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Sample records for pyelonephritis

  1. Emphysematous pyelonephritis; Emphysematoese Pyelonephritis

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    Heinze, A.; Migeod, K. [Klinikum Ingolstadt (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie

    1998-05-01

    Emphysematous pyelonephritisis a relatively rare, gas-producing, destructive and usually unilateral renal infection. Often the patients are female diabetics and mostly the left kidney is affected. The pathological gas formation is either limited to the kidney or extends to the perirenal space. Two cases are reported, which - in clinical presentation, extension of pathological gas, and treatment - present two possible ends of the spectrum of this disease. (orig.) [Deutsch] Bei der Emphysematoesen Pyelonephritis handelt es sich um eine relativ seltene gasbildende destruierende und gewoehnlich unilateral auftretende renale Infektion. Die Erkrankung betrifft haeufig Diabetikerinnen und meistens die linke Niere. Die Gasbildung ist entweder auf die Niere beschraenkt oder zeigt eine Ausbreitung auf den Perirenalraum. Es wird ueber zwei Faelle dieser Erkrankung berichtet, die in klinischer Darstellung, Ausbreitung der Gasbildung und Therapie zwei moegliche Eckpunkte eines Spektrums dieser Erkrankung repraesentieren. (orig.)

  2. Emphysematous pyelonephritis

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    Tomiie, Fumitaka; Maeda, Tomoho [Kyoto Prefectural Univ. of Medicine (Japan); Nakano, Yasuhiko; Yasuda, Yoshikazu; Kashii, Akiyoshi; Kanazawa, Kyotaro; Furuse, Makoto; Ohsawa, Tadashi; Munechika, Hirotsugu

    1995-09-01

    Emphysematous pyelonephritis is a rare, life-threatening necrotizing renal infection characterized by the production of intrarenal and perirenal gas. Six cases of emphysematous pyelonephritis were reviewed. Five cases were associated with diabetes mellitus and one with obstructive nephrouropathy. Bilateral emphysematous involvement was seen in two and unilateral involvement in four cases. Those two cases with bilateral involvement were accompanied with thoracic lesions such as mediastinitis and/or pleuritis. In two cases of medical management alone, multiple organ failure secondary to sepsis was a cause of death. CT provided valuable information for a correct diagnosis and for the progression of a disease process. The thorax of CT examination should be included for survey of possible mediastinal and/or pleural involvement. (author).

  3. Emphysematous pyelonephritis: surgical implications.

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    Shahatto, N; al Awadhi, N Z; Ghazali, S

    1990-12-01

    Emphysematous pyelonephritis in patients with diabetes mellitus is increasingly recognised as a disease requiring urgent and aggressive treatment. We present 3 cases of emphysematous pyelonephritis; 1 patient required percutaneous nephrostomy followed by nephroureterectomy but the other 2 were successfully managed with antibiotics and control of diabetes. Diagnosis was confirmed by sequential imaging techniques which demonstrated an inflammatory renal mass associated with gas and fluid.

  4. Pyelonephritis following phenazopyridine use.

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    Nordt, Sean Patrick

    2017-05-01

    We present a case of pyelonephritis following the extended andsolitary use of over-the-counter phenazopyridine in a forty-year-oldfemale. The patient initially had uncomplicated cystitis signs andsymptoms which partially resolved with phenazopyridine and therefore she continued use. She presented to the emergency department with systemicsigns and symptoms of acute pyelonephritis. As phenazopyridine is devoidof antibacterial properties this allowed the lower urinary tractinfection to progress to acute pyelonephritis requiring intravenousantibiotics. Better patient education may preclude this complication. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Acute bilateral emphysematous pyelonephritis

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    Surur, John

    2011-01-01

    The author reports the case of a well and fit patient who presented herself to the emergency department and was found to have bilateral emphysematous pyelonephritis. She was admitted to the intensive care where she was initially treated conservatively with antibiotics, percutaneous drainage and continuous renal replacement therapy, but her condition deteriorated. She underwent a left total nephrectomy and a partial right nephrectomy that resulted in remarkable improvement. The patient started passing urine spontaneously, so no haemofiltration was required. She was discharged home and her case was followed-up by an urologist and nephrologist. This case lays emphasis on thoroughly investigating and managing a patient with bilateral emphysematous pyelonephritis and, in relation to its management, on the dilemma of whether the treatment of choice should be conservative or surgical. PMID:22707665

  6. Acute pyelonephritis in ER

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    Giovanni Volpicelli

    2007-10-01

    Full Text Available Symptoms and signs of acute pyelonephritis sometimes are subtle and emergency physicians attending overcrowded and busy institutions could easily miss the right diagnosis. The presence of a renal damage is decisive in the therapeutic choice. Aims of our study are: 1 to assess prevalence of renal damage in patients presenting to our ED with symptoms and signs of primary urinary tract infection (UTI; 2 to evaluate the reliability of such symptoms and signs in predicting a renal damage; 3 to assess accuracy of the contrast enhanced ultrasound (CEUS in the ED diagnosis of renal damage due to acute uncomplicated pyelonephritis. We studied 54 patients with suspected UTI. Each patient underwent clinical examination, routine blood and urine sampling and conventional renal ultrasound (US. 23 patients had confirmation of acute primary UTI, and performed renal magnetic resonance (MR to rule out renal parenchymal involvement. In 16 patients (69,6% one or more parenchymal lesions were visualized at MR, and diagnosis of acute uncomplicated pyelonephritis was confirmed (group A. The other 7 patients had a diagnosis of UTI without renal involvement (group B. Some of 23 patients presented with few atypical symptoms. Lumbar pain was the most frequent symptom (n = 21, without a statistically significant difference between group A and B (P 0,958; p = 0,328. No other symptom or sign has demonstrated statistically valid in predicting the renal involvement. Renal US was positive in only 3 patients of group A (18,7%. During this first part of our study, CEUS was performed in a limited number of patients (n = 8, and in 7 examinations data were concordant with MR. In conclusion, analysis of our preliminary data confirms that a distinction between patients with different extension of the UTI is not possible through the simple clinical examination and routine tests. CEUS is very promising and its routine employment in the ED could simplify the diagnostic practice in

  7. [Chronic pyelonephritis in polycystic kidney].

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    Todorov, V; Penkova, S; Monov, A

    1989-01-01

    The characteristics of chronic pyelonephritis are studied in 37 patients out of a total of 53 patients with proved renal polycystosis. A group of 71 patients with chronic pyelonephritis selected at random are used as a control group. The frequency of chronic pyelonephritis among the patients with renal polycystosis is 69.8%. The difference between the mean age of the patients with renal polycystosis and chronic pyelonephritis and the patients with renal polycystosis without chronic pyelonephritis is 8.6 years. A significant difference is established between these two groups of patients concerning the frequency of symptomatic hypertension--89.2% for the patients with renal polycystosis and chronic pyelonephritis and 45% for the patients with uncomplicated renal polycystosis. A similar difference is established also for the renal failure--respectively 64.9% and 37.5%. The frequency of hypertension and chronic renal failure is lower in the control group of patients. 59% of the patients with renal polycystosis and chronic pyelonephritis have significant bacteriuria, E. coli and Proteus being the most frequently isolated bacteria but Pseudomonas shows the highest drug resistance. The isolated bacteria are most sensitive to nitroxoline and aminoglycoside antibiotics.

  8. Acute pyelonephritis in children.

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    Morello, William; La Scola, Claudio; Alberici, Irene; Montini, Giovanni

    2016-08-01

    Acute pyelonephritis is one of the most serious bacterial illnesses during childhood. Escherichia coli is responsible in most cases, however other organisms including Klebsiella, Enterococcus, Enterobacter, Proteus, and Pseudomonas species are being more frequently isolated. In infants, who are at major risk of complications such as sepsis and meningitis, symptoms are ambiguous and fever is not always useful in identifying those at high risk. A diagnosis of acute pyelonephritis is initially made on the basis of urinalysis; dipstick tests for nitrites and/or leukocyte esterase are the most accurate indicators of infection. Collecting a viable urine sample for urine culture using clean voided methods is feasible, even in young children. No gold standard antibiotic treatment exists. In children appearing well, oral therapy and outpatient care is possible. New guidelines suggest less aggressive imaging strategies after a first infection, reducing radiation exposure and costs. The efficacy of antibiotic prophylaxis in preventing recurrence is still a matter of debate and the risk of antibiotic resistance is a warning against its widespread use. Well-performed randomized controlled trials are required in order to better define both the imaging strategies and medical options aimed at preserving long-term renal function.

  9. Conservative management of emphysematous pyelonephritis

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    Bashir Ahmad Laway

    2012-01-01

    Full Text Available Emphysematous pyelonephritis, though uncommon, is a severe necrotizing kidney infection common in patients with diabetes. Surgical treatment has been advocated as the treatment of choice in most of the patients. We present the clinical course of an elderly lady who presented with emphysematous pyelonephritis and was successfully managed with medical treatment despite the presence of adverse prognostic factors like acute renal failure and thrombocytopenia.

  10. Pyelonephritis (acute) in non-pregnant women

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    Neumann, Ignacio; Moore, Philippa

    2011-01-01

    Pyelonephritis is usually caused by ascent of bacteria from the bladder, most often Escherichia coli, and is more likely in people with structural or functional urinary tract abnormalities. The prognosis of acute uncomplicated pyelonephritis is good if pyelonephritis is treated appropriately, but complications include renal abscess, renal impairment, and septic shock.

  11. Systematic kidney biopsies after acute allograft pyelonephritis.

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    Cartery, Claire; Guilbeau-Frugier, Céline; Esposito, Laure; Sallusto, Federico; Guitard, Joelle; Cardeau-Desangles, Isabelle; Cointault, Olivier; Game, Xavier; Rostaing, Lionel; Kamar, Nassim

    2013-06-01

    Scarce data exist regarding the effect of acute graft pyelonephritis on kidney histology after a kidney transplant. This study sought to assess the kidney histology at 1 month, and kidney function at 1 year, after acute graft pyelonephritis in kidney transplant patients. All kidney transplant patients with acute graft pyelonephritis between October 2006, and December 2008, underwent a kidney biopsy 1 month later (n=28). Histologic findings were compared with those observed in a control group (n=28) who underwent a protocol kidney biopsy at 1 year posttransplant and did not present with acute graft pyelonephritis. Patients were matched according to age, sex, and immunosuppressive regimen. Kidney function was impaired by the acute graft pyelonephritis episodes at the time of biopsy. In 40% of patients, the estimated glomerular filtration rate did not return to baseline by 1 month after acute graft pyelonephritis and remained impaired thereafter. Three patients had features of acute rejection. Tubulitis was seen more frequently in the acute graft pyelonephritis group, especially in patients in whom estimated glomerular filtration rate did not completely recover by 1 month after acute graft pyelonephritis. Patients with acute graft pyelonephritis who had inflammatory infiltrate of > 20% 1 month after acute graft pyelonephritis had worse kidney function 1 year later. After transplant, when kidney function remains impaired 1 month after acute graft pyelonephritis, kidney biopsies allowed graft rejection diagnosis and predicted kidney function recovery.

  12. [Emphysematous pyelonephritis: a case report].

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    Rabii, R; Fekak, H; Mezzour, H; Joual, A; Moufid, K; el Mrini, M; Benjelloun, S; Cherkab, R; Bensaid, A; el Kettani, C; Barrou, L

    2003-04-01

    Diabetic patients with urinary tract infections had a certain risk of developping emphysematous pyelonephritis with gas producting bacteria. This disease was accompagned with high mortalité. We will report one case who was treated successfully by high dose antibiotic regim and emergency nephrectomy.

  13. Xantogranulomatøs pyelonephritis

    DEFF Research Database (Denmark)

    Nielsen, Claus Buhl; Skovgaard, Niels; Mortensen, Svend O

    2002-01-01

    Xanthogranulomatous pyelonephritis is a rare disease probably caused by long-standing obstruction and secondary infection. We report a case in a 47-year-old woman with no previous history of renal stones. Preoperative diagnostic workout included ultrasonography, CT scan, and drainage. Nephrectomy...

  14. The role of zinc in acute pyelonephritis.

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    Mahyar, Abolfazl; Ayazi, Parviz; Farzadmanesh, Shahin; Sahmani, Mehdi; Oveisi, Sonia; Chegini, Victoria; Esmaeily, Shiva

    2015-09-01

    This study was conducted to determine the serum concentration of zinc in children with acute pyelonephritis. Serum zinc levels of 60 children with acute pyelonephritis and 60 healthy children were compared. Acute pyelonephritis was diagnosed using Tc-99m dimercaptosuccinic acid (DMSA) renal scan. Serum zinc levels were measured by the atomic absorption flame spectrophotometry. The levels in question in the case and control groups were 70.73 ± 14.15 and 87.61 ± 12.68 mcg/dL, respectively (P=0.001). There was no correlation between serum zinc level with inflammatory markers, severity of acute pyelonephritis and duration of the disease. This study showed that there is a correlation between serum zinc level and acute pyelonephritis. Zinc would therefore appear to play a certain role in the pathogenesis of acute pyelonephritis.

  15. Novel immunotherapeutic strategies for pyelonephritis.

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    Tsaganos, Thomas; Giamarellos-Bourboulis, Evangelos J

    2016-01-01

    Acute pyelonephritis is an infection of the renal parenchyma and renal pelvis. When it is caused by a typical pathogen in an immunocompetent female patient with normal urinary tract, it is considered uncomplicated. In all other cases, sepsis is the most worrisome complication. In the event of sepsis, patients should be hospitalized and treated aggressively with antibiotics, intravenous fluids and agents that enhance the immune response of the host. In this review, we summarize findings from immunomodulatory interventions in experimental studies of acute pyelonephritis and the application of these interventions into clinical practice. Vaccine against bacterial virulence factors and agents aiming to modulate the immune response of the host belong to these interventions and they are discussed.

  16. Acute complicated pyelonephritis: contrast-enhanced ultrasound.

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    Fontanilla, Teresa; Minaya, Javier; Cortés, Cristina; Hernando, Concepción González; Arangüena, Rafael Pérez; Arriaga, Jesús; Carmona, Maria Soledad; Alcolado, Ana

    2012-08-01

    Imaging is required if complication is suspected in acute pyelonephritis to assess the nature and extent of the lesions, and to detect underlying causes. The current imaging modality of choice in clinical practice is computed tomography. Because of associated radiation and potential nephrotoxicity, CEUS is an alternative that has been proven to be equally accurate in the detection of acute pyelonephritis renal lesions. The aims of this study of 48 patients are to describe in detail the CEUS findings in acute pyelonephritis, and to determine if abscess and focal pyelonephritis may be distinguished. Very characteristic morphologic and temporal patterns of enhancement are described. These allow differentiation of focal pyelonephritis from renal abscess, and detection of tiny suppurative foci within focal pyelonephritis. The detection of abscesses is important because follow-up in 25 patients revealed a longer clinical course. Typical pyelonephritis CEUS features permit distinction from other renal lesions. As a whole, CEUS is an excellent tool in the work-up of complicated acute pyelonephritis, so it may be considered as the imaging technique of choice in the evaluation and follow-up of these patients who frequently are very young, so as to minimise radiation exposure.

  17. Imaging of acute pyelonephritis in the adult

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    Stunell, H.; Buckley, O.; Feeney, J.; Geoghegan, T.; Browne, R.F.J.; Torreggiani, W.C. [The Adelaide and Meath Hospital, Incorporating the National Children' s Hospital, Department of Radiology, Tallaght, Dublin 24 (Ireland)

    2007-07-15

    The diagnosis of acute pyelonephritis in adults is predominantly made by a combination of typical clinical features of flank pain, high temperature and dysuria combined with urinalysis findings of bacteruria and pyuria. Imaging is generally reserved for patients who have atypical presenting features or in those who fail to respond to conventional therapy. In addition, early imaging may be useful in diabetics or immunocompromised patients. In such patients, imaging may not only aid in making the diagnosis of acute pyelonephritis, but more importantly, it may help identify complications such as abscess formation. In this pictorial review, we discuss the role of modern imaging in acute pyelonephritis and its complications. We discuss the growing role of cross-sectional imaging with computed tomography (CT) and novel magnetic resonance imaging (MRI) techniques that may be used to demonstrate both typical as well as unusual manifestations of acute pyelonephritis and its complications. In addition, conditions such as emphysematous and fungal pyelonephritis are discussed. (orig.)

  18. Emphysematous and xanthogranulomatous pyelonephritis: rare diagnosis

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    Lya Duarte Ramos

    2010-08-01

    Full Text Available Pyelonephritis is a pyogenic infection of renal parenchyma that involves the renal pelvis. It is generally of easy diagnosis. The present case report aims to describe two different manifestations of this infection: xanthogranulomatous pyelonephritis and emphysematous pyelonephritis, which have poor prognosis and require a more effective treatment. The two cases were women in the fiftieth and sixtieth decade of life, with diabetes mellitus and history of weight loss. The diagnosis of the renal infection was established through computed tomography and the treatment was based in surgical procedure, with favorable outcome.

  19. Severe emphysematous pyelonephritis mimicking intestinal obstruction.

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    Sun, Ji Ning; Zhang, Bao Long; Yu, Hai Yan; Wang, Bin

    2015-12-01

    Emphysematous pyelonephritis is a severe necrotizing infection characterized by the presence of gas and/or fluid in the renal parenchyma, collecting system, or perirenal tissues. Emphysematous pyelonephritis with approximately 15 cm air-fluid level, diffused ureteral involvement, and the accumulation of gas in liver and peritoneal cavity is very rare. Here, we reported a severe emphysematous pyelonephritis with multiple huge air-fluid level mimicking intestinal obstruction and with the accumulation of gas in liver and ureter in computed tomography imaging. The patient was successfully managed by percutaneous nephrostomy combined with medical treatment.

  20. Emphysematous and xanthogranulomatous pyelonephritis: rare diagnosis

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    Lya Duarte Ramos

    Full Text Available Pyelonephritis is a pyogenic infection of renal parenchyma that involves the renal pelvis. It is generally of easy diagnosis. The present case report aims to describe two different manifestations of this infection: xanthogranulomatous pyelonephritis and emphysematous pyelonephritis, which have poor prognosis and require a more effective treatment. The two cases were women in the fiftieth and sixtieth decade of life, with diabetes mellitus and history of weight loss. The diagnosis of the renal infection was established through computed tomography and the treatment was based in surgical procedure, with favorable outcome.

  1. Is postpartum pyelonephritis associated with the same maternal morbidity as antepartum pyelonephritis?

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    McDonnold, Mollie; Friedman, Alexander; Raker, Christina; Anderson, Brenna

    2012-09-01

    Pregnant women with pyelonephritis are at higher risk for significant morbidty than nonpregnant women with pyelonephritis. The risk from pregnancy may continue into the postpartum period. Many of the physiologic and hormonal changes that occur during pregnancy persist after delivery. The objective of this study was to compare maternal morbidity in postpartum and antepartum pyelonephritis. A retrospective cohort analysis included all pregnant and postpartum women hospitalized for pyelonephritis at a single tertiary care hospital between January 2004 and June 2007. The postpartum period was defined as up to 6 weeks from delivery. The primary outcome measure was maternal morbidity measured by length of hospitalization. 256 cases of antepartum pyelonephritis and 23 cases of postpartum pyelonephritis were included in the analysis. Women in both groups were admitted for a mean of 4 days (p = 0.3). Women who were diagnosed in the postpartum period were more likely to be febrile (91.3% vs. 51.7%, p = 0.0001) and had a higher temperature on presentation (102.9°F vs. 99.1°F p Pyelonephritis was equally morbid in the postpartum and antepartum periods. Postpartum pyelonephritis may warrant the same close inpatient observation as antepartum pyelonephritis.

  2. Acute Pyelonephritis Caused by Staphylococcus xylosus

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    Tselenis-Kotsowilis, Angelina D.; Koliomichalis, Maria P.; Papavassiliou, John T.

    1982-01-01

    Staphylococcus xylosus was recovered from the urine of a patient with pyelonephritis. Antibodies against the teichoic acid of the microorganism were demonstrated in the patient's serum by the agar gel diffusion technique. PMID:7130375

  3. Xanthogranulomatous Pyelonephritis Associated with Hepatic Dysfunction in Pregnancy

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    Ferreira, L.; Oliveira, C.; CRUZ, C; A. Pacheco

    2015-01-01

    Xanthogranulomatous pyelonephritis is a rare disease characterised by the replacement of normal renal parenchyma by foamy macrophages. The only treatment for this type of pyelonephritis is of a surgical nature with partial or total nephrectomy. The occurrence of xanthogranulomatous pyelonephritis during pregnancy is a rare event (with only 6 cases described in the literature). We report a case of xanthogranulomatous pyelonephritis in a 32-week pregnant woman associated with hepatic dysfunction.

  4. Emphysematous pyelonephritis: a review of six cases.

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    Ali, Sohrab Naushad; Ahmed, Niqad; Naushad, Aymon; Naushad, Mian

    2014-01-01

    Emphysematous pyelonephritis is a severe life threatening necrotising infection of the renal parenchyma. The infection most commonly occurs in the diabetic population, often associated with the organism E. coli Emphysematous pyelonephritis differs from standard pyelonephritis by the bacterial liberation and accumulation of gas in the surrounding tissues. The condition is rarely encountered in clinical practice and since the first description by Kelly et al in 1898, approximately 200 cases have been reported in the literature. The case series examines our experience with six diagnosed cases of emphysematous pyelonephritis over a one year period. All patients were female, the mean age of presentation being 53 years. Of the six patients, five were diabetics with hypertension, the one exception being a non-diabetic patient who had undergone renal exploration in the past. Computed tomography confirmed the diagnosis in all patients except one which was confirmed during renal exploration. Urine culture was positive for E. coli in two patients. Emphysematous pyelonephritis which used to be a rare disease is now being more readily diagnosed. The cases were diagnosed at a late stage making its conservative management not feasible

  5. [Circulatory failure in chronic glomerulo- and pyelonephritis].

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    Kulakov, G P; Melikian, A M; Seĭsembekov, T Z

    1982-01-01

    The frequency and degree of circulatory insufficiency depending on the stage of the disease are analyzed in 404 patients with chronic glomerulonephritis and 145 patients with chronic pyelonephritis aged 15 to 74 years. When the renal function is still preserved different degrees of circulatory insufficiency are diagnosed in 29.4% of patients. Circulatory insufficiency complicates more often chronic glomerulonephritis than pyelonephritis and is more common in the aged. Latent cardiac insufficiency is more common. In the period of chronic renal insufficiency cardiac decompensation is seen in 78.1% of cases, its frequency is practically the same in glomerulonephritis and pyelonephritis. The mechanisms of development of cardiac insufficiency and the principles of treatment depending on the functional state of the kidneys are discussed.

  6. PYELONEPHRITIS IN PREGNANCY: A RARE CASE

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    Preeti Amit

    2015-06-01

    Full Text Available Urinary tract infection is a very much common during pregnancy. It has been observed it is taken very lightly and may get worsen in the form of pyelonephritis. P yelonephritis is associated with complications in pregnancy if not treated completely . H ere is a case report which was difficult to treat but was treated successfully with good neonatal outcome. She required surgical assist ance to relive her symptoms and treat the disease. There are lot of observational comparative studies done for the pyelonephritis during pregnancy .

  7. Focal xanthogranulomatous pyelonephritis: reports of 2 cases

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    Han, Dae Hee; Jeong, Young Ki; Kim, Seung Hyup [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-07-01

    Xanthogranulomatous pyelonephritis is a chronic inflammatory condition which in most cases involves either an entire non-duplicated kidney or a moiety of a duplicated kidney. These cases present with quite characteristic radiologic findings including an enlarged nonfunctioning kidney and renal stones. However, when the condition involves only a part of a non-duplicated kidney and especially where there is an absence of the specific findings described above, differentiation from cystic neoplasm may be difficult. We report the radiologic findings of two such cases of focal xanthogranulomatous pyelonephritis.

  8. Xanthogranulomatous pyelonephritis: an uncommon pediatric renal mass

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    Smith, Ethan A.; Dillman, Jonathan R. [University of Michigan Health System, C. S. Mott Children' s Hospital, Department of Radiology, Ann Arbor, MI (United States); Styn, Nicholas; Wan, Julian [University of Michigan Health System, C. S. Mott Children' s Hospital, Department of Urology, Ann Arbor, MI (United States); McHugh, Jonathan [University of Michigan Health System, C. S. Mott Children' s Hospital, Department of Pathology, Ann Arbor, MI (United States)

    2010-08-15

    Xanthogranulomatous pyelonephritis (XGP) is a chronic suppurative infectious process that only rarely affects pediatric patients, and most commonly occurs in the setting of a large obstructing calculus. Histologically, XGP is characterized by the presence of chronic inflammation and lipid-laden macrophages. This case report illustrates the radiological, surgical, and pathologic findings in a young patient who presented to our institution for treatment of this uncommon condition. Although rare, xanthogranulomatous pyelonephritis is a clinically important entity that can affect pediatric patients. This condition should be considered in the differential diagnosis for an atypical-appearing renal mass. (orig.)

  9. Paecilomyces pyelonephritis in a patient with urolithiasis

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    K Sriram

    2007-01-01

    Full Text Available Fungal organisms are increasingly implicated in nosocomial urinary tract infections. Although Candida, Mucor and Aspergillus are the most commonly identified species, rare fungi are also occasionally observed to infect humans. Misidentification of the organism could result in treatment with an inappropriate antifungal agent, which could result in a florid fungal pyelonephritis. We report the occurrence of fungal pyelonephritis in a patient with stone disease secondary to Paecilomyces variotii . This case report emphasizes the need for an accurate identification of the organism and early and appropriate treatment.

  10. EMPHYSEMATOUS PYELONEPHRITIS: OUR INSTITUTIONAL EXPERIENCE

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    Prakasa Rao

    2015-11-01

    Full Text Available : Emphysematous pyelonephritis (EPN is a rare acute necrotizing infection of renal parenchyma. We discuss clinical details and treatment strategies of 28 patients with EPN followed at our hospital. EPN is common in persons with diabetes, often has a fulminating course and can be fatal if not recognized and treated promptly. Its overall mortality rate ranges between 19% and 43%. METHODS: We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 18 patients with EPN followed at our hospital between 2012 and 2014. RESULTS: The mean patient age (Female: 12; male: 6 was 65 years (Range: 51–82. Based on computed tomographic findings, EPN was classified as class I (n=3, class II (n=6, class IIIA (n=5, class IIIB (n=3 and class 1V (n=1. All patients had fever, flank pain, nausea, and vomiting. Sixteen patients had type 2 diabetes mellitus and 4 diabetic patients also had renal stones. Escherichia coli (n=14, Klebsiella species (n=3, and mixed species (n=1 were grown in urine cultures. Seventeen patients had unilateral involvement. Increased white blood cell counts, sedimentation rate, and C-reactive protein levels were detected in all cases. In addition to medical treatment, 5 patients underwent a nephrostomy catheter placement and a total of 3 patients underwent nephrectomy upon deterioration. After achieving clinical stabilisation with medical treatment, 7 patients underwent endoscopic ureteral stone treatment. The remaining 3 cases were treated only with antibiotics. One patient died even after nephrostomy and antibiotic therapy and seventeen patients were discharged with clinical cure. CONCLUSION: Mortality rates of EPN are gradually decreasing. Preservation of renal reserve is possible due to early diagnosis, appropriate antibiotic therapy, and drainage.

  11. Sonographic findings of xanthogranulomatous pyelonephritis

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    Kim, Jong Chul [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    2000-12-15

    To analyze ultrasonographic (US) findings of xanthogranulomatous pyelonephritis (XGP). Thirty-five cases of pathologically proven XGP in 32 patients (bilateral in three patients) were analyzed for preoperative US findings. Compared with findings of computed tomography (CT) and pathology, US findings were retrospectively analyzed for the appearance and size of the kidney, extent and pattern of the disease, and presence and characteristics of calculi, by three radiologists who made a consensus. Of 32 patients, 30 (94%) except two children were older than 27 years, and 25 (78%) were female. The mean age of the patients was 46 (range 3 to 62 years). Of 35 cases in 32 patients, US appearance of the kidney was reniform in all cases, with nephromegaly in 26 (74%) and hydronephrosis 27 (77%). XGP was diffuse in 28 (80%) and focal in 7 (20%). Hypoechoic or anechoic inflammatory lesions of XGP were found on US in 28 cases, but the lesions were not detected on US due to the echo pattern similar to the normal renal parenchyma in two cases and due to marked acoustic shadowing of staghorn calculi in five cases. Acoustic shadowing of renal calculi was minimal due to the dense peripelvic fibrosis in two cases. Of 21 cases with the extrarenal extension of XGP, the extrarenal extension was not definitely detected in five cases (24%) on US. Urinary calculi were detected in 20 (71%) of 28 cases on US. All of the 12 staghorn calculi were detected in US. XGP had variable US findings in addition to the classic ones. Absence of calculi, nephromegaly or diffusibility may be found on US of XGP. In spite of advantages of US, US also had some limitations in the evaluation of renal function, extrarenal extension, and renal parenchyma with large staghorn stone. CT and excretory urography may compensate for these US limitations.

  12. 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)

  13. Xanthogranulomatous Pyelonephri-tis in a Child

    Directory of Open Access Journals (Sweden)

    M. Alehossein

    2004-06-01

    Full Text Available Xanthogranulomatous pyelonephritis (XGPN is a rare chronic inflammatory disorder in children that results from infection usually associated with longstanding urinary obstruction. There are two morphologic types: diffuse and focal. In the more common diffuse form, the entire kidney is involved. We present a case of diffuse type, in which some foci in the kidney are spared.

  14. Inflammation drives renal scarring in experimental pyelonephritis.

    Science.gov (United States)

    Li, Birong; Haridas, Babitha; Jackson, Ashley R; Cortado, Hanna; Mayne, Nicholas; Kohnken, Rebecca; Bolon, Brad; McHugh, Kirk M; Schwaderer, Andrew L; Spencer, John David; Ching, Christina B; Hains, David S; Justice, Sheryl S; Partida-Sanchez, Santiago; Becknell, Brian

    2017-01-01

    Acquired renal scarring occurs in a subset of patients following febrile urinary tract infections and is associated with hypertension, proteinuria, and chronic kidney disease. Limited knowledge of histopathology, immune cell recruitment, and gene expression changes during pyelonephritis restricts the development of therapies to limit renal scarring. Here, we address this knowledge gap using immunocompetent mice with vesicoureteral reflux. Transurethral inoculation of uropathogenic Escherichia coli in C3H/HeOuJ mice leads to renal mucosal injury, tubulointerstitial nephritis, and cortical fibrosis. The extent of fibrosis correlates most significantly with inflammation at 7 and 28 days postinfection. The recruitment of neutrophils and inflammatory macrophages to infected kidneys is proportional to renal bacterial burden. Transcriptome analysis reveals molecular signatures associated with renal ischemia-reperfusion injury, immune cell chemotaxis, and leukocyte activation. This murine model recapitulates the cardinal histopathological features observed in humans with acquired renal scarring following pyelonephritis. The integration of histopathology, quantification of cellular immune influx, and unbiased transcriptional profiling begins to define potential mechanisms of tissue injury during pyelonephritis in the context of an intact immune response. The clear relationship between inflammatory cell recruitment and fibrosis supports the hypothesis that acquired renal scarring arises as a consequence of excessive host inflammation and suggests that immunomodulatory therapies should be investigated to reduce renal scarring in patients with pyelonephritis. Copyright © 2017 the American Physiological Society.

  15. [Proinflammatory cytokines in patients with pyelonephritis].

    Science.gov (United States)

    Gaĭseniuk, F Z; Driianskaia, V E; Drannik, G N; Rudenko, M Iu; Lavrenchuk, O V; Stepanova, N M; Stashevskaia, N V; Busygina, Iu S

    2013-09-01

    The antiinflammatory cytokines participate in antiinfective immunity, that is why it is advisable to study their peculiarities in determination of the role in immunologic pathogenesis of pyelonephritis. Of the work is to study the levels of pro-inflammatory blood cytokines in the patients with pyelonephritis (PN), to determine the peculiarities in acute and chronic its course in children and adults. The immuno-enzymic method ELISA and the corresponding test-systems were used to study the levels of cytokines in blood. There were studied the levels of pro-inflammatory cytokines (TNF, MCP and IL-23) in blood serum of patients with acute (APN) and chronic (CPN) pyelonephritis. The analysis showed the reliable increase in levels of all studied findings in both forms of PN--both in all 173 patients and in every group--children (87) and adults (86). The MCP-1 levels in APN are reliably higher than in CPN, while in TNF-b and IL-23--do not differ. The levels of all three cytokines in blood of adults were higher than in children in APN, but TNF--in CPN as well. The high level of TNF, MCP-1 and IL-23 in blood of adults and children confirm their important role both in APN and CPN, but MCP-1 can be considered as a predictor of acute/exacerbation of chronic pyelonephritis. By the findings of the studied cytokines, more expressed immune response was noted in the adults.

  16. A case of xanthogranulomatous pyelonephritis associated with xanthogranulomatous epididymoorchitis

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Kwon; Jeon, Hae Jeong; Park, Dong Rib; Park, Jeong Hee; Lho, Yong Soo; Yoon, Sang Ae [Kunkuk Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-09-01

    Xanthogranulomatous pyelonephritis is an atypical severe renal parenchymal infection, characterized macroscopically by a yellow lobulated mass, and microscopically by massive inflammatory cells and foamy hystiocytes. Preoperatively it can be confused with hypernephroma, pyonephrosis with stone or other renal inflammatory diseases. We present a case of xanthogranulomatous pyelonephritis associated with xanthogranulomatous epididymoorchitis. To our knowledge this is the first report of xanthogranulomatous pyelonephritis associated with xanthogranulomatous epididymo-orchitis.=20.

  17. [Effectiveness of antibiotic therapy in pyelonephritis after kidney transplantation].

    Science.gov (United States)

    Vasina, T A; Kutasova, I V; Lobanova, E D

    1981-04-01

    Determination of bacteriuria, leucocyturia, active leucocytes and Sternheimer-Malbin's cells in patients with transplanted kidneys during the postoperative period provided identification of pyelonephritis in the transplanted kidney. E. coli, Proteus, Staphylococcus, P. aeruginosa and microbial associations were the main causative agents of pyelonephritis in such patients. The majority of the causative agents were polyresistant to antibiotics. Investigation of the microbial sensitivity to antibiotics and determination of their levels in the patients promote development of rational schemes for the treatment of pyelonephritis. Early identification of pyelonephritis of the transplanted kidney and its timely treatment with antibiotics allow avoiding destruction of the transplanted organ and promote its normal functioning.

  18. Emphysematous pyelonephritis. Clinical findings and radiological diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Tomiie, Fumitaka; Okuyama, Chio; Kizu, Osamu [Kyoto Prefectural Univ. of Medicine (Japan)] [and others

    1996-01-01

    Emphysematous pyelonephritis is a rare, life-threatening necrotizing renal infection characterized by the production of intrarenal and perirenal gas. Seven patients with emphysematous pyelonephritis were reviewed. Six patients were associated with diabetes mellitus and one with obstructive nephrouropathy. Bilateral emphysematous involvement was seen in two and unilateral involvement in five patients. Bilateral disease was accompanied by thoracic lesions such as mediastinitis and/or pleuritis. In two of three patients with medical management alone, multiple organ failure secondary to sepsis was a cause of death. CT provided information indispensable to a correct diagnosis and was useful in evaluating the extension of the disease process. In patients with bilateral disease or unilateral involvement with a prolonged history, CT scan of the thorax is recommended for the survey of mediastinal and/or pleural involvement. (author).

  19. PYELONEPHRITIS IN PREGNANCY: A RARE CASE

    OpenAIRE

    Preeti Amit

    2015-01-01

    Urinary tract infection is a very much common during pregnancy. It has been observed it is taken very lightly and may get worsen in the form of pyelonephritis. P yelonephritis is associated with complications in pregnancy if not treated completely . H ere is a case report which was difficult to treat but was treated successfully with good neonatal outcome. She required surgical assist ance to relive her symptoms and treat the disease. There are ...

  20. Emphysematous pyelonephritis: clinical characteristics and prognostic factors.

    Science.gov (United States)

    Lu, Yu-Chuan; Chiang, Bing-Juin; Pong, Yuan-Hung; Chen, Chung-Hsin; Pu, Yeong-Shiau; Hsueh, Po-Ren; Huang, Chao-Yuan

    2014-03-01

    Emphysematous pyelonephritis is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens. The aim of the present study was to determine the clinical characteristics and prognostic factors of patients with emphysematous pyelonephritis. We retrospectively analyzed the clinical and laboratory data, imaging findings, and outcomes of 32 patients with emphysematous pyelonephritis. Receiver operating characteristic curve analysis was carried out on variables that were significantly associated with patient mortality. The overall survival rate was 87.5% (28/32). Escherichia coli (43.6%) was the most common organism cultured from urine and blood specimens. Hypoalbuminemia, shock as the presenting feature, bacteremia, need for hemodialysis and polymicrobial infection were significantly more common in cases resulting in death. The area under the receiver operating characteristic curve was 0.96. The cut-off point determined by the maximum Youden index (0.93) for three of these five factors yielded a sensitivity of 1.00 and specificity of 0.93. Shock as an initial presentation (P = 0.039) and polymicrobial infection (P = 0.010) were significantly associated with poor outcome. There were no significant differences in the clinical or laboratory features of the patients who did or did not undergo nephrectomy. Hypoalbuminemia, shock as an initial presentation, bacteremia, indications for hemodialysis and polymicrobial infection represent prognostic factors for mortality in patients with emphysematous pyelonephritis. Patients presenting with more than two of these prognostic factors carry the highest risk of mortality, and they require timely diagnosis and aggressive management. © 2013 The Japanese Urological Association.

  1. Febrile urinary tract infections: pyelonephritis and urosepsis.

    Science.gov (United States)

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

    2016-02-01

    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. It remains difficult to obtain insight into the epidemiology of febrile UTI because urine and blood cultures are frequently missing. The relationship between host and virulence factors of Escherichia coli was further explored showing that less virulent strains can cause infection in immunocompromised patients. In contrast to obstructive uropathy, diabetes, and being older, neutropenia was not a risk factor for lower UTI or urosepsis. A randomized controlled trial revealed that ceftolozane-tazobactam was marginally superior to levofloxacin as treatment for complicated UTI. Case series supported the notion that xanthogranulomatous and emphysematous pyelonephritis are more common in diabetic patients and that drainage or surgery is often required. Neutropenia was not a risk factor for lower UTI or urosepsis. When local resistance percentages to the frequently prescribed fluoroquinolones are high, the combination of ceftolozane-tazobactam may be an alternative as treatment for complicated UTI. Xanthogranulomatous and emphysematous pyelonephritis need to be considered in diabetic patients presenting with UTI symptoms.

  2. Xanthogranulomatous pyelonephritis in a young postpartal female.

    Science.gov (United States)

    Ramteke, Vishal V; Shrivastava, Makardhwaj S; Agrawal, Brijesh A; Raiyani, Ankit D; Darole, Pramod A; Padwal, Namita J; Kamath, Sandhya A

    2011-02-02

    Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory disorder of the kidney characterised by an infectious phlegmon arising in the renal parenchyma. It is seen in patients who have urolithiasis, urinary tract infection and immunocompromised status. The clinical presentation is variable and renal neoplasm is considered as a differential due to its characteristic extrarenal visceral invasion. The treatment is almost universally extirpative and can pose a formidable challenge to the treating physician and surgeon. The authors report a rare case of XGP in a postpartal woman who presented with multiple visceral abscesses whose diagnosis was arrived on histopathological examination.

  3. Anaesthetic Management of Nephrectomy for Emphysematous Pyelonephritis

    Directory of Open Access Journals (Sweden)

    N Dua

    2008-01-01

    Full Text Available Emphysematous pyelonephritis (EPN is a serious and often life threatening infection of the renal and perirenal tissues. The characteristic feature of this infection is the presence of gas within the kidney and perinephric tissues. The triad of symptoms of fever, flank pain and pyuria, especially in a diabetic female patient which did not respond promptly to conventional antibiotic therapy raised the possibility of EPN. CT scan established the diagnosis and the line of management. After failing medical management, uncontrolled frustrating hyperglycemia with fear of septice-mia, nephrectomy was done in life threatening fulminant infection of the kidney.

  4. Ascending necrotizing mediastinitis secondary to emphysematous pyelonephritis.

    Science.gov (United States)

    Dajer-Fadel, Walid Leonardo; Pichardo-González, Martha; Estrada-Ramos, Sandra; Palafox, Damián; Navarro-Reynoso, Francisco Pascual; Argüero-Sánchez, Rubén

    2014-09-01

    Mediastinal infections usually originate from postoperative complications or in a descending manner from a cervical infectious process; few reports have emerged describing an ascending trajectory. A 56-year-old woman with a Huang class 1 left emphysematous pyelonephritis was referred due to a progression of an ascending necrotizing mediastinitis. A left posterolateral thoracotomy was performed, drainage and thorough lavage were carried out with a successful outcome. We believe this is the first reported case of ascending necrotizing mediastinitis secondary to an emphysematous renal infection. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  5. [Xanthogranulomatous pyelonephritis: Review of 10 cases].

    Science.gov (United States)

    Leoni, Francisco Alberto; Kinleiner, Pablo; Revol, Martín; Zaya, Alejandro; Odicio, Alejandro

    2009-05-01

    To report our experience with clinical presentation, appearance, diagnosis and treatment of Xanthogranulomaous pyelonephritis (XP). Multicenter, observational, descriptive and retrosprospective study carried out during six years. We studied 10 patients, 8 women and 2 males, with an average age of 50 years. All cases presented with lumbar and abdominal pain, loss of weight, conjuntival pallor, renal lithiasis and chronic evolution Fever and palpable abdominal mass, were present in 80% of cases and 60% presented history of urinary tract infection. Initial diagnosis, in most cases, was pyonephrosis. Two cases (20 %). were associated with cancer and other 2 (20 %)with Psoriasis. Mortality was of (10 %).Laboratory hallmark were anemia, high SGV rate and leukocytosis. Urinary sediment showed pyuria. Urine culture was positive in the 50 % of the patients. On the other hand urine cultures obtained from nephrostomy tube were always positive. The onset was unilateral and diffuse in all cases without predominance in the location. Direct abdominal x-ray showed lithiasis, ultrasound showed increased renal size, with a pattern of hydronephrosis and/or intraparenchymatous abscesses. CT scan was useful to demonstrate disease extension. Xanthogranulomatous pyelonephritis (XP) is a chronic and unusual inflammatory-infectious disease with acute episodes involving renal parenchyma. Most cases appear in medium aged women. Histopathologic study offers the accurate diagnosis. Antibiotic therapy avoids septic complications. Total or partial nephrectomy is the definitive treatment. We propose nephrostomy because it facilitates the microbiological diagnosis and surgery (nephrectomy).

  6. Emphysematous pyelonephritis: A single center study

    Directory of Open Access Journals (Sweden)

    R Fatima

    2013-01-01

    Full Text Available We present our experience of 22 cases of emphysematous pyelonephritis (EPN treated from 1996 to 2012. Medical records were analyzed retrospectively for demographic profile, presence and duration of diabetes mellitus, and mode of clinical presentation. EPN was diagnosed based on demonstration of intra-renal gas by plain X-ray, ultrasound, and/or computed tomography (CT scan. Details of medical treatment, reason for surgical intervention, and final outcome were recorded. Univariate analysis was performed to identify risk factors for mortality and P value of less than 0.05 was taken as significant. Twenty-two cases (6 males, 16 females of EPN were diagnosed. Seven cases presented with acute pyelonephritis, seven cases with urosepsis, and the remaining eight patients with multi-organ dysfunction. CT grading of EPN was class IV in three, class III in four, class II in 14, and class I in one. All were initially managed medically with parenteral antibiotics. Ten patients needed additional surgical intervention. The overall survival rate was 86.3% (19/22. Among the risk factors analyzed higher CT grade, altered sensorium and thrombocytopenia were significantly associated with mortality. We conclude that a more conservative approach in managing EPN has become the standard of care. Patients having high CT grade of lesions (III and IV with altered sensorium and thrombocytopenia at presentation are more likely to die due to the disease and may be better managed by an aggressive surgical plan.

  7. Corticosteroids for renal scar prevention in children with acute pyelonephritis.

    Science.gov (United States)

    Sakulchit, Teeranai; Goldman, Ran D

    2017-04-01

    Question Acute pyelonephritis in children is of great concern and I usually refer these patients to a pediatrician or send them to the emergency department owing to the risk of renal scarring. Are steroids an acceptable treatment to reduce risk of scarring? Answer Several agents have been studied in an effort to prevent renal scar formation following acute pyelonephritis in children. Use of corticosteroids, in conjunction with standard therapy for acute pyelonephritis, shows promising findings. However, evidence is very limited and steroids should not be offered on a regular basis as part of treatment. Copyright© the College of Family Physicians of Canada.

  8. 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

  9. [Imaging strategy for children after a first episode of pyelonephritis].

    Science.gov (United States)

    Bocquet, N; Biebuyck, N; Lortat Jacob, S; Aigrain, Y; Salomon, R; Chéron, G

    2015-05-01

    Pyelonephritis is a common bacterial disease in young children and is a serious infection because of its potential to produce renal scarring. One of the concerns of physicians is therefore the diagnosis of uropathy at risk for recurrence of pyelonephritis, especially high-grade reflux. There are no French recommendations on imaging evaluation after a first episode of pyelonephritis. Voiding cystography was systematically proposed years ago and recommended by the American Academy of Pediatrics until 1999. This systematic strategy exposed all children to a painful, irradiating exam, and exposed them to urinary tract infection. The American recommendations changed in 2011 and cystography is now only proposed to children with recurrence of pyelonephritis or with ultrasound abnormalities. A collaborative review of the literature involving the Pediatric Emergency, Nephrology and Surgery Departments at Necker-Enfants-Malades Hospital led us to propose an algorithm for imaging after the first episode of pyelonephritis in children. This algorithm was based on data from the past medical history (results of prenatal ultrasonography or recurrence of pyelonephritis), the results of the ultrasound exam at the time of diagnosis, and the procalcitonin concentration, to limit the indications for voiding cystography, limiting risk for delaying high-grade reflux diagnosis. Children with low risk for high-grade reflux can be followed up with an ultrasound exam 6 months after acute infection. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  10. Emphysematous pyelonephritis with calculus: Management strategies

    Directory of Open Access Journals (Sweden)

    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.

  11. Xanthogranulomatous Pyelonephritis with Incomplete Double Ureter

    Directory of Open Access Journals (Sweden)

    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.

  12. Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis

    Directory of Open Access Journals (Sweden)

    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.

  13. Esmolol: immunomodulator in pyelonephritis by Pseudomonas aeruginosa.

    Science.gov (United States)

    Dimopoulos, George; Theodorakopoulou, Maria; Armaganidis, Apostolos; Tzepi, Ira-Maria; Lignos, Michael; Giamarellos-Bourboulis, Evangelos J; Tsaganos, Thomas

    2015-09-01

    Based on previous animal studies showing promising immunomodulatory efficacy esmolol, a selective β1-blocker, it was assumed that administration of esmolol in experimental pyelonephritis by multidrug-resistant Pseudomonas aeruginosa would prolong survival and modulate immune response. Acute pyelonephritis was induced in 80 rabbits and assigned to eight groups receiving normal saline (controls), esmolol, amikacin, or both agents as pretreatment and as treatment. Blood was sampled for measurement of malondialdehyde and tumor necrosis factor alpha. Animals were followed up for survival, and after death quantitative tissue cultures were performed. The in vitro effect of esmolol on bacterial growth and on the oxidative burst of neutrophils of healthy controls and of sepsis patients was studied. Survival of pretreatment groups administered single esmolol or esmolol and amikacin was prolonged compared with that of controls (P = 0.018 and P = 0.014, respectively); likewise, survival of treatment groups administered single esmolol or both agents was prolonged compared with that of controls (P = 0.007 and P = 0.014, respectively). Circulating malondialdehyde was significantly lower in pretreated animals administered esmolol or esmolol and amikacin compared with that in controls and in treated animals administered both agents compared with in controls (P = 0.020). In these groups, the bacterial load of the lung was significantly lower compared with controls. Serum tumor necrosis factor alpha did not change. Amikacin was increased in serum of esmolol-treated animals at levels which inhibited the in vitro growth of the studied isolate. Esmolol did not modify the in vitro growth of P aeruginosa and the oxidative burst of neutrophils. It is concluded that esmolol prolonged survival after experimental infection by multidrug-resistant P aeruginosa. Survival benefit may be related with pleiotropic actions connected with modulation of pharmacokinetics and attenuation of inflammation

  14. The Effects of Anemia on Pregnancy Outcome in Patients with Pyelonephritis

    OpenAIRE

    Dotters-Katz, Sarah K.; Grotegut, Chad A.; R. Phillips Heine

    2013-01-01

    Objective. Pyelonephritis is a common infectious morbidity of pregnancy. Though anemia is commonly associated with pyelonephritis, there are little data describing the effect of pyelonephritis with anemia on pregnancy outcomes. The purpose of this study was to further assess the association of anemia with infectious morbidity and pregnancy complications among women with pyelonephritis. Study Design. We conducted a retrospective cohort study of pregnant women admitted to Duke University Hospit...

