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PubMed1992

Bilateral xanthogranulomatous pyelonephritis involving native kidneys in a renal transplant recipient: association with renal cell carcinoma and amyloidosis.

An unusual case of a 44-year-old male renal transplant recipient who developed bilateral xanthogranulomatous pyelonephritis (XPN) of his native kidneys is presented. Bilateral nephrectomy specimens showed classic features of XPN. In addition, there was amyloidosis involving both kidneys and a small renal cell carcinoma in the left kidney. To the best of our knowledge, such a combination of pathologic conditions in one patient has not been previously reported.

Adult↗

PubMed2003

[Revised prevalence of afa+ Escherichia coli strains in acute pyelonephritis of children].

Two hundred E. coli strains isolated from children with pyelonephritis were investigated for the presence of six virulence factors. The used primers amplified adhesin pap and sfa, toxin haemolysin (hly) and cytotoxic necrotizing factor 1 (cnf1) and aerobactin (aer). For afimbrial adhesin, the previously used set of primers could not allow to detect the newly reported afa operons (Le Bouguenec et al., 2001). With a new set of primers specific for the afa operon family the prevalence of afa+ strains increased from 3.5% to 13.5%. Combinations of three or more factors in a same strain were found in 48.5%. Thirty two different urovirulent genotypes were observed; two strains contained the six studied factors.

Adhesins, Escherichia coli↗

PubMedDate not supplied

US and CT findings of xanthogranulomatous pyelonephritis.

Ultrasonographic and computed tomographic findings of 21 cases of pathologically proven xanthogranulomatous pyelonephritis (XGP) in 20 patients were retrospectively evaluated. Seventeen (81%) were diffuse, and extrarenal extension occurred in 13 cases (62%). The kidney was enlarged diffusely in 12 cases (57%), and focally in 3 (14%). Urinary calculi were present in 16 cases (76%), with staghorn calculi in 4 of these, and hydronephrosis occurred in 17 (81%). In addition to typical features of XGP, the condition may also show variable imaging findings.

Adolescent↗

PubMedDate not supplied

Pediatric focal xanthogranulomatous pyelonephritis: dynamic contrast-enhanced MRI findings.

Xanthogranulomatous pyelonephritis (XPN) is the result of chronic renal infection. It is very rare in childhood and the focal form, which is said to be more common in children, is often misdiagnosed as a renal tumor. We report a case of a focal XPN in a 14-year-old girl. The true preoperative diagnosis may be very hard in children especially in the focal form but it seems to be possible by the help of dynamic contrast-enhanced MRI.

Adolescent↗

PubMedDate not supplied

Emphysematous pyelonephritis- conversion of type i to type II appearance on serial CT studies.

Recently, emphysematous pyelonephritis (EPN) has been classified into two subtypes based on CT findings. We recently experienced a patient whose CT image changed from type I (extensive destruction of the renal parenchyma with a large amount of air density without any fluid collection) to type II (containing a large amount of fluid) during the course of conservative treatment. We believe that some patients with type I EPN can change to type II EPN.

Disease Progression↗

PubMed2002

Piperacillin 2 g/tazobactam 0.5 g is as effective as imipenem 0.5 g/cilastatin 0.5 g for the treatment of acute uncomplicated pyelonephritis and complicated urinary tract infections.

This randomised, double-blind, multicentre trial compared piperacillin/tazobactam (2 g/0.5 g/q8h) and imipenem/cilastatin (0.5 g/0.5 g/q8h) as monotherapy in patients with acute pyelonephritis or complicated urinary tract infections. In total, 237 patients were randomised to receive either piperacillin/tazobactam (n=161) or imipenem/cilastatin (n=166). At the early follow-up (=test-of-cure-visit) 5-9 days after antibiotic therapy, clinical success was noted in 122/147 (83.0%) piperacillin/tazobactam recipients compared with 123/154 (79.9%) imipenem/cilastatin recipients, thus proving that both treatments were equally effective. On a descriptive level, an advantage of piperacillin/tazobactam was demonstrated. Microbiological success at the early follow-up was 78/135 (57.8%) for piperacillin/tazobactam and 70/144 (48.6%) for imipenem/cilastatin. These results were confirmed by equivalent success rates on the last therapy day. Both drugs were generally well tolerated.

