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PubMed1998

Is diffuse xanthogranulomatous pyelonephritis a contraindication to retroperitoneoscopic nephroureterectomy? A case report.

Diffuse xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic infection of the child's kidney. The clinical presentation is nonspecific, and investigation often reveals a nonfunctional kidney. Preoperative diagnosis is very difficult even with ultrasonography and computed tomography. Total nephrectomy is the treatment of choice, but it is considered very difficult and is usually contraindicated for laparoscopic or retroperitoneoscopic techniques. Reported here is a case of retroperitoneal laparoscopic nephroureterectomy for XGP.

Adolescent↗

PubMed1998

[Clinical indications for echography in acute pyelonephritis in adult women].

BACKGROUND: Echography is a non-invasive procedure which detects abnormalities in kidney and/or urinary tract. OBJECTIVE: To determine whether the routine use of an echography in women with the diagnosis of acute pyelonephritis (APN) provides relevant findings to diagnosis and determines a change in therapy. MATERIAL AND METHODS: A total of 100 patients admitted to the hospital with the diagnosis of APN who had undergone an echography were studied. Seven clinical criteria were evaluated: persistent fever for longer than 72 hours after starting an appropriate antibiotic therapy, episodes of previous urinary tract infections, previous history of kidney stones, anatomic abnormalities in the urinary tract, colic pain, persistent hematuria, and pregnancy. On the basis of these criteria two groups were defined: a) indicated echography (IE), for patients fulfilling at least one the above criteria; b) non-indicated echography (NIE), for patients fulfilling none of the above criteria. RESULTS: IE group was made up of 47 patients, with a normal echography in 18 (38%); the NIE group was made up of 53 women, with a normal echography in 51 of them (96%). The abnormal findings in echography led to a change in therapeutic behaviour in 11 patients in the IE group (23%) and in 2 patients in the NIE group (4%). CONCLUSIONS: The routine use of abdominal echography in women with the diagnosis of APN is not indicated in absence of clinical data supporting the presence of a complicated APN.

Acute Disease↗

PubMed1998

[The epidemiology of kidney infection and chronic pyelonephritis in Ukraine].

This study was undertaken to gain insights into the time-related trends in incidence and prevalence of infectious and inflammatory diseases of the kidneys in the population of Ukraine, with special reference to industrial and geographic division of the country, identifying those areas having been exposed to ionizing radiation (IR). The analysis was done on the basis of the official statistical data over a 6-year period (1990-1995) on the "infection of the kidneys" and chronic pyelonephritis morbidity in the country. In the data analysis, conventional statistical methods were employed together with those of regression analysis. The results obtained will enable us to suggest certain IR influence on the incidence rate of renal diseases. There was a significant difference in the indices among different areas and regions. Proposed in the paper are methods that will, we believe, help in finding out the real prevalence and incidence of infectious and inflammatory diseases of the kidneys in the country as well as in making the diagnosis thereof more accurate.

Chronic Disease↗

PubMedDate not supplied

[Disorders of the processes of protein biosynthesis and a decrease in the content of cytochromes P-450 and b5 in the microsomal fraction of rat kidney in the dynamics of development of acute pyelonephritis].

Noticeable decrease in microsomal protein level MOS terminal component--cytochrome P-450 and MOS median link--cytochrome b5 contents in microsomal fraction implicated in renal pathologic process was established in development of acute unilateral pyelonephritis. These findings reduction expression directly depended on severity and pathologic process development degree. One of the main causes led to reduction in cytochromes P-450 and b5 level and inhibition proteins biosynthesis may be influence of toxic products which are generated in substance exchange involved in prevalence of catabolic processes in injured kidney and intensification in endogenous intoxication syndrome on renal structures. Implication of many other factors effecting decrease in microsomal hemoproteins and protein levels in the damaged kidney in above pathology showed necessity to perform further investigations in the field given.

Acute Disease↗

PubMed1998

[A case of xanthogranulomatous pyelonephritis followed by computed tomographic scan].