  15. 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...... 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....

  16. Risk and outcome of pyelonephritis among renal transplant recipients.

    Science.gov (United States)

    Graversen, Mette Elneff; Dalgaard, Lars Skov; Jensen-Fangel, Søren; Jespersen, Bente; Østergaard, Lars; Søgaard, Ole Schmeltz

    2016-06-10

    Urinary tract infection is the most common infectious disease requiring hospitalisation following renal transplantation. However, the risk and outcome of post-transplant pyelonephritis remains unclear. This population-based cohort study was conducted from 1 January 1990 to 31 December 2009. Each member of a Danish population-based, nationwide cohort of first-time renal transplant recipients was matched by age and gender with up to 19 population controls. Information on hospital discharge diagnosis, emigration, and mortality was obtained from nationwide administrative databases. Individuals were observed from the date of first renal transplantation and until graft loss, emigration, or death. Risk factors were assessed by Poisson regression. The incidence rate (IR) of first-time hospitalisation for pyelonephritis was 18.5 (95 % confidence interval [CI]: 16.4-20.9) per 1,000 person-years of follow-up (PYFU) among renal transplant recipients (N = 2,656) and 0.26 (CI: 0.21-0.31) per 1,000 PYFU among population controls (N = 49,226) yielding an incidence rate-ratio (IRR) of 72.0 (95 % CI: 57.8-89.7). Among renal transplant recipients, the risk of pyelonephritis decreased during the entire study period and was lowest in 2005-09 (IRR = 0.46, CI: 0.31-0.68). The highest risk of pyelonephritis was observed within the first six months post-transplantation (IR = 69.9 per 1,000 PYFU; CI: 56.4-86.7). Other risk factors for post-transplant pyelonephritis included female gender, high Charlson comorbidity index score, HLA-DR mismatch, cause of renal failure, and calendar period. Interestingly, we found that the combined risk of graft loss and death was 45 %, (CI: 19-77 %) higher in renal transplant recipients following post-transplant pyelonephritis compared to those who had no admission due to pyelonephritis. The risk of first-time hospitalisation for pyelonephritis among renal transplant recipients is high. Further, post-transplant pyelonephritis was

  17. Risk Factors Associated with Acute Pyelonephritis in Healthy Women

    Science.gov (United States)

    Scholes, Delia; Hooton, Thomas M.; Roberts, Pacita L.; Gupta, Kalpana; Stapleton, Ann E.; Stamm, Walter E.

    2013-01-01

    Background Although most cases of acute pyelonephritis occur in otherwise healthy women, data on risk factors for this condition are lacking. Objective To evaluate infection characteristics, incidence, and risk factors associated with acute pyelonephritis in a sample of women. Design Population-based case–control study. Setting Group Health Cooperative, a prepaid health plan in Washington. Participants 788 nonpregnant women, 18 to 49 years of age. Case-patients (n = 242) were women with pyelonephritis who were identified from computerized databases. Controls were 546 similar-age women with no pyelonephritis diagnosis in the previous 5 years who were randomly selected from enrollment databases. Response rates for case-patients and controls were 73% and 64%, respectively. Measurements Characteristics of infection and potential risk factors for pyelonephritis, ascertained through computer-assisted telephone interview and computerized databases. Results 7% of case-patients were hospitalized. Escherichia coli was the infecting pathogen in 85% of cases. In multivariable models, factors associated with pyelonephritis risk were frequency of sexual intercourse in the previous 30 days (odds ratio, 5.6 [95% CI, 2.8 to 11.0] for ≥3 times per week), recent urinary tract infection (UTI) (odds ratio, 4.4 [CI, 2.8 to 7.1]), diabetes (odds ratio, 4.1 [CI, 1.6 to 10.9]), recent incontinence (odds ratio, 3.9 [CI. 2.6 to 5.9]), new sexual partner in the previous year (odds ratio, 2.2 [CI, 1.4 to 3.6]), recent spermicide use (odds ratio, 1.7 [CI, 1.1 to 2.8]), and UTI history in the participant's mother (odds ratio, 1.6 [CI, 1.1 to 2.5]). Risk factors for selected subgroups (patients ≤ 30 years of age, patients > 30 years of age, patients with no UTI history, and inpatients) were also evaluated. Limitations Potential recall bias, reliance on automated case definition criteria, and limited data on diabetes and incontinence variables. Conclusions Few nonpregnant, community

  18. CT findings of acute pyelonephritis and clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Rha, Sung Eun; Byun, Jae Young; Kim, Ki Jun; Kim, Jong Kyu; Kim, Han Bock; Chun, Ho Jong; Bang, Byung Gi; Choi, Kyu Ho; Shinn, Kyung Sub [Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-02-01

    To evaluate postcontrast CT findings of acute pyelonephritis and correlate these with clinical findings and severities. We retrospectively reviewed the medical records and CT scans of 50 patients with abnormal CT findings among 52 patients of acute pyelonephritis whose postcontrast CT scans had been examined. Fifty cases of acute pyelonephritis were classified into three subgroups on the basis of postcontrast CT findings : Group 1(n=20, 40%) wedge-shaped lesions; Group 2(n=13, 26%) mass-like lesions; Group 3 (n=17, 34%) renal abscess formation. In each group, clinical findings and severity were analyzed and correlated with CT findings. The results were statistically analyzed. Although mean values of clinical parameters of group 1 were lower than those of group 2 and 3 with regard to all clinical parameters (including maximal temperature and duration of fever, flank pain, leukocytosis, and admission period), there was no statistically significant correlation among the three groups (p > 0.05). All cases were successfully treated with antibiotics only, despite the high rate of abscess formation (34%). Acute pyelonephritis spans a continuum of CT findings of varying severity from wedge-shaped or mass-like lesions to multifocal abscesses; postenhanced CT scan shows high sensitivity (96%) in the detection of acute pyelonephritis. Although the clinical course of groups of mass-like lesions and abscess formation was longer and more severe than that of wedge-shaped lesions, there was no statistically significant clinicoradiologic correlation among the three groups.

  19. Emphysematous pyelonephritis (class IIIa) managed with antibiotics alone.

    Science.gov (United States)

    Chauhan, Vivek; Sharma, Rajesh

    2015-08-01

    A 54-year-old male with long-standing diabetes presented with vague left flank pain for 5 days with uncontrolled blood glucose. The patient was commenced on insulin and injectable ceftriaxone empirically, for possibly acute pyelonephritis. Ultrasound examination revealed extensive emphysematous pyelonephritis of upper half of left kidney with involvement of perinephric space. Computed tomography of abdomen confirmed the diagnosis of emphysematous pyelonephritis which was categorised as class IIIa. The recommended treatment for class IIIa emphysematous pyelonephritis is nephrectomy but the patient refused to give consent for surgery or even percutaneous drainage. Thus, the patient was continued on medical management alone and surprisingly showed marked recovery over the next few days. There were no new complications, and the patient was discharged after 2 weeks of antibiotics with 2 more weeks of oral antibiotics. After 4 months, the ultrasound showed normal kidneys. We present this case because it adds to the little existing evidence that conservative management can successfully cure patients with class IIIa emphysematous pyelonephritis, although supplementation with percutaneous drainage would have been better in this case.

  20. Ampicillin Resistance and Outcome Differences in Acute Antepartum Pyelonephritis

    Science.gov (United States)

    Greer, Laura G.; Roberts, Scott W.; Sheffield, Jeanne S.; Rogers, Vanessa L.; Hill, James B.; Mcintire, Donald D.; Wendel, George D.

    2008-01-01

    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. PMID:18923674

  1. Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Grattan-Smith, J.D. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Little, Stephen B. [Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Jones, Richard A. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States)

    2008-01-15

    MR urography has the potential to significantly improve our understanding of the relationship between reflux nephropathy, pyelonephritis, vesicoureteric reflux and renal dysplasia. MR urography utilizes multiple parameters to assess both renal anatomy and function and provides a more complete characterization of acquired and congenital disease. Pyelonephritis and renal scarring can be distinguished by assessing the parenchymal contours and signal intensity. Characteristic imaging features of renal dysplasia include small size, subcortical cysts, disorganized architecture, decreased and patchy contrast enhancement as well as a dysmorphic pelvicalyceal system. Because of its ability to subdivide and categorize this heterogeneous group of disorders, it seems inevitable that MR urography will replace DMSA renal scintigraphy as the gold standard for assessment of pyelonephritis and renal scarring. MR urography will contribute to our understanding of renal dysplasia and its relationship to reflux nephropathy. (orig.)

  2. Renal sinus hyperechogenicity in acute pyelonephritis: description and pathological correlation

    Energy Technology Data Exchange (ETDEWEB)

    Dacher, J.N.; Monroc, M.; Eurin, D.; Dosseur, P. le [Hopital Charles Nicolle, Rouen (France). Dept. of Pediatric Radiology; Avni, F.; Rypens, F. [Hopital Erasme, Brussels (Belgium). Dept. of Radiology; Francois, A. [Hopital Charles Nicolle, Rouen (France). Dept. of Pathology

    1999-03-01

    This paper reports on the association between renal sinus hyperechogenicity and acute pyelonephritis. The medical records and imaging studies of 18 children displaying this pattern were retrospectively studied. Thickening of the renal pelvis and renal enlargement were the most frequent associated sonographic abnormalities. Further subtle findings can be found on sonography and colour/power Doppler. Their identification can help in the diagnostic approach to acute pyelonephritis and may obviate the need for other imaging modalities such as enhanced CT or {sup 99} {sup m}Tc-DMSA scintigraphy. Renal sinus hyperechogenicity was also identified in a parallel study performed in female rabbits with experimental pyelonephritis and was shown, histologically, to be related to exudates of fibrin and polymorphonuclear leukocytes, interstitial oedema and micro-abscesses. (orig.) With 3 figs., 18 refs.

  3. Segmentation of acute pyelonephritis area on kidney SPECT images using binary shape analysis

    Science.gov (United States)

    Wu, Chia-Hsiang; Sun, Yung-Nien; Chiu, Nan-Tsing

    1999-05-01

    Acute pyelonephritis is a serious disease in children that may result in irreversible renal scarring. The ability to localize the site of urinary tract infection and the extent of acute pyelonephritis has considerable clinical importance. In this paper, we are devoted to segment the acute pyelonephritis area from kidney SPECT images. A two-step algorithm is proposed. First, the original images are translated into binary versions by automatic thresholding. Then the acute pyelonephritis areas are located by finding convex deficiencies in the obtained binary images. This work gives important diagnosis information for physicians and improves the quality of medical care for children acute pyelonephritis disease.

  4. Best oral empirical treatment for pyelonephritis in children

    DEFF Research Database (Denmark)

    Salomonsson, Petra; von Linstow, Marie-Louise; Knudsen, Jenny Dahl

    2016-01-01

    BACKGROUND: Pyelonephritis is a common infection in childhood and may cause renal scarring. The aim was to determine an effective oral antibiotic treatment of first time pyelonephritis in children. METHODS: The study is a retrospective analysis of positive urine cultures collected at a Danish...... prevalence of other Gram-negative rods (16% vs 7%, p resistance rates of 6.......9% and 7.2%, respectively, and 6% for both antimicrobials in patients older than 6 months. Uropathogens from boys above 6 months of age were more resistant to piv-mecillinam compared to girls (25% vs 2.4%, p 

  5. Emphysematous pyelonephritis presenting as a sonologically absent kidney

    Directory of Open Access Journals (Sweden)

    Chirag Patel

    2015-01-01

    Full Text Available Emphysematous pyelonephritis is an acute necrotizing infection of the kidney caused by gas-producing organisms. It is being increasingly recognized as an underlying cause of sepsis. We present a case of emphysematous pyelonephritis where the affected kidney was filled with extensive gas. This made the detection of the kidney difficult by ultrasound. Also, this case presents the dilemma of managing a septic patient medically and the risks entailed in surgical intervention in such cases. Most often, these patients have underlying diabetes mellitus with underlying co-morbidities, making indicated surgical management difficult as illustrated by our patient.

  6. Ultrasonographic features of focal xanthogranulomatous pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Chul [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2003-09-15

    To analyze ultrasonographic (US) features of focal xanthogranulomatous pyelonephritis (XGP). US features of 15 patients with pathologically proven focal XGP were retrospectively analyzed by two radiologists who reached a consensus, in terms of the location, margin, size, and echo texture of the mass-like lesion, and presence or absence of associated calculi, lymphadenopathy, or local extension. These US findings were compared with CT findings. The patients were checked for the clinical symptom and sign through the review of hospital records. Thirteen of 15 patients were adults and 2 were children, and 10 were males. Their age ranged from 6 to 57 (mean, 39) years at presentation. Eight of 15 cases (53%) were in right kidney, and on US scan 12 cases (80%) were well circumscribed. The size of the mass ranged from 2.5 to 5.8 (mean, 3.8) cm. Of 15 masses, 13 (87%) were solid and two were cystic. Thirteen solid masses were composed of 10 masses (77%) with inner hypo- or anechoic foci and the other three masses without inner hypo- or anechoic foci, and the preoperative diagnosis was either renal cell carcinoma (n=11) or Wilms' tumor (n=2). The preoperative diagnosis in two cystic lesions (13%) was renal abscess. Renal calculi were found in one case, but lymphadenopathy or local extension was not depicted. Clinical symptoms and signs of flank pain, fever, leukocytosis, or anemia were found in 11 of 15 patients. Focal XGP revealed US features of solid or cystic masses confined within the renal outline mimicking renal tumor or abscess. US features, however, in association with clinical findings and other imaging findings (such as CT or MR imaging) may help the differential diagnosis of this lesion.

  7. Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis

    Science.gov (United States)

    Lu, Yu-Chuan; Hong, Jian-Hua; Chiang, Bing-Juin; Pong, Yuan-Hung; Hsueh, Po-Ren; Huang, Chao-Yuan; Pu, Yeong-Shiau

    2016-01-01

    Abstract The aim of this study was to investigate the profiles of pathogens and patterns of antibiotic resistance of emphysematous pyelonephritis (EPN), offering recommendations for initial antibiotic treatment. Between January, 2001, and November, 2014, demographic data, presenting clinical features, management strategies, and treatment outcomes of 51 patients with EPN were retrospectively reviewed, analyzing microbiological characteristics of causative pathogens and patterns of antibiotic resistance. Overall survival rate was 90.2% (46/51). Pathogens isolated most frequently were Escherichia coli (49.0%), Klebsiella pneumoniae (19.6%), and Proteus mirabilis (17.7%). Approximately 24% of E coli isolates and 22% K pneumoniae isolates were resistant to fluoroquinolones. Improper empiric antibiotic use (P = 0.02) and third-generation cephalosporin-resistant pathogens (G3CRP) (P = 0.01) were significantly more common in cases of patient fatality. Prior hospitalization and antibiotic use within past year (P = 0.03), need for emergency hemodialysis (P = 0.03), and development of disseminated intravascular coagulation (DIC) (P = 0.03) were factors correlating significantly with microbial resistance to third-generation cephalosporins. The area under the receiver operating characteristic curve was 0.91. The cut-off point determined by the maximum Youden index for 2 of these 3 factors yielded a sensitivity of 0.8 and specificity of 0.93. Third-generation cephalosporins are recommended as initial treatment of EPN. In patients with histories of prior hospitalization and antibiotic use and in those needing emergency hemodialysis or developing DIC, carbapenem is the empiric antibiotic of choice. Patients presenting with 2 or more factors carry the highest risk of G3CRP involvement. Fluoroquinolone and gentamicin should be avoided. PMID:27227920

  8. Safety and efficacy of ureteroscopy after obstructive pyelonephritis treatment.

    Science.gov (United States)

    Kanno, Toru; Matsuda, Ayumu; Sakamoto, Hiromasa; Higashi, Yoshihito; Yamada, Hitoshi

    2013-09-01

    An obstructed, infected kidney combined with ureteral stones can be lethal, and requires urgent drainage and complete stone removal. However, the optimal method of stone removal, and its safety and efficacy have yet to be conclusively established. The aim of this study was to determine the safety and efficacy of carrying out ureteroscopy after kidney drainage for septic patients with obstructing stones. From January 2004 to September 2011, 88 patients underwent stone removal by either ureteroscopy (n = 48) or extracorporeal shock wave lithotripsy (n = 40) after drainage of obstructive pyelonephritis. Patients' characteristics were analyzed, and treatment outcomes between the ureteroscopy and extracorporeal shock wave lithotripsy groups were compared. The outcomes of ureteroscopy carried out during the same period between patients with preoperative obstructive pyelonephritis and those without were also compared. Obstructed, infected kidneys were decompressed with retrograde ureteral stenting, except for two and three cases treated with nephrostomy in the ureteroscopy and extracorporeal shock wave lithotripsy groups, respectively. The severity of preoperative pyelonephritis was similar in both groups. Importantly, the success rate was 67.5% for extracorporeal shock wave lithotripsy and 98% for ureteroscopy (P pyelonephritis had similar stone-free and ureteroscopy complication rates (97% vs 93%, and 10% vs 12%). Ureteroscopy after drainage of an obstructed infected kidney can be a safe and effective option, as it seems to not be associated with an increased risk of complications. © 2013 The Japanese Urological Association.

  9. 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)

  10. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis.

    Science.gov (United States)

    Wing, Deborah Ann; Fassett, Michael John; Getahun, Darios

    2014-03-01

    We sought to describe the incidence of acute pyelonephritis in pregnancy, and to assess its association with perinatal outcomes in an integrated health care system. A retrospective cohort study was performed using medical records on 546,092 singleton pregnancies delivered in all Kaiser Permanente Southern California hospitals from 1993 through 2010. These medical records include the perinatal service system along with inpatient and outpatient encounter files. Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) were used to estimate associations. The incidence of acute antepartum pyelonephritis was 0.5% (2894/543,430). Women with pyelonephritis in pregnancy were more likely to be black or Hispanic, young, less educated, nulliparous, initiate prenatal care late, and smoke during pregnancy. Pregnancies of women with pyelonephritis compared to those without were more likely to be complicated by anemia (26.3% vs 11.4%; OR, 2.6; 95% CI, 2.4-2.9), septicemia (1.9% vs 0.03%; OR, 56.5; 95% CI, 41.3-77.4), acute pulmonary insufficiency (0.5% vs 0.04%; OR, 12.5; 95% CI, 7.2-21.6), acute renal dysfunction (0.4% vs 0.03%; OR, 16.5; 95% CI, 8.8-30.7), and spontaneous preterm birth (10.3% vs 7.9%; OR, 1.3; 95% CI, 1.2-1.5). Most of the preterm births occurred between 33-36 weeks (9.1%). We characterize the incidence of pyelonephritis in an integrated health care system where routine prenatal screening for asymptomatic bacteriuria is employed. Maternal complications are commonly encountered and the risk of preterm birth is higher than the baseline obstetric population. Copyright © 2014 Mosby, Inc. All rights reserved.

  11. Perirenal fat stranding is not a powerful diagnostic tool for acute pyelonephritis

    Science.gov (United States)

    Fukami, Hirotaka; Takeuchi, Yoichi; Kagaya, Saeko; Ojima, Yoshie; Saito, Ayako; Sato, Hiroyuki; Matsuda, Ken; Nagasawa, Tasuku

    2017-01-01

    Purpose Pyelonephritis, an upper urinary tract infection, is a serious infection that often requires hospitalization. However, the accurate diagnosis of acute pyelonephritis can be difficult, especially among older individuals who can present with unusual symptoms. Imaging with computed tomography (CT) is not unusual in the diagnosis of pyelonephritis, with some clinicians regarding perirenal fat stranding (PFS) as a characteristic finding. However, the sensitivity and specificity of PFS in diagnosing pyelonephritis are currently unknown. We therefore sought to clarify the relevance of PFS in diagnosing acute pyelonephritis. Patients and methods We conducted a case-controlled retrospective analysis of medical records. The pyelonephritis group included 89 patients who had been diagnosed with acute pyelonephritis, while the control group included 319 patients who had undergone percutaneous renal biopsy. CT findings were available for both groups. The frequency of PFS and its sensitivity and specificity for the diagnosis of acute pyelonephritis were investigated. Results The mean ages of the pyelonephritis and control groups were 74±15 years and 63±16 years, respectively. A total of 28% of men were in the pyelonephritis group vs 61% of men in the control group. The frequency of PFS was 72% in the pyelonephritis group vs 39% in the control group. Age and renal dysfunction were associated with an increased frequency of PFS. After adjusting for age, sex, and renal function using a propensity score analysis, the sensitivity, specificity, and positive likelihood ratio of PFS for diagnosing acute pyelonephritis were 72%, 58%, and 1.7, respectively. Conclusion The presence of PFS was not useful in diagnosing acute pyelonephritis. PMID:28507449

  12. Acute pyelonephritis: classification, terminology and imaging diagnosis; Pielonefrite aguda: classificacao, nomenclatura e diagnostico por imagem

    Energy Technology Data Exchange (ETDEWEB)

    D' Ippolito, Giuseppe; Abreu Junior, Luiz de; Borri, Maria Lucia; Galvao Filho, Mario de Melo; Hartmann, Luiz Guilherme de Carvalho; Wolosker, Angela Maria Borri [Hospital e Maternidade Sao Luiz, Sao Paulo, SP (Brazil). Servico de US/TC/RM

    2005-07-15

    In order to present an imaging based classification to acute pyelonephritis and to review the main aspects at computed tomography (CT) and magnetic resonance imaging (MRI) we performed a research in PuMed between 1990 and 2004, looking for articles that were approaching the terminology related to 'acute pyelonephritis'. We retrospectively selected examples of patients with clinical and laboratory evidences of acute pyelonephritis and highlighted the CT and MRI findings. We observed a tendency to use the term 'acute pyelonephritis' among the authors researched. The more adopted terminology characterizes acute pyelonephritis as: focal or diffuse; unilateral or bilateral; with kidney enlargement or no kidney enlargement; with abscess or without abscess. The main radiological findings are: kidney enlargement; heterogeneous nephrogram; perinephric heterogeneity; intrarenal or extrarenal abscess. A simple and well accepted terminology for acute pyelonephritis should be adopted. (author)

  13. Severe renal failure in acute bacterial pyelonephritis: Do not forget corticosteroids

    Directory of Open Access Journals (Sweden)

    Sqalli Tarik

    2010-01-01

    Full Text Available Acute renal failure (ARF is a rare complication of acute pyelonephritis in adult immunocompetent patients. Recovery of renal function usually occurs if antibiotics are promptly initiated. However, long-term consequences of renal scarring due to acute pyelonephritis are probably underestimated, and some patients present with prolonged renal failure despite adequate antibiotic therapy. We report two cases of severe ARF complicating bacterial pyelonephritis successfully treated with corticosteroids in association with conventional antibiotics.

  14. Extensive bilateral emphysematous pyelonephritis with calculi managed conservatively with antibiotics and DJ stent

    Directory of Open Access Journals (Sweden)

    Madhulika Mahashabde

    2013-01-01

    Full Text Available Emphysematous pyelonephritis is a life threatening, necrotizing upper urinary tract infection associated with gas within the kidney and/or perinephric space. To prevent mortality from this fulminant infection, early diagnosis is essential. CT scan should be done early in patients with suspected emphysematous pyelonephritis. Here, we present a case of Type II Diabetes Mellitus complicated with left obstructive ureteric calculi, diagnosed on CT scan to have extensive bilateral emphysematous pyelonephritis of class 4. We treated conservatively with antibiotics and DJ stent. The patient responded and a repeat CT scan was done after 4 weeks which showed no evidence of emphysematous pyelonephritis.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Medical and infectious complications associated with pyelonephritis among pregnant women at delivery.

    Science.gov (United States)

    Dotters-Katz, Sarah K; Heine, R Phillips; Grotegut, Chad A

    2013-01-01

    Pyelonephritis is a common cause of antepartum admission and maternal morbidity. Medical complications associated with pyelonephritis during delivery are not well described; thus the objective of this study was to estimate medical, infectious, and obstetric complications associated with pyelonephritis during the delivery admission. We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) for the years 2008-2010. The NIS was queried for all delivery-related discharges. During the delivery admission, the ICD-9-CM codes for pyelonephritis were used to identify cases and were compared to women without pyelonephritis. A multivariable logistic regression model was constructed for various medical, infectious, and obstetric complications among women with pyelonephritis compared to women without, while controlling for preexisting medical conditions and demographics. During the years 2008-2010, there were 26,397 records with a diagnosis of pyelonephritis during the delivery admission, for a rate of 2.1 per 1000 deliveries. Women with pyelonephritis had increased associated risks for transfusion, need for mechanical ventilation, acute heart failure, pneumonia, pulmonary edema, acute respiratory distress syndrome, sepsis, acute renal failure, preterm labor, and chorioamnionitis, while controlling for preexisting medical conditions. Pyelonephritis at delivery admissions is associated with significant medical and infectious morbidity.

  17. [Pyelonephritis table during the pregnancy: think of the listeriosis].

    Science.gov (United States)

    El Ameri, A; Achenani, M; Hmamouche, K; Ghazouani, M; Benaouda, A; El Ouennass, M

    2011-10-01

    Listeriosis in pregnancy is usually benign; however the foetal consequences are serious. We report a case of atypical listeriosis simulating pyelonephritis, in a pregnant woman who presented at 25 weeks gestation a left renal colic, operating in a febrile context; it was treated as urinary tract infection with gentamicin and ceftriaxon. The evolution was marked by the exacerbation of symptoms followed by in utero foetal death. Blood culture was performed in post abortion; the diagnosis was retained after bacteriological examination of the placenta. This observation suggested evoking listeriosis in any case of unexplained fever during pregnancy, even with clinical signs suggestive of pyelonephritis, and not delay making blood cultures and prescribing antibiotics in general an amoxicillin.

  18. [The bioregulatory therapy of patients with chronic pyelonephritis].

    Science.gov (United States)

    al-Shukri, S Kh; Gorbachev, A G; Kuz'min, I V

    1997-01-01

    Prostatilen (5 mg/day i.m. for 5 days) was given to 46 patients with chronic pyelonephritis in the latent inflammation phase. The treatment resulted in relief of clinical symptoms, positive trend in laboratory indices characterizing activity of renal inflammation, albumin-globulin ratio. There was a decrease in leukocyturia, bacteriuria, ESR, blood fibrinogen and ceruloplasmin levels. Prostatilen reduced hypercoagulation and enhanced fibrinolytic activity of blood. The immunograms showed prostatilen-induced correction of immunity: T-lymphocyte count and functional activity increased, proportion of T-cell subpopulations returned to normal, metabolic activity of phagocyte oxygen-dependent substances became more intensive. The ability of prostatilen to initiate normalization of hemocoagulation and immunity is thought to be an essential factor of its therapeutic efficacy in chronic pyelonephritis.

  19. Pyelonephritis with bacteremia caused by Listeria monocytogenes: A case report.

    Science.gov (United States)

    Uno, Shunsuke; Hase, Ryota; Toguchi, Akihiro; Otsuka, Yoshihito; Hosokawa, Naoto

    2017-02-01

    Listeria monocytogenes is a well-known cause of meningitis, colitis, and bacteremia; however, obstructive pyelonephritis caused by L. monocytogenes has never been reported. We herein report on a 90-year-old Japanese woman with obstructive pyelonephritis and bacteremia due to uterus carcinoma invading the ureter. She was admitted to our hospital complaining of fever and chills, and her physical examination revealed left costovertebral angle tenderness. Computed tomography showed hydronephrosis and complete ureteral obstruction due to tumor invasion. Blood and urine cultures upon nephrostomy revealed the growth of L. monocytogenes. We treated the patient with two weeks of intravenous ampicillin and an additional one-week treatment of oral sulfamethoxazole/trimethoprim. This case shows the importance to recognize L. monocytogenes as a potential causative agent of urinary tract infection. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  20. Staghorn calculi and xanthogranulomatous pyelonephritis associated with transitional cell carcinoma

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. [Potentials of phytotherapy in the complex treatment of acute pyelonephritis].

    Science.gov (United States)

    Neĭmark, A I; Kablova, I V

    2014-01-01

    The purpose of this study was to increase the effectiveness of treatment of patients with acute pyelonephritis by incorporating of phytopreparation "Prolit Super Septo" in complex therapy. The study included 38 patients with acute primary pyelonephritis. All patients have received standard medical therapy, 21 of them (Group 2) have additionally received "Prolit Super Septo" 2 capsules 2 times a day for 1 month. Outcome measures included basic laboratory parameters, and results of bacteriological examination and immunological assessment of patients 12-14 and 28-30 days after initiation of therapy. Against the background of the therapy, positive dynamics of the level of leukocyturia and bacteriuria was detected in both groups; therapeutic effect, however, was more pronounced in the Group 2 treated with complex therapy: after the end of treatment, the proportion of sterile cultures was 85.7%, whereas in Group 1--70.6%. In addition, complex treatment had a positive effect on the immune status of patients, as evidenced by normalization of blood immunoglobulins, circulating immune complexes and C-reactive protein. The inclusion of "Prolit Super Septo" in the complex conservative treatment of patients with acute pyelonephritis promotes the development of an adequate immune response and the rapid elimination of the pathogens, thus preventing the development of purulent forms of the disease, or chronization of process.

  3. The sonographic appearance of acute focal pyelonephritis 8 years experience

    Energy Technology Data Exchange (ETDEWEB)

    Farmer, Kim D.; Gellett, Laura R.; Dubbins, Paul A

    2002-06-01

    AIM: Acute focal pyelonephritis (AFP) is a variant of pyelonephritis in which single or multiple discrete areas show changes of inflammation. The reported sonographic appearances of AFP are varied but are typically described as being echopoor. The purpose of this study was to review the sonographic appearances of AFP and attempt to explain the range of findings by correlation with clinical details. MATERIALS AND METHODS: We reviewed retrospectively the sonographic findings and medical records of 17 cases of AFP. The study group consisted of 13 women and four men (mean age 20 years). Lesions were designated as echogenic, echopoor or of mixed echogenicity as compared to the adjacent renal cortex, and to the liver or spleen. RESULTS: The abnormal areas were echogenic in 12 patients, echopoor in three and of mixed echogenicity in two. An attempt was made to explain the variation in appearances by correlation with clinical details including the patient's age, the duration of symptoms, the length of antibiotic treatment and the presence of haematuria. CONCLUSION: Areas of acute focal pyelonephritis may be echogenic, echopoor or of mixed echogenicity. Our data would suggest that areas of increased echogenicity are more common. There is no discernible correlation with clinical findings. Farmer, K.D. et al. (2002)

  4. A guideline for the inpatient care of children with pyelonephritis

    Science.gov (United States)

    Chishti, Aftab S.; Maul, Erich C.; Nazario, Rubén J.; Bennett, Jeffrey S.; Kiessling, Stefan G.

    2010-01-01

    BACKGROUND AND OBJECTIVES: Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxic. The American Academy of Pediatrics (AAP) practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children provides experience and evidence-based guidelines for the practitioner caring for children between the ages of 2 months to 2 years. No established guideline exists for older children and the AAP guideline does not specifically focus on inpatient care. METHODS: We conducted a comprehensive review of recently published literature and practice guidelines to develop a consensus on the inpatient diagnosis and management of children with pyelonephritis. RESULTS: Eight recommendations are proposed for the diagnosis and management, including revised guidelines for the imaging studies postpyelonephritis on the basis of current best evidence. CONCLUSION: Proper diagnosis of pyelonephritis, timely initiation of appropriate therapy and identification of children at risk for renal injury will help to reduce immediate as well as long-term complications due to chronic kidney disease. PMID:20716830

  5. Percutaneous drainage of abscess in the treatment of emphysematous pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jin Yong; Jeong, Yong Yeon; Kim, Jae Kyu; Park, Seung Jei; Park, Jin Gyoon; Kang, Heoung Keun [Chonnam Univ. School of Medicine, Kwangju (Korea, Republic of); Roh, Byung Suk [Wonkwang Univ. School of Medicine, Iksan (Korea, Republic of)

    1997-02-01

    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.

  6. Comparison of Escherichia coli Strains Recovered from Human Cystitis and Pyelonephritis Infections in Transurethrally Challenged Mice

    Science.gov (United States)

    Johnson, David E.; Lockatell, C. Virginia; Russell, Robert G.; Hebel, J. Richard; Island, Michael D.; Stapleton, Ann; Stamm, Walter E.; Warren, John W.

    1998-01-01

    Urinary tract infection, most frequently caused by Escherichia coli, is one of the most common bacterial infections in humans. A vast amount of literature regarding the mechanisms through which E. coli induces pyelonephritis has accumulated. Although cystitis accounts for 95% of visits to physicians for symptoms of urinary tract infections, few in vivo studies have investigated possible differences between E. coli recovered from patients with clinical symptoms of cystitis and that from patients with symptoms of pyelonephritis. Epidemiological studies indicate that cystitis-associated strains appear to differ from pyelonephritis-associated strains in elaboration of some putative virulence factors. With transurethrally challenged mice we studied possible differences using three each of the most virulent pyelonephritis and cystitis E. coli strains in our collection. The results indicate that cystitis strains colonize the bladder more rapidly than do pyelonephritis strains, while the rates of kidney colonization are similar. Cystitis strains colonize the bladder in higher numbers, induce more pronounced histologic changes in the bladder, and are more rapidly eliminated from the mouse urinary tract than pyelonephritis strains. These results provide evidence that cystitis strains differ from pyelonephritis strains in this model, that this model is useful for the study of the uropathogenicity of cystitis strains, and that it would be unwise to use pyelonephritis strains to study putative virulence factors important in the development of cystitis. PMID:9632566

  7. Pyelonephritis caused by Actinobaculum schaalii in a child with pyeloureteral junction obstruction.

    NARCIS (Netherlands)

    Pajkrt, D.; Simoons - Smit, A.M.; Savelkoul, P.H.M.; Hoek, van den J.; Hack, WW; Furth, van A.M.

    2003-01-01

    Reported here is the case of a 5-year old boy with a pyeloureteral junction (PUJ) obstruction and pyelonephritis caused by Actinobaculum schaalii, an Actinomyces-like organism. Pyelonephritis or any other urinary tract infection caused by Actinobaculum schaalii has not been described in children

  8. The effects of anemia on pregnancy outcome in patients with pyelonephritis.

    Science.gov (United States)

    Dotters-Katz, Sarah K; Grotegut, Chad A; Heine, R Phillips

    2013-01-01

    Pyelonephritis is a common infectious morbidity of pregnancy. Though anemia is commonly associated with pyelonephritis, there are little data describing the effect of pyelonephritis with anemia on pregnancy outcomes. The purpose of this study was to further assess the association of anemia with infectious morbidity and pregnancy complications among women with pyelonephritis. We conducted a retrospective cohort study of pregnant women admitted to Duke University Hospital between July 2006 and May 2012 with pyelonephritis. Demographic, laboratory, and clinical data from the subject's pregnancy and hospitalizations were analyzed. Patients with pyelonephritis and anemia (a hematocrit pyelonephritis and 45 (39.5%) had anemia on admission. There was no significant difference in age, race, preexisting medical conditions, or urine bacterial species between patients with anemia and those without. Women with anemia were more likely to deliver preterm (OR 3.3 (95% CI 1.07, 11.4), P = 0.04). When controlling for race and history of preterm delivery, women with anemia continued to have increased odds of preterm birth (OR 6.0, CI 1.4, 35, P = 0.012). Women with pyelonephritis and anemia are at increased risk for preterm delivery.

  9. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience

    Energy Technology Data Exchange (ETDEWEB)

    Chen, M.; Huang, C.; Chou, Y.; Huang, Ch.; Chiang, C.; Liu, G. [Chung-Ho Memorial Hospital, Kaohsiung Medical College, Taiwan (China)

    1997-11-01

    CT is an efficient imaging method for diagnosis, guiding the drainage procedures and monitoring response to percutaneous drainage of emphysematous pyelonephritis. Antibiotic therapy combined with CT guided percutaneous drainage of emphysematous pyelonephritis is an acceptable alternative to antibiotic therapy with surgical intervention. (authors)

  10. The Effects of Anemia on Pregnancy Outcome in Patients with Pyelonephritis

    Directory of Open Access Journals (Sweden)

    Sarah K. Dotters-Katz

    2013-01-01

    Full Text Available Objective. Pyelonephritis is a common infectious morbidity of pregnancy. Though anemia is commonly associated with pyelonephritis, there are little data describing the effect of pyelonephritis with anemia on pregnancy outcomes. The purpose of this study was to further assess the association of anemia with infectious morbidity and pregnancy complications among women with pyelonephritis. Study Design. We conducted a retrospective cohort study of pregnant women admitted to Duke University Hospital between July 2006 and May 2012 with pyelonephritis. Demographic, laboratory, and clinical data from the subject’s pregnancy and hospitalizations were analyzed. Patients with pyelonephritis and anemia (a hematocrit < 32 were compared to those without anemia. Descriptive statistics were used to compare the two groups. Results. 114 pregnant women were admitted with pyelonephritis and 45 (39.5% had anemia on admission. There was no significant difference in age, race, preexisting medical conditions, or urine bacterial species between patients with anemia and those without. Women with anemia were more likely to deliver preterm (OR 3.3 (95% CI 1.07, 11.4, . When controlling for race and history of preterm delivery, women with anemia continued to have increased odds of preterm birth (OR 6.0, CI 1.4, 35, . Conclusion. Women with pyelonephritis and anemia are at increased risk for preterm delivery.

  11. Sporadic bilateral synchronous multicentric papillary renal cell carcinoma masquerading as bilateral multifocal pyelonephritis.

    Science.gov (United States)

    Karthikeyan, V S; Dorairajan, L N; Kumar, S; Vijayakumar, A R; Ramesh, A; Ganesh Rajesh, N; Halanaik, D; Gupta, S

    2014-07-01

    Pyelonephritis is defined as an inflammation of the kidney and renal pelvis. The diagnosis is usually clinical. Acute multifocal bacterial nephritis is a rare form of pyelonephritis that is more severe and sepsis is more common. We report a patient who presented with fever and right-sided abdominal pain associated with right flank tenderness, suggesting right acute pyelonephritis. Bilateral multifocal pyelonephritis was diagnosed on ultrasonography, radionuclide renal scintigraphy and computed tomography. However, owing to non-resolution of symptoms, a biopsy was performed, which showed bilateral papillary renal cell carcinoma (PRCC). PRCC is known to exhibit multicentricity. To our knowledge, a case of bilateral multicentric PRCC masquerading as bilateral multifocal pyelonephritis has not been reported in the English literature. This case highlights the need to be vigilant while treating patients with focal lesions of the kidney as an inflammatory condition lest a malignancy should be missed.

  12. Nephrostomy tube related pyelonephritis in patients with cancer: epidemiology, infection rate and risk factors.

    Science.gov (United States)

    Bahu, Ramez; Chaftari, Anne-Marie; Hachem, Ray Y; Ahrar, Kamran; Shomali, William; El Zakhem, Aline; Jiang, Ying; AlShuaibi, Munirah; Raad, Issam I

    2013-01-01

    Nephrostomy tube placement is often necessary to avert acute renal failure in patients with cancer with obstructive uropathy or in patients with ureteral leak. However, there have been limited published studies on the rate and risk of nephrostomy tube related pyelonephritis in patients with cancer. Therefore, in this study we determined rates of nephrostomy tube related pyelonephritis and predisposing risk factors in patients with cancer. We retrospectively reviewed patients who underwent nephrostomy tube placement between September 1, 2009 and September 16, 2010 at MD Anderson Cancer Center. Patients were followed for 90 days. The primary outcome assessed was the development of nephrostomy tube related pyelonephritis and the secondary outcome was the development of asymptomatic bacteriuria. We also determined risk factors associated with pyelonephritis. Of the 200 patients analyzed 38 (19%) had pyelonephritis and 15 (7.5%) had asymptomatic bacteriuria. Of the nephrostomy tube related infections 34 cases (89%) were with the primary nephrostomy tube. Subsequently 4 of the patients who underwent nephrostomy tube exchange had an episode of pyelonephritis. Pyelonephritis developed within the first month in 19 (10%) patients. Prior urinary tract infection and neutropenia were found to be significant risk factors for pyelonephritis (p = 0.047 and 0.03, respectively). The placement of nephrostomy tubes in patients with cancer is associated with a significant rate of pyelonephritis. Neutropenia and history of urinary tract infection were significant risk factors for pyelonephritis. This finding warrants further investigation into preventive strategies to reduce the infection rate. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Imaging technologies in the diagnosis and treatment of acute pyelonephritis.

    Science.gov (United States)

    Enikeev, Dmitry V; Glybochko, Petr; Alyaev, Yuriy; Enikeev, Mikhail; Rapoport, Leonid

    2017-08-01

    The aim of this study was to evaluate the possibilities of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosing acute pyelonephritis (AP) and renal abscess. Two hundred and seven patients with AP were followed up from 2010 throughout 2015. All the patients were divided into three groups. Group 1 included 113 (54.6%) patients with acute nonobstructive pyelonephritis; group 2 included 33 (15.9%) patients with acute obstructive pyelonephritis; and group 3 included 61 (29.5%) pregnant female patients with AP.All 207 patients with AP underwent ultrasound examination of the kidneys. Computed tomography (CT) was performed in 87 patients (42.0%). MRI was performed in 14 patients (6.7%). We identified the ultrasound (US), magnetic resonance (MR), and CT-signs of acute renal inflammation at different stages of the process.The main us-signs were decreased mobility of the kidney, its enlargement, thickened parenchyma, hydrophilic parenchyma and an impairment of corticomedullary differentiation.The typical CT-signs of AP were enlargement of the kidney with its thickened parenchyma and an impairment of corticomedullary differentiation.The main MR-signs of AP were enlargement of the kidney (>12 cm lengthwise), thickened parenchyma (<2 cm in the median segment of the kidney) and an impairment of corticomedullary differentiation. Assessment of the structural and functional state of renal parenchyma and the upper urinary tract using techniques such as ultrasonography, CT, MRI contributes to more efficacious treatment of patients at different stages of AP and timely drainage with properly adjusted pathogenetic therapy at the infiltrative stage is instrumental in preventing purulent destructive forms of AP.

  14. A case of emphysematous pyelonephritis induced by Citrobacter freundii infection

    Directory of Open Access Journals (Sweden)

    Youichi Yanagawa

    2013-01-01

    Full Text Available A 79-year-old female with diabetes mellitus had general fatigue, a high fever and vomiting. A CT revealed acute emphysematous pyelonephritis (EPN. A nephrectomy was performed on the 2 nd hospital day. The results of the blood culture showed the presence of Citrobacter freundii infection. The patient′s post-operative course was uneventful. This case is the second reported case of EPN induced by Citrobacter freundii. Bacteremia induced by Citrobacter freundii infection typically results in a high mortality rate. In this case, the early diagnosis of the EPN using CT and immediate medical treatment, including urgent elective nephrectomy, were key to the favorable outcome.

  15. Are serum procalcitonin and interleukin-1 beta suitable markers for diagnosis of acute pyelonephritis in children?

    Science.gov (United States)

    Mahyar, Abolfazl; Ayazi, Parviz; Ahmadi, Reza; Daneshi-Kohan, Mohammad Mahdi; Hashemi, Hassan Jahani; Dalirani, Reza; Moshiri, Seyed Alireza; Habibi, Morteza; Sahmani, Mehdi; Sahmani, Ahmad Ali

    2014-01-01

    Rapid diagnosis of acute pyelonephritis is important because of its association with long-standing complications. This study was conducted to compare the reliability of serum procalcitonin (PCT) and interleukin-1 beta (IL-1β) with conventional laboratory parameters for diagnosis of acute pyelonephritis in children. Seventy nine children with urinary tract infection were divided into two groups based on the result of Tc-99m dimercaptosuccinic acid renal scan: acute pyelonephritis (n=33) and lower UTI (urinary tract infection) (n=46) groups. White blood cell (WBC) count, neutrophil count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), PCT and IL-1β concentrations of both groups were measured and compared. WBC count, neutrophil count, ESR, serum CRP, PCT and IL-1β concentrations were higher in acute pyelonephritis patients than in the lower UTI group (Ppyelonephritis were 31, 84.7% and 27.2, 90% respectively (using a cut-point value of 0.5 ng/ml for PCT and 6.9 pg/ml for IL-1β). The sensitivity of PCT and IL-1β for diagnosis of acute pyelonephritis was less than that of conventional markers such as ESR and CRP. This study revealed that serum PCT and IL-1β are not good biologic markers for differentiating acute pyelonephritis from lower UTI. It seems that conventional inflammatory markers such as ESR and CRP besides the clinical findings are more reliable for the diagnosis of acute pyelonephritis in children.

  16. Family History and Risk of Recurrent Cystitis and Pyelonephritis in Women

    Science.gov (United States)

    Scholes, Delia; Hawn, Thomas R.; Roberts, Pacita L.; Li, Sue S.; Stapleton, Ann E.; Zhao, Lue-Ping; Stamm, Walter E.; Hooton, Thomas M.

    2011-01-01

    Purpose Recurrent urinary tract infections and pyelonephritis have risk factors suggesting genetic sources. Family history variables indicative of genetic risk merit further investigation. We evaluated the risk of recurrent cystitis and pyelonephritis in women with and those without a family history of urinary tract infection. Materials and Methods We conducted a population based case-control study of 1,261 women 18 to 49 years old enrolled in a Northwest health plan. Participants were cases identified from plan databases with documented recurrent cystitis (431) or pyelonephritis (400). Shared controls (430) were similar age women with no urinary tract infection history. We evaluated the history of urinary tract infection and pyelonephritis in first-degree female relatives (mother, sister[s], daughter[s]) and other covariates, ascertained through questionnaires and computerized databases. Results Of the cases 70.9% with recurrent cystitis and 75.2% with pyelonephritis, and of the controls 42.4% reported a urinary tract infection history in 1 or more female relative (p pyelonephritis were 3.3 (2.2, 5.0) and 5.5 (3.4, 9.0), respectively. Conclusions In these community dwelling women a urinary tract infection history in female relatives was strongly and consistently associated with urinary tract infection recurrence and pyelonephritis. Risk estimates increased with stronger family history indices, suggesting a genetic component for increased susceptibility to these infections. PMID:20639019

  17. Renal Power Doppler Ultrasonographic Evaluation of Children With Acute Pyelonephritis

    Directory of Open Access Journals (Sweden)

    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.

