FOLLOW-UP DATA ON 179 DANISH CHILDREN AFTER THEIR FIRST PYELONEPHRITIS

DEFF Research Database (Denmark)

Breinbjerg, Anders; Kamperis, Konstantinos; Frøkjær, Jørgen

Introduction: Controversy exists regarding follow-up investigations in children diagnosed with their first pyelonephritis. In our centre children with upper urinary tract infections are subjected to a DMSA or MAG3 scan to assess renal parenchymal damage app. 6 months following the UTI. We aimed...... to analyse follow-up data on 179 consecutive Danish children after their first pyelonephritis. Material and methods:We examined the records of children diagnosed with their first upper UTI confirmed by urine culture during the years 2011-2013.We collected data on the clinical course of the pyelonephritis...

Emphysematous Pyelonephritis in a 32-Year-Old Diabetic Female

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Muhammad Abdur Rahim

2015-05-01

Full Text Available Emphysematous pyelonephritis is a rare, severe, necrotizing renal parenchymal infection characterized by gas accumulation in kidney(s with or without involving surrounding tissues. Patients with diabetes mellitus are the usual sufferers. Here we describe a case history of a young Bangladeshi diabetic lady who presented with dysuria, fever and abdominal pain. Investigations confirmed left sided emphysematous pyelonephritis. She responded to and recovered with intravenous antibiotics.

Selective imaging modalities after first pyelonephritis failed to identify significant urological anomalies, despite normal antenatal ultrasounds

DEFF Research Database (Denmark)

Mola, Gylli; Wenger, Therese Ramstad; Salomonsson, Petra

2017-01-01

AIM: We investigated the consequences of applying different imaging guidelines for urological anomalies after first pyelonephritis in children with normal routine antenatal ultrasounds. METHODS: The cohort comprised 472 children treated for their first culture-positive pyelonephritis and investig......AIM: We investigated the consequences of applying different imaging guidelines for urological anomalies after first pyelonephritis in children with normal routine antenatal ultrasounds. METHODS: The cohort comprised 472 children treated for their first culture-positive pyelonephritis...... identified all patients initially treated with surgery and avoided 65 scintigraphies. CONCLUSION: Dilated VUR was the dominant anomaly in a cohort with first time pyelonephritis and normal antenatal ultrasound. The optimal imaging strategy after pyelonephritis must be identified....

Persistent fever during treatment of a pregnant woman with acute pyelonephritis

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Hasan Tahsin Gozdas

2017-01-01

Full Text Available Acute pyelonephritis is a serious infection in pregnancy. It is presented with fever, shaking chills and flank pain. Intravenous hydration and antimicrobial therapy are sufficient in the treatment unless pyelonephritis is complicated. In case of fever persisting for more than 48 h despite appropriate antimicrobial treatment, a possible complication such as urinary tract obstruction, abscess or phlegmon should be considered. Here, we present an 18-year-old pregnant woman with acute pyelonephritis whose persistent fever returned to normal after double-J ureteral stent was placed even if she had no finding of such a complication.

[Etiology of acute and chronic pyelonephritis in children in Khabarovsk region].

Science.gov (United States)

Kozlova, E A; Kholodok, G N; Alekseeva, I N; Kozlov, V K

2008-01-01

Microflora of urinary tract was studied in 419 children aged 1 - 17 years and hospitalized due to acute or chronic pyelonephritis. Etiology of inflammatory process was established in 57.8% of cases. According to our study, etiologic structure of causative agents of pyelonephritis did not differ from all-Russian data. The leading positions belonged to Gram-negative microorganisms from Enterobacteriaceae family: Escherichia coli, Proteus mirabilis, and Klebsiella spp. Results of the study point to high susceptibility of main causative agents of pyelonephritis to cephalosporins, aminoglycosides, and fluoroquinolones. High resistance to aminopenicillines was noted. In several isolates from Enterobacteriaceae family significant resistance to nalidixic acid and furazidin was observed.

Chronic pyelonephritis as false interpretation in the excretory urogram

International Nuclear Information System (INIS)

Rieden, K.; Weber, M.

1985-01-01

Chronic pyelonephritis, which is largely diagnosed via imaging procedures, is characterised by defined parenchymal scars that become manifest in the excretory urogram as contour recessions of the kidney and result in deformations of the calyces and papillae. The authors describe other renal diseases, dysplasias, variations from the standard, and artifacts resulting in similar signs on X-ray film, thus leading to the wrong diagnosis of chronic pyelonephritis. The essential differential diagnostic criteria are explained. (orig.) [de

Value of renal cortical scintigraphy in children with acute pyelonephritis

International Nuclear Information System (INIS)

Paul, A.K.; Miah, M.S.R.; Rahman, H.A.; Hasan, M.H.

2004-01-01

Purpose: Acute pyelonephritis is a major cause of morbidity in children with urinary tract infection and can result in irreversible renal scarring leading to hypertension and end-stage renal disease. Tc-99m-dimercaptosuccinic acid (DMSA) scintigraphy is the imaging modality of choice for the detection of acute pyelonephhfis and renal scarfing. This study evaluated the importance of renal cortical scintigraphy to identify children at risk from renal damage due to acute pyelonephritis. Methods: Forty-nine children (ages 9 months to 11 years) with urinary tract infection having positive urine culture were studied. A DMSA scan was performed within 72 hours of receiving antibiotic during acute infection. Single or multiple areas of varying degrees of diminished cortical uptake or diffusely decreased uptake in an enlarged kidney was considered for the diagnosis of acute pyelonephrifis. Follow-up scintigraphy was done at 6 months of initial scan in children with acute pyelonephritis documented by DMSA scan. Renal scarring was considered if the affected kidney shows cortical thinning or focal cortical defect with loss of volume or become small kidney. Children with known renal tract abnormalities were excluded from the study. RESULTS: Twenty-seven children (55%) wine considered acute pyelonephritis by DMSA scintigraphy and the abnormality was bilateral in 17(63%) cases and unilateral in 10(37%) cases. Among these 44 abnormal kidneys, scintigraphy showed solitary defect in 29 kidneys, multiple defects in 6 kidneys and diffuse decreased uptake in 9 kidneys. Of them, twenty children were available for follow-up evaluation and scintigraphy demonstrated complete recovery in 21 of 34 (62%) kidneys and renal scarfing in 13 of 34 (38%) kidneys. Renal scarring was found in 5 of 7 kidneys (71%) with diffuse decreased uptake, 2 of 5 kidneys (40%) with multiple cortical defect and 6 of 22 (27%) with single focal detect. Conclusion: The scintigraphic pattern of acute pyelonephritis

Radioisotope examination of the renal function in gravidic pyelonephritis

Energy Technology Data Exchange (ETDEWEB)

Voigt, R; Stoll, W; Arndt, J [Friedrich-Schiller-Universitaet, Jena (German Democratic Republic). Radiologische Klinik und Poliklinik

1980-08-01

By means of the results of combined renal sequence scintigraphy and /sup 131/I-hippurate clearance in 18 pregnant women with gravidic pyelonephritis as well as in 22 voluntary healthy pregnant women of the corresponding duration of pregnancy and in 13 non-pregnant women without hormonal anticonception as control groups the detection of the renal function with the clinical picture of gravidic pyelonephritis is discussed. The clearance equivalents are represented globally as well as subdivided to the single kidney. Besides typical activity-time curves of the control groups are demonstrated. It was shown that at the time of the most frequent occurrence of gravidic pyelonephritis in the 7th-8th month of pregnancy the clearance equivalents are decreased compared to those of uncomplicated pregnancy. The changes in the course of activity-time curves manifest themselves in a decreased initial phase as well as in an increased excretory phase. Conclusions are drawn for the clinical preliminary diagnosis of risky pregnancies from the results discussed regarding further references.

Radioisotope examination of the renal function in gravidic pyelonephritis

International Nuclear Information System (INIS)

Voigt, R.; Stoll, W.; Arndt, J.

1980-01-01

By means of the results of combined renal sequence scintigraphy and 131 I-hippurate clearance in 18 pregnant women with gravidic pyelonephritis as well as in 22 voluntary healthy pregnant women of the corresponding duration of pregnancy and in 13 non-pregnant women without hormonal anticonception as control groups the detection of the renal function with the clinical picture of gravidic pyelonephritis is discussed. The clearance equivalents are represented globally as well as subdivided to the single kidney. Besides typical activity-time curves of the control groups are demonstrated. It was shown that at the time of the most frequent occurrence of gravidic pyelonephritis in the 7th-8th month of pregnancy the clearance equivalents are decreased compared to those of uncomplicated pregnancy. The changes in the course of activity-time curves manifest themselves in a decreased initial phase as well as in an increased excretory phase. Conclusions are drawn for the clinical preliminary diagnosis of risky pregnancies from the results discussed regarding further references. (author)

Ampicillin Resistance and Outcome Differences in Acute Antepartum Pyelonephritis

Directory of Open Access Journals (Sweden)

Laura G. Greer

2008-01-01

Full Text Available Objective. To measure the incidence of ampicillin-resistant uropathogens in acute antepartum pyelonephritis and to determine if patients with resistant organisms had different clinical outcomes. Study design. This was a secondary analysis of a prospective cohort study of pregnant women admitted with pyelonephritis, diagnosed by standard clinical and laboratory criteria. All patients received ampicillin and gentamicin. Results. We identified 440 cases of acute pyelonephritis. Seventy-two percent (316 cases had urine cultures with identification of organism and antibiotic sensitivities. Fifty-one percent of uropathogens were ampicillin resistant. The patients with ampicillin-resistant organisms were more likely to be older and multiparous. There were no significant differences in hospital course (length of stay, days of antibiotics, ECU admission, or readmission. Patients with ampicillin-resistant organisms did not have higher complication rates (anemia, renal dysfunction, respiratory insufficiency, or preterm birth. Conclusion. A majority of uropathogens were ampicillin resistant, but no differences in outcomes were observed in these patients.

Оptimization of pharmacotherapy of osteopenia in children with chronic pyelonephritis

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L.A. Osipova

2010-03-01

Full Text Available The purpose of present research wras definition of frequency of osteopenia development in children with chronic pyelonephritis and optimization of pharmacological correction of revealed disorders. 121 children with chronic pyelonephritis and normal glomerular filtration rate were included in the investigation. Mineral density of bone tissue, biochemical parameters of bone remodeling, cytokine profiles were examined. 3 varients of therapy were used. Control period lasted 12 months. Clinical predictors of osteopenia were indicated. The increased biochemical parameters of bone resorption, IL-6, IL-4, OPG were revealed in chidren with chronic pyelonephritis, the indices were higher in case of osteopenia. The article concluded that the most effective treatment scheme included the use of 3 medicines with different effects

Pyelonephritis and Bacteremia from Lactobacillus delbrueckii

OpenAIRE

DuPrey, Kevin M.; McCrea, Leon; Rabinowitch, Bonnie L.; Azad, Kamran N.

2012-01-01

Lactobacilli are normal colonizers of the oropharynx, gastrointestinal tract, and vagina. Infection is rare, but has been reported in individuals with predisposing conditions. Here we describe the case of a woman with pyelonephritis and bacteremia in which Lactobacillus delbrueckii was determined to be the causative agent.

18F-FDG PET/CT Finding in a Case of Xanthogranulomatous Pyelonephritis

International Nuclear Information System (INIS)

Choi, Bong Hoi; Hong, Sun Pyo; Yoon, Joon Kee; Pai, Ki Soo; Hong, Jeong; Yim, Hyun Ee

2009-01-01

Xanthogranulomatous pyelonephritis is an uncommon chronic renal infection, which is usually found on middle-aged women and is rare in infant. Sometimes it forms focal mass like lesion of kidney with pathologically characteristic lipid-laden macrophage. A 1-month female infant was admitted for fever and moaning sound. On work-up of urinary tract infection, abdomen ultrasonography and computed tomography revealed a large mass on the upper portion of right kidney and PET/CT showed homogeneously increased 18 F-FDG uptake. The radical nephrectomy of right kidney was performed and histology revealed a focal xanthogranulomatous pyelonephritis. To our knowledge, this is the first report presenting the finding of 18 F-FDG PET/CT in the childhood xanthogranulomatous pyelonephritis

Xanthogranulomatous Pyelonephritis Can Simulate a Complex Cyst: Case Description and Review of Literature

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Salvatore Butticè

2014-05-01

Full Text Available Xanthogranulomatous pyelonephritis is a rare and peculiar form of chronic pyelonephritis and is generally associated with renal lithiasis. Its incidence is higher in females. The peculiarity of this disease is that it requires a differential diagnosis, because it can often simulate dramatic pathologic conditions. In fact, in the literature are also described cases in association with squamous cell carcinoma of the kidney The radiologic clinical findings simulate renal masses, sometimes in association with caval thrombus. We describe a case of xanthogranulomatous pyelonephritis with radiologic aspects of a complex cyst of Bosniak class III in a man 40-year old.

Pyelonephritis and Bacteremia from Lactobacillus delbrueckii

Directory of Open Access Journals (Sweden)

Kevin M. DuPrey

2012-01-01

Full Text Available Lactobacilli are normal colonizers of the oropharynx, gastrointestinal tract, and vagina. Infection is rare, but has been reported in individuals with predisposing conditions. Here we describe the case of a woman with pyelonephritis and bacteremia in which Lactobacillus delbrueckii was determined to be the causative agent.

Conservative management of emphysematous pyelonephritis in a ...

African Journals Online (AJOL)

M.M. Gargouri

EPN in a horseshoe kidney, presented in a 67-year-old, diabetic woman. A percutaneous .... [7] Shokeir AA, El-Azab M, Mohsen T, El-Diasty T. Emphysema- ... for mortality in patients with emphysematous pyelonephritis: a meta- analysis.

THE STRATEGY OF ANTIMICROBIAL THERAPY OF ACUTE UNCOMPLICATED PYELONEPHRITIS FROM THE POSITION OF ETIOLOGICAL DATA

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A. D. Kaprin

2015-01-01

Full Text Available Abstract:Acute pyelonephritis is one of the common diseases both in outpatient and in the hospital practice. The leading causative agent of this disease is E. coli. Obstructive uropathy, foreign body, vesicoureteral reflux, sexual activity, use of local contraceptives contribute to the upward development of urinary infection. The goals of antimicrobial therapy for acute uncomplicated pyelonephritis are: relief of symptoms, restoration of social activity, prevention of complications and relapse prevention. The choice of an antimicrobial agent in most cases is carried out empirically based on the data on the dominant pathogens and their regional resistance. In acute uncomplicated pyelonephritis duration of antimicrobial therapy should be 7–14 days. The drugs of choice for treatment of acute uncomplicated pyelonephritis non-severe in adults are ciprofloxacin and levofloxacin, ceftibuten and cefixime. Patients with acute uncomplicated pyelonephritis severe emergency hospitalization is shown in urological outpatient and parenteral antimicrobial therapy (carbapenems or protected aminopenicillins combined with or without amikacin with subsequent conversion to oral drugs and infusion therapy.

Rational use of CT in acute pyelonephritis: findings and relationships with reflux

International Nuclear Information System (INIS)

Dacher, J.N.; Boillot, B.; Eurin, D.; Marguet, C.; Mitrofanoff, P.; Le Dosseur, P.

1993-01-01

Enhanced renal CT scanners were performed in 38 children (82% girls) to rule out acute pyelonephritis. Patients were divided in 2 groups on the basis of clinical presentation and bacteriology data. In patients of group A (n = 16, preliminary study), upper urinary tract infection (UTI) was certain. CT confirmed the diagnosis in all but 3 patients (a 2-year-old child and 2 patients with UTI developed on prior obstruction). In subsequently studied patients of group B (n = 22), clinical findings or bacteriology data were negative or questionable. CT made the diagnosis of acute pyelonephritis in 11 patients. As well as DMSA scintigraphy, CT scanner can help to diagnose or to rule out upper UTIs in difficult cases. In all boys of both groups, ipsilateral vesico-ureteric reflux (VUR) was found by subsequent voiding cystourethrography (VCUG) on the side of pyelonephritis. In girls, this correlation was shown in only 7 of the 25 kidneys with pyelonephritis. This result supports the hypothesis of a gender-dependent contamination. We believe that absence of radiologic reflux cannot exclude the possibility of bacterial crossings of ureteric meatus capable to lead to genuine upper UTIs. (orig.)

[Formation of microbial biofilms in causative agents of acute and chronic pyelonephritis].

Science.gov (United States)

Lagun, L V; Atanasova, Iu V; Tapal'skiĭ, D V

2013-01-01

Study the intensity of formation of microbial biofilms by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus strains isolated during various forms of pyelonephritis. 150 clinical isolates of microorganisms isolated from urine ofpatientswith acute and chronic pyelonephritiswere included into the study. Determination of intensity of film-formation was carried out by staining of the formed biofilms by crystal violet with consequent extraction of the dye and measurement of its concentration in washout solution. Among causative agents ofpyelonephritis P. aeruginosa isolates had the maximum film-forming ability. The intensity of biofilm formation of these isolates was 2-3 time higher than staphylococcus and enterobacteria strains. Strains isolated from patients with chronic pyelonephritis by ability to form biofilms significantly surpassed strains isolated from acute pyelonephritis patients. A higher ability to form microbial biofilms for microorganisms--causative agents of pyelonephritis progressing against the background ofurolithiasis was noted. The ability to form biofilms is determined by both causative agent species and character of the infectious process in which this microorganism participates. Intensive formation of biofilms by E. coli, P. aeruginosa, K. pneumoniae, S. aureus clinical isolates may be an important factor of chronization of urinary tract infections.

Febrile urinary tract infections: pyelonephritis and urosepsis

NARCIS (Netherlands)

Schneeberger, Caroline; Holleman, Frits; Geerlings, Suzanne E.

2016-01-01

Complicated infections of the urinary tract (UTI) including pyelonephritis and urosepsis are also called febrile UTI. This review describes insights from the literature on this topic since July 2014. Recent studies regarding risk factors and consequences of febrile UTI confirmed existing knowledge.

Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes.

Science.gov (United States)

Gomi, Harumi; Goto, Yoshihito; Laopaiboon, Malinee; Usui, Rie; Mori, Rintaro

2015-02-13

Pyelonephritis is a type of urinary tract infection (UTI) that affects the upper urinary tract and kidneys, and is one of the most common conditions for hospitalisation among pregnant women, aside from delivery. Samples of urine and blood are obtained and used for cultures as part of the diagnosis and management of the condition. Acute pyelonephritis requires hospitalisation with intravenous administration of antimicrobial agents. Several studies have questioned the necessity of obtaining blood cultures in addition to urine cultures, citing cost and questioning whether blood testing is superfluous. Pregnant women with bacteraemia require a change in the initial empirical treatment based on the blood culture. However, these cases are not common, and represent approximately 15% to 20% of cases. It is unclear whether blood cultures are essential for the effective management of the condition. To assess the effectiveness of routine blood cultures to improve health outcomes in the management of pyelonephritis in pregnant women. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register without language or date restrictions (31 December 2014). Randomised controlled trials and quasi-randomised trials comparing outcomes among pregnant women with pyelonephritis who received initial management with or without blood cultures. Cluster-randomised trials were eligible for inclusion in this review but none were identified. Clinical trials using a cross-over design were not eligible for inclusion. Two review authors independently assessed one trial report for inclusion. We identified one trial report but this was excluded. No clinical trials met the inclusion criteria for this review. There are no large-scale randomised controlled trials to assess outcomes in the management of pyelonephritis in pregnancy with or without blood cultures. Randomised controlled trials are needed to evaluate the effectiveness of managing pyelonephritis in pregnant women with or without

Percutaneous drainage of abscess in the treatment of emphysematous pyelonephritis

International Nuclear Information System (INIS)

Jung, Jin Yong; Jeong, Yong Yeon; Kim, Jae Kyu; Park, Seung Jei; Park, Jin Gyoon; Kang, Heoung Keun; Roh, Byung Suk

1997-01-01

To assess the usefulness of percutaneous drainage of abscess in the treatment of emphysematous pyelonephritis. Ten cases of nine patients with emphysematous pyelonephritis were percutaneously drained. All were suffering from diabetes mellitus. The procedure was performed under fluoroscopic guidance in nine cases and US guidance in one case in which bilateral multiloculated abscesses were present in the perirenal space. The results were classified as cure, partial success, recurrence, or failure. The mean drainage period and complication were analyzed. Eight cases were cured, and there was one case success. In one case, who had diffuse renal parenchymal destruction without perirenal fluid collection, the treatment failed. The longest drainage period was 45 days, in a case of re-insertion due to incidental catheter removal; the mean was 23 days. Bacteremia in one case was cured with antibiotic therapy which lasted two days. In diabetic patients, percutaneous drainage of obscess is thought to be a safe and effective method for the treatment of emphysematous pyelonephritis, and is one that does not involve diffuse destruction of renal parenchyma

Emphysematous pyelonephritis: Case report

International Nuclear Information System (INIS)

Gomez, Carolina; Saab Said; Zuluaga, Claudia

2009-01-01

Emphysematous pyelonephritis is a rare and potentially fatal kidney infection that occurs mainly in patients with diabetes mellitus and is characterized by the presence of facultative anaerobic bacteria and gas production. It compromises the renal parenchyma, collecting system, perirenal space or retro peritoneal. The clinical presentation is usually not correlated with the severity of infection and the images, mainly the scan images, play an important role in diagnosis and classification to define management. The treatment of this disease has traditionally been aggressive and was considered essential percutaneous catheter drainage and / or nephrectomy.

{sup 18}F-FDG PET/CT Finding in a Case of Xanthogranulomatous Pyelonephritis

Energy Technology Data Exchange (ETDEWEB)

Choi, Bong Hoi; Hong, Sun Pyo; Yoon, Joon Kee; Pai, Ki Soo; Hong, Jeong; Yim, Hyun Ee [Ajou University School of Medicine, Suwon (Korea, Republic of)

2009-04-15

Xanthogranulomatous pyelonephritis is an uncommon chronic renal infection, which is usually found on middle-aged women and is rare in infant. Sometimes it forms focal mass like lesion of kidney with pathologically characteristic lipid-laden macrophage. A 1-month female infant was admitted for fever and moaning sound. On work-up of urinary tract infection, abdomen ultrasonography and computed tomography revealed a large mass on the upper portion of right kidney and PET/CT showed homogeneously increased {sup 18}F-FDG uptake. The radical nephrectomy of right kidney was performed and histology revealed a focal xanthogranulomatous pyelonephritis. To our knowledge, this is the first report presenting the finding of {sup 18}F-FDG PET/CT in the childhood xanthogranulomatous pyelonephritis.

Pyelonephritis, renal scarring, and reflux nephropathy: a pediatric urologist's perspective

International Nuclear Information System (INIS)

Smith, Edwin A.

2008-01-01

Imaging of children with a clinical diagnosis of pyelonephritis is performed to characterize the extent of the infection, to identify associated renal injury and to uncover risk factors for future infections and renal damage. Although there is general agreement regarding the need for parenchymal imaging and the need to exclude processes that are either functionally or anatomically obstructive, there is controversy regarding the need for routine cystography, especially when parenchymal involvement has not been documented. A protocol that limits the use of cystography for evaluation of urinary tract infections must assume that the diagnosis of reflux is at least of variable clinical significance. It is now clear that vesicoureteral reflux and reflux nephropathy represent a diverse population that includes both congenital and acquired processes. MR imaging will improve our understanding of vesicoureteral reflux, pyelonephritis and renal scarring and might help us to identify and manage those patients most at risk for recurrent infections and renal injury. To recognize the potential contributions of this newer imaging technique it is helpful to look at our understanding of the pathophysiology of pyelonephritis, reflux and reflux nephropathy. (orig.)

Concurrent emphysematous pyelonephritis and thigh necrotizing fasciitis after intramuscular administration of diclofenac

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Fateme Shamekhi Amiri

2014-01-01

Full Text Available Necrotizing fasciitis (NF is a rapidly progressive, life-threatening soft tissue infec-tion. NF may result from any injury to the skin or from hematogenous spread. However, con-current emphysematous pyelonephritis and necrotizing fasciitis of the left thigh has not been reported. We report a case of emphysematous pyelonephritis and necrotizing fasciitis of the left thigh after intramuscular administration of diclofenac that improved with aggressive management including broad-spectrum antibiotics, nephrectomy and surgical intervention.

Xanthgranulomatous pyelonephritis associated with staphylococcus aureus

International Nuclear Information System (INIS)

Al-Hwiesh, Abdulla K.

2007-01-01

A 44-year-old man with xanthgranulomatous pyelonephritis presented with abdominal distention, left lumber pain, fever, loss of appetite and loss of weight. He had been known to have diabetes mellitus type II for 20 years and he was diagnosed to have a left renal stone three months prior to this presentation. The patient's urine and the left psous abscess grew staphylococcus aureus. (author)

99MTc - DMSA renal scintigraphy in the diagnosis and follow-up of acute pyelonephritis in children

International Nuclear Information System (INIS)

Wallin, L.

1997-06-01

The aim of the present thesis was to define and evaluate a strategy for identification of children who are at risk of developing progressive renal lesions after acute pyelonephritis. Qualitative and quantitative evaluation standards were elaborated to improve the interpretation of DMSA scintigraphy. The normal DMSA distribution pattern, the average background uptake, and scintigraphic kidney length according to age were assessed in 95 presumably healthy kidneys. Furthermore, typical DMSA distribution patterns in acute pyelonephritis were assessed on 65 kidneys in 38 children, and typical DMSA distribution patterns of 152 kidneys with VUR in 101 children with and without previous pyelonephritis. Measurement of scintigraphic kidney length, width and volume was validated in piglets and on a kidney phantom. The scintigraphic kidney length was found to be an accurate measure of renal size, whereas kidney width and volume were less reliable, at least on small kidneys. Criteria of kidney swelling in acute pyelonephritis were defined, and found to be beneficial for identifying reinfections in the absence of clinical symptoms. In 34 children with acute pyelonephritis quantitative and qualitative DMSA scintigraphic findings were correlated to clinical symptoms and laboratory data, in the acute stage and at follow up. We found that quantitative DMSA scintigraphy in the acute stage of pyelonephritis and again after one year will identify children who are at risk of developing progressive renal lesions. Qualitative assessment of DMSA distribution pattern is not reliable enough in this respect. 116 refs., 7 figs

Extensive emphysematous pyelonephritis leading to renal destruction

African Journals Online (AJOL)

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the kidney characterized by the presence of gas in the renal parenchyma, collecting system or perinephric tissues. It can be life-threatening if not recognized and treated promptly.We report the case of a 56-year-old woman, on treatment for diabetes ...

A near-fatal case of emphysematous pyelonephritis: Embracing the ...

African Journals Online (AJOL)

A. Adam

2017-01-17

Jan 17, 2017 ... (A) Plain (erect) abdominal X-ray, revealing the underlying air-fluid level (arrows). (B) Contrasted ... A background history of insulin dependent diabetes, .... Devasia A. Emphysematous pyelonephritis: outcome of conservative.

Peculiarities of pregnancy development and condition of fetus in pregnant women diagnosed with gestational and chronic pyelonephritis

Directory of Open Access Journals (Sweden)

N. A. Gaystruk

2017-01-01

The article presents the data of the study of basically healthy pregnant women and pregnant women diagnosed with gestational and chronic pyelonephritis. There was carried out the analysis of pregnancy development and complications, delivery and post-delivery period, as well as the condition of fetus on the basis of the data of the bio-physical profile of fetus, cardiotocographic study and dopplerometric indicators of the bloodstream in uterine arteries and arteries of the navel-cord.Pregnant women with gestational pyelonephritis, compared to healthy pregnant women, more often experience such complications in pregnancy as light and moderate degree of preeclampsia, threatened miscarriage, anemia of pregnancy, placenta dysfunction. In accordance with the data of cardiotocography and bio-physical profile, disorder in the condition of fetus is observed, and resistance in the vessels of feto-placental system enhances. The mentioned above complications in conditions of chronic pyelonephritis are of a much larger-scale being compared with the ones in conditions of gestational pyelonephritis. Key words: gestational and chronic pyelonephritis in pregnancy, bio-physical profile of fetus, cardiotocographic study, dopplerometric indicators of bloodstream

A Comparison of Hospital Versus Outpatient Parenteral Antibiotic Therapy at Home for Pyelonephritis and Meningitis.

Science.gov (United States)

Hensey, Conor C; Sett, Arun; Connell, Tom G; Bryant, Penelope A

2017-09-01

Despite the benefits of home treatment with outpatient parenteral antimicrobial therapy (OPAT), children with pyelonephritis and meningitis are rarely included. We aimed to compare clinical characteristics and outcomes between hospital and home treatment for these conditions and to identify factors influencing home treatment. Children admitted to the hospital with pyelonephritis or proven and presumed bacterial meningitis from January 1, 2012, to December 31, 2013 were identified retrospectively. Patients who received any OPAT (home group) received daily visits via our Hospital-in-the-Home (HITH) program; inpatients (hospital group) received standard care. Clinical and demographic features, length of stay, readmission rate and cost were compared between hospital and home groups. One hundred thirty-nine children with pyelonephritis and 70 with meningitis were identified, of which 127 and 44 were potentially suitable for OPAT, respectively. Of these, 12 (9%) with pyelonephritis received OPAT, contrasting with 29 (66%) with meningitis. Clinical features did not differ between hospital- and home-treated patients for either condition. Patients with meningitis in the hospital group were younger than those transferred to HITH (1 vs. 2 months; P = 0.01). All patients were afebrile before transfer to HITH. Admissions for pyelonephritis were brief with inpatients having a shorter length of stay than home patients (median: 3 vs. 4.5 days; P = 0.002). Unplanned readmission rates were comparable across all groups. Transfer to HITH resulted in a saving of AU$178,180. Children with pyelonephritis and meningitis can feasibly receive OPAT. Age, treatment duration and fever influence this decision. None of these should be barriers to OPAT, and the cost savings support change in practice.

Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

NARCIS (Netherlands)

Shaikh, Nader; Borrell, Jessica L.; Evron, Josh; Leeflang, Mariska M. G.

2015-01-01

Background In children with urinary tract infection (UTI), only those with pyelonephritis (and not cystitis) are at risk for developing long-term renal sequelae. If non-invasive biomarkers could accurately differentiate children with cystitis from children with pyelonephritis, treatment and

99m-Tc DMSA scintigraphy and color/power doppler sonography for children pyelonephritis diagnosis and follow-up

International Nuclear Information System (INIS)

Hitzel, A.; Manrique, A.; Gardin, I.; Vera, P.; Hitzel, A.; Dacher, J.N.; Manrique, A.; Menard, J.F.; Gardin, I.; Vera, P.; Dacher, J.N.; Liard, A.; Menard, J.F.

2004-01-01

Early diagnosis of acute pyelonephritis is essential to avoid scarring development. This study was performed to evaluate capabilities of color/doppler sonography to detect pyelonephritis and to predict scarring when compared with 99m Tc-DMSA scintigraphy. Fifty-seven children were evaluated during pyelonephritis: biology (CRP, creatinine, blood formula), color/power doppler sonography and 99m Tc-DMSA scintigraphy (DMSA1). 7 ± 2 months later, follow-up consisted in biological tests and a 99m 'Tc-DMSA scintigraphy (DMSA2). During pyelonephritis, body temperature, CRP value and neutrophil counts were significantly higher in patients with an abnormal DMSA1 but not in patients with abnormal doppler sonography. When compared with DMSA1, doppler sonography sensitivity and specificity were 80% and 81% respectively. DMSA1 and doppler sonography were concordant in 86% of children with a pyelonephritis. At follow-up, all clinical et biological parameters were normalized. DMSA2 was abnormal in 51% of children. When compared with DMSA2, positive and negative predictive values for scarring of doppler sonography were 57% and 75% respectively. DMSA 1, positive and negative predictive values for scarring were 62% and 100%. In conclusion, color/power doppler sonography is a reliable tool for pyelonephritis diagnosis, but its predictive value for scarring is poor. Negative predictive value of DMSA scintigraphy is excellent. (author)

Transition Hand-Off from Inpatient to Outpatient Treatment of Acute Pyelonephritis in an Elderly Male.

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Orlando, Patricia L; Shane-McWhorter, Laura

2017-04-01

Pyelonephritis is the progression of a urinary tract infection (UTI) to the kidney. In younger patients the infection may not be as severe and may even be treated with oral antibiotics. However, in elderly males pyelonephritis can be more complex and may require hospitalization and treatment with intravenous antibiotics. In the United States UTIs are responsible for frequent visits to emergency departments by elderly individuals. Current literature suggests that pyelonephritis in elderly males is a serious infection that may result in significant morbidity and mortality. Pharmacists are in a unique position to oversee the transition of antibiotic treatment from the inpatient to outpatienT SETTING.

Acute renal failure caused by Klebsiella pneumoniae pyelonephritis

NARCIS (Netherlands)

Creyghton, W. M.; Lobatto, S.; Weening, J. J.

2001-01-01

We report a 34-year-old male patient without prior medical history who presented with acute renal failure due to acute bacterial pyelonephritis. Both blood and urine cultures grew Klebsiella pneumoniae. Although a kidney biopsy revealed extensive necrosis and no viable glomeruli, renal function

Experience with the use of Stimol® in Acute Pyelonephritis in Children

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G.Yu. Zvenigorodska

2013-10-01

Full Text Available The results of the clinical use of Stimol® in the comprehensive treatment of acute pyelonephritis in 58 children. It is established that the inclusion of metabolism corrector Stimol® in complex of medical treatment of patients with acute pyelonephritis contributes to the stabilization of the clinical condition of patients, reducing symptoms of intoxication (improved appetite, reduced general malaise, normalization of temperature. The findings show the feasibility and clinical efficacy of Stimol® administration, which can be regarded as one of the promising methods of detoxification therapy.

The role of serum and urine interleukin-8 on acute pyelonephritis and subsequent renal scarring in children.

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Sheu, Ji-Nan; Chen, Shan-Ming; Meng, Meng-Hsiao; Lue, Ko-Huang

2009-10-01

Interleukin (IL)-8 acts as a potent neutrophils chemoattractant responsible for the migration of neutrophils into the infected renal tissue to protect against invading pathogens. The aim of this study was to assess the role of IL-8 on acute-phase pyelonephritis and later renal scarring in children. A total of 124 children with a first-time febrile urinary tract infection (UTI) were studied. The diagnosis of acute pyelonephritis was confirmed by Tc-dimercaptosuccinic acid (DMSA) renal scan. Serum and urine samples were obtained from 124 children with UTI and 20 healthy children for IL-8 measurement. The 124 children were divided into acute pyelonephritis (n = 70) and lower UTI (n = 54) groups according to the results of DMSA scans. The initial serum and urine IL-8 values of children with acute pyelonephritis were significantly higher when compared with lower UTI and healthy controls (all P or =III all were independent predictors of renal scarring. Those children younger than 2 years of age with the highest IL-8 concentrations during the acute phase of pyelonephritis as well as children with reflux grades of III or greater are at a high-risk for developing renal scarring in the future.

Antibiotics for acute pyelonephritis in children.

Science.gov (United States)

Strohmeier, Yvonne; Hodson, Elisabeth M; Willis, Narelle S; Webster, Angela C; Craig, Jonathan C

2014-07-28

Urinary tract infection (UTI) is one of the most common bacterial infections in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent kidney damage. There remains uncertainty regarding the optimum antibiotic regimen, route of administration and duration of treatment. This is an update of a review that was first published in 2003 and updated in 2005 and 2007. To evaluate the benefits and harms of antibiotics used to treat children with acute pyelonephritis. The aspects of therapy considered were 1) different antibiotics, 2) different dosing regimens of the same antibiotic, 3) different duration of treatment, and 4) different routes of administration. We searched the Cochrane Renal Group's Specialised Register, CENTRAL, MEDLINE, EMBASE, reference lists of articles and conference proceedings without language restriction to 10 April 2014. Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0 to 18 years with proven UTI and acute pyelonephritis were selected. Four authors independently assessed study quality and extracted data. Statistical analyses were performed using the random-effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). This updated review included 27 studies (4452 children). This update included evidence from three new studies, and following re-evaluation, a previously excluded study was included because it now met our inclusion criteria.Risk of bias was assessed as low for sequence generation (12 studies), allocation concealment (six studies), blinding of outcome assessors (17 studies), incomplete outcome reporting (19 studies) and selective outcome reporting (13 studies). No study was blinded for participants or investigators. The 27 included studies evaluated 12 different

{sup 99M}Tc - DMSA renal scintigraphy in the diagnosis and follow-up of acute pyelonephritis in children

Energy Technology Data Exchange (ETDEWEB)

Wallin, L

1997-06-01

The aim of the present thesis was to define and evaluate a strategy for identification of children who are at risk of developing progressive renal lesions after acute pyelonephritis. Qualitative and quantitative evaluation standards were elaborated to improve the interpretation of DMSA scintigraphy. The normal DMSA distribution pattern, the average background uptake, and scintigraphic kidney length according to age were assessed in 95 presumably healthy kidneys. Furthermore, typical DMSA distribution patterns in acute pyelonephritis were assessed on 65 kidneys in 38 children, and typical DMSA distribution patterns of 152 kidneys with VUR in 101 children with and without previous pyelonephritis. Measurement of scintigraphic kidney length, width and volume was validated in piglets and on a kidney phantom. The scintigraphic kidney length was found to be an accurate measure of renal size, whereas kidney width and volume were less reliable, at least on small kidneys. Criteria of kidney swelling in acute pyelonephritis were defined, and found to be beneficial for identifying reinfections in the absence of clinical symptoms. In 34 children with acute pyelonephritis quantitative and qualitative DMSA scintigraphic findings were correlated to clinical symptoms and laboratory data, in the acute stage and at follow up. We found that quantitative DMSA scintigraphy in the acute stage of pyelonephritis and again after one year will identify children who are at risk of developing progressive renal lesions. Qualitative assessment of DMSA distribution pattern is not reliable enough in this respect. 116 refs., 7 figs.

A near-fatal case of emphysematous pyelonephritis: Embracing the ...

African Journals Online (AJOL)

A. Adam

2017-01-17

Jan 17, 2017 ... Abstract. Introduction: Emphysematous pyelonephritis (EPN) is a rare, acute, severe infection of the renal parenchyma and its surrounding tissues and is associated with a significant morbidity and mortality. Underlying diabetes is the most commonly associated risk factor. Observation: We report on the ...

Pyelonephritis, renal scarring, and reflux nephropathy: a pediatric urologist's perspective

Energy Technology Data Exchange (ETDEWEB)

Smith, Edwin A. [Emory University School of Medicine, Department of Urology, Atlanta, GA (United States)

2008-01-15

Imaging of children with a clinical diagnosis of pyelonephritis is performed to characterize the extent of the infection, to identify associated renal injury and to uncover risk factors for future infections and renal damage. Although there is general agreement regarding the need for parenchymal imaging and the need to exclude processes that are either functionally or anatomically obstructive, there is controversy regarding the need for routine cystography, especially when parenchymal involvement has not been documented. A protocol that limits the use of cystography for evaluation of urinary tract infections must assume that the diagnosis of reflux is at least of variable clinical significance. It is now clear that vesicoureteral reflux and reflux nephropathy represent a diverse population that includes both congenital and acquired processes. MR imaging will improve our understanding of vesicoureteral reflux, pyelonephritis and renal scarring and might help us to identify and manage those patients most at risk for recurrent infections and renal injury. To recognize the potential contributions of this newer imaging technique it is helpful to look at our understanding of the pathophysiology of pyelonephritis, reflux and reflux nephropathy. (orig.)

Chronic pyelonephritis: Modulation of host defenses by cyclosporin A

International Nuclear Information System (INIS)

Findon, G.; Miller, T.E.

1989-01-01

Chronic experimental pyelonephritis is characterized by a stable level of infection, which persists for many months. Administration of cyclosporin A (CsA) reactivated previously healed renal lesions and caused a marked increase in bacterial numbers in the kidney. Studies were then carried out to compare the effects of CsA, and the nonselective cytodepletive agents irradiation and cyclophosphamide, on both host defenses and the bacteriologic status of chronically infected kidneys. Two different responses were observed. In animals treated with CsA, bacterial numbers increased markedly, although circulating neutrophil numbers were relatively unaffected. This observation was in contrast to the severe ablation of leukocyte numbers and competence needed to achieve an equivalent effect when irradiation and cyclophosphamide were used. One possible explanation for the adverse effect of CsA on the host-parasite balance in chronic pyelonephritis is that CsA affects mediators that control the inflammatory response or induces a qualitative change in a critical cellular defense compartment

Renal replacement lipomatosis and xanthogranulomatous pyelonephritis: differential diagnosis

International Nuclear Information System (INIS)

Romero, Frederico R.; Pilati, Roberto; Brenny Filho, Thadeu; Caboclo, Maria Fernanda Sales Ferreira; Silva, Antonio de Padua Gomes; Cravo, Marco Aurelio

2011-01-01

Renal replacement lipomatosis (RRL) is a relatively uncommon entity, although misdiagnosis - mainly with xanthogranulomatous pyelonephritis (XGP) - due to lack of awareness by urologists, radiologists, and pathologists may be responsible for underreporting. We illustrate a case of RRL that was initially misdiagnosed as XGP, and compare it with a classic case of XGP, underscoring the similarities and the differences between them. (author)

Renal replacement lipomatosis and xanthogranulomatous pyelonephritis: differential diagnosis

Energy Technology Data Exchange (ETDEWEB)

Romero, Frederico R. [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil); Pilati, Roberto; Brenny Filho, Thadeu; Caboclo, Maria Fernanda Sales Ferreira [Hospital Sao Vicente de Curitiba, PR (Brazil); Silva, Antonio de Padua Gomes [Centro de Citopatologia Parana Ltda. (Citopar), Curitiba, PR (Brazil); Cravo, Marco Aurelio [Laboratorio de Patologia e Citologia (Consulpat), Curitiba, PR (Brazil)

2011-05-15

Renal replacement lipomatosis (RRL) is a relatively uncommon entity, although misdiagnosis - mainly with xanthogranulomatous pyelonephritis (XGP) - due to lack of awareness by urologists, radiologists, and pathologists may be responsible for underreporting. We illustrate a case of RRL that was initially misdiagnosed as XGP, and compare it with a classic case of XGP, underscoring the similarities and the differences between them. (author)

Serum levels of interleukin-6 and interleukin-8 as diagnostic markers of acute pyelonephritis in children

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Abolfazl Mahyar

2013-05-01

Full Text Available <b>Purpose:</b> Early diagnosis and treatment of acute pyelonephritis in children is of special importance in order to prevent serious complications. This study was conducted to determine the diagnostic value of serum interleukin (IL-6 and IL-8 in children with acute pyelonephritis. <b>Methods:</b> Eighty seven patients between 1 month to 12 years old with urinary tract infection (UTI were divided into 2 groups based on the result of 99m-technetium dimercapto-succinic acid (DMSA renal scan: acute pyelonephritis (n=37 and lower UTI (n=50 groups. White blood cell (WBC count, neutrophil (Neutl count, erythrocyte sedimentation rate (ESR, C-reactive protein (CRP concentration, platelet count, and serum IL-6 and IL-8 concentrations of both groups were measured and compared . <b>Results:</b> There was a significant difference between two groups regarding WBC count, Neutl count, ESR, and CRP concentration (P<0.05. In addition, the difference between the two groups regarding serum IL-6 and IL-8 concentrations was not significant (IL-6, 60 and 35.4 pg/mL and IL-8, 404 and 617 pg/mL, respectively. The sensitivity and specificity of serum IL-6 and IL-8 for diagnosis of acute pyelonephritis were 73%, 42% and 78%, 32%, respectively. Sensitivity, specificity, negative and positive predictive values of serum IL-6 and IL-8 were less than those of acute phase serum reactants such as CRP. <b>Conclusion:</b> This study showed that there was no significant difference between acute pyelonephritis and lower UTI groups regarding serum IL-6 and IL-8 levels. Therefore, despite confirming results of previous studies, it seems that IL-6 and IL-8 are not suitable markers for differentiating between acute pyelonephritis and lower UTI.

Double J stenting: A rewarding option in the management of emphysematous pyelonephritis

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Debiprasad Das

2016-01-01

Conclusion: Emphysematous pyelonephritis can be managed conservatively by DJ stenting, wcich is a less morbid procedure or percutaneous nephrostomy with proper antibiotics and adequate glycemic control.

Nephrobronchial fistula and lung abscess secondary to Xanthogranulomatous pyelonephritis

OpenAIRE

Abhay Uppe; Ravindra Nikalji; Manish Dubey; Nilesh Kadu

2015-01-01

There are multiple causes of lung abscess, but the differential rarely includes pyelonephritis as a primary cause leading to lung abscess resulting from the development of a nephrobronchial fistula. The patient had no urinary symptoms or abdominal pain and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.

Time course of transient cortical scintigraphic defects associated with acute pyelonephritis

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Ditchfield, Michael R.; Summerville, Dianne; Cook, David J.; Campo, John F. de [Department of Radiology, Royal Children' s Hospital, Melbourne 3052 (Australia); Grimwood, Keith; Nolan, Terrance M. [Department of General Paediatrics, Royal Children' s Hospital, Melbourne (Australia); Department of Paediatrics, University of Melbourne, Melbourne (Australia); Powell, Harley R. [Department of Nephrology, Royal Children' s Hospital, Melbourne (Australia); Sloane, Robert [Department of General Paediatrics, Royal Children' s Hospital, Melbourne (Australia)

2002-12-01

Acute pyelonephritis is distinguished from renal scarring using repeat cortical scintigraphy. The defects of acute pyelonephritis resolve, while those of scars persist. To determine the duration of reversible cortical defects following acute pyelonephritis and the time interval required to differentiate infection from scars. Materials and methods. An observational prospective study of 193 children (386 kidneys) aged less than 5 years following their first proven urinary tract infection (UTI). Renal cortical scintigraphic defects were detected in 112 (29%) kidneys within 15 days of diagnosis. Of these, 95 underwent repeat renal cortical scans 2 years after the UTI, including 50 with additional scans performed within 2-6 months of infection. Of the 50 kidneys undergoing a second renal cortical scan within 2-6 months of the first UTI, 22 (44%) had persistent defects. A third scan was performed on 17 (77%) kidneys after 2 years, by which time defects had resolved in another 8 (47%) kidneys. The predictive value of defects detected within 2-6 months of UTI representing scars is 53% (95% CI 28, 77). Overall, nine (18%) kidneys with initial renal cortical abnormalities had permanent defects. In the 45 kidneys undergoing a second cortical scan more than 6 months after the UTI, 11 (24%) had persistent defects. None of the 95 kidneys undergoing serial scans developed new or larger defects. Renal scars may not be reliably diagnosed by cortical scintigraphy performed within 6 months of UTI because the inflammatory lesions may not have fully resolved. (orig.)

Time course of transient cortical scintigraphic defects associated with acute pyelonephritis

International Nuclear Information System (INIS)

Ditchfield, Michael R.; Summerville, Dianne; Cook, David J.; Campo, John F. de; Grimwood, Keith; Nolan, Terrance M.; Powell, Harley R.; Sloane, Robert

2002-01-01

Acute pyelonephritis is distinguished from renal scarring using repeat cortical scintigraphy. The defects of acute pyelonephritis resolve, while those of scars persist. To determine the duration of reversible cortical defects following acute pyelonephritis and the time interval required to differentiate infection from scars. Materials and methods. An observational prospective study of 193 children (386 kidneys) aged less than 5 years following their first proven urinary tract infection (UTI). Renal cortical scintigraphic defects were detected in 112 (29%) kidneys within 15 days of diagnosis. Of these, 95 underwent repeat renal cortical scans 2 years after the UTI, including 50 with additional scans performed within 2-6 months of infection. Of the 50 kidneys undergoing a second renal cortical scan within 2-6 months of the first UTI, 22 (44%) had persistent defects. A third scan was performed on 17 (77%) kidneys after 2 years, by which time defects had resolved in another 8 (47%) kidneys. The predictive value of defects detected within 2-6 months of UTI representing scars is 53% (95% CI 28, 77). Overall, nine (18%) kidneys with initial renal cortical abnormalities had permanent defects. In the 45 kidneys undergoing a second cortical scan more than 6 months after the UTI, 11 (24%) had persistent defects. None of the 95 kidneys undergoing serial scans developed new or larger defects. Renal scars may not be reliably diagnosed by cortical scintigraphy performed within 6 months of UTI because the inflammatory lesions may not have fully resolved. (orig.)

Role of Conservative Management in Emphysematous Pyelonephritis - A Retrospective Study

Science.gov (United States)

Irom, Keshorjit Singh; Khumallambam, Ibomcha Singh; Sinam, Rajendra Singh

2015-01-01

Introduction Emphysematous pyelophritis (EPN) is a serious condition with significant mortality. The prognosis of patients with EPN has changed over the years. Mortality has declined with prompt and aggressive medical management and minimally invasive strategies. Aim To identify the prognostic factors and assess the outcome of conservative management of emphysematous pyelonephritis. Settings and Design This was a retrospective study of 8 consecutive patients who were diagnosed with EPN in two medical institutes between July 2010 and June 2015. Materials and Methods Eight consecutive patients diagnosed with emphysematous pyelonephritis between July 2010 and June 2015 was studied retrospectively. On the basis of Computerised tomographic scan findings they were grouped into four classes (1 to 4) according the modified classification recommended by Huang and Tseng. The management was conservative (combination of percutaneous drainage and antibiotics), immediate nephrectomy or delayed nephrectomy (when conservative management failed). Demographic, clinical, biochemical and radiological characteristics were assessed and compared between survivors and nonsurvivors. Results Seven (87.5%) of a total of 8 patients had diabetes mellitus. Escherichia coli (71.4 %) was the most common offending pathogen identified in pus culture. With conservative management in 7 patients (combination of percutaneous drainage and antibiotics), treatment was successful in 57.14 % and with immediate nephrectomy (one patient), the success rate was 100%. The risk factors for mortality were thrombocytopenia, shock and altered sensorium at presentation. The mortality rate in class 1, 2 and 3 was 0%, 33.3% and 66.7%. None of the patient had class 4 EPN. Conclusion A combination of percutaneous drainage with antibiotics offers an effective therapy for emphysematous pyelonephritis. PMID:26675196

Nephrobronchial fistula and lung abscess secondary to Xanthogranulomatous pyelonephritis

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Abhay Uppe

2015-01-01

Full Text Available There are multiple causes of lung abscess, but the differential rarely includes pyelonephritis as a primary cause leading to lung abscess resulting from the development of a nephrobronchial fistula. The patient had no urinary symptoms or abdominal pain and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.

Acute Pyelonephritis with Perinephric Stranding on CT

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Ronald Goubert

2018-01-01

Full Text Available History of present illness: A 54-year old female presented to the emergency department with complaints of fevers, dysuria, urinary frequency, and diffuse abdominal pain. Her temperature was 103°F, but the remainder of her vital signs were normal. Upon physical examination, the patient had tenderness to palpation in the left upper and left lower abdomen and left costovertebral angle tenderness. Due to the location of pain (diverticulitis is in the differential for left-sided abdominal pain in this age group and patient’s reported history of nephrolithiasis, a computed tomography (CT scan of the abdomen and pelvis with intravenous (IV contrast was ordered because the physician felt this could best work up both of these possible conditions. Significant findings: A CT abdomen and pelvis with IV contrast showed neither nephrolithiasis nor diverticulitis, and instead showed heterogeneous enhancement of the left kidney with mild edematous enlargement and striated left nephrogram. Significant perinephric stranding (red arrows was also noted and was consistent with severe acute pyelonephritis. Discussion: Acute pyelonephritis (APN is a bacterial infection of the renal parenchyma which can present with a spectrum of symptoms including flank pain, high-grade fever, vomiting, and urinary tract symptoms.1,2 The diagnosis of APN can be made based on these clinical features with associated laboratory findings of bacteriuria, pyuria, positive urine cultures, and leukocytosis.1,2,7 Early diagnosis and treatment of APN is essential to prevent complications such as renal abscess or infarct, which could lead to renal failure, sepsis, and shock.3 CT has a sensitivity and specificity of 86.8% and 87.5%, respectively, for diagnosing APN. Common findings include striated nephrograms or perinephric fat stranding.2 However, imaging is not required for diagnosis and is typically reserved for patients who are immunocompromised, have severe symptoms, or show no clinical

[Pyelonephritis with massive renal tissue necrosis in child with urinary tract malformation--a case report].

Science.gov (United States)

Pawlak-Bratkowska, Monika; Finke, Daria; Olejniczak, Dariusz; Midel, Anna; Tkaczyk, Marcin

2009-04-01

The aim of the case report is presentation of unusual and heavy clinical course of pyelonephritis with renal tissue necrosis in a child with urinary tract malformation. Nine month old girl was admitted to hospital in heavy clinical status due to pyelonephritis--urosepsis. It was complicated by acute renal insufficiency. Patient was treated by broad-spectrum antibiotics and parenteral nutrition. She was feverish for 14 days. Computed tomography done in order to exclude abdominal abscess showed massive renal tissue necrosis of on both sides. Antibiotic treatment was successful after 6 weeks. Urological evaluation revealed bilateral vesico-ureteral refluxes grade IV. Scintigraphy showed multiple scars. Patient was treated Deflux injections (twice). We noted 5 urinary tract recurrences despite antibiotic profilaxis. GFR of 75 ml/min/1.73 m2 was estimated at age of 16 m. Immunodeficiency or malignancy as background of clinical course were excluded. The case we describe presents severe clinical course of pyelonephritis due to complex urinary tract malformation that is to be considered despite based on modern publications "sparing" strategies of diagnosis and profilaxis in urinary tract malformations.

LOWER URINARY TRACT DYSFUNCTION IN PATIENTS WITH CHRONIC PYELONEPHRITIS

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V. B. Berdichevskyy

2014-01-01

Full Text Available  As a result of this study found that the lower urinary tract dysfunction in patients with chronic pyelonephritis is a consequence of the parasympathetic, visceral dysfunction with clinical manifestations in the form ARRHYTHMOLOGY syndrome, and frequent urination scant. Appointment of α1-blocker tamsulosin is accompanied by more effective in abolishing the clinical and laboratory manifestations of the disease. 

Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis

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Jose R. De Souza

2003-06-01

Full Text Available 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.

[Bilateral nephrectomy in patients with end-stage renal failure and chronic active pyelonephritis].

Science.gov (United States)

Lysenko, M A; Vtorenko, V I; Trushkin, R N; Lubennikov, A E; Sysoev, A M; Sokolov, A A

2016-02-01

This study analyzed the results of bilateral nephrectomy in 14 patients with end-stage renal disease (ESRD) and chronic active pyelonephritis. Seven patients had urosepsis, and 10 patients had a purulent form of pyelonephritis, which was one-sided in 7 of them. In the early postoperative period, on average, after 9.3 days, 9 patients died. Statistically significant risk factors for death were: chronic hemodialysis, long-term antibiotic therapy, and existing sepsis. Intraoperative complications and postoperative morbidity were not significantly associated with death. The study results imply the need of differentiated approach to bilateral nephrectomy in patients with ESRD and risk factors for fatal outcome. It must be performed on the strong indications since the intervention does not lead to eradication of sepsis. It is advisable to perform "preventive, sanation" bilateral nephrectomy in the "cold period" in patients at risk for developing urosepsis.

Staghorn calculi and xanthogranulomatous pyelonephritis associated with transitional cell carcinoma

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Chao-Wei Tseng

2015-03-01

Full Text Available Untreated staghorn calculi can cause xanthogranulomatous pyelonephritis (XGP, diminished renal function, and renal malignancy. Squamous cell carcinoma (SCC of the upper urinary tract is associated with kidney stones and chronic infection, but their association with transitional cell carcinoma (TCC has not been proven and has rarely been reported in literature. We present a rare case of staghorn calculi and XGP associated with TCC.

Evaluation of diagnostic value of procalcitonin in pediatric acute pyelonephritis

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Simin Sadeghi-bojd

2012-05-01

Full Text Available Background and Aim: Urinary tract infection (UTI in children is among the prevalent infections of childhood, which occurs due to growth of bacteria in the urinary tract. The aim of this study was to evaluate the usefulness of procalcitonin (PCT as a reliable marker for distinguishing urinary tract infection (UTI with or without renal parenchyma (cystitis. Materials and Methods: Eighty children, who were suspicious of having UTI and had been referred to Ali Ibne Abitaleb hospital (in Zahedan or pediatric clinics (June 2007- Oct 2009 were included in the study after their urine culture revealed their infection. Besides, their clinical and lab symptoms including erythrocyte sedimentation rate (ESR, C– reactive protein (CRP, serum WBC, and serum procalcitonin (PCT were recorded. The patients were divided into two groups based on their lab clinical symptoms and radio-isotope scans, namely acute pyelonephritis and acute cystitis (lower UTI. Serum procalcitonin was measured in these cases in a semi-quantitative manner. Results: Fifty children with mean age of 4.89±3.50 years were compared with 30 children with mean age of 5.20±3.07 years. ESR, WBC, and PCT were significantly higher in patients with upper UTI (P<0.001 , but CRP was not significantly different in the two groups. PCT, which was semi-quantitatively measured, when lower than 0.5 had a relationship with sensitivity, specificity, positive predictive value, and negative value of 72%, 83.3%, 87.8%, and 64.1% respectively. When PCT was more than 2, the relationship with the mentioned features was 50%, 96.6%, 96.2%, and 53.7%, respectively. The relationships in these two domains can both be assistant in differentiating pyelonephritis from cystitis. Conclusion: PCT was more sensitive and specific for the diagnosis of upper versus lower UTI compared with CRP, and it can be a better marker than CRP for early prediction of febrile pyelonephritis in children.

Emphysematous pyelonephritis with calculus: Management strategies.

Science.gov (United States)

Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

2007-07-01

Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures.

Blockade of Rennin-Angiotensin system blunts the fibrotic response in experimental acute pyelonephritis

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Singal A

2005-01-01

Full Text Available Aim: To study the impact of Renin-Angiotensin system blockade in experimental acute pyelonephritis, induced by a novel surgical approach via dorsal lumbotomy incision. Materials and Methods : 45 Adult female WISTAR rats aged 8-12 weeks, underwent direct inoculation of 0.1 ml of E.coli suspension into the parenchyma of the surgically exposed kidney. 3 groups of rats were studied: Group A - treated with antibiotics only; Group B- Captopril and antibiotics and Group C- Losartan and antibiotics. Changes of acute inflammation, parenchymal destruction and scarring were compared between the groups on histopathological sections. Kruskal-Wallis test was used for statistical analysis. Results : Changes consistent with acute pyelonephritis were seen in all the kidneys. Mean% scar area in Group A, Group B and Group C was 37.08±1.79, 24.40±1.88 and 24.68±1.32% respectively at end of six weeks. Mean tubular density in Group A, B and C was 17.26±1.92, 47.18±3.00 and 47.00±5.08-tubules/lac mm2 respectively. The differences between the control and the treated animals were significant, though the results did not differ between the losartan and captopril treated rats. Conclusions : Dorsal lumbotomy approach to the kidney provides a good exposure of the kidney. Induction of acute pyelonephritis by direct inoculation of bacteria into renal cortex produced a consistent scar at 6 weeks. Blockade of renin angiotensin system by either captopril or losartan decreased the renal scar area by almost 1/3 at 6 weeks.

High diagnostic value of general practitioners' presumptive diagnosis for pyelonephritis, meningitis and pancreatitis.

Science.gov (United States)

Sriskandarajah, Srishamanthi; Carter-Storch, Rasmus; Frydkjær-Olsen, Ulrik; Mogensen, Christian Backer

2016-01-01

In Denmark, patients referred from the general practitioner (GP) to the emergency department (ED) can be referred with either specific symptoms or with a presumptive diagnosis. The aim of the present study was to evaluate the diagnostic accuracy for various presumptive diagnoses made by the GP in a population acutely referred to an ED. This was a retrospective cohort study of all registered acute referrals for admission to Kolding ED in 2010. Eight presumptive diagnoses were selected for further studies: meningitis, acute coronary syndrome (ACS), pulmonary embolism, pneumonia, pancreatitis, deep venous thrombosis (DVT), pyelonephritis and intestinal obstruction. The presumptive diagnoses were compared with the final diagnosis on discharge. Sensitivity, specificity, predictive values and likelihood ratios were calculated. A total of 8,841 patients were enrolled. The highest and lowest sensitivities were seen for DVT (90%) and meningitis (36%), respectively; and the highest and lowest values for specificity were observed for meningitis (99%) and ACS (30%), respectively. The positive predictive value had a wide range with the lowest value for ACS (9%) and the highest for pneumonia (59%). For pyelonephritis, meningitis and pancreatitis, the likelihood ratio of a positive test was above 10. The likelihood ratio of a negative test was above 0.1 for all diagnoses. Patients referred with the presumptive diagnoses pyelonephritis, meningitis and pancreatitis had a high likelihood of having the disease in question. It is important not to discard any of the included presumptive diagnoses even if the GPs fail to suggest them on admission. none. none.

Renal Power Doppler Ultrasonographic Evaluation of Children With Acute Pyelonephritis

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Ali Pahlusi

2011-10-01

Full Text Available Urinary tract infections are common in children. The available gold standard method for diagnosis, Tc-99m dimercaptosuccinic acid scan is expensive and exposes patients to considerable amount of radiation. This study was performed to compare and assess the efficacy of Power Doppler Ultrasound versus Tc-99m DMSA scan for diagnosis of acute pyelonephritis. A quasi experimental study was conducted on 34 children with mean age of 2.82.7 years who were hospitalized with their first episode of febrile urinary tract infection. All children were evaluated in the first 3 days of admission by Doppler Ultrasound and Tc-99m DMSA scan. Patients with congenital structural anomalies were excluded. Each kidney was divided into three zones. The comparison between efficacy of Doppler Ultrasound and DMSA scan was carried out based on number of patients and on classified renal units. Based on the number of patients enrolled; the sensitivity, specificity, positive and negative predictive values and accuracy of Doppler Ultrasound were 89%, 53%, 70%, 80% and 74%, respectively but based on the renal units, it was 66%, 81%, 46%, 91% and 79% , respectively. Although Doppler Ultrasound has the potential for identifying acute pyelonephritis in children, but it is still soon to replace DMSA scan.

Bilateral type emphysematous pyelonephritis: imaging evaluation

International Nuclear Information System (INIS)

Salvador Cueto-Alvarez, L.; Piriz-Campos, E.; Ruiz-Garcia, T.; Roldan-Lora, F.

2000-01-01

Emphysematous pyelonephritis (EPN) is a serious infectious disease that occurs more frequently in diabetic patients. Radiological studies are indispensable for distinguishing between the two types since each is associated with a markedly different prognosis. We present a case of bilateral EPN diagnosed as type I on the basis of computed tomography findings, differentiating it from type II EPN, taking into account the prognostic value of this distinction. Type I EPN is characterized by the destruction of the renal parenchyma, a mottled or linear gas pattern and the absence of renal and perirenal fluid collection. Type II EPN is characterized by a loculated or bubbly gas pattern, the existence of fluid collection and less marked renal destruction. Type I is more aggressive and is associated with high rate of mortality. (Author) 7 refs

Emphysematous pyelonephritis with calculus: Management strategies

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Tanmaya Goel

2007-01-01

Full Text Available Objective: Emphysematous pyelonephritis (EPN with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Materials and Methods: Over four years, we diagnosed seven cases (eight renal units of EPN, out of which two patients (three renal units had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. Results: EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. Conclusion: In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures.

Nephrobronchial fistula complicating neglected nephrolithiasis and xanthogranulomatous pyelonephritis

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Indu B Dubey

2011-01-01

Full Text Available Nephrobronchial fistula is a rare complication seen in association with renal infections, trauma or stone disease. Xanthogranulomatous pyelonephritis (XGP is an infectious disease with a potential for fistulization to lung, skin, colon and other organs. We present a case of nephrolithiasis complicated by obstruction leading to pyonephrosis and nephrobronchial fistula, treated successfully by nephrectomy and excision of fistulous tracts. Nephrobronchial fistula, although a rare complication of longstanding renal stone, should be considered when a patient presents with perirenal suppurative process. This clinical case illustrates the natural history of nephro-bronchial fistula and the relevance of early treatment of nephrolithiasis.

Experience with the NICE Guidelines for Imaging Studies in Children with First Pyelonephritis

DEFF Research Database (Denmark)

Lytzen, R; Thorup, Jørgen Mogens; Cortes, D

2011-01-01

PURPOSE: This retrospective study evaluates the applicability of a selective approach for imaging in children aged 0-15 years with a first episode of pyelonephritis, based on the UTI guidelines of the National Institute for Health and Clinical Excellence (NICE). MATERIAL AND METHODS: A total of 96...

Dynamic scintigraphy of the kidneys in chronic pyelonephritis of patients with artrial hypertension

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Kramer, A.A.; Belichenko, O.I.; Arabidze, G.G.

1985-01-01

It has been shown that latent renal diseases are detected by sectoral scintigraphy earlier than by other methods, and the former acquires particular importance when the only sign of disease is arterial hypertension. Early diagnosis of latent pyelonephritis makes this method especially valuable both for the selection of patients for further thorough examination and for the start of adequate therapy. Scintigraphy serves as a reliable criterion for the evaluation of the therapeutic efficacy in patients with chronic pyelonephritis (CP). Changes of scintigraphy parametres coincide quite exactly with the changed level of arterial pressure, concentration and nitrogen clearing function of the kidneys during treatment. This method (sectoral scintigraphy) is very important when used over time in CP patiens with chronic renal insufficiency making it possible to detect with a sufficient deg ree of significance the improvement as well as impairment of renal function which is a crucial point for the choice of further therapeutic tactics

Challenges in preventing pyelonephritis in pregnant women in Indigenous communities.

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Bookallil, M; Chalmers, E; Andrew, B

2005-01-01

To measure the quality of antenatal care in rural and remote regions of the Northern Territory, using asymptomatic bacteruria as an indicator. Indigenous Australian women and their babies have a greater frequency of adverse outcomes in pregnancy than their non-Indigenous counterparts. It is well established that asymptomatic bacteriuria may have serious outcomes in pregnancy, including an increased risk of pyelonephritis and a strong association with preterm and low birth weight delivery. Ensuring good quality antenatal care can reduce the individual risks of pregnancy for mothers and their babies. In the Northern Territory there are well established guidelines for antenatal care in rural and remote Indigenous communities. These are documented in the Women's Business Manual. Audit and feedback is one method that has been shown to have a small to moderate effect in changing clinician behaviour, in this case improving compliance with guidelines. A retrospective chart audit of antenatal clients was conducted at 10 rural and remote primary health care clinics in the Northern Territory, Australia. The audit reviewed all the available charts (n = 268) of pregnant women, from the participating communities, who gave birth in 2002 or 2003. The diagnosis and management of asymptomatic bacteriuria was chosen as the indicator of quality antenatal care, as it is one of five areas of antenatal care where there is evidence that appropriate management improves outcomes. The quality of care was measured against the local guidelines, the Women's Business Manual. Women frequently had urine tests with where the dipstick showed an abnormal result, with 75% (95% CI [0.70,0.80]) of women having at least one episode of abnormal urinalysis during pregnancy. Six hundred and twenty episodes of abnormal urinalysis in pregnancy were identified. The incidence of bacteriuria at first visit was 16%, (95%-confidence interval = 95% CI [0.10, 0.21]). Compliance with the guidelines was poor. Fifty

Incidence of abnormal imaging and recurrent pyelonephritis after first febrile urinary tract infection in children 2 to 24 months old.

