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PubMed1993

[Bacteriology of urinary germs responsible of pyelonephritis].

Cytobacteriological examination of urine is indispensable in patients with acute or chronic pyelonephritis. Direct examination through the microscope is fundamental in acute pyelonephritis where immediate antibiotic therapy is mandatory. A significant bacteriuria points to an obstacle to urine flow. Escherichia coli is the most common pathogen in acute and chronic pyelonephritis. Isolating a Proteux strain suggests that lithiasis is present. Pseudomonas aeruginosa always has a nosocomial origin and is often responsible for chronic asymptomatic pyelonephritis. Staphylococci and enterococci may produce pyelonephritis, notably when it is associated with urinary stones. Since hospital- or community-acquired strains of E. Coli are strongly resistant to aminopenicillins and cotrimoxazole, these antibacterials must not be used as first-line treatment of pyelonephritis.

Acute Disease↗

PubMed1997

Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience.

PURPOSE: We investigated the effect of percutaneous drainage for the treatment of emphysematous pyelonephritis. MATERIALS AND METHODS: A retrospective analysis was done of 25 patients with emphysematous pyelonephritis who were treated initially with computerized tomography (CT) guided percutaneous drainage during a 10-year period. The patients were concomitantly treated with antibiotics, fluids, and correcting blood glucose and/or ureteral obstruction. We also compared our results of percutaneous drainage to CT findings. RESULTS: CT identified 12 patients with emphysematous pyelonephritis who had gas with little fluid and 13 who had gas with renal or perirenal fluid collections. In 20 of 25 patients (80%) antibiotic therapy combined with percutaneous drainage constituted the only treatment required. Three patients (12%) whose clinical status improved after percutaneous drainage subsequently underwent elective nephrectomy without further complications. Two patients (8%) died of multiple organ failure. There was no correlation between the gas patterns of emphysematous pyelonephritis and initial success with the antibiotics and percutaneous drainage. There were no recurrences and no complications during a followup of 1 to 10 years (mean 5). Mean duration of treatment was 5.54 weeks (range 1 to 12.6). CONCLUSIONS: CT is an efficient imaging method for diagnosis, guiding the drainage procedures and monitoring response to percutaneous drainage of emphysematous pyelonephritis. Antibiotic therapy combined with CT guided percutaneous drainage of emphysematous pyelonephritis is an acceptable alternative to antibiotic therapy with surgical intervention.

Adult↗

PubMedDate not supplied

[The level of interleukins (IL-1 and IL-2) and of IL-2R+ cells in patients with acute and chronic pyelonephritis].

It has been shown that in patients with acute pyelonephritis a spontaneous production of the interleukin IL-1 remains unchanged, while that stimulated with the aid of LPS is significantly below the norm. A spontaneous secretion of IL-2 in patients with chronic pyelonephritis has also been found unchanged, whereas in acute pyelonephritis this same parameter tends to rise above the level recordable in healthy donors. The production of this lymphokine stimulated with the aid of PhHA is significantly lower both in acute and chronic pyelonephritis. The level of cells carrying receptors to IL-2 is appreciably above the norm in patients with acute pyelonephritis, whereas in those presenting with the chronic process this parameter does not differ from that in the control group. The data obtained suggest distinctive features in the interleukin link of immunity (IL-1, IL-1, IL-2P) in patients with pyelonephritis.

Acute Disease↗

PubMed1994

Interleukin-6 and interleukin-8 in the urine of children with acute pyelonephritis.

Interleukin-6 (IL-6) and interleukin-8 (IL-8) are important mediators of the inflammatory response in serious bacterial infections. We studied the levels of these two cytokines (standardised for urinary creatinine) in the urine of infants and children during and 6 weeks after acute pyelonephritis and in non-renal febrile controls and healthy children without apparent infection. IL-6 was detected in the urine of 52% of children with pyelonephritis compared with 15% of other children (P < 0.001). The median urinary IL-6 level in acute pyelonephritis was 4 pg/mumol compared with undetectable levels in the control group (P < 0.001). IL-8 was detected in 98% of children with pyelonephritis and 42% of other children (P < 0.001). The median concentration of IL-8 was 188 pg/mumol in pyelonephritis; it was undetectable in controls (P < 0.001). IL-8 levels were higher in children less than 1 year of age (P < 0.001).

Acute Disease↗

PubMed1995

D-arabinitol versus mannan antigen and candidal protein antigen as a serum marker for Candida pyelonephritis.

