoglobulins, T-lymphocytes, complement, the neutrophil phagocytosis, and urinary IgA concentrations). Variations were also found in examining the excretion of a number of metabolites. There was a substantial decrease in urea, creatinine, titrated acid, phosphorus excretions in patients with deficient Ca(2+)-ATPase activity than in those with its high activity. It was concluded that there was a relationship between some clinical manifestations of pyelonephritis and the functional activity of enzymes of cation transmembrane transport. To treat metabolic disorders, membrane-protective agents are recommended to include into combined therapy.

Adenosine Triphosphatases↗

PubMed1991

[Xanthogranulomatous pyelonephritis combined with retroperitoneal xanthogranuloma, simulating kidney tumor].

Xanthogranulomatous pyelonephritis is a special variant of interstitial nephritis, when an inflammatory infiltration contains xanthomatous cells. Its diagnosis is difficult and possible only on the basis of a histologic analysis of a surgically removed kidney. A case of xanthogranulomatous pyelonephritis combined with retroperitoneal xanthogranuloma is presented. Kidney carcinoma was suspected and in the course of operation the biopsy of kidney was taken. In the authors' opinion a histologic express diagnosis is recommended during the operation.

Adult↗

PubMed1991

Hydronephrosis and pyelonephritis associated with an anomalous vas deferens in a bull.

Hydronephrosis and pyelonephritis were diagnosed in a 2-year-old Limousin bull. Salient historical and clinical observations included weight loss, anorexia, intermittent colic, polyuria, polydypsia, and an ammoniacal breath odor. Intravenous treatment with fluids and antibiotics did not induce a favorable response. An anomalous vas deferens was observed on postmortem examination. The vas deferens ended in a blind polyp that protruded into the lumen of the urethra. This polyp may have caused chronic intermittent obstruction, predisposing to the hydronephrosis and pyelonephritis.

Animals↗

PubMed1991

[Nephrosonography--findings in acute pyelonephritis gravidarum].

Nephrosonographic checks were made on 25 women during pregnancy (prior to and after treatment) and after childbirth, in order to obtain morphological information on dynamics of upper urinary tract in cases of acute pyelonephritis gravidarum. Pyelectasia was recorded from 19 patients (76 per cent) on the right side, one patient (four per cent) on the left, two patients (eight per cent) on either side, and was not recorded at all from three women (twelve per cent). Moderate to severe dilatations had been more often recordable from patients with high temperature, but not as often from mild cases. Recurrence rates went up along with severity of ectasia. Physical treatment (lateral positioning and heat) yielded subjectively perceived improvement but failed to result in nephrosonographically recordable decline in dilatation. Pregnancies ended in premature births in 20 per cent of these cases. No dilatation of upper urinary tract was any detectable three months after parturition. While nephrosonography for routine still is disputed in the context of normal pregnancy, it should be used on all cases of acute pyelonephritis gravidarum.

Adult↗

PubMed1991

[Gastroduodenal pathology in pyelonephritis in children].

The authors describe lesions of the upper alimentary tract in 91 children aged 4 to 15 years suffering from pyelonephritis. Intragastric pH-metry, endoscopy and histological examination of biopsy specimens from the gastric and duodenal mucosa were carried out, as a result of which gastroduodenal pathology was diagnosed in 3/4 of the patients. In 69.4% of the children, biopsy specimens of the mucous membrane of the antrum of the stomach showed Campylobacter pylori. Such combined pathology requires, in addition to the treatment of pyelonephritis correction of the diet, administration of agents that may contribute to the decrease of upper alimentary tract inflammation. If Campylobacter pylori are detected, the treatment eliminating those bacteria is to be administered.

Adolescent↗

PubMedDate not supplied

[The correction of immunodeficiency states in patients with acute suppurative pyelonephritis].

The analysis of the examination findings of 54 patients with purulent pyelonephritis showed a great variety of immunological changes, which appeared both as differences in the types of abnormal immunity parameters and in the degree of the recorded pathological conditions. T-cell immunity deficiency was revealed in 55.6% of the patients, in a half of whom it was associated with humoral factor deficiency. In 25.9% of the patients the immunograms were similar to those in the controls and in 18.5% they were indicative of humoral immunity activation. Supplement of T-activin to the conventional antibacterial therapy contributed to an early immunological and clinical remission. The immunomodulatory effect was associated with the initial immune deficiency and manifested itself by higher relative and absolute T-lymphocyte contents along with elimination of their subpopulation imbalance. The effect proved to be less profound on the humoral immunity system. The arrest of an inflammatory reaction was evidenced by a decrease in beta-lysine levels in the serum up to normal ones. In contrast, antibacterial therapy without immunomodulation deteriorated the abnormal ratios of immunocompetent cells. The findings suggest that it is essential to take an individual approach to the use of immunomodulating therapy in patients with acute purulent pyelonephritis, taking into account not only clinical but immunological indications. It is most advisable to apply T-activin in cases of T-cell immune deficiencies with a significant imbalance of T-lymphocyte populations.

Acute Disease↗

PubMed1990

[Lipid peroxidation in patients with hypertension and chronic pyelonephritis with arterial hypertension].

++Non-ezymatic lipid peroxidation (LP) and total lipids (TL) in serum and erythrocytic membranes were studied in 42 hypertensive subjects and 35 chronic sufferers with pyelonephritis accompanied by arterial hypertension. The measurements performed at different phases of the clinical course provided evidence in favour of possible application of LP and TL tests in differentiating essential hypertension from chronic pyelonephritis with arterial hypertension.

Adult↗