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PubMedDate not supplied

CT findings in xanthogranulomatous pyelonephritis with coexistent renocolic fistula.

A case of diffuse xanthogranulomatous pyelonephritis of the kidney with an associated renocolic fistula is reported. Computed tomography demonstrated typical findings with an enlarged poorly functioning kidney with multiple near-water-density masses replacing the renal parenchyma surrounding a central staghorn calculus. A mottled gas collection within the renal parenchyma was secondary to a renocolic fistula rather than a pyogenic abscess.

Abscess↗
PubMedDate not supplied

Focal xanthogranulomatous pyelonephritis simulating a renal tumor: CT characteristics.

Xanthogranulomatous pyelonephritis is the replacement of renal parenchyma by large lipid-filled macrophages clinically associated with an enlarged, nonfunctioning kidney containing a calculus in the diffuse form or tissue destruction in one pole of a duplicated kidney associated with a calculus in the focal form. We report a case where a focal mass in a functioning kidney with no evidence of calculus, duplication, or fat density simulated a primary renal tumor.

Adult↗
PubMedDate not supplied

CT and 99mTc-DMSA scintigraphy in adult acute pyelonephritis: a comparative study.

PURPOSE: The aim of this prospective study was to evaluate the relative value of CT and (99m)Tc-DMSA scintigraphy in the diagnosis of acute pyelonephritis (APN) in adult patients suspected of having urinary tract infection. METHOD: The study was conducted in 36 patients presenting with symptoms suggestive of urinary tract infection. Plain B-mode sonography, CT with contrast medium, and (99m)Tc-DMSA scintigraphy of the kidneys were performed in all patients. Both CT and (99m)Tc-DMSA scintigraphy were performed within 72 h after admission. RESULTS: Twelve patients with clinical and biological signs of urinary tract infection had no CT or (99m)Tc-DMSA scintigraphy abnormalities. Among these patients, lower urinary tract infection was found in 10 patients and 2 patients had ureteral obstruction. In the 24 remaining patients, the diagnosis of APN was made. Among these patients, a correlation was found between CT and (99m)Tc-DMSA scintigraphy in 11 cases. In two cases, both examinations were normal, and in nine cases, both were abnormal. In 11 cases of the 13 remaining patients, abnormal CT was found with normal (99m)Tc-DMSA scintigraphy, whereas the 2 last cases had normal CT and abnormal (99m)Tc-DMSA scintigraphy results. In two cases, bilateral lesions found on CT manifested as unilateral abnormalities on (99m)Tc-DMSA scintigraphy images. CONCLUSION: The diagnosis of APN in adult patients is based on clinical presentation and biological findings. Few studies have compared (99m)Tc-DMSA scintigraphy with CT in the detection of parenchymal involvement in APN. We conclude that CT is more accurate than (99m)Tc-DMSA scintigraphy in the detection of APN lesions in adult patients.

Acute Disease↗
PubMed2001

99Tcm-dimercaptosuccinic acid renal scintigraphy for detection of renal cortical defects in acute pyelonephritis: posterior 180 degrees SPECT versus planar image and 360 degrees SPECT.

To evaluate the usefulness of the posterior 180 degrees acquisition technique for renal defects in acute pyelonephritis (APN), a prospective study was conducted using planar imaging, 360 degrees and posterior 180 degrees renal single photon emission computed tomography (SPECT) with 99Tcm-dimercaptosuccinic acid. Sixty subjects with the suspicion of APN were included. The kidneys were divided into three zones: each was graded as positive, equivocal or negative for renal defects. To evaluate inter-observer variation, each study was read in a double-blind fashion by two nuclear physicians. Renal defects were found in 24 patients (31 kidneys and 47 zones) with posterior 180 degrees SPECT, 23 patients (29 kidneys and 44 zones) with 360 degrees SPECT (McNemar's test, P = 0.375 for zones) and 15 patients (16 kidneys and 24 zones) with planar image (P = 0.001 for zones, vs 180 degrees and 360 degrees SPECT). The proportion of positive agreement for posterior 180 degrees and 360 degrees SPECT between readers for the presence of renal defects was 0.81 and 0.62, respectively, whereas the proportion of negative agreement was 0.92 and 0.87, respectively. Both posterior 180 degrees and 360 degrees SPECTs significantly detected more renal defects than planar imaging. The detectability of renal defects in APN by posterior 180 degrees renal SPECT was equal to 360 degrees SPECT but inter-observer agreement was better.

Adolescent↗
PubMed1994

The value of urinalysis in differentiating acute pyelonephritis from lower urinary tract infection in febrile infants.