Since it is difficult to differentiate xanthoglanulomatous pyelonephritis (XGP) from renal cancer, most cases of XGP are diagnosed after nephrectomy. We report a rare case of XGP followed by abdominal computed tomographic (CT) scan. A 65-year-old woman was admitted with high fever. Drip infusion pyelography showed a right renal stone but did not visualize the right kidney. A swollen right kidney was revealed on abdominal CT scan. Diabetes mellitus was detected by blood examinations and XGP was suspected. Conservative therapy with antibiotics was performed, the symptoms disappeared within 2 weeks and the right atrophic kidney was revealed on abdominal CT scan 12 months after onset. Histopathological findings on a renal biopsy specimen obtained 1.5 months after treatment were compatible with XGP. The diagnosis of XGP will become easier by using a combined approach including radiographic findings, physical finding and other data.

Aged↗

PubMed1998

[Cefixime versus amoxicillin plus netilmicin in the treatment of community-acquired non-complicated acute pyelonephritis].

BACKGROUND: Community-acquired non-complicated acute pyelonephritis (APN) is a frequent, occasionally serious infection (around 20% of the cases are bacteremic) that usually requires hospital admission. The third generation oral cephalosporins which are active against more than 95% of E. coli strains should allow the outpatient management of these patients. OBJECTIVE: To evaluate the bacteriological and clinical efficacy of oral cefixime in comparison to amoxicilin plus netilcilin in the treatment of APN. PATIENTS AND METHODS: Patients older than 18 years affected by APN were included in a fourteen month prospective study. According to a random numbers chart, the patients received cefixime (400 mg/24 h in a single daily dose for 12 days) or amoxicilin (1 g/8 h per os) plus netilmicin (4 mg/kg/24 h in a single intramuscular daily dose) during five days followed by 7 days of an oral treatment chosen according to the susceptibility pattern of isolated microorganism. RESULTS: Sixty-one patients received cefixime and 65 amoxicillin plus retilmicin. There were no significant differences between both groups of patients. Thirty-two patients presented bacteremia (25.4%). The mean (SD) eak and trough concentrations of netilmicin were 11.4 (2.8) mg/l and 0.38 (0.4) mg/l, respectively. Clinical response was favorable in 97% of patients treated with cefixime and in 98% of those treated with amoxicilin plus netilmicin (p = NS). The infection recurred in 10 out of 59 patients (16.9%) in the cefixime arm of the study and in 9 out of 64 patients (14%) treated with amoxicillin plus netilmicin (p = NS). Tolerance to the study drugs was good in both arms of the study, and renal function remained normal. CONCLUSION: Cefixime seems to be an acceptable alternative to the regimens containing an aminopenicillin and an aminoglycoside for the treatment of community-acquired non-complicated APN.

Acute Disease↗

PubMed1998

[Acute pyelonephritis as presentation form of renal angiomyolipoma with large granulomatous component].

Angiomyolipoma is a benign tumour of the kidney; is most cases is a finding during radiologic studies (ultrasound and CAT) and therefore asymptomatic. Due to their histologic features, these tumours show characteristic ultrasound and CAT patterns. This paper presents one case of angiomyolipoma in a 26-year old female patient who presented with a clinical picture of acute pyelonephritis. The tumour features in both ultrasound and CAT were not the typical ones for this kind of tumour. The surgical piece removed corresponded to an angiomyolipoma with a large granulomatous reaction.

Adult↗

PubMed1998

[Current role of aminoglycosides in the treatment of acute pyelonephritis].

In view of the very great efficacy of 3rd generation cephalosporins and fluoroquinolones used as monotherapy in the treatment of uncomplicated acute pyelonephritis, the addition of an aminoglycoside is not currently recommended, because of the unfavourable balance of the advantages and disadvantages of this antibiotic class. However, a brief course of aminoglycosides may nevertheless be useful during the initial phase of treatment, especially in hospitalised subjects. The authors analyse the contribution of three recently published studies to this debate.

Acute Disease↗

PubMed1976

Effect of indomethacin and sodium meclofenamate on the renal concentrating defect in experimental enterococcal pyelonephritis in rats.

