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The presence of intramural gas in the urinary bladder is rare and gas in the kidney is also rare. Our patient had both conditions. We have not seen these two rare conditions ever described in one patient. Both conditions are commoner in diabetics. Nephrectomy was resorted to after unsuccessful antibiotic treatment of the emphysematous pyelonephritis.
The interrelation between transplantation antigens of the HLA system and predisposition to acute pyelonephritis (PN) were studied in 81 patients, of them 36 with acute serous PN and 45 with acute purulent PN. HLA phenotype was identified with a routine lymphocytotoxic microtest in which a home-made typing panel of HLA antiserum to antigens of A and B loci was used. 150 healthy donors were subjected to control typing. Variance in HLA frequency reliability in patients and controls was verified with chi 2 criterion for tables 2 X 2. The study demonstrated higher frequency of B8 and B14 and lower of Aw19 and B35 antigens in patients with PN versus the healthy controls. Differential analysis with regard to the clinical course of the disease revealed that predisposition to acute serous PN was associated with the occurrence of A3 and B14 antigens while A10 and B8 antigens were indicative of acute purulent PN. It has been stated that purulent PN is developing in presence of secondary deficiency of T and B immune systems. Cross-reacting antigens B14 and B8, as well as splitting antigens A10 and A25 lend more ground to varying clinical course of the disease. HLA antigen B35 is found associated with the development of acute PN resistance.
The authors report one case of one case of xanthogranulomatous pyelonephritis associated with very extensive fatty proliferation in the renal space. This mass surrounded a small, pyelonephritic kidney with a considerable xanthomatous component containing a coral calculus. It was associated with a streaming abscess in the lumbar fossa. The computed tomography (CT) and magnetic resonance imaging (MRI) features are described in this article.
Based on the examination of 1050 patients the authors make a conclusion of great significance of renoscintigraphy, ultrasonic scanning and thermography for differential diagnostics of acute pyelonephritis, acute cholecystitis and pancreatitis.
Kinetic parameters (Km and Vmax) of renal brush border membrane (BBM) enzymes alkaline phosphatase, maltase, leucine aminopeptidase and gamma-glutamyltranspeptidase were worked out in control, infected and immunized-infected rats. There was no significant change in the Km of all the enzymes studied in three groups. The Vmax of all the enzymes studied decreased significantly (p less than 0.05) 3 or 4 days postinfection and onwards in the left obstructed kidney of infected and immunised-infected animals. However, in the right unobstructed kidney the Vmax of alkaline phosphatase and leucine aminopeptidase increased significantly (p less than 0.05) in the early stages and decreased (p less than 0.05) in later stages in both the experimental groups. The significant difference (p less than 0.05) in the Vmax of infected and immunized-infected groups at various stages of infection revealed the partial protective role of antipili antibody against ascending pyelonephritis.
The paper is devoted to a very important problem of immune mechanisms participation in the origination and maintenance of the inflammatory processes in kidneys and urinary ducts. The results from the study of lymphocyte subpopulations, making use of monoclonal antibodies in patients with clinical-laboratory data about chronic pyelonephritis without chronic renal insufficiency, as compared with healthy controls, are reported. Significantly reduced total T-lymphocyte (OKT1+) were established as well as T-helpers lymphocytes (OKT4+) and increased number of monocytes (OKM5+). The values are presented as weighted geometrical mean. A likely interpretation of those data is rather difficult at the present stage.
It is reported on a 25-year-old female patient suffering from chronic pyelonephritis. Six times coagulase-negative staphylococci were bacteriological proved in a significant number. Four strains were identified as Staphylococcus saprophyticus. The in each case in the autumn occurring complaints could be correlated well with the seasonal fluctuations of urinary tract infections by S. saprophyticus as described in the literature. Chemotherapeutic measures be determined by the clinical symptoms and subjective complaints of the patient. By an antibiotic therapy only a temporary loss of complaint and normalization of urinary findings, respectively, were obtained. In the presence of a marked leukocyturia a capsula-fashioned variant of S. saprophyticus was established. By scanning electron microscopy investigations fimbria-like surface structures were detected for the first time in this germ species. Three morphological different appendage structures are described. By a hypothetical model possible functions of these structures in the adherence process are discussed.
We report five cases of renal parenchymal malakoplakia. They represent a histologic spectrum of this uncommon inflammatory process as it involves the renal parenchyma. Only one of these five cases presented the classical histologic picture of malakoplakia ("diagnostic stage"). Two cases--although with similar cellular infiltrate--had a marked paucity of Michaelis-Gutmann bodies and thus might have been classified as megalocytic interstitial nephritis were it not for the identification of such calcific intracellular inclusions under the electron microscope. The fourth case presented a pseudosarcomatous morphology and is similar to what has been described as a late or fibrous stage in malakoplakia of the urinary bladder. The last case had a destructive, frankly granulomatous histologic picture with a preponderance of foamy histiocytes reminiscent of xanthogranulomatous pyelonephritis, but with clusters of von Kossa-positive Michaelis-Gutmann bodies. The last two forms of the disease have not been previously reported to occur in the kidney. We believe that these cases represent various stages of development of the disease.
Eighteen children with acute pyelonephritis were investigated by urography at the time of and about two months after the acute infection. Renal size was evaluated as renal length and parenchymal area. During the acute infection renal size was larger than at the follow-up examination two months later. In conclusion, urography performed in close connection with the acute pyelonephritic infection gives an overestimation of renal size.
