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PubMed2006

Are blood cultures necessary in the management of women with complicated pyelonephritis?

OBJECTIVES: Data from previous studies suggest that blood cultures in women with uncomplicated acute pyelonephritis (APN) are of limited value. Our objective was to assess the role of blood cultures in the management of complicated APN in women, and to examine the demographic and clinical characteristics, and the outcome as related to the bacteremic status of these patients. METHODS: Data from medical records of 158 women hospitalized with complicated APN over a 2-year period were analyzed retrospectively. It included demographic, clinical and laboratory data, details of the empiric antimicrobial therapy, urine and blood culture results, complications and clinical outcome. RESULTS: Out of 158 women with complicated APN, in 155 (98%) pathogens grew in the urine culture, and 33 (20.9%) of them had bacteremia. In the great majority of patients (98.7%), the blood cultures were sterile, or contained the same phenotypically profiled pathogen that was isolated from the urine. Only in two patients (1.3%), the blood cultures grew pathogens different from those found in the urine. The initial empiric antimicrobial therapy was not changed in any of the patients. No significant difference existed between the bacteremic and nonbacteremic patients in the demographic and clinical characteristics, the severity of disease or the outcome. CONCLUSION: In the management of complicated APN, routine cultures of blood should be reevaluated.

Adolescent↗
PubMed2006

Feasibility of laparoscopic approach in management of xanthogranulomatous pyelonephritis.

OBJECTIVES: To report the feasibility of the laparoscopic approach for management of xanthogranulomatous pyelonephritis (XGP). METHODS: From 2002 to 2005, 11 patients underwent laparoscopic (n = 7) or hand-assisted laparoscopic (n = 4) nephrectomy by a single surgeon for pathologically confirmed XGP. The preoperative presentation, operative details, postoperative recovery, and complications were recorded. RESULTS: A total of 5 men and 6 women were included in this study, and the mean patient age was 51 years (range 28 to 78). All cases began with the laparoscopic approach (6 left and 5 right). Four cases were converted to the hand-assisted technique because of the difficulty in progression, but no case required conversion to open nephrectomy. The mean operative time was 157 minutes (range 101 to 201), with a mean estimated blood loss of 217 mL (range 50 to 440). No intraoperative complications occurred. The mean hospital duration was 2.4 days (range 1.5 to 4). Four patients had postoperative complications, including two with an ileus, one with a persistent fever requiring intravenous antibiotics, and one with a renal fossa abscess requiring percutaneous drainage. All specimens were pathologically confirmed to be XGP. CONCLUSIONS: Laparoscopic nephrectomy for XGP is complicated and more technically demanding than the laparoscopic nephrectomy for noninfectious etiologies. Consideration should be made for using a hand port should the laparoscopic procedure fail to progress in a satisfactory manner. In experienced hands, the laparoscopic approach presents a reasonable surgical option for the treatment of XGP. For the novice laparoscopist, however, the open approach should remain the modality of choice.

Adult↗
PubMed2006

Is laparoscopic nephrectomy the preferred approach in xanthogranulomatous pyelonephritis?

OBJECTIVES: To report our experience with laparoscopic nephrectomy in patients with xanthogranulomatous pyelonephritis (XGP) and compare it with the open approach. XGP is an atypical and severe form of chronic renal infection. Open nephrectomy has been the procedure of choice for XGP. The laparoscopic approach has been used in cases of XGP but with increased complications and operative time. METHODS: A retrospective analysis of all the patients who underwent laparoscopic nephrectomy with a pathologic diagnosis of XGP from January 2001 to August 2005 was done. The demographic profile and data on the operative time, operative technique, blood loss, and complications were obtained. RESULTS: In all, 25 patients underwent nephrectomy with a pathologic diagnosis of XGP, 10 laparoscopically and 15 by the open approach. Laparoscopic nephrectomy for XGP was successful in 80% of the cases. The dissection of the kidney was comparatively difficult in all cases because of dense adhesions in the perirenal region and required modification of the technique. The incidence of major complications was 20% and 10% in the open and laparoscopic groups, respectively. The mean hospital stay in the laparoscopic group was 3.8 days, significantly less than that for the open nephrectomy group (8.2 days). The mean operative time in the laparoscopic group was 3.8 hours compared with 2.5 hours in the open group. CONCLUSIONS: Laparoscopy can be successfully performed in patients with a pathologic diagnosis of XGP. Although a longer operative time is required because of perinephric adhesions, the postoperative recovery is faster and cosmesis superior compared with the open approach. Modifications in the standard laparoscopic technique can be made to complete the procedure successfully and safely.

