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PubMed1976

Long-term study of humoral immune response in patients with chronic pyelonephritis.

Indirect immunofluorescence was used for the measurement of serum antibody titers against the hemologous urinary strain of infecting organism in patients with a clinical diagnosis of chronic pyelonephritis. The passive hemagglutination technique was employed for comparison. The antibody response of the patients was followed-up for a period of two to four years. In contrast to titers determined by hemagglutination, antibody titers determined by immunofluorescence were found to be persistently elevated, and the indirect immunofluorescence technique is considered a sensitive and reliable method for the serological diagnosis of chronic pyelonephritis.

Anti-Bacterial Agents↗

PubMed1994

The clinical utility of a day of hospital observation after switching from intravenous to oral antibiotic therapy in the treatment of pyelonephritis.

BACKGROUND: This study was undertaken to investigate the clinical utility of a widespread practice: the 24-hour in-hospital observation period that commonly follows when the treatment of patients hospitalized with acute pyelonephritis is switched from intravenous to oral antibiotics. A preliminary survey of infectious disease specialists confirmed the pervasiveness of this practice and the lack of scientific evidence to support it. METHODS: The clinical utility of in-hospital observation was examined by means of a retrospective chart review of 138 consecutive nonpregnant adult patients who were between the ages of 17 and 65 and had been admitted to a university hospital with a diagnosis of acute pyelonephritis. The progress notes, temperature charts, and laboratory test results were reviewed for any evidence of clinical relapse or adverse reaction to the antibiotic that occurred in the 24-hour period after the switch from intravenous to oral antibiotic therapy. RESULTS: Only two (1%) patients had evidence of clinical relapse within the study period. Five (4%) patients had adverse reactions to their oral antibiotic, none of which were serious. The 95% confidence interval for the percentage of patients who might experience a clinical relapse was from 1% to 5%; for adverse antibiotic reaction, 1% to 8%. CONCLUSIONS: This study shows the limited usefulness of an in-hospital observation period. Savings resulting from avoiding an extra day of hospitalization could amount to millions of dollars annually in the United States.

Acute Disease↗

PubMedDate not supplied

[Acupuncture in the combined treatment of pyelonephritis].

In the treatment of pyelonephritis which continues to cause problems in practical uronephrology, the main efforts of the clinicians are now directed at enhancement of the patients resistance, improvement of renal blood flow and urodynamics. Acupuncture (AP) is thought capable to meet the above requirements. It was used in combined treatment of 102 pyelonephritis cases (51 with acute and 51 with chronic manifestations) showing intact renal function. According to radionuclide renography, a positive trend in the secretion and urodynamics of the upper urinary tract was demonstrable in 50% of the patients. Dynamic nephroscintigraphy reported a positive response in 60% of cases versus 25% in those treated without AP. AP promotion of earlier recovery or remission, reduction of the scope of chemotherapy, good short- and long-term response permit this modality to be recommended for application in urological and nephrological practice.

Acupuncture Points↗

PubMedDate not supplied

[The use of efferent methods in the combined treatment of pyelonephritis in pregnant women].

After-treatment immune effects of therapy were assessed in 57 pregnant females with pyelonephritis. Eleven patients received standard antibacterial treatment (ABT), 25 patients ABT plus plasmapheresis, 21 patients underwent UV irradiation of blood and ABT. ABT alone resulted in improved general condition of the patients, in reduced renal inflammation, but it failed to remove completely signs of immunodeficiency, B-lymphocyte and Ig levels remained low. The combined treatment with UV blood irradiation and plasmapheresis promoted rapid disappearance of clinical and laboratory evidence indicating pyelonephritis. UV irradiation could not correct deficiency of cellular immunity, while adjuvant plasmapheresis led to a complete cure of immune deficiency symptoms.

Acute Disease↗

PubMed1994

[Serum antigens in the evaluation of the effectiveness of pyelonephritis therapy].

Blood serum levels of stage-specific antigens were measured by radioimmunoassay and immunodiffusion methods in patients with acute pyelonephritis at various stages of traditional antibacterial therapy and ultraviolet autoblood irradiation. Under study were ferritin, beta 2-microglobulin, C-reactive protein, transferrin, alpha 2-macroglobulin, and haptoglobin levels. Kinetics of the measured proteins was demonstrated and the possibility of applying their identification to assessment of treatment efficacy shown. The levels of these proteins are shown to be not only indicators of inflammation and destruction in pyelonephritis, but to reflect as well the repair reactions in the body which course most actively when UV irradiation of autoblood is added to multiple-modality treatment schemes.

Acute Disease↗

PubMedDate not supplied

[The importance of studies of calcium reabsorption and of the capacity of the blood plasma to inhibit Ca-ATPase activity for the diagnosis of the activity of the inflammatory process and for the prognosis of tubular function in patients with chronic pyelonephritis].

