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The analysis of observations on 36 patients is presented. Anuria complicated by acute pyelonephritis is considered as an acute surgical pathology requiring emergency operative intervention. The suggested tactics for complex examination and treatment of the patients contributed to decrease in the postoperative lethality down to 5.9%.
The appearance of intestinal fistulas secondary to kidney disease is a rare occurrence. Even rarer are complex fistulas involving several organs or systems [correction of apparati]. In this study, the authors report on a case of reno-colo-cutaneous fistula which set in as a complication of xanthogranulomatous pyelonephritis.
We report on two cases of xanthogranulomatous pyelonephritis (XGP) in children. In one patient preoperative diagnosis could be made on the basis of computerized tomography. Although XGP is a pathology diagnosis, new imagine techniques should allow its suspicion in a growing number of cases. This unusual disease should be suspected in from of a IVP showing non-functioning kidney specially when associated with urinary infection and/or lithiasis. Nephrectomy should be performed in all cases.
Polypoid cystitis, pyelonephritis, and obstructive uropathy was found in a cow with hematuria, dysuria, and colic. The cow was treated with penicillin, multiple B vitamin supplementation, and isotonic sodium chloride. Polypoid cystitis, diagnosed in this cow by use of endoscopic examination, is a common response to chronic inflammation of the bladder and can lead to obstructive uropathy. Although endoscopic confirmation of this diagnosis may not always be feasible, recognition of corresponding clinical signs can allow timely, appropriate treatment.
The results are presented of anaemia treatment during pyelonephritis in 20 children with the preparation obtained from animal blood livex. The preparation was administered for eight weeks. After the treatment of a statistically significant rise was observed of haematocrit and haemoglobin concentration. No adverse effects of the preparation were observed.
Twelve cases of xanthogranulomatous pyelonephritis (XGPN) complicated by urolithiasis in upper tract were presented in this study. Fifty-four cases of XGPN, including 12 cases of this study, reported in China were clinically analysed in the article. All cases were with one suffered kidney, 57.4% of the cases had both XGPN and urolithiasis, 27.8% had the history of urinary infections, 99.0% had function-impaired kidney or renal failure. XGPN was frequently mis-diagnosed as renal cancer, renal tuberculosis and renal abscess etc. The diagnosis and treatment of XGPN are discussed.
Eight pediatric cases of the diffuse form of xanthogranulomatous pyelonephritis are reported. These patients were selected among 17 with destruction of one kidney. Clinical symptoms were suggestive of a tumor in some instances. However, an infectious etiology was strongly suggested by the presence of a renal lithiasis in seven cases (including five staghorn stones) and of a urinary tract infection in six cases (usually caused by a Proteus). Nephrectomy was performed in every case.
The authors report on a case of a emphysematous pyelonephritis due to Klebsiella pneumoniae, occurring in a diabetic patient and successfully treated by nephrectomy. They compare it to the literature.
In acute "primary" pyelonephritis (APP), kidney infection occurs despite normal urinary tract morphology. Typical features of APP are spiking fever and chills, loin pain, pyuria, bacteriuria, isolation of uropathogenic strains of E. coli, and specific renal CT scan images. APP may be atypical when lacking pain, or fever, or when urine cultures are negative, or when urinary bacteria do not exhibit characters of uropathogenicity, or when CT scan examination is negative. Such atypical features entail loss of time in diagnosis, and thereby delayed treatment and increased risk of cortical scar formation. However, they are virtually never observed simultaneously in a given patient.
Renal function was investigated in a group of ten patients aged two months to eleven years, with chronic or recurrent urinary tract infection caused by different malformations of the urinary tract. The following tests were performed: endogenous creatinine clearance, maximal urinary concentrating ability, urinary acidification, maximal urinary diluting ability, free water clearance, index of fractional distal sodium delivery and index of distal tubular reabsorption of sodium. It is concluded that the follow-up of glomerular function by means of creatinine clearance and of tubular function by means of maximal concentrating ability consitute the most sensible way to detect renal functional impairment in children with chronic or recurrent pyelonephritis.