There is an ongoing debate on the best way to screen febrile infants for urinary tract infection. We examined the urinanalysis (UA) findings on admission among infants less than 16 weeks old, with and without acute pyelonephritis (APN), as defined by the dimercaptosuccinic acid (DMSA) renal scan findings, performed during a 57-month period. Forty-nine cases with a positive DMSA scan were compared with 79 negative study cases. A negative UA for leukocytes (< 5 white blood cells/high power field) was found in 4 of 49 (8.1%) cases with APN by DMSA, and in 34 of 79 (43%) cases with a negative DMSA (odds ratio 10.88 (95% confidence interval, 2.31 to 70.3; P < 0.001)). Three of the 4 infants not suspected to have APN by their UA findings would have been admitted for a full sepsis workup based on their clinical presentation and/or their laboratory findings on admission. We conclude that a fresh UA may be a sufficient screening method for the exclusion of APN in infants assessed for fever of no obvious origin.

Acute Disease↗
PubMed2001

Predictive factors associated with significant urinary tract abnormalities in infants with pyelonephritis.

BACKGROUND: Major urinary tract abnormalities are detected in 20 to 40% of infants with acute pyelonephritis (APN). Early detection of structural defects is essential for protecting the kidneys from reinfection and subsequent scarring. The purpose of this study was to investigate whether any factors present during the acute phase of infection could predict the presence of existing significant urinary tract abnormalities in infants. METHODS: A prospective study of 180 infants, aged 1 to 24 months, with APN was conducted. Blood and urine samples were collected. Renal ultrasound (US) was performed within 0 to 6 days from admission. Final diagnosis of the urinary tract anatomy was elucidated using the results of two or more radiologic imaging studies. RESULTS: Risk factors for the presence of significant urinary tract abnormalities in infants were pathogens other than Escherichia coli in urine [relative risk (RR) 3.4, 95% confidence interval (CI) 2.2 to 5.3; P = 0.001], positive blood culture (RR 2.3, 95% CI 1.3 to 4.0; P = 0.039), young age (1 to 6 months) (RR 2.2, 95% CI 1.3 to 3.9; P = 0.004), lack of papG adhesin genes of E. coli in urine (RR 2.1, 95% CI 1.2 to 3.9; P = 0.016) and abnormal renal US (RR 2.0, 95% CI 1.2 to 3.4; P = 0.008). CONCLUSIONS: Infants 1 to 6 months of age with APN caused by bacteria other than E. coli or by papG-negative E. coli strain, positive blood culture and abnormal renal US carry an increased risk for significant urinary tract abnormalities and need enforced follow-up.

Acute Disease↗
PubMed1980

Reversible acute renal failure secondary to acute pyelonephritis.

We have described a case of reversible acute renal failure caused by acute pyelonephritis. In this entity, the kidneys are swollen by an interstitial infiltrate and edema, and white cell tubular casts and microabscesses may be present. Fractional excretion of sodium is high, and nephrotic proteinuria may occur without glomerular abnormalities. Recovery of renal function may occur if antibiotics are promptly instituted. Renal size generally decreases after recovery.

Acute Disease↗
PubMed1986

Emphysematous pyelonephritis: diagnosis and treatment.

Emphysematous pyelonephritis is a rare life-threatening bacterial infection usually occurring in patients with diabetes mellitus and producing gas within the renal parenchyma and/or perirenal tissue. We add four cases to the 62 previously reported in the literature. The overall mortality is 38%, with only 29% survival for those treated medically compared to 71% for those given both medical and surgical treatment. Early diagnosis with the aid of renal ultrasonography and/or computerized axial tomography and aggressive early combined medical-surgical management are emphasized.

Adult↗
PubMed2004

Once daily, extended release ciprofloxacin for complicated urinary tract infections and acute uncomplicated pyelonephritis.