An 11-year-old boy suffered from malaise, weight loss and pallor. A palpable abdominal tumor on the right side, anemia and increased C-reactive protein were detected. Intravenous urography revealed destruction of the right kidney resembling Wilms tumor. But ultrasound and computered tomography rised skepticism. Analysis of previously documented cases suggests that xanthogranulomatous pyelonephritis must equally be considered in a child with unilaterally enlarged kidney without function, especially when the child shows fever, leukocytosis, bacteriuria, anemia, leukocyturia, calculi of the urinary tract, abdominal pain and/or a palpable abdominal tumor. Ultrasound and computered tomography can lead to the diagnosis, and identify extrarenal infiltration. Nephrectomy results in complete cure and is therefore the treatment of choice.
Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of granulomatous inflammation characterized by destruction of the renal parenchyma and replacement by solid sheets of lipid-laden macrophages. The first report was made by Schlagenhaufer in 1916. Due to diagnostic difficulties, relatively few cases have been reported. However, within the past 20 years, XGP has been recognized with increasing frequency. At present, over 400 cases have been reported. Recently, the computed tomographic (CT) findings of XGP have been described in a few sporadic case reports (1-4). Our clinical experience consists of 8 cases of XGP. The sonographic and computed tomographic findings in our cases are presented along with the correlation with the pathological specimens. We stress the importance of sonography and CT in preoperative planning. Moreover, in our cases we could obtain typical findings on sonography and CT, which enabled us to make a correct preoperative diagnosis. In this report we describe some specific features.
Metastatic adenocarcinoma, involving the trigone of the urinary bladder, resulted in bilateral pyelonephritis and hydroureter in an aged dog. Salient physical examination and clinicopathologic findings included bacterial urinary tract infection, renal pain response to abdominal palpation, and the observation of WBC casts in urine sediment. A good response to antimicrobial drug administration was observed initially; however, the dog later was euthanatized because of progressive renal disease. Necropsy revealed extensive peritoneal carcinomatosis with metastatic lesions causing occlusion of both ureters. Ostensibly, metastatic carcinoma involving the trigone resulted in urine stasis and enhanced the development of renal infection and hydroureter.
The authors describe a rare case of this disease that has clinically manifested in a 12-days-old boy. At the age of 1.5 months a right-side nephrectomy for a supposed Wilms' tumor has been performed. Histologic examination has diagnosed congenital xanthogranulomatous pyelonephritis. The authors put forward a hypothesis on the existence of primary forms of this condition not associated with persistent infections or urinary tract obstructions.
Studies to determine the effect of kidney parenchymal infection upon urinary lactic dehydrogenase (ULDH) isoenzyme composition were performed in 12 female Sprague-Dawley rats on Day 0 and on Days 2, 5, and 10, after experimental inducement of Escherichia coli pyelonephritis. An additional group of 12 animals was subjected to similar experimental manipulations and served as sham controls. Repeated 12-h urine collections revealed lower urine osmolalities and significantly higher levels of ULDH 5 excretion in the experimental than in the sham operated animals (P less than 0-05). These differences persisted for the length of the experiment (10 days). Leucocyte excretion rates were also higher in the experimental than in the sham group, and a high correlation with ULDH 5 activity was demonstrated (r = 0-815). No other evidence that the two variables may be causally related was found.
Lobar nephronia, although initially indistinguishable from acute pyelonephritis, is characterized by a prolonged febrile course. The diagnosis is established radiographically using computed tomography. Treatment involves continuation of antimicrobials until the patient has been afebrile for 48 hours. Lobar nephronia has not been previously reported with pregnancy.
Urinary tract infections are a common problem for women and frequently result in a visit to the Emergency Department. Most of these infections are easily diagnosed and treated; however, subclinical pyelonephritis is a recently recognized entity and signs of upper tract involvement should always be sought, especially in compromised hosts and patients who are at risk for developing complicated infections. Each of these situations demands a more thorough evaluation and more prolonged and aggressive treatment to minimize the possibility of renal damage. Fortunately, there is a narrow spectrum of organisms responsible for most urinary tract infections, and they respond well to a wide range of commonly used antibiotics. Newer diagnostic techniques, the acceptance of short-course therapy for lower tract infections, and the development of new antibiotics have increased our diagnostic and therapeutic options. Further developments in these areas, as well as the possibility of nonantibiotic prevention of urinary tract infections, predict a brighter future for patients with complicated or frequently recurring urinary tract infections.
Unilateral acute pyelonephritis were produced in rabbits by injecting E. coli, using the retrograde route and after a temporary ureteral obstruction. Animals were treated with ceftriaxone IM at a dose of 50 mg/kg/d and 100 mg/kg/d (corresponding to 1 g/d and 2 g/d in humans) either by a single daily injection or by two daily injections at 12th intervals. Sacrifices were performed at day 5 and 7 of therapy. Analysis of bacteriological, morphological and histological data obtained in infected kidneys demonstrates that the single daily injection of ceftriaxone is more effective than the same dose divided in two injections at 12 h intervals. These results are observed as well with low and high doses of ceftriaxone.
Pharmacokinetics and characteristic features of ampicillin kidney distribution were studied in 21 children with chronic pyelonephritis without signs of renal insufficiency who had undergone urological operations. It was found possible to provide the antibiotic concentrations efficient against ampicillin sensitive and partially middle sensitive microorganisms in the renal parenchyma, pelvis wall, ureterocele, megaureter and urinary bladder. Ampicillin concentrations in tissues of the urinary system were shown to correspond to a higher extent to the concentrations attained in blood than those in urine.