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Juliano, Trisha M; Stephany, Heidi A; Clayton, Douglass B; Thomas, John C; Pope, John C; Adams, Mark C; Brock, John W; Tanaka, Stacy T

2013-10-01

The AAP (American Academy of Pediatrics) no longer recommends voiding cystourethrogram in children 2 to 24 months old who present with a first urinary tract infection if renal-bladder ultrasound is normal. We identified factors associated with abnormal imaging and recurrent pyelonephritis in this population. We retrospectively evaluated children diagnosed with a first episode of pyelonephritis at age 2 to 24 months using de-identified electronic medical record data from an institutional database. Data included age at first urinary tract infection, gender, race/ethnicity, need for hospitalization, intravenous antibiotic use, history of abnormal prenatal ultrasound, renal-bladder ultrasound and voiding cystourethrogram results, urinary tract infection recurrence and surgical intervention. Risk factors for abnormal imaging and urinary tract infection recurrence were analyzed by univariate logistic regression, the chi-square test and survival analysis. We identified 174 patients. Of the 154 renal-bladder ultrasounds performed 59 (38%) were abnormal. Abnormal prenatal ultrasound (p = 0.01) and the need for hospitalization (p = 0.02) predicted abnormal renal-bladder ultrasound. Of the 95 patients with normal renal-bladder ultrasound 84 underwent voiding cystourethrogram. Vesicoureteral reflux was more likely in patients who were white (p = 0.003), female (p = 0.02) and older (p = 0.04). Despite normal renal-bladder ultrasound, 23 of 84 patients (24%) had dilating vesicoureteral reflux. Of the 95 patients with normal renal-bladder ultrasound 14 (15%) had recurrent pyelonephritis and 7 (7%) went on to surgical intervention. Despite normal renal-bladder ultrasound after a first pyelonephritis episode, a child may still have vesicoureteral reflux, recurrent pyelonephritis and the need for surgical intervention. If voiding cystourethrogram is deferred, parents should be counseled on these risks. Copyright © 2013 American Urological Association Education and Research, Inc

Xanthogranulomatous Pyelonephritis with Incomplete Double Ureter

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Yutaro Hayashi

2017-01-01

Full Text Available Introduction. Xanthogranulomatous pyelonephritis (XGP is a type of chronic renal inflammation that usually occurs in immunocompromised middle-aged women with chronic urinary tract infection or ureteral obstruction induced by the formation of ureteral stones. XGP with an incomplete double ureter is extremely rare. Case Presentation. A 76-year-old woman was referred to our department to undergo further examination for a left renal tumor that was detected by ultrasonography. Dynamic contrast computed tomography (CT revealed an enhanced tumor in the upper renal parenchyma. Laparoscopic radical nephrectomy was performed based on a preoperative diagnosis of renal cell carcinoma. Histological sections showed the aggregation of foam cells; thus, XGP was diagnosed. Conclusion. We herein report a rare case of XGP in the upper pole of the kidney, which might have been associated with an incomplete double ureter.

Characterization of subclinical bacteriuria, bacterial cystitis, and pyelonephritis in dogs with chronic kidney disease.

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Foster, Jonathan D; Krishnan, Harathi; Cole, Stephen

2018-05-15

OBJECTIVE To determine the prevalence of bacteriuria (ie, a positive microbial culture result for ≥ 1 urine sample) in dogs with chronic kidney disease (CKD) and characterize findings of subclinical bacteriuria (SBU), bacterial cystitis, or pyelonephritis in these patients. DESIGN Retrospective, observational study. ANIMALS 182 dogs. PROCEDURES Medical records from January 2010 through July 2015 were reviewed to identify dogs with CKD that underwent urinalysis and urine microbial culture. Signalment, clinicopathologic data, stage of CKD according to previously published guidelines, results of urinalysis and urine culture, and abdominal ultrasonographic findings were recorded. Dogs with positive urine culture results were categorized as having SBU, bacterial cystitis, or pyelonephritis on the basis of these data. Prevalence of bacteriuria was calculated. Associations between CKD stage, presence of bacteriuria, and diagnosis category were analyzed statistically. RESULTS 33 of 182 (18.1%) dogs (40/235 [17.0%] urine samples) had positive culture results. All dogs received antimicrobials on the basis of culture and susceptibility test findings. Most positive culture results (18/40 [45%] samples) were found for dogs with SBU, followed by dogs with pyelonephritis (16/40 [40%]) and cystitis (6/40 [15%]). Escherichia coli was the most frequently observed isolate (29/40 [73%] cultures from 25/33 dogs). The CKD stage was not associated with presence of bacteriuria or diagnosis category. CONCLUSIONS AND CLINICAL RELEVANCE The prevalence of positive urine culture results in dogs with CKD was lower than that reported for dogs with some systemic diseases that may predispose to infection. Prospective research is needed to assess the clinical importance of SBU in dogs with CKD.

Risk factors and structure of obstetric and perinatal complications in woman, which ill of pyelonephritis (Review of literature and results of own researches

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M. Yu. Golubenko

2017-01-01

Full Text Available Actuality. Morbidity on a pyelonephritis and complication of motion of pregnancy is the important indicators of the state of health of woman population and baby that determines social meaningfulness of this problem. Research aim. To learn data of anamnesis of illness, life, professional features, domestic and surrounding environment, data of somatic status and to set forth leading risk of origin of placenta disfunction factors for pregnant, patients with a pyelonephritis. Material and methods. On the basis of retrospective analysis there are 20779 histories of illnesses of women, patients with a pyelonephritis, the study of risk of forming of somatic pathology of women and development of placenta disfunction factors is conducted with the aim of warning of complications of pregnancy and pathology of fetal and child. Results of researches. Research of the somatic state of pregnant that are ill a chronic pyelonephritis showed the presence of concomitant pathology in 100% cases, from that the diseases of the cardiovascular system laid down 61,5%, endocrine violations 50,2%, the dyspepsia phenomena and gastroenterology pathology 40,5%. The structure of obstetric, perinatal complications for women with a chronic pyelonephritis (20779 supervisions included: early toxicosis (65,5%, placental dysfunction (73,3%, an eclampsia (78,3%, threat of abortion (76,1% and premature luing-ins (56,2%, subzero placentation (76,1%, high water-level (76,7%, gestational anaemia (67,8%, delay of height of fetal (17,1%, chronic fetal distress (21,3%, premature removing layer by layer of placenta (26,3%; in luing-ins: premature outpouring of  near of fetal waters (22,4%, weakness of childbirth (72,3%, obstetric bleeding (47,1%; in a puerperium: subinvolution of uterus (26,3%. Conclusion. Thus, executed by us research in relation to the study of morbidity and prevalence of pyelonephritis among pregnant allowed to set the following: placenta disfunction in the period of

Emphysematous Pyelonephritis Complicated with Extrarenal Abscesses

International Nuclear Information System (INIS)

Hamza, A.E.; Obeidin, A.G.; Al-Subaity, Yousuf H.; Al-Kamel, A.A.; Sarwar, M.S.

2004-01-01

We report a 53 year old Saudi man a known diabetic for more than 15 years. He presented with lower abdominal pain, diarrhea and vomitting. He had symptoms and signs of sepsis. He had pancytopenia, renal faiure and his blood culture grew E.Coli. He remained febrile despite antibiotics, administration forone week and developed crepitation over both thighs. Radiologically plain X-ray, ultrasound and CT scan of the abdomen confirmed the presence of air in the left kidney involving the renal parenchyma and the collecting systemand extensive gas in subcutaneous tissue of the thighs with abscesses. Repeated surgical drainage of the renal and extra renal abscesses helped the antbiotic that was continued for several weeks to control the infection. Emphysematous pyelonephritis is rare but life threatning condition that can be difficult to treat especially if the gas forming organism extend outside the kidney. (author)

Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis

Science.gov (United States)

Sahin, Selcuk; Resorlu, Berkan; Eksi, Mithat; Aras, Bekir; Atar, Arda; Tugcu, Volkan

2016-01-01

Objective: To compare the safety and effectiveness of flexible ureteroscopy (F-URS) with transperitoneal laparoscopic ureterolithotomy (TPLU) in cases of obstructive pyelonephritis secondary to large proximal ureteral stones. Methods: A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU (Group I), and 20 patients were treated with F-URS (Group II). Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group. Results: It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone- free rate (100% vs 80%. p=0.043) and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain (p=0.008), a shorter hospital stay (p<0.001) and a faster return to daily activities (p<0.001). Conclusions: The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities. PMID:27375691

[Intravesical electrostimulation and magnetotherapy in chronic pyelonephritis and cystitis in children with urodynamic disorders].

Science.gov (United States)

Sharkov, S M; Iatsik, S P; Bolotova, N V; Raĭgorodskiĭ, Iu M; Konova, O M; Tkacheva, E N

2011-01-01

The results of the treatment of 38 children (6 boys and 32 girls, age 6-14 years) with chronic pyelonephritis and/or cystitis complicated with neurogenic dysfunction of the urinary bladder (NDUB) and/or vesicoureteral reflux (VUR) of the first-third degree demonstrate efficacy of intravesical electrostimulation (IVES) and adrenal magnetotherapy. IVES was conducted with high-frequency current impulses (2.2 kHz) by means of INTRASTIM attachment to the device AMUS-01-INTRAMAG in the region of the urethrovesical anastomosis via solution of the drugs for instillation. As the result of exposure to both physical factors in the presence of standard medication, NDUB symptoms alleviated (by E.L. Vishnevsky's criteria) by 59.5% against 38.1% in the control group. Dopplerographic examination of renal vessels stated a 24.3% increase in blood flow in the major renal artery in the study group against 10.5% in the control. The proposed complex pharmacological plus physiotherapeutic treatment of chronic pyelonephritis and cystitis in abnormal urodynamics resulted in a 2.2-fold decrease in the number of recurrences compared to the standard treatment.

Pielonefritis Enfisematosa. Presentación de un caso Emphysematous Pyelonephritis. A case report

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Ihosvani Baños Hernández

2011-06-01

Full Text Available Se describe la evolución fatal de un caso de pielonefritis enfisematosa en una mujer, con antecedentes de ser diabética, y control metabólico deficiente y ántrax lumbar. A pesar de haberse realizado la nefrectomía de urgencia y recibir el tratamiento apropiado en la unidad de cuidados intensivos, no se recupera del shock séptico y fallece. La pielonefritis enfisematosa es un enfermedad extremadamente rara, pero con una letalidad muy elevada cuando se presenta. Es necesario conocer sus factores de riesgo, sobre todo, la diabetes mellitus mal tratada, para establecer un diagnóstico y tratamiento temprano.The lethal natural history of Emphysematous Pyelonephritis is described in a case of a female patient with diabetes records, deficient metabolic control and lumbar anthrax. Despite performing an emergency nephrectomy and receiving a correct treatment in the intensive care unit, the patient did not recover from the septic shock and died. Emphysematous Pyelonephritis is a very rare disease, but highly lethal when present. It is necessary to learn about its risk factors, particularly, poor-treated diabetes mellitus to establish an early diagnosis and treatment.

Bacteriological, histological and functional examination of rat kidneys during 5-days gentamycin therapy of experimental E. coli pyelonephritis as compared to 9-days therapy

International Nuclear Information System (INIS)

Hagemann, I.; Briedigkeit, H.; Strangfeld, D.; Ditscherlein, G.; Schuerer, M.; Pietsch, R.; Kruse, L.; Camu, A.; Blank, W.

1985-01-01

Short-term antibiotic treatment is recommended in infections of the lower urinary tract but its effectiveness is questioned in upper urinary tract infections. 5 and 9-days treatment of experimental E. coli 022 pyelonephritis after unilateral nephrectomy in 127 male Wistar rats were compared. 9 mg gentamycin per kg b.w. twice daily were applied. 131 I-hippurate excretion was not decreased during the 5 day treatment but was temporarily diminished during 9-days treatment. Histologically the severe acute pyelonephritis was decreased after 9-days treatment but not after 5 days of treatment. Bacteriologically almost all the kidneys were sterile after 9-days treatment but the majority of the kidneys showed the injected strain of E. coli after 5-days treatment. The results indicated that the shortened treatment was much less effective in acute experimental pyelonephritis. (author)

Can We Differentiate Pyelonephritis and Cystitis without 99mTc-Dimercaptosuccinic Acid Scan in Children?

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Buket Kilicaslan

2015-09-01

Conclusion: Using a combination of procalcitonin and C-Reactive Protein is preferred to predict pyelonephritis in children, instead of the 99mTc-Dimercaptosuccinic Acid scan. Because of its disadvantages, the 99mTc-Dimercaptosuccinic Acid scan should be avoided in children. [Cukurova Med J 2015; 40(3.000: 495-503

Prevalence of acute pyelonephritis and incidence of renal scarring in children under the age of two with urinary tract infection evaluated by {sup 99m}Tc-DMSA renal scintigraphy: the experience of a university hospital

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Berdichevski, Eduardo Herz; Vilas, Eduardo Rosito de, E-mail: duduberdi@hotmail.com [Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil). Hospital Sao Lucas. Service of Medicine; Mattos, Silvia Gelpi; Bezerra, Sofia; Baldisserotto, Matteo [Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil). Faculdade de Medicina

2013-01-15

Objective: To calculate the frequencies of acute pyelonephritis and renal scarring in patients under the age of two, with first episode of urinary tract infection in a Brazilian university hospital, comparing with data reported in the international literature. Materials and Methods: Scintigraphic reports of children less than two years old submitted to {sup 99m}Tc-DMSA renal scintigraphy in a university hospital in Rio Grande do Sul between 2006 and 2009 were reviewed to investigate acute pyelonephritis/renal scarring. Additionally, the presence of vesicoureteral reflux, early use of antibiotics, and comorbidities were investigated on electronic records. The sample size calculation was based on a systematic review study and obtained a minimum of 147 patients. Patients whose electronic records were not available were excluded. Results: One hundred and fifty-seven children met the inclusion criteria; among them 48 had acute pyelonephritis and 8 of these had renal scars. Neither age nor sex presented any significant association with acute pyelonephritis (p = 0.405 and p = 0.124, respectively). No statistical significance was observed in the association between vesicoureteral reflux and acute pyelonephritis (p = 1.0) and other comorbidities (p = 0.470), and in relation to early use of antibiotics with acute pyelonephritis (p = 0.130) and renal scarring (p = 0.720). Conclusion: The frequencies found in the present study for acute pyelonephritis/renal scarring are in agreement with the results reported by most studies in the literature. (author)

Childhood Xantho granulomatous Pyelonephritis; an Uncommon Entity

International Nuclear Information System (INIS)

Bravo-Bravo, C.; Martinez-Leon, M. I.; Ceres-Ruiz, L.; Weil-Lara, B.

2003-01-01

Xanthogranulomotous pyelonephritis is an uncommon chronic inflammatory illness characterized by the replacement of renal parenchyma with a cellular infiltration of lipid-laden macrophages. There are few cases in the literature which describe the disease in children. Its pathogenesis remains unknown, although in up to 76% of cases it has been related to lithiasic obstruction of the pyeloureteral junction. Escherichia coli and Proteus mirabilis are most often cited as being the causing bacteria. Since neither its clinical characteristics nor radiological manifestations are specific, it is frequently infra diagnosed, Its definitive diagnosis is anatomophatological, and it is treated by nephrectomy. We present the case of a child with poorly evolving pyonephrosis diagnosed after the anatomopathological study of a renal sample. Special not is made of the importance of performing a preoperative diagnosis, and including such in a differential diagnosis with slowly evolving infectious/obstructive processes. (Author) 11 refs

[A giant fecalith complicated by acute urinary retention, hydronephrosis and acute obstructive pyelonephritis].

Science.gov (United States)

Davidov, M I

2016-04-01

The article reports a rare case of a 30-year-old man with Hirschsprung's disease, who developed a giant fecalith in the rectum and sigmoid (weight 3.5 kg, the largest diameter 20 cm). The fecalith impaired urine flow by compressing urinary tract, thereby causing acute urinary retention and right-sided hydronephrosis with acute obstructive pyelonephritis. Removing fecalith resulted in the patient recovery and normal functioning of genitourinary system.

Xanthogranulomatous pyelonephritis in childhood: ultrasound and CT diagnosis

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Cousins, C [City Hospital, Nottingham (United Kingdom); Somers, J [City Hospital, Nottingham (United Kingdom); Broderick, N [City Hospital, Nottingham (United Kingdom); Rance, C [City Hospital, Nottingham (United Kingdom); Shaw, D [Hospital for Sick Children, London (United Kingdom)

1994-06-01

Four cases of diffuse xanthogranulomatous pyelonephritis (XPN) in young children are presented. In three patients the clinical picture was one of weight loss, anaemia and neutrophilia with a large renal mass. The fourth presented with haematuria. Ultrasound (US) and CT findings were almost identical in all four patients. US showed the affected kidney was massively enlarged but retained a reniform shape. Dilated fluid spaces containing calculi were present. CT confirmed the US findings and revealed peripheral enhancement without contrast excretion, with dilated calyceal spaces producing the ''bear paw sign''. Extrarenal extension into abdominal wall and psoas muscle is typical and was well demonstrated by CT. The affected kidneys were non-functioning and nephrectomy was required. Typical US and CT features allow a confident diagnosis of XPN and appropriate early treatment. (orig.)

Xanthogranulomatous pyelonephritis in childhood: ultrasound and CT diagnosis

International Nuclear Information System (INIS)

Cousins, C.; Somers, J.; Broderick, N.; Rance, C.; Shaw, D.

1994-01-01

Four cases of diffuse xanthogranulomatous pyelonephritis (XPN) in young children are presented. In three patients the clinical picture was one of weight loss, anaemia and neutrophilia with a large renal mass. The fourth presented with haematuria. Ultrasound (US) and CT findings were almost identical in all four patients. US showed the affected kidney was massively enlarged but retained a reniform shape. Dilated fluid spaces containing calculi were present. CT confirmed the US findings and revealed peripheral enhancement without contrast excretion, with dilated calyceal spaces producing the ''bear paw sign''. Extrarenal extension into abdominal wall and psoas muscle is typical and was well demonstrated by CT. The affected kidneys were non-functioning and nephrectomy was required. Typical US and CT features allow a confident diagnosis of XPN and appropriate early treatment. (orig.)

Treatment of a case of emphysematous pyelonephritis that presented with acute abdomen and pneumoperitoneum: a case report.

Science.gov (United States)

Park, Sang Hyun; Kim, Ki Hoon

2015-08-01

Emphysematous pyelonephritis is a severe, life-threatening infection of the renal parenchyma and perinephric tissues. This condition is primarily encountered in patients with diabetes mellitus or ureteral obstruction, and is characterized by the production of intrarenal and perinephric gas. Emphysematous pyelonephritis is associated with a high degree of morbidity and a high mortality rate. A 72-year-old woman with a history of diabetes mellitus, hypertension, and renal calculi was referred to our emergency department following 6 days of abdominal pain. She suddenly developed pain in the entire abdomen, and was transferred. Physical examination was a distended abdomen with hypoactive bowel sounds. The tenderness was diffuse, but was most prominent in the right upper abdominal quadrant; moreover, rebound tenderness was noted. Laboratory tests revealed a white blood cell count of 4,480/mm(3), platelet count of 17,000/mm(3), creatinine level of 1.64 mg/dl, and serum glucose level of 603 mg/dl. Abdominal computed tomography indicated the presence of free air in the intraperitoneal cavity and right perirenal space, hydronephrosis of the right kidney, and stones in the right distal ureter. After 1 hour, the vital signs changed and she appeared to become drowsy. Therefore, the patient was transferred to the operation room for laparotomy. On exploration of the abdomen, 1.5 L of pus-colored fluid was removed. Although the abdominal viscera and pelvic organs were examined, hollow viscus perforation site could not be observed. Moreover, tissue necrosis and a perforation site were identified at the superior border of the right kidney. Thus, emphysematous pyelonephritis was diagnosed and she underwent right radical nephrectomy. After the surgery, the patient was admitted to the intensive care unit for postoperative management. Follow-up CT performed after 10 days showed fluid collection and hematoma at the nephrectomy site. Hence, percutaneous drainage was performed. Another

Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis

Energy Technology Data Exchange (ETDEWEB)

Upasani, Anand, E-mail: anand.upasani@gosh.nhs.uk [Great Ormond Street Hospital, Department of Paediatric Urology (United Kingdom); Barnacle, Alex, E-mail: alex.barnacle@gosh.nhs.uk; Roebuck, Derek, E-mail: derek.roebuck@gosh.nhs.uk; Cherian, Abraham, E-mail: abraham.cherian@gosh.nhs.uk [Great Ormond Street Hospital (United Kingdom)

2017-03-15

Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis

International Nuclear Information System (INIS)

Upasani, Anand; Barnacle, Alex; Roebuck, Derek; Cherian, Abraham

2017-01-01

Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

Emphysematous Pyelonephritis Presenting as Necrotizing Fasciitis of the Leg

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Yu-Xiong Ye

2009-03-01

Full Text Available We report a 50-year-old man with poorly controlled diabetes mellitus who presented with a painful, swollen right leg. He had also experienced right flank pain for 1 week prior to admission. Physical examination was notable for tenderness over the right flank. The right leg was diffusely swollen and exquisitely tender to touch, with palpable crepitance. Laboratory tests revealed leukocytosis and pyuria. Computed tomography showed a right ureteral stone with hydronephrosis and characteristic findings of emphysematous pyelonephritis. Furthermore, a right perirenal gas-forming abscess with extension to the right leg was noted. The patient was successfully treated with antibiotic therapy, aggressive control of blood sugar, percutaneous drainage of the hydronephrosis and perirenal abscess, and aggressive debridement of the leg.

[Xanthogranulomatous pyelonephritis in a child with severe malnutrition and recurrent fever].

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Gramage Tormo, J; Gavilán Martín, C; Atienza Almarcha, T

2015-01-01

Xanthogranulomatous pyelonephritis is a rare inflammatory disease, characterized by replacement of renal parenchyma with granulomatous tissue. Initial clinical presentation includes abdominal pain and constitutional symptoms related to recurrent urinary infections. The microorganisms most commonly involved are Escherichia coli and Proteus mirabilis. Final diagnosis is made by histopathology, and the only curative treatment is total or partial nephrectomy. A recently diagnosed case in our unit is presented, as well as an update on the knowledge of this disease. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Septic liver - Clinical relevance of early inhomogeneous enhancement of the liver in patients with acute pyelonephritis

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Han, Ga Jin; Lee, Nam Kyung; Kim, Suk [Dept. of Radiology, Biomedical Research Inst., Pusan National Univ. Hospital, Pusan National Univ. School of Medicine, Busan (Korea, Republic of)], e-mail: kimsuk@medimail.co.kr; Kim, Tae Un [Dept. of Radiology, Pusan National Univ. Yangsan Hospital, Pusan National Univ. School of Medicine, Yangsan (Korea, Republic of); Song, Sang Heon [Dept. of Internal Medicine, Biomedical Research Inst., Pusan National Univ. Hospital, Pusan National Univ. School of Medicine, Busan (Korea, Republic of); Kim, Hyun Sung; Jo, Hong Jae [Dept. of Surgery, Biomedical Research Inst., Pusan National Univ. Hospital, Pusan National Univ. School of Medicine, Busan (Korea, Republic of)

2013-10-15

Background: CT scans of patients with febrile illness occasionally show hepatobiliary changes, although infection does not originate in the hepatobiliary system. These findings may cause radiologists and clinicians to misrecognize hepatobiliary diseases and initiate an inappropriate treatment. Thus, it is important to recognize hepatobiliary CT findings in cases of extrahepatobiliary infectious disease. Purpose: To evaluate extrarenal CT manifestations in patients with acute pyelonephritis and to determine the correlation between these extrarenal CT findings and septic liver based on laboratory parameters of sepsis. Material and Methods: This study included 157 retrospectively identified patients with confirmed acute pyelonephritis based on CT imaging and urine test, and who had also undergone multi-phase dynamic contrast-enhanced CT scan. Two radiologists reviewed CT findings including early inhomogeneous enhancement of the liver, periportal low density and gallbladder edema, which were correlated with laboratory data including liver function enzymes, albumin, C-reactive protein, white blood cell count, and results of a blood culture by using the Fisher's exact test and Mann-Whitney U test. Results: Forty-six patients (29.3%) showed early inhomogeneous enhancement of the liver, which was associated with increased C-reactive protein (P < 0.001), a positive blood culture (P < 0.005), and decreased albumin level (P < 0.002). The periportal low density and gallbladder wall edema were noted in 15 patients (9.6%) and six patients (3.8%), respectively. These two CT findings were significantly associated with only decreased albumin level (P < 0.001 and P < 0.040). Conclusion: Early inhomogeneous enhancement of the liver in patients with acute pyelonephritis was significantly associated with increased CRP level, a positive blood culture and decreased albumin level, reflecting sepsis and sepsis-associated liver dysfunction, requiring rapid and appropriate intensive

Septic liver - Clinical relevance of early inhomogeneous enhancement of the liver in patients with acute pyelonephritis

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Han, Ga Jin; Lee, Nam Kyung; Kim, Suk; Kim, Tae Un; Song, Sang Heon; Kim, Hyun Sung; Jo, Hong Jae

2013-01-01

Background: CT scans of patients with febrile illness occasionally show hepatobiliary changes, although infection does not originate in the hepatobiliary system. These findings may cause radiologists and clinicians to misrecognize hepatobiliary diseases and initiate an inappropriate treatment. Thus, it is important to recognize hepatobiliary CT findings in cases of extrahepatobiliary infectious disease. Purpose: To evaluate extrarenal CT manifestations in patients with acute pyelonephritis and to determine the correlation between these extrarenal CT findings and septic liver based on laboratory parameters of sepsis. Material and Methods: This study included 157 retrospectively identified patients with confirmed acute pyelonephritis based on CT imaging and urine test, and who had also undergone multi-phase dynamic contrast-enhanced CT scan. Two radiologists reviewed CT findings including early inhomogeneous enhancement of the liver, periportal low density and gallbladder edema, which were correlated with laboratory data including liver function enzymes, albumin, C-reactive protein, white blood cell count, and results of a blood culture by using the Fisher's exact test and Mann-Whitney U test. Results: Forty-six patients (29.3%) showed early inhomogeneous enhancement of the liver, which was associated with increased C-reactive protein (P < 0.001), a positive blood culture (P < 0.005), and decreased albumin level (P < 0.002). The periportal low density and gallbladder wall edema were noted in 15 patients (9.6%) and six patients (3.8%), respectively. These two CT findings were significantly associated with only decreased albumin level (P < 0.001 and P < 0.040). Conclusion: Early inhomogeneous enhancement of the liver in patients with acute pyelonephritis was significantly associated with increased CRP level, a positive blood culture and decreased albumin level, reflecting sepsis and sepsis-associated liver dysfunction, requiring rapid and appropriate intensive

Emphysematous pyelonephritis: A rare life-threatening complication after extracorporeal shock wave lithotripsy

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Kim, Su Ho; Chung, Dong Jin; Yeo, Dong Myung; Sonh, Dong Wan; Hahn, Sung Tae

2015-01-01

Emphysematous pyelonephritis (EPN), caused by extracorporeal shock wave lithotripsy (ESWL), has not been reported in the literature; and the mechanism of this disease is unknown. Although many studies have conjectured about the various causes of EPN, ESWL was not one of them. The patient in this report was a 65-year-old woman with a past medical history of diabetes; the patient underwent an ESWL that caused the EPN. To the best of our knowledge, this is the first report of an EPN case that was caused by ESWL

Emphysematous pyelonephritis: A rare life-threatening complication after extracorporeal shock wave lithotripsy

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Kim, Su Ho; Chung, Dong Jin; Yeo, Dong Myung; Sonh, Dong Wan; Hahn, Sung Tae [Yeouido St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

2015-09-15

Emphysematous pyelonephritis (EPN), caused by extracorporeal shock wave lithotripsy (ESWL), has not been reported in the literature; and the mechanism of this disease is unknown. Although many studies have conjectured about the various causes of EPN, ESWL was not one of them. The patient in this report was a 65-year-old woman with a past medical history of diabetes; the patient underwent an ESWL that caused the EPN. To the best of our knowledge, this is the first report of an EPN case that was caused by ESWL.

Infusion dynamic ureteroscintigraphy in assessment of ureteral and pelvic contractivity in renal tuberculosis and chronic pyelonephritis

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Savin, I.B.; Tovstykh, A.M.; Morozov, N.V.

1995-01-01

A novel radionuclide method: infusion dynamic ureterscintigraphy was used in examinations of 42 patients with the initial forms of nephrotuberculosis, 18 patients with chronic nonspecific pyelonephritis, and 51 healthy controls. The new method was shown to be highly sensitive in assessment of ureteral and pelvic contractility in specific and nonspecific involvement of the kidneys. 16 refs.; 3 figs

Endocan, a putative endothelial cell marker, is elevated in preeclampsia, decreased in acute pyelonephritis, and unchanged in other obstetrical syndromes

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Adekola, Henry; Romero, Roberto; Chaemsaithong, Piya; Korzeniewski, Steven J.; Dong, Zhong; Yeo, Lami; Hassan, Sonia S.; Chaiworapongsa, Tinnakorn

2015-01-01

Abstract Objective: Endocan, a dermatan sulphate proteoglycan produced by endothelial cells, is considered a biomarker for endothelial cell activation/dysfunction. Preeclampsia is characterized by systemic vascular inflammation, and endothelial cell activation/dysfunction. Therefore, the objectives of this study were to determine whether: (1) plasma endocan concentrations in preeclampsia differ from those in uncomplicated pregnancies; (2) changes in plasma endocan concentration relate to the severity of preeclampsia, and whether these changes are specific or observed in other obstetrical syndromes such as small-for-gestational age (SGA), fetal death (FD), preterm labor (PTL) or preterm prelabor rupture of membranes (PROM); (3) a correlation exists between plasma concentration of endocan and angiogenic (placental growth factor or PlGF)/anti-angiogenic factors (soluble vascular endothelial growth factor receptor or sVEGFR-1, and soluble endoglin or sEng) among pregnancies complicated by preeclampsia; and (4) plasma endocan concentrations in patients with preeclampsia and acute pyelonephritis (both conditions in which there is endothelial cell activation) differ. Method: This cross-sectional study included the following groups: (1) uncomplicated pregnancy (n = 130); (2) preeclampsia (n = 102); (3) pregnant women without preeclampsia who delivered an SGA neonate (n = 51); (4) FD (n = 49); (5) acute pyelonephritis (AP; n = 35); (6) spontaneous PTL (n = 75); and (7) preterm PROM (n = 64). Plasma endocan concentrations were determined in all groups, and PIGF, sEng and VEGFR-1 plasma concentrations were measured by ELISA in the preeclampsia group. Results: (1) Women with preeclampsia had a significantly higher median plasma endocan concentration than those with uncomplicated pregnancies (p = 0.004); (2) among women with preeclampsia, the median plasma endocan concentration did not differ significantly according to disease severity (p = 0

Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis.

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Yeom, Jung Sook; Koo, Chung Mo; Park, Ji Sook; Seo, Ji-Hyun; Park, Eun Sil; Lim, Jae-Young; Woo, Hyang-Ok; Youn, Hee-Shang

2018-02-01

We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by Escherichia coli . The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of urine culture, which detected cefotaxime-sensitive E. coli . Although intravenous cefotaxime and tobramycin were administered, her fever persisted and her C-reactive protein level increased to 307 mg/L. On day 3 of admission, she demonstrated abnormal neuropsychiatric symptoms, such as delirium, ataxia, and word salad. Magnetic resonance imaging (MRI) of the brain performed on day 4 showed marked hyperintensities in the bilateral corpus callosum and deep white matter on diffusion-weighted images, with corresponding diffusion restriction on apparent diffusion coefficient mapping. No abnormalities or pathogens were detected in the cerebrospinal fluid; however, lipopolysaccharides (LPS, endotoxin) were detected in plasma (41.6 pg/mL), associated with acute neurological deterioration. Her clinical condition gradually improved, and no neurological abnormalities were observed on day 6. Follow-up brain MRI performed 2 weeks later showed near-disappearance of the previously noted hyperintense lesions. In this patient, we first proved endotoxemia in a setting of MERS. The release of LPS following antibiotic administration might be related to the development of MERS in this patient. The possibility of MERS should be considered in patients who present with acute pyelonephritis and demonstrate delirious behavior.

Evolution of scintigraphic renal lesions in children after an episode of acute pyelonephritis

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Donoso, Gilda; Lagos, Elizabeth; Rosati, Pia; Hevia, Pilar; Cuevas, Karen; Lobo, Gabriel; Perez, Andres; Gutierrez, Daniela

2012-01-01

Background: Abnormal Dimercaptosuccinic acid (DMSA) renal scintigraphy performed six months after an acute pyelonephritis (AP) is generally interpreted as scarring. Aim: To perform a follow up of childhood patients showing scintigraphic renal lesions during the acute phase of pyelonephritis (within 7 days from the beginning of fever). Material and Methods: A scintigraphic control was carried out at 5-7 months and, in case of persistent lesions, an additional late scintigraphy at 10-13 months. All patients were followed clinically for one year and those with a relapse of urinary tract infection were excluded from the study. Results: Eighty five patients with a median age of 8 months were included. Among these, the first scintigraphic control was normal in 59 (69%) and abnormal in 26 patients (31%). In five of these 26 patients (5/26:19%-5/85:6%), a considerable regression of the lesions was obvious on the early control, and normalized completely on the late control. When expressing the results in kidney units, 107 showed lesions during the acute phase of infection; 69% was normal at the early control. Thirty three showed lesions persisting at the early control (31%) and 7 out of these 33 (21%) became normal on the late control (7/107: 7%). In total, 25% of the children included in the study (24% of the kidney units) remained with renal sequelae one year after the initial episode of AP. Conclusions: The persistence of scintigraphic lesions six months after an episode of AP, does not necessarily correspond to permanent scars, since normalization can sometimes be observed on late controls

Enterovesical fistula and acute pyelonephritis in renal transplantation. Role of ultrasound

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Antonio De Pascalis

2014-12-01

Full Text Available The enterovesical fistula is a communication between the urinary tract and the colon and is a rare complication of various inflammatory and cancer diseases. The most frequent cause is represented by diverticulitis of the sigmoid colon and less frequently from Crohn's disease, tumors of the colon and bladder, trauma, radiation therapy and appendicitis. In this report we describe the occurrence of an enterovesical fistula in a patient with renal allograft from a cadaveric donor, which onsetted with signs of acute pyelonephritis and pneumaturia due to diverticulitis of the sigmoid colon, clinically silent. The ultrasound in the diagnosis of enterovesical fistula, yet with a minor role compared to computed tomography (CT, is fundamental being always the first level examination.

Imaging findings of xanthogranulomatous pyelonephritis

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Kim, Jong Chul [School of Medicine, Chungnam National University, Taejon (Korea, Republic of)

2000-01-01

To define the imaging patterns of xanthogranulomatous pyelonephritis (XGP). The demographic, clinical, and imaging findings of 21 cases of pathologically proven XGP in 20 patients (bilateral in one) were evaluated. The findings of ultrasonography and CT were retrospectively evaluated with regard to distribution and extent of the disease, kidney size, the presence of calculi, hydronephrosis, and renal function. The findings were assessed by two radiologists, who established a consensus. Imaging and pathologic findings were compared. Sixteen of the 20 patients were female, and 19 were adults. Their age ranged from 3 to 16 (mean, 45) years. In all patients except one, the disease was unilateral (right: left =3D 13 :16). In one patient, XGP was bilateral, and there were thus 21 cases. Seventeen (81%) of these were diffuse, and four (19%) were focal; extrarenal extension occurred in 13 cases (62%), among which ipsilateral pleural effusion was noted in two. The kidney was enlarged diffusely in 12 cases (57%), and focally in three (14%); urinary calculi were present in 16 cases (76%), with staghorn calculi in four of these; and hydronephrosis occurred in 17 (81%). Impairment of ipsilateral renal function was noted in 13 cases (62%). Clinical findings of inflammation such as fever, pyuria, bacteriuria, or leucocytosis were noted in all patients. In addition to nephromegaly, renal function impairment, and urinary obstruction due to calculi, which are typical features of XGP, the condition may also show variable imaging findings. If the images obtained in the case of a middle-aged woman with clinical findings of urinary infection are atypical, we believe that XGP should be included in the differential diagnosis. (author)

Fluorodeoxyglucose positron emission tomography-computed tomography findings in a case of xanthogranulomatous pyelonephritis

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Joshi, Prathamesh; Lele, Vikram; Shah, Hardik

2013-01-01

Xanthogranulomatous pyelonephritis (XGNP) is an uncommon condition characterized by chronic suppurative renal inflammation that leads to progressive parenchymal destruction. This condition can clinically present as recurrent urinary tract infections, flank pain, hematuria, and occasionally sepsis, and weight loss. This condition is usually associated with obstructing renal calculus. We present 18-fluorodeoxyglucose positron emission tomography-computed tomography (18-FDG PET/CT) findings in an elderly male suffering from pyrexia and weight loss and suspected urinary tract infection. PET/CT findings in this case lead to diagnosis of XGNP. This diagnosis should be kept in mind while evaluating similar symptoms and PET/CT scan findings. PMID:24019680

Study on Antimicrobial Effects of Phytotherapy in the Treatment of Children with Pyelonephritis

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Natal’ya I. Averyanova

2017-01-01

Full Text Available Background. Improvement of treatment methods and relapse prevention of pyelonephritis in children is relevant to pediatrics. The study of the antibacterial possibilities of herbal medicines (HM provoke great interest for researches . The aim of the survey was to investigate the antimicrobial properties of combined phytotherapy in vitro. Methods. Two microbiological researches were performed in vitro. One of them was conducted using the microtechnique for serial dilution-antibiotic sensitivity testing of 62 cultures (genera Escherichia, Klebsiella, Proteus and Pseudomonas, Staphylococcus, Streptococcus isolated in significantly diagnostic concentration from the urine of children in the acute phase of pyelonephritis. The antibacterial effect of RLP was detected using the microtechnique for serial dilution. To exclude the antibacterial effect of the alcohol present in the phytopreparations, a number of analogous dilutions were placed in 19.5% solution of ethyl alcohol. At the same time, the sterility of the reaction components was monitored. The second research studied the concentration changes of the microbial suspension of Escherichia coli isolated from the urine of children before the treatment onset with incubation of different concentrations of phytopreparations and at a different exposure periods. Results. Studies on the antimicrobial activity of HM in vitro demonstrated the antimicrobial effect of HM on 58% of the examined cultures. The highest drug sensitivity was revealed in the genera Klebsiella (80%, Staphylococcus (77%, and E. coli (51.5%. Studies on the concentration changes of microbial suspension of E. coli detected 100% activity of undiluted HM at a 24-hour exposure period (sample D. A significant decrease in the pathogen growth was also obtained with HM with the dilution ratio 1:1 at a 24-hour exposure period. Conclusion. The microbiological analyses demonstrated and confirmed the antibacterial characteristics of HM. 

Renal Parenchymal Hypoxia in Young Children in the Period of Complete Remission of Acute Uncomplicated Pyelonephritis without Renal Impairment

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N.S. Lukianenko

2016-04-01

Conclusions. To predict the formation and for the purpose of early diagnosis of renal parenchymal hypoxia and the processes of nephrothelial membrane destruction in young children with pyelonephritis, it is recommended to use such markers, as indicators of urine ability to prevent crystal formation, daily excretion of salts, excretion of lipid peroxidation products and polar lipids in the urine. It is recommended to apply the methods to correct these changes.

Pielonefritis enfisematosa aguda bilateral: Un desafío terapéutico Acute bilateral emphysematous pyelonephritis: A therapeutic challenge

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Marcelo J. Melero

2007-06-01

Full Text Available La pielonefritis enfisematosa es una forma poco común de infección renal, caracterizada por la presencia de bacterias coliformes productoras de gas que afecta preferentemente a los pacientes diabéticos. Comunicamos el caso de una mujer diabética de 57 años de edad que ingresó en el hospital por un shock séptico, signos de pielonefritis enfisematosa aguda bilateral y cetoacidosis diabética. En los cultivos de las muestras de orina y sangre desarrolló Escherichia coli. La paciente fue tratada exitosamente con antibióticos de amplio espectro por un tiempo prolongado, control diabético y medidas de sostén solamente. No fue necesario el drenaje con catéteres o la nefrectomía para superar esta situación potencialmente letal.Emphysematous pyelonephritis is a rare form of kidney infection characterized by the presence of gas-forming coliform bacteria which affects more frequently diabetic subjects. We report the case of a 57-years-old diabetic woman, who was admitted in septic shock, signs of acute bilateral emphysematous pyelonephritis, and diabetic ketoacidosis. Both blood and urine cultures yielded Escherichia coli. The patient was successfully treated using long-term broad-spectrum antibiotics, diabetic control and supportive measures alone. Catheter drainage and nephrectomy were not necessary to overcome this life threatening situation.

Delayed diagnosis of xanthogranulomatous pyelonephritis in a quadriplegic patient with uncontrolled cutaneous fistula

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Yang, Jae-Hyuk; Shin, Jin Yong; Roh, Si-Gyun; Chang, Suk-Choo; Lee, Nae-Ho

2018-01-01

Abstract Rationale: Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation that is characterized by urinary tract obstruction and invasion of the renal parenchyma. Although rare, XGP can lead to fatal complications, including perinephric inflammation, psoas abscess, and cutaneous fistula. Patient concerns: A quadriplegic patient initially presented to the hospital with a chronic open wound and cutaneous fistula. Diagnoses: Abdominal computed tomography revealed a renal obstructing stone and enlarged right kidney with a perinephric fluid collection that communicated with the cutaneous fistula. Interventions: The patient underwent a right nephrectomy at the department of urology. Outcomes: Two months after surgery, the patient was clinically well with no discharging fistula. Lessons: The XGP accompanied by complications requires an immediate evaluation and early diagnosis. In this case, the diagnosis was delayed because the state of quadriplegia rendered no symptoms of XGP. PMID:29480882

Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI.

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Leroy, Sandrine; Fernandez-Lopez, Anna; Nikfar, Roya; Romanello, Carla; Bouissou, François; Gervaix, Alain; Gurgoze, Metin K; Bressan, Silvia; Smolkin, Vladislav; Tuerlinckx, David; Stefanidis, Constantinos J; Vaos, Georgos; Leblond, Pierre; Gungor, Firat; Gendrel, Dominique; Chalumeau, Martin

2013-05-01

Urinary tract infections (UTIs) are common childhood bacterial infections that may involve renal parenchymal infection (acute pyelonephritis [APN]) followed by late scarring. Prompt, high-quality diagnosis of APN and later identification of children with scarring are important for preventing future complications. Examination via dimercaptosuccinic acid scanning is the current clinical gold standard but is not routinely performed. A more accessible assay could therefore prove useful. Our goal was to study procalcitonin as a predictor for both APN and scarring in children with UTI. A systematic review and meta-analysis of individual patient data were performed; all data were gathered from children with UTIs who had undergone both procalcitonin measurement and dimercaptosuccinic acid scanning. A total of 1011 patients (APN in 60.6%, late scarring in 25.7%) were included from 18 studies. Procalcitonin as a continuous, class, and binary variable was associated with APN and scarring (P children who had APN during the early stages of UTI, as well as those with late scarring.

Bilateral type emphysematous pyelonephritis: imaging evaluation; Pielonefritis enfisematosa bilateral tipo I. Evaluacion por la imagen

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Salvador Cueto-Alvarez, L.; Piriz-Campos, E.; Ruiz-Garcia, T.; Roldan-Lora, F. [Hospital Universitario Virgen Macarena. Sevilla (Spain)

2000-07-01

Emphysematous pyelonephritis (EPN) is a serious infectious disease that occurs more frequently in diabetic patients. Radiological studies are indispensable for distinguishing between the two types since each is associated with a markedly different prognosis. We present a case of bilateral EPN diagnosed as type I on the basis of computed tomography findings, differentiating it from type II EPN, taking into account the prognostic value of this distinction. Type I EPN is characterized by the destruction of the renal parenchyma, a mottled or linear gas pattern and the absence of renal and perirenal fluid collection. Type II EPN is characterized by a loculated or bubbly gas pattern, the existence of fluid collection and less marked renal destruction. Type I is more aggressive and is associated with high rate of mortality. (Author) 7 refs.

The clinical meaning of oxaluria in chronic obstructive pulmonary disease patients with comorbid chronic pyelonephritis on the background of urolithiasis.

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O. S. Khukhlina

2017-06-01

Full Text Available Aim. To study clinical peculiarities of chronic obstructive pulmonary disease in patients with comorbid chronic pyelonephritis on the background of urolithiasis with oxaluria. Materials and methods. 60 patients were included into the study and divided into 3 groups. Study groups: I-st group - 18 patients with isolated course of chronic pyelonephritis (CP and urolithiasis (U of oxalic and mixed genesis, II-nd group - 19 patients with chronic obstructive pulmonary disease (COPD, study group III - 23 patients with COPD, CP and U of oxalic genesis. Additional control group consisted of 20 practically healthy individuals (PHI of corresponding age and gender. Laboratory and clinical examination of the patients was conducted. Spectrophotometry with polarization of biologic material was performed. Statistical analysis was done in Primer of Biostatistics, Origin 8.0. Results. Systemic inflammation in patients with COPD and comorbid CP with oxaluria form the syndrome of mutual burdening. This fact was proved by inverse correlation between oxalate salts in sputum (15,5±1,0 mg/24h and reduction of forced expiratory volume in 1 second (FEV1 in group III. This result was in 2,1 lower than in PHI (r = -0,53,р<0,05. Conclusions. Taking into account data of the anamnesis, patients with COPD, comorbid CP and urolithiasis with oxaluria, had more severe course of COPD than patients with isolated COPD. This can be explained by the oxalic acid crystals deposition in bronchial wall. Stated above clinical characteristics are the features of respiratory oxalosis that needs special treatment.

Clofibric and ethacrynic acids prevent experimental pyelonephritis by Escherichia coli in mice.

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Balagué, Claudia E; de Ruiz, Clara Silva; Rey, Rosario; de Duffard, Ana María Evangelista; Nader-Macías, María Elena

2004-11-01

Interfering Escherichia coli attachment to the urinary tract, using P-fimbriation inhibitors, can prevent pyelonephritis. Clofibric and ethacrynic acids are organic compounds structurally related, but with different pharmacological uses. These agents are potentially active in the urinary tract due to its elimination in an unaltered form by the renal route. This study described a pyelonephritogenic E. coli strain, grown in the presence of sub-inhibitory concentrations of clofibric or ethacrynic acids (0.1 and 1 mM, respectively), which exhibits inhibition of P1 erythrocytes agglutination and a drastic decrease in fimbriation, using electron microscopy and quantitative analyses of superficial proteins (decrease to a 17-25% in comparison with the control). In vivo assays were performed using ascending urinary tract infection in mice. The treatment with therapeutic doses of the drugs, administered 2 days before the bacterial challenge and daily until the end of the experiment (22 days), abolished renal infection after 7-10 days of drug exposure. Within this period clofibric acid did not produce adverse effects on the renal parenchyma. However, ethacrynic acid caused pyelitis and tubular cellular desquamation. These results suggested that clofibric acid might be useful in the short-term prophylaxis of urinary tract infection.

Childhood Xantho granulomatous Pyelonephritis; an Uncommon Entity; Pielonefritis xantogranulomatorsa en la infancia: una entidad rara

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Bravo-Bravo, C.; Martinez-Leon, M. I.; Ceres-Ruiz, L.; Weil-Lara, B. [Hospital Materno-Infantil CHU Carlos Haya. Malaga (Spain)

2003-07-01

Xanthogranulomotous pyelonephritis is an uncommon chronic inflammatory illness characterized by the replacement of renal parenchyma with a cellular infiltration of lipid-laden macrophages. There are few cases in the literature which describe the disease in children. Its pathogenesis remains unknown, although in up to 76% of cases it has been related to lithiasic obstruction of the pyeloureteral junction. Escherichia coli and Proteus mirabilis are most often cited as being the causing bacteria. Since neither its clinical characteristics nor radiological manifestations are specific, it is frequently infra diagnosed, Its definitive diagnosis is anatomophatological, and it is treated by nephrectomy. We present the case of a child with poorly evolving pyonephrosis diagnosed after the anatomopathological study of a renal sample. Special not is made of the importance of performing a preoperative diagnosis, and including such in a differential diagnosis with slowly evolving infectious/obstructive processes. (Author) 11 refs.

Laparascopic-assisted nephroureterectomy for shaped urolithiasis and xanthogranulomatous pyelonephritis: Case report and review of literature

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Valentina Pastore

2013-01-01

Full Text Available We report a case of xanthogranulomatous pyelonephritis (XGP complicated by shaped urolithiasis, severe hydroureteronephrosis and kidney exclusion treated by laparoscopic-assisted nephroureterectomy. A 9 year-old boy was referred to us for recurrent episodes of urinary tract infection, abdominal pain and severe hydronephrosis. Abdominal CT and a Tc-99m MAG3 scan showed a non-functioning obstructed kidney with shaped urolithiasis of the distal ureter. XGP was suspected, and nephroureterectomy was performed by laparoscopic distal ureterectomy and open extraperitoneal nephrectomy. This technique avoided the need for a more extended nephrectomy incision or even a second iliac incision. It also ensured complete excision of the distal ureter with minimal risk of developing the ureteral stump syndrome, which sometimes follows nephroureterectomy. We believe that laparoscopic-assisted nephroureterectomy may be a suitable technique in those cases of difficult nephrectomy where a ureteral stump syndrome is likely to develop.

Childhood acute pyelonephritis: comparison of power Doppler sonography and Tc-DMSA scintigraphy

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Stogianni, Aggeliki; Oikonomou, Ippoliti; Dimitriadis, Athanasios [Aristotle University of Thessaloniki, Department of Radiology, AHEPA Hospital, Thessaloniki (Greece); Nikolopoulos, Panagiotis [424 Army Hospital, Department of Radiology, Thessaloniki (Greece); Gatzola, Magdalini [Aristotle University of Thessaloniki, 2nd Paediatric Clinic, AHEPA Hospital, Thessaloniki (Greece); Balaris, Vassilios [Aristotle University of Thessaloniki, Department of Nuclear Medicine, AHEPA Hospital, Thessaloniki (Greece); Farmakiotis, Dimitrios [Infectious Diseases Hospital of Thessaloniki, Department of Medicine, Thessaloniki (Greece)

2007-07-15

Tc 99m DMSA scintigraphy is regarded as the gold standard for the detection and localization of acute pyelonephritis (APN) in children. Power Doppler sonography (PD US) is a radiation-free and cost-effective technique that could be useful in the diagnosis of APN in children. To compare the predictive value of PD US with DMSA scintigraphy in the diagnosis of APN in children. A total of 74 neonates and children with clinical findings consistent with possible upper urinary tract infection were evaluated with PD US and DMSA scintigraphy. Children with anatomic (grey-scale) abnormalities were excluded. A total of 147 kidneys were examined within the first 48 h after the onset of symptoms. Each kidney was divided into three zones (upper, middle, and lower third). APN was diagnosed by PD US in 46 kidneys. Sensitivity and specificity for detecting APN using DMSA scintigraphy as the reference standard were 73.8% and 85.7%, respectively. There was good agreement between PD US and DMSA scintigraphy in the localization of lesions. In clinically suspected APN, PD US has acceptable specificity and sensitivity, if performed within the first 48 h and could be helpful in neonates and children under 3 months of age in whom the use of scintigraphy is generally discouraged. (orig.)

Xanthogranulomatous pyelonephritis in adults: clinical and radiological findings in diffuse and focal forms

International Nuclear Information System (INIS)

Loffroy, R.; Guiu, B.; Watfa, J.; Michel, F.; Cercueil, J.P.; Krause, D.

2007-01-01

Aim: To describe the clinical and radiological features of focal and diffuse xanthogranulomatous pyelonephritis (XGP) in adults. Materials and methods: A retrospective review of the clinical data, laboratory findings, imaging features, and surgical treatment of 13 cases of histologically proven XGP diagnosed between January 1993 and December 2005 was undertaken. There were 10 women and three men with a mean age of 55.2 years (range 30-87 years). All patients underwent both sonography and computed tomography (CT) of the kidneys. Magnetic resonance imaging (MRI) was performed in two patients. Results: XGP was diffuse in 11 patients and focal in two patients. Fever, anorexia and weight loss, urinary symptoms, and flank pain were the most common manifestations. Urinary tract infection was found in eight patients. Sonography and CT showed diffuse kidney enlargement in seven cases and atrophy in five cases; a solitary solid mass was found in two patients. Hydronephrosis was noted in nine cases, staghorn calculus in six, and extensive pararenal disease in six. MRI failed to provide the preoperative diagnosis in the two patients with focal XGP. Total or partial nephrectomy was performed without postoperative complications. Conclusion: Although rare, XGP is the main differential diagnosis of malignant renal neoplasia. The definitive diagnosis depends on histological examination of the operative specimen. Preoperatively, the diagnosis can often be suspected based on imaging studies, primarily CT

Xanthogranulomatous pyelonephritis in adults: clinical and radiological findings in diffuse and focal forms

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Loffroy, R. [Department of Radiology, Bocage Hospital, University Hospital Center, Dijon (France)]. E-mail: loffroy.romaric@neuf.fr; Guiu, B. [Department of Radiology, Bocage Hospital, University Hospital Center, Dijon (France); Watfa, J. [Department of Urology, Bocage Hospital, University Hospital Center, Dijon (France); Michel, F. [Department of Urology, Bocage Hospital, University Hospital Center, Dijon (France); Cercueil, J.P. [Department of Radiology, Bocage Hospital, University Hospital Center, Dijon (France); Krause, D. [Department of Radiology, Bocage Hospital, University Hospital Center, Dijon (France)

2007-09-15

Aim: To describe the clinical and radiological features of focal and diffuse xanthogranulomatous pyelonephritis (XGP) in adults. Materials and methods: A retrospective review of the clinical data, laboratory findings, imaging features, and surgical treatment of 13 cases of histologically proven XGP diagnosed between January 1993 and December 2005 was undertaken. There were 10 women and three men with a mean age of 55.2 years (range 30-87 years). All patients underwent both sonography and computed tomography (CT) of the kidneys. Magnetic resonance imaging (MRI) was performed in two patients. Results: XGP was diffuse in 11 patients and focal in two patients. Fever, anorexia and weight loss, urinary symptoms, and flank pain were the most common manifestations. Urinary tract infection was found in eight patients. Sonography and CT showed diffuse kidney enlargement in seven cases and atrophy in five cases; a solitary solid mass was found in two patients. Hydronephrosis was noted in nine cases, staghorn calculus in six, and extensive pararenal disease in six. MRI failed to provide the preoperative diagnosis in the two patients with focal XGP. Total or partial nephrectomy was performed without postoperative complications. Conclusion: Although rare, XGP is the main differential diagnosis of malignant renal neoplasia. The definitive diagnosis depends on histological examination of the operative specimen. Preoperatively, the diagnosis can often be suspected based on imaging studies, primarily CT.

Plasma neutrophil gelatinase-associated lipocalin: a marker of acute pyelonephritis in children.

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Kim, Byung Kwan; Yim, Hyung Eun; Yoo, Kee Hwan

2017-03-01

This study was designed to compare the diagnostic accuracy of plasma neutrophil gelatinase-associated lipocalin (NGAL) with procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) for predicting acute pyelonephritis (APN) in children with febrile urinary tract infections (UTIs). In total, 138 children with febrile UTIs (APN 59, lower UTI 79) were reviewed retrospectively. Levels of NGAL, PCT, CRP, and WBCs in blood were measured on admission. The diagnostic accuracy of the biomarkers was investigated. Independent predictors of APN were identified by multivariate logistic regression analysis. Receiver operating curve (ROC) analyses showed good diagnostic profiles of NGAL, PCT, CRP, and WBCs for identifying APN [area under the curve (AUC) 0.893, 0.855, 0.879, and 0.654, respectively]. However, multivariate analysis revealed only plasma NGAL level was an independent predictor of APN (P = 0.006). At the best cutoff values of all examined biomarkers for identifying APN, sensitivity (86 %), specificity (85 %), positive predictive value (81 %), and negative predictive value (89 %) of plasma NGAL levels were the highest. The optimal NGAL cutoff value was 117 ng/ml. The positive likelihood ratio [odds ratio (OR) 5.69, 95 % confidence interval (CI) 3.56-8.78], and negative likelihood ratio (OR 0.16, 95 % CI 0.08-0.29) of plasma NGAL for APN diagnosis also showed it seemed to be more accurate than serum PCT, CRP, and WBCs. Plasma NGAL can be more useful than serum PCT, CRP, and WBC levels for identifying APN in children with febrile UTIs.

[Renal scarring in children under 36 months hospitalised for acute pyelonephritis].

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Rodríguez Azor, Begoña; Ramos Fernández, José Miguel; Sánchiz Cárdenas, Sonia; Cordón Martínez, Ana; Carazo Gallego, Begoña; Moreno-Pérez, David; Urda Cardona, Antonio

2017-02-01

Acute pyelonephritis (APN) is one of the most common causes of serious bacterial infection in infants. Renal scarring is the most prevalent long-term complication. To review the incidence of renal scarring within 6 months after an episode of APN in children under 36 months and its relationship with imaging studies, clinical settings, and bacteriology. A retrospective study of previously healthy patients aged one to 36 months, admitted for a first episode of APN, with a minimum follow-up of 6 months. Demographic and clinical variables were collected along with bacteriology, renal and bladder ultrasound scan, voiding cystourethrography, DMSA-scintigraphy, and re-infection events. A total of 125 patients were included in the study, of which 60% were male, the large majority (92%) febrile, and due to E. coli (74.6%). There was a history of prenatal ultrasound scan changes in 15.4%. Ultrasound scan found dilation of the urinary tract in 22.1%. Voiding cystourethrography was performed on 70 patients: 54.3% no abnormalities, 12.8% vesicoureteral reflux (VUR) grade i-iii, and 32.9% iv-v grade VUR. Six patients had iv-v grade VUR with a normal ultrasound scan. Adherence to DMSA-scintigraphy at 6 months was only 61% of that indicated. Renal scarring was found in 44.3% of those in which it was performed (60 cases). Almost half (44%) DMSA-scintigraphy in children aged one to 36 months hospitalised for APN show renal scarring at 6 months, which was found to be associated with the re-infection events and the iv-v grade VUR. There was no relationship between scarring and the bacteriology or the elevations of inflammatory biochemical markers. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

The climate impact on female acute pyelonephritis in Taiwan: A population-based study.

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Liu, Jui-Ming; Chang, Yu-Lung; Hsu, Ren-Jun; Su, Her-Young; Teng, Sen-Wen; Chang, Fung-Wei

2017-08-01

Urinary tract infection (UTI) is the main reason of community-acquired infection which causes large losses in social economy. The individual as well as climate factors make changes on the incidence. Acute pyelonephritis (APN) is one of the most serious UTI in female. The object of our study is to analyze whether climate factors will have effect on the incidence of female APN in Taiwan. This study consisted of 14,568 female patients with APN from 2001 to 2013 in Taiwan and patients with repeated APN were excluded. The monthly climate data was collected from the Central Weather Bureau. The available monthly climate data included highest, lowest, and average level of temperatures, humidity, rainfall, total rain days, and sunshine hours. The total incidence of female APN was 23.44 each 10,000 populations. The incidence of APN was positively correlated with temperature (r = 0.66), sunshine hours (r = 0.45), rainfall (r = 0.42), rain days (r = 0.29), and humidity (r = 0.23) per month. There is the strongest correlation between the average monthly temperature and the incidence of APN (β = 0.54). The correlation with the incidence of APN was also followed by rain days (β = 0.28) and humidity (β = 0.27). There is a significant expression on the incidence of female APN affected by seasonality and climate parameters. The monthly average temperature has the strongest correlation with female APN. The results of this research may facilitate the potential preventive strategies on female APN. Copyright © 2017. Published by Elsevier B.V.

Detection of parenchymal abnormalities in experimentally induced acute pyelonephritis in rabbits using contrast-enhanced ultrasonography, CT, and MRI

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Ryu, Jeong Ah; Kim, Bo Hyun; Kim, Seung Kwon; Seo, Jin Won [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jong Sung [Laboratory Animal Research Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2016-12-15

We evaluated the efficacy of contrast-enhanced ultrasonography (CEUS) in detecting acute pyelonephritis (APN) using the rabbit kidney model and compared it with CT and MRI. This study was approved by the Institutional Review Board. In a total of 20 New Zealand White rabbits, APN was induced experimentally. CEUS, CT, and MRI were performed on the first, third, and seventh postoperative days. After imaging studies, the subjects were sacrificed and the pathological diagnosis of APN was confirmed in each animal by a pathologist. Imaging studies were obtained in eight animals, including eight CEUS, four computed tomography (CT), and four magnetic resonance imaging (MRI) images. CEUS depicted diffuse renal enlargement (7), diffuse heterogeneous parenchymal enhancement (6), and focal areas of decreased parenchymal enhancement (6). These findings were well correlated with the CT and MRI findings in five cases in which these studies were available. CT and MRI showed diffuse renal enlargement, diffuse heterogeneous parenchymal enhancement, focal areas of decreased parenchymal enhancement, focal contour bulging, and the finding of perinephric spread of infection. In a rabbit model, CEUS could depict the parenchymal lesions of APN similar to CT or MRI; however, it was limited in depicting the perinephric extension of inflammation.

Bioenhanced advanced third generation solid dispersion of tadalafil: Repurposing with improved therapy in pyelonephritis

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Prashant P. Mande

2017-11-01

Full Text Available Tadalafil (TDL a BCS-II drug is recently reported for repurposing nephroprotective effect in Pyelonephritis (PN. However, poor water solubility and dissolution rate limited oral bioavailability pose serious challenges in its therapeutic applications. We present an advanced third generation Solid Dispersion (SD of TDL comprising a polymer in combination with a Self Micro-emulsifying Composition (SMEC to achieve high drug loading, improved stability and rapid dissolution of TDL for enhancing bioavailability and efficacy in PN. TDL-SMEC-SD was coated onto rapidly disintegrating inert tablet cores which disintegrated rapidly in water to release SD as a film. TDL-SMEC-SD was evaluated for in-vivo oral bioavailability and in-vivo efficacy in lipopolysaccharide-induced PN in rats. TDL exhibited high solubility (45.6 mg/ml in the SMEC. TDL-SMEC-SD exhibited remarkably high TDL loading (45%w/w, exceptionally low contact angle (9°, rapid in-vitro release (t50 7.3 min, microemulsion formation (globule size ~100 nm in aqueous dispersion, and stability as per ICH guidelines. SEM, DSC, and XRD confirmed high physical stability. A relative bioavailability of 350% and 150% compared to TDL and TDL-SD without SMEC respectively, established the superiority of TDL-SMEC-SD. A significant reduction in serum creatinine, blood urea nitrogen and nitric oxide levels in the lipopolysaccharide-induced PN confirmed the benefit of the TDL-SMEC-SD. The advanced third generation SMEC SDs presents the possibility of platform technology for bioenhancement of poorly water soluble drugs.

Comparison Of Dimercaptosuccinic Acid Scintigraphic And Voiding Cystourethrographic Findings In Patient With Acute Pyelonephritis

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Fahimi P

2003-11-01

Full Text Available Acute Pyelonephritis (APN is one of the most common bacterial infections seen in children that may lead to renal scarring. Vesicoureteral reflux (VUR is an important risk factor of renal damage but not the only one. Materials and Methods: In order to determine the association between dimercaptosuccinic acid (DMSA scintigraphic and voiding cystourethrographic findings, a retrospective study was performed on 50 children (100 renal units with APN that had been admitted to Bahrami Hospital from 1995 through 1998. Voiding cystourethrography (VCUG and DMSA scan were performed in all patients within 1 to 2 weeks after termination of treatment and a second scan was performed 6 months later in patients whose kidneys showed cortical defects in the first one. The grade of reflux was based on international reflux classification (I-V. The DMSA scans were considered abnormal if one or more areas of decreased cortical uptake were noted (cortical defect. The scar was defined as persistence of these defects in the second scan. DMSA cortical defect and VUR were demonstrated in 42 (42% and 26 (26% of renal units respectively."nResults: Fourteen out of 26 renal units (54% with reflux had cortical defects and 28 out of 74 renal units (38% without reflux had cortical defects (P=0.15. Permanent renal scarring was noted in 25/ 42 of renal units (62 % in second scan. Conclusion: It seems that VCUG alone is insufficient as a screening modality to identity those kidneys at risk of damage and DMSA scan may provide additional information about this."n 

Antimicrobial-induced endotoxaemia in patients with sepsis in the field of acute pyelonephritis.

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Giamarellos-Bourboulis E

2003-01-01

Full Text Available BACKGROUND: In vitro results have shown that antimicrobial agents may induce the Gram-negative bacteria to release endotoxins (LPS, which in turn, could trigger the secretion of cytokines from monocytes. AIMS: To compare the effect of cefuroxime, netilmicin or ciprofloxacin on serum levels of LPS and tumour necrosis factor-alpha (TNFalpha. METHODS: Seventy-four patients with acute pyelonephritis caused by Gram-negative bacteria and signs of sepsis were randomly assigned to receive one of three intravenous regimens of cefuroxime, netilmicin or ciprofloxacin. Blood samples were collected before therapy and at specified time intervals for 96 hours after the initiation of treatment for the determination of serum levels of LPS and of TNFalpha. RESULTS: Patients treated with cefuroxime presented an early peak of LPS and of TNFalpha in serum two hours after the initiation of treatment compared to the other study groups. After that time interval, concentrations of LPS and TNFalpha were similar in all the study groups. Fever accompanied by endotoxaemia was still detected for 48 hours after the start of therapy in 36, 37.5 and 36% of patients treated with cefuroxime, netilmicin and ciprofloxacin respectively. The corresponding figures for these agents at 72 hours were 28, 12.5 and 24%, respective and 12, 4.2 and 4% at 96 hours (P value not significant. CONCLUSIONS: With the exception of an early peak in the serum levels of LPS and TNFalpha in patients treated with cefuroxime, no significant difference could be detected amongst the study groups as far as their effect on serum levels of LPS and TNFalpha were concerned. This suggests that these three antimicrobial agents may be administered safely at the early stages of sepsis.

Acute pyelonephritis in pediatric age: comparative study between power Doppler ultrasound scan and DMSA

International Nuclear Information System (INIS)

Muro, M. D.; Sanguesa, C.; Otero, M. C.; Piqueras, A. I.; Lloret, M. T.

2002-01-01

To evaluate the usefulness of power Doppler (PD) Ultrasound Scan in the study of acute pyelonephritis (APN). To compare ultrasound scan results with those obtained with renal gammagraphy (DMSA). To relate the findings to the clinical criteria and to determine the presence of vesicoureteral reflux (VUR) in the serial micturition cystography (SMC). Prospective study of 92 patients (ages between 1 month and 10 years) with suspected clinical PNA. All children were initially subjected to PD ultrasound scan and DMSA. Those under 3 years old were also subjected to SMC for the study of VUR. PNA in the PD ultrasound scan was manifested by decrease in vascularisation and in the DMSA by decrease in caption in the affected zones. 87 renal units (RU) with PNA foci were detected. Conformity between the PD ultrasound scan and DMSA was 157 RU (92%): 52 positives, 22 negatives with PNA and 83 normal RU. The sensitivities of PD and DMSA were 65.5% and 69.0%. 51 SMC were performed, with VUR being detected in 18 (13 bilateral and 5 unilateral), in which the sensitivities of PD and DMSA were 65.5% and 69.0%. 51 SMC were performed, with VUR being detected in 18 (13 bilateral and 5 unilateral), in which the sensitivities of PD and DMSA were 80% and 85%, respectively. Mode B ultrasound scan and PD can replace DMSA in the initial study of PPNA. It is non-invasive, simple, economical and just as reliable as DMSA in expert hands. it can also postpone by up to 6 months the need to perform DMSA for detection of permanent renal damage. (Author) 22 refs

Clinical utility of FDG PET/CT in acute complicated pyelonephritis - results from an observational study

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Wan, Chih-Hsing [Mackay Memorial Hospital at Taipei, Department of Nuclear Medicine, Taipei (China); Tseng, Jing-Ren; Yen, Tzu-Chen [Chang Gung Memorial Hospital at Linkou, Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Taoyuan (China); Chang Gung University, Department of Medical Imaging and Radiological Science, College of Medicine, Taoyuan (China); Lee, Ming-Hsun [Chang Gung Memorial Hospital at Linkou, Division of Infectious Diseases, Department of Internal Medicine, Taoyuan (China); Yang, Lan-Yan [Chang Gung Memorial Hospital at Linkou, Biostatistics Unit, Clinical Trial Center, Taoyuan (China)

2018-03-15

Acute complicated pyelonephritis (ACP) is an upper urinary tract infection associated with coexisting urinary tract abnormalities or medical conditions that could predispose to serious outcomes or treatment failures. Although CT and magnetic resonance imaging (MRI) are frequently used in patients with ACP, the clinical value of {sup 18}F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) has not been systematically investigated. This single-center retrospective study was designed to evaluate the potential usefulness of FDG PET/CT in patients with ACP. Thirty-one adult patients with ACP who underwent FDG PET/CT were examined. FDG PET/CT imaging characteristics, including tracer uptake patterns, kidney volumes, and extrarenal imaging findings, were reviewed in combination with clinical data and conventional imaging results. Of the 31 patients, 19 (61%) showed focal FDG uptake. The remaining 12 study participants showed a diffuse FDG uptake pattern. After volumetric approximation, the affected kidneys were found to be significantly enlarged. Patients who showed a focal uptake pattern had a higher frequency of abscess formation requiring drainage. ACP patients showing diffuse tracer uptake patterns had a more benign clinical course. Seven patients had suspected extrarenal coinfections, and FDG PET/CT successfully confirmed the clinical suspicion in five cases. FDG PET/CT was as sensitive as CT in identifying the six patients (19%) who developed abscesses. Notably, FDG PET/CT findings caused a modification to the initial antibiotic regimen in nine patients (29%). FDG PET/CT may be clinically useful in the assessment of patients with ACP who have a progressive disease course. (orig.)

