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PubMed1998

Technetium-99m-MAG3 in early identification of pyelonephritis in children.

UNLABELLED: The purpose of this study was to determine whether 99mTc-mercaptotriacetylglycine (MAG3) can substitute for 99mTc-glucoheptonate (GH) in the detection of pyelonephritis. METHODS: One hundred thirty renal scintigraphies were evaluated retrospectively in 38 children (21% boys, 79% girls; age range 1 mo-21 yr; mean age 7.2 yr) referred for evaluation during an acute clinical urinary tract infection and for follow-up studies. Twelve topographical regions were designated on each kidney. Each area was graded for severity of decreased radionuclide localization: mild (Grade 1), moderate (Grade 2) or marked (Grade 3). Early posterior views of MAG3 studies were compared to delayed posterior GH images. In all patients, both studies were performed on the same day. RESULTS: Eighty-two studies were performed during an acute clinical infection and 48 were performed as follow-up. Seventy-seven percent of the studies had focal cortical lesions. Of all the cortical lesions identified by GH, MAG3 detected 74% (match lesions). A comparable percentage of lesions was identified in each region by both studies. GH scintigraphy detected 261 lesions (63 Grade 1, 149 Grade 2 and 49 Grade 3), and MAG3 detected 201 lesions (37 Grade 1, 117 Grade 2 and 47 Grade 3). MAG3 was unable to recognize 60 lesions identified by GH studies in 11 patients (mismatch lesions). Of these, 41% (26 of 63) were Grade 1, 21% (32 of 149) were Grade 2 and 4% (2 of 49) were Grade 3. In three cases, MAG3 identified lesions not seen by GH (reverse mismatch); all had acute symptomatic infection. CONCLUSION: These data document that MAG3 in the early phase of the study (1-2 min) can detect Grade 2 to Grade 3 cortical lesions in patients with pyelonephritis, but it is less effective in detecting Grade 1 lesions.

Child↗
PubMedDate not supplied

[Effects of plasmapheresis and lasers on the state of urinary microflora in chronic pyelonephritis].

Bacteria isolated from the urine of 142 patients with chronic pyelonephritis (CPN) were examined for pathogenic properties of the strains (bacteriuria, hemolytic, proteolytic properties, urease, adhesive activity, antibiotic resistance, the ability to inactivate bactericidal activity of the serum) to control the effect of the treatment: antibiotics combined with plasmapheresis or antibiotics combined with laser radiation (intravascular, transcutaneous, or both). Combined application of intravascular and transcutaneous laser irradiation in multimodality treatment reduces the number of highly pathogenic strains as well as antibactericidal activity of the urine strains. It also promotes normalization of bacteriuria level. Plasmapheresis is inferior to laser radiation but ranks the second in efficacy of action on urinary microflora. Thus, use of efferent methods, especially transcutaneous plus intravascular laser radiation, plasmapheresis, in combined treatment of pyelonephritis decreases pathogenicity of urine strains and normalizes bacteriuria.

Bacteria↗
PubMed1998

[Renal cell carcinoma discovered in a patient with typical acute pyelonephritis: a case report].

A case of renal cell carcinoma that was discovered in a patient with typical acute pyelonephritis is reported. A 62-year-old woman admitted with fever and right flank pain, was diagnosed as having acute pyelonephritis. Intravenous urography showed a compressed renal pelvis and mild dilated calyces, suggesting the existence of a tumor. Computed tomography revealed a parapelvic tumor 6 cm in diameter and a small low-density area separated from the tumor in the renal parenchyma. Selective renal arteriography revealed a typical renal cell carcinoma lesion. The patient underwent right radical nephrectomy, and her postoperative course was uneventful. She has remained free of disease for 7 months.

Acute Disease↗
PubMed1976

[Glutamic dehydrogenase activities in renal tissue during experimental and human ehronie pyelonephritis (author's transl)].