The contribution of pyelonephritis activity to calcium reabsorption defects was investigated in 176 patients with chronic pyelonephritis (CP) aged 18-54 with normal tubular filtration and calcium serum concentrations under calcium reabsorption above 98%. 86 of these patients had CP complicated by nonocclusive pelvic stones. Ca-excretory capacity of the kidneys was evaluated with estimation of the excreted calcium by activity phases considering individual deviations or without them. Measurements were also made of CP activity and severity by the inhibition of Ca-ATPase activity of the microsomes isolated from rat intact kidneys. The findings indicate that in active CP calcium-reabsorption impairments related to the inflammation are combined with the preexisting ones, the changes being more pronounced with growing activity of the inflammation, irrespective of the presence of nephrolithiasis. The relationship established between the shifts in excreted calcium induced by inflammation and plasma ability of CP patients to inhibit Ca-ATPase activity of rat renal microsomes in single tests in the same patients allows assessment of calcium reabsorption changes due to CP activity in patients when analysing their blood inhibitory effect on the test enzyme system. Simultaneous one-stage determination in CP patients of their blood inhibition in response to the test enzyme system and excreted calcium helps prognosticate calcium reabsorption expected in remission.

Absorption↗

PubMed1993

A case of xanthogranulomatous pyelonephritis in a child.

We report an additional case of histopathologically confirmed xanthogranulomatous pyelonephritis in a 9-year-old boy. He was admitted to hospital with a two-day history of sustained fever. Physical examination revealed tenderness in the right upper quadrant of the abdomen. Results of a complete blood count and serum biochemical investigations showed slight anemia and positive C reactive protein. Culture of urine failed to grow any bacteria. Excretory urography revealed deformity of the right renal calyces. Computed tomography showed a focal area of low density in the right kidney. Nephrectomy was carried out as fever had been sustained despite intensive treatment with antibiotics. Sectioning revealed that the renal parenchyma had been replaced by a butter yellow nodule, which was histopathologically confirmed as xanthogranulomatous pyelonephritis. This is the nineteenth reported case in children in Japan to our knowledge.

Adolescent↗

PubMed1976

[Acute abdomen masking pyelonephritis (author's transl)].

Analysis of 10 case histories shows that the picture of the acute abdomen may predominate in acutely exacerbated pyelonephritis. Viscero-dermal reflexes with hyperalgesia and muscular defense, visero-visceral organ reflexes with shock, vomiting, meteorism and disturbances of intestinal motility and metabolic acidosis are temptations to laparotomy. Fever in particular, pathological urinalysis, renal acidosis and occasionally hyperchloremia suggest the diagnosis of "abdominal type of acutely exacerbated pyelonephritis".

Abdomen, Acute↗

PubMed1994

[A case of renal pseudotumor caused by pyelonephritis].

A case of renal pseudotumor due to pyelonephritis is reported. A 70-year-old female was admitted to our hospital for the evaluation of right renal mass in pyelogram. She had had episodes of pyelonephritis many times. Computed tomography (CT) revealed poorly marginated low density mass that exhibits inhomogenous enhancement with contrast medium. Angiography showed an avascular mass. On magnetic resonance imaging (MRI), the mass was isointensity or slightly low intensity on T1 weighted scan, while it showed low intensity on T2 weighted scan. The patient died from small cell carcinoma in the lung two years later. Autopsy was performed and no malignancy was found in the kidney. MRI was useful to differentiate such inflammatory change from renal tumor, which is mostly high intensity on T2 weighted scan.

Aged↗

PubMed1993

[The use of plasmapheresis in the combined treatment of pregnant patients with pyelonephritis].

The results of pyelonephritis treatment in 48 pregnant patients are analyzed. Twenty-three patients were administered routine antibacterial therapy, in 25 ones plasmapheresis was added to it. Immunity status of all the patients was examined. Antibiotic therapy was conducive to improvement of the patients' status, to a reduction of the renal inflammation severity, though it did not completely eliminate immunodeficiency signs. B lymphocyte and immunoglobulin levels persisted reduced. Plasmapheresis promoted a more swift elimination of clinical and laboratory signs of pyelonephritis and virtually completely liquidated immunodeficiency.

Adolescent↗

PubMed1993

[The treatment of acute suppurative pyelonephritis in diabetes mellitus patients].

The analysis of clinical, diagnostic and treatment efficacy data has been made for 160 diabetes mellitus patients (50 cases of insulin-dependent and 110 of noninsulin-dependent) with acute purulent pyelonephritis (APP). A diffuse form of the disease was detected in 100 patients (62.5%), purulent-destructive one in 60 patients (37.5%). Intoxication, resistant to insulin decompensation of diabetes mellitus, sepsis may be resultant from latent APP. Nondestructive forms of APP were responsive to antibacterial and detoxication therapy combined with catheterization of the urinary tracts. On demand, conservative therapy was reinforced with renal drainage by nephrostomy. Primary nephrectomy was recommended in purulent-destructive forms and purulent para-nephritis. Radical surgery in intensive and advanced purulent-destructive pyelonephritis produced a decrease in postoperative lethality by 26.8%. Adequate therapeutic policy provided positive results in 80% of the patients. Lethal outcomes (20%) were due to grave diabetes mellitus and APP.

