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PubMed2002

Pyelonephritis and interstitial nephritis--clinical-pathological correlations.

AIMS: The relation between histological and clinical parameters were studied in 54 consecutive patients with acute interstitial nephritis or pyelonephritis without primary glomerular disorders, in all of whom percutaneous renal core biopsy had been performed. PATIENTS AND METHODS: Based on clinical criteria and without detailed knowledge of the appearance of the biopsy, the material was divided into 4 main groups: patients with septic and/or tubulotoxic conditions, hypersensitivity reactions (eosinophilic nephritis), ascending infections and other specified conditions. RESULTS: The overall correlation between the histological and the clinical diagnoses was good, but there were large overlaps between the histological findings in 3 of the groups, making classification of individual cases difficult. The histological and paraclinical findings were poorly correlated. Histologically, ascending infections were characterized by the presence of leukocyte casts and an increased number of neutrophilic granulocytes. CONCLUSION: The material justifies the present rough classification of the conditions mentioned above. By kidney biopsy, the interstitial conditions can be separated from glomerular and other conditions, but the biopsy offers little information about the clinical severity or the prognosis.

Adolescent↗
PubMed2004

Candida tropicalis-associated bilateral renal papillary necrosis and emphysematous pyelonephritis.

Although the kidney is often involved in disseminated and localized candidiasis, bilateral emphysematous pyelonephritis (EPN) is infrequently reported. Renal papillary necrosis (RPN) caused by fungi is also rare. We describe a patient with bilateral RPN and EPN caused by Candida tropicalis, who suffered from recurrent hematuria, flank pain, acute fulminant renal failure, and obstruction by a sloughed papilla. He was treated successfully with antifungal therapy and percutaneous nephrostomy (PCN). This is the first case report of C. tropicalis-associated EPN and RPN.

Adult↗
PubMed2003

[Pseudotuberculous pyelonephritis associated with staghorn calculus: a case report].

This report describes a 56-year old woman with an unusual form of chronic pyelonephritis mimicking tuberculosis on histopathological findings. She visited our hospital complaining of left flank pain. Left staghorn calculus and retroperitoneal abscess extending from the kidney were demonstrated on CT. No bacteria, including mycobacteria were identified in preoperative urine bacterial culture. Left nephrectomy with drainage of retroperitoneal abscess was performed. Microscopically, the nephrectomy specimen showed caseating granulomas, formed by epitheloid cells, highly suggestive renal tuberculosis. In spite of these findings, acid-fast bacteria were not revealed in the renal lesion nor the abscess, and cultures of the abscess for mycobacteria were also negative. Because of failure of identifying Mycobacterium tuberculosis, this case should be diagnosed as not renal tuberculosis, but pseudotuberculous pyelonehritis, which has been mentioned in recent literatures. Although this disease is not widely recognized, we must be aware of it to avoid unnecessary antituberculous therapy.

Abscess↗
PubMed1984

Xanthogranulomatous pyelonephritis: sonographic--pathologic correlation of 16 cases.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon renal inflammatory disease characterized by the destruction and replacement of normal parenchyma by sheets of lipid-laden histiocytes. The process may be diffuse or segmental. Sonograms of 16 cases of XGP (13 diffuse, three segmental) were retrospectively reviewed and correlated with their pathologic findings. The typical case of diffuse XGP demonstrates the following: renal enlargement, replacement of normal architecture by multiple fluid-filled masses, pelvic contraction or only moderate separation of the central echo complex, and a pelvic calculus. Although most cases have a large staghorn calculus, its sonographic demonstration may be difficult, perhaps as a consequence of peripelvic fibrosis. Atypical cases of diffuse XGP mimic pyelonephrosis with massive hydronephrosis and fluid--debris levels. In these atypical cases, a staghorn calculus is often conspicuously absent. Segmental XGP is recognized as an area of parenchymal destruction surrounding one calyx or one pole of duplication. Segmental XGP should be distinguished from focal xanthogranulomatous inflammation of the kidney, which is a distinct pathologic entity (cortical location, no pelvic communication, absent pyelitis). When typical gross pathologic features are present, sonography should make possible accurate identification of diffuse and segmental XGP.

