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PubMedDate not supplied

[The combined treatment of calculous pyelonephritis with the use of perfusion of the kidney cavitary system with the preparation Palisan in the postoperative period].

Results are submitted of use of perfusion of the kidney cavitary system with the drug Palisan in the postoperative period in a multimodality treatment of calculous pyelonephritis. On the basis of bacteriological investigations a high efficacy of the drug in carrying out perfusion of the caliceal-and-pelvic system in treating the inflammatory process in the kidneys has been ascertained. An optimal methodical approach to the carrying out of perfusion has been developed. Also emphasized in the paper is value of perfusion of the kidney cavitary system in metaphylaxis of urolithiasis.

Anti-Infective Agents, Urinary↗
PubMed2000

[Two patients with emphysematous pyelonephritis].

A 55-year-old man with diabetes mellitus was sick with shivering, abdominal pain and Escherichia coli in blood and urine cultures; a 40-year-old woman with asthmatic bronchitis had abdominal pain and anaemia. Both had renal dysfunction and the CT scan showed hydronephrosis with a perirenal inflammatory infiltrate and gas in the right and left renal pelvis, respectively. The man had a difficult recovery after treatment with antibiotics and percutaneous drainage. In the woman, a calculus obstructed the pyelo-ureteral passage; the resected kidney contained a squamous cell carcinoma. She was operated, received chemotherapy and recovered. Emphysematous pyelonephritis is a rare, severe disease. Percutaneous drainage and, if necessary, nephrectomy are paramount in the treatment. The condition is observed mostly in patients with diabetes mellitus or obstruction of the urinary tract.

Adult↗
PubMed2000

[Comparison between scintigraphy, B-mode, and power Doppler sonography in acute pyelonephritis in children].

PURPOSE: Comparing Power Doppler imaging versus technetium-dimercapto-succinic-acid (Tc-DMSA) scintigraphy in acute pyelonephritis of childhood. PATIENTS AND METHODS INCLUSION CRITERIA: First episode of urinary tract infection, clinical and biological findings suggesting an upper lesion, absence of urological malformation or obstruction, absence of reflux (or vesico-ureteral reflux inferior to grade 3). Number of patients: 49, length of the study: 26 months (from November 95 to January 98). METHODS: Tc99m-DMSA scintigraphy (after five days), B mode and Power Doppler imaging (on the day of admission or the following day). Systematic cystography (day 5 to day 30). RESULTS: In terms of positive diagnosis, scintigraphy was superior to Power Doppler, and the latter was superior to B mode ultrasonography. Sensitivity (scintigraphy being the gold standard) was equal for both B mode and Power DopplerUS imaging, but combined Power Doppler and B mode US provided improved results. CONCLUSION: Currently, the results with Power Doppler imaging are insufficient to replace DMSA scintigraphy. However, Power Doppler is a good complement to B mode US.

Acute Disease↗
PubMed1999

Effect of haemodialysis on peripheral lymphocyte carnitine levels in patients with chronic pyelonephritis.

The effect of haemodialysis on peripheral blood lymphocyte levels of total carnitine (TC), free carnitine (FC) and acylcarnitine (AC), and on the ratio of AC to FC, is investigated in 20 healthy subjects (13 men and seven women) and 27 patients (10 men and 17 women) with chronic pyelonephritis. The mean predialysis peripheral lymphocyte levels of TC, FC and AC were not significantly different from those in the healthy controls (P > 0.05). However, after haemodialysis, peripheral lymphocyte levels of TC, FC and AC decreased significantly, compared with either predialysis (TC: 40%, FC: 37%, AC: 52%) or healthy controls (TC: 61%, FC: 63%, AC: 50%) (P < 0.01). Furthermore, after haemodialysis the AC/FC ratio was significantly higher, compared with either predialysis (41%) or healthy controls (38%) (P < 0.01).

Carnitine↗
PubMed2000

[Etiology, pathogenesis, clinical course and treatment of the special forms of acute purulent destructive pyelonephritis].

Ethiopathogenetic peculiarities of an acute purulent obstructive pyelonephritis (PN) were studied in 280 patients. If urinogenic infectioning of kidney occurs the diffuse purulent inflammation which begins from the renal tub spreads on interstitial or the organ medullary substance. In untimely restoration of the urodynamics disorders together with urinogenic the hematogenic infectioning of the kidney had occurred with formation of foci of destruction and purulent processes in cortical substance of kidney. For destructive PN the open operative intervention was performed to patients, in presence of nondestructive purulent PN--transcutaneous nephrostomy.

