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PubMed1987

[Modification by cyclophosphamide of the effect of autovaccination in chronic pyelonephritis in an animal experiment].

In an existing chronic pyelonephritis the influence of cyclophosphamide on the efficacy of an immunisation with autopathogenic antigens and the surface antigen of an E. coli rough strain was tested in an animal experiment. After an existence of the infection of about five weeks a decisive decrease of the antibody production by cyclophosphamide was not to be observed. The animals treated with cyclophosphamide did not show any improved elimination of germs. The histological findings of the kidneys documented the cytotoxical effect of the cyclophosphamide on the renal tissues and the epithelium of the urinary tract. The immunisation of animals with chronic pyelonephritis with various autopathogenic antigens altogether led to a statistically significant decrease of inflammatorily changed kidneys.

Animals↗

PubMed1977

[Serum and urinary antibodies in pyelonephritis (author's transl)].

Pyelonephritis is accompanied by complex immunological reactions, the study of which is just now being undertaken. Study of 216 patients with a significant monomicrobial urinary infection showed that in more than 95 per cent of cases of Gram negative infection the urine contained IgG type antibodies, often associated with IgA. These antibodies may be easily detected using an immunofluorescent technique, which would appear to be the best method available at present for distinguishing between pyelonephritis and an infection of the lower urinary tract. They may also be found in the serum, though less frequently. Detection by immunofluorescence is markedly more sensitive than using the classical passive haemagglutination technique. The biological significance of these antibodies remains imprecise, and their protective or facilitating role may be discussed. Their specificity must be determined, in order that sequential study of these immunological reactions may be of help in the conduct of treatment.

Antibodies, Bacterial↗

PubMed1987

[Autovaccination in chronic pyelonephritis in the animal experiment--effect of cyclophosphamide on splenic and thymus lymphocytes].

In rats with experimental pyelonephritis, cyclophosphamide leads to changes in the spleen and thymus lymphocyte populations. When cyclophosphamide was given five times a week from the fifth week of infection on, the population of electrophoretically slow moving spleen lymphocytes, which are believed to be B-lymphocytes, decreased in the seventh week. This effect is independent of autovaccination. During the same period the number of immature slow moving thymus lymphocytes decreased. Further treatment with cyclophosphamide until the twelfth week of infection led to the differences almost disappearing in the histogramm. Cyclophosphamide showed a slight effect on antibody production and did not influence the elimination of infective agents from the kidneys of animals with pyelonephritis.

Animals↗

PubMed1987

[Emphysematous pyelonephritis. Apropos of a case diagnosed by ultrasonography].

Emphysematous pyelonephritis is a severe infection of the Kidney observed mainly in diabetic patients. The disease is characterized by the production of intra-renal and occasionally perirenal gas. Because of the high mortality associated with this fulminant septic infection, it is imperative to establish a prompt diagnosis and start an appropriate therapy early in the course of the disease. We report a case of emphysematous pyelonephritis diagnosed by sonography: sonographic features consist of multiple high amplitude echoes within the renal parenchyma, renal sinus and perirenal space associated with distal shadows containing low level echoes. We discuss the value of the radiologic imaging methods.

Diabetic Nephropathies↗

PubMed1977

[Urinary and serum o-antibodies in patients with chronic pyelonephritis (author's transl)].

Urine (24-hour-specimen, 100-fold concentrated) and serum samples from adults with chronic pyelonephritis have been investigated for O antibody against the strain isolated from the urine by means of the indirect hemagglutination and indirect immunofluorescence technique. Using the hemagglutination technique about one third of the urine showed the presence of O antibody. The highest titer demonstrated was 1:16. O antibody determined by the immunofluorescence technique could be demonstrated in 54.9% of the urine samples. Titers up to 1:256 were found. Serum O antibody corresponded to those found in adults with chronic pyelonephritis. In general there was no correlation between urine and serum O antibody. The diagnostic and prognostic value of the results is discussed.

Adult↗

PubMed1988

[Clinico-therapeutic and microbiological research on the preparation Monaspor in patients with active pyelonephritis].