To evaluate serum markers for the diagnosis of Candida pyelonephritis, levels of D-arabinitol, candidal mannan antigen and candidal protein antigen were measured using an enzymatic fluorometric assay, an enzyme immunoassay and a latex agglutination assay, respectively. The study group comprised 36 patients with candiduria (11 disseminated candidiasis, 9 Candida pyelonephritis and 16 colonization) and 27 without candiduria. The D-arabinitol/creatinine ratio was the only marker that differentiated between Candida pyelonephritis and colonization (p < 0.01). Using the cut-off values (1.4 mumol/mg of D-arabinitol/creatinine ratio, 0.28 of mannan/creatinine ratio (x 10(4)) and 1:4 of protein antigen titer) D-arabinitol/creatinine ratio showed the highest sensitivity in Candida pyelonephritis (77.8%) as compared to mannan/creatinine ratio (55.6%) and protein antigen titer (11.1%) although there were no differences in specificity, positive predictive value or negative predictive value. These results suggest that D-arabinitol/creatinine ratio is the most useful marker of Candida pyelonephritis.

Aged↗

PubMed1997

[Microproteinuria and enzymuria in fever and pyelonephritis in childhood. A prospective study of 180 children].

In 180 children (87 children belonging to a control group, 68 with fever of non-renal origin, and 25 with pyelonephritis) albumin and immunoglobulin G (markers for glomerular dysfunction), alpha-1-microglobulin and beta-NAG (markers for proximal tubular dysfunction) and apolipoprotein A1 (marker of "postrenal' dysfunction) were measured in second-voided morning urine. In children with fever of non-renal origin, glomerular dysfunction was encountered in 8.8%, tubular dysfunction in 17.6% and mixed glomerular-tubular dysfunction in 14.7% of cases. Among children with pyelonephritis, 28% revealed glomerular dysfunction and 44% mixed glomerular-tubular dysfunction. No case of solitary proximal tubular dysfunction was observed in children with pyelonephritis. There were highly significant differences in presence and expression of glomerular dysfunction between children with fever of non-renal origin and children with pyelonephritis (P < 0.0001), whereas with regard to proximal tubular dysfunction, the differences were only moderately significant (beta-NAG: P < 0.01) or of low significance (alpha-1-microglobulin: P < 0.05). This may indicate that morphologic changes occur during interstitial pyelonephritis due to inflammation of glomeruli, resulting in glomerular dysfunction, while proximal tubular dysfunction may additionally be due to fever-associated function processes.

Acetylglucosaminidase↗

PubMed1993

Uterine contractions after antibiotic therapy for pyelonephritis in pregnancy.

OBJECTIVE: The purpose of our study was to investigate the pathogenesis of preterm labor in pyelonephritis, we determined the number of uterine contractions occurring in patients with pyelonephritis before and after antibiotic therapy. STUDY DESIGN: We recorded the uterine contractions before and after antibiotic administration in 30 patients with acute pyelonephritis at Lyndon B. Johnson Hospital in Houston. Exclusion criteria were cervical dilatation > or = 4 cm, < 26 weeks' gestation, antibiotics within 7 days, clinical intraamniotic infection, rupture of membranes, or other maternal infection. Statistical analysis was by Kruskal-Wallis analysis of variance and Wilcoxon rank sum tests. RESULTS: The patients averaged eight contractions per hour on admission. The contraction rate significantly increased in hours +1 to +4 after antibiotic administration. The increase in uterine contractility occurred in patients with urinary tract gram-negative isolates. CONCLUSIONS: Pregnant women with pyelonephritis resulting from gram-negative bacteria increase their rate of uterine contractility after antibiotic treatment. This observation may be important in understanding the pathogenesis of preterm labor in pyelonephritis.

Adult↗

PubMed1995

Outpatient treatment of pyelonephritis in pregnancy: a randomized controlled trial.

