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PubMed2003

Bilateral emphysematous pyelonephritis combined with subcapsular hematoma and disseminated necrotizing fasciitis.

Emphysematous pyelonephritis (EPN) is a rapidly progressive and potentially life-threatening necrotizing infection of the renal parenchyma characterized by the presence of gas. Bilateral EPN is a rare disease process with a high mortality rate. Bleeding associated with EPN is an extremely rare complication. Necrotizing fasciitis is a rare but serous condition with a poor prognosis. Herein we present a rare case of bilateral EPN combined with subcapsular hematomas which progressed to the development of disseminated necrotizing fasciitis.

Emphysema↗
PubMed2003

Percutaneous drainage and/or nephrectomy in the treatment of emphysematous pyelonephritis.

OBJECTIVES: To assess the current and past literature relating to the differential treatment of emphysematous pyelonephritis (EPN). Some of the newer literature suggests percutaneous drainage (PCD), as compared to the standard nephrectomy, as a better modality. Since these two may complement each other, we sought to seek indications when to perform each treatment. METHODS: Medline and MD Consult were used for our journal review. Ten articles, ranging from 1980 to 2000, were chosen, which covered 162 patients. The criteria for selecting these articles were study size (n < 3 were excluded) and non-overlapping of patient information. Patient data was then used to certain risks of the various treatment modalities. RESULTS: Due to the lack of randomization of the studies, it is difficult to say whether PCD is superior to nephrectomy or not. It appears to be that each treatment may complement each other, and that treatment should be individualized based on the severity of the EPN and the medical condition of the patient. PCD though appears to be acceptable for use in the initial phases of the disease. However, long-term data is lacking to corroborate the overall benefit of PCD compared to nephrectomy. CONCLUSION: PCD could be utilized initially in some cases of EPN if certain conditions exist. This treatment may complement nephrectomy if the need exists, and therefore, treatment may be staged. Truly randomized studies need to be done to determine if one treatment is better than the other, and provide documented long-term follow-up of these patients.

Drainage↗
PubMed2004

Cytokines and cell adhesion molecules in the inflammatory response during acute pyelonephritis.

Urinary tract infection is a common bacterial infection of childhood. Renal parenchymal scarring, a recognised complication of urinary tract infection, is responsible for up to 24% of children entering end-stage renal failure. Why acute inflammation results in renal scarring in some children whilst in others complete resolution occurs without scarring is at present poorly understood. This article reviews the role of the cytokines, adhesion molecules and growth factors in the inflammatory response during acute pyelonephritis and renal parenchymal scarring. We hypothesize that inter-individual variability in cellular response may in part be responsible for this variable clinical outcome.

Acute Disease↗
PubMed2005

Severe emphysematous pyelonephritis in diabetic patients: diagnosis and aspects of surgical management.

PURPOSE: Emphysematous pyelonephritis (EPN) is a rare, severe gas-forming infection of renal parenchyma and surrounding tissues seen mostly in diabetic patients. Diagnosis and adequate therapeutic regimen are controversial. We reviewed the clinical presentation, diagnosis and aspects of surgical management of patients presenting with severe EPN. PATIENTS AND METHODS: Patients with EPN managed in our unit between 1996 and 2004 were reviewed. Diagnosis was confirmed by CT scan appearance of gas in the renal or perirenal area in a very ill patient. We compared the outcome of immediate nephrectomy with drainage of perinephric abscesses in patients presenting with severe EPN. RESULTS: Seven patients were managed in our unit during the 8-year period. All patients were diabetic and women outnumbered men (6:1). Renogram in all 7 patients showed renal function of affected kidney to be less than 15% in 6 patients. Escherichia coli was isolated in all patients from either urine, blood or perinephric pus. Management consisted of intensive resuscitation, control of blood glucose and use of intravenous antibiotics. Emergency nephrectomy was performed in 3 patients, delayed nephrectomy after an initial period of percutaneous drainage in 2 patients, incision and drainage in one patient and immediate percutaneous drainage was performed in one patient. One patient died 5 days post-nephrectomy of myocardial infarction. Patients who had immediate nephrectomy recovered quicker (18-21 days) and had no postoperative complications. Patients who had incision and drainage, or percutaneous drainage presented with recurrent discharging sinuses or perinephric abscesses requiring further surgical interventions and spent longer time in hospital (28-37 days). CONCLUSION: Patients with severe EPN often present in extremis and require intensive medical treatment. The diagnosis must be entertained in diabetic women presenting with flank pain and septicemia. The function of the affected kidney is often very poor and early nephrectomy offers the best outcome. Percutaneous drainage or incision and drainage of the abscess may be performed in patients too ill for immediate formal nephrectomy.

Adult↗
PubMed1978

Xanthogranulomatous pyelonephritis-presentation as acute renal failure in a child with a solitary kidney.

