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PubMed1979

Xanthogranulomatous pyelonephritis (XGP): a local disease with systemic manifestations. Report of 23 patients and review of the literature.

The clinical, pathological and radiographic findings of 135 cases of xanthogranulomatous pyelonephritis have been reviewed. It is a form of renal suppuration and obstruction most commonly seen in middle aged women although all ages and both sexes may be affected. There is no race predilection. Gram-negative organisms are usually present and bilateral involvement has not been reported. The most common offending organism is Proteus mirabilis. Hepatic dysfunction is seen and appears to normalize with removal of the XGP process. Preoperative angiography may increase the accuracy of differentiating this disorder from hypernephroma and may aid the surgeon in planning his approach to kidney resection depending upon the staging of XGP. Chronic renal failure is not usually a feature of XGP and nephrectomy is curative without any incidence of recurrence.

Female↗
PubMed1979

Vesicoureteric reflux and pyelonephritis. Long time effect on area of renal parenchyma.

The effect of gross vesicoureteric reflux in combination with urinary tract infection on the area of the renal parenchyma was analysed in 8, non-selected, girls during 3 to 6 years. A progressive significant decrease of the relative size of the kidneys with vesicoureteric reflux occurred as compared with that of kidneys with normal ureters. The decrease was mainly due to scars in the upper and lower poles. A positive correlation was found between the reduction of parenchyma and the number of episodes of pyelonephritis.

Adolescent↗
PubMedDate not supplied

[Urinary infection and pyelonephritis].

Actual concepts on urinary tract infection (UTI) and pyelonephritis have changed constantly through the years. A brief historical review has been considered in this paper, with the hope that nowadays concepts may help the clinician towards a better diagnostic and management approach of these still so common clinical disorders. Bacteriological studies were performed in 245 urine samples obtained by three different procedures, in order to evaluate the reability of each technique, which were: different procedures, in order to evaluate the reability of each technique, which were: a) suprapubic puncture; b) single culture obtained by midstream voiding technique, and c) serial cultures in three different samples, also obtained by the latter technique. E. coli was isolated in 91% of the initial diagnosed episode of UTI, and in 87% of the recurrences. Same bacteria, as well as other organisms and mixed flora were isolated from patients with predisposing factors present within the urinary tract (intra UT predisposing factor). Results show that suprapubic tap is the most reliable technique, since bacterial contamination of the sample is avoided. Fifty percent incidence of false positive results was found when a single culture by midstream voiding technique was used. A better correlation between suprapubic puncture and serial cultures obtained by midstream voiding technique was found. Both procedures are recommended. Predisposing factors, mainly within the urinary tract, were found in 68% of the cases with demonstrated UTI. Vesicoureteral reflux was found in 27% from the total number of patients studied, and in 52% of the patients with intra-UT predisposing factors. Suggestions are made in relationship with diagnostic approach and management of patients with UTI, in order to reveal the presence of predisposing factors, since they are the main feature to take into account regarding UTI, location of the site of infection, recurrences, chronic evolution, treatment and prognosis.

Bacteria↗
PubMed1979

[Morphogenesis of acute pyelonephritis (electron microscopic study)].

Investigations of fine changes of nephron elements in acute pyelonephritis against the background of urolithiasis in 19 patients and 43 rabbits showed the developing morphological lesions in the kidneys to be due to combined effect of the inflammatory and ischemic factors. The inflammation began with the development of serous oedema leading to destruction of tubular epithelium and impairment of urine passage. These lesions contributed to transformation of the serous inflammation into purulent one with formation of histolysis foci. The ischemic factor progressed with the advance of the inflammatory process and was aggravated by the development of foci of histolysis and hephrohydrosis and subsequently of vascular-parenchymatous block at the tubular level.

Acute Disease↗
PubMed1977

[Xanthogranulomatous pyelonephritis in a young child (author's transl)].

UNLABELLED: Case report on a boy aged 4. The whole of the right kidney showed changes of xanthogranulomatous pyelonephritis. HISTOLOGY: dense granulomatous infiltrations of xanthome cells, epitheloid and plurinuclear giant-cells, lymphocytes and plasma cells. Diagnostic proof was based on the xanthome cells, large histocells with partially pycnotic nucleus and wide margin of cytoplasm. This condition has, so far, been seen only very rarely in children.

Child, Preschool↗
PubMed1977

[Relationships between the value of combined PAH-inulin clearance, the kidney-cortex index as well as between additional radiographic findings in chronic pyelonephritis].