Modern approaches to the correction of dysbiotic intestinal disorders in children with chronic pyelonephritis

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T.O. Kryuchko

2017-04-01

Full Text Available Background. It is known that more than 80 % of children with chronic pyelonephritis (СP have abnormal intestinal disorders, which requires correction and recovery of microflora by inclusion of probiotics into therapeutic and prophylactic regimens. The purpose of the study was to study the effectiveness of probiotic Subalin in the comprehensive treatment of СP in preschool children. Materials and methods. We examined 40 children aged 0 to 6 years with a primary СP and preserved kidney function. Group I of patients received standard therapy according to the protocol. Bifido- or lactobacilli were used to correct the dysbiosis in children of this group. Patients of group II received basic therapy in combination with probiotic Subalin according to the scheme suggested by us. The rate of elimination of intoxication and dyspeptic syndromes, duration of clinical and laboratory remission of the underlying disease were assessed. Results. Evaluation of clinical effectiveness of Subalin in children for 1 month showed its more significant effectiveness in eliminating the main manifestations of dysbiosis. A significantly more pronounced frequency of normalization of feces was revealed on the background and after treatment with Subalin, in contrast to the comparison group. There was a tendency to decrease in duration (p ≤ 0.1 and a significant (p < 0.05 decrease in manifestations of intoxication syndrome in children of group II. During the 6 months of follow-up, 94.7 % of the children in group II had a significantly higher antiretroviral effectiveness of the therapy, and the duration of complete clinical and laboratory remission was 5.9 ± 0.4 months, compared with the identical indices in group I (66.7 % and 3.1 ± 0.1 months, respectively. Conclusions. The obtained results confirmed the expediency of using Subalin in the comprehensive treatment of CP in children of preschool age.

The presence of plasmid-mediated resistance genes among uropathogenes isolated from diabetic and non-diabetic patients with chronic pyelonephritis

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O.I. Chub

2014-10-01

Full Text Available Increased multidrug resistance of extended-spectrum beta-lactamases (ESBLs compromises the efficacy of treatment of urinary tract infections. The objective of this study is to determine the prevalence of ESBL-producing uropathogens from patients with chronic pyelonephritis (CP and to evaluate the risk factors of these types of infections. Screening for the presence of plasmid-mediated ESBL was performed by polymerase chain reaction. Out of 105 patients, 22 (20.9% revealed strains with resistance genes: 11 (36.7%, 11 (36.7% and 8 (26.7% were identified to carry bla(TEM, bla(SHV and bla(CTX-M beta-lactamase genes, respectively. We have demonstrated that prevalence of the resistance among patients with CP combined with type 2 DM was 31.3%, while among patients with CP without type 2 DM was 27.4%; however the difference between these groups was not significant. The main factors related with appearance of plasmid-mediated resistance genes were age range above 55 years, Chronic Kidney Disease stage ІІІ and ІV, in-patient treatment history, history of using antibiotics last year. Isolation and detection of ESBL-producing strains are essential fоr the sеlection оf the mоst effеctive antibiоtic for the empiric trеatment.

Cytotoxic Necrotizing Factor-1 (CNF1) does not promote E. coli infection in a murine model of ascending pyelonephritis.

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Michaud, Jason E; Kim, Kwang Sik; Harty, William; Kasprenski, Matthew; Wang, Ming-Hsien

2017-05-25

Urinary tract infections (UTI) are among the most common and costly infections in both hospitalized and ambulatory patients. Uropathogenic E. coli (UPEC) represent the majority of UTI isolates and are a diverse group of bacteria that utilize a variety of virulence factors to establish infection of the genitourinary tract. The virulence factor cytotoxic necrotizing factor-1 (CNF1) is frequently expressed in clinical UPEC isolates. To date, there have been conflicting reports on the role of CNF1 in the pathogenesis of E. coli urinary tract infections. We examined the importance of CNF1 in a murine ascending kidney infection/ pyelonephritis model by performing comparative studies between a clinical UPEC isolate strain and a CNF1-deletion mutant. We found no alterations in bacterial burden with the loss of CNF1, whereas loss of the virulence factor fimH decreased bacterial burdens. In addition, we found no evidence that CNF1 contributed to the recruitment of inflammatory infiltrates in the kidney or bladder in vivo. While further examination of CNF-1 may reveal a role in UTI pathogenesis, our data casts doubt on the role of CNF-1 in the pathogenesis of UPEC UTI. As with other infections, different models and approaches are needed to elucidate the contribution of CNF1 to E. coli UTI.

[Acute complicated and uncomplicated pyelonephritis in the emergency department: process-of-care indicators and outcomes].

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Delgado Vicente, Miriam; Lecaroz Agara, Mª Concepción; Barrios Andrés, José Luis; Canut Blasco, Andrés

2017-02-01

To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.

Diagnostic performance of procalcitonin for hospitalised children with acute pyelonephritis presenting to the paediatric emergency department.

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Chen, Shan-Ming; Chang, Hung-Ming; Hung, Tung-Wei; Chao, Yu-Hua; Tsai, Jeng-Dau; Lue, Ko-Huang; Sheu, Ji-Nan

2013-05-01

Urinary tract infection (UTI) is a common bacterial infection in children that can result in permanent renal damage. This study prospectively assessed the diagnostic performance of procalcitonin (PCT) for predicting acute pyelonephritis (APN) among children with febrile UTI presenting to the paediatric emergency department (ED). Children aged ≤10 years with febrile UTI admitted to hospital from the paediatric ED were prospectively studied. Blood PCT, C reactive protein (CRP) and white blood cell (WBC) count were measured in the ED. Sensitivity, specificity, predictive values, multilevel likelihood ratios, receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess quantitative variables for diagnosing APN. The 136 enrolled patients (56 boys and 80 girls; age range 1 month to 10 years) were divided into APN (n=87) and lower UTI (n=49) groups according to (99m)Tc-dimercaptosuccinic acid scan results. The cut-off value for maximum diagnostic performance of PCT was 1.3 ng/ml (sensitivity 86.2%, specificity 89.8%). By multivariate regression analysis, only PCT and CRP were retained as significant predictors of APN. Comparing ROC curves, PCT had a significantly greater area under the curve than CRP, WBC count and fever for differentiating between APN and lower UTI. PCT has better sensitivity and specificity than CRP and WBC count for distinguishing between APN and lower UTI. PCT is a valuable marker for predicting APN in children with febrile UTI. It may be considered in the initial investigation and therapeutic strategies for children presenting to the ED.

Once daily, extended release ciprofloxacin for complicated urinary tract infections and acute uncomplicated pyelonephritis.

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Talan, David A; Klimberg, Ira W; Nicolle, Lindsay E; Song, James; Kowalsky, Steven F; Church, Deborah A

2004-02-01

We assessed the efficacy and safety of 1,000 mg extended release ciprofloxacin orally once daily vs conventional 500 mg ciprofloxacin orally twice daily, each for 7 to 14 days, in patients with a complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis (AUP). In this prospective, randomized, double-blind, North American multicenter clinical trial adults were stratified based on clinical presentation of cUTI or AUP and randomized to extended release ciprofloxacin or ciprofloxacin twice daily. Efficacy valid patients had positive pretherapy urine cultures (105 or greater cFU/ml) and pyuria within 48 hours of study entry. Bacteriological and clinical outcomes were assessed at the test of cure visit (5 to 11 days after therapy) and the late followup visit (28 to 42 days after therapy). The intent to treat population comprised 1,035 patients (extended release ciprofloxacin in 517 and twice daily in 518), of whom 435 were efficacy valid (cUTI in 343 and AUP in 92). For efficacy valid patients (cUTI and AUP combined) bacteriological eradication rates at test of cure were 89% (183 of 206) vs 85% (195 of 229) (95% CI -2.4%, 10.3%) and clinical cure rates were 97% (198 of 205) vs 94% (211 of 225) (95% CI -1.2%, 6.9%) for extended release vs twice daily ciprofloxacin. Late followup outcomes were consistent with test of cure findings. Eradication rates for Escherichia coli, which accounted for 58% of pathogens, were 97% or greater per group. Drug related adverse event rates were similar for extended release and twice daily ciprofloxacin (13% and 14%, respectively). Extended release ciprofloxacin at a dose of 1,000 mg once daily was as safe and effective as conventional treatment with 500 mg ciprofloxacin twice daily, each given orally for 7 to 14 days in adults with cUTI or AUP. It provides a convenient, once daily, empirical treatment option.

Is 5 days of oral fluoroquinolone enough for acute uncomplicated pyelonephritis? The DTP randomized trial.

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Dinh, A; Davido, B; Etienne, M; Bouchand, F; Raynaud-Lambinet, A; Aslangul-Castier, E; Szwebel, T A; Duran, C; Der Sahakian, G; Jordy, C; Ranchoux, X; Sembach, N; Mathieu, E; Davido, A; Salomon, J; Bernard, L

2017-08-01

The treatment duration of acute uncomplicated pyelonephritis (AUP) is still under debate. As shortening treatment duration could be a means to reduce antimicrobial resistance, we aimed to establish whether 5 days of antibiotic treatment is non-inferior to 10 days in patients with AUP. We performed an open-label prospective randomized trial comparing 5 days to 10 days of fluoroquinolone treatment for AUP. The inclusion criteria were: female patients aged ≥18 years with clinical signs of urinary tract infection, fever >38 °C, and positive urinalysis. Patients were randomized to either 5 or 10 days of fluoroquinolone treatment. Outcome was cure at day 10 and day 30 after the end of treatment. One hundred patients were randomized and 12 were excluded after randomization. The mean ± standard deviation (SD) age was 31.8 ± 11 years old and the mean ± SD temperature was 38.6 ± 0.7 °C. The main bacterium involved was Escherichia coli (n = 86; 97.7%) and 3 (3.4%) patients had a positive blood culture. In the post-hoc analysis, clinical cure 10 days after the end of the treatment was 28/30 (93.3%) in the 5-day arm and 36/38 (94.7%) in the 10-day arm (p = 1.00). At day 30, the clinical cure rate was 23/23 (100%) in the 5-day arm and 20/20 (100%) in the 10-day arm (p = 1.00). The microbiological cure rate was 20/23 (87.0%) in the 5-day arm and 16/20 (80.0%) in the 10-day arm (p = 1.00). The efficacy of 5 days of fluoroquinolone treatment does not seem different from 10 days of treatment for AUP.

Cintilografia renal com ácido dimercaptossuccínico marcado com tecnécio no diagnóstico da pielonefrite na infância: estudo de 17 casos Renal scintigraphy using technetium dimercaptosuccinic acid in the diagnosis of pyelonephritis in children: study of 17 cases

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Eliana B.M. Guidoni

2001-04-01

Full Text Available OBJETIVO: a infecção do trato urinário é uma das doenças bacterianas mais freqüentes em pediatria. O envolvimento infeccioso renal (pielonefrite pode evoluir com formação de cicatriz renal irreversível com conseqüente perda funcional e dano renal progressivo. Estudos recentes sugerem que até 50-60% das cicatrizes renais poderiam ser evitadas ou atenuadas com o diagnóstico precoce da pielonefrite. O objetivo deste estudo é determinar se a presença de alterações na cintilografia renal com DMSA na fase aguda da infecção urinária pode ser indicadora de pielonefrite. MÉTODOS: empregamos a técnica de washout em 17 meninas portadoras de infecção urinária como padrão-ouro na localização do sítio da infecção. Todas as crianças realizaram cintilografia renal com DMSA na fase aguda da infecção. Os resultados foram analisados pelo teste do qui-quadrado ou de Fisher. RESULTADOS: a cintilografia renal com DMSA detectou alterações em todos os cinco casos de pielonefrite diagnosticados pelo washout sugerindo envolvimento renal. Observamos também que apenas uma das crianças com cistite (total = 12 casos apresentava alterações ao DMSA. Portanto, a sensibilidade e especificidade deste estudo com DMSA na fase aguda da infecção foi de 100% e 92% respectivamente no diagnóstico da pielonefrite. CONCLUSÕES: a cintilografia renal com DMSA mostrou-se método sensível no diagnóstico da pielonefrite aguda em crianças.OBJECTIVE: to determine whether the presence of abnormal results in DMSA renal scintigraphy indicates pyelonephritis. METHODS: we performed the washout test in 17 children with urinary tract infection, as a criterion standard, to locate the infection site. All the children underwent DMSA renal scintigraphy in the acute phase of the disease. The results were analyzed by the chi-square test or Fisher test. RESULTS: DMSA renal scintigraphy revealed changes in all five cases of pyelonephritis, suggesting acute kidney

Anti-GBM disease after nephrectomy for xanthogranulomatous pyelonephritis in a patient expressing HLA DR15 major histocompatibility antigens: a case report.

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O'Hagan, Emma; Mallett, Tamara; Convery, Mairead; McKeever, Karl

2015-01-01

Antiglomerular basement membrane (anti-GBM) antibody disease is uncommon in the pediatric population. There are no cases in the literature describing the development of anti-GBM disease following XGP or nephrectomy. We report the case of a 7-year-old boy with no past history of urological illness, treated with antimicrobials and nephrectomy for diffuse, unilateral xanthogranulomatous pyelonephritis (XGP). Renal function and ultrasound scan of the contralateral kidney postoperatively were normal. Three months later, the child represented in acute renal failure with rapidly progressive glomerulonephritis requiring hemodialysis. Renal biopsy showed severe crescentic glomerulonephritis with 95% of glomeruli demonstrating circumferential cellular crescents. Strong linear IgG staining of the glomerular basement membranes was present, in keeping with anti-GBM disease. Circulating anti-GBM antibodies were positive. Treatment with plasma exchange, methylprednisolone, and cyclophosphamide led to normalization of anti-GBM antibody titers. Frequency of hemodialysis was reduced as renal function improved, and he is currently independent of dialysis with estimated glomerular filtration rate 20.7 mls/min/1.73 m 2 . Case studies in the adult literature have reported the development of a rapidly progressive anti-GBM antibody-induced glomerulonephritis following renal surgery where patients expressed HLA DR2/HLA DR15 major histocompatibility (MHC) antigens. Of note, our patient also expresses the HLA DR15 MHC antigen.

THE IMPORTANCE OF 99m-Tc DMSA RENAL SCINTIGRAPHY IN EVALUATION OF RENAL LESIONS IN CHILDREN WITH ACUTE PYELONEPHRITIS

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N Ataei

2008-11-01

Full Text Available "nUrinary tract infection (UTI may lead to irreversible changes in renal parenchyma. Early diagnosis using scintigraphy with technetium-99m-labeled dimercaptosuccinic acid (DMSA scan and early treatment may decrease or prevent development of renal parenchymal lesions. The aim of this study was to assess the occurrence of renal parenchymal lesion in children admitted with a first-time symptomatic UTI and to evaluate the relation between renal parenchymal damage and severity of vesicoureteral reflux (VUR. A total of 102 children with first time acute pyelonephritis (APN were enrolled in the study. All children studied with DMSA scan and ultrasonography (US. Voiding cystourethrography (VCUG was performed in 98 children when urine culture became negative. Changes on the DMSA scan and US were found in 178 (88% and 5 (2.4% out of 203 renal units during the acute phase, respectively. All abnormal renal units on US showed severe parenchymal involvement on DMSA. We also found significant correlation between severity of VUR and abnormal US results on kidneys. Of 40 kidneys with reflux, 38 (95% were found to have abnormal renal scan. Among 155 kidneys with non-refluxing ureters 132 (85.2% revealed parenchymal changes on renal cortical scintigraphy. Kidneys with moderate to severe reflux were more likely to have severe renal involvement. We found a high incidence of renal parenchymal changes in children with APN. Additionally, renal involvement was significantly higher in children with moderate to severe reflux. When there are high-grade VUR and female gender, the risk of renal parenchymal involvement is higher.

Usefulness of analytical parameters in the management of paediatric patients with suspicion of acute pyelonephritis. Is procalcitonin reliable?

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Bañuelos-Andrío, L; Espino-Hernández, M; Ruperez-Lucas, M; Villar-Del Campo, M C; Romero-Carrasco, C I; Rodríguez-Caravaca, G

To investigate the usefulness of procalcitonin (PCT) and other analytical parameters (white blood cell count [WBC], C-reactive protein [CRP]) as markers of acute renal damage in children after a first febrile or afebrile urinary tract infection (UTI). A retrospective study was conducted on children with a first episode of UTI admitted between January 2009 to December 2011, and in whom serum PCT, CRP and white blood cell count were measured, as well as assessing the acute renal damage with renal scintigraphy with 99m Tc-DMSA (DMSA) within the first 72h after referral. A descriptive study was performed and ROC curves were plotted, with optimal cut-off points calculated for each parameter. The 101 enrolled patients were divided into two groups according to DMSA scintigraphy results, with 64 patients being classified with acute pyelonephritis (APN), and 37 with UTI. The mean WBC, CRP and PCT values were significantly higher in patients with APN with respect to normal acute DMSA. The area under the ROC curve was 0.862 for PCR, 0.774 for WBC, and 0.731 for PCT. The optimum statistical cut-off value for PCT was 0.285ng/ml (sensitivity 71.4% and specificity 75%). Although the mean levels of fever, WBC, CRP, and PCT were significantly increased in patients with APN than in those who had UTI, the sensitivity and specificity of these analytical parameters are unable to predict the existence of acute renal damage, making the contribution by renal DMSA scintigraphy essential. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Research of Urinary Tract Infections in Family Medicine Physicians' Offices – Empiric Antimicrobial Therapy of Urinary Tract Infections – Croatian Experience

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Škerk, Vedrana; Škerk, Višnja; Jakšić, Jerko; Kolumbić Lakoš, Adela; Matrapazovski, Mirjana; Maleković, Gordan; Tambić Andrašević, Arjana; Radošević, Velena; Markotić, Alemka; Begovac, Josip

2009-01-01

In the period between October 1st and November 30th, 2006, we investigated a total of 3188 episodes of UTI (802 among males; 2386 among females) recorded in 108 family medicine offices in 20 cities in Croatia. The most common UTIs in women were acute uncomplicated cystitis (62%), complicated UTIs – cystitis and pyelonephritis (14%), urethritis (9%), acute uncomplicated pyelonephritis (6%), recurrent cystitis (5%), asymptomatic bacteriuria (3%) and recurrent pyelonephritis. The most common UTI...

Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis

International Nuclear Information System (INIS)

Jaksic, E.; Bogdanovic, R.; Artiko, V.

2011-01-01

Assessment of the first febrile urinary tract infection (UTI) in children has been the subject of debate for many years. Diagnosis of acute pyelonephritis (APN) is usually based on clinical and biological data. The clinical usefulness of early Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy remains controversial, although it may influence the type and duration of treatment. The aim of this study was to assess the role of initial cortical scintigraphy in the detection of early renal parenchymal damage in children highly suspected of having APN and to compare the scintigraphic findings with selected clinical/laboratory parameters and ultrasonography. A prospective study was conducted in 34 infants and young children (18 boys, 16 girls), aged 1.5-36 months (mean 9.8±8.7 months), hospitalized with a first episode of clinically suspected APN. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography (US), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC) and urine analyses were performed. DMSA scintigraphy showed changes consistent with APN in 27/34 (79%) patients, with a mean age of 10.9 months, including 12 males (44%) and 15 (56%) females. Out of 9 febrile children with negative urine culture and supportive evidence of UTI, scintigraphy showed parenchymal involvement in 8 children (24% in the whole group, 30% in scintigraphically documented APN). There were no statistically significant correlations between the frequency or size of the initial scintigraphic abnormalities and age, sex, body temperature, CRP levels or ESR. A CRP level of >54 mg/L and a WBC of >13,300/mm 3 had sensitivities of 56 and 59% and specificities of 86 and 71%, respectively. US showed changes consistent with APN in 7/34 (21%) in the whole group and in 7/27 (26%) patients with positive cortical scan (p<0.05). Initial DMSA renal scintigraphy is a sensitive method for the early diagnosis of APN in young children and is

The combination of urinary IL - 6 and renal biometry as useful diagnostic tools to differentiate acute pyelonephritis from lower urinary tract infection.

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Azab, Sherif; Zakaria, Mostafa; Raafat, Mona; Seief, Hadeel

2016-01-01

To evaluate the role of renal ultrasound (RUS) and urinary IL-6 in the differentiation between acute pyelonephritis (APN) and lower urinary tract infection (LUTI). This prospective study was carried out at the Pediatric and urology outpatient and inpatient departments of Cairo University Children's Hospital as well as October 6 University Hospital and it included 155 children between one month and fourteen years old with positive culture UTI. Patients were categorized into APN and LUTI based on their clinical features and laboratory parameters. Thirty healthy children, age and sex matched constituted the control group. Children with positive urine cultures were treated with appropriate antibiotics. Before treatment, urinary IL-6 was measured by enzyme immunoassay technique (ELISA), and renal ultrasound (RUS) was done. CRP (C-reactive protein), IL-6 and RUS were repeated on the 14th day of antibiotic treatment to evaluate the changes in their levels in response to treatment. UIL-6 levels were more significantly higher in patients with APN than in patients with LUTI (24.3±19.3pg/mL for APN vs. 7.3±2.7pg/mL in LUTI (95% CI: 2.6-27.4; p20pg/mL and serum CRP >20μg/mL were highly reliable markers of APN. Mean renal volume and mean volume difference between the two kidneys in the APN group were more than that of the LUTI and control groups (Purinary IL-6 levels have a highly dependable role in the differentiation between APN and LUTI especially in places where other investigations are not available and/ or affordable. Copyright© by the International Brazilian Journal of Urology.

The combination of urinary IL - 6 and renal biometry as useful diagnostic tools to differentiate acute pyelonephritis from lower urinary tract infection

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Sherif Azab

Full Text Available ABSTRACT Objective: To evaluate the role of renal ultrasound (RUS and urinary IL-6 in the differentiation between acute pyelonephritis (APN and lower urinary tract infection (LUTI. Patients and methods: This prospective study was carried out at the Pediatric and urology outpatient and inpatient departments of Cairo University Children's Hospital as well as October 6 University Hospital and it included 155 children between one month and fourteen years old with positive culture UTI. Patients were categorized into APN and LUTI based on their clinical features and laboratory parameters. Thirty healthy children, age and sex matched constituted the control group. Children with positive urine cultures were treated with appropriate antibiotics. Before treatment, urinary IL-6 was measured by enzyme immunoassay technique (ELISA, and renal ultrasound (RUS was done. CRP (C-reactive protein, IL-6 and RUS were repeated on the 14th day of antibiotic treatment to evaluate the changes in their levels in response to treatment. Results: UIL-6 levels were more significantly higher in patients with APN than in patients with LUTI (24.3±19.3pg/mL for APN vs. 7.3±2.7pg/mL in LUTI (95% CI: 2.6-27.4; p20pg/mL and serum CRP >20μg/mL were highly reliable markers of APN. Mean renal volume and mean volume difference between the two kidneys in the APN group were more than that of the LUTI and control groups (P<0.001. Renal volume between 120-130% of normal was the best for differentiating APN from LUTI. Conclusions: RUS and urinary IL-6 levels have a highly dependable role in the differentiation between APN and LUTI especially in places where other investigations are not available and/ or affordable.

Experience of Cefixime Application for the Treatment of Urinary Tract Infection in Children

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G.O. Lezhenko

2014-04-01

Full Text Available There has been investigated the efficiency of Cefix (cefixim application as a monotherapy of acute cystitis, acute and chronic pyelonephritis in children. Cefixime was found to be etiologically reasonable, high-performance and safe for the therapy of non-complicated cystitis and pyelonephritis in children.

Three types of gall-bladder motility at men with chronic cholecystitis and pyelonephritis and accompanying their parameters of kidney excretory function as well as metabolism

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Oksana M Ivanyts’ka

2018-04-01

Full Text Available Background. Previously it has been shown that balneotherapy in the spa Truskavets’ (Ukraїna in men with chronic cholecystitis combined with pyelonephritis causes changes in gall-bladder motility. This is combined with changes in diurese and urinary excretion of metabolites.Individual analysis revealed not only quantitative but also qualitative differences in the postprandial motility of the gall-bladder. The purpose of this study is to identify the parameters of kidney excretory function as well as metabolism under which three types of the gall-bladdermotility skills differ significantly from each other. Materialandmethods. The object of observationwere the same ones 22men aged24-70 years old,who cameto the spaTruskavets’ for the treatment of chronic cholecystitiscombined withpyelonephritis inremission. On thetone and motility of gall-bladder judged byits fasting and postprandial volume (echocamera “Radmir”. In the daily  determined content of oxalate and nitrogen metabolites: creatinine, urea and uric acid, electrolytes: phosphates, chloride, calcium, magnesium, potassium and sodium. Nitrogenous metabolites in plasma of venous blood were determined also. The survey was conducted twice, before and after balneotherapy. Results. The method of cluster analysis has formed three homogeneous cholekinetics groups, namely:normokinesia as well as hypertonic-hyperkinetic and hyperkinetic-hypertonic dyskinesia.The method of discriminatory analysis revealed 13 parameters of daily urine and three parameters of blood, as well as body weight and height, electrokinetic index and Kerdoe’s index, in the totality of which three types of cholekinetics are clearly delineated.Conclusion. The type of postprandial cholekinetics is naturally associated with a number of parameters of the excretory renal function and metabolism.

Exploring the Anti-quorum Sensing and Antibiofilm Efficacy of Phytol against Serratia marcescens Associated Acute Pyelonephritis Infection in Wistar Rats

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Srinivasan, Ramanathan; Mohankumar, Ramar; Kannappan, Arunachalam; Karthick Raja, Veeramani; Archunan, Govindaraju; Karutha Pandian, Shunmugiah; Ruckmani, Kandasamy; Veera Ravi, Arumugam

2017-01-01

Quorum Sensing (QS) mechanism, a bacterial density-dependent gene expression system, governs the Serratia marcescens pathogenesis through the production of virulence factors and biofilm formation. The present study demonstrates the anti-quorum sensing (anti-QS), antibiofilm potential and in vivo protective effect of phytol, a diterpene alcohol broadly utilized as food additive and in therapeutics fields. In vitro treatment of phytol (5 and 10 μg/ml) showed decreasing level of biofilm formation, lipase and hemolysin production in S. marcescens compared to their respective controls. More, microscopic analyses confirmed the antibiofilm potential of phytol. The biofilm related phenomenons such as swarming motility and exopolysccharide productions were also inhibited by phytol. Furthermore, the real-time analysis elucidated the molecular mechanism of phytol which showed downregulation of fimA, fimC, flhC, flhD, bsmB, pigP, and shlA gene expressions. On the other hand, the in vivo rescue effect of phytol was assessed against S. marcescens associated acute pyelonephritis in Wistar rat. Compared to the infected and vehicle controls, the phytol treated groups (100 and 200 mg/kg) showed decreased level of bacterial counts in kidney, bladder tissues and urine samples on the 5th post infection day. As well, the phytol treatment showed reduced level of virulence enzymes such as lipase and protease productions compared to the infected and vehicle controls. Further, the infected and vehicle controls showed increasing level of inflammatory markers such as malondialdehyde (MDA), nitric oxide (NO) and myeloperoxidase (MPO) productions. In contrast, the phytol treatment showed decreasing level of inflammatory markers. In histopathology, the uninfected animal showed normal kidney and bladder structure, wherein, the infected animals showed extensive infiltration of neutrophils in kidney and bladder tissues. In contrast, the phytol treatment showed normal kidney and bladder tissues

ASYMPTOMATIC BACTERIURIA IN PREGNANT WOMEN: DIAGNOSTICS AND TREATMENT

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N. B. Gordovskaya; I. V. Korotchaeva

2014-01-01

In this article, the questions of screening, diagnostics and treatment of asymptomatic bacteriuria in pregnant women are considered. AB is found in 2-13% of pregnant women and it is a risk factor of gestational pyelonephritis development in 30-40% of pregnant women. Timely antibacterial therapy of AB prevents development of pyelonephritis in 70-80% of cases.

Kidney Infection (Pyelonephritis)

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... Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información ... Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información ...

ASYMPTOMATIC BACTERIURIA IN PREGNANT WOMEN: DIAGNOSTICS AND TREATMENT

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N. B. Gordovskaya

2014-01-01

Full Text Available In this article, the questions of screening, diagnostics and treatment of asymptomatic bacteriuria in pregnant women are considered. AB is found in 2-13% of pregnant women and it is a risk factor of gestational pyelonephritis development in 30-40% of pregnant women. Timely antibacterial therapy of AB prevents development of pyelonephritis in 70-80% of cases.

Xanthogranulomatous pyclonephritis in childhood. Radiologic an pathologic correlation

International Nuclear Information System (INIS)

Mattoso, A.L.O.; Caldas, M.L.R.

1989-01-01

Xanthogranulomatous pyelonephritis in childhood. Radiologic and pathologic correlation. Four cases of xanthogranulomatous pyelonephritis in children are presented and a correlation between the main radiological and pathological findings of the two forms of presentation of the disease (focal and diffuse) is showed, with emphasis in its sonographic and computed tomographic findings. Clinical comments and a review of the literature is also presented. (author) [pt

The valuation of 99Tcm-DMSA renal cortical scintigraphy for prediction of renal scarring in children with acute pyelonephritis

International Nuclear Information System (INIS)

Zhao Ruifang; Ji Zhiying; Lv Xiaomei; Wu Ha; Li Yiwei; Gu Fanlei; Zhao Xiaofei

2009-01-01

Objective: Acute pyelonephritis (APN) is a common infectious disease in childhood. APN may result in ineversible renal scarring. 99 Tc m -dimercaptsuccinic (DMSA) renal cortical scintigraphy was reported to be highly sensitive and specific for detection APN and renal scarring. The aim of this study was to determine the incidence of renal scarring in a group of children with APN and to evaluate the relative factors at risk of scarring using 99 Tc m -DMSA renal cortical scintigraphy. Methods: One hundred and eighteen patients (44 males, 74 females, age range: 1 month to 14 years) with APN underwent DMSA renal cortical scan before treatment and six month after treatment to identify renal damage and renal scarring. The degree of renal damage was divided to grade I to IV. A directed radionuclide cystography (DRC) was performed in 72 cases to evaluate vesicoureteric reflux (VUR). Statistical analysis between all those relative factors was performed using Spearman grading relational analysis. The software was SPSS 11.5. Results: The follow-up renal cortical scan revealed that 79 normal kidneys on first scan remained normal; of 64 kidneys with grade I damage, 7.81% (5/64) developed renal scar; of 51 kidneys with grade II, 49.02% (25/51) developed renal scar; of 19 with grade III, 68.42% (13/19) developed renal scar; of 23 with grade IV, 100.00% (23/23) developed renal scar. There was a significant relationship between the incidence of renal scar on follow-up and the grade of renal damage on first scan (r=0.877, P<0.01). VUR was found in 54.17% (78/144) per renal unit. Only 4.55% (3/66) of those with non-refluxing ureters developed renal scars on follow-up. One of four patients with mild-refluxing ureters developed renal scars. 46.51% (20/43) of those with moderate-refluxing ureters developed renal scars. 87.10% (27/31) of those with severe-refluxing ureters developed renal scars. There was a significant relationship between the incidence of renal scarring in follow-up and

[Determination of homeostatic kidney function in the diagnosis of chronic glomerulonephritis].

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Ratner, M J

1977-12-01

The latent and hypertonic forms of the course of compensated nephritides more frequently make difficulties concerning the differential diagnosis between a chronic glomerulonephritis and a chronic pyelonephritis. According to the results achieved the determination of the renal processes furthering homoeostasis gives the possibility to demarcate the two diseases. A certain reduction of the creatinine clearance (to less than 90 ml/min) and of the maximum water diuresis (to less than 10.0 per 100 ml glomerular filtrate) is suitable for the latent form of the chronic glomerulonephritis. On the other hand, a reduction of the ammonia secretion (to less than 35 per 100 ml glomerular (filtrate) and of the total H+-ion secretion (to less than 50 per 100 ml glomerular filtrate) in the determination after Alkinton is characteristic for the chronic pyelonephritis. In the hypertensive form of the course of the chronic glomerulonephritis in contrast to the same form in chronic pyelonephritis a reduction of the maximum water diuresis to less than 7.5, of the clearance of the "osmotically free" water to less than 6.0, of the titrable acidity to less than 25 is the result. Here the ammonia quotient transgresses 45%. In chronic pyelonephritis the titrable acidity in considerably increased and the ammonia genesis relatively decreased (to less than 45%).

Interstitial nephritis.

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Papper, S

1980-01-01

There are many causes of interstitial nephritis other than pyelonephritis. The term interstitial nephritis does not connote a single etiologic or pathogenetic mechanism; it rather arbitrarily places together a wider variety of renal diseases that have a predilection for early and major involvement of the renal interstitium. The prototype of acute interstitial nephritis is acute pyelonephritis. In addition, there is a drug-related acute interstitial disease that is probably of immunological nature and usually reverses with discontinuance of the offending drug. Chronic interstitial nephritis includes many diverse illnesses. Nonobstructive pyelonephritis occurs but its prevalence is debated. Analgesic abuse nephropathy is not rare and is potentially reversible. Papillary necrosis has many causes and a wide spectrum of clinical presentations. Heavy metals, such as lead, cause interstitial nephritis. Balkan nephropathy occurs in an endemic area and although not bacterial in origin is of unknown cause.

Population Pharmacokinetic Analysis of Cefiderocol, a Parenteral Siderophore Cephalosporin, in Healthy Subjects, Subjects with Various Degrees of Renal Function, and Patients with Complicated Urinary Tract Infection or Acute Uncomplicated Pyelonephritis.

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Kawaguchi, Nao; Katsube, Takayuki; Echols, Roger; Wajima, Toshihiro

2018-02-01

Cefiderocol, a novel parenteral siderophore cephalosporin, exhibits potent efficacy against most Gram-negative bacteria, including carbapenem-resistant strains. The aim of this study was to perform a population pharmacokinetic (PK) analysis based on plasma cefiderocol concentrations in healthy subjects, subjects with various degrees of renal function, and patients with complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis (AUP) caused by Gram-negative pathogens and to calculate the fraction of the time during the dosing interval where the free drug concentration in plasma exceeds the MIC ( fT MIC ). Population PK models were developed with three renal function markers, body surface area-adjusted estimated glomerular filtration rate (eGFR), absolute eGFR, and creatinine clearance, on the basis of 2,571 plasma concentrations from 91 subjects without infection and 238 patients with infection. The population PK models with each renal function marker adequately described the plasma cefiderocol concentrations. Clear relationships of total clearance (CL) to all renal function markers were observed. Body weight and disease status (with or without infection) were also significant covariates. The CL in patients with infection was 26% higher than that in subjects without infection. The fT MIC values were more than 75% in all patients (and were 100% in most patients), suggesting that a sufficient exposure to cefiderocol was provided by the tested dose regimens (2 g every 8 h as the standard dose regimen) for the treatment of cUTI or AUP caused by Gram-negative pathogens. Copyright © 2018 Kawaguchi et al.

Acute pyelonephritis in pediatric age: comparative study between power Doppler ultrasound scan and DMSA; Pielonefritis aguda en la edad pediatrica: estudio comparative entre la ecografiapower-Doppler y el DMSA

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Muro, M. D.; Sanguesa, C.; Otero, M. C.; Piqueras, A. I.; Lloret, M. T. [Hospital Infantil Universitario La Fe. Valencia (Spain)

2002-07-01

To evaluate the usefulness of power Doppler (PD) Ultrasound Scan in the study of acute pyelonephritis (APN). To compare ultrasound scan results with those obtained with renal gammagraphy (DMSA). To relate the findings to the clinical criteria and to determine the presence of vesicoureteral reflux (VUR) in the serial micturition cystography (SMC). Prospective study of 92 patients (ages between 1 month and 10 years) with suspected clinical PNA. All children were initially subjected to PD ultrasound scan and DMSA. Those under 3 years old were also subjected to SMC for the study of VUR. PNA in the PD ultrasound scan was manifested by decrease in vascularisation and in the DMSA by decrease in caption in the affected zones. 87 renal units (RU) with PNA foci were detected. Conformity between the PD ultrasound scan and DMSA was 157 RU (92%): 52 positives, 22 negatives with PNA and 83 normal RU. The sensitivities of PD and DMSA were 65.5% and 69.0%. 51 SMC were performed, with VUR being detected in 18 (13 bilateral and 5 unilateral), in which the sensitivities of PD and DMSA were 65.5% and 69.0%. 51 SMC were performed, with VUR being detected in 18 (13 bilateral and 5 unilateral), in which the sensitivities of PD and DMSA were 80% and 85%, respectively. Mode B ultrasound scan and PD can replace DMSA in the initial study of PPNA. It is non-invasive, simple, economical and just as reliable as DMSA in expert hands. it can also postpone by up to 6 months the need to perform DMSA for detection of permanent renal damage. (Author) 22 refs.

Results of a five-year study of 99mTc DMSA renal scintigraphy in children and adolescents following acute pyelonephritis

International Nuclear Information System (INIS)

Chroustova, D.; Palyzova, D.; Kolska, M.; Urbanova, I.

2006-01-01

Renal scintigraphy, generally using 99' mTc-DMSA, is the accepted reference standard for detection of renal cortical changes. The timing of the test, i.e., whether an acute 99m Tc-DMSA scan, a follow-up only or both scans should be performed, however, remains open to discussion. In our study, a six-month follow- up DMSA scan was performed in all the children diagnosed with a first attack of acute pyelonephritis (APN) in two large paediatric clinics of Charles University's 3 rd School of Medicine in Prague during a five-year period. All diagnoses were confirmed by a paediatric nephrologist. 382 children (267 girls, 115 boys) aged between 7 months and 19 years were included in the study. For analytical purposes, the patients were divided into 4 age groups: I - less than 1 year of age, II - 1-5 years, III - 5-10 years, and IV - 10-19 years. In all children younger than five years, a micturition cystourethrogram (MCUG) for detection of vesicoureteric reflux (VUR) was performed between one and three months after the APN episode. Static renal scintigraphy, using an HR collimator with parallel holes was performed using a planar Gamma camera MB 9200 (Gamma Budapest) in all children six months after APN, with a complement of pinhole images, SPECT or PSPECT of the kidneys. 1. In group I, all four children with positive VUR on MCUG had a pathological DMSA scan, while only two of the 32 patients with negative VUR had a pathological DMSA. 2. In group II, 17 children had VUR on MCUG, six of them with a pathological and 11 with a normal DMSA scan. Most of the 221 children without VUR had a normal DMSA scintigraphy; pathological findings were present in 17 children only. 3. In group III, all children with VUR, but only 5 out of 53 without VUR, had a pathological DMSA scan. 4. Five out of 50 children in group IV had a pathological DMSA. APN occurred most frequently in group II (62.3%, or 238 children) and ranged between 10-15% in the remaining groups. APN was found very frequently

Developing an Instrument to Measure Socioeconomic Disparities in Quality of Care for Men with Early Stage Prostate Cancer

Science.gov (United States)

2010-09-01

April;2008:1988, released April 2008. 6. Yost K, Perkins C, Cohen R, et al. Socioeconomic status and breast cancer incidence in California for different...Fistula), 998.7 (Post-Op Foreign Substance Reaction), 604.0 (Orchitis with Abscess ), E870.0 (Acc Cut/Hem in Surgery), E870.4 (Acc Cut/Hem with Scope Exam...Surgical Complications: 595.89 (Cystitis Nec), 590.1 (Acute Pyelonephritis), 590.2 (Renal/Perirenal Abscess ), 590.8 (Pyelonephritis or pyonephrosis not

Uncomplicated Urinary Tract Infections in Women in a Sao Paulo Quaternary Care Hospital: Bacterial Spectrum and Susceptibility Patterns

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Marcelo Hisano

2014-03-01

Full Text Available Uncomplicated urinary tract infections (UTI in women are very common. Regular analysis of bacterial flora is important to formulate updated guidelines. The objective of this study is to determine and compare the microbiology of UTIs and their susceptibility patterns in a quaternary care hospital. In a seven-year review, the urine culture results of 480 female patients with uncomplicated UTIs were analyzed. Patients were divided into three groups according to their diagnosis and treatment characteristics: Group 1, cystitis at outpatient basis; group 2, cystitis at the Emergency Unit; and group 3, pyelonephritis. Group 1 included older patients, with a higher incidence of concomitant diabetes mellitus and recurrent UTIs. E. coli was the most common pathogen, responsible for 75.1% of cases, mainly for pyelonephritis (87.3%. Of the oral antimicrobials tested for cystitis, amoxicillin/clavulanate and nitrofurantoin had the highest susceptibility profiles (84.4% and 87.3%, respectively. For E. coli only, their susceptibility profiles were as high as 90.8% and 97.4%, respectively. For pyelonephritis treatment, fluoroquinoles had a susceptibility profile <90%, while ceftriaxone and gentamicin had susceptibility >90%. Uncomplicated UTI treatment is becoming more challenging because the susceptibility profiles of oral antimicrobials are increasingly resistant. In our environment, cystitis can still be managed with nitrofurantoin. Uncomplicated pyelonephritis should be managed with ceftriaxone or gentamicin.

Urinary tract infections in pregnancy.

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Ovalle, A; Levancini, M

2001-01-01

Urinary tract infections are very common during pregnancy. Escherichia coli is the most common pathogen isolated from pregnant women. Ampicillin should not be used because of its high resistance to Escherichia coli. Pyelonephritis can cause morbidity and can be life-threatening to both mother and fetus. Second and third-generation cephalosporins are recommended for treatment, administered initially intravenously during hospitalization. Cultures and the study of virulence factors of uropathogenic Escherichia coli are recommended for the adequate management of pyelonephritis. The lower genital tract infection associated with pyelonephritis is responsible for the failure of antibiotic treatment. Asymptomatic bacteriuria can evolve into cystitis or pyelonephritis. All pregnant women should be routinely screened for bacteriuria using urine culture, and should be treated with nitrofurantoin, sulfixosazole or first-generation cephalosporins. Recurrent urinary infection should be treated with prophylactic antibiotics. Pregnant women who develop urinary tract infections with group B streptococcal infection should be treated with prophylactic antibiotics during labour to prevent neonatal sepsis. Preterm delivery is frequent. Evidence suggests that infection plays a role in the pathogenesis of preterm labour. Experimental models in pregnant mice support the theory that Escherichia coli propagated by the transplacental route, involving bacterial adhesins, induces preterm delivery, but this has not been demonstrated in humans. Ascending lower genital tract infections are the most probable cause of preterm delivery, but this remains to be proved.

Fecal colonization with P-fimbriated Escherichia coli in newborn children and relation to development of extraintestinal E. coli infections.

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Tullus, K

1987-01-01

The incidence of E. coli pyelonephritis before the age of one year among the children born at Danderyd Hospital during a ten year period was studied. During the study period, 4 or 5 outbreaks of E. coli pyelonephritis occurred among the children who had previously been staying in the hospital's neonatal ward. These outbreaks seemed to have been caused by nosocomial spread of and fecal colonization with certain virulent E. coli strains among the children staying in the ward during certain periods of time. The strains that were spread in the ward seemed to belong to certain pyelonephritogenic E. coli clones of the serotypes O6:K5, O4:K3 and possibly O6:K2. Although the children became fecally colonized with the strains in the neonatal ward, most fell ill some time after they had left the ward. The mean age at the development of their first pyelonephritis was 3.4 months for the boys and 6.2 months for the girls, who had been cared for in this ward. A correlation between the number of infections and the bed occupancy of the ward could be found (p less than 0.01). The risk for a child staying in the ward during an outbreak to develop pyelonephritis was about 5-10%. There was a baseline incidence rate of 0.6-0.7% during non-epidemic periods. During one of the outbreaks there was also an increased incidence rate of E. coli septicemia among the children staying in the neonatal ward. The predictive value of fecal colonization with P-fimbriated E. coli for the later development of extraintestinal E. coli infections was studied in a 2.5 year prospective study. During this study period there was a baseline incidence rate of 10-20% fecal colonization with P-fimbriated E. coli among the children staying in both the neonatal and maternity wards, interrupted only by minor peaks of colonization with such strains. Length of stay in the neonatal ward and a high bed occupancy of the neonatal ward were statistically correlated to fecal colonization with P-fimbriated E. coli strains (p

Efficacy and safety of ceftazidime-avibactam versus imipenem-cilastatin in the treatment of complicated urinary tract infections, including acute pyelonephritis, in hospitalized adults: results of a prospective, investigator-blinded, randomized study.

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Vazquez, José A; González Patzán, Luis Demetrio; Stricklin, David; Duttaroy, Dipesh D; Kreidly, Zouheir; Lipka, Joy; Sable, Carole

2012-12-01

The aim of this prospective phase II, randomized, investigator-blinded study (NCT00690378) was to compare the efficacy and safety of ceftazidime-avibactam and imipenem-cilastatin in hospitalized adults with serious complicated urinary tract infection (cUTI) due to Gram-negative pathogens. Patients aged between 18 and 90 years with cUTI were enrolled and stratified by infection type (acute pyelonephritis or other cUTI) and randomized 1:1 to receive intravenous ceftazidime 500 mg plus avibactam 125 mg every 8 hours or imipenem-cilastatin 500 mg every 6 hours. Patients meeting pre-specified improvement criteria after 4 days could be switched to oral ciprofloxacin. Patients were treated for a total of 7-14 days. The primary efficacy objective was a favorable microbiological response at the test-of-cure (TOC) visit 5-9 days post-therapy in microbiologically evaluable (ME) patients. Overall, 135 patients received study therapy (safety population); 62 were included in the ME population (ceftazidime-avibactam, n = 27; imipenem-cilastatin, n = 35). The predominant uropathogen was Escherichia coli. Favorable microbiological response was achieved in 70.4% of ME patients receiving ceftazidime-avibactam and 71.4% receiving imipenem-cilastatin at the TOC visit (observed difference -1.1% [95% CI: -27.2%, 25.0%]). Among ME patients with ceftazidime-resistant uropathogens, response was observed in 6/7 (85.7%) receiving ceftazidime-avibactam. Adverse events were observed in 67.6% and 76.1% of patients receiving ceftazidime-avibactam and imipenem-cilastatin, respectively. Limitations of the study include the small number of patients in the ME population. The results suggest that the efficacy and safety of ceftazidime-avibactam may be similar to that of imipenem-cilastatin.

[Urinary tract infections in pregnancy: when to treat, how to treat, and what to treat with].

Science.gov (United States)

Kladenský, J

2012-04-01

Urinary tract infections (UTI) in pregnant women are a relatively frequent occurrence and the spectrum of these infections ranges from lower urinary tract disease (asymptomatic bacteriuria, acute cystitis) to upper urinary tract disease (acute pyelonephritis). Anatomical and functional changes in the urinary tract in pregnancy result in significantly higher susceptibility to progression of the infection from asymptomatic bacteriuria to the stage of acute pyelonephritis. Untreated asymptomatic bacteriuria in pregnancy leads, in as much as 40%, to the development of acute pyelonephritis with all the subsequent negative effects not only for the woman herself, but particularly for the fetus. Bacteriuria in pregnancy accounts for a significantly higher number of newborns with a low birth weight, low gestational age and higher neonatal mortality rate. Therefore, it is necessary to perform screening for bacteriuria in pregnant women and, when the finding is positive, to treat this bacteriuria. The selection of an appropriate antimicrobial agent to treat urinary tract infection in pregnancy is limited by the safety of a given drug not only for the woman, but particularly for the fetus. The article provides an overview of medications that can be safely used throughout the pregnancy or only in certain stages of pregnancy. The selection of an appropriate antibiotic should always be preceded by the result of urine culture. The article presents the principles and rules for treating asymptomatic bacteriuria, acute cystitis and acute pyelonephritis in pregnant women.

Prognostic value of the acute DMSA scan in hospitalized children with urinary tract infection

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Hashemian H

2008-12-01

Full Text Available "nBackground: Urinary Tract Infection (UTI is one of the major etiological factors of permanent kidney impairment, resulting in renal scarring and severe and pernicious side effects, such as arterial hypertension and renal failure. The purpose of this study was to clarify the impression of renal parenchyma involvement by first UTI (on the basis of acute DMSA scan and vesicoureteral reflux (VUR-on the basis of VCUG/ RNC on the renal scar formation (on the basis of late DMSA scan. "nMethods: Children diagnosed with their first UTI at the Children's Hospital Medical Center, Tehran, Iran, were evaluated. For each patient, we recorded age, sex, results of VCUG/RNCs and acute DMSA scan, as well as those of a late DMSA scan performed 4-6 months later. The results of acute and late DMSA scans were compared along with the results of VCUG/RNCs. "nResults: This study included a total of 103 children, of whom 16 (15.5% were boys and 87 (84.5% were girls. The mean age was 27.2±27.7 months. The frequency of renal scars in kidneys with mild (28.6%, 8.7% and moderate (33.3%, 18.2% pyelonephritis with or without VUR was not significantly different, while the frequency of renal scars in kidneys with severe pyelonephritis (84.6%, 23.1% in the presence of VUR was significantly higher than non-refluxing kidneys with severe pyelonephritis (p=0.005. Furthermore, the frequency of renal scars in refluxing kidneys increased significantly with the severity of pyelonephritis (normal 8.3%, mild 28.6%, moderate 33.3%, and severe 84.6%; p=0.001. This pattern was not significant in non-refluxing kidneys (0%, 10.3%, 18.2%, and 23.1%, respectively; p=0.062. "nConclusion: The present study indicates that the incidence of renal scarring increases with pyelonephritis severity in patients with VUR. Furthermore, we can estimate the risk of renal scar formation from the results of acute DMSA scan and VCUG/RNC.

Clinical and diagnostic significance of urinary neutrophil gelatinase-associated lipocalin-2 measurement in children with microbial inflammatory kidney and urinary tract diseases

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A. V. Eremeeva

2015-01-01

Full Text Available Objective: to study the clinical and diagnostic significance of urinary neutrophil gelatinase-associated lipocalin-2 (NGAL measurement in children with urinary tract infection (я=15 and pyelonephritis (я=15. The patients' age was 1 to 16 years (mean age, 7.32+4.52 years. The diagnosis was verified on the basis of clinical and laboratory findings and medical history and instrumental examination data. Urinary NGAL levels were measured by enzyme immunoassay (a Bio\\fendor Laboratory Medicine kit and calculated with reference to mg of creatinine. Urinary NGAL levels were established to depend on the degree of renal parenchymal damage. The investigation showed a relationship between the excretion of NGAL during the acute phase of pyelonephritis and the detection of renal scarring, as evidenced by statistical DMCA nephroscintigraphy. The acute pyelonephritis group exhibited a moderate direct correlation between the renal excretion of NGAL and the degree of leukocytosis and the blood levels of C-reactive protein. The findings allow recommendations for measuring urinary NGAL levels as an additional noninvasive marker for the early detection of renal parenchymal damage.

Urinary tract infection in childhood: lower or upper level? DMSA scintigraphic validation of a new clinical risk index

International Nuclear Information System (INIS)

Bayet-Papin, B.; Decomps-Hofmann, A.; Bovier-Lapierre, M.

2001-01-01

Urinary tract infection in children can be limited most of time at the lower level of the urinary tractus but an extension to the upper level of the tractus should not be neglected due to the asymptomatic nature of the disease. In our study, we suggest a new graph to predict the probability of acute pyelonephritis only if the bacteriological urinary analyse were obtained in good conditions and without any treatment. In the other cases, a DMSA scintigram should be proposed at the earlier phase of the diagnosis not to underestimate the risk of asymptomatic pyelonephritis. (authors)

Urinary tract infection in childhood: lower or upper level? DMSA scintigraphic validation of a new clinical risk index; Infection urinaire de l'enfant: est-elle haute ou basse? proposition d'un score diagnostique valide par la scintigraphie renale au DMSA

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Bayet-Papin, B.; Decomps-Hofmann, A.; Bovier-Lapierre, M. [Centre Hospitalier, Service de Medecine Nucleaire, 73 - Chambery (France)

2001-04-01

Urinary tract infection in children can be limited most of time at the lower level of the urinary tractus but an extension to the upper level of the tractus should not be neglected due to the asymptomatic nature of the disease. In our study, we suggest a new graph to predict the probability of acute pyelonephritis only if the bacteriological urinary analyse were obtained in good conditions and without any treatment. In the other cases, a DMSA scintigram should be proposed at the earlier phase of the diagnosis not to underestimate the risk of asymptomatic pyelonephritis. (authors)

Xanthogranulomatous pyelonephritis: Six case reports

OpenAIRE

Tentoni, Ubaldo; Siri, Natalia; García, Ana Valeria; Pierucci, María Alejandra; Flaherty, Nicolás R; Testa, Mariano Piñeiro

2011-01-01

Introducción. La pielonefritis xantogranulomatosa (PX) es una forma de infección crónica del parénquima renal. Objetivos. Describir las características imagenológicas de la PX. Materiales y Métodos. Se realizó un análisis retrospectivo de una serie de 6 casos de PX confirmados. Resultados. Se describieron los hallazgos imagenológicos de los casos mencionados. Discusión. Las manifestaciones clínicas sugieren la afección renal y las imágenes orientan hacia su probable diagnóstico. El proceso se...

An update on new antibiotic prophylaxis and treatment for urinary tract infections in children.

Science.gov (United States)

Delbet, Jean Daniel; Lorrot, Mathie; Ulinski, Tim

2017-10-01

This review focuses on the treatment of urinary tract infections (UTI) in children and in particular its recent changes. Areas covered: Acute pyelonephritis, acute cystitis and asymptomatic bacteriuria or asymptomatic infections have to be clearly distinguished. Prompt treatment is required in pyelonephritis and cystitis, but not in asymptomatic bacteriuria or infection, in order to avoid selection of more virulent strains. This concept should be considered even in immunocompromised or bedridden children. In case of pyelonephritis, there should be no delay in beginning the antibiotic treatment in order to decrease the risk of long term complication, such as renal scars. Predisposing conditions for UTI, such as voiding anomalies and urinary tract malformation should be carefully evaluated. Expert opinion: One major concern is the increasing resistance to 3 rd generation cephalosporins. Therefore overconsumption in low-risk settings should be absolutely avoided. The prevalence of infections with E. coli producing extended spectrum ß-lactamase (ESBL) is increasing and pediatricians should be aware about the specific treatment options. Any recommendation about (initial) antibiotic treatment should be regularly updated and adapted to local resistance profiles and to economic factors in different health systems.

The prevalence of virulence genes of E. coli strains isolated from children with urinary tract infection

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Farshad Shohreh

2009-01-01

Full Text Available To evaluate the prevalence of virulence genes in E. coli strains isolated from urine samples of children with urinary tract infection(UTI and their correlation with clinical data, we iso-lated E. coli strains from urine samples of children with UTI during the period of August 2005 - August 2006 and studied them for the presence of the virulence genes by PCR. A total of 96 E. coli strains were isolated. The prevalence of genes, pyelonephritis associated pili (pap genes, S-family adhesions (sfa gene, hemolysin (hly gene, and cytotoxic nercotizing factor type 1 (cnf-1-1 gene among the isolated strains was 27.1%, 14.6%, 13.5% and 22.9 %, respectively. Pyelonephritis was more prevalent in the cases with positive virulence genes. The results showed significant correlation bet-ween age of the patient and the presence of the genes (P< 0.05. Cnf-1 gene was significantly more common in samples of patients with abnormal finding on the ultrasound of kidneys (P= 0.049. Our study demonstrated higher prevalence of pyelonephritis in the presence of E. coli virulence genes. Detection of the genes in urine samples may help in the management of UTI.

Role of procalcitonin in predicting dilating vesicoureteral reflux in young children hospitalized with a first febrile urinary tract infection.

Science.gov (United States)

Sun, Hai-Lun; Wu, Kang-Hsi; Chen, Shan-Ming; Chao, Yu-Hua; Ku, Min-Sho; Hung, Tong-Wei; Liao, Pen-Fen; Lue, Ko-Huang; Sheu, Ji-Nan

2013-09-01

The aim of this article was to assess the usefulness of procalcitonin (PCT) as a marker for predicting dilating (grades III-V) vesicoureteral reflux (VUR) in young children with a first febrile urinary tract infection. Children ≤2 years of age with a first febrile urinary tract infection were prospectively evaluated. Serum samples were tested for PCT at the time of admission to a tertiary hospital. All children underwent renal ultrasonography (US), Tc-dimercaptosuccinic acid renal scan, and voiding cystourethrography. The diagnostic characteristics of PCT test for acute pyelonephritis and dilating VUR were calculated. Of 272 children analyzed (168 boys and 104 girls; median age, 5 months), 169 (62.1%) had acute pyelonephritis. There was VUR demonstrated in 97 (35.7%), including 70 (25.7%) with dilating VUR. The median PCT value was significantly higher in children with VUR than in those without (P predictors of dilating VUR. PCT is useful for diagnosing acute pyelonephritis and predicting dilating VUR in young children with a first febrile urinary tract infection. A voiding cystourethrography is indicated only in children with high PCT values (≥1.0 ng/mL) and/or abnormalities found on a US.

The prevalence of virulence genes of E. coli strains isolated from children with urinary tract infection

International Nuclear Information System (INIS)

Farshad, Shohreh; Emamghorashi, Fatemeh

2009-01-01

To evaluate the prevalence of virulence genes in E. coli strains isolated from urine samples of children with urinary tract infection(UTI) and their correlation with clinical data, we isolated E. coli strains from urine samples of children with UTI during the period of August 2005 - August 2006 and studied them for the presence of the virulence genes by PCR. A total of 96 E. coli strains were isolated. The prevalence of genes, pyelonephritis associated pili (pap genes), S-family adhesions (sfa gene), hemolysin (hly gene), and cytotoxic nercotizing factor type 1 (cnf-1-1 gene) among the isolated strains was 27.1%, 14.6%, 13.5% and 22.9 %, respectively. Pyelonephritis was more prevalent in the cases with positive virulence genes. The results showed significant correlation between age of the patient and the presence of the genes (P< 0.05). Cnf-1 gene was significantly more common in samples of patients with abnormal finding on the ultrasound of kidneys (P0.049). Our study demonstrated higher prevalence of pyelonephritis in the presence of E. coli virulence genes. Detection of the genes in urine samples may help in the management of UTI. (author)

Urinary Tract Infection and Bacteriuria in Pregnancy.

Science.gov (United States)

Glaser, Alexander P; Schaeffer, Anthony J

2015-11-01

Bacteriuria during pregnancy may be classified as asymptomatic bacteriuria, infections of the lower urinary tract (cystitis), or infections of the upper urinary tract (pyelonephritis). Lower tract bacteriuria is associated with an increased risk of developing pyelonephritis in pregnancy, which is itself associated with adverse maternal and fetal outcomes. Pregnant women should be screened for the presence of bacteriuria early in pregnancy. All bacteriuria in pregnancy should be treated, and antimicrobial choice in pregnancy should reflect safety for both the mother and the fetus. After treatment of bacteriuria, patients should be followed closely due to risk of recurrent bacteriuria. Copyright © 2015 Elsevier Inc. All rights reserved.

URINARY TRACT INFECTIONS IN PREGNANCY

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N Sivalingam

2007-01-01

Full Text Available Urinary tract infections frequently affect pregnant mothers. This problem causes significant morbidity and healthcare expenditure. Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis. Escherichia coli remains the most frequent organism isolated in UTIs. All pregnant mothers should be screened for UTIs in pregnancy and antibiotics should be commenced without delay. Urine culture and sensitivity is the gold standard in diagnosing UTIs. Without treatment, asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth retardation, low birth weight, maternal hypertension, pre-eclampsia and anaemia. Acute pyelonephritis can lead to maternal sepsis. Recurrent UTIs in pregnancy require prophylactic antibiotic treatment.

Urinary tract infection in the setting of vesicoureteral reflux [version 1; referees: 2 approved

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Michael L. Garcia-Roig

2016-06-01

Full Text Available Vesicoureteral reflux (VUR is the most common underlying etiology responsible for febrile urinary tract infections (UTIs or pyelonephritis in children. Along with the morbidity of pyelonephritis, long-term sequelae of recurrent renal infections include renal scarring, proteinuria, and hypertension. Treatment is directed toward the prevention of recurrent infection through use of continuous antibiotic prophylaxis during a period of observation for spontaneous resolution or by surgical correction. In children, bowel and bladder dysfunction (BBD plays a significant role in the occurrence of UTI and the rate of VUR resolution. Effective treatment of BBD leads to higher rates of spontaneous resolution and decreased risk of UTI.

Urinary tract infection - adults

Science.gov (United States)

Bladder infection - adults; UTI - adults; Cystitis - bacterial - adults; Pyelonephritis - adults; Kidney infection - adults ... control. Menopause also increases the risk of a UTI. The following also increase your chances of developing ...

Urinary tract infection during pregnancy: current concepts on a common multifaceted problem.

Science.gov (United States)

Kalinderi, Kallirhoe; Delkos, Dimitrios; Kalinderis, Michail; Athanasiadis, Apostolos; Kalogiannidis, Ioannis

2018-02-06

Urinary tract infections (UTIs) are the most common bacterial infection in pregnancy, increasing the risk of maternal and neonatal morbidity and mortality. Urinary tract infections may present as asymptomatic bacteriuria, acute cystitis or pyelonephritis. Escherichia coli is the most common pathogen associated with both symptomatic and asymptomatic bacteriuria. If asymptomatic bacteriuria is untreated, up to 30% of mothers develop acute pyelonephritis, with an increased risk of multiple maternal and neonatal complications, such as preeclampsia, preterm birth, intrauterine growth restriction and low birth weight. Urinary tract infection is a common, but preventable cause of pregnancy complications, thus urinary tests, such as urine culture or new technologies such as high-throughput DNA sequence-based analyses, should be used in order to improve antenatal screening of pregnant women.

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections

Science.gov (United States)

Ha, U-Syn; Lee, Seung-Ju; Yeo, Jeong Kyun; Min, Seung Ki; Lee, Heeyoung

2018-01-01

Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guidelines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs. The current guideline was developed by the update and adaptation method. This clinical practice guideline provides recommendations for the diagnosis and management of UTIs, including asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, complicated pyelonephritis related to urinary tract obstruction, and acute bacterial prostatitis. This guideline targets community-acquired UTIs occurring among adult patients. Healthcare-associated UTIs, catheter-associated UTIs, and infections in immunocompromised patients were not included in this guideline. PMID:29637759

PICTORIAL INTERLUDE Xanthogranulomatous pyelonephritis in a ...

African Journals Online (AJOL)

infection and calculus formation, and have an increased risk of renal malignancy development, especially Wilms' tumour. CT findings. The combination of a nonfunctioning enlarged kidney, a central calculus within a contracted renal pelvis, expansion of the calyces, and inflammatory changes in the perinephric fat is strongly.

Low back pain - look for the “Red Flag Signs ”

African Journals Online (AJOL)

Ann Burgess

Urinary tract: pyelonephritis, renal calculus, perinephric abscess, prostatitis ... Gastrointestinal: peptic ulcer, cholecystitis, bowel cancer, pancreatitis ... known primary carcinoma (e.g. breast, lung or prostate) gives a useful pointer to a probable ...

1047-IJBCS-Article-Anthony Igwegbe

African Journals Online (AJOL)

KODJIO NORBERT

eclampsia, pyelonephritis, preterm labour, low birth weight and prematurity. Determining ... This cross sectional, case controlled study examined 440 women comprising equal numbers of pregnant and ..... As our antenatal women pay for their.

The Immediate Results of Surgical Treatment of Bladder Cancer

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Alexei L. Charyshkin

2016-06-01

Full Text Available The objective of this study was to evaluate the immediate results of the use of ureterointestinal anastomosis according to the Bricker technique at radical cystectomy (RC for bladder cancer (BC. Materials and Results: The study included 96 patients (11.5% women and 88.5% men with bladder cancer (BC, aged from 31 to 74 years (mean age 63.8±7.2, who underwent RC in the Lipetsk Regional Oncology Center, in the period from 2005 to 2014. Among the early postoperative complications, we identified dynamic ileus (16.7%, inflammatory complications of the surgical wound (12.5%, acute pyelonephritis (10.4%, and failure of ureterointestinal anastomosis (4.2%. The frequency of postoperative acute pyelonephritis corresponded to the findings of other authors. Two (2.1% patients died from early postoperative complications because of concomitant diseases (ischemic heart disease, myocardial infarction; thus, postoperative mortality in the early postoperative period was 4.2%. Chronic pyelonephritis with chronic renal failure detected in 15(15.6% patients after one year after surgery was the most frequent late postoperative complication. The stricture of ureterointestinal anastomosis in 9(9.4% patients has been eliminated through relaparotomy and resection of anastomosis. The development of urolithiasis in 12(12.5% patients after one year after surgery has required the implementation of contact lithotripsy and litholytic therapy.

Peritransplant Soluble CD30 as a Risk Factor for Slow Kidney Allograft Function, Early Acute Rejection, Worse Long-Term Allograft Function, and Patients' Survival.

Science.gov (United States)

Trailin, Andriy V; Ostapenko, Tetyana I; Nykonenko, Tamara N; Nesterenko, Svitlana N; Nykonenko, Olexandr S

2017-01-01

We aimed to determine whether serum soluble CD30 (sCD30) could identify recipients at high risk for unfavorable early and late kidney transplant outcomes. Serum sCD30 was measured on the day of kidney transplantation and on the 4th day posttransplant. We assessed the value of these measurements in predicting delayed graft function, slow graft function (SGF), acute rejection (AR), pyelonephritis, decline of allograft function after 6 months, and graft and patient survival during 5 years of follow-up in 45 recipients. We found the association between low pretransplant serum levels of sCD30 and SGF. The absence of significant decrease of sCD30 on the 4th day posttransplant was characteristic for SGF, early AR (the 8th day-6 months), late AR (>6 months), and early pyelonephritis (the 8th day-2 months). Lower pretransplant and posttransplant sCD30 predicted worse allograft function at 6 months and 2 years, respectively. Higher pretransplant sCD30 was associated with higher frequency of early AR, and worse patients' survival, but only in the recipients of deceased-donor graft. Pretransplant sCD30 also allowed to differentiate patients with early pyelonephritis and early AR. Peritransplant sCD30 is useful in identifying patients at risk for unfavorable early and late transplant outcomes.

Peritransplant Soluble CD30 as a Risk Factor for Slow Kidney Allograft Function, Early Acute Rejection, Worse Long-Term Allograft Function, and Patients' Survival

Science.gov (United States)

Ostapenko, Tetyana I.; Nykonenko, Tamara N.; Nesterenko, Svitlana N.; Nykonenko, Olexandr S.