  18. Amplifying renal immunity: the role of antimicrobial peptides in pyelonephritis.

    Science.gov (United States)

    Becknell, Brian; Schwaderer, Andrew; Hains, David S; Spencer, John David

    2015-11-01

    Urinary tract infections (UTIs), including pyelonephritis, are among the most common and serious infections encountered in nephrology practice. UTI risk is increased in selected patient populations with renal and urinary tract disorders. As the prevalence of antibiotic-resistant uropathogens increases, novel and alternative treatment options will be needed to reduce UTI-associated morbidity. Discoveries over the past decade demonstrate a fundamental role for the innate immune system in protecting the urothelium from bacterial challenge. Antimicrobial peptides, an integral component of this urothelial innate immune system, demonstrate potent bactericidal activity toward uropathogens and might represent a novel class of UTI therapeutics. The urothelium of the bladder and the renal epithelium secrete antimicrobial peptides into the urinary stream. In the kidney, intercalated cells--a cell-type involved in acid-base homeostasis--have been shown to be an important source of antimicrobial peptides. Intercalated cells have therefore become the focus of new investigations to explore their function during pyelonephritis and their role in maintaining urinary tract sterility. This Review provides an overview of UTI pathogenesis in the upper and lower urinary tract. We describe the role of intercalated cells and the innate immune response in preventing UTI, specifically highlighting the role of antimicrobial peptides in maintaining urinary tract sterility.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Host Response to Porcine Strains of Escherichia coli in a Novel Pyelonephritis Model

    DEFF Research Database (Denmark)

    Isling, L. K.; Aalbæk, B.; Birck, M. M.

    2011-01-01

    The initial pathology and pathogenesis of pyelonephritis and the influence of different strains of Escherichia coli were investigated in a novel porcine model. Nine female pigs were divided into three groups (A, B and C) and inoculated repeatedly into one renal pelvis with porcine pyelonephritis E...... kidneys. Gross and microscopical lesions of acute pyelonephritis were demonstrated in all but one kidney inoculated with E. coli, but in none of the control kidneys. Renal parenchymal infiltration with both neutrophils and mononuclear cells, primarily CD3+ T lymphocytes, was observed at 6hpi. Most T...

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

    Science.gov (United States)

    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.

  2. [Emphysematous pyelonephritis. Epidemiological, clinical, biological, bacteriological, radiological, therapeutic and prognostic features. Retrospective study of 30 cases].

    Science.gov (United States)

    Cherif, Mohamed; Kerkeni, Walid; Bouzouita, Abderrazak; Selmi, Mohamed Slim; Derouiche, Amine; Ben Slama, Mohamed Riadh; Chebil, Mohamed

    2012-10-01

    Emphysematous pyelonephritis is an uncommon, necrotizing bacterial infection of the kidney. It is a severe, life threatening affection. To study the epidemiological, clinical, biological, bacteriological and radiological features of this affection, and to describe its therapeutic management and prognostic characteristics. We conducted a retrospective study including 30 patients who were treated for an emphysematous pyelonephritis, in Charles Nicolle hospital department of urology, from 1987 to 2009. Emphysematous pyelonephritis generally affects adults. It is especially favored by diabetes and urinary tract obstruction. Escherichia coli is the main causative agent. Uroscan is the key of diagnosis. It is both medical and surgical emergency; the treatment combines intensive care with appropriate antibiotics and often drainage. Nephrectomy may be necessary from the outset, or after drainage failure. Prognosis is poor, with a high mortality rate (23 %), in our series. Management of emphysematous pyelonephritis poses real problems. This affection is still threatening, despite of advances in intensive care.

  3. 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...... ultrasound (2 with bilateral hydronephrosis, 3 with unilateral hydronephrosis). Conclusions: Renal DMSA/MAG3 scans are important tools when assessing differential renal function and renal parenchymal defects following a pyelonephritis.Whether to perform these investigations already after the first...

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Bilateral psoas and bilateral perinephric abscesses complicating acute pyelonephritis in pregnancy

    OpenAIRE

    2013-01-01

    Acute pyelonephritis complicates 1-2% of pregnancies and causes significant maternal and fetal morbidity and mortality. The diagnosis of renal tuberculosis (TB) is often delayed and commonly presents with sterile pyuria or along with other pyogenic organisms. We report a case where the diagnosis of renal TB was missed in a pregnant woman when she presented with acute pyelonephritis, septic shock, and acute renal failure. There was clinical recovery with antibiotics, but bilateral psoas and pe...

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

    Science.gov (United States)

    Amiri, Fateme Shamekhi; Foroughi, Alireza

    2014-11-01

    Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection. 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.

  7. The peripheral whole-blood transcriptome of acute pyelonephritis in human pregnancya.

    Science.gov (United States)

    Madan, Ichchha; Than, Nandor Gabor; Romero, Roberto; Chaemsaithong, Piya; Miranda, Jezid; Tarca, Adi L; Bhatti, Gaurav; Draghici, Sorin; Yeo, Lami; Mazor, Moshe; Hassan, Sonia S; Chaiworapongsa, Tinnakorn

    2014-01-01

    Human pregnancy is characterized by activation of the innate immune response and suppression of adaptive immunity. The former is thought to provide protection against infection for the mother, and the latter, tolerance against paternal antigens expressed in fetal cells. Acute pyelonephritis is associated with an increased risk of acute respiratory distress syndrome and sepsis in pregnant (vs. nonpregnant) women. The objective of this study was to describe the gene expression profile (transcriptome) of maternal whole blood in acute pyelonephritis. A case-control study was conducted to include pregnant women with acute pyelonephritis (n=15) and women with a normal pregnancy (n=34). Affymetrix HG-U133 Plus 2.0 arrays (Affymetrix, Santa Clara, CA, USA) were used for gene expression profiling. A linear model was used to test the association between the presence of pyelonephritis and gene expression levels while controlling for white blood cell count and gestational age. A fold change of 1.5 was considered significant at a false discovery rate of 0.1. A subset of differentially expressed genes (n=56) was tested with real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) (cases, n=19; controls, n=59). Gene ontology and pathway analyses were applied. A total of 983 genes were differentially expressed in acute pyelonephritis: 457 were upregulated and 526 were downregulated. Significant enrichment of 300 biological processes and 63 molecular functions was found in pyelonephritis. Significantly impacted pathways in pyelonephritis included (a) cytokine-cytokine receptor interaction, (b) T-cell receptor signaling, (c) Jak-STAT signaling, and (d) complement and coagulation cascades. Of 56 genes tested by qRT-PCR, 48 (85.7%) had confirmation of differential expression. This is the first study of the transcriptomic signature of whole blood in pregnant women with acute pyelonephritis. Acute infection during pregnancy is associated with the increased

  8. Detection of virulence genes in Escherichia coli isolated from patients with cystitis and pyelonephritis.

    Science.gov (United States)

    Firoozeh, Farzaneh; Saffari, Mahmood; Neamati, Foroogh; Zibaei, Mohammad

    2014-12-01

    Uropathogenic Escherichia coli (UPEC) is a common cause of ascending urinary tract infections including cystitis and pyelonephritis. The purpose of this study was to investigate virulence genes among Escherichia coli isolated from patients with cystitis and pyelonephritis. Between December 2012 and June 2013, 150 E. coli isolates from hospitalized patients with pyelonephritis (n = 72) and cystitis (n=78) were collected at Shahid Beheshti Hospital in Kashan. A PCR assay was used to evaluate the presence of virulence genes including pap, hly, aer, sfa, cnf, afa, traT, and pathogenicity island (PAI) markers in isolates. Of the total 150 UPEC isolates, 130 (86.7%) were found to carry the virulence genes studied. Nineteen different virulence patterns were identified. The most prevalent virulence pattern was UPEC including traT-PAI operons. The pap, traT, aer, hly, and PAI operons were more prevalent among patients with pyelonephritis than cystitis, and the sfa, afa, and cnf genes were not detected in any of the isolates. Higher virulence gene diversity was found among pyelonephritis UPEC isolates in comparison to cystitis UPEC isolates, showing that UPEC strains that cause pyelonephritis need more virulence factors. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Acute pyelonephritis and associated complications during pregnancy in 2006 in US hospitals.

    Science.gov (United States)

    Jolley, Jennifer A; Kim, Soojin; Wing, Deborah A

    2012-12-01

    To describe the occurrence of hospitalization for acute pyelonephritis during pregnancy and associated complications in 2006 in USA. Cases were defined as those with ICD-9-CM codes corresponding to the infections of the genitourinary tract in pregnancy and pyelonephritis in the 2006 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Additional analyses identified those cases also coupled with ICD-9-CM codes corresponding to obstetrical and medical complications. Calculations were weighted to produce national estimates and hospitalization rates were determined. Twenty-eight thousand nine hundred and twenty-three hospitalizations for pyelonephritis in pregnancy were identified. Women aged 8-19 had the highest hospitalization rate (175.06/10 000 cases) compared to other age groupings. Hispanic patients had the highest hospitalization rate of the recorded ethnicities (100.93/10 000 cases). Diabetes was a concomitant diagnosis in 3.7% of patients. Of the pregnant patients hospitalized with pyelonephritis, 3.77% had threatened preterm labor, 1.95% was diagnosed with sepsis, 0.77% had acute respiratory failure, and several deaths also occurred. The mean length of hospital stay was 2.8 days. The estimated annual cost of hospitalization for pyelonephritis in pregnancy was $263 million. Hospitalization for pyelonephritis in pregnancy is associated with recognizable characteristics including age and diabetes. Serious medical complications and even mortality can occur.

  10. Pyelonephritis during pregnancy: A cause for an acquired deficiency of protein Z

    Science.gov (United States)

    Nien, Jyh Kae; Romero, Roberto; Hoppensteadt, Debra; Erez, Offer; Espinoza, Jimmy; Soto, Eleazar; Kusanovic, Juan Pedro; Gotsch, Francesca; Kim, Chong Jai; Mittal, Pooja; Fareed, Jawed; Santolaya, Joaquin; Chaiworapongsa, Tinnakorn; Edwin, Samuel; Pineles, Beth; Hassan, Sonia

    2010-01-01

    Objective Pyelonephritis has a more severe course during pregnancy than in the non-pregnant state. This has been attributed to the increased susceptibility of pregnant women to microbial products. An acquired protein Z deficiency has been reported when there is excessive thrombin activity. The aim of this study was to determine whether pyelonephritis during pregnancy is associated with changes in maternal plasma protein Z concentrations. Study Design A cross-sectional study was conducted to compare plasma protein Z concentrations between normal pregnant women (n=71) and pregnant women with pyelonephritis (n=42). Protein Z concentrations were measured by ELISA. Parametric and non-parametric statistics were used for analysis. Results Patients with pyelonephritis had a significantly lower median plasma concentration of protein Z than did patients with normal pregnancies [median 2.14 μg/mL (0.4-3.4) vs. median 2.36 μg/mL (1.09-3.36); p=0.03]. There was no difference in the median plasma concentration of anti-protein Z antibodies between patients with pyelonephritis and those with normal pregnancies. Conclusion The median maternal plasma protein Z concentration was significantly lower in patients with pyelonephritis during pregnancy than in patients with normal pregnancies. PMID:18828054

  11. Association of interleukin-10 gene promoter polymorphisms with susceptibility to acute pyelonephritis in children.

    Science.gov (United States)

    Javor, Juraj; Králinský, Karol; Sádová, Eva; Červeňová, Oľga; Bucová, Mária; Olejárová, Michaela; Buc, Milan; Liptáková, Adriana

    2014-07-01

    Interleukin-10 (IL-10) is a potent inhibitor of leukocyte chemotaxis, bacterial killing in phagocytes and synthesis of pro-inflammatory cytokines and chemokines, and recent studies have suggested an important role for this immunoregulatory cytokine in the pathogenesis of urinary tract infections (UTIs). Therefore, the gene encoding IL-10 (IL10) is an attractive candidate for association studies attempting to identify susceptibility genes conferring risk of UTIs. In this case-control study, we aimed to investigate the association of single nucleotide polymorphisms (SNPs) in the promoter region of IL10 with acute pyelonephritis in the Slovak population. Polymerase chain reaction with sequence-specific primers was used to analyse IL10 -1082A/G (rs1800896), -819C/T (rs1800871) and -592C/A (rs1800872) SNPs in 147 children with acute pyelonephritis and 215 healthy controls. Comparison of patients with healthy controls using the logistic regression analysis revealed significantly increased risk of developing recurrent attacks of acute pyelonephritis for -1082 G allele in a dominant genetic model GG (GG + AG vs. AA, P = 0.019, odds ratio (OR) = 2.26). A similar tendency was also found when the recurrent acute pyelonephritis subgroup was compared to episodic pyelonephritis cases (GG + AG vs. AA, P = 0.009, OR = 3.38). In conclusion, our results suggest that IL10 -1082 A/G SNP is a susceptibility factor for development of recurrent attacks of acute pyelonephritis.

  12. Reverse kinetics of angiopoietin-2 and endotoxins in acute pyelonephritis: Implications for anti-inflammatory treatment?

    Science.gov (United States)

    Safioleas, Konstantinos; Giamarellos-Bourboulis, Evangelos J; Carrer, Dionyssia-Pinelopi; Pistiki, Aikaterini; Sabracos, Lambros; Deliveliotis, Charalambos; Chrisofos, Michael

    2016-05-01

    Based on former studies showing an antagonism between angiopoietin-2 (Ang-2) and bacterial endotoxins (LPS), we investigated the role of Ang-2 as immunomodulatory treatment. At first, kinetics of circulating LPS in Gram-negative pyelonephritis developing after urinary obstruction was studied. Serum LPS, interleukin (IL)-6 and Ang-2 were measured in 25 patients with acute pyelonephritis and sepsis before and after removal of the obstruction performed either with insertion of a pigtail catheter (n=12) or percutaneous drainage (n=13). At a second stage, Ang-2 was given as anti-inflammatory treatment in 40 rabbits one hour after induction of acute pyelonephritis by ligation of the ureter at the level of pelvo-ureteral junction and upstream bacterial inoculation. Survival was recorded; blood mononuclear cells were isolated and stimulated for the production of tumour necrosis factor-alpha (TNFα). The decrease in circulating LPS was significantly greater among patients undergoing drainage than pigtail insertion. This was accompanied by reciprocal changes of Ang-2 and IL-6. Treatment with Ang-2 prolonged survival from Escherichia coli pyelonephritis despite high levels of circulating LPS. When Ang-2 was given as treatment of Pseudomonas aeruginosa pyelonephritis, sepsis-induced decrease of TNFα production by circulating mononuclear cells was reversed without an effect on tissue bacterial overgrowth. It is concluded that Ang-2 and LPS follow reverse kinetics in acute pyelonephritis. When given as experimental treatment, Ang-2 prolongs survival through an effect on mononuclear cells. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Emphysematous Pyelonephritis Presenting as Necrotizing Fasciitis of the Leg

    Directory of Open Access Journals (Sweden)

    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.

  14. Challenges in preventing pyelonephritis in pregnant women in Indigenous communities.

    Science.gov (United States)

    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

  15. Immunomodulatory intervention with interferon-γ in Escherichia coli pyelonephritis.

    Science.gov (United States)

    Katsaris, Matthew P; Adamis, Theodoros; Pistiki, Aikaterini; Carrer, Dionyssia-Pinelopi; Galani, Irene; Sabracos, Labros; Droggiti, Dionyssia-Irini; Georgitsi, Marianna; Damoraki, Georgia; Giamarellos-Bourboulis, Evangelos J; Chrisofos, Michael

    2014-08-01

    We investigated the efficacy of recombinant human interferon-γ in experimental pyelonephritis due to Escherichia coli. Pyelonephritis was induced by intrapelvic inoculation of bacteria after ureteral ligation in 38 rabbits assigned to 1 of 3 groups, including group 1-16 controls, group 2-14 rabbits treated with intravenous recombinant human interferon-γ and group 3-8 rabbits treated with intravenous recombinant human interferon-γ plus amikacin. Bacterial counts, cytokines and malondialdehyde were measured in blood. Peripheral blood mononuclear cells were isolated to measure TNFα transcripts, cytokine stimulation and apoptosis. Survival was recorded, and the tissue bacterial load and myeloperoxidase activity were measured after sacrifice. The mortality rate in groups 1, 2 and 3 was 66.7%, 25% and 12.5%, respectively. The circulating bacterial count and tissue bacterial load were less in group 2 than in group 1. Circulating malondialdehyde negatively correlated with the bacterial load of the spleen. Although the number of TNFα transcripts in circulating peripheral blood mononuclear cells did not differ, peripheral blood mononuclear cells isolated from group 2 at 48 hours produced much greater concentrations of tumor necrosis factor-α after stimulation with Pam3Cys. In parallel, the apoptosis rate of circulating monocytes was increased in group 2 at 48 hours. Lung myeloperoxidase activity at 24 hours, serving as indirect evidence of neutrophil infiltration, was decreased in group 2. Recombinant human interferon-γ administration prolonged survival in rabbits with experimental E. coli urosepsis. Its action was probably related to increased bacterial phagocytosis after modulation of oxidant status and reversal of monocyte immunoparalysis. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Severe acute pyelonephritis: a review of clinical outcome and risk factors for mortality.

    Science.gov (United States)

    Chung, Vera Y; Tai, C K; Fan, C W; Tang, C N

    2014-08-01

    OBJECTIVE. To review demographics of patients with acute pyelonephritis, their outcomes of severe upper urinary tract infection, and to identify risk factors for long hospital stay and mortality. DESIGN. Case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Patients admitted between June 2007 and June 2012 for acute pyelonephritis were identified. Those with the most severe outcomes were analysed of their mortality, need for care in the intensive care unit, or necessitation of urological intervention. RESULTS. Overall, 68 patients fulfilled our criteria for severe acute pyelonephritis. The female-to-male ratio was 7:3. Their mean age was 58 years. Overall, 57% of the patients had impaired renal function and 37% were diabetic; 47% developed shock after admission and 56% required further intensive care unit care; 75% of the patients demonstrated radiological evidence of urinary tract obstruction and required subsequent drainage procedures. Five patients died due to severe acute pyelonephritis. The prevalence of bacteraemia and bacteriuria was 57% and 74%, respectively. Escherichia coli accounted for the majority of causative organisms. Four risk factors-bacteraemia, shock, need for intensive care, and suppurative pyelonephritis-were associated with hospital stay of longer than 14 days. Old age (≥65 years), male sex, deranged renal function, and presence of disseminated intravascular coagulation were associated with mortality. CONCLUSION. There was high prevalence of bacteraemia and septic shock in patients with severe acute pyelonephritis. The factors of old age (≥65 years), male sex, deranged renal function, and presence of disseminated intravascular coagulation were associated with mortality. With the support of intensive care, early recognition of urinary tract obstruction and timely drainage, patients with severe acute pyelonephritis generally carry a good prognosis.

  17. Emphysematous pyelonephritis in a diabetic patient on maintenance hemodialysis: a case report.

    Science.gov (United States)

    Hamouda, M; Aloui, S; Skhiri, H; Letaif, A; Frih, M A; Ben Dhia, N; Elmay, M

    2014-05-01

    Emphysematous pyelonephritis (EP) is an uncommon acute infection characterized by the presence of gas in the renal parenchyma. It is extremely rare in hemodialysis (HD) patients and diabetics account for most cases. It is a rapidly progressive and life threatening infection with a high mortality rate. We report a case of emphysematous pyelonephritis in a HD patient who was treated successfully with radical nephrectomy and antibiotic therapy. A 46-year-old diabetic male with end stage renal disease (ESRD) secondary to diabetic nephropathy and on maintenance HD for the last five years presented with a two weeks history of fever and loin pain. He was treated with oral ciprofloxacin for one week with no improvement. His blood culture isolated Escherichia coli. Computed tomography scan of the abdominal disclosed an enlarged left kidney with massive gaseous collections. Accordingly, the diagnosis of emphysematous pyelonephritis was put forward, the patient underwent left nephrectomy together with intravenous imipenum and amikacin with good clinical response. The removed kidney showed features of acute pyelonephritis with micro-abscesses on histopathology. . Emphysematous pyelonephritis should always be considered in diabetics presenting with fever, loin pain, and features of sepsis not responding to antibiotic therapy; even though being on dialysis. Computed tomography scan of the abdomen remains an early diagnostic tool. Early treatment with potent antibiotics with or without surgical intervention can save patients' life.

  18. Role of diffusion-weighted MRI in acute pyelonephritis: a prospective study.

    Science.gov (United States)

    Rathod, Santosh B; Kumbhar, Sachin S; Nanivadekar, Avinash; Aman, Kumar

    2015-02-01

    Imaging is vital in diagnosis of complicated pyelonephritis and has been traditionally performed by computed tomography (CT). However, CT with contrast agents cannot be performed in patients with renal failure. Diffusion-weighted (DW) magnetic resonance imaging (MRI) has the potential to overcome this disadvantage. To prospectively evaluate the accuracy of quantitative apparent diffusion coefficient (ADC) values to differentiate nephritis from renal abscesses in patients with pyelonephritis. Forty-two patients with clinical and laboratory diagnosis of pyelonephritis underwent CT and DW MRI examinations. Diffusion images were obtained by using a non-breath-hold, single-shot echo-planar sequence with b values of 0, 600, and 1000 s/mm(2). Circular regions of interest were places on areas of nephritis, normal renal parenchyma, and renal abscesses as localized by CT and DW MRI images to obtain the ADC values of each of these regions. The ADC values of these three different tissue types were statistically compared using the one-way analysis of variance test for statistical significance. A P value pyelonephritis, DW MRI had a higher sensitivity of 95.3% as compared to that of non-contrast CT (66.7%) and contrast-enhanced CT (88.1%). Areas of nephritis had significantly lower ADC values (P pyelonephritis. ADC values derived from the diffusion sequence have significantly lower values in renal abscesses than in areas of nephritis. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  19. Urinary adrenomedullin level in children with acute pyelonephritis before and after treatment.

    Science.gov (United States)

    Sharifian, Mostafa; Esmaeli Zand, Rana; Ahmadi, Mitra; Ziaee, Seyyed Ali; Mohkam, Masoomeh; Reza Dalirani, Reza Dalirani; Esfandiar, Nasrin

    2013-07-01

    Adrenomedullin (AM) is a 52-amino acid peptide that causes vasodilatation by increased synthesis of nitric oxide. Its production by different cells such as cardiac myocytes, smooth muscle, endothelial, and oncogenic cells is stimulated by inflammatory processes. It has been shown that in the presence of inflammation in the urinary system, concentration of AM increases. In this study, we measured urinary AM in children with acute pyelonephritis before and after treatment and compared its level with that in healthy children. In a case-control study, 31 children with clinical and paraclinical documentation of pyelonephritis (case group) and 30 healthy children without pyelonephritis or other infections (control group) were studied. Urinary AM were measured on spot urine samples by high-performance liquid chromatography, and creatinine was measured by spectrophotometry to report the AM-creatinine ratio. Urinary AM-creatinine ratios were 61.3 +/- 119.4 pg/mg and 4.26 +/- 11.4 pg/mg, respectively, in the case and control groups (P = .01). After treatment of pyelonephritis in the patients of the case group, this ratio decreased to 13.1 +/- 21.9 (P = .048). The coefficient correlation between urinary AM and leukocytes count was 0.252 (P = .17). Urinary AM levels were 1896 +/- 1748 pg/dL and 391 +/- 477 pg/dL in the patients with 4+ versus negative C-reactive protein levels, respectively (P = .008). Urinary AM increases in the course of pyelonephritis and decreases significantly after treatment.

  20. [Prognostic factors of morbimortality in patients with emphysematous pyelonephritis].

    Science.gov (United States)

    Torres-Mercado, León Octavio; García-Padilla, Miguel Ángel; Serrano-Brambila, Eduardo; Maldonado-Alcaraz, Efraín; López-Sámano, Virgilio Augusto; Montoya-Martínez, Guillermo; Moreno-Palacios, Jorge

    2016-01-01

    Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN. It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome. 73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p <0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p <0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p < 0.001) were factors significantly associated with adverse outcome. Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.

  1. Оptimization of pharmacotherapy of osteopenia in children with chronic pyelonephritis

    Directory of Open Access Journals (Sweden)

    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

  2. Plasmatic presepsin (sCD14-ST) concentrations in acute pyelonephritis in adult patients.

    Science.gov (United States)

    Claessens, Yann-Erick; Trabattoni, Eloise; Grabar, Sophie; Quinquis, Laurent; Der Sahakian, Guillaume; Anselmo, Marine; Schmidt, Jeannot; de la Coussaye, Jean-Emmanuel; Plaisance, Patrick; Casalino, Enrique; Potel, Gilles; Lecomte, François; Borderie, Didier; Chenevier-Gobeaux, Camille

    2017-01-01

    Presepsin (sCD14-ST) is an emerging biomarker for infection. We hypothesized that presepsin could specifically increase during acute pyelonephritis and correlate with severity. We compared presepsin values in patients with acute pyelonephritis and controls, and we assessed its capacity to predict bacteraemia and admission in patients. In 312 patients with acute pyelonephritis (median age 33years), presepsin concentrations were higher than in controls (476 vs 200ng/L, ppyelonephritis patients with bacteraemia (614 vs. 461ng/L, p,=0.001) and in those requiring admission (614ng/L vs. 320ng/L, ppyelonephritis. However, it presents mild performance to predict bacteraemia and the need for admission, and offers no advantage as compared to CRP and PCT. Copyright © 2016 Elsevier B.V. All rights reserved.

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

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    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.

  4. Clinical Significances of {sup 99m}Tc-DMSA Renal Scan in Patients with Acute Pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Mok, Cha Soo; Shin, Dong Jin; Choi, Ho Cheon; Kim, Gyeong Wook; Yi, Gang Wook; Choi, Dae Seop [Sang Ae General Hospital, Seoul (Korea, Republic of)

    1989-07-15

    Patients with acute pyleonephritis may present with a spectrum of clinical symptoms and signs. There are few noninvasive diagnostic studies, however to confirm or exclude this diagnosis. To evaluate the clinical utility of {sup 99m}Tc-DMSA renal scan in diagnosis of acute pyelonephritis, we performed {sup 99m}Tc-DMSA renal scan in 37 patients suspected with urinary tract infection. Simultaneously kidney ultrasonography was done in 21 patients diagnosed with acute pyelonephritis, clinically. And we performed the followup scan after treatment in two to six weeks. The results were as follows. 1) {sup 99m}Tc-DMSA renal scan disclosed single of multiple cortical defects and decreased radiouptake ratio of affected kidney in 23 patients among 25 patients diagnosed with acute pyleonephritis. 2) In the 21 patients with acute pyelonephritis, kidney ultrasonography showed abnormal findings in the 7 patients. And {sup 99m}Tc-DMSA renal scan disclosed abnormal cortical defects in this 7 patients also. 3) Between the patients with acute pyelonephritis and those with lower urinary tract infection, asymptomatic bacteriuria or pyuria, right-to-left radiouptake ratios (R/L ratio ) were significantly different(p<0.001). 4) In two to six weeks after antibiotic therapy, we performed followup {sup 99m}Tc-DMSA renal scan for 5 patients among 25 acute pyelonephritis patients. And we have found the improvement of cortical defects and the right-to-left radiouptake ratio. In conclusion, we thought that {sup 99m}Tc-DMSA renal scan should be useful in diagnosis of acute pyelonephritis and follow up examination.

  5. 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

  6. Virulence determinants, phylogenetic groups and fluoroquinolone resistance in Escherichia coli isolated from cystitis and pyelonephritis.

    Science.gov (United States)

    Ferjani, S; Saidani, M; Ennigrou, S; Hsairi, M; Ben Redjeb, S

    2012-10-01

    The aim of this study is to assess the relation between virulence genotype, phylogenetic group and susceptibility to fluoroquinolones and the urinary tract infection type including pyelonephritis and cystitis due to Escherichia coli. Between 2006 and 2007, 129 non-duplicate E. coli isolates from pyelonephritis (n=56) and cystitis (n=73) were prospectively collected. The antibiotic susceptibility was done by disk diffusion method. The phylogenetic groups, A, B1, B2 and D and 18 virulence genes were determined by multiplex PCR. Statistical analysis was done with the Pearson χ2 test, Mann-Whitney U-test, Kruskal-Wallis test and stepwise multivariable logistic regression analysis, P values below 0.05 were considered statistically significant. For the pyelonephritis group, sex ratio was 0.3, the median age for women was 30 years and for men it was 54 years. For the cystitis group, sex ratio was 0.4, the median age for women was 41.5 years and for men it was 67.8 years. Significant statistical correlations were found between pyelonephritis isolates and susceptibility to ciprofloxacin (P=4 10(-5)), papG allele II (P=2 10(-6)), hlyA (P=10(-03)), iroN (P=0.04), iha (P=0.03) and ompT (P=0.03) virulence genes, high virulence score (P=0.008) and B2 phylogenetic group (P=0.03). In multivariate logistic regression analysis, papG II as predictor of pyelonephritis, no correlation could be established for the cystitis group. Our findings argue for a direct link between pyelonephritis, virulence factors, susceptibility to fluroquinolones and B2 phylogenetic group among uropthogenic E. coli. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  7. 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.

  8. Maternal Plasma Retinol Binding Protein 4 in Acute Pyelonephritis during Pregnancy

    Science.gov (United States)

    Vaisbuch, Edi; Romero, Roberto; Mazaki-Tovi, Shali; Kusanovic, Juan Pedro; Chaiworapongsa, Tinnakorn; Dong, Zhong; Kim, Sun Kwon; Ogge, Giovanna; Gervasi, Maria Teresa; Hassan, Sonia S.

    2010-01-01

    Objective Adipokines have been implicated in metabolic regulation and the immune response thus providing a molecular mechanism for the interaction between these two systems. Retinol binding protein 4 (RBP4) is a novel adipokine that plays a role in the pathophysiology of obesity-induced insulin resistance, as well as in the modulation of inflammation. The aim of this study was to determine whether there are changes in maternal plasma concentrations of RBP4 in pregnant women with acute pyelonephritis. Study design This cross-sectional study included pregnant women in the following groups: 1) normal pregnancy (n=80); 2) pyelonephritis (n=39). Maternal plasma RBP4 concentrations were determined by enzyme-linked immunoassays. Non-parametric statistics were used for analyses. Results 1) The median maternal plasma RBP4 concentration was lower in patients with acute pyelonephritis than in those with a normal pregnancy (3709.6 ng/mL, IQR 2917.7-5484.2 vs. 9167.6 ng/mL, IQR 7496.1-10384.1, ppyelonephritis who had a positive blood culture and those with a negative culture (3285.3 ng/mL, IQR 2274.1-4741.1 vs. 3922.6 ng/mL, IQR 3126.8-5547.1, respectively, p=0.2); and 3) lower maternal plasma RBP4 concentrations were independently associated with pyelonephritis after adjustment for confounding factors. Conclusions In contrast to what has been reported in preeclampsia, acute pyelonephritis during pregnancy is associated with lower maternal plasma RBP4 concentrations than in normal pregnancy. This finding suggests that the acute maternal inflammatory process associated with pyelonephritis is fundamentally different from that of the chronic systemic inflammatory process suggested in preeclampsia, in which RBP4 concentrations were found to be elevated. PMID:20163326

  9. An uncommon cause of postpartum renal failure--bilateral emphysematous pyelonephritis.

    Science.gov (United States)

    Kumar, Naresh; Singh, Narinder Pal; Mittal, Amit; Valson, Anna T; Hira, Harmanjeet Singh

    2009-01-01

    Peripartum acute renal failure is an important complication related to pregnancy leading to significant morbidity and mortality. Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma, with formation of gas within the collecting system, renal parenchyma, or perirenal tissues. EPN is common in persons with diabetes or urinary tract obstruction. Herein we report a case of bilateral emphysematous pyelonephritis in a postpartum lady who had no evidence of diabetes or urinary tract obstruction. Management of this condition has traditionally been aggressive, and surgery has been considered mandatory. Our patient was managed successfully with antibiotics and supportive measures alone.

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

    Directory of Open Access Journals (Sweden)

    G.Yu. Zvenigorodska

    2013-11-01

    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.

  11. Emphysematous pyelonephritis treated with elective nephrectomy in a 75-year-old diabetic patient

    Directory of Open Access Journals (Sweden)

    Yayi He

    2012-01-01

    Full Text Available We present a case of 75-year-old man with type 2 diabetes and emphysematous pyelonephritis (EPN. The patient presented with abdominal pain, fever of undetermined origin and progressive decrease in urine output. Computerized tomography scan revealed gas formation in the left renal parenchyma and capsule. A left nephrectomy was performed. He made a quick recovery. EPN should be taken into consideration in diabetic patients with symptoms of pyelonephritis who show a poor response to conventional treatment. Elective nephrectomy may be life saving in some patients.

  12. Emphysematous pyelonephritis: A 10-year experience with 26 cases

    Science.gov (United States)

    Misgar, Raiz Ahmad; Mubarik, Idrees; Wani, Arshad Iqbal; Bashir, Mir Iftikhar; Ramzan, Mahroosa; Laway, Bashir Ahmad

    2016-01-01

    Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection which results in gas within the renal parenchyma, collecting system, or perinephric tissue. A majority of cases occur in patients with diabetes mellitus (DM). In EPN, early aggressive medical treatment may avoid nephrectomy. Aims: The aim of this study was to analyze the characteristics of patients with EPN with respect to patient demographics, clinical presentation, diagnostic investigations, microbiological findings, treatment modality and outcome, and the influence of prognostic factors on the outcome. Materials and Methods: We reviewed the hospital records of 26 patients with EPN for clinical, laboratory, radiological, and microbiological findings, treatments given, and outcome. The severity of EPN was graded as per the Huang classification. We applied the reported prognostic factors to our patients to find out whether these factors correlated with failure of conservative treatment. Results: All the study subjects had DM and all but two of them were females. The majority of our patients (61.5%) had extensive EPN (class 3 or 4) and majority (76.9%) had two or more bad prognostic factors. Escherichia coli was the most common causative organism involved in 50% of our cases. Twenty-three (88.5%) of our patients responded to conservative treatment, two required nephrectomy, and one expired on conservative treatment. Conclusions: In this series of patients with EPN, all had DM, nearly all were women, and E. coli was the most frequently isolated pathogen. Nearly a third of our patients had bilateral disease. Despite the presence of two or more bad prognostic factors and extensive EPN (class 3 or 4) in a majority of our patients, conservative treatment afforded a striking success rate of 88.5%. We recommend early aggressive medical treatment and suggest that nephrectomy should be considered only if patients deteriorate or do not improve on conservative treatment. PMID:27366713

  13. Pathology of emphysematous pyelonephritis: A study of 11 cases

    Directory of Open Access Journals (Sweden)

    Archana Laxman Khade

    2016-01-01

    Full Text Available Objective: The objective was to study the pathological features of emphysematous pyelonephritis (EPN. Materials and Methods: A total of 11 nephrectomy specimens of EPN received in the surgical pathology section of a tertiary hospital in a metropolis city during the period 2005-2014 are included in this study. Clinical details were obtained from the patients′ records. All the patients had undergone total nephrectomy. All the specimens were fixed in 10% buffered formalin and processed for paraffin wax sectioning. The sections were stained with hematoxylin and eosin stain. Results: The most common symptoms were fever and costovertebral pain. Diabetes mellitus was present in 9 out of 11 cases and one case had calculus in the pelvis. One patient had underlying diabetes which was undiagnosed during the nephrectomy. Diagnosis of EPN was confirmed by the presence of gas and fluid in the renal tissue by computed tomography. The left kidney (nine cases, 81% was more frequently affected than the right kidney (two cases, 19%. EPN occurred in 40-60 years of age (mean age 51.5%, and out of 11 patients, 8 (81% were female. Escherichia coli was the commonly isolated organism from urine. Eight cases were of Type II EPN and three cases were Type I EPN. Histopathologic examination of all the cases of EPN showed acute suppurative (necrotizing inflammation of renal parenchyma and perirenal tissues associated with vasculitis of vessels and infarction. Conclusion: EPN is most commonly seen in patients with diabetes mellitus, and E. coli is the most common causative organism.

  14. [Xanthogranulomatous pyelonephritis: conservative therapy in the para-nephritic stage. Apropos of a case].

    Science.gov (United States)

    Ferretti, S; Peracchia, G; Larosa, M; Cortellini, P

    1996-09-01

    Xantogranulomatous pyelonephritis is a rare disease, occuring most frequently in middle-aged woman. The patients usually present with recurrent fever, dysuria, renal colic or aspecific findings. We report a case of focal PXG (paranephric stage) treated with conservative surgery. Generally, treatment consists of nephrectomy for diffuse or advanced stage diseases, excision of the diseased renal segment for localized and low/high stage.

  15. [Acute Pyelonephritis and Candidemia Due to Candida lusitaniae: A Case Report].

    Science.gov (United States)

    Tsuboi, Motoyuki; Uno, Shunsuke; Hase, Ryota; Yano, Yudai; Sando, Eiichiro; Otsuka, Yoshihito; Hosokawa, Naoto

    2016-03-01

    Although candiduria is becoming increasingly common among hospitalized patients, Candida lusitaniae is a rare pathogen that account for less than 1% of Candida species isolated from urine. Ascending pyelonephritis and candidemia due to Candida species are uncommon complications. We report herein on a case of acute pyelonephritis and candidemia due to C. lusitaniae. A 66-year-old man presented with a high fever during hospitalization at our hospital following septic shock due to ischial osteomyelitis treated with tazobactam/piperacillin for 29 days. We suspected acute pyelonephritis, and urinary Gram staining showed only yeasts and leucocytes. The next day, blood culture and urine culture tested positive and showed yeast-like fungi. We diagnosed acute pyelonephritis and candidemia due to Candida species and started treatment with fluconazole. C. lusitaniae was identified on the hospital day 34 and treated with fluconazole for 14 days. Candida albicans was the most prevalent species isolated from the urinary tract, however non-albicans Candida species have emerged and are now dominant because of the advent and increasing use of fluconazole. C. lusitaniae is a rare but important pathogen, that is generally susceptible to fluconazole and resistant to amphotericin B. It is necessary to choose an appropriately effective antifungal drug based on identification of the fungal species.

  16. [Acute pyelonephritis associated with intestinal dysbacteriosis: incidence and enhancement of efficiency of treatment].

    Science.gov (United States)

    Ukhal', E M; Ukhal', M I

    2000-09-01

    A study was made on the incidence rate of acute pyelonephritis associated with intestinal dysbacteriosis in urological patients (n = 68). Prehospitalization and precombined-treatment duration of the illness came up to one to four days. It has been ascertained as a result of the conducted study that under present ecological conditions, acute pyelonephritis runs its course in the presence in patients of dysbacteriosis of the intestines even before the start of treatment in an urological clinic setting. Antibacterial treatment of patients with acute pyelonephritis without simultaneous action on the pathogenic intestinal microflora and normalization of colonizing normoflora was found to produce profound aggravation of dysbacteriosis and to result in the development of candidasis. Extermination with the aid of the intestinal antibiotic intetrix of the pathogenic microflora in the intestines together with achieving of normalization of intestinal normoflora by way of the enteral intake by patients with acute pyelonephritis of eubiotics permit the marked improvement to be achieved in results of combined treatment thereof.

  17. Co-existing malakoplakia and xanthogranulomatous pyelonephritis of kidney: Two different spectrum of same disease process

    Directory of Open Access Journals (Sweden)

    Debi Prasad Das

    2016-01-01

    Full Text Available Xanthogranulomatous pyelonephritis (XGP and malakoplakia (MKP are chronic inflammatory condition of kidney characterized by infiltration of inflammatory cells. We are presenting a rare case of concomitant XGP and MKP in the same kidney. This signifies that the two are different spectrums of the same disease process.

  18. Bilateral emphysematous pyelonephritis resolving to medical therapy: demonstration by US and CT

    Energy Technology Data Exchange (ETDEWEB)

    Grozel, F. [Centre Hospitalier Lyon Sud, Services de Radiologie A et B, F-69 310 Pierre Benite (France); Berthezene, Y. [Centre Hospitalier Lyon Sud, Services de Radiologie A et B, F-69 310 Pierre Benite (France); Guerin, C. [Centre Hospitalier Lyon Sud, Reanimation Medicale Sud, F-69 310 Pierre Benite (France); Tran-Minh, V.A. [Centre Hospitalier Lyon Sud, Services de Radiologie A et B, F-69 310 Pierre Benite (France); Croisille, M. [Centre Hospitalier Lyon Sud, Services de Radiologie A et B, F-69 310 Pierre Benite (France)

    1997-08-01

    Emphysematous pyelonephritis (EPN) is an uncommon and life-threatening necrotizing infection of the renal parenchyma occurring mostly in diabetic patients. It is usually unilateral. Nephrectomy is the current therapeutic procedure. We report the plain radiograph, US and CT findings in a 26-year-old diabetic woman who presented with bilateral EPN and was cured by medical treatment alone. (orig.). With 5 figs.

  19. Atypical cystic manifestation of acute pyelonephritis on initial ultrasonographic examination: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Eun Jeong; Kim, Kyeong Ah; Park, Cheol Min; Lee, Jean Hwa; Choi, Jae Woong; Seol, Hae Young [Korea University College of Medicine, Seoul (Korea, Republic of)

    2003-09-15

    We present a case of acute pyelonephritis with an atypical imaging manifestation mimicking renal cyst on initial ultrasonogram (US). On follow-up US, this cyst mimicking lesion transformed to a mass with heterogeneous echo and then disappeared completely following treatment.

  20. Renal infarction versus pyelonephritis in a woman presenting with fever and flank pain.

    Science.gov (United States)

    Piccoli, Giorgina B; Priola, Adriano M; Vigotti, Federica N; Guzzo, Gabriella; Veltri, Andrea

    2014-08-01

    Patients with fever, flank pain, and dysuria frequently are encountered in the emergency department. Acute pyelonephritis is the most likely diagnosis; however, its clinical and radiologic presentation consistently overlap with that of acute renal infarction. Ultrasound is unable to distinguish early infarction from nonabscessed acute pyelonephritis. Hence, computed tomography or magnetic resonance imaging are needed. We report the case of a 68-year-old woman who presented with fever, flank pain, and dysuria, along with respiratory distress and tachycardia. Elevated values for inflammatory indexes suggested a diagnosis of acute pyelonephritis, and subsequent contrast-enhanced computed tomography showed hypodense wedge-shaped areas in both kidneys. However, the presence of a thin rim of capsular enhancement (cortical rim sign), the absence of perirenal inflammatory changes, and the location of the lesions apart from defined calyces suggested the alternative diagnosis of renal infarction. The underlying cause was not identified until an episode of acute dyspnea revealed paroxysmal arrhythmia. Our case demonstrates that a thorough knowledge of the imaging findings of renal infarction and acute pyelonephritis is essential to correctly making the diagnosis. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  1. Etiological agents and antimicrobial susceptibility in hospitalized children with acute pyelonephritis.

    Science.gov (United States)

    Flor-de-Lima, Filipa; Martins, Tânia; Teixeira, Ana; Pinto, Helena; Botelho-Moniz, Edgar; Caldas-Afonso, Alberto

    2015-01-01

    Antibiotic resistance driven by antibiotic use remains a major public health and professional concern. Our aim was to know the local prevalence of uropathogens and their antimicrobial susceptibility profile in acute pyelonephritis. A prospective study of patients admitted in a level III Pediatric Department ward with acute pyelonephritis from 1994 to 2012 was performed in Northern Portugal. Etiological agents and their antimicrobial sensitivity profile were evaluated in four timed periods (G1: 1994-97; G2: 2002; G3: 2007; G4: 2012). We evaluated 581 patients, 66% female with median age 22 months. Escherichia coli was the leading uropathogen and its prevalence remained stable during the last 18 years. It showed an increased sensitivity to amoxicillin-clavulanate from 71% in G1 to 81.5% in G4 (p = 0.001) and a decreased resistance rate from 8.7% in G1 to 2.8% in G4 (p = 0.008). Its sensitivity to 2nd and 3rd generation cephalosporin was more than 90% (p = ns) and more than 95% to nitrofurantoin (p = ns). Resistance rate of cotrimoxazole increased from 22% to 26% (p = 0.008). Escherichia coli remains the main uropathogen responsible for acute pyelonephritis, reason why its antimicrobial sensitivity profile will determine the empirical therapeutic choice. Amoxicillin-clavulanate remains a good first-line choice for empirical treatment of acute pyelonephritis in our inpatient health care.

  2. [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.

  3. 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

    type when it comes to human isolates. However, relatively little has been done to characterise the corresponding porcine strains. On this background we have analysed 20 porcine pyelonephritis E coli strains isolated from infected pig kidneys. The strains were quite distinct from that of human...

  4. Pyelonephritis: what are the present day causative organisms and antibiotic susceptibilities?

    Science.gov (United States)

    Prabhu, Ajay; Taylor, Peter; Konecny, Pam; Brown, Mark A

    2013-06-01

    Infections of the lower urinary tract and acute pyelonephritis are commonly encountered in clinical practice. Widespread usage of antibiotics and changing susceptibility profiles of uropathogens requires regular review of treatment guidelines to meet these challenges. We aimed to better understand the prevalence of uropathogens and emerging antibiotic resistance in patients with pyelonephritis requiring hospital admission. In this single centre, 12-year retrospective observational study, we reviewed case notes and urine culture results of 249 patients admitted with acute pyelonephritis under the care of the nephrology department, along with 46,660 urine samples with positive isolates from the emergency department (ED) during the same period. The prevalence of uropathogens, their antibiotic susceptibilities and emerging resistance patterns to commonly used antibiotics were studied. Antibiotic susceptibilities were also reviewed in line with the currently recommended national guidelines for empiric therapy. We found the most prevalent uropathogen to be Escherichia coli. Approximately 50% of E. coli infections were resistant to ampicillin. First and third generation cephalosporin resistance was pyelonephritis. Antibiotic resistance of uropathogens to commonly used antibiotics is increasing with time and there is a need for hospitals to review their recommended guidelines for empiric therapy in line with local patterns of uropathogens and antibiotic susceptibilities. © 2013 The Authors. Nephrology © 2013 Asian Pacific Society of Nephrology.

  5. Acute Graft Pyelonephritis Occurring up to 30 Days After Kidney Transplantation: Epidemiology, Risk Factors, and Survival.

    Science.gov (United States)

    Kroth, L V; Barreiro, F F; Saitovitch, D; Traesel, M A; d'Avila, D O L; Poli-de-Figueiredo, C E

    2016-09-01

    Acute graft pyelonephritis is a very common infection in renal transplantation. The impact of acute graft pyelonephritis (AGPN) on graft and patient outcome has not yet been established. Eight hundred seventy kidney and kidney-pancreas transplants were retrospectively studied, over last 13 years, to verify occurrence of AGPN in the first 30 days post-transplantation. We found that 112 patients (15.8%) presented post-transplantatiom AGPN up to 30 days after a kidney transplantation. The occurrence was higher in older patients (P = .005) and in those with ureteral stents (P = .06). Escherichia coli was the most frequent microorganism in urine cultures (32%). Ureteral stent (relative risk = 1.7; confidence interval [CI], 1.1-2.5; P = .018) was a major risk factor for AGPN as well as older ages (RR = 1.02; CI 1.01-1.04; P = .001), length of hospitalization stay (RR = 1.01; CI, 1.01-1.02; P pyelonephritis in the first 30 days after transplantation (OR 1.43; 95% CI, 0.95-2.16; P = .024 and OR 1.77; 95% CI, 1.12-2.80; P = .006, respectively). Acute pyelonephritis in the first 30 days after transplantation is therefore associated with a lower long-term graft and patient survival. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Xanthogranulomatous pyelonephritis: MRI findings in the diffuse and the focal type

    Energy Technology Data Exchange (ETDEWEB)

    Verswijvel, G.; Oyen, R. [Catholic Univ. of Leuven (Belgium). Univ. Hospitals Gasthuisberg, Dept. of Radiology; Poppel, H. van [Catholic Univ. of Leuven (Belgium). Univ. Hospitals Gasthuisberg, Dept of Urology; Roskams, T. [Catholic Univ. of Leuven (Belgium). Univ. Hospitals Gasthuisberg, Dept. of Pathology

    2000-04-01

    Two cases of xanthogranulomatous pyelonephritis (XGP) are presented with emphasis on MR appearances. One case is the diffuse type of XGP secondary to chronic obstruction caused by transitional cell carcinoma of the renal pelvis. The other case is the focal or 'tumefactive' type of XGP which mimics renal cell carcinoma. (orig.)