The present studies have confirmed a severe urinary concentrating defect early in the course of experimental enterococcal pyelonephritis. This defect in maximum concentrating ability was almost completely reversed immediately following indomethacin or sodium meclofenamate intravenously. This effect of indomethacin and sodium meclofenamate was transient and was not associated with a fall in numbers of enterococci per gram of kidney. Injection of indomethacin or sodium meclofenamate in noninfected rats had no effect on maximum renal concentrating ability. The potential mechanisms by which indomethacin and sodium meclofenamate, inhibitors of renal prostaglandin synthesis, could reverse a defect in maximum urinary concentration are discussed.

Animals↗

PubMed2001

Diagnostic Investigation of Pyelonephritis.

Urinary tract infections are common, especially among women, and cause significant morbidity. While prognosis is probably more dependent on whether or not an episode of urinary tract infection is complicated (ie, associated with functional, metabolic, or anatomic abnormalities of the urinary tract) or uncomplicated, anatomic localization of infection has important implications for therapy. Pyelonephritis is difficult to diagnose with a high degree of accuracy based on clinical findings alone. Radiologic imaging plays an important role in the diagnosis and management of selected patients. Noninvasive and inexpensive methods to allow accurate localization of infection are needed.

Journal Article↗

PubMed1994

Methylation patterns in pap regulatory DNA control pyelonephritis-associated pili phase variation in E. coli.

We have examined the roles of pap DNA methylation patterns in the regulation of the switch between phase ON and OFF pyelonephritis-associated pili (Pap) expression states in E. coli. Two Dam methyltransferase sites, GATC1028 and GATC1130, were shown previously to be differentially methylated in phase ON versus phase OFF cells. In work presented here, these sites were mutated so that they could not be methylated, and the effects of these mutations on Pap phase variation were examined. Our results show that methylation of GATC1028 blocks formation of the ON state by inhibiting the binding of Lrp and PapI regulatory proteins to this site. Conversely, methylation of GATC1130 is required for the ON state. Evidence indicates that this occurs by the inhibition of binding of Lrp to sites overlapping the pilin promoter. A model describing how the transition between the phase ON and OFF methylation states might occur is presented.

Bacterial Proteins↗

PubMed2005

Emphysematous pyelonephritis: clues to rapid diagnosis in the Emergency Department.

Emphysematous pyelonephritis (EPN) is an acute life-threatening bacterial infection. EPN leads to rapid necrotizing destruction of the renal parenchyma and peri-renal tissue, requiring early and aggressive care to reduce morbidity and mortality. Previous studies have described the use of computed tomography scan and radiology-performed ultrasound to make the diagnosis of EPN We report a case of EPN diagnosed by bedside Emergency Department (ED) ultrasound performed by emergency physicians, allowing a more rapid diagnosis and subsequent treatment.

Emergency Service, Hospital↗

PubMed2004

99mTc ethylene dicysteine scintigraphy for diagnosing cortical defects in acute pyelonephritis: a comparative study with 99mTc dimercaptosuccinic acid.

AIM: To evaluate the clinical usefulness of early cortical phase images in the diagnosis of acute pyelonephritis and to compare the measurements of differential renal function obtained by both 99mTc ethylene dicysteine (99mTc-EC) and 99mTc dimercaptosuccinic acid (99mTc-DMSA). METHODS: Forty-three children who had undergone both 99mTc-EC and 99mTc-DMSA studies within 5 days of acute infection were studied. Cortical images of 99mTc-EC were obtained by the sum of the renogram frames achieved between the first 60-120 s of the renogram study. DMSA and EC images were visually interpreted using four points of semiquantitative ratings: 0, normal; 1, mild hypoactivity; 2, moderate hypoactivity with partial loss of margins; 3, marked hypoactivity with loss of cortical margins. Values for the differential renal function were obtained for both studies. RESULTS: DMSA detected a total of 109 lesions in 36 patients and EC detected 90 lesions with a sensitivity of 82.5%. 99mTc-EC successfully detected moderate-to-severe cortical lesions but was less effective with mild lesions (sensitivity 60%). Bland-Altman analysis demonstrated good agreement among the results for differential renal function (95% CI -0.26 to 0.96). CONCLUSION: 99mTc-EC early phase images detected most of the cortical lesions. Its sensitivity depends on the severity of the lesions. EC provided reliable information in the estimation of differential renal function.