QUESTION: These studies are one part of systemic comparative investigations concerning biochemically feasible changes of renal cells and tissues due to chronic pyelonephritis (PN) as correlated to the histological results. The experiments aim at more detailed knowledge on the pathogenesis and conditions of the progressive chronicity of PN which could be of value for the further development of therapeutic measures. In previous papers (Esp. Path., vols. 8, 9 and 10) the author reported on the acid and alkaline phosphatase as well as on the glutaminase I activities. In the present study the glutamic dehydrogenase (GIDH) activities are analyzed. MATERIAL AND METHODS: In 139 adult male rabbits (body weight 2.4 to 2.8 kg) unilateral pyelonephritis was experimentally induced in the left kidney. In additional 19 rabbits no PN developed despite of similar technique. 37 animals were used for controls. The animals were kept on standard diet in individual cages. Dependent on duration of the disease the 139 rabbits affected by experimental PN were divided into 6 groups: 1. Sacrification after 20 days, 2. Sacrification after 31 days, 3. Sacrification after 64 days 4. Sacrification after 100 days, 5. Sacrification after 212 days, 6. Sacrification after 261 days. The 19 rabbits which did not develop PN WERE LIKEWISE SACRIFICED AT DIFFERENT TERMS: AFTER 64 DAYS (5 ANIMALS), AFTER 100 DAYS (7 ANIMALS), AFTER 212 DAYS (7ANIMALS). These rabbits were designated "B-series". From 31 human kidneys with clinically quiescent pyelonephritic renal shrinkage wedge-shaped tissue samples were removed. Furthermore, 20 tissue samples of surgical specimens of extirpated human tumor kidneys were removed far distant from the site of the tumor. Induction of unilateral PN in the rabbits was done after the method of LEPPER (5) as modified by PRAT et al. (14). Coli of the strain O 55 K 59 were used for infection in a germ suspension of 500 millions of bacterial/ml 0.9% sterile physiological saline (control of the germ suspension by means of nephelometry). 24 hours after unilateral renal ligation each animal was i.v. administered 800-1000 millions of germs. At the end of the test the left side lesioned kidney was removed within maximally 100 sec after having been rinsed bloodless by means of cooled physiological saline (0 to 2 degrees C) during this period. On an ice-cooled glass plate the decapsulation and preparative separation of the medulla from the cortex was done using a magnifier; remnants of the capsule, hilar and fatty tissue were removed. Simultaneously tissue samples were obtained from 70 impaired kidneys and from 6 animals of the B-series (see above) for histological examination. The medullary and cortical parts were immediately swabbed with filter paper and weighed in moist state. Preparation for enzyme analysis: The renal medulla was minced and homogenized after the method of SCHMIDT, SCHMIDT and WILDHIRT (17) for 5 min at 0 degrees C...

Animals↗
PubMed1978

[A contribution to radiological diagnostics of xanthogranulomatous pyelonephritis (author's transl)].

Pyelonephritis xanthogranulomatosa is a peculiar manifestation of destructive interstitial nephritis which can be differentiated from other types of pyonephrosis exclusively by microscopic examination. Clinical symptomatology often points towards the existence of a renal tumor. The author analyses the clinical and radiological symptomatology of seven patients treated by him. The angiographic picture presented by pyelonephritis xanthogranulomatosa differs according to the character and extension of the inflammatory tissue lesion. The angiographic picture of the circumscribed and diffuse granular proliferative types resembles that of a poorly vascularised malignoma, whereas the destructive type resembles hydropyonephrosis.

Adolescent↗
PubMed1976

[Antibiotic sensitivity of the causative agents of pyelonephritis in pregnant and puerperal women].

The data presented are evident of the fact that the causative agents of pyelonephritis in pregnant women and puerpera are mostly Ecsherichia. Ilebsiella, Enterococcus and Ps. aeruginosa were isolated not so often. Strains with multiple antibiotic resistance were mainly isolated from the urine. It should be noted that 64 per cent of the Klebsiella strains and 90 per cent of the Proteus strains were sensitive to ampicillin. It should be taken into account in development of rational therapy of pyelonephritis in pregnant women and puerpera.

Anti-Bacterial Agents↗
PubMed1999

[Bilateral emphysematous pyelonephritis, a rare cause of acute renal failure].

