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PubMed1987

Renal size, glomerular function and urinary excretion of albumin and beta 2-microglobulin in patients with renal scarring due to pyelonephritis.

We have determined glomerular filtration rate (GFR), renal plasma flow (RPF), urinary excretion of albumin and beta 2-microglobulin, urinary osmolality and total renal area in 22 female patients with renal scarring and a history of febrile urinary tract infections (UTI) and in nine healthy age-matched controls with normal i.v. urography. The aim of the study was to compare different methods of determining glomerular function in patients with renal scarring due to previous pyelonephritis and to determine the urinary excretion of beta 2-microglobulin in these patients. All individuals were investigated in hydropenia. The patients with renal scarring had significantly lower GFR, smaller kidneys and lower urinary osmolality than the controls. A significant positive correlation between GFR and total renal area (r = 0.70, p less than 0.001) and between GFR and urinary albumin excretion (r = -0.69, p less than 0.001) was demonstrated. This indicates that determinations of total renal area from an i.v. urography and the urinary albumin excretion can be used for estimating GFR. Increased urinary excretion of beta 2-microglobulin does not occur in patients with renal scarring until the glomerular function is severely deteriorated.

Adult↗
PubMed1988

Role of hypervolemia and renin in the blood pressure control of patients with pyelonephritis renal scarring.

Patients with pyelonephritic renal scarring are at risk of developing renal failure and hypertension. We studied glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF), systolic (SBP) and diastolic (DBP) blood pressure, fractional sodium, potassium and phosphate excretion, peripheral renin activity (PRA), plasma aldosterone (p-Aldo), urinary albumin excretion (U-Alb) and urinary beta 2-microglobulin excretion (beta 2-M) in hydropenia and during transition to 3% volume expansion with isotonic saline infusion in 22 female patients with renal scarring due to pyelonephritis and 9 healthy controls. The patients had significantly lower GFR, higher SBP and higher PRA in hydropenia, but there was no significant difference in RPF, FF, DBP or p-Aldo. After volume expansion, SBP, DBP, PRA and p-Aldo were significantly higher in patients than in controls. Transition to 3% volume expansion was associated with a similar increase in SBP in both patients and controls, whereas DBP increased significantly more in the patients (p less than 0.01). Volume expansion resulted in a significant suppression of PRA and p-Aldo in both patients and controls. The patients with renal scarring had the same capacity to excrete sodium and water during transition to volume expansion as the healthy controls. The renin-aldosterone system seems abnormally activated and is probably more important than hypervolemia in the development of hypertension in this group of patients.

Adult↗
PubMed2006

A case of Papillon-Lefevre syndrome associated with xanthogranulomatous pyelonephritis and hepatitis.

Papillon-Lefevre syndrome (PLS) is an autosomally recessive palmoplantar keratoderma accompanied by psoriasiform plaques on the extensor surfaces of extremities and leading to premature loss of deciduous and permanent teeth by progressive periodontitis. Patients with PLS may exhibit mental retardation, intracranial ectopic calcifications, nail dystrophies and a tendency to various infectious disorders, in addition to skin and oral findings. Herein, we report a 26-year-old man with PLS, who had experienced xanthogranulomatous pyelonephritis and hepatitis during childhood and adolescence. To the best of our knowledge, this is the first report of PLS associated with xanthogranulomatous inflammation.

Adult↗
PubMed1988

Intravenous enoxacin for the treatment of acute pyelonephritis: pharmacokinetic and clinical study.

1. Eight women with acute pyelonephritis were treated with i.v. enoxacin for 5 days. All were clinically cured and five had a bacteriological cure. Five women reported side effects. 2. During treatment there was no significant accumulation of enoxacin and the total clearance of the drug did not alter with repeated dosing. Drug elimination half-life (mean 4.3 h, s.d. 2.1) was similar to that reported in healthy volunteers. 3. Enoxacin should be compared with the aminoglycosides and beta-lactam antibiotics for the treatment of severe or complicated urinary tract infections.

Acute Disease↗
PubMed1993

Regulation of pyelonephritis-associated pili phase-variation in Escherichia coli: binding of the PapI and the Lrp regulatory proteins is controlled by DNA methylation.

Expression of pyelonephritis-associated pili (Pap) in Escherichia coli is under a phase-variation control mechanism in which individual cells alternate between pili+ (ON) and pili- (OFF) states through a process involving DNA methylation by deoxyadenosine methylase (Dam). Methylation of two GATC sites (GATC1028 and GATC1130) within the pap regulatory region is differentially inhibited in phase ON and phase OFF cells. The GATC1028 site of phase ON cells is non-methylated and the GATC1130 site is fully methylated. Conversely, in phase OFF cells the GATC1028 site is fully methylated whereas the GATC1130 site is non-methylated. Two transcriptional activators, PapI and Lrp (leucine-responsive regulatory protein), are required for this specific methylation inhibition. DNA footprint analysis using non-methylated pap DNAs indicates that Lrp binds to a region surrounding the GATC1130 site, whereas PapI does not appear to bind to pap regulatory DNA. However, addition of Lrp and PapI together results in an additional DNaseI footprint around the GATC1028 site. Moreover, Dam methylation inhibits binding of Lrp/PapI near the GATC1028 site and alters binding of Lrp at the GATC1130 site. Our results support a model in which Dam and Lrp/PapI compete for binding near the GATC1028 site, regulating the methylation state of this GATC site and, consequently, the pap transcription state.