In 85 patients with ascertained chronic pyelonephritis the relations between the measured values of the combined PAH-inulin-clearance, the index of the adrenal cortex and other radiological findings were investigated. Here the determination of the cortex of the adrenal cortex resulted in a better correlation with the sizes clarification values than the calculation of the size of the kidney. By variance analysis (F-test) significant differences between the individual function groups became clear.

Aminohippuric Acids↗
PubMed1978

[Roentgen diagnosis of interstitial nephritis (pyelonephritis) by excretory urography and renovasography. Indications and diagnostic value of both methods including elektronic harmonization (author's transl)].

The roentgen signs of pyelonephritis may well be demonstrated by intravenous or infusion excretory urography. Discrete lesions of the calyces are better demonstrable by means of electronic magnification and harmonization. Inflammatory disease of the kidneys have characteristic patterns of vascular formation in renal arteriography. Electronic magnification and harmonization allow to detect initial stages of this illness.

Angiography↗
PubMed1983

Experience in the management of hypertension with unilateral chronic pyelonephritis: results of nephrectomy in selected patients.

We report the experience of a regional centre serving a population of 3 millions in the management of patients with hypertension and unilateral scarred kidneys between 1972 and 1981. Thirty one patients were studied, fifteen have been subjected to nephrectomy and sixteen managed conservatively. The medically and surgically treated patients differed only in that the diseased kidney was smaller, 7.7 +/- 1.9 vs 9.9 +/- 1.7 cm, (p less than 0.01), and systolic blood pressure higher, 224 +/- 34 vs 198 +/- 30 mmHg, (p = 0.05), in the surgically treated group. Following nephrectomy blood pressure was normal without drugs in four patients, control was made easier in 10 patients and only one patient, who had bilateral disease, failed to benefit. In the non-surgical group drugs could be withdrawn in only one patient and control became easier in only five. Serum creatinine did not increase following nephrectomy, but had increased significantly at the time of the most recent follow up in the medically treated patients (89 +/- 20 to 102 +/- 32 mumol 1(-1), p less than 0.05). We conclude that nephrectomy is of value in the management of some patients with unilateral chronic pyelonephritis and need not result in loss of renal function. Renal vein renin studies may be helpful in selecting patients for surgery but examination of the effect of nephrectomy in patients without differences in renal vein renin is necessary to establish this.

Adolescent↗
PubMed1983

[Clinico-therapeutic and microbiologic studies of the Bulgarian antibiotic cephalothin in patients with active pyelonephritis].

A total of 38 patients with active pyelonephritis and significant bacteriuria were treated with the Bulgarian antibiotic cephalotin, the bacteria isolated from their urine manifesting susceptibility to the Bulgarian broad-spectrum antibiotic cephalotin. Twenty six from the patients were with preserved renal function, and 12 with various stages of renal insufficiency. The subjective complaints, febrility, leukocyturia and bacteriuria were best affected. The highest anti-bacterial effect was observed in the patients with uroinfections caused by E. coli, Proteus mirabilis, Klebsiella and staphylococci. Cephalotin has a good tolerance and has no adverse effects. Painful infiltrations were established in some of the patients in the region of the site of intramuscular application, with a transitory character. Cephalotin was assessed, on the base of the study, to be a good and prospective broad-scpectrum antibiotic, deserving to be widely applied in the therapeutic practice.

Adult↗
PubMed1984

[Serum resistance of Escherichia coli in chronic pyelonephritis. 1. Serum resistance in the human serum pool].

123 patients of the kidney department of the Clinic for Inner Medicine of Rostock University suffering from chronic pyelonephritis were taken into microbiological observation for between one and four years. 170 E. coli strains were bred from 59 patients with significant bacteriuria in the course of the disease and their serum resistence was determined with pooled human serum using Taylor's method. 78.24% of the strains examined were serum-sensitive, 11.18% intermediate and 10.59% serum-resistent. All strains were O-, K- and H-typed. 57.06% were successfully O-typed and were distributed over 40 O-serogroups. 24.12% were not typable and 18.82% were rough colonies. 86.50% of the resistent and intermediate strains strains were O-typable, 13.50% could not be typed. The significance of E. coli antigens (O, K, H) and serum resistence for the maintenance of a chronic infection is discussed.

Antigens, Bacterial↗
PubMed1984

[Xanthogranulomatous pyelonephritis in childhood: analysis of 4 cases].

