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Acute pyelonephritis in pregnancy.

Acute pyelonephritis is one of the most common serious medical complications of pregnancy and may result in significant maternal morbidity. E. coli and Klebsiella are the two most common causative organisms. Pregnant women with acute pyelonephritis should be hospitalized and treated with parenteral antibiotics. Clinical response is usually dramatic, with the majority of patients being asymptomatic within 48 to 72 hours of therapy. Recurrent infection is common, and these women must be followed closely with frequent surveillance cultures. Detection and eradication of bacteriuria at the initial prenatal visit is important in preventing this complication.

Acute Disease↗

Antibiotic activity of cefazedone in experimental pyelonephritis.

The new cephalosporin derivative (6R,7R)-7-(2-[3,5-dichloro-4-oxo-1(4H)-pyridyl]-acetamido)-3-([(5-methyl-1,3,4-thiadiazol-2-yl)-thio]methyl)-8-oxo-5-thia-1-azabicyclo[4,2,0]oct-2-ene-2-carboxylic acid (cefazedone, Refosporen) has been tested for antibacterial activity in the infection and therapy model of acute E. coli pyelonephritis in rats. The reference substance was cephalothin. The tests showed a superiority of cefazedone which, however, could not be clearly confirmed by the significance test. Owing to its favourable pharmacokinetics in combination with good antibacterial activity, cefazedone can be added to the cephalosporins considered for use in clinical practice, especially so as the statistics for 1977 show that the causative agents of pyelonephritis which these drugs can often combat effectively are present in the majority of the urine strains: E. coli accounted for 45%, enterococci for 18%, and Proteus for 15% out of a total number of 6100 urine strains.

Animals↗

Appearance of immunoglobulin classes and complement (C3) during Corynebacterium renale-induced experimental pyelonephritis in the rat.

The local appearance of various immunoglobulin (Ig) isotypes in the urinary tract during ascending pyelonephritis was studied in rats experimentally infected with Corynebacterium renale. The indirect fluorescent antibody assay was used to detect IgG, IgM, IgA, IgE, and C3 on C renale present in the urine of the experimental animals. Corynebacterium renale coated with IgM and IgG antibodies was found beginning on the 4th day after induced infection, with IgG being the more abundant isotype. Coating with IgA occurred as early as the 4th day, but was less dense than coating with IgG. The presence of C3 on C renale was concurrent with IgM and IgG coating. A significant quantity of IgE could not be identified on antibody-coated C renale. Thus, IgG is the major component of the humoral immune response in this model of ascending pyelonephritis. The IgM early during infection and IgA later during infection seem not to be a major component of the immune response in this model.

Animals↗

[Comparative clinical x-ray, radioisotope nephrographic and ultrasonic studies of chronic pyelonephritis patients].

The authors compare the incidence of the changes established by X-ray, radioisotope-nephrographic and ultrasound studies on 115 patients with chronic pyelonephritis. Most frequent and most characteristic are the changes with venous urography. Though not specific, the changes in the isotope-nephrogram and ultrasound contribute to the establishment of functional and structural disturbances in chronic pyelonephritis. They have no contraindications for application, hence they are of high value in the presence of chronic renal insufficiency, where venous urographic is not effective. The ultrasound study has indisputable advantages in establishing the X-ray negative calculi, renal cysts and a functioning kidney.

Adult↗

Pyelonephritis alters the reabsorption of nutrients and brush border membrane enzymes of rat kidney.

The uptake of nutrients and activities of membrane enzymes in the kidney were investigated using renal brush border membrane (BBM) vesicles in acute pyelonephritis in rats. A significant decrease (P less than 0.001) in the uptake of D-glucose and L-phenylalanine was observed in both the unobstructed right and obstructed left kidney, while there was a significant increase (P less than 0.001) in the uptake of L-alanine in the left kidney of pyelonephritic rats, demonstrating disturbances in the reabsorption of the glucose and aminoacids in the kidneys. Vmax of alkaline phosphatase, leucine-amino-peptidase and maltase was found to be decreased in the left kidney, suggesting that there was a reduction in the active enzyme molecule number. Km of alkaline phosphatase and leucine-aminopeptidase remained unchanged, while km of maltase decreased in both the right and left kidneys. An increase in the Vmax of alkaline phosphatase and leucine-aminopeptidase and substrate affinity of the maltase in the right kidney demonstrated a compensatory phenomenon for the malfunctioning of the left kidney. This is the first report demonstrating alterations in reabsorption of nutrients and BBM enzymes in experimental pyelonephritis.

