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[Incidence and the degree of cardiovascular changes and causes of death in 717 patient who died of chronic pyelonephritis with and without arterial hypertension].

The authors examined 9015 necropsies, over the age of 14, in a general hospital for the period January 1, 1967 to March 1, 1979. They found that the chronic pyelonephritis (ChPN) was the most frequent renal diseases with a lethal end--62.83 per cent of the renal patients and 7.95 per cent of all deceased. In 458 (63.87%) of them ChPN was accompanied by arterial hypertension (AH), which with an average duration of 8.8 years had caused a considerable hypertrophy of left ventricle. A better manifested atheromatosis of aorta, coronary, cerebral and renal arteries, being statistically significant, was found in the deceased with ChPN and AH as compared with the control group of 524 subjects, deceased without hypertension but that atheromatosis was less manifested than in those that died of hypertonic disease. That fact was explained by the authors with the shorter duration of hypertension in ChPN, with a more strict nutritional regimen among them, with the shorter life span and azotemia, as well as with the more active involvement of adrenergic systems of the patients with ChD. Whereas in 2/3 of the deceased with ChPN, without hypertension, the cause for the lethal end was uremia and urosepsis, the incidence of cardiac and cerebral-vascular complications, in those deceased with ChPN and AH, was 6 times greater than the first and uremia and urosepsis--considerably less frequent.

Adult↗

Scanning electron microscopy of experimentally induced pyelonephritis in the rat.

Scanning electron microscopy was used to observe epithelial and inflammatory changes in kidneys of rats during Corynebacterium renale-induced experimental ascending pyelonephritis. Bacteria were not observed adhering to pelvic epithelium, although there was evidence of cell sloughing. Bacteria was observed in the interstitium of the renal medulla. Bacteria, when present in the tubular lumen, were associated with discontinuities in cell membranes. Phagocytic cells appeared in the interstitium and phagocytosis was evident in the renal medulla.

Animals↗

[Effect of galascorbin on activity of lactate and malate dehydrogenases and their isoenzymic spectrum in experimental pyelonephritis].

It is shown that per os administration of galascorbin to animals with acute experimental pyelonephritis in a dose of 100 mg/1 kg of mass per day normalizes the total activity of lactate dehydrogenase (EC 1.1.1.27), malate dehydrogenase (EC 1.1.1.37) and their isoenzymic spectrum in kidney tissue and blood serum. The content of pyruvic and lactic acids in blood serum also normalizes, that promotes a favourable course of the disease.

Animals↗

[Use of gentamycin and furosemide in acute pyelonephritis (an experimental morphological study)].

The favourable effect of gentamicin and its combination with furosemid was shown in treatment of rats with experimental pyelonephritis. However, alongside the favourable effect, a danger of the gentamicin nephrotoxic effect, especially in combination with furosemid was noted. The nephrotoxic effect was evident from foci of distrophic and necrobiotic changes in the epithelium of the convoluted tubules, impairment of the cortical hemodynamics and development of the cortical hypoxia of the kidneys resulting in severe renal insufficiency. Gentamicin had no direct inhibitory effect on the tissue respiration, did not block the oxygen uptake and oxidative phosphorilation in isolated mitochondria. To prevent the development of the nephrotoxic effect of gentamicin and its combination with furosemid strict and effective control of the antibiotic plasma levels is necessary. Informative tests for the control of the renal function are the concentration parameters of creatinine and urea, especially at the beginning of the pathological state when the level of hyperazotemia is still of a low informative value. The diurnal urine excretion is not an important informative index of renal function.

Acute Disease↗

Focal xanthogranulomatous pyelonephritis in adulthood.

In adults with xanthogranulomatous pyelonephritis (XGP) focal involvement occurs in 17% Of patients and the remainder have diffuse involvement of the kidney. Most patients are in the fourth and fifth decades. There appears to be a predilection for the left kidney, and 60% of patients will have a positive urine culture. Radiographically, a poorly-functioning, hypovascular renal mass is seen. The clinical and pathological presentations of focal XGP can closely resemble clear-cell renal cell carcinoma, but partial nephrectomy is the preferred treatment for this inflammatory disorder. We discuss three adults with focal XGP who have been treated at The Johns Hopkins Hospital in the past 2 1/2 years.

Adenocarcinoma↗

[Combination of renal artery stenosis and pyelonephritis in arterial hypertension].

Stenosis and thrombosis of the main renal artery were detected in 248 of 867 patients with arterial hypertension (28%). The combination of renal artery stenosis with pyelonephritis was encountered in 19% (46 subjects) of patients with the affected main renal artery. The syndrome of malignant arterial hypertension in the combined affections was diagnosed in 39.1% of patients. The study of the total renal filtration function in combined diseases may be of prognostic importance from the standpoint of normalization of arterial pressure after surgical treatment.