Adolescent↗
PubMed2001

[Bilateral emphysematous pyelonephritis].

Based on a case report and a review of the literature, the authors describe the features of bilateral emphysematous pyelonephritis. This rare disease with a poor prognosis constitutes a difficult clinical diagnosis. The positive diagnosis is based on urgent computed tomography. The reference treatment is emergency nephrectomy in an intensive care context.

Aged↗
PubMed2003

[Emphysematous pyelonephritis: a case report].

Diabetic patients with urinary tract infections had a certain risk of developping emphysematous pyelonephritis with gas producting bacteria. This disease was accompagned with high mortalité. We will report one case who was treated successfully by high dose antibiotic regim and emergency nephrectomy.

Anti-Bacterial Agents↗
PubMed1999

Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis.

We report a case of staghorn nephrolithiasis that evolved into xanthogranulomatous pyelonephritis with perinephric abscess, nephrobronchial fistula, and lung abscess. The patient was an intravenous drug abuser who tested positive for human immunodeficiency virus, without evidence of acquired immunodeficiency syndrome. He presented with a 2-month history of untreated repeated episodes of left flank pain and hyperpyrexia. Treatment involved left nephrectomy, debridement of abscess, tube drainage, and intravenous antibiotics. The patient illustrates the need to consider untreated nephrolitiasis as a predisposing factor for pulmonary complications.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

The goat as a model for Corynebacterium renale pyelonephritis.

Nubian goats were experimentally infected with Corynebacterium renale type II by either the intravenous or intraurethral routes using infection rates of 1.75 x 10(10), 7.08 x 10(19) or 5 x 10(23) organisms. All inoculated goats were anorexic, lost weight and became dull or depressed. Albuminuria, pyuria and epithelial casts were noted in the urine. Following intravenous challenge the animals showed a dose-related elevation of serum ammonia, urea, and creatinine with significant changes in haemoglobin concentration, packed cell volume and leucocyte counts. A mild to severe (sometimes haemorrhagic) cystitis and urethritis and a mild nephrosis were noted post mortem and mucoserous or mucogelatinous non-purulent discharges were present in the renal pelvis. The findings are compared to the naturally occurring C. renale pyelonephritis in cattle and the suitability of the goat as a model for that disease is discussed.

Animals↗
PubMed2004

Imaging features and guided drainage in emphysematous pyelonephritis: a study of 11 cases.

AIM: The purpose of the present study is to evaluate the role of image-guided drainage in emphysematous pyelonephritis (EPN). MATERIALS AND METHODS: We reviewed 11 patients with EPN treated either by ultrasonography (three patients) or computed tomography (CT)-guided drainage (eight patients). There were eight male and three female patients in our study with ages ranging from 24 to 75 years, mean 56.3 years. All the patients underwent plain radiography, ultrasonography and plain CT of the abdomen. Contrast-enhanced CT was performed in seven patients. RESULTS: Seven of 11 patients, were successfully treated with per cutaneous drainage. One patient died within 24 h (case 2), due to septicaemia. Three patients subsequently required nephrectomy. Replacement of the drainage catheter was required in one patient. The catheter was kept in situ, for an average of 17 days. The catheter drained pus and gas in all patients. The quantity of pus ranged from 300 to 2000 cm(3). All 10 patients improved symptomatically within 24 h of drainage, with improved urine output and serum creatinine levels within 48 h. CONCLUSION: CT-guided drainage of EPN has established itself as a safe, quick and life-saving palliative treatment of choice as opposed to conventional emergency nephrectomy. Excluding the patient who died, the success rate of our study was 70%.

Adult↗
PubMed1990

Xanthogranulomatous pyelonephritis in childhood.

A case of multifocal xanthogranulomatous pyelonephritis (XPN) in childhood diagnosed by ultrasound, computed tomography and needle biopsy is described. Following antibiotic therapy, ultrasound and a DMSA renal scintiscan showed no discernible scarring and restoration of function. This has not been previously described.

Child, Preschool↗
PubMed1979

Urographic and angiographic changes in acute unilateral pyelonephritis.

The pyelographic and angiographic changes in acute unilateral bacterial pyelonephritis are illustrated in our series of 12 patients. The radiographic abnormalities were completely reversible within a few weeks after clinical recovery. Complications (abscess) occurred in only one patient. Unilateral renal enlargement, diffuse or focal, impaired or absent excretory function, and attenuated calyces were the predominant findings; non-obstructive pelvicalyceal and/or ureteral dilatation were infrequent. Angiographic studies (fivepatients), performed to rule out vascular occlusion, tumour or carbuncle, showed attenuated and somewhat stretched intrarenal vessels associated with the diffuse or focal cortical swelling. Occasionally, a characteristic striated nephrogram is seen.