  7. Diagnostic and Treatment Difficulties of Pyelonephritis in Pregnancy in Resource-Limited Settings

    Science.gov (United States)

    McGready, Rose; Wuthiekanun, Vanaporn; Ashley, Elizabeth A.; Tan, Saw Oo; Pimanpanarak, Mupawjay; Viladpai-nguen, Samuel Jacher; Jesadapanpong, Wilarat; Blacksell, Stuart D.; Proux, Stephane; Day, Nicholas P.; Singhasivanon, Pratap; White, Nicholas J.; Nosten, François; Peacock, Sharon J.

    2010-01-01

    Limited microbiology services impede adequate diagnosis and treatment of common infections such as pyelonephritis in resource-limited settings. Febrile pregnant women attending antenatal clinics at Shoklo Malaria Research Unit were offered urine dipstick, sediment microscopy, urine culture, and a 5-mL blood culture. The incidence of pyelonephritis was 11/1,000 deliveries (N = 53 in 4,819 pregnancies) between January 7, 2004 and May 17, 2006. Pyelonephritis accounted for 20.2% (41/203) of fever cases in pregnancy. Escherichia coli was the most commonly isolated pathogen: 87.5% (28/32) of organisms cultured. Susceptibility of E. coli to ampicillin (14%), cotrimoxazole (21%), and amoxicillin-clavulanic acid (48%) was very low. E. coli was susceptible to ceftriaxone and ciprofloxacin. The rate of extended spectrum β-lactamase (4.2%; 95% confidence interval = 0.7–19.5) was low. The rate and causes of pyelonephritis in pregnant refugee and migrant women were comparable with those described in developed countries. Diagnostic innovation in microbiology that permits affordable access is a high priority for resource-poor settings. PMID:21118943

  8. Tc-99m Dimercaptosuccinic Acid (DMSA) Renal Scintigraphy in Patients with Acute Pyelonephritis

    Science.gov (United States)

    Lee, Kang Wook; Bin, Ki Tae; Jeong, Min Soo; Shong, Min Ho; Shin, Young Tai; Ro, Heung Kyu

    1995-01-01

    Objectives Recently, several authors reported that Tc-99m DMSA renal scan frequently showed cortical defects of the involved kidneys even in the patients with acute pyelonephritis who did not show abnormal findings in the ultrasonography and intravenous pyelography IVP). Methods In order to evaluate the utilities of Tc-99m DMSA renal scan and the clinical meanig of cortical defects in the Tc-99m DMSA renal scan of the patients with acute pyelonephritis, ninety two patients with acute pyelonephritis, from March 1991 to February 1994 in Chungnam National University Hospital(CNUH), were included in this study. Patients were subdivided as Group A:Patients showing normal Tc-99m DMSA renal scan(n=42) and Group B:Patients with definit cortical defects on the Tc-99m DMSA renal scan(n=50). We compared clinical characteristics such as age and sex, recurrency, duration of fever, bacterial culture study, incidence of renal insufficiency and the results of renal ultrasonography and intravenous pyelography between the two groups. Results Fifty four percents of 92 patients with acute pyelonephritis showed a significantly longer febrile period after admission, higher positive rates on the urine and blood culture studies and higher incidence of renal insufficiency than those of the Group A patients. Sixty nine percents of Group B patients showed normal results in ultrasonography or IVP study. Conclusions Tc-99m DMSA renal scan was a more sensitive imaging test than ultrasonography in kidneys and IVP to detect pyelonephritis lesions and may be useful to predict the patient group with a severe disease course. These patients may need more careful management and further studies to evaluate the possibility of complications. PMID:7626556

  9. CT of acute pyelonephritis in children : comparison with Tc-99m DMSA scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Wha; Baek, Seung Yeon; Lee, Seung Joo [Ewha University, Seoul (Korea, Republic of). Coll. of Medicine

    1998-05-01

    The purpose of the study was to compare CT with scintigraphy in the detection of parenchymal lesions of acute pyeolonephritis in children, and to assess the diagnostic value of CT. This study involved 32 children with acute pyelonephritis; their ages ranged from 1 month to 10 years. Renal Ct, Tc-99m DMSA planar and SPECT images, and medical records were retrospectively reviewed. We evaluated the number, size, shape, density, and location of pyelonephritis lesions, as seen on CT and scintigraphic images. In 43 involved kidneys, 193 parenchymal lesions of acute pyelonephritis were identified. The results of CT were abnormal in 42 kidneys (98%), and those of scintigraphy , in 39 (91%). CT showed single or multiple hypoenhancing parenchymal lesions; these were streaky (n=151), wedge-shaped (n=34), or oval (n=8), and ranged from about 3 - 30 mm in maximum diameter. Abscess (n=5), renal fascial thickening (n=6) and thickening of the bridging septae (n=7) were associated. Scintigraphic findings were more precisely identified on SPECT than on planar images. For the detection of 55 of 193 pyelonephritis lesions, CT was more sensitive than scintigraphy; 29 of the 55 lesions were less than 5 mm in diameter. For the detection of phyelonephritic lesions, particularly smaller ones, and for the evaluation of complications such as abscess formation, CT is more sensitive than Tc-99m DMSA scintigraphy. We conclude that in children with subtle scintigraphic findings who are in serious clinical condition or in whom complications are suspected, CT is a useful tool for assessing a therapeutic plan and the prognosis of acute pyelonephritis. (author). 19 refs., 1 tab., 4 figs.

  10. Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?

    Science.gov (United States)

    Salomonsson, Petra; von Linstow, Marie-Louise; Knudsen, Jenny Dahl; Heiberg, Ida; Mola, Gylli; Wenger, Therese Ramstad; Cortes, Dina; Nygaard, Ulrikka

    2016-10-01

    Pyelonephritis is a common infection in childhood and may cause renal scarring. The aim was to determine an effective oral antibiotic treatment of first time pyelonephritis in children. The study is a retrospective analysis of positive urine cultures collected at a Danish paediatric department from 2010-2013. Urine samples from 378 children aged 0-15.9 years, without renal anomalies and treated for first time pyelonephritis, were included. The urine pathogens and antimicrobial susceptibilities were analysed. The most common aetiologic agents found were Escherichia coli (85%), Klebsiella species and other Enterobacteriaecea (9.7%) and Enterococcus species (5.3%). Escherichia coli was significantly more common in girls than in boys (90% vs 74%, p pyelonephritis in Danish children from 6 months of age. Age and gender of patients should be taken into consideration when initiating empirical treatment.

  11. Acute bilateral emphysematous pyelonephritis successfully managed by medical therapy alone: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Calleja Juan

    2002-06-01

    Full Text Available Abstract Background Bilateral emphysematous pyelonephritis is a life threatening condition usually occurring in diabetics. Management of this condition has traditionally been aggressive and surgery is considered mandatory. However, this is itself a hazardous intervention in a septic, unstable patient with circulatory or liver failure. When bilateral disease is present, the need for long-term dialysis is obviously unavoidable. Case presentation We herein report one of the few cases of bilateral emphysematous pyelonephritis successfully managed by non-surgical treatment.

  12. {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.

  13. Medial pathway patterns of the right retromesenteric plane: anatomical investigation using MDCT in patients with acute pancreatitis and pyelonephritis.

    Science.gov (United States)

    Takaji, Ryo; Mori, Hiromu; Yamada, Yasunari; Kiyonaga, Maki; Matsumoto, Shunro

    2016-01-01

    To investigate the medial pathways of the right retromesenteric plane by reviewing multidetector CT (MDCT) findings in patients with acute pancreatitis and pyelonephritis. 112 patients with acute pancreatitis and 114 patients with pyelonephritis underwent MDCT scans. 64 of the 112 patients with acute pancreatitis and 34 of the 114 patients with pyelonephritis had right retromesenteric plane thickening because of inflammatory extensions. The medial pathways of the right retromesenteric plane were evaluated by two radiologists in consensus. In 18 (28%) of the 64 patients with acute pancreatitis and 10 (29%) of the 34 patients with pyelonephritis, the right retromesenteric plane continued to the central retroperitoneum behind the descending duodenum and pancreatic head (Type 1 pathway). The right retromesenteric plane extended to the right wall of the descending duodenum (Type 2 pathway) in 46 patients (72%) with acute pancreatitis and 24 patients (71%) with pyelonephritis. There was no significant difference in the pathway patterns of the right retromesenteric plane between the acute pancreatitis group and the pyelonephritis group (Type 1 pathway, p = 0.89; Type 2 pathway, p = 0.76). Two patterns were confirmed regarding the medial pathways of the right retromesenteric plane; this anatomical knowledge is important for evaluating the extension of retroperitoneal diseases. Medial aspect of the right retromesenteric plane is thought to have two pathways. The right retromesenteric plane continuing to the right duodenal wall is a common type. Knowledge of these variations is important when evaluating the retroperitoneal diseases.

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

    Directory of Open Access Journals (Sweden)

    Abolfazl Mahyar

    2013-05-01

    Full Text Available &lt;b&gt;Purpose:&lt;/b&gt; 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. &lt;b&gt;Methods:&lt;/b&gt; 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 . &lt;b&gt;Results:&lt;/b&gt; There was a significant difference between two groups regarding WBC count, Neutl count, ESR, and CRP concentration (P&lt;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. &lt;b&gt;Conclusion:&lt;/b&gt; 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.

  15. PECULIARITIES OF HLA-PHENOTYPES IN PATIENTS WITH PYELONEPHRITIS

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    Haiseniuk F

    2016-12-01

    Full Text Available Introduction. Of great interest are the studies on the role of human leucocyte antigens (HLA in pathogenesis of a disease. The kidneys is vulnerable to injury in the context of inflammatory responses, with the potential involvement of a number of different inflammatory processes. There are shown the associative links of the HLA antigens which stipulate the relative and attributive risks of some autoimmune diseases, with immune disorder and high production of pro-inflammatory cytokines, that confirms their important role in immunopathogenesis. The aim was to determine the value of some HLA in the development of such important desease as pyelo- and glomerulonephritis. Material and Methods. The distribution of HLA-A, B, DR antigens in 364 patients with kidney diseases (120 – pyelonephritis and 244 - glomerulonephritis was analyzed. HLA antigens were defined using a standard microlymphocytotoxic test on the Terasakiґs planchette with special panels of anti-HLA serums (20 antigens of locus A, 31 – B and 9 – DR. The control group consisted of 350 healthy donors – students from Kiev. The HLA antigen frequencies in normal and deseased subjects were compared taking each antigen separately, using χ2 test. The etiologic fraction (attributive risk  more 0.1 was counted using the formula:  = (x - y/(I- y, where x is frequency of antigen in patients and y – frequency in healthy. The  reading was considered reliable when it exceeded 0.1. Results and discussion. It is advisable to associate PN are А10, А11, В14, В16 и В17 (RR > 2; the causal role (σ > 0.1 was determined for А10, А11, В14, В16; antigens-protectors - А2, В21, В35, В40. Associated with CGN, NS (RR > 2 are with antigens HLA- A23, 24, 28; B8, 38, 44 in patients; the causal role (σ > 0.1 was determined for A24, 28; B8; antigens-protectors – B12, B16. The analysis of the associative features of HLA-phenotype and identified pathogens in patients with PN is carried

  16. Xanthogranulomatous pyelonephritis: Unusual clinical presentation: A case report with literature review

    Directory of Open Access Journals (Sweden)

    Shirish S Chandanwale

    2013-01-01

    Full Text Available Xanthogranulomatous pyelonephritis (XGP is rare and aggressive form of chronic infectious pyelonephritis. No single clinical or radiological feature is diagnostic of XGP. A 75-year-old man with prostatic enlargement presented with difficulty and burning micturition fever, abdominal and flank pain. X-ray, ultrasonography and computed tomography scan diagnosis was right kidney pyonephrosis. Intravenous urography revealed non-excretory right kidney. Right nephrectomy was done. Histological diagnosis of XGP was made. In all patients of prostatic enlargement, renal function must be assessed for the extent of damage. Surgery is the treatment choice in most cases. Pre- and post-operative antibiotics are key factors for successful management and better prognosis.

  17. Nephrolithiasis and pyelonephritis in two West Indian manatees (Trichechus manatus spp.).

    Science.gov (United States)

    Keller, Martha; Moliner, José L; Vásquez, Grettys; Cruz, Danilo; Bello, Orestes; Costidis, Alex M; Rommel, Sentiel A; Mays, Maron B Calderwood; Gearhart, Scott

    2008-07-01

    Two West Indian manatees (Trichechus manatus spp.) were reported with severe emaciation. One animal was a Florida manatee from the Everglades; the other was an Antillean manatee from Cuba. On necropsy, both animals had nephrolithiasis, pyelonephritis, and moderate to severe renomegaly. Histopathology revealed multifocal to diffuse pyelonephritis, interstitial nephritis, and nephrocalcinosis. The stones were analyzed and consisted primarily of calcium carbonate. Serum chemistry values for the Florida animal revealed no renal abnormalities. The mechanism of calculus formation remains unclear in manatees. In horses, another hindgut fermenter, the most common urolith is also calcium carbonate. Urinalyses performed on manatees are very similar to those of horses (i.e., alkaline urine, low specific gravity, and calcium carbonate crystals). Formation of uroliths in manatees may have a pathogenesis similar to equine urolithiasis.

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

    DEFF Research Database (Denmark)

    Breinbjerg, Anders; Kamperis, Konstantinos; Frøkjær, Jørgen;

    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...... with bilateral and 6 with unilateral hydronephrosis). Twenty-one children (12%) presented with parenchymal defects in the DMSA/MAG3 scans (17 unilateral, 4 bilateral). Fifteen children (8%) all with scars presented with an uneven renal differential function on renal scans (... a VCUG and in all reflux was confirmed, 8 unilateral (n=3 grade V, n=3 grade IV, n=1 grade III, n=1 grade II) and 1 bilateral reflux (grade IV). Six of these patients underwent endoscopic reflux treatment.Of the 21 children with DMSA/MAG3 abnormalities only 5 presented with abnormalities in renal...

  19. Antibody-coated bacteria in the urine of obstetrical patients with acute pyelonephritis.

    Science.gov (United States)

    Thomas, V L; Harris, R E; Gilstrap, L C; Shelokov, A

    1975-05-01

    The direct immunofluorescence method for the detection of antibody-coated bacteria in urine sediments was used to test urine samples from obstetrical patients with the clinical diagnosis of acute pyelonephritis or cystitis. Antibody-coated bacteria were present in the urine from 12 of 15 patients with acute pyelonephritis, but they were not observed in the urine from 13 patients with cystitis. The clases of antibody coating the bacteria were IgG, IgA, and, in some cases, IgM. A correlation between a high titer of antibody in serum and the presence of antibody-coated bacteria in the urine was noted. These results confirm that the immunofluorescence test can be useful, as previously reported, in distinguishing infection of the kidney from infection of the bladder.

  20. A 13-Month-Old With Xanthogranulomatous Pyelonephritis With Features of Renal Malakoplakia

    Directory of Open Access Journals (Sweden)

    Tova Appleson DO

    2016-02-01

    Full Text Available Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder caused by chronic infection with gram-negative bacteria leading to destruction of the renal parenchyma and replacement with foamy lipid-laden macrophages. Renal malakoplakia is another rare form of chronic inflammatory granulomatous disease in the kidney associated with infection usually occurring in adults with immunocompromised status or debilitating disease. It is hallmarked by the finding of foamy histiocytes with distinctive basophilic inclusions (Michaelis-Gutmann bodies. We present a case of a 13-month-old male with history of congenital hydronephrosis who presented with clinical and radiologic findings suggestive of xanthogranulomatous pyelonephritis. However, further pathologic studies revealed the presence of Michaelis-Gutmann bodies, which are pathognomonic for renal malakoplakia. With this case we hope to bring further evidence to support that these two conditions are not mutually exclusive but rather represent two pathologic processes on the same disease spectrum.

  1. 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...... with urological anomalies subsequently prescribed prophylactic antimicrobial therapy would have been missed. CONCLUSION: We do not recommend following the imaging strategies of the NICE guidelines for children with a first episode of pyelonephritis. Our most important argument is that at follow-up, after...... was prescribed for 19 (20%), and VUR was diagnosed by VCU in 9 patients. Surgery was carried out in 7 (7%) patients, primarily for VUR. If the NICE guidelines had been initially followed, 5 of our 9 patients with VUR would not have been identified. VUR surgery was performed in 4 of these cases. Moreover, 9 cases...

  2. Extensive emphysematous pyelonephritis in association with hepatic portal venous gas and emphysematous gastritis: A rare case

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    Vikram Prabha

    2014-01-01

    Full Text Available Although emphysematous pyelonephritis is recognized from more than hundred years, the etiology is still controversial. Glucose fermentation is the proposed possible mechanism for gas fermentation. The extension of emphysematous pyelonephritis into portal vein and stomach is a rare condition. We present a 52-year-old woman with uncontrolled diabetes who was admitted with sepsis and left flank pain. She was investigated, and results revealed gas in the left renal system with extension into portal vein and stomach. She was resuscitated and managed with percutaneous drainage, DJ stenting, and broad spectrum antibiotics, she did not improve and hence nephrectomy was done. Prompt diagnosis, early and aggressive treatment is crucial because of high mortality.

  3. Acute pyelonephritis and renal vein thrombosis: A case report and review of the literature.

    Science.gov (United States)

    Yildiz, Halil; Van Nieuwenhove, Sandy; Doyen, Marie; Yombi, J C

    2016-11-01

    A 68-year-old female presented with a week history of fever and generalized weakness. Clinical examination, blood work and urinalysis were compatible with sepsis due to acute pyelonephritis. Urine cultures were positive for Escherichia coli and blood cultures were negative. After 5 days of antibiotic therapy with cefuroxime, inflammatory parameters (CRP level and white blood cell count) remained highly elevated. Abdominal CT scan showed right kidney pyelonephritis with renal and perirenal abscess and right renal vein thrombosis. The patient improved after percutaneous drainage of the perirenal abscess and anticoagulation treatment. She was discharged on hospital day 14. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  4. Antibiotic resistance of uropathogens in newborns and young children with acute pyelonephritis

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    Peco-Antić Amira

    2012-01-01

    Full Text Available Introduction. Urinary tract infection is common in childhood. Depending on the localization of the infection, severity of its clinical presentation and possible acute and long-term complications, it may be described as either acute cystitis or acute pyelonephritis. Objective. The aim of this study was to assess the resistance patterns of uropathogens during the last 5 years in newborns and young children with acute pyelonephritis. Methods. Uropathogens resistance to commonly usable anti-microbial agents (ampicillin, a combination of sulphamethoxasole and trimethoprim, cephalexin, ceftriaxone, cefotaxime, ceftazidime, gentamycin, amikacin, ciprofloxacin, imipenem and nalidixic acid was retrospectively studied in newborns and young children treated during early (2005-2007 and late (2008-2009 study periods. Anti-bacterial susceptibility testing of the urine isolates was performed by the standard disc diffusion method. Results. 117 newborns and 294 children aged 9.3±0.7 months were treated during early (n=136 or late (n=275 study period due to the first episode of acute pyelonephritis. Escherichia coli was the most common bacterial pathogen (85.5%. Compared to children older than one month, newborns had higher degree of antibacterial resistance to 2nd and 3rd generation cephalosporins, aminoglycosides, and nalidixic acid during early, and to ceftazidime, aminoglycosides and nalidixic acid during late study period. Also, multidrug resistance was more common in newborns during the early study period. Conclusion. Newborns had higher rate of antibacterial resistance than young children. The progressive increase of anti-microbial resistance in children with acute pyelonephritis is of great concern.

  5. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up.

    OpenAIRE

    1989-01-01

    OBJECTIVE--Determination of the long term incidence of uraemia, hypertension, and toxaemia in pregnancy associated with non-obstructive focal renal scarring after pyelonephritis in childhood 25-35 years earlier. DESIGN--27 Year follow up of patients with non-obstructive focal scarring identified from a retrospective review of intravenous urograms performed in childhood between 1951 and 1967. SETTING--Paediatric primary referral centre and urological clinic in tertiary referral centre. PATIENT...

  6. Community-Acquired Pyelonephritis in Pregnancy Caused by KPC-Producing Klebsiella pneumoniae

    Science.gov (United States)

    Khatri, Asma; Naeger Murphy, Nina; Wiest, Peter; Osborn, Melissa; Garber, Kathleen; Hecker, Michelle; Hurless, Kelly; Rudin, Susan D.; Jacobs, Michael R.; Kalayjian, Robert C.; Salata, Robert A.; van Duin, David; Harris, Patrick N. A.

    2015-01-01

    Carbapenem-resistant Enterobacteriaceae (CRE) usually infect patients with significant comorbidities and health care exposures. We present a case of a pregnant woman who developed community-acquired pyelonephritis caused by KPC-producing Klebsiella pneumoniae. Despite antibiotic treatment, she experienced spontaneous prolonged rupture of membranes, with eventual delivery of a healthy infant. This report demonstrates the challenge that CRE may pose to the effective treatment of common infections in obstetric patients, with potentially harmful consequences to maternal and neonatal health. PMID:26185273

  7. LOW CIRCULATING MATERNAL ADIPONECTIN IN PATIENTS WITH PYELONEPHRITIS: ADIPONECTIN AT THE CROSSROADS OF PREGNANCY AND INFECTION

    Science.gov (United States)

    Mazaki-Tovi, Shali; Romero, Roberto; Vaisbuch, Edi; Chaiworapongsa, Tinnakorn; Erez, Offer; Mittal, Pooja; Kim, Sun Kwon; Gotsch, Francesca; Lamont, Ronald; Ogge, Giovanna; Pacora, Percy; Goncalves, Luis; Kim, Chong Jai; Gomez, Ricardo; Espinoza, Jimmy; Hassan, Sonia S.; Kusanovic, Juan Pedro

    2009-01-01

    Objective An emerging theme in modern biology is that adipose tissue can respond to metabolic stress, and to inflammatory stimuli, by regulating the secretion of a complex network of soluble mediators, termed adipokines. Adiponectin, the most prevalent circulating adipokine in human, has profound insulin-sensitizing and anti-inflammatory properties. Indeed, the notion that adiponectin plays an important role in the interactions between the metabolic and the immune systems has been strongly suggested. Thus, the aim of this study was to determine if pyelonephritis during pregnancy is associated with changes in maternal serum adiponectin concentrations. Study design This cross-sectional study included women in the following groups: 1) normal pregnant women (n=200); and 2) pregnant women with pyelonephritis (n=50). Maternal plasma adiponectin concentrations were determined by ELISA. Non-parametric statistics were used for analyses. Results 1) The median maternal plasma adiponectin concentration was lower in patients with pyelonephritis than in those with a normal pregnancy (ppyelonephritis had a lower median plasma adiponectin concentration than those with a normal pregnancy (ppyelonephritis had a lower median plasma adiponectin concentration than those with a normal pregnancy (ppyelonephritis was independently associated with maternal plasma adiponectin concentrations after adjustment for maternal age, smoking, gestational age at sampling, and pre-gestational BMI. Conclusion 1) The findings that acute pyelonephritis in pregnancy is characterized by low maternal plasma concentrations of adiponectin in both lean and overweight/obese patients are novel and concur with the anti-inflammatory properties of adiponectin; and 2) the results of this study support the notion that adiponectin may play a role in the intricate interface between inflammation and metabolism during pregnancy. PMID:19650757

  8. The lectin like domain of thrombomodulin is involved in the defence against pyelonephritis.

    Science.gov (United States)

    Lattenist, Lionel; Teske, Gwendoline; Claessen, Nike; Florquin, Sandrine; Conway, Edward M; Roelofs, Joris J T H

    2015-12-01

    Pyelonephritis, a common complication of urinary tract infections, is frequently associated with kidney scarring and may lead to end-stage renal disease. During bacterial infections inflammatory and coagulation pathways and their mutual interaction are playing pivotal roles in the host response. Given that thrombomodulin (TM) is crucially involved in the interplay between coagulation and inflammation, we aimed to investigate the roles of its EGF and lectin-like domains in inflammation during acute pyelonephritis. Indeed, the EGF-like and the lectin-like domains of TM, are especially known to orchestrate inflammation and coagulation in different ways. Acute pyelonephritis was induced by intravesical inoculation of 1 × 10(8) CFU of uropathogenic Escherichia coli in two strains of TM transgenic mice. TM(pro/pro) mice carry a mutation in the EGF-like domain making them unable to activate protein C, an anticoagulant and anti-inflammatory protein. TM(LeD/LeD) mice lack the lectin-like domain of TM, which is critical for its anti-inflammatory and cytoprotective properties. Mice were sacrificed 24 and 48 h after inoculation. Bacterial loads, the immune response and the activation of coagulation were evaluated in the kidney and the bladder. TM(LeD/LeD) mice showed elevated bacterial load in bladder and kidneys compared to WT mice, whereas TM(pro/pro) had similar bacterial load as WT mice. TM(LeD/LeD) mice displayed a reduced local production of pro-inflammatory cytokines and neutrophil renal infiltration. Activation of coagulation was comparable in TM(LeD/LeD) and WT mice. From these data, we conclude that the lectin-like domain of thrombomodulin is critically involved in host defence against E. coli induced acute pyelonephritis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Could pyelonephritic scarring be prevented by anti-inflammatory treatment? An experimental model of acute pyelonephritis.

    Science.gov (United States)

    Bahat Özdoğan, Elif; Özdemir, Tuğba; Arslansoyu Çamlar, Seçil; Imamoğlu, Mustafa; Cobanoğlu, Ümit; Sönmez, Bircan; Tosun, İlknur; Doğan, Ismail

    2014-01-01

    This study aimed to demonstrate if the addition of anti-inflammatory treatment to antibiotic therapy shows any superiority to the treatment with antibiotic only. Forty-nine Wistar rats were divided into 7 groups. Pyelonephritis was performed by E. coli injection to upper pole of kidneys except control group. Group 2 was not treated. Ceftriaxone, ketoprofen, "ceftriaxone + ketoprofen," methylprednisolone, and "ceftriaxone + methylprednisolone" were given in the groups. The technetium-99m-dimercaptosuccinic acid scintigraphies were performed in 3rd day to detect pyelonephritis and 10th week to detect renal scarring. All kidneys were also histopathologically evaluated. When 3rd day and 10th week scintigraphies were compared, initial 2.00 ± 0.30 point pyelonephritis score resulted in 0.71 ± 0.36 renal scar score in "ceftriaxone + ketoprofen" group (P = 0.039). Initial 2.00 ± 0.43 point pyelonephritis score resulted in 0.86 ± 0.26 renal scar score in "ceftriaxone + methylprednisolone" group (P = 0.041). Renal scar score was declined in "ceftriaxone + ketoprofen" group and "ceftriaxone + methylprednisolone" group compared with no-treatment group on 10th week of the study (P = 0.026, P = 0.044). On histopathological evaluation, it was seen that renal scar prevalence and expansion declined significantly in "ceftriaxone + ketoprofen and ceftriaxone + methylprednisolone" (P = 0.011, P = 0.023). It was evidenced that ceftriaxone treatment in combination with ketoprofen or methylprednisolone declined scar formation in scintigraphic and histopathologic examinations of the kidneys.

  10. [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.

  11. Xanthogranulomatous pyelonephritis in pediatric patients: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Carolina Talini

    2016-09-01

    Full Text Available Xanthogranulomatous pyelonephritis (XGPN is a rare and severe variation of chronic pyelonephritis characterized by suppurative destruction of renal parenchyma and its substitution with chronic inflammatory infiltrate. Male, 8 years old, admitted to the pediatric urology service at 7 years of age, with bladder and renal lithiasis. First symptoms started when he was 2 years old but presented no relapse until he turned 7 years old. During two years he had recurrence of renal lithiasis and underwent multiple surgical procedures. He remained asymptomatic for a short period of time and when presented fever and urinary symptoms again and underwent CT scanning that demonstrated left kidney enlargement associated with calculi and air bubbles in its interior, suggesting xanthogranulomatous pyelonephritis. Uretherostomy was performed and the patient had good clinical improvement. Renal exclusion was documented through scintigraphy and total left nephrectomy was performed, with a large amount of pus drained. Histopathology confirmed XGPN diagnosis. One year after surgery, there has been no recurrent renal lithiasis or urinary tract infection. Despite being a rare condition in children, XGPN has great importance as it can be often confused with pediatric renal tumours. Early diagnosis is important in order to promote better survival and clinical outcomes.

  12. 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.)

  13. Clinical Impact of Discordant Prescribing of Fluoroquinolones and Alternative Treatments in Escherichia coli Pyelonephritis.

    Science.gov (United States)

    Hong, Minh T; Seifert, Charles F

    2016-10-01

    The emergence of resistant Escherichia coli to fluoroquinolones (FQs) is of growing concern, yet the latest guidelines for the treatment of pyelonephritis still recommend FQs as first-line treatment. Our primary objective was to determine the impact of discordant prescribing of FQs in E coli pyelonephritis on hospital length of stay (LOS) and early clinical response (ECR). We retrospectively compared discordant and concordant prescribing of FQs for LOS and ECR. We also compared FQs, ceftriaxone, piperacillin/tazobactam, and carbapenems for these clinical outcomes. Forty-nine patients included in the comparison between discordant (n = 9) and concordant (n = 40) prescribing of FQs. There was significantly lower ECR in patients with discordant prescribing of FQs (38 of 40, 95% vs 5 of 9, 55.6%, P = .0074) and a trend toward longer LOS (4 [2.3] days vs 3 [2.0] days, P = .0571). Illness severity, estimated using Simplified Acute Physiology Score (SAPS II) score, was similar between groups (P = .717). There was a significantly decreased ECR and a trend toward increased LOS when FQs were used in FQ-resistant E coli. Regarding alternative treatment for E coli pyelonephritis, ceftriaxone was as effective as concordant FQs and significantly better than discordant FQs. © The Author(s) 2015.

  14. Acute pyelonephritis: frequency of findings in patients submitted to computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Campos, Flavio do Amaral; Rosas, George de Queiroz; Szarf, Gilberto; D' Ippolito, Giuseppe [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. of Imaging Diagnosis]. E-mail: giuseppe_dr@uol.com.br; Goldenberg, Decio [Hospital Sao Luiz, Sao Paulo, SP (Brazil). Dept. of Computed Tomography

    2007-09-15

    Objective: The present study was aimed at establishing the frequency of renal/perirenal and extrarenal computed tomography findings in patients with acute pyelonephritis, and evaluating the interobserver agreement. Materials and methods: Retrospective study based on the analysis of computed tomography images of 47 patients with clinical and laboratory findings of acute pyelonephritis. Two independent observers evaluated the main renal/perirenal and extrarenal alterations. The frequency of tomographic findings and interobserver agreement were analyzed by the kappa ({kappa}) test. Results: The frequency of tomographic findings for the several parameters was the following: striated nephrogram, 100%; renal enlargement, 65%; perirenal fat heterogeneity, 62.5%; renal calculi, 16.6%; abscesses, 21%; pleural effusion, 36%; thickened gallbladder wall, 32.5%; periportal edema, 32.5%. The {kappa} test for interobserver agreement demonstrated reproducibility ranging between moderate ({kappa} = 0.511 for renal enlargement) to almost perfect ({kappa} 0.87 for striated nephrogram) for all of the parameters analyzed, except for perirenal fat heterogeneity ({kappa} = 0.268). Conclusion: The frequency of findings of acute pyelonephritis on computed tomography is high. Overall, striated nephrogram was the most frequent finding. Peri- and extra-renal alterations were found in about 2/3 of the cases. Computed tomography demonstrated a good interobserver agreement. (author)

  15. 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.)

  16. Acute pyelonephritis: role of enhanced CT scan in the prediction of clinical outcome

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    Jo, Byung June; Kim, Ki Whang; Yu, Jeong Sik; Kim, Jai Keun; Yoon, Sang Wook; Ha, Sung Kyu; Park, Chong Hoon [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-04-01

    To correlate the CT findings of acute pyelonephritis with its outcome and with clinical data. Thirty five contrast enhanced CT scans in patients diagnosed as suffering from acute pyelonephritis were retrospectively analyzed. Findings based on the morphology of perfusion defect in the renal parenchyma were classified as normal, focal wedge, multifocal wedge, focal mass, or mixed form composed of wedge and mass. These findings were correlated with clinical data such as degree of fever, leukocytosis, the period after antibiotic treatment during which fever was reduced, and the presence of pyuria in each group Analysis was then performed. Perfusion defects were seen in 23 of 35 cases, and their morphology was classified as follow; focal wedge (n=2), multifocal wedge (n=8), focal mass (n=4), and mixed form (n=9). Twelve cases (34.3%) showed no perfusion defect. The duration of fever was significantly prolonged in patients with focal mass form (p < .05). There was no significant correlation between the morphology of perfusion defect, bilaterality, and other clinical factors. The present study shows that the clinical course of the focal mass form of perfusion defect, as seen on CT, is different from that of other types. CT could be effective in predicting clinical progress and the outcome of treatment in cases of acute pyelonephritis.

  17. Urine macrophage migration inhibitory factor (MIF) in children with urinary tract infection: a possible predictor of acute pyelonephritis.

    Science.gov (United States)

    Otukesh, Hasan; Fereshtehnejad, Seyed-Mohammad; Hoseini, Rozita; Hekmat, Sepideh; Chalian, Hamid; Chalian, Majid; Bedayat, Arash; Salman Yazdi, Reza; Sabaghi, Saeed; Mahdavi, Saeed

    2009-01-01

    Macrophage migration inhibitory factor (MIF) is an important pro-inflammatory cytokine expressed at sites of inflammation. We have assessed this factor (MIF) in urinary tract infections with the aim of determining a non-invasive and sensitive method to differentiate upper and lower renal involvement. Thirty-three pediatric patients with urinary track infection (25 with acute pyelonephritis, eight with acute cystitis) and 40 healthy subjects were recruited for this prospective case-control study. Pyelonephritis was differentiated from cystitis by dimercaptosuccinic acid (DMSA) scan. Urinary MIF concentration was determined using an enzyme-linked immunosorbent assay method. The urine MIF/creatinine (Cr) ratio was significantly higher in pyelonephritis patients than in those with acute cystitis and the control group (P < 0.001). The optimal cut-point of 4.90 pg/micromol Cr for the urine MIF/Cr ratio has the potential to be a biomarker for distinguishing patients with acute pyelonephritis from those with acute cystitis. Determination of the urinary MIF was also useful in selecting the patients at risk of permanent renal damage. Of those patients with pyelonephritis, based on the DMSA scan at the time of infection, scarring on follow-up DMSA scan 9-12 months later occurred in patients with the highest urinary MIF/Cr ratios. We conclude that the urine MIF/Cr ratio is a sensitive test for differentiating acute pyelonephritis from acute cystitis and also for detecting children with acute pyelonephritis who are at a higher risk for permanent renal scars in the future.

  18. Maternal serum concentrations of the chemokine CXCL10/IP-10 are elevated in acute pyelonephritis during pregnancy

    Science.gov (United States)

    Gotsch, Francesca; Romero, Roberto; Espinoza, Jimmy; Kusanovic, Juan Pedro; Mazaki-Tovi, Shali; Erez, Offer; Than, Nandor Gabor; Edwin, Samuel; Mazor, Moshe; Yoon, Bo Hyun; Hassan, Sonia S.

    2008-01-01

    Objective Acute pyelonephritis is one of the most frequent medical complications of pregnancy, as well as a common cause of antepartum hospitalization. Interferon (IFN)-γ inducible protein, CXCL10/IP-10, is a member of the CXC chemokine family with pro-inflammatory and anti-angiogenic properties. The purpose of this study was to determine whether maternal serum concentrations of CXCL10/IP-10 change in patients with acute pyelonephritis during pregnancy. Study Design This cross-sectional study was conducted to determine the difference in maternal serum concentrations of CXCL10/IP-10 in pregnant women with acute pyelonephritis (N=41) and normal pregnant women (N=89). Pyelonephritis was defined in the presence of a positive urine culture, fever and maternal clinical signs; blood cultures were performed in 36 cases. Maternal serum concentrations of CXCL10/IP-10 were measured by a sensitive immunoassay. Non-parametric statistics were used for analysis. Results (1) The median serum concentration of CXCL10/IP-10 in pregnant patients with pyelonephritis was significantly higher than in normal pregnant women (median 318.5 pg/mL, range: 78.8–2459.2 vs. median: 116.1 pg/mL, range:40.7–1314.3, respectively; p pyelonephritis with and without bacteremia (positive blood cultures: median: 362.6 pg/mL, range: 100.2–2459.2 vs. negative blood cultures: median 298.9 pg/mL, range: 108.5–1148.7, respectively; p = 0.3). Conclusions Pyelonephritis in pregnant women is associated with increased maternal serum concentration of the chemokine CXCL10/IP-10. PMID:17763275

  19. Pyelonephritis in slaughter pigs and sows: Morphological characterization and aspects of pathogenesis and aetiology

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    Isling Louise K

    2010-08-01

    Full Text Available Abstract Background Pyelonephritis is a serious disease in pig production that needs to be further studied. The purpose of this study was to describe the morphology, investigate the pathogenesis, and evaluate the aetiological role of Escherichia coli in pyelonephritis in slaughtered pigs by concurrent bacteriological, gross and histopathological examinations. Methods From Danish abattoirs, kidneys and corresponding lymph nodes from 22 slaughtered finishing pigs and 26 slaughtered sows with pyelonephritis were collected and evaluated by bacteriology and pathology. Based on gross lesions, each kidney (lesion was grouped as acute, chronic, chronic active, or normal and their histological inflammatory stage was determined as normal (0, acute (1, sub-acute (2, chronic active (3, or chronic (4. Immunohistochemical identification of neutrophils, macrophages, T-lymphocytes, B-lymphocytes, plasma cells, E. coli and Tamm-Horsfall protein (THP in renal sections was performed. The number of E. coli and the proportion of immunohistochemically visualized leukocytes out of the total number of infiltrating leukocytes were scored semi-quantitatively. Results Lesions in finishing pigs and sows were similar. Macroscopically, multiple unevenly distributed foci of inflammation mostly affecting the renal poles were observed. Histologically, tubulointerstitial infiltration with neutrophils and mononuclear cells and tubular destruction was the main findings. The significant highest scores of L1 antigen+ neutrophils were in inflammatory stage 1 while the significant highest scores of CD79αcy+ B-lymphocytes, IgG+ and IgA+ plasma cells were in stage 3 or 4. Neutrophils were the dominant leukocytes in stage 1 while CD3ε+ T-lymphocytes dominated in stage 2, 3 and 4. Interstitially THP was seen in 82% and 98% of kidneys with pyelonephritis from finishing pigs and sows, respectively. E. coli was demonstrated in monoculture and/or identified by immunohistochemistry in

  20. Maternal serum soluble CD30 is increased in pregnancies complicated with acute Pyelonephritis

    Science.gov (United States)

    Kusanovic, Juan Pedro; Romero, Roberto; Espinoza, Jimmy; Gotsch, Francesca; Edwin, Samuel; Chaiworapongsa, Tinnakorn; Mittal, Pooja; Soto, Eleazar; Erez, Offer; Mazaki-Tovi, Shali; Than, Nandor Gabor; Friel, Lara; Yoon, Bo Hyun; Mazor, Moshe; Hassan, Sonia

    2007-01-01

    Objectives Normal pregnancy is characterized by activation of the innate immunity and suppression of the adaptive limb of the immune response. However, pregnant women are more susceptible to the effects of infection and microbial products than non-pregnant women. CD30 is a member of the tumor necrosis factor receptor superfamily and is preferentially expressed by activated T cells producing Th2-type cytokines. Its soluble form (sCD30) is proposed to be an index of Th2 immune response. High serum concentrations of sCD30 have been found in the acute phase of viral infections, such as HIV-1 and hepatitis B. There is, however, conflicting evidence about serum sCD30 concentration in patients with bacterial infections. The objective of this study was to determine whether there are changes in the serum concentration of sCD30 in pregnant women with pyelonephritis. Methods This cross-sectional study included normal pregnant women (N=89) and pregnant women with pyelonephritis (N=41). Maternal serum concentration of sCD30 was measured by a specific and sensitive enzyme-linked immunoassay. Non-parametric tests were used for comparisons. A p value pyelonephritis had a significantly higher median serum concentration of sCD30 than those with a normal pregnancy (median: 44.3 U/ml, range: 16–352.5 vs. median: 29.7 U/ml, range: 12.2–313.2, respectively; ppyelonephritis who had a positive blood culture compared to those with a negative blood culture (median:47.7 U/mL, range: 17.1–118.8 vs. median: 42.6 U/mL, range: 16–352.5, respectively; p=0.86). Conclusions Acute pyelonephritis during pregnancy is associated with a higher maternal serum concentration of sCD30 than normal pregnancy. This finding is novel, and suggests that pregnant women with pyelonephritis may have a complex immune state in which there is activation of some components of what is considered a Th2 immune response. PMID:17853184

  1. Pyelonephritis in slaughter pigs and sows: Morphological characterization and aspects of pathogenesis and aetiology

    Science.gov (United States)

    2010-01-01

    Background Pyelonephritis is a serious disease in pig production that needs to be further studied. The purpose of this study was to describe the morphology, investigate the pathogenesis, and evaluate the aetiological role of Escherichia coli in pyelonephritis in slaughtered pigs by concurrent bacteriological, gross and histopathological examinations. Methods From Danish abattoirs, kidneys and corresponding lymph nodes from 22 slaughtered finishing pigs and 26 slaughtered sows with pyelonephritis were collected and evaluated by bacteriology and pathology. Based on gross lesions, each kidney (lesion) was grouped as acute, chronic, chronic active, or normal and their histological inflammatory stage was determined as normal (0), acute (1), sub-acute (2), chronic active (3), or chronic (4). Immunohistochemical identification of neutrophils, macrophages, T-lymphocytes, B-lymphocytes, plasma cells, E. coli and Tamm-Horsfall protein (THP) in renal sections was performed. The number of E. coli and the proportion of immunohistochemically visualized leukocytes out of the total number of infiltrating leukocytes were scored semi-quantitatively. Results Lesions in finishing pigs and sows were similar. Macroscopically, multiple unevenly distributed foci of inflammation mostly affecting the renal poles were observed. Histologically, tubulointerstitial infiltration with neutrophils and mononuclear cells and tubular destruction was the main findings. The significant highest scores of L1 antigen+ neutrophils were in inflammatory stage 1 while the significant highest scores of CD79αcy+ B-lymphocytes, IgG+ and IgA+ plasma cells were in stage 3 or 4. Neutrophils were the dominant leukocytes in stage 1 while CD3ε+ T-lymphocytes dominated in stage 2, 3 and 4. Interstitially THP was seen in 82% and 98% of kidneys with pyelonephritis from finishing pigs and sows, respectively. E. coli was demonstrated in monoculture and/or identified by immunohistochemistry in relation to inflammation in

  2. SIMULTANEOUS OCCURANCE OF EMPHYSEMATOUS PYELONEPHRITIS AND EMPHYSEMATOUS CHOLECYSTITIS IN AN UNCONTROLLED TYPE 2 DIABETIC: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Savitri

    2015-04-01

    Full Text Available Emphysematous pyelonephritis a life - threatening, fulminant, necrotizing upper urinary tract infection associated with gas within the kidney . W hich is a rare condition. Only 1 - 2 cases per year are encountered in a urological department in the United States. Emphysematous cholecystitis is a variant of acute cholecystitis which is generally caused by gas - forming organisms. This condition d evelops in approximately 1% of all cases of acute cholecystitis. Compared with typical acute pyelonephritis and typical acute cholecystitis , emphysematous pyelonephritis and emphysematous cholecystitis is associated with much higher rates of morbidity and significantly increased rates of mortality (15 - 25%. Individually these conditions are less reported, there by, Simultaneous occcurance of emphysematous pyelonephritis and emphysematous cholecystitis are uncommon and only two cases are reported in literature . As clinical course of both entities are individually severe and life - threatening if not recognized and treated promptly, so in a case of simultaneous occurrence, early diagnosis is to be made and a potentially devastating outcome is to be avoided. We present a case of emphysematous pyelonephritis with emphysematous cholecystitis and pneumoperitoneum in a middle aged uncontrolled diabetic patient and discussed etio - pathogenesis, classification and therapy of these entities.

  3. FRAGMENT Bb: EVIDENCE FOR ACTIVATION OF THE ALTERNATIVE PATHWAY OF THE COMPLEMENT SYSTEM IN PREGNANT WOMEN WITH ACUTE PYELONEPHRITIS

    Science.gov (United States)

    Soto, Eleazar; Romero, Roberto; Vaisbuch, Edi; Erez, Offer; Mazaki-Tovi, Shali; Kusanovic, Juan Pedro; Dong, Zhong; Chaiworapongsa, Tinnakorn; Yeo, Lami; Mittal, Pooja; Hassan, Sonia S.

    2010-01-01

    OBJECTIVE Pyelonephritis during pregnancy is associated with a more severe course than in the non-pregnant state. This has been attributed to an increased susceptibility of pregnant women to microbial products. The complement system is part of innate immunity and its alternative pathway is activated mainly by microorganisms. The purpose of this study was to determine if activation of the alternative pathway of the complement system (determined by maternal fragment Bb concentrations) occurs in pregnant women with acute pyelonephritis. METHODS This cross-sectional study included the following groups: 1) normal pregnant women (n=62); and 2) pregnant women with pyelonephritis (n=38). Maternal plasma Fragment Bb concentrations were determined by ELISA. Non-parametric statistics were used for analyses. RESULTS 1) Pregnant women with pyelonephritis had a higher median plasma concentration of fragment Bb than those with a normal pregnancy (1.3 μg/ml, IQR: 1.1-1.9 vs. 0.8 μg/m, IQR: 0.7-0.9; ppyelonephritis who had a positive blood culture and those with a negative blood culture (1.4 μg/ml, IQR: 1.1-3.5 vs. 1.3 μg/ml, IQR: 1.1-1.9; p=0.2). CONCLUSIONS Pregnant women with acute pyelonephritis have evidence of activation of the alternative pathway of the complement system, regardless of the presence or absence of a positive blood culture. PMID:20218820

  4. Differentiation of acute pyelonephritis from other febrile states in children using urinary neutrophil gelatinase-associated lipocalin (uNGAL).

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    Arambašić, Jadranka; Mandić, Sanja; Debeljak, Željko; Mandić, Dario; Horvat, Vesna; Šerić, Vatroslav

    2016-01-01

    Acute pyelonephritis is a severe disease which is sometimes difficult to recognize based on clinical symptoms and routinely available diagnostic tests, especially in young children. The aim of this study was to assess the diagnostic value of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a biomarker of acute pyelonephritis. In this case-control study we analyzed 134 children (median age 2.5 years) who were admitted to the Pediatric Clinic of University Hospital Centre Osijek, Croatia. Eighty of them had acute pyelonephritis, while 54 children had febrile state of different etiology including cystitis and they represented the control group. uNGAL, white blood cells, C-reactive protein, urinanalysis, urine culture, kidney ultrasound and a dimercaptosuccinic acid scintigraphic scan were done for each child. uNGAL was measured using chemiluminiscent microparticle immunoassay on ARHITECT i1000SR (Abbott Diagnostics, IL, USA). uNGAL values were significantly higher in children with acute pyelonephritis compared to the control groups (113.6 ng/mL vs. 10.2 ng/mL, ppyelonephritis from cystitis (cut-off 38.5 ng/mL), and for differentiation of cystitis from febrile states with etiology other than urinary tract infection (UTI) (cut-off 20.4 ng/mL). uNGAL can be a useful diagnostic biomarker in acute pyelonephritis in children, but also in differentiating cystitis from febrile states other than UTI.

  5. Transmission of an extended-spectrum-beta-lactamase-producing Escherichia coli (sequence type ST131) strain between a father and daughter resulting in septic shock and Emphysematous pyelonephritis.

    Science.gov (United States)

    Ender, Peter T; Gajanana, Deepakraj; Johnston, Brian; Clabots, Connie; Tamarkin, Frank J; Johnson, James R

    2009-11-01

    Probable transmission of an extended-spectrum-beta-lactamase-producing Escherichia coli strain (sequence type ST131) between a father and daughter was documented. The father developed severe, recurrent pyelonephritis with multiple small abscesses; the daughter later developed septic shock, bacteremia, and extensive emphysematous pyelonephritis. This multidrug-resistant E. coli clone appears to be highly pathogenic and transmissible.