Chronic Disease↗

[The preoperative anti-inflammatory and postoperative therapy of patients with calculous pyelonephritis and prostatic adenoma with chronic prostatitis under outpatient polyclinic conditions].

Such wide-spread urological diseases as nephrolithiasis and prostatic adenoma requiring surgical management are often associated with chronic infection or inflammation (pyelonephritis, prostatitis, adenomitis). Relevant antiinflammatory treatment as a rule is conducted after the patient hospitalization which may induce unwanted emotional stress, occasional hospital infection, additional material expenditures. The authors have the experience of bactericidal and antiinflammatory treatment of the kidneys (143 patients with nephrolithiasis) and prostate (287 patients with adenoma) in the outpatient setting. Three-stage system of the patients' care is recommended: district outpatient clinic-consultative outpatient department of the Research Urological Center-Hospital of the above Center. Such an approach noticeably improved the treatment outcomes: the frequency of inflammatory postoperative complications reduced 2-fold, no more lethal outcomes occurred, the duration of the hospital stay decreased two-fold. The authors suggest to introduce the above three-stage system of pre- and posthospital outpatient antiinfectious and antiinflammatory treatment of nephrolithiasis-affected kidney and prostate in adenoma into the practice of all national, regional and local urological centers.

Aged↗

[The potentials of local and intravascular laser irradiation for eliminating the immunological disorders in patients with chronic pyelonephritis].

61 patients suffering from chronic pyelonephritis in the stage of active inflammation associated with either urolithiasis (67.4%) or prostatic adenoma (32.6%) were divided into three groups. Group 1 received conventional antibacterial treatment, group 2 conventional treatment + local laser radiation (LLR), group 3 received combined therapy including intravascular laser irradiation of blood (IVLIB). The treatments efficacy was controlled by urine seeding for microflora and its sensitivity to antibiotics, by immunological supervision. The patients were found to have immunological abnormalities in the form of cellular and humoral immunity suppression, neutrophil phagocytic hypoactivity, elevated levels of medium-molecular peptides nonresponsive to standard antibacterial therapy. Adjuvant use of LLR improved humoral immunity and reduced total urine bacterial count. LLR replacement for IVLIB resulted in a complete regression of immunological shifts and more pronounced reduction of urinary bacterial contamination.

Antibody Formation↗

[The etiological factors in pyelonephritis occurring against a background of nephrolithiasis].

656 urine and 78 blood samples were examined immunomicrobiologically. No bacterial growth was recorded in 43.8% of urine samples. Opportunistic bacteria were represented by Enterobacteriaceae, nonfermenting gram-negative bacteria with predominance of E. coli, P. mirabilis, P. aeruginosa isolated both in monocultures and in associations in conventional diagnostic titers (1g 5 CFU/ml). Throughout 40 days of the hospital stay microflora continuously changed, but until the discharge the infection persisted. The study of the immunological aspect of anti-infection resistance showed that most of the examinees (73%) at admission with pyelonephritis exacerbation have deficient cellular and humoral defense.

Antibody Formation↗

[The heparin and kurantil treatment of patients with chronic pyelonephritis in relation to the circadian rhythms of the blood coagulation indices].

Circadian rhythms of hemocoagulations and platelet aggregation were determined in chronics with pyelonephritis suffering from or free of renal dysfunction. Chronostructure of relevant circadian rhythms was recorded before and after 3-week combined chronotherapy with heparin and curantil. The readings were taken 6 times a day. The results obtained at group-mean and individual cosinor analysis showed disorganization of circadian rhythms of hemostasis in the above patients. Combined heparin and curantil chronotherapy corrected the above defects. Normalization occurred on the treatment day 26.

Blood Coagulation↗

[The efficacy of heparin chronotherapy in patients with chronic pyelonephritis].

The efficacy of conventional treatment (CT) in 20 controls was compared to that of heparin chronotherapy (HC) in 40 patients with chronic pyelonephritis. The results were indicative of the advantages of HC when heparin was given at the time of maximal clotting activity and platelet aggregation over CT when heparin daily dose was divided into 4 portions 5000 U each. A persistent clinical and laboratory effect with a pronounced trend to normalization of chronostructure of hemocoagulation circadian rhythms became evident on day 19 in patients on CT and on day 14 on HC. Side effects in CT appeared less frequent.

Adult↗

The pathogenesis of reflux nephropathy (chronic atrophic pyelonephritis).