Bacterial Proteins↗
PubMed2005

An unusual case of pyelonephritis in a pediatric renal transplant recipient.

Emphysematous (Gas-forming) pyelonephritis (EPN) is a rare and life-threatening infection of the renal parenchyma with or without involvement of the peri-renal tissues. Diagnosis of this condition is usually made on clinical and radiological grounds. Risk factors for this condition include diabetes mellitus, urinary tract obstruction, renal anomalies such as polycystic kidneys, stones, old age and others. Review of the literature did not reveal any reports of (EPN) in the pediatric age group especially in transplanted patients. We report the first case of EPN in a child, a 12-yr-old boy with a renal transplant, and discuss the various diagnostic and management issues of this particular case and EPN in general.

Child↗
PubMed2006

Acute graft pyelonephritis following renal transplantation.

BACKGROUND: Urinary tract infection is the most common form of bacterial infection encountered in a renal transplant recipient. Studies explaining the long-term consequences of acute graft pyelonephritis (AGPN) are few. METHODS: A total of 1022 consecutive renal allograft recipients were studied retrospectively over a period of 10 years for evidence of AGPN. These patients were classified into two groups according to the presence or absence of at least one AGPN episode. Only culture-proven infections were included in the study. RESULT: Of the 1022 renal transplant recipients, 169 patients (16.5%) developed AGPN. In the multivariate analysis with stepwise logistic regression, significant associations were observed between AGPN and placement of ureteric stent (odds ratio [OR]=4.6), urological malformations of native kidney (OR=2.1), cytomegalovirus (CMV) disease (OR=2.0), mycophenolate mofetil (MMF)-based regimen (OR=1.9), and acute rejection episodes (OR=1.5). However, age>40 years, female gender, induction therapy, anti-CD3 treatment, and hyperglycemia did not show such an association. In comparison with the non-AGPN group, these patients had a lower graft and patient survival (though it did not attain statistical significance). In the multivariate analysis using the Cox model for the entire study population, AGPN did not independently contribute to poor graft or patient survival. CONCLUSION: AGPN in the renal transplant setting is an ominous event, as these patients are also more prone to develop bacteremia, acute rejection, and CMV disease, which could then lead to poor graft and patient survival. Its association with MMF needs further clarification.

Acute Disease↗
PubMed1979

Immunopathology of the glomerular changes in chronic pyelonephritis.

To investigate the presence of intraglomerular immunoprotein deposition in chronic pyelonephritis (CPN), 29 renal specimens from patients with various urological diseases were examined by immunofluorescence. The relationship between immunohistological findings and types of glomerular changes which were classified according to Heptinstall's criteria was studied. Only type 2 glomeruli, which were considered to be ischemic changes, demonstrated granular and globular depositions of IgM and C3 in the collapsed and solidified shrunken tufts. IgM was positive in 117 of 258 (45.3%), and C3 in 122 of 264 (46.2%) type 2 glomeruli. The distribution patterns of IgM and C3 were much the same. IgG and IgA were rarely observed and neither fibrinogen nor albumin was observed in the tufts of type 2 glomeruli. Normal glomeruli and other types of glomerular changes in CPN showed few or no intraglomerular immunoprotein deposition.

Chronic Disease↗
PubMed1982

Alpha 1-antitrypsin and antithrombin III in atrophic nephrons of chronic pyelonephritis.

In a series of investigation to elucidate the roles of chemical substances in the atrophic process of nephron in chronic pyelonephritis (CPN), two protease inhibitors (PI) and enterobacterial antigen were examined by immunofluorescence (IF). Alpha-antitrypsin (alpha 1AT) was always found in the sclerotic glomerular tuft (GT) and along the thickened Bowman's capsule (BC) as well as the thickened tubular basement membrane (TBM) in every atrophic nephron of CPN. Antithrombin III (AT III) was always found along the inside of thickened TBM in every atrophic nephron, but not found in the sclerotic GT nor along the thickened BC. No enterobacterial antigen was present in the sclerotic GT, thickened BC, and thickened TBM. Therefore, alpha 1AT and AT III seem to play significant roles in the process of atrophy of nephrons as a different factor from the persistence of enterobacterial antigen which has been considered to be one of the progressive factors of CPN. At III was easily dissociated from the thickened TBM after the incubation in warm (37 degrees C) 0.01 M phosphate buffered saline of various pH (pH 4.0, pH 7.2 or pH 10.0) and cold (4 degrees C) or warm (37 degrees C) 0.75 M hydrazine solutions of the same pH, while alpha 1AT was not dissociated from the atrophic nephrons after the incubation in all solutions. These results may imply different processes of deposition between the two PI in the atrophic nephrons.