Adolescent↗

PubMed1999

Impact of cefuroxime administration on endotoxin (LPS) and tumour necrosis factor-alpha (TNFalpha) blood levels in patients suffering from acute pyelonephritis: a preliminary report.

It has been suggested that treatment of systemic infections caused by Gram-negative bacteria with beta-lactam agents might add to the inflammatory process by resulting in the release of endotoxins (LPS) upon death of the Gram-negative bacteria. To evaluate that hypothesis, 25 patients with acute pyelonephritis of Gram-negative aetiology were given intravenous cefuroxime 1.5 g tid. Blood samples were collected at various time intervals for blood culture and for the determination of LPS, tumour necrosis factor-alpha (TNFalpha) and cefuroxime levels. LPS remained elevated at levels equal to those before the administration of cefuroxime over the first 24 h of therapy. A positive correlation was detected between LPS and drug levels 6 h after the initiation of therapy. Fever persisted in 50, 37.5 and 16.7% of patients 48, 72 and 96 h after the start of treatment, respectively, followed by a rise of LPS at levels above the baseline. Blood cultures taken at the same time were sterile. A wide range of TNFalpha levels were found at similar times of sampling, indicating that LPS triggers considerable TNFalpha production in the serum of some patients but not in others. It is concluded that antibiotic-induced endotoxaemia is a phenomenon that might be observed in patients receiving cefuroxime and that might be responsible for the persistence of fever despite negative blood cultures.

Acute Disease↗

PubMed1994

Dynamics of connective matrix deposition in acute experimental E. coli pyelonephritis in rats.

Adult male rats were subjected to pyelonephritis by direct kidney intramedullary injection of 0.1 ml saline suspension of 10(5) E. coli. Animals were killed at intervals of 4, 10, 15, 30 and 60 days. Half of each kidney and bladder were cultured in proper bacteriologic media to demonstrate the existence of infection. The other halves were submitted to light microscopy and ultrastructural studies. Immunofluorescence methods were used for the study of connective matrix components, at the initial stage of the inflammatory process (4, 10 and 15 days). Infection was documented by bacteriologic, gross and microscopic findings in all groups following inoculation, and it lasted up to two months. Following the acute inflammatory reaction, fibronectin and type III collagen were deposited in the interstitium of kidneys. Small amounts of type I collagen were found later. Type IV collagen appeared in small quantities, associated with collapse of structures containing basement membranes. Fibronectin became concentrated in re-activated foci. The subsequent scarring and associated focal renal atrophy depended upon the extension of the acute lesion.

Animals↗

PubMed2006

Xanthogranulomatous pyelonephritis: Analysis of 18 cases.

OBJECTIVE: To review and evaluate patients with a clinicopathological diagnosis of xanthogranulomatous pyelonephritis (XGP) with emphasis on the diagnostic methods and the effect of socioeconomic status on disease severity. METHODS: Data compiled from the previous history of the patients, clinical, laboratory, radioimaging findings, preoperative, operative, histopathological diagnosis and postoperative follow-up period were analysed. On the basis of presentation, XGP was classified as complicated and simple. RESULTS: There were 18 cases of XGP. The clinical characteristics included: calculi or obstruction in the urinary tract, and damage to the kidney, complication of urinary tract infection, anaemia, increased erythrocyte sedimentation rate and liver dysfunction. All patients had diffuse XGP. Associated pathological findings such as psoas abscess, nephrocutaneous fistula, renocolonic fistula and paranephric abscess were found in 33.3% of cases. Eleven of 14 patients (78.6%) who were evaluated by computed tomography (CT) had the correct diagnosis made prior to nephrectomy. Urine culture was positive in 88.9% of patients and Proteus mirabilis was the most common organism. CONCLUSION: Our experience with a small number of patients demonstrates that low socioeconomic status could be a risk factor in the development of complicated cases of XGP. CT is considered to be the best radiological test for correct preoperative diagnosis and evaluation of XGP. Nephrectomy and removal of all surrounding affected tissue proved to be curative for XGP.

Adolescent↗

PubMed2005

Treatment of emphysematous pyelonephritis with broad-spectrum antibacterials and percutaneous renal drainage: an analysis of 10 patients.

