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PubMedDate not supplied

[Activity of proteolytic enzymes and trypsin inhibitor in blood serum and kidney in pyelonephritis].

In 116 patients with acute and chronic pyelonephritis and in 66 healthy persons the total proteolytic, trypsin-like, catheptic, BAEE-esterase activities and the content of trypsin inhibitor were determined in blood serum and kidney tissue. The total proteolytic and catheptic activities were distinctly increased in blood serum and, especially, in kidney tissue under acute pyelonephritis. In chronic pyelonephritis the activity of cathepsins was decreased in blood serum. The trypsin-like activity tended to decrease both in blood serum and kidney. The BAEE-esterase activity was increased in kidney, particularly in acute pyelonephritis, but in blood serum it was decreased. The inhibitor of trypsin was not found in kidney; in blood serum its content was slightly increased in acute pyelonephritis but there were only slight alterations in the chronic disease.

Acute Disease↗

PubMed1990

[Echographic dynamic control of the urinary system and fetal development in pregnant women with acute pyelonephritis].

Ultrasonography in 52 pregnant women with acute pyelonephritis has been found to be a useful marker of efficacy of aggressive care. Reversal of inflammation in acute pyelonephritis without an associated disease reduced the kidney size and restored urine flow by the end of the 7-9th day of therapy. In pyelonephritis coexisting with nephrolithiasis, reversal of inflammation did not completely restore urine flow until a stone in the urinary tract was passed or surgically removed. The clinical patterns of pyelonephritis were elucidated in congenital renal malformations. The urine flow was completely restored and kidney sizes were maximally contracted postpartum. With an early therapy, the fetal development was appropriate for gestational age. Frequently relapsing pyelonephritis concomitant with toxemia or severe congenital renal disease led to intrauterine growth retardation.

Acute Disease↗

PubMed1990

[The quantitative analysis of the x-ray changes in the kidney calices in chronic pyelonephritis in children].

As many as 89 patients aged 6 months to 14 years with microbial inflammatory diseases of the urinary tract and 40 controls of the same age were examined. Of the patients, 55 had chronic pyelonephritis, 21 acute pyelonephritis, and 13 an infection of the urinary tract. For examination use was made of the planimetric method of measuring the width of the fornix and the cervix of the renal calyces on excretory urography. The fornicocervical index, product of the indicated parameters of the calyces, was computed. In health, that index did not exceed 24 units. In the majority of patients suffering from chronic pyelonephritis, it turned out higher. The false negative results were obtained in 7 cases. The fornicocervical index remained unchanged in patients with acute pyelonephritis and urinary tract infection. It is suggested that the fornicocervical index be computed for use as an objective criterion in the diagnosis of chronic pyelonephritis in children.

Adolescent↗

PubMed1987

Cellular basis of host defence in pyelonephritis. III. Deletion of individual components.

Hosts were depleted of individual cellular components to determine the effects of these manipulations on cellular defence mechanisms in acute and chronic pyelonephritis. T-lymphocytes were found to have little or no involvement in host protection but cyclosporin A administration had a dramatic effect on the gross pathology and bacteriological status of experimentally induced pyelonephritis. This change represented a major depression of host defence status. Cyclosporin A also activated resolved lesions in chronic pyelonephritis, associated with an increase in bacterial numbers. Administration of antineutrophil serum also led to a 1000-fold increase in bacterial numbers in the acute phase but had little effect on the host-parasite balance in chronic pyelonephritis. Macrophage blockade, on the other hand, did not affect the course of either acute or chronic infection. These studies have provided additional information on the immunobiology of experimental pyelonephritis and have focussed attention on the role of neutrophils, and an unidentified mechanism, affected by cyclosporin A, in host defence to renal infection.

Animals↗

PubMed1988

[Effect of immunization with Escherichia coli J5 on the course of experimental pyelonephritis in rats].