PURPOSE: We assessed the efficacy and safety of 1,000 mg extended release ciprofloxacin orally once daily vs conventional 500 mg ciprofloxacin orally twice daily, each for 7 to 14 days, in patients with a complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis (AUP). MATERIALS AND METHODS: In this prospective, randomized, double-blind, North American multicenter clinical trial adults were stratified based on clinical presentation of cUTI or AUP and randomized to extended release ciprofloxacin or ciprofloxacin twice daily. Efficacy valid patients had positive pretherapy urine cultures (105 or greater cFU/ml) and pyuria within 48 hours of study entry. Bacteriological and clinical outcomes were assessed at the test of cure visit (5 to 11 days after therapy) and the late followup visit (28 to 42 days after therapy). RESULTS: The intent to treat population comprised 1,035 patients (extended release ciprofloxacin in 517 and twice daily in 518), of whom 435 were efficacy valid (cUTI in 343 and AUP in 92). For efficacy valid patients (cUTI and AUP combined) bacteriological eradication rates at test of cure were 89% (183 of 206) vs 85% (195 of 229) (95% CI -2.4%, 10.3%) and clinical cure rates were 97% (198 of 205) vs 94% (211 of 225) (95% CI -1.2%, 6.9%) for extended release vs twice daily ciprofloxacin. Late followup outcomes were consistent with test of cure findings. Eradication rates for Escherichia coli, which accounted for 58% of pathogens, were 97% or greater per group. Drug related adverse event rates were similar for extended release and twice daily ciprofloxacin (13% and 14%, respectively). CONCLUSIONS: Extended release ciprofloxacin at a dose of 1,000 mg once daily was as safe and effective as conventional treatment with 500 mg ciprofloxacin twice daily, each given orally for 7 to 14 days in adults with cUTI or AUP. It provides a convenient, once daily, empirical treatment option.

Acute Disease↗
PubMed2005

Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis.

PURPOSE: We correlated abnormal findings on renal ultrasonography (US) and inflammatory volume (Volume) on technetium dimercaptosuccinic acid renal single photon emission computerized tomography (DMSA) in children with acute pyelonephritis (APN) with renal scars. MATERIALS AND METHODS: A total of 31 males and 14 females (9 days to 9.8 years old) who fulfilled diagnostic criteria for APN and who underwent initial DMSA between January 1995 and July 2002 and followup DMSA at least 6 months later were enrolled in the study. APN was diagnosed by initial DMSA, and placement in the scar or scar-free group was determined by followup DMSA. Photopenic areas on initial DMSA were calculated as Volume, and were compared to US findings. RESULTS: Ultrasound demonstrated 35 abnormal kidneys (38.9%) among these children with APN. Significant differences in age, Volume (11.19 +/- 2.52 ml vs 3.02 +/- 0.75 ml, p <0.005), C-reactive protein (CRP) and photopenic lesion on initial DMSA were found between children with abnormal and normal US. Of 65 children with initial APN foci 33 (50.8%) recovered, and the others had development of scars. The sensitivity of US for detecting APN (identified by DMSA scan) was 49.2%, and the specificity was 88% (OR 7.1, 95% CI 2.18 to 24.41). The sensitivity of US for predicting renal scarring was 59.4%, and the specificity was 60.6% (OR 2.3, 95% CI 0.82 to 7.65). Patients with abnormal US findings and high serum CRP (greater than 70 mg/l) had a large Volume (10.96 +/- 3.05 ml) and a 76.2% chance of being in the scar group. CONCLUSIONS: US findings are significantly correlated to Volume in APN. Along with a high level of CRP, US is helpful in predicting development of renal scarring.

Acute Disease↗
PubMed2003

Power Doppler sonography versus Tc-99m DMSA scintigraphy for diagnosing acute pyelonephritis in children: are these two methods comparable?

PURPOSE This study assessed the role of renal power Doppler ultrasonography (PDU) to identify acute pyelonephritis (APN) and to determine whether PDU can replace Tc-99m DMSA renal scintigraphy in the diagnosis of APN in children. METHODS A prospective study was conducted in 40 infants and young children (78 kidneys were evaluated) with a mean age of 25.9 months (range, 1 to 68 months) who were hospitalized with a first episode of high fever and bacteruria, possibly APN. All children were examined by PDU and Tc-99m DMSA within the first 3 days after admission. Patients with congenital abnormalities, hydronephrosis, and urinary reflux were excluded. RESULTS Twenty-seven of the 78 kidneys appeared abnormal on Tc-99m DMSA, and 20 of them were abnormal on PDU. Fifty-one of 78 kidneys were normal on Tc-99m DMSA, and 3 of 51 appeared diseased on PDU. The accuracy of PDU was 87%, sensitivity was 74%, and specificity was 94%. The positive predictive and negative predictive values were both 87%. When considering the numbers of lesions in 27 kidneys with positive Tc-99m DMSA studies (38 lesions), PDU did not disclose 16 lesions (false-negative results). Thus, the sensitivity of PDU for diagnosing lesions of APN decreased to 58%. CONCLUSIONS A positive PDU finding should obviate the use of Tc-99m DMSA in patients thought to have possible APN. However, because of a large number of false-negative results (26%) and underestimation of the number of pyelonephritic lesions (low sensitivity of 58%), PDU cannot replace Tc-99m DMSA in the diagnosis of APN in children.