  6. Serum procalcitonin level for the prediction of severity in women with acute pyelonephritis in the ED: value of procalcitonin in acute pyelonephritis.

    Science.gov (United States)

    Park, Jeong Ho; Wee, Jung Hee; Choi, Seung Pill; Park, Kyu Nam

    2013-07-01

    Predicting medical outcomes for acute pyelonephritis (APN) in women is difficult. Delay in diagnosis and treatment often results in rapid progression to circulatory collapse, multiple-organ failure, and death. The aim of this study was to investigate the value of procalcitonin (PCT) level in women with APN at ED. We conducted a prospective study of women with APN presenting to the ED. The authors measured inflammatory biomarkers, and the severity of pyelonephritis was assessed by 4 severity of disease classification system and stage of sepsis. We performed an analysis to assess the value of PCT for the prediction of 28-day mortality and disease severity. A total of 240 female patients with APN are included. Patients were divided into 4 groups on the basis of systemic inflammatory response syndrome criteria, organ dysfunction, and persistent hypotension. The median PCT level was higher in the septic shock group compared with other groups. Of the other inflammatory markers, only white blood cell count was significantly different among the groups, whereas high-sensitivity C-reactive protein level and erythrocyte sedimentation rate revealed no differences. The area under the curve for PCT in predicting 28-day mortality was 0.68. For predicting mortality, a cutoff value of 0.42 ng/mL had a sensitivity of 80% and a specificity of 50%. However, the disease classification systems were demonstrated to be superior to PCT in predicting 28-day mortality. Relative to other classic markers of inflammation, by distinguishing the severity of sepsis related to APN, PCT levels can provide additional aid to clinicians in disease severity classification and their decision of treatment at ED. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Rare coexistence of keratinizing squamous cell carcinoma with xanthogranulomatous pyelonephritis in the same kidney: Report of two cases

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    Mardi Kavita

    2010-01-01

    Full Text Available Squamous cell carcinoma of urinary tract is a rarely encountered tumor. It is more frequently reported in urinary bladder and male urethra than renal pelvis. Squamous cell carcinoma of renal pelvis is usually associated with nephrolithiasis. However, coexistence of keratinizing squamous cell carcinoma with xanthogranulomatous pyelonephritis is exceedingly rare with only one case on record so far. We report two such cases detected incidentally in patients who have undergone nephrectomy for hydronephrosis. The post operative histological evaluation revealed unsuspected squamous cell carcinoma of renal pelvis with concomitant xanthogranulomatous pyelonephritis.

  8. [IMPACT OF THE UPPER URINARY WAYS DRAINAGE METHOD ON RESTORATION OF RENAL FUNCTION IN PATIENTS, SUFFERING ACUTE OBSTRUCTIVE PYELONEPHRITIS].

    Science.gov (United States)

    Buchok, O O

    2015-05-01

    Renal function was studied, using radionuclide renography, in 142 patients, suffering acute obstructive pyelonephritis, in 73 of whom transcutaneous nephrostomy was applied and in 69--the ureter's stenting, for the urine passage restoration. The investigation was peformed in 1 month and 1 year after miniinvasive treatment. After comparison of the investigation results there was established, that after transcutaneous nephrostomy, using miniinvasive technologies, the affected kidney's functional inhibition was trustworthy less, than after stenting. Because of better preservation of renal function, the transcutaneous nephrostomy conduction in patients, suffering an acute obstructive pyelonephritis, constitutes a less invasive method, than the ureter's stenting.

  9. 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.

  10. Role of genetic mutations in development of immunological and clinical disorders in children with chronic pyelonephritis.

    Science.gov (United States)

    Harshman, Vira P; Kryuchko, Tetyana O; Kolenko, Iryna O; Kushnereva, Tetyana V; Tkachenko, Olha Y

    At the present time, the study of mechanisms of recognition of foreign agents, which is realized by means of Toll-like receptors (TLR) of the innate immune system, has become one of the main tasks of clinical immunology. The aim of our study was to investigate the prevalence of polymorphism of Toll-like receptor 4 (Asp299Gly, Gly299Gly) among children with chronic pyelonephritis (CP) and determine the association of this TLR4 polymorphism with phenotypic features of chronic pyelonephritis and level of interleukin-6 (IL-6). The clinical and laboratory examination of 60 children with chronic pyelonephritis during the stage of exacerbation, who were under inpatient treatment at the pediatric department of Children's Regional Clinical Hospital in Poltava, was performed. The group of healthy patients included 95 people, living in the Poltava region. Significantly higher frequency of the mutant allele 299Gly among children with CP was revealed. Significant correlation between the presence of 299Gly TLR4, association of U. urealyticum and M. hominis in lower sections of urinary tract and highest levels of IL-6 concentration was reflected. Sick children with polymorphous locus of TLR4 gene had higher risk of CP early manifestation and formation of its recurrent course with protracted urinary syndrome and unstable remission in comparison with the carriers of "wild" genotype. Obtained results prove the important role of TLR4 in the realization of innate immune response in children with CP and allow considering the TLR4 polymorphism as an additional prognostic indicator in this category of patients.

  11. 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

  12. Comparison of MRI and renal cortical scintigraphy findings in childhood acute pyelonephritis: preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Kovanlikaya, Arzu; Okkay, Nese; Cakmakci, Handan E-mail: cakmakh@egenet.com.tr; Oezdogan, Oezhan; Degirmenci, Berna; Kavukcu, Salih

    2004-01-01

    Objective: The diagnosis of acute pyelonephritis in children remains a clinical challenge. It may cause permanent renal scar formation and results in the chronic renal failure if prompt diagnosis and treatment are delayed. The purpose of this study is to compare magnetic resonance imaging (MRI) and renal cortical scintigraphy (RCS) findings in childhood acute pyelonephritis and to determine pyelonephritic foci in the acute phase. Materials and method: Twenty children (15 females and five males) with symptoms dysuria, enuresis, costovertebral pain, fever of 37.5 degree sign C or more and/or positive urine culture were imaged by unenhanced turbo spin echo T2, spin echo T1-weighted, pre- and post-gadolinium inversion recovery MRI and RCS. Both imaging techniques were read independently by two radiologists and nuclear medicine specialists. Sensitivity and specificity of MRI in detecting acute pyelonephritic foci and scar lesions were calculated. Furthermore, in order to calculate the reliability of MRI over RCS in differentiating scar tissue and acute pyelonephritic foci, follow-up MRI studies were done in six patients after treatment of acute pyelonephritis. Results: Sensitivity and specificity of MRI in the detection of pyelonephritic lesions were found to be 90.9 and 88.8%, respectively. There is no statistically significant difference in lesion detection between the two diagnostic modalities (P>0.05). Conclusion: Post-gadolinium MR images show significant correlation with RCS in the determination of renal pathology. Moreover, the ability of discriminating acute pyelonephritic foci and renal scar in early stages of disease is the superiority of MRI.

  13. Obstructive pyelonephritis as a result of urolithiasis in Japan: diagnosis, treatment and prognosis.

    Science.gov (United States)

    Hamasuna, Ryoichi; Takahashi, Satoshi; Nagae, Hiroshi; Kubo, Tatsuhiko; Yamamoto, Shingo; Arakawa, Soichi; Matsumoto, Tetsuro

    2015-03-01

    To study the current scenario of diagnosis, treatment and mortality of obstructive pyelonephritis secondary to urolithiasis in Japan. The study was a retrospective and multicenter survey for hospitalized patients with obstructive pyelonephritis as a result of urolithiasis in educational facilities for specialists by the Japanese Urological Association. Patients' characteristics including physical or laboratory examinations, treatment and prognosis were recorded, and the risk factors for disease death were analyzed. A total of 1363 patients from 208 hospitals were analyzed. The median age of patients was 68 years, and there were 2.2-fold more female patients than male patients. From 844 patients, 891 species of bacteria or fungi were isolated, and Gram-negative rods accounted for 76.5% of cases. The mortality of patients was 2.3%. The risk factors related to disease death by univariate analysis were identified as older age, solitary kidney, ambulance use to visit hospital, disturbance of consciousness, severe appetite loss, higher performance status, disseminated intravascular coagulation status or systemic inflammatory response syndrome, vasopressors and anti-disseminated intravascular coagulation therapies, increased pulse rates, lower hemoglobin, lower serum albumin, and high blood urea nitrogen values. The predictive risk factors for disease death of patients' status at hospitalization were age over 80 years, systemic inflammatory response syndrome, disseminated intravascular coagulation status, disturbance of consciousness and solitary kidney by multivariate analysis. Obstructive pyelonephritis as a result of urolithiasis represents an emergent disease in the urological field with relatively high mortality. Patients with older age or poor conditions should be hospitalized, and intervention by a urology specialist is likely to be required. © 2014 The Japanese Urological Association.

  14. Predictive accuracy of urinary β2-microglobulin for kidney injury in children with acute pyelonephritis.

    Science.gov (United States)

    Kangari, Gholamreza; Esteghamati, Maryam; Ghasemi, Kambiz; Mahboobi, Hamidreza

    2015-01-01

    Leukocyte count, erythrocyte sediment rate and C-reactive protein are available laboratory markers which may be helpful in prediction of technetium Tc 99m dimercaptosuccinic acid (DMSA) renal scintigraphy results. None of these, however, have enough accuracy for prediction of renal injury and scar. This study was aimed to evaluate the diagnostic accuracy of urinary β2-microglobulin in detection of renal injury in children with acute pyelonephritis. Eighty-nine children between 2 months and 14 years old with the diagnosis of acute pyelonephritis that had no past history of infection in the urinary tract system were enrolled in the study. A standard urine sample according to patients' age was obtained for urine culture, urinalysis, and urinary β2-microglobulin tests. Blood sample was obtained for leukocyte count, creatinine, blood urea nitrogen, C-reactive protein, erythrocyte sediment rate, and electrolytes tests. All patients underwent DMSA scan. The cutoff point for urinary β2-microglubulin for prediction of positive DMSA scan was 0.8 mg with a sensitivity of 40.9% (95% CI, 26.3% to 56.8%) and a specificity of 84.1% (95% CI, 69.9% to 93.4%), a positive predictive value of 72.0% (95% CI, 50.6% to 87.9%) and an negative predictive value of 58.7% (95% CI, 45.6% to 71.0%). Urinary β2-microglobulin is not enough sensitive and specific to be used as a diagnostic marker for prediction of renal injury. Other common markers such as erythrocyte sediment rate, leukocyte count, and C-reactive protein can be used in combination to predict kidney injury in children with acute pyelonephritis.

  15. State of acid-basic ballance in children's oral cavity with chronic pyelonephritis

    Directory of Open Access Journals (Sweden)

    Kozlitina Y.A.

    2011-03-01

    Full Text Available In the present thesis are reported the results of study of mixed saliva of children and adolescents diagnosed with chronic pyelonephtitis. Chronic pyelonephritis is a chronic destructive inflammation in the tissues of kidneys in most cases accompanied by hyperparathyreoidism, which in turn leads to the phenomena of acidosis throughout the body. In the study of pH-level and buffer saliva capacity it was revealed, how this values correlate with the studies of underlying disease, that is the risk factor of the occurrence and development of major dental diseases, and it should be considered by dentists in the development of therapeutic and preventive measures

  16. Megalocytic interstitial nephritis following acute pyelonephritis with Escherichia coli bacteremia: a case report.

    Science.gov (United States)

    Kwon, Hee Jin; Yoo, Kwai Han; Kim, In Young; Lee, Seulkee; Jang, Hye Ryoun; Kwon, Ghee Young

    2015-01-01

    Megalocytic interstitial nephritis is a rare form of kidney disease caused by chronic inflammation. We report a case of megalocytic interstitial nephritis occurring in a 45-yrold woman who presented with oliguric acute kidney injury and acute pyelonephritis accompanied by Escherichia coli bacteremia. Her renal function was not recovered despite adequate duration of susceptible antibiotic treatment, accompanied by negative conversion of bacteremia and bacteriuria. Kidney biopsy revealed an infiltration of numerous histiocytes without Michaelis-Gutmann bodies. The patient's renal function was markedly improved after short-term treatment with high-dose steroid.

  17. Comparison of urinary microflora of chronic pyelonephritis-affected patients treated with laser therapeutic techniques

    Science.gov (United States)

    Neimark, A. I.; Karabasova, E. B.; Kuklina, N. V.; Neimark, B. A.

    2001-04-01

    An investigation was made on 142 patients suffering from chronic pyelonephritis (62 young and middle-aged patients and 80 aged and senile patients). The efficiency of antibacterial therapy, laser transcutaneous irradiation of kidneys, and intravenous laser irradiation of blood was estimated by the pathogenic properties of urostrains extracted from the patients' urine. The therapeutic effect of the treatment was assessed by bacteriuria, hemolytic and proteolytic properties, urease and adhesive activities, bacteria resistance, and the ability of antibiotics to inactivate bacteria of the serum. It was found that laser transcutaneous irradiation of kidneys and the intravenous laser irradiation of blood combined with antibacterial therapy effectively reduced pathogenicity of urostrains and normalized bacteriuria.

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

    Science.gov (United States)

    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.

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

    DEFF Research Database (Denmark)

    Sriskandarajah, Srishamanthi; Carter-Storch, Rasmus; Frydkjær-Olsen, Ulrik;

    2016-01-01

    , 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. RESULTS: 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...

  20. The first case of atrial fibrillation-related graft kidney infarction following acute pyelonephritis.

    Science.gov (United States)

    Tsai, Shang-Feng

    2014-01-01

    Native renal infarction is uncommon in patients with atrial fibrillation (AF)-related thromboembolism. Graft infarction is also rare, with such cases mostly occurring in the main graft artery postoperatively. To date, there have been no studies of AF-related graft kidney infarction. We herein describe the first case of AF-related graft kidney infarction. The clinical manifestations of this condition mimic and follow those of acute pyelonephritis; therefore, these diseases should be differentially diagnosed as early as possible using lactic dehydrogenase testing and computed tomography. Aggressive treatment with intravascular thrombolysis should be administered, even when the diagnosis is delayed, in order to restore a viable renal function.

  1. Economic issue in pediatric nuclear medicine: Cortical scanning of acute pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Mandell, G. A. [Pont Hospital for Children, Wilmington (United States). Dept. of Medical Imaging

    1997-12-01

    Pediatric nuclear medicine must be innovative in finding ways of competing with other pediatric imagining subspecialties for the health care dollars. Newer radiopharmaceuticals and imagining methods that are time-effective in answering clinical problems and cost-effective in attracting the health care providers are ways of accomplishing this difficult task. Renal cortical scanning for the diagnosis of acute pyelonephritis is presented as an example of an existing nuclear medicine study that is accurate and cost-effective, but has not yet taken a major place in the imaging `armamentarium`. In this discussion, the cortical scan is endorsed as the primary imaging tool for children presenting with acute urinary infection.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. Differential gene expression pattern in biopsies with renal allograft pyelonephritis and allograft rejection

    Science.gov (United States)

    Oghumu, Steve; Nori, Uday; Bracewell, Anna; Zhang, Jianying; Bott, Cherri; Nadasdy, Gyongyi M.; Brodsky, Sergey V.; Pelletier, Ronald; Satoskar, Abhay R.; Nadasdy, Tibor; Satoskar, Anjali A.

    2016-01-01

    Differentiating acute pyelonephritis (APN) from acute rejection (AR) in renal allograft biopsies can sometimes be difficult because of overlapping clinical and histologic features, lack of positive urine cultures, and variable response to antibiotics. We wanted to study differential gene expression between AR and APN using biopsy tissue. Thirty-three biopsies were analyzed using NanoString multiplex platform and PCR (6 transplant baseline biopsies, 8 AR, 15 APN [8 culture positive, 7 culture negative], and 4 native pyelonephritis [NP]). Additional 22 biopsies were tested by PCR to validate the results. CXCL9, CXCL10, CXCL11, and IDO1 were the top differentially expressed genes, upregulated in AR. Lactoferrin (LTF) and CXCL1 were higher in APN and NP. No statistically significant difference in transcript levels was seen between culture-positive and culture-negative APN biopsies. Comparing the overall mRNA signature using Ingenuity pathway analysis, interferon-gamma emerged as the dominant upstream regulator in AR and allograft APN, but not in NP (which clustered separately). Our study suggests that chemokine pathways in graft APN may differ from NP and in fact resemble AR, due to a component of alloreactivity, resulting in variable response to antibiotic treatment. Therefore, cautious addition of steroids might help in resistant cases of graft APN. PMID:27352120

  4. Interleukin 8 Receptor Deficiency Confers Susceptibility to Acute Experimental Pyelonephritis and May Have a Human Counterpart

    Science.gov (United States)

    Frendéus, Björn; Godaly, Gabriela; Hang, Long; Karpman, Diana; Lundstedt, Ann-Charlotte; Svanborg, Catharina

    2000-01-01

    Neutrophils migrate to infected mucosal sites that they protect against invading pathogens. Their interaction with the epithelial barrier is controlled by CXC chemokines and by their receptors. This study examined the change in susceptibility to urinary tract infection (UTI) after deletion of the murine interleukin 8 receptor homologue (mIL-8Rh). Experimental UTIs in control mice stimulated an epithelial chemokine response and increased chemokine receptor expression. Neutrophils migrated through the tissues to the epithelial barrier that they crossed into the lumen, and the mice developed pyuria. In mIL-8Rh knockout (KO) mice, the chemokine response was intact, but the epithelial cells failed to express IL-8R, and neutrophils accumulated in the tissues. The KO mice were unable to clear bacteria from kidneys and bladders and developed bacteremia and symptoms of systemic disease, but control mice were fully resistant to infection. The experimental UTI model demonstrated that IL-8R–dependent mechanisms control the urinary tract defense, and that neutrophils are essential host effector cells. Patients prone to acute pyelonephritis also showed low CXC chemokine receptor 1 expression compared with age-matched controls, suggesting that chemokine receptor expression may also influence the susceptibility to UTIs in humans. The results provide a first molecular clue to disease susceptibility of patients prone to acute pyelonephritis. PMID:10993918

  5. Differential gene expression pattern in biopsies with renal allograft pyelonephritis and allograft rejection.

    Science.gov (United States)

    Oghumu, Steve; Nori, Uday; Bracewell, Anna; Zhang, Jianying; Bott, Cherri; Nadasdy, Gyongyi M; Brodsky, Sergey V; Pelletier, Ronald; Satoskar, Abhay R; Nadasdy, Tibor; Satoskar, Anjali A

    2016-09-01

    Differentiating acute pyelonephritis (APN) from acute rejection (AR) in renal allograft biopsies can sometimes be difficult because of overlapping clinical and histologic features, lack of positive urine cultures,and variable response to antibiotics. We wanted to study differential gene expression between AR and APN using biopsy tissue. Thirty-three biopsies were analyzed using NanoString multiplex platform and PCR (6 transplant baseline biopsies, 8 AR, 15 APN [8 culture positive, 7 culture negative], and 4 native pyelonephritis [NP]). Additional 22 biopsies were tested by PCR to validate the results. CXCL9, CXCL10, CXCL11, and IDO1 were the top differentially expressed genes, upregulated in AR. Lactoferrin (LTF) and CXCL1 were higher in APN and NP. No statistically significant difference in transcript levels was seen between culture-positive and culture-negative APN biopsies. Comparing the overall mRNA signature using Ingenuity pathway analysis, interferon-gamma emerged as the dominant upstream regulator in AR and allograft APN, but not in NP (which clustered separately). Our study suggests that chemokine pathways in graft APN may differ from NP and in fact resemble AR, due to a component of alloreactivity, resulting in variable response to antibiotic treatment. Therefore, cautious addition of steroids might help in resistant cases of graft APN.

  6. [Conservative treatment in diabetic patients with emphysematous pyelonephritis: about five cases].

    Science.gov (United States)

    El Majdoub, Aziz; Khallouk, Abdelhak; Farih, Moulay Hassan

    2016-01-01

    Acute emphysematous pyelonephritis (EPN) is a severe kidney infection. Early and effective treatment is essential to reduce high mortality rates due to this disease. Our study aims to highlight the clinical and paraclinical features as well as the peculiarities of therapeutic management of this disease and focus on the possibility of conservative treatment in diabetic patients. We analyzed the medical records of patients with EPN treated in the Department of Urology at the Hassan II University Hospital, Fez between January 2004 and January 2010. For each medical record we described clinical, paraclinical and therapeutic features as well as patient's evolution after treatment. We here report the case of 5 female patients whose average age was 45,6 years. All patients were diabetic. Lithiasic obstruction of the upper urinary tract was found in 3 patients (60%). The diagnosis was made by means of abdominal CT scan. All patients underwent resuscitation measures including antibiotic and insulin therapy. Conservative surgical procedure was performed in all cases. Indeed, surgical drainage of perirenal collections was performed in two cases, percutaneous renal drainage in one case and drainage using double-J ureteral catheter in 2 cases. Clinical and radiological evolution was excellent with renal preservation in all patients Emphysematous pyelonephritis is a rare and serious complication, especially in diabetic patients. Diagnosis is based on CT scan. Surgical treatment should be conservative in most cases, apart from severe forms, especially in diabetic patients who have potential risk of chronic renal failure.

  7. Relevance of blood cultures in acute pyelonephritis in a single-center retrospective study.

    Science.gov (United States)

    Ledochowski, Stanislas; Abraham, Paul-Samuel; Jacob, Xavier; Dumitrescu, Oana; Lina, Gérard; Lepape, Alain; Piriou, Vincent; Wallet, Florent; Friggeri, Arnaud

    2015-08-01

    Pyelonephritides are frequently encountered diagnosis in Emergency Departments. Urinalyses have a central place in the management of this situation but the usefulness of blood cultures is not clear. We conducted a single-center retrospective study of 24 months to study the microbiological relevance of blood cultures in pyelonephritis. We included patients with blood cultures (BC) and urine cultures (UC) drawn at the same time, if they were not exposed to antibiotics prior to these tests. Of our 264 patients, 39 (15 %) had no bacteriological documentation. There were 83 (31 %) bacteremic patients. Seven patients had contaminated or sterile UC with positive BC. Four patients had positive UC and BC with the latter allowing identification of a pathogen absent from the UC (n = 1) or identifying the main pathogen in three cases. A total of 11 patients theoretically benefited from BC representing 4.2 % of our population. Excluding one patient who was known to be infected with multi-drug resistant bacteria, all empirical antibiotics regimens were effective against the identified pathogens. We did not reveal any significant therapeutic impact of blood cultures in the management of pyelonephritis, when BC and UC are performed before any antimicrobials treatment.

  8. Effect of N-acetylcysteine on inflammation biomarkers in pediatric acute pyelonephritis: a randomized controlled trial.

    Science.gov (United States)

    Allameh, Zahra; Karimi, Abdollah; Rafiei Tabatabaei, Seddigheh; Sharifian, Mostafa; Salamzadeh, Jamshid

    2015-11-01

    This study was designed to investigate the effect of N-acetylcysteine (NAC), as a potent and safe antioxidant, on inflammatory biomarkers of acute pyelonephritis in pediatric patients. Children (pyelonephritis were recruited in a randomized placebo-controlled trial. They were randomly allocated to 2 groups and recieved placebo or NAC effervescent tablets with daily dose based on their weight, for 5 days. The children were evaluated for serum procalcitonin level, leukocyte count, C-reactive protein (CRP), serum creatinine, and clinical symptoms on the 1st and the 5th days. Seventy patients, 35 in each group, with a mean age of 5.54 ± 3.10 years completed the study. There was no significant difference between the two groups in the amount of changes in procalcitonin levels after 5 days (P = .90). Within-group analysis confirmed CRP reduction in both groups (P < .001); however, between-group analysis did not show significant difference in CRP reductions, either (P = .65). No significant differences were found between the two groups in the day of resolving pyuria (P = .46), day of resolving bacteriuria (P = .81), or reductions in leukocyte count (P = .64) and neutrophil count (P = .49). A short period of NAC administration with the recommended doses could not lead to a significant decrease in inflammation biomarkers. Studies on higher doses and longer duration of NAC administration along with evaluation of the long-term effects of the intervention by tools such as renal scntigraphy are suggested.

  9. Resolution of cortical lesions on serial renal scans in children with acute pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Agras, Koray; Tuncel, Altug; Atan, Ali [Numune Teaching and Research Hospital, Department of Urology, Ankara (Turkey); Ortapamuk, Huelya; Naldoeken, Seniha [Numune Teaching and Research Hospital, Department of Nuclear Medicine, Ankara (Turkey)

    2007-02-15

    The ideal time for distinguishing a renal scar from acute inflammatory lesions by renal DMSA scintigraphy remains controversial. To determine the time needed for resolution of lesions after acute pyelonephritis. A total of 105 children with acute pyelonephritis underwent renal sonography, voiding cystourethrography and baseline DMSA scintigraphy. Two subsequent scans were performed during the 6th and 12th months in patients with abnormal findings on the previous scan. The baseline DMSA scintigraphy revealed cortical lesions in 37 patients. At 6 months, 13 patients (38.2%) were found to have cortical lesions. At 12 months, 6 patients (17.6%) were found to have persistent renal cortical lesions. The resolution rates for lesions detected on the first scan were 61.8% and 82.4% on the 6- and 12-month scans, respectively. Vesicoureteric reflux, and bilaterality or multifocality were not relevant for resolution of lesions. Female gender seemed to be associated with a higher persistence rate. The renal cortical defects present at 6 months have a high rate of resolution later during follow-up. DMSA scintigraphy performed 12 months after the infection provides more reliable data regarding persistence of renal cortical lesions. (orig.)

  10. Characterization and study the antibiotic resistance of Uropathogenic Escherichia coli isolated from pediatrics with pyelonephritis and cystitis in Iran

    Directory of Open Access Journals (Sweden)

    banafshe dormanesh

    2013-09-01

    Full Text Available Background: A lot of children suffer from urinary infections which can lead to pyelonephritis and cystitis. The main cause of these infections is uropathogenic strains of Escherichia coli.  Serogroups and virulence factors of this bacterium play an important role in occurrence of infection’s symptoms. Unfortunately, due to the occurrence of antibiotic resistances, common treatments are ineffective and costly. The aim of this study was to study the distribution of virulence factors, serogroups and antibiotic resistance properties of uropathogenic Escherichia coli isolated from pediatrics with pyelonephritis and cystitis. Material and Methods: In this study which was conducted during the year 2012 to 2013, 121 Escherichia coli strains were isolated from boys (51 samples and girls (70 samples with pyelonephritis and cystitis impatient in Baqiat-alah Hospital, Tehran. Antibiotic resistance of the isolates against commonly used antibiotics in the cases of urinary infections was investigated using disk diffusion method. Finally, PCR reactions using specific primers were done in order to detect  virulence factors, serogroups and antibiotic resistance genes. Results: Totally, 45.09% of boys and 55.71% of girls were positive for presence of uropathogenic Escherichia coli. The highest distribution of bacterium was seen in less than one year old boys (71.42% and 5-12 years old girls (75%. Results showed that the distribution of Escherichia coli in children with pyelonephritis and cystitis were 55.55% and 44.89%, respectively. The most commonly detected serogroups in children with pyelonephritis were O1, O2, O4 and O7 while, the most commonly detected serogroups in children with cystitis were O1, O2, O6 and O16. The most frequent virulence factors in the cases of pyelonephritis were pap (100%, afa (97.5%, sfa (95%, hly (95% and cnf-1 (92.5% and their most frequent in the cases of cystitis were fim (100%, pap (72.7%, afa (63.6% and hly (45.4%. The genes

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

    Science.gov (United States)

    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

  12. INCIDENCE OF ABNORMAL IMAGING AND RECURRENT PYELONEPHRITIS AFTER FIRST FEBRILE URINARY TRACT INFECTION IN CHILDREN 2-24 MONTHS

    Science.gov (United States)

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

    2013-01-01

    Purpose The American Academy of Pediatrics no longer recommends a voiding cystourethrogram (VCUG) for children aged 2 to 24 months presenting with their first urinary tract infection (UTI) if renal-bladder ultrasound (RBUS) is normal. Our goal was to identify factors associated with abnormal imaging and recurrent pyelonephritis for this population. Materials and Methods We retrospectively evaluated children diagnosed with first episode of pyelonephritis between 2 to 24 months using de-identified electronic medical record data from an institutional database. Data included age at first UTI, gender, race/ethnicity, need for hospitalization, intravenous antibiotic use, history of abnormal prenatal ultrasound, RBUS and VCUG results, UTI recurrence and surgical intervention. Risk factors for abnormal imaging and UTI recurrence were analyzed with univariate logistic regression, chi square and survival analysis. Results We identified 174 patients. Of 154 RBUS performed, 59 (38%) were abnormal. Abnormal prenatal ultrasound (p=0.01) and need for hospitalization (p=0.02) predicted abnormal RBUS. Of the 95 patients with normal RBUS, 84 had a VCUG. Vesicoureteral reflux was more likely in Caucasians (p=0.003), females (p=0.02) and older patients (p=0.04). Despite normal RBUS, 23 of 84 (24%) patients had dilating vesicoureteral reflux. Of the 95 patients with normal RBUS, 14 (15%) had recurrent pyelonephritis and 7 (7%) went on to surgical intervention. Conclusions Despite a normal RBUS after first episode of pyelonephritis, a child may still have vesicoureteral reflux, recurrent pyelonephritis, and need for surgical intervention. If VCUG is deferred, parents should be counseled regarding these risks. PMID:23353046

  13. Antibiotic therapy for acute uncomplicated pyelonephritis in women. Take resistance into account.

    Science.gov (United States)

    2014-12-01

    Acute uncomplicated pyelonephritis is a bacterial infection of the renal parenchyma, common in women. The bacterium responsible is usually Escherichia coli. Empirical antibiotic therapy should be initiated promptly to prevent serious complications. As of 2014, which empirical antibiotic regimen should be offered to non-pregnant adult women with acute uncomplicated pyelonephritis, while awaiting the results of antimicrobial susceptibility testing? We reviewed the available evidence using the standard Prescrire methodology. Certain oral fluoroquinolones were effective in a few clinical trials in the 2000s and 2010s: ciprofloxacin and levofloxacin, an isomer of ofloxacin. Symptoms resolved within 5 to 7 days in about 96% of the women. In France, in 2011, about 10% of E. coli isolated in community laboratories from outpatients with urinary tract infections were resistant to ciprofloxacin. Resistance is mainly a problem in patients treated with a quinolone during the preceding months and in recently hospitalised patients. In hospital laboratories, the fluoroquinolone resistance rate was about 18% in 2012 in France, and even higher in some other European countries. The main harms of fluoroquinolones are neuropsychiatric disorders, photosensitivity, tendon disorders, arrhythmia and cardiac conduction disorders, and Clostridium difficile infection. Injectable "third-generation" cephalosporins, such as ceftriaxone, are often effective against enterobacteria, in particular E. coli, and have good kidney penetration. The prevalence of E. coli resistance to third-generation cephalosporins is rising rapidly in France, particularly in hospitals: 1% in 2005 versus 10% in 2012. The main harms of cephalosporins are hypersensitivity reactions and C. difficile infection. Monotherapy with an aminoglycoside is an alternative that has not been evaluated in this clinical situation. Due to the serious irreversible adverse effects of aminoglycosides (nephrotoxicity, ototoxicity), they

  14. Maternal Plasma Concentration of the Pro-Inflammatory Adipokine Pre-B-Cell Enhancing Factor (PBEF)/ Visfatin Is Elevated In Pregnant Patients with Acute Pyelonephritis

    Science.gov (United States)

    Mazaki-Tovi, Shali; Vaisbuch, Edi; Romero, Roberto; Kusanovic, Juan Pedro; Chaiworapongsa, Tinnakorn; Kim, Sun Kwon; Nhan-Chang, Chia-Ling; Gomez, Ricardo; Yoon, Bo H.; Yeo, Lami; Mittal, Pooja; Ogge, Giovanna; Gonzalez, Juan M.; Hassan, Sonia S.

    2012-01-01

    Problem Visfatin/pre-B-cell enhancing factor (PBEF) has been implicated in the regulation of the innate immune system, as well as in glucose metabolism. Specifically, visfatin plays a requisite role in delayed neutrophil apoptosis in patients with sepsis. The aim of this study was to determine whether pyelonephritis during pregnancy is associated with changes in maternal plasma visfatin concentration in normal weight and overweight/obese patients. Methods of Study This cross-sectional study included the following groups: 1) normal pregnant women (n=200); and 2) pregnant women with pyelonephritis (n=40). Maternal plasma visfatin concentrations were determined by ELISA. Non-parametric statistics were used for analyses. Results 1) The median maternal plasma visfatin concentration was significantly higher in patients with pyelonephritis than in those with a normal pregnancy; 2) among overweight/obese pregnant women, those with pyelonephritis had a significantly higher median plasma visfatin concentration than women with a normal pregnancy; and 3) pyelonephritis was independently associated with higher maternal plasma visfatin concentrations after adjustment for maternal age, pre-gestational BMI, smoking status, gestational age at sampling, and birthweight. Conclusions Acute pyelonephritis during pregnancy is associated with a high circulating maternal visfatin concentration. These findings suggest that visfatin/PBEF may play a role in the regulation of the complex and dynamic crosstalk between inflammation and metabolism during pregnancy. PMID:20085562

  15. Host Response to Porcine Strains of Escherichia coli in a Novel Pyelonephritis Model

    DEFF Research Database (Denmark)

    Isling, L. K.; Aalbæk, B.; Birck, M. M.;

    2011-01-01

    . coli strain LK67 (P fimbriae PapGI), LK76 (type 1 fimbriae) or LK82 (type 1 fimbriae and P fimbriae PapGII/III), respectively. The contralateral kidneys were inoculated with saline and served as controls. Pigs were killed 6h post-inoculation (hpi). Differential leucocyte counts, serum biochemical...... kidneys. Gross and microscopical lesions of acute pyelonephritis were demonstrated in all but one kidney inoculated with E. coli, but in none of the control kidneys. Renal parenchymal infiltration with both neutrophils and mononuclear cells, primarily CD3+ T lymphocytes, was observed at 6hpi. Most T...... lymphocytes were CD8+. Pigs in group C had the highest mean pathology scores. Neutrophils were the dominant renal leucocyte in this group, while the number of mononuclear cells was at least equal to the number of neutrophils in the lesions of pigs from groups A and B. Kidneys with a high number of E. coli had...

  16. Emphysematous pyelonephritis in failed renal allograft: Case report and review of literature.

    Science.gov (United States)

    Bansal, Rahul Kumar; Lambe, Shahid; Kapoor, Anil

    2016-01-01

    Emphysematous pyelonephritis (EPN) in renal allograft is rare but potentially lethal complication and requires aggressive medical and/or surgical therapy to achieve cure. We report a case of 60-year-old diabetic male with poor cardiac function on maintenance hemodialysis, who underwent delayed allograft nephrectomy for EPN in failed renal allograft. Blood culture grew Bacteroides. He was stable in the postoperative period but passed away on day 4 due to myocardial infarction likely secondary to poor baseline cardiac function. Delay in diagnosis and treatment could have contributed to this unfavorable outcome. There is a paucity of published literature regarding EPN in the transplant population, such that management decisions (percutaneous conservative versus urgent surgical) are challenging. Further studies are required to establish treatment guidelines.

  17. 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.

  18. 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.

  19. The first case report of emphysematous pyelonephritis and bacteremia due to Oligella urethralis.

    Science.gov (United States)

    Yamaguchi, Hirotaka; Yamaguchi, Yukihiro; Hadano, Yoshiro; Hayashi, Kenichi; Nagahara, Chie; Muratani, Tetsuro; Ohkusu, Kiyofumi

    2017-04-01

    Oligella urethralis (O. urethralis) is an organism that rarely causes infections in humans. We report the case of a 90-year-old bedridden woman with progressive dementia who was placed in a long-term-care facility. She was admitted to our hospital due to fever and unconsciousness with pyuria. The abdominal computed tomography showed left pneumatosis and urinary stone. Fluoroquinolones-resistant O. urethralis, which was identified by the Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) and the 16S rRNA gene sequencing, was isolated form the blood and urine cultures at admission. To the best of our knowledge, this is the first case of emphysematous pyelonephritis caused by O. urethralis. Copyright © 2017 Elsevier GmbH. All rights reserved.

  20. 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.

  1. In vivo susceptibility of ESBL producing Escherichia coli to ceftriaxone in children with acute pyelonephritis

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    Peco-Antić Amira

    2012-01-01

    Full Text Available Introduction. The choice of empiric therapy of acute pyelonephritis (APN in children should be based on the knowledge of Escherichia coli (E. coli as the most common uropathogen and its antibiotic sensitivities considering that nowadays ESBL-producing [ESBL (+] E. coli is on the rise worldwide. Objective. To examine in vivo susceptibility of ESBL (+ E. coli to ceftriaxone (CTX, and to evaluate the options for empiric therapy for APN in children. Methods. Retrospective study of CTX empiric therapy of APN in children treated at the University Children΄s Hospital in Belgrade from January 2005 to December 2009. ESBL phenotypic confirmatory test with ceftazidime, CTX and cefotaxime was performed for all urine isolates by disc diffusion method on Mueller-Hinton agar plates. In vivo sensitivity of CTX documented by clinical response to empiric CTX therapy was compared between two groups of children: group I with ESBL (+ E. coli and group II with ESBL (- E. coli APN. Results. Group I with ESBL (+ APN consisted of 94 patients and group II of 120 patients with ESBL (- APN, respectively. All patients received CTX as empiric therapy at a mean dose of 66.9 mg during 7.2±2.6 days of therapy. Clinical effect of CTX was similar in patients with ESBL (+ compared to those with ESBL (- APN. Conclusions. In vitro resistance of ESBL E. coli to CTX determined by standard methods is not sufficiently predictive for its in vivo sensitivity. Therefore CTX may be used as empiric therapy for acute pyelonephritis in children.

  2. [ROLE α2-ADRENERGIC RECEPTORS IN REGULATION PLATELET REACTIVITY IN THE ELDERLY AT CHRONIC OBSTRUCTIVE PYELONEPHRITIS].

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    Barinov, E F

    2016-01-01

    Objective of the research was to determine involvement of platelets and the role of adrenaline in chronic inflammation maintaining and the initiation of acute inflammatory response in elderly patients with chronic obstructive pyelonephritis against this background. The study includes 60 patients with chronic obstructive pyelonephritis (COPN), which are distributed into two groups: basic - 22 elderly patients (age 73±1,5 years) and the comparison group - 38 middle-aged patients (52,5±2,4 years). The study excluded patients who took antiplatelet drugs and non-selective blockers of α adrenergic receptors at least 1 week before the study. Analysis of platelets adrenoreactivity in vitro was carried out at the time of hospitalization before the start of conservative therapy. Platelet-rich plasma was isolated from peripheral blood by centrifuging. ADP and epinephrine were used in the effective (EC50) and sub-threshold (EC10) concentrations to stimulate platelets. The formation of platelet-leukocyte aggregates was reproduced in vitro upon incubation of stimulated platelets (at a concentration of adrenaline EC50) and intact leukocytes isolated from patient peripheral blood. The study of platelet reactivity revealed that in elderly patients acute inflammatory response realization (relapse of COPN) is against optimal functioning of platelets α2 adrenergic receptors. Significant increase in the number of platelet-leukocyte aggregates is possible. Remission of COPN (the presence of chronic inflammation) in the examined patients of various ages was associated with platelet hypoadrenoreactivity. Increased platelet adrenoreactivity during transition from remission to relapse of COPN in the elderly patients is possible if adequate synthesis of ADP in platelets and its secretion from dense granules are preserved. The observed interaction of adrenaline and ADP with stimulated platelet hyporesponsiveness probably ensures adaptive response aimed at acute inflammatory response in

  3. Vitamin E as adjuvant treatment for urinary tract infection in girls with acute pyelonephritis.

    Science.gov (United States)

    Yousefichaijan, Parsa; Kahbazi, Manigeh; Rasti, Sara; Rafeie, Mohammad; Sharafkhah, Mojtaba

    2015-03-01

    Vitamin E is a fat-soluble vitamin that functions as an antioxidant. The aim of this study was to investigate the effects of vitamins E supplementation in combination with antibiotics for the treatment of girls with acute pyelonephritis. This double-blinded randomized controlled trial was conducted on 152 girls aged 5 to 12 years with a first acute pyelonephritis episode based on technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA). They were randomized to receive a 14-day treatment with only antibiotics (control group; n = 76) and 14-day treatment with supplements of vitamin E (intervention group; n = 76) in addition to the antibiotics. Patients' clinical symptoms were monitored for 14 days and urine culture was performed 3 to 4 days and 7 to 10 days after the start of the treatment and its completion, respectively. All of the girls once underwent DMSA scan 4 to 6 months after the treatment. During the follow-up days, the mean frequency of fever (P = .01), urinary frequency (P = .001), urgency (P = .003), dribbling (P = .001), and urinary incontinence (P = .006) were significantly lower in the intervention group compared to the control group. There was no significant difference in the results of urine culture 3 to 4 days after the start of treatment (P = .16) and 7 to 10 days after its termination (P = .37). There was also no significant difference between the results of DMSA scan 4 to 6 months after the start of treatment (P = .31). Vitamin E supplementation has a significant effect in ameliorating sign and symptoms of UTI. However, further studies are recommended to confirm these findings.

  4. Acute Pyelonephritis in Renal Allografts–A New Role for MicroRNAs?

    Science.gov (United States)

    Oghumu, Steve; Bracewell, Anna; Nori, Uday; Maclean, Kirsteen H.; Balada-Lasat, Joan-Miquel; Brodsky, Sergey; Pelletier, Ronald; Henry, Mitchell; Satoskar, Abhay R.; Nadasdy, Tibor; Satoskar, Anjali A.

    2014-01-01

    Background Acute pyelonephritis (APN) versus acute rejection (AR) is a frequently encountered diagnostic and therapeutic dilemma in kidney transplants. Variable culture results, overlapping histologic features, and persistent graft dysfunction despite antibiotics are frequently encountered. Therefore, we explored the utility of intragraft microRNA profiles to distinguish between allograft APN and AR. Materials and Methods Between 2003 and 2011, we identified 49 patients with biopsy features of APN, within the first 2 years posttransplant. MicroRNA profiling was performed on 20 biopsies (normal kidney, n=4; unequivocal AR, n=5; features of APN, n=11). Results Only 32% (16/49) of the patients had concomitant positive urine cultures at biopsy, and in 8 of 16 patients, colony count was less than 105 CFU/mL. In 14 of 49 patients, positive urine culture did not coincide with the biopsy, and in 19 of 49 patients, urine cultures were negative. On microRNA profiling, good clustering was seen among the normal kidneys and among AR biopsies. Among the 11 biopsies with features of APN, 4 biopsies showed good clustering with a pattern distinct from AR; (these patients recovered graft function with antibiotics); 7 of 11 biopsies showed heterogeneity in microRNA profiles and variable outcomes with antibiotic treatment. We identified a panel of 25 microRNAs showing statistical difference in expression between AR and APN. MiR-99b, miR-23b let-7b-5p, miR-30a, and miR-145 were validated using qPCR. Conclusion Allograft pyelonephritis can be a diagnostic and therapeutic challenge. A gestalt approach is required. In addition to histology and cultures, differential intragraft microRNA expression may prove helpful to distinguish APN from AR in renal allograft biopsies. PMID:24521778

  5. Institutional characteristics associated with receipt of emergency care for obstructive pyelonephritis at community hospitals.

    Science.gov (United States)

    Borofsky, Michael S; Walter, Dawn; Li, Huilin; Shah, Ojas; Goldfarb, David S; Sosa, R Ernest; Makarov, Danil V

    2015-03-01

    Delivering the recommended care is an important quality measure that has been insufficiently studied in urology. Obstructive pyelonephritis is a suitable case study for this focus because many patients do not receive such care, although guidelines advocate decompression. We determined the influence of hospital factors, particularly familiarity with urolithiasis, on the likelihood of decompression in such patients. We used the NIS from 2002 to 2011 to retrospectively identify patients admitted to community hospitals with severe infection and ureteral calculi. Hospital familiarity with nephrolithiasis was estimated by calculating hospital stone volume (divided into quartiles) and hospital treatment intensity (the decompression rate in patients with ureteral calculi and no infection). After calculating national estimates we performed logistic regression to determine the association between the receipt of decompression and hospital stone volume, controlling for treatment intensity and other covariates thought to be associated with receiving recommended care. Of an estimated 107,848 patients with obstructive pyelonephritis 27.4% failed to undergo decompression. Discrepancies were greatest between hospitals with the highest and lowest stone volumes (76% vs 25%, OR 2.77, 95% CI 1.94-3.96, p <0.01) as well as high and low treatment intensity (78% vs 37%, p <0.01). High hospital stone volume and treatment intensity were associated with an increased likelihood of receiving decompression. Such findings might be useful to identify hospitals and regions where access to quality urological care should be augmented. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?

    Science.gov (United States)

    Taniguchi, Lincoln S; Torres, Ulysses S; Souza, Saulo M; Torres, Lucas R; D'Ippolito, Giuseppe

    2017-05-01

    Background The most widely accepted computed tomography (CT) protocol for diagnosis of acute pyelonephritis (APN) includes at least a pre- and post-contrast scan, which may expose patients to higher doses of ionizing radiation. Purpose To establish the accuracy, reproducibility, and degree of confidence in CT diagnosis of acute pyelonephritis (APN) and urolithiasis using only images obtained during the nephrographic phase. Material and Methods A retrospective study of 100 consecutive patients (88 women; age range, 19-70 years) with clinical and laboratory suspicion of APN and who underwent triphasic abdominal CT scans (non-contrast, nephrographic, and excretory phases) was performed. Two readers first evaluated independently only the nephrographic phase of scans, and, in a second session, the entire study. The diagnostic reference standard was settled by a third experienced radiologist who reviewed all triphasic scans and clinical data. Results The accuracy of only nephrographic phase for diagnosis of APN and urolithiasis was in the range of 90.3-91.78% and 96.27-99.25%, respectively. There was no significant difference in comparison with the triphasic reading (z: -0.4 - 0.2; P = 0.34-0.83). The average degree of confidence for APN also showed no significant variation for both readers ( P = 0.4 and 0.08). Almost perfect inter-observer agreements for the diagnosis of APN (k = 0.86, P < 0.001) and for urolithiasis (k = 0.84, P < 0.001) were observed when considering only the nephrographic phase. Conclusion CT assessment of APN and urolithiasis can be accurately performed using only the late nephrographic phase, with consequent dose reduction.

  7. Recurrent obstructive acute pyelonephritis: A rare form of Actinotignum (Actinobaculum) schaalii infection in a HIV-1 infected patient.

    Science.gov (United States)

    Vallet, Anaïs; Noël, Nicolas; Bahi, Rachid; Teicher, Elina; Quertainmont, Yann; Delfraissy, Jean-François; Ferlicot, Sophie; Potron, Anaïs; Goujard, Cécile; Lambotte, Olivier

    2017-02-01

    Actinobaculum schaalii is a rarely reported, anaerobic, Gram-positive bacterium which role as uropathogen is emerging. We report here the case of a 47 year old HIV-1 infected woman presented with five recurrent episodes of obstructive pyelonephritis in the context of multiple renal stones. No bacteria was found until the fifth episode, during which prolonged urinary cultures as well as 16S rDNA sequencing allowed the diagnosis of A. schaalii infection. She had developed a life-threatening condition with severe renal failure. A right nephrectomy was performed and found that the intrarenal stones were attributed to the antiretroviral therapy. The renal parenchyma corresponded to an end-stage renal disease with chronic pyelonephritis without abcesses or granules. The situation improved after six months of amoxicillin therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Genetic Polymorphism of Toll-like Receptor 4 — Predictor of Susceptibility to Recurrent Course of Chronic Pyelonephritis in Children

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    T.A. Kryuchko

    2013-11-01

    Methods. We examined a group of children aged 1–15 years with chronic pyelonephritis in the active stage (n = 60. Control group consisted of 95 apparently healthy people. Results. There were revealed significantly higher prevalence of Toll-like receptor 4 Asp299Gly gene polymorphism among children with chronic pyelonephritis (n = 60, identified a statistically significant correlation of mutant genotypes Asp299Gly, Gly299Gly with manifestation of the disease before the age of 3, and frequent episodes of acute respiratory viral infections, torpid urinary syndrome, unstable remission and increased secretion of interleukin-6 (p < 0.001. Thus, genetically determined Toll-like receptor 4 Asp299Gly gene polymorphism is a marker of high risk of early manifestation of chronic inflammation in the kidney interstitium and prolonged recurrent clinical course of the disease in children.