Among the germs of urinary tract infections is a great heterogenicity. Therefore, in search of vaccine candidates of pyelonephritis such germs must be checked the antigens of which to be occurred as much in other pyelonephritis germs as possible. E. coli J5 as a re-mutante of E. coli O111 has a core-antigen which is found in the most enterobacteria. We have examined whether a pyelonephritis in rats was prevented by prophylactic use of a E. coli J5 vaccine and if the course of the disease was influenced by vaccine treatment of animals with pyelonephritis, respectively. Neither a pyelonephritis was prevented nor an existing infection was influenced favourable by the vaccine of E. coli J5.

Animals↗

PubMed1986

[Incidence of antibody-coated bacteria in patients with chronic pyelonephritis].

Of 168 urine sediments, which were obtained from 55 patients with chronic pyelonephritis in the course of 3 years when a significant bacteriuria with E. coli was present, we demonstrated antibody-loaded bacteria in 81 cases (48.21%). In the active stage of the disease with 54.10% were found significantly more than in the inactive with 32.61%. In obstructive chronic pyelonephritis the positive rate was 54.79% in contrast to 43.16% in non-obstructive chronic pyelonephritis. While in the active stage of the obstructive chronic pyelonephritis with 57.41% more antibody-containing bacteria were excreted than with 47.31% in the inactive stage, the positive rate in the active stage of the non-obstructive chronic pyelonephritis was with 54.47% significantly increased in contrast to 22.22% in the inactive stage. 25.71% of the patients excreted only ACB+-, 34.29% only ACB(-)- and 40% ACB+- and ACB(-)-germs in the course of the disease. The ACB-positive quote was in rough forms with 62.50% statistically significantly increased in contrast to 45.54% in O-typable and 42.86% in non-O-typable strains. In the ACB+- group the immunofluorescence titres to the homologous strain and the C3-activator in the serum as well as the urine lysozyme were significantly higher than in the ACB(-)-group.

Antibody-Coated Bacteria Test, Urinary↗

PubMed1986

[Defense mechanisms of the macro-organism in bacteriuria in chronic pyelonephritis].

In the course of 4 years we isolated 193 E. coli strains of 55 patients with chronic pyelonephritis. In patients with obstructive chronic pyelonephritis the mean value of the immunofluorescence titre (in the serum) to the E. coli strain excreted in the urine as well as the total complement were significantly increased, the serum lysozyme was significantly lower than in patients with non-obstructive chronic pyelonephritis. A relation to the activity of the disease was existing only in the non-obstructive chronic pyelonephritis, where in the active stage the total complement was significantly decreased, the complement factors C3 and C4 as well as the urine lysozyme were significantly increased in comparison to the inactive stage. 94.64% of all immunofluorescence titres obtained to the homologous strain in the patients' serum were above the border of the normal area of 1:40. A relation between level of the titre and activity of the disease could not be established. No significant differences could be proved between the titres taken to serum-sensitive and serum-resistant strains. In 32.73% of the patients we observed disturbances of the serum bactericidia against the homologous serum-sensitive E. coli urine strain at one or several points. They fall to equal shares to patients with obstructive and non-obstructive chronic pyelonephritis and were found at 66.67% in the active stage of the two forms of the disease. In patients with and without disturbances of bactericidia no significant differences in the total complement, in the complement factors C3 and C4, the C3-activator, the serum lysozyme and the immunofluorescence titres could be proved.

Antibody Formation↗

PubMed1986

[Microcirculatory and hemostatic disorders in calculous pyelonephritis patients].

The state of microcirculation and the system of hemostasis were studied over time in 52 patients with chronic calculous pyelonephritis. Investigations were performed before operation, after 2-4 days, 5-7 days and on discharge. The patients were divided into 2 groups: with chronic pyelonephritis in the phase of active inflammation and with chronic pyelonephritis in the phase of remission. Marked disorders in the system of hemostasis characterized by hyperfibrinogenemia, thrombinemia, a decrease in the heparincofactor plasma activity, activation of platelet hemostasis, a decrease in CPa-dependent fibrinolysis were noted in the patients with calculous pyelonephritis in the phase of active inflammation. These shifts were combined with disorders in the microcirculatory system: intermittent blood flow and disseminated erythrocyte aggregation, a prolonged period of nuclide half-life in the intracutaneous depot. In the patients with calculous pyelonephritis in the remission phase shifts in the system of hemostasis were less noticeable, microcirculatory disorders were undetectable.