BACKGROUND: This retrospective study was designed to determine the efficacy of broad-spectrum antibacterials combined with percutaneous renal drainage in the treatment of emphysematous pyelonephritis (EPN). METHODS: From July 1992 to September 2002, 10 patients (nine females and one male) with EPN were managed at our institution. All patients had diabetes and presented with fever and chills, flank pain or tenderness, vomiting, and altered consciousness. The diagnosis of EPN was confirmed by the presence of intraparenchymal and/or perinephric gas in imaging studies (kidney-ureter-bladder film, sonogram, and/or computed tomography scan). Broad-spectrum antibacterial therapy, combined with percutaneous renal drainage, was started in all patients. Follow-up studies consisted of computed tomography scan and technetium-labeled diethylenetriaminepentaacetic acid (DTPA) radioisotope renography. RESULTS: The outcome was good in all patients. Three patients underwent delayed nephrectomy due to non-functioning of the involved kidney. The DTPA radioisotope renography results (glomerular filtration rate of the diseased kidney/ contralateral healthy kidney) were 0/57 mL/min, 2.7/68.1 mL/min and 3.7/63.9 mL/min. CONCLUSION: Combined broad-spectrum antibacterial therapy and percutaneous renal drainage is a safe and effective treatment for EPN, especially in high-risk patients for whom nephrectomy under general anesthesia is not feasible.

Aged↗

PubMed2001

Morphometric parameters of inflammatory infiltration in renal tissue and personality characteristics of patients at risk of pyelonephritis attack after percutaneous nephrolithotomy.

A correlation between personality traits and the type of inflammatory infiltration in the renal pelvicalyceal system was revealed in patients with nephrolithiasis. The study demonstrated the possibility of indirect evaluation of the inflammatory process in the pelvicalyceal system and preoperative prediction of acute pyelonephritis attack after percutaneous nephrolithotomy on the basis of patient's psychological status.

Humans↗

PubMed2002

Haemophilus influenzae acute pyelonephritis in the elderly.

Haemophilus influenzae has rarely been implicated as the causative agent of urinary tract infections in adults. We report a case of H. influenzae pyelonephritis in a 78-year old man with benign prostatic hyperplasia and discuss the possible underestimation of the true incidence of H. influenzae in adult urinary tract infections.

Acute Disease↗

PubMed1981

Immunology of pyelonephritis in the primate model: live versus heat-killed bacteria.

We produced nonobstructive pyelonephritis in the rhesus monkey (Macaca mulatta) by means of a retrograde inoculation of Escherichia coli to the point of pyelotubular backflow. To evaluate the immune response separate from the effects of infection, we introduced heat-killed bacteria in the same fashion. The disease from live bacteria is self-limited and associated with both a local and generalized immune response. The most marked cellular response is in the regional lymph nodes and is more specific to the bacterial antigen than is generalized stimulation of the immune system. Dead bacteria, while eliciting the formation of serum antibody to the O antigen, appear to ablate the cellular response seen with live bacteria. Loss of renal tubules with attended scarring and loss of renal function does occur from live bacteria. This does not appear to be due to the antigen alone (unless a heat labile antigen is responsible), because heat-killed bacteria do not cause renal scarring. Thus, renal damage seems dependent on an active infection and not on the immune response.

Animals↗

PubMed1981

Pyelonephritis: the relationship between infection, renal scarring, and antimicrobial therapy.

We studied the relationship between infection, renal scarring, and antimicrobial therapy in pyelonephritis by an experimental model of the disease. Our specific concern was to identify those aspects of the acute phase of infection associated with the induction of the inflammatory response. Our hypothesis was that the degree of the inflammatory response and the extent of the subsequent lesion in the kidney depended on the rate at which a critical number of microorganisms was reached in the kidney. We proposed that the rapid increase in bacterial numbers in the kidney was the stimulus initiating the inflammatory response and not the total number of microorganisms in the kidney. In the experimental investigation, we treated animals with induced renal infection at varying intervals after the establishment of infection, and we determined the effect of antimicrobial therapy on the bacteriologic, gross, and histopathologic features of the disease. The early events relating to the bacterial invasion of the kidney were important determinants but the hypothesis needed extending to account for the fact that antimicrobial agents, administered after bacterial numbers had reached a plateau, still reduced markedly the damage to the kidney. Two factors seem to be involved in the genesis of the pyelonephritic lesion. The first is the rate of acquisition of a bacterial population by a previously sterile organ, but an additional and important component is the total number of microorganisms in the kidney up to 4 days after challenge. Clinically, the results are relevant in that they demonstrate that renal scarring can be prevented or significantly reduced by prompt antimicrobial therapy.

