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At least 919 records · Page 51Linked to original sources
PubMed1990

Xanthogranulomatous pyelonephritis in children and adults--an 8 year study.

20 cases of Xanthogranulomatous Pyelonephritis (XPN) were encountered over an 8 year period, constituting 0.4 percent of the total of 47,370 surgical biopsies, 10 percent of the total of 188 nephrectomy specimens removed for various reasons and 35 percent of the nephrectomy specimens associated with chronic pyelonephritis. This is the largest single series, reported in Indian literature. 16 patients were adults and 4 were children, thus 25 percent of our cases were children, a significantly high proportion. Our youngest patient a 5 1/2 month old male, is to the best of our knowledge, the youngest case reported from India. Males predominated in our series, the M:F ratio being 3:1, this contrasts with western literature in which there is a definite female preponderance. The common presenting symptoms were lumbar pain, fever and palpable non-functioning kidney. 4 cases were complicated by cutaneous sinuses. There was a slight predominance of affectation of the left side over the right side. On gross examination, diffuse lesions were commoner than focal lesions and were seen in children as well. An accurate pre-operative diagnosis was made in only 2 cases, in the rest, the diagnosis was either tuberculosis or pyonephrosis. Thus XPN is quite frequently seen in the adult Indian population and is not as rare in children, as it was once thought to be.

Adolescent↗
PubMed1990

[Intravenous urography in acute pyelonephritis].

Intravenous urography, systematically performed in 50 consecutive acute pyelonephritis patients, revealed abnormalities in 17 of them: in 12 cases (24%), treatment and follow-up were modified; in the other 5 cases (10%), the anomalies were insignificant. The nephrogram was normal for 33 patients (66%). The frequency of significant abnormalities was higher in patients over 50 years of age (46.2%) than in those under 50 (16.2%) (p less than 0.05), and was also higher in patients remaining febrile for 3 days after the onset of an appropriate antibiotic therapy (66.6%) than in responsive patients (14.4%) (p less than 0.01). Among the significant lesions, 10 were detectable by echography and another by abdominal X-ray. Thus, a population of women under 50 years of age with acute pyelonephritis can be selected for urography, as shown by these results, however, they must be confirmed before changing the systematic practice of urography.

Acute Disease↗
PubMed1990

[A case report of emphysematous pyelonephritis].

A 51-year-old male patient with diabetes mellitus consulted his home doctor because of high fever and right flank pain. Urinalysis showed marked pyuria. Treatment with antibiotics was not completely effective, and he was referred to our hospital for further examination and treatment. CT scan showed an abnormal gas shadow in right renal parenchyma. He was diagnosed with emphysematous pyelonephritis and right subcapsular nephrectomy was done after the control of diabetes mellitus. We reviewed 57 cases of emphysematous pyelonephritis including our case in the Japanese literature, and we discussed about its etiology, symptomatology, choice of treatment and prognosis.

Diabetic Nephropathies↗
PubMed1990

Acute pyelonephritis in pregnancy: a prospective study of oral versus intravenous antibiotic therapy.

Ninety pregnant women admitted to the high-risk pregnancy unit with a diagnosis of acute pyelonephritis were randomized to receive either oral (cephalexin 500 mg every 6 hours) or intravenous (IV) (cephalothin 1 g every 6 hours) antibiotic therapy. All patients were initially hydrated with 1 L of normal saline IV over 4 hours. Neither parenteral analgesics nor antiemetics were used. Bacteremia was noted in 13 (14.4%) of the 90 patients and mandated IV therapy. There was no difference between the oral and IV groups concerning predefined criteria for successful therapy (91.4 versus 92.9% successful therapy, respectively). No characteristic available at presentation predicted bacteremia or ultimate failure of therapy. Two patients (2.2%) experienced significant complications. These data suggest that in nonbacteremic patients, oral antibiotics are both safe and effective for the treatment of acute pyelonephritis in pregnancy.

Acute Disease↗
PubMed1990

[A clinical trial of pefloxacin (Abaktal) in the treatment of acute pyelonephritis].