  9. Inflammatory pre-conditioning of mesenchymal multipotent stromal cells improves their immunomodulatory potency in acute pyelonephritis in rats.

    Science.gov (United States)

    Plotnikov, Egor Y; Pulkova, Natalya V; Pevzner, Irina B; Zorova, Ljubava D; Silachev, Denis N; Morosanova, Maria A; Sukhikh, Gennady T; Zorov, Dmitry B

    2013-06-01

    Acute pyelonephritis is one of the most frequent infectious diseases of the urinary tract and a leading cause of kidney failure worldwide. One strategy for modulating excessive inflammatory responses in pyelonephritis is administration of mesenchymal multipotent stromal cells (MMSCs). The putative protective effect of injection of MMSCs against experimental acute pyelonephritis was examined. We used in vivo experimental model of APN where bacteria are introduced in the bladder of rat. Three days after, intravenous injection of MMSCs was done. On the 7th day blood samples and kidneys were taken for further analysis. We found obvious signs of oxidative stress and inflammation in the kidney in acute pyelonephritis in rats. Particularly, pro-inflammatory cytokine tumor necrosis factor-α levels, malondialdehyde, nitrite and myeloperoxidase activity were significantly increased. Histologic evaluation revealed numerous attributes of inflammation and tissue damage in the kidney. Treatment with MMSCs caused a remarkable decrease of all of these pathologic signs in renal tissue. Also, activated leukocytes induced pre-conditioning-like signaling in MMSCs. We showed alterations of expression or activity of inducible nitric oxide synthase, transforming growth factor-β, matrix metalloproteinase-2 and glycogen synthase kinase-3β, which could mediate immunomodulation and protective effects of MMSCs. This signaling could be characterized as inflammatory pre-conditioning. The beneficial capacity of MMSCs to alleviate renal inflammation was more pronounced when pre-conditioned MMSCs were used. This approach could be used to prime MMSCs with different inflammatory modulators to enhance their engraftment and function in an immunoprotected fashion. Copyright © 2013 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  10. Role of P-fimbrial-mediated adherence in pyelonephritis and persistence of uropathogenic Escherichia coli (UPEC) in the mammalian kidney.

    Science.gov (United States)

    Lane, M C; Mobley, H L T

    2007-07-01

    P fimbria, a mannose-resistant adhesin of uropathogenic Escherichia coli (UPEC), has been shown to be associated with acute pyelonephritis. The pap gene cluster encodes the proteins required for P-fimbrial biogenesis, including papG, which encodes the tip adhesin. The three most studied PapG molecular variants, which are shown to bind distinct isoreceptors, are PapGI, -II, and -III. PapGII preferentially binds globoside, or GbO4, a glycolipid isoreceptor of the human kidney. Studies using different animal models of ascending urinary tract infection (UTI) have demonstrated a variable role for P fimbriae, and specifically PapGII-mediated adherence, in renal colonization. The disparities in the results obtained from those studies are likely to be attributed to the differences in animal models and UPEC strains utilized. One explanation that is discussed in detail is the contribution of multiple fimbriae of UPEC that potentially mediate adherence to the mammalian kidney. Overall, P fimbriae appear to play some role in mediating adherence to uroepithelial cells in vivo and establishing an inflammatory response during renal colonization, thus contributing to kidney damage during acute pyelonephritis. To verify that P fimbriae contribute to the pathogenesis of UPEC during ascending UTI (and in particular acute pyelonephritis), future studies should be conducted to satisfy fully all three tenets of the molecular Koch's postulates, including complementation of a mutated allele.

  11. Activation of endogenous anti-inflammatory mediator cyclic AMP attenuates acute pyelonephritis in mice induced by uropathogenic Escherichia coli.

    Science.gov (United States)

    Wei, Yang; Li, Ke; Wang, Na; Cai, Gui-Dong; Zhang, Ting; Lin, Yan; Gui, Bao-Song; Liu, En-Qi; Li, Zong-Fang; Zhou, Wuding

    2015-02-01

    The pathogenesis of pyelonephritis caused by uropathogenic Escherichia coli (UPEC) is not well understood. Here, we show that besides UPEC virulence, the severity of the host innate immune response and invasion of renal epithelial cells are important pathogenic factors. Activation of endogenous anti-inflammatory mediator cAMP significantly attenuated acute pyelonephritis in mice induced by UPEC. Administration of forskolin (a potent elevator of intracellular cAMP) reduced kidney infection (ie, bacterial load, tissue destruction); this was associated with attenuated local inflammation, as evidenced by the reduction of renal production of proinflammatory mediators, renal infiltration of inflammatory cells, and renal myeloperoxidase activity. In primary cell culture systems, forskolin not only down-regulated UPEC-stimulated production of proinflammatory mediators by renal tubular epithelial cells and inflammatory cells (eg, monocyte/macrophages) but also reduced bacterial internalization by renal tubular epithelial cells. Our findings clearly indicate that activation of endogenous anti-inflammatory mediator cAMP is beneficial for controlling UPEC-mediated acute pyelonephritis in mice. The beneficial effect can be explained at least in part by limiting excessive inflammatory responses through acting on both renal tubular epithelial cells and inflammatory cells and by inhibiting bacteria invasion of renal tubular epithelial cells. Copyright © 2015 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  12. A Seven-Day Course of TMP-SMX May Be as Effective as a Seven-Day Course of Ciprofloxacin for the Treatment of Pyelonephritis.

    Science.gov (United States)

    Fox, Miriam T; Melia, Michael T; Same, Rebecca G; Conley, Anna T; Tamma, Pranita D

    2017-07-01

    The Infectious Diseases Society of America guidelines recommend either 14 days of trimethoprim-sulfamethoxazole (TMP-SMX) or 7 days of ciprofloxacin for the treatment of pyelonephritis. Antibiotic courses of 7 days of TMP-SMX vs 7 days of ciprofloxacin for pyelonephritis have not been previously compared. We evaluated the odds of a subsequent, symptomatic urinary tract infection (UTI) for women with Escherichia coli pyelonephritis receiving a 7-day course of TMP-SMX vs a 7-day course of ciprofloxacin. Women ages 16 years and older with E. coli pyelonephritis presenting to 5 health care facilities in the greater Maryland area between 2010 and 2016 receiving either TMP-SMX or ciprofloxacin were included. Patients were excluded if they met any of the following criteria: (a) pregnancy, (b) dialysis dependency, (c) E. coli not susceptible to the treatment prescribed, (d) polymicrobial urine culture, or (e) >48 hours of antibiotic therapy other than TMP-SMX or ciprofloxacin. Of 272 women meeting eligibility criteria, 81 (30%) and 191 (70%) received 7 days of TMP-SMX and 7 days of ciprofloxacin, respectively. In an adjusted model, the likelihood of a recurrent UTI within 30 days for the TMP-SMX and ciprofloxacin groups was similar (adjusted odds ratio 2.30; 95% confidence interval, 0.72-7.42). Our findings suggest that 7 days of TMP-SMX therapy may result in similar clinical outcomes compared with 7 days of ciprofloxacin for the treatment of pyelonephritis. Considering the frequency of pyelonephritis and risks of antibiotic resistance and associated toxicities, decreasing the duration of antibiotic therapy for pyelonephritis may impact a large number of women. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Acute Pyelonephritis Focusing on Perfusion Defects on Contrast Enhansed Computerized Tomography(CT) Scans and Its Clinical Outcome

    Science.gov (United States)

    Ha, Sung-Kyu; Seo, Jung-Kun; Kim, Seung-Jung; Park, Seung-Ho; Park, Chong-Hoon; Lee, Ho-Yung; Han, Dae-Suk; Kim, Ki-Whang

    1997-01-01

    Objectives Many cases of acute pyelonephritis show renal perfusion defects on contrast enhanced computerized tomography (CT) imaging studies. The purpose of this study is to show the frequency of renal perfusion defects in uncomplicated acute pyelonephritis and to compare the clinical responses of patients who had perfusion defects or not. Methods We studied patients who had symptoms and signs of acute pyelonephritis through CT examinations with contrast enhancement. We identified 21 cases who had perfusion defects among 35 patients who had undergone CT imaging studies and compared the clinical data in the two groups of patients who had perfusion defects on CT (group 1) and who had not (group 2). Results Nearly all patients had typical symptoms and signs of acute pyelonephritis such as high fever and chill, flank pain and costovertebral angle tenderness. Combined clinical problems were septic shock (one case, 4.8%) and disseminated intravascular coagulation (DIC) (one case, 4.8%) in group 1. Laboratory findings were not different between the two groups. All patients were treated with antibiotics and had successful recoveries. The duration of recovery of pyuria in group 1 (5.2±9.6 days) was not longer than that in group 2(3.1±2.9 days) (p>0.05). The length of defeverscence in group 1 (7.0±4.6 days) was longer than in group 2 (3.5±2.7 days) (ppyelonephritis patients). We classified CT findings of group 1 as focal unilateral (2 cases, 9.5%), multifocal unilateral (14 cases, 66.7%) and multifocal bilateral (5 cases, 23.8%), and there were no differences between the subgroups of group 1 in the duration of defeverscence. Conclusion Those patients who had perfusion defects on CT showed relatively severe clinical courses but responses to early antibiotics were very good. Contrast enhanced CT scans may be very sensitive for the detection of acute renal parenchymal inflammatory disease and for defining the extent of disease, but it is clinically not essential to perform

  14. Distribution of phylogenetic groups, sequence type ST131, and virulence-associated traits among Escherichia coli isolates from men with pyelonephritis or cystitis and healthy controls.

    Science.gov (United States)

    Kudinha, T; Johnson, J R; Andrew, S D; Kong, F; Anderson, P; Gilbert, G L

    2013-04-01

    Urinary tract infections (UTI), which are mostly caused by Escherichia coli, are an important public health problem worldwide. Although men experience diverse UTI syndromes, there have been relatively few molecular-epidemiological studies of UTI pathogenesis in men. We studied the distribution of 22 E. coli virulence factor (VF) genes, major phylogenetic groups, sequence type ST131, and UTI-associated O antigens among 101 pyelonephritis, 153 cystitis and 135 fecal healthy control E. coli isolates from men aged 30-70 years in a regional area of NSW, Australia. Overall, the studied traits exhibited a prevalence gradient across these groups, highest in pyelonephritis, intermediate in cystitis, and lowest among fecal isolates. Differences in virulence gene prevalence between cystitis and pyelonephritis isolates were limited to eight genes. The UTI-associated O antigens were also distributed widely, but types O6, O25 and O75 were significantly associated with pyelonephritis. The ST131 clonal group, which accounted for 13% of isolates overall (22% of group B2 isolates), likewise exhibited a significant descending prevalence gradient from pyelonephritis (36%), through cystitis (8%), to fecal (0%) isolates. These findings contribute to better understanding of the pathogenesis of UTIs in men and identify specific VF genes and O types, and a prominent clonal group (ST131), as being important in UTI pathogenesis in this population. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  15. Previously undiagnosed hereditary spherocytosis in a patient with jaundice and pyelonephritis: a case report

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    Yuki Tateno

    2016-12-01

    Full Text Available Abstract Background Hereditary spherocytosis is autosomal dominant inherited extravascular hemolytic disorder and is the commonest cause of inherited hemolysis in northern Europe and the United States. The classical clinical features of hereditary spherocytosis are anemia, jaundice, and splenomegaly. However, all of these classical features are not always revealed in the case of mild hemolysis or when hemolysis is well compensated. Patients with hereditary spherocytosis may remain undiagnosed for years if their hemolysis is mild. Case presentation A 42-year-old Asian woman presented to our clinic with a sudden onset of high fever with shaking chills and jaundice, suggesting septicemia; however, following detailed investigation, the patient was diagnosed with pyelonephritis and accelerated hemolysis of hereditary spherocytosis due to infection. Conclusions It is important to note that transient anemia or jaundice can sometimes be the only initial presenting symptoms in cases of undiagnosed latent hereditary spherocytosis. This case also highlights the fact that physicians should consider concomitant hemolytic disease in patients in whom jaundice and infections that rarely cause jaundice coexist.

  16. Diagnostic performance of initial serum lactate for predicting bacteremia in female patients with acute pyelonephritis.

    Science.gov (United States)

    Seo, Dong Young; Jo, Sion; Lee, Jae Baek; Jin, Young Ho; Jeong, Taeoh; Yoon, Jaechol; Park, Boyoung

    2016-08-01

    The purpose of the present study was to investigate the diagnostic value of lactate for predicting bacteremia in female patients with acute pyelonephritis (APN). We conducted a retrospective study of female patients with APN who visited the study hospital emergency department. The demographics, comorbidities, physiologies, and laboratory variables including white blood cell count and segmented neutrophil count, C-reactive protein, and initial serum lactate levels were collected and analyzed to identify associations with the presence of bacteremia. During the study period, a total of 314 patients were enrolled. One hundred twenty-three patients (39.2%) had bacteremia. Escherichia coli was the most frequent pathogen. Logistic regression analysis demonstrated that the lactate level was independently associated with the presence of bacteremia (odds ratio, 1.39 [95% confidence interval, 1.08-1.78]). The C-statistic of the lactate level was 0.67 (95% CI, 0.60-0.73). At a cutoff value of 1.4mmol/L, the lactate level predicted bacteremia with a sensitivity (53.7%), specificity (72.3%), positive predictive value (55.5%), negative predictive value (70.8%), positive likelihood ratio (1.93), and negative likelihood ratio (0.64). The initial serum lactate level showed poor discriminative performance for predicting bacteremia in female patients with APN. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Relationship between uncommon computed tomography findings and clinical aspects in patients with acute pyelonephritis.

    Science.gov (United States)

    Kim, Jang Sik; Lee, Sangwook; Lee, Kwang Woo; Kim, Jun Mo; Kim, Young Ho; Kim, Min Eui

    2014-07-01

    Computed tomography (CT) has become popular in the diagnosis of acute pyelonephritis (APN) and its related complications in adults. The aim of this study was to investigate the relationship between uncommon CT findings and clinical and laboratory data in patients with APN. From July 2009 to July 2012, CT findings and clinical data were collected from 125 female patients with APN. The six uncommon CT findings (excluding a wedge-shaped area of hypoperfusion in the renal parenchyma) studied were perirenal fat infiltration, ureteral wall edema, renal abscess formation, pelvic ascites, periportal edema, and renal scarring. The clinical parameters analyzed were the age and body mass index of the patients as well as the degree and duration of fever. Laboratory parameters related to inflammation and infection included white blood cell count, C-reactive protein (CRP) level, erythrocyte sedimentation rate, pyuria, and bacteriuria. The most common CT finding was perirenal fat infiltration (69 cases, 55%). A longer duration of fever, higher CRP level, and grade of pyuria were related with perirenal fat infiltration (p=0.010, p=0.003, and p=0.049, respectively). The CRP level was significantly higher in patients with renal abscess and ureteral wall edema (p=0.005 and p=0.015, respectively). The uncommon CT findings that were related to aggravated clinical and laboratory parameters of APN patients were perirenal fat infiltration, ureteral wall edema, and renal abscess formation. The inflammatory reaction and tissue destruction may be more aggressive in patients with these CT findings.

  18. Gallbladder Wall Thickening and Periportal Tracking on CT in Patients with Acute Pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Jae Shik; Sung, Deuk Jae; Park, Beom Jin; Kim, Min Ju; Cho, Sung Bum; Han, Na Yeon; Lee, Nam Joon [Dept. of Radiology, Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2012-09-15

    To assess gallbladder (GB) wall thickening and periportal tracking on CT in patients with acute pyelonephritis (APN) by each kidney involvement. A total of 117 patients diagnosed with APN by clinical examination and CT were included in this retrospective study. The patients were divided into three groups based on kidney involvement seen on CT: right APN, left APN, and bilateral APN. Two radiologists reviewed CT images in consensus for the presence of diffuse GB wall thickening and periportal tracking. The prevalence of these two manifestations was compared among the three groups. The prevalence of GB wall thickening in patients with right APN (26.4%) and bilateral APN (19%) was significantly higher than in patients with left APN (0%) (p < 0.016). The prevalence of periportal tracking in patients with right APN (15.1%) and bilateral APN (26%) was higher than in patients with left APN (3%), with a significant difference between patients with bilateral APN and left APN (p < 0.016). GB wall thickening and periportal tracking are predominantly encountered on CT in patients with APN involving the right kidney (right and bilateral APN), and should be considered in differential diagnosis of diseases associated with GB wall thickening and periportal tracking.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. Imaging features and guided drainage in emphysematous pyelonephritis: a study of 11 cases

    Energy Technology Data Exchange (ETDEWEB)

    Narlawar, R.S.; Raut, A.A. E-mail: abhijitaraut@hotmail.com; Nagar, A.; Hira, P.; Hanchate, V.; Asrani, A

    2004-02-01

    AIM: The purpose of the present study is to evaluate the role of image-guided drainage in emphysematous pyelonephritis (EPN). MATERIALS AND METHODS: We reviewed 11 patients with EPN treated either by ultrasonography (three patients) or computed tomography (CT)-guided drainage (eight patients). There were eight male and three female patients in our study with ages ranging from 24 to 75 years, mean 56.3 years. All the patients underwent plain radiography, ultrasonography and plain CT of the abdomen. Contrast-enhanced CT was performed in seven patients. RESULTS: Seven of 11 patients, were successfully treated with per cutaneous drainage. One patient died within 24 h (case 2), due to septicaemia. Three patients subsequently required nephrectomy. Replacement of the drainage catheter was required in one patient. The catheter was kept in situ, for an average of 17 days. The catheter drained pus and gas in all patients. The quantity of pus ranged from 300 to 2000 cm{sup 3}. All 10 patients improved symptomatically within 24 h of drainage, with improved urine output and serum creatinine levels within 48 h. CONCLUSION: CT-guided drainage of EPN has established itself as a safe, quick and life-saving palliative treatment of choice as opposed to conventional emergency nephrectomy. Excluding the patient who died, the success rate of our study was 70%.

  2. A clinical study of bilateral non-obstructive acute pyelonephritis with acute kidney injury in patients of type 2 diabetes mellitus.

    Science.gov (United States)

    Yadla, Manjusha; Parvithina, Sriramnaveen; Chennu, Krishna Kishore; Reddy, Sandeep; Sridhar, A V S S N; Vijayalakshmi, B; Lakshmi, A Y; Kalawat, Tek Chand; Sivakumar, V

    2014-03-01

    The aim of our study was to study the clinical profile of type 2 diabetes mellitus patients admitted with the diagnosis of acute kidney injury (AKI) due to bilateral acute non-obstructive pyelonephritis. The bilateral involvement was identified on various imaging modalities (ultrasound, computed tomography, nuclear scintigrapy). All the patients had AKI. Those with severe AKI underwent hemodialysis. The factors associated with the severity of illness were identified. Twenty-five patients of type 2 diabetes mellitus admitted with the diagnosis of AKI due to bilateral acute non-obstructive pyelonephritis were identified. On ultrasound, bilateral involvement was found in 12 patients and in 17 patients on computed tomography and eight patients on nuclear scintigraphy. Fourteen of them needed dialysis support. Bilateral acute pyelonephritis needs to be considered while evaluating the AKI in type 2 diabetes mellitus patients.

  3. Soluble TRAIL in normal pregnancy and acute pyelonephritis: a potential explanation for the susceptibility of pregnant women to microbial products and infection.

    Science.gov (United States)

    Chaemsaithong, Piya; Romero, Roberto; Korzeniewski, Steven J; Schwartz, Alyse G; Stampalija, Tamara; Dong, Zhong; Yeo, Lami; Hernandez-Andrade, Edgar; Hassan, Sonia S; Chaiworapongsa, Tinnakorn

    2013-11-01

    Pregnancy is characterized by activation of the innate immune response demonstrated by phenotypic and metabolic changes in granulocytes and monocytes. This state of activation has been implicated in the pathophysiology of multiorgan dysfunction of pregnant women with acute viral or bacterial infection. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is one of the mediators responsible for neutrophil apoptosis. Gene deletion of TRAIL results in delayed neutrophil apoptosis and resolution of inflammation after the administration of bacterial endotoxin. The aim of this study was to determine whether maternal plasma concentrations of the soluble form of TRAIL (sTRAIL) differ in women with uncomplicated pregnancy and those with acute pyelonephritis. A cross-sectional study was conducted to include women in the following groups: (1) non-pregnant (n = 23); (2) uncomplicated pregnancies (n = 93) and (3) pregnancies with acute pyelonephritis (n = 23). Plasma concentrations of sTRAIL were determined by enzyme-linked immunoassay. (1) Women with uncomplicated pregnancies had a lower mean plasma sTRAIL concentration (pg/mL) than non-pregnant women (31.5 ± 10.1 versus 53.3 ± 12.5; p pyelonephritis than in those with uncomplicated pregnancies (20.5 ± 6.6 versus 31.5 ± 10.1; p pyelonephritis, patients with bacteremia had a significantly lower mean plasma concentration of sTRAIL (pg/mL) than those without bacteremia (15.1 ± 4.8 versus 24.7 ± 4.6; p pyelonephritis, and this could account, at least in part, for the exaggerated intravascular inflammatory response previously reported in pyelonephritis during pregnancy.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

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

    2015-01-20

    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 follow-up could potentially be individualized. The objectives of this review were to 1) determine whether procalcitonin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) can replace the acute DMSA scan in the diagnostic evaluation of children with UTI; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other. We searched MEDLINE, EMBASE, DARE, Web of Science, and BIOSIS Previews for this review. The reference lists of all included articles and relevant systematic reviews were searched to identify additional studies not found through the electronic search. We only considered published studies that evaluated the results of an index test (procalcitonin, CRP, ESR) against the results of an acute-phase DMSA scan (conducted within 30 days of the UTI) in children aged 0 to 18 years with a culture-confirmed episode of UTI. The following cutoff values were used for the primary analysis: 0.5 ng/mL for procalcitonin, 20 mg/L for CRP and 30 mm/h for ESR. Two authors independently applied the selection criteria to all citations and independently abstracted data. We used the bivariate model to calculate pooled random-effects pooled sensitivity and specificity values. A total of 24 studies met our inclusion criteria. Seventeen studies provided data for the primary analysis: six studies (434 children) included data on procalcitonin, 13 studies (1638 children) included data on CRP, and six studies (1737 children) included data on ESR (some studies had data on more than one test). The summary sensitivity estimates (95% CI) for the procalcitonin, CRP, ESR tests at the aforementioned

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

    Science.gov (United States)

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

    2015-01-01

    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. 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. (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 = 0.1), abnormal uterine artery Doppler

  7. Concurrent Diffuse Pyelonephritis and Prostatitis: Discordant Findings on Sequential FDG PET/CT and 67Ga SPECT/CT Imaging.

    Science.gov (United States)

    Lucaj, Robert; Achong, Dwight M

    2017-01-01

    A 45-year-old man underwent FDG PET/CT for initial imaging evaluation of recurrent Escherichia coli urinary tract infections, which demonstrated no significant FDG uptake in either kidney and subtle FDG uptake in the right prostate lobe. Subsequent Ga SPECT/CT demonstrated abnormal intense gallium uptake throughout the right kidney and entire prostate gland, clearly discordant with PET/CT findings and consistent with unexpected concurrent pyelonephritis and prostatitis. Although FDG has effectively replaced Ga in everyday clinical practice, the current case serves as a reminder that there is still a role for Ga in the evaluation of genitourinary infections.

  8. A case report of a xanthogranulomatous pyelonephritis case mimicking the recurrence of renal cell carcinoma after partial nephrectomy

    Directory of Open Access Journals (Sweden)

    Rakan M AlDarrab

    2015-01-01

    Full Text Available A 44-year-old female presented to the urology clinic with flank pain and tenderness. After full assessment, the patient was booked for surgery for partial nephrectomy and the patient was diagnosed with renal cell carcinoma (RCC chromophob type. Six months later, the patient came back for follow-up; a mass was detected on the same kidney. Radical nephrectomy was performed to excise what is thought to be a recurrence of RCC and the tissues were sent to pathology. The postoperative pathology report confirmed the presence of xanthogranulomatous pyelonephritis rather than RCC recurrence.

  9. 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

  10. Diagnostic value of MAG3 scintigraphy and DMSA scintigraphy in renal parenchyma damage and acute pyelonephritis of children

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    Buket Kilicaslan

    2016-09-01

    Results: The fever, elevated leukocytes, C-reactive protein and sedimentation rate were found statistically significant in the detection of pyelonephritis. However, these values were not significant statistically in the demonstration of the severity of parenchyma damage. In the detection of damage in renal parenchyma, MAG3 scintigraphy had a sensitivity of 32.5 % and a specificity of 98.1 %. Conclusion: MAG3 scintigraphy can not replace DMSA scan to determine the renal parenchyma damage in childhood. [Cukurova Med J 2016; 41(3.000: 464-471

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

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    T.O. Kryuchko

    2017-06-01

    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.

  12. Emphysematous pyelonephritis in type II diabetes: A case report of an undiagnosed ureteric colic.

    Science.gov (United States)

    Vollans, Samuel R; Sehjal, Ranjit; Forster, James A; Rogawski, Karol M

    2008-09-30

    Emphysematous pyelonephritis (EPN) is a severe acute necrotising infection of the renal parenchyma and perirenal tissue, characterised by gas formation. 90% of cases are seen in association with diabetes mellitus. We report a case of undiagnosed ureteric obstruction in a type II diabetic, leading to EPN requiring emergency nephrectomy. A 59-year-old type II tablet controlled diabetic woman presented complaining of a five day history of right sided abdominal pain associated with vomiting, abdominal distension and absolute constipation. There were no lower urinary tract symptoms. Past surgical history included an open appendectomy and an abdominal hysterectomy. On examination, she was haemodynamically stable, the abdomen was soft, distended, and tender in the right upper and lower quadrants with no bowel sounds. Investigations revealed a CRP of 365 and 2+ blood and nitrite positive on the urine dipstick. The AXR was reported as normal on admission, however when reviewed in retrospect revealed the diagnosis. She was managed, therefore, as having adhesional bowel obstruction and a simple UTI. After four days, a CT was organised as she was not settling. This showed a right pyohydronephrosis with gas in the collecting system secondary to an 8 mm obstructing ureteric calculus. The kidney was drained percutaneously via a nephrostomy and the patient was commenced on a broad spectrum intravenous antibiotics. Despite this, she went on to need an emergency nephrectomy for uncontrolled severe sepsis. She was discharged in good health 15 days later. EPN carries a mortality of up to 40% with medical management alone. Early recognition of EPN in an obstructed kidney is essential to guide aggressive management, and in the presence of continued severe sepsis or organ dysfunction an urgent nephrectomy should be carried out. Diabetic patients who are known to have renal or ureteric calculi, whether symptomatic or not, should be considered for percutanous or ureteroscopic treatment. In

  13. Clinical Observation on Chinese and Western Integrative Medicine in Treating Repeatedly Recurrent Chronic Pyelonephritis

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To explore the clinical efficacy of Chinese and western integrative medicine (TCM-WM) in treating repeatedly recurrent chronic pyelonephritis (CPN) and its therapeutic mechanism. Methods: Ninety-one repeatedly recurrent CPN patients were randomly divided into 2 groups, the control group (45 cases) treated with sufficient amount of sensitive antibiotics and other WM, the treated group (46 cases) treated with above-mentioned WM complemented with TCM syndrome differentiation (SD). Results: In the treated group completely cured was 14 cases (30.4%), markedly effective 14 cases (30.4%), the total effective rate was 91.3%; while that of the control group was 4 (8.9%), 5 (11.1%), and 48.9% respectively, (P<0.05) and (P<0.01); the mean days of urinary bacteria and urinary routine negative conversion were in the treated group 19.6±12.6 days and 24.3±11.5 days, obviously shorter than those of the control group (35.6±14.6 days and 53.6±16.4 days), P<0.01; the various symptoms of the treated group improved or disappeared in a short time, while in the control group a few patients improved in a longer period (P<0.01); the various immune parameters improved in the treated group, while in the control group only IgA was elevated to some extent (P<0.05), in comparing these data, the difference was significant (P<0.01). Conclusion: The TCM-WM integrative treatment could obviously raise the clinical efficacy, accelerate the symptom improvement, and enhance the immune function.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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 

  16. CT findings of acute pyelonephritis in children; correlation with clinical manifestations

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    Lee, Jeong Kyong; Lee, Sun Wha; Kim, Jung Eun; Lee, Seung Joo [Ewha Womans Univ., Seoul (Korea, Republic of)

    2001-02-01

    The purpose of this study was to evaluate the CT findings of acute pyelonephritis (APN) in children and to assess the correlation between these findings, clinical parameters and renal scar development, as seen on follow-up CT scans. Contrast-enhanced CT scans of thirty children in whom APN had been diagnosed were assigned to one of three groups according to whether an abscess had formed, and then to subgroups on the basis of the number of lesions in the renal parenchyme. Initial CT findings were retrospectively correlated with five clinical parameters (maximal body temperature, fever duration, leukocytosis, pyuria and admission period) and renal scar development, as seen on follow-up CT (n=12). CT scans demonstrated linear, wedge-shaped, low-density renal parenchymal lesions in 35 kidneys of 25 patients and abscesses in seven kidneys of seven patients, but no abnormal lesions in five patients. In the three groups there was correlation between these findings and some clinical parameters(maximal body temperature, fever duration and admission period), but no subgroup showed significant correlation with any clinical parameter. Renal cortical scars detected by follow-up CT were more prevalent in patients in whom initial CT demonstrated the presence of an abscess. Clinical parameters correlated with the presence of renal parenchymal hypoenhancing lesions and abscess formation, as seen on CT scans, rather than the number of renal parenchymal lesions. Renal cortical scars were more prevalent in patients in whom initial CT revealed the presence of an abscess. Enhanced CT is thought to be useful both for diagnosing APN and for predicting its clinical course in children.

  17. 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)

  18. The Nursing and Treating Experience of Elderly Pyelonephritis%老年肾盂肾炎的护理体会

    Institute of Scientific and Technical Information of China (English)

    刘玉艳

    2014-01-01

    目的:探讨老年人肾盂肾炎患者的临床护理体会。方法选取临床2013年3月~14年3月收治的肾于肾炎患者28例均为老年人,现对护理方法资料进行分析。结果治疗见效后停药,复查无菌尿21例,治疗后复查细菌尿转阴6例,无效1例。结论做好老年肾盂肾炎患者临床护理,提高疗效,缩短疗程,减少并发症。%Objective The nursing and treating experience of elderly pyelonephritis to be investigated. Methods Analyzing the clinical treatment data selected from 28 patients with elderly pyelonephtitis who have been treated in hospital from March 2013 to March 2014. Results The patients are asked to stop taking medicine when there is a sign of effectiveness and improvement, then have their urine rechecked and 21 cases are to be as sterile, 6 cases have negative bacteria in urine and only one case is invalid. Conclusion Doing a good job in the nursing and treating patients with elderly pyelonephritis, improving the effectiveness and shortening treat-time and reducing the occurrence of complications.

  19. 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.

  20. Are first-generation cephalosporins obsolete? A retrospective, non-inferiority, cohort study comparing empirical therapy with cefazolin versus ceftriaxone for acute pyelonephritis in hospitalized patients.

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    Hobbs, Athena L V; Shea, Katherine M; Daley, Mitchell J; Huth, R Gordon; Jaso, Theresa C; Bissett, Jack; Hemmige, Vagish

    2016-06-01

    Literature is lacking regarding the utilization of first-generation cephalosporins for the treatment of acute pyelonephritis. The aim of this study was to determine whether cefazolin is non-inferior to ceftriaxone for the empirical treatment of acute pyelonephritis in hospitalized patients. The primary outcome included a composite of symptomatic resolution plus either defervescence at 72 h or normalization of serum white blood cell count at 72 h (non-inferiority margin 15%). Secondary outcomes included length of stay and 30 day readmission. A subgroup analysis of the composite outcome was also conducted for imaging-confirmed pyelonephritis. This was a retrospective, non-inferiority, multicentre, cohort study comparing cefazolin versus ceftriaxone for the empirical treatment of acute pyelonephritis in hospitalized patients. Overall, 184 patients received one of the two treatments between July 2009 and March 2015. The composite outcome was achieved in 80/92 (87.0%) in the cefazolin group versus 79/92 (85.9%) in the ceftriaxone group (absolute difference 1.1%, 95% CI -11.1% to 8.9%, P = 0.83), meeting the pre-defined criteria for non-inferiority. The composite outcome for patients with imaging-confirmed pyelonephritis was achieved in 46/56 (82.1%) versus 42/50 (84.0%) for the cefazolin group and the ceftriaxone group, respectively (absolute difference 1.9%, 95% CI -12.8% to 16.5%, P = 0.80). Additionally, there were no statistically significant differences in length of stay or 30 day readmission for cystitis or pyelonephritis. Cefazolin was non-inferior to ceftriaxone with regard to clinical response for the treatment of hospitalized patients with acute pyelonephritis in this study. No difference was observed for length of stay or 30 day readmission. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  1. Pielonefritis xantogranulomatosa: Nuestra experiencia en 6 casos Xanthogranulomatous pyelonephritis: Six case reports

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    Ubaldo Tentoni

    2011-12-01

    Full Text Available 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 extiende frecuentemente al espacio perirrenal. La TC es muy útil, ya que los hallazgos de la ecografía y la urografía pueden ser inespecíficos. En la TC, la PX se asocia con la presencia de un gran cálculo, un aumento del tamaño renal o de un segmento, la pobre o nula eliminación del medio de contraste y la presencia de masas focales de baja atenuación (-10 a +30 UH, cuyas paredes realzan con la administración del contraste endovenoso. Conclusiones. El diagnóstico se sospecha cuando se combinan la unilateralidad, la presencia de litiasis, el aumento de tamaño del riñón, la ausencia de eliminación del medio de contraste, la presencia de masas de baja atenuación y la afectación del espacio perirrenal.Introduction. Xanthogranulomatous Pyelonephritis (XP is a chronic infection of the renal parenchyma. Objectives. To analyze the imaging features of XP. Materials and Methods. We conducted a retrospective analysis of 6 confirmed cases of XP. Results. We described the imaging findings of the abovementioned cases. Discussion. Clinical manifestations suggest renal disease and imaging leads to probable diagnosis. The process often extends to the perirenal space. CT is very useful because sonographic and urographic findings may be nonspecific. In CT scans, XP is associated with the presence of a large calculus, enlargement of the kidney or of a segment , poor or no elimination of the contrast agent and the presence of focal masses of low

  2. Incidence, risk factors, and the impact of allograft pyelonephritis on renal allograft function.

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    Singh, R; Geerlings, S E; Peters-Sengers, H; Idu, M M; Hodiamont, C J; Ten Berge, I J M; Bemelman, F J

    2016-10-01

    The impact of allograft pyelonephritis (AGPN) on renal allograft function is controversial. In this study, we evaluated the incidence, risk factors, and the impact of AGPN on renal allograft function. Retrospective cohort study in adult renal allograft recipients with 1-year follow-up after transplantation (Tx). Renal allograft function was evaluated by estimated glomerular filtration rate (eGFR) (by Modification of Diet in Renal Disease formula) and 24-h urine protein excretion. A total of 431 renal allograft recipients were analyzed; 57 (13.2%) developed AGPN within 1 year after Tx. Median time between Tx and AGPN was 50 days. Risk factors for AGPN were the presence of a urological catheter (odds ratio [OR] = 18.93, 95% confidence interval [CI] = 8.00-44.81, P < 0.001) and preceding asymptomatic bacteriuria (ASB) (OR = 2.16, 95% CI = 1.20-3.90, P = 0.009). In 72.7%, the causative microorganism of ASB was identical to that of the succeeding AGPN episode. Multivariable linear regression analysis showed that experiencing AGPN did not decrease the eGFR (P = 0.61) nor did increased proteinuria (P = 0.29) 1 year after Tx. For the eGFR, an interaction was found between AGPN/bacteriuria (BU) and acute rejection (AR): the group experiencing BU preceding AR had significantly (P < 0.001) lower eGFR compared with the group that experienced only AR (21 mL/min/1.73 m(2) vs. 48 mL/min/1.73 m(2) ), as a result of increased prevalence of combined rejections within the BU group. Indwelling urological catheters and preceding ASB are associated with developing AGPN. An incident of AGPN itself does not impair renal allograft function 1 year after Tx. However, a relevant interaction occurs between BU and AR, in which the sequence of occurrence of these 2 events synergistically impairs the eGFR. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Urinary cytokines as markers of latent inflammation in children with chronic pyelonephritis and anorectal malformations.

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    Morozov, Dmitry; Morozova, Olga; Budnik, Ivan; Pervouchine, Dmitri; Pimenova, Evgeniya; Zakharova, Natalya

    2016-06-01

    Anorectal malformations (ARMs) comprise a range of defects in the development of the lowest portion of the intestinal tract that are often associated with anomalies of the urinary tract. We hypothesize that ARMs may specifically predispose the patients to prolonged urinary tract infection (UTI) and transition from a state of active (clinically apparent) inflammation to a state of latent inflammation following antibiotic treatment. Yet diagnosis of latent inflammation in the urinary tract is problematic. The aim was to investigate the urinary levels of proinflammatory (IL-1β, IL-6, IL-8, and MCP-1), anti-inflammatory (IL-10), and proangiogenic (VEGF) cytokines in the clinical course of chronic pyelonephritis (CP) as potential biomarkers of latent inflammation in the urinary tract in children with ARM. A total of 34 children (age range 4-120 months) with CP in the active phase of inflammation were divided into two groups: CP with ARM group included 20 patients and CP without ARM group included 14 patients. The control group included 20 healthy children similar by age and gender. Urine samples were collected at the time of enrollment, 5-7 days after institution of antibiotic treatment, and 1.5 months after enrollment. Cytokine concentrations were measured by ELISA. Upon enrollment, we detected increased urinary levels of IL-10 and MCP-1 and normal levels of IL-1β, IL-6, IL-8, and VEGF in CP with ARM patients as well as normal levels of all of these cytokines in CP without ARM patients. After 5-7 days of antibiotic treatment, despite significant clinical and laboratory improvement observed in both patient groups, we documented a prominent increase in the urinary concentrations of all measured cytokines indicating ongoing inflammation in the urinary tract. Following 1.5 months of enrollment, in CP without ARM patients, IL-8 and MCP-1 were increased, IL-1, IL-6, and VEGF were close to control, and IL-10 was below the control level, indicating partial resolution of the

  4. Diagnostic Performance of Gray-scale Sonographic Findings for the Detection of Acute Pyelonephritis

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    Lee, Hui Jin; Kim, Young Jun; Park, Hee Sun; Jeon, Hae Jeong; Park, Hyoung Keun; Paick, Sung Hyun; Kim, Hyeong Gon; Lho, Yong Soo; Jung, Sung Il [Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    To evaluate the diagnostic performance of gray-scale renal sonographic findings for the diagnosis of acute pyelonephritis (APN) by using computed tomography as a reference standard. We retrospectively reviewed gray-scale renal sonographic findings of 48 patients for the detection of APN. All patients had clinical symptoms such as fever, flank pain, or dysuria and were confirmed as APN by contrast- enhanced CT. The presence of sonographic findings such as renal swelling, alteration of the parenchymal echogenicity, wall thickening of the renal pelvis, loss of the renal sinus fat echogenicity, and loss of the corticomedullary differentiation were evaluated. We also categorized all patients into mild APN or severe APN groups according to the volume of the morbid renal parenchyma on contrast-enhanced CT, and evaluated the aforementioned sonographic findings between the two groups. Overall diagnostic sensitivity, specificity, and accuracy of gray-scale renal ultrasonography (US) for the detection of APN were 32.5%, 72.0%, and 58.5%, respectively. The sensitivity and specificity of each sonographic finding were measured for each group. Renal swelling sensitivity and specificity were 33.8% and 70.8% for the mild APN group, but 45.8% and 66.7% for the severe APN group. Sensitivity and specificity for alteration of the parenchymal echogenicity were 41.7% and 79.2% for the mild APN group, but 58.3% and 66.7% for the severe APN group. The sensitivity and specificity for wall thickening of the renal pelvis was 37.5% and 95.8% for the mild APN group, but 50.0% and 95.8% for the severe APN group. The sensitivity and specificity of loss of the renal sinus fat echogenicity were 12.5% and 83.3% for the mild APN group, but 12.5% and 91.7% for the severe APN group. The sensitivity and specificity of the loss of the corticomedullary differentiation were 12.5% and 95.8% for the mild APN group, but 20.8% and 75.0% for the severe APN group. There was no significant difference of gray

  5. [Type 1 and type 2 interferon inductor (cycloferon) in therapy of children with pyelonephritis associated with herpes viruses].

    Science.gov (United States)

    Orekhova, S B; Botvin'ev, O K; Romantsov, M G

    2009-01-01

    The clinical and laboratory efficacy of the treatment of children with pyelonephritis with addition of cycloferon, an inductor of early interferon of types 1 and 2, to the main therapy was studied. The mechanism of the cycloferon action was described. The clinical and laboratory remission within a year was observed in 64.3% of the patients treated with addition of cycloferon vs. 47.1% of the patients under the main therapy without the cycloferon addition. The number of the relapses lowered to 7.1% vs. 20.6% of the episodes in the control group. The minimal risk of the disease exacerbation (0.37) in the patients treated with cycloferon and the relative risk of the unfavourable outcomes among the patients under the therapy with addition of cycloferon (0.5967< or =1) were determined.

  6. The clinical and imaging presentation of acute "non complicated" pyelonephritis: A new profile for an ancient disease

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    Piccoli Giorgina

    2011-12-01

    Full Text Available Abstract Background Acute pyelonephritis (APN is differently defined according to imaging or clinical criteria. In adults information on the relationship between imaging and clinical data is lacking. Our study was aimed at analysing the relationship between the clinical and imaging presentation of APN, defined according to imaging criteria (parenchymal involvement at MR or CT scan. Methods All consecutive patients hospitalized for "non-complicated" APN were considered (June 2005-December 2009. Clinical, biochemical and imaging data at hospitalization were analyzed by univariate and logistic regression analysis. Results There were 119 patients, all females, median age 32 years (15-72. At hospitalization, inflammatory markers were elevated (CRP median: 12.1 mg/dL, normal Conclusions APN is a protean disease. In the absence of strict correlation with clinical or biochemical markers, imaging studies are required to assess the severity of kidney involvement.

  7. The gender specific risk factors for prolonged hospitalization due to acute pyelonephritis in a Japanese tertiary emergency center.

    Science.gov (United States)

    Muneishi, Risa; Tanimoto, Ryuta; Wada, Koichiro; Hsiao, Philip; Eguchi, Jun; Araki, Motoo; Watanabe, Toyohiko; Nasu, Yasutomo; Akebi, Naoki

    2016-02-01

    The aim of this study is to characterize the potential differences between male and female patients with acute pyelonephritis (AP) and to predict the severity of AP based on the length of hospital stay. We conducted a retrospective medical chart review of 172 consecutive adult patients who were hospitalized in Tsuyama Central Hospital due to AP from January 2007 through June 2012. We analyzed the length of hospital stay by the proportional hazard model. A total of 172 patients were identified who were admitted to our hospital with a diagnosis of AP. Of them, 62% (106/172) were female. Except for urological malignancy, there was no significant difference between men and women in underlying disease. Out of 26 variables, univariate analysis in male showed that only urolithiasis (OR 1.75, p = 0.0294) was significantly associated with longer hospital stay, while septic shock (OR 3.18, P = 0.003), urological malignancy (OR 2.94, P = 0.002), age over 65 (OR 1.66, p = 0.018) and neurogenic bladder (OR 1.92, p = 0.014) were all associated with longer hospital stay in female patients. This is the first report to identify the risk factors for prolonged hospital stay for the patients who were admitted with AP in the Japanese population. The risk factors causing prolonged hospital stay were totally different between males and females. Reviewing the medical history based on sex gender might enable a clinician to predict the severity of acute pyelonephritis during the initial evaluation. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  8. Retrograde pyelonephritis and lumbar spondylitis as a result of Salmonella typhi in a type 2 diabetes patient with neurogenic bladder.

    Science.gov (United States)

    Fukuda, Tatsuya; Bouchi, Ryotaro; Minami, Isao; Ohara, Norihiko; Nakano, Yujiro; Nishitani, Rie; Murakami, Masanori; Takeuchi, Takato; Akihisa, Momoko; Fujita, Masamichi; Izumiyama, Hajime; Hashimoto, Koshi; Yoshimoto, Takanobu; Ogawa, Yoshihiro

    2016-05-01

    We present a case of a 62-year-old diabetic woman with acute pyelonephritis and spondylitis caused by Salmonella typhi. She was admitted to Tokyo Medical Dental University Hospital, Tokyo, Japan, because of unconsciousness and was diagnosed with sepsis by retrograde pyelonephritis as a result of Salmonella typhi. Antibiotics treatment was immediately started; however, she subsequently developed lumbar spondylitis, and long-term conservative treatment with antibiotics and a fixing device were required. This is the first report of a diabetic patient who developed retrograde urinary tract infection with Salmonella typhi, followed by sepsis and spondylitis. The infection could be a result of diabetic neuropathy, presenting neurogenic bladder and hydronephrosis. The patient was successfully treated with antibiotics and became asymptomatic with normal inflammatory marker levels, and no clinical sign of recurrence was observed in the kidney and spine at 4 months.

  9. Initial presentation of scintigraphic changes during the first episode of acute pyelonephritis in children. Simultaneous evaluation with MAG3 and DMSA

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    Grbac-Ivankovic, S.; Smokvina, A.; Girotto, N. [Clinical Hospital Centre Rijeka (Croatia). Dept. of Nuclear Medicine; Licul, V. [Clinical Hospital Centre Rijeka (Croatia)

    2007-07-01

    {sup 99m}Tc-DMSA scintigraphy is generally accepted as the method of choice for detecting renal parenchymal damage in pyelonephritis. {sup 99m}Tc-MAG3 dynamic scintigraphy is not routinely used for this purpose. The aim of this study was to evaluate the MAG3 scintigraphic presentation in the acute phase of pyelonephritis in children and re-evaluate them at least 6 months later, as well as to establish whether a MAG3 in the parenchymal phase is as reliable and sensitive in the detection of a renal parenchymal damage as the DMSA. Patients, methods: The MAG3 scintigraphic pattern was evaluated during the first episode of acute pyelonephritis in 31 children (median age: 2.5 years) and compared to the DMSA scan. The scintigraphy was performed on the same day with both radiopharmaceuticals. After at least 6 months the whole procedure was repeated on 28 patients. A scoring system was designed to evaluate the parenchymal lesions, and categorize them as positive or equivocal. The findings on the initial scans were compared to those obtained in the follow up studies. Results: When all lesions (equivocal + positive) were analysed, MAG3 sensitivity was 98%, and specificity 78%, while for positive lesions only, the values were 83 and 100%, respectively. The average acute severity score was significantly lower for both MAG3 and DMSA then the follow up score (p <0.0001). These results corresponded to a clinical convalescence, which was observed in 26/28 children in the follow up. Conclusion: With the MAG3 scintigraphy a reliable semi quantitative and qualitative detection of the renal inflammatory lesions can be obtained in acute pyelonephritis, as well as their recovery, thus obviating the need for a DMSA scan. Moreover, the duration of the MAG3 procedure is shorter, enabling the visualization of the entire collecting system as well, while the radiation exposure is approximately a half of that delivered by the DMSA scan. (orig.)