Ampicillin↗

PubMed1983

Infection-induced immunosuppression in pyelonephritis: characteristics of the suppressor cell(s).

Infection-induced suppressor cells may be associated with a depression of cell-mediated immune (CMI) mechanisms in pyelonephritis. In the present study, cell viability and cell to cell contact were established as prerequisites for immunosuppression and the role of mononuclear phagocytic cells and polymorphonuclear leukocytes, as immunoregulatory cells affecting CMI, was also examined. Fractionation of spleen cell suspensions was carried out using carbonyl iron, nylon wool, glass beads, and sephadex. These procedures restored mitogenic responsiveness to splenic lymphocytes from pyelonephritic animals, and it was possible to isolate cells with accessory and suppressor activity from nylon wool columns. Elutable cells (that is, cells which adhere to the column but could be recovered by the addition of EDTA) were characteristically accessory cells and increased the mitogenic responsiveness of normal lymphocytes. Adherent splenocytes which suppress mitogenic responses were isolated from pyelonephritic animals. Additionally, neutrophils, at concentrations readily demonstrable in lesions, depressed CMI responses in vitro. With this information available it should now be possible to carry out a detailed analysis of the cellular mechanism by which CMI in renal infection is depressed.

Animals↗

PubMed1992

The pathobiology of subclinical pyelonephritis--an experimental evaluation.

Clinical studies have demonstrated a poor correlation between localization tests, which are designed to determine the site of urinary tract infection, and symptoms of upper urinary tract infection. One explanation is that microorganisms may be present in the kidney but not initiate an inflammatory response with associated symptoms. An animal model has been developed to obtain quantitative information on the comparative pathobiology of lesion-inducing and non-lesion-inducing infections. In this model, non-manipulated kidneys had acquired a persistent microbial flora within 48 hours of the lower urinary tract becoming infected. This bacterial invasion was not associated with gross or histologic changes within the renal parenchyma, but minor foci of inflammatory cells were seen beneath the epithelium lining the calyces. Ureteric urines from such kidneys contained many leukocytes and high numbers of bacteria. These results showed that the kidneys were infected, rather than colonized, and the term "subclinical" infection was appropriate. Antimicrobial agents were variably successful at eradicating the infection. These experimental observations support the concept of subclinical pyelonephritis and may explain the absence of symptoms in the clinically equivalent situation in humans.

Animals↗

PubMed2005

Emphysematous pyelonephritis.

BACKGROUND: A 54-year-old nondiabetic male presented with high fever, vague lower abdominal pain and leakage of urine around his long-standing suprapubic catheter. Examination revealed pyrexia and tenderness in the right renal angle. White cell count was 22.8 x 10(9)/l. Plain abdominal X-ray showed calculi in the right kidney, ureter and bladder. Intravenous pyelogram showed gas confined to the right upper renal pelvis and perinephric space. INVESTIGATIONS: Urine and blood cultures, plain abdominal X-ray, intravenous pyelogram, abdominal ultrasound, MAG3 renogram and histopathology. DIAGNOSIS: Emphysematous pyelonephritis: class 2 or type 1. Escherichia coli was isolated from urine obtained by endoscopic drainage. MANAGEMENT: Endoscopic drainage of pus and simple nephrectomy.

Emphysema↗

PubMed1988

Development of fatal bilateral xanthogranulomatous pyelonephritis in a paraplegic patient: case report.

The first case of a bilateral xanthogranulomatous pyelonephritis (XGPN) is reported in a paraplegic patient who did not practise intermittent catheterisation after discharge from the hospital but resorted to the Crede manoeuvre which predisposed to a fatal urinary tract infection and development of XGPN over a period of 5 weeks. The advantages of clean, unsterile, intermittent self catheterisation over the Crede manoeuvre in patients with a neuropathic bladder are discussed especially in preventing infective complications of the upper urinary tract which may prove life threatening as occurred in this patient.

Adult↗