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Xanthogranulomatous pyelonephritis can become clinically apparent in a variety of manners. The paper contributes a very infrequent presentation; a picture of acute peritonitis following non-focal generalized toxic syndrome and haematuria episodes.
The authors report four cases of emphysematous pyelonephritis. All patients (3 females and 1 male) were diabetic. The clinical symptoms and signs were non-specific. The diagnosis was suggested in every case on conventional x-rays and was confirmed by computed tomography, which provides a detailed assessment of the lesions by demonstrating diffusion of gas in or beyond the renal compartment (2 cases). Urine cultures isolated an E. coli in one case and Klebsiella pneumoniae in 2 cases. In the fourth patient, Candida albicans was present in the urine at pathological levels, as confirmed by the presence of spores on histological examination of the nephrectomy specimen. The only effective treatment remains nephrectomy which was performed primarily in 2 cases or secondarily, after drainage, in the other 2 cases. The prognosis remains severe, with a high mortality; 2 of our patients died in a context of severe septic shock with end-stage renal failure.
The ultrastructure of xanthogranulomas developing during obstructive suppurative pyelonephritis was studied in rats with a permanent ligature of one ureter and an intravenous injection of E. coli suspension. The xanthogranulomas consisted of macrophages with numberous phagolysosomes containing rests of phagocytosed polymorphonuclear leucocytes and bacteria. Lipids identifiable as triglycerides were found in such cells particularly as isolated intracytoplasmic droplets and, less frequently, within the phagolysosomes. The source of isolated intracytoplasmic lipid droplets within the macrophages has remained obscure. Their origin in the macrophages by synthesis could not be excluded, similarly as in the polymorphonuclear leucocytes. PAS positive cells occurring as late as 2 months after the beginning of the experiment at the periphery of xanthogranulomas contained multiple intracytoplasmic vacuoles, most probably phagolysosomes. These cells, with high probability the oldes ones of the macrophagic population in the xanthogranulomas were virtually devoid of lipid droplets.
The authors report a new case of an exceptional benign renal tumour: nephronogenic nephroma, composed of differentiation of the blastema into primitive nephronic formations. It raises the problem of differential diagnosis with adult Wilms' tumour and renal blastematosis. In this patient, it was associated with segmental xanthogranulomatous pyelonephritis, presenting in the form of psoïtis and an abscess of the thigh. Total nephrectomy was performed.
Combined therapy for chronic nonobstructive pyelonephritis introduced by the authors includes such components as etiological, pathogenetic, resistance-stimulating. The cure was achieved in 60% of the patients.
Puerperae with acute and chronic pyelonephritis complicated by gestosis often develop postpartum inflammatory complications in the presence of marked deficiency of T lymphocytes and phagocytic function. Clinical criteria are suggested to single out risk groups. Prophylactic injections of leukinferon (alpha-interferon) and other immune response first phase cytokines in complex with metabolic agents help almost normalize the immunologic parameters in the majority of puerperae within 3-6 days and reduce threefold the incidence of early and late postpartum inflammatory complications.
Renocolic fistula is very rare. Only slightly over 100 cases have been reported in the world literature. We present a case of renocolic fistula secondary to chronic pyelonephritis discovered intraoperatively and discuss its diagnosis and management in the light of published data.
Analysis of 2058 pregnancy histories of patients with acute pyelonephritis helped work out and specify the indications for conservative and surgical treatment and characterize the etiopathogenetic factors and diagnostic methods. The necessity is emphasized of 'relieving' calix catheterization leading to elimination of retention shifts in the upper urinary tract and improving the efficacy of comprehensive antibacterial and detoxifying therapy. Methods and volumes of surgical interventions are substantiated.
Xanthogranulomatous pyelonephritis is a clinico-pathological entity that is gaining awareness amongst urologists worldwide. It is an unusual chronic inflammatory lesion involving the kidney that destroys renal parenchyma and may mimic renal carcinoma. It is usually seen in middle-aged women and is associated with urinary tract infections and urinary calculi. Most reports and reviews of this condition come from the West; this study reviews the incidence and presentation of the condition in a Malaysian population.
We report a case of xanthogranulomatous abscess of the left psoas muscle in a patient who underwent nephrectomy for xanthogranulomatous pyelonephritis four years earlier. Pathogens unlike those usually found in this type of inflammatory reaction were grown on culture. The possible relationship between the two infectious disease processes is analyzed.
A patient presented with a reno-cutaneous fistula revealing a xanthogranulomatous pyelonephritis secondary to staghorn calculus. Total nephrectomy was necessary because of renal destruction. This treatment allowed closure of the fistula and a good clinical result.