2017-01-01

Background We aimed to determine whether serum soluble CD30 (sCD30) could identify recipients at high risk for unfavorable early and late kidney transplant outcomes. Methods Serum sCD30 was measured on the day of kidney transplantation and on the 4th day posttransplant. We assessed the value of these measurements in predicting delayed graft function, slow graft function (SGF), acute rejection (AR), pyelonephritis, decline of allograft function after 6 months, and graft and patient survival during 5 years of follow-up in 45 recipients. Results We found the association between low pretransplant serum levels of sCD30 and SGF. The absence of significant decrease of sCD30 on the 4th day posttransplant was characteristic for SGF, early AR (the 8th day–6 months), late AR (>6 months), and early pyelonephritis (the 8th day–2 months). Lower pretransplant and posttransplant sCD30 predicted worse allograft function at 6 months and 2 years, respectively. Higher pretransplant sCD30 was associated with higher frequency of early AR, and worse patients' survival, but only in the recipients of deceased-donor graft. Pretransplant sCD30 also allowed to differentiate patients with early pyelonephritis and early AR. Conclusions Peritransplant sCD30 is useful in identifying patients at risk for unfavorable early and late transplant outcomes. PMID:28694560

The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria.

Science.gov (United States)

Nicolle, Lindsay E

2016-04-19

Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic bacteriuria, supported a conclusion that asymptomatic bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients.

The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria

Directory of Open Access Journals (Sweden)

Lindsay E. Nicolle

2016-04-01

Full Text Available Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic bacteriuria, supported a conclusion that asymptomatic bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients.

Urinary tract infections of Escherichia coli strains of chaperone-usher system.

Science.gov (United States)

Zalewska-Piatek, Beata M

2011-01-01

Urinary tract infections are a very serious health and economic problem affecting millions of people each year worldwide. The most common etiologic agent of this type of bacterial infections, involving the upper and lower urinary tract, are E. coli strains representing approximately 80% of cases. Uropathogenic E. coli strains produce several urovirulence factors which can be divided into two main types, surface virulence factors and exported virulence factors. Surface-exposed structures include mainly extracellular adhesive organelles such as fimbriae/pili necessary in adhesion, invasion, biofilm formation and cytokine induction. Among the surface-exposed polymeric adhesive structures there are three most invasive groups, type 1 pili, type P pili and Dr family of adhesins which are bioassembled via the conserved, among Gram-negative bacteria, chaperone-usher secretion system. Type 1 and P-piliated E. coli cause cystitis and pyelonephritis. The Dr family of adhesins recognizing DAF receptor is responsible for cystitis, pyelonephritis (especially in pregnant women) and diarrhoea (in infants). In addition, Dr-positive E. coli strains carry the risk of recurrent urinary tract infections. Pyelonephritis in pregnant women leads to a series of complications such as bacteremia, urosepsis, acute respiratory distress syndrome and even death. In the era of increasing drug resistance of bacteria, the development of vaccines, drugs termed pilicides and inhibitors of adhesion may be a promising tool in the fight against urogenital infections.

Flexible ureteroscopy for lower calyceal stones in a horseshoe kidney

African Journals Online (AJOL)

P. Bansal

2016-07-21

Inourseries,2patients had low-grade postoperative fever. The administration of antibiotics resulted in the fever subsiding within one day. One patient had acute pyelonephritis and needed readmission. At our center, we perform.

TropJrnal Vol 29 No 1 for PDF

African Journals Online (AJOL)

Mr Olusoji

asymptomatic bacteriuria with the vast majority antedating pregnancy ... urinary tract infections in pregnancy in Aminu Kano teaching hospital Kano. Methods: Retrospective ... For acute pyelonephritis treatment is usually. 3,14 for 10-14days.

Download this PDF file

African Journals Online (AJOL)

symptomatic cystitis and up to 50% of women develop pyelonephritis. ... susceptibility pattern of bacteriuria in pregnant women attending the antenatal ... routine urine screening at the first antenatal visit with subsequent treatment will prevent ...

Urinary tract infection - children

Science.gov (United States)

UTI - children; Cystitis - children; Bladder infection - children; Kidney infection - children; Pyelonephritis - children ... Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev . 2011;(3):CD001534. PMID: ...

Antibiotics for asymptomatic bacteriuria in pregnancy.

Science.gov (United States)

Smaill, Fiona M; Vazquez, Juan C

2015-08-07

Asymptomatic bacteriuria occurs in 2% to 10% of pregnancies and, if not treated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and preterm birth. To assess the effect of antibiotic treatment for asymptomatic bacteriuria on the development of pyelonephritis and the risk of low birthweight and preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (19 March 2015) and reference lists of retrieved studies. Randomized trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Fourteen studies, involving almost 2000 women, were included. Antibiotic treatment compared with placebo or no treatment reduced the incidence of pyelonephritis (average risk ratio (RR) 0.23, 95% confidence interval (CI) 0.13 to 0.41; 11 studies, 1932 women; very low quality evidence). Antibiotic treatment was also associated with a reduction in the incidence of low birthweight babies (average RR 0.64, 95% CI 0.45 to 0.93; six studies, 1437 babies; low quality evidence) and preterm birth (RR 0.27, 95% CI 0.11 to 0.62; two studies, 242 women; low quality evidence). A reduction in persistent bacteriuria at the time of delivery was seen (average RR 0.30, 95% CI 0.18 to 0.53; four studies; 596 women). There were very limited data on which to estimate the effect of antibiotics on other infant outcomes and maternal adverse effects were rarely described.Overall, all 14 studies were assessed as being at high or unclear risk of bias. While many studies lacked an adequate description of methods and the risk of bias could only be assessed as unclear, in almost all studies there was at least one domain where the risk of bias was judged as high. The three primary outcomes were assessed with

Prevalence and risk factors of asymptomatic bacteriuria in pregnancy

Directory of Open Access Journals (Sweden)

Ghafarnezhad M

2001-07-01

Full Text Available Asymptomatic bacteriuria is prevalent during pregnancy. It can lead to pyelonephritis, premature pregnancy and low birth weight. In this prospective study, to determine prevalence and risk factors of asymptomatic bacteriuria, 205 consecutive pregnant women who visited our prenatal care clinic in Mirza-Koochakkhan Hospital and had no urinary symptom were entered. Patients data were recorded using a questionnaire and urine samples were obtained for urinalysis and urine culture. We analysed data by using fisher exact and chi-squared test. 14 cases had positive urine culture (6.8%. Significant correlation was seen between asymptomatic bacteriuria and age, parity, past history of kidney stone, pyelonephritis, urinary tract infection, preterm delivery and pyuria pvalue <0.05. We suggest routine urine culture in first visit of high risk and 16th week of low risk pregnancies.

145 Prevalence of Asymptomatic Bacteriuria in Secondary School ...

African Journals Online (AJOL)

User

2011-07-21

Jul 21, 2011 ... Asymptomatic bacteriuria is a form of urinary tract infection (UTI) ... pyelonephritis especially in pregnant women (Kass, 1970). Presence of ... promptly. Various antibiotic therapies are available for adequate treatment but if left ...

A Study of Plazomicin Compared With Colistin in Patients With Infection Due to Carbapenem-Resistant Enterobacteriaceae (CRE)

Science.gov (United States)

2016-10-03

Bloodstream Infections (BSI) Due to CRE; Hospital-Acquired Bacterial Pneumonia (HABP) Due to CRE; Ventilator-Associated Bacterial Pneumonia (VABP) Due to CRE; Complicated Urinary Tract Infection (cUTI) Due to CRE; Acute Pyelonephritis (AP) Due to CRE

Abdominal and Pelvic CT

Medline Plus

Full Text Available ... as: infections such as appendicitis , pyelonephritis or infected fluid collections, also known as abscesses. inflammatory bowel disease ... caused by a burst appendix or an infected fluid collection and the subsequent spread of infection. CT ...

Abdominal and Pelvic CT

Medline Plus

Full Text Available ... to help detect diseases of the small bowel, colon and other internal organs and is often used ... diseases of the internal organs, small bowel and colon, such as: infections such as appendicitis , pyelonephritis or ...

Abdominal and Pelvic CT

Medline Plus

Full Text Available ... infections such as appendicitis , pyelonephritis or infected fluid collections, also known as abscesses. inflammatory bowel disease such ... by a burst appendix or an infected fluid collection and the subsequent spread of infection. CT scanning ...

Abdominal and Pelvic CT

Medline Plus

Full Text Available ... the Abdomen/Pelvis? Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic ... the internal organs, small bowel and colon, such as: infections such as appendicitis , pyelonephritis or infected fluid ...

Procalcitonin and C-reactive protein in urinary tract infection diagnosis.

Science.gov (United States)

Xu, Rui-Ying; Liu, Hua-Wei; Liu, Ji-Ling; Dong, Jun-Hua

2014-05-30

Urinary infections are a common type of pediatric disease, and their treatment and prognosis are closely correlated with infection location. Common clinical manifestations and laboratory tests are insufficient to differentiate between acute pyelonephritis and lower urinary tract infection. This study was conducted to explore a diagnostic method for upper and lower urinary tract infection differentiation. The diagnostic values of procalcitonin (PCT) and C-reactive protein (CRP) were analyzed using the receiver operating characteristic curve method for upper and lower urinary tract infection differentiation. PCT was determined using chemiluminescent immunoassay. The PCT and CRP values in children with acute pyelonephritis were significantly higher than those in children with lower urinary tract infection (3.90 ± 3.51 ng/ml and 68.17 ± 39.42 mg/l vs. 0.48 ± 0.39 ng/ml and 21.39 ± 14.92 mg/l). The PCT values were correlated with the degree of renal involvement, whereas the CRP values failed to show such a significant correlation. PCT had a sensitivity of 90.47% and a specificity of 88% in predicting nephropathia, whereas CRP had sensitivity of 85.71% and a specificity of 48%. Both PCT and CRP can be used for upper and lower urinary tract infection differentiation, but PCT has higher sensitivity and specificity in predicting pyelonephritis than CRP. PCT showed better results than CRP. PCT values were also correlated with the degree of renal involvement.

Nuclear medicine in acute and chronic renal failure

Energy Technology Data Exchange (ETDEWEB)

Sherman, R.A.; Byun, K.J.

1982-07-01

The diagnostic value of renal scintiscans in patients with acute or chronic renal failure has not been emphasized other than for the estimation of renal size. /sup 131/I OIH, /sup 67/gallium, /sup 99m/TcDTPA, glucoheptonate and DMSA all may be valuable in a variety of specific settings. Acute renal failure due to acute tubular necrosis, hepatorenal syndrome, acute interstitial nephritis, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy may be obtained. Radionuclide studies in patients with chronic renal failure may help make apparent such causes as renal artery stenosis, chronic pyelonephritis or lymphomatous kidney infiltration. Future correlation of scanning results with renal pathology promises to further expand nuclear medicine's utility in the noninvasive diagnosis of renal disease.

Nuclear medicine in acute and chronic renal failure

International Nuclear Information System (INIS)

Sherman, R.A.; Byun, K.J.

1982-01-01

The diagnostic value of renal scintiscans in patients with acute or chronic renal failure has not been emphasized other than for the estimation of renal size. 131 I OIH, 67 gallium, /sup 99m/TcDTPA, glucoheptonate and DMSA all may be valuable in a variety of specific settings. Acute renal failure due to acute tubular necrosis, hepatorenal syndrome, acute interstitial nephritis, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy may be obtained. Radionuclide studies in patients with chronic renal failure may help make apparent such causes as renal artery stenosis, chronic pyelonephritis or lymphomatous kidney infiltration. Future correlation of scanning results with renal pathology promises to further expand nuclear medicine's utility in the noninvasive diagnosis of renal disease

Polycystic Kidney Disease In Pregnancy In A Nigerian Woman ...

African Journals Online (AJOL)

Adult Polycystic Kidney disease (ADPKD) is a known but uncommon cause of haematuria in pregnancy in this environment. Other causes include, haemaglobinopathies, calculi, pyelonephritis, schistosomiasis, haemangiomata and neoplasms. Although ADPKD is the commonest single gene disorder of man affecting both ...

Urinary tract infections at aga Khan University hospital nairobi - a ...

African Journals Online (AJOL)

2013-06-11

Jun 11, 2013 ... (Uti) are normally treated empirically and urine culture is usual ordered for as a last ... symptomatic Uti in patients at aga Khan University hospital by looking at the trends of Uti ... in the context of pyelonephritis in pregnancy(9).

Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study

NARCIS (Netherlands)

Kazemier, Brenda M.; Schneeberger, Caroline; de Miranda, Esteriek; van Wassenaer, Aleid; Bossuyt, Patrick M.; Vogelvang, Tatjana E.; Reijnders, Frans J. L.; Delemarre, Friso M. C.; Verhoeven, Corine J. M.; Oudijk, Martijn A.; van der Ven, Jeanine A.; Kuiper, Petra N.; Feiertag, Nicolette; Ott, Alewijn; de Groot, Christianne J. M.; Mol, Ben Willem J.; Geerlings, Suzanne E.

2012-01-01

Background: The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor

Common Pediatric Urological Disorders: Clinical and radiological evaluation

OpenAIRE

Robson, Wm. Lane M.; Leung, Alexander K.C.; Boag, Graham S.

1991-01-01

The clinical and radiological presentations of 12 pediatric urological disorders are described. The described disorders include pyelonephritis, vesicoureteral reflux, ureteropelvic obstruction, ureterovesical obstruction, ectopic ureterocele, posterior urethral valves, multicystic dysplastic kidney, polycystic kidney disease, ectopic kidney, staghorn calculi, urethral diverticulum, and urethral meatal stenosis.

Characterization of homeostasis and erythron and their correlation with both immune and metabolic indices at liquidators of the Chernobyl accident

International Nuclear Information System (INIS)

Flyunt, I.S.

2001-01-01

Patients with urolithiasis and calculus pyelonephritis who are liquidators of the accident at the Chernobyl nuclear power plant have disturbances of homeostasis as disseminated intravascular coagulation and of erythron as hyperchrome macrocytic hypo regenerative anemia that are correlated with certain immune and metabolic changes

A study of asymptomatic bacteriuria in Egyptian school-going children

African Journals Online (AJOL)

A study of asymptomatic bacteriuria in Egyptian school-going children. Ahmed Mohammed, Magid Abdelfattah, Ayman Ibraheem, Ahmad Younes. Abstract. Background: Urinary tract infections (UTI) are a common and important clinical problem in childhood. Upper urinary tract infections (i.e., acute pyelonephritis) may lead ...

Bacterial isolates and drug susceptibility patterns of urinary tract ...

African Journals Online (AJOL)

Urinary tract infection (UTI) during pregnancy may cause complications such as pyelonephritis, hypertensive disease of pregnancy, anaemia, chronic renal failure, premature delivery and foetal mortality. This study aimed to identify the etiologic agents of UTI and to determine the patterns of antimicrobial drug susceptibility ...

Severe sepsis secondary to emphysematous cystitis

African Journals Online (AJOL)

M.M. Gargouri

reserved. Introduction. Emphysematous infections of the urinary system are rare infec- tions characterized by gas producing pathogens in the urinary system. Emphysematous pyelonephritis is well known to ... presence of two small vesical stones and diffuse gas throughout the bladder wall. The diagnosis of EC with bladder ...

Corynebacterium renale as a cause of reactions to the complement fixation test for Johne's disease

NARCIS (Netherlands)

Gilmour, N.J.L.; Goudswaard, J.

Complement fixation (C.F.) tests and fluorescent antibody (F.A.) tests were carried out on sera from rabbits inoculated with Corynebacterium renale and Mycobacterium johnei, and on sera from cattle with C. renale pyelonephritis and with Johne's disease. Cross-reactions were a feature of the C.F.

Emphysematous cystitis and emphysematous pyelitis: a clinically ...

African Journals Online (AJOL)

abp

2013-09-17

Sep 17, 2013 ... We present a rare case of emphysematous cystitis associated with an emphysematous pyelonephritis ... A 60-year-old man was admitted to the emergency department with confusion and hypogastric mass. ... The Pan African Medical Journal - ISSN 1937-8688. ... scenario of peritonitis and septic shock [1].

Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy.

Science.gov (United States)

Schnarr, J; Smaill, F

2008-10-01

Symptomatic and asymptomatic bacteriuria is common in pregnant women. A history of previous urinary tract infections and low socioeconomic status are risk factors for bacteriuria in pregnancy. Escherichia coli is the most common aetiologic agent in both symptomatic and asymptomatic infection and quantitative culture is the gold standard for diagnosis. Treatment of asymptomatic bacteriuria has been shown to reduce the rate of pyelonephritis in pregnancy and therefore screening for and treatment of asymptomatic bacteriuria has become a standard of obstetrical care. Antibiotic treatment of asymptomatic bacteriuria is associated with a decrease in the incidence of low birth weight, but the methodological quality of the studies limits the strength of the conclusions that can be drawn. Debate exists in the literature as to whether treated pyelonephritis is associated with adverse fetal outcomes. There is no clear consensus in the literature on antibiotic choice or duration of therapy for infection. With increasing antibiotic resistance, consideration of local resistance rates is necessary when choosing therapy.

Is single-dose fosfomycin trometamol a good alternative for asymptomatic bacteriuria in the second trimesterof pregnancy?

Science.gov (United States)

Bayrak, Omer; Cimentepe, Ersin; Inegöl, Ilknur; Atmaca, Ali Fuat; Duvan, Candan Iltemir; Koç, Akif; Turhan, Nilgün Oztürk

2007-05-01

Untreated asymptomatic bacteriuria has been associated with acute pyelonephritis, which may have a role in many maternal and fetal complications. Acute pyelonephritis in pregnancy is related to anemia, septicemia, transient renal dysfunction, and pulmonary insufficiency. A randomized study was conducted to assess the clinical and microbiological efficacy of a single dose of fosfomycin trometamol for the treatment of asymptomatic bacteriuria in the second trimester of pregnancy compared with a 5-day regimen of cefuroxime axetyl. Forty-four women received fosfomycin trometamol and 40 women received cefuroxime axetyl. There were no statistically significant differences between both groups regarding the mean age and mean duration of pregnancy. Therapeutic success was achieved in 93.2% of the patients treated with fosfomycin trometamol vs 95% of those treated with cefuroxime axetyl. A single dose of fosfomycin trometamol is a safe and effective alternative in the treatment of asymptomatic urinary tract infections in the second trimester of pregnancy.

Clinical significance of determination of plasma leptin, NPY and serum Hcy levels in patients with chronic renal diseases

International Nuclear Information System (INIS)

Lu Zhifeng

2010-01-01

Objective: To study the relationship between progress of disease and blood levels of leptin, NPY, Hcy in patients with chronic renal diseases. Methods: Plasma leptin, NPY (with RIA) and serum Hcy (with CLIA) were determined in (1) 32 patients with chronic pyelonephritis (2) 28 patients with dibetic nephropathy (3) 30 patients with chronic renal failure and (4) 30 controls. Results: Blood levels of leptin, NPY and Hcy were slightly higher in patients with chronic pyelonephritis than those in controls but without significance (P>0.05). In patients with diabetic nephropathy, the plasma leptin and serum Hcy levels were significantly higher than those in controls (P 0.05). In patients with chronic renal failure,the blood levels of NPY (P<0.05) and leptin, Hcy (P<0.01) were all significantly higher than those in controls. Conclusion: Blood levels of these three parameters especially leptin and Hcy, were increased in patients with chronic renal diseases and the increase was most significant in advanced cases. (authors)

The role of overweight and obesity in urinary tract infection in children.

Science.gov (United States)

Mahyar, Abolfazl; Ayazi, Parviz; Gholmohammadi, Parisa; Moshiri, Seyed Alireza; Oveisi, Sonia; Esmaeily, Shiva

2016-01-01

This study was conducted to determine the relationship between overweight/obesity and UTI in children. A comparison was made, in terms of overweight and obesity, between 135 children with UTI (case group) and 135 healthy children (control group). UTI was diagnosed through urine culture. Dimercaptosuccinic acid renal scanning (DMSA) was also used to distinguish between lower UTI and acute pyelonephritis. Overweight and obesity were determined based on standard body mass index (BMI) curves. There were 12 (8.8%) overweight and 26 (19.2%) obese children in the case group. Four (3.0%) overweight and five (3.7%) obese children were found in the control group. There was a significant difference between the two groups regarding overweight and obesity frequencies. However, no such difference existed between children with cystitis and acute pyelonephritis. This study showed a significant relationship between overweight/obesity and UTI. Therefore, overweight and obesity may play a role in the pathogenesis of UTI in children.

The localization of urinary tract infection with sup(99m)Tc glucoheptonate scintigraphy

International Nuclear Information System (INIS)

Traisman, E.S.; Conway, J.J.; Traisman, H.S.; Yogev, R.; Firlit, C.; Shkolnik, A.; Weiss, S.; Northwestern Univ., Chicago, IL; Children's Memorial Hospital, Chicago, IL

1986-01-01

A retrospective study was performed of 39 children at the Children's Memorial Hospital, Chicago, Illinois, who underwent technetium-99m glucoheptonate (sup(99m)TcGH) scintigraphy for evaluation of possible urinary tract infection. Clinical and laboratory criteria classified the children as having pyelonephritis, cystitis, or no urinary tract infection. Of 28 children classified as having pyelonephritis, 24 (86%) children had abnormalities on sup(99m)TcGH scintigraphy. Only 8 of 19 (42%) renal ultrasound scans and 4 of 17 (24%) intravenous pyelography studies performed in these children demonstrated findings consistent with parenchymal disease. Only 9 of 19 (47%) cystograms demonstrated vesicoureteral reflux. Three children who underwent gallium-67 citrate scintigraphy had localization at the sites of focal defects with sup(99m)TcGH scintigraphy. sup(99m)TcGH scintigraphy is a sensitive and specific indicator of renal parenchymal involvement that helps localize urinary tract infection to the kidney. (orig.)

A case of right ectopic kidney associated with malrotation of left kidney

International Nuclear Information System (INIS)

Kim, Jong Kun

1982-01-01

The terms 'renal ectopia' describes kidneys which are congenitally located in abnormal anatomic positions. I have experienced a female patient with right ectopic kidney located in lower abdomen and pelvis associated with hydronephrosis and chronic pyelonephritis. Her left kidney showed malrotation. This case was reported with review of literatures

A case of right ectopic kidney associated with malrotation of left kidney

Energy Technology Data Exchange (ETDEWEB)

Kim, Jong Kun [Jeon Bug National University College of Medicine, Jeonju (Korea, Republic of)

1982-06-15

The terms 'renal ectopia' describes kidneys which are congenitally located in abnormal anatomic positions. I have experienced a female patient with right ectopic kidney located in lower abdomen and pelvis associated with hydronephrosis and chronic pyelonephritis. Her left kidney showed malrotation. This case was reported with review of literatures.

MATERNAL AND PERINATAL MORBIDITy AND MORTALITy OF ...

African Journals Online (AJOL)

2011-08-08

). Thromboembolic event. 1(1.2). 0. Endometritis. 3(3.5). 0. Cystitis. 1(1.2). 2(2.3). Acute pyelonephritis. 2(2.4). 0. Hysterectomy. 1(1/2). 1(1.2). Re-operation. 3(3.5). 3(3.5). Readmission. 3(3.5). 3(3.5). PPH (atonic uterus). 1(1.2).

Is aggressive therapy the answer for all cases of emphysematous ...

African Journals Online (AJOL)

Is aggressive therapy the answer for all cases of emphysematous pyelonephritis: A report of three cases. S Kumar, S Neogi, KK Gautam. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4103/2006-8808.110268.

Long-term follow-up of reflux nephropathy in adults with vesicoureteral reflux - radiological and pathoanatomical analysis

International Nuclear Information System (INIS)

Koehler, J.; Thysell, H.; Tencer, J.; Forsberg, L.; Hellstroem, M.

2001-01-01

Purpose: To study the long-term development of urographic renal morphology in adults with vesicoureteral reflux, to investigate the relationship between renal damage and reflux grade, and to analyse the association between the long-term urographic outcome and the occurrence of acute pyelonephritis and reflux during follow-up. The purpose was also to try to distinguish between acquired and developmental renal damage, based on analyses of renal histological specimens and urographic features, and to analyse associated congenital urogenital abnormalities and family history of reflux, reflux nephropathy, urological malformation or death from end-stage renal disease. Material and Methods: Renal damage was identified in 100 (83 women) of 115 adults, selected because of documented reflux. Eighty-seven patients had two urographies done (median interval 14.3 years). The extent and progression of renal damage were assessed and features of developmental renal damage were determined. Histological renal specimens were available in 23 patients with renal damage. Results and Conclusions: The extent of renal damage correlated positively with the severity of reflux. No renal damage developed during the follow-up in 45 previously undamaged kidneys and progression of renal damage was rare (4 of 120 previously damaged kidneys), despite persisting reflux in half of the cases and episodes of acute pyelonephritis during follow-up. Thus, repeated renal imaging is rarely justified in adults with reflux nephropathy. Histological examination showed 'chronic pyelonephritis' in all 23 cases and co-existing renal dysplasia in 1 case. The detailed urographic analysis did not reveal support for developmental renal damage. High frequencies of associated congenital urogenital abnormalities and of a positive family history were found. Thus, congenital and/or hereditary factors cannot be discarded as background factors for the development of renal damage

Epidemiology of urinary tract infections in Hiroshima

Energy Technology Data Exchange (ETDEWEB)

Freedman, L R; Phair, J P; Seki, Masafumi; Hamilton, H B; Nefzger, M D

1964-08-19

The present study was conducted at ABCC on a sample of Hiroshima residents systematically seleced for determining the influence on general health status of exposure to the atomic bomb of 1945. A survey for urinary infections was taken on persons in the sample examined in the ABCC clinic over a 1-year period: approximately 3000 women and 2000 men. The purpose of the study was to determine the prevalence of urinary infection and to study the relation between bacteriuria and various aspects of the general examination, particularly blood pressure. In addition, the rates of urinary tract infection in the clinic were compared with the rates of chronic pyelonephritis at autopsy. Results showed that infections were much more common in women than in men and rose with age in both sexes. The greatest increase in the prevalence was found in women age 60 years and over was due to coliform bacteria in all but a few instances. There was no difference in hematuria, glycosuria, diabetes, serum cholesterol, blood groups, electrocardiograms, audiometry, vibrometry, hemoglobin levels or height-weight ratios. Blood pressure is higher in infected women as compared with noninfected women and the finding of higher rates for cardiac enlargement suggests that this small difference in blood pressures may have biological significance. However, the data do not permit a conclusion as to whether the urinary infections were responsible for the higher blood pressure levels, or whether the higher blood pressure levels increased the frequency of detectable infection. The difference between the clinical rates of urinary infection in men and women, and the pathological diagnosis of pyelonephritis in the same population, supports a previous suggestion that much of what is called pyelonephritis at autopsy is not due to urinary tract infection. 27 references, 2 figures, 10 tables.

Role of scintigraphy in urinary tract infection

International Nuclear Information System (INIS)

Conway, J.J.

1988-01-01

There is controversy regarding the role of radiological imaging for urinary tract infection (UTI). The gold standard has been the intravenous pyelogram (IVP). Yet, the IVP has a very limited value with only about 25% of children with pyelonephritis demonstrating abnormalities. Ultrasound (US) has recently been advocated as a replacement for the poorly sensitive and poorly specific IVP. However, comparative studies between US and IVP indicate only an equivalent sensitivity and specificity. Cortical scintigraphy with Technetium-99m glucoheptonate (99mTc GH) or 99mTc dimercaptosuccinic acid (99mTc DMSA) has also been advocated as a means of differentiating parenchymal (pyelonephritis) from nonparenchymal (lower UTI) involvement in UTI. The clinical presentation may be misleading especially in the infant and child in whom an elevated temperature, flank pain, shaking chills, or an elevated sedimentation rate are often lacking. The clinician attempts to localize the site of infection for it has a direct bearing upon the therapy. A collecting system infection can often be eradicated with a single oral dose of an appropriate antibiotic, whereas renal parenchymal involvement requires IV therapy for an extended interval. Cortical scintigraphy can localize the site of infection with a high degree of accuracy. Recent studies report a sensitivity of 86% and specificity of 81% of pyelonephritis. This is in contrast to the IVP with a sensitivity of only 24% and US with a sensitivity of only 42%. The scintigraphic appearance of parenchymal infection of the kidney is a spectrum of minimal to gross defects reflecting the degree of histologic involvement that spans from a mild infection to frank abscess. Cortical scintigraphy can be used to monitor the evolution of scarring following infection. Cortical scintigraphy with 99mTc DMSA or 99mTc GH is the method of choice for the initial evaluation of UTI. 37 references

The clinical application of 99Tcm-DMSA renal cortical scintigraphy in children with urinary tract infection

International Nuclear Information System (INIS)

Zhao Ruifang; Zeng Jihua; Xu Hong; Ji Zhiying; Yuan Hong

2002-01-01

Objective: To study the value of 99 Tc m -dimercaptosuccinic acid (DMSA) renal cortical scintigraphy in distinguishing between upper urinary tract infection (UUTI) and lower UTI (LUTI), determining renal scarring, and following-up curative effect for UTI in children. Methods: The authors reviewed 252 results of 99 Tc m -DMSA renal cortical scintigraphy in children with UTIs during a period of the past five years. The age of the patients was from 1 month to 14 years. The ratio of males: females was 94:158. A standard 99 Tc m -DMSA renal cortical scintigraphic protocol was used. The studies were scored as normal (indicating LUTI) and abnormal (indicating acute pyelonephritis or renal scarring). And differential function of renal was calculated. Results: Of 252 children with UTI, 110 cases had normal images diagnosed as with LUTI. 142 cases had abnormal images, 116 cases were diagnosed as with acute pyelonephritis, 26 cases were diagnosed as with renal cortical scars. The differential function range of LUTI was 46%-54%. Of UUTIs, the differential function of single renal involved was less than 45%. Of 142 UUTIs, 17 cases repeatedly underwent renal cortical scan after therapy. 12 of 13 cases with acute pyelonephritis completely recovered normal or obviously ameliorated after 6 months, 1 cases did not show any change after 4 months. Four cases were found with renal scarring, and showed little change on repeated images for the following 6 months. conclusions: 99 Tc m -DMSA renal cortical scintigraphy is of valuable significance in distinguishing between upper and lower UTI, and in estimating renal scarring. The sequelae of renal infection can be monitored by renal cortical scan. A follow-up of 6 months may be recommended after therapy

[COMPLICATED URINARY TRACT INFECTIONS IN THE ELDERLY].

Science.gov (United States)

Ćosić, I; Ćosić, V

2016-12-01

Urinary tract infections (UTI) are the most common bacterial infections involving lower (cystitis, prostatitis) or upper (pyelonephritis, renal abscess, perinephric abscess) urinary tract. Differentiation of complicated and uncomplicated UTI is usually based on the presence of structural or functional urinary tract abnormalities, which can increase the risk of treatment failure and development of serious complications. Factors that increase the risk are foreign bodies, stones, obstruction, neurogenic bladder, kidney transplantation, immunosuppression, and pregnancy. Complicated UTI includes a spectrum of conditions that increase the risk of treatment failure, as well as of serious complications such as bacteremia and sepsis, perinephric abscess, renal impairment and emphysematous pyelonephritis. To avoid the potentially devastating outcomes, appropriate diagnostic procedures, antibiotic and surgical treatment, and appropriate follow-up are required. The incidence of complicated UTI will grow in the future due to general aging of the population, increasing incidence of diabetes, and ever growing number of immunocompromised and immunosuppressed patients. It is of key importance to recognize complicated UTI on time, and treat it wisely and aggressively to reduce duration of the disease and the risk of antibiotic resistance.

Renal scar formation after urinary tract infection in children

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Young Seo Park

2012-10-01

Full Text Available Urinary tract infection (UTI is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Until now, vesicoureteral reflux (VUR has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However, reflux nephropathy is not always acquired; rather, it reflects refluxassociated congenital dysplastic kidneys. The viewpoint that chronic kidney disease results from renal maldevelopment-associated VUR has led to questioning the utility of any regimen directed at identifying or treating VUR. Despite the recognition that underlying renal anomalies may be the cause of renal scarring that was previously attributed to infection, the prevention of renal scarring remains the goal of all therapies for childhood UTI. Therefore, children at high risk of renal scar formation after UTI should be treated and investigated until a large clinical study and basic research give us more information.

A HISTOPATHOLOGICAL STUDY OF NON-NEOPLASTIC AND NEOPLASTIC LESIONS OF KIDNEY FOR A PERIOD OF TWO YEARS

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Jagadeeswari Suvvari

2018-01-01

Full Text Available BACKGROUND Nephrectomy is a common procedure in surgical practice. There are many indications for nephrectomy, non-neoplastic and neoplastic conditions. The common conditions being chronic pyelonephritis and renal tumours. A detailed and meticulous histopathological examination is essential to establish the diagnosis of lesions of kidney. MATERIALS AND METHODS It is a retrospective study for a period of two years from January 2015 to December 2016 at a tertiary care centre. 34 cases of nephrectomy specimens were analysed and data recorded. RESULTS Non-neoplastic lesions were constituting 47.05% (16 of cases and 52.94% (18 cases were neoplastic lesions. Lesions were more common in females with male:female ratio of 1:1.4. Both the lesions were common in age group of 41-50 years. CONCLUSION The prevalence of neoplastic lesions was more common than non-neoplastic lesions. The commonest indication for nephrectomy was chronic pyelonephritis followed by renal tumours. Histopathological examination in correlation with clinical and radiological features plays a great role in subcategorisation of lesions accurately to ensure better therapy.

Value of imaging studies after a first febrile urinary tract infection in young children: data from Italian renal infection study 1.

Science.gov (United States)

Montini, Giovanni; Zucchetta, Pietro; Tomasi, Lisanna; Talenti, Enrico; Rigamonti, Waifro; Picco, Giorgio; Ballan, Alberto; Zucchini, Andrea; Serra, Laura; Canella, Vanna; Gheno, Marta; Venturoli, Andrea; Ranieri, Marco; Caddia, Valeria; Carasi, Carla; Dall'amico, Roberto; Hewitt, Ian

2009-02-01

We examined the diagnostic accuracy of routine imaging studies (ultrasonography and micturating cystography) for predicting long-term parenchymal renal damage after a first febrile urinary tract infection. This study addressed the secondary objective of a prospective trial evaluating different antibiotic regimens for the treatment of acute pyelonephritis. Data for 300 children urinary tracts were mostly normal. The acute technetium-99m-dimercaptosuccinic acid scans showed pyelonephritis in 54% of cases. Renal scarring developed in 15% of cases. The ultrasonographic and cystographic findings were poor predictors of long-term damage, showing minor sonographic abnormalities for 12 and reflux for 23 of the 45 children who subsequently developed scarring. The benefit of performing ultrasonography and scintigraphy in the acute phase or cystourethrography is minimal. Our findings support (1) technetium-99m-dimercaptosuccinic acid scintigraphy 6 months after infection to detect scarring that may be related to long-term hypertension, proteinuria, and renal function impairment (although the degree of scarring was generally minor and did not impair renal function) and (2) continued surveillance to identify recurrent urinary tract infections that may warrant further investigation.

Seminal vesicle abscess causing unilateral hydroureteronephrosis: A case report

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Vittorio Imperatore

2017-12-01

Full Text Available Seminal vesicle abscess (SVA is a rare urologic entity. It mainly occurs in subjects with predisposing factors and may be associated with other urogenital infections. We describe the case of a diabetic subject with SVA associated with funiculitis, epididymitis and obstructive pyelonephritis. Treatment consisted of laparotomic surgical drainage of the abscess and ureteral stent placement.

Journal of Special Operations Medicine. Volume 7, Edition 1, Winter 2007. Training Supplement: USSOCOM Medic Certification Program

Science.gov (United States)

2007-01-01

Complicated intra-abdominal infections Complicated skin infections Pneumonia Complicated UTI , including pyelonephritis Acute pelvic infections Drug of...nitroimidazole derivatives. Pregnancy (first trimester in patients with Trichomoniasis). Administer with caution to patients with CNS diseases. Use with caution...under 12 years Dehydration Use with caution in pregnancy . Dosage: Patient in shock, bleeding not controlled: hold fluid and control bleeding. Patient

Bilateral transrenal ureteral occlusion by means of n-butyl cyanoacrylate and AMPLATZER vascular plug

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Rosario F Grasso

2014-01-01

Full Text Available AMPLATZER vascular plug is a widely used embolic agent. In the present paper, we present a case of an 86-year-old female patient who underwent bilateral ureteral occlusion by means of AMPLATZER vascular plug II coupled to n-butyl cyanoacrylate (NBCA because of recurring pyelonephritis following cystectomy with subsequent bilateral ureterosigmoidostomy (sec. Mainz type II.

Urine heat shock protein 70 levels as a marker of urinary tract infection in children.

Science.gov (United States)

Yilmaz, Alev; Yildirim, Zeynep Yuruk; Emre, Sevinc; Gedikbasi, Asuman; Yildirim, Tarik; Dirican, Ahmet; Ucar, Evren Onay

2016-09-01

Heat shock proteins (HSPs) are a multi-family group of proteins which are upregulated by the cell in response to exposure to hazardous (stress) factors, including infectious agents, to prevent changes in protein structure. The aim of our study was to assess whether urine levels of the 70-kDa family of HSPs (HSP70s) increase in children with urinary tract infection (UTI) and to determine the optimal urine (u) HSP70 cut-off level to predict UTI in children. Forty patients with symptomatic UTI (UTI group), 30 healthy children (control group), 21 asymptomatic patients with proven bacterial contamination in their urine culture (contamination group) and 30 patients with fever caused by other infections (non-UTI infection group) were enrolled in the study. Random urine samples were obtained for measurement of HSP70 and creatinine (Cr) from all groups. Urine was collected prior to the treatment of UTI at the time of presentation and after treatment. Urine HSP70 levels were measured by enzyme-linked immunosorbent analysis. A dimercaptosuccinic acid (DMSA) scan was performed at 5-7 days after presentation in UTI group to distinguish patients with acute pyelonephritis from those with cystitis; based on this scan, no patients had acute pyelonephritis. Patients were classified with pyelonephritis in the presence of all of the following signs: axillary fever of ≥39 °C, leukocytosis and positivity for C-reactive protein. The mean urine HSP70:Cr ratio (uHSP70/Cr) prior to treatment was significantly higher in the UTI group (449.86 ± 194.33 pg/mg) than in the control, contamination and non-UTI infection groups (39.93 ± 47.61, 32.43 ± 9.09 and 45.14 ± 19.76, respectively; p = 0.0001). Using a cut-off of 158 pg/mg uHSP70/Cr for the prediction of UTI, the sensitivity and specificity of the assay were 100 and 100 %, respectively (area under the time-concentration curve = 1). The uHSP70/Cr was highest in the patients with clinical pyelonephritis (p�

Surgical infections with Mycoplasma

DEFF Research Database (Denmark)

Levi-Mazloum, Niels Donald; Prag, Jørgen Brorson; Jensen, J S

1997-01-01

Mycoplasma hominis and Ureaplasma urealyticum are common inhabitants of the human genital tract. Evidence for an aetiological role in pyelonephritis, pelvic inflammatory disease, post-abortion and post-partum fever has been presented. There are sporadic reports of Mycoplasma causing serious...... extragenital infection such as septicemia, septic arthritis, neonatal meningitis and encephalitis. We review 38 cases of surgical infections with Mycoplasma....

[Impact of reflux on the kidney].

Science.gov (United States)

Mollard, P; Louis, D; Basset, T

1984-03-01

Description of the reflux nephropathy. Pyelonephritis lesions are undoubtedly linked to the vesico-ureteric reflux. The role of the intra-renal reflux ( Hodson ) and the Big Bang Theory ( Ransley ) are discussed as the data from animal experiments. The role of the sterile reflux and of the segmental hypoplasia is relatively less important. The actual management of vesico-ureteric reflux treatment is questioned.

Emphysematous liver abscess in diabetic patient: two cases report

International Nuclear Information System (INIS)

Rhim, Hyun Chul; Koo, Ja Hong; Kim, Sung Tae; Kim, Yong Soo; Koh, Byung Hee; Cho, On Koo

1995-01-01

There has not been any report on massive air-containing liver abscess in diabetic patients, although emphysematous cholecystitis or pyelonephritis is a well-known complication in them. Authors report two cases of emphysematous liver abscess in diabetic patient, which showed typical findings of massive air-containing hepatic abscess on ultrasonography and computed tomography, but very poor prognosis in spite of immediate and successful percutaneous drainage procedure

sup(99m)Tc-DMSA renal scintigraphy in renal failure due to various renal diseases

Energy Technology Data Exchange (ETDEWEB)

Hosokawa, S; Daijo, K; Okabe, T; Kawamura, J; Hara, A [Kyoto Univ. (Japan). Hospital

1979-08-01

Renal contours in renal failure were studied by means of sup(99m)Tc-dimercaptosuccinic acid (DMSA) renoscintigraphy. Renal cortical images were obtained even in renal failure cases. Causes of renal failure were chronic glomerulonephritis in 7, bilateral renal tuberculosis in 2, chronic pyelonephritis in 3, bilateral renal calculi in 3, diabetic nephropathy in 2, polycystic kidney disease in 2 and stomach cancer in 1.

sup(99m)Tc-DMSA renal scintigraphy in renal failure due to various renal diseases

International Nuclear Information System (INIS)

Hosokawa, Shin-ichi; Daijo, Kazuyuki; Okabe, Tatsushiro; Kawamura, Juichi; Hara, Akira

1979-01-01

Renal contours in renal failure were studied by means of sup(99m)Tc-dimercaptosuccinic acid (DMSA) renoscintigraphy. Renal cortical images were obtained even in renal failure cases. Causes of renal failure were chronic glomerulonephritis in 7, bilateral renal tuberculosis in 2, chronic pyelonephritis in 3, bilateral renal calculi in 3, diabetic nephropathy in 2, polycystic kidney disease in 2 and stomach cancer in 1. (author)

ACUTE RENAL FAILURE WITH NORMAL PLASMA UREA LEVEL SECONDARY TO ACUTE PYELONEPHITIS IN A SINGLE KIDNEY PATIENT

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Imperiali N

2006-03-01

Full Text Available SUMMARYAcute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one.In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels. RESUMEN:La insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia.En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal.

INSUFICIENCIA RENAL AGUDA CON UREMIA NORMAL EN PACIENTE MONO-RENO SECUNDARIA A PIELONEFRITIS AGUDA

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Musso CG

2006-03-01

Full Text Available RESUMEN:La insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia.En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal. SUMMARYAcute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one.In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels.

INSUFICIENCIA RENAL AGUDA CON UREMIA NORMAL EN PACIENTE MONO-RENO SECUNDARIA A PIELONEFRITIS AGUDA

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Musso CG

2007-04-01

Full Text Available RESUMENLa insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia. En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal.SUMMARYAcute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one. In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels.

ACUTE RENAL FAILURE WITH NORMAL PLASMA UREA LEVEL SECONDARY TO ACUTE PYELONEPHITIS IN A SINGLE KIDNEY PATIENT

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Algranati L

2007-04-01

Full Text Available SUMMARY: Acute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one. In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels.RESUMEN: La insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia. En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal.

Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border.

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Rose McGready

2010-11-01

Full Text Available Fever in pregnancy is dangerous for both mother and foetus. In the 1980's malaria was the leading cause of death in pregnant women in refugee camps on the Thai-Burmese border. Artemisinin combination therapy has significantly reduced the incidence of malaria in the population. The remaining causes of fever in pregnancy are not well documented.Pregnant women attending antenatal care, where weekly screening for malaria is routine, were invited to have a comprehensive clinical and laboratory screen if they had fever. Women were admitted to hospital, treated and followed up weekly until delivery. A convalescent serum was collected on day 21. Delivery outcomes were recorded.Febrile episodes (n = 438 occurred in 5.0% (409/8,117 of pregnant women attending antenatal clinics from 7-Jan-2004 to 17-May-2006. The main cause was malaria in 55.5% (227/409. A cohort of 203 (49.6% of 409 women had detailed fever investigations and follow up. Arthropod-borne (malaria, rickettsial infections, and dengue and zoonotic disease (leptospirosis accounted for nearly half of all febrile illnesses, 47.3% (96/203. Coinfection was observed in 3.9% (8/203 of women, mostly malaria and rickettsia. Pyelonephritis, 19.7% (40/203, was also a common cause of fever. Once malaria, pyelonephritis and acute respiratory illness are excluded by microscopy and/or clinical findings, one-third of the remaining febrile infections will be caused by rickettsia or leptospirosis. Scrub and murine typhus were associated with poor pregnancy outcomes including stillbirth and low birth weight. One woman died (no positive laboratory tests.Malaria remains the leading cause of fever in pregnancy on the Thai-Burmese border. Scrub and murine typhus were also important causes of fever associated with poor pregnancy outcomes. Febrile pregnant women on the Thai-Burmese border who do not have malaria, pyelonephritis or respiratory tract infection should be treated with azithromycin, effective for typhus

UH-USA Agreement - A Telemedicine Research Proposal

Science.gov (United States)

2004-11-01

institutions in Hawaii and include specialists such as pharmacists to them. Initially, interest was limited in utilizing the technology and nutritionists, as...the physician infections ( UTI ). for inclusion in the telemedicine program. Before Treating patients at home is one alternative that can considering...infection.’ 5 Patients with UTI are excluded if they have uncomplicated pyelonephritis or if they have an obstructed ureter or sepsis syndrome. Patients with

ASYMPTOMATIC BACTERIURIA AMONG PREGNANT WOMEN ATTENDING THE OUTPATIENT CLINIC OF CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL, CHITWAN, NEPAL

OpenAIRE

Mamata Sharma Neupane; Kalpana Sharma Dhakal; Harish Chandra Neupane; Shital Adhikari; Bijay Aryal

2012-01-01

Urinary Tract Infection (UTI) refers to both microbial colonization of the urine and tissue invasion of any structure of the urinary tract. Pregnancy enhances the progression from asymptomatic to symptomatic bacteriuria which could lead to pyelonephritis and adverse obstetric outcomes such as prematurity, low-birth weight, and higher fetal mortality rates. This study was undertaken to determine the prevalence of asymptomatic bacteriuria in pregnancy; its causative agents and their antimicrobi...

The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria

OpenAIRE

Nicolle, Lindsay E.

2016-01-01

Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequenc...

PATTERN OF ANTIMICROBIAL USE FOR URINARY TRACT INFECTION DURING PREGNANCY IN A TERTIARY CARE TEACHING HOSPITAL

OpenAIRE

Haldia Priyanka, Sharma Taruna, Nautiyal Ruchira

2015-01-01

Background: Urinary Tract Infection (UTI) may be classified as lower (cystitis and asymptomatic bacteriuria) or upper urinary tract infections (pyelonephritis). The recommended antibiotics for use in pregnancy for management of ASB include amoxicillin, oral cephalosporins and nitrofurantoin; and for the treatment of lower UTI during pregnancy include penicillins, oral cephalosporins. Data from the antibiotic usage study in UTI during pregnancy will help in establishing a proper antibiotic uti...

Managing urinary tract infections

OpenAIRE

Saadeh, Sermin A.; Mattoo, Tej K.

2011-01-01

Urinary tract infections (UTI) are common in childhood. Presence of pyuria and bacteriuria in an appropriately collected urine sample are diagnostic of UTI. The risk of UTI is increased with an underlying urological abnormality such as vesicoureteral reflux, constipation, and voiding dysfunction. Patients with acute pyelonephritis are at risk of renal scarring and subsequent complications such as hypertension, proteinuria with and without FSGS, pregnancy-related complications and even end-sta...

Asymptomatic bacteriuria & obstetric outcome following treatment in early versus late pregnancy in north Indian women

OpenAIRE

Jain, Vaishali; Das, Vinita; Agarwal, Anjoo; Pandey, Amita

2013-01-01

Background & objectives: Asymptomatic bacteriuria during pregnancy if left untreated, may lead to acute pyelonephritis, preterm labour, low birth weight foetus, etc. Adequate and early treatment reduces the incidence of these obstetric complications. The present study was done to determine presence of asymptomatic bacteriuria (ASB) and obstetric outcome following treatment in early versus late pregnancy. Methods: A prospective cohort study was conducted at a tertiary care teaching hospital of...

Urinary Concentrating Ability in Women with Asymptomatic Bacteriuria in Pregnancy

Science.gov (United States)

Williams, G. L.; Campbell, H.; Davies, K. J.

1969-01-01

The incidence of impaired renal concentrating ability in pregnant women with asymptomatic significant bacteriuria is significantly less than previously reported when osmolality readings are performed on every urine specimen obtained during the 24 hours' deprivation of fluids. The concentrating defect is more considerable as pregnancy progresses. The lower the maximum urinary osmolality the more difficult is the treatment of the patient, and the higher the incidence of acute pyelonephritis. PMID:5792611

Diagnosis and clinical management of urinary tract infection

OpenAIRE

Heilberg, Ita Pfeferman; Schor, Nestor

2003-01-01

A review about recent aspects on diagnosis and clinical management of urinary tract infection (UTI) is presented. There is a wide variation in clinical presentation of UTI which include different forms as cystitis, pyelonephritis, urethral syndrome and the clinical relevance of asymptomatic bacteriuria and low-count bacteriuria that must be distinguished from contamination. Pathogenetic aspects concerning bacterial virulence as well as host factors in susceptibility to UTI as urinary tract ob...

Contribution of the renal scintiscanning with the DMSA in the diagnosis of Pyelonephritides, acute and chronic, of the child

International Nuclear Information System (INIS)

Sellem, Ali

2008-01-01

In the case of urinary infection of children, a complete clinical and biological picture can be enough to retain the diagnosis of a high attack. However, this possibility is rare. In the contrary cases, a renal scintiscanning with the DMSA must be carried out with the acute phase, to confirm the diagnosis. For the children carrying acute pyelonephritis, a scintigraphic control is necessary to detect the cortical scars.

Principles of radionuclide studies of the genitourinary system

International Nuclear Information System (INIS)

Kim, E.E.; Pjura, G.A.; Lowry, P.A.

1988-01-01

The clinical assessment of renal diseases with radionuclide procedures is discussed. It has achieved general recognition only during the last decade. The proper assessment of renal function with radionuclides provides useful information for the management of patients with renal disease and renal transplant recipients. Renal imaging with radionuclides gives some information on morphology and the integrity of the urinary collecting system, but more importantly it provides functional information that may include renal blood flow or effective renal plasma flow (ERPF), glomerular filtration rate (GFR), the quantitation of differential renal function, the evaluation of vesicoureteral reflux, the quantitation of postvoiding residual urine volume, and the differential diagnosis of testicular disease. Acute renal failure resulting from acute tubular necrosis, hepatorenal syndrome, acute interstitial nephirits, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized by radionuclide studies. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy also may be obtained. Radionuclide studies in patients with chronic renal failure may reveal such causes as renal artery stenosis, chronic pyelonephritis, or infiltrative renal disease. Finally, nuclear study in transplant recipients is useful to help differentiate rejection from acute tubular necrosis and other causes of reduced renal function

Safety and Efficacy of transarterial nephrectomy as an alternative to surgical nephrectomy

International Nuclear Information System (INIS)

Cho, Jooae; Shin, Ji Hoon; Yoon, Hyun Ki; Ko, Gi Young; Gwon, Dong Il; Ko, Heung Kyu; Kim, Jin Hyoung; Sung, Kyu Bo

2014-01-01

To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy. This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes. The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension. Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.

Urinary tract infections during pregnancy.

Science.gov (United States)

Le, Jennifer; Briggs, Gerald G; McKeown, Anna; Bustillo, Gerardo

2004-10-01

To provide a comprehensive review of urinary tract infections (UTIs) during pregnancy. All aspects of UTIs, including epidemiology, pathogenesis, resistance, clinical features, diagnosis, treatment, and prevention, were reviewed. MEDLINE (1966-August 2003) and Cochrane Library searches were performed using the key search terms urinary tract infection, pyelonephritis, cystitis, asymptomatic bacteriuria, and resistance. All article abstracts were evaluated for relevance. Only articles pertaining to pregnancy were included. The majority of published literature were review articles; the number of original clinical studies was limited. UTIs are the most common bacterial infections during pregnancy. They are characterized by the presence of significant bacteria anywhere along the urinary tract. Pyelonephritis is the most common severe bacterial infection that can lead to perinatal and maternal complications including premature delivery, infants with low birth weight, fetal mortality, preeclampsia, pregnancy-induced hypertension, anemia, thrombocytopenia, and transient renal insufficiency. Enterobacteriaceae account for 90% of UTIs. The common antibiotics used are nitrofurantoin, cefazolin, cephalexin, ceftriaxone, and gentamicin. Therapeutic management of UTIs in pregnancy requires proper diagnostic workup and thorough understanding of antimicrobial agents to optimize maternal outcome, ensure safety to the fetus, and prevent complications that lead to significant morbidity and mortality in both the fetus and the mother.

Safety and Efficacy of transarterial nephrectomy as an alternative to surgical nephrectomy

Energy Technology Data Exchange (ETDEWEB)

Cho, Jooae; Shin, Ji Hoon; Yoon, Hyun Ki; Ko, Gi Young; Gwon, Dong Il; Ko, Heung Kyu; Kim, Jin Hyoung; Sung, Kyu Bo [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2014-08-15

To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy. This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes. The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension. Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.

Procalcitonin as an indicator of urosepsis

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Sugimoto K

2013-03-01

Full Text Available Koichi Sugimoto, Shogo Adomi, Hiroyuki Koike, Atsunobu Esa Department of Urology, NTT West Osaka Hospital, Osaka, Japan Background: Procalcitonin has been advocated as a marker of bacterial infection, so this study was carried out to determine the usefulness of serum procalcitonin in the early diagnosis of urosepsis. Methods: The subjects were 37 febrile patients with urinary tract infection in whom we examined the serum procalcitonin concentration at the start of treatment. Results: Thirty patients had acute pyelonephritis (16 simple, 14 complex, one had emphysematous pyelonephritis, five had acute prostatitis, and one had acute epididymitis. The procalcitonin level was <0.5 ng/mL in 18 patients, ≥0.5 ng/mL in one patient, ≥2 ng/mL in seven patients, and ≥10 ng/mL in 11 patients. Five of the 11 patients with procalcitonin levels ≥ 10 ng/mL had disseminated intravascular coagulation. All patients with urinary tract obstruction and disseminated intravascular coagulation had procalcitonin levels ≥ 10 ng/mL. Conclusion: Although this retrospective study comprised a small number of patients, we found that procalcitonin was a useful marker for urinary tract infection. Keywords: procalcitonin, urosepsis, urinary tract infection, urology

Developing an Instrument to Measure Socioeconomic Disparities in Quality of Care for Men with Early-Stage Prostate Cancer

Science.gov (United States)

2013-03-01

status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control. 2001 Oct;12(8):703-11. PubMed PMID: 11562110...998.6 (Persist Post-Op Fistula), 998.7 (Post-Op Foreign Substance Reaction), 604.0 (Orchitis with Abscess ), E870.0 (Acc Cut/Hem in Surgery), E870.4...infection) Diagnosis of GU Surgical Complications: 595.89 (Cystitis Nec), 590.1 (Acute Pyelonephritis), 590.2 (Renal/Perirenal Abscess ), 590.8

Maternal Factors Influencing Perinatal Transmission of HIV Infection

Science.gov (United States)

1990-01-01

Hypertension 37. *38. Infections *38. *a. cystitis *a. *b. pyelonephritis *b. *c. herpes *c. *d. vaginal candidiasis *d. *e. gonorrhea *e. *f. syphilis...after delivery and at 6 weeks and 6 months after the baby is born. Periodic blood tests, urine tests and vaginal cultures will be done to monitor...Maternal hemorrhage *32. *33. Other *33. DELIVERY *34. Type of Delivery (may choose only one) *34. 1 = Vertex Vaginal 2 = C-Section indication 3 = Breech

9. The Contribution of Animal Experiments to Kidney Transplantation

OpenAIRE

Botting, Jack Howard

2016-01-01

Haemodialysis is life-saving and curative in acute renal failure. By reversing the build-up of metabolic products normally excreted by a functioning kidney, dialysis enables the temporarily affected kidneys to heal and resume normal function. In chronic renal failure however, the burden of regular dialysis is necessary unless a healthy kidney from a donor can be grafted. Chronic Renal Failure Chronic renal failure (CRF) due to glomerulonephritis, pyelonephritis or polycystic kidney disease is...

Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial.

Science.gov (United States)

Kazemier, Brenda M; Koningstein, Fiona N; Schneeberger, Caroline; Ott, Alewijn; Bossuyt, Patrick M; de Miranda, Esteriek; Vogelvang, Tatjana E; Verhoeven, Corine J M; Langenveld, Josje; Woiski, Mallory; Oudijk, Martijn A; van der Ven, Jeanine E M; Vlegels, Manita T W; Kuiper, Petra N; Feiertag, Nicolette; Pajkrt, Eva; de Groot, Christianne J M; Mol, Ben W J; Geerlings, Suzanne E

2015-11-01

composite of pyelonephritis with or without preterm birth at less than 34 weeks, analysed by intention to treat at 6 weeks post-partum. This trial is registered with the Dutch Trial Registry, number NTR3068. Between Oct 11, 2011, and June 10, 2013, we enrolled 5621 women into our screening cohort, of whom 5132 were eligible for screening. After exclusions for contaminated dipslides and patients lost to follow-up, in our final cohort of 4283 women, 248 were asymptomatic bacteriuria positive, of whom 40 were randomly assigned to nitrofurantoin and 45 to placebo for the randomised controlled trial, whereas the other 163 asymptomatic bacteriuria-positive women were followed without treatment. The proportion of women with pyelonephritis, preterm birth, or both did not differ between untreated or placebo-treated asymptomatic bacteriuria-positive women and asymptomatic bacteriuria-negative women (6 [2·9%] of 208 vs 77 [1·9%] of 4035; adjusted odds ratio [OR] 1·5, 95% CI 0·6-3·5) nor between asymptomatic bacteriuria-positive women treated with nitrofurantoin versus those who were untreated or received placebo (1 [2·5%] of 40 vs 6 [2·9%] of 208; risk difference -0·4, 95% CI -3·6 to 9·4). Untreated or placebo-treated asymptomatic bacteriuria-positive women developed pyelonephritis in five [2·4%] of 208 cases, compared with 24 [0·6%] of 4035 asymptomatic bacteriuria-negative women (adjusted OR 3·9, 95% CI 1·4-11·4). In women with an uncomplicated singleton pregnancy, asymptomatic bacteriuria is not associated with preterm birth. Asymptomatic bacteriuria showed a significant association with pyelonephritis, but the absolute risk of pyelonephritis in untreated asymptomatic bacteriuria is low. These findings question a routine screen-treat-policy for asymptomatic bacteriuria in pregnancy. ZonMw (the Netherlands Organisation for Health Research and Development). Copyright © 2015 Elsevier Ltd. All rights reserved.

Vigilance on use of drugs, herbal products, and food supplements during pregnancy: focus on fosfomycin.

Science.gov (United States)

Mannucci, C; Dante, G; Miroddi, M; Facchinetti, F; D'Anna, R; Santamaria, A; Lenti, M C; Vannacci, A; Calapai, F; Perone, M; Migliardi, G; Alibrandi, A; Navarra, M; Calapai, G

2017-09-17

Urinary tract infection (UTI) is defined as a common bacterial infection that can lead to significant morbidity such as stricture, fistula, abscess formation, bacteremia, sepsis, pyelonephritis, and kidney dysfunction with a mortality rates reported of 1% in men and 3% in women because of development of pyelonephritis. UTIs are more common in women and the 33% of them require antimicrobials treatment for at least one episode by the age of 24 years. UTIs are the most common infections observed during pregnancy and up to 30% of mothers with not treated asymptomatic bacteriuria may develop acute pyelonephritis which consequently can be associated to adverse maternal and fetal outcomes. All bacteriuria in pregnancy should be treated with antimicrobial treatments being safe for both the mother and the fetus. Approximately one every four women receives prescription of antibiotic treatment during pregnancy, nearly 80% of all the prescription medications during gestation. The use of fosfomycin to treat cystitis in pregnancy generally considered safe and effective. Even though use on antibiotics for urinary tract infections is considered generally safe for the fetus and mothers, this opinion is not based on specific studies monitoring the relationship of among urinary infections, consumption of antibiotics, and pregnancy outcomes. On this basis we decided to analyze data from the database of our multicenter study PHYTOVIGGEST, reporting data from 5362 pregnancies, focusing on use of fosfomycin. Principal outcomes of pregnancy in women treated with fosfomycin were taken into consideration. Women who have been treated with urinary antibiotics during the pregnancy were 183. With respect to the total number of pregnancies of our sample, these women represented the percentage of 3.49% (187/5362). Analysis of different outcomes of pregnancy such as gestational age, neonatal weight, and neonatal Apgar index did not show any significant difference. At the same time, analysis of

The innate immune response during urinary tract infection and pyelonephritis.

Science.gov (United States)

Spencer, John David; Schwaderer, Andrew L; Becknell, Brian; Watson, Joshua; Hains, David S

2014-07-01

Despite its proximity to the fecal flora, the urinary tract is considered sterile. The precise mechanisms by which the urinary tract maintains sterility are not well understood. Host immune responses are critically important in the antimicrobial defense of the urinary tract. During recent years, considerable advances have been made in our understanding of the mechanisms underlying immune homeostasis of the kidney and urinary tract. Dysfunctions in these immune mechanisms may result in acute disease, tissue destruction and overwhelming infection. The objective of this review is to provide an overview of the innate immune response in the urinary tract in response to microbial assault. In doing so, we focus on the role of antimicrobial peptides-a ubiquitous component of the innate immune response.

Asymptomatic bacteriuria and urinary tract infections in women: focus on diabetes mellitus and pregnancy

OpenAIRE

Schneeberger, Caroline

2014-01-01

There is a shortage of evidence for clinical guidelines on diagnosis and management of both asymptomatic bacteriuria (the presence of bacteria in urine without symptoms of an infection) and urinary tract infections in women with diabetes and pregnant women. Asymptomatic bacteriuria and urinary tract infections in these two risk groups may have far-reaching consequences such as pyelonephritis and preterm birth. The results of the studies in this thesis can be used to fill some of the knowledge...

ASSIMPTOMATIC BACTERIURIA OF PREGNANCY, DIAGNOSTICS AND EXPERIENCE OF TREATMENT IN THE HEALTH CENTER IN OMSK

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Данияр Агыбаевич Сатыбалдин

2018-01-01

Full Text Available Asymptomatic bacteriuria, according to different authors, occurs in 2-22 % of pregnant women and, in the absence of treatment, in 30 % is complicated by the development of gestational pyelonephritis, and is also associated with the development of severe complications of pregnancies and childbirth. Effective diagnosis and treatment leads to a significant reduction in the incidence of these complications. A single dose of phosphomycin is as effective as the course of antibiotic therapy.

Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study

OpenAIRE

Kazemier, B.M.; Schneeberger, C.; Miranda, de, E.; Wassenaer, van, A.G.; Bossuyt, P.M.; Vogelvang, T.E.; Reijnders, F.J.L.; Delemarre, F.M.C.; Verhoeven, C.J.M.; Oudijk, M.A.; Ven, van der, J.A.; Kuiper, P.N.; Feiertag, N.; Ott, A; Groot, de, C.J.M.

2012-01-01

Abstract Background The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor quality. Methods/Design We plan a combined screen and treat study in women with a singleton pregnancy. We will screen women between 16 and 22 weeks of gestation for ASB using the urine dips...

Management of urinary tract infections in pregnancy.

Science.gov (United States)

Hodgman, D E

1994-06-01

Urinary tract infections (UTIs) are one of the most frequent complications of pregnancy. When the lower UTIs of asymptomatic bacteriuria and cystitis are not eradicated, the subsequent risk of the development of pyelonephritis is increased. The associated decreased maternal morbidity and fetal prematurity are the goals of a screening and treatment program for pregnant women. This clinical article presents information on the etiology, incidence, diagnosis, and management of asymptomatic bacteriuria and cystitis. Nursing implications regarding teaching are included.

Radioisotopic investigation of renal arterial hypertension using 99m Tc-DTPA

International Nuclear Information System (INIS)

Champailler, A.; Defour-Decousus, M.; Houzard, C.; Healy, J.C.; Gonthier, R.; Juge, J.; Berthoux, F.C.

1984-01-01

To evaluate the clinical validity of renal investigation using 99m Tc-DTPA, 60 hypertensive patients divided into four groups according to diagnosis were studied: 1) renovascular hypertension (22 patients); 2) chronic pyelo-nephritis (11 patients); 3) renal hypoplasia (12 patients); 4) hypertension due to bilateral parenchymatous (15 patients). A good correlation was found between clearance of DTPA and creatinine clearance/1.73 m 2 body surface (n = 51, r = 0.68, p 2 BS [fr

Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study.

Science.gov (United States)

Kazemier, Brenda M; Schneeberger, Caroline; De Miranda, Esteriek; Van Wassenaer, Aleid; Bossuyt, Patrick M; Vogelvang, Tatjana E; Reijnders, Frans J L; Delemarre, Friso M C; Verhoeven, Corine J M; Oudijk, Martijn A; Van Der Ven, Jeanine A; Kuiper, Petra N; Feiertag, Nicolette; Ott, Alewijn; De Groot, Christianne J M; Mol, Ben Willem J; Geerlings, Suzanne E

2012-06-21

The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor quality. We plan a combined screen and treat study in women with a singleton pregnancy. We will screen women between 16 and 22 weeks of gestation for ASB using the urine dipslide technique. The dipslide is considered positive when colony concentration ≥105 colony forming units (CFU)/mL of a single microorganism or two different colonies but one ≥105 CFU/mL is found, or when Group B Streptococcus bacteriuria is found in any colony concentration. Women with a positive dipslide will be randomly allocated to receive nitrofurantoin or placebo 100 mg twice a day for 5 consecutive days (double blind). Primary outcomes of this trial are maternal pyelonephritis and/or preterm delivery before 34 weeks. Secondary outcomes are neonatal and maternal morbidity, neonatal weight, time to delivery, preterm delivery rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal admission days and costs. This trial will provide evidence for the benefit and cost-effectiveness of dipslide screening for ASB among low risk women at 16-22 weeks of pregnancy and subsequent nitrofurantoin treatment. Dutch trial registry: NTR-3068.

Nontraumatic spontaneous rupture of the kidney : etiology and CT findings

International Nuclear Information System (INIS)

Heo, Tae Haeng; Jeon, Hae Jeong; Shin, Hyun Joon; Kim, Bo Hyun; Cho, Kyoung Sik; Kim, Young Hwa; Kim, Seung Hyup; Park, Churl Min

1997-01-01

To evaluate the usefulness of CT scanning in determining the etiology of spontaneous rupture of the kidney We retrospectively analyzed the CT findings of spontaneous rupture of the kidney in eleven patients, Four were male and seven were female, and they were aged between 20 and 71 (mean, 46.6) years. Both pre- and post-contrast enhanced CT scanning was performed in all patients. Spontaneous renal rupture was induced in seven cases by neoplasms (three angiomyolipomas, three renal cell carcinomas, and one metastatic choriocarcinoma), in three cases by infection or inflammation (acute and chronic pyelonephritis, and renal abscess), and in one, by renal cyst. Common CT findings of rupture of the kidney were the accumulation of high density fluid in the perirenal and anterior pararenal space, and inhomogeneous irregular low density of renal parenchyma and the rupture site. Angiomyolipoma showed fat and an angiomatous component in the lesion, while acute and chronic pyelonephrities revealed thinning of the renal parenchyma and an irregular renal outline. Renal cell carcinoma showed a dense soft tissue mass in the parenchyma. Well-defined, round low-density lesions were noted in the case of renal cyst and renal abscess. CT is very useful in diagnosing and determining the etiology of non-traumatic spontaneous rupture of the kidney and plays an important role in the evaluation of emergency cases

Prevalence of asymptomatic bacteriuria and associated risk factors among antenatal women attending a tertiary care hospital

OpenAIRE

Aruna Rajkumari; Humera Qudsia Fatima Ansari

2011-01-01

Asymptomatic bacteriuria (ASB) is the commonest bacterial infec-tion which requires medical treatment in pregnancy. Untreated ASB in 25-30% of can cases lead to pyelonephritis which may lead to increased risk of abortions, intrauterine fetal deaths, prematurity and low birth weight. A cross-sectional study was conducted at Gandhi Hospital over a period of ten months with 125 asymptomatic pregnant women in the age group of 15-35 years. The objectives of the study were to determine prevalence o...