The urinary antiseptic efficacy of cefsulodin (Monaspor--Ciba) was studied in 22 patients with active pyelonephritis. The results were considered very good in 81.8% of the patients with urologic infections caused by P. aeruginosa, P. mirabilis and E. Coli. The drug was well tolerated. The microbiological studies in vitro of the urinary antiseptic efficacy of Monaspor on 575 bacterial strains isolated from patients with active pyelonephritis showed that the antibiotic was most active against Pseudomonas sp., beta-streptococcus, Staph. aureus, P. mirabilis.

Adolescent↗

PubMed1987

Pyelonephritis in pregnancy. The role of in-hospital management and nitrofurantoin suppression.

Acute pyelonephritis remains a frequent complication of pregnancy. Prevention of the potential complications of this disease requires aggressive in-hospital management. However, the high frequency of positive outpatient cultures following discharge has cast doubt on the adequacy of in-hospital care and, at the same time, has concentrated attention on follow-up care. In a randomized, prospective study, we evaluated the effects of in-hospital management and outpatient nitrofurantoin on subsequent urine cultures. The overall frequency of positive cultures following discharge from the hospital was 38%. However, appropriate antibiotic selection, a negative follow-up in-hospital culture and nitrofurantoin suppression reduced the rate to 8% (P less than .01). Nitrofurantoin did not reduce the rate of positive cultures if antibiotic selection was inappropriate or if the in-hospital follow-up culture was positive. These results suggest that more aggressive management of acute pyelonephritis in pregnancy may be indicated and that suppressive therapy cannot compensate for inappropriate in-hospital management.

Adult↗

PubMed1987

Xanthogranulomatous pyelonephritis in a functioning kidney. A case report.

A 34-year-old woman with xanthogranulomatous pyelonephritis mimicking a renal tumour is presented. Preoperative examinations including renal ultrasonography, computed tomography, renal angiography and fine needle biopsy could not exclude malignancy. The diseased kidney had good function and there was no history or signs of urinary tract infection or calculi. During operation a frozen section biopsy showed xanthogranulomatous pyelonephritis and a kidney-saving enucleation of the tumour was performed. The patient recovered uneventfully with good kidney function on the operated side.

Adult↗

PubMed1986

Cellular basis of host defence in pyelonephritis. I. Chronic infection.

Infection persists for long periods in chronic pyelonephritis, but the cellular basis of the host-parasite relationship is poorly understood. We have obtained quantitative data on the relationship between the pathogen (E. coli) and cellular defence mechanisms. Depletion of cellular components was carried out using whole body irradiation, methylprednisolone, cyclophosphamide or carrageenan and silica particles. A system of administering cyclophosphamide and methylprednisolone through the use of a slow release carrier, as well as graded doses of irradiation, was then developed to allow the controlled reduction of cellular competence. Quantitative studies in a host with chronic pyelonephritis and normal cellular defence reserves showed that severe depletion of granulocytic cells is necessary before host defence mechanisms are adversely affected. This finding conflicts with the observation that microorganisms survive and persist in the kidney for extended periods. Additionally, noncellular factors may also limit bacterial growth.

Animals↗

PubMed1986

Effect of captopril on the progression of induced pyelonephritis in the rat.

The effect of captopril, an angiotensin-converting enzyme inhibitor, was studied in rats subjected to Escherichia coli pyelonephritis. Eight weeks after pyelonephritis was induced in male Sprague-Dawley rats, the rats were randomly assigned to treatment groups based on urinary protein excretion. In experiment 1, rats were given captopril, 50 mg/kg of body weight, or saline solution via daily intraperitoneal injection. To eliminate complications with captopril-induced peritonitis, experiment 2 was performed in which rats were given the same treatment by daily gavage. In both experiments, 24-hour urinary protein excretion in the saline-treated rats was significantly greater than that of the captopril-treated rats after 12 weeks of treatment (P less than 0.05). Plasma urea nitrogen, plasma creatinine, and endogenous creatinine clearance did not differ between treatment groups during the course of therapy in experiment 1. There were no differences in these values in experiment 2, except at week 8 of treatment when the captopril-treated rats had significantly lower plasma creatinine and higher endogenous creatinine clearance than did the saline-treated rats (P less than 0.05). There was also no difference between treatment groups in the degree of morphologic renal damage based on light microscopic evaluation of kidneys at the end of treatment.