Adult↗
PubMed1984

Sonography of emphysematous pyelonephritis.

Emphysematous pyelonephritis is a rare gas-producing bacterial infection of the renal parenchyma seen primarily in patients with diabetes mellitus. Sonographic findings in four patients with this disease are described. Sonographic features consist of multiple high-amplitude echoes within the renal parenchyma, renal sinus, and/or perirenal space accompanied by acoustic shadowing. Computed tomography confirmed bilateral involvement in one case. Plain abdominal radiographs demonstrated abnormal extraluminal gas in three of four cases. The role of sonography in diagnosis is discussed.

Aged↗
PubMed2006

Focal xanthogranulomatous pyelonephritis -- a diagnostic dilemma.

Focal Xanthogranulomatous Pyelonephritis (XGPN) may be erroneously interpreted as renal cell carcinoma. We report a case of a young Philippino who presented with persisting right flank pain for 2 years. Imaging showed a well-delineated lesion in the lower pole of the right kidney extending to the hilum. Nephrectomy was performed under a tentative diagnosis of renal cell carcinoma, whereas histology revealed focal XGPN. Pre-operative diagnosis of focal XGPN was difficult because of radiological similarities to renal cell carcinoma and lack of the usual clinical presentation.

Adult↗
PubMed1976

[Results of treatment of chronic exacerbated pyelonephritis with unroantiseptics under clinical conditions].

The results are reported from the carried out 701 shortterm therapeutic courses in 527 patients with exacerbated chronic pyelonephritis. The results are considered as "very good" in realization of a full clinical remission (normalization of temperature and ESR), disappearance of leucocyturia and bacteriuria), "good" - in normalization of three of those indices and "withfut effect". Co-trimoxazol (88.3 per cent of the patients), gentamycin (61.7%), ampicillin (58.8%), nelidix acid (57.4%), nitrfuran (55.0%) and choloramphenicol (53.1%) have manifested the highest effectiveness (very good and good effect). In a small number of the treated patients with cephalosporins effect was obtained in 50.0 per cent, with urovalidin - 44.4 per cent and with carbenicillin - 62.5 per cent. According to the authors' opinion the therapeutic schemes for a long-term treatment must include chlorampheniacal, nelidix acid, co-trimoxazol and nitrofuran sometives -amplicillin. Gentamycin, ampicillin and cephalosporins and with indications - some other uroantiseptics must be used in the coping with severe exacerbation of the disease. The authors recommend the chronic intermittent uroantiseptic treatment.

Adolescent↗
PubMed1978

Experimental pyelonephritis in the monkey. VI. Infection of infants versus adults.

Pyelonephritis followed ureteral inoculation of bacteria in both infant and adult monkeys. Because of the frequency of reflux in infants this was done by bladder inoculation, although ureteral inoculation was necessary in adults. The longer duration of bacteriuria in infants may be attributable to a relative immunodeficiency.

Age Factors↗
PubMed1978

Chronic pyelonephritis. An electron microscopic study in nonhuman primates.

The rhesus monkey (Macaca mulatta) proved to be a successful model for the ultrastructural study of ascending nonobstructive pyelonephritis. The most severe kidney damage occurred where the inflammatory response was greatest, and these areas overlaid a dilated or clubbed calyx. The most prominent ultrastructural changes were in the renal tubular cells that showed swollen mitochondria with ruptured inner membranes, dilated endoplasmic reticulum, and flocculent and irregular basal laminae. No recognizable bacterial structures were seen.

Animals↗
PubMed1999

Emphysematous pyelonephritis: imaging diagnosis and follow-up.