Antithrombin III↗
PubMed1982

Ascending pyelonephritis with Pseudomonas aeruginosa in mice.

Elastase- and protease- producing strain of Pseudomonas aeruginosa induced ascending pyelonephritis in mice by intracystic challenge. The pelvis was the site of primary foci development and necrotic, purulent lesions spread from the pelvis to the perihilar area and to the cortex. Severe necrosis was a characteristic of the present infection and caused systemic infection and host death without the development of chronic lesions. In animals challenged with inocula great enough to destroy the cystic mucosa, immediate hematogenous systemic infection without cellular responses led to host death.

Animals↗
PubMed2004

Coexistence of renal replacement lipomatosis with xanthogranulomatous pyelonephritis.

We report on a case of coexistence of replacement lipomatosis with xanthogranulomatous pyelonephritis (XGP) in the same kidney associated with staghorn calculi. A 63-year-old man was admitted to hospital complaining of a right abdominal mass. Computed tomography (CT) showed renal parenchymal atrophy with extremely increased perirenal fat. Right nephrectomy was performed. Postoperative diagnosis was renal replacement lipomatosis with XGP. Renal replacement lipomatosis and XGP have several similarities in terms of clinical background and CT findings. Sometimes it is difficult to differentiate them from malignant diseases. It is extremely rare that both conditions coexist in the same kidney. To our knowledge, only one such case has been reported.

Humans↗
PubMed2004

Pneumomediastinum and subcutaneous emphysema as the manifestation of emphysematous pyelonephritis.

Pneumomediastinum, a collection of mediastinal air, often results from the rupture of intrathoracic structures. A 41-year-old diabetic woman initially presented with signs of pneumomediastinum and nuchal subcutaneous emphysema, but was finally diagnosed with unilateral emphysematous pyelonephritis. Pneumomediastinum as a presentation in retroperitoneal infection has not been reported previously, which prompts us to discuss its etiology and emphasize the importance of physical examination.

Adult↗
PubMed2005

Renal matrix stones in an emphysematous pyelonephritis.

A 74-year-old-woman was referred to our hospital for further examination. Her chief complaint had been a high-grade fever, but she was seen at our hospital without fever. Plain fi lm of kidney, ureter and bladder drip infusion pyelography and abdominal computed tomography (CT) showed a gas shadow surrounding calcifications in the right renal pelvis. We diagnosed right emphysematous pyelonephritis. Since changes in the CT findings were not remarkable for 2 weeks, we performed laparoscopic right nephrectomy, even though her condition had not worsened. The renal pelvis contained brownish and clayish matter. We report here this rare case of renal matrix stones.

Aged↗
PubMed2006

Renal tuberculosis simulating xanthogranulomatous pyelonephritis with contagious hepatic involvement.

Xanthogranulomatous pyelonephritis (XGPN) is a chronic renal infection typically associated with nephrolithiasis and a non-functioning kidney. Renal tuberculosis is a major cause of morbidity in developing countries. Despite recent advances in diagnosis, it is sometimes difficult to differentiate renal tuberculosis preoperatively from XGPN. We present herewith a case report of a patient who was preoperatively diagnosed with a right non-functioning kidney due to renal calculus with stage 3 XGPN and adjacent liver abscess on computed tomography. Subsequent histopathological examination of the nephrectomised specimen revealed renal tuberculosis. To our knowledge this is the first case of renal tuberculosis spreading to the liver and causing liver abscess formation which was misdiagnosed as XGPN preoperatively.

Adult↗
PubMed1977

Xanthogranulomatous pyelonephritis in Malaysians.

Eight cases of xanthogranulomatous pyelonephritis occurring in an oriental population are reported. The patients were mostly middle-aged, and there was a female preponderence. Nephrectomy controlled the disease in all cases. Diagnosis on clinical and radiological grounds is difficult, and it is often only made on pathological examination of the kidney after nephrectomy. The nature of the disease remains obscure.

Adult↗
PubMed1975

The Bristol Pyelonephritis Registry: 10 years on.

The reasons for the initiation and the basic structure of the Bristol Pyelonephritis Registry have been discussed. The detailed follow-up data on those patients clinically at "renal risk" has been noted, with a demonstrably low incidence of proven bacterial infection, no radiological progression and minimal interference with pregnancy. Satisfactory and reassuring information has thus accrued for the first time in a particular group of patients with often severe recurrent symptoms.

Adolescent↗
PubMed1978

Renal mobility in women attending a pyelonephritis clinic and in controls.

The range of vertical renal mobility was established in a group of 129 healthy female subjects and compared with the range of mobility observed in 236 female patients attending a pyelonephritis clinic. The mobility was significantly greater on the right side in both groups and both kidneys moved significantly more in the patient group than in the controls. Excessive mobility could not be directly related to bacteriologically confirmed infection, renal pain or IVP abnormality. Nephroptosis remains an enigma and excessive renal mobility must not be interpreted in isolation.

Adult↗