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Acute pyelonephritis is one of three clinical entities within the spectrum of urinary tract infection. It occurs commonly in pregnancy and, as recognized recently, can be associated with acute respiratory insufficiency.
The uptake of nutrients was investigated in the renal cortical brush border membrane (BBM) vesicles at different stages of ascending pyelonephritis. There was significant difference (p less than 0.05) in the uptake of D-glucose, L-alanine, L-aspartate, L-lysine and L-proline 3 days postinfection and onwards in both right unobstructed and left obstructed experimental kidneys as compared to the sham operated control. The uptake of D-glucose, L-lysine and L-proline was found to be significantly decreased (p less than 0.05) during the course of infection. While uptake of L-alanine and L-aspartate increased (p less than 0.05) in early stages and decreased (p less than 0.05) in later stages of infection. The differential effect was attributed to the compensatory measure and different kinds of transport systems for different types of amino acids.
A 20-year-old gelding with weight loss and generalized weakness that progressed gradually over a 3-month period was diagnosed as having pyelonephritis caused by Staphylococcus aureus infection. Abnormal laboratory findings included high values for BUN, creatinine, potassium, and calcium, and depletion of sodium. Determination of glomerular filtration rate and effective renal plasma flow indicated a severe decrease in renal filtration and perfusion.
Analyzing correlation of the results of excretory urography and histological findings (kidney biopsy) in 2852 nephrological patients the author has come to a conclusion that changes in the structure of the pelvicaliceal system (PCS) which are usually regarded as x-ray signs of primary chronic pyelonephritis (PCPN), are not typical of this disease and can be also observed in patients with diffuse renal lesions. PCS changes of "pyelonephritic" type were detected in 2470 patients, histologically in 698 (28.1%), in them PCPN morphological signs were detected, and 1772 patients (71.9%) had different diffuse renal lesions. In the author's opinion, PCS changes in such patients could result from an increase in the kidney mass caused by edema or sclerosis of morphological elements of the renal tissue. The absence of both in 382 patients with diffuse renal lesions was not accompanied by PCS changes. The author has been of opinion that identity of the pictures of PCS changes is in the unity of the existing process: compression of the PCS fragments as a result of edema or sclerosis. Therefore PCPN absolute x-ray criteria could be based on the histological confirmation of this disease and what is most important on the absence of morphological data in favor of any diffuse renal lesion or on the detection of the normal renal tissue. In the interpretation of changes in the PCS structure to avoid diagnostic errors the author insists upon the necessity of regarding these changes, first of all, as a result of renal lesion only with subsequent patient's examination to determine the true nature of renal lesion. A decisive point in this respect is a histological study.
The total area and the proportion of lumen, epithelium, submucosa and muscularis as well as connective tissue, musculature, and edema were determined by histologic and morphometric evaluation in cross sections of 30 segments of undilatated proximal ureter. The conditions in 8 reflux ureters from children were almost identical to those in 12 reflux ureters from adults. No statistically significant increase in proliferation of connective tissue within the submucosa and muscularis could be established. The primary difference between the reflux ureters and the 10 proximal ureters in reflux-unrelated chronic pyelonephritis was extensive inflammatory edema in the submucosa and muscularis in the latter. Pathophysiologic and pathogenetic aspects are discussed.
Ten patients with pyelonephritis and impaired renal function were treated with 2.0 g mezlocillin (Baypen) 8-hourly. They all recovered from urinary tract infection and showed a distinct improvement of their kidney function measured by blood urea nitrogen, serum creatinine and creatinine clearance. No side effects were seen and the blood coagulation remained within normal limits. An overview of the literature on urinary tract infections treated in patients with impaired kidney function is given.
The behaviour of N-acetyl-B-D-Glucosaminidase (NAG) was studied in the urine of patients with chronic pyelonephritis under pharmacological treatment for renewed attacks of acute renal inflammation. It was noted that by the end of target chemo-antibiotic treatment all patients presented a reduction in the inflammation and hence the tubular distress. Once treatment was suspended several patients showed an increase tendency in the activity of the enzyme followed by the reappearance of significant bacteriuria and/or leukocyturia. The acute attack of renal inflammation would not have been recognised if the enzymuria technique had been used to monitor the patients.
The article presents results of a comparative study of clinico-biochemical and morphological alterations in 38 patients with obstructive calculous pyelonephritis before and after operation. The data obtained show considerably elevated activity of LDG and other enzymes, content of cholesterin, total phospholipids followed by histomorphological alterations in the kidney.
A case of emphysematous pyelonephritis is presented. A 49-year-old male with diabetes mellitus complaining of high grade fever attack and right flank pain was referred from internal medicine. KUB demonstrated that the right ureter, pelvis and calyces were filled with gas. Anti-bioticus was given intensively and the abnormal gas shadow on plain film disappeared before RP was done, but high grade fever attack persisted and right nephrectomy was undergone. After this operation, the fever was relieved and the patient was discharged at the 30th day post-operatively. A search of available literature in Japan has disclosed only 17 reported cases. Diagnostic methods, treatment, complication and etiology are discussed.
Autopsy findings in chronic pyelonephritis patients on dialysis were studied in 122 cases. The greatest number of cases was in the 50-59 year-old group among males and in the 60-69 year-old group among females. Infection was the most frequent cause of death (39.3%), followed by bleeding (23.5%). The total number of patients with infections and bleeding was 68 cases (55.7%) and 39 cases (32.0%), respectively. Pneumonia and bronchitis were the most frequent (27.0%) in cases with infections and gastrointestinal bleeding was the most frequent (21.3%) in cases with bleeding. The incidence of tuberculosis (16.4%) as a complication was high.