Adult↗

PubMed1979

[Primary pyelonephritis (the focal problem)].

On different experimental models of pyelonephritis in dogs and rabbits an experiment for the classification of the pathogenesis of this disease with the special questioning of the possible development of the so-called primary pyelonephritis was performed. A series of experiments consisted of 3 groups: 1. Injection of an E.-coli-suspension into the musculature of the urinary bladder of dogs and rabbits. 2. Injection of an E.-coli-suspension into the testicles of rabbits. 3. Injection of an E.-coli-suspension into the seminal bladders of rats. The experiments lasted 2 to 15 days and 16 to 110 days, respectively. In the second series of experiment in rats and rabbits an E.-coli-suspension was injected into the gall-bladder of rats and rabbits. Bacteriologic blood cultures and histologic investigations of the kidneys, the ureters, the wall of the urinary bladder and the adjacent lymphatic and fatty tissue as well as of the gall-bladders were performed. The results showed that the pyelonephritis developed secondarily after the infection of the other infected organs by haematogenic or interstitial dissemination of the pathogenic agents. Conclusions are drawn: 1. Every pyelonephritis, also the haematogenic, is a secondary process. 2. Therefore all must be done to find out the primary inflammatory change in the organism and to cure it. 3. Severe forms of the pyelonephritis may, on the other hand, effect as focus and evoke in inflammation of other organs on lymphogenic and haematogenic way. 4. Taking into consideration the facts mentioned perhaps the great number of pyelonephritiides having become latent might be reduced.

Animals↗

PubMed1985

[Direct bacteriological studies of patients with calculous pyelonephritis].

The authors report their observations on the bacteriological studies in 115 patients with chronic calculous pyelonephritis. Intraoperatively, pelvic urine and biopsic material was taken from the pyelonephritis changed areas of the kidney and directly inoculated upon enriched nutrient medium "Difco" Later, inoculations were carried out on solid nutrient media. A total of 225 bacteria of 8 species were isolated. Bacteria were present in pelvic urine or in kidney punched-out material of all patients with calculous pyelonephritis, often--in both places. In 52.2% of the cases the bacteria established in both the places were identical, and in the rest of the cases--different or association of the same with another bacterium. An attempt was made to explain that phenomenon. E. coli, Pr. mirabilis and Staph. aureus were most frequently isolated. Consideration given to the observations, the authors recommend active uroantiseptic therapy in case of clinic of exacerbated chronic calculous pyelonephritis evan in case of sterile urine, as well as not very strict observation of the requirements of antibiogram with bacteriuria established. The experience of the inclusion of antistaphylococcal treatment is indicated in case of a picture of urosepsis in patients with chronic calculous pyelonephritis even in the absence of the isolated Staph. aureus from urine.

Adult↗

PubMed1979

Radiographic findings in induced bacterial pyelonephritis in dogs.

Unilateral bacterial pyelonephritis was induced in nine dogs. The upper urinary tracts of these and six control dogs were evaluated by excretory urography prior to and 9 to 10 days following experimental manipulations. Two of the dogs with unilateral pyelonephritis and one control dog were evaluated at intervals throughout a 58-day period. At necropsy, all nine inoculated kidneys were infected, one experimental dog had bilateral pyelonephritis, and one control dog had unilateral pyelonephritis. Most of the infected kidneys had abnormal radiographic changes 9 to 10 days after induction of infection. There was no statistically significant radiographic change in size of infected kidneys at 9 to 10 days. Seven of the 11 infected kidneys and 7 of the 9 inoculated kidneys had renal pelvic and ureteral dilatation. Of the nine dogs with unilateral pyelonephritis, six had decreased opacity of contrast medium in the collecting system and of the vascular nephrogram on the infected side. The size of infected kidneys decreased progressively during the 58-day period. In one of the two dogs evaluated throughout the period, the collecting system of the infected kidney remained dilated; in the other, it returned toward normal size.

Animals↗

PubMed1978

[Pathologic features in diagnosis and differential diagnosis of pyelonephritis (author's transl)].