128 infants between 1 and 18 months, 80 girls and 48 boys suffering from their first pyelonephritis (PN), were investigated and followed up over 2.9 +/- 2.2 years (mean +/- SD). 20 children showed urinary tract obstructions. In 49 of 108 cases (45%) with nonobstructive PN a vesico-uretero-renal reflux (VUR) was found and surgically corrected in 13 cases. In 36 patients (52 renal units) the VUR disappeared in most cases under medical management within 3 years. Recurrences of urinary tract infections (UTI) were found in the same frequency in children with and without reflux (28%), but those with VUR showed significantly more PN. 22 of 108 patients with nonobstructive PN (20%) developed renal scars, 39% of children with reflux (mostly VUR III. or IV. degree), 5% of those without reflux. In more than half of these cases renal scars were found already after the first PN. We conclude that a reduction of the risk of renal damage and an improvement of the prognosis can achieved by the following measures: 1. early detection of obstruction by pre- or postnatal sonographic screening, 2. early and exact diagnosis of PN and antibiotic therapy without delay. PN has to be excluded in all infants with unclear fever. 3. In all infants with PN a voiding cystography should be performed. In children with VUR, long-term chemoprophylaxis is necessary to avoid recurrence of PN.
A case of emphysematous pyelonephritis to E. coli, in a 63-year-old female diabetic patient is presented herein. Imaging techniques (plain abdomen X-Ray, ultra-sonography and computed tomography) allowed the authors to make the diagnosis. Percutaneous nephrostomy, combined with medical therapeutics, contributed to a favourable clinical evolution of the patient.
In immunocompromised subjects pyelonephritis is not more frequent than in healthy subjects and has the same clinical presentation. This is not true for kidney transplant recipients, in whom the physician is faced with fever of unknown origin. However, diagnosis of urinary tract infection is soon made by dipstick and confirmed by the laboratory finding of leucocyturia and bacteriuria. Degradation of renal function indicates that the renal tissue is infected. Treatment must be immediate and prolonged during four weeks. Return to normal renal function is then the rule.
In children, pyelonephritis (or upper urinary tract infection) exposes to systemic complications and renal sequelae. The diagnosis rests on cytobacteriological examination of urine, but its results are difficult to interpret in neonates and small infants due to the possible contamination of urine collected in bags. It is recommended to repeat samplings in order to confirm a positive result or to collect the urine by a reliable technique such as puncture of the bladder. In 50% of the cases urinary infection reveals a urinary tract abnormality to be localized in all cases by ultrasonography and cystography completed, if there is any doubt, by intravenous urography. In infants younger than 18 months antibiotic therapy consists of a third generation cephalosporin administered, jointly with an aminoside, by the parenteral routes for at least 10 days. Older children with a better tolerance of the infectious syndrome may be treated with a betalactam antibiotic (amoxicillin-clavulanic acid or cephalosporin) injected alone or with cotrimoxazole administered orally. The effectiveness of treatment is tested by a bacteriological examination of the urine 48 hours after the end of therapy. Antibiotic prophylaxis to avoid recurrences is prescribed after the curative treatment until cystography is performed.
A 35-year-old nondiabetic renal allograft recipient developed emphysematous pyelonephritis and cystitis emphysematosa necessitating graft nephrectomy. The patient received cyclosporin and prednisolone as immunosuppressive therapy. He developed the first episode of urinary tract infection one week after transplantation and another episode 3 months later. Abdominal CT scan revealed presence of gas in the graft kidney, urinary bladder, and surrounding tissues. Despite appropriate antibiotic therapy, his renal function deteriorated rapidly and he died on the first postoperative day.
In 55% of 100 patients (54 with glomerulonephritis and 46 with pyelonephritis) who had been dialysed in the permanent dialysis treatment for more than one year the tactics of a dialysis per week was estabished at the beginining of the permanent dialysis treatment: in the diuresis of more than 1 litre a day with the residual glomerular filtration about 5 ml/min, in stabilised body-weight, in controllable hypertension and in the compensated clinical picture of renal insufficiency. The residual glomerular filtration can be presumed only in the optimally hydrated patients. The canulation of the subclavian vein has proved significant for the evaluation of optimum hydration.
It is described a test for the presence of diffuse nephropathies which is based on the fact that after application 20 ml of the renal diatrizoate X-ray contrast medium Visotrast or of 500 ml of a 10% mannitol solution in patients with preexisting renal diseases appear reversible, diagnostically relevant increases of the alanine aminopeptidase excretion with the urine. In persons with healthy kidneys the excretion of enzymes changes insignificantly. The increased excretion of alanine aminopeptidase is also observed in patients with latent pyelonephritis and is traced back to the increased formation of an osmotic nephropathy in patients with preexisting nephropathies.