The therapeutic effect of Pefloxacin in the treatment of acute pyelonephritis was examined in a randomized clinical trial. The patients in the control group have been treated by gentamycin. With a success rate of 80% in the treatment of acute pyelonephritis caused by various bacteria (E. coli, Pseudomonas, Klebsiella, Staphylococcus aureus, Proteus mirab.), a side frequency of side effects and a good compliance Pefloxacin is recommended as an effective antimicrobiell drug.

Acute Disease↗
PubMed1990

[A case of xanthogranulomatous pyelonephritis].

A case of a 38 years old man with xanthogranulomatous pyelonephritis is presented. The ultrasound examination of the abdomen found a tumorous formation above the left kidney. Arterial hypertension and changes in the lipid metabolism were found clinically. The i. v. urography revealed more characteristic changes. The diagnosis xanthogranulomatous pyelonephritis is based on the computed tomography findings and the clinico-laboratory examinations.

Adult↗
PubMed1990

[Xanthogranulomatous pyelonephritis. A benign, solid kidney tumor].

We report the case of a 68 year-old woman who underwent surgical treatment for xanthogranulomatous pyelonephritis. Xanthogranulomatous pyelonephritis is a rare, chronic, inflammatory lesion of the kidney. It is most frequently seen in middle-aged women. Because of its clinical and radiological similarities to other renal lesions it can be difficult to establish a preoperative diagnosis. Nephrectomy is needed in most patients.

Aged↗
PubMedDate not supplied

[The urinary excretion of renal prostanoids in children with chronic obstructive pyelonephritis in vesicoureteral reflux before and after antireflux operations].

The excretion of renal prostaglandins (PGE, PGF2 alpha, 6-keto-PGE1 alpha and TKB2) was studied in 45 children with chronic obstructive pyelonephritis in the presence of vesicoureteral reflux with account for the disease stage (partial remission--group I; total clinical and laboratory remission--group II) in various periods of surgical corrections of the impaired urodynamics in the area of vesicoureteral segments (in the early postoperative period of 12-14 days after the surgery; in the follow-up period of 6-12 months after the surgery). Preoperative observation of Group I children revealed a significant decrease in urinary PGF2 alpha excretion in the presence of an increase in the circadian TKB2 and 6-keto-PGF1 alpha excretion, whereas the patients from Group II who had normal levels of TKB2 and 6-keto-PGF1 alpha excretion, the levels of PGE and PGF2 alpha were lowered. The retention of sodium was documented in both groups. There was a total recovery of renal sodium and water excretion 6-12 months after the surgery. Children without the urinary syndrome (group II) demonstrated normalization of all secreted prostanoids, whereas in those with pronounced severity of pyelonephritis (group I), the excretion of sodium and diuresis were likely to be provided by hyperproduction of vasodilating sodium and diuretic PGE.

Adolescent↗
PubMed1990

Atubular glomeruli in patients with chronic pyelonephritis.

In an animal model of chronic nephropathy a large proportion of the apparently normal glomeruli have been shown to be small and without connection to a proximal tubule. The present study examines the degree to which atubular glomeruli are also present in human renal disease. Eleven patients with chronic pyelonephritis (CP) and seven controls were investigated. The number of glomeruli connected to a normal proximal tubule was determined in serial sections and the volumes of individual glomeruli estimated with stereological methods. Only glomeruli with little or no sclerosis were investigated. The volume fractions of proximal tubules and interstitial tissue were estimated using point counting. The results showed that 50% of glomeruli in the CP group were connected to a normal proximal tubule, whereas 35% of the glomeruli were without any recognizable connection to a proximal tubule (atubular glomeruli). The remaining 15% were connected to an atrophic tubule. The mean volume of the glomeruli without a connection to a normal proximal tubule was only half that of glomeruli with a normal proximal tubule. No significant difference was found between the mean glomerular volume in the two groups, but the intraindividual variation of glomerular volumes was larger in the CP group. A significant negative correlation was found in the CP group between the percentage of glomeruli without connection to a normal proximal tubule and the volume fraction of proximal tubules. A significant positive correlation was found between the percentage of glomeruli that were not connected to a normal proximal tubule and the volume fraction of the interstitial tissue. This study shows that atubular glomeruli, which only can be identified in serial sections, constitute a large proportion of glomeruli in chronic pyelonephritis. Their existence could be a major reason for the irreversibility of nonglomerular chronic renal diseases.