Acute Disease↗

PubMed1993

[Acute pyelonephritis in women. Short-term hospitalization].

One-hundred women suffering from acute pyelonephritis were hospitalized for less than 4 days on average, in order to make a diagnosis based on bacteriology and computerized tomography (CT) and to bring fever down with a 21-day antibiotic therapy. In cases of acute pyelonephritis due to a urinary tract obstacle, endoscopic uereteral drainage was added to the antibiotic treatment. In the absence of obstacle, medical treatment was sufficient to obtain apyrexia. Fluoroquinolone therapy made it possible to reduce the hospital stay to 2 or 3 days, depending on whether the lesions observed at CT were triangular or round.

Acute Disease↗

PubMedDate not supplied

[The dynamics of the nonspecific immunity indices during the lymphotropic therapy of children with acute pyelonephritis].

The comparison of the effect obtained in children with primary acute pyelonephritis treated with lymphotropic ampiox plus lidase against oral or intramuscular ampiox showed more rapid induction of clinical remission and more pronounced tendency to normalization of immunological indices in the patients on lymphotropic ampiox. In addition, the lymphotropic route made it possible to decrease the drug dose and number of its injections which is of importance in pediatric practice. The above advantages say in favour of wide application of indirect lymphotropic therapy for pyelonephritis in children.

Acute Disease↗

PubMed1993

[Viewpoints of the urologist on acute pyelonephritis].

For the urologist acute pyelonephritis is a relatively common disease when it is uncomplicated and occurs in otherwise healthy patients. In such cases, admission to hospital is not always required. On the other hand, there are situations in which the disease is more difficult to manage. A poor general condition, the existence of a congenital malformation, the presence of a foreign body in the urinary tract, the occurrence of the disease after a surgical or instrumental procedure may transform acute pyelonephritis into a dangerous condition which sometimes follows a dramatic course.

Acute Disease↗

PubMed1993

[Imaging of acute pyelonephritis].

Despite the advances achieved in imaging methods, the diagnosis of acute pyelonephritis rests on clinical and bacteriological date. Yet imaging is of considerable value to exclude a possible obstacle in the excretory canals which might be responsible for acute pyelonephritis. Ultrasonography associated with plain abdominal radiography without preparation or with intravenous urography is the choice method. In case of atypical forms, patients at risks or resistance to medical treatment, computerized tomography provides an information that is invaluable for the diagnosis as well as for the prognosis.

Acute Disease↗

PubMed1993

Sexual acquisition of acute pyelonephritis in a man.

A 51-year-old man presented with acute cystitis at a time when his wife was admitted with symptoms of acute pyelonephritis. Before the man developed his symptoms his wife had complained of urinary frequency and dysuria for a 2-week period. Two weeks after a 10-day course with trimethoprim he experienced a relapse manifesting as acute febrile pyelonephritis. The strains of Escherichia coli isolated from the urine of both patients belonged to the same serotype O51, O117:K1, were non-haemolytic, produced aerobactin, expressed P-fimbriae, and showed identical antibiotic susceptibility pattern. The findings strongly suggest that the E. coli strain might have been sexually transmitted from the wife to her husband.

Cystitis↗

PubMed1995

[Splenic abscess secondary to xanthogranulomatous pyelonephritis].

OBJECTIVE: We report another case of splenic abscess after nephrectomy, a condition which must be considered in the differential diagnosis of post-operative fever. METHODS/RESULTS: A 20-year-old man presented with lumbar pain and fever. A diagnosis of xanthogranulomatous pyelonephritis was made and he was treated by subcapsular nephrectomy. Thirty days later the patient presented with a lumbar fistula from a splenic abscess and was treated by splenectomy. CONCLUSIONS: Fistulas and abscesses are more common after nephrectomy for xanthogranulomatous pyelonephritis. In our view, the subcapsular approach is an additional risk factor for the foregoing complications.

Abscess↗

PubMed1995

[Emphysematous pyelonephritis].

OBJECTIVES: The etiopathogenic and therapeutic aspects of emphysematous pyelonephritis, an uncommon disease entity, are discussed. METHODS/RESULTS: We describe the clinical history of a diabetic with intercurrent gas-forming infection in the form of emphysematous pyelonephritis that was successfully treated. CONCLUSIONS: This disease entity, which is almost exclusive to diabetic patients, is unique. It produces a type of organism that warrants early and aggressive treatment.

Chronic Disease↗