Asymptomatic Bacteriuria in Pregnant Women in Outpatient Facilities

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Maral G. Nogayeva

2015-02-01

Full Text Available Urinary tract morbidity has increased by 7% in Kazakhstan between 2007 to 2011. Pregnant women with extragenital pathologies or kidney diseases had the greatest prevalence of morbidity. Asymptomatic bacteriuria (AB is one of the most important risk factors of pyelonephritis development in pregnant women, and it can affect the course and outcome of pregnancy, delivery, and postnatal period. AB prevention requires prevention of pregnancy complications including early diagnostic of urinary tract infections, timely optimization of therapy at outpatient facilities, and dynamic follow-up.

Emphysematous pyelonephritis: An 8-year retrospective review across four acute hospitals

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James Hok-Leung Tsu

2013-07-01

Conclusion: Severe hyperglycemia and CT class of EPN are significant risk factors for death. CT is the investigation of choice for correct diagnosis of EPN. Additional intervention should be offered to EPN patients with Wan type 1 and Huang and Tseng class 3 CT features.

Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study

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Kazemier Brenda M

2012-06-01

Full Text Available Abstract Background The prevalence of asymptomatic bacteriuria (ASB in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor quality. Methods/Design We plan a combined screen and treat study in women with a singleton pregnancy. We will screen women between 16 and 22 weeks of gestation for ASB using the urine dipslide technique. The dipslide is considered positive when colony concentration ≥105 colony forming units (CFU/mL of a single microorganism or two different colonies but one ≥105 CFU/mL is found, or when Group B Streptococcus bacteriuria is found in any colony concentration. Women with a positive dipslide will be randomly allocated to receive nitrofurantoin or placebo 100 mg twice a day for 5 consecutive days (double blind. Primary outcomes of this trial are maternal pyelonephritis and/or preterm delivery before 34 weeks. Secondary outcomes are neonatal and maternal morbidity, neonatal weight, time to delivery, preterm delivery rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal admission days and costs. Discussion This trial will provide evidence for the benefit and cost-effectiveness of dipslide screening for ASB among low risk women at 16–22 weeks of pregnancy and subsequent nitrofurantoin treatment. Trial registration Dutch trial registry: NTR-3068

The uriscreen test to detect significant asymptomatic bacteriuria during pregnancy.

Science.gov (United States)

Teppa, Roberto J; Roberts, James M

2005-01-01

Asymptomatic bacteriuria (ASB) occurs in 2-11% of pregnancies and it is a clear predisposition to the development of acute pyelonephritis, which, in turn, poses risk to mother and fetus. Treatment of bacteriuria during pregnancy reduces the incidence of pyelonephritis. Therefore, it is recommended to screen for ASB at the first prenatal visit. The gold standard for detection of bacteriuria during pregnancy is urine culture, but this test is expensive, time-consuming, and labor-intensive. To determine the reliability of an enzymatic urine screening test (Uriscreen; Savyon Diagnostics, Ashdod, Israel) for detecting ASB in pregnancy. Catheterized urine samples were collected from 150 women who had routine prenatal screening for ASB. Patients with urinary symptoms, active vaginal bleeding, or who were previously on antibiotics therapy were excluded from the study. Sensitivity, specificity, and the positive and negative predictive values for the Uriscreen were estimated using urine culture as the criterion standard. Urine cultures were considered positive if they grew >10(5) colony-forming units of a single uropathogen. Twenty-eight women (18.7%) had urine culture results indicating significant bacteriuria, and 17 of these 28 specimens had positive enzyme activity. Of 122 samples with no growth, 109 had negative enzyme activity. Sensitivity, specificity, and positive and negative predictive values for the Uriscreen test were 60.7% (+/-18.1), 89.3% (+/-5.6), 56.6%, and 90.8%, respectively. The Uriscreen test had inadequate sensitivity for rapid screening of bacteriuria in pregnancy.

Anti-inflammatory therapy for urinary tract infection in children

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A. A. Vyalkova

2015-01-01

Full Text Available Objective: to substantiate the importance of an etiological approach to diagnosing urinary tract infection in children in terms of the species and biological properties of an infectious agent and to evaluate the efficiency of anti-inflammatory therapy. The study included 116 patients aged 3-15 years with chronic pyelonephritis (Group 1 and isolated bacteriuria (Group 2. After 10-14-day antibiotic therapy, Group 1 patients were allocated to two subgroups: Subgroup la («=30 took furamag 5 mg/kg/day; Subgroup lb («=30 received furamag at the same dose in combination with canephron. The treatment cycle lasted 10-14 days. Subgroup 2a («=26 children had furamag 5 mgДg/day and Subgroup 2b (« =30 took furamag in combination with canephron. The duration of treatment was 14 days. The investigators established the high efficiency of therapy with furamag for renal infection in the children with the active and decrement phases and that of the drug of choice for its monotherapy of isolated highly virulent bacteriuria. Therapeutic efficiency was proven to be related to the species and biological characteristics of an infectious agent. Anti-inflammatory therapy for pyelonephritis in terms of the species of pathogenic bacteria was ascertained to improve the efficiency of treatment. A rationale was provided for the individual choice of antibiotics, followed by the use of furamag, eubiotics, and drugs aimed at inhibiting virulence factors and persistence of the pathogen to sanitize the primary focus of infection.

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with febrile urinary tract infection.

Science.gov (United States)

Okamoto, Takayuki; Sato, Yasuyuki; Yamazaki, Takeshi; Hayashi, Asako

2014-04-01

Common pathogens of clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) are viruses, such as influenza virus. However, bacteria are rare pathogens for MERS. We report the first patient with MERS associated with febrile urinary tract infection. A 16-year-old lupus patient was admitted to our hospital. She had fever, headache, vomiting, and right back pain. Urinary analysis showed leukocyturia, and urinary culture identified Klebsiella pneumoniae. Cerebrospinal fluid examination and brain single-photon emission computed tomography showed no abnormalities. Therefore, she was diagnosed with febrile urinary tract infection. For further examinations, 99mTc-dimercaptosuccinic acid renal scintigraphy showed right cortical defects, and a voiding cystourethrogram demonstrated right vesicoureteral reflux (grade II). Therefore, she was diagnosed with right pyelonephritis. Although treatment with antibiotics administered intravenously improved the fever, laboratory findings, and right back pain, she had prolonged headaches, nausea, and vomiting. T2-weighted, diffusion-weighted, and fluid attenuated inversion recovery images in brain magnetic resonance imaging showed high intensity lesions in the splenium of the corpus callosum, which completely disappeared 1 week later. These results were compatible with MERS. To the best of our knowledge, our patient is the first patient who showed clinical features of MERS associated with febrile urinary tract infection. In patients with pyelonephritis and an atypical clinical course, such as prolonged headache, nausea, vomiting, and neurological disorders, the possibility of MERS should be considered.

Compartment model for the measurement of the effective renal plasma flow by radionuclidenephrography

International Nuclear Information System (INIS)

Ryabov, S.I.; Degtyareva, O.A.

1988-01-01

By reason of model ideas on hippuran kinetics radionuclide nephrograms were split up into a renal component and a component of the tissue background. New indices for the evaluation of renal function symmetry were proposed comprising the proportional determination of the effective renal plasma flow as well as of the symmetrical blood flow. For early diagnosis of latent renal dysfunction a new index is proposed characterizing the excretory renal transport as to local renal blood supply. Empirical indices of 120 patients suffering from chronic glomerulonephritis and pyelonephritis, resp., are stated

Management of urinary tract infections in pregnancy: a review with comments on single dose therapy.

Science.gov (United States)

Zinner, S H

1992-01-01

Most investigators agree that the adverse effects of urinary tract infections in pregnancy can be abrogated by effective early detection and treatment. However, the optimal methods for screening and treatment remain controversial. Although single-dose therapy has not been applied to pregnant women with acute pyelonephritis, most but not all studies which have compared single-dose with longer courses of beta-lactam or other antibiotics in pregnant asymptomatic bacteriuric women have shown no differences in outcome. This paper reviews recent trials of single-dose treatment of bacteriuria in pregnant women.

Persistence of Escherichia coli clones and phenotypic and genotypic antibiotic resistance in recurrent urinary tract infections in childhood

DEFF Research Database (Denmark)

Kõljalg, Siiri; Truusalu, Kai; Vainumäe, Inga

2009-01-01

. Altogether, 78 urinary E. coli isolates from 27 children, who experienced recurrences during a 1-year follow-up after the first attack of acute pyelonephritis, were investigated. The MICs of sulfamethoxazole, trimethoprim-sulfamethoxazole (SXT), ampicillin, cefuroxime, cefotaxime, and gentamicin...... and the presence or absence of the intI gene for class 1 integrons and the sulfamethoxazole resistance-encoding genes sul1, sul2, and sul3 were determined. All E. coli strains were genotyped by pulsed-field gel electrophoresis. There were no significant differences in the prevalences of resistance to beta...

Dynamic scintigraphy of the kidneys with lasix

International Nuclear Information System (INIS)

Yudin, L.A.; Reznichenko, A.A.; Uskov, I.A.; Gol'dman, V.E.; Ivanova, Yu.V.; Naryshkina, V.M.; Budkevich, Yu.B.

1991-01-01

Dynamic scintigraphy with lasix in patients with hydronephrosis, nephrolithialis, chronic pyelonephritis, ureterohydronephrosis on an initial scintigram has shown retention of 99m Tc-DTPA in the urinary tracts: an increase or absence of the excretory segment on the activity-time curve up to the appearance of an obstructive type of a curve. Verified operative findings have shown a high sensitivity and accuracy of the detection of stenosis of the urinary tracts in the absence of the excretory segment on an initial scintigram irrespective of the reaction of lasix administration

Comparative analysis of antibiotic resistance and phylogenetic group patterns in human and porcine urinary tract infectious Escherichia coli

DEFF Research Database (Denmark)

Hancock, Viktoria; Nielsen, E.M.; Krag, L.

2009-01-01

Urinary tract infections (UTIs) are one of the most common infectious diseases in humans and domestic animals such as pigs. The most frequent infectious agent in such infections is Escherichia coli. Virulence characteristics of E. coli UTI strains range from highly virulent pyelonephritis strains...... to relatively benign asymptomatic bacteriuria strains. Here we analyse a spectrum of porcine and human UTI E. coli strains with respect to their antibiotic resistance patterns and their phylogenetic groups, determined by multiplex PCR. The clonal profiles of the strains differed profoundly; whereas human...

Ureterocolonic anastomosis in clinically normal dogs

International Nuclear Information System (INIS)

Stone, E.A.; Walter, M.C.; Goldschmidt, M.H.; Biery, D.N.; Bovee, K.C.

1988-01-01

Ureterocolonic anastomosis was evaluated in 13 clinically normal dogs. Urinary continence was maintained after surgery, and the procedure was completed without technique errors in all but 2 dogs. Three dogs died within 5 weeks (2 of undetermined causes and 1 of aspiration pneumonia and neurologic disease), and 1 dog was euthanatized 4 months after surgery because of neurologic signs. Two healthy dogs were euthanatized 3 months after surgery for light microscopic evaluation of their kidneys. Five dogs were euthanatized 6 months after surgery for light microscopic evaluation of their kidneys. Gastrointestinal and neurologic disturbances developed in 4 dogs at various postoperative intervals. Plasma ammonia concentration measured in 2 dogs with neurologic signs was increased. Plasma ammonia concentration measured in 5 dogs without neurologic signs was within normal limits. All 5 dogs, in which metabolic acidosis was diagnosed, had high normal or above normal serum chloride concentration. Serum urea nitrogen values were increased after surgery because of colonic absorption of urea. Serum creatinine concentration was increased in 1 dog 6 months after surgery. Individual kidney glomerular filtration rate was reduced in 38% (3/8) of the kidneys from 4 other dogs at 6 months after surgery. Of 5 dogs euthanatized at 3 to 4 months after surgery, 4 had bilateral pyelitis, and 1 had unilateral pyelonephritis. Six months after surgery, pyelonephritis was diagnosed in 40% (4/10) of the kidneys from 5 dogs. The ureterocolonic anastomosis procedure is a salvage procedure that should allow complete cystectomy. However, variable degress of metabolic acidosis, hyperammonemia, and neurologic disease may result

Early diagnosis and treatmente of hydronephrosis in childhood

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Kokorkin A.D.

2016-03-01

Full Text Available Objective: To evaluate early and late results of the diagnosis and treatment of children with congenital hydronephrosis. Materials and methods. Conducted diagnosis and treatment of 47 children with hydronephrosis. Comparing the immediate and long6term outcomes in the two groups: primary (n=22 and control (n=25. In the study group vice diagnosed prenatally was exposed using ultrasound diagnostics and MRI. In the control group exhibited diagnosed after hospital survey for recurrent pyelonephritis. Results and discussion. All children performed surgery on the methodology of Andersen—Hines. Duration of external drainage of the urinary tract in the control group was 14–15 days in core — 7–8 days. In 9% of the children performing morphological situation demanded organo6blowing operation. In the late postoperative period in comparison groups differed significantly in the number of recurrent pyelonephritis background of sustained reductions in dilation of the urinary tract and the growth layer parenchymal kidney operated respectively 88% and 75% of the operated patients. Conclusions. Early verification of congenital hydronephrosis affects the outcomes of vice and to prevent deformation of the kidney function and save it. Late diagnosis on the background of persistent urinary tract infections in 9% of cases leads to organo-blowing operation. Persistent infection of the urinary tract is dependent on the timing of postoperative drainage of the kidney. The optimal duration of drainage 7–8 days. Prenatally diagnosed vice number of recurrences of urinary tract infections in the late postoperative period was 8%, and 87% of renal morphometric parameters were approaching the age norm.

Robot-Assisted Laparoscopic Management of Caliceal Diverticular Calculi

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Anneleen Verbrugghe

2017-07-01

Full Text Available Standard treatment modalities of caliceal diverticular calculi range from extracorporal shockwave lithotripsy (SWL over retrograde intrarenal surgery (RIRS, percutaneous nephrolithotomy (PNL and laparoscopic stone removal. A 55-year-old woman presented with a history of pyelonephritis based on a caliceal diverticular calculus. Due to the narrow infundibulum and anterior location, a robot-assisted laparoscopic calicotomy with extraction of the calculi and fulguration of the diverticulum was performed, with no specific perioperative problems and good stone-free results. This article shows technical feasibility with minimal morbidity of robot-assisted laparoscopic stone removal and obliteration of a caliceal diverticulum.

Evaluation of the renal blood flow by densitometry using cine-angiograms

International Nuclear Information System (INIS)

Nikolaev, G.G.; Slobodzyan, B.M.; Mikhajlov, V.A.

1983-01-01

A method of the quantitative determination of the blood flow in the renal artery and the arterial bed of the renal parenchyma was developed basing on roentgenocinematography and subsequent densitometric analysis of a roentgenocinefilm. Advantages of the utilization of this method are considered with reference to two groups of patients with chronic pyelonephritis and hypertension without change of a vascular pattern on the angiograms. They are associated with a possibility of separate determination of the hemodynamics on topographycatly Definite zones of the renal arterial bed and hemodynamic disturbances in morphological changes of the renal vessels that are invisible on the angiogra

Simple differential functional study of the kidney using sup(99m) technetium DMSA

International Nuclear Information System (INIS)

Handmaker, H.

1976-01-01

A simple technique has been developed to study the differential kidney function. It involves the intravenous injection of a product labelled with sup(99m)Tc, which possesses in vivo the characteristics of organo-mercurial derivatives. High-resolution kidney images are obtained, eliminating the excretion component which may be obtained with DTPA type products studying the glomerular filtration. The absolute quantitative uptake and the left kidney to right kidney activity ratio were measured successfully. This technique should find an increasing application in the evaluation of patients suffering from various kidney disorders including hypertension and acute pyelonephritis [fr

PRIMARY SQUAMOUS CELL CARCINOMA OF RENAL PELVIS ASSOCIATED WITH RENAL CALCULUS AND RECURRENT PYONEPHROSIS

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Hoti Lal

2015-11-01

Full Text Available Primary Squamous Cell Carcinoma in the kidney is a rare malignant neoplasm associated with nephrolithiasis, typically monobacterial pyonephrosis and rarely Xanthogranulomatous pyelonephritis. It is an aggressive disease with a poor prognosis mostly due to lack of presenting clinical features like a palpable mass, gross haematuria and pain. We report a case presenting with renal calculus and pyonephrosis managed initially with percutaneous nephrostomy followed by nephrectomy due to complete loss of renal function. Histopathological evaluation revealed poorly differentiated squamous cell carcinoma which is managed by chemotherapy, although initially beneficial, patients later develop disseminated metastatic disease which holds a poor prognosis.

[Recurrent urinary tract infections should not be treated cavalierly. First verify the diagnosis!].

Science.gov (United States)

Wagenlehner, F M E; Naber, K G

2003-10-23

Acute uncomplicated cystitis (AUC) and acute uncomplicated pyelonephritis (AUP) are two common urinary tract infections (UTI) in otherwise healthy young women. Both weaknesses of the mucosal barrier and specific factors of uropathogenic bacteria must be present before the bacteria can adhere to the urothelium and give rise to an infection. These circumstances are also of relevance in recurrent UTI. Antibiotic treatment of AUC and AUP is based on the guidelines of the Infectious Diseases Society of America (IDSA). For the prevention of recurrent UTI, antibiotics, functional foods, injections, probiotic agents and other measures are recommended with varying potential for success.

Renal Transplant Ureteral Stenosis: Treatment by Self-Expanding Metallic Stent

International Nuclear Information System (INIS)

Cantasdemir, Murat; Kantarci, Fatih; Numan, Furuzan; Mihmanli, Ismail; Kalender, Betul

2003-01-01

We report the use of a metallic stent in a transplant ureteral stenosis. A 28-year-old man with chronic renal failure due to chronic pyelonephritis, who received a living-donor renal transplant, presented with transplant ureteral stenosis. The stenosis was unresponsive to balloon dilation and was treated by antegrade placement of a self-expanding Memotherm stent. The stentedureter stayed patent for 3 years. It may be reasonable to treat post-transplant ureteral stenosis resistant to balloon dilation with self-expanding metallic stents. However, long-term follow-up is required to evaluate the efficacy of this treatment

99mTc-DMSA scintigraphy in acute urinary tract infection in children

International Nuclear Information System (INIS)

Verboven, M.; Ingels, M.; Delree, M.; Piepsz, A.; Vrije Univ., Brussels

1990-01-01

24 children with symptomatic urinary tract infection (UTI) underwent systematically ultrasound studies (US) and 99m Tc-DMSA renal scans. Among the 15 patients considered as acute pyelonephritis (APN) on clinical grounds, the scan was abnormal in 12 cases, in contrast with only 1 abnormal scan in the clinical subgroup of the lower UTI. Among the 10 abnormal scans that were repeated later on, 6 did completely normalize. US showed only once a parenchymal appearance suggestive for APN. Our findings suggest that the DMSA scan has to be considered at present as the most sensitive imaging technique for the detection of APN. (orig.)

Post transplant urinary tract infection in Autosomal dominant polycystic kidney disease a perpetual diagnostic dilema - 18-fluorodeoxyglucose - Positron emission computerized tomography - A valuable tool

International Nuclear Information System (INIS)

Sainaresh, VV; Jain, SH; Patel, HV; Shah, PR; Vanikar, AV; Trivedi, HL

2011-01-01

Urinary tract infection (UTI) is the most common infection contracted by renal allograft recipients. In patients of autosomal dominant polycystic kidney disease (ADPKD), cyst infection presents a complex diagnostic and therapeutic challenge especially in the post transplant period. Accurate diagnosis forms the cornerstone in salvaging the graft from potentially catastrophic outcome. We describe a case of xanthogranulomatous pyelonephritis (XPN) in the native kidney in a patient of post transplant ADPKD which presented as frequently relapsing UTI with graft dysfunction where in accurate diagnosis was made possible with the aid of 18-fluorodeoxyglucose (FDG) - Positron emission computerized tomography (PET/CT)

Percutaneous Manual Aspiration Embolectomy of Renal Vein Thrombosis Due to Acute Pyelonephritis

International Nuclear Information System (INIS)

Novelli, Luigi; Raynaud, Alain; Pellerin, Olivier; Carreres, Thierry; Sapoval, Marc

2007-01-01

We report the case of a 50-year-old man who presented to our institution with septic thrombosis of the renal vein which had not resolved despite several days of antibiotic therapy. Optimal restoration of renal vein flow was obtained by percutaneous manual aspiration embolectomy (PMAE) in this patient with contraindication to fibrinolytic therapy and surgery

Genotypic and phenotypic characterisation of Escherichia coli strains associated with porcine pyelonephritis

DEFF Research Database (Denmark)

Krag, L.; Hancock, Viktoria; Aalbæk, B.

2009-01-01

Urinary tract infection (UTI) is a severe problem in humans as well as in many domestic animals like pigs. The most frequent infectious agent in UTI is uropathogenic Escherichia coli. Such strains have been extensively characterised with respect to virulence and fitness factors as well as clonal...

Should asymptomatic bacteriuria be screened in pregnancy?

Science.gov (United States)

Uncu, Y; Uncu, G; Esmer, A; Bilgel, N

2002-01-01

The incidence of asymptomatic bacteriuria is reported as 2-14% during pregnancy. Fetal and maternal complications like acute pyelonephritis, hypertension, anemia, preterm labor, low-birth-weight infants and intrauterine growth retardation can be expected. The purpose of this study was to determine the incidence of asymptomatic bacteriuria during pregnancy and its relation to pregnancy complications. The study involved 270 pregnant women up to 32 gestational weeks during a 9-month period. At the initial visit, they were screened with urine culture in order to detect asymptomatic bacteriuria. A control group was formed in a retrospective manner from the first day of the study with 186 pregnant women who delivered in our clinic and who were not screened for asymptomatic bacteriuria. The incidence of asymptomatic bacteriuria was 9.31%. Escherichia coli accounted for 79%, which was the most frequent of the isolates. We observed recurrence and had to apply treatment again to 21.7% of the women. The sensitivity, specificity, positive predictive and negative predictive values of leucocyturia as a screening test for asymptomatic bacteriuria were 91.3%, 83.6%, 45.6% and 98.5%, respectively. We diagnosed preterm labor in six of 23 (26%) with asymptomatic bacteriuria and 16 in 163 (9.3%) women in the urine culture negative group. The ratio acute pyelonephritis in the group which was routinely screened and treated for asymtomatic bacteriuria was 0.5% while the prevalence was 2.1% in the nonscreened group. Considering the relatively high incidence of asymptomatic bacteriuria during pregnancy and the relevant complications, we propose to screen and treat asymptomatic bacteriuria routinely in all pregnant women.

Virulence Genes and Antibiotic Susceptibilities of Uropathogenic E. coli Strains.

Science.gov (United States)

Uzun, Cengiz; Oncül, Oral; Gümüş, Defne; Alan, Servet; Dayioğlu, Nurten; Küçüker, Mine Anğ

2015-01-01

The aim of this study is to detect the presence of and possible relation between virulence genes and antibiotic resistance in E. coli strains isolated from patients with acute, uncomplicated urinary tract infections (UTI). 62 E. coli strains isolated from patients with acute, uncomplicated urinary tract infections (50 strains isolated from acute uncomplicated cystitis cases (AUC); 12 strains from acute uncomplicated pyelonephritis cases (AUP)) were screened for virulence genes [pap (pyelonephritis-associated pili), sfa/foc (S and F1C fimbriae), afa (afimbrial adhesins), hly (hemolysin), cnf1 (cytotoxic necrotizing factor), aer (aerobactin), PAI (pathogenicity island marker), iroN (catecholate siderophore receptor), ompT (outer membrane protein T), usp (uropathogenic specific protein)] by PCR and for antimicrobial resistance by disk diffusion method according to CLSI criteria. It was found that 56 strains (90.3%) carried at least one virulence gene. The most common virulence genes were ompT (79%), aer (51.6%), PAI (51.6%) and usp (56.5%). 60% of the strains were resistant to at least one antibiotic. The highest resistance rates were against ampicillin (79%) and co-trimoxazole (41.9%). Fifty percent of the E. coli strains (31 strains) were found to be multiple resistant. Eight (12.9%) out of 62 strains were found to be ESBL positive. Statistically significant relationships were found between the absence of usp and AMP - SXT resistance, iroN and OFX - CIP resistance, PAI and SXT resistance, cnf1 and AMP resistance, and a significant relationship was also found between the presence of the afa and OFX resistance. No difference between E. coli strains isolated from two different clinical presentations was found in terms of virulence genes and antibiotic susceptibility.

Indications for pediatric 99mTc-dimercaptosuccinic-scintigraphy

International Nuclear Information System (INIS)

Meller, J.; Becker, W.; Zappel, H.

2000-01-01

This paper gives an overview about the diagnostic use of 99m Tc-Dimercaptosuccinic ( 99m Tc-DMSA)-scintigraphy in siblings and children and presents our own results with this tracer in pediatric nephro-urology. 99m Tc-DMSA offers a high renal accumulation and therefore is suited for the diagnosis of renal malformations. Furthermore, a calculation of the tubular renal split function and imaging of the renal cortex is possible due its high tubular retention. The tracer may be used with success in the non invasive diagnostic work up of both renoparenchymal and renovascular hypertension in childhood and especially in the diagnosis of segmental renal artery stenosis. Scintigraphy with 99m Tc-DMSA is a simple and highly effective method in the diagnosis of pyelonephritis and renal scarring. It offers important informations about the further prognosis of a child with urinary tract infection. In upper urinary tract infection 99m Tc-DMSA-scintigraphy may be more specific than available clinical tests. In the diagnosis of pyelonephritis and renal scarring scintigraphic imaging has been proven to be more sensitive than pyelography and ultrasound and its diagnostic power is at least equal compared with computed tomography. Therefore, imaging with 99m Tc-DMSA can be considered as the reference method in these questions. Regarding that reflux is seen in less than 40% of children with a pathologic DMSA-scan and that the prognosis of children with an urinary tract infection without a pathologic DMSA-scan is usually good, one could question the use of micturating cystourethrography in the diagnostic work up of children with symptomatic urinary tract infection and a normal DMSA-scan. (orig.) [de

Radionuclide and/or radiological technique as a comprehensive renal function study in clinical pediatric pratice

International Nuclear Information System (INIS)

D'Errico, G.; La Vecchia, G.; Nodari, A.; Cenci, F.

1984-01-01

84 patients with clinically suspected urinary pathway pathology always underwent CRRA (Computerized Radionuclide Renal Angiography) and IVP (Intra Venous Pyelography); in some selected children RC (Retrograde Cystography) and CRDC (Computerized Retrograde Cysto Scintigraphy) and/or RCS (Retrograde Cysto Scintigraphy) and/or RCS (Retrograde Cysto Scintigraphy) were performed. These children, ranging from 1 day to 14 years of age, were classified, on the basis of clinical features, as: glomerulonephritis (34 cases); pyelonephritis (7 cases); vesico-ureteral reflux (15 cases); kidney and/or urinary tract malformations (29 cases). Clinical suspicion was proven by radioisotope and radiographic studies in 55 patients, namely: glomerulonephritis (23 cases); pyelonephritis (5 cases); vesico-ureteral reflux (11 cases); kidney and/or urinary tract malformation (16 cases). Among complications of the last pathology two cases of pyelo-pyelic reflux in a Y shaped duplication, cause of recurrent lumbar pain and urinary infection, not detected by IVP and RC, were discovered by CRRA; in addition two cases of vesico-ureteral reflux in patients with recurrent urinary infection were detected by CRDC but not confirmed by RC (these refluxes were considered as insignificant and transient). In our opinion, radioisotope studies (CRRA-CRDC-RCS) by i.v. injection (99m-Tc-DTPA; 0.30 MBq/kg) or by vesical catheterisation (99m-Tc-pertecnetate; 18 MBq) are particularly useful to differentiate complete from incomplete, organic from functional urinary tract obstruction, since they allow a quantitative assessment of both kidney function and unilateral renal impairment. Radiographic examination (IVP and RC), on the other hand, provide more detailed anatomical information, but are less suitable for monitoring treatment because of the higher radiation dose delivered to the patients. (Author)

Human Alpha Defensin 5 Expression in the Human Kidney and Urinary Tract

Science.gov (United States)

Porter, Edith; Bevins, Charles L.; DiRosario, Julianne; Becknell, Brian; Wang, Huanyu

2012-01-01

Background The mechanisms that maintain sterility in the urinary tract are incompletely understood. Recent studies have implicated the importance of antimicrobial peptides (AMP) in protecting the urinary tract from infection. Here, we characterize the expression and relevance of the AMP human alpha-defensin 5 (HD5) in the human kidney and urinary tract in normal and infected subjects. Methodology/Principal Findings Using RNA isolated from human kidney, ureter, and bladder tissue, we performed quantitative real-time PCR to show that DEFA5, the gene encoding HD5, is constitutively expressed throughout the urinary tract. With pyelonephritis, DEFA5 expression significantly increased in the kidney. Using immunoblot analysis, HD5 production also increased with pyelonephritis. Immunostaining localized HD5 to the urothelium of the bladder and ureter. In the kidney, HD5 was primarily produced in the distal nephron and collecting tubules. Using immunoblot and ELISA assays, HD5 was not routinely detected in non-infected human urine samples while mean urinary HD5 production increased with E.coli urinary tract infection. Conclusions/Significance DEFA5 is expressed throughout the urinary tract in non-infected subjects. Specifically, HD5 is expressed throughout the urothelium of the lower urinary tract and in the collecting tubules of the kidney. With infection, HD5 expression increases in the kidney and levels become detectable in the urine. To our knowledge, our findings represent the first to quantitate HD5 expression and production in the human kidney. Moreover, this is the first report to detect the presence of HD5 in infected urine samples. Our results suggest that HD5 may have an important role in maintaining urinary tract sterility. PMID:22359618

A New Urease Inhibitor from Viola betonicifolia

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Naveed Muhammad

2014-10-01

Full Text Available Urease has attracted much attention, as it is directly involved in the formation of infection stones and contributes to the pathogenesis of urolithiasis, pyelonephritis, ammonia and hepatic encephalopathy, hepatic coma and urinary catheter encrustation. Moreover, urease is the major cause of pathologies induced by H. pylori, such as gastritis and peptic ulcer. In the present work, the new natural compound, 3-methoxydalbergione, was isolated from Viola betonicifolia. A mechanistic study of this compound as a natural urease inhibitor was performed by using enzyme kinetics and docking studies. 3-Methoxydalbergione could be considered as a lead molecule for drugs useful in the urease associated diseases.

Asymptomatic bacteriuria and symptomatic urinary tract infections during pregnancy.

Science.gov (United States)

Macejko, Amanda M; Schaeffer, Anthony J

2007-02-01

Urinary tract infections are common complications of pregnancy; upper tract infections in particular may lead to significant morbidity for both the mother and fetus. Bacteriuria is a significant risk factor for developing pyelonephritis in pregnant women. Therefore, proper screening and treatment of bacteriuria during pregnancy is necessary to prevent complications. All women should be screened for bacteriuria in the first trimester, and women with a history of recurrent urinary tract infections or anomalies should have repeat bacteriuria screening throughout pregnancy. Treatment of bacteriuria should include 3-day therapy with appropriate antimicrobials, and women should be followed closely after treatment because recurrence may occur in up to one third of patients.

Chronic renal failure due to unilateral renal agenesis and total renal dysplasia (=aplasia)

International Nuclear Information System (INIS)

Kroepelin, T.; Ziupa, J.; Wimmer, B.

1983-01-01

Three adult patients with unilateral renal agenesis/total dysplasia (= aplasia) and with an early chronic renal failure are presented. One patient had renal agenesis without ureter bud and ureteric ostium on one side, and reflux pyelonephritis on the other; one had small compact total renal dysplasia (= aplasia) on one side, while chronic uric acid nephropathy (chronic renal disease as a cause of gout) was diagnosed on the other; the third patient had a total large multicystic dysplasia on one side, and on the other a segmental large multicystic dysplasia. Radiological steps and radiodiagnostic criteria are discussed and the combination of urogenital and extraurogenital anomalies is referred to. (orig.)

Scintigraphic detection of 'yo-yo' phenomenon in incomplete ureteric duplication

International Nuclear Information System (INIS)

Chu, Winnie C.W.; Chan, Kam-wing; Metreweli, Constantine

2003-01-01

'Yo-yo' reflux in an incompletely duplicated renal system was demonstrated on 99m Tc-mercaptoacetyltriglycine (MAG3) renal scintigraphy in a 7-year-old girl presenting with low-grade fever and pyelonephritis. Incomplete duplication and a bifid renal pelvis, which may be seen in up to 4% of the North American population, occasionally causes symptoms because of recurrent urinary tract infection or loin pain. 99m Tc-MAG3 renal scintigraphy can demonstrate 'yo-yo' reflux in patients with incomplete renal duplication and should be considered in cases with unexplained loin pain, even if 99m Tc-dimercaptosuccinic acid (DMSA) renal scintigraphy is normal. (orig.)

DMSA 99mTc an old molecule for a new future

International Nuclear Information System (INIS)

Moretti, J.L.

1992-01-01

This lecture is concerned with the use of DMSA 99m Tc in nephrology. It described human pharmaceutic and clinical applications of this radiopharmaceutical. As DMSA 99m Tc concentrates actively in the proximal convoluted tubule, it gives an image of functional renal mass. Its integrity is dependent upon several factors, predominantly intrarenal blood flow and intact enzyme function. Its role in pathology is clear in pyelonephritis, hydronephrotic kidney and pediatric diseases. The irradiation dosimetry of DMSA 99m Tc is well established, the critical organ is the renal cortex which receives between 15 and 250 mGy per MBq. Dosimetry remains favourable for the patients if compared with intravenous urography

Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review.

Science.gov (United States)

Angelescu, Konstanze; Nussbaumer-Streit, Barbara; Sieben, Wiebke; Scheibler, Fülöp; Gartlehner, Gerald

2016-11-02

Most European and North American clinical practice guidelines recommend screening for asymptomatic bacteriuria (ASB) as a routine pregnancy test. Antibiotic treatment of ASB in pregnant women is supposed to reduce maternal upper urinary tract infections (upper UTIs) and preterm labour. However, most studies supporting the treatment of ASB were conducted in the 1950s to 1980s. Because of subsequent changes in treatment options for ASB and UTI, the applicability of findings from these studies has come into question. Our systematic review had three objectives: firstly, to assess the patient-relevant benefits and harms of screening for ASB versus no screening; secondly, to compare the benefits and harms of different screening strategies; and thirdly, in case no reliable evidence on the overarching screening question was identified, to determine the benefits and harms of treatment of ASB. We systematically searched several bibliographic databases, trial registries, and other sources (up to 02/2016) for randomised controlled trials (RCTs) and prospective non-randomised trials. Two authors independently reviewed abstracts and full-text articles and assessed the risk of bias of the studies included. As meta-analyses were not possible, we summarised the results qualitatively. We did not identify any eligible studies that investigated the benefits and harms of screening for ASB versus no screening or that compared different screening strategies. We identified four RCTs comparing antibiotics with no treatment or placebo in 454 pregnant women with ASB. The results of 2 studies published in the 1960s showed a statistically significant reduction in rates of pyelonephritis (odds ratio [OR] = 0.21, 95 % confidence interval [CI] 0.07-0.59) and lower UTI (OR = 0.10, 95 % CI 0.03-0.35) in women treated with antibiotics. By contrast, event rates reported by a recent study were not statistically significantly different, neither regarding pyelonephritis (0 % vs. 2.2 %; OR�

A rational approach to imaging the upper urinary tract in children with pyelonephritis

International Nuclear Information System (INIS)

Merrick, M.V.; Glass, J.; Uttley, W.S.

1982-01-01

At least seven techniques of imaging the urinary tract are commonly used for the investigation of children in whom infection is suspected or proven, namely Excretion Urography (EU), Micturating Cysto-Urethrography (MCU), Isotope Renography (IR), Indirect Radionucleide Voiding Cysto-Urethrography (IRVC), Renal Scintigraphy (RS), Direct Radionucleide Voiding Cysto-Urethrography (DRVC) and Ultrasonography (US). There is at the present time no single investigation which is clearly suitable for use as a stand-alone screening test for predicting risk of progressive renal damage in children with upper tract infections. Radioisotope renography, associated with indirect radionuclide voiding cysto-urethrography, and supplemented by ultrasound may be the combination of tests which give the maximum information for the lowest radiation dose

Management of group B streptococcal bacteriuria in pregnancy.

Science.gov (United States)

Allen, Victoria M; Yudin, Mark H

2012-05-01

To provide information regarding the management of group B streptococcal (GBS) bacteriuria to midwives, nurses, and physicians who are providing obstetrical care. The outcomes considered were neonatal GBS disease, preterm birth, pyelonephritis, chorioamnionitis, and recurrence of GBS colonization. Medline, PubMed, and the Cochrane database were searched for articles published in English to December 2010 on the topic of GBS bacteriuria in pregnancy. Bacteriuria is defined in this clinical practice guideline as the presence of bacteria in urine, regardless of the number of colony-forming units per mL (CFU/mL). Low colony counts refer to pregnancies in which it is appropriate to treat GBS bacteriuria to optimize maternal and perinatal outcomes, to reduce the occurrences of antibiotic anaphylaxis, and to prevent increases in antibiotic resistance to GBS and non-GBS pathogens. No cost-benefit analysis is provided. 1. Treatment of any bacteriuria with colony counts ≥ 100 000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics. (II-2A) 2. Women with documented group B streptococcal bacteriuria (regardless of level of colony-forming units per mL) in the current pregnancy should be treated at the time of labour or rupture of membranes with appropriate intravenous antibiotics for the prevention of early-onset neonatal group B streptococcal disease. (II-2A) 3. Asymptomatic women with urinary group B streptococcal colony counts pregnancy should not be treated with antibiotics for the prevention of adverse maternal and perinatal outcomes such as pyelonephritis, chorioamnionitis, or preterm birth. (II-2E) 4. Women with documented group B streptococcal bacteriuria should not be re-screened by genital tract culture or urinary culture in the third trimester, as they are presumed to be group B streptococcal colonized. (II-2D).

Strategy to reduce E. coli bacteraemia based on cohort data from a London teaching hospital.

Science.gov (United States)

Hsu, Desmond; Melzer, Mark

2018-04-01

In 2017, National Health Service Improvement set a 10% reduction target for Escherichia coli bacteraemia by 2018, followed by a 50% reduction in healthcare-associated Gram-negative bacteraemias by 2022. We analysed consecutive cases of E. coli bacteraemia and devised a strategy to achieve these targets. From December 2012 to November 2013, demographic, clinical and microbiological data were prospectively collected on all patients with bacteraemia at the Royal London Hospital in East London, UK. There were 594 significant bacteraemic episodes and 207 (34.8%) were E. coli . Twenty-four (11.6%) of the E. coli isolates were extended spectrum beta-lactamase producers, 22 (10.6%) gentamicin resistant and 2 (1.0%) amikacin resistant. The three most common sites of infection were pyelonephritis 105 (56.7%), catheter-associated urinary tract infection 22 (10.6%), and other medical devices and procedures that cause bacteraemia 32 (15.5%). In the pyelonephritis group, trimethoprim resistance in urinary isolates was 16/47 (34.0%) compared with 3/47 (6.4%) for nitrofurantoin. Twelve months postbacteraemia, recurrent bacteraemia rates were 10/105 (9.5%). There were 44 medical device-associated E. coli bacteraemias, and 22 (50%) were urinary catheter associated. There were 10 patients with E. coli bacteraemia caused by procedures, seven genitourinary or biliary tract instrumentation and three postgastrointestinal surgery. E. coli bacteraemias related to urosepsis could have been prevented by better empirical treatment and targeted prophylaxis. Urinary catheter quality improvement programmes should contribute to a further reduction. For patients undergoing high-risk urinary or biliary tract procedures or device manipulation, we advocate single-dose amikacin prophylaxis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Preconception prophylactic of the urinary tract infection in women of high-risk groups: reserves to reduce perinatal and obstetric complications

Directory of Open Access Journals (Sweden)

A. Limanskaya

2016-06-01

Full Text Available The aim of the study is to reveal the effectiveness of «Novoks» manufacturing by Organosin companies in preconception treatment of urinary tract infections in women with lupus nephritis and pyelonephritis gestational history. Material and methods. The study involved 30 women with gestational pyelonephritis history and 15 women with lupus nephritis. Inclusion criteria were the presence of at least one of the clinical symptoms (pain in the lumbar region, dysuria, pain in the PST region in conjunction with microbiological criteria: number of leukocytes in the urine over a field of view of 10–15; the number of colony forming units of a microorganism > 104; sensitivity to levofloxacin as a result of urine culture. Inclusion criteria: urinalysis, urine culture with antibiotic susceptibility, clinical and biochemical blood tests, an ultrasound examination of the kidneys. All women received the drug Novaks (Organosin 500 mg once daily for 5–7 days, and the probiotic Probiz Femina 1 capsule 2 times per day till 14 days. Results. After a treatment with Novaks in combination with a probiotic Probiz-Femina (Organosin noted a progressive decrease in the degree of bacteriuria, which was manifested during a urine test research absence of bacteria and decrease the number of white blood cells. Also regressed inflammatory changes in the peripheral blood. During the control urine culture after 10 days of treatment and 1 month later, revealed no growth of pathogenic organisms in the relevant titer. Conclusions. Novoks (levofloxacin is recommended for use in preconception prevention and treatment of infectious diseases of the urinary system in women at high risk. Using microbial interference therapy using modern probiotic Probiz Femina leads to a significant improvement in intestinal microbiocenosis in antibiotic therapy, reduce contamination of the intestines and the vagina, which allows you to take drug treatment Novaks without impairing the quality of life.

Genetic polymorphisms in Toll-like receptors among pediatric patients with renal parenchymal infections of different clinical severities.

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Chi-Hui Cheng

Full Text Available BACKGROUND: Although several studies have suggested single gene defects or variations in the genes associated with host immune response could confer differences in susceptibility to urinary pathogen invasion, no studies have examined the genetic polymorphisms in various toll-like receptors (TLRs that activate innate immune responses in pediatric renal parenchymal infections of different clinical severities, namely acute pyelonephritis and the clinically more severe disease, acute lobar nephronia. METHODOLOGY: Patients who fulfilled the diagnostic criteria for acute pyelonephritis (APN and acute lobar nephronia (ALN without underlying diseases or structural anomalies, except for vesicoureteral reflux (VUR, were enrolled. Genotyping of the single nucleotide polymorphisms (SNPs in the genes encoding TLR-1, TLR-2, TLR-4, TLR-5, and TLR-6 was performed by matrix-assisted laser desorption/ionization time-of-flight-based mini-sequencing analysis. PRINCIPAL FINDINGS: A total of 16 SNPs were selected for genotyping. Analysis of 96 normal and 48 patients' samples revealed that only four SNPs had heterozygosity rates >0.01. These SNPs were selected for further investigation. Hardy-Weinberg equilibrium was satisfied for the observed genotype frequencies. Statistically significant differences in the genotype frequency of TLR-2 (rs3804100, T1350C between controls and ALN or (APN+ALN combined group were identified using the recessive model with the correction for multiple-SNP testing. Further genotype pattern frequency analysis in TLR-2 SNPs (rs3804099 and rs3804100 showed significantly reduced occurrence of the rare allele homozygote (CC+CC in the no-VUR subgroup of APN and ALN cases. CONCLUSIONS: As the inflammatory responses in ALN patients are more severe than those in APN patients (higher CRP levels, longer duration of fever after antibiotic treatment, these findings suggest that the genetic variant in TLR-2 (rs3804100, T1350C may protect the host from

Hypertensive disease and renal hypertensions: renal structural and functional studies by using dynamic computed tomography

International Nuclear Information System (INIS)

Arabidze, G.G.; Pogrebnaya, G.N.; Todua, F.I.; Sokolova, R.I.; Kozdoba, O.A.

1989-01-01

Dynamic computed tomography was conducted by the original methods; the findings were analyzed by taking into account time-density curves which made it possible to gain an insight into the status of blood flow and filtration in each individual kidney. Computed tomography and dynamic computed tomography revealed that hypertensive disease was characterized by normal volume and thickness of the renal cortical layer and symmetric time-density curves, whereas a hypertensive type of chronic glomerulonephritis featured lower renal cartical layer thickness, reduced renal volume, symmetrically decrease amplitudes of the first and second peaks of the time-density curve, chronic pyelonephritis showed asymmetric time-density diagrams due to the lower density areas in the afflicted kidney

Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation

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Young Kun Lee

2015-08-01

Full Text Available Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN, for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.

Radioimmunoassay of changes in the level of. beta. -2-microglobulin in neoplasms

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Zubovskij, L G; Polevaya, E B; Kirsanov, A G; Shiryaev, S V [Akademiya Meditsinskikh Nauk SSSR, Moscow. Onkologicheskij Nauchnyj Tsentr

1982-08-01

A study was made of 17 practically healthy persons, 12 patients with benign tumors, 8 with chronic pyelonephritis, 70 with renal carcinoma, 51 with breast carcinoma, 11 with pulmonary cancer, 7 with prostatic cancer, 23 with gastric cancer and 8 with colonic cancer at different stages of disease and therapy. The concentration of ..beta..-2-microglobulin was measured using the Pharmacia commercial kit of reagents (Sweden). It has been established that in spite of the elevated mean level of ..beta..-2-microglobulin, almost half of the patients have normal concentration of this protein. Altogether the number of coincidences of the elevated level of ..beta..-2-microglobulin with the presence of malignancy for the above sites was 48.7%.

PROBLEMATIC ISSUES OF CAUSAL TREATMENT FOR URINARY TRACT INFECTIONS IN CHILDREN

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V. I. Kirillov

2016-01-01

Full Text Available The review gives data on shortcomings in the antimicrobial measures that are associated with the defects in the effective treatment of urinary system infections, such as the high risk of disease relapses and the stable proportion of secondary pyelonephritis among the causes of chronic renal failure. The vulnerability of this approach is to accelerate the rate of acquiring the resistance of uropathogens to the currently available antibiotics that may also have a number of side effects, including those involved in the pathogenesis of urinary tract infections. Difficulties in conducting adequate causal therapy are also associated with some subjective factors that largely hamper the personalized diagnosis of diseases of causative agents.

[Results of two treatment regimens for pyelonephritis during pregnancy and correlation with pregnancy outcome].

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Calegari, Saron Souza; Konopka, Cristine Kolling; Balestrin, Bruna; Hoffmann, Maurício Scopel; de Souza, Floriano Soeiro; Resener, Elaine Verena

2012-08-01

To determine the epidemiological profile of women admitted for urinary tract infection as well as to verify the most prevalent agents and response to antibiotic therapy. A retrospective study of 106 pregnant women admitted to a university hospital for urinary tract infection treatment during the period between January 2007 to December 2010. The evaluation was based on analysis of the medical records of these pregnant women, with the observation of hospitalization and pregnancy data, as well as its outcome. Statistical analysis was performed using Statistical Package for the Social Science, version 15.0. The bilateral Fisher exact test and Student's t test were used for data analysis, as well as descriptive statistical methods. Positive urine cultures were observed in 60.5% of pregnant women admitted due to urinary tract infection. The most frequent infectious agent was Escherichia coli and no difference in resistance, recurrence or complications was observed between the most frequent etiologic agents. Pregnant women with previous UTI had a higher recurrence risk (OR=10.8; p<0.05). The antibiotics most commonly used during hospitalization were ampicillin and cefazolin. Change of therapeutic agent due to bacterial resistance occurred in 11.9% of patients who took cefazolin and in 20% of patients who took ampicillin (OR=5.5; p<0.05). The rate of gestational complications was the same for both treatments. There was no difference in mean number of days of hospitalization between the treatments. In the studied population ampicillin showed a higher rate of bacterial resistance than cefazolin, requiring a larger number of treatment regimen exchanges, without resulting in differences in clinical outcome or time of hospitalization.

Sorting the Alphabet Soup of Renal Pathology: A Review.

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Curran-Melendez, Sheilah M; Hartman, Matthew S; Heller, Matthew T; Okechukwu, Nancy

2016-01-28

Diseases of the kidney often have their names shortened, creating an arcane set of acronyms which can be confusing to both radiologists and clinicians. This review of renal pathology aims to explain some of the most commonly used acronyms within the field. For each entity, a summary of the clinical features, pathophysiology, and radiological findings is included to aid in the understanding and differentiation of these entities. Discussed topics include acute cortical necrosis, autosomal dominant polycystic kidney disease, angiomyolipoma, autosomal recessive polycystic kidney disease, acute tubular necrosis, localized cystic renal disease, multicystic dysplastic kidney, multilocular cystic nephroma, multilocular cystic renal cell carcinoma, medullary sponge kidney, paroxysmal nocturnal hemoglobinuria, renal papillary necrosis, transitional cell carcinoma, and xanthogranulomatous pyelonephritis. Copyright © 2016 Mosby, Inc. All rights reserved.

Spontaneous Dissection of the Renal Artery in Vascular Ehlers-Danlos Syndrome

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Filipa Pereira

2015-01-01

Full Text Available Ehlers-Danlos syndrome (EDS is a rare heterogeneous group of connective tissue disorders. The vascular type (vEDS is an autosomal dominant disorder caused by heterozygous mutations in the COL3A1 gene predisposing to premature arterial, intestinal, or uterine rupture. We report a case of a 38-year-old woman with a recent diagnosis of vEDS admitted in the Emergency Department with a suspicion of a pyelonephritis that evolved to a cardiopulmonary arrest. A fatal retroperitoneal hematoma related with a haemorrhagic dissection of the right renal artery was found after emergency surgery. This case highlights the need to be aware of the particular characteristics of vEDS, such as a severe vascular complication that can lead to a fatal outcome.

Urinary tract infections during pregnancy - an updated overview.

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Szweda, Hanna; Jóźwik, Marcin

Urinary tract infections (UTIs) are the most common type of infection during pregnancy, affecting up to 10% of pregnant women. They are also recognized as the second most common ailment of pregnancy, after anemia. Three clinical types of pregnancy-related UTI are distinguished: asymptomatic bacteriuria (ASB), cystitis, and pyelonephritis. A particular form of ASB is the presence of Group B streptococci in the urinary tract of the pregnant woman. All clinical types of UTI may lead to serious maternal and fetal complications. Therefore, unlike in the nonpregnant female patient, all UTIs during pregnancy, including the asymptomatic infection, require treatment. In some patients, antibiotic prophylaxis should also be introduced. In the present work, we collectively summarize current practical recommendations from a number of international bodies and organizations.

Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems.

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Matuszkiewicz-Rowińska, Joanna; Małyszko, Jolanta; Wieliczko, Monika

2015-03-16

Urinary tract infections (UTIs) are common in pregnant women and pose a great therapeutic challenge, since the risk of serious complications in both the mother and her child is high. Pregnancy is a state associated with physiological, structural and functional urinary tract changes which promote ascending infections from the urethra. Unlike the general population, all pregnant women should be screened for bacteriuria with urine culture, and asymptomatic bacteriuria must be treated in every case that is diagnosed, as it is an important risk factor for pyelonephritis in this population. The antibiotic chosen should have a good maternal and fetal safety profile. In this paper, current principles of diagnosis and management of UTI in pregnancy are reviewed, and the main problems and controversies are identified and discussed.

Vesical-ureteral reflux in children

International Nuclear Information System (INIS)

Desvignes, V.; Palcoux, J.B.; Cochat, P.

1995-01-01

The vesical-ureteral reflux is the most frequent uropathy in children. The diagnosis is made by uretero-cystography, often after pyelonephritis, sometimes after ante-natal diagnosis from echographic abnormalities. Spontaneous recovery is possible in 50 to 80% of cases. This is especially true in grade 1, 2 and 3, however complications may occur. They are more frequent in the case of reflux nephropathy with a resulting risk of hypertension and chronic renal failure. The therapeutic choice is between the conservative management with urinary antiseptics ad the surgical treatment with ureters re-implantation or endoscopic treatment. The therapeutic indications take into account vesical-ureteral reflux grades, the child's age, the associated diseases and the child's and parents' compliance. (authors). 22 refs., 2 figs

Evaluation of renal scintigraphy and renography for the cases of severe allergic reactions to urinary contrast media

International Nuclear Information System (INIS)

Yanagisawa, Munetoshi; Machida, Toyohei; Miki, Makoto; Ohishi, Yukihiko; Ueda, Masataka

1981-01-01

The evaluation of nuclear medical examination had been observed in eight cases who had had severe complications of urinary contrast media. These were 2 ureter calculus, 2 pyelonephritis, 2 idiopathic renal hematuria, 1 renal cell carcinoma and 1 renal tuberculosis. All of the eight cases were performed by renal scintigraphy with sup(99m)Tc-DTPA, four cases by renography with 131 I-Hippuran and one case was performed by renography with sup(99m)Tc-DTPA. Allergie complications were not observed in all of the eight cases with satisfactory informations by the nuclear medical examinations. In conclusion we think that the nuclear medical examinations are helpful in patients with iodine-allergy complication by using other urological examinations together. (author)

Prospective, randomized, double-blind, Phase 2 dose-ranging study comparing efficacy and safety of imipenem/cilastatin plus relebactam with imipenem/cilastatin alone in patients with complicated urinary tract infections.

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Sims, Matthew; Mariyanovski, Valeri; McLeroth, Patrick; Akers, Wayne; Lee, Yu-Chieh; Brown, Michelle L; Du, Jiejun; Pedley, Alison; Kartsonis, Nicholas A; Paschke, Amanda

2017-09-01

The β-lactamase inhibitor relebactam can restore imipenem activity against imipenem non-susceptible pathogens. To explore relebactam's safety, tolerability and efficacy, we conducted a randomized (1:1:1), controlled, Phase 2 trial comparing imipenem/cilastatin+relebactam 250 mg, imipenem/cilastatin+relebactam 125 mg and imipenem/cilastatin alone in adults with complicated urinary tract infections (cUTI) or acute pyelonephritis, regardless of baseline pathogen susceptibility. Treatment was administered intravenously every 6 h for 4-14 days, with optional step-down to oral ciprofloxacin. The primary endpoint was favourable microbiological response rate (pathogen eradication) at discontinuation of intravenous therapy (DCIV) in the microbiologically evaluable (ME) population. Non-inferiority of imipenem/cilastatin+relebactam over imipenem/cilastatin alone was defined as lower bounds of the 95% CI for treatment differences being above -15%. At DCIV, 71 patients in the imipenem/cilastatin + 250 mg relebactam, 79 in the imipenem/cilastatin + 125 mg relebactam and 80 in the imipenem/cilastatin-only group were ME; 51.7% had cUTI and 48.3% acute pyelonephritis. Microbiological response rates were 95.5%, 98.6% and 98.7%, respectively, confirming non-inferiority of both imipenem/cilastatin + relebactam doses to imipenem/cilastatin alone. Clinical response rates were 97.1%, 98.7% and 98.8%, respectively. All 23 ME patients with imipenem non-susceptible pathogens had favourable DCIV microbiological responses (100% in each group). Among all 298 patients treated, 28.3%, 29.3% and 30.0% of patients, respectively, had treatment-emergent adverse events. The most common treatment-related adverse events across groups (1.0%-4.0%) were diarrhoea, nausea and headache. Imipenem/cilastatin + relebactam (250 or 125 mg) was as effective as imipenem/cilastatin alone for treatment of cUTI. Both relebactam-containing regimens were well tolerated. (NCT01505634). �

Bladder volume at onset of vesicoureteral reflux is an independent risk factor for breakthrough febrile urinary tract infection.

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Alexander, Siobhan E; Arlen, Angela M; Storm, Douglas W; Kieran, Kathleen; Cooper, Christopher S

2015-04-01

Improved identification of children with vesicoureteral reflux at risk for recurrent febrile urinary tract infection may impact management decisions. We hypothesized that reflux occurring earlier during bladder filling increases the duration of exposure of the kidneys to bacteria, and, therefore, increases the risk of pyelonephritis. Children with vesicoureteral reflux and detailed voiding cystourethrogram data were identified. Bladder volume at onset of reflux was normalized for age. Demographics, reflux grade, laterality, presence/absence of bladder-bowel dysfunction and breakthrough febrile urinary tract infections were assessed. Median followup was 24 months (IQR 12 to 52). A total of 208 girls and 47 boys were analyzed with a mean ± SD age at diagnosis of 3.1 ± 2.6 years. On univariate analysis history of febrile urinary tract infection (HR 2.17, 95% CI 1.33-2.85, p = 0.01), dilating vesicoureteral reflux (HR 1.6, 95% CI 1.05-2.42, p = 0.03) and bladder-bowel dysfunction (HR 1.66, 95% CI 0.99-2.75, p = 0.05) were associated with an increased risk of breakthrough febrile urinary tract infection. Median bladder volume at onset of reflux in children with breakthrough febrile urinary tract infection was significantly less (33.1%) than in those without infection (49.5%, p = 0.003). Reflux onset at 35% predicted bladder capacity or less was associated with a significantly increased risk of breakthrough febrile urinary tract infection on multivariate analysis (HR 1.58, 95% CI 1.05-2.38, p = 0.03). Children with early filling vesicoureteral reflux are at increased risk for breakthrough febrile urinary tract infection independent of reflux grade. Bladder volume at onset of reflux should be recorded during cystograms since it provides additional prognostic information about the risk of pyelonephritis and resolution, and may assist with counseling and clinical decision making. Copyright © 2015 American Urological Association Education and Research, Inc. Published by

Hypercalciuria, a promoting factor to urinary tract infection in children

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Gheissari Alaleh

2009-01-01

Full Text Available Aim: Urinary tract infection (UTI is one of the most common diseases of urogenital tract in children. Detecting predisposing factors for UTI takes an important place in managing patients with UTI. Recently, a few studies emphasized on idiopathic hypercalciuria (IH as a predisposing factor for UTI and dysfunctional voiding. Therefore, we carried out a survey to find out whether non-calculus IH is a contributing factor in children with the first attack of pyelonephritis. Materials and Methods: This is a case-control study carried out on 60 children aged 2-11 years admitted at St Al-Zahra hospital, Isfahan, Iran, with the first episode of upper UTI and 200 age- and gender-matched normal healthy children between September 2003 and February 2005. We used second fasting spot urine sample to measure calcium and creatinine. Two urine samples were obtained one week apart to increase the accuracy of measurement. All samples were collected after at least 6 weeks of completing the treatment course of pyelonephritis. Ultrasound examination and VCUG were performed in all patients before entering the survey as case group to rule out obstruction and VUR. Results: Mean age of case and control group were 4.86 ± 3.08 years and 4.22 ± 2.9 years, respectively. The mean calcium to creatinine ratio (Ca/Cr in case and control group were 0.308 ± 0.21 and 0.208 ± 0.12 mg/mg, respectively, P < 0.001. The difference between the mean values of these two groups was significant only in age group ≤6 years, P < 0.0001 and odds ratio was 2.1 (95% CI 1.03-7.8. After determining the mean values of urine Ca/Cr ration according to both age groups and gender, it was cleared that only significant difference was related to male < 6 years. Conclusion: The likelihood of hypercalciuria should be assessed especially in male children with UTI and without any urinary tract obstruction.

Results and technical problems of therapeutic vascular embolization with special reference to the use of spirals

International Nuclear Information System (INIS)

Grosse-Vorholt, R.; Zeitler, E.

1980-01-01

31 therapeutic vascular embolizations were performed: 4 for osteolytic lesions; 24 for renal tumors and 3 for malignant hypertension in 3 patients with chronic pyelonephritis and corresponding bilateral kidney shrinkage with the kidneys left in the patients (-one patient being put on chronic dialysis and 2 having undergone renal transplantation). Opacifying chemical substances (Ethibloc) and nonopacifying chemical substances (Fibrospum, Butyl-2-Cyanoacrylat) were sometimes used for embolization; but most of the time, metal spiral (licenced by Cianturco) were taken, because of the following advantages: Their insertion is simple and easily controlled by fluoroscopy; they cause less pain, and they induce progressive thrombosis in the embolised artery. In cases, however, where catheterisation is difficult or impossible (narrow lumen/collaterals), embolization with chemical substances has to be done in addition to that by spiral. (orig.) [de

Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems

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Małyszko, Jolanta; Wieliczko, Monika

2015-01-01

Urinary tract infections (UTIs) are common in pregnant women and pose a great therapeutic challenge, since the risk of serious complications in both the mother and her child is high. Pregnancy is a state associated with physiological, structural and functional urinary tract changes which promote ascending infections from the urethra. Unlike the general population, all pregnant women should be screened for bacteriuria with urine culture, and asymptomatic bacteriuria must be treated in every case that is diagnosed, as it is an important risk factor for pyelonephritis in this population. The antibiotic chosen should have a good maternal and fetal safety profile. In this paper, current principles of diagnosis and management of UTI in pregnancy are reviewed, and the main problems and controversies are identified and discussed. PMID:25861291

ACUTE LYMPHOBLASTIC LEUKEMIA WITHOUT CIRCULATING BLASTS PRESENTING AS SEVERE HYPERCALCEMIA

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Z. Oloomi

2007-05-01

Full Text Available Hypercalcemia complicating malignancy is a rare complication in pediatric age group. In this article, we present a case with acute lymphoblastic leukemia presenting as severe hypercalcemia. A 10 years old girl presented with an acute onset of fever, nausea, vomiting, loss of weight, costovertebral pain and frequency. She was admitted with a presumptive diagnosis of acute pyelonephritis. Her examination showed mild hepatosplenomegaly. In laboratory studies she had sever hypercalcemia. Despite the absence of circulating blast, bone marrow aspiration was diagnostic of acute lymphoblastic leukemia. The hypercalcemia was initially treated with intravenous hydration and furosemide but the serum calcium levels normalized only after the beginning of specific chemotherapy. Hypercalcemia represents an emergency in children, and acute leukemia must be considered in differential diagnosis even when there are no circulating blasts.

Technetium-99m DMSA preparation: Trivial issues causing severe problems

International Nuclear Information System (INIS)

Kumar, V.

1997-01-01

Urinary tract infection (UTI) in children involving renal parenchyma, upper collecting system or bladder is one of the major causes for consideration in the diagnosis and management of paediatric nuclear medicine. Acute pyelonephritis is one of the prime causes of morbidity associated with urinary tract infection in children which can lead to progressive renal damage. Technetium-99m dimercaptosuccinic acid (DMSA) is used extensively for the assessment of UTI in paediatrics. The radiopharmaceutical preparation could be influenced by several factors, most of them are trivial, but invariably have severe impact on the quality of the scintiphotographs. This communication is mainly to highlight some of the issues related to 99 mTc-DMSA preparation and the possible precautionary measures that need to be taken to obviate unwarranted problems. (author)

The Results of the Study of Microbiologic Pattern of the Urinary Tract Infection in Children from Kyiv and Kyiv Region

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T.V. Budnik

2016-04-01

Full Text Available The article presents the results of a retrospective analysis of the species composition of microbial pathogens of the urinary tract infection according to the results of urine culture and their sensitivity to antibiotics of different classes in children with the active stage of the disease (mainly with pyelonephritis, who were treated in the nephrology unit of Kyiv Children’s City Hospital № 1 in 2009–2014. A consistently high sensitivity (94.1 % and low resistance (3.2 % of Escherichia coli strains to a modern derivative of nitrofuran — furazidin K (Furamag has been shown compared with other classes of antibacterial agents. The findings correspond with the international literature data and allow us to recommend this drug for empiric therapy of uncomplicated infections of the urinary system in children.

Clinical Case of Immune Dysregulation, Polyendocrinopaty, Enteropathy, X-Linked (IPEX Syndrome with Severe Immune Deficiency and Late Onset of Endocrinopathy and Enteropathy

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R. Savova

2014-01-01

Full Text Available Objective. To describe the clinical characteristics of IPEX syndrome in a child with FOXP3 mutation. Clinical Case. A boy aged 2.3 years was born from first normal pregnancy with a weight of 3420 gr. Family History. Two brothers of the mother died before the age of 3 years with severe infections, diarrhea, erythroderma, and elevated immunoglobulins class E (IgEs. Since first month of life, our patient suffered from septicemia, pneumonias, pyelonephritis, and meningitis, accompanied with eczematous dermatitis and IgEs up to 4000 IU/L (normal A, p. (Arg337Gln, which confirmed IPEX syndrome. The same mutation in heterozygotic state was found in the mother. A prenatal diagnosis of her second pregnancy ensured a daughter carrier of the mutation.

Investigation in uro-nephrology (2): renal cortical scintigraphy using {sup 99m}Tc-Dmsa in children; Enquete en uro-nephrologie (2): la scintigraphie renale au 99mTc-DMSA chez l'enfant

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Archambaud, F. [Centre Hospitalier Universitaire de Bicetre, 94 - Le Kremlin-Bicetre (France); Olivier, P. [Centre Hospitalier Universitaire Nancy-Brabois, 54 - Vandoeuvre-les-Nancy (France); Guillet, J. [Centre Hospitalier Universitaire, 47 - Agen (France); Wioland, M. [Centre Hospitalier Universitaire Armand Trousseau, 75 - Paris (France); Bonnin, F. [Centre Hospitalier Universitaire Beaujon, 92 - Clichy (France)

2002-08-01

We present the results of a national investigation about the daily practice of renal cortical scintigraphy using {sup 99m}Tc-DMSA in children by comparison with the recommendations of the international consensus from the experts designated by the Scientific Committee of 'Radionuclides in Nephrology'. Questions were related to radiopharmaceutical image acquisition, processing and visualisation, relative renal function determination and indications of renal scan in urinary tract infection. National daily practice are similar to the one suggested by the international consensus about many aspects. However, a controversy exists between the experts in acquiring pinhole or tomographic images. Similarly to the international consensus, {sup 99m}Tc-DMSA renal scan is widely performed for detection of renal sequelae, while its indication in acute pyelonephritis remains to define. (authors)

[Acute pyelonephritis in the neonatal period] [Article in Italian] • Pielonefrite acuta in epoca neonatale

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Giovanni Ottonello; Angelica Dessì; Danila Manus; Anna Paola Pinna; Fabiana Sau; Vassilios Fanos

2014-01-01

Urinary tract infections (UTIs) represent one of the most common pathological conditions in children. It is estimated that even in the countries with the most advanced health care programmes, such as the United States and Europe, UTIs represent the most common serious infections in pediatrics. In the earliest stages of life, UTIs represent the most common febrile illness, although the non specific clinical presentation often leads to diagnostic underestimation. Neonatal UTIs surely represent...

[Acute pyelonephritis in the neonatal period] [Article in Italian] • Pielonefrite acuta in epoca neonatale

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Giovanni Ottonello

2014-01-01

Full Text Available Urinary tract infections (UTIs represent one of the most common pathological conditions in children. It is estimated that even in the countries with the most advanced health care programmes, such as the United States and Europe, UTIs represent the most common serious infections in pediatrics. In the earliest stages of life, UTIs represent the most common febrile illness, although the non specific clinical presentation often leads to diagnostic underestimation. Neonatal UTIs surely represent a special case among pediatric UTIs and need specific considerations and separate treatment with respect to later age: it is no coincidence that the main national and international guidelines for the diagnosis and treatment of UTIs, such as those issued by the American Academy of Pediatrics (AAP and by the Working Group of the Italian Society of Pediatric Nephrology, exclude from their indications the newborn and the infant under two months of age. Low gestational age, low birth weight, association with malformative uropathies are considered specific risk factors. Breastfeeding has a protective effect. E. coli is the major responsible of UTI in term newborns and infants, followed by K. pneumoniae, Proteus spp., E. cloacae. Finally, Candida spp. is very important in hospitalized children. Treatment includes the combination of ampicillin plus an aminoglycoside (frequently gentamicin. The article shows the main aspects of the urinary tract infections in the neonatal period and a review of the most recent literature on the subject.Articoli Selezionati del “3° Convegno Pediatrico del Medio Campidano” · Guspini · 25 Maggio 2013 Guest Editor: Roberto Antonucci

LEPROSY NEPHROPATHY: A REVIEW OF CLINICAL AND HISTOPATHOLOGICAL FEATURES

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Geraldo Bezerra da Silva Junior

2015-02-01

Full Text Available Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

[Urinary tract infections : What has been confirmed in therapy?