Morphological diagnosis and differential diagnosis of pyelonephritis are discussed particularily considering macroscopic features. A special form with radiological significance is ncrotizing "emphysematous" pyelonephritis. Chronic non-obstructive pyelonephritis is rarer than formerly thought if strict morphological criteria are applied. It should be differentiated from nephropathy caused by analgetics. In analgesic nephropathy bilateral papillary necrosis is the earliest and most characteristic alteration. Differentiation between chronic pyelonephritis and analgesic nephropathy is possible in most cases but may be difficult if analgesic nephropathy is complicated by bacterial infection. A classification of "unilateral small kidney" is presented. Unilateral acquired "renal shrinkage" should be differentiated from congenital "unilateral hypoplasia". It remains to be discussed whether the so-called "Ask-Upmark-Kidney" is a malformation or the result of chronic pyelonephritis.

Acute Disease↗

PubMed1996

Technetium-99m-DMSA renal cortical scintigraphy to detect experimental acute pyelonephritis in piglets: comparison of planar (pinhole) and SPECT imaging.

UNLABELLED: The purpose of this study was to directly compare the sensitivity and specificity of SPECT and pinhole imaging for the detection of acute pyelonephritis using histology as the standard of reference. METHODS: Bilateral vesicoureteral reflux of infected urine was induced in 16 piglets (32 kidneys) by unroofing the intravesical ureter and subsequently instilling a broth culture of E. coli into the bladder. DMSA scans were obtained by both pinhole and SPECT techniques at 24 hr (4 piglets), 48 hr (5 piglets), 72 hr (4 piglets) and 10 days (3 piglets) after instillation of bacteria into the bladder. Kidneys were harvested immediately after scintigraphy for histopathologic examination. Results of the SPECT images, pinhole images and histologic findings were interpreted independently in a blinded fashion. The images of each kidney were classified as positive or negative for pyelonephritis regardless of the severity and number of lesions. To evaluate accuracy of SPECT and pinhole imaging for the detection of individual lesions, each kidney was arbitrarily divided into three zones (upper, middle and lower). Image findings were then compared with the pathology results for the presence or absence of pyelonephritis in each zone. RESULTS: Histopathology revealed pyelonephritis in 24 of 32 kidneys (58 of 96 zones). The sensitivity of the DMSA scan for detection of affected kidneys was 92% for SPECT and 83% for pinhole; overall accuracy was 88% for both. The sensitivity of SPECT for the detection of affected renal zones was slightly better than pinhole imaging (91% compared with 86%), but its specificity was lower (82% compared with 95%) resulting in a similar accuracy. Excluding four piglets where scans were obtained within 24 hr after instillation of bacteria into the bladder, the sensitivity of SPECT and pinhole for the detection of affected kidneys were 95% and 90%, respectively. Their overall accuracy were 96% and 92%. In this subgroup, the sensitivity, specificity and accuracy of SPECT for the detection of involved zones were 96%, 95% and 96%, respectively. The corresponding values for pinhole imaging were 90%, 95% and 92%, respectively. CONCLUSION: Although the sensitivity of SPECT for the detection of acute pyelonephritis is slightly better than pinhole DMSA scan, the overall accuracy of these two imaging techniques is essentially the same.

Acute Disease↗

PubMed1998

[Mononuclear phagocyte function in children with pyelonephritis under dynamic observation].

A total of 84 pediatric patients who ranged from 4 to 14 years old were examined. Of these, 12 were patients with acute nonobstructive pyelonephritis, 44 had chronic obstructive pyelonephritis in the remission period. Children with pyelonephritis demonstrated depressed migration of mononuclear phagocytes as per aseptic inflammatory skin test. In children with acute pyelonephritis there have been established correlations between parameters characterizing the functional activity of mononuclears. There were no such correlations in patients with chronic obstructive pyelonephritis, which fact suggests to us a decompensation in this link of immunity.

Acute Disease↗

PubMed1997

The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions.