Absorption↗

[Xanthogranulomatous pyelonephritis. Radiological and ultrasonographic aspects].

Clinical, radiological and ultrasonographical features of three cases of xanthogranulomatous pyelonephritis, one of which in a child, are reported. Presurgical diagnosis of xanthogranulomatous pyelonephritis is difficult and infrequent to date (10-14% of cases according to different workers). This complaint is generally mistaken for other types of kidney infections or tumours. The use of ultrasonography and computed tomography in particular help recognition of the disease and above all help to assess its extra-renal spread: something that has only recently been made possible.

Adult↗

[Dynamic scintigraphy of the kidneys during chronic pyelonephritis in patients with arterial hypertension].

It has been shown that latent renal diseases are detected by sectoral scintigraphy earlier than by other methods, and the former acquires particular importance when the only sign of disease is arterial hypertension. Early diagnosis of latent pyelonephritis makes this method especially valuable both for the selection of patients for further thorough examination and for the start of adequate therapy. Scintigraphy serves as a reliable criterion for the evaluation of the therapeutic efficacy in patients with chronic pyelonephritis (CP). Changes of scintigraphy parameters coincide quite exactly with the changed level of arterial pressure, concentration and nitrogen clearing function of the kidneys during treatment. This method (sectoral scintigraphy) is very important when used over time in CP patients with chronic renal insufficiency making it possible to detect with a sufficient degree of significance the improvement as well as impairment of renal function which is a crucial point for the choice of further therapeutic tactics.

Adult↗

[Chronic pyelonephritis as a false interpretation in the excretory urogram].

Chronic pyelonephritis, which is largely diagnosed via imaging procedures, is characterised by defined parenchymal scars that become manifest in the excretory urogram as contour recessions of the kidney and result in deformations of the calyces and papillae. The authors describe other renal diseases, dysplasias, variations from the standard, and artifacts resulting in similar signs on x-ray film, thus leading to the wrong diagnosis of chronic pyelonephritis. The essential differential diagnostic criteria are explained.

Chronic Disease↗

[Ampicillin pharmacokinetics in pregnant women with acute pyelonephritis].

The pharmacokinetics of ampicillin was studied in 38 patients with acute pyelonephritis in the second and third trimesters of pregnancy after the first and the last (28th-32nd) intramuscular injections of the antibiotic. The ampicillin levels in the blood and urine were determined with the agar diffusion method. The pharmacokinetic parameters were estimated in a one-compartmental model by computer The ampicillin levels in the blood and urine of the patients did not practically differ at all the investigation periods (0.5-6 hours after the antibiotic administration) in the second and third trimesters of pregnancy. During the treatment, the rate of ampicillin elimination from the host increased and the period of half-elimination from the blood decreased. The antibiotic levels in the urine within 4-6 hours after the last injection were practically lower in the second trimester of pregnancy as compared with the second trimester. The therapy resulted in an increase in the antibiotic renal clearance, which returned to normal in the second trimester of pregnancy and remained under normal in the third trimester of pregnancy. The increase was due to an approximately 2-fold acceleration of the rate of ampicillin secretion by the renal tubules. The total clearance of ampicillin practically increased in the second trimester of pregnancy and remained decreased in the third trimester of pregnancy. The estimation performed in accordance with the Krueger-Timmer principles on the basis of the characteristic features of the pharmacokinetics of ampicillin shown in the study provides recommendation of the following scheme for pyelonephritis treatment in pregnant women: 500 mg of ampicillin injected intramuscularly every 6 hours followed by gradual decreasing of the intervals between the injections to 4 hours as the rate of ampicillin elimination increases.