Acute Disease↗
PubMed2007

Procalcitonin and pyelonephritis in children.

PURPOSE OF REVIEW: In the past few years, procalcitonin has been proposed as a sensitive and specific inflammatory marker in various fields of medicine, especially in infectivology, where it has been used to discriminate between bacterial infections, viral infections and inflammation processes. Recently, different studies have emerged in the literature on the use of this marker to identify renal involvement in febrile urinary tract infections. RECENT FINDINGS: Procalcitonin seems to be a valid biological marker, with an acceptable sensitivity and specificity, which predicts a renal involvement of the infection (pyelonephritis), in comparison with the low specificity of C-reactive protein. Procalcitonin also seems to be correlated with the degree of the involvement at the moment of diagnosis of febrile urinary tract infections and with scarring. SUMMARY: Renal involvement has always been the main diagnostic objective in children with febrile urinary tract infections. If more studies confirm the correlation between procalcitonin, renal involvement during urinary infections and scar formation, we will finally have a noninvasive tool that can identify children at risk of complications and in need of a close follow-up as early as their first episode of febrile urinary tract infection.

Biomarkers↗
PubMed1995

An ascending non-obstructive model for chronic pyelonephritis in BALB/c mice.

Chronic pyelonephritis was successfully produced in female BALB/c mice with Escherichia coli after introduction of the bacterial inoculum by the ascending route. E. coli strain 31-B, a nalidixic acid-resistant derivative of strain TN675 expressing type-1 pili, and E. coli strain BH-5, a mutant of 31-B, not expressing type-1 pili, were used in the model. Both the strains were able to induce chronic renal inflammation in the experimental animals. Whereas the initial colonisation was greater with strain 31-B, its non-pilate mutant BH-5 caused a significantly greater inflammatory response and also caused renal scarring observable 5 months after the infection.

Animals↗
PubMed1997

Role of type-1 fimbriae in the pathogenesis of chronic pyelonephritis in relation to reactive oxygen species.

The role of type-1 fimbriae in the pathogenesis of chronic pyelonephritis was studied for two Escherichia coli strains. Although both strains produced a similar total oxidative burst of chemiluminescence in macrophages from uninfected mice, the extracellular oxidative burst was greater with the non-fimbriate mutant E. coli BH-5 than its type-1 fimbriate parent E. coli 31-B. Moreover, macrophages from mice infected with the non-fimbriate mutant gave a much greater oxidative burst when stimulated with latex particles than that given by macrophages from mice infected with the type-1 fimbriate parent. These results correlated with the degree of renal inflammation and scarring as measured by malondialdehyde formation. Hence, the role of type-1 fimbriae in the pathogenesis of chronic UTI although documented does not appear to be significant.

Animals↗
PubMed2006

MarA, SoxS and Rob function as virulence factors in an Escherichia coli murine model of ascending pyelonephritis.

MarA, SoxS and Rob are transcription factors belonging to the AraC family. While these proteins have been associated historically with control of multiple antibiotic resistance, and tolerance to oxidative stress agents and organic solvents, only a paucity of experimental data support a role in regulating virulence. Clinical Escherichia coli isolates, and isogenic strains lacking marA, soxS and rob, were studied in a murine model of ascending pyelonephritis, which is a clinically relevant model of urinary tract infection. Organisms lacking all three transcription factors (triple knockouts) were significantly less virulent than parental strains, and complementation studies demonstrated that the addition of marA, soxS and rob individually restored wild-type virulence in the triple-knockout strain. Deletion of soxS or rob alone was more detrimental than the removal of marA. Thus, all three proteins contribute to virulence in vivo.

Animals↗
PubMed1980

Failure of excessive doses of ampicillin to prevent bacterial relapse in the treatment of acute pyelonephritis.

In order to evaluate whether very high doses of ampicillin might be more effective than conventional therapy in eradicating bacteria in patients with acute pyelonephritis, 34 affected patients were randomly assigned into two treatment groups. One group was given ampicillin in a daily dose of 30 g for three days and 20 g for four days without further treatment. The other group was given ampicillin in moderate doses for one month. Out of 13 patients treated with excessive doses for one week, only three were completely cured whereas conventional therapy cured 9 out of 21. Thus, excessive doses of ampicillin given for one week were not more effective but more expensive and possibly less beneficial than conventional therapy.

Acute Disease↗