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Marcon, J; Stief, C G; Magistro, G

2017-12-01

Urinary tract infections (UTIs) affect approximately 150 million people worldwide per year, causing annual health costs of over three billion dollars just in the USA. Every second woman experiences at least one UTI in her lifetime, with every one in four experiencing recurrence. Uncomplicated infections like single or recurrent cystitis and pyelonephritis can be distinguished from complicated disease. UTIs in men can spread to the male glands, causing prostatitis and epididymitis. Antibiotic therapy is the standard procedure for UTIs. However, the extensive and sometimes irrational use of antibiotics for the treatment of infections has led to an increase in the incidence of multiresistant pathogens in recent years. Therefore, preventive nonantibiotic approaches are of great interest. This article provides an overview of the current management of urological infections as well as an outline of nonantibiotic preventive treatment modalities.

Office diagnosis of asymptomatic bacteriuria in pregnant women.

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Van Dorsten, J P; Bannister, E R

1986-10-01

Diagnosis and treatment of asymptomatic bacteriuria in pregnant patients can virtually eliminate pyelonephritis, the most common medical cause for antepartum hospitalization. However, the ever-increasing cost of the urine culture has led most clinicians away from routine urine screening. Uricult dip-slide paddles provide an inexpensive, efficient way to screen urine. Clean-catch urine specimens were obtained from 544 consecutive asymptomatic pregnant patients seen in the outpatient obstetric clinic at the Medical University of South Carolina. Specimens were analyzed by both traditional culture techniques and the Uricult dip-slide paddles. By comparison, the Uricult test detected 55 of the 56 significant gram-negative urinary pathogens found by culture. Detection of potential gram-positive pathogens is more difficult. A scheme is proposed that allows reliable, inexpensive surveillance in all pregnant patients. Hopefully, this algorithm will rekindle the obstetrician's interest in urine screening.

Urofacial syndrome: A subset of neurogenic bladder dysfunction syndromes?

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K N Stamatiou

2010-01-01

Full Text Available The urofacial syndrome is probably a subset of neurogenic bladder dysfunction syndromes characterized by detrusor-sphincter discoordination along with a characteristic inversion of facial expression with laughing. This characteristic facial expression can facilitate early detection of this disorder, which leads to poor bladder emptying with high residual urine, hydro-nephrosis with vesico-ureteral reflux and potentially renal failure if left untreated. The etiology of the urofacial syndrome is unknown. In our case, a 12-year-old boy of Middle-Eastern origin presented to the Outpatient Department of our hospital with left pyelonephritis, hydronephrosis and bladder dilatation. Voiding cystourethrography performed 15 days later revealed left vesicoureteral reflux. Cystoscopy revealed bladder trabeculation however an anatomic urethral obstruction was not noticed. Both, neurological examination and radiography of the lumbosacral spine were normal. Urodynamic evaluation revealed the typical findings of detrusor-sphincter discoordination.

Diuretic Scintigraphy of kidneys using lazex

International Nuclear Information System (INIS)

Yudin, L.; Reznichenko, A.; Uskov, I.; Budkevich, Yu.; Shejretova, E.; Sultanov, S.

1993-01-01

Diuretic scintigraphy performed in 59 patients with hydronephrosis, nephrolithiasis, chronic pyelonephritis and ureteral hydronephrosis, discloses 99m Tc-DTPA retention in the urinary tract - prolongation and absence of excretory segment on the nephrogram to appearance of an obstructive type curve. As shown by the data from 19 operatively verified patients with hydronephrosis and nephrolithiasis diagnosed as stenosis of the pelviureteral segment, a high sensitivity and accuracy of stenosis demonstration is recorded in the absence of excretory segment in the initial nephrogram regardless of whether or not it appears later, after Lazex administration. Stenosis of the pelviureteral segment may be likewise observed in the presence of excretory segment in the initial nephrogram with a prolonged half-period of excretion. A two-fold shortening of the latter is documented in the diuretic nephrogram. 12 refs., 3 figs. (orig.)

VALUE OF RHEUMATIC PATIENTS' AWARENESS OF HAVING INFECTIOUS COMORBIDITIES

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Rimma Mikhailovna Balabanova

2010-01-01

Results. The patients with RD frequently reported to have nasopharyngeal infection. The latter was accompanied by an exacerbation of articular syndrome in more than half of the patients with RD. The rate of pneumonias experienced by patients with systemic lupus erythematosus (SLE (10/55 engages our attention. Urogenital tract infections (mainly cystitis and pyelonephritis are more typical of patients with rheumatic arthritis (RA and those with osteoarthrosis (OA, respectively. The clinical manifestations of herpes simplex virus type 1 (HSV-1 recurred most frequently in patients with SLE and those with OA and less in patients with RA. The percentage of HSV-1 recurrences was high in the medical staff. Conclusion. The findings suggest that it is necessary to thoroughly collect medical history data especially in patients who need aggressive immunosuppressive therapy as activation of latent infection makes management of these patients difficult

Retrograde cystography US. A new ultrasound technique for the diagnosis and staging of vesicoureteral reflux

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Farina, R.; Arena, C.; Pennisi, F.; Di Benedetto, V.; Politi, G.; Di Benedetto, A.

1999-01-01

The authors investigated the accuracy of a new US (ultrasound) investigation technique, called retrograde cystography US, in the early diagnosis and staging of vesicoureteral reflux. 5 patients, aged 3 months to 10 years, suffering from hydronephrosis and/or pyelonephritis, were examined using retrograde cystography US followed by conventional retrograde cystography. Retrograde cystography US consists in the transcatheter introduction of a contrast agent into the bladder and a subsequent color Doppler examination to show or exclude the presence of reflux. Superpubic scanning of bladder, ureters and pyelocaliceal cavity was performed after echo contrast agent introduction to assess the reflux grade. US was performed with an Esaote AU 590 asynchronous scanner with a 3.5 MHz convex probe. The total agreement of conventional and US findings seems to confirm the importance of the US method for the diagnosis and staging of vesicoureteral reflux [it

Renal and perirenal abscesses

International Nuclear Information System (INIS)

Patterson, J.E.; Andriole, V.T.

1987-01-01

Our knowledge of the spectrum of renal abscesses has increased as a result of more sensitive radiologic techniques. The classification of intrarenal abscess now includes acute focal bacterial nephritis and acute multifocal bacterial nephritis, as well as the previously recognized renal cortical abscess, renal corticomedullary abscess, and xanthogranulomatous pyelonephritis. In general, the clinical presentation of these entities does not differentiate them; various radiographic studies can distinguish them, however. The intrarenal abscess is usually treated successfully with antibiotic therapy alone. Antistaphylococcal therapy is indicated for the renal cortical abscess, whereas therapy directed against the common gram-negative uropathogens is indicated for most of the other entities. The perinephric abscess is often an elusive diagnosis, has a more serious prognosis, and is more difficult to treat. Drainage of the abscess and sometimes partial or complete nephrectomy are required for resolution. 73 references

Clinical and Genetic Aspects of Chronic Pyelonephritis in Children: the Structure of Addiction and Primary Prognosis

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T.O. Kryuchko

2013-04-01

Full Text Available Currently studying the mechanisms of recognition of foreign agents, which is implemented by Toll-like receptor of innate immune system, has become one of the main tasks of clinical immunology. The aim of our study was an analysis of the association between Toll-like receptor 4 gene polymorphism (Asp299Gly and main pathogens of urinary system infections. These results confirm the important role of Toll-like receptors in the realization of an innate immune response and enables to consider Toll-like receptor 4 gene polymorphism as an additional prognostic indicator in genetic researches.

CT staging of renal cell carcinoma

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Spina, Juan C.; Garcia, Adriana T.; Rogondino, Jose; Spina, Juan C. h; Vidales, Valeria; Troiani, Guillermo; Iotti, Alejandro; Venditti, Julio

2002-01-01

Objective: To assess the usefulness of computerized tomography (CT) in the characterization of renal masses, in order to stage them, determine their prognosis and their appropriate clinical and/or surgical management. Material and Methods: Between 1988 and 2001, we selected 63 patients with renal tumors that had been examined by pathology. Patient's ages ranged from 16 to 88 years (25 women, 38 men). The studies were performed with a sequential helical CT, using 5 mm thickness sections every 5mm evaluating the cortico medullar and nephrographic phases. Renal tumors were characterized and staged without any knowledge about the pathological findings; subsequently the tomographic characteristics were compared to such findings. The following characteristics were evaluated: 1) mixed solid-cystic nature; 2) size; 3) borders; 4) enhancement; 5) necrosis; 6) hemorrhage; 7) central scar; 8) presence of fat; 9) collecting system; 10) capsular invasion; 11) perirenal fat invasion; 12) vessels; 13) Gerota's fascia; 14) lymph nodes; and 15) local and/or distant metastases. Results: Of the 63 tumors, 2 were complicated cysts; of the 61 remaining tumors, 10 were angiomyolipomas, 1 was a renal lymphoma, 1 was a focal xantogranulomatose pyelonephritis, 1 was a metanephric adenoma, 3 papillary renal cell carcinoma (RCC), 4 transitional cell tumors, 4 oncocytomas, 37 clear cell renal carcinoma. The CT could correctly characterize the 2 cystic tumors as such, as well as the 9 angiomyolipomas and the 4 transitional cell tumors. The 48 other tumors (1 angiomyolipoma, 1 lymphoma, 1 focal xantogranulomatose pyelonephritis, 1 metanephric adenoma, 3 papillary RCC, 4 oncocytomas, and 37 cell renal carcinomas) remaining were characterized as renal adenocarcinomas and CT staged. Conclusion: CT is a useful method to characterize renal masses since it determines their solid-cystic or fatty structure; aiding in many cases to define a surgical treatment. For the CT staging of renal tumors, the

[Urinary tract infection in pregnancy].

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Duarte, Geraldo; Marcolin, Alessandra Cristina; Quintana, Silvana Maria; Cavalli, Ricardo Carvalho

2008-02-01

Several factors cause urinary tract infection (UTI) to be a relevant complication of the gestational period, aggravating both the maternal and perinatal prognosis. For many years, pregnancy has been considered to be a factor predisposing to all forms of UTI. Today, it is known that pregnancy, as an isolated event, is not responsible for a higher incidence of UTI, but that the anatomical and physiological changes imposed on the urinary tract by pregnancy predispose women with asymptomatic bacteriuria (AB) to become pregnant women with symptomatic UTI. AB affects 2 to 10% of all pregnant women and approximately 30% of these will develop pyelonephritis if not properly treated. However, a difficult-to-understand resistance against the identification of AB during this period is observed among prenatalists. The diagnosis of UTI is microbiological and it is based on two urine cultures presenting more than 10(5) colonies/mL urine of the same germ. Treatment is facilitated by the fact that it is based on an antibiogram, with no scientific foundation for the notion that a pre-established therapeutic scheme is an adequate measure. For the treatment of pyelonephritis, it is not possible to wait for the result of culture and previous knowledge of the resistance profile of the antibacterial agents available for the treatment of pregnant women would be the best measure. Another important variable is the use of an intravenous bactericidal antibiotic during the acute phase, with the possibility of oral administration at home after clinical improvement of the patient. At our hospital, the drug that best satisfies all of these requirements is cefuroxime, administered for 10-14 days. Third-generation cephalosporins do not exist in the oral form, all of them involving the inconvenience of parenteral administration. In view of their side effects, aminoglycosides are considered to be inadequate for administration to pregnant women. The inconsistent insinuation of contraindication of

Treatment ofurinary tract infection inchildren

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Danuta Zwolińska

2016-09-01

Full Text Available Urinary tract infection is the most frequent bacterial infection in children. Its prevalence in the population younger than 14 years of age has been estimated at 5–10%. Its high recurrence, especially in patients with risk factors, poses a significant problem. The risk factors most common in the group of children ≤3 years are congenital defects blocking the flow of urine to the bladder, whereas in older children they most typically include a tendency for constipation and dysfunction of the lower urinary tract. The clinical picture is variable and depends on the child’s age, immunity status, pathogen virulence and localisation of infection. The mildest form of urinary tract infection is asymptomatic bacteriuria, whereas more severe presentations include acute pyelonephritis, acute focal bacterial nephritis and urosepsis. Prognosis is usually good, but under certain circumstances hypertension, proteinuria and chronic kidney disease may develop. Therefore, early introduced appropriate treatment is essential. According to the Polish Society for Paediatric Nephrology guidelines, asymptomatic bacteriuria does not warrant treatment, whereas febrile patients (>38°C under 24 months old with a suspicion for urinary tract infection must be promptly administered antibiotic therapy, after a urine specimen has been obtained for culture. For many years, urinary tract infection has remained a topic of controversy in terms of therapy duration and administration route. Inpatient treatment of children under 3 months of age is an accepted rule. Acute pyelonephritis necessitates a longer therapy, lasting from 7 to 10 days, whereas the duration of treatment of lower urinary tract infection has been cut down to 3 up to 5 days. Routine prophylactic antimicrobial therapy is not recommended following the initial urinary tract infection episode, yet should be considered in special circumstances. Alternative

IMPROVING THE RESULTS OF TREATMENT OF PATIENTS WITH URETERAL CONCREMENTS AFTER CONTACT URETEROLITHOTRIPSY

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R. M. Solh

2017-01-01

Full Text Available Purpose. Im proving the results of treatment of patients with ureteral stones and reducing the dam aging effects of contact lithotripsy.Materials and methods. In this study, 48 patients were examined aged 20 to 63 years. All patients admitted to the urology department with diagnoses: urolithiasis, calculus of the ureter. In all cases contact ureterolithotripsy with stenting of the upper urinary tract were performed. The patients were divided into two groups: main and control. 25 patients (52 .1% were included into the main group, which in the postoperative period, we used low-level laser therapy (L-therapy. 23 patients were included in a control group (47.9% who did not receive low-laser therapy. Laboratory tests and ultrasound with Doppler renal blood vessels scan were performed on admission, on the first day after the operation and on the 5-th day of hospitalization. Low-intensity laser therapy was performed within 5 days after contact ureterolithotripsy on projection of placement of stone and kidney projection by series for 5 minutes.Results. All patients admitted to the hospital, were spared from ureteral stones. In the main group during the treatment with L-therapy a decrease in the level of beta-2 microglobulin to normal was observed. (4.8 ± 0.1 mg/l on the first day. On the 5th day 2 .3 + 0.1 mg/l. In the control group during the treatment without the use of L-therapy, the average level of beta-2 microglobulin decreased but did not reach normal levels. (5.5 ± 0.1 mg/l on the first day. On the 5th day 3,2 ±0, l mg/l.Resistance index in the study group decreased compared to the control. In the control group, cases of acute pyelonephritis were observed. The average hospital stay for patients of the main group (6 days was less than in the control group (6 .5 + days.Conclusion. The use of laser therapy in the treatment of patients who did undergo ureterolithotripsy can reduce the length of stay of the patient in the hospital and reduce the

Study of intrarenal vasculature in cases of primary and secondary hypertension (by metallic impregnation technique on whole kidney section

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Mittal B

1992-10-01

Full Text Available Study of intrarenal vasculature was carried out by using the metallic impregnation technique on whole kidney sections in 31 [corrected] cases of (primary and secondary hypertension and 10 normal controls. Distinct patterns of intrarenal vasculature were noted in controls and in cases of hypertension. Gradual tapering of vessels, absence of tortuosity and good peripheral vascularisation were noted in controls. Abrupt tapering, tortuosity of vessels and poor peripheral vascularisation were noted in hypertensive cases. In essential hypertension moderate to severe changes of dilatation of the segmental and/or arcuate arteries was noted. The degree of dilatation was related to the level of systolic BP rather than diastolic in cases of essential hypertension. Secondary hypertension even if severe, rarely showed significant dilatation lesions. Avascular zones and conglomeration of vessels at poles was seen only in cases of pyelonephritis. This helped in distinguishing these, from cases of glomerulonephritis.

[Asymptomatic bacteriuria; management choices in different patient groups].

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Meiland, R; Geerlings, S E; Hoes, A W; Hoepelman, I M

2002-04-06

Asymptomatic bacteriuria is a common medical condition, especially in women and elderly people. It is generally considered to be a benign condition, which does not require screening or antibiotic treatment. However, there are a few exceptions for which screening is possibly worthwhile. For children it is unclear whether the early detection of ASB can result in better clinical outcomes. Screening is therefore not advised, except for young children during the first few months after a symptomatic urinary tract infection. For pregnant women the use of screening for ASB is also unclear and in general not indicated. Research is necessary into the possible transition from ASB to pyelonephritis and the possible connection with low birth weight and premature births. There are indications that ASB in women with type I diabetes mellitus can lead to a deterioration in the renal function, yet these are insufficient to recommend screening as a routine procedure.

[Diagnosis and clinical management of urinary tract infection].

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Heilberg, Ita Pfeferman; Schor, Nestor

2003-01-01

A review about recent aspects on diagnosis and clinical management of urinary tract infection (UTI) is presented. There is a wide variation in clinical presentation of UTI which include different forms as cystitis, pyelonephritis, urethral syndrome and the clinical relevance of asymptomatic bacteriuria and low-count bacteriuria that must be distinguished from contamination. Pathogenetic aspects concerning bacterial virulence as well as host factors in susceptibility to UTI as urinary tract obstruction, vesicoureteral reflux, indwelling bladder catheters, pregnancy, diabetes mellitus, sexual activity, contraceptive methods, prostatism, menopause, advanced age and renal transplantation are discussed. Diagnostic criteria and the most common tests utilized for differentiation between lower and upper UTI have been reviewed. The authors conclude that a careful evaluation of the underlying factors is required for the correct diagnosis of UTI and to prevent recurrence and that appropriate strategies and specific therapeutic regimens may maximize the benefit while reducing costs and adverse reactions.

Transient Fanconi syndrome with severe polyuria and polydipsia in a 4-year old Shih Tzu fed chicken jerky treats.

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Major, A; Schweighauser, A; Hinden, S E; Francey, T

2014-12-01

Acquired Fanconi syndrome is characterized by inappropriate urinary loss of amino acids, bicarbonate, electrolytes, and water. It has recently been described in dogs fed chicken jerky treats from China, a new differential diagnosis to the classical inciting infectious diseases (e.g. leptospirosis, pyelonephritis) and toxins. A dog fed exclusively chicken jerky treats purchased in Switzerland was presented to our clinic with severe polyuria, polydipsia and profound electrolyte and acid base disturbances. Other inciting causes of Fanconi syndrome were ruled out. The requirement of a very intensive supportive treatment in this dog stands in contrast to treatment of chronic forms of Fanconi syndrome as described in the Basenji. This intensive therapy and the associated monitoring can be a real challenge and a limiting factor for the prognosis of acquired Fanconi syndrome. Veterinarians should be aware of the risk of excessive feeding of chicken jerky treats.

Spectrum of pathological lesions in acute renal failure

International Nuclear Information System (INIS)

Kazi, J.I.; Mubarak, M.; Akhter, F.; Ahmed, E.; Naqvi, R.; Naqvi, S.A.; Rizvi, S.A.H.

2003-01-01

Objective: To determine the spectrum of pathological lesions in percutaneous renal biopsies of patients with acute renal failure (ARF) and to compare our findings with reported literature. Results: A total of 158 patients were studied. Of these 57 were males and 101 females. Mean age of the patients in this series were 30.7 years with a range of 6 to 75 years. Of these 61 (38.6%) had acute tubular necrosis, 36 (22.7%) acute cortical necrosis and 49(31%) patients had various types of glomerculonephriits (GN). Eight patients (5%) had acute tubulointerstitial nephritis, 3(1.8%) acute pyelonephritis and one patient had mucormycosis. Conclusion: This study showed that even in the selected population of biopsied ARF cases, there was a high prevalence of ischemic renal disease. A substantial number of cases in unexplained ARF on renal biopsy were due to various forms of glomerulonephritis. (author)

A study of the validity of urinary tract infection diagnosis in children younger than two years of age at Hvidovre Hospital

DEFF Research Database (Denmark)

Roed-Petersen, Casper; Møller, Alice Friis; Høgh, Birthe

2008-01-01

INTRODUCTION: The aim of this study is to validate the diagnosis of urinary tract infection (UTI) concerning false-positive diagnoses in children younger than two years of age at Hvidovre Hospital. MATERIALS AND METHODS: The material consists of 89 children (50 girls and 39 boys) diagnosed...... with acute pyelonephritis from September 2002 until October 2004. Two patients dropped out as they were diagnosed in other countries. The patient records were investigated to identify the children who fulfilled the UTI criteria used in the department: 1) Two mid-stream urine samples with bacterial growth...... of = 10.000 cfu (colony forming units)/cc, 2) growth of = 100 cfu/cc in urine obtained by a suprapubic puncture of the bladder or 3) a mid-stream urine sample with bacterial growth of = 10.000 cfu/cc and a clinical picture of UTI together with elevated inflammatory laboratory parameters. RESULTS: 70 out...

IMMUNOLOGIC INDICES IN GERONTOLOGICAL PATIENTS WITH ISCHEMIC HEART DESEASE AND URINARY SYSTEM PATHOLOGY

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G.V. Korschunov

2009-09-01

Full Text Available Patients of middle and old age with ischemic heart desease and diseases of urinary system (DUS have been examined. Leukocytic index of intoxication (Lll, hematologic parameter of intoxication (HPI, parameter of immunity intensity (Pll have been significantly increased in groups of patients with benign prostatic hyperplasia, diabetes and DUS. These indices have been directly correlated with content of IL6 and TNFa, and examined autoantibodies (AAb, especially with contents of antibodies to DNA, to collagen, to fiber-regulator of differentiation and migration immature neuroblast S100. Indices of Lll, HPI and Pll have been decreased in group of patients with normal body weight and urolithiasis. In this group the increase of allergization index (Al and content of IL6, TNFa has been noticed. Indices of AAb pointed to metabolic disorders. The increase of cytokines in patients with pyelonephritis has been revealed. Content of AAb has been slightly increased in comparison with normal indices

Pielonefritis xantogranulotamosa: reporte de 15 casos y revisión de la literatura

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Byron López de Mesa

1996-10-01

Full Text Available Fifteen cases of Xantogranulomatous pyelonepbritis diagnosed at Hospital San Juan de Dios in Bogota, are presented. The disease ocurred in middle aged women, particularly in those with history of urinary infection (33%. The most common complaints were abdominal pain, fever and lumbalgia, while fever, pallor, palpable mass and lumbar pain evoked by percussion were the most frecuent signs disclosed by medical examination. Proteus mirabilis (55% and Escherchia coli (22%, were the germs more commonly isolated from patients' urine specimens. Lithiasis and renal exclussion were the most remarkable roengtenologic findings, whereas lithiasis, increased renal size and hydronephrosis vs. pyonephrosis pattern were seen in echografic examination. Gammagraphic examination disclosed functional exclussion of the kidney and obstructive pattern and the CAT scan allow a definite diagnosis and stablished the extension of the disease. Just 33% of the patients arrived with diagnosis of Xantogranulomatous pyelonephritis to the operation room. A brief review of the literature is presented.

[Morphology and pathogenesis of visceral manifestations of chronic alcoholism].

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Lebedev, S P

1982-01-01

Chronic alcoholism is accompanied by systemic involvement of the internal organs. Clinico-morphological forms of chronic alcoholism are distinguished on the basis of the prevailing organ pathology, Morphological data are presented, and pathogenesis of the lesions of the liver, heart, pancreas, and kidneys in patients with chronic alcoholism is analysed. The hepatic form may present alcoholic dystrophy, hepatitis or cirrhosis which are stages of progressing hepatopathy. The toxic and metabolic effect of ethanol is important in the pathogenesis of liver lesion. The cardiac form is characterized by the development of alcoholic myocardiodystrophy. In addition to the toxic influence of ethanol, hormonal and electrolyte changes and microcirculatory disorders play a role in its pathogenesis. Chronic calcifying pancreatitis in chronic alcoholism is associated with the effect of ethanol on the mediatory system. The renal form any present necronephrosis, hepatorenal syndrome, glomerulonephritis or pyelonephritis. Their pathogenesis is determined by toxicity of ethanol, circulation of immune complexes in the blood, or immunosuppression.

The usefulness of sup(99m)Tc-DTPA renogram in the functional and diagnostic evaluations of chronic renal insufficiency in children

International Nuclear Information System (INIS)

Matsueda, Yoriko; Hiraiwa, Mikio; Meguro, Hidenori; Fujii, Ryochi

1980-01-01

As there are some difficulties in the performance of renal biopsy and intravenous pyelography is of little use in children with chronic renal insufficiency, we evaluated the usefulness of sup(99m)Tc-DTPA renogram in two children. The causes of the renal insufficiency presented were obstructive congenital anomalies and chronic pyelonephritis in one patient and polycystic kidneys in the other. As expected, intravenous pyelography poorly visualized in the upper urinary tracts of both the cases examined. sup(99m)Tc-DTPA renogram gave us distinct image for the diagnosis of the kidneys and urinary tracts, and the individual renal functions were clarified as well. It was apparently superior to the combined use of sup(99m)Tc-DMSA renoscintigram and 131 I-Hippuran renogram in both the imaging and functional evaluations. In such cases as are reported herein, sup(99m)Tc-DTPA renogram might be a useful alternative to several other diagnostic tests. (author)

Asymptomatic bacteriuria in pregnancy.

Science.gov (United States)

Smaill, Fiona

2007-06-01

Screening for asymptomatic bacteriuria is a standard of obstetrical care and is included in most antenatal guidelines. There is good evidence that treatment of asymptomatic bacteriuria will decrease the incidence of pyelonephritis. All pregnant women should be screened for asymptomatic bacteriuria, and there are no new data that would indicate otherwise. Antibiotic treatment of asymptomatic bacteriuria is associated with a decrease in the incidence of preterm delivery or low birth weight, but the methodological quality of the studies means any conclusion about the strength of this association needs to be drawn cautiously. A better understanding of the mechanism by which treatment of asymptomatic bacteriuria could prevent preterm delivery is needed. While several rapid screening tests have been evaluated, none perform adequately to replace urine culture for detecting asymptomatic bacteriuria. Until there are data from well-designed trials that establish the optimal duration of therapy for asymptomatic bacteriuria, standard treatment courses are recommended.

[Urinary tract infection in pregnancy].

Science.gov (United States)

Herráiz, Miguel Angel; Hernández, Antonio; Asenjo, Eloy; Herráiz, Ignacio

2005-12-01

Urinary tract infections, asymptomatic bacteriuria (AB), acute cystitis (AC) and acute pyelonephritis (AP), are favored by the morphological and functional changes involved in pregnancy. AB increases the risk of preterm labor, low birth weight and AP. AB should be detected by uroculture (other methods are not sufficiently effective) and treated early. Approximately 80% of cases are caused by Escherichia coli. The risks and effectiveness of the distinct antibiotic regimens should be evaluated: fosfomycin trometamol in monotherapy or as short course therapy is safe and effective for the treatment of AB and AC. AP is the most frequent cause of hospital admission for medical reasons in pregnant women and can lead to complications in 10% of cases, putting the lives of the mother and fetus at risk. Currently outpatient treatment of AP is recommended in selected cases. Adequate follow-up of pregnant women with urinary tract infections is required due to frequent recurrence.

Hand-assisted bilateral nephrectomy in a patient with adult polycystic kidney disease

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Marcello Alves Pinto

Full Text Available CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.

Struvite urolithiasis in a litter of miniature Schnauzer dogs.

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Klausner, J S; Osborne, C A; O'Leary, T P; Gebhart, R N; Griffith, D P

1980-05-01

Magnesium ammonium phosphate calculi developed in the urinary bladders and urethras of four of five offspring of Miniature Schnauzer parents with recurrent struvite urolithiasis. Calculi were detected by radiograhy when the dogs were 12 to 15 months old. Males and females were affected. A significant number of urease-producing staphylococci were identified in the urine of three of four dogs before urolith formation, and in one dog after urolith formation. The dogs were evaluated until they were 26 months old. Serum concentrations of calcium, phosphorus, and magnesium were inside usual limits throughout the study. Abnormalities that might predispose to urinary tract infection were not identified by radiography or necropsy studies. In one dog, bladder calculi recurred after surgical removal of multiple cystoliths. In another, urethral obstruction and acute generalized pyelonephritis induced a lethal uremic crisis. Gross and microscopic lesions, detected after necropsy of all dogs with uroliths, were typical of bacterial infection.

Radionuclide uroflowmetry and urethral caliper in girls with urinary tract disease

International Nuclear Information System (INIS)

Mrhac, L.; Mrhacova, L.; Cerny, J.; Marten, J.; Goj, P.; Hladik, M.

1988-01-01

In a group of 178 girls aged 4 to 15 years suffering from various inflammations of the urinary tract a clinical and laboratory examinations were made, calibration of the urethra and radionuclide uroflowmetry (UFM). The methods are described of calibration of the urethra and uroflowmetry. Presented are normal and pathological values of both examinations and the evaluation of the relationship between calibration values of the urethra and parameters of UFM. No correlation was found between the results of these examinations. In the group of girls with urinary tract infections impaired urodynamics were found in 26 to 34%. Higher incidence was not revealed of impaired urodynamics in more serious conditions, i.e. pyelonephritis. A bladder residue was significantly more frequent in impaired urodynamics. This was not the case in vesiculoureteral reflux. In girls with enuresis a significantly higher incidence of impaired urodynamics was observed. Calibration of the urethra and uroflowmetry are complementary examination methods which cannot replace each other. (author). 3 figs., 2 tabs., 18 refs

Multiple renal aspergillus abscesses in an AIDS patient: contrast-enhanced helical CT and MRI findings

International Nuclear Information System (INIS)

Heussel, C.P.; Kauczor, H.U.; Thelen, M.; Heussel, G.; Jahn, B.

1999-01-01

Renal insufficiency or allergic reactions for X-ray contrast agents are frequent limitations in immunocompromised hosts such as neutropenic or AIDS patients. Due to a better tolerance of contrast agents in MRI, this technique is well suited for investigation of parenchymal organs. We demonstrate an allergic AIDS patient who presented with fever and flank pain. At sonography, anechoic renal lesions were supposed to be non-complicated cysts; however, on T2-weighted MRI, the center was of high signal. Dynamic contrast-enhanced MRI of the kidneys demonstrated an enhancing rim with ill-defined margins. The lesions were supposed to be multiple bilateral abscesses. Due to the multiple dynamic contrast series, a delayed enhancement of renal parenchyma was detectable adjacent to the lesion. This was suggested as accompanying local pyelonephritis and an infectious etiology became more reliable. Aspergillus fumigatus was identified by CT-guided biopsy as the underlying microorganism. The MR appearance of this manifestation has not been described previously. (orig.)

Novel management of urinary tract infections.

Science.gov (United States)

Storm, Douglas W; Patel, Ashay S; Koff, Stephen A; Justice, Sheryl S

2011-07-01

To highlight observations that have suggested the need for changing the conventional approach to the evaluation and management of urinary tract infections (UTIs) and vesicoureteral reflux in children and examine new alternative approaches to prevention of UTI and renal scarring based on research into host-pathogen interaction. Recent studies have questioned the traditional approach of using prophylactic antibiotics to prevent recurrence of UTI and development of renal scarring in children with vesicoureteral reflux. Ongoing research on host-pathogen interactions reveals a promising capability to analyze virulence factors in bacteria causing UTIs in children, identify highly virulent bacteria capable of causing pyelonephritis and renal injury, and to selectively target the gastrointestinal reservoirs of these bacteria for elimination using probiotics. Promising experimental studies correlating bacterial virulence with pattern of UTI and identification and characterization of a newly available probiotic capable of eradicating uropathogenic bacteria make targeted probiotic prevention of renal injury-inducing UTIs a potential therapeutic reality.

Renal sequence and functional series scintigraphy with o131I-hippuric acid in patients with diabetes mellitus

International Nuclear Information System (INIS)

Kempken, K.; Heidenreich, P.; Langhammer, H.; Bottermann, P.; Pabst, H.W.; Technische Univ. Muenchen

1974-01-01

The appearance of disturbances of the renal function in diabetes mellitus is a function of the quality of the therapy and control of the patient, the duration of the disease, and the age of manifestation as well as other factors such as the lipide metabolism and unspecific infections. Such infections often lead to pyelonephritis which may be regarded as a real complication and in particular so in connection with the late diabetic syndrome (Lundbaek), i.e. especially in diabetics of advanced age. Apart from the true diabetic nephropathia, gromerulosclerosis, which is more frequently found in younger patients, arterio-arteriolosclerosis of the kidneys and tubular atrophies due to interstitial deposits of proteins and glycogens should also be mentioned. An assessment of the renal function in all stages of diabetes mellitus and in hypertonicity was carried out with the aid of renal sequential and functional series scintigraphy. No similar investigations have been reported in the relevant literature. (orig./AK) [de

A Study on the Effectiveness of Diuretic Renal Scan on Functional and Pathologic Obstructive Uropathy

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Ahn, Cu Rie; Lee, Hun Yong; Kwon, In Sun

1983-01-01

Diuretic renal scan, a modified method of convectional radionuclide renography by administration of intravenous furosemide was performed in 54 patients with suspected urinary tract obstruction. Two showed normal responses, 41 showed increased washout patterns, and the remainder 15 revealed no changes in response to the furosemide administration. IVP was done in 34 patients. In comparison to the diuretic renal scan, the following results were obtained. 1) Patients with normal results by the scan, showed normal IVP findings also. 2) 10 patients who showed delayed excretory patterns not influenced by the diuretics administration. 9 patients revealed obstructive lesions and hydronephrotic changes, and CPN was diagnosed for the remainder one and the one patient without obstruction was diagnosed as chronic pyelonephritis. 3) 22 patients showed positive results to the diuretics. Among them 10 patients had positive results in IVP. but, were not related to the speed of decrement of the renal activity after the furosemide administration.

Medical image of the week: Lynch syndrome

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Athale A

2016-11-01

Full Text Available No abstract available. Article truncated at 150 words. A 43-year-old woman with a history of anemia, thrombocytopenia, and recent treatment for pyelonephritis was transferred to our hospital for increasing shortness of breath. Four months prior to admission, she developed unprovoked bilateral deep vein thrombosis (DVT and pulmonary emboli (PE and was started on rivaroxaban at that time. At presentation, she was complaining of worsening shortness of breath, heavy menstrual bleeding and pain in her calves. CT angiography of chest showed multiple pulmonary emboli to the lower lobes and left upper lobe (Figure 1 and lower extremity venous Doppler showed extensive, acute deep vein thrombosis involving the femoral, popliteal and calf veins bilaterally. Rivaroxaban was held due to anemia and thrombocytopenia and there was concern for respiratory failure since she developed new DVT and PE. She was transfused with 1 unit of packed red blood cells and started on a heparin drip. She continued to have significant menorrhagia, the ...

[The role of percutaneous renal biopsy in kidney transplant].

Science.gov (United States)

Manfro, R C; Lee, J Y; Lewgoy, J; Edelweiss, M I; Gonçalves, L F; Prompt, C A

1994-01-01

Percutaneous renal biopsy (PRB) is an useful tool for diagnostic and therapeutic orientation in renal transplantation. PURPOSE--To evaluate the current role of PRB in post-transplant acute renal dysfunction (ARD) of renal allografts. METHODS--Sixty-five renal transplant patients were submitted to 95 valid renal biopsies with no major complications. RESULTS--There was disagreement between the clinical and the pathological diagnosis in 28 occasions (29.5%). In 36 cases (37.9%) the results of the pathological examination led to a modification in patient's management. These modifications were most commonly the avoidance or witholding of a steroid pulse (8 cases); nephrectomy of the renal allograft (8 cases); witholding or decrease of cyclosporine dosage (6 cases); giving a steroid pulse (5 cases) and giving antibiotics to treat acute pyelonephritis in 4 cases. The use of kidneys from cadaveric donors was significantly associated with an increased number of biopsies (p renal biopsy is still an indispensable method to the management of ARD in renal transplant patients.

Urinary tract infection in children

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Kovacs, L.; Janko, V.

2014-01-01

Urinary tract infections (UTIs) are among the most common bacterial infections in children which can be a source of significant morbidity. For as yet unknown reasons a minority of UTIs in children progress to renal scarring, hypertension and renal insufficiency. Clinical presentation of UTI in children may be nonspecific, and the appropriateness of certain diagnostic tests remains controversial. The diagnostic work-up should be tailored to uncover functional and structural abnormalities such as dysfunctional voiding, vesicoureteral reflux and obstructive uropathy. A more aggressive work-up is recommended for patients at greater risk for pyelonephritis and renal scarring, including infants less than one year of age. Early sequential (intravenous treatment followed by oral antibiotics) antibacterial therapy is recommended to prevent renal scarring. Routine antibiotic prophylaxis is not recommended, it may be used in patients with higher grade reflux, obstructive uropathy or recurring UTI who are at greater risk for subsequent infections and complications. (author)

The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos.

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Vilada Chansamouth

2016-04-01

Full Text Available Laos has the highest maternal mortality ratio in mainland Southeast Asia and a high incidence of infectious diseases. Globally, malaria has been the pathogen most intensively investigated in relation to impact on pregnancy, but there has been relatively little research on the aetiology and impact of other diseases. We therefore aimed to determine the causes and impact of fever in pregnant women admitted to two central hospitals in Vientiane City, Lao PDR (Laos.This hospital-based prospective study was conducted in Mahosot Hospital and the Mother and Child Hospital, Vientiane, between 2006 and 2010, with the aim to recruit 250 consenting pregnant women admitted with tympanic temperature ≥37.5°C. Primary outcome was the cause of fever and secondary outcomes were pregnancy outcomes. Specific investigations (culture, antigen, molecular and serological tests were performed to investigate causes of fever. After discharge, all pregnant women were asked to return for review and convalescence serum on day 10-14 and were monitored until delivery.250 pregnant women were recruited to this study between February 2006 and November 2010. Fifty percent were pregnant for the first time. Their median (range gestational age on admission was 24 (4-43 weeks. The median (range tympanic admission temperature was 38.5°C (37.5-40.5°C. Fifteen percent of patients stated that they had taken antibiotics before admission. Headache, myalgia, back pain and arthralgia were described by >60% of patients and 149 (60% were given a laboratory diagnosis. Of those with confirmed diagnoses, 132 (53% had a single disease and 17 (7% had apparent mixed diseases. Among those who had a single disease, dengue fever was the most common diagnosis, followed by pyelonephritis, scrub typhus, murine typhus and typhoid. Patients were also diagnosed with tuberculosis, appendicitis, Staphylococcus aureus septicemia, leptospirosis, Japanese encephalitis virus infection and Plasmodium falciparum

Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting.

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Michelle T Hecker

Full Text Available To evaluate adherence to uncomplicated urinary tract infections (UTI guidelines and UTI diagnostic accuracy in an emergency department (ED setting before and after implementation of an antimicrobial stewardship intervention.The intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18-65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1, and after audit and feedback (period 2.Adherence to UTI guidelines increased from 44% (baseline to 68% (period 1 to 82% (period 2 (P≤.015 for each successive period. Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline to 14% (period 1 to 13% (period 2 (P<.001 and P = .7 for each successive period. Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period. For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods.A stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI.

Nephron-sparing surgery for treatment of reninoma: a rare renin secreting tumor causing secondary hypertension.

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Torricelli, Fabio Cesar Miranda; Marchini, Giovanni Scala; Colombo, Jose Roberto; Coelho, Rafael Ferreira; Nahas, Willian Carlos; Srougi, Miguel

2015-01-01

A 25-year-old hypertensive female patient was referred to our institution. Initial workup exams demonstrated a 2.8 cm cortical lower pole tumor in the right kidney. She underwent laparoscopic partial nephrectomy without complications. Histopathologic examination revealed a rare juxtaglomerular cell tumor known as reninoma. After surgery, she recovered uneventfully and all medications were withdrawn. Case hypothesis: Secondary arterial hypertension is a matter of great interest to urologists and nephrologists. Renovascular hypertension, primary hyperadosteronism and pheocromocytoma are potential diagnosis that must not be forgotten and should be excluded. Although rare, chronic pyelonephritis and renal tumors as rennin-producing tumors, nephroblastoma, hypernephroma, and renal cell carcinoma might also induce hypertension and should be in the diagnostic list of clinicians. Promising future implications: Approximately 5% of patients with high blood pressure have specific causes and medical investigation may usually identify such patients. Furthermore, these patients can be successfully treated and cured, most times by minimally invasive techniques. This interesting case might expand knowledge of physicians and aid better diagnostic care in future medical practice.

EMERGENCY UROLOGIC IN PREGNANCY

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Putu Surya Utami

2013-12-01

Full Text Available Normal 0 false false false EN-US X-NONE X-NONE A variety of anatomical and physiological changes occurring during pregnancy, which can affect any organ system. Urological problems in pregnancy represent a diagnostic and therapeutic challenge. Urinary tract symptoms in pregnant women comprise urinary tract infection, acute pyelonephritis, acute urinary retention, hematuria, placenta percreta, nefrolithiasis, uropathy obstructive, and malignancy urologic. A multidisciplinary approach is necessary, from the anesthetic and obstetric team. In this review, I will discuss the common urological problems that occur during pregnancy and outline an approach to their management. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";}

Pediatric renovascular hypertension in Thailand: CT angiographic findings

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Visrutaratna, Pannee; Srisuwan, Tanop; Sirivanichai, Chusak [Chiang Mai University, Department of Radiology, Faculty of Medicine, Chiang Mai (Thailand)

2009-12-15

Renovascular disease is an uncommon but important cause of hypertension in children. When unrecognized and untreated, renovascular hypertension in children can have serious complications. To review the causes of renovascular hypertension and computed tomography angiographic (CTA) findings in children and adolescents. Twenty-eight CTAs from January 2004 to March 2008 of 23 children and adolescents with hypertension were reviewed for the causes and CTA findings. Nine of the 23 children (39%) had abnormal renal arteries with or without abnormal abdominal aortas. Four of these children had Takayasu arteritis, one had moyamoya disease, and one had median arcuate ligament syndrome. One with chronic pyelonephritis had severe stenosis of the proximal right renal artery. The other two children had renal artery stenosis with a nonspecific cause. One child with a normal abdominal aorta and renal arteries had a right suprarenal mass. On pathological examination a ganglioneuroma was found. CTA can help in diagnosis of renovascular hypertension in children and adolescents. Although CTA is not a screening modality, it is appropriate in some situations. (orig.)

The evaluation of kidney scan: On comparison with excretory urography

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Choe, Yong Kyu; Kim, Chung Kyu; Choi, Byung Sook [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1970-10-15

The kidney scan and the excretory urography of 21 cases in kidney disease proved clinically or pathologically at Yonsei University, Severance Hospital were reviewed and analysed briefly. Following were the results: 1. In all except 2 cases of pyelonephritis, changes on the kidney scan were noted with generalized motted density and cold area in the kidney, and with diffuse poor or non uptake density and various size or shape of the kidney. 2. On the excretory urogram, the demonstrable findings in the kidney parenchyma were discribed on the only 7 of 21 cases, hypernephroma, tuberculosis kidney, necrotizing papillits, medullary sponge kidney, and stenosis of renal artery. 3. Three of all cases, renal carbuncle, retroperitoneal hematoma with aberrant vessel and angiolipomyoma were no appreciable finding on the pyelography, but on the view of kidney scanning, there were apparently demonstrated abnormal cold area and some enlargement of kidney size. We concluded that the close correlation of the two techniques, kidney scanning and excretory urography on the kidney disease leads to more improved diagnostic accuracy.

Pediatric renovascular hypertension in Thailand: CT angiographic findings

International Nuclear Information System (INIS)

Visrutaratna, Pannee; Srisuwan, Tanop; Sirivanichai, Chusak

2009-01-01

Renovascular disease is an uncommon but important cause of hypertension in children. When unrecognized and untreated, renovascular hypertension in children can have serious complications. To review the causes of renovascular hypertension and computed tomography angiographic (CTA) findings in children and adolescents. Twenty-eight CTAs from January 2004 to March 2008 of 23 children and adolescents with hypertension were reviewed for the causes and CTA findings. Nine of the 23 children (39%) had abnormal renal arteries with or without abnormal abdominal aortas. Four of these children had Takayasu arteritis, one had moyamoya disease, and one had median arcuate ligament syndrome. One with chronic pyelonephritis had severe stenosis of the proximal right renal artery. The other two children had renal artery stenosis with a nonspecific cause. One child with a normal abdominal aorta and renal arteries had a right suprarenal mass. On pathological examination a ganglioneuroma was found. CTA can help in diagnosis of renovascular hypertension in children and adolescents. Although CTA is not a screening modality, it is appropriate in some situations. (orig.)

Radionuclide studies in paediatric nephro-urology

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Piepsz, Amy E-mail: amypiepsz@yahoo.com

2002-08-01

The main tool of radionuclide techniques applied to paediatric uro-nephrology is the quantitation of function, which is an information not easily obtained by other diagnostic modalities. The radiation burden is low. Drug sedation is only rarely needed, whatever the age of the patient. Accurate determination of glomerular filtration rate can be obtained by means of an intravenous injection of Cr-51 EDTA and one or two blood samples. Tc-99m DMSA scintigraphy is an accurate method for evaluation of regional cortical impairment during acute pyelonephritis and later on, for detection of permanent scarring. Tc-99m MAG3 renography is nowadays a well-standardized method for accurate estimation of the split renal function and of renal drainage with or without furosemide challenge. This technique is particularly indicated in uni- or bilateral uropathies with or without renal and/or ureteral dilatation. Direct and indirect radionuclide cystography are two alternative modalities for X-ray MCUG. Their relative place in the strategy of management of vesicoureteral reflux is discussed.

Síndrome urológica felina: 13 casos Feline urologic syndrome: 13 cases

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Flademir Wouters

1998-09-01

Full Text Available Treze casos (8,44% de síndrome urológica felina foram diagnosticados em 154 necropsias de gatos realizadas de 1991 a 1997. Dados epidemiológicos, sinais clínicos, lesões de necropsia e achados histopatológicos foram revisados. Sete animais eram machos inteiros e seis eram machos castrados. Obstrução uretral, hematúria, disúria e distensão vesical foram os principais sinais clínicos. Os principais achados de necropsia e histopatológicos foram cistite hemorrágica, pielonefrite, edema perirrenal, hidronefrose, necrose tubular e uretrite.Thirteen cases (8.44% of feline urologic syndrome were diagnosed in 154 necropsies carried out in cats from 1991 to 1997. Epidemiological data, clinical signs, gross, and histopalhological features were reviewed. Seven cats were intact males and six were castrated males. Urethral obstruction, hematuria, dysuria, and urinary bladder distention were the main clinical signs. Main gross and histopathological findings were hemorrhagic cystitis, pyelonephritis, perirenal edema, hydronephrosis, tubular necrosis, urethritis.

The normal and pathologic renal medulla: a comprehensive overview.

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López, José I; Larrinaga, Gorka; Kuroda, Naoto; Angulo, Javier C

2015-04-01

The renal medulla comprises an intricate system of tubules, blood vessels and interstitium that is not well understood by most general pathologists. We conducted an extensive review of the literature on the renal medulla, in both normal and pathologic conditions. We set out in detail the points of key interest to pathologists: normal and pathological development, physiology, microscopic anatomy, histology and immunohistochemistry; and the specific and most common other types of disease associated with this part of the kidney: developmental abnormalities, (multicystic dysplastic kidney, autosomal dominant and recessive polycystic kidney diseases, medullary cystic kidney disease), inflammatory conditions (xanthogranulomatous pyelonephritis, malakoplakia), hyperplasia and dysplasia, and neoplastic processes (oncocytoma, atypical oncocytic tumors, chromophobe cell carcinoma, collecting duct carcinoma, urothelial carcinoma, other carcinomas, renal medullary fibroma and metastatic tumors). This condensed overview of the origin, function and pathology of the renal medulla, both in terms of development, inflammation and neoplastic processes, should help focus the interest of clinical pathologists on this widely overlooked part of the kidney. Copyright © 2014 Elsevier GmbH. All rights reserved.

The evaluation of kidney scan: On comparison with excretory urography

International Nuclear Information System (INIS)

Choe, Yong Kyu; Kim, Chung Kyu; Choi, Byung Sook

1970-01-01

The kidney scan and the excretory urography of 21 cases in kidney disease proved clinically or pathologically at Yonsei University, Severance Hospital were reviewed and analysed briefly. Following were the results: 1. In all except 2 cases of pyelonephritis, changes on the kidney scan were noted with generalized motted density and cold area in the kidney, and with diffuse poor or non uptake density and various size or shape of the kidney. 2. On the excretory urogram, the demonstrable findings in the kidney parenchyma were discribed on the only 7 of 21 cases, hypernephroma, tuberculosis kidney, necrotizing papillits, medullary sponge kidney, and stenosis of renal artery. 3. Three of all cases, renal carbuncle, retroperitoneal hematoma with aberrant vessel and angiolipomyoma were no appreciable finding on the pyelography, but on the view of kidney scanning, there were apparently demonstrated abnormal cold area and some enlargement of kidney size. We concluded that the close correlation of the two techniques, kidney scanning and excretory urography on the kidney disease leads to more improved diagnostic accuracy

Diagnosis and management of ureteral complications following renal transplantation

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Brian D. Duty

2015-10-01

Full Text Available When compared with maintenance dialysis, renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life. Approximately 9% of patients will develop a major urologic complication following kidney transplantation. Ureteral complications are most common and include obstruction (intrinsic and extrinsic, urine leak and vesicoureteral reflux. Ureterovesical anastomotic strictures result from technical error or ureteral ischemia. Balloon dilation or endoureterotomy may be considered for short, low-grade strictures, but open reconstruction is associated with higher success rates. Urine leak usually occurs in the early postoperative period. Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression (nephrostomy tube, ureteral stent, and indwelling bladder catheter. Proximal, large-volume, or leaks that persist despite urinary diversion, require open repair. Vesicoureteral reflux is common following transplantation. Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment. Deflux injection may be considered in recipients with low-grade disease. Grade IV and V reflux are best managed with open reconstruction.

Potential utility of MRI in the evaluation of children at risk of renal scarring

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Chan Yuleung; Chan Kamwing; Roebuck, D.J.; Chu, W.C.W.; Metreweli, C. [Dept. of Diagnostic Radiology and Organ Imaging, Chinese Univ. of Hong Kong, Shatin (China); Yeung Chungkwong; Lee Kimhung [Dept. of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong (China)

1999-11-01

Background. Gadolinium-enhanced MRI has recently been employed in the diagnosis of acute pyelonephritis. Its potential utility in the diagnosis of renal scars in children is unknown. Objective. To evaluate the potential utility of MRI using fat-saturated T1-weighted (T1-W) and post-gadolinium, short-tau inversion-recovery (STIR) sequences in detecting renal scarring by comparison with technetium dimercaptosuccinic acid ({sup 99} {sup m}Tc-DMSA) renal scintigraphy in children at risk of renal scarring. Materials and methods. A group of 24 children with spina bifida and neurogenic bladder or anorectal anomaly was studied. No patient had a history of acute pyelonephritis. Documented urinary tract infection (UTI) was present in 10 children (42 %). The remaining 14 (58 %) children had a history of asymptomatic bacteriuria. None had clinical signs or symptoms of acute UTI at the time of the study. {sup 99} {sup m}Tc-DMSA and MRI were performed to detect renal scarring. {sup 99} {sup m}Tc-DMSA scans were supplemented with pinhole imaging. MRI of the kidneys employed a fat-saturated T1-W sequence and a post-gadolinium STIR sequence employing a short echo time. Results. Of the kidneys studied, 33 % (n = 16) had evidence of a renal parenchymal defect suggestive of scarring on {sup 99} {sup m}Tc-DMSA. The concordance in the detection of a scarred kidney by post-gadolinium STIR sequence and {sup 99} {sup m}Tc-DMSA is 94 %; that by fat-saturated T1-W sequence and {sup 99} {sup m}Tc-DMSA is 82 %; that by both sequences (positive result on either sequence) and {sup 99} {sup m}Tc-DMSA is 100 %. Using {sup 99} {sup m}Tc-DMSA as the gold standard, MRI had a sensitivity of 100 % and a specificity of 78 % in the diagnosis of a scarred kidney. The concordance in the detection of a scarred zone by post-gadolinium STIR sequence and {sup 99} {sup m}Tc-DMSA is 68 %; that by fat-saturated T1-W sequence and DMSA is 44 %; that by both sequences (positive result on either sequence) and {sup 99

Potential utility of MRI in the evaluation of children at risk of renal scarring

International Nuclear Information System (INIS)

Chan Yuleung; Chan Kamwing; Roebuck, D.J.; Chu, W.C.W.; Metreweli, C.; Yeung Chungkwong; Lee Kimhung

1999-01-01

Background. Gadolinium-enhanced MRI has recently been employed in the diagnosis of acute pyelonephritis. Its potential utility in the diagnosis of renal scars in children is unknown. Objective. To evaluate the potential utility of MRI using fat-saturated T1-weighted (T1-W) and post-gadolinium, short-tau inversion-recovery (STIR) sequences in detecting renal scarring by comparison with technetium dimercaptosuccinic acid ( 99 m Tc-DMSA) renal scintigraphy in children at risk of renal scarring. Materials and methods. A group of 24 children with spina bifida and neurogenic bladder or anorectal anomaly was studied. No patient had a history of acute pyelonephritis. Documented urinary tract infection (UTI) was present in 10 children (42 %). The remaining 14 (58 %) children had a history of asymptomatic bacteriuria. None had clinical signs or symptoms of acute UTI at the time of the study. 99 m Tc-DMSA and MRI were performed to detect renal scarring. 99 m Tc-DMSA scans were supplemented with pinhole imaging. MRI of the kidneys employed a fat-saturated T1-W sequence and a post-gadolinium STIR sequence employing a short echo time. Results. Of the kidneys studied, 33 % (n = 16) had evidence of a renal parenchymal defect suggestive of scarring on 99 m Tc-DMSA. The concordance in the detection of a scarred kidney by post-gadolinium STIR sequence and 99 m Tc-DMSA is 94 %; that by fat-saturated T1-W sequence and 99 m Tc-DMSA is 82 %; that by both sequences (positive result on either sequence) and 99 m Tc-DMSA is 100 %. Using 99 m Tc-DMSA as the gold standard, MRI had a sensitivity of 100 % and a specificity of 78 % in the diagnosis of a scarred kidney. The concordance in the detection of a scarred zone by post-gadolinium STIR sequence and 99 m Tc-DMSA is 68 %; that by fat-saturated T1-W sequence and DMSA is 44 %; that by both sequences (positive result on either sequence) and 99 m Tc-DMSA is 84 %. MRI had a sensitivity of 84 % and a specificity of 86 % in the diagnosis of a

Adopted Korean woman with symptoms of cystitis – Delayed diagnosis of tuberculosis leading to disseminated disease

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Mose M

2017-01-01

Full Text Available We report a rare case of miliary tuberculosis (TB in an adopted woman that developed following delayed diagnosis of presumed urogenital TB. The patient had a two year history of urological symptoms, diagnosed as interstitial cystitis and treated with cyclosporine. At admission, she presented with symptoms of pyelonephritis. Neck stiffness led to lumbar puncture that showed pleocytosis with lymphocytic predominance, high protein and low glucose levels, suggestive of TB meningitis. Computed tomography and magnetic resonance imaging scans showed nodular lung changes, lumbar spine destructive lesions, a unilateral kidney abscess and a parietal lobe tuberculoma. Urine and cerebrospinal fluids were positive for TB by polymerase chain reaction (PCR and culture. The patient developed complications in the form of hydrocephalus. She was treated with a ventriculoperitoneal shunt and four drug anti-tuberculosis therapy. She was discharged to neurorehabilitation on continued anti-tuberculosis treatment, developing longer term sequelae in the form of severe cognitive disabilities. This case emphasizes the importance of continuing to include TB in the differential diagnosis of a variety of diseases, particularly in patients at possible increased risk of infection, and highlights the potentially serious consequences of delayed or missed TB diagnosis.

Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience

Science.gov (United States)

Biočíc, Mihovil; Todoríc, Jakov; Budimir, Dražen; Roíc, Andrea Cvitkovíc; Pogorelíc, Zenon; Juríc, Ivo; Šušnjar, Tomislav

2012-01-01

Background The goals of medical intervention in patients with vesicoureteral reflux are to allow normal renal growth, prevent infections and pyelonephritis, and prevent renal failure. We present our experience with endoscopic treatment of vesicoureteral reflux in children by subureteral dextranomer/hyaluronic acid copolymer injection. Methods Under cystoscopic guidance, dextranomer/hyaluronic acid copolymer underneath the intravesical portion of the ureter in a subureteral or submucosal location was injected in patients undergoing endoscopic correction of vesicoureteral reflux. Results A total of 282 patients (120 boys and 162 girls) underwent the procedure. There were 396 refluxed ureters altogether. The mean age of patients was 4.9 years. The mean overall follow-up period was 44 months. Among the 396 ureters treated, 76% were cured with a single injection. A second and third injection raised the cure rate to 93% and 94%, respectively. Twenty-two (6%) ureters failed all 3 injections, and were converted to open surgery. Conclusion Endoscopic treatment of vesicoureteral reflux can be recommended as a first-line therapy for most cases of vesicoureteral reflux, because of the short hospital stay, absence of complications and the high success rate. PMID:22854114

PATTERN OF ANTIMICROBIAL USE FOR URINARY TRACT INFECTION DURING PREGNANCY IN A TERTIARY CARE TEACHING HOSPITAL

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Haldia Priyanka, Sharma Taruna, Nautiyal Ruchira

2015-04-01

Full Text Available Background: Urinary Tract Infection (UTI may be classified as lower (cystitis and asymptomatic bacteriuria or upper urinary tract infections (pyelonephritis. The recommended antibiotics for use in pregnancy for management of ASB include amoxicillin, oral cephalosporins and nitrofurantoin; and for the treatment of lower UTI during pregnancy include penicillins, oral cephalosporins. Data from the antibiotic usage study in UTI during pregnancy will help in establishing a proper antibiotic utilisation guideline and promotes rational prescribing of medicines. Aim: To study the antimicrobial prescription practices for urinary tract infection during pregnancy. Materials & Methods: The study was conducted in the Department of Pharmacology and Department of Obstetrics & Gynaecology, Himalayan Institute of Medical Sciences (HIMS, Dehradun, over a period of 12 months. This was an observational cross sectional study done in 45 pregnant women with or without symptoms of UTI. Results: 29.4% of the pregnant women with symptomatic UTI were culture positive while all were culture positive who had asymptomatic UTI. Cephalosporins were most frequently prescribed followed by nitrofurantoin. Conclusion: Urine culture should be performed as a screening and diagnostic tool for UTI during pregnancy. Various classes of antimicrobials were being prescribed for UTI during pregnancy.

A histomorphologic and ultrastructural study of the malignant tumours of the renal pelvis.

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Tyagi N

1993-10-01

Full Text Available The study was carried at two different centres. Only 9 cases of primary malignant tumours of the renal pelvis could be collected during the period of 7 years (1984-1990. Renal pelvis malignancies constituted 0.21% of all the malignancies and 12.16% of all the malignant growths of the kidney (9 out of 74 cases. The age of these patients ranged from 24 to 70 years; the mean being 41.7 years. Male/female ratio was 8:1. Common triad of complaints (pain, haematuria and lump was noticed in 22.2% of patients. Individually they were noticed in 77.8%, 66.7% and 44.4% of patients respectively. Transitional cell carcinoma was the commonest, seen in 7 patients (77.8% whereas squamous cell carcinoma and adenocarcinoma were noticed in one patient (11.1% each. Hydronephrosis, chronic pyelonephritis and nephrolithiasis were noticed in 66.7%, 44.4% and 22.2% of patients respectively. Ultrastructural study of urothelial tumours revealed tumour cells in various stages of differentiation with loss of intercellular junctions and dense collection of rough endopasmic reticulum fibrils around the nucleus.

α-Intercalated cells defend the urinary system from bacterial infection.

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Paragas, Neal; Kulkarni, Ritwij; Werth, Max; Schmidt-Ott, Kai M; Forster, Catherine; Deng, Rong; Zhang, Qingyin; Singer, Eugenia; Klose, Alexander D; Shen, Tian Huai; Francis, Kevin P; Ray, Sunetra; Vijayakumar, Soundarapandian; Seward, Samuel; Bovino, Mary E; Xu, Katherine; Takabe, Yared; Amaral, Fábio E; Mohan, Sumit; Wax, Rebecca; Corbin, Kaitlyn; Sanna-Cherchi, Simone; Mori, Kiyoshi; Johnson, Lynne; Nickolas, Thomas; D'Agati, Vivette; Lin, Chyuan-Sheng; Qiu, Andong; Al-Awqati, Qais; Ratner, Adam J; Barasch, Jonathan

2014-07-01

α-Intercalated cells (A-ICs) within the collecting duct of the kidney are critical for acid-base homeostasis. Here, we have shown that A-ICs also serve as both sentinels and effectors in the defense against urinary infections. In a murine urinary tract infection model, A-ICs bound uropathogenic E. coli and responded by acidifying the urine and secreting the bacteriostatic protein lipocalin 2 (LCN2; also known as NGAL). A-IC-dependent LCN2 secretion required TLR4, as mice expressing an LPS-insensitive form of TLR4 expressed reduced levels of LCN2. The presence of LCN2 in urine was both necessary and sufficient to control the urinary tract infection through iron sequestration, even in the harsh condition of urine acidification. In mice lacking A-ICs, both urinary LCN2 and urinary acidification were reduced, and consequently bacterial clearance was limited. Together these results indicate that A-ICs, which are known to regulate acid-base metabolism, are also critical for urinary defense against pathogenic bacteria. They respond to both cystitis and pyelonephritis by delivering bacteriostatic chemical agents to the lower urinary system.

Menarche? A Case of Abdominal Pain and Vaginal Bleeding in a Preadolescent Girl.

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Riney, Lauren C; Reed, Jennifer L; Kruger, Laura L; Brody, Alan J; Pomerantz, Wendy J

2015-11-01

Abdominal pain is one of the most common complaints in the pediatric ED. Because of the broad range of potential diagnoses, it can pose challenges in diagnosis and therapy in the preadolescent girl. An 11-year-old previously healthy girl presented to our pediatric ED with fever, decreased appetite, vaginal bleeding, and abdominal pain. Initial evaluation yielded elevated creatinine levels, leukocytosis with bandemia, elevated inflammatory markers, and urine concerning for a urinary tract infection. She began receiving antibiotics for presumed pyelonephritis and was admitted to the hospital. After worsening respiratory status and continued abdominal pain, a computed tomography scan was obtained and a pelvic foreign body and abscess were identified. Adolescent gynecology was consulted for examination under anesthesia for abscess drainage and foreign body removal. A foreign body in the vagina or uterus can present as vaginal discharge, vaginal bleeding, abdominal pain, dysuria, or hematuria. Because symptoms can be diverse, an intravaginal or uterine foreign body should be considered in the preteen female patient presenting to the ED with abdominal pain. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Pediatric febrile urinary tract infections: the current state of play

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Hewitt Ian K

2011-11-01

Full Text Available Abstract Studies undertaken in recent years have improved our understanding regarding the consequences and management of febrile urinary tract infections (UTIs, which are amongst the most common serious bacterial infections in childhood, with renal scarring a frequent outcome. In the past pyelonephritic scarring of the kidney, often associated with vesico-ureteral reflux (reflux nephropathy was considered a frequent cause of chronic renal insufficiency in children. Increasing recognition as a consequence of improved antenatal ultrasound, that the majority of these children had congenital renal hypo-dysplasia, has resulted in a number of studies examining treatment strategies and outcomes following UTI. In recent years there is a developing consensus regarding the need for a less aggressive therapeutic approach with oral as opposed to intravenous antibiotics, and less invasive investigations, cystourethrography in particular, following an uncomplicated first febrile UTI. There does remain a concern that with this newer approach we may be missing a small subgroup of children more prone to develop severe kidney damage as a consequence of pyelonephritis, and in whom some form of intervention may prove beneficial. These concerns have meant that development of a universally accepted diagnostic protocol remains elusive.

[Appendicouretheroplasty].

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Komiakov, B K; Guliev, B G; Dorofeev, S Ia; Burlaka, O O

2006-01-01

Repair of long uretheral defects with the appendix (appendi-couretheroplasty--AUP) was made in 5 patients. Stenosis of the lumbar urether was caused by a gunshot wound in one patient. Uretheral strictures developed after iatrogenic injury during extended gynecological operations in 3 women. The strictures arose after radiotherapy in one female. The man has undergone plastic reconstruction of the upper third of the right ureter, while women - replacement of the pelvic urether, including one case on the left. In two cases a modified surgical technique was used for better appendicocystanastomosis--a flap was dissected from the cupola of the cecum. In one case surgery was combined with simultaneous contralateral Boari's operation, in the other case--with transvaginal suturing of the vesicovaginal fistula. Exacerbation of chronic pyelonephritis occurred in one patient. In the other case antegrade pyeloureterography has detected stricture of ureteroappendicoanastomosis. Resection of the stricted place and reanastomosing were performed in this patient. Passability of the urinary tract recovered in all the patients. Thus, replacement of any part of the right and pelvic part of the left ureter with the appendix is feasible with good results.

Enterovesical Fistula: A Rare Complication of Urethral Catheterization

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Amr Hawary

2009-01-01

Full Text Available This report describes the case of an eighty-two-year old lady with an indwelling urethral catheter inserted eight years prior to her presentation to manage her urinary incontinence. She underwent radiotherapy for muscle-invasive bladder cancer (stage T2b in 1991 and had a laparotomy and drainage of an appendicular abscess in her early twenties. She presented with a short history of fecaluria, pneumaturia, and passage of urine per rectum. On laparotomy she was found to have an inflated catheter balloon that has eroded through the bladder wall into the lumen of a terminal ileal segment. To our knowledge this is the first reported case in literature of a patient developing an enterovesical fistula as a result of a urethral catheter eroding through the bladder wall into the bowel lumen. There are numerous known complications of long-term urethral catheterization. They include recurrent urinary tract infections, recurrent pyelonephritis, sepsis, urethral stricture, blocked and retained catheters, among many other reported complications. This case describes an unusual presentation secondary to an even more unusual complication. This should be considered when handling patients with indwelling urethral catheters inserted in unhealthy bladders.

Ribonuclease 7, an antimicrobial peptide up-regulated during infection, contributes to microbial defense of the human urinary tract

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Spencer, John David; Schwaderer, Andrew L.; Wang, Huanyu; Bartz, Julianne; Kline, Jennifer; Eichler, Tad; DeSouza, Kristin R.; Sims-Lucas, Sunder; Baker, Peter; Hains, David S.