OBJECTIVE: To compare the safety and efficacy of outpatient and inpatient treatment of pyelonephritis in pregnancy. METHODS: We performed a randomized controlled trial of pregnant women with pyelonephritis before 24 weeks' estimated gestational age, comparing inpatient and outpatient treatment. Sixty inpatients received cefazolin intravenously until afebrile for 48 hours, and 60 outpatients received two injections of ceftriaxone intramuscularly. All patients completed a 10-day course of oral cephalexin. We performed a urine culture 5-14 days after completion of therapy. RESULTS: The two groups were similar with respect to age, parity, temperature, estimated gestational age, initial white blood cell count, and incidence of bacteremia. Escherichia coli was the major uropathogen isolated (86% of cultures, 95 of 111). Twelve percent (13 of 111) of bacteria were resistant to cefazolin. Eleven outpatients and 12 inpatients had positive urine cultures after therapy (relative risk 0.9, 95% confidence interval 0.4-1.9). Three patients in each group had recurrent pyelonephritis. We switched six inpatients to gentamicin because of a worsening clinical picture (two) or a prolonged febrile course (four); no outpatients required a change in antibiotic (Fisher exact test, P = .03). One preterm delivery occurred in an inpatient with recurrent pyelonephritis. CONCLUSION: Outpatient antibiotic therapy is effective and safe in selected pregnant women with pyelonephritis.

Administration, Oral↗

PubMed1987

Computerized tomography and acute pyelonephritis in children. A clinical correlation.

The clinical records and computerized tomography (CT) scans of 14 patients who presented with pyelonephritis to the Children's Hospital of Buffalo between 1976-1985 have been reviewed. The CT findings were as follows: multifocal pyelonephritis (6), lobar nephronia (6), focal pyelonephritis (2). All patients were treated with intravenous antibiotics, and none was surgically drained. Significant underlying diseases were present in 8 patients: diabetes (6), von Gierke disease (1), hepatorenal syndrome (1). The diabetic children tended to have focal disease. Ten voiding cystourethrograms were performed and only four demonstrated reflux. All children became afebrile within a few days. Lobar nephronia was as clinically responsive as pyelonephritis to antibiotic therapy. Urine cultures were most often positive, although there was 1 patient in each category with negative cultures. Blood cultures were rarely positive in any group. Gram negative organisms predominated. CT scanning in children with clinical acute pyelonephritis reveals three major imaging patterns. While distinct radiographically, they behave in a similar clinical manner. Lobar nephronia does not imply a worse clinical prognosis. Intravenous antibiotic therapy alone was adequate for all patients.

Child↗

PubMed1997

Virulence characteristics and DNA fingerprints of Escherichia coli isolated from women with acute uncomplicated pyelonephritis.

PURPOSE: Previous studies indicated that acute pyelonephritis in infants is initiated by the dominance of uropathogenic strains in fecal flora. Such pathogenic evidence, however, is still lacking for adult women. In this study, the validity of a fecal-perineal-urethral hypothesis in acute uncomplicated pyelonephritis of adult women was assessed at a genetic level. MATERIALS AND METHODS: A total of 1,200 Escherichia coli isolates from the urine and rectal swab of 12 adult women with acute uncomplicated pyelonephritis were examined. The clonality of the urinary and fecal isolates was evaluated by genotyping of 6 urovirulence determinants and pulsed-field gel electrophoresis. Furthermore, urovirulence genotypes were examined in E. coli isolates from the rectal swab of 30 normal healthy women (mean 26.7 isolates per person). RESULTS: The E. coli strains causing pyelonephritis were present in the rectal swab in 10 of 12 patients and were a predominant fecal clone in 9 cases. Also, P-fimbriated strains dominated in the fecal flora in 10 of 30 normal healthy women. CONCLUSIONS: The clonal identity of the urinary and fecal strains in acute pyelonephritis clearly supports the fecal-perineal-urethral hypothesis.

Acute Disease↗

PubMed1988

Evaluation of 99mtechnetium-dimercapto-succinic acid renal scans in experimental acute pyelonephritis in piglets.

We evaluated the sensitivity and specificity of 99mtechnetium-dimercapto-succinic acid renal scans in the detection and localization of experimental acute pyelonephritis in piglets. To create pyelonephritis vesicoureteral reflux of infected urine was surgically induced in 22 piglets. Nine animals were evaluated with a dimercapto-succinic acid renal scan at 1 week and 13 at 2 weeks. Autopsy and histopathological examination of the kidneys were performed subsequently. The location and extent of the inflammatory response found on histopathological examination were compared to dimercapto-succinic acid renal scan findings in a blinded fashion. Of the 22 kidneys subjected to vesicoureteral reflux 15 had positive histopathological findings of acute pyelonephritis, including 13 detected by the dimercapto-succinic acid renal scan findings. The 2 kidneys in which inflammation was not detected had only minimal grade I lesions and were grossly normal. There were no false positive scans in any of these kidneys. The sensitivity of the scan for detection of acute pyelonephritis in the kidneys subjected to reflux was 87 per cent and the specificity was 100 per cent. Furthermore, in these same kidneys the dimercapto-succinic acid renal scan findings correctly predicted the presence or absence of individual pyelonephritic lesions in 62 of 66 poles for an over-all agreement rate of 94 per cent. Thus, dimercapto-succinic acid renal cortical imaging is a highly sensitive and reliable imaging modality to detect and localize experimental acute pyelonephritis in piglets.