Abscess↗
PubMed2000

[A case of emphysematous pyelonephritis improved with conservative therapy--indication for conservative therapy].

A 51-year-old female patient was hospitalized in our department with high fever and left flank pain. Laboratory examination showed leukocytosis, increase of C-reactive protein (CRP), hyperglycemia and renal insufficiency. Enterobacter aerogenes grew out of the cultured urine. The radiograph and computerized tomographic (CT) scan revealed streaky gas in the destroyed left renal parenchyma with perirenal gas. She was diagnosed with left emphysematous pyelonephritis. Antibiotics therapy, treatment for sepsis and disseminated intravesicular coagulation was initiated resulting in mitigation of inflammation. High blood glucose initially required insulin therapy, but finally returned to normal levels through administration of oral antidiabetics. Although leukocytosis and low grade fever continued, the patient was discharged on day 53 with a negative CRP. CT scan indicated that the emphysematous change was localized after three months and almost resolved after four months. Renal scintigram indicated the residual function of the affected kidney. Because of the possibility of residual renal function and the cure by conservative therapy alone, the conservative therapy is preferred when the initial treatment is effective.

Anti-Bacterial Agents↗
PubMed1999

[Chronic pyelonephritis. Synopsis of laboratory values and ultrasound lead to diagnosis].

Bacteria or their antigens persisting in the kidneys may induce the classical type of chronic pyelonephritis (CP), which progresses slowly, and may finally result in end-stage renal failure requiring dialysis. Pyelonephrogenic strains enter uro-epithelial and renal epithelial cells--where they accumulate--or may invade the renal interstitium. Promoting factors are obstruction, reflux, urolithiasis, nephrolithiasis, pregnancy, diabetes mellitus, humoral and cellular immunodeficiencies, immunosuppression treatment (e.g. following transplants), autoimmune phenomena (antigenic mimicry). Therapy comprises the treatment of underlying disease, antibiotics as indicated by the resistogram, acidification of urine (L-methionine), i.v. immunoglobulins (IgM, IgG) and oral vaccination with lyophilized uropathogens.

Diagnosis, Differential↗
PubMed1975

[Pivampicillin and ampicillin in experimental E. coli pyelonephritis].

The antimicrobiol activity of 6-[D(--)-alpha-aminophenylacetamido]-penicillanic acid-(pivaloyloxymethyl)-ester (privampicillin) was tested in comparison to ampicillin during the acute ascending pyelonephritis of the rat caused by E. coli. Two groups of rats were treated with different drug concentrations; group I:3 times 70 mg/kg/day pivampicillin and 3 times 50 mg/kg/day ampicillin, group II: 3 times 70 mg/kg/day pivampicillin and 3 times 150 mg/kg/day ampicillin; controls were inoculated three times daily with 1.0 ml physiological saline. A higher activity of pivampicillin was found in the first group as proved by bacterial counting in the left and the right renal parenchyma as well as in the urine. In the second group the efficacy of ampicillin was increased.

Administration, Oral↗
PubMedDate not supplied

[The effect of Velikobagachanskaia mineral water on the course of chronic pyelonephritis].

The employing of Velikobagachanskaia mineral water internally by drinking and externally by taking a bath with it adds to the effectiveness of treatment of chronic pyelonephritis, modulates parameters associated with immune homeostasis, reduces the number of carriers of antibodies to M. hominis, facilitates prolongation of clinical and laboratory remission.

Adolescent↗
PubMed2000

[Severe chronic renal failure subsequent to acute pyelonephritis in alcoholic patients].

BACKGROUND: Chronic alcoholism and malnutrition are uncommon causes of complicated acute pyelonephritis (APN). CASE REPORTS: Since 1997, we have seen 5 patients with chronic alcoholism (3 women and 2 men, mean age 53.4 +/- 13 years) without cirrhosis, diabetes or renal failure who developed severe APN in a state of malnutrition (albumin 22 +/- 3 g/l, total cholesterol 0.86 +/- 0.2 g/l). Diagnosis was made 14.6 +/- 9 days after onset of atypical symptoms which the patients neglected. There was a major bacterial inoculum: Escherichia coli 10(6.2 +/- 2) (3 multisusceptible and 2 amoxicillin-resistant strains); positive blood cultures in 3 cases. The imaging study showed bilateral diffuse lesions with focal swelling and kidney enlargement, without obstacle, abscess, or papillary necrosis. All patients had severe acute renal failure (maximum serum creatinine: 582 +/- 210 mumol/l; 3 patients underwent dialysis). Mean duration of antibiotic therapy was 40 +/- 7 days (i.v.: 22 +/- 3 d). Renal scarring occurred since creatinine clearance was 33 +/- 22 ml/min 2 months after the initial episode. One patient progressed to end-stage renal failure. CONCLUSION: In malnourished alcoholic patients, APN may be unusually severe due to late diagnosis leading to the risk of irreversible renal damage and severe chronic renal failure.