A 4-year-old girl, who had been in perfect health, presented with the acute onset of renal failure and abdominal mass. Investigations revealed a solitary left kidney which on histology had the typical features of xanthogranulomatous pyelonephritis. The child had no previous history suggestive of chronic renal disease and had no radiologic evidence of renal osteodystrophy. She had no improvement in renal function and has gone on to hemodialysis and transplantation. The unique mode of presentation and the unusual features of this case are discussed.

Acute Kidney Injury↗
PubMed1979

Immunological and bacteriological studies in chronic pyelonephritis associated with kidney stones.

Histological and immunofluorescent techniques, urine, stone and renal fragment culture, demonstration of bacteria with fluorescent specific antisera in the renal tissue and determination of circulating antiGBM and antiTBM antibodies in the serum, were studied on the renal biopsies of 46 patients with chronic pyelonephritis (CPN) associated to kidney stones. Results show that the bacteria are often present in renal tissue of CPN with negative urine culture. The presence of C3 and C4 in some cases, and C3 and C3PA in others, at the tubular level associated with bacteria, suggest that the activation of the C system may be through the classic way, i.e., through the bacteriological immune complexes, or the alternate pathway, i.e., through the bacteria or their products. In conclusion, the evolution of the CPN may be related to the activation of the C system and the coagulation mechanism, as shown by frequent fibrinogen deposits.

Adolescent↗
PubMed1983

Deposition of alpha 1-antitrypsin and loss of glycoconjugate carrying Ulex europaeus agglutinin-I binding sites in the glomerular sclerotic process. Phenomena common to chronic pyelonephritis and chronic diffuse proliferative glomerulonephritis.

Sclerotic processes of glomeruli in chronic pyelonephritis (CPN) and chronic diffuse proliferative glomerulonephritis (CDPGN) were investigated in a lectin binding study in connection with an immunofluorescent examination of protease inhibitor deposition. Ulex europaeus agglutinin-I (UEA-I), which is specific to a certain terminal alpha-L-fucosyl residue of glycoconjugates, specifically labelled intact endothelia of glomerular capillaries, peritubular capillaries and blood vessels in human kidneys. Segmental or global loss of the UEA-I binding with glomerular capillaries was observed in the sclerotic areas where alpha 1-antitrypsin (alpha 1AT) deposits were always detected in the glomeruli with segmental or global sclerosis of CPN. This high correlation between loss of UEA-I binding and alpha 1AT deposition was also observed in the affected glomeruli of CDPGN. In considering glomerular sclerosis, it is significant that loss of UEA-I binding and alpha 1AT deposition are common to both CPN and CDPGN, although their original etiologies are quite different.

Animals↗
PubMed1985

Genetic factor(s) influence scar formation in experimental pyelonephritis.

Two inbred strains of rat have been identified that show markedly different responses to experimentally induced renal infection. Experiments involving these two strains and their F1 progeny have shown that a genetic factor either protects the host from a tissue-destructive inflammatory response (autosomal dominant gene) or potentiates lesion formation (autosomal recessive gene). The data are the first indication that genetic factors may determine the degree of renal damage in pyelonephritis.

Animals↗
PubMed1994

Clinical value of DMSA planar and single photon emission computed tomography as an initial diagnostic tool in adult women with recurrent acute pyelonephritis.

Routine DMSA scintigraphy, ultrasound (US) of the kidney, intravenous pyelography (IVP) and voiding cystoureterography (VCU) were performed in 27 consecutive adult women with recurrent acute pyelonephritis (APN) during a 12-month follow-up. Both planar and single photon emission computed tomography (SPECT) images were obtained for DMSA scan. DMSA scans were repeated in those patients with abnormal initial scan. DMSA-SPECT showed normal findings in 2, single renal cortical detect (RCD) in 9 and multiple RCD in 16 (including nonvisualization in 2). Of the 11 kidneys with normal findings or single RCD on DMSA-SPECT, only 1 (9%) showed vesicoureteral reflux (VUR) on VCU (grade I). A large proportion of those with multiple RCDs showed abnormal findings on IVP (44%, 7/16), US (38%, 6/16) or VCU (31%, 5/16); 63% in any of these three studies. 5 of 6 patients with VUR had multiple RCDs on DMSA-SPECT, and 3 of these 5 showed no abnormality on IVP or US. 7 patients who needed other managements besides initial standard antibiotic treatment had multiple RCDs on DMSA-SPECT. 15 normal women were also studied and showed normal DMSA-SPECT, US and IVP, in all cases. Follow-up DMSA-SPECT was done in 16 patients (7 with single RCD, 9 with multiple RCD). All 7 patients with single RCD showed improvement, in those with multiple RCDs improvement was observed in 2, no change in 7 on follow-up studies. We conclude: (1) DMSA-SPECT is a useful initial diagnostic tool in adult women with recurrent APN to identify patients who need more extensive radiological studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Preventive effect of ulinastatin on renal scarring in rat model of pyelonephritis induced by direct or ascending infection with Serratia marcescens or Escherichia coli.