Acute Disease↗

PubMed1995

Treatment of pyelonephritis in adults.

Although prescribing an antibiotic for the treatment of pyelonephritis seems to be a relatively easy task, a close look at the available data is disturbing. Optimal therapies for the different clinical syndromes of pyelonephritis have not yet been defined. The high failure rate suggests that in pyelonephritis (bacteria protected in the medulla) as well as in bacterial endocarditis (bacteria sequestered in vegetations) and in infections in neutropenic patients (host defenses not necessarily operating in conjunction with antibiotics), it may be necessary to maintain bactericidal levels at the site of infection (infected medulla) to achieve cure. Pharmacodynamic studies suggest that TMP/SMX, quinolones, and aminoglycosides, which penetrate well the infected renal parenchyma and are not impaired by the local inflammatory process, should, with the exception of pyelonephritis in pregnancy, be preferred to beta-lactams as first-choice agents for the therapy of gram-negative pyelonephritis.

Acute Disease↗

PubMed1988

Aerobactin-mediated uptake of iron by strains of Escherichia coli causing acute pyelonephritis and bacteraemia.

A total of 285 strains of Escherichia coli isolated from children and women with acute non-obstructive pyelonephritis and from patients with bacteraemia as well as 120 faecal strains of E. coli from healthy children and adults were examined for aerobactin-mediated uptake of iron. The incidence of aerobactin-positive strains was significantly more in isolates from children with acute pyelonephritis (81%) than in faecal isolates from healthy children (50%, P less than 0.01). It was also higher in isolates of E. coli from women with acute pyelonephritis (72%) compared with faecal isolates from healthy adults (42%, P less than 0.001). Of the E. coli strains causing bacteraemia, 55% were aerobactin-positive. A significant correlation was found between the presence of aerobactin and expression of P-fimbriae in strains of E. coli isolated from children with acute pyelonephritis (P less than 0.01) and in isolates from bacteraemic patients (P less than 0.001). These results indicate that the presence of an aerobactin-mediated system of iron uptake may be an important virulence factor in strains of E. coli that cause ascending pyelonephritis.

Acute Disease↗

PubMed1985

The therapeutic response of cephalosporin-treated E. coli pyelonephritis of the rat, in relation to variations of the infection model.

In the E. coli pyelonephritis, induced in female Wistar rats by retrograde infection (high pressure reflux), we investigated the influence of 1) the time of commencement of therapy, 2) the renal bacterial counts, i.e. the inflammatory activity of the pyelonephritis after endovesical instillation of cultures with different bacterial concentrations, and 3) the level of infection resistance of the experimental animal strain on the therapeutic response of the model infection with single doses of cefoxitin (150 mg/ml) and cefotaxime (5 mg/ml). Early commencement of therapy post inoculation was therapeutically advantageous provided the intrarenal multiplication of the infective organisms was not delayed or the initial bacterial concentrations were not too high. The mild form of pyelonephritis with lower renal bacterial concentrations and poor inflammatory activity after endovesical instillation of a low inoculum (10(4) cfu/ml) was less amenable to treatment than the inflammatory active pyelonephritis with high renal bacterial counts, using a high inoculum (10(7) cfu/ml). High renal bacterial counts after retrograde inoculation of an E. coli culture of 10(8) cfu/ml resulted in significant reduction of bacterial counts 48, 72 and 96 h post infectionem, with i.m. application of cefoxitin 12 h prior. For Wistar rat strain Bor:WIST, which showed a stronger infection resistance with lower renal bacterial concentrations and a stronger tendency to spontaneous healing, application of a single dose of cefotaxime (5 mg/ml) was therapeutically ineffective, whereas, in contrast, with Han: WIST rats the acute phase of E. coli pyelonephritis could be treated effectively.

Animals↗

PubMed1991

Management of acute pyelonephritis in an emergency department observation unit.