Adolescent↗
PubMed1990

Emphysematous pyelonephritis: case report.

We report a case of emphysematous pyelonephritis in a diabetic patient with some atypical features with a successful surgical outcome. This uncommon complication should be considered in any diabetic patient with fulminant or resistant pyelonephritis.

Diabetes Mellitus, Type 2↗
PubMed1990

Prevalence of antibiotic-resistant uropathogens in obstetric patients with acute pyelonephritis.

The purpose of this investigation was to determine the prevalence of antibiotic-resistant uropathogens in 121 pregnant patients hospitalized with acute pyelonephritis. We obtained urine for culture by catheterization and defined a positive culture as greater than 100 colony-forming units per milliliter of urine. We determined bacterial sensitivities with either the Bauer-Kirby disc diffusion test or the Vitek Auto Microbic System. During the 4 years of the study, the prevalence of ampicillin-resistant organisms was 26% (95% confidence interval 18-34%). However, only 4% (95% confidence interval 0-8%) of the uropathogens were resistant to limited-spectrum, first-generation cephalosporins. This observed difference in antibiotic sensitivity was highly significant (P less than .005). Therefore, we conclude that a limited-spectrum cephalosporin is more appropriate than ampicillin for empirical therapy of pyelonephritis in pregnancy.

Acute Disease↗
PubMed1988

Escherichia coli-specific T lymphocytes in experimental pyelonephritis.

We have assessed the phenotype and specificity of infiltrating mononuclear cells in a model of unilateral ascending acute pyelonephritis induced in rats with nephritogenic Escherichia coli or Pseudomonas aeruginosa. Histologic examination showed a predominance of mononuclear cells in the interstitium at all periods examined (4, 8, 15, 21, and 25 days), although at 4 and 8 days neutrophils were also abundant. Most of the mononuclear cells had the morphologic appearance of large lymphocytes. Immunoperoxidase studies with mAb showed that most of the mononuclear cells were W3/25+; many were W3/13+ and a small proportion were OX8+. Many of the mononuclear cells were Ia+. T cells were propagated in IL-2-containing media from small fragments of renal tissue with pyelonephritic lesions. Most of the propagated cells were W3/25+; fewer than (10%) were OX8+ or Ia+. T cells propagated from kidneys infected with E. coli responded, in proliferation assays, to the infecting strain or other E. coli strains, but not to P. aeruginosa or enterococci. The response to non-p-pilus-bearing E. coli was as great or greater than to E. coli with adhesins. T cells derived from lesions induced by P. aeruginosa responded to the infecting organisms, but not to E. coli. The response to the infecting organism (E. coli or P. aeruginosa) was MHC restricted, as indicated by the requirement for syngeneic APC. The results show that large numbers of T lymphocytes, especially with the "helper/inducer" phenotype, accumulate in the lesions of acute pyelonephritis in rats. Among the infiltrating T lymphocytes are activated cells and cells with specific reactivity to the infecting bacteria (or related strains). The findings indicate that T lymphocytes play a role within the kidney in response to the invading bacteria.

Animals↗
PubMed1989

[Chronic pyelonephritis and its differential diagnosis. A disease changing with time].