The relationship between vesico-ureteric reflux and coarse renal scarring (atrophic pyelonephritis) has been studied in swine. Scars were observed to develop where reflux took place into the kidney substance via the renal papillae (intrarenal reflux). They were confined to these regions and were similar in size, distribution and other features peculiar to those found in the human from early childhood onwards. Intrarenal reflux was found to be related to the pressure within the urinary tract as well as to vesico-ureteric reflux. Infection was not an essential factor in scar-formation, but it appeared to intensify the scarring process. The histological findings were a progressive focal interstitial fibrosis confined to the zones of intrarenal reflux, extending from the capsule to the papillary tip, and varying in severity with pressure, time and the extent of intrarenal reflux. Nephron and tubular damage accompanied all grades of fibrosis, with the possible exception of the earliest. In many respects the histological changes closely resemble those due to obstruction, except they are focal in distribution. Added features are the early peripheral lymphocytic aggregations and interstitial fibrosis which appear to suggest that some "irritant"--possibly urine--reaches the interstitium and drains away via the lymphatic system. Many of the phenomena observed were strikingly similar to those present in children with the more severe grades of vesico-ureteric reflux. In some cases a mixture of generalized obstructive nephropathy and focal scarring developed; in others focal scarring took place with normal papillae elsewhere. The results are readily reproducible. The basic questions as to whether it is bladder pressure, or infection, or a mixture of the two which is responsible for scar-formation are discussed.

Adult↗

[Vesicoureteropelvic reflux in pregnant animals and its role in the pathogenesis of acute gestational pyelonephritis (experimental research)].

The experiments on naturally pregnant rats have demonstrated that pregnancy contributes to much more frequent occurrence of vesicoureteropelvic reflux (VUPR) which, in its turn, is essential for pathogenesis of acute gestational pyelonephritis (AGP). Dynamic obstruction of the urine flow as a result of reduced function of leiomyocytes of urinary tract muscles, decreased urothelial glycocalyx and consequent adhesion of pathogenic agents comprise parts of this pathogenesis. The conclusion is made that VUPR pregnant females are at risk to develop AGP and should be placed by the urologist on ultrasonic monitoring lasting all pregnancy and postpartum periods.

Acute Disease↗

[Plasmapheresis in the treatment of complicated forms of acute suppurative pyelonephritis in pregnant women].

Plasmapheresis was carried out in the course of treatment of 46 19-28-year-old females (gestation 13-37 weeks) suffering from complicated acute purulent pyelonephritis (APP) versus 50 controls treated conventionally without plasmapheresis. Nonconventional scheme included antibacterial therapy, infusions, plasmapheresis, surgical interventions. The number of plasmapheresis sessions ranged from 3 to 6 per 1 patient depending on APP severity and efficacy of the treatment. Plasma removal reached 600-900 ml of plasma per session, a total of 2000-2600 ml per course of treatment. Introduction of plasmapheresis made it easier to manage pyoseptic intoxication, to achieve clinico- laboratory remission. The efficacy of treatment increased by 20%.

Acute Disease↗

Immunological enhancement in the pathogenesis of pyelonephritis.

The role of the immune response in pyelonephritis was investigated by manipulation of the host's immune capacity using the immunosuppressive drugs 6-mercaptopurine, cyclophosphamide and thiamphenicol. Treatment with 6-mercaptopurine depressed the humoral immune response but did not have an adverse effect on the course of renal infection. Thiamphenicol administration prevented the development of pathological lesions but this was due to the anti-bacterial activity of thiamphenicol and not to its immunosuppressive activity. Pyelonephritic animals treated with cyclophosphamide did not produce anti-bacterial antibody. Despite this, cyclophosphamide-treated animals were able to eliminate organisms more readily from the infected kidney than untreated animals with a normal humoral immune response. We believe that blocking of the phenomenon of immunological enhancement explains these unexpected results and that the immune response to renal infection may have an immunoenhancing role protecting the bacterial cell from otherwise effective host defence mechanisms.

Animals↗

[Lipid peroxidation in patients with nephrolithiasis and chronic pyelonephritis in the remission stage].

Lipid peroxidation (LPO) was evaluated in 31 patients with nephrolithiasis and chronic pyelonephritis in remission. Chronic inflammation of renal parenchyma is shown to be associated with LPO activation. Urine diene conjugates excretion, plasma and red cell membrane malonic dialdehyde concentrations increase. LPO activation may contribute to maintenance of chronic renal inflammation in nephrolithiasis.

Adult↗

[Xanthogranulomatous pyelonephritis].

Based on the evidence obtained on 28 cases of xanthogranulomatous pyelonephritis (XP), the authors suggest to distinguish two XP clinical forms: obstructive and nonobstructive. The former may occur in noticeable destruction of renal tissue and urine retention secondary, most frequently, to long-standing nephrolithiasis. The latter simulates by symptoms and examination results renal carcinoma. In suspicion of nonobstructive XP, the surgeon should consider fast-made intraoperative biopsy to decide on feasibility of sparing intervention.

Adolescent↗