STUDY OBJECTIVES: To determine whether moderately to severely ill patients with acute pyelonephritis can be treated successfully on an outpatient basis, and whether any aspect of history, physical examination, or initial laboratory data predicts failure of outpatient therapy and the need for hospitalization. DESIGN: Retrospective chart review of all patients with a diagnosis of acute pyelonephritis seen during a three-year period. SETTING: Emergency department observation unit of an urban teaching hospital serving residents of the city and county of Denver. TYPE OF PARTICIPANTS: Women between the ages of 15 and 50 with symptoms, physical examination, and initial laboratory data consistent with a diagnosis of pyelonephritis. INTERVENTIONS: Patients received IV antibiotics, rehydration, analgesics, and antiemetics in an observation unit for up to 12 hours, when they were either admitted to the hospital or discharged home on oral antibiotics. MEASUREMENTS AND MAIN RESULTS: Sixty-three of 87 patients (72%) with acute pyelonephritis were managed successfully as outpatients, nine (22%) were hospitalized directly from the observation unit because they were considered to be too ill to go home, and five (6%) returned with persistent symptoms after ED therapy and were hospitalized. No clinical or laboratory variable predicted success or failure of ED observation unit therapy at the time of initial presentation. CONCLUSION: In selected patients, the observation unit may be used to initiate therapy for acute pyelonephritis. Those with an adequate clinical response to initial treatment may be discharged on oral antibiotic therapy with appropriate follow-up.

Adolescent↗

PubMed1998

The role of power Doppler ultrasonography in the diagnosis of acute pyelonephritis.

OBJECTIVE: To assess the ability of power Doppler ultrasonography (PDU) to detect acute pyelonephritis and to compare the findings from PDU with those from enhanced computed tomography (CT). PATIENTS AND METHODS: Eleven patients (mean age 18.5 years, range 5-37) admitted to hospital with a clinical diagnosis of pyelonephritis were assessed with PDU and enhanced CT. the latter providing the reference method. RESULTS: The imaging studies showed normal findings in three patients; a single focus of pyelonephritis was detected by CT in six, whereas a matching defect was detected on PDU in five, with PDU failing to detect an infective focus in one. Multifocal diffuse pyelonephritis was diagnosed correctly by enhanced CT and PDU in two patients. CONCLUSION: Power Doppler ultrasonography had an overall sensitivity of 88% and complete specificity in the evaluation of patients with acute pyelonephritis.

Acute Disease↗

PubMed1992

Acute renal failure in adults with uncomplicated acute pyelonephritis: case reports and review.

Acute renal failure is a rare complication of acute pyelonephritis in patients who do not have urinary obstruction. Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure nor is renal failure considered a likely consequence of bacteriuria. In this review, the cases of acute renal failure caused by acute pyelonephritis that have been reported in the last quarter century are examined. Including two new cases reported, only 12 cases of acute pyelonephritis resulting in acute renal failure were found. Three of these occurred in patients with a solitary kidney. All cases occurred in individuals who had no history of urinary tract infections, and all were caused by Escherichia coli. In several cases, the administration of non-steroidal antiinflammatory drugs contributed to disease. Three cases occurred after catheter-acquired bacteriuria. Acute renal failure is an uncommon but serious consequence of uncomplicated acute pyelonephritis in adults.

Acute Disease↗

PubMed1982

Protection against chronic pyelonephritis in rats by suppression of acute suppuration: effect of colchicine and neutropenia.

Previous experiments in rats have suggested that renal scarring after acute, obstructive pyelonephritis due to Escherichia coli results from parenchymal damage due to acute inflammation and suppuration. To assess the role of acute infiltration by polymorphonuclear leukocytes (PMNLs) in the pathogenesis of chronic pyelonephritis (CPN), rats were either treated with colchicine to depress leukocyte motility or rendered neutropenic with a single dose of cyclophosphamide. Colchicine given during acute pyelonephritis reduced kidney inflammation and protected against CPN two months later. Similarly, neutropenia reduced acute inflammation and protected against chronic parenchymal destruction and scarring. Protection against renal scarring in both colchicine-treated and neutropenic rats occurred despite higher renal bacterial counts during acute pyelonephritis. These experiments provide further evidence that CPN (renal scarring) results from kidney damage that occurs during early acute obstructive pyelonephritis. This damage appears to result from infiltration of the kidney by PMNLs rather than direct damage from bacterial infection.

Abscess↗