BACKGROUND: The emphysematous pyelonephritis is a life-threatening complication of a bacterial interstitial nephritis, and it occurs mainly in diabetics. The infection with optional anaerobic microorganisms, which are able to produce gas, is supported by a reduced state of resistance, a high glucose level in the tissue in diabetic derailment and ischemia in the infected organ, for example by a kidney infarction or by an obstructive uropathy. Mostly the inflammation occurs unilateral, only in 10% of all cases both kidneys are affected. Computer tomography allows a fast diagnosis by demonstrating gas accumulation in the kidney. Surgical measures and antibiotic therapy are the principal therapeutic methods. CASE REPORT: The example of a 55-year-old diabetic man with bilateral emphysematous pyelonephritis demonstrates the diagnostic and therapeutic possibilities. After a fast diagnostic procedure, immediate hemodialysis in uremia and bilateral nephrectomy let the patient survive in a stable clinical condition dependent on regular dialysis treatment.

Acute Kidney Injury↗
PubMed2004

Lung abscesses and jaundice due to prolonged Escherichia coli bacteremia associated with pyelonephritis: a forgotten entity.

We describe a previously healthy, middle-aged patient with prolonged bacteremia and Escherichia coli presenting with jaundice and lung abscesses. At presentation, a paucity of respiratory signs and symptoms was found, although the patient appeared to be very ill. The cavitary pulmonary lesions and jaundice were due to hematogenous spread of E. coli from a pyelonephritis. Pulmonary abscesses and jaundice in the setting of prolonged bacteremia due to pyelonephritis was frequently observed before the antibiotic era. Nowadays, it is almost a forgotten phenomenon.

Journal Article↗
PubMed2004

Use of administrative healthcare claims to examine the effectiveness of trimethoprim-sulfamethoxazole versus fluoroquinolones in the treatment of community-acquired acute pyelonephritis in women.

OBJECTIVE: To evaluate the effectiveness of trimethoprim-sulfamethoxazole and fluoroquinolones in the treatment of community-acquired acute pyelonephritis. PATIENTS AND METHODS: We identified a population-based cohort of non-pregnant women aged 18-65 years, initially treated with trimethoprim-sulfamethoxazole or a fluoroquinolone for community-acquired pyelonephritis in an ambulatory care setting. Subjects were identified from a healthcare claims database in Manitoba, Canada for the period 15 February 1996 to 31 March 1999. Subsequent treatment failure, as evidenced by the provision of additional treatment up to 42 days post-diagnosis, was compared between the two treatments. RESULTS: A total of 1084 women met inclusion criteria: 653 (60.2%) treated with trimethoprim-sulfamethoxazole and 431 (39.8%) treated with a fluoroquinolone. Treatment outcomes were affected by subject age. At age 20, treatment with a fluoroquinolone resulted in a reduced probability of treatment failure compared with trimethoprim-sulfamethoxazole (odds ratio, 0.56; 95% CI, 0.33-0.97). At age 60, there was no difference in the probability of treatment failure (odds ratio, 1.61; 95% CI, 0.82-3.16). No other subject characteristics impacted comparative effectiveness; however, several characteristics increased the odds of treatment failure irrespective of the initial antibiotic. These included: recent urinary tract infection (odds ratio, 2.07; 95% CI, 1.14-3.57), recent antibiotic use (odds ratio, 1.40; 95% CI, 1.00-1.96;), and a treatment duration of less than 10 days (odds ratio, 2.18; 95% CI, 1.59-2.99). CONCLUSION: Younger subjects ( approximately 20 years) treated with fluoroquinolones were less likely to experience treatment failure than those treated with trimethoprim-sulfamethoxazole. Treatment durations of less than 10 days resulted in a higher probability of treatment failure regardless of the initial antibiotic.

Adolescent↗
PubMedDate not supplied

[An efficacy study of the treatment of patients with chronic pyelonephritis and urolithiasis using sulfate-bicarbonate calcium-magnesium mineral water].

Clinical effects of spa treatment on renal function in middle-aged and elderly male and female patients with chronic pyelonephritis and urolithiasis was studied. Combined sanatorium treatment included a course intake of low-mineral sulphate-hydrocarbonate calcium-magnesium mineral water Kazanskaia. Diuresis, especially daytime, was activated in all the patients. Maximum diuresis was observed in cool seasons in the elderly patients. To the end of the treatment proteinuria, oxaluria and uraturia diminished. A course of drinking mineral water Kazanskaia proved effective and is recommended for patients with chronic pyelonephritis and urolithiasis.