  10. Сlinical case of hemolytic anemia combined with secondary chronic pyelonephritis and intracellular infection in a 7-year-old child

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    I.G. Samoylenko

    2017-06-01

    Full Text Available Hemolytic anemias are group of diseases that are characterized by decreased lifetime of erythrocytes due to their accelerated destruction caused by membrane and enzymopathies of red blood cells, defects in globin synthesis or external factors such as intoxications and autoimmune processes. The most common hemolytic anemia in Europe is hereditary spherocytosis, which occurs in a ratio of 1 : 2000. Hereditary spherocytosis (Minkowski — Chauffard disease is hereditary microspherocytic hemolytic anemia, which occurs as a result of mutation, leading to the erythrocyte membrane defect. Clinical manifestations of Minkowski — Chauffard anemia may vary from asymptomatic to fulminant hemolytic anemia, but commonly this disease has a undulant course. In our clinical practice, we observed hereditary spherocytosis combined with secondary chronic pyelonephritis and chronic persistent intracellular infection in a 7-year-old girl. The patient complained of high fever, general fatigue and weakness, and pain in the lower extremities. Complete doubling of the left kidney and urethra was diagnosed in a patient (her father has the same congenital pathology, which was diagnosed after the birth of his daughter and refluxing megаureter of the lower half of left doubled kidney in the first year of her life. The girl underwent heminephroureterectomy on the left. Despite the surgical intervention, a secondary chronic pyelonephritis developed. Due to frequent anemia, patient was previously observed in the hematological department, but diagnosis of hemolytic anemia was not confirmed. Our clinical case shows that presence of concomitant diseases, especially chronic intracellular infection combined with pyelonephritis, can significantly complicate hemolytic anemia. Pale skin and mucous membranes are considered as a symptom of pyelonephritis, and ictericity is considered as a manifestation of liver damage with intracellular infection. As a result, more detailed

  11. [The effectiveness of empirical antibiotic therapy of pyelonephritis in patients with type 2 diabetes and without depending on the availability of plasmid-mediated resistance genes].

    Science.gov (United States)

    Chub, O I; Bilchenko, A V

    2015-02-01

    Multi-drug resistance has been increasing in the treatment of urinary tract infections, especially complicated. The prevalence of plasmid-mediated resistance genes among urinary pathogens has nether been studied in Ukraine. So, the aim of our study was to identify the plasmid-mediated resistance genes and to determine their impact on the efficacy of the treatment. A total of 105 adult patients with chronic pyelonephritis were included in the study. Among them, 32 patients were diagnosed with type 2 diabetes mellitus. The diagnosis of pyelonephritis was verified according to the criteria EAU, 2013. Plasmid-mediated resistance genes were determined by polymerase chain reaction (PCR). The prevalence of plasmid-mediated resistance mechanisms among patients with pyelonephritis were 44,4%. ESBLs was the most common isolated genes. Favorable clinical response was seen in 11/31 (35,5%) infected with ESBL-producing organisms compared with 59/74 (79,7%) patients with non-ESBL-producing organisms (ppyelonephritis due to presence of plasmid-mediated resistance genes. Therefore, prоpеr mаnagеment fоr prescriptiоn of аntibiоtics and also idеntificаtiоn of ESBL-prоducing bаcteria in cоmmunitiеs arе impоrtant fоr prevеntion.

  12. Selection of first-line i.v. antibiotics for acute pyelonephritis in patients requiring emergency hospital admission.

    Science.gov (United States)

    Yasufuku, Tomihiko; Shigemura, Katsumi; Yamashita, Masuo; Arakawa, Soichi; Fujisawa, Masato

    2011-04-01

    Febrile urinary tract infections (UTIs) often require the intravenous infusion of antibiotics and/or hospitalization. Acute pyelonephritis (AP) is one of the most severe forms of UTI, and the antibiotics we should use as the first line and the risk factors for treatment failure remain controversial. The objective of this study was to investigate the efficacy of i.v. antibiotics selected for the treatment of febrile AP and to examine the risk factors for antibiotic resistance. We set risk factors for antibiotic treatment failure such as age, sex, and the presence of underlying urinary tract disease. We classified all cases into 49 cases of complicated AP and 24 cases of uncomplicated AP according to the presence of underlying urinary tract diseases, and examined the characteristics of the patients and the efficacy of the antibiotics used in this study. We investigated risk factors which relate to initial treatment failure and the duration of antibiotic treatment. Initial antibiotic treatment failure was significantly correlated to C-reactive protein in complicated AP and to positive blood culture in uncomplicated AP. We revealed a significant correlation between the duration of the given antibiotics and diabetes mellitus or positive blood culture in uncomplicated AP, and tazobactam/piperacillin was significantly related to prolongation of antibiotic treatment in complicated AP. In conclusion, in this study, a positive blood culture was the representative risk factor that related to both initial treatment failure and longer duration of the given antibiotics in uncomplicated AP.

  13. Discordant findings of dimercaptosuccinic acid scintigraphy in children with multi-detector row computed tomography-proven acute pyelonephritis

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    Jeongmin Lee

    2011-05-01

    Full Text Available Purpose : The diagnosis of acute pyelonephritis (APN is often difficult, as its clinical and biological manifestations are non-specific in children. If not treated quickly and adequately, however, APN may cause irreversible renal damage, possibly leading to hypertension and chronic renal failure. We were suspecting the diagnostic value of 99mTc-dimercaptosuccinic acid (DMSA scan by experiences and so compared the results of DMSA scan to those of multi-detector row computed tomography (MDCT. Methods : We retrospectively selected and analyzed 81 patients who were diagnosed as APN by MDCT during evaluation of their acute abdomen in emergency room and then received DMSA scan also for the diagnostic work-up of APN after admission. We evaluated the results of imaging studies and compared the diagnostic value of each method by age groups, &lt;2 years (n=45 and ?#242; years (n=36. Results : Among total 81 patients with MDCT-proven APN, DMSA scan was diagnostic only in 55 children (68%, while the remaining 26 children (32% showed false negative normal findings. These 26 patients were predominantly male and most of them, 19 (73.1% were &lt;2 years of age. Conclusion : DMSA scan holds obvious limitation compared to MDCT in depicting acute inflammatory lesions of kidney in children with APN, especially in early childhood less than 2 years of age. MDCT showed hidden lesions of APN, those were undetectable through DMSA scan in children.

  14. 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.

  15. Clarithromycin is an effective immunomodulator when administered late in experimental pyelonephritis by multidrug-resistant Pseudomonas aeruginosa

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    Panagou Charalambos

    2006-02-01

    Full Text Available Abstract Background To apply clarithromycin as an immunomodulatory treatment in experimental urosepsis by multidrug-resistant Pseudomonas aeruginosa. Methods Acute pyelonephritis was induced in 40 rabbits after inoculation of the test isolate in the renal pelvis. Therapy was administered upon signs of sepsis in four groups: A, controls; B, intravenous clarithromycin; C, amikacin; and D, both agents. Survival and vital signs were recorded; blood was sampled for culture and estimation of pro-inflammatory mediators; monocytes were isolated for determination of apoptotic rate and ex vivo TNFα secretion. Quantitative cultures and biopsies of organs were performed after death. Results Increased rectal temperature and oxygen saturation were found in groups B and D compared to A and C. Mean survival of groups A, B, C and D was 2.65, 7.15, 4.25 and 8.70 days respectively. No differences were noted between groups concerning bacterial load in blood and tissues and serum endotoxins. Serum MDA and total caspase-3 activity of monocytes of group D decreased following treatment compared to other groups. Negative correlation was detected between cytoplasmic caspase-3 and ex vivo secretion of TNFα of blood monocytes of group A; similar correlation was not found for any other group. Pathology scores of liver and lung of group B were lower than group A. Conclusion Clarithromycin administered late in experimental urosepsis by multidrug-resistant P. aeruginosa prolonged survival and ameliorated clinical findings. Its effect is probably attributed to immunomodulatory intervention on blood monocytes.

  16. Comparison of acute lobar nephronia and acute pyelonephritis in children: a single-center clinical analysis in southern taiwan.

    Science.gov (United States)

    Chen, Wan-Ling; Huang, I-Fei; Wang, Jiun-Ling; Hung, Chih-Hsin; Huang, Jer-Shyung; Chen, Yao-Shen; Lee, Susan Shin-Jung; Hsieh, Kai-Sheng; Tang, Chia-Wan; Chien, Jen-Hung; Chiou, Yee-Hsuan; Cheng, Ming-Fang

    2015-06-01

    Patients with acute lobar nephronia (ALN) require a longer duration of antimicrobial treatment than those with acute pyelonephritis (APN), and ALN is associated with renal scarring. The aim of this study was to provide an understanding of ALN by comparing the clinical features of pediatric patients with ALN and APN. We enrolled all of the patients with ALN (confirmed by computed tomography) admitted to our hospital from 1999 to 2012 in the ALN group. In addition, each patient diagnosed with APN who was matched for sex, age, and admission date to each ALN patient was enrolled in the APN group. The medical charts of patients in these two groups were retrospectively reviewed and analyzed for comparison. The fever duration after hospitalization in the ALN group and the APN group were 4.85 ± 2.33 days and 2.30 ± 1.47 days respectively. The microbiological distributions and the majority of susceptibilities were similar in the ALN and APN groups. The majority of clinical manifestations are nonspecific and unreliable for the differentiation of ALN and APN. The patients with ALN were febrile for longer after antimicrobial treatment, had more nausea/vomiting symptoms, higher neutrophil count, bandemia, and C-reactive protein (CRP) levels, and lower platelet count (all p  5 days after antimicrobial treatment. Copyright © 2014. Published by Elsevier B.V.

  17. Exploiting the antivirulence efficacy of an ajoene-ciprofloxacin combination against Pseudomonas aeruginosa biofilm associated murine acute pyelonephritis.

    Science.gov (United States)

    Vadekeetil, Anitha; Saini, Hina; Chhibber, Sanjay; Harjai, Kusum

    2016-01-01

    The study investigated the in vitro, ex vivo and in vivo efficacy of ajoene and ciprofloxacin (CIP) alone and in combination against Pseudomonas aeruginosa biofilms and biofilm-associated murine acute pyelonephritis. The ajoene-CIP combination exhibited significant greater (p < 0.05) antimotility and biofilm inhibitory effects than those obtained when they were applied individually. The combined action of the agents resulted in a significant increase in serum sensitivity and phagocytic uptake and killing of P. aeruginosa (p < 0.001) compared to the untreated control. Mice groups treated with an ajoene (25 mg kg(-1)) and CIP (30 mg kg(-1) or 15 mg kg(-1)) combination showed a significantly (p < 0.001) reduced bacterial load in the kidney and bladder as compared to that of infected controls and mice treated with solo agents on the fifth day post-infection. The decreased levels of biomarkers and photomicrographs of the kidney tissue of the treated mice showed a reduced severity of damage. Hence, the study highlights the antivirulent and therapeutic efficacy of the ajoene-CIP combination at the minimal dosage of CIP.

  18. The clinical and imaging presentation of acute "non complicated" pyelonephritis: A new profile for an ancient disease

    Science.gov (United States)

    2011-01-01

    Background Acute pyelonephritis (APN) is differently defined according to imaging or clinical criteria. In adults information on the relationship between imaging and clinical data is lacking. Our study was aimed at analysing the relationship between the clinical and imaging presentation of APN, defined according to imaging criteria (parenchymal involvement at MR or CT scan). Methods All consecutive patients hospitalized for "non-complicated" APN were considered (June 2005-December 2009). Clinical, biochemical and imaging data at hospitalization were analyzed by univariate and logistic regression analysis. Results There were 119 patients, all females, median age 32 years (15-72). At hospitalization, inflammatory markers were elevated (CRP median: 12.1 mg/dL, normal < 0.8). Incomplete presentations were frequent: fever was absent in 6.7%, pain in 17.8%, lower urinary tract symptoms in 52.9%. At CT or MR scan the lesions were bilateral in 12.6%, multiple in 79.8%; abscesses were present in 39.5%. Renal scars were found in 15.1%. Positive cultures were correlated with multiple foci (multivariate OR 4.2; CI 1.139-15.515). No other sign/symptom discriminated between small lesions, abscesses or multifocal involvement. Conclusions APN is a protean disease. In the absence of strict correlation with clinical or biochemical markers, imaging studies are required to assess the severity of kidney involvement. PMID:22171968

  19. Comparison of Ertapenem and Ceftriaxone Therapy for Acute Pyelonephritis and Other Complicated Urinary Tract Infections in Korean Adults: A Randomized, Double-Blind, Multicenter Trial

    OpenAIRE

    PARK, DAE WON; Peck, Kyong Ran; Chung, Moon Hyun; Lee, Jin Seo; Park, Yoon Soo; Kim, Hyo Youl; Lee, Mi Suk; Kim, Jung Yeon; Yeom, Joon Sup; Kim, Min Ja

    2012-01-01

    The efficacy and safety of ertapenem, 1 g once daily, were compared with that of ceftriaxone, 2 g once daily, for the treatment of adults with acute pyelonephritis (APN) and complicated urinary tract infections (cUTIs) in a prospective, multicenter, double-blinded, randomized study. After ≥ 3 days of parenteral study therapy, patients could be switched to an oral agent. Of 271 patients who were initially stratified by APN (n = 210) or other cUTIs (n = 61), 66 (48.9%) in the ertapenem group an...

  20. SoxS Increases the Expression of the Zinc Uptake System ZnuACB in an Escherichia coli Murine Pyelonephritis Model

    OpenAIRE

    Warner, Douglas M; Levy, Stuart B.

    2012-01-01

    Paralogous transcriptional regulators MarA, Rob, and SoxS act individually and together to control expression of more than 80 Escherichia coli genes. Deletion of marA, rob, and soxS from an E. coli clinical isolate prevents persistence beyond 2 days postinfection in a mouse model of pyelonephritis. We used microarray analysis to identify 242 genes differentially expressed between the triple deletion mutant and its parent strain at 2 days postinfection in the kidney. One of these, znuC of the ...

  1. Xanthogranulomatous Pyelonephritis in a male child with renal vein thrombus extending into the inferior vena cava: a Case Report

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    Kotasthane Vaishali D

    2010-07-01

    Full Text Available Abstract Background We present a case of Xanthogranulomatous pyelonephritis (XGPN in a male child with renal vein thrombus extending into the inferior vena cava. This is a rare presentation. XGPN is a rare type of renal infection characterised by granulomatous inflammation with giant cells and foamy histiocytes. The peak incidence is in the sixth to seventh decade with a female predominance. XGPN is rare in children. Case presentation An 11 year old male child presented with a history of high grade fever and chills, right flank pain and progressive pyuria for two months. He had a history of vesical calculus for which he was operated four years back. In our case, a subcapsular right nephrectomy was performed. The surgical specimens were formalin fixed and paraffin embedded. The sections were stained with routine Hematoxylin & Eosin stain. Grossly; the kidney was enlarged with adherent capsule and thickening of the perinephric tissue. The pelvicalyceal system was dilated and was filled with a cast of pus. Histological evaluation revealed diffuse necrosis of the renal parenchyma and perinephric fat. Neutrophils, plasma cells, sheets of foamy macrophages and occasional multinucleate giant cells were seen. The renal vein was partially occluded by an inflammatory thrombus with fibrin, platelets and mixed inflammatory cells. The thrombus was focally adherent to the vein wall with organization. Conclusions The clinical presentation and the macroscopic aspect, together with the histological pattern, the cytological characteristics addressed the diagnosis towards XGPN with a vena caval thrombus. Our case illustrates that the diagnosis of XGPN should be considered even in paediatric age group when renal vein and vena caval thrombi are present.

  2. 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.

  3. Comparison of computed tomography findings between bacteremic and non-bacteremic acute pyelonephritis due to Escherichia coli

    Institute of Scientific and Technical Information of China (English)

    Seon Jung Oh; Bo-Kyung Je; Seung Hwa Lee; Won Seok Choi; Doran Hong; Sung-Bum Kim

    2016-01-01

    AIM:To identify computed tomography(CT)findings that are associated with the presence of bacteremia in patients with acute pyelonephritis(APN)due to Escherichia coli(E.coli).METHODS:The clinical data and contrast-enhanced CT findings of 128 patients who were diagnosed with APN due to E.coli and showed renal abnormality on contrast-enhanced CT between January 2003 and November 2013 were retrospectively reviewed.The patients were divided into two groups according to the presence of bacteremia:The bacteremia group and the non-bacteremia group.The abnormality on contrast-enhanced CT were categorized into 5 renal and 4 extrarenal CT findings and compared between the two groups using the χ~2 test and multivariate logistic regression.RESULTS:Among the 128 patients,34 patients(26.6%)were classified into the bacteremia group and 94 patients(73.4%)into the non-bacteremia group.There was no statistically significant difference in gender between the two groups(P = 0.09),but the age of thepatients in the bacteremia group was higher than that of the patients in the non-bacteremia group(P < 0.01).Compared to the non-bacteremia group,1 renal CT finding such as urothelial thickening and 3 extrarenal CT findings such as diffuse peritoneal thickening,cystitis and pulmonary congestion were more frequently observed in the bacteremia group with statistical significance.The logistic regression analysis revealed that CT findings,including urothelial thickening,diffuse peritoneal thickening,cystitis and pulmonary congestion were suggested as the predictive CT findings of bacteremic APN.CONCLUSION:On CT,urothelial thickening,diffuse peritoneal thickening,cystitis,and pulmonary congestion are more frequently observed in patients with bacteremic APN due to E.coli.

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

    Science.gov (United States)

    Wan, Chih-Hsing; Tseng, Jing-Ren; Lee, Ming-Hsun; Yang, Lan-Yan; Yen, Tzu-Chen

    2017-09-26

    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 (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.

  5. Use of cefuroxime for women with community-onset acute pyelonephritis caused by cefuroxime-susceptible or -resistant Escherichia coli.

    Science.gov (United States)

    Chang, U-Im; Kim, Hyung Wook; Wie, Seong-Heon

    2016-01-01

    Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli. We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN. Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p = 0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319). Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.

  6. Delta Neutrophil Index as a Marker for Differential Diagnosis between Acute Graft Pyelonephritis and Acute Graft Rejection

    Science.gov (United States)

    Shin, Dong Ho; Kim, Eun Jung; Kim, Soo Jin; Park, Ji-Young; Oh, Jieun

    2015-01-01

    Introduction The delta neutrophil index (DNI) is the fraction of circulating immature granulocytes, which reflect infectious and/or septic condition. Acute graft pyelonephritis (AGPN) versus acute graft rejection is a frequently encountered diagnostic and therapeutic dilemma in kidney transplant recipients, but little is known about the clinical usefulness of DNI value in the differentiation of the two conditions. Material & Methods A total of 90 episodes of AGPN or acute graft rejection were evaluated at the Kangdong Sacred Heart Hospital between 2008 and 2014. We performed retrospective analysis of demographic, clinical, and laboratory parameters data. Receiver operating curves (ROC) and multivariate logistic regression were conducted to ascertain the utility of DNI in discriminating between AGPN and acute graft rejection. Results AGPN group had significantly higher DNI values than acute graft rejection group (2.9% vs. 1.9%, P < 0.001). The area under the ROC curve for DNI value to discriminate between AGPN and acute graft rejection was 0.85 (95% confidence interval [CI]; 0.76–0.92, P < 0.001). A DNI value of 2.7% was selected as the cut-off value for AGPN, and kidney transplant recipients with a DNI value ≥ 2.7% were found to be at a higher risk of infection than those with a DNI < 2.7% (odd ratio [OR] 40.50; 95% CI 8.68–189.08; P < 0.001). In a multivariate logistic regression analysis, DNI was a significant independent factor for predicting AGPN after adjusting age, sex, log WBC count, log neutorphil count, log lymphocyte count, CRP concentration, and procalcitonin concentration (OR 4.32; 95% CI 1.81–10.34, P < 0.001). Conclusions This study showed that DNI was an effective marker to differentiate between AGPN and acute graft rejection. Thus, these finding suggest that DNI may be a useful marker in the management of these patients. PMID:26275220

  7. Serious acute pyelonephritis: a predictive score for evaluation of deterioration of treatment based on clinical and radiologic findings using CT

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    Kim, See Hyung; Kim, Young Whan; Lee, Hee Jung (Department of Radiology, Keimyung University, Dongsan Hospital, Daegu (Korea, Republic of)), Email: kseehdr@dsmc.or.kr

    2012-03-15

    Background. Acute pyelonephritis (APN) requires prompt diagnosis and immediate treatment. Purpose To develop a simple score to assist in diagnosing treatment deterioration in patients with serious APN. Material and Methods. Using data from a retrospective cohort of 193 patients with APN, we developed scores based on multivariate logistic regression after the jackknife procedure. We validated the scores in a prospective cohort of 40 patients. Results. Nine criteria were independently associated with our investigation: Abscess (adjusted odds ratio [OR], 19.8; 95% confidence interval [95% CI] 4.5-72.1), pyonephrosis with or without stone (18.3; 4.8-70.9), pelvicalyceal air (15.5; 3.2-26.9), poor global excretion of contrast (12.3; 2.9-68.5), tachycardia or hypotension (10.1; 2.5-28.0), obliteration of the renal sinus (9.6; 2.5-45.2), persistent fever or pyuria (9.8; 1.9-25.8), diabetes (9.4; 2.0-31.8), and global renal enlargement (7.5; 2.1-35.8). The APN score was based on these nine criteria. Low-risk and high-risk groups were derived from the score (probability, 3.5% [95% CI 0-7.5] and 67% [51-83]). Application of these criteria to the prospective cohort confirmed the diagnostic accuracy of the score (probability 0% [0-15] and 71% [25-100] in the low-risk and high-risk groups, respectively). Conclusion. This easy-to-calculate score may prove useful for diagnosing patients with serious APN who deteriorate with treatment

  8. XanthogranuIomafous Pyelonephritis(XGP)1 Case Report%特殊的黄色肉芽肿性肾盂肾炎1例

    Institute of Scientific and Technical Information of China (English)

    曾柯; 李家泉; 黄贵书

    2014-01-01

    目的:通过探讨黄色肉芽肿性肾盂肾炎的临床及病理特点以提高正确诊断率。方法报道1例特殊的黄色肉芽肿性肾炎,并结合文献对其组织学和免疫组织化学特点进行回顾。结果 CT提示输尿管恶性肿瘤。免疫组织化学染色显示透明细胞CD68阳性,RCC和KER阴性。结论黄色肉芽肿性肾盂肾炎是一种比较罕见的炎性病变,根据其临床特点及组织学和免疫组织化学特征可以进行明确诊断。%Objective To discuss the pathological characteristics of xanthogranulomatous pyelonephfitis (XGP),for raise the correct diagnosis rate.Methods One case of especial xanthogranulomatous pyelonephritis Was reported and the pathological features were studied by microscopy and immunohistochemistry.Results CT consider that is tumour of ureter . Immunohistochemistry showed the fomay cells were positive for CD68,and negative for RCC .Conclusion Xanthogranulomatous pyelonephritis is a rare kidney disease but can be diagnosed by itscharacters of histology and immunohistochemistry.

  9. MRI and suspected acute pyelonephritis in children: comparison of diffusion-weighted imaging with gadolinium-enhanced T1-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Vivier, Pierre-Hugues [Rouen University Hospital, CHU C. Nicolle, Service de radiopediatrie, Rouen, Cedex (France); Universite de Rouen, INSERM U1096, Rouen, Cedex (France); CHU Charles Nicolle, Service d' imagerie pediatrique et foetale, INSERM U1096, Rouen CEDEX (France); Sallem, Asmaa [Rouen University Hospital, CHU C. Nicolle, Service de radiopediatrie, Rouen, Cedex (France); Beurdeley, Marion; Leroux, Julien; Liard, Agnes [Rouen University Hospital, CHU C. Nicolle, Service de chirurgie pediatrique, Rouen, Cedex (France); Lim, Ruth P. [Austin Health, Radiology Department, Heidelberg, Victoria (Australia); Caudron, Jerome; Dacher, Jean-Nicolas [Rouen University Hospital, CHU C. Nicolle, Service de radiopediatrie, Rouen, Cedex (France); Universite de Rouen, INSERM U1096, Rouen, Cedex (France); Coudray, Cyril [G. E. Healthcare, Velizy Villacoublay Cedex (France); Michelet, Isabelle [Rouen University Hospital, CHU C. Nicolle, Service de pediatrie, Rouen, Cedex (France)

    2014-01-15

    To evaluate the performance of diffusion-weighted imaging (DWI) against the reference standard of gadolinium-enhanced T1-weighted imaging (Gd-T1-WI) in children. Thirty-nine consecutive patients (mean age 5.7 years) with suspected acute pyelonephritis underwent magnetic resonance imaging (MRI) including DWI and (the reference standard) Gd-T1-WI. Each study was read in double-blinded fashion by two radiologists. Each kidney was graded as normal or abnormal. Sensitivity and specificity of DWI were computed. Agreement between sequences and interobserver reproducibility were calculated (Cohen κ statistic and the McNemar tests). Thirty-two kidneys (41 %) had hypo-enhancing areas on Gd-T1-W images. The sensitivity and specificity of DWI were 100 % (32/32) and 93.5 % (43/46). DWI demonstrated excellent agreement (κ = 0.92,) with Gd-T1-W, with no significant difference (P = 0.25) in detection of abnormal lesions. Interobserver reproducibility was excellent with DWI (κ = 0.79). DWI enabled similar detection of abnormal areas to Gd-T1-WI and may provide an injection-free means of evaluation of acute pyelonephritis. (orig.)

  10. Diffusion-weighted imaging and apparent diffusion coefficient values versus contrast-enhanced MR imaging in the identification and characterisation of acute pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Faletti, Riccardo; Cassinis, Maria Carla; Fonio, Paolo; Grasso, Angela; Battisti, Giacomo; Bergamasco, Laura; Gandini, Giovanni [University of Torino, Radiology Institute, Department of Surgical Sciences, Torino (Italy)

    2013-12-15

    To compare contrast-enhanced (CEMR) and diffusion-weighted (DWI) magnetic resonance imaging in diagnosing acute pyelonephritis (APN) and to assess ADC measurement reliability in differentiating among normal renal parenchyma, APN and abscesses. Eighty-eight patients (80 women, mean age 36.5 years) with clinical suspicion of APN were retrospectively reviewed. An experienced observer quantified lesions with a score ranging from 0 to 3. DWI and CEMR were compared on the basis of the assigned score, total examination number (88) and on presence (36)/absence (52) of abscesses. ADC values, calculated at the healthy parenchyma, APN and abscessed were compared to each other. Agreement between CEMR and DWI was 94.3 % (83/88 patients; P < 0.05). In the APN group, DWI was awarded the highest visibility score compared to CEMR (P = 0.05), while in the abscess group CEMR had the highest score (P = 0.04). The difference between ADC values of the APN-healthy parenchyma and abscess-APN groups was significant (P < 0.05). The area under the ROC curve of ADC values of the APN-healthy and abscess-APN groups were found to be 0.94 (95 % CI; cutoff value = 2) and 0.78 (95 % CI; cutoff value = 1.2) respectively. Diffusion-weighted imaging appears reliable in the diagnosis and follow-up of acute pyelonephritis and could provide a reasonable alternative to contrast-enhanced magnetic resonance imaging. (orig.)

  11. Acute pyelonephritis in transplanted kidneys: can diffusion-weighted magnetic resonance imaging be useful for diagnosis and follow-up?

    Science.gov (United States)

    Faletti, Riccardo; Cassinis, Maria Carla; Gatti, Marco; Giglio, Jacopo; Guarnaccia, Carla; Messina, Marina; Bergamasco, Laura; Fonio, Paolo

    2016-03-01

    To assess reliability of diffusion-weighted magnetic resonance imaging (DW-MRI) in the management of acute pyelonephritis (APN) foci in transplanted kidneys. In the 2012-2014 period, 24 kidney-transplanted patients underwent MR screening for clinical suspicion of APN. Two readers independently analyzed all images, establishing presence and location of APN foci. The 22 patients who were positive at the MR exam constituted the study population. For each patient the apparent diffusion coefficient (ADC) was measured in the APN foci and in three sites of the healthy parenchyma (case-control comparison). The data were matched to the laboratory measurements for white blood cell, C-reactive protein, and serum creatinine. Forty-six APN foci were found in 22/24 patients. At the acute stage, the difference in ADC between healthy parenchyma and APN foci was significant (2.06 ± 0.16 vs. 1.43 ± 0.32 × 10(-3) mm(2)/s; p < 0.0001). The performance of ADC as APN indicator was tested by the receiving operating characteristics (ROC) curve: the area under curve AUC = 0.99 witnessed an excellent discriminatory ability, with threshold APN/normal parenchyma 1.9 × 10(-3) mm(2)/s. At the 1-month follow-up 43/46 APN foci were no longer visible, with ADC values significantly higher than at the acute stage; all laboratory data were physiological, with WBC significantly reduced from the acute phase (5.2 ± 1.6 × 10(9)/L vs. 10.6 ± 4.8 × 10(9)/L; p < 0.0001). The other 3 patients underwent further therapy and exams, including a third MR. DW-MRI with ADC measurement seems to be a reliable tool in diagnosing and monitoring APN foci in transplanted kidneys, with clinical impact on patient management.

  12. 99m-Tc DMSA scintigraphy and color/power doppler sonography for children pyelonephritis diagnosis and follow-up; Scintigraphie au 99m-Tc DMSA et echo-doppler couleur/energie dans le diagnostic et le suivi des pyelonephrites de l'enfant

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    Hitzel, A.; Manrique, A.; Gardin, I.; Vera, P. [Centre de Lutte Contre le Cancer Henri-Becquerel, Dept. de Medecine Nucleaire, 76 - Rouen (France); Centre Hospitalier Universitaire Charles Nicolle, 76 - Rouen (France); Dacher, J.N.; Menard, J.F.; Vera, P. [Laboratoire Universitaire Quant.I.F., Faculte de Medecine de Rouen, 76 (France); Dacher, J.N. [Centre Hospitalier Universitaire Charles Nicolle, Dept. de Radiologie, 76 - Rouen (France); Liard, A. [Centre Hospitalier Universitaire Charles Nicolle, Dept. de Chirurgie Pediatrique, 76 - Rouen (France); Menard, J.F. [Centre Hospitalier Universitaire Charles Nicolle, Dept. de BioStatistiques, 76 - Rouen (France)

    2004-04-01

    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 {sup 99m}Tc-DMSA scintigraphy. Fifty-seven children were evaluated during pyelonephritis: biology (CRP, creatinine, blood formula), color/power doppler sonography and {sup 99m}Tc-DMSA scintigraphy (DMSA1). 7 {+-} 2 months later, follow-up consisted in biological tests and a {sup 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)

  13. MarA, SoxS and Rob function as virulence factors in an Escherichia coli murine model of ascending pyelonephritis.

    Science.gov (United States)

    Casaz, Paul; Garrity-Ryan, Lynne K; McKenney, David; Jackson, Caroline; Levy, Stuart B; Tanaka, S Ken; Alekshun, Michael N

    2006-12-01

    MarA, SoxS and Rob are transcription factors belonging to the AraC family. While these proteins have been associated historically with control of multiple antibiotic resistance, and tolerance to oxidative stress agents and organic solvents, only a paucity of experimental data support a role in regulating virulence. Clinical Escherichia coli isolates, and isogenic strains lacking marA, soxS and rob, were studied in a murine model of ascending pyelonephritis, which is a clinically relevant model of urinary tract infection. Organisms lacking all three transcription factors (triple knockouts) were significantly less virulent than parental strains, and complementation studies demonstrated that the addition of marA, soxS and rob individually restored wild-type virulence in the triple-knockout strain. Deletion of soxS or rob alone was more detrimental than the removal of marA. Thus, all three proteins contribute to virulence in vivo.

  14. Optimazation of antibiotic therapy in patients with chronic pyelonephritis combined with pancreatic diabetes of the 2 type by evaluation of the expression of plasmid resistance genes

    Directory of Open Access Journals (Sweden)

    Ольга Игоревна Чуб

    2015-07-01

    Full Text Available The resistance caused by the transfer of resistance genes among the uropathogenes with a help of plasmids in the treatment of chronic pyelonephritis (CP combined with pancreatic diabetes (PD of the 2 type increased last years. The aim of research was an optimization of methods of differentiated prescription of antibiotic therapy (ABT for patients with CP and contaminant PD of the 2 type depending on expression of plasmid-induced genic mechanisms of antibiotic resistance.Methods. There were examined 105 patients with chronic pyelonephritis, 73 of them – against the background of PD of the 2 type. The sensitivity of isolated cultures to antibiotics was carried out by the disco-diffuse method of Bauer-Kirbi on the medium of Hinton-Muller using commercial discs. The study of plasmid-induced mechanisms of resistance was carried out by the method of polymerase chain reaction (PCR.Results. Detectability of plasmid-induced mechanisms in patients with CP and PD of the 2 type is 31,5 %. Β-lactamase of extended spectrum (βLES – were the most diffuse detected genes. The highest inhibitory activity against the strains with plasmid genes was shown by meropenem, fosfomicyn, nitroxolinum, 4th generation of cephalosporins and the 3th generation of fluoroquinolones. According to received results it was elaborated an algorithm of differentiated prescription of ABT for patients with CP and PD of the 2 type depending on expression of plasmid-induced resistance genes.Conclusions. There was studied the prevalence of plasmid-induced resistance mechanisms and elaborated the methods for increase an efficiency of empirical ABT for patients with CP and contaminant PD of the 2 type. 

  15. Acute Pyelonephritis during Pregnancy Changes the Balance of Angiogenic and Anti-Angiogenic Factors in Maternal Plasma

    Science.gov (United States)

    Chaiworapongsa, Tinnakorn; Romero, Roberto; Gotsch, Francesca; Kusanovic, Juan Pedro; Mittal, Pooja; Kim, Sun Kwon; Erez, Offer; Vaisbuch, Edi; Mazaki-Tovi, Shali; Kim, Chong Jai; Dong, Zhong; Yeo, Lami; Hassan, Sonia S

    2012-01-01

    Objective Angiogenic factors have been implicated in the pathophysiology of sepsis. In experimental models of sepsis (endotoxemia and/or cecal ligation puncture), there is increased expression of vascular endothelial growth factors (VEGF) and the administration of exogenous soluble VEGF receptor (sVEGFR)-1, an antagonist to VEGF, reduces morbidity and mortality. Moreover, a dramatic elevation in sVEGFR-1 has been demonstrated in human sepsis. Although a balance between angiogenic and anti-angiogenic factors is essential for feto-placental development, the changes of angiogenic factors during pregnancy in the context of infection have never been explored. Angiogenic factors also play crucial roles in the pathophysiology of preeclampsia. This study was conducted to determine if maternal plasma concentrations of placental growth factor (PlGF), sVEGFR-2 and soluble endoglin (sEng) change in pregnancies complicated by acute pyelonephritis (AP) compared to normal pregnancy and preeclampsia (PE). Study Design A case-control study was conducted in patients with AP, normal pregnant women (NP) and patients with PE (n=36 for each group) matched for gestational age. AP was diagnosed in the presence of fever (temperature ≥ 38°C), clinical signs of infection, and a positive urine culture for micro-organisms. Plasma concentrations of PlGF, sVEGFR-2 and sEng were determined by ELISA. The results of plasma sVEGFR-1 concentrations has previously been reported before, but were included in this study to provide a complete picture of the angiogenic/anti-angiogenic profiles. Serum concentrations of interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, interferon (IFN)-γ, Granulocyte macrophage colony stimulating factor (GM-CSF), and tumor necrosis factor (TNF)-α were also determined using high sensitivity multiplexed immunoassays in patients with AP and NP. Results AP was associated with a lower median plasma concentration of PlGF and sVEGFR-2 than NP

  16. Kidney Infection (Pyelonephritis)

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    ... Disease Chronic Kidney Disease (CKD) What Is Chronic Kidney Disease? Causes of CKD Tests & Diagnosis Managing CKD Eating Right Preventing CKD What If My Kidneys Fail? Clinical Trials Anemia High Blood Pressure Heart ... Nephropathy Kidney Disease in Children Childhood Nephrotic Syndrome Hemolytic ...

  17. A prospective, randomized, double dummy, placebo-controlled trial of oral cefditoren pivoxil 400mg once daily as switch therapy after intravenous ceftriaxone in the treatment of acute pyelonephritis.

    Science.gov (United States)

    Monmaturapoj, Teerapong; Montakantikul, Preecha; Mootsikapun, Piroon; Tragulpiankit, Pramote

    2012-12-01

    To compare the clinical and bacteriological effectiveness of intravenous (IV) ceftriaxone followed by oral cefditoren pivoxil or IV ceftriaxone for acute pyelonephritis. A prospective randomized controlled trial of patients with a presumptive diagnosis of acute pyelonephritis was performed. Daily 2g IV ceftriaxone was initially given to all patients. After day 3, patients who satisfied the criteria for switch therapy were randomized to either group A (IV ceftriaxone) or group B (oral cefditoren pivoxil 400mg once daily). Eighty-two patients were enrolled; 41 (50%) patients in group A and 41 (50%) patients in group B were evaluated. There was no statistically significant difference in baseline characteristics between the two groups. Clinical cure was observed in 39 of 41 (95.1%) patients in group A and 41 of 41 (100%) patients in group B (p=0.15, 95% confidence interval (CI) -0.12 to 0.02). Urine bacteriological eradication was found in 63.4% in group A and 60% in group B (p=0.75, 95% CI -0.18 to 0.25). There was no statistically significant difference in adverse effects between the two treatment groups. These data suggest that IV ceftriaxone followed by oral cefditoren pivoxil is highly effective and well-tolerated for the treatment of acute pyelonephritis, even for uropathogens with a high proportion of quinolone-resistant strains. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  18. Immunopathological and antimicrobial effect of black pepper, ginger and thyme extracts on experimental model of acute hematogenous pyelonephritis in albino rats.

    Science.gov (United States)

    Nassan, M A; Mohamed, E H

    2014-01-01

    Recent studies showed prominent antimicrobial activity of various plant extracts on certain pathogenic microorganisms, therefore we prepared crude aqueous extracts of black pepper, ginger and thyme and carried out an in vitro study by measuring antimicrobial activity of these extracts using the agar well diffusion method. An in vivo study was carried out on 50 adult healthy male albino rats which were divided into 5 groups, 10 rats each. Group 1: negative control group which received saline solution intragastrically daily; Group 2: Positive control group, injected with mixed bacterial suspension of S.aureus and E.coli as a model of pyelonephritis, then received saline solution intragastrically daily; Group 3: injected with the same dose of mixed bacterial suspension, then received 100 mg/kg/day black pepper extract intragastrically; Group 4: injected with mixed bacterial suspension then received 500 mg/kg/day ginger extract intragastrically. Group 5: injected with mixed bacterial suspension then received 500 mg/kg/day thyme extract intragastrically. All groups were sacrificed after either 1 or 4 weeks. Serum and blood samples were collected for lysozyme activity estimation using agarose lysoplate, measurement of nitric oxide production, and lymphocyte transformation test as well as for counting both total and differential leukocytes and erythrocytes. Kidney samples were tested histopathologically. Both in vivo and in vitro results confirm the efficacy of these extracts as natural antimicrobials and suggest the possibility of using them in treatment procedures.

  19. Blocking yersiniabactin import attenuates extraintestinal pathogenic Escherichia coli in cystitis and pyelonephritis and represents a novel target to prevent urinary tract infection.

    Science.gov (United States)

    Brumbaugh, Ariel R; Smith, Sara N; Subashchandrabose, Sargurunathan; Himpsl, Stephanie D; Hazen, Tracy H; Rasko, David A; Mobley, Harry L T

    2015-04-01

    The emergence and spread of extended-spectrum beta-lactamases and carbapenemases among common bacterial pathogens are threatening our ability to treat routine hospital- and community-acquired infections. With the pipeline for new antibiotics virtually empty, there is an urgent need to develop novel therapeutics. Bacteria require iron to establish infection, and specialized pathogen-associated iron acquisition systems like yersiniabactin, common among pathogenic species in the family Enterobacteriaceae, including multidrug-resistant Klebsiella pneumoniae and pathogenic Escherichia coli, represent potentially novel therapeutic targets. Although the yersiniabactin system was recently identified as a vaccine target for uropathogenic E. coli (UPEC)-mediated urinary tract infection (UTI), its contribution to UPEC pathogenesis is unknown. Using an E. coli mutant (strain 536ΔfyuA) unable to acquire yersiniabactin during infection, we established the yersiniabactin receptor as a UPEC virulence factor during cystitis and pyelonephritis, a fitness factor during bacteremia, and a surface-accessible target of the experimental FyuA vaccine. In addition, we determined through transcriptome sequencing (RNA-seq) analyses of RNA from E. coli causing cystitis in women that iron acquisition systems, including the yersiniabactin system, are highly expressed by bacteria during natural uncomplicated UTI. Given that yersiniabactin contributes to the virulence of several pathogenic species in the family Enterobacteriaceae, including UPEC, and is frequently associated with multidrug-resistant strains, it represents a promising novel target to combat antibiotic-resistant infections. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  20. Comparison of ertapenem and ceftriaxone therapy for acute pyelonephritis and other complicated urinary tract infections in Korean adults: a randomized, double-blind, multicenter trial.

    Science.gov (United States)

    Park, Dae Won; Peck, Kyong Ran; Chung, Moon Hyun; Lee, Jin Seo; Park, Yoon Soo; Kim, Hyo Youl; Lee, Mi Suk; Kim, Jung Yeon; Yeom, Joon Sup; Kim, Min Ja

    2012-05-01

    The efficacy and safety of ertapenem, 1 g once daily, were compared with that of ceftriaxone, 2 g once daily, for the treatment of adults with acute pyelonephritis (APN) and complicated urinary tract infections (cUTIs) in a prospective, multicenter, double-blinded, randomized study. After ≥ 3 days of parenteral study therapy, patients could be switched to an oral agent. Of 271 patients who were initially stratified by APN (n = 210) or other cUTIs (n = 61), 66 (48.9%) in the ertapenem group and 71 (52.2%) in the ceftriaxone group were microbiologically evaluable. The mean duration of parenteral and total therapy, respectively, was 5.6 and 13.8 days for ertapenem and 5.8 and 13.8 days for ceftriaxone. The most common pathogen was Escherichia coli. At the primary efficacy endpoint 5-9 days after treatment, 58 (87.9%) patients in the ertapenem group and 63 (88.7%) in the ceftriaxone had a favorable microbiological response. When compared by stratum and severity, the outcomes in the two groups were equivalent. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. The results indicate that ertapenem is highly effective and safe for the treatment of APN and cUTIs.

  1. Autotransporter genes pic and tsh are associated with Escherichia coli strains that cause acute pyelonephritis and are expressed during urinary tract infection.

    Science.gov (United States)

    Heimer, Susan R; Rasko, David A; Lockatell, C Virginia; Johnson, David E; Mobley, Harry L T

    2004-01-01

    We have identified two chromosomal open reading frames in uropathogenic Escherichia coli (UPEC) strain CFT073 which are highly homologous to serine protease autotransporters Pic and Tsh. Both cloned determinants were correlated with the presence of 105- to 110-kDa proteins in the culture supernatants. Furthermore, in cellular fractionation experiments, 30-kDa polypeptides were identified in the outer membrane; we speculated that these proteins are the beta-barrel portions of the autotransporter homologues. Furthermore, Pic-containing culture supernatants have serine protease activity. In reverse transcription-PCR analyses, the expression of the pic and tsh genes in E. coli CFT073 was higher in broth cultures grown at 37 degrees C than at 25 degrees C. Moreover, pic and tsh were expressed by bacteria isolated from urine of transurethrally infected mice. The tsh determinant was identified in 63% of our clinical UPEC strain isolates (n = 87) and in 33% of fecal strains (n = 27), whereas pic was present in 31% of the pyelonephritis (n = 67) and 7% of the fecal strains. There was no significant correlation between cystitis strains (n = 20) and the pic determinant.

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

    Directory of Open Access Journals (Sweden)

    O.I. Chub

    2016-08-01

    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.

  3. The effect of vitamin A on renal damage following acute pyelonephritis in children: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Zhang, Guo-Qiang; Chen, Jin-Liang; Zhao, Yong

    2016-03-01

    Renal scarring after acute pyelonephritis (APN) in children is of concern and in the worst cases leads to long-term cardiovascular morbidity. There are reports that vitamin A may alleviate renal damage following APN. We conducted a meta-analysis to investigate the role of vitamin A in the alleviation of renal damage. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials (CENTRAL, the Cochrane Library) and the Wang Fang database (Chinese) from their inception to February 3, 2015 for randomized controlled trials (RCTs) investigating vitamin A and renal damage. Primary outcome was number of patients/kidneys with renal damage, defined as persistence of photopenic lesions based on technetium-99m dimercaptosuccinic acid renal scintigraphy. We calculated pooled relative risks for renal damage in the vitamin A group. Four RCTs, involving a total of 248 patients aged 1-144 months (120 in experimental group, 128 in control group), were included in the meta-analysis. Vitamin A was inversely associated with renal damage (relative risk 0.53, 95 % confidence interval 0.43, 0.67) when compared with placebo group after an average follow-up of 5 months. Current evidence indicates that vitamin A may exert a preventive effect on renal damage in children with APN. However, this finding largely relies on a few studies of low methodological quality, i.e., high risk of selection bias, performance bias and attrition bias. Hence, high-quality and adequately powered RCTs are warranted.

  4. Genomic analysis of a pathogenicity island in uropathogenic Escherichia coli CFT073: distribution of homologous sequences among isolates from patients with pyelonephritis, cystitis, and Catheter-associated bacteriuria and from fecal samples.

    Science.gov (United States)

    Guyer, D M; Kao, J S; Mobley, H L

    1998-09-01

    Urinary tract infection is the most frequently diagnosed kidney and urologic disease and Escherichia coli is by far the most common etiologic agent. Uropathogenic strains have been shown to contain blocks of DNA termed pathogenicity islands (PAIs) which contribute to their virulence. We have defined one of these regions of DNA within the chromosome of a highly virulent E. coli strain, CFT073, isolated from the blood and urine of a woman with acute pyelonephritis. The 57,988-bp stretch of DNA has characteristics which define PAIs, including a size greater than 30 kb, the presence of insertion sequences, distinct segmentation of K-12 and J96 origin, GC content (42.9%) different from that of total genomic DNA (50.8%), and the presence of virulence genes (hly and pap). Within this region, we have identified 44 open reading frames; of these 44, 10 are homologous to entries in the complete K-12 genome sequence, 4 are nearly identical to the sequences of E. coli J96 encoding the HlyA hemolysin, 11 encode P fimbriae, and 19 show no homology to J96 or K-12 entries. To determine whether sequences found within the junctions of the PAI of CFT073 were common to other uropathogenic strains of E. coli, 11 probes were isolated along the length of the PAI and were hybridized to dot blots of genomic DNA isolated from clinical isolates (67 from patients with acute pyelonephritis, 38 from patients with cystitis, 49 from patients with catheter-associated bacteriuria, and 27 from fecal samples). These sequences were found significantly more often in strains associated with the clinical syndromes of acute pyelonephritis (79%) and cystitis (82%) than in those associated with catheter-associated bacteriuria (58%) and in fecal strains (22%) (P < 0.001). From these regions, we have identified a putative iron transport system and genes other than hly and pap that may contribute to the virulent phenotype of uropathogenic E. coli strains.