Administration, Oral↗

PubMed1986

Pyelonephritis, cortical abscess, and perinephric abscess.

The causative agent in nonobstructive pyelonephritis has been shown most often to be P-fimbriated Escherichia coli, mainly because receptors for these fimbriae are found in the bladder, ureter, and the kidney tubules. Age and sex are factors leading to differences in the presentation of the disease, and early diagnosis followed by intensive therapy lessens the chance of renal damage. Renal abscess, perinephric abscess, and pyonephrosis all follow pyelonephritis in the host who is compromised by the presence of stone, obstruction, diabetes, or immunosuppression.

Adult↗

PubMedDate not supplied

[Pseudotumoral xanthogranulomatous pyelonephritis. Apropos of a case].

Xanthogranulomatous pyelonephritis may, rarely, occur as a renal tumour syndrome (simulating mainly a renal cell carcinoma). We report one case. The diagnosis is often difficult (even with surgical findings) and frequently a histological surprise. This points out the importance of identifying it in preoperative staging; the diagnosis may be suggested by the association of chronic pyelonephritis, renal stones and hypovascular renal tumour syndrome without specificity at sonography and CT.

Adult↗

PubMed1987

[Acute pneumonia complicating chronic pyelonephritis in persons over 60-years-old].

A study was made of the clinical, x-ray and immunological features of acute pneumonias (AP) developing against a background of chronic pyelonephritis in 28 patients aged 60 and over this age. Routine microbiological inoculation of the sputum as well as noncultural methods (definition of antigen substances and specific antibodies in the blood serum) were employed for etiological deciphering. A modern program of etiological diagnosis ensured the detection of a wide spectrum of agents including viruses, Mycoplasma and Legionella. Pneumococci, streptococci, hemophilic bacteria in the form of monocultures as well as part of associations of microorganisms were shown to be the most frequent agents causing AP. The resistance of 495 strains of pneumococci, streptococci and hemophilic bacteria to antibiotics was considered. A low sensitivity of these cultures to tetracyclines and biseptol was observed. Caramycin and chloramphenicol were recommended for the treatment of AP combined with chronic pyelonephritis.

Acute Disease↗

PubMed1987

[Two cases of emphysematous pyelonephritis--considerations on the choice of treatment].

Emphysematous pyelonephritis is a severe infection characterized by the presence of gas within the renal parenchyma and perirenal tissues. Two cases of this disease are presented. They were the 16th and 17th case reported in Japan. Case 1 was a 63-year-old woman with diabetes mellitus and liver cirrhosis. She was hospitalized for abdominal pain and anuria. Renal X-rays showed a gas shadow in and around the left kidney, but no evidence of upper urinary tract obstruction. Although hemodialysis was done, she died of heart failure. Case 2 was a 54-year-old man with diabetes mellitus was admitted with the complaint of fever and left abdominal pain. Renal X-rays showed a gas shadow in and around the left kidney but no evidence of upper urinary tract obstruction. He was treated with intensive antibiotic therapy, control of blood sugar, intravenous drips and percutaneous drainage. Clinical features improved, but deteriorated after 40 days of therapy. The gas shadow remained unchanged on CT scanning, and aortography showed the occlusion of the left renal artery. Nephrectomy was done after 50 days. Seventeen cases of emphysematous pyelonephritis in the literature including our cases are reviewed, especially the choice of the treatment is discussed.

Drainage↗

PubMed1978

Chronic pyelonephritis. Electron microscopic study. II. Persistence of variant bacterial forms.