Diagnostic potentialities of the crystallo-optic++ analysis of cupric chloride crystallographs++ were studied in 76 children with pyelonephritis and in 50 children with glomerulonephritis. The structural and morphological characteristics of cupric chloride crystallization under the influence of the urine from children with pyelo- and glomerulonephritis may serve as the additional differential-diagnostic signs of the diseases. The use of raster electron microscopy widens the diagnostic potentialities of the crystallographic method. Different dimensions of the little crystals formed as a result of isomorphic replacement of copper atoms by potassium ions (and, possibly, by sodium ions) and in the presence of urea and creatinine underlie the differences in cupric chloride crystallographs.
One case of xanthogranulomatous pyelonephritis diagnosed following nephrectomy is described, considering its outstanding characteristics such as male adolescent, right kidney, involvement with normal function and without pathological history for which there is no explanation to date. This disease usually occurs in women 60 years or older, suggesting a renal tumor. In 50% of the cases, urine cultures are positive for Escherichia coli or Proteus mirabilis; in accordance with different reports renal tissue cultures are positive in more than 90%. Malnutrition, calcification, urolithiasis and renal failure with hydronephrosis are common findings. The left kidney is more frequently involved. The etiology is unclear: many hypotheses are discussed, with malnutrition and peroxidase deficit as important causes.
Experimental results of the present study evidenced the following aspects: a) the antigen, prepared from type I Escherichia coli purified fimbriae (H. 2946 strain), induced immunity at urinary tract level; b) the immunoprotection induced by oral vaccination with multiple doses of fimbriated antigen produced a significant decrease of acute pyelonephritis in newborn guinea pigs and at the same time, a local protection of the urinary tract; c) the immunoprophylaxis by vaccine prepared from fimbriae represents a preferential solution for urinary tract infections prevention in general and especially in children; d) the frequency distribution differences between "protected" and "non-protected" animals were evaluated by chi-square--test with YATES correction and proved to be statistically significant at probability levels.
A total of 40 children who suffered from acute or chronic pyelonephritis underwent immunological treatment with polypeptide drug tactivin. There was an evidence of clinical and laboratory improvement in 82.5 per cent of treated persons, first manifest in decreased proteinuria and normalized urinary sedimentation, and then in lower levels of bacteriuria due to the developing resistance to infectious agents. In 15 per cent of tactivin-treated children leukocyturia persisted though the disease progression was hindered. In the course of the treatment no side-effects were noted. In line with the stimulation of humoral immune response and activation of the complement system, tactivin administration evoked the competence of T-lymphocytes and potentiated the development of this link of immune system. As part of combined treatment the above preparation favourably affected the disease pathogenesis in children.
Fistulization is an uncommon complication in Xanthogranulomatous Pyelonephritis, but harmful for the adjacent organs. Owing to their rare localization we present 6 cases with scrotal skin, bronchi, colon and spleen fistulization.
To optimize the therapeutic approach to acute pyelonephritis (PNA), the medical records of 89 patients (73 women and 16 men) hospitalized with diagnosis of PNA between January 1984 and 1987 have been studied. According to routine bacteriological urinalysis, gram-negatives were found in more than 92% (E. coli in 79%, Proteus in 6%). Gram-positives were found in only 8%. The gram-negatives (n = 82) showed resistance to amoxicillin in 36%, to amoxicillin/clavulanic acid in 17%, to cotrimoxazole in 18%, and to ceftriaxone in 1%. No resistance to netilmicin or norfloxacin was found. These results justify treatment with norfloxacin or ceftriaxone instead of amoxicillin, amoxicillin/clavulanic acid or cotrimoxazole for gram-negatives. Among the 7 cases with gram-positives, resistance was found to amoxicillin/clavulanic acid, cotrimoxazole and also netilmicin, and to norfloxacin, ceftriaxone and amoxicillin. Therefore, an initial therapy using the association amoxicillin-netilmicin is recommended in PNA.
The authors studied the renal plasma flow, glomerular filtration, indices of osmoregulating and ion-regulating renal function in 382 patients with hydronephrosis. Regularities of functional changes in the absence of infection, pyelonephritis and nephrolithiasis with uni- and bilateral processes and hydronephrosis of the single kidney.
UNLABELLED: A study is presented of 79 patients with acute and chronic pyelonephritis examined by means of dynamic calorimetry and contact thermometry. Thermal asymmetry of the lumbar region were revealed in 22 patients by means of contact thermometry. Dynamic calorimetry revealed changes of the transitional process in 75 patients as compared with the control. CONCLUSION: the method has a diagnostic value.