Adult↗
PubMed1976

Cellular immunity in pyelonephritis: identification of suppressor cell activity of spleen cells in response to concanavalin A and inhibition of lymphocyte-mediated L cell cytotoxicity.

A population of fast sedimenting spleen cells was identified as the cause of impaired in vitro response of spleen cells to concanavalin A (Con A) in acute pyelonephritis in rats. These fast-sedimenting cells responded to Con A by suppressing the DNA synthetic response of normal spleen cells to Con A. In addition, spleen cells from acute pyelonephritis rats were significantly less able to mediate in vitro cell destruction in xenogeneic aggressor lymphocyte: target L cell mixtures. On the basis of these findings, the hypothesis is proposed that a suppressor cell can protect the pyelonephritic kidney against immunologically mediated tissue damage.

Animals↗
PubMed2001

Clinical characteristics of emphysematous pyelonephritis.

A total of 21 patients (20 women and one man) with emphysematous pyelonephritis (EPN), treated in the Kaohsiung Veterans General Hospital during the period from 1991 through 1999 were included in this study. All of the patients were diabetic. The most common symptoms or signs were fever/chills (80%) and costovertebral angle knocking pain (71%). Diagnosis was confirmed by the presence of gas in the parenchyma or paranephric space on plain X-ray of the abdomen or computed tomography. The left kidney (11 cases, 52%) was more frequently affected than the right one (nine cases, 43%), and both kidneys were involved in one case. Obstruction of the corresponding renoureteral unit was found in 19% of the patients, and renal or ureteral stone was found in 23% of the patients. One third of the patients had type I EPN, and two-thirds had type II EPN. Escherichia coli was the most commonly isolated organism, accounting for 61%, 76%, and 47% of isolates from blood, urine, and aspirated pus culture respectively. Prompt control of blood sugar was begun and intravenous antibiotics were given. Drainage was performed in 71% of the patients, and two persons required nephrectomy because of poor control of the infection or complications. Overall survival was 72%. Emphysematous pyelonephritis is a rare, life-threatening, suppurative infection of the renal parenchyma and perirenaL tissues. For successful management of EPN, appropriate medical treatment should be initiated, and immediate nephrectomy or drainage should not be delayed.

Adult↗
PubMedDate not supplied

[The effect of ultra high frequency electromagnetic fields on the intrarenal blood flow and kidney morphology in pyelonephritis (experimental study].

The study was made of the action of electromagnetic decimetric waves (DMW) of mild and strong heat power and placebo on intraorganic circulation using functional polyrheography and morphological examination of the kidneys with infectious-inflammatory process. DMW of the above power have a marked hemodynamic action via stimulation of the circulation of the intermediary zone with an effect of redistribution of the intrarenal blood flow. Weak heat DMW in experimental pyelonephritis exhibit a distinct antiinflammatory effect while strong DMW impact aggravates vascular reaction associated with inflammation. This deteriorates the inflammation and gives rise to hyperimmune reactions. The findings provide pathogenetic grounds for DMW therapy. It is recommended for treatment of patients with chronic pyelonephritis with dynamic obstruction of the upper urinary tracts allowing for the power of the impact and activity of the inflammation.

Animals↗
PubMed1994

Xanthogranulomatous pyelonephritis with multiple cutaneous fistulae.

Xanthogranulomatous pyelonephritis is characterized by a xanthogranulomatous inflammatory response by the kidney to bacterial infection. The actual histologic diagnosis of this condition is usually made by the pathologist following nephrectomy. Cutaneous fistulae and internal sinus formation, albeit rare, have been reported to occur. Herein we report a case of xanthogranulomatous pyelonephritis in which multiple internal and cutaneous sinuses first developed two months following nephrectomy.

Journal Article↗
PubMed2004

Clinics in diagnostic imaging (99). Left emphysematous pyelonephritis.

A 57-year-old woman, known to have diabetes mellitus, presented with a one-week history of fever, dysuria, and left flank pain. Computed tomography showed extensive left renal parenchymal destruction and a large gas collection. Urine culture revealed growth of Escherichia coli. The diagnosis of emphysematous pyelonephritis was confirmed at left nephrectomy. The clinical manifestations of emphysematous pyelonephritis, types of gas-forming renal infection, and their radiological findings are discussed.