Child↗

PubMed1987

The frequency of expression of pyelonephritis-associated pili is under regulatory control.

The Escherichia coli urinary tract isolate C1212 contains two pyelonephritis-associated pili (pap) DNA sequences designated here as pap-17 and pap-21. Each of these pap sequences encodes antigenically-distinct pilin monomers, pilin-17 and pilin-21, respectively. Most individual strain C1212 cells isolated from a single bacterial colony expressed pilin-21. Only a small fraction (5%) of strain C1212 cells expressed pilin-17. Most of the latter population simultaneously expressed pilin-21, but a low percentage of cells expressed pili composed of pilin-17 alone. In contrast, almost every E. coli K-12 cell containing multicopy pap-17 expressed pilin-17 at the cell surface. These results indicated that the regulation of pilin-17 expression observed for strain C1212 was lost when pap-17 was in the multicopy state. Transfer of pap-17 to a single copy vector resulted in a pilin-17 expression frequency lower than strain C1212 (1%). Using E. coli K-12 containing single copy pap-17, we found that the frequency of pilin-17 expression increased about 15-fold when pap-21 was present in multiple copies in trans. Subcloning of pap-21 showed that a 2.2 kilobase-pair DNA sequence adjacent to, but not including, the pilin-21 structural gene was sufficient for activation of pilin-17 expression.

Bacterial Outer Membrane Proteins↗

PubMed1970

Pyelonephritis XI. Effect of Growth Phase of Streptococcus faecalis on Serum Susceptibility and Virulence.

Rapidly growing Streptococcus faecalis was found to be markedly susceptible to the bactericidal activity of normal rat and rabbit sera, whereas stationary-phase organisms were resistant. In contrast, human serum killed neither phase organism. Further, human serum was found to interfere with killing by rabbit serum. The serosusceptible, rapidly growing organisms were less virulent than the seroresistant, stationary-phase organisms. This was tested by production of pyelonephritis in the rat after intravenous inoculation of the organism. Renal bacterial content over a period of 4 weeks was significantly less in those animals which had received rapidly growing organisms.

Journal Article↗

PubMedDate not supplied

Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis.

INTRODUCTION: Nephrobronchial fistula is a rare complication of xanthogranulomatous pyelonephritis, a disease that can fistulize to lungs, skin, colon and other organs. CASE REPORT: A 37-year old patient presented a chronic history of lumbar pain and thoracic symptoms such as cough, dyspnea and oral elimination of pus. Patient went to several services and was submitted to 2 thorax surgeries before definitive treatment (nephrectomy) was indicated. After nephrectomy, the patient presented an immediate improvement with weight gain (8 kg / 1 month) and all his symptoms disappeared. CONCLUSION: This clinical case illustrates the natural history of nephrobronchial fistula, the importance of clinical history for diagnosis and the relevance of early treatment of renal lithiasis.

Journal Article↗

PubMedDate not supplied

[Xanthogranulomatous pyelonephritis].

A four years-old boy with Xanthogranulomatous pyelonephritis was surgically treated at the Pediatric Surgery Unit of the Santa Casa de Misericórdia of Maceió. Comments are made upon pathology, pre-operative diagnostic difficulties, differential diagnosis, and the rare occurrence in children.

English Abstract↗

PubMed2002

Emphysematous pyelonephritis.

Emphysematous pyelonephritis is a rare life-threatening suppurative necrotising infection of the renal parenchyma and perirenal tissue producing abscess formation and intrarenal gas. It is almost always seen in diabetics, making it a concern of the physician. A high index of suspicion is required for diagnosis and a combined approach has significantly reduced the mortality.

Diabetes Complications↗