A critical retrospective evaluation of four cases of xanthogranulomatous pyelonephritis (XPG) treated between 1966 and 1980. Incidence was 1.93%. Age range was from 1.5 and 24 months. Interval since first symptoms to diagnosis was between one and 14 months. Clinical presentation was nonspecific in two and urinary symptoms in the rest, abdominal mass present in all, the fourth had an onset similar to an acute leucosis. There were was a grossly dilated pelvis and calices in two patients and nonfunctioning kidney in the others, one with multiple calculi. Ureteral stenosis was present in two and three showed a vesiureteral reflux grade IV. Urinculture yielded E. coli and Proteus mirabilis. In all cases diagnosis was confirmed by macro and microscopic examination. Nephrectomy was effectively cure in all four children. All patients are well at the end of follow-up, between one and four years.

Child, Preschool↗
PubMed1984

Respiratory insufficiency associated with pyelonephritis during pregnancy.

A previously unreported complication of acute pyelonephritis during pregnancy is described. Acute respiratory distress accompanied by varying manifestations of liver, kidney, hypothalamic, and hematopoietic dysfunction is chronicled in four women. Because these latter organ system effects are attributable to endotoxin, the authors postulate that endotoxin caused alveolar-capillary injury leading to respiratory failure in these pregnant women with acute renal infection.

Adolescent↗
PubMedDate not supplied

[Dioxidine in experimental pyocyanic pyelonephritis in rats].

A model of obturation hematogenous pyelonephritis was reproduced in rats by infecting them with Pseudomonas aeruginosa. On the model subject to study was chemotherapeutic activity of dioxidine (50--100 mg/kg per day) as compared to gentamycin (5 mg/kg per day). The drugs were administered intramuscularly for 7 days, starting 24 hours after inoculation of the animals. The action of both dioxidine and gentamycin on lethality, bacteriura, the mass of the kidneys and macroscopic changes in them was approximately the same, but dioxidine extered a greater influence on the seeding rate of the causative agent coming from the kidneys. Both drugs fail to bring about complete recovery of the animals.

Animals↗
PubMed1983

[Detection of antibody-coated bacteria in the urine of adults with chronic pyelonephritis].

Urine samples of 59 patients suffering from chronic pyelonephritis were tested repeatedly for antibody-coated bacteria (ACB). We demonstrated that the number of positive results increased with the frequency of the tests performed. It was observed, however, that antibody-coated bacteria were not found consistently in every sample during a longer period of observation.

Adult↗
PubMed1978

[Spontaneous birth of a live healthy child during successful hemodialysis treatment of pregnancy pyelonephritis with acute oligo-anuria].

A 19-year-old nullipara developed uremia due to acute pyelonephritis in the 30th week of pregnancy, necessitating hemodialysis within one week of onset of clinical infective symptoms. Almost daily prophylactic hemodialyses (7 in all) were performed. BUN and serum creatinine levels were maintained below 75 mg/100 ml and 12 ml/100 ml respectively, and the patient's weight was kept constant until delivery in the 32nd week of pregnancy. A live healthy child of 1.7 kg was born with a length of 39 cm and a normal neurologic examination. After 10 hemodialyses, polyuria set in and the maternal BUN and serum creatinine levels were within normal ranges 3 weeks after delivery. The importance of close cooperation between gynecologist and internist is stressed.

Adult↗
PubMed1983

Tubulointerstitial inflammation, cast formation, and renal parenchymal damage in experimental pyelonephritis.

Some basic changes in experimental pyelonephritis were studied by transmission and scanning electron microscope. Initially, bacteria settled and multiplied in capillaries and venules. Leukocytes first marginated and then escaped from the capillaries, particularly to the wide peritubular interstitium. After opening the tubular basement membrane, the infiltrating leukocytes were immediately localized in the tubular wall between epithelial cells but were never seen between the epithelial cells and the underlying basement membrane. The inflammatory cells seemed not to be able to pass through the tight junctions of the nonnecrotic tubular epithelium. As a consequence of severe inflammatory injury, the tight junctions exhibited alterations of intermediate junction type. Where circumscribed necrosis of the tubular walls occurred, leukocytes appeared in the lumen. Thus, pus casts originated from these sites, apparently as drainage of interstitial abscesses. The secondary/regressive and regenerative/tubular changes were similar to those occurring after various tubular lesions.

Abscess↗