  5. Primary renal mucosa-associated lymphoid tissue lymphoma,the result of chronic pyelonephritis?%肾脏黏膜相关淋巴瘤,是慢性肾孟肾炎的后果吗?

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective:To report 2 cases of primary renal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma), and observe the relations between this rare tumor of kidney and chronic pyelonephritis. Methods: 2renal MALT lymphomas were collected from referral consultation. Detailed clinical information were reviewed, morphological analysis based on the HE section, and immunohistochemistry were performed by CD20, CD79a, CDS, CD10, CD43, CD23,BCL10 and Cyclin D1 antibodies. Results: 2 female patients with age of 48 and 55, respectively, all had a history of chronic pyelonephritis. Under the B ultrasonic and CT scanning a bump in the kidney was found. Renal carcinoma suspected and hereby the whole nephrectomy performed. In the macroscopic, tumors were laid in the renal medulla, with dark red color and ill-defined boundary. In the microscopic, there were mixed lymphoid cells infiltrate which mainly consisted of small lymphocytes, centrocyte-like cells, lymphoplasmacytoid and plasma cells, reactive follicles and lymphoepithelial lesions also could be seen in the lesion, but follicles colonization was rare. In fact, except changes of lymphoma, basic renal disease also could be seen. Most glomeruli were atrophic, some glomeruli were hyperplastic and hypertrophic. Tubules were dilated or contacted, many dilated tubules contained pink-color glassy-appearing casts that suggest the appearance of thyroid tissue.As a result, those 2 cases showed juxtaposed changes of lymphoma and pyelonephritis. Immunohistochemistry showed that tumor cells were CD20 and CD79a positive, CD43 was weak positive, but CD5, CD10, CD23, BCL10 and Cyclin D1 were all negative. Conclusion: Primary renal MALT lymphoma was very rare disease. According to the clinical manifestation, it's hard to differentiate from renal cell carcinoma. But the morphological features were consistent with the classic MALT lymphomas in other sites. Immunophenotypic profiles were helpful for diagnosis. Based

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

    Science.gov (United States)

    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.

  7. Effects of gentamicin monotherapy for the initial treatment of community-onset complicated non-obstructive acute pyelonephritis due to Enterobacteriaceae in elderly and non-elderly women.

    Science.gov (United States)

    Wie, S-H; Kim, H W; Chang, U-I

    2014-11-01

    Aminoglycosides may serve as fluoroquinolone-sparing or cephalosporin-sparing agents if the clinical effectiveness of aminoglycoside monotherapy is demonstrated. The purposes of this study were to investigate the clinical efficacy of gentamicin as an initial empirical antimicrobial agent and to evaluate the effects of gentamicin resistance on clinical outcomes in women with complicated non-obstructive acute pyelonephritis (APN). Medical records of 1066 women with a diagnosis of APN were reviewed retrospectively. We enrolled 275 women with community-onset complicated non-obstructive APN due to Enterobacteriaceae who received gentamicin as their initial antibiotic. Of these 275 patients, 43 had gentamicin-resistant (GM-R) Enterobacteriaceae APN, and 232 had gentamicin-susceptible (GM-S) Enterobacteriaceae APN. The early clinical success rates were 67.4% (29/43) versus 89.7% (208/232) at 72 h in the GM-R versus the GM-S groups (p 0.001). The overall clinical cure rate was 100% (43/43) and 98.7% (229/232) in the GM-R and GM-S groups, respectively. The duration of hospital stay was significantly longer in the elderly, although there were no significant differences in the rates of early clinical success, final clinical cure, mortality, and time to fever clearance between the elderly and non-elderly groups. Resistance of Enterobacteriaceae to gentamicin, haematuria and serum C-reactive protein level≥20 mg/dL were independently associated with early clinical failure. Gentamicin can be an effective initial antibiotic option for empirical therapy in women with community-onset complicated APN who do not need urological interventional procedures. The use of gentamicin may contribute to a reduction of fluoroquinolone or broad-spectrum cephalosporin use in the treatment of complicated APN.

  8. Role of piperacillin/tazobactam as a carbapenem-sparing antibiotic for treatment of acute pyelonephritis due to extended-spectrum β-lactamase-producing Escherichia coli.

    Science.gov (United States)

    Yoon, Young Kyung; Kim, Jong Hun; Sohn, Jang Wook; Yang, Kyung Sook; Kim, Min Ja

    2017-04-01

    Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) is a frequent cause of acute pyelonephritis (APN), requiring carbapenem therapy. However, alternatives to carbapenems are needed due to the emergence of carbapenemase-producing micro-organisms. The purpose of this study was to compare the clinical efficacy of piperacillin/tazobactam (TZP) versus ertapenem in the treatment of adult patients with APN caused by ESBL-Ec. A retrospective observational study of APN caused by ESBL-Ec susceptible to TZP was performed at a university-affiliated hospital in the Republic of Korea between February 2011 and June 2013. All adult patients initially treated with in vitro-active TZP were compared with those treated with ertapenem to evaluate antibiotic clinical efficacy. The primary endpoint was treatment failure, defined as a composite of in-hospital mortality, change of initial antibiotic regimen and microbiological eradication failure. During the study period, 68 patients prescribed TZP and 82 patients prescribed ertapenem were eligible for inclusion in the study. There was no significant difference between the two treatment groups in the occurrence of in-hospital mortality, change of initial antibiotic regimen or microbiological eradication failure. In the multivariate analyses, predictors associated with treatment failure included septic shock [odds ratio (OR) = 4.27, 95% confidence interval (CI) 1.66-10.99] and recent administration of immunosuppressive agents (OR = 2.84, 95% CI 1.02-7.91). However, the type of antibiotic was not associated with treatment failure. TZP could be an effective alternative to ertapenem for the treatment of APN caused by ESBL-Ec, sparing carbapenem consumption in the multidrug-resistant era. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  9. Diagnostic value of serum procalcitonin for acute pyelonephritis in infants and children with urinary tract infections: an updated meta-analysis.

    Science.gov (United States)

    Zhang, Huhai; Yang, Jurong; Lin, Lirong; Huo, Bengang; Dai, Huanzi; He, Yani

    2016-03-01

    The aims were to assess (1) the diagnostic value of serum procalcitonin (PCT) for acute pyelonephritis (APN) in infants and children with urinary tract infections (UTIs) and (2) to compare the performance of two commonly used cutoff values. A meta-analysis of serum PCT in the diagnosis of APN among pediatrics with lower UTIs was conducted. The process of search strategy, publications selection and data analysis was in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. Eighteen high-quality studies with a total of 831 APN patients and 651 individuals with lower UTIs were analyzed. The overall performance of serum PCT ≥ 0.5 ng/mL was as follows: pooled sensitivity of 0.86 (95 % CI 0.73-0.93), pooled specificity of 0.76 (95 % CI 0.66-0.83), DOR of 18.90 (95 % CI 6.78-52.71) and AUROC of 0.86 (95 % CI 0.83-0.89), with significant heterogeneity. However, use of 1.0 ng/mL as a cutoff value produced an improved specificity of 0.91 (95 % CI 0.86-0.94), a DOR of 55.06 (95 % CI 22.57-115.48) and an AUROC of 0.94 (95 % CI 0.92-0.96), without obvious heterogeneity. In pediatrics with UTIs, the cutoff value of serum PCT, 1.0 ng/mL, has a preferable diagnostic performance compared with 0.5 ng/mL for APN. Additional prospective studies that propose an appropriate cutoff value and validate the performance of PCT for young with APN are needed in the future.

  10. A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis.

    Science.gov (United States)

    Chang, U-Im; Kim, Hyung Wook; Noh, Yong-sun; Wie, Seong-Heon

    2015-05-01

    Acute pyelonephritis (APN) is the most common cause of community-onset bacteremia in hospitalized elderly patients. The objectives of this study were to investigate the differences in the clinical and microbiological data of hospitalized elderly and non-elderly women with community-onset APN. Women with community-onset APN as a discharge diagnosis were identified from January 2004 to December 2013 using an electronic medical records system. We compared the clinical and microbiologic data in elderly and non-elderly women with community-onset APN due to Enterobacteriaceae. Of the 1,134 women with community-onset APN caused by Enterobacteriaceae, 443 were elderly and 691 were non-elderly women. The elderly group had a lower frequency of upper and lower urinary tract symptoms/signs than the non-elderly. The incidence of bacteremia, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, patients with a C-reactive protein (CRP) level ≥ 15 mg/dL, and patients with a leukocyte count ≥ 15,000/mm(3) in the blood, were significantly higher in the elderly group than in the non-elderly group. The proportion of patients requiring hospitalization for 10 days or more was significantly higher in the elderly group compared to the non-elderly group (51.5% vs. 26.2%, p < 0.001). The clinical cure rates at 4 to 14 days after the end of therapy were 98.3% (338/344) and 97.4% (519/533) in the elderly and non-elderly groups, respectively (p = 0.393). Elderly women with APN exhibit higher serum CRP levels, a higher frequency of bacteremia, a higher proportion of ESBL-producing uropathogens, and require a longer hospitalization than non-elderly women, although these patients may not complain of typical urinary symptoms.

  11. Ciprofloxacin Treatment Failure in a Murine Model of Pyelonephritis Due to an AAC(6′)-Ib-cr-Producing Escherichia coli Strain Susceptible to Ciprofloxacin In Vitro

    Science.gov (United States)

    Guillard, T.; Cambau, E.; Chau, F.; Massias, L.; de Champs, C.

    2013-01-01

    AAC(6′)-Ib-cr is a plasmid-mediated quinolone resistance mechanism described worldwide for Escherichia coli. Since it confers in vitro only a low level of resistance to ciprofloxacin, we evaluated its impact on the in vivo activity of ciprofloxacin. Isogenic strains were obtained by transferring plasmid p449, harboring aac(6′)-Ib-cr, into the quinolone-susceptible strain E. coli CFT073-RR and its D87G gyrA mutant. MICs were 0.015, 0.06, 0.25, and 0.5 μg/ml against E. coli strains CFT073-RR, CFT073-RR/p449, CFT073-RR GyrAr, and CFT073-RR GyrAr/p449, respectively. Bactericidal activity was reduced at 1× the MIC for the three resistant derivatives, while at a fixed concentration of 0.5 μg/ml, 99.9% killing was observed for all strains except E. coli CFT073-RR GyrAr/p449. In the murine model of pyelonephritis, an optimal regimen of ciprofloxacin (10 mg/kg of body weight twice a day [b.i.d.]) significantly decreased the bacterial count in the kidneys of mice infected with E. coli CFT073 (1.6 versus 4.3 log10 CFU/g of kidney compared to untreated controls; P = 0.0001), while no significant decrease was observed for E. coli CFT073-RR/p449 (2.7 versus 3.1 log10 CFU/g; P = 0.84), E. coli CFT073-RR GyrAr (4.2 versus 4.1 log10 CFU/g; P = 0.35), or E. coli CFT073-RR GyrAr/p449 (2.9 versus 3.6 log10 CFU/g; P = 0.47). While pharmacokinetic and pharmacodynamic (PK/PD) parameters accounted for ciprofloxacin failure against gyrA-containing mutants, this was not the case for the aac(6′)-Ib-cr-containing strains, suggesting an in situ hydrolysis of ciprofloxacin in the latter case. PMID:24018262

  12. The Epidemiologic Survey of Acute Pyelonephritis with Pregnancy in Dongguan City%东莞地区妊娠合并急性肾盂肾炎的流行病学研究

    Institute of Scientific and Technical Information of China (English)

    袁艳芳

    2015-01-01

    Objective:To analyze the epidemiologic data of acute pyelonephritis with pregnancy in Dongguan district.Method:483 patients of acute pyelonephritis with pregnancy were enrolled from January 2012 to December 2013.Morbidity of acute pyelonephritis with pregnancy,symptom and complication,spectrum of pathogen,tolerance, prognosis were investigated.Result:Morbidity of acute pyelonephritis with pregnancy was 3.13%,morbidity of acute pyelonephritis with pregnancy in 2013 for 3.69%was significantly higher than that in 2012 for 2.47%,the difference was statistically significant(P=0.000).Symptom and complication included pyrexia>38.3℃were 429 cases for 88.82%, anemia(hemoglobin<90 g/L)were 265 cases for 54.87%,acute kidney dysfunction(baseline creatinine increased 1.5 times)were 89 cases for 18.43%and electrolyte disorder were 58 cases for 12.01%.In 483 were a total of 392 urine cultures were positive,including bacillus were 229 cases accounted for 58.42%,coccus were 117 cases accounted for 29.85%,fungi were 46 cases accounted for 11.73%,the major pathogen were as follows:escherichia coli for 40.82%, staphylococcus saprophyticus for 16.58%,klebsiella pneumonia for 11.22%and enterococcus faecalis for 8.16%.Morbidity of fungal infection in 2013 for 14.40%was significantly higher than that in 2012 for 7.04%,the difference was statistically significant(P=0.044).Detectable rate of candida tropicalis in 2013 for 8.00%was significantly higher than that in 2012 for 1.41%,the difference was statistically significant(P=0.013).Escherichia coli,staphylococcus saprophyticus, klebsiella pneumonia were sensitive to common antibiotics.Pregnancy outcomes in patients with acute pyelonephritis was better.Conclusion:Morbidity of acute pyelonephritis with pregnancy is high.We could pay more attention to fungal infection.%目的:分析东莞地区妊娠合并急性肾盂肾炎的流行病学特点。方法:收集2012年1月-2013年12月本院483例妊娠合并急性肾盂肾炎患者的

  13. 肠球菌所致急性肾盂肾炎耐药性分布%Enterococcus Resistance Distribution Caused by Acute Pyelonephritis

    Institute of Scientific and Technical Information of China (English)

    刘智勇; 刘旭辉; 冯亚群; 张永标

    2013-01-01

    目的:探讨肠球菌所致急性肾盂肾炎的耐药性基因,探讨治疗对策,指导临床合理用药。方法选取我院2012年5月~2013年6月收治的有肠球菌导致的急性肾盂肾炎患者常规培养检出148株肠球菌为研究对象,分析其耐药性。结果148株肠球菌属构成比例为:粪肠球菌72株(48.65%);尿肠球菌55株(37.16%);鸟肠球菌17株(11.49%);其他肠球菌4株(2.70%)。粪肠球菌对利福平、四环素、红霉素耐药率>70%。尿肠球菌对左氧氟沙星、青霉素、安卡西林、红霉素、呋喃妥因耐药率达到70%以上。尿肠球菌对红霉素、氨苄西林耐药率达到70%以上。结论随着社会的发展和一些用药的不同,肠球菌的耐药性也在不断的增强,而且肠球菌也有很多种不同的类型,就它的这种中间差异性来说,一些抗生素的耐药性也不同,这也是如今比较严重的问题,在此同时也预示着临床上药根据肠球菌的耐药不同,来有针对性的去选择抗生素。药物的使用在不断的增多,药物的药效也在逐渐的增强,由此导致肠球菌不断地演变,分化的菌种类型增多,其耐药性也不断的增强,因此在治疗肠球菌所引发的疾病时,应根据不同肠球菌的耐药性,选择合适的治疗方法,减少临床上的治疗错误。%Objective:Investigate the drug resistance of enterococcus caused by acute pyelonephritis genes,treatment countermeasures is discussed,and to guide clinical rational drug use. Methods:Select our hospital from May 2012 to June 2012 treated with enterococcus in patients with acute pyelonephritis regular train detection 148 strains enterococcus as the research object,Analysis of the resistance. Results:148 strains of enterococcus belong to constitute ratio for:Dung enterococcus72strains (48.65%);Urine 55 strains enterococcus (37.16%); Bird 17 strains enterococcus (11.49%);The other 4 strains

  14. Litíase Renal em Adolescente Evoluindo com Pielonefrite Crônica e Fístula Renocutânea: Relato de Caso/ Nephrolithiasis Teenager and Chronic Pyelonephritis Evolving to Renocutaneo us Fistula: Case Report

    Directory of Open Access Journals (Sweden)

    Nelson dos Santos Neto

    2013-03-01

    Full Text Available Introdução: Litíase renal é a formação de cálculos no trato urinário que resulta de fatores epidemiológicos, anatômicos e modificações físico-químicas da urina, por alterações urodinâmicas. A presença de cálculos no trato urinário favorece a proliferação bacteriana e leva ao quadro de pielonefrite crônica. Como complicação desse quadro infeccioso, surge o abscesso renal e peri-renal. Casuística: Relata-se um caso de fístula renocutânea relativamente pouco frequente no curso de uma pielonefrite crônica por cálculo coraliforme, perfurando a pelve renal em paciente masculino de 14 anos. Discussão: O caso relatado mostra de forma sequenciada a evolução desfavorável de uma pielonefrite crônica, causada por nefrolitíase em criança. As queixas relatadas e os sinais/sintomas evidenciados servem para nos orientar na tentativa de diagnósticos cada vez mais precoces. Conclusão: Os exames complementares devem ser solicitados com ponderação, mas não omitidos, em caso de dúvidas quanto ao diagnóstico. Introduction: Renal lithiasis is the formation of calculi in the urinary tract that results of epidemiologic factors, anatomical and physico-chemical changes in the urine urodynamic changes. The presence of calculi in the urinary tract favors bacterial proliferation and leads to chronic pyelonephritis. As a complication of infection, abscess arises renal and peri-renal. Case report: We report a case of fistula renocutânea relatively uncommon in the course of chronic pyelonephritis with staghorn calculus piercing the renal pelvis in a male patient of 14 years. Discussion: This case shows the sequenced so unfavorable a chronic pyelonephritis, caused by nephrolithiasis in children. Complaints reported and signs/symptoms evidenced serve to guide us in trying to increasingly earlier diagnoses. Conclusion: The exams must be requested in weight, but not omitted in case of doubt about the diagnosis.

  15. Ureteral Drainage by Double-J-Catheters in Treating Hydronephrosis with Acute Pyelonephritis During Pregnancy%双J管内引流治疗妊娠期肾积水合并急性肾盂肾炎的体会

    Institute of Scientific and Technical Information of China (English)

    王荣; 王雪刚; 陈宣余; 江敏; 章小平

    2011-01-01

    Objective: To evaluate the safety and effectiveness of Double-J-stents in treating hydronephrosis with acute pyelonephritis during pregnancy. Methods: 34 cases of hydronephrosis with acute pyelonephritis in pregnancy,whose infection can not be controlled by using antibiotics alone, received internal drainage of ureter with double J stent. Results:Double-J stents were placed into renal pelvis successfully in all patients and relief of symptoms such as fever and lumbago were observed during the first 48 hours after the treatment with antibiotics. No complication was found in all the cases. Conclusions.. Double-J-ureteral stenting is an effective, simple and safe method in treating hydronephrosis with acute pyelonephritis during pregnancy.%目的:评估妊娠期肾积水合并急性肾盂肾炎内引流的治疗效果及安全性.方法:采用经膀胱镜下置人输尿管双J管治疗院外抗生素治疗失败的妊娠期肾积水合并急性肾盂肾炎患者34例.结果:34例全部顺利置入输尿管双J管并保留2~4天,术中和术后无明显并发症,经抗炎治疗后所有患者48 h内体温恢复正常,腰痛症状消失.胎儿出生后无畸形、智力障碍及先天性疾病报告.结论:经膀胱镜下逆行置入输尿管双J管具有操作简单、效果满意等优点,可作为临床上妊娠期肾积水合并急性肾盂肾炎单用抗生素治疗无效时的重要辅助治疗手段.

  16. Acute pyelonephritis in adults: comparison between DMSA-{sup 99m}Tc scintigraphy and computed tomography; Pyelonephrite aigue primitive de l`adulte: comparaison de la scintigraphie au {sup 99m}Tc-DMSA et de la tomodensitometrie

    Energy Technology Data Exchange (ETDEWEB)

    Moretti, J.L.; Tamgac, F.; Baillet, G.; Weinmann, P.; Rocchisani, J.M.; Krief, S.; Buchet, P.; Meyrier, A. [Hopital Avicenne, 93 - Bobigny (France)

    1997-12-31

    We performed a retrospective study comparing computed tomography (CT) and DMSA-{sup 99m}Tc scintigraphy (DMSA) in the evaluation of renal disease in acute pyelonephritis. Thirty-four 39{+-} 20 year old female patients were studied. DMSA scintigraphy was performed 11.4{+-}5.8 days after infection onset. Planar posterior views were obtained 4 to 6 hours after injection of 80 MBq of {sup 99m}Tc-DMSA. Renal uptake was also quantified after kidney depth had been measured by ultrasonography. CT was performed with and without bolus injection of contrast medium 15.5{+-} 10.6 days after infection onset. DMSA images were read independently by three blind NM doctors, using three posterior views. Cortical renal defects were evaluated on three different renal segments on the top, middle and bottom. CT films were also read by three expert physicians. Thirty-two out of 34 patients had renal cortical defects on DMSA and 17 had only CT consistent with pyelonephritis. Cortical defects were bilateral in 22 out of 32 patients and in three out of 17 CT studies. Bilateral and left kidney lesions on CT (five cases) were also present on DMSA. Four out of 12 patients with isolated right kidney abnormalities at CT scan showed defects limited to the right kidney on DMSA, but eight had bilateral defects. After exclusion of two patients with renal failure, ten normal kidneys had a 22.9{+-}5.4 % uptake that was significantly different from that of damaged kidneys (18.8{+-}7.4 %), p<0.05. In 204 renal segments, 29 showed a concordant defect on CT and DMSA, and 127 were normal on both scans. Eighteen showed defects on CT but did not on DMSA, 27 were CT negative but DMSA positive, with three DMSA false positives due to renal cysts. We concluded that DMSA cortical renal scan appears to be more sensitive than CT to evaluate renal damage in patients with acute pyelonephritis. (authors). 36 refs.

  17. Urinary tract infections and pyelonephritis

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970374 The relationship between chronic pyelitis andcytomegalovirus infection: a primary study. LI Na(李娜), et al. 81021st Milit Hosp, Changchun,130021. Chin J Med Lab Sci 1997; 20(1): 26-27. Objective: To research the relationship betweenchronic pyelitis and cytomegalovirus (CMV) infection.

  18. Renal scintigraphy by DMSA: early or tardy imaging? Comparison of performances in the diagnosis of acute pyelonephritis in infants; Scintigraphie renal au DMSA: imagerie precoce ou tardive? Comparaison des performances dans le diagnostic des pyelonephrites aigues de l`enfant

    Energy Technology Data Exchange (ETDEWEB)

    Ouhayoun, E. [Medecine Nucleaire, Hopital Purpan, 31059 Toulouse (France); Bouissou, F.; Decramer, S. [Pediatrie, Hopital Purpan, 31059 Toulouse (France); Tafani, J.A.M.; Simon, J.; Esquerre, J.P. [Medecine Nucleaire, Hopital Purpan, 31059 Toulouse (France)

    1997-12-31

    Several authors suggest early imaging (around 4 h after injection) invoking feasibility and counting statistics. On the other side, the tardy images (> 12 h ) constitutes another approach based on two arguments: the fixation curve of DMSA is a plateau, on one hand, and one avoids the presence of circulating or still present DMSA in the interstitial spaces and pyelo-calyceal cavities, on the other hand. The aim of this work is to compare the performances of these two approaches in detecting focuses of acute pyelonephritis. One hundred infants (average age, 3.3 {+-} 3.6 years), with a suspicion of APN clinic and biologic affliction, benefited by a DMSA scintigraphy. In 89 cases, there was a first episode, while in 7 and 4, of the second and third episode, respectively. The scintigraphy was performed 2 days after the debut of urinary infection. The images were achieved 3 h {+-} 30 min and 18 h {+-} 1 h for every infant. The incidences were frontal-posterior in 2 cases, supplemented by right and left oblique-posterior, on the early films. The images were qualitatively analyzed by 2 observers recording the number, intensity and the defect size. The following results were obtained. The detection rate is of 66% for the 3 h images and 70% for the 18 h images. The images were considered as equivalent in 57% of cases. Particularly, the oblique-posterior incidences have not increased the rate of detection. In 30% cases the tardy images allowed a better detection of lesions, particularly, in 17% of cases where a higher number of lesions was detected (in 4 cases the focuses were evidenced solely on the tardy films). The early films were more contributive only in 11% of cases. For 3% of cases the detection of focus was due uniquely to the early oblique-posteriors. In conclusion, these results show the superiority of tardy films in detecting the lesions of pyelonephritis. They urge to realize images in these clinic indication not before at least 6 hours after injection

  19. Multiple Renal Abscesses due to ESBL Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Causing Acute Pyelonephritis and Bacteremia: A Case Report with a Good Outcome (No Drainage Required)

    Science.gov (United States)

    Qurash, Musaad; Saleh, Asem; Ali, Rasha

    2016-01-01

    Extended-spectrum beta-lactamase-producing Enterobacteriaceae urinary tract infections are challenging infections with increased mortality, morbidity, and failure of therapy. A 44-year-old Saudi male diabetic patient was seen at the ER of IMC Hospital with features of acute pyelonephritis: fever, burning urine, and left flank pain for three days. He was treated for cystitis at the Endocrine Clinic two weeks prior to his ER visit with nitrofurantoin and levofloxacin orally according to urine culture and sensitivity result. The patient was admitted, received IV meropenem, and continued to be febrile for three days. His urine and blood culture at ER grew the same ESBL-producing E. coli as in his urine culture from the Endocrine Clinic. His abdomen CT scan showed two left renal abscesses at the upper and middle poles. His temperature resolved on the fourth day of IV therapy. Intravenous meropenem was continued for 4 weeks after inserting PICC line and the patient was followed up by home healthcare. He was feeling better with occasional left flank pain and repeated abdomen CT scan showed complete resolution of both renal abscesses. PMID:28018690

  20. 肾盂肾炎患者经验用抗菌药物与药敏结果符合率%Coincidence rates between empiric antimicrobial use and antimicrobial sus-ceptibility testing results in patients with pyelonephritis

    Institute of Scientific and Technical Information of China (English)

    张海谱; 梁霞; 贾克然; 赵会海; 史文俊; 王缚鲲

    2016-01-01

    目的:了解某院住院肾盂肾炎患者经验使用抗菌药物情况,为临床合理用药提供依据。方法收集2011年1月—2014年9月该院肾内科收治的620例肾盂肾炎患者资料,分析其抗菌药物应用情况,及不同种类、不同年龄患者经验用抗菌药物与细菌药敏结果符合情况。结果药敏结果报告前,620例患者应用抗菌药物625例次,其中5例患者同时应用了2种抗菌药物,共涉及8类抗菌药物15个品种,应用最多的抗菌药物依次为第三代头孢菌素、头霉素类、氟喹诺酮类。应用抗菌药物与细菌药敏结果符合率为64.32%(402例次),部分符合率为8.32%(52例次),不符合率为27.36%(171例次)。急性肾盂肾炎患者总符合率(77.61%,357例次)高于慢性肾盂肾炎(58.79%,97例次),差异具有统计学意义(P <0.05)。<50岁组、≥50岁组肾盂肾炎患者总符合率分别为68.12%(156/229)、75.25%(298/396),两组比较,差异无统计学意义(χ2=2.93,P =0.09)。结论肾盂肾炎患者经验用抗菌药物与细菌药敏结果不符合率较高,需采取措施提高经验用抗菌药物水平。%Objective To understand the empiric antimicrobial use in patients with pyelonephritis in a hospital,and pro-vide reference for clinical rational antimicrobial use.Methods Data of 620 patients with pyelonephritis admitted to the nephrology department of a hospital between January 2011 and September 2014 were collected,application of antimicrobial agents,coincidence between empiric antimicrobial use and antimicrobial susceptibility testing results in patients with different diseases and different ages were analyzed.Results Before antimicrobial susceptibility testing results were reported,620 pa-tients use 625 times of antimicrobial agents,5 of whom used two kinds of antimicrobial agents at the same time,8 varieties in 15 types of

  1. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  2. Propensity-Matched Analysis To Compare the Therapeutic Efficacies of Cefuroxime versus Cefotaxime as Initial Antimicrobial Therapy for Community-Onset Complicated Nonobstructive Acute Pyelonephritis Due to Enterobacteriaceae Infection in Women

    Science.gov (United States)

    Chang, U-Im; Kim, Hyung Wook

    2015-01-01

    This study was performed to compare the therapeutic efficacy of cefuroxime with that of cefotaxime as initial antimicrobial therapies in women with complicated nonobstructive acute pyelonephritis (APN) caused by Enterobacteriaceae infections. The clinical characteristics and outcomes of a cefuroxime-treated group (n = 156) were compared with those of a cefotaxime-treated group (n = 166). Of these 322 women, 90 from each group were matched by propensity scores. The defervescence rates were not significantly different in the cefuroxime and cefotaxime groups at 72 h after the start of antimicrobial therapy (81.1% versus 78.9%, P = 0.709). The clinical and microbiological cure rates during the follow-up visits that were 4 to 14 days after the end of the antimicrobial therapies were not significantly different in the cefuroxime versus cefotaxime groups, which were 97.8% (87/89) versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P = 0.807), respectively. The median hospital stay duration and the median times to defervescence in the cefuroxime versus cefotaxime groups were 8 days (interquartile range [IQR], 7 to 10 days) versus 9 days (IQR, 7 to 11 days), respectively, and 55 h (IQR, 37 to 70 h) versus 55 h (IQR, 35 to 69 h), respectively. Bacteremia, extended-spectrum-β-lactamase-producing Enterobacteriaceae, C-reactive protein levels of ≥15 mg/dl, and white blood cell counts of ≥15,000/mm3 of blood had independent effects on the rates of early clinical failure. Our data suggest that the effects of cefuroxime are not different from those of cefotaxime when they are used as an initial antimicrobial treatments for community-onset complicated nonobstructive APN in women. PMID:25645837

  3. Propensity-matched analysis to compare the therapeutic efficacies of cefuroxime versus cefotaxime as initial antimicrobial therapy for community-onset complicated nonobstructive acute pyelonephritis due to Enterobacteriaceae infection in women.

    Science.gov (United States)

    Chang, U-Im; Kim, Hyung Wook; Wie, Seong-Heon

    2015-05-01

    This study was performed to compare the therapeutic efficacy of cefuroxime with that of cefotaxime as initial antimicrobial therapies in women with complicated nonobstructive acute pyelonephritis (APN) caused by Enterobacteriaceae infections. The clinical characteristics and outcomes of a cefuroxime-treated group (n = 156) were compared with those of a cefotaxime-treated group (n = 166). Of these 322 women, 90 from each group were matched by propensity scores. The defervescence rates were not significantly different in the cefuroxime and cefotaxime groups at 72 h after the start of antimicrobial therapy (81.1% versus 78.9%, P = 0.709). The clinical and microbiological cure rates during the follow-up visits that were 4 to 14 days after the end of the antimicrobial therapies were not significantly different in the cefuroxime versus cefotaxime groups, which were 97.8% (87/89) versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P = 0.807), respectively. The median hospital stay duration and the median times to defervescence in the cefuroxime versus cefotaxime groups were 8 days (interquartile range [IQR], 7 to 10 days) versus 9 days (IQR, 7 to 11 days), respectively, and 55 h (IQR, 37 to 70 h) versus 55 h (IQR, 35 to 69 h), respectively. Bacteremia, extended-spectrum-β-lactamase-producing Enterobacteriaceae, C-reactive protein levels of ≥ 15 mg/dl, and white blood cell counts of ≥ 15,000/mm(3) of blood had independent effects on the rates of early clinical failure. Our data suggest that the effects of cefuroxime are not different from those of cefotaxime when they are used as an initial antimicrobial treatments for community-onset complicated nonobstructive APN in women.

  4. Detection of pyelonephritis and renal scars by 99 Tcm-DMSA renal scan: an experimental study in piglets%99Tcm-DMSA肾显像诊断肾盂肾炎和 肾脏瘢痕的动物模型实验研究

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    目的 制作猪肾盂肾炎和肾脏瘢痕动物模型,评价99Tcm-二巯基丁二酸(DMSA)肾脏平面显像和SPECT断层显像诊断肾盂肾炎和肾脏瘢痕的灵敏度和特异性,并探讨SPECT的诊断价值。方法 中国实验动物小型猪13只,先制成膀胱输尿管返流动物模型,然后引入大肠埃稀杆菌导致上尿路感染,感染前后用ADAC Vertex型双探头SPECT仪,配低能高分辨率准直器进行肾脏前后位平面和断层显像,将显像结果同组织病理学检查进行对比研究。结果 平面显像诊断肾盂肾炎和肾脏瘢痕的灵敏度为71.2%,特异性为100%,准确性为87.5%;平面加断层显像诊断肾盂肾炎和肾脏瘢痕的灵敏度为78.3%,特异性为100%,准确性为90.5%。以病理检查为标准,平面显像和平面加断层显像对病灶的检出率差异无显著性。结论 99Tcm-DMSA肾脏显像是诊断肾盂肾炎和肾脏瘢痕的灵敏可靠方法。平面加断层显像可能有助于提高检测的灵敏度,并对病变范围作更准确的估价。%Objective To provide an accurate and scientific method of radionuclide imaging for the clinical application and to study the value of SPECT imaging in detection and localization of the lesions in diagnosing pyelonephritis and renal scars in children, we evaluated the sensitivitiy and specificity of planar and planar+SPECT imaging with 99 Tcm-DMSA renal scan in diagnosing the pyelonephritis and renal scars in an experimental piglet model of pyelonephritis and renal scars established in this hospital. Methods We surgically created vesicoureteral reflux (VUR) in 13 female Chinese piglets, then we introduced Escherichia coli broth culture into the bladder of those presenting VUR two weeks later. 99 Tcm-DMSA renal scan (planar and SPECT) was performed before and after introducing infection by VETEX dual-headed SPECT, then the animal and compared the images with histopathological findings were sacrificed. At last, there were

  5. 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

    Directory of Open Access Journals (Sweden)

    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

  6. Xanthogranulomatous Pyelonephritis: Analysis of 18 Cases

    Directory of Open Access Journals (Sweden)

    Mohammed Ahmed Al-Ghazo

    2006-10-01

    Conclusion: Our experience with a small number of patients demonstrates that low socioeconomic status could be a risk factor in the development of complicated cases of XGP. CT is considered to be the best radiological test for correct preoperative diagnosis and evaluation of XGP. Nephrectomy and removal of all surrounding affected tissue proved to be curative for XGP.

  7. An excerpt of 2010 international clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women%2010女性急性单纯性膀胱炎和肾盂肾炎临床治疗指南(摘译)

    Institute of Scientific and Technical Information of China (English)

    刘辉(译); 刘树元(译)

    2016-01-01

    A Panel of International Experts was convened by the Infectious Diseases Society of America ( IDSA) in collaboration with the European Society of Clinical Microbiology and Infec-tious Diseases ( ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelo-nephritis, diagnoses limited in these guidelines to remenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy ( collateral amage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommenda-tions. The main parts of 2010 guideline were translated as below.%美国感染病学会、欧洲临床微生物与感染病学会共同组织专家对1999年美国感染病学会单纯性尿路感染的指南进行了更新。2010指南更新的重点是治疗女性急性单纯性膀胱炎和肾盂肾炎,仅适用于无已知尿道畸形或合并症的绝经前及未妊娠的女性患者。作者就指南的主要内容进行摘译。

  8. A two-year report on scintigraphies by DMSA-{sup 99m}Tc in emergency diagnosis of acute pyelonephritis in infants; Bilan de 2 ans de scintigraphies au {sup 99m}Tc - DMSA dans le diagnostic en urgence de la pyelonephrite aigue de l`enfant

    Energy Technology Data Exchange (ETDEWEB)

    Pham, T.; Hossein-Foucher, C. [Service de Medecine Nucleaire, CHRU de Lille, 59037 Lille Cedex (France); Foulard, N. [Servide de Nephropediatry, CHRU de Lille, 59037 Lille Cedex (France); Marchandise, X. [Service de Medecine Nucleaire, CHRU de Lille, 59037 Lille Cedex (France)

    1997-12-31

    During 2 years, 232 DMSA scintigraphies were achieved in case of clinic suspicion of acute pyelonephritis (APN); the infants addressed for renal infectious scars were not taken into account. The 148 girls and 84 boys, 1 month to 14 years old (average age, 4 years and 3 months) have benefited by at least one planar image of 600 seconds achieved with a parallel collimator, 6 hours after injection with 50 {mu}Ci/kg of DMSA. Two hundred infants (86%) presented infectious episodes, while in 32 (14%) it was a recurrence. Thirty two infants presented an associated uro-nephrologic malformation. In association with the scintigraphy, the boys benefited by a blood and urinary examination and a renal echography; the cystography was achieved long after the infectious episode as well as the non-systematic UIV. The scintigraphies indicated absence of APN signs in 124 patients (53%), a scar aspect in 12 patients (5%) and an aspect evoking acute lesions in 83 patients (38%), unilaterally, most often, with superior or inferior polar localized hypo-fixation (70 cases), a global hypo-fixation with a heterogenous kidney (11 cases), a cortical polar, possibly, hilar cutting (7 cases). However, in 18 patients (4%) the scintigraphy allowed not to conclude formally (one or several moderate, uni- or bilateral, hypo-fixations). In comparison with the initial data, the clinic and biologic follow-up over more than 6 months confirms the contribution of DMSA scintigraphy in the APN diagnosis

  9. Comparison of 99Tcm-DMSA renal cortical scintigraphy and ultrasonography in diagnosing acute pyelonephritis in children%99Tcm-DMSA肾皮质显像和肾超声检查在小儿急性肾盂肾炎中的对比研究

    Institute of Scientific and Technical Information of China (English)

    李益卫; 钱蔷英; 赵瑞芳; 季志英; 吕孝妹; 吴哈; 程献影; 顾凡磊; 赵晓菲

    2010-01-01

    目的 比较肾超声检查和99Tcm-二巯基丁二酸(DMSA)肾皮质显像在诊断小儿急性肾盂肾炎(APN)中的作用.方法 对临床拟诊为APN的165例患儿均行肾超声检查及99Tcm-DMSA肾皮质显像.其中男79例,女86例,年龄1.5个月11岁,平均20个月.以肾皮质显像为诊断参考标准,确定肾超声检测APN的灵敏度及特异性.结果 165例患儿330个肾,其中99Tcm-DMSA肾皮质显像发现99个肾存在APN阳性表现,而肾超声仅发现31个肾表现阳性.在余231个99Tcm-DMSA肾皮质显像无异常的肾中,超声检查发现4个肾有异常表现.肾超声探测APN的灵敏度为31.3%(31/99),特异性为98.3%(227/231).结论 肾超声对小儿APN的诊断特异性较高,但灵敏度较低.对于肾超声检查阴性的APN,临床仍需采用99Tcm-DMSA肾皮质显像以帮助确诊.%Objective To compare the diagnostic value of renal ultrasound scan (RUS) and 99Tcmdimercaptosuccinic acid (DMSA) renal scintigraphy in children with acute pyelonephritis (APN). Methods In all, 165 children with initial clinical diagnosis of APN, aged from 1.5 months to 11 yrs ( median 20 months), were included in the study, all of which were examined with RUS and DMSA renal scientigraphy. The diagnosis with DMSA renal scientigraphy results was taken as the standard reference to evaluate the diagnostic sensitivity and specificity of RUS. Results Of 99 out of all 330 kidneys that were found abnormal on DMSA renal scientigraphy, 31 were abnormal on RUS. Of the rest normal kidneys on DMSA scans renal scientigraphy, 4 were abnormal on RUS. Thus diagnostic sensitivity of RUS for APN was 31.3%(31/99) and specificity was 98.3% (227/231). Conclusions Although RUS provides with high diagnostic specificity for children with APN, its low sensitivity may underestimate the clinical evaluation of APN.More often than not, 99Tcm-DMSA renal scientigraphy is a clinical necesscity for the definite RUS diagnosis.

  10. Renal papillary necrosis and pyelonephritis accompanying fenoprofen therapy.

    Science.gov (United States)

    Husserl, F E; Lange, R K; Kantrow, C M

    1979-10-26

    Renal papillary necrosis occurred after fenoprofen calcium administration in a patient with systemic lupus erythematosus and urinary tract infection. Possible mechanisms of renal damage may be hypersensitivity, decreased blood flow, and decreased production of a prostaglandin E-like substance.

  11. 15.5.Urinary tract infections and pyelonephritis

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920361 Monitoring and controlling of renaltransplant infection.FU Weiling (府伟灵),et al.Dept Infect Dis,Xinan Hosp,3rd Med Univ.NatlMed J Chin 1991;71(12):676-679.Infection is still the leading cause of death in

  12. 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.

  13. CASE REPORT CASE Emphysematous pyelonephritis in a patient ...

    African Journals Online (AJOL)

    Abstract. A case report demonstrating the plain film and CT find- ... history of frank haematuria, severe lower back ache, diarrhoea and ... Plain radiographs of the chest and abdomen showed an elevated left ... Stellenbosch University. Fig 1.

  14. Liesegang Rings in Xanthogranulomatous Pyelonephritis: A Case Report

    Directory of Open Access Journals (Sweden)

    Karla Laís Pegas

    2010-01-01

    Full Text Available Liesegang rings are concentric noncellular lamellar structures, rarely seen in vivo, occurring as a consequence of the accumulation of insoluble products in a colloidal matrix. These characteristic structures are a rare phenomenon usually found in association with cystic or inflammatory lesions and may be mistaken for parasites. The authors examined Liesegang rings from an inflammatory kidney lesion identified previously as a tumoral lesion on computerized tomography. On microscopic evaluation, Liesegang rings can be mistaken for eggs and larvae of parasites, psammoma bodies and calcification. Special stains like PAS, Grocott, von Kossa and Masson's trichrome facilitate the diagnosis.

  15. The valuation of 99Tcm-DMSA renal cortical scintigraphy for prediction of renal scarring in children with acute pyelonephritis%99Tcm-DMSA肾皮质显像预测急性肾盂肾炎患儿肾瘢痕危险性的价值

    Institute of Scientific and Technical Information of China (English)

    赵瑞芳; 季志英; 吕孝妹; 吴哈; 李益卫; 顾凡磊; 赵晓斐

    2009-01-01

    Objective Acute pyelonephritis (APN) is a common infectious disease in childhood. APN may result in irreversible renal scarring.99Tcm-dimereaptsuccinic (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 99Tcm-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 sears on follow-up. One of four patients with mild-refluxing ureters developed renal scars. 46.51% (20/43) of those with mederate-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

  16. Maternal immunization with P fimbriae for the prevention of neonatal pyelonephritis.

    OpenAIRE

    1988-01-01

    Rhesus monkeys (Macaca mulatta) were immunized with purified P fimbriae from Escherichia coli during the last trimester of pregnancy. Infants born of these mothers were compared with those from nonimmunized rhesus mothers. A delay in the onset of renal disease after bladder infection showed protection from passive immunization. This was associated with a high antibody titer in serum. In addition to delayed onset of renal infection, a decreased number of immunized monkeys developed pyelonephri...

  17. [Right obstructive pyelonephritis due to supra-piriform herniation of the pelvic ureter: a clinical case].

    Science.gov (United States)

    Forgues, A; Junes, F; Gateau, T; Geissman, A; Merignargues, F; Ballanger, P; Robert, G

    2011-11-01

    Ureteric herniations are extremely rare. We are reporting the case of a 57-year-old female presenting with an upper urinary tract sepsis due to a pelvic ureteral herniation into the supra-piriform sciatic foramen. The diagnosis was made by the CT scan and the treatment was performed in two steps: first the upper urinary tract was drained, and then the hernia was surgically treated. Although ureteral hernias are exceptional causes for nephritic colic, urologists must be aware of the specificity of the diagnosis and of the treatment in order to avoid complications.

  18. Perinephric Capsular Haematoma Associated with Complicated Pyelonephritis in a Patient with HIV

    Directory of Open Access Journals (Sweden)

    Seong K. Lee

    2010-10-01

    Full Text Available A 53 year-old-male patient presented with 24 hours of left flank pain. He was an undiagnosed HIV positive individual with no history of trauma. He was anaemic and in acute renal failure with a serum creatinine of 4.14 mg/dL. A CT scan demonstrated a left perinephric capsular haematoma with retroperitoneal stranding. Due to haemodynamic instability, the patient was taken to the operating room and a nephrectomy was performed. Post-operatively, the patient required temporary haemodialysis. Pathologic examination of the specimen demonstrated active infection with a haematoma surrounding a fistulous tract communicating with the capsular surface. Infection is a rare cause of non-traumatic capsular hematomas of the kidney.

  19. Significance of echotomography in the diagnostic algorithm for acute pyelonephritis and glomerulonephritis

    Directory of Open Access Journals (Sweden)

    Martinović Brankica

    2016-01-01

    Full Text Available Introduction: Dental caries is the most common oral disease in all age groups. Being more and more frequent in preschool and school-age children, it has become one of the most important problems in oral pathology. The aim of this study was to determine the incidence of dental caries in schoolchildren aged 12 and 15 years in the northern part of Kosovo and Metohija, as well as to inform them about the importance of oral health. Materials and Methods: The study included 626 schoolchildren of both sexes from five schools from the municipalities of Kosovska Mitrovica, Zvečan and Leposavić. Klein-Palmer DMFT system (D-Decayed, M-Missing, F-filled was used to estimate the prevalence of dental caries the following indices were also used: Person Caries Index, Teeth Caries Index, Average Caries Index and DMFT structure. All the selected children were examined using standard dental diagnostic agents. Tooth surfaces were examined dry under artificial lighting. Results: The average value of DMFT index for children aged 12 and 15 years was 4.2. On average, 92.3% of the examined children had caries. The mean value of caries index was 15.11%.Conclusion: After these new epidemiological studies, it can be concluded that the state of children's oral health, considering the high levels of untreated caries and all other features of DMFT index, is not satisfactory. This situation points to the necessity of applying modern preventive and prophylactic measures to preserve and improve the population oral health.

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

    DEFF Research Database (Denmark)

    Sriskandarajah, Srishamanthi; Carter-Storch, Rasmus; Frydkjær-Olsen, Ulrik

    2016-01-01

    INTRODUCTION: 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. METHODS: 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...

  1. First report of a Wautersiella falsenii isolated from the urine of an infant with pyelonephritis

    NARCIS (Netherlands)

    Velden, L.B. van der; Jong, A.S. de; Jong, H. de; Gier, R.P. de; Rentenaar, R.J.

    2012-01-01

    Here, we report the first isolation of Wautersiella falsenii from the urine of an infant with a complicated urinary tract infection. W. falsenii was correctly identified by matrix-assisted laser desorption ionisation time of flight mass spectrometry. The identification was confirmed by 16S

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    T.O. Kryuchko

    2013-06-01

    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.

  4. Immunization with the yersiniabactin receptor, FyuA, protects against pyelonephritis in a murine model of urinary tract infection.

    Science.gov (United States)

    Brumbaugh, Ariel R; Smith, Sara N; Mobley, Harry L T

    2013-09-01

    Urinary tract infections (UTI) are common and represent a substantial economic and public health burden. Roughly 80% of these infections are caused by a heterogeneous group of uropathogenic Escherichia coli (UPEC) strains. Antibiotics are standard therapy for UTI, but a rise in antibiotic resistance has complicated treatment, making the development of a UTI vaccine more urgent. Iron receptors are a promising new class of vaccine targets for UTI, as UPEC require iron to colonize the iron-limited host urinary tract and genes encoding iron acquisition systems are highly expressed during infection. Previously, three of six UPEC siderophore and heme receptors were identified as vaccine candidates by intranasal immunization in a murine model of ascending UTI. To complete the assessment of iron receptors as vaccine candidates, an additional six UPEC iron receptors were evaluated. Of the six vaccine candidates tested in this study (FyuA, FitA, IroN, the gene product of the CFT073 locus c0294, and two truncated derivatives of ChuA), only FyuA provided significant protection (P = 0.0018) against UPEC colonization. Intranasal immunization induced a robust and long-lived humoral immune response. In addition, the levels of FyuA-specific serum IgG correlated with bacterial loads in the kidneys [Spearman's rank correlation coefficient ρ(14) = -0.72, P = 0.0018], providing a surrogate of protection. FyuA is the fourth UPEC iron receptor to be identified from our screens, in addition to IutA, Hma, and IreA, which were previously demonstrated to elicit protection against UPEC challenge. Together, these iron receptor antigens will facilitate the development of a broadly protective, multivalent UTI vaccine to effectively target diverse strains of UPEC.

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

    Directory of Open Access Journals (Sweden)

    Michelle T Hecker

    Full Text Available OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

  6. Renal scarrings (RS) after acute pyelonephritis (APN) in the children under the age of 5 years and its correlation with clinical risk factors

    Energy Technology Data Exchange (ETDEWEB)

    Lee, B. S.; Moon, D. H.; Ahn, S. H.; Lee, W. W.; Yoon, S. Y.; Yoon, J. H.; Park, Y. S. [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2001-07-01

    In children with APN, risk factors for