2012-01-01

The mechanisms that maintain sterility in the urinary tract are incompletely understood; however, recent studies stress the importance of antimicrobial peptides in protecting the urinary tract from infection. Ribonuclease 7 (RNase 7), a potent antimicrobial peptide contributing to urinary tract sterility, is expressed by intercalated cells in the renal collecting tubules and is present in the urine at levels sufficient to kill bacteria at baseline. Here, we characterize the expression and function of RNase 7 in the human urinary tract during infection. Both quantitative real-time PCR and ELISA assays demonstrated increases in RNASE7 expression in the kidney along with kidney and urinary RNase 7 peptide concentrations with infection. While immunostaining localized RNase 7 production to the intercalated cells of the collecting tubule during sterility, its expression during pyelonephritis was found to increase throughout the nephron but not in glomeruli or the interstitium. Recombinant RNase 7 exhibited antimicrobial activity against uropathogens at low micromolar concentrations by disrupting the microbial membrane as determined by atomic force microscopy. Thus, RNase 7 expression is increased in the urinary tract with infection, and has antibacterial activity against uropathogens at micromolar concentrations. PMID:23302724

Sigma-1 receptor agonist fluvoxamine for delirium in intensive care units: report of five cases

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Hashimoto Kenji

2010-04-01

Full Text Available Abstract Background Delirium is a highly prevalent disorder among older patients in intensive care units (ICUs. Although antipsychotic drugs are the medications most frequently used to treat this syndrome, these drugs are associated with a variety of adverse events, including sedation, extrapyramidal side effects, and cardiac arrhythmias. Drug treatment for delirium requires careful consideration of the balance between the effective management of symptoms and potential adverse effects. Methods We report on five Japanese men (an 84 year old (acute aortic dissociation: Stanford type A, a 55 year old (traumatic subarachnoid hemorrhage and brain contusion, a 76 year old (sepsis by pyelonephritis, an 85 year old (cerebral infarction, and an 86 year old (pulmonary emphysema and severe pneumonia in which the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the delirium of the patients. Results Delirium Rating Scale (DRS scores in these five patients dramatically decreased after treatment with fluvoxamine. Conclusion Doctors should consider fluvoxamine as an alternative approach to treating delirium in ICU patients in order to avoid the risk of side effects and increased mortality from antipsychotic drugs.

Pielonefritis xantogranulomatosa en la infancia: Presentación de 3 casos

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. Aurelio J. Álvarez Quiñones

2000-06-01

Full Text Available Se analizan las historias clínicas de 3 pacientes en edades pediátricas, los cuales se estudiaron y cuyo diagnóstico fue de pielonefritis xantogranulomatosa, en el período comprendido entre 1985 y 1995. Dos enfermos pertenecían al sexo masculino y 1 al femenino. Todos los pacientes tenían antecedentes de sepsis urinaria, y se comportaron, desde el punto de vista radiológico: 1 con ausencia de eliminación renal, otro con ureteronefrosis y el último como una variedad pseudotumoral renal. A los 3 se les realizó nefrectomía y evolucionaron satisfactoriamente, lo que precisó el diagnóstico posoperatorio. Se revisó la literatura médica nacional e internacional.The medical records of three pediatric patients, two boys and one girl who were studied and diagnosed with xanthogranulomatous pyelonephritis in the period from 1985 to 1995 were analyzed. All of them had histories of urinary sepsis and from the radiological viewpoint, one presented no renal urine disposal, another one had ureteronephrosis and the third had a renal pseudotumoral variety. The three children underwent nephrectomy and recovered satisfactorily which was confirmed by the postoperative diagnosis. A review of the international and national literature was made.

Transport proteins promoting Escherichia coli pathogenesis

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Tang, Fengyi; Saier, Milton H.

2014-01-01

Escherichia coli is a genetically diverse species infecting hundreds of millions of people worldwide annually. We examined seven well-characterized E. coli pathogens causing urinary tract infections, gastroenteritis, pyelonephritis and haemorrhagic colitis. Their transport proteins were identified and compared with each other and a non-pathogenic E. coli K12 strain to identify transport proteins related to pathogenesis. Each pathogen possesses a unique set of protein secretion systems for export to the cell surface or for injecting effector proteins into host cells. Pathogens have increased numbers of iron siderophore receptors and ABC iron uptake transporters, but the numbers and types of low-affinity secondary iron carriers were uniform in all strains. The presence of outer membrane iron complex receptors and high-affinity ABC iron uptake systems correlated, suggesting co-evolution. Each pathovar encodes a different set of pore-forming toxins and virulence-related outer membrane proteins lacking in K12. Intracellular pathogens proved to have a characteristically distinctive set of nutrient uptake porters, different from those of extracellular pathogens. The results presented in this report provide information about transport systems relevant to various types of E. coli pathogenesis that can be exploited in future basic and applied studies. PMID:24747185

Transport proteins promoting Escherichia coli pathogenesis.

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Tang, Fengyi; Saier, Milton H

2014-01-01

Escherichia coli is a genetically diverse species infecting hundreds of millions of people worldwide annually. We examined seven well-characterized E. coli pathogens causing urinary tract infections, gastroenteritis, pyelonephritis and haemorrhagic colitis. Their transport proteins were identified and compared with each other and a non-pathogenic E. coli K12 strain to identify transport proteins related to pathogenesis. Each pathogen possesses a unique set of protein secretion systems for export to the cell surface or for injecting effector proteins into host cells. Pathogens have increased numbers of iron siderophore receptors and ABC iron uptake transporters, but the numbers and types of low-affinity secondary iron carriers were uniform in all strains. The presence of outer membrane iron complex receptors and high-affinity ABC iron uptake systems correlated, suggesting co-evolution. Each pathovar encodes a different set of pore-forming toxins and virulence-related outer membrane proteins lacking in K12. Intracellular pathogens proved to have a characteristically distinctive set of nutrient uptake porters, different from those of extracellular pathogens. The results presented in this report provide information about transport systems relevant to various types of E. coli pathogenesis that can be exploited in future basic and applied studies. Copyright © 2014 Elsevier Ltd. All rights reserved.

Acute Kidney Injury in Pregnancy.

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Jim, Belinda; Garovic, Vesna D

2017-07-01

Pregnancy-related acute kidney injury (AKI) has declined in incidence in the last three decades, although it remains an important cause of maternal and fetal morbidity and mortality. Pregnancy-related causes of AKI such as preeclampsia, acute fatty liver of pregnancy, HELLP (Hemolysis, Elevated Liver function tests, Low Platelets) syndrome, and the thrombotic microangiopathies (thrombotic thrombocytopenic purpura, atypical hemolytic-uremic syndrome [HUS]) exhibit overlapping features and often present as diagnostic dilemmas. Differentiating among these conditions may be difficult or impossible based on clinical criteria only. In difficult and rare cases, a renal biopsy may need to be considered for the exact diagnosis and to facilitate appropriate treatment, but the risks and benefits need to be carefully weighed. The use of eculizumab for the treatment of atypical HUS has demonstrated efficacy in early case reports. Non-pregnancy related causes such as volume depletion and pyelonephritis require early and aggressive resuscitative as well as antibiotic measures respectively. We will discuss in this review the various etiologies of AKI in pregnancy, current diagnostic approaches, and the latest treatment strategies. Given the recent trends of increasing maternal age at the time of pregnancy, and the availability of modern reproductive methods increase the risks of AKI in pregnancy in the coming years. Copyright © 2017 Elsevier Inc. All rights reserved.

Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part II

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Merchant, Suleman; Bharati, Alpa; Merchant, Neesha

2013-01-01

This article reviews the computed tomography and magnetic resonance imaging (MRI) features of renal tuberculosis (TB), including TB in transplant recipients and immunocompromised patients. Multi detector computed tomography (MDCT) forms the mainstay of cross-sectional imaging in renal TB. It can easily identify calcification, renal scars, mass lesions, and urothelial thickening. The combination of uneven caliectasis, with urothelial thickening and lack of pelvic dilatation, can also be demonstrated on MDCT. MRI is a sensitive modality for demonstration of features of renal TB, including tissue edema, asymmetric perinephric fat stranding, and thickening of Gerota's fascia, all of which may be clues to focal pyelonephritis of tuberculous origin. Diffusion-weighted MR imaging with apparent diffusion coefficient (ADC) values may help in differentiating hydronephrosis from pyonephrosis. ADC values also have the potential to serve as a sensitive non-invasive biomarker of renal fibrosis. Immunocompromised patients are at increased risk of renal TB. In transplant patients, renal TB, including tuberculous interstitial nephritis, is an important cause of graft dysfunction. Renal TB in patients with HIV more often shows greater parenchymal affection, with poorly formed granulomas and relatively less frequent findings of caseation and stenosis. Atypical mycobacterial infections are also more common in immunocompromised patients

[Clinical and bacteriological profiles of the urinary infections associated the VIH/AIDS in hospital area of Bamako, Mali].

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Dao, S; Oumar, A A; Dembele, J P; Noutache, J L; Fongoro, S; Maiga, I; Bougoudogo, F

2007-01-01

The syndrome of immunodepression is the bed of multiple infections of which urinary infections. The goal of this study was to determine the aspects clinical and bacteriological urinary infections during the AIDS with the service of the infectious diseases of the hospital of the Point G of February 1, 2003 to June 30 2005. The diagnosis of the urinary infection was retained on the basis of bacteria number > or =10(4) bacteriury and or leucocytes count > or =10(5)/mm3. The prevalence of the urinary infection was estimated at 8.85%. The principal clinical aspects were a symptomatic pyelonephritis 73.5%, the leucocytiury 11.8%, the cystitis 8.8%, and acute prostatitis 5.9%. Escherichia coli was the most frequent bacterium (46.7%). The sensitivity of the germs was 91.7% with the aminosides, 90.9% with the fluoroquinolones, from 63.6 to 80% respectively with the cephalosporines of first and second generation. Resistance to ampicilline, chloramphenicol and sulfamides was about 72 and 80%. The systematic research of the urinary infection is necessary during the AIDS and the antibiotherapy of choice in first intention in absence of etiologic possibility of diagnosis should be the aminosides and or the fluoroquinolones.

Expression and Significance of the HIP/PAP and RegIIIγ Antimicrobial Peptides during Mammalian Urinary Tract Infection.

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John David Spencer

Full Text Available Recent evidence indicates that antimicrobial peptides (AMPs serve key roles in defending the urinary tract against invading uropathogens. To date, the individual contribution of AMPs to urinary tract host defense is not well defined. In this study, we identified Regenerating islet-derived 3 gamma (RegIIIγ as the most transcriptionally up-regulated AMP in murine bladder transcriptomes following uropathogenic Escherichia coli (UPEC infection. We confirmed induction of RegIIIγ mRNA during cystitis and pyelonephritis by quantitative RT-PCR. Immunoblotting demonstrates increased bladder and urinary RegIIIγ protein levels following UPEC infection. Immunostaining localizes RegIIIγ protein to urothelial cells of infected bladders and kidneys. Human patients with UTI have increased urine concentrations of the orthologous Hepatocarcinoma-Intestine-Pancreas / Pancreatitis Associated Protein (HIP/PAP compared to healthy controls. Recombinant RegIIIγ protein does not demonstrate bactericidal activity toward UPEC in vitro, but does kill Staphylococcus saprophyticus in a dose-dependent manner. Kidney and bladder tissue from RegIIIγ knockout mice and wild-type mice contain comparable bacterial burden following UPEC and Gram-positive UTI. Our results demonstrate that RegIIIγ and HIP/PAP expression is induced during human and murine UTI. However, their specific function in the urinary tract remains uncertain.

The prevalence and bacteriology of asymptomatic bacteriuria among antenatal patients in Nnamdi Azikiwe University Teaching Hospital Nnewi; South Eastern Nigeria.

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Oli, A N; Okafor, C I; Ibezim, E C; Akujiobi, C N; Onwunzo, M C

2010-12-01

Urinary tract infection in pregnancy leads to poor pregnancy outcome. Diagnosis and treatment of asymptomatic bacteriuria markedly improves pregnancy outcome as well as reduce the incidence of acute pyelonephritis. To determine the prevalence and bacteriology of asymptomatic bacteriuria among Antenatal patients in our centre, and to know if routine screening will be justifiable. This was a prospective study carried out between April and August 2008. Sample size was statistically determined. Women who consented were interviewed and mid stream urine samples were collected and processed in the microbiology laboratory, using standard microbiological methods. Out of 357 women studied, 65(18.21%) had significant bacteriuria. Escherichia coli was the commonest isolate (25.6%), while proteus mirabilis was the least frequent isolate (3.66%). Women in third trimester had the highest prevalence (25.68%) while those in the first trimester had the least (15.79%). Women that had only primary education had the highest prevalence (27.50%) while those that had tertiary education had the least prevalence (21.10%). The prevalence of significant asymptomatic bacteriuria among the women studied was high. Screening of all the pregnant women and treatment will reduce the incidence and complications of overt urinary tract infection in pregnancy among these women.

Asymptomatic bacteriuria in pregnancy: maternal and fetal complications.

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Grio, R; Porpiglia, M; Vetro, E; Uligini, R; Piacentino, R; Minì, D; Marchino, G L

1994-12-01

From an analysis of the data reported in the literature it is clear that pregnancy is a predisposing factor for urinary tract infection and that pregnant women with this pathology are exposed to dangerous risks which may influence maternal wellbeing and fetal prognosis. Authors do not concur on the specific risks to the mother and fetus, one reason being that the statistics reported to date reveal discrepancies relating to the presence of disorders prior to pregnancy and the environmental, working and socio-hygienic conditions of the populations studied. The apparently paradoxical finding of a higher incidence of perinatal problems in pregnant women with asymptomatic bacteriuria compared to manifest forms can be attributed to the fact that the latter are treated with adequate therapies whereas asymptomatic bacteriuria, which is difficult to diagnose, may persist throughout pregnancy. This underlines the importance of early diagnosis using a protocol which entails the execution of serial urine tests and urine cultures and adequate treatment of all cases of asymptomatic bacteriuria in order to reduce the incidence of urinary tract infections and materno-fetal complications. Non-treated asymptomatic bacteriuria in fact represents a considerable risk factor since it may lead to the onset of acute pyelonephritis in approximately 5% of pregnant women and may increase the risk of fetal mortality.

Prevalence of asymptomatic bacteriuria and associated risk factors among antenatal women attending a tertiary care hospital

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Aruna Rajkumari

2011-07-01

Full Text Available Asymptomatic bacteriuria (ASB is the commonest bacterial infec-tion which requires medical treatment in pregnancy. Untreated ASB in 25-30% of can cases lead to pyelonephritis which may lead to increased risk of abortions, intrauterine fetal deaths, prematurity and low birth weight. A cross-sectional study was conducted at Gandhi Hospital over a period of ten months with 125 asymptomatic pregnant women in the age group of 15-35 years. The objectives of the study were to determine prevalence of asymptomatic bacteriuria, to identify its risk factors and to compare the screening methods. Of the 125 pregnant women, significant bacteriuria was seen in 21 (16%. The prevalence of bacteriuria showed a rise with increasing maternal age and increasing gestational period. Anemics and hypertensives were at greater risk. The most common isolates were Klebsiella pneumoniae and Staphylococcus aureus (28% each. Culture proved to be the gold standard for diagnosis. Catalase and Nitrate reduction tests were used as screening methods with a sensitivity of 90.48% and 71.43% respectively. Multiple drug resistance was observed in Gram-positive and Gram-negative isolates. Routine screening for asymptomatic bacteriuria is therefore recommended throughout pregnancy to avoid adverse fetal and maternal outcomes.

Children's UTIs in the new millennium. Diagnosis, investigation, and treatment of childhood urinary tract infections in the year 2001.

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White, C. T.; Matsell, D. G.

2001-01-01

OBJECTIVE: To provide an effective approach for family physicians treating children presenting with urinary tract infections (UTIs). QUALITY OF EVIDENCE: The information presented, and articles quoted, are drawn from both review of the literature and recent consensus guidelines. Data and recommendations come from prospective multicentre trials; retrospective reviews; expert consensus statements; and some smaller trials, commentaries, and editorials. MAIN MESSAGE: Urinary tract infections are often seen in family practice. Diagnosis requires suspicion and a realization that children, especially those younger than 2 years, often have very few, nonspecific signs of infection. Obtaining a proper urine sample is vital, because true infections require radiographic studies. Antibiotic prophylaxis is promoted because of the link between vesicoureteral reflux, recurrent UTIs, and renal scarring and hypertension. We generally provide prophylaxis until children are 3 or 4 years, when risk of damage from reflux is lessened and timely urine samples are easier to obtain for prompt therapy. Surgical opinion is sought only when medical management has failed. Failure is defined as either recurrent infections and pyelonephritis or poor renal growth. CONCLUSION: To diagnose UTIs in children, physicians must suspect them, obtain proper urine samples, order appropriate investigations to rule out underlying anatomic abnormalities, and treat with appropriate antibiotics considering both organism sensitivities and length of therapy. PMID:11561337

Renal inflammatory response to urinary tract infection in rat neonates.

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Zarepour, M; Moradpoor, H; Emamghorashi, F; Owji, S M; Roodaki, M; Khamoushi, M

2015-09-01

Urinary tract infection (UTI) is one of the most common bacterial infections. Maternal UTI is a risk factor for neonatal UTI. The aim of the present study was to determine the severity of renal inflammation in neonate rats born from mothers with induced UTI. Twelve pregnant rats (Sprague-Dawley) were included in study. The rats were divided into two groups (six rats in each group). In the first group, pyelonephritis was induced in the third trimester of pregnancy and the second group was used as a control group. After delivery, the neonates were divided into three groups based on days after birth (the 1 st, 3 rd and 7 th days after birth). In each group, two neonates of each mother were killed and a midline abdominal incision was made and both kidneys were aseptically removed. On the 7 th day, rat mothers were killed and their kidneys were removed. The preparations were evaluated with a bright field microscope for inflammatory response. Renal pathology showed inflammation in all UTI-induced mothers, but only two cases of neonates (2.1%) showed inflammation in the renal parenchyma. There was no relation between the positive renal culture and the pathological changes. We conclude that neonates with UTI born to UTI-induced mothers showed a lesser inflammatory response.

Asymptomatic bacteriuria in pregnancy: a diagnostic and therapeutic approach.

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Grio, R; Porpiglia, M; Vetro, E; Uligini, R; Piacentino, R; Minì, D; Marchino, G L

1994-12-01

Pregnancy is a predisposing factor for urinary tract infection and pregnant women suffering from this pathology are exposed to dangerous risks which may condition maternal wellbeing and fetal prognosis. The apparently paradoxal finding of a higher incidence of perinatal problems in pregnant women with asymptomatic bacteriuria compared to those with manifest infections may be explained by the fact that the latter are adequately treated, whereas asymptomatic bacteriuria, which is difficult to diagnose, may continue in a subtle form for the entire duration of pregnancy. This emphasises the importance of the early diagnosis of infection using a protocol based on urine tests and urine culture and the adequate treatment of all cases of asymptomatic bacteriuria in order to reduce the incidence of maternal and fetal complications (acute pyelonephritis, increased fetal morbidity and mortality). The choice of the antibiotic to be used must be made on the basis of the urine culture test, the stage of gestation, maternal clinical data and the characteristics of the antibiotic itself (pharmacokinetics, maternal and fetal toxicity). With regard to the treatment protocol, the "single-dose" protocol is currently preferred. After negative urine culture tests, all patients must carry out a complete urine test each month with hormonal and echographic monitoring of the fetoplacental unit.

Ascaridíase das vias urinárias: um caso de penetração de Ascaris lumbricoides através do rim

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Mario Caymmi Gomes

1977-10-01

Full Text Available Uma criança de 2 anos com desnutrição grave e infestação intestinal maciça por Ascaris lumbricoides, apresentou como complicação, documentada em necrópsia, a migração de vermes adultos para a cavidade peritonial e penetração aberrante de dois parasitos através do rim esquerdo. Os Ascaris ficaram alojados no sistema pielo-ureteral, determinando grave infecção purulenta e obstrução ureteral. Esta complicação demonstra a capacidade agressiva de vermes erráticos na cavidade peritonial, com possibilidade de perfurar mesmo uma víscera sólida. São comentados os fatores que facilitaram a migração dos vermes por aqueles órgãos.The author reports an autopsy case of a two year old child with massive intestinal ascariasis and malnutrition, presenting the migration of two adult Ascaris lumbricoides through the left kidney into the pyelo-ureteral system. As a result she developed acute pyelonephritis and ureteral obstruction. Previously the worms left the intestine into the peritoneal cavity (lesser sac through a duodenal cleft. Factors contributing to the migration of the roundworms by those pathways are discussed.

Virulence Factors and Antibiotic Resistance in Uropathogenic and Commensal Escherichia coli Isolates

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Iraj Sedighi

2016-10-01

Full Text Available Background: Urinary Tract Infections (UTIs, including cystitis and pyelonephritis, are the most common infectious diseases in childhood. Aim and Objectives: Escherichia coli (E. coli account for as much as 90% of the community-acquired and also 50% of nosocomial UTIs. Therefore, the identification of E. coli strains and antibiotic resistance patterns is important for both clinical and epidemiological implications. Material and Methods: To characterize uropathogenic strains E. coli, we studied 100 strains recovered from both urine samples of children aged less than 7 years with community-acquired UTIs and stool samples of healthy children, respectively. Results: We assessed Virulence Factors (VFs and drug sensitivities of E. coli isolates. Drug sensitivities of the isolates were 94% (amikacin, 90% (nitrofurantoin, 66% (gentamicin, 56% (cefixime, 40% (nalidixic acid and 28% (cotrimoxazol. Laboratory tests showed that the prevalence of virulence factors ranged from 18% for hemolysin and P-fimbriae to 2% for type1-fimbriae. Most drug resistance was cotrimoxazole and amikacin was the lowest. P-fimbriae and hemolysin in uropathogenic E. coli were more frequent than non-pathogen type of E. coli. Conclusion: Although amikacin appeared to be the first choice for UTI in children, but nitrofurantoin seems to be practical and could be considered as the selective choice for uncomplicated lower UTIs.

Investigation and identification of etiologies involved in the development of acquired hydronephrosis in aged laboratory mice with the use of high-frequency ultrasound imaging

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Springer, Danielle A.; Allen, Michele; Hoffman, Victoria; Brinster, Lauren; Starost, Matthew F.; Bryant, Mark; Eckhaus, Michael

2014-01-01

Laboratory mice develop naturally occurring lesions that affect biomedical research. Hydronephrosis is a recognized pathologic abnormality of the mouse kidney. Acquired hydronephrosis can affect any mouse, as it is caused by any naturally occurring disease that impairs free urine flow. Many etiologies leading to this condition are of particular significance to aging mice. Non-invasive ultrasound imaging detects renal pelvic dilation, renal enlargement, and parenchymal loss for pre-mortem identification of this condition. High-frequency ultrasound transducers produce high-resolution images of small structures, ideal for detecting organ pathology in mice. Using a 40 MHz linear array transducer, we obtained high-resolution images of a diversity of pathologic lesions occurring within the abdomen of seven geriatric mice with acquired hydronephrosis that enabled a determination of the underlying etiology. Etiologies diagnosed from the imaging results include pyelonephritis, neoplasia, urolithiasis, mouse urologic syndrome, and spontaneous hydronephrosis, and were confirmed at necropsy. A retrospective review of abdominal scans from an additional 149 aging mice shows that the most common etiologies associated with acquired hydronephrosis are mouse urologic syndrome and abdominal neoplasia. This report highlights the utility of high-frequency ultrasound for surveying research mice for age-related pathology, and is the first comprehensive report of multiple cases of acquired hydronephrosis in mice. PMID:25143818

The Comparison of Double J Stent Insertion and Conservative Treatment Alone in Severe Pure Gestational Hydronephrosis: A Case Controlled Clinical Study

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Çeçen, Kürşat; Ülker, Kahraman

2014-01-01

Objective. Management options of gestational hydronephrosis are based on the coexisting stone disease, pyelonephritis, and renal disease. However, the management option and its consequences in the absence of a coexisting disease state are not clear. In this study we aimed to compare the effectiveness of conservative treatment and double J insertion in symptomatic pure gestational hydronephrosis. Material and Methods. The data of the women with severe pure gestational hydronephrosis over a nine-year period was collected retrospectively. The included women were grouped into two according to receiving double J stent insertion or conservative treatments. Results. Double J insertion and conservative treatment groups included 24 and 29 women, respectively. Hydronephrosis was demonstrated on the right, left, or both kidneys in 37 (70%), 13 (24%), and 3 (6%) women, respectively. None of the participants gave birth prior to the 37th week. The demographics, initial pain scores, the severity of the hydronephrosis during first admission, and pain scores one week after the interventions did not differ significantly between groups (P > 0.05). Similarly, the rates of complications, postpartum pain scores, and permanent hydronephrosis did not differ between groups (P > 0.05). Conclusion. Double J insertion in symptomatic pure gestational hydronephrosis adds no benefit to conservative treatment. PMID:24574939

Role of Ultrasonography in Acute Abdomen

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An, Ji Hyun; Lee, Yeon Hee; Kim, Tae Hoon; Yu, Pil Mun; Choi, Young Hi; Kim, Sang Joon; Kim, Seung Cheul; Cho, Jeong Hee; Jung, Jae Un

1996-01-01

Authors analyzed the distribution of diseases and compared ultrasonographic conclusions with confirmed diagnoses of emergency abdominal ultrasonographies in acute abdominal conditions. We evaluated the role of emergency abdominal ultrasonography especially in the decision of emergency operation. In one hundred and forty five patients, emergent abdominal ultrasonography was performed within on admission. We compared the sonographic conclusion with postoperative pathology and analyzed the diagnoses of medically treated diseases. Twenty-eight patients under vent surgery and 117 patients were treated conservatively. Among the surgically treated patients, 19 patients (70.4%) were correctly diagnosed by preoperative ultrasonography.These included acute appendicitis (N = 8), acute cholecystitis (n = 7), ovarian cyst torsion (n = 2), and liver abscess (n = 1). Correct preoperative diagnosis was not made in 9 patients, including acute appendicitis (n = 4),peritonitis due to bowel perforation (n = 2), ectopic pregnancy (n = 1), colonic diverticulitis (n = 1 ) and pelvic inflammatory disease (n = 1 ). Clinical follow up was possible in 50 patients among the non-operative patient group, and the clinical diagnoses were chronic liver disease (n = 14), acute pyelonephritis (n = 10), and biliary stone (n = 10). Emergent ultrasonography plays an important role in acute abdominal conditions by supporting the differential diagnosis of medical and surgical disease

Role of Uropathogenic Escherichia coli Virulence Factors in Development of Urinary Tract Infection and Kidney Damage

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Bien, Justyna; Sokolova, Olga; Bozko, Przemyslaw

2012-01-01

Uropathogenic Escherichia coli (UPEC) is a causative agent in the vast majority of urinary tract infections (UTIs), including cystitis and pyelonephritis, and infectious complications, which may result in acute renal failure in healthy individuals as well as in renal transplant patients. UPEC expresses a multitude of virulence factors to break the inertia of the mucosal barrier. In response to the breach by UPEC into the normally sterile urinary tract, host inflammatory responses are triggered leading to cytokine production, neutrophil influx, and the exfoliation of infected bladder epithelial cells. Several signaling pathways activated during UPEC infection, including the pathways known to activate the innate immune response, interact with calcium-dependent signaling pathways. Some UPEC isolates, however, might possess strategies to delay or suppress the activation of components of the innate host response in the urinary tract. Studies published in the recent past provide new information regarding how virulence factors of uropathogenic E. coli are involved in activation of the innate host response. Despite numerous host defense mechanisms, UPEC can persist within the urinary tract and may serve as a reservoir for recurrent infections and serious complications. Presentation of the molecular details of these events is essential for development of successful strategies for prevention of human UTIs and urological complications associated with UTIs. PMID:22506110

The Comparison of Double J Stent Insertion and Conservative Treatment Alone in Severe Pure Gestational Hydronephrosis: A Case Controlled Clinical Study

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Kürşat Çeçen

2014-01-01

Full Text Available Objective. Management options of gestational hydronephrosis are based on the coexisting stone disease, pyelonephritis, and renal disease. However, the management option and its consequences in the absence of a coexisting disease state are not clear. In this study we aimed to compare the effectiveness of conservative treatment and double J insertion in symptomatic pure gestational hydronephrosis. Material and Methods. The data of the women with severe pure gestational hydronephrosis over a nine-year period was collected retrospectively. The included women were grouped into two according to receiving double J stent insertion or conservative treatments. Results. Double J insertion and conservative treatment groups included 24 and 29 women, respectively. Hydronephrosis was demonstrated on the right, left, or both kidneys in 37 (70%, 13 (24%, and 3 (6% women, respectively. None of the participants gave birth prior to the 37th week. The demographics, initial pain scores, the severity of the hydronephrosis during first admission, and pain scores one week after the interventions did not differ significantly between groups (P>0.05. Similarly, the rates of complications, postpartum pain scores, and permanent hydronephrosis did not differ between groups (P>0.05. Conclusion. Double J insertion in symptomatic pure gestational hydronephrosis adds no benefit to conservative treatment.

Measurement of total phospholipids in urine of patients treated with gentamicin.

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Saunders, D A; Begg, E J; Kirkpatrick, C M; Yeo, J; Graham, G G; Bailey, R R

1997-04-01

The excretion of phospholipids in urine may be a marker of the early renal toxicity of the aminoglycoside antibiotics. Urinary phospholipids are formed in myeloid bodies which develop in the lysosomes of proximal tubules during treatment with the aminoglycosides, and overflow into the urine. Published assays were modified in order to measure the total phospholipid concentrations in human urine. Phospholipids were extracted from freeze-dried urine samples, digested in concentrated sulphuric acid, and the inorganic phosphorus content determined by complexing with ammonium molybdate and measuring the absorbance at 820 nm. Ten septicaemic patients treated with gentamicin for 5-7 days had significantly higher urine phospholipid concentrations than 10 healthy untreated control subjects (P < 0.0001). There was a negative linear relationship between phospholipid excretion and creatinine clearance (r2 = 0.71). In 34 patients with acute pyelonephritis, increased phospholipid concentrations were observed prior to treatment compared with healthy controls (P < 0.001) and did not alter during treatment with gentamicin. However, the phospholipid concentrations decreased significantly after treatment was completed (P < 0.03). These studies suggest that urinary phospholipids may indicate early aminoglycoside toxicity but with poor specificity, as many of the infections being treated may themselves be associated with phospholipiduria.

The prevalence of O serogroups of Escherichia coli strains causing acute urinary tract infection in children in Iran

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Fatemeh Emamghorashi

2011-01-01

Full Text Available The aim of present study was to determine the prevalence of O serogroups of Escherichia coli (E. coli strains that cause community-acquired urinary tract infections (UTI in children. In this study, 96 children with UTI referred to two Jahrom University-affiliated Hospitals in Iran were enrolled, during the period from August 2005 to August 2006. Drug sensitivity was tested by disk diffusion method and serotyping done by slide agglutination method. A total of 96 E. coli strains were isolated from urine samples of the study children whose age ranged from one month to 14 years. Cystitis was diagnosed in 49.2% and pyelonephritis in 50.8% of the study patients. Maximum drug resistance was seen with ampicilin (80.2% and the least with imipenem (1.1%. The most common type of O antigen was O1 (12.2%. There was significant correlation between the presence of O antigens and sensitivity to nalidixic acid and gentamicin (P < 0.05. This is the first report of E. coli serotyping in children with UTI from the south of Iran and their relation to antibiotic resistance and clinical presentation. Further studies from other parts of Iran and on other serotypes are recommended.

Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections?

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Kavanagh, Eoin C.; Ryan, Stephanie; McCourbrey, Siobhan; O' Connor, Rachel; Donoghue, Veronica [Children' s University Hospital, Department of Radiology, Dublin (Ireland); Awan, Atif [Children' s University Hospital, Department of Paediatrics, Dublin (Ireland)

2005-03-01

Renal parenchymal defects may be a consequence of urinary tract infections (UTI) in childhood. MRI is a non-radiation imaging modality compared with DMSA scanning. To compare DMSA with MRI for the detection of renal parenchymal defects in children presenting for radiological investigation after a first UTI. Both DMSA and MRI were performed at the same appointment in 37 children (aged 4 months-13 years; mean 4.5 years) with a history of UTI. Both planar and SPECT DMSA were performed. MRI of the kidneys employed axial and coronal T1-, T2- and fat-saturated T1-weighted (T1-W) sequences. Some children had imaging after IV contrast medium. The coronal fat-saturated T1-W sequence was the best sequence and it detected all the findings on MRI. MRI had a sensitivity of 77% and a specificity of 87% for the detection of a scarred kidney using DMSA as the gold standard. MRI diagnosed pyelonephritis in two children that had been interpreted as scarring on DMSA. Renal MRI using a single, coronal, fat-saturated T1-W sequence is a rapid, accurate and minimally invasive technique for the detection of renal scarring that does not employ ionizing radiation. (orig.)

Expression and Significance of the HIP/PAP and RegIIIγ Antimicrobial Peptides during Mammalian Urinary Tract Infection

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Spencer, John David; Jackson, Ashley R.; Li, Birong; Ching, Christina B.; Vonau, Martin; Easterling, Robert S.; Schwaderer, Andrew L.; McHugh, Kirk M.; Becknell, Brian

2015-01-01

Recent evidence indicates that antimicrobial peptides (AMPs) serve key roles in defending the urinary tract against invading uropathogens. To date, the individual contribution of AMPs to urinary tract host defense is not well defined. In this study, we identified Regenerating islet-derived 3 gamma (RegIIIγ) as the most transcriptionally up-regulated AMP in murine bladder transcriptomes following uropathogenic Escherichia coli (UPEC) infection. We confirmed induction of RegIIIγ mRNA during cystitis and pyelonephritis by quantitative RT-PCR. Immunoblotting demonstrates increased bladder and urinary RegIIIγ protein levels following UPEC infection. Immunostaining localizes RegIIIγ protein to urothelial cells of infected bladders and kidneys. Human patients with UTI have increased urine concentrations of the orthologous Hepatocarcinoma-Intestine-Pancreas / Pancreatitis Associated Protein (HIP/PAP) compared to healthy controls. Recombinant RegIIIγ protein does not demonstrate bactericidal activity toward UPEC in vitro, but does kill Staphylococcus saprophyticus in a dose-dependent manner. Kidney and bladder tissue from RegIIIγ knockout mice and wild-type mice contain comparable bacterial burden following UPEC and Gram-positive UTI. Our results demonstrate that RegIIIγ and HIP/PAP expression is induced during human and murine UTI. However, their specific function in the urinary tract remains uncertain. PMID:26658437

An endogenous ribonuclease inhibitor regulates the antimicrobial activity of ribonuclease 7 in the human urinary tract

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Spencer, John David; Schwaderer, Andrew L.; Eichler, Tad; Wang, Huanyu; Kline, Jennifer; Justice, Sheryl S.; Cohen, Daniel M.; Hains, David S.

2013-01-01

Recent studies stress the importance of antimicrobial peptides in protecting the urinary tract from infection. Previously, we have shown that ribonuclease 7 (RNase 7) is a potent antimicrobial peptide that has broad-spectrum antimicrobial activity against uropathogenic bacteria. The urothelium of the lower urinary tract and intercalated cells of the kidney produce RNase 7 but regulation of its antimicrobial activity has not been well defined. Here we characterize the expression of an endogenous inhibitor, ribonuclease inhibitor (RI), in the urinary tract and evaluate its effect on RNase 7’s antimicrobial activity. Using RNA isolated from non-infected human bladder and kidney tissue, quantitative real-time PCR showed that RNH1, the gene encoding RI, is constitutively expressed throughout the urinary tract. With pyelonephritis, RNH1 expression and RI peptide production significantly decrease. Immunostaining localized RI production to the umbrella cells of the bladder and intercalated cells of the renal collecting tubule. In vitro assays showed that RI bound to RNase 7 and suppressed its antimicrobial activity by blocking its ability to bind the cell wall of uropathogenic bacteria. Thus, these results demonstrate a new immunomodulatory role for RI and identified a unique regulatory pathway that may affect how RNase 7 maintains urinary tract sterility. PMID:24107847

Influence of vestibulovaginal stenosis, pelvic bladder, and recessed vulva on response to treatment for clinical signs of lower urinary tract disease in dogs: 38 cases (1990-1999).

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Crawford, Jason T; Adams, William M

2002-10-01

To determine influence of vestibulovaginal stenosis, pelvic bladder, and recessed vulva on response to treatment for clinical signs of lower urinary tract disease in dogs. Retrospective study. 38 spayed female dogs. Medical records and client follow-up were reviewed for dogs evaluated via excretory urography because of clinical signs of lower urinary tract disease. Clinical signs, results of radiography, and response to surgical or medical treatment were analyzed. Clinical signs included urinary tract infection (n = 24), urinary incontinence (20), vaginitis (11), pollakiuria or stranguria (10), and perivulvar dermatitis (4). Vaginocystourethrographic findings included vestibulovaginal stenosis (n = 28), pelvic bladder (17), and ureteritis or pyelonephritis (4). Ten dogs had a vestibulovaginal ratio of stenosis), 9 dogs had a ratio of 0.20 to 0.25 (moderate stenosis), 9 dogs had a ratio of 0.26 to 0.35 (mild stenosis), and 10 dogs had a ratio of > 0.35 (anatomically normal). Lower urinary tract infection, incontinence, and pelvic bladder were not associated with response to treatment for recessed vulva. Vestibulovaginal stenosis with a ratio Dogs without severe vestibulovaginal stenosis that received vulvoplasty for a recessed vulva responded well to treatment. Vestibulovaginal stenosis is likely an important factor in dogs with vestibulovaginal ratio dogs with severe vestibulovaginal stenosis and signs of lower urinary tract disease.

Role of Ultrasonography in Acute Abdomen

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An, Ji Hyun; Lee, Yeon Hee; Kim, Tae Hoon; Yu, Pil Mun; Choi, Young Hi; Kim, Sang Joon; Kim, Seung Cheul; Cho, Jeong Hee [Dankook University College of Medicine, Cheonan (Korea, Republic of); Jung, Jae Un [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1996-12-15

Authors analyzed the distribution of diseases and compared ultrasonographic conclusions with confirmed diagnoses of emergency abdominal ultrasonographies in acute abdominal conditions. We evaluated the role of emergency abdominal ultrasonography especially in the decision of emergency operation. In one hundred and forty five patients, emergent abdominal ultrasonography was performed within on admission. We compared the sonographic conclusion with postoperative pathology and analyzed the diagnoses of medically treated diseases. Twenty-eight patients underwent surgery and 117 patients were treated conservatively. Among the surgically treated patients, 19 patients (70.4%) were correctly diagnosed by preoperative ultrasonography.These included acute appendicitis (N = 8), acute cholecystitis (n = 7), ovarian cyst torsion (n = 2), and liver abscess (n = 1). Correct preoperative diagnosis was not made in 9 patients, including acute appendicitis (n = 4), peritonitis due to bowel perforation (n = 2), ectopic pregnancy (n = 1), colonic diverticulitis (n = 1) and pelvic inflammatory disease (n = 1). Clinical follow up was possible in 50 patients among the non-operative patient group, and the clinical diagnoses were chronic liver disease (n = 14), acute pyelonephritis (n = 10), and biliary stone (n = 10). Emergent ultrasonography plays an important role in acute abdominal conditions by supporting the differential diagnosis of medical and surgical disease

The Role of MicroRNAs in Kidney Disease

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Sydwell Mukhadi

2015-11-01

Full Text Available MicroRNAs (miRNAs are short noncoding RNAs that regulate pathophysiological processes that suppress gene expression by binding to messenger RNAs. These biomolecules can be used to study gene regulation and protein expression, which will allow better understanding of many biological processes such as cell cycle progression and apoptosis that control the fate of cells. Several pathways have also been implicated to be involved in kidney diseases such as Transforming Growth Factor-β, Mitogen-Activated Protein Kinase signaling, and Wnt signaling pathways. The discovery of miRNAs has provided new insights into kidney pathologies and may provide new innovative and effective therapeutic strategies. Research has demonstrated the role of miRNAs in a variety of kidney diseases including renal cell carcinoma, diabetic nephropathy, nephritic syndrome, renal fibrosis, lupus nephritis and acute pyelonephritis. MiRNAs are implicated as playing a role in these diseases due to their role in apoptosis, cell proliferation, differentiation and development. As miRNAs have been detected in a stable condition in different biological fluids, they have the potential to be tools to study the pathogenesis of human diseases with a great potential to be used in disease prognosis and diagnosis. The purpose of this review is to examine the role of miRNA in kidney disease.

Etiologic study of urinary tract infection in dogs

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Marcia Mery Kogika

1995-03-01

Full Text Available Urinary tract infections were documented in 51 dogs. Several factors such as etiologic agents, localization of the infection, predisposing factors, sex, age, and breed were considered. The diagnosis of urinary tract infection (UTI was based on bacteriological investigation and it was considered positive when urine sample collected by catheterization contained more than 105 bacteria/ml. Mixed infection was found in 4 of the infected dogs, totallizing 55 isolates. Among them, Escherichia coli (35.3% was the most frequently isolated, followed by Staphylococcus sp. (23.5%, Proteus mirabilis (15.7%, Streptococcus sp. (13.7%, Klebsiella sp. (9.8%. Pseudomonas aeruginosa (3.9%, Enterobacter cloacae (2.0%, Citrobacter freundii (2.0% and Providencia rettgeri (2.0%. As to antimicrobial susceptibility, norfloxacin and gentamicin were successful for the treatment of gram-negative microorganisms, while the most effective drugs for gram-positive bacteria were cephalothin and nitrofurantoin. UTI was observed more frequently in Cocker Spaniel and German Shepherd; male dogs were more involved, and pyelonephritis was the predominant disease observed. Infection was seen in all ages, but the frequency was higher in middle aged dogs. Urolithiasis were observed as common predisposing or underlying factors to UTI being, cither Staphylococcus sp. or Proteus mirabilis isolated in those cases which alkaline urine pH was observed.

Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones.

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Tligui, M; El Khadime, M R; Tchala, K; Haab, F; Traxer, O; Gattegno, B; Thibault, P

2003-05-01

To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections?

International Nuclear Information System (INIS)

Kavanagh, Eoin C.; Ryan, Stephanie; McCourbrey, Siobhan; O'Connor, Rachel; Donoghue, Veronica; Awan, Atif

2005-01-01

Renal parenchymal defects may be a consequence of urinary tract infections (UTI) in childhood. MRI is a non-radiation imaging modality compared with DMSA scanning. To compare DMSA with MRI for the detection of renal parenchymal defects in children presenting for radiological investigation after a first UTI. Both DMSA and MRI were performed at the same appointment in 37 children (aged 4 months-13 years; mean 4.5 years) with a history of UTI. Both planar and SPECT DMSA were performed. MRI of the kidneys employed axial and coronal T1-, T2- and fat-saturated T1-weighted (T1-W) sequences. Some children had imaging after IV contrast medium. The coronal fat-saturated T1-W sequence was the best sequence and it detected all the findings on MRI. MRI had a sensitivity of 77% and a specificity of 87% for the detection of a scarred kidney using DMSA as the gold standard. MRI diagnosed pyelonephritis in two children that had been interpreted as scarring on DMSA. Renal MRI using a single, coronal, fat-saturated T1-W sequence is a rapid, accurate and minimally invasive technique for the detection of renal scarring that does not employ ionizing radiation. (orig.)

Nonfunctioning Renal Allograft Embolization as an Alternative to Graft Nephrectomy: Report on Seven Years' Experience

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Atar, Eli; Belenky, Alexander; Neuman-Levin, Margalit; Yussim, A.; Bar-Nathan, Nathan; Bachar, Gil N.

2003-01-01

Purpose: Graft nephrectomy is the treatment of choice in patients with graft intolerance syndrome, but it is associated with high morbidity and mortality rates. Renal vascular embolization has been suggested as a possible alternative. The aim of this study was to evaluate the efficacy and safety of arterial embolization of these nonfunctioning transplanted kidneys. Methods: Twenty-six transplanted kidneys in 25 patients with irreversible renal graft rejection and graft intolerance who underwent arterial embolization at our center from August 1994 to April 2001 we reanalyzed for procedural success and long-term outcome. Embolization was performed with absolute alcohol or with polyvinyl alcohol (Ivalon) and coils. Results: Twenty-four of the 26 (92%) procedures were technically successful, but in one patient only partial occlusion of one of two renal arteries was achieved, and in another the renal artery was already completely occluded. There were two major complications: emphysematous pyelonephritis necessitating nephrectomy and groin abscess that was drained. Follow-up ranged from 8 to 84 months. Clinical success was achieved in 24 of the 26 procedures(92%), and only in one patient did embolization fail to relieve the symptoms, and nephrectomy was performed 3 months later. Conclusion: Renal vascular embolization is a simple, safe and effective technique for the treatment of nonfunctioning renal allografts associated with graft intolerance syndrome. We suggest that it be considered the treatment of choice

Virulence Genes Profile of Multidrug Resistant Pseudomonas aeruginosa Isolated from Iranian Children with UTIs

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Zohreh Heidary

2016-04-01

Full Text Available Virulent and resistant strains Pseudomonas aeruginosa (P. aeruginosa is one of the most important cause of UTIs in pediatrics. The present study was carried to investigate the frequency of virulence factors in the multi-drug resistant strains of P. aeruginosa isolated from pediatrics hospitalized due to the UTIs. One - hundred and forty three urine samples were collected from pediatric patients suffered from UTIs. Samples were cultured and those that were P. aeruginosa positive were analyzed for the presence of putative virulence genes. Seventy one out of 143 samples (49.65% were positive for P. aeruginosa. Monthly, sex and age-dependent prevalence were seen for P. aeruginosa. Bacterial strains had the highest levels of resistance against ampicillin (95.77%, gentamicin (92.95% and ciprofloxacin (81.69%. Of 71 P. aeruginosa isolates, 12 strains were resistant to more than 9 antibiotics (16.90%. The most commonly detected virulence factors in the cases of urethral infections were exoU and plcH while those of pyelonephritis and cystitis were were exoS and lasB. Our findings should raise awareness about antibiotic resistance in hospitalized pediatrics with UTIs in Iran. Clinicians should exercise caution in prescribing antibiotics, especially in cases of UTIs. Such information can help in identifying these virulence genes as useful diagnostic markers for clinical P. aeruginosa strains isolated from UTIs.

Virulence factors in Proteus bacteria from biofilm communities of catheter-associated urinary tract infections.

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Hola, Veronika; Peroutkova, Tereza; Ruzicka, Filip

2012-07-01

More than 40% of nosocomial infections are those of the urinary tract, most of these occurring in catheterized patients. Bacterial colonization of the urinary tract and catheters results not only in infection, but also various complications, such as blockage of catheters with crystalline deposits of bacterial origin, generation of gravels and pyelonephritis. The diversity of the biofilm microbial community increases with duration of catheter emplacement. One of the most important pathogens in this regard is Proteus mirabilis. The aims of this study were to identify and assess particular virulence factors present in catheter-associated urinary tract infection (CAUTI) isolates, their correlation and linkages: three types of motility (swarming, swimming and twitching), the ability to swarm over urinary catheters, biofilm production in two types of media, urease production and adherence of bacterial cells to various types of urinary tract catheters. We examined 102 CAUTI isolates and 50 isolates taken from stool samples of healthy people. Among the microorganisms isolated from urinary catheters, significant differences were found in biofilm-forming ability and the swarming motility. In comparison with the control group, the microorganisms isolated from urinary catheters showed a wider spectrum of virulence factors. The virulence factors (twitching motility, swimming motility, swarming over various types of catheters and biofilm formation) were also more intensively expressed. © 2012 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.

Renal abscess after the Fontan procedure: a case report

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Kumar Suresh

2011-02-01

Full Text Available Abstract Introduction The Fontan procedure is an intervention that helps to correct single ventricle physiology. There are many known long-term complications of 'Fontan physiology'. However, the occurrence of renal abscess in such patients has not yet been reported in the literature. The first generation of adults has now undergone the procedure and it is necessary to be aware of the long-term outcomes and complications associated with it. Case presentation We report the case of a 22-year-old South Indian man who had developed a staphylococcal renal abscess against a background of xanthogranulomatous pyelonephritis, nine years after Fontan surgery. He presented to our hospital with a high-grade fever of 25-days duration but with no other symptoms. Physical examination identified costovertebral angle tenderness and pedal edema. An ultrasound scan revealed a mass in his left kidney. The results of a computed tomography scan were consistent with a renal abscess. Despite treatment with the appropriate parenteral antibiotics, there was no change in the size of the abscess and a left nephrectomy was performed as a curative procedure. Conclusions The learning points here are manifold. It is important to be aware of the possibility of renal abscess in a post-procedural patient. The early diagnosis of a septic focus in the kidneymay help to prevent the rare outcome of nephrectomy.

Elective appendicovesicostomy in association with monfort abdominoplasty in the treatment of prune belly syndrome

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Riberto Liguori

2006-12-01

Full Text Available OBJECTIVE: To evaluate the role of elective appendicovesicostomy in association with Monfort abdominoplasty to avoid urinary tract infection (UTI and renal damage in the post-operative follow-up of patients with prune belly syndrome. MATERIALS AND METHODS: We followed 4 patients operated in our institution (UNIFESP (Monfort, orchidopexy and Mitrofanoff and compared them to 2 patients treated similarly, but without an appendicovesicostomy, in a second institution (UFBA. We evaluated postoperative clinical complications, UTI and preservation of renal parenchyma. Patients were followed as outpatients with urinalysis, ultrasonography (US and occasionally with renal scintigraphy. RESULTS: Mean follow-up was 23.5 months. Immediate post-operative course was uneventful. We observed that only one patient with the Mitrofanoff channel persisted with UTI, while the 2 patients used as controls persisted with recurrent pyelonephritis (> 2 UTI year. CONCLUSION: Our data suggest that no morbidity was added by the appendicovesicostomy to immediate postoperative surgical recovery and that this procedure may have a beneficial effect in reducing postoperative UTI events and their consequences by reducing the postvoid residuals in the early abdominoplasty follow-up. However, we recognize that the series is small and only a longer follow-up with a larger number of patients will allow us to confirm our suppositions. We could not make any statistically significant assumptions regarding differences in renal preservation due to the same limitations.

Renal inflammatory response to urinary tract infection in rat neonates

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M Zarepour

2015-01-01

Full Text Available Urinary tract infection (UTI is one of the most common bacterial infections. Maternal UTI is a risk factor for neonatal UTI. The aim of the present study was to determine the severity of renal inflammation in neonate rats born from mothers with induced UTI. Twelve pregnant rats (Sprague-Dawley were included in study. The rats were divided into two groups (six rats in each group. In the first group, pyelonephritis was induced in the third trimester of pregnancy and the second group was used as a control group. After delivery, the neonates were divided into three groups based on days after birth (the 1 st, 3 rd and 7 th days after birth. In each group, two neonates of each mother were killed and a midline abdominal incision was made and both kidneys were aseptically removed. On the 7 th day, rat mothers were killed and their kidneys were removed. The preparations were evaluated with a bright field microscope for inflammatory response. Renal pathology showed inflammation in all UTI-induced mothers, but only two cases of neonates (2.1% showed inflammation in the renal parenchyma. There was no relation between the positive renal culture and the pathological changes. We conclude that neonates with UTI born to UTI-induced mothers showed a lesser inflammatory response.

Urologic evaluation of urinary tract infection in pregnancy.

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Diokno, A C; Compton, A; Seski, J; Vinson, R

1986-01-01

Thirty-three antepartum patients with urinary tract infections underwent urologic evaluation as soon as the infection had been successfully treated. The evaluation included history of voiding habits, cystometry, urethral calibration and cystourethroscopy. A second phase of the urologic evaluation included an excretory urogram and repeat cystometry 10-12 weeks postpartum. Sixty percent had a history of infrequent voiding, and 90% of them had a bladder capacity greater than 450 mL. Forty-one percent of the patients had a normal bladder capacity (less than 450 mL), and 85% of this group did not have any history of infrequent voiding. The radiographic evaluation postpartum in 18 of 33 patients revealed major abnormalities in 50%. These abnormalities were seen as often and were as significant in women with asymptomatic bacteriuria as in those who presented with acute pyelonephritis. The results suggest that the large bladder seen in pregnant women may be secondary to the chronic, unphysiologic habit of infrequent voiding. Furthermore, this study reinforced the fact that most pregnant women with urinary tract infection have preexisting chronic bladder or renal abnormalities that predispose them to infection. Those at risk should be identified early through a careful history and urinalysis to determine which ones need urinary prophylaxis during pregnancy. Postpartum urologic investigation should be carried out to identify any structural or functional problems; understanding them is helpful in present and future management.

Bacterial Pathogens and Antimicrobial Resistance Patterns in Pediatric Urinary Tract Infections: A Four-Year Surveillance Study (2009–2012

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Seyed Reza Mirsoleymani

2014-01-01

Full Text Available The aims of this study were to assess the common bacterial microorganisms causing UTI and their antimicrobial resistance patterns in Bandar Abbas (Southern Iran during a four-year period. In this retrospective study, samples with a colony count of ≥105 CFU/mL bacteria were considered positive; for these samples, the bacteria were identified, and the profile of antibiotic susceptibility was characterized. From the 19223 samples analyzed, 1513 (7.87% were positive for bacterial infection. UTI was more frequent in male (54.9%. E. coli was reported the most common etiological agent of UTI (65.2%, followed by Klebsiella spp. (26%, Pseudomonas aeruginosa (3.6%, and Staphylococcus coagulase positive (3.7%. Results of antimicrobial susceptibility analysis for E. coli to commonly used antibiotics are as follows: Amikacin (79.7%, Ofloxacin (78.3%, Gentamicin (71.6%, Ceftriaxone (41.8, Cefotaxime (41.4%, and Cefixime (27.8%. Empirical antibiotic selection should be based on awareness of the local prevalence of bacterial organisms and antibiotic sensitivities rather than on universal or even national guidelines. In this study, Amikacin and Gentamicin were shown to be the most appropriate antibiotics for empiric therapy of pyelonephritis, but empirical therapy should only be done by specialist physicians in cases where it is necessary while considering sex and age of children.

Prevalence of Group B Streptococcus Vaginal Colonization in The Third Trimester of Pregnancy.

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MR Nazer

2011-03-01

Full Text Available Introduction: Group B Strepococcus(GBS is one of the most important causes of neonatal infections including septicemia and meningitis. It also plays an important role in maternal infections such as chorioamnionitis, pyelonephritis, metritis and post partum infection. The present study was carried out to find the prevalence of GBS in pregnant women with 28 to 38 weeks gestational age. Methods: In this study, 100 pregnant women referring to the obstetrical clinic of Asalian Hospital in Khorramabad city in the third trimester of pregnancy (after explaining the study, getting informed consent and demographic informations were tested for GBS by taking a vaginal sample. The sample was taken by sterile cotton swab. The swabs were placed in transport media, transported to the central Lab, and were inoculated in blood agar. Then all samples were analyzed for the presence of GBS. Results: In this study, the prevalence of positive vaginal GBS culture in pregnant women was 14% (CI: 7.2-20.8%. No significant correlation were found between this positive culture and maternal age, gestational age, abortion status, diabetes mellitus and pregnancy induced hypertension, while a significant correlation was found between positive cultures and parity. Conclusion: As the colonization rate of GBS in pregnant women of Khorramabad is high, routine culture-based screening is recommended for all pregnant women in third trimester of pregnancy.

[Laparoscopic pyeloplasty for hydronephrosis of horseshoe kidney].

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Guliev, B G

2016-11-01

Horseshoe kidney is often associated with other congenital abnormalities and obstruction of pyeloureteral segment (PUS). The aim of our study was to evaluate the results of laparoscopic pyeloplasty (LP) in patients with hydronephrosis of horseshoe kidney. From February 2010 to March 2016, 130 patients underwent LP. Ten (7.7%) of them (6 men and 4 women) had a hydronephrosis of horseshoe kidney. Left and right PUS obstruction were diagnosed in 6 and 4 patients, respectively. All the patients underwent PL transperitoneally using the Anderson-Hynes method. In patients with left hydronephrosis, surgery was performed by transmesenteric access. There were no cases of conversion to open surgery and drainage urine leakage. Exacerbation of chronic pyelonephritis was observed in 2 cases. Operating time ranged from 125 to 160 minutes (median 130 minutes), time of performing pyeloureteral anastomosis - from 50 to 105 minutes. Patients were ambulated within the first day after surgery, the length of hospital stay was 3 - 4 days. One patient with recurrent strictures of PUS 8 months after the LP underwent retrograde endopyelotomy with the placement of endopyelotomy stent. The effectiveness of operations over a 6-38 month follow-up was 90%. LP is an effective and minimally invasive treatment for patients with hydronephrosis of horseshoe kidney. In a left PUS obstruction, pyeloplasty can be performed using transmesenteric access.

Clinical study of infectious diseases on aged A-bomb survivors in Hiroshima Welfare Home for aged A-bomb survivors

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Aisaka, Tadakazu; Orimen, Akio; Niimi, Masanobu; Simizu, Kiyoshi.

1978-01-01

Infections, especially urinary passage and respiratory infections of aged A-bomb survivers under special protective care was examined. Urinary passage infections have recently shown an increasing tendency. These infections are related to the factors such as their basic diseases and wearing napkins rather than a severe degree of protective care. In the case of respiratory infection, diseases such as influenza are observed rather in patients who can walk, but they tend to be aggravated in bedridden patients. It cannot be said that more urinary passage infections are observed in A-bomb survivers than non A-bomb survivers. Both urinary passage infection and respiratory infection tend to recur repeatedly. Aged A-bomb survivers show no significant difference of acquired immunity from that of non A-bomb survivers group. However, a maintenance of neutralizing antibody by vaccination of influenza in the former is worse than in the latter. Bedridden patients show a higher rate of infection to potential urinary passage diseases than patients who can walk, irrespective of sex. Moreover, bedridden patients have a large number of bacteria, but other significant host reaction couldn't be observed. In bedridden patients with potential urinary passage infection, a variety of bacteria, most of which are bacteria resistant to rutinely used broad spectrum antibiotics, is detected. As a main disease or a direct cause of death, pyelonephritis in women and bronchopneumonia are often observed. (Iwagami, H.)

Vitamin D deficiency is associated with urinary tract infection in children.

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Shalaby, Sherein Abdelhamid; Handoka, Nesrein Mosad; Amin, Rasha Emad

2018-01-01

In humans, vitamin D has been shown to play a role in infectious diseases, but its association with acquisition and a complicated course of febrile urinary tract infections (UTIs) has not been investigated. We aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D 3 ) levels and the risk of first time febrile UTI in children. This prospective case-control study included 50 children with first febrile UTI, with no risk factors for UTI, and 50 age- and sex-matched healthy siblings as controls. White blood cell count, serum C-reactive protein, calcium, phosphorus, alkaline phosphatase and parathormone were measured in all studied children. Vitamin D status was determined by measuring plasma 25(OH)D 3 level. Deficiency was defined as a plasma 25(OH)D 3 level ≤ 25 nmol/l. Children with UTI had significantly lower mean serum levels of 25(OH)D 3 (10.5 ±2.7 nmol/l) than those of controls (25.9 ±5.6 nmol/l) ( p UTI had significantly higher serum levels of 25(OH)D 3 compared to those with acute pyelonephritis (12.4 ±2.59 vs. 8.2 ±3.2 nmol/l; p UTI (OR = 1.94, 95% CI: 1.61-2.82; p = 0.04). Vitamin D deficiency (≤ 25 nmol/l) was an independent risk factor for UTI in children.

Introduction of a Successful Pregnancy in a Patient with Advanced Chronic Renal Insufficiency

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H. Saghafi

2008-04-01

Full Text Available Background and ObjectiveIn the women with chronic renal insufficiency ovulation is suppressed therefore they rarely become pregnant. If pregnancy occurs, they might encounter many conflictions. It may lead to death (fetus or mother. The aim of this study was reporting a successful pregnancy in a patient with advanced chronic renal insufficiency.Case reportThe patient was a 32 years old woman with long period of infertility (8 years. The first main clinical symptom was abdominal pain especially in hypogastric area as well as hyperuremia, elevated levels of creatinine (2.9 mg/dl, mild proteinuria and hematuria. The urine specific gravity was 1010. Sonography data showed asymmetrical small kidneys. Other complaints were pruritus and flank pain during urination. The primary diagnosis was chronic renal failure due to probable chronic pyelonephritis. After an interval she returned with positive pregnancy test. She decided to continue the pregnancy in despite of obstetrician belief for aborting. During pregnancy, proteinuria reached to two plus, hemoglobin fell to 9.7, creatinine levels reached to 3.7 mg/dl and blood pressure was fluctuating between 110/80 and 130/85 mmHg. She admitted in the hospital in third trimester of pregnancy because of preterm labor. However the pain was suppressed after starting magnesium sulfate infusion. Keywords: Renal Insufficiency, Chronic Renal Insufficiency, Pregnancy

Ultrasonographic findings in 14 dogs with ectopic ureter

International Nuclear Information System (INIS)

Lamb, C.R.; Gregory, S.P.

1998-01-01

To evaluate ultrasonography as an alternative to contrast radiographyfor diagnosis of ectopic ureter in dogs, ultrasonography of the urinary tract was performed prospectively in a series of urinary incontinent dogs anesthetized for contrast radiography, Fourteen dogs had ectopic ureter based ore surgical, necropsy or unequivocal contrast radiographic findings, There were eight females and six males of a variety of breeds; five were Labrador retrievers, Mean (range) age at the time ofdiagnosis was 1.2 (0.2-4) years for females and 3.5 (0.3-5) for males(p < 0.05). Ectopic ureters were unilateral in five dogs (2 left; 3 right) find bilateral in nine dogs. Both ultrasound images and contrastradiographs were positive for 21 (91%) ectopic ureters; the same two ectopic ureters were not defected using either modality, The termination of each of the five normal ureters was visible on ultrasound images; two (40%) were visible on radiographs, Other ultrasonographic findings included dilatation of the ectopic ureter and/or ipsilateral renal pelvis ill ten (43%) instances, evidence of pyelonephritis in two dogs(with enlargement of the contralateral kidney in one dog), and urethral diverticuli in one dog, Ultrasonography is a practical diagnostic Best for ectopic ureter in clogs. In this series these was close correlation between the ultrasonographic and contrast radiographic findings for each ectopic meter, but ultrasonography enabled more accurate determination of normal ureteral anatomy

Laparoscopic nephrectomy: analysis of 34 patients

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Domingos André Luís Alonso

2003-01-01

Full Text Available OBJECTIVE: To analyze the clinical experience of laparoscopic nephrectomy for benign and malignant diseases at a university hospital. METHODS: From February 2000 to March 2003, 34 patients (14 men and 20 women underwent transperitoneal laparoscopic total nephrectomy at the Hospital das Clinicas - FMRP-USP: 28 (82.3% patients had benign diseases and 6 (17.7% malignant neoplasias. Benign diseases were represented by: urinary stones (N-9, 32.1%, chronic pyelonephritis (N-8, 28.6%, vesicoureteral reflux (N-4, 14.3%, ureteropelvic obstruction (N-3, 10.7%, multicystic kidney (N-2, 7.1% and pyonephrosis (N-2, 7.1%. Patients age range was 2-79 years (mean - 35,1 years. RESULTS: In 32/34 patients the procedures were accomplished successfully. In 2 (5.8% cases of pyonephrosis, open conversion was necessary due to perinephric abscess and difficulties in dissection of renal hilum. Two patients had intraoperative complications (1 duodenum serous laceration an 1 vascular lesion of renal hilum, but both were managed laparoscopically. Two (5.8% post operative complications (1 delayed bleeding and 1 pancreatic fistula required open surgical exploration. The mean time of hospital stay was 58h (18 to 240h. CONCLUSION: Laparoscopic nephrectomy proved to be a method safe and associated with a low rate of morbidity, shorter hospital stay and no casualties.

Captopril 99mTc-DTPA Renal Scintigraphy in Diagnosis of Renovascular Hypertension

International Nuclear Information System (INIS)

Yang, In Hyung; Lee, Dong Soo; Kim, Sung Chul

1992-01-01

To evaluate the sensitivity and specificity of captopril renal scan for renovascular hypertension, we employed the captopril renal scan in conjunction with renal angiography in 81 patients, 159 kidneys, who were referred to evaluate the cause of hypertension. We defined the renovascular hypertension by the criteria of demonstration of renal artery stenosis by angiography, and improvement or cure of hypertension by revascularization. Visual and quantitative evaluation of 99m Tc-DTPA renal scan was performed pre and post captopril administration. The prevalence rate of renovascular hypertension was 40% in comparing with renal angiography, and 70% in confirmed cases. The causes of renovascular hypertension in 81 patients were Takayasu's arteritis, fibromuscular dysplasia, atherosclerosis, essential hypertension, chronic pyelonephritis etc. The sensitivity and specificity of captopril renal scan in comparing with renal angiography were 80%, 86.5%, respectively and also 84.2%, 72.6% in confirmed cases of renovascular hypertension, respectively. The causes of false negative cases were nonfunctioning kidney due to complete obstruction or long duration of disease in basal scan, segmental branch artery stenosis, unknown causes, and suspicious true negative cases without confirmation. The false positive cases were abdominal aortic stenosis or aneurysm, dehydration, unknown causes, and suspicious true positive cases. We conclude that captopril renal scintigraphy is highly sensitive, reasonably specific diagnostic method and comparable to other techniques very favorably.

[Ultrasound guided percutaneous nephrolithotripsy].

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Guliev, B G

2014-01-01

The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff.

Asymptomatic urinary tract infection among pregnant women attending the antenatal clinic of Hawassa Referral Hospital, Southern Ethiopia.

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Tadesse, Endale; Teshome, Million; Merid, Yared; Kibret, Belayhun; Shimelis, Techalew

2014-03-17

Untreated asymptomatic bacteriuria (ASB) during pregnancy may cause serious complications including pyelonephritis and delivery of premature or low-birth-weight infants. However, little is known about asymptomatic bacteriuria in pregnancy in Ethiopia. This study aimed to assess the prevalence of asymptomatic bacteriuria, bacterial agents, and their antibiotic susceptibility pattern in pregnant women attending antenatal clinic of the Hawassa Teaching and Referral Hospital. A cross-sectional study was conducted in a total of 244 pregnant women with no sign and symptom of urinary tract infection from March 2012 to September 2012. Clean catch mid-stream urine samples were collected from all study participants using sterile containers. Urine samples were cultured using standard bacteriological methods. Identification of suspected colonies and antibiotic sensitivity testing were done. Out of 244 pregnant women, 46(18.8%) were positive for asymptomatic bacteriuria (Colony Forming Unit ≥ 105/mL). There was no difference in prevalence of asymptomatic bacteriuria with respect to age (p = 0.07) and trimester (p = 0.27).The most frequently isolated bacteria were coagulase negative Staphylococcus (32.6%), followed by Escherichia coli (26.1%), and Staphylococcus auerus (13%). The susceptibility rate of bacterial isolate was highest for norfloxacin (64.7%) and lowest for ampicillin (17.6%). The high prevalence of ASB in pregnant women warrant the need to screen all pregnant women and treat those infected with appropriate antimicrobial regimens in order to reduce its complications.

[Urinary tract infections in adults].

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Michno, Mikolaj; Sydor, Antoni

Review of urinary tract infections in adults including etiology, pathogenesis, classification and the most important therapeutic recommendations. Urinary tract infections are still a common clinical problem occurring more often in sexually active women, pregnancy, elderly , after catherization of a urinary bladder and urological surgery as well as in the co-existence of diabetes or nephrolithiasis. Due to the anatomical differences, women suffer more often than men. The main etiological factor is Escherichia coli, even though it plays a lesser role in the complicated infections, than in non-complicated ones. Apart from that, the infections may also be caused by atypical microbes, viruses and fungi. Relapses as well as reinfections are typical features of urinary tract infections and in some cases prolonged infections can spread from lower to upper urinary tract contributing to pyelonephritis, urosepsis or even death. These long-term infections can progress in a hidden, insidious, oligosymptomatic or asymptomatic manner leading to irreversible, progressive deterioration of renal function. They can also mask other diseases such as tuberculosis or neoplasms of the urinary tract, which leads to the delayed diagnosis and treatment. Diagnosis and treatment of urinary tract infections is a complex problem, often requiring specialized procedures as well as hospitalization. The choice of a therapy is determined by the type of infection, general condition, age and coexisting diseases. Rapid diagnosis and implementation of proper pharmacotherapy may shorten the time of treatment and hospitalization, preventing serious complications and reinfections.

Prevalence, detection and treatment of asymptomatic bacteriuria in a Turkish obstetric population.