The therapeutic effectiveness of (6R,7R)-7-(2-[3,5-dichloro-4-oxo-1(4H)-pyridyl]-acetamido)-3-([(5-methyl-1,3,4-thiadiazol-2-yl)-thio]methyl)-8-oxo-5-thia-1-azabicyclo[4,2,0]oct-2-ene-2-carboxylic acid (cefazedone, Refosporen), cephazolin, cephacetrile and cephalothin was compared in the test model of estradiol-induced E. coli pyelonephritis in the rat. Cefazedone and cephazolin were similar in effect. The relations between results of treatment and microbiological and pharmacokinetic characteristics of the cephalosporins tested are discussed.
40 uninephrectomized male Wistar rats with an experimental E.-coli-022-pyelonephritis (PN) were treated twice daily for 9 days with 30 mg trimethoprim and 150 mg sulfamethoxazole (TMP-SMO) i.p. Bacteriologically most of the kidneys became sterile. Histologically a significant reduction of the frequency of severe PN was found in the treated group. The biologic half-life of 131I-hippuran indicated a decrease of excretory function which was reversible. Urine osmolality and osmotic clearance were increased after oral water loading in 10 untreated control animals with PN but not in the treated group. The 9 day treatment had a favourable effect bacteriologically, histologically and also on renal function.
Five patients who presented with acute renal failure in association with urinary tract infection are reported. Renal function improved rapidly on antibacterial therapy and no alternative cause for acute renal failure could be identified. None had previously been known to have renal disease but three of the five had taken considerable amounts of analgesics. The unusual severity of renal functional impairment resulting from urinary tract infection in these patients is unexplained but may relate to previous analgesic abuse and/or delay in treatment. Since acute non-obstructive pyelonephritis may result in severe reversible renal failure, this diagnosis must be considered in patients presenting with acute uraemia.
Diagnostic possibilities of selective examination of renal urine particularly collected under medicamentous polyuria conditioned by the administration of Lazix were studied in latent bacteriuria. By means of separate collection of renal urine against the background of polyuria it was possible additionally to detect bacteriuria in 1/3 of the patients, to record increase in the intensity of the index in almost half of the patients with renal bacteriuria and, in 1/4 of them to detect, in renal urine, the aetiological agent absent from bladder urine. The latter circumstance not only has a diagnostic significance but also plays a certain role in the selection of medicamentous therapy in chronic pyelonephritis. In addition to traditional bacteriological methods, filtration through membrane filters was used to isolate and identify microflora in the urine. By means of this method it is possible to detect extremely low bacteriuria which cannot be established by any other method.
The combined enzymological investigation including determination of the total activity of asparagine transaminase and alanine transaminase, two serum enzymes, alkaline phosphatase, gamma-glutamyl transpeptidase, acetyl cholinesterase, and butyryl cholinesterase was applied to two groups of pregnant women with pyelonephritis treated with ampicillin (12 patients) and roscillin (14 patients). The investigation was performed at the following stages: before the treatment, on the 7th and on the 12th day of the treatment. No statistically significant differences in the average values of the activity of the above enzymes at these stages were observed in patients of the both groups which indicated the absence of the hepatotoxic effect of the preparations on the patients of a group as a whole. An increase in the levels of transaminases recorded in some patients after discontinuation of the treatment course was evident of a possible cytotoxic effect of the drugs without the signs of cholestasis. The effect was connected with the initial functional renal insufficiency.
A case of emphysematous pyelonephritis is presented. A 54-year-old woman with diabetes mellitus was admitted because of bilateral ureteral stones. Five days after bilateral ureterolithotomy, she developed left flank pain, chills and fever. Plain x-rays of the abdomen (KUB) showed an enlarged left kidney with a giant gas shadow on the left renal area and no evidence of stone shadow. Drip infusion pyelogram revealed a decrease in the left renal function and the presence of the gas in the pyelocalyceal system. Contrast-enhanced computerized tomograms confirmed the presence of the gas in the parenchyma and pyelocalyceal system. The patient was treated conservatively with intensive antibiotic therapy, intravenous fluids and control of diabetes mellitus. After 3 weeks of therapy, the gas shadow disappeared, and a good recovery of renal architecture and function was achieved.
A trial was conducted with long-term intermittent netilmicin therapy in six patients suffering from chronic pyelonephritis. Netilmicin was given in full dose for a period of 3-10 days (2-6 mg/kg/day), followed by 2 mg/kg doses once or twice weekly for 3-6 months. Individual doses were determined by computer based on the age, sex, lean body weight and serum creatinine concentrations of the patients. During the full-dose period of treatment netilmicin concentrations in serum were between 2 and 16 mg/l in serum and between 50 and 200 mg/l in urine. During intermittent treatment serum levels remained below 2 mg/l (except for 8-12 hours after dosing); in the urine concentrations were permanently in therapeutic ranges (150-4 mg/l). Renal tissue levels were simulated. Six to 12 months after long-term netilmicin treatment all patients are abacteriuric and free from symptoms. No auditory or renal toxic effects occurred.
The authors studied the etiological spectrum of 226 patients with chronic pyelonephritis, with 926 microbic strains isolated from the urocultures. The most frequent microbic causative agents were E. coli (40,82%), Proteus (a total of 17,82%), Enterobacter (8,86%), Klebsiella (8,64%), Pseudomonas (6,16%), Enterococcus (5,94%). The drug susceptibility of the majority of the isolated gram-negative microorganisms versus ampicillin and chloramphenicol, widely used in out-patient department practice, is relatively low. An important condition for the effectiveness of the treatment is the consideration given to the susceptibility of the microbic strains, isolated from the uroculture.