Diabetes Complications↗
PubMed1964

INCREASED SUSCEPTIBILITY OF MICE INFECTED WITH MOUSE ADENOVIRUS TO ESCHERICHIA COLI-INDUCED PYELONEPHRITIS.

Mouse adenovirus causes a persistent infection in the mouse kidney that produces extensive mononuclear cell infiltrates in cortex and medulla. Tubular necrosis, dilatation, and occasional collapse occur but no glomerular changes or periglomerular fibrosis have been observed. Acute and chronic adenovirus infection of the kidney predispose the kidney to develop acute pyelonephritis when the mouse is challenged by the intravenous or retrograde route with Escherichia coli.

Adenoviridae↗
PubMed2000

Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a rare, severe gas-forming infection of renal parenchyma and its surrounding areas. The radiological classification and adequate therapeutic regimen are controversial and the prognostic factors and pathogenesis remain uncertain. OBJECTIVES: To elucidate the clinical features, radiological classification, and prognostic factors of EPN; to compare the modalities of management (ie, antibiotic treatment alone, percutaneous catheter drainage combined with antibiotic treatment, or nephrectomy) and outcome among the various radiological classes of EPN; and to clarify the gas-forming mechanism and pathogenesis of EPN by gas analysis and pathological findings. PATIENTS AND METHODS: Forty-eight EPN cases from our institution were enrolled between August 1,1989, and November 30, 1997. According to the radiological findings on computed tomographic scan, they were classified into the following classes: (1) class 1: gas in the collecting system only; (2) class 2: gas in the renal parenchyma without extension to extrarenal space; (3) class 3A: extension of gas or abscess to perinephric space; class 3B: extension of gas or abscess to pararenal space; and (4) class 4: bilateral EPN or solitary kidney with EPN. The clinical manifestations, management, and outcome were compared. The gas contents of specimens from 6 patients were analyzed. The pathological findings from 8 patients who received nephrectomy were reviewed. The statistical methods consisted of the Fisher exact test (2 tailed) for categorical variables and Wilcoxon rank sum test for continuous variables to test the predictors of poor prognosis. RESULTS: Forty-six patients (96%) had diabetes mellitus, and 10 (22%) of the 46 also had urinary tract obstruction in the corresponding renoureteral unit. The other 2 nondiabetic patients (4%) had severe hydronephrosis. Twenty-one (72%) of the 29 patients with diabetes mellitus also had a glycosylated hemoglobin A(1c) level higher than 0.08. Escherichia coli (69%) and Klebsiella pneumoniae (29%) were the most common pathogens. The mortality rate in patients who received antibiotic treatment alone was 40% (2 of 5 patients). The success rate of management by percutaneous catheter drainage (PCD) combined with antibiotic treatment was 66% (27 of 41 patients). In classes 1 and 2 EPN, all the patients who were treated using a PCD or ureteral catheter combined with antibiotic treatment survived. In extensive EPN (classes 3 and 4), 17 (85%) of the 20 patients with fewer than 2 risk factors (ie, thrombocytopenia, acute renal function impairment, disturbance of consciousness, or shock) were successfully treated using PCD combined with antibiotic treatment; and the patients with 2 or more risk factors had a significantly higher failure rate than those with no or only 1 risk factors (92% vs 15%, P<.001). Eight of the 14 patients who had an unsuccessful treatment using a PCD underwent subsequent nephrectomy, 7 of whom survived. Only 2 patients were managed by direct nephrectomy and survived. The overall success rate of nephrectomy was 90% (9 of 10 patients). The total mortality was 18.8% (9 of 48 patients). Five of the 6 gas samples contained hydrogen (average, 12.8%), and all had carbon dioxide (average, 14.4%). The pathological findings from 8 of 10 who underwent nephrectomy revealed poor perfusion in most cases (ie, infarction, 5 patients; vascular thrombosis, 3 patients; and arteriosclerosis and/or glomerulosclerosis, 4 patients). CONCLUSION: Acute renal infection with E coli or K pneumoniae in patients with diabetes mellitus and/or urinary tract obstruction is the cornerstone for the development of EPN. Mixed acid fermentation of glucose by Enterobacteriaceae is the major pathway of gas formation. For localized EPN (classes 1 and 2), PCD combined with antibiotic treatment can provide a good outcome. (ABSTRACT TRUNCATED)

Adult↗