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Kutlay, Sim; Kutlay, Baran; Karaahmetoglu, Ozgur; Ak, Cetin; Erkaya, Salim

2003-08-01

To prospectively determine the prevalence of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) and presenting symptoms of UTI as well as the most appropriate diagnostic test and success of single/combination drug treatment in a Turkish obstetric population. Between September and December 2000, 406 of 412 pregnant women admitted for an initial obstetric examination during the first trimester were evaluated. Results of clean-catch urine culture, microscopic urinalysis and dipstick urine tests were analyzed. The prevalence of ASB (n = 43) and symptomatic UTI (n = 19) were 10.6% and 4.7%, respectively. The sensitivity and specificity of microscopic urinalysis were 71.0% and 73.6%, respectively. The sensitivity and specificity of dipstick testing were 38.7% and 35.8%, respectively. Eighty-three percent of ASB/UTI cases were effectively treated with a course of a single antimicrobial (amoxicillin or a first-generation cephalosporin). If untreated, ASB can lead to acute, symptomatic UTI, including acute pyelonephritis, which in turn is associated with preterm labor and low birth weight. Therefore, screening for ASB early in pregnancy by methods with high sensitivity and treatment with appropriate antimicrobial regimens can decrease the risk of symptomatic UTI. In a Turkish clinical unit where culture is not available, the use of microscopic urinalysis was a clinically effective alternative method of detecting ASB. In this study, the sensitivity and specificity of dipstick testing were not high enough to recommend them as means of detecting ASB/UTI.

Asymptomatic group B streptococcal bacteriuria among pregnant women in Saudi Arabia.

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Ahmad, S

2015-01-01

This study aims to determine the asymptomatic bacteriuria in pregnancy due to GBS and its antimicrobial sensitivity pattern for planning strategy for the management of these cases and also to determine the relationship between asymptomatic bacteriuria and pyuria. A total of 3863 consecutive urine specimens were collected from 3863 pregnant women with asymptomatic bacteriuria attending the obstetrics and gynaecology department of our hospital over a period of two years. Specimens were processed using standard microbiological procedures. All the subjects were evaluated for bacteriuria. The prevalence of asymptomatic bacteriuria due to group B streptococci (GBS) was 82/3863 (2.1%) among pregnant women in Saudi Arabia. Among these, 69/82 patients (84.2%) had clinical and microbiological features consistent with cystitis, versus 13/82 (15.8%) for pyelonephritis. About 51.2% (42/82) of the patients who had urine analysis performed had positive results based on positive urinary leucocyte esterase and pyuria. Disc-diffusion analysis of all 82 GBS isolates showed that they were highly susceptible to Augmentin and linezolid. Screening for bacteriuria in pregnancy and proper treatment must be considered as an essential part of antenatal care in this community. To prevent asymptomatic bacteriuria complications, all pregnant women should be screened at the first antenatal visit. A negative test for pyuria is not a reliable indicator of the absence of asymptomatic bacteriuria in pregnant women. Further, ongoing surveillance and evaluation of outcomes in pregnancies complicated by GBS bacteriuria is required to optimise maternal and newborn care.

Increased serum procalcitonin levels in pregnant patients with asymptomatic bacteriuria.

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Bilir, Filiz; Akdemir, Nermin; Ozden, Selcuk; Cevrioglu, A Serhan; Bilir, Cemil

2013-09-05

Among the pregnancy urinary tract infections, asymptomatic bacteriuria (ASB) is the most common one. Untreated ASB can progress to pyelonephritis in 30-50% of the patients and can also result in prematurity in 27% of the pregnancy so it needs immediate diagnosis and treatment. In this study, we wanted to evaluate procalcitonin levels, compared to other inflammatory in pregnant women with ASB. The study was designed between the period of January 2012 and February 2013 at Sakarya University School of Medicine, Department of Gynecology and Obstetrics. The study population included 30 pregnant patients with asymptomatic bacteriuria and 39 healthy pregnant controls. Mean age was 28 (SD, 5.5) of the study population; mean maternal weight was 70 (SD, 8) kilogram. There were no statically significant differences between the groups according to the routine biochemical parameters, but gestational age was significantly lower in the ASB group compared to the controls (20.4 vs 28.6, respectively; p 0.05 ng/ml and 21(70%) patients had negative procalcitonin levels (Chi-squrae, p treatment of the first ASB diagnosis. Procalcitonin levels were significantly higher in ASB group than the control group and serum procalcitonin levels were higher in pregnant women with recurrent ASB. This finding is an important result revealed that high procalcitonin level can predict the further urinary tract infection risk. Finally, serum procalcitonin levels were normal in healthy pregnant women while other inflammatory markers such as WBC, ESR and CRP levels were higher.

Asymptomatic Bacteriuria and Bacterial Interference.

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Nicolle, Lindsay E

2015-10-01

Asymptomatic bacteriuria is very common. In healthy women, asymptomatic bacteriuria increases with age, from women age 80 years, but is uncommon in men until after age 50 years. Individuals with underlying genitourinary abnormalities, including indwelling devices, may also have a high frequency of asymptomatic bacteriuria, irrespective of age or gender. The prevalence is very high in residents of long-term-care facilities, from 25% to 50% of women and 15% to 40% of men. Escherichia coli is the most frequent organism isolated, but a wide variety of other organisms may occur. Bacteriuria may be transient or persist for a prolonged period. Pregnant women with asymptomatic bacteriuria identified in early pregnancy and who are untreated have a risk of pyelonephritis later in pregnancy of 20% to 30%. Bacteremia is frequent in bacteriuric subjects following mucosal trauma with bleeding, with 5% to 10% of patients developing severe sepsis or septic shock. These two groups with clear evidence of negative outcomes should be screened for bacteriuria and appropriately treated. Asymptomatic bacteriuria in other populations is benign and screening and treatment are not indicated. Antimicrobial treatment has no benefits but is associated with negative outcomes including reinfection with antimicrobial resistant organisms and a short-term increased frequency of symptomatic infection post-treatment. The observation of increased symptomatic infection post-treatment, however, has led to active investigation of bacterial interference as a strategy to prevent symptomatic episodes in selected high risk patients.

Antibiotics Dispensed to Privately Insured Pregnant Women with Urinary Tract Infections - United States, 2014.

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Ailes, Elizabeth C; Summers, April D; Tran, Emmy L; Gilboa, Suzanne M; Arnold, Kathryn E; Meaney-Delman, Dana; Reefhuis, Jennita

2018-01-12

Urinary tract infections (UTIs) occur in about 8% of pregnant women, and untreated UTIs can have serious consequences, including pyelonephritis, preterm labor, low birth weight, and sepsis (1). Pregnant women are typically screened for UTIs during early pregnancy, and those with bacteriuria are treated with antibiotics (1,2). Antibiotic stewardship is critical to improving patient safety and to combating antibiotic resistance. Because of the potential risk for birth defects, including anencephaly, heart defects, and orofacial clefts, associated with use of sulfonamides and nitrofurantoin during pregnancy (3), a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG) recommended that sulfonamides and nitrofurantoin may be prescribed in the first trimester of pregnancy only when other antimicrobial therapies are deemed clinically inappropriate (4). To assess the effects of these recommendations, CDC analyzed the Truven Health MarketScan Commercial Database* to examine antibiotic prescriptions filled by pregnant women with UTIs. Among 482,917 pregnancies in 2014, 7.2% of women had an outpatient UTI diagnosis during the 90 days before the date of last menstrual period (LMP) or during pregnancy. Among pregnant women with UTIs, the most frequently prescribed antibiotics during the first trimester were nitrofurantoin, ciprofloxacin, cephalexin, and trimethoprim-sulfamethoxazole. Given the potential risks associated with use of some of these antibiotics in early pregnancy and the potential for unrecognized pregnancy, women's health care providers should be familiar with the ACOG recommendations and consider the possibility of early pregnancy when treating women of reproductive age.

Diabetic Kidney Disease: A Syndrome Rather Than a Single Disease

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Piccoli, Giorgina B.; Grassi, Giorgio; Cabiddu, Gianfranca; Nazha, Marta; Roggero, Simona; Capizzi, Irene; De Pascale, Agostino; Priola, Adriano M.; Di Vico, Cristina; Maxia, Stefania; Loi, Valentina; Asunis, Anna M.; Pani, Antonello; Veltri, Andrea

2015-01-01

The term "diabetic kidney" has recently been proposed to encompass the various lesions, involving all kidney structures that characterize protean kidney damage in patients with diabetes. While glomerular diseases may follow the stepwise progression that was described several decades ago, the tenet that proteinuria identifies diabetic nephropathy is disputed today and should be limited to glomerular lesions. Improvements in glycemic control may have contributed to a decrease in the prevalence of glomerular lesions, initially described as hallmarks of diabetic nephropathy, and revealed other types of renal damage, mainly related to vasculature and interstitium, and these types usually present with little or no proteinuria. Whilst glomerular damage is the hallmark of microvascular lesions, ischemic nephropathies, renal infarction, and cholesterol emboli syndrome are the result of macrovascular involvement, and the presence of underlying renal damage sets the stage for acute infections and drug-induced kidney injuries. Impairment of the phagocytic response can cause severe and unusual forms of acute and chronic pyelonephritis. It is thus concluded that screening for albuminuria, which is useful for detecting "glomerular diabetic nephropathy", does not identify all potential nephropathies in diabetes patients. As diabetes is a risk factor for all forms of kidney disease, diagnosis in diabetic patients should include the same combination of biochemical, clinical, and imaging tests as employed in non-diabetic subjects, but with the specific consideration that chronic kidney disease (CKD) may develop more rapidly and severely in diabetic patients. PMID:26676663

Hematoma and abscess formation caused by Mycoplasma hominis following cesarean section

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Koshiba, Hisato; Koshiba, Akemi; Daimon, Yasushi; Noguchi, Toshifumi; Iwasaku, Kazuhiro; Kitawaki, Jo

2011-01-01

Mycoplasma species cannot be identified by routine bacteriological culture methods and are resistant to common antimicrobial agents. Mycoplasma hominis usually colonizes the lower urogenital tract and causes pyelonephritis, pelvic inflammatory disease, chorioamnionitis, rupture of fetal membranes, preterm labor, postpartum fever, postabortal fever, and neonatal infection. This organism is highly prevalent in cervicovaginal cultures of sexually active women. M. hominis, M. genitalis, Ureaplasma urealyticum, and U. parvum may invade and infect placental and fetal tissues, leading to adverse pregnancy outcomes. M. hominis occasionally causes nongenitourinary infection of the blood, wounds, central nervous system, joints, or respiratory tract. We present a case of a 27-year-old woman who developed abdominal wound hematoma and abscess after cesarean section. The wound was drained, but her high fever persisted, in spite of antibiotic treatment using flomoxef sodium and imipenem·cilastatin sodium. Because the exudate exhibited M. hominis growth in an anaerobic environment, we administered the quinolone ciprofloxacin. This therapy resolved her fever, and her white blood cell count and C-reactive protein level diminished to the normal ranges. To our knowledge, there are four published articles regarding the isolation of M. hominis from postcesarean incisions. Based on the current study and the literature, infection by this pathogen may cause hematoma formation with or without abscess after cesarean section or in immunosuppressed postoperative patients. In such cases, physicians may need to suspect Mycoplasma infection and initiate appropriate antibacterial treatment as soon as possible in order to avoid persistent fever. PMID:21339933

The value of filtered planar images in pediatric DMSA scans

International Nuclear Information System (INIS)

Mohammed, A.M.; Naddaf, S.Y.; Elgazzar, A.H.; Al-Abdul Salam, A.A.; Omar, A.A.

2006-01-01

The study was designed to demonstrate the value of filtered planar images in paediatric DMSA scanning. One hundred and seventy three patients ranged in age from 15 days to 12 years (mean: 4.3 years) with urinary tract infection (UTI) and clinical and/or laboratory suspicion of acute pyelonephritis (APN) were retrospectively studied. Planar images were filtered using Butterworth filter. The scan findings were reported as positive, negative or equivocal for cortical defects. Each scan was read in a double-blind fashion by two nuclear medicine physicians to evaluate inter-observer variations. Each kidney was divided into three zones, upper, middle and lower, and each zone was graded as positive, negative or equivocal for the presence of renal defects. Renal cortical defects were found in 66 patients (91 kidneys and 186 zones) with filtered images, 58 patients (81 kidneys and 175 zones) with planar images, and 69 patients (87 kidneys and 180 zones) with SPECT images. McNemar's test revealed statistically significant difference between filtered and planar images (p=0.038 for patients, 0.021 for kidneys and 0.034 for number of zones). Inter-observer agreement was 0.877 for filtered images, 0.915 for planar images and 0.915 for SPECT images. It was concluded that filtered planar images of renal cortex are comparable to SPECT images and can be used effectively in place of SPECT, when required, to shorten imaging time and eliminate motion artifacts, especially in the paediatric population. (author)

Effect of size and site on the outcome of extracorporeal shock wave lithotripsy of proximal urinary stones in children.

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Habib, Enmar I; Morsi, Hany A; Elsheemy, Mohammed S; Aboulela, Waseem; Eissa, Mohamed A

2013-06-01

To determine the effect of location and size of stones on the outcome of extracorporeal shock wave lithotripsy (ESWL) in children. In 2008-2010, 150 children (median age 6.6 years) with radio-opaque ureteric and renal stones measuring ≤4 cm were treated. Exclusion criteria were coagulation disorders, pyelonephritis, distal obstruction, non-functioning kidney and hypertension. ESWL was performed under general anesthesia. Follow up period was 5-22 months. 186 stones were treated: 76 calyceal, 92 pelvic and 18 proximal ureteral. Mean stone size was 1.3 cm. A total of 312 sessions were performed (mean per stone = 1.67 sessions). The mean number of shock waves per session was 2423.68. Overall stone-free rate was 89.24%. Having a calyceal location did not significantly affect the stone-free rate (p = 0.133). The failure rate was significantly higher (66.7%) in stones >3 cm in size (p auxillary ureteroscopy and 4 uretrolithotomy for treatment of steinstrasse. ESWL is a safe and effective method for treatment of stones up to 2 cm in children. Rate of auxillary procedures increases in stones >2 cm in size. About 80% of failures were associated with stone size >1.35 cm while 52.3% of completely cleared stones were associated with size <1.35 cm. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Computed tomography localization of the appendix in the pediatric population relative to the lumbar spine

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Davis, John; Kopelman, Tammy R. [Maricopa Integrated Health System, Maricopa Medical Center Department of Surgery, Phoenix, AZ (United States); Roh, Albert T.; Matz, Samantha L.; Gridley, Daniel G.; Connell, Mary J. [Maricopa Integrated Health System, Maricopa Medical Center Department of Radiology, Phoenix, AZ (United States); Petterson, Matthew B. [University of Arizona College of Medicine, Phoenix, AZ (United States)

2017-03-15

Computed tomography (CT) is commonly used to evaluate suspected acute appendicitis. Although very effective, CT uses ionizing radiation, exposing patients to an increased risk of cancer. This study assessed the potential for decreasing the field of view of the CT (and therefore the dose to the patient) in the evaluation of suspected acute appendicitis in children. This study was a retrospective review of prospectively collected data from 212 consecutive patients who underwent CT for suspected acute appendicitis. The most superior aspect of the appendix with respect to vertebral bodies was recorded. Age, gender and diagnosis (negative, acute appendicitis or alternative diagnosis) were noted. The appendix was visualized in 190 of 212 subjects (89.6%). Overall, all visualized appendixes were located at or below the level of L1. Sixty-three of the subjects (29.7%) were diagnosed with acute appendicitis via CT imaging. All appendixes in patients with acute appendicitis were located at or below the level of the L3 vertebral body, predominating at the level of L5. Six subjects (3.1%) received alternative diagnoses, including pneumonia, pyelonephritis, small bowel obstruction and infected urachal cyst. There were no differences in appendix location with regard to diagnosis, gender, or age (P=0.664, 0.748 and 0.705, respectively). CT field of view may be decreased to the level of L1 or L3 superiorly, decreasing radiation dose without affecting the rate of appendix visualization. (orig.)

Comparing between results and complications of doing voiding cystourethrogram in the first week following urinary tract infection and in 2-6 weeks after urinary tract infection in children referring to a teaching hospital.

Science.gov (United States)

Yousefichaijan, Parsa; Dorreh, Fatemeh; Shahsavari, Someyeh; Pakniyat, Abdolghader

2016-01-01

Urinary tract infection is the most common genitourinary disease in children so about 40% of the children with urinary tract infection suffering from reflux that caused some consequences such as pyelonephritis and kidney parenchymal injury. This research was conducted to compare the timing of voiding cystourethrogram (VCUG) in children with urinary tract infection in first week and after the first week of urinary tract infection. This research is a case-control study that both case and control groups include 208 children from 1 month to 12 years old with the complain of urinary tract infection. In case group, the VCUG was performed at the first week of infection and in control group, the VCUG was performed after the first week of infection. complication such as dysuria was observed in two-thirds of children who VCUG was performed during first week after urinary tract infection. Parents stress in case group was more than the other (P=0.015). For overall, the incidence of reflux in case and control groups was 49.5% and 50%, respectively. The mean of reflux grading in right kidney in case group was lower than control group resulting in significant differences between two groups. According to higher grade of stress in parents and complications due to VCUG at the first week of urinary tract infection, it is suggested that VCUG be conducted on selective patients in the hospital at the first week of urinary tract infection and during hospitalization.

Neuroendocrine-immune and metabolic accompaniments of cholecystokinetic effects of balneotherapy on SPA Truskavets’

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O M Marfiyan

2015-05-01

4Faculty of Physical Education, Health and Tourism, Kazimierz Wielki University, Bydgoszcz, Poland w.zukow@ukw.edu.pl   SUMMARY   Objective. Ability balneofactors spa Truskavets’ (Ukraine, including bioactive water Naftussya, affect Gall-bladder motility has long been known. We set a goal to identify changes related neuroendocrine-immune complex and metabolism accompanying cholecystokinetic effect of balneotherapy on spa. Results. In observation of 22 men with chronic cholecystitis in combination with pyelonephritis, found that 10-12-day course of balneotherapy (drinking of bioactive water Naftussya, application of ozokerite, mineral baths reduces Gall-bladder volume fasting by 16% (p0,05, by increasing PSD HF greater extent than LF. The basal levels of plasma cortisol decreased by 20% (p0,2 and 8% (p<0,05 respectively. Regarding immunity parameters revealed significant increase in blood CD16+ lymphocytes only (+17%, p<0,01 in the absence of changes in levels of CD3+CD4+ and CD3+CD8+ T cells and CD19+ B lymphocytes. Do not change significantly either serum Igg G, M, A, or circulating immune complexes. Finally, stated a slight but significant increase electrokinetic index cell nuclei of buccal epithelium, indicating the "rejuvenation" of the body. Conclusion: balneotherapy on spa Truskavets’ be significantly cholecystokinetic effect, combined with the activation excretory and depurative kidney functions and neutrophil bactericidal function against a background of lower levels of neuroendocrine markers of stress. Keywords: Truskavets’, balneotherapy, cholekinetic, diuresis, neuroendocrine-immune complex.

Renal dynamic scintigraphy with captropil in systemic arterial hypertension diagnosis

International Nuclear Information System (INIS)

Cervo, Marco Antonio Cadorna; Amarante Junior, Jose Luiz de Medeiros; Souza, Ricardo Alberto Manhaes; Evangelista, Maria Gardenia

1995-01-01

Forty one patients, 15 male and 16 female presenting systemic arterial hypertension were submitted to Basal RDC and after being simulated by Captopril; the radiotracer used was 99 mTc-DTPA (dietileno triamino pentacetic acid-99 Tc-technetium). From the 41 patients studied, 13 had the GFR (Glomerular filtration rate) Captopril when compared to Basal RDC radioactive, 11 of them were confirmed as having vascular renal disease by Renal Artiography and two of them were false (one case renal litiase and the other chronic pyelonephritis). Two more false negative cases have occurred in the RDC and three patients refused to be submitted to a Renal Arteriography. In the cases which the Total Glomerular Filtration Rate was reduced, there was an agreement of 89,5% between the RDC and the Renal Arteriography. No alterations have been observed in the Renal Arteriography on the remaining 23 patients and in the RDC after Captopril there was normal increase in the Glomerular Filtration Rate when compared to the Basal RDC. The method has showed sensitivity of 84% and specificity of 92%. We can conclude that the RDC with Captopril test is not an invasive method, it has good sensitivity and specificity and it can be indicated as a beginning test to select patients when you intend to detect vascular renal disease; nevertheless the RDC will never be used as a final test of vascular lesion. (author)

Assessment of infective urinary tract disorders

International Nuclear Information System (INIS)

Sixt, R.; Stokland, E.

1998-01-01

Urinary tracts infection (UTI) is common in children, particularly in the youngest age groups. There is a risk for progressive deterioration of renal function in these children if aggravating factors such as gross reflux and/or outflow obstruction of the urinary tract are present. In this review the pros and cons of available scintigrafic and radiological imaging techniques for the work-up of these children are presented. Ultrasound can be used in the acute phase to exclude obstruction but can not reliably show transient or permanent parenchymal lesions. The presence of reflux can be established with X-ray or direct nuclide cystography. The X-ray technique gives good morphological information and has a grading system with prognostic relevance. Both techniques are invasive and great care must be taken to keep the radiation burden down with the X-ray technique. Indirect nuclide cystography following a renographic study is non-invasive but has a lower sensitivity than direct techniques. More experience is needed with the indirect technique to evaluate the consequences of its apparently low sensitivity. Urography has a limited place in the acute work-up of urinary tract infection but can be used to look for renal scarring 1-2 years after an acute pyelonephritis. The 99m Tc dimercaptosuccinic acid (DMSA) scan can be used during the acute UTI to show pyelonephritic lesions with good accuracy and/or during the follow-up after six months to show permanent lesions. The acute DMSA scan can be omitted

Assessment of infective urinary tract disorders

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Sixt, R.; Stokland, E. [Goteborg, Sahlgrenska Univ. Hospital/Ostra (Sweden). Dept. of Pediatric Clinical Physiology and Dept. of Pediatric Radiology

1998-06-01

Urinary tracts infection (UTI) is common in children, particularly in the youngest age groups. There is a risk for progressive deterioration of renal function in these children if aggravating factors such as gross reflux and/or outflow obstruction of the urinary tract are present. In this review the pros and cons of available scintigrafic and radiological imaging techniques for the work-up of these children are presented. Ultrasound can be used in the acute phase to exclude obstruction but can not reliably show transient or permanent parenchymal lesions. The presence of reflux can be established with X-ray or direct nuclide cystography. The X-ray technique gives good morphological information and has a grading system with prognostic relevance. Both techniques are invasive and great care must be taken to keep the radiation burden down with the X-ray technique. Indirect nuclide cystography following a renographic study is non-invasive but has a lower sensitivity than direct techniques. More experience is needed with the indirect technique to evaluate the consequences of its apparently low sensitivity. Urography has a limited place in the acute work-up of urinary tract infection but can be used to look for renal scarring 1-2 years after an acute pyelonephritis. The {sup 99m}Tc dimercaptosuccinic acid (DMSA) scan can be used during the acute UTI to show pyelonephritic lesions with good accuracy and/or during the follow-up after six months to show permanent lesions. The acute DMSA scan can be omitted.

DMSA SPECT imaging using oblique reconstruction in a paediatric population - benefits and technical considerations

International Nuclear Information System (INIS)

Parsons, G.; Ford, M.; Crisp, J.; Bernard, E.; Howman-Giles, R.

1997-01-01

Full text: DMSA renal scans are frequently requested for the diagnosis and follow-up of acute pyelonephritis and cortical scarring. This study was designed to:- 1. evaluate oblique reconstruction of DMSA SPECT over standard plane reconstruction and planar imaging; and 2. report on the technical aspects important in obtaining high quality DMSA SPECT, particularly in neonates. Over seven months, 210/231 (91 %) of DMSA scans were performed with SPECT on children from age nine days to 16 years, the median age being 2.5 years. 65 patients (31 %) were under one year and 39 (18%) were under six months. Planar and SPECT imaging with standard plane reconstruction and oblique reorientation was performed on the Siemens triple-headed gamma camera. High quality SPECT images were obtained on the smallest babies using a paediatric palette, and were of comparable quality to those of older children. At the time of reporting, the nuclear medicine physician assessed the diagnostic value of the three types of date presented: (1) planar images; (2) standard plane SPECT reconstruction; and (3) oblique SPECT reconstruction. Cortical defects were identified separately for upper, middle and lower poles. Three physicians concluded that high quality SPECT is superior to planar images when assessing the renal cortex. In addition, oblique reorientation is superior to standard reconstruction, particularly at the upper and lower poles. SPECT is now performed routinely on patients of all ages, and the oblique sagittal and coronal reorientation is now used in place of the standard reconstruction

A Clinical Observation of Ultrasonographic Diagnosis on Right upper Quadrant Pain

International Nuclear Information System (INIS)

Lee, Suck Hong; Moon, T. Y.; Chang, H. Y.; Kim, B. S.

1982-01-01

The author analyzed a total of 127 cases of ultrasonography studied for evaluation of the causes of right upper quadrant pain during ten months from Feb.1 to Nov. 30 1981, at the department of radiology, Busan national university and St. Benedict hospital. The results were as follows: 1. ultrasonographic findings of the total of 127 cases are normal in 41(32.3%) cases, and abnormal in 86(67.6%) cases. 2. Clinical diagnosis of normal ultrasonographic cases is unknown in 15(36.6%) cases, hepatitis in 10(24.3%) cases, pancreatitis in 6(14.6%) case,enterocolitis in 5(12.1%) cases, acute gastritis in 3(7.5%), acute pyelonephritis in 1(2.4%) case, and clonorchiasis in 1(2.4%) case. 3. Pathological diagnosis of 50 cases out of 86 cases of abnormal ultrasonography is GB stone in 36(72.0%) cases, pancreatic cancer in 5(10.0%) cases, hepatoma in 3(6.0%) cases, CBD stone in 4(8.0%) cases, pancreatic pseudocyst in 1(12.9%) case and liver abscess in 1(2.0%) case. 4. Diagnostic accuracy of ultrasonography of GB stone was 91.7%, false positive 2.8% and false negative 6.6%. 5. Ultrasonography has the advantage of noninvasiveness and easy performance, but the diagnostic accuracy of ultrasonography alone was low. Ultrasonography is considered as a good screening and complementary method for evaluation of right upper quadrant pain

A Clinical Observation of Ultrasonographic Diagnosis on Right upper Quadrant Pain

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Lee, Suck Hong; Moon, T. Y.; Chang, H. Y.; Kim, B. S. [Pusan National University College of Medicine, Busan (Korea, Republic of)

1982-12-15

The author analyzed a total of 127 cases of ultrasonography studied for evaluation of the causes of right upper quadrant pain during ten months from Feb.1 to Nov. 30 1981, at the department of radiology, Busan national university and St. Benedict hospital. The results were as follows: 1. ultrasonographic findings of the total of 127 cases are normal in 41(32.3%) cases, and abnormal in 86(67.6%) cases. 2. Clinical diagnosis of normal ultrasonographic cases is unknown in 15(36.6%) cases, hepatitis in 10(24.3%) cases, pancreatitis in 6(14.6%) case,enterocolitis in 5(12.1%) cases, acute gastritis in 3(7.5%), acute pyelonephritis in 1(2.4%) case, and clonorchiasis in 1(2.4%) case. 3. Pathological diagnosis of 50 cases out of 86 cases of abnormal ultrasonography is GB stone in 36(72.0%) cases, pancreatic cancer in 5(10.0%) cases, hepatoma in 3(6.0%) cases, CBD stone in 4(8.0%) cases, pancreatic pseudocyst in 1(12.9%) case and liver abscess in 1(2.0%) case. 4. Diagnostic accuracy of ultrasonography of GB stone was 91.7%, false positive 2.8% and false negative 6.6%. 5. Ultrasonography has the advantage of noninvasiveness and easy performance, but the diagnostic accuracy of ultrasonography alone was low. Ultrasonography is considered as a good screening and complementary method for evaluation of right upper quadrant pain

Rectal bladder-type: ileum-sigma-rectum pouch

International Nuclear Information System (INIS)

Krajka, K.; Mikszewicz, A.; Stachurski, L.; Perkowski, D.

1994-01-01

The paper presents a method of creating rectal bladder by using the proximal part of rectum, the distal part of sigma and a 40 cm long segment of detubularized ileum. Ureters were attached to the proximal end of ileal segment by Wallace-I technique. Initially the retrograde pyelonephritis was to be prevented by intussuscepting a 4 cm long part of the uretero-ilea anastomosis and by positioning isoperistaltically a 15-16 cm long part of the ileal segment. Because of the insufficiency of such a mechanism, in 4 latest cases the intussuscepted segment was increased to 8 cm. 8 patients suffering from stage T3a and T3b invasive carcinoma of the bladder were treated by this procedure. The ureteral stens were led out via the rectal tube. They were removed days after the operation. The whole post-operative period was uneventful. The patients were under close follow-up from 5 to 22 months. Three of them died due to a progression of the disease. All the patients had 3-4 watery stools a day and one at night. Check-ups performed three and six months after the operation revealed a proper out flow of contrast medium from kidneys and a reduction in the dilatation of ureters. In one case the kidney that failed to function before the procedure, restored its secretion afterwards. The contrast medium reached colon descendens only when more than 350 ml of it were infused into the rectal bladder. (author)

Clinical use of MRI for the evaluation of acute appendicitis during pregnancy.

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Patel, Darshan; Fingard, Jordan; Winters, Sean; Low, Gavin

2017-07-01

The purpose of this study was to determine the diagnostic accuracy of MRI for detecting acute appendicitis in pregnancy in a multi-institution study involving general body MR readers with no specific expertise in MR imaging of the pregnant patient. Retrospective review of MRI examinations on PACS in 42 pregnant patients was evaluated for acute right lower quadrant pain. Three fellowship-trained general body radiologists analyzed the MRI examinations in consensus and attempted to localize the appendix, assess for features of appendicitis, and exclude alternative etiologies for the right lower quadrant pain. Of the 42 MRI examinations, the readers noted 6 cases of acute appendicitis, 16 cases of a normal appendix, and 20 cases involving non-visualization of the appendix but where there were no secondary features of acute appendicitis. Based on the surgical data and clinical follow-up, there were 3 true-positive cases, 3 false-positive cases, 34 true-negative cases, and 2 false-negative cases of acute appendicitis on MRI. This yielded an accuracy of 88.1%, sensitivity of 60%, specificity of 91.9%, positive predictive value of 50%, and negative predictive value of 94.4% for the detection of acute appendicitis in the pregnant patient on MRI. Alternative etiologies for the right lower quadrant pain on MRI included torsion of an ovarian dermoid in 1 case and pyelonephritis in 1 case. MRI is an excellent modality for excluding acute appendicitis in pregnant patients presenting with right lower quadrant pain.

[Laparoscopic cystectomy and transileal ureterostomy for neurogenic vesicosphincteric disorders. Evaluation of morbidity].

Science.gov (United States)

Guillotreau, Julien; Gamé, Xavier; Castel-Lacanal, Evelyne; Mallet, Richard; De Boissezon, Xavier; Malavaud, Bernard; Marque, Philippe; Rischmann, Pascal

2007-04-01

To evaluate the morbidity and mortality of laparoscopic cystectomy combined with transileal ureterostomy to treat neurogenic vesicosphincteric disorders. Prospective study performed between february 2004 and april 2006 on 26 consecutive patients with a mean age of 55.0 +/- 12.7 years treated by laparoscopic cystectomy for neurogenic vesicosphincteric disorders. The underlying neurological disease was multiple sclerosis (MS) in 20 cases, spinal cord injury in 4 cases and transverse myelitis in 2 cases. The median preoperative ASA score was 3 (range: 2-3). No open conversion was necessary. One intraoperative complication was observed (vascular injury). No perioperative death was observed. The nasogastric tube was maintained postoperatively for an average of 8.69 +/- 5.9 hours. The mean time to resumption of oral fluids was 1.4 +/- 0.7 days and mean time to resumption of solids was 2.6 +/- 1.0 days. The mean time to resumption of bowel movements was 3.8 +/- 3.2 days. The mean intensive care stay was 3.9 +/- 1.1 days. Two postoperative complications were observed in the same patient (ileus and bronchial congestion). Postoperative narcotic analgesics were necessary in 60% of cases. The mean hospital stay was 10.3 +/- 4.1 days. Two late postoperative complications were observed in the same patient (two episodes of pyelonephritis). Laparoscopic cystectomy has a low morbidity in neurological patients, allowing early return of feeding and a moderate length of hospital stay.

COMMON ORGANISMS AND ANTIBIOTIC SENSITIVITY OF E COLI IN URINARY TRACT INFECTION, IN A TERTIARY CARE TEACHING HOSPITAL, NORTHERN KERALA

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Shanavas

2015-11-01

Full Text Available Urinary tract infection (UTI includes a spectrum of Asymptomatic Bacteruria (ABU, Cystitis, Prostitis and Pyelonephritis. Except in ABU, UTI is represented by symptomatic disease that warrants antimicrobial therapy. 1 Many of the studies have shown increasing antibiotic resistance to these agents. This study consists of a retrospective observational study of culture and sensitivity of 150 urinary samples, collected from patients who presented with symptoms of UTI, in a tertiary care teaching hospital, Northern Kerala, irrespective of their age and sex for a period of six months from June 2015 to November 2015. These results are then analyzed to find common organisms causing UTI in different age groups in either sex and their respective antibiotic resistance are noted. Out of 150 urinary samples 69.34% were sterile, while 30.66% were culture positive. Among the culture positive patients sex distribution was almost equal, with a slight female predominance, having a contribution of 54.35% females and 45.65% males. The most common organism was found to be E.coli, which contributed more than 50 per cent of total culture positivity (54.35%. Others include Staphylococci, Klebsiella Pnuemoniae, Proteus species, Pseudomonas, Enterococci, Candida Albicans etc. Collateral damage is an ecological adverse effect that resist the use of a highly efficacious drug to be considered as first line agent. Our study shows that drugs causing minimal collateral damages like Nitrofurantoin and Fosfomycin can be used as first line agent for treatment of UTI.

The use of systemic fluoroquinolones.

Science.gov (United States)

2006-09-01

The only indications for which a fluoroquinolone (ie, ciprofloxacin) is licensed by the US Food and Drug Administration for use in patients younger than 18 years are complicated urinary tract infections, pyelonephritis, and postexposure treatment for inhalation anthrax. Nonetheless, approximately 520,000 prescriptions for fluoroquinolones were written in the United States for patients younger than 18 years in 2002; 13,800 were written for infants and children 2 to 6 years of age, and 2750 were written for infants younger than 2 years. Clinical trials of fluoroquinolones in pediatric patients with various diagnoses have been published and are reviewed. Fluoroquinolones cause arthrotoxicity in juvenile animals and have been associated with reversible musculoskeletal events in both children and adults. Other adverse events associated with fluoroquinolones include central nervous system disorders, photosensitivity, disorders of glucose homeostasis, prolongation of QT interval with rare cases of torsade de pointes (often lethal ventricular arrhythmia in patients with long QT syndrome), hepatic dysfunction, and rashes. The increased use of fluoroquinolones in adults has resulted in increased bacterial resistance to this class of antibacterial agents. This report provides specific guidelines for the systemic use of fluoroquinolones in children. Fluoroquinolone use should be restricted to situations in which there is no safe and effective alternative to treat an infection caused by multidrug-resistant bacteria or to provide oral therapy when parenteral therapy is not feasible and no other effective oral agent is available.

Paediatric dialysis and renal transplantation in the state of Rio Grande do Sul, Brazil.

Science.gov (United States)

Garcia, C; Goldani, J; Garcia, V

1992-01-01

Renal replacement therapy (RRT) for Brazilian children with uraemia has been utilized since 1970 in the state of Rio Grande do Sul. One hundred and eighty patients receiving this therapy between 1970 and 1988 have been reviewed. The annual acceptance rate of new paediatric patients in this period increased from 0.6 to 6.5 patients per million child population. Glomerulonephritis (36.1%) and pyelonephritis including urological anomalies (31.7%) were the most frequent causes of end-stage renal disease. Outpatient hospital haemodialysis was the primary form of dialytic treatment in patients 5-15 years of age. Continuous ambulatory peritoneal dialysis was more often used in patients less than 5 years of age. The survival after 1 year on dialysis was 79.9% for children aged 5-15 years starting dialysis during the period 1985-1988. Fluid overload with congestive heart failure and infection were the main causes of death in children on dialysis. Eighty-four children received 93 grafts; only 14 (15%) were from cadaveric donors. One-year patient and graft survival of first living-related donor transplants were 92.2% and 78.5% respectively during the period 1985-1988. Infection accounted for 43.5% of deaths after transplantation. We conclude that RRT is becoming increasingly successful for children in our region but that greater emphasis upon patient compliance with all forms of RRT and upon cadaver kidney donation is needed.

Duration of treatment for asymptomatic bacteriuria during pregnancy.

Science.gov (United States)

Widmer, Mariana; Lopez, Ivana; Gülmezoglu, A Metin; Mignini, Luciano; Roganti, Ariel

2015-11-11

A previous Cochrane systematic review has shown that antibiotic drug treatment of asymptomatic bacteriuria in pregnant women substantially decreases the risk of pyelonephritis and reduces the risk of preterm delivery. However, it is not clear whether single-dose therapy is as effective as longer conventional antibiotic treatment. To assess the effects of different durations of treatment for asymptomatic bacteriuria in pregnancy. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015) and reference lists of identified articles. Randomized and quasi-randomized trials comparing antimicrobial therapeutic regimens that differed in duration (particularly comparing single dose with longer duration regimens) in pregnant women diagnosed with asymptomatic bacteriuria. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach. We included 13 studies, involving 1622 women. All were comparisons of single-dose treatment with short-course (four- to seven-day) treatments. The risk of bias of trials included in this review was largely unclear, and most trials were at high risk of performance bias. The quality of the evidence was assessed using the GRADE approach. When the any antibiotic agent was used, the 'no cure' rate for asymptomatic bacteriuria in pregnant women was slightly lower for the short-course treatment over the single-dose treatment, although there was evidence of statistical heterogeneity (average risk ratio (RR) 1.28, 95% confidence interval (CI) 0.87 to 1.88; women = 1502, studies = 13; I² = 56%; very low quality evidence). Data from only good quality trials also showed better cure rates with short (four- to seven-day) regimens of the same microbial agent (average RR 1.72, 95% CI 1.27 to 2.33; women = 803, studies = two; I² = 0%; high quality evidence). There was no clear difference in the

Hugh de Wardener - the Man and the Scientist.

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Phillips, M E; de Wardener, S

2016-02-01

Hugh de Wardener died on 29th September 2013, ten days before his 98th birthday. He had a diverse upbringing and qualified in Medicine in 1939. He joined the army but was captured in 1942 and imprisoned in Singapore and Thailand until 1945. His clinical care of fellow prisoners was highly regarded. He preserved their clinical records and used them, post-war, to write two Lancet papers. One showed, for the first time, that Wernickes encephalopathy could be caused by severe malnutrition and cured by small doses of vitamin B1. His later academic interests were based on the emphasis he placed on renal physiology. This applied to the topic most associated with his name-Natriuretic Hormone. Whilst de Wardener never isolated this hormone, his early experiments, demonstrating that a third factor other than GFR and aldosterone affected renal sodium transport, were substantiated by others. Hugh had many research interests: pyelonephritis, renal histology, maintenance dialysis and metabolic/renal bone disease. In his later years he researched intensively into the role of sodium and salt in the aetiology of essential hypertension. Hugh was president of the International Society of Nephrology (1969-72) and the UK Renal Association (1975-78). He received many awards and recognitions from across the world, many of them after his (so-called) retirement. Throughout his career he never neglected the care of his patients. As Bob Schrier wrote in his obituary of de Wardener in Kidney International he was a caring physicianwhose dedication to his patients welfare was exemplary.

Renal lesions associated with autoimmune pancreatitis: CT findings

International Nuclear Information System (INIS)

Triantopoulou, Charikleia; Maniatis, Petros; Siafas, Ioannis; Papailiou, John; Malachias, George; Anastopoulos, John

2010-01-01

Background: Autoimmune pancreatitis (AIP) is a chronic inflammatory condition characterized by IgG4-positive plasma cells. Recent evidence suggests that it is a systemic disease affecting various organs. Tubulointerstitial nephritis has been reported in association with AIP. Purpose: To investigate the incidence and types of renal involvement in patients with AIP. Material and Methods: Eighteen patients with no history of renal disease and a diagnosis of AIP (on the basis of histopathologic findings or a combination of characteristic imaging features, increased serum IgG4 levels, and response to steroid treatment) were included. All patients underwent computed tomography (CT) imaging and follow-up ranged from 6 months to 2 years. CT images were reviewed for the presence of renal lesions. Results: Seven patients had renal involvement (38.8%). None of the lesions was visible on non-contrast-enhanced CT scan. Parenchymal lesions appeared as multiple nodules showing decreased enhancement (four cases). Pyelonephritis, lymphoma, and metastases were considered in the differential diagnosis. An ill-defined low-attenuation mass-like lesion was found in one patient, while diffuse thickening of the renal pelvis wall was evident in the last two cases. Renal lesions regressed in all patients after steroid treatment, the larger one leaving a fibrous cortical scar. Conclusion: Different types of renal lesions in patients with AIP are relatively common, appearing as multiple nodules with decreased enhancement. These findings support the proposed concept of an IgG4-related systemic disease. Autoimmune disease should be suspected in cases of renal involvement in association with pancreatic focal or diffuse enlargement.

Renal lesions associated with autoimmune pancreatitis: CT findings

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Triantopoulou, Charikleia; Maniatis, Petros; Siafas, Ioannis; Papailiou, John (CT and Radiology Dept., ' Konstantopouleion' General Hospital, Athens (Greece)), e-mail: ctriantopoulou@gmail.com; Malachias, George; Anastopoulos, John (Radiology Dept., ' Sismanogleio' General Hospital, Athens (Greece))

2010-07-15

Background: Autoimmune pancreatitis (AIP) is a chronic inflammatory condition characterized by IgG4-positive plasma cells. Recent evidence suggests that it is a systemic disease affecting various organs. Tubulointerstitial nephritis has been reported in association with AIP. Purpose: To investigate the incidence and types of renal involvement in patients with AIP. Material and Methods: Eighteen patients with no history of renal disease and a diagnosis of AIP (on the basis of histopathologic findings or a combination of characteristic imaging features, increased serum IgG4 levels, and response to steroid treatment) were included. All patients underwent computed tomography (CT) imaging and follow-up ranged from 6 months to 2 years. CT images were reviewed for the presence of renal lesions. Results: Seven patients had renal involvement (38.8%). None of the lesions was visible on non-contrast-enhanced CT scan. Parenchymal lesions appeared as multiple nodules showing decreased enhancement (four cases). Pyelonephritis, lymphoma, and metastases were considered in the differential diagnosis. An ill-defined low-attenuation mass-like lesion was found in one patient, while diffuse thickening of the renal pelvis wall was evident in the last two cases. Renal lesions regressed in all patients after steroid treatment, the larger one leaving a fibrous cortical scar. Conclusion: Different types of renal lesions in patients with AIP are relatively common, appearing as multiple nodules with decreased enhancement. These findings support the proposed concept of an IgG4-related systemic disease. Autoimmune disease should be suspected in cases of renal involvement in association with pancreatic focal or diffuse enlargement.

[Infected subdural hematoma having a surgery of chronic subdural hematoma 1 year ago:a case report].

Science.gov (United States)

Nagao, Takaaki; Miyazaki, Chikao; Ando, Shunpei; Haga, Daisuke; Kuroki, Takao; Sugo, Nobuo; Nagao, Takeki

2015-02-01

We report a case of an infected subdural hematoma that occurred 1 year after burr-hole irrigation for chronic subdural hematoma. A 78-year-old woman who had developed left hemiparesis was admitted to our hospital. A computed tomography(CT)scan revealed the presence of a chronic subdural hematoma in the right hemisphere. Her clinical symptoms improved immediately after emergency burr-hole irrigation, which allowed her discharge from the hospital. One year after the initial surgery, she developed an infection of the urinary tract infection, which led to severe pyelonephritis and septic shock. Treatment of the urological symptoms eliminated the systemic inflammation. One month after the urinary infection, the patient was readmitted to the hospital in a comatose state. A CT scan showed regrowth of a residual subdural hematoma surrounded by a thick capsule, causing a midline shift in the brain. An emergency operation for removal of the subdural hematoma by burr-hole irrigation was performed, and pus was drained from the subdural mass. Microbiological cultures of the abscess revealed the presence of Proteus mirabilis. After surgery, the patient was administered an antibiotic treatment for three weeks and she was discharged with no neurological deficits. Cultures of blood from the septic shock as well as from the abscess both revealed the presence of Proteus mirabilis. Therefore, a diagnosis of infected subdural hematoma, which was caused by hematogenous infection, was made. We conclude that attention should be paid to the risk of infection of the hematoma capsule in subdural hematomas.

Preoperative evaluation of renal anatomy and renal masses with helical CT, 3D-CT and 3D-CT angiography.

Science.gov (United States)

Toprak, Uğur; Erdoğan, Aysun; Gülbay, Mutlu; Karademir, Mehmet Alp; Paşaoğlu, Eşref; Akar, Okkeş Emrah

2005-03-01

The aim of this prospective study was to determine the efficacy of three-dimensional computed tomography (3D-CT) and three-dimensional computed tomographic angiography (3D-CTA) that were reconstructed by using the axial images of the multiphasic helical CT in the preoperative evaluation of renal masses and demonstration of renal anatomy. Twenty patients that were suspected of having renal masses upon initial physical examination and ultrasonographic evaluation were examined through multiphasic helical CT. Two authors executed CT evaluations. Axial images were first examined and then used to reconstruct 3D-CT and 3D- CTA images. Number, location and size of the renal masses and other findings were noted. Renal vascularization and relationships of the renal masses with the neighboring renal structures were further investigated with 3D-CT and 3D-CTA images. Out of 20 patients, 13 had histopathologically proven renal cell carcinoma. The diagnoses of the remaining seven patients were xanthogranulomatous pyelonephritis, abscess, simple cyst, infected cyst, angiomyolipoma, oncocytoma and arteriovenous fistula. In the renal cell carcinoma group, 3 patients had stage I, 7 patients had stage II, and 3 patients had stage III disease. Sizes of renal cell carcinoma masses were between 23 mm to 60 mm (mean, 36 mm). Vascular invasion was shown in 2 renal cell carcinoma patients. Collecting system invasion was identified in 11 of 13 renal cell patients. These radiologic findings were confirmed with surgical specimens. Three-dimensional CT and 3D-CTA are non-invasive, effective imaging techniques for the preoperative evaluation of renal masses.

Pregnancy in spinal cord-injured women, a cohort study of 37 pregnancies in 25 women.

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Le Liepvre, H; Dinh, A; Idiard-Chamois, B; Chartier-Kastler, E; Phé, V; Even, A; Robain, G; Denys, P

2017-02-01

A retrospective observational study. To describe specificities of pregnancy in a traumatic spinal cord-injured (SCI) population managed by a coordinated medical care team involving physical medicine and rehabilitation (PMR) physicians, urologists, infectious diseases' physicians, obstetricians and anaesthesiologists. NeuroUrology Department in a University Hospital, France. All consecutive SCI pregnant women managed between 2001 and 2014 were included. A preconceptional consultation was proposed whenever possible. Obstetrical and urological outcomes, delivery mode and complications were reported. Overall, thirty-seven pregnancies in 25 women, of a mean age of 32±4 years, were included. Thirty-five children were born alive (three miscarriages, a twin pregnancy) without complications except for a case of neonatal respiratory distress in premature twins born at 33 weeks. The mean birth weight was 2979±599 g. Twenty-one (57%) pregnancies benefited from preconceptional care. A weekly oral cyclic antibiotic programme was prescribed in 28 (75%) pregnancies. The main complications during pregnancy included pyelonephritis (30%), lower urinary tract infections (UTI) (32%), pressure sores (8.8%) and prematurity (12% deliveries before 37 weeks, with only one delivery before 36 weeks). Two patients suffered from autonomic dysreflexia, one with serious complication (brain haematoma). Caesarean sections were performed for 68% of deliveries (23/34) to prevent syringomyelia deterioration (n=10), stress urinary incontinence aggravation (n=3) or for obstetrical reasons (n=7). Mothers' and infants' outcomes were satisfying after pregnancy in SCI women, but required many adjustments. Pregnancy must be prepared by a preconceptional consultation, and managed by a multidisciplinary team involving specialists of neurological disability and pregnancy.

The kidney in pregnancy: A journey of three decades.

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Prakash, J

2012-05-01

The spectrum of kidney disease occurring during pregnancy includes preeclampsia, hypertensive disorders of pregnancy, urinary tract infection, acute kidney injury, and renal cortical necrosis (RCN). Preeclampsia affects approximately 3-5% of pregnancies. We observed preeclampsia in 5.8% of pregnancies, and 2.38% of our preeclamptic women developed eclampsia. Severe preeclampsia and the eclampsia or hemolysis, elevated liver enzymes levels, and low platelets count (HELLP) syndrome accounted for about 40% of cases of acute kidney injury (AKI) in pregnancy. Preeclampsia/eclampsia was the cause of acute renal failure (ARF) in 38.3% of the cases. Preeclampsia was the most common (91.7%) cause of hypertension during pregnancy, and chronic hypertension was present in 8.3% of patients. We observed urinary tract infection (UTI) in 9% of pregnancies. Sepsis resulting from pyelonephritis can progress to endotoxic shock, disseminated intravascular coagulation, and AKI. The incidence of premature delivery and low birth weight is higher in women with UTI. The incidence of AKI in pregnancy with respect to total ARF cases has decreased over the last 30 years from 25% in 1980s to 5% in 2000s. Septic abortion-related ARF decreased from 9% to 3%. Prevention of unwanted pregnancy and avoidance of septic abortion are key to eliminate abortion-associated ARF in early pregnancy. The two most common causes of ARF in third trimester and postpartum periods were puerperal sepsis and preeclampsia/HELLP syndrome. Pregnancy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome and acute fatty liver of pregnancy were rare causes of ARF. Despite decreasing incidence, AKI remains a serious complication during pregnancy.

The Role of Chaperone-subunit Usher Domain Interactions in the Mechanism of Bacterial Pilus Biogenesis Revealed by ESI-MS*

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Morrissey, Bethny; Leney, Aneika C.; Toste Rêgo, Ana; Phan, Gilles; Allen, William J.; Verger, Denis; Waksman, Gabriel; Ashcroft, Alison E.; Radford, Sheena E.

2012-01-01

The PapC usher is a β-barrel outer membrane protein essential for assembly and secretion of P pili that are required for adhesion of pathogenic E. coli, which cause the development of pyelonephritis. Multiple protein subunits form the P pilus, the highly specific assembly of which is coordinated by the usher. Despite a wealth of structural knowledge, how the usher catalyzes subunit polymerization and orchestrates a correct and functional order of subunit assembly remain unclear. Here, the ability of the soluble N-terminal (UsherN), C-terminal (UsherC2), and Plug (UsherP) domains of the usher to bind different chaperone-subunit (PapDPapX) complexes is investigated using noncovalent electrospray ionization mass spectrometry. The results reveal that each usher domain is able to bind all six PapDPapX complexes, consistent with an active role of all three usher domains in pilus biogenesis. Using collision induced dissociation, combined with competition binding experiments and dissection of the adhesin subunit, PapG, into separate pilin and adhesin domains, the results reveal why PapG has a uniquely high affinity for the usher, which is consistent with this subunit always being displayed at the pilus tip. In addition, we show how the different soluble usher domains cooperate to coordinate and control efficient pilus assembly at the usher platform. As well as providing new information about the protein-protein interactions that determine pilus biogenesis, the results highlight the power of noncovalent MS to interrogate biological mechanisms, especially in complex mixtures of species. PMID:22371487

The role of chaperone-subunit usher domain interactions in the mechanism of bacterial pilus biogenesis revealed by ESI-MS.

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Morrissey, Bethny; Leney, Aneika C; Toste Rêgo, Ana; Phan, Gilles; Allen, William J; Verger, Denis; Waksman, Gabriel; Ashcroft, Alison E; Radford, Sheena E

2012-07-01

The PapC usher is a β-barrel outer membrane protein essential for assembly and secretion of P pili that are required for adhesion of pathogenic E. coli, which cause the development of pyelonephritis. Multiple protein subunits form the P pilus, the highly specific assembly of which is coordinated by the usher. Despite a wealth of structural knowledge, how the usher catalyzes subunit polymerization and orchestrates a correct and functional order of subunit assembly remain unclear. Here, the ability of the soluble N-terminal (UsherN), C-terminal (UsherC2), and Plug (UsherP) domains of the usher to bind different chaperone-subunit (PapDPapX) complexes is investigated using noncovalent electrospray ionization mass spectrometry. The results reveal that each usher domain is able to bind all six PapDPapX complexes, consistent with an active role of all three usher domains in pilus biogenesis. Using collision induced dissociation, combined with competition binding experiments and dissection of the adhesin subunit, PapG, into separate pilin and adhesin domains, the results reveal why PapG has a uniquely high affinity for the usher, which is consistent with this subunit always being displayed at the pilus tip. In addition, we show how the different soluble usher domains cooperate to coordinate and control efficient pilus assembly at the usher platform. As well as providing new information about the protein-protein interactions that determine pilus biogenesis, the results highlight the power of noncovalent MS to interrogate biological mechanisms, especially in complex mixtures of species.

"Urinary Tract Infection"-Requiem for a Heavyweight.

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Finucane, Thomas E

2017-08-01

"Urinary tract infection" ("UTI") is an ambiguous, expansive, overused diagnosis that can lead to marked, harmful antibiotic overtreatment. "Significant bacteriuria," central to most definitions of "UTI," has little significance in identifying individuals who will benefit from treatment. "Urinary symptoms" are similarly uninformative. Neither criterion is well defined. Bacteriuria and symptoms remit and recur spontaneously. Treatment is standard for acute uncomplicated cystitis and common for asymptomatic bacteriuria, but definite benefits are few. Treatment for "UTI" in older adults with delirium and bacteriuria is widespread but no evidence supports the practice, and expert opinion opposes it. Sensitive diagnostic tests now demonstrate that healthy urinary tracts host a ubiquitous, complex microbial community. Recognition of this microbiome, largely undetectable using standard agar-based cultures, offers a new perspective on "UTI." Everyone is bacteriuric. From this perspective, most people who are treated for a "UTI" would probably be better off without treatment. Elderly adults, little studied in this regard, face particular risk. Invasive bacterial diseases such as pyelonephritis and bacteremic bacteriuria are also "UTIs." Mindful decisions about antibiotic use will require a far better understanding of how pathogenicity arises within microbial communities. It is likely that public education and meaningful informed-consent discussions about antibiotic treatment of bacteriuria, emphasizing potential harms and uncertain benefits, would reduce overtreatment. Emphasizing the microbiome's significance and using the term "urinary tract dysbiosis" instead of "UTI" might also help and might encourage mindful study of the relationships among host, aging, microbiome, disease, and antibiotic treatment. © 2017, Copyright the Author Journal compilation © 2017, The American Geriatrics Society.

The DMSA scan in paediatric urinary tract infection

International Nuclear Information System (INIS)

Ditchfield, M.R.; Nadel, H.R.

1998-01-01

The objective of the present paper was to review the use of the dimercaptosuccinic acid (DMSA) scan in urinary tract infection at British Columbia's Children's Hospital to determine the frequency of cortical defects and the association between vesico-ureteric reflux and the presence of cortical defects in children with urinary tract infection. A total of 129 consecutive children with a urinary tract infection referred for a DMSA scan in a 2-year period (January 1992-January 1994) were retrospectively studied. The results were analysed in terms of kidneys, and the incidence of cortical defects was determined. Eighty-eight patients (68%) had a radiographic micturating cysto-urethrogram within 6 months of the DMSA scan, and in this group the relationship of defects with vesico-ureteric reflux was determined. Overall, 81/258 (31%) of kidneys had a cortical defect on a DMSA scan. Of those who had a micturating cysto-urethrogram, 53/176 (30%) kidneys had vesico-ureteric reflux, and of those that had reflux, 21/53 (40%) had a cortical defect on a DMSA scan. In the group of children without reflux, 38/123 (31%) had a cortical defect. Renal cortical scan defects are common findings in paediatric urinary infection, and frequently occur in the absence of vesico-ureteric reflux. These defects represent either established scars or acute pyelonephritis that can proceed to scarring. The micturating cysto-urethro-gram alone is insufficient as a screening modality to identify those kidneys at risk of renal scarring. Copyright (1998) Blackwell Science Pty Ltd

Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient

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M. A. C. Onuigbo

2014-01-01

Full Text Available Despite decades of research, a full understanding of chronic kidney disease (CKD-end stage renal disease (ESRD progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34% patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92 years. Precipitating AKI followed pneumonia (8, acutely decompensated heart failure (7, pyelonephritis (4, post-operative (5, sepsis (3, contrast-induced nephropathy (2, and others (2. Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.

Drug and Vaccine Development for the Treatment and Prevention of Urinary Tract Infections

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O’Brien, Valerie P.; Hannan, Thomas J.; Nielsen, Hailyn V.; Hultgren, Scott J.

2016-01-01

Urinary tract infections (UTI) are among the most common bacterial infections in humans, affecting millions of people every year. UTI cause significant morbidity in women throughout their lifespan, in infant boys, in older men, in individuals with underlying urinary tract abnormalities, and in those that require long-term urethral catheterization, such as patients with spinal cord injuries or incapacitated individuals living in nursing homes. Serious sequelae include frequent recurrences, pyelonephritis with sepsis, renal damage in young children, pre-term birth, and complications of frequent antimicrobial use including high-level antibiotic resistance and Clostridium difficile colitis. Uropathogenic E. coli (UPEC) cause the vast majority of UTI, but less common pathogens such as Enterococcus faecalis and other enterococci frequently take advantage of an abnormal or catheterized urinary tract to cause opportunistic infections. While antibiotic therapy has historically been very successful in controlling UTI, the high rate of recurrence remains a major problem, and many individuals suffer from chronically recurring UTI, requiring long-term prophylactic antibiotic regimens to prevent recurrent UTI. Furthermore, the global emergence of multi-drug resistant UPEC in the past ten years spotlights the need for alternative therapeutic and preventative strategies to combat UTI, including anti-infective drug therapies and vaccines. In this chapter, we review recent advances in the field of UTI pathogenesis, with an emphasis on the identification of promising drug and vaccine targets. We then discuss the development of new UTI drugs and vaccines, highlighting the challenges these approaches face and the need for a greater understanding of urinary tract mucosal immunity. PMID:26999391

Urological disorders and pregnancy: An overall experience

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Debasmita Mandal

2017-01-01

Full Text Available Aim: Pregnancy is an anatomical and physiological altered state and the presence of various urological problems not only aggravates the disease itself, but also results in unfavourable pregnancy outcome. Aim is to highlight obstetric outcome in pregnant women with urological problems. Materials and Methods: Longitudinal prospective cohort study conducted in tertiary care hospital, IPGME and R, Kolkata from Jan 2011 to Dec 2012. All pregnant women with urological problems were included as subjects. Results: A total of 33 subjects were followed up throughout their antenatal period. Among them majority (72.72% presented with hydro nephrosis followed by hydroureter (60.6%, PUJ obstruction and pyelonephritis each with incidence of 15.15%, then urolithiasis (12.12%, nephrolithiasis (6.06% and renal abscess (12.12%. Interventions required were DJ stenting (72.72%, pyeloplasty (15.15% and others were RURSL, abscess drainage and ATT. The pregnancy outcome was complicated with preterm labor in majority of patients (45.45%, oligohydramnious (18.18%, PIH (9.09% and still birth (6.06%. Twenty four live birth were there. Majority required NICU admissions as predominantly prematurity was an important concern. Majority women with hydronephrosis underwent DJ stenting. Conclusion: Preterm labor is an important obstetric concern. Vaginal delivery is the choicest mode of termination and LSCS can be reserved for obstetric reason. DJ stenting is safe and practical approach for continuation of pregnancy with hydronephrosis. Regular follow up, vigilant antenatal care and multidisciplinary approach from urologist, obstetrician and neonatologist will bring out successful pregnancy outcome.

Cumulative clinical experience from over a decade of use of levofloxacin in community-acquired pneumonia: critical appraisal and role in therapy

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Noreddin AM

2011-10-01

Full Text Available Ayman M Noreddin1, Walid F Elkhatib2, Kenji M Cunnion3, George G Zhanel41Department of Pharmacy Practice, Hampton University, Hampton, VA, USA; 2Department of Microbiology and Immunology, Ain-Shams University, Cairo, Egypt; 3Department of Pediatrics, East Virginia Medical School, Norfolk, VA, USA; 4Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada Abstract: Levofloxacin is the synthetic L-isomer of the racemic fluoroquinolone, ofloxacin. It interferes with critical processes in the bacterial cell such as DNA replication, transcription, repair, and recombination by inhibiting bacterial topoisomerases. Levofloxacin has broad spectrum activity against several causative bacterial pathogens of community-acquired pneumonia (CAP. Oral levofloxacin is rapidly absorbed and is bioequivalent to the intravenous formulation such that patients can be conveniently transitioned between these formulations when moving from the inpatient to the outpatient setting. Furthermore, levofloxacin demonstrates excellent safety, and has good tissue penetration maintaining adequate concentrations at the site of infection. The efficacy and tolerability of levofloxacin 500 mg once daily for 10 days in patients with CAP are well established. Furthermore, a high-dose (750 mg and short-course (5 days of once-daily levofloxacin has been approved for use in the US in the treatment of CAP, acute bacterial sinusitis, acute pyelonephritis, and complicated urinary tract infections. The high-dose, short-course levofloxacin regimen maximizes its concentration-dependent antibacterial activity, decreases the potential for drug resistance, and has better patient compliance.Keywords: levofloxacin, community-acquired pneumonia, pharmacodynamics, resistance, pharmacokinetics, clinical use

Persistent renal cortical scintigram defects in children 2 years after urinary tract infection

International Nuclear Information System (INIS)

Ditchfield, Michael R.; Cook, David J.; Campo, John F. de; Grimwood, Keith; Powell, Harley R.; Gulati, Sanjeev; Sloane, Robert

2004-01-01

Background: Renal cortical scintigraphic studies challenge the role of vesicoureteric reflux in renal scar development, emphasizing instead the part played by acute pyelonephritis. Objective: To determine the prevalence of renal cortical defects in a child cohort 2 years after the child's first diagnosed urinary tract infection and to analyze the relationship of these defects with acute illness variables, primary vesicoureteric reflux and recurrent infections. Materials and methods: In a prospective cohort study, 193 children younger than 5 years with their first proven urinary tract infection underwent renal sonography, voiding cystourethrogram, and renal cortical scintigraphy within 15 days of diagnosis. Two years later, 150 of the 193 children, or 77.7%, had a further renal cortical scintigram, including 75, or 86.2%, of the 87 children who had acute scintigraphic defects. The relationship of cortical defects to age, gender, pre-treatment symptom duration, hospitalization, presence and grade of vesicoureteric reflux, and recurrent urinary tract infections was evaluated. Results: Overall, 20 of the 150 (13.3%; 95% confidence interval (CI) 8.3, 19.8) children had persistent defects 2 years after infection. This included 20 of 75 (26.7%; 95% CI 17.1, 38.1) with initially abnormal scintigrams. No new defects were detected. Although acute defects were more common in the young, those with persistent defects were older (median ages 16.4 vs. 6.8 months, P=0.004) than those with transient abnormalities. After adjustment for age, persistent defects were no longer associated with gender and were not predicted by acute illness variables, primary vesicoureteric reflux or recurrent infections. (orig.)

Evaluation of new American Academy of Pediatrics guideline for febrile urinary tract infection

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Choi, Da Min; Heo, Tae Hoon; Yoo, Kee Hwan

2015-01-01

Purpose To evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline. Methods We retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, laboratory, and imaging results were analyzed and compared between the groups. Results A total of 300 children were enrolled. The serum C-reactive protein level was lower in children in group II than in those in groups I and III (P<0.05). Children in group I showed a higher frequency of hydronephrosis than those in groups II and III (P<0.05). However, the frequencies of acute pyelonephritis (APN), vesicoureteral reflux (VUR), renal scar, and UTI recurrence were not different between the groups. In group I, recurrence of UTI and presence of APN were associated with the incidence of VUR (recurrence vs. no recurrence: 40% vs.11.4%; APN vs. no APN: 23.3% vs. 9.2%; P<0.05). The incidence of VUR and APN was not related to the presence of hydronephrosis. Conclusion UTI in febrile children cannot be ruled out solely on the basis of positive urinalysis or urine culture findings. Recurrence of UTI and presence of APN may be reasonable indicators of the presence of VUR. PMID:26512260

Urine Stasis Predisposes to Urinary Tract Infection by an Opportunistic Uropathogen in the Megabladder (Mgb) Mouse

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Becknell, Brian; Mohamed, Ahmad Z.; Li, Birong; Wilhide, Michael E.; Ingraham, Susan E.

2015-01-01

Purpose Urinary stasis is a risk factor for recurrent urinary tract infection (UTI). Homozygous mutant Megabladder (Mgb-/-) mice exhibit incomplete bladder emptying as a consequence of congenital detrusor aplasia. We hypothesize that this predisposes Mgb-/- mice to spontaneous and experimental UTI. Methods Mgb-/-, Mgb+/-, and wild-type female mice underwent serial ultrasound and urine cultures at 4, 6, and 8 weeks to detect spontaneous UTI. Urine bacterial isolates were analyzed by Gram stain and speciated. Bladder stones were analyzed by x-ray diffractometry. Bladders and kidneys were subject to histologic analysis. The pathogenicity of coagulase-negative Staphylococcus (CONS) isolated from Mgb-/- urine was tested by transurethral administration to culture-negative Mgb-/- or wild-type animals. The contribution of urinary stasis to CONS susceptibility was evaluated by cutaneous vesicostomy in Mgb-/- mice. Results Mgb-/- mice develop spontaneous bacteriuria (42%) and struvite bladder stones (31%) by 8 weeks, findings absent in Mgb+/- and wild-type controls. CONS was cultured as a solitary isolate from Mgb-/- bladder stones. Bladders and kidneys from mice with struvite stones exhibit mucosal injury, inflammation, and fibrosis. These pathologic features of cystitis and pyelonephritis are replicated by transurethral inoculation of CONS in culture-negative Mgb-/- females, whereas wild-type animals are less susceptible to CONS colonization and organ injury. Cutaneous vesicostomy prior to CONS inoculation significantly reduces the quantity of CONS recovered from Mgb-/- urine, bladders, and kidneys. Conclusions CONS is an opportunistic uropathogen in the setting of urinary stasis, leading to enhanced UTI incidence and severity in Mgb-/- mice. PMID:26401845

Changes in ion transport in inflammatory disease

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Eisenhut Michael

2006-03-01

Full Text Available Abstract Ion transport is essential for maintenance of transmembranous and transcellular electric potential, fluid transport and cellular volume. Disturbance of ion transport has been associated with cellular dysfunction, intra and extracellular edema and abnormalities of epithelial surface liquid volume. There is increasing evidence that conditions characterized by an intense local or systemic inflammatory response are associated with abnormal ion transport. This abnormal ion transport has been involved in the pathogenesis of conditions like hypovolemia due to fluid losses, hyponatremia and hypokalemia in diarrhoeal diseases, electrolyte abnormalites in pyelonephritis of early infancy, septicemia induced pulmonary edema, and in hypersecretion and edema induced by inflammatory reactions of the mucosa of the upper respiratory tract. Components of membranous ion transport systems, which have been shown to undergo a change in function during an inflammatory response include the sodium potassium ATPase, the epithelial sodium channel, the Cystic Fibrosis Transmembrane Conductance Regulator and calcium activated chloride channels and the sodium potassium chloride co-transporter. Inflammatory mediators, which influence ion transport are tumor necrosis factor, gamma interferon, interleukins, transforming growth factor, leukotrienes and bradykinin. They trigger the release of specific messengers like prostaglandins, nitric oxide and histamine which alter ion transport system function through specific receptors, intracellular second messengers and protein kinases. This review summarizes data on in vivo measurements of changes in ion transport in acute inflammatory conditions and in vitro studies, which have explored the underlying mechanisms. Potential interventions directed at a correction of the observed abnormalities are discussed.