We conducted the study to evaluate the efficacy and roles of different imaging modalities in the diagnosis and follow-up of emphysematous pyelonephritis (EPN) and to correlate imaging findings with clinical outcome. Retrospective analysis of the imaging studies and clinical outcome were performed in 28 consecutive patients with EPN. They were all initially treated with CT-guided percutaneous drainage (PCD). The imaging studies performed included plain abdominal radiography (KUB) (n = 28), sonography (US)(n = 24), intravenous urography (IVU)(n = 5), retrograde pyelography (RP)(n = 20) and computed tomography (CT)(n = 28). Follow-up imaging studies included CT(n = 23) and renal scintigraphy (n = 15). The sensitivities of detecting abnormal gas in EPN on KUB and US were 66% and 88%. The mortality rate was 11%, not associated with different types, stages or renal involvement. On the follow-up CT performed within one month of PCD, type I EPN evolved into type II in 86% of the cases. On the long-term follow-up CT, renal atrophy and focal scarring were revealed in the diffuse and focal renal involvement of EPN. The mean split renal function shown on the follow-up scintigraphy was 30%. We concluded KUB and US were valuable for screening EPN, although CT was the most specific and sensitive. Follow-up CT studies not only demonstrate the response of treatment but also depict the different courses and the results of different types and renal involvement of EPN, although not associated with mortality rate.

Adult↗
PubMedDate not supplied

[The staged medical rehabilitation of patients with secondary chronic pyelonephritis in infravesical obstructions].

The authors believe that chronic pyelonephritis patients operated for infravesical obstructions need staged postoperative rehabilitation. In antibacterial postoperative treatment, a significant response was seen in 7.9%, a partial response in 18.4% and no response in 73.7% of patients. After combined physiotherapy--in 38%, 41.7% and 20.3% of patients, respectively.

Chronic Disease↗
PubMedDate not supplied

[The use of laser radiation and sinusoidal modulated currents in the therapy of patients with chronic calculous pyelonephritis].

The authors present a technique of treating chronic calculous pyelonephritis with laser radiation and sinusoidal modulated currents which promotes a complete elimination of the calculus fragments in 100, 70 and 50% of the patients in the stone size 0.2-0.5 cm, 0.5-0.7 cm and > 7 cm, respectively. This combined therapy had also antiinflammatory, and immunity-stimulating effects.

Antibody Formation↗
PubMed1999

[Emphysematous pyelonephritis: apropos of a case and review of the literature].

Based on a case report and a review of the literature, the authors describe the features of 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.

Emergencies↗
PubMedDate not supplied

[The combined therapy of patients with chronic nonspecific pyelonephritis using interference currents and and radon procedures].

The exposure of the lumbar region to interference currents in combination with radon baths conducted in 37 patients with chronic pyelonephritis inhibited activity of the inflammation, hypercalciuria and hyperoxaluria, improved function of the kidneys. The same clinical effects were achieved in 32 patients who had received interference therapy in combination with intake of radon water.

Adolescent↗
PubMed1976

Co-trimoxazole in the long-term treatment of pyelonephritis with normal and impaired renal function.

The effect of co-trimoxazole was studied in 29 cases of acute or chronic pyelonephritis. The therapy produced the desired effect in 22 out of 23 cases and in the 6 cases treated prophylactically. We used a special dosage schedule for the combination of sulphamethoxazole and trimethoprim in the treatment of patients with normal renal function and with varying degrees of renal impairment. The results show that the plasma concentrations were at satisfactory therapeutic levels, with no accumulation of the three substances and without causing any toxic side effects, even in patients with severe impairment of the renal function. The mean duration of the treatment was 12.3 months. The material is, however, not largelu enough to warrant the recommendation of standardized treatment according to the schedule described, in spite of the favourable experience gained. It does, however, permit us to recommend that the plasma concentrations should be determined, particularly of the total sulphamethoxazole in patients with severely impaired renal function.

Acute Disease↗