Acute Disease↗

[Diagnosis and therapy of pyelonephritis and glomerulonephritis].

In a comprehensive survey the diagnostic and therapeutic problems of pyelonephritis and glomerulonephritis are discussed. The importance of thorough nephrological diagnostics is pointed out. The first section of the paper describes the diagnostic procedures such as x-ray and laboratory work (tubular proteinuria, antibody-coated bacteria) and the chemotherapy in pyelonephritis. The second part deals with glomerulonephritis, the aspects of histological classification, etiology, pathogenesis, diagnostic principles, prognosis, and results of therapy with penicillin G (acute form), corticosteroids, azathioprine, indomethacin, and cyclophosphamide.

Glomerulonephritis↗

Hematogenous Streptococcus faecalis pyelonephritis in the rat. A histologic, immunopathologic and bacteriologic study.

The demonstration of bacterial antigens in active pyelonephritis in man has been inconsistent. In this paper we have studied 110 rats with experimental pyelonephritis induced by a single intravenous injection of Streptococcus faecalis. The animals were studied at intervals up to 1 year; bacteremia, urine and renal parenchymal bacterial counts were monitored. In these animals it was observed that bacteriuria and positive bacterial cultures of renal tissue persisted up to 1 year in some rats. Bacteria and their antigenic products in small foci were detected by immunofluorescence in the pyelonephritic lesions. The highly focal distribution of the bacterial antigens in bacteriologically positive tissues of this model suggest the need for careful fixation technics, availability of large tissue specimens and careful control of immunologic factors. These specific requirements to detect bacterial antigens may preclude the practical study of human pyelonephritic kidneys.

Animals↗

Experimental pyelonephritis in dogs.

Both E. coli and S. aureus were simultaneously injected into the left renal arteries of 55 female dogs. The arteries were occluded for 10 minutes prior to the injection and 10 minutes after. The renal veins were occluded during the injection and for 10 minutes after. Ten animals did not survive longer than 24 hours. Ten of 45 developed neither renal lesions nor bacteriuria; of the remaining 35 which did, five were killed on each of the second, seventh and fourteenth days, and their renal lesions were assessed. Eighteen of the remaining 2 which developed bacteriuria were killed 3 to 12 weeks following surgery when bacteria could no longer be recovered from the urine. Only two dogs had persistent bacteriuria 12 weeks after surgery. All animals which developed bacteriuria had gross lesions in the left kidney but not the right. Naturally occurring renal lesions were found in 17 of 78 random-source dogs at laparotomy. E. coli was cultured from the urine of five of these dogs but not from the kidneys. These lesions were morphologically similar to experimental ones. It is concluded that with this method renal lesions similar to spontaneous ones can be produced, but care must be taken to exclude the relatively large percentage of random-source dogs with naturally occurring lesions from any study. Various forms of infectious nephritis have been reported to be among the commonest diseases of dogs (1, 2). The successful production of chronic pyelonephritis in dogs depends on a variety of factors in addition to injecting bacteria into either the renal artery or ureter. Thus, ureteral obstruction, renal anoxia and reduced pulse pressure increased the susceptibility to renal infection (3, 4, 6, 7, 8). Our laboratory has been concerned with the production of experimental pyelonephritis in dogs so that the efficacy of various treatments could be studied. The present work was undertaken to standardize methods of producing the disease and to compare experimental renal lesions with naturally occurring ones.

Animals↗

[I-131-hippuran clearance and isotope nephrography in chronic pyelonephritis].

The results from the complex radioisotope and clinical examination of 105 patients with chronic pyelonephritis are presented. 131J-hippuran clearance was performed according to the single injection method. The obtained average value 583--166 ml/min 1,73 m2 for the patients in renal compensated stage is lower than the normal. The average value for renal plasma flow is 229.58--127 ml/min/1,73 m2 for patients in renal decompensated stage. The filtration fraction--FF showed decreased values both in renal compensated (0,14) and in decompensated patients (0,09). That gives us sufficient grounds to assume some changes in the glomerular function even in the compensated stage of chronic pyelonephritis and during the decompensated stage it considerably decreases due to manifested morphological changes, addecting also the glomerular apparatus. Isotope nephrogram was made to 71 of the patients, which proved normal in those in the compensated stage or with slight alteration, predominatly unilaterally, while in the cases with decompensated stage--the changes were strongly manifested, most frequently in the three segments, bilaterally.