Technetium 99m-dimercaptosuccinic acid (DMSA) scintigraphy has emerged as the imaging agent of choice for the detection and evaluation of acute pyelonephritis and renal cortical scarring in children. Consequently, DMSA scintigraphy provides a unique opportunity to study the progression of renal damage and functional loss from the initial insult of acute pyelonephritis to the subsequent development of irreversible renal scarring. Over the last few years, clinical and experimental investigations using DMSA renal scintigraphy have provided new insights into the etiology, pathophysiology, and clinical outcome of acute pyelonephritis in children. These studies have confirmed the primary role of the acute inflammatory response, associated with both reflux and nonreflux pyelonephritis, in the etiology of irreversible renal scarring. Furthermore, several studies have shown that renal scarring can be prevented or diminished by the early diagnosis and treatment of pyelonephritis. This review highlights these recent observations and makes recommendations regarding current clinical and future research applications.

Humans↗

PubMed1995

Acute pyelonephritis as a cause of hyponatremia/hyperkalemia in young infants with urinary tract malformations.

Obstructive uropathy causes tubular resistance to aldosterone and severe metabolic imbalance may be precipitated by an episode of pyelonephritis. In the last 3 years we investigated 52 episodes of pyelonephritis (positive urine culture, elevated C reactive protein, fever, elevated neutrophil count) in 50 children between 15 days and 15 months of age. Ultrasonography voiding cystography and renal scintiscan were performed in all cases and i.v. urography in some. A salt-losing syndrome with hyponatremia and hyperkalemia (Na < 125 meq/liter; K > 6.3 meq/liter) was observed in 17 infants < 3 months, accompanied by plasma aldosterone concentration of 5000 to 23,000 pg/ml (normal value, < 1000 pg/ml). All these children had a severe urinary tract (UT) malformation (ureteropelvic junction stenosis in 7 cases, vesicoureteral reflux in 7, posterior urethral valves in 2, double system in 1). Thirteen infants < 3 months, 7 with no urinary tract malformations, did not have electrolyte imbalance. Pyelonephritis was diagnosed in 20 other patients ages 4 to 15 months, including 16 with severe UT malformations; 4 had normal UTs. We conclude that a salt-losing syndrome with tubular resistance to aldosterone can occur during pyelonephritis in young infants with congenital UT malformation, that the risk diminishes considerably or disappears after 3 months of age and that in the absence of UT malformation pyelonephritis does not cause acute sodium loss of clinical relevance.

Age Factors↗

PubMed1993

Rational use of CT in acute pyelonephritis: findings and relationships with reflux.

Enhanced renal CT scanners were performed in 38 children (82% girls) to rule out acute pyelonephritis. Patients were divided in 2 groups on the basis of clinical presentation and bacteriology data. In patients of group A (n = 16, preliminary study), upper urinary tract infection (UTI) was certain. CT confirmed the diagnosis in all but 3 patients (a 2-year-old child and 2 patients with UTI developed on prior obstruction). In subsequently studied patients of group B (n = 22), clinical findings or bacteriology data were negative or questionable. CT made the diagnosis of acute pyelonephritis in 11 patients. As well as DMSA scintigraphy, CT scanner can help to diagnose or to rule out upper UTIs in difficult cases. In all boys of both groups, ipsilateral vesico-ureteric reflux (VUR) was found by subsequent voiding cystourethrography (VCUG) on the side of pyelonephritis. In girls, this correlation was shown in only 7 of the 25 kidneys with pyelonephritis. This result supports the hypothesis of a gender-dependent contamination. We believe that absence of radiologic reflux cannot exclude the possibility of bacterial crossings of ureteric meatus capable to lead to genuine upper UTIs.

Acute Disease↗

PubMed1998

Magnetic resonance imaging in acute pyelonephritis.

The diagnosis of acute pyelonephritis in children remains a clinical challenge. We assessed the feasibility of magnetic resonance imaging (MRI) detection of pyelonephritis in four pediatric patients and compared the results with renal cortical scintigraphy. MRI revealed areas of high signal intensity in the kidney that coincided with photon-deficient regions in the radionuclide scans in two children with acute pyelonephritis. These findings confirm work in experimental animals and indicate that MRI can accurately detect acute pyelonephritis in children.

Acute Disease↗