Renal scarring is considered to be a characteristic of reflux nephropathy. The effects of ulinastatin, a strong inhibitor of polymorphonuclear leukocyte elastase, on renal scarring following direct parenchymal or intravesical ascending infection by Serratia marcescens or Escherichia coli were determined. Four days of treatment with ulinastatin initiated 2 or 5 days after infection prevented renal scarring. Doses of 1,000-4,000 units/kg inhibited renal scar formation, but 8,000 units/kg did not. These results suggest that it may be possible to limit renal scar formation in pyelonephritis by the use of an appropriate pharmacologic agent.

Animals↗
PubMed1996

Pyelonephritis as a cause of pleural effusion.

Although pancreatitis and subphrenic abscess frequently cause pleural effusion, renal disease rarely does so. We report a case of a young patient who presented with pleural effusion due to pyelonephritis and renal outflow obstruction secondary to nephrolithiasis. The effusion and the initial absence of urinary abnormalities resulted in delay in diagnosis and initiation of appropriate therapy.

Adult↗
PubMed1975

Preventive effects of trimethoprim/sulphamethoxazole on experimental staphylococcic pyelonephritis in rats.

108 white rats weighing 170-250 G were given trimethoprim, sulphamethoxazole and the combination trimethoprim 1/sulphamethoxazole orally and parenterally in order to test the preventive effect of these substances on experimental hematogenous pyelonephritis due to Staphylococcus aureus. Oral applications of 48 mg/kg/24h of trimethoprim/sulphamethoxazole prevented abscess formation. Intraperitoneal applications of 48mg/24h of the combination did not seem as effective as the oral applications. On the other hand, there was no difference between the effects of oral and parenteral applications when the doses were 96 mg/kg/24h. The preventive effects of trimethoprim and sulphamethoxazole alone were much less than those observed when the combination trimethoprim/sulphamethoxazole was given. No peritoneal or other tissue damage was observed after intraperitoneal injections of trimethoprim/sulphamethoxazole in rats.

Administration, Oral↗
PubMed1981

Xanthogranulomatous pyelonephritis. An immunohistochemical and ultrastructural study on the occurrence of bacteria and bacterial antigen.

Nine kidneys with typical xanthogranulomatous pyelonephritis (XP) involvement were investigated on the occurrence of bacteria, bacterial fragments and antigen, in light microscopy using Gram staining and immunohistochemistry, and by electron microscopy. The present study did not reveal any occurrence of bacteria, bacterial fragments or antigen. It is concluded that the xanthogranulomatous reaction in man represents a resorption phenomenon, and not an immunological reaction to bacteria or bacterial antigen.

Animals↗
PubMed1992

Coexisting renal cell carcinoma and xanthogranulomatous pyelonephritis in a chronic calculous disease.

Association of renal cell carcinoma (RCC) with renal calculi is very rare. Herein we report a case of RCC developing in a non-functioning kidney containing multiple renal and ureteric calculi. Histologically, the kidney, in addition, revealed changes of xanthogranulomatous pyelonephritis (XGP). XGP can be confused clinically, grossly and microscopically with RCC. In the present case both were coexistent and thus make it interesting.

Carcinoma, Renal Cell↗
PubMed1992

Focal xanthogranulomatous pyelonephritis: diagnostic and therapeutic aspects.

The authors report 2 cases of localized xanthogranulomatous pyelonephritis (XGP) in which computed tomography (CT) permitted to raise a motivated clinical suspicion of inflammatory disease: the surgical exploration documented absence of neoplasm and allowed a conservative therapy implying only the removal of the mass. A literature review confirms that some CT signs in XGP permit differentiation from carcinoma. If they are present, in unifocal cases of disease, the authors suggest a limited surgical approach and a therapeutic strategy as conservative as possible.

Female↗
PubMed1996

Xanthogranulomatous pyelonephritis associated with transitional cell carcinoma of the renal pelvis.

Xanthogranulomatous pyelonephritis (XPN) is an uncommon, but not rare, type of bacterial infection of the kidneys. Malignancies originating within the renal pelvis are uncommon. We report a case of XPN associated with a transitional cell carcinoma (TCC) of the renal pelvis in a 70-year-old woman. The pathogenesis of carcinoma of the renal pelvis in the presence of XPN is related to obstruction, chronic inflammation, and mechanical irritation caused by calculi. In the case reported here, obstruction was due to a concomitant TCC of the ureter without the presence of calculi. A review of the twelve published case reports of XPN with TCC of the renal pelvis, including the present case, showed that the frequency of this association is 3.3%, the average age at presentation is 65.3 (range 49-78) years, and that the male:female ratio is 2:1. Moreover, 25% of the patients had TCC of the ureter and 8.3% TCC of the bladder. The combination of XPN, TCC of the renal pelvis, and lithiasis occurred in 33.3% of the cases. XPN must be treated by nephrectomy not only because it is a destructive inflammatory process leading to complete loss of renal function, but also because the kidney may be harboring a malignant tumor.

Adult↗