Chronic Disease↗

[Problems of serological diagnosis of chronic pyelonephritis (author's transl)].

Using the passive hemagglutination test, 588 sera of patients with chronic pyelonephritis and 163 sera of pregnant women with persistent bacteriuria were investigated for the presence of antibodies aginst the enterobacterial common antigen (ECA). 10.2 percent of titers in the pyelonephritis group and 6.1 percent of titers of the pregnant women showed values higher than 1:16. The results were compared to a group of blood donors where 0.9 percent of the sera had pathological titers. The demonstration of ECA antibodies does not seem to be suitable for the diagnosis of urinary tract infections.

Antibodies, Bacterial↗

[The clinical value of unspecific humoral immune parameters. Attempt at an immunogram. 1. Quantitative determination of IgG, IgM, IgA and IgD and demonstration of antibodies against cell and tissue bound antigens in patients with chronic pyelonephritis].

In the serum of patients with chronic pyelonephritis IgG, IgM, IgA, IgD and autoantibodies against organ- and species-specific renal antigens were determined. Clinical questions concerned relations to the activity of the disease and the renal function. The Ig-mean-values lying within the biological norm could be precised by taking into consideration individual biological boundary titres and relative ratio values. Pictures of tendency led to the estimation that increases of IgG and IgD appear in severely restricted renal function in normal or decreased IgM. Increases may be a criterion of activity in diseases with normal or slightly restricted renal function. IgA determinations remained without any evidence.-- Autoantibodies were found in 32,5%, increased titres were a sign of deteriorated renal function. The apparently given possibility of a humoral immunogramme for the chronic pyelonephritis is discussed, in which case a combination with other test parameters seems to be necessary.

Autoantibodies↗

[Abdominal manifestations of chronic pyelonephritis].

The most frequent abdominal complaints in chronic pyelonephritis are analyzed and one patient is described, who with the exacerbation of the disease manifested the clinical picture of acute abdomen. The involvement of visceral-dermal reflexes with hyperalgesia, muscular defense, vomiting, meteroism and disturbances in intestinal motility imitated the picture of acute abdominal drama, forcing the surgical intervention. The varied abdominal symptomatics in about 20 per cent of the cases with chronic exacerbated pyelonephritis, should be critically assessed by the therapeutists.

Abdomen, Acute↗

The antibody response in chronic pyelonephritis.

Serum antibodies specific for the bacteria isolated from the urines of 41 patients with chronic pyelonephritis and 14 with asymptomatic bacteriuria were assayed. Even though it is clear that infections which involve the kidney evoke higher antibody responses than do purely bladder infections, it is difficult to establish a cut-off level for distinguishing the two by this method. There is a greater probability that there will be an upper urinary tract infection without an antibody response than that there will be a good antibody response in cases with lower tract infections. In our case list, 49% of the patients with chronic pyelonephritis had titers equal to or greater than 1:400, and another 44% had titers between 1:50 and 1:100. Therefore it appears that the magnitude of the antibody response depends not only on the location of the infection but also on other factors, such as the intrinsic immunogenicity of the different bacterial strains and the properties of the immunological system of the patient.

Adolescent↗

Differential antibiotic excretion in unilateral structural pyelonephritis.

Differential antibiotic excretion studies in eight patients with unilateral structural pyelonephritis showed that in all instances there was impairment in antibiotic excretion on the affected side compared with the normal kidney. Both peak and mean urinary concentrations were decreased on the structurally abnormal side. The degree of defect in antibiotic concentration was proportional to the amount of unilateral medullary damage, as measured by differential renal function studies. While the antibiotic concentrations achieved had an inconsistent relationship to cure in three patients with proven unilateral infections, the striking decreases in urinary antibiotic levels may argue against oral penicillin-G treatment of unilateral pyelonephritis in which there is renal parenchymal damage.

Cephaloglycin↗