Acute Disease↗
PubMed2000

Diuretic MAG3 scintigraphy (F0) in acute pyelonephritis: regional parenchymal dysfunction and comparison with DMSA.

UNLABELLED: 99mTc-DMSA late static planar imaging or SPECT is being used for the investigation of focal acute pyelonephritis (APN), especially in children with urinary tract infection (UTI). Diuretic 99mTc-mercaptoacetyltriglycine (MAG3) dynamic scintirenography has been applied in the evaluation of kidney function and structure, frequently to exclude obstruction. However, in children and adults with a clinical picture of APN, diuretic MAG3 scintigraphy with zero time injection of furosemide (MAG3-F0) was observed to display focal parenchymal abnormalities; regional dysfunction (focal parenchymal decrease in early uptake; slow filling in and prolonged late retention of activity); or, less frequently, fixed defects. This observation was further studied both retrospectively and prospectively, and its sensitivity and specificity for APN were compared with those of dimercaptosuccinic acid (DMSA). METHODS: In the retrospective study, for 36 children with UTI and regional parenchymal findings on MAG3-F(0), data were reviewed, analyzed, and compared with the results of concurrent DMSA studies. In the prospective study, for 57 children with clinical and laboratory findings suggestive of APN, the 2 radiopharmaceuticals were used for imaging sequentially and the results of the 2 studies were compared. The criteria for abnormal findings compatible with the diagnosis of APN were, for MAG3-F(0), regional parenchymal dysfunction and fixed focal defects and, for DMSA, focal defects without parenchymal loss. RESULTS: In all groups of patients, most abnormal MAG3-F(0) studies (80%) showed regional parenchymal dysfunction, but in some (20%) a fixed defect was found. Compared with DMSA and when both regional dysfunction and focal defects were considered, MAG3-F(0) was as sensitive as DMSA. Some patients had only MAG3-F(0) abnormalities, suggesting a slightly lower specificity for MAG3-F(0) compared with DMSA (86%); this finding needs further study, because it also raises questions about the sensitivity of DMSA, considering that only a small percentage of patients with clinically suggestive findings had abnormal study findings. In most patients with fixed defects on both DMSA and MAG3-F(0), follow-up studies showed no resolution, suggesting that a fixed defect on MAG3-F(0) may indicate either more severe APN or preexistent scars and that regional dysfunction may be a sign more specific for APN and prognostic of potential recovery. In addition, a pattern more specific for a scar--a fixed defect with a dilated regional calyx--was seen on follow-up MAG3-F(0). CONCLUSION: A fast (25-min) planar dynamic MAG3-F(0) study was found to be as sensitive at depicting focal parenchymal abnormalities in APN as was the 3- to 4-h DMSA routine procedure. The sensitivity and specificity of both studies need further evaluation.

Acute Disease↗
PubMedDate not supplied

[Homeostatic and antioxidant defense enzymes activity in chronic pyelonephritis].

As shown by the analysis of chronic pyelonephritis, manifestations in patients with high and low activity of antioxidant system enzymes, patients with high catalase activity have more effective defense of red cells, glomerular epithelium. This was concluded from marked differences in urinary excretion of metabolites, hemoglobin levels compared to those in patients with low activity of catalase. In low activity of glutathione peroxidase, inflammation gains activity, nonspecific resistance weakens, excretion of some metabolites inhibits vs patients with high activity of this enzyme. The data provide criteria for diagnosis of antioxidant system defects and show necessity of antioxidant drugs inclusion into the therapeutic scheme (unitiol, antioxidant complex of vitamins A, E, C, P).

Adolescent↗
PubMed2000

[Diagnosis of acute pyelonephritis in childhood: comparison of ultrasonographic examination and renal scintigraphy using 99mTc DMSA].

THE CURRENT STATE: Infections of the urinary tract are a frequent paediatric problem. Their treatment requires to assess the localisation of infection within the uropoetic tract. Especially the acute pyelonephritis (AP) can lead to irreversible changes within the renal parenchyma and alteration of renal functions. Some imaging examinations can help in the assessment of the diagnosis of AP and contribute to appropriate therapy. SUBJECTIVE: The analysis of results gained from imaging examinations in children with AP was based on the comparison of used techniques and the assessment of their exploitation for the diagnosis of AP. METHODS AND MATERIAL: 38 children (17 girls and 21 boys at average age of 11.6 years) with clinical criteria of AP were subdued to ultrasonographic examination with B record (US-B) and ultrasonographic examination with energetic Doppler (US-D). Both methods were compared with the findings gained by use of renal scintigraphy 99mTc DMSA. RESULTS: The positive finding of AP was proved in 36 children (94.7%). The results of US-B proved AP in 14 children (36.8%) of the whole group of patients, i.e. in 38.8% with positive DMSA finding. US-D changes indicated AP in 15 children (39.4%) of the whole group, i.e. in 41.6% with positive DMSA finding. The sensitivity of both methods US-B and US-D appear to be low for the verification of changes in renal parenchyma in AP. CONCLUSION: Despite its advantages and availability, the gain from ultrasonographic examination in children suffering from AP is small. Clinical and laboratory criteria are fully sufficient for AP verification in common clinical practice. DMSA scintigraphy is a method of choice in complicated cases of AP. (Tab. 1, Ref. 17.)

Acute Disease↗
PubMed1979

Chronic pyelonephritis. Electron microscopic study. III. The ureter.

The ultrastructure of the ureter in the nonhuman primate is described. In experimentally produced chronic pyelonephritis, the ureter shows extensive ultrastructural changes throughout the wall. The epithelium has cellular damage progressing from the basal cells to the superficial cells. There is an invasion of leukocytes into the intercellular spaces at all levels. The connective tissue layer seems thickened with an increase in active fibroblasts, leukocytes, collagen, and elastic fibers. There are various stages of damage in the smooth muscle layer and an abnormal increase of connective tissues between bundles and smooth muscle cells. The interdigitating nexuses seem stretched and altered. The changes are similar to those seen in ureteral obstruction and are assumed to be reparative.

Animals↗
PubMed2000

[Xanthogranulomatous pyelonephritis presenting as a Grawitz tumor in a 21-year-old female patient. Case report] ].

Xanthogranulomatous pyelonephritis is a chronic inflammatory disease of the kidney characterized by destruction and replacement of the renal parenchyma with granulomatous tissue containing lipid-filled macrophages. The disease affects mainly elders, more frequent females and is difficult to differentiate it from renal neoplasms by standard diagnostic imaging methods. This case report confirms it.

Adult↗
PubMed2000

[Xanthogranulomatous pyelonephritis. Our experience and review of the literature].

BACKGROUND: Ten cases of xanthogranulomatous pyelonephritis (XGP) with diagnostic and therapeutic observation are described and other experiences reported in the literature are analyzed. METHODS: The clinical, laboratory and radiological features of 10 patients who had undergone nephrectomy in our Istitute, between October 1993 and March 2000, with a postoperative pathological diagnosis of XGP have been retrospectively re-evaluated. RESULTS: The most frequent symptom was flank pain. All the patients presented leucocytosis. Urine culture was positive for Proteus Mirabilis in four patients (40%) and for E. Coli in three (30%). In all the patients an ultrasound scan and urography were performed, six patients (60%) had undergone a CT scan and two of them (20%) a MRI. In six patients (60%) urinary lithiasis was associated and it was ramified in four of them (40%). The disease was always unilateral, affecting the right kidney in six cases and the left one in the other four. In three cases (30%) it presented in the focal form. The treatment was always surgical and it consisted of nephrectomy; a conservative surgical approach was used in two cases (20%). At the follow-up 4 patients (40%) showed recurrent urinary tract infections. None presented relapse. CONCLUSIONS: XGP is an uncommon chronic inflammatory disease, often associated with urinary tract infections and/or urolithiasis. The clinical presentation is nonspecific so that differential diagnosis with other kidney diseases becomes difficult. A CT scan can be helpful in formulating diagnosis. The treatment is surgical and it consists of a nephrectomy, while a conservative approach can be reserved in some cases for the focal form. Cases treated with antibotics have been described.

Adult↗
PubMedDate not supplied

[Immune disorders in congenital hydronephrosis complicated by obstructive pyelonephritis].

Congenital hydronephrotic transformation complicated by obstructive pyelonephritis with intact renal function in children exhibited association with some antigens of the major histocompatibility system and their combinations, changes in immunity and nonspecific resistance. Marked and stable shifts in immune reactivity give grounds for inclusion of immunomodulating drugs in combined treatment of the above patients.

Adjuvants, Immunologic↗