Ascending nonobstructive pyelonephritis was produced in nonhuman primates by ureteral catheterization which delivered Escherichia coli (04:H1) to the renal pelvis while creating intrarenal reflux. Female rhesus monkeys (Macaca mulatta) were immunosuppressed by cyclophosphamide before infection and weekly thereafter and compared to those with infection only. Kidney tissue was examined by electron microscopy in an effort to compare the development of the infection in the two groups of monkeys, i.e., immunocompetent and immunosuppressed. Reorganization of bacterial cytoplasm into small dense bodies (averaging 250 A in diameter) was seen in two of the suppressed animals. These particles were within bacteria that were either free in the medullary interstitium or in macrophages. Clusters of electron-dense bodies of the same size and morphology were also seen within subendothelial spaces of glomerular capillaries. Protoplast-like forms were observed within the medullary interstitium. One cell wall-less form contained particles (as previously described) within a large peripheral vesical. Gross pyelonephritic scarring occurred in all immunosuppressed animals. This study has shown morphologically that classical bacterial organisms placed into the intact kidneys of partially immunoincompetent nonhuman primates will cause pyelonephritis and continue to exist for 18 days. These observations of the futile efforts by suppressed populations of leukocytes to clear intrarenal bacteria raise interesting questions about the host-paradise relationship in chronic renal infection.

Animals↗

PubMed1987

Temocillin in the treatment of pyelonephritis in children.

Temocillin is a beta-lactamase-stable penicillin with a selective. Gram-negative spectrum of activity and a long half-life. Previous studies in adult patients have demonstrated its efficacy and safety in the treatment of Gram-negative infections. The aim of the study was to evaluate the clinical and bacteriological efficacy and safety of temocillin in children with complicated urinary tract infections. Twenty-two children, aged 3 months to 13 years (mean 5.8 years) were treated with temocillin i.v. at a dose of 25 mg/kg 12 hourly for a mean period of 5.9 days (range 3-12 days). Acute pyelonephritis was diagnosed in 21 patients (one case associated with septicaemia); one patient presented recurrent bacteriuria due to a multiresistant pathogen. Some 20/22 children presented an underlying condition complicating the urinary tract infection (UTl). The causative pathogens, isolated from the urine, were: E. coli (17), Proteus mirabilis (3), Enterobacter cloacae (1), enterococcus (1). The enterococcus and one Proteus mirabilis were found to be resistant to temocillin. Clinical improvement was obtained after 24-36 h in all children with temocillin-sensitive organisms. Bacteriological cure was obtained in all patients with temocillin-sensitive organisms. The two patients with temocillin-resistant pathogens were treated with another antibiotic. Follow-up treatment was given per os during +/- 2 weeks. No adverse reactions or abnormal laboratory values were noted. In the authors' limited experience temocillin proved to be effective and safe in the treatment of pyelonephritis often due to ampicillin-resistant strains in children.

Acute Disease↗

PubMed1986

Xanthogranulomatous pyelonephritis in childhood--report of two cases and review of the literature.

Xanthogranulomatous pyelonephritis is a rare disease in children. Two young patients of 9 years and 3 months of age are described, with diffuse XPN in a non-functioning left kidney. Nephrectomy was performed in both cases. XPN is a rare variant of chronic, nonspecific pyelonephritis with either diffuse or local segmental involvement of the kidney. Histologically the renal tissue shows a granulomatous inflammatory infiltrate composed of foam cells, plasma cells, lymphocytes and sometimes multinucleated giant cells, abscesses may be present. An accurate preoperative diagnosis is seldom made; in the presence of a non-functioning kidney treatment is nephrectomy.

Child↗

PubMed1986

[Drug sensitivity of urinary microflora and the effect of treatment in exacerbated chronic pyelonephritis].

A total of 226 patients with exacerbated chronic pyelonephritis were studied and the effect of 10-day antibacterial course--followed up. In 178 cases the treatment was consistent with the drug susceptibility of urine microflora and in 48, it was carried out in the absence of such susceptibility. The susceptible strains were affected in a considerably higher percentage (64.60) than the nonsusceptible (41.67). The chronic renal insufficiency (ChRI) has been a factor restricting the effectiveness of the antibacterial agents. Out of III affected patients 24 (21.62%) were with ChRI, whereas they were 38 (46.34%) from not-affected ones. It has been concluded that the treatment of chronic exacerbated pyelonephritis should individually be carried out with a dynamic microbiological control.

Adolescent↗