Acute Disease↗
PubMed1985

Urographic findings in adults with chronic pyelonephritis.

The radiological findings in a cohort of 138 adults with chronic pyelonephritis are presented and the following conclusions made. Scarring is commoner in the right kidney than the left and is found in the upper, middle and lower poles with decreasing frequency from above down. Agreement between observers in the grading of scarring in urograms taken without standardisation or routine tomography, is sufficiently high to justify the continued use of the intravenous urogram as a screening test but is not high enough to detect any progression of scars in the group over a 6.5-year period. Repetition of urograms seldom reveals the development of calculi or other new abnormalities and is not justified as a clinical routine. The combination of extensive bilateral renal scarring and proteinuria is associated with the worst renal function.

Adult↗
PubMed1988

Percutaneous drainage in emphysematous pyelonephritis--an alternative to major surgery.

Emphysematous pyelonephritis is a rare, life-threatening infection of the kidney associated with the production of gas, usually found in diabetic patients. Experience of this condition reported in the literature suggests that vigorous medical treatment and early nephrectomy are advisable. We report a case in which percutaneous renal drainage combined with medical therapy produced not only complete recovery of the patient, but also preservation of renal function on the affected side.

Aged↗
PubMed1976

An electronmicroscopic study of experimental hematogenous pyelonephritis.

This paper consists of an electronmicroscopic study of hematogenous experimental pyelonephritis. In the first 5 days cell degenerations mitochondrial swellings, slight lysosomal increase, rupture of the apical cell membranes, deterioration of the basal labyrinth and a leucocyte-predominant cell infiltration into the interstitial tissue were observed. On the 10th day, beside these common findings, the complete necrosis of the tubular cells was also observed and was supposed to be the result of an increase of lysosomes directly proportional with elapsed time and of the destruction and extreme contraction of the basal membrane. The cause of these destructions was supposed to be primary schaemia and probably the antigen-antibody-complement complex.

Animals↗
PubMedDate not supplied

Semiquantitative histological examinations of the kidneys of rabbits (64-day, 100-day and 212-day series) with experimentally induced pyelonephritis.

The kidneys of each 8 rabbits of a 64-day series (group E) and a 100-day series (group F) and of 6 rabbits of a 212-day series (group G) with experimentally induced unilateral hematogenous obstructive E. coli pyelonephritis were histologically examined and the glomerular and tubular lesions quantitatively evaluated using an ocular micrometer. An attempt was made to correlate the morphological changes with the results of simultaneous enzyme analyses (acid and alkaline phosphatases, glutaminase I).

Animals↗
PubMed1980

Xanthogranulomatous pyelonephritis in childhood.

Two cases of xanthogranulomatous pyelonephritis are reported in Arabs. Reviewing the literature, these cases were similar to previously reported cases. Although there are no pathognomonic clinical features, this disease should be considered in the differential diagnosis of a renal mass.

Child↗
PubMed1989

Xanthogranulomatous pyelonephritis.

Four patients with xanthogranulomatous pyelonephritis are presented; all patients were male and their symptoms were not urinary but nonspecific. Three of the patients are from a low socioeconomic class and did not have adequate medical services; therefore, we suggest that the disease is underreported.

Child, Preschool↗
PubMed1989

Special virulence of the Escherichia coli O1:K1:H7 clone in acute pyelonephritis.

The relationship between acute-phase responses and bacterial properties was studied in a population of 88 children with their first known episode of acute pyelonephritis. One strain from each patient was included in the study. Eighty-four of the patients were infected with Escherichia coli, which was assigned a clonotype according to the O:K:H stereotype; 55 patients carried one of the 12 multiply occurring clones. Globotetraosylceramide-specific (globo+) adhesion was present in 90% of these 12 clones, compared with 62% in the remaining 29 singly occurring clones. The patients infected with globo+ strains had significantly increased inflammatory reactions compared with patients with globo- strains. The O1:K1:H7 strain was the single most frequent clone (n = 14) that always expressed globo+ adhesins. Patients infected with O1:K1:H7 had an inflammatory response similar to that of other globo+ infections, but had a shorter duration of symptoms before diagnosis, higher fever, and higher peripheral leukocyte count. These results demonstrate special virulence of the O1:K1:H7 clone, reflected by the acuteness of onset of infection.

Child↗