Chronic pyelonephritis (c.p.) is by definition an infectious tubulo-interstitial nephritis. It has to be differentiated from other etiologic forms of tubulo-interstitial nephritis. Therefore strict morphological criteria are needed for diagnosis. The characteristic lesion is a large cortico-medullary scar overlying a dilated chronically inflammed calyx. The macroscopic aspect and the histologic survey picture are more important than histologic details. A diagnosis on renal biopsies is therefore not warranted. Vesico-renal reflux and papillary morphology play an important pathogenetic role. Beside the more common focal scar a diffuse form of scarring can be observed. A limited number of conditions only have to be considered in differential diagnosis. The Ask-Upmark kidney seems to be a special form of c.p. related to urinary tract infection and reflux in early infancy. Pelvi-calyceal lithiasis without superimposed infection causes a picture very similar to a pyelonephritic scar. A reliable differentiation between c.p. and analgesic nephropathy may cause problems in endstage kidneys with sloughed off papillae. Various mechanisms of renal damage such as bacterial infection, immunological mediated inflammation, leakage of urinary constituents into the interstitium especially Tamm-Horsfall-protein and ischemia have to be considered. Despite the frequency of urinary tract infections chronic progressive pyelonephritis is rare. Predisposing factors are needed for progression of the disease. These include congenital or acquired urinary tract obstruction, vesico-renal reflux and papillary damage with intrarenal obstruction to the urinary flow. Other important factors are focal and segmental glomerulosclerosis and hypertension.

Analgesics↗
PubMed1989

Xanthogranulomatous pyelonephritis--(a clinicopathological study of 15 cases)

The clinico-pathological features of 15 patients with xanthogranulomatous pyelonephritis (XGP) are described and the probable histogenesis is discussed. Based on our data and the review of literature, we believe that XGP should be regarded as a destructive and at times tumefactive inflammatory process that may complicate chronic pyelonephritis. The initiation of this process remains obscure, but the features commonly associated with XGP are pelvi-calyceal obstruction, ulceration of the pelvic urothelium with collection of necrotic material and bacterial infection.

Adult↗
PubMedDate not supplied

Perinephric xanthogranulomatous pyelonephritis simulating a renal or retroperitoneal tumor on X-ray CT and angiography.

A case of perinephric xanthogranulomatous pyelonephritis is presented. Ultrasonography and X-ray computed tomography (X-CT) showed a mass on the posterior aspect of the right kidney, causing us to suspect right renal cell carcinoma. Pyelography showed a deformity of the right renal calyces. From angiographic results, we considered the possibility of hypovascular renal cell carcinoma, subcapsular tumor, or retroperitoneal tumor. The mass was diagnosed pathologically as perinephric xanthogranulomatous pyelonephritis.

Angiography↗
PubMedDate not supplied

[Lipid peroxidation and transmembrane transport in patients with chronic pyelonephritis].

Lipid peroxidation (LPO) and transmembranous transportation were analysed in the red cells of 56 patients with chronic pyelonephritis with regard to the pathologic changes in the membranes. LPO registration was made on the basis of the levels of diene conjugates and Schiff's bases. The activity of enzymes of transmembranous transportation-calcium, magnesium, sodium/potassium pump--was studied. The levels of the LPO markers were found to be tending to an increase in the active stage of the disease and to a decrease in its remission. Though the initial control levels of the markers were not reached. In the active stage of the disease the levels of diene conjugates were 59.66 +/- 6.43 nmol (42.6 +/- 94 nmol/litre in the control) while in the remission they were 22.16 +/- 3.22 a. u. (14.80 +/- 1.06 in the control). The results obtained are indicative of the polymorphism of clinically manifest metabolic changes. In the patients with higher levels of Ca2-ATPase the disease ran more silent than in those in whom the enzymic functional activity were lower. Inadequate activity of enzyme transmembranous transportation revealed in some patients in the course of manifest inflammation was a direct reflection of the failure in the mechanism of adaptation and an evidence of the initially heterogeneous activity (individuality) the enzymes of transmembranous cation transportation. The revealed phenomena contributed to the clinical course of pyelonephritis in a particular person and with regard to pathogenetic mechanisms required an approach to the therapy on an individual basis.

Adult↗
PubMed1989

[Emphysematous pyelonephritis and perinephritis].

The authors report an eighth case of emphysematous perinephritis and a new case of emphysematous pyelonephritis. The general features of these two diseases and their similarities are described: middle aged diabetic women, clinical picture of sepsis, gas images projected over the renal area with delayed excretion on intravenous pyelography, computed tomography reveals the exact site of the emphysematous images (perinephritic and or intraparenchymal). Emphysematous perinephritis may be an early form of emphysematous pyelonephritis. Surgical drainage of the renal compartment allows conservative management at this early stage.

Diabetes Mellitus, Type 2↗