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PubMed2005

Evaluation of the use of DMSA in culture positive UTI and culture negative acute pyelonephritis.

This prospective study was done to assess the frequency of acute pyelonephritis (APN) in febrile children with positive urine culture as documented by Tc99m DMSA scintigraphy (DMSA) and the frequency of vesicoureteric reflux (VUR) in these children. Secondly, to determine the frequency of APN, in febrile children with supportive evidence for UTI but with negative urine culture, as documented by DMSA and frequency of VUR in them. Thirdly to stress the utility of DMSA to diagnose APN in urine culture negative febrile children and to suggest DMSA as a clinical tool in evaluation of fever of unknown origin (FUO). This study included 42 children with positive urine culture and 26 children with negative urine culture who had supportive evidence of UTI as determined by the predetermined criteria and diagnosed to have APN by DMSA. All of them had ultrasonogram (USG), DMSA and voiding cystourethrogram (VCU). They were followed up for a minimum period of 6 months. Out of the 42 children with positive urine culture 92.9% had features of APN in the DMSA of whom 82.1% had vesicoureteric relux (VUR). The DMSA was abnormal in 26 children with negative urine culture, of whom 65.4% had VUR. Ultrasound suggestive of parenchymal change was observed in 47.6% in the culture positive group and 65.4% in the culture negative group. In conclusion, it is suggested, that DMSA is a useful investigation for the diagnosis of APN in febrile UTI. DMSA is indicated in febrile children with negative urine culture but with supportive evidence of UTI and in FUO. An abnormal DMSA is a strong indication for work up for VUR.

Acute Disease↗
PubMed2005

Emphysematous pyelonephritis caused by Candida infection.

We present an interesting and rare case of a diabetic patient who developed extensive unilateral emphysematous pyelonephritis (EPN) which was caused by fungal infection. The diagnosis was confirmed on computed tomography (CT) scan of the abdomen. Repeated urine cultures grew Candida albicans but no other organisms were isolated. The patient remained febrile and unwell despite parenteral broad spectrum antibiotics and antifungal treatment. She underwent nephrectomy and then made a good clinical recovery.

Adult↗
PubMedDate not supplied

[Use of cryoprecipitate in combined therapy of acute purulent pyelonephritis].

The treatment of 120 patients with acute purulent pyelonephritis (APP) brought about the following results. 86% patients given standard therapy showed deterioration of their condition, DIC syndrome and inflammatory process were not cured, pyoinflammatory process in the kidney continued. On the contrary, 84.1% patients on combined conservative treatment improved: DIC syndrome and active inflammation relieved, fibronectin content, IgA, IgM and IgG levels rose. Ultrasonic examination and dopplerography indicated that combined conservative therapy including cryoprecipitate arrested development of a purulent focus in the kidney, reestablished intraorganic circulation. Mean stay in hospital was 13.9 days.

Acute Disease↗
PubMed1992

Chemiluminescence response of phagocytes in E. coli induced experimental ascending pyelonephritis.

The mechanism of tissue injury at the cellular level by following the chemiluminescence response of various phagocytes in E. coli induced experimental pyelonephritis in mice was investigated. There was a marked increase in the capacity of various phagocytic cells viz; renal neutrophils and macrophages peritoneal macrophages, blood monocytes and neutrophils to produce reactive oxygens species through the respiratory burst activity as monitored by the chemiluminescence response. The chemiluminescence response was observed to be increased significantly (p less than 0.001) with increasing days post infection in all phagocytic cells. However, the quantity of total reactive oxygen species produced per million cells was much more in the renal and peritoneal macrophages as compared to blood monocytes and neutrophils. The peak chemiluminescence response time was observed to be decreased from 4 to 2 minutes with the progression of the diseases. The implications of these findings have been discussed.

Animals↗
PubMed1992

[Fatal emphysematous pyelonephritis].

A man aged 46 years with diabetes mellitus was admitted with acute right-sided renal symptoms. Pyelonephritis emphysematous without concretions was found. The patient was treated with insulin, fluids, electrolytes and antibiotics and nephrostomy was performed and, subsequently, an internal JJ-catheter in the ureter. The symptoms disappeared and he was discharged on a low dosage of sulphamethizol. After the planned removal of the JJ-catheter, sepsis running a lethal course developed. This emphasizes the importance of adequate prophylactic antibiotic therapy in connection with interventions in the urinary tracts.

Anti-Bacterial Agents↗
PubMed2005

Xanthogranulomatous pyelonephritis in a 1-year old boy.

Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic inflammatory lesion of the kidney associated with both chronic infection and obstruction. Most common in middle-aged females, it is important to recognize in children because it may be confused with childhood renal malignancies particularly Wilms' tumor. We report a case of a 1-year old male with antenatally detected and postnatally confirmed hydronephrosis. Further investigation revealed a left incomplete duplex collecting system with obstructing lower pole stones, pelvicaliectasis and widespread foci of calcification. He underwent a left nephroureterectomy with the pathological report noting XGP.

Humans↗
PubMedDate not supplied

[Doppler technologies in combined diagnosis of acute pyelonephritis].

We studied diagnostic potentialities of conventional clinical, device, x-ray and ultrasonic methods including current Doppler technology in differentiation of serous and purulent stages of acute pyelonephritis (AP) in 50 patients (mean age 25.5 +/- 5.5 years). Energetic dopplerangiography (EDA) showed the highest diagnostic significance. EDA was highly informative in renal carbuncle and total purulent destruction of the kidney and low informative in serous and apostematous AP, renal abscess. Conventional ultrasonic, x-ray, clinical and device investigations as well as impulse dopplerography and color Doppler mapping of blood flow are of secondary importance in AP.

Acute Disease↗
PubMedDate not supplied

[Renal scintigraphy with Tc99m DMSA (dimercaptosuccinic acid) in acute pyelonephritis].

Twenty patients, 6 months to 11 year old, with clinically recognized acute pyelonephritis, were evaluated with Tc99m DMSA renal scintigraphy in the first 15 days of their illness to validate this method in the detection of the acute renal inflammatory disease. In 85% of Tc99m DMSA scintigraphies some kind of abnormality (focal or diffuse, unilateral or bilateral) was observed. Second renal images obtained at an average 8.5 months later, showed total disappearance of abnormal findings in 42%; partial regression in 50% and no changes in 8% of these cases. Tc99m DMSA scintigraphy seems to be a good diagnostic tool to confirm acute renal compromise in urinary tract infections. Besides follow up examinations, at least three months later with this same method, were able to confirm sustained renal lesions.

Acute Disease↗
PubMed2006

Results of a five-year study of 99mTc DMSA renal scintigraphy in children and adolescents following acute pyelonephritis.

BACKGROUND: Renal scintigraphy, generally using 99mTc-DMSA, is the accepted reference standard for detection of renal cortical changes. The timing of the test, i.e., whether an acute 99mTc-DMSA scan, a follow-up only or both scans should be performed, however, remains open to discussion. In our study, a six-month follow- up DMSA scan was performed in all the children diagnosed with a first attack of acute pyelonephritis (APN) in two large paediatric clinics of Charles University's 3rd School of Medicine in Prague during a five-year period. All diagnoses were confirmed by a paediatric nephrologist. MATERIAL AND METHODS: 382 children (267 girls, 115 boys) aged between 7 months and 19 years were included in the study. For analytical purposes, the patients were divided into 4 age groups: I--less than 1 year of age, II--1-5 years, III--5-10 years, and IV--10-19 years. In all children younger than five years, a micturition cystourethrogram (MCUG) for detection of vesicoureteric reflux (VUR) was performed between one and three months after the APN episode. Static renal scintigraphy, using an HR collimator with parallel holes was performed using a planar Gamma camera MB 9200 (Gamma Budapest) in all children six months after APN, with a complement of pinhole images, SPECT or PSPECT of the kidneys. RESULTS: 1. In group I, all four children with positive VUR on MCUG had a pathological DMSA scan, while only two of the 32 patients with negative VUR had a pathological DMSA. 2. In group II, 17 children had VUR on MCUG, six of them with a pathological and 11 with a normal DMSA scan. Most of the 221 children without VUR had a normal DMSA scintigraphy; pathological findings were present in 17 children only. 3. In group III, all children with VUR, but only 5 out of 53 without VUR, had a pathological DMSA scan. 4. Five out of 50 children in group IV had a pathological DMSA. CONCLUSIONS: APN occurred most frequently in group II (62.3%, or 238 children) and ranged between 10-15% in the remaining groups. APN was found very frequently in boys less than one year old and showed a marked decrease with increasing age. Among girls, however, APN incidence was observed to increase with age. Pathological renal changes were present in children with, as well as without, VUR. The incidence of pathological DMSA findings six months after APN was relatively low (44/382 patients, or 11.5%). Regular monitoring of these children is very important for detection of renal scarring.

Acute Disease↗
PubMed2006

[Disturbances of lipid exchange and peroxidation system in patients with chronic pyelonephritis].

The aim of the study was to evaluate the lipid parameters of blood in patients with total or partial clinico-laboratory remission of chronic pyelonephritis (CP), and the role of these parameters in their metabolic status. The subjects were 93 CP patients (mean age 47.4 +/- 0.8 years). The metabolic status of each patient was evaluated according to the activity of the inflammatory reaction, glomerular filtration, and reabsorption, as well as indices of lipid exchange, lipid peroxidation (LPO), and antioxidative protection (AOP). Factor analysis revealed that lipid exchange and LPO-AOP system disturbances played a significant role in the metabolic status of CP patients with total or partial clinico-laboratory remission. There were three variants of these disturbances: an increased serum level of cholesterol (CS) of very low-density lipoproteins (VLDLP), and LPO-AOP disbalance; light hypercholesterinemia, an increased level of VLDLP CS, low-density lipoproteins (LDLP) CS, and a decreased level of LPO-AOP parameters; an increased level of total CS, VLDLP CS, LDLP CS, apoprotein B, and a prominent depression of AOP.

Antioxidants↗
PubMedDate not supplied

[Endovascular Helium-Neon laser irradiation of the blood in the treatment of chronic pyelonephritis].

The authors analyze the condition of free-radical oxidation and activity of antioxidant system, clinical effectiveness of He-Ne laser therapy of patients with chronic pyelonephritis. It is shown that clinical manifestation of the disease is accompanied with activation of free radical oxidation and hypoactivity of antioxidant system. Endovascular laser hemotherapy stimulates antioxidant system, activity of superoxide dismutase, in particular. A good response and immunomodulation are achieved.

Adolescent↗
PubMedDate not supplied

Type B aortic dissection with early presentation mimicking acute pyelonephritis.

Aortic dissection is a life-threatening illness requiring early diagnosis and treatment. Uncommon early presentations mimicking various illnesses can delay diagnosis. This case study describes a 44-year-old woman with type B aortic dissection initially presenting as acute pyelonephritis (APN). Early clinical manifestations were sudden onset of left flank pain, fever, hematuria and pyuria, and following admission, severe abdominal pain, nausea, vomiting, reduced urine output and renal function deterioration. Abdominal computed tomography showed type B aortic dissection complicated with a small bowel infarct, ischemic ascending colon and left renal infarct. Emergency surgical interventions of small bowel resection, ileoduodenostomy and cholecystectomy were performed; a second laparotomy was subsequently performed for anastomosis leakage. The patient died due to septic shock with multiorgan failure. Aortic dissection initially mimicking APN is rare. Accurate early diagnosis of aortic dissection with indeterminate presentation is crucial. Early surgical intervention for visceral organ ischemia is important to preventing morbidity and mortality.

Adult↗
PubMed2006

Sleep and temperature responses of inbred mice with Candida albicans-induced pyelonephritis.

Human patients with renal disease frequently develop disturbed sleep and severe fatigue. To develop a model for studying factors that contribute to these symptoms, we characterized the sleep patterns of various strains of mice after acute challenge with the fungal organism Candida albicans. After intravenous administration to mice, C. albicans typically colonizes the kidney, producing acute pyelonephritis. Various strains of inbred mice demonstrate marked variation in the temperature and sleep responses that develop after challenge, with individual strains generally showing increased or reduced somnolence in association with fever or hypothermia, respectively. C. albicans-infected mice may be a useful model for identifying the genes and mechanisms that link sleep, temperature, fatigue, and the immune response.

Animals↗
PubMedDate not supplied

[Acute gestation pyelonephritis in terms of systemic inflammatory reaction syndrome].

Laboratory indices reflecting phases and level of systemic inflammatory reaction were analysed in 30 patients with acute gestation pyelonephritis (AGP). The patients were divided into two groups depending on clinical manifestations and drainage of the kidney. AGP course runs according to major regularities of systemic inflammatory reaction the analysis of which enables formulation of principles of optimal AGP treatment.

Acute Disease↗
PubMed2006

[Bilateral pyelonephritis and emphysematous cystitis: an exceptional association].

The authors report the case of a patient hospitalized for bilateral pyelonephritis and emphysematous cystitis requiring bilateral nephrostomy. This rare disease occurs in diabetic patients and is essentially due to Escherichia coli and Klebsiella pneumoniae. Treatment consists of antibiotics and renal drainage or nephrectomy. The prognosis is poor with a mortality rate greater than 50%.

Aged, 80 and over↗
PubMed2006

[Secondary pseudohypoaldosteronism in neonates due to pyelonephritis and congenital urinary tract malformations].

We report two cases of neonates with secondary pseudohypoaldosteronism due to pyelonephritis and congenital urinary tract malformations. Both patients presented with failure to thrive, dehydration, severe hyponatraemia and metabolic acidosis. One of the patients also developed severe hyperkalaemia. Secondary pseudohypoaldosteronism may resemble congenital adrenal hyperplasia. Early diagnosis is essential since both conditions, when untreated, are fatal, and treatment of the two differs significantly. Differential diagnosis may be achieved by acute analysis of urine culture and renal ultrasonography.

Diagnosis, Differential↗
PubMedDate not supplied

[Interference currents in combined therapy of chronic pyelonephritis in children].

Investigations performed by the authors proved pathogenetic validity of interference therapy of chronic pyelonephritis in children. A course of interference currents has a positive effect on partial renal functions, excretion of beta2-microglobulin, urodynamics of the lower urinary tract, humoral and cell links of immunity, lipid peroxidation in red cell membranes. Advantages of interference currents impact on the reflex-segmentary zone and urinary bladder projection area in children with concomitant neurogenic dysfunction of the urinary bladder are shown.

Adolescent↗