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On the fifth day of a course of antibiotic therapy for acute Klebsiella pyelonephritis, a 21-year-old pregnant woman developed adult respiratory distress syndrome. She improved rapidly on fluid restriction and intravenous furosemide and did not require mechanical ventilation. 17 weeks later, after 40 weeks of pregnancy, she spontaneously delivered a healthy male infant weighing 3280 g.
In the treatment of one male patient with chronic pyelonephritis, complicated with renal stone, the pathological state of the renal inflammatory lesion was determined. The patient had been persistently infected by the same strain of S. marcescens for more than a year. When he was treated by several antimicrobial agents, the urinary bacteriological response was well correlated to the MICs of each agent. On the basis of the findings obtained, a new index of local antimicrobial activity was proposed. Analysis of such items as strains appearing after treatment, interval of relapse and the identification of the strains relapsed, were suggestive of the renal inflammatory, and pathological conditions. The clinical response also correlated well with the index. The lesion was considered to be mainly localized in the right lower calyx where a tiny stone existed. This disease is considered curable with effective chemotherapy after withdrawal of the stone. This index should be useful for evaluation of the effectiveness of antimicrobial agents.
To determine the role of hypoxia in the evolution of tubular damage in acute pyelonephritis (PN), the blockage of blood flow and injury to peritubular capillaries and tubules were studied morphologically in hematogenous acute E. coli PN of rats. Renal microvessels were stained by in situ intraarterial administration of Alcian blue. The non-occurrence of staining indicated blockage of perfusion. Injury to cortical capillaries and tubules was examined by electron microscope. In areas of inflammation, binding of Alcian blue did not occur in capillaries plugged by polymorphonuclear leukocytes (PMNL-s) and in the majority of glomerules. Ultrastructurally, severe injury to capillaries was found around endothelium-adhered, degranulated PMNL-s containing bacteria: the vessel wall was fragmented, the capillary basement membrane perivascular connective tissue matrix and collagen fibrils had disappeared, and fibrin had deposited intra- and extravascularly. Tubular changes varied from swelling to ischemic necrosis. The observations suggest that tubular damage was related to hypoxia due to preglomerular and capillary perfusion defects, and that PMNL-s injure capillaries via lysosomal enzymes discharged into the capillary fluid during the phagocytosis of bacteria. Since leukocyte plugs in capillaries, PMNL-dependent lytic injury to capillaries and mild ischemic tubular changes, but not ischemic necrosis, have been found in human acute PN previously, the preglomerular vasospasm may cause the tubular necrosis in experimental acute PN.
The quantitative and functional state of different populations of immunocompetent cells was studied in 45 patients with acute serous and 46 patients with acute purulent pyelonephritis. An imbalance has been found in the system of regulatory cells, activation of phagocytosis with reduction of its reserve capacities, disorders of IL-producing capacity of mononuclears and suppression of the functional activity of NK cells.
Intravenous pyelography (IVP) is a common procedure in acute pyelonephritis (APN). In fact, IVP is unable to show the extent of the renal tissue lesions. It only determines the patency of the urinary tract, thus ruling out secondary (i.e. surgical) APN. Modern imaging comprises ultrasonography, CT scan with injection of contrast medium, and cortical scintigraphy using GH or DMSA technetium. These investigations, used separately or in combination, are of considerable interest in the diagnosis, treatment and follow up of acute infections of the upper urinary tract. Such infections entail more severe sequelae (cortical scars) than previously thought.
One hundred and twenty patients (64 men and 56 women, aged 19 to 63) with chronic pyelonephritis were subdivided into two groups: a control group of 30 subjects and an experimental one of 90 subjects. Experimental subjects underwent short wave therapy (460 MHz, 50-60 W, for 8-20 minutes) in the lumbar area. Lumbosacral pain disappeared in 87 out of 90, subjects, intercostal pain in 20 out of 28, headache mitigated in 40 out of 53, asthenia was markedly reduced in 49 out of 50. Systolic and diastolic hypertension was reduced, as well as the Kakorski-Addis count in urine. Diurnal diuresis and lysozyme increased, while IgG, IgA and IgM were reduced.
A Holstein-Friesian heifer had shown a haemorrhagic discharge from the vulva since three days. The animal had delivered a calf nine months previously and was seven months pregnant. On admission, haemorrhagic fluid was obtained by catheterisation from the urinary bladder and by paracentesis from the abdominal cavity. At autopsy, bilateral cysto-uretero-pyelonephritis, associated with peritonitis, was observed. A perforation of one of the lobules of the right kidney was believed to be the cause of the peritonitis. The vesicoureteral reflux might have been enhanced by the presence of polyps in the urinary bladder.
The authors report their experience of forty-two cases of xanthogranulomatous pyelonephritis. They point out the various difficulties of preoperative identification of such diseases by the imaging modalities. They also discuss the main pathogenic hypotheses proposed in the literature.
The authors report the case of a 20 year old patient in whom the clinical findings combined with the radiological signs, suggested the diagnosis of renal cancer. The histological findings after nephrectomy established the diagnosis of xanthogranulomatous pyelonephritis. This disease may rarely give the appearance of a renal tumor. This points out the importance of identifying this lesion in preoperative staging to avoid carcinologic surgery and all of its difficulties.
The activity of N-acetyl-beta-D-glucosaminidase (NAGase) activity was determined in urine of patients with pyelonephritis and glomerulonephritis. Determination was done with the non-commercial "Boehringer-Mannheim" test reagents for research purposes only. The protein concentrations were measured in the same samples. The obtained results were compared with results obtained in the control group and the significant increase (p less than 0.001) in NAGase activity was found in both groups of patients. At the same time normal protein values were found in 33% of all cases. It can be concluded that NAGase is a more sensitive parameter for early detection of renal disease.
Although urine cultures are performed routinely in managing acute pyelonephritis in pregnancy, little is known about the clinical usefulness of these cultures. The same is true for blood cultures. To evaluate their role in managing patients, we reviewed the records of 156 cases to determine to what extent such cultures influenced treatment. Over 90% of urine isolates were sensitive to the initial antibiotic. Most changes in therapy were based on clinical response; only 3% of pre-treatment urine cultures and 2% of blood cultures led to a change in antibiotics. On a nationwide basis, urine and blood cultures cost $10-20 million each year. Our data suggest that more limited use of cultures will simplify management and save money without compromising patient care.
Eighteen patients with senile pyelonephritis and nephrogenic arterial hypertension were examined for the effect of trental monotherapy (600 mg/day) on intrarenal hemodynamics, the rate of glomerular filtration (effective renal blood flow, the intensity of blood flow in the medullary layer of the kidney), activity of the renin-angiotensin-aldosterone system (plasma renin activity, plasma and urine aldosterone), prostaglandin synthetic capacity of the kidneys (PGE and PGF2 alpha), water-electrolyte balance (circulating blood volume, sodium content in the serum and its excretion with urine), and on arterial pressure and general vascular peripheral resistance. Prolonged administration of the drug (from 3 weeks to 6 months) led to a significant improvement of the medullary blood flow, increase (p less than or equal to 0.05) of excretion of natriuretic PGE [correction of RGE] and lowering (p less than or equal to 0.05) of diurnal excretion of PGF2 alpha, which was accompanied by a rise of natriuresis (p less than or equal to 0.05) and diuresis.
Overall 162 patients with chronic pyelonephritis (CPN) were examined. The control group was made up of 47 practically healthy subjects. Conventional research methods were employed in the diagnosis of CPN. The status of the main substance of connective tissues and collagen structures was estimated by measurements of the content of glycosaminoglycans, hydroxyproline and their fractions in the blood serum and urine. Cellular and humoral immunity was also investigated. It has been established that in the presence of a clinical remission, the lack of the urinary syndrome, bacteriuria and acute-phase inflammation tests, glycoaminoglycanuria, hyperhexosemia, abnormal metabolism of collagen structures, and high concentration of IgA and IgM remained unchanged. The data obtained indicate that in patients with CPN, the changes of connective tissue metabolism, cellular and humoral immunity are of unidirectional nature, which can serve an objective enough criterion for the efficacy and duration of the treatment.
The paper reports on a case of chronic pyelonephritis with bacillus Proteus, generated by an intravesical foreign body (sewing needle). The needle was extracted with surgical cystoscope. After removing the foreign body, nalidixic acid was administered. The immediate evolution of the case was good.
The authors used monoclonal antibody (CD3, CD4, CD8) and indirect immunofluorescence technic to study peripheral blood lymphocyte surface markers in patients with chronic pyelonephritis (CPN) and in normal controls. In CPN patients, a significant decrease in CD3, a lower percentage of CD4 and significant higher percentage of CD8 leading to a decrease in the CD4/CD8 ratio were noted. No differences could be observed between Spleen-Kidney Yang deficiency and Kidney Yin deficiency. The overall picture shown by the CPN patients was compatible to a cell-mediated immune response defection. The CPN patients were then treated with Zi-Ling capsule (ZLC)/transfer factor (TF) and various antibiotics for three months, during which period the authors found a significant increase in CD3, CD4, but no significant change in CD8. Symptoms such as lumbago, fatigue, frequency of urination were improved. A significant decreased in CD4 after cessation of treatment with ZLC and TF was observed. These observations suggested that both ZLC and TF could also improve the immune function, however, they mainly affect CD4 but not CD8 cells, and the effect lasted for only a short period. In conclusion, ZLC/TF and antibiotics administered together would serve as a useful therapeutic measure to be recommended for patients with CPN.
The urographic, angiographic, sonographic and computed tomographic findings in 4 cases of xanthogranulomatous pyelonephritis are presented along with correlation with the pathological specimens. The parenchyma of the kidney was replaced by multiple, rounded, low-density respectively hypoechogenic areas on CT and sonography that corresponded to dilated calices and/or inflammatory tissue. For diagnosing the characteristic extrarenal extension of the disease sonography was not as accurate as CT.
Urinary excretion of N-acetyl-beta-glucosaminidase (NAG) was measured in random urine as the ratio of NAG to grams of urinary creatinine in 120 normal Chinese children. The results showed that the NAG was elevated in newborn babies and infants, and decreased to adult level after two years of age. Thirteen children with urinary tract infection, who were clinically suggested or proved to have pyelonephritis, were evaluated for their urinary NAG excretion. The level of enzymuria at diagnosis in these patients was significantly higher than that of normal children for age. Eleven longitudinal follow-up data including levels at diagnosis, end of treatment, and two to four weeks after treatment showed that the mean urinary NAG at diagnosis was 109.82 +/- 87.30 u/g creatinine, compared with 75.26 +/- 48.82 u/g creatinine at the end of treatment and 15.37 +/- 9.69 u/g creatinine after recovery. These data suggest the presence of renal tubular cell injury in upper urinary tract infection. Thus urinary NAG may play a role in differentiating lower from upper urinary tract infections.
We are reporting 2 cases of xanthogranulomatous pyelonephritis in boys of 7 and 2 year-old. The inflammatory lesion had extended to perirenal tissues and appeared as a lumbar abscess in case 1. The kidneys affected were diffusely compromised by the lesion. Both cases showed Proteus mirabilis after microbiologic cultures. Definitive diagnosis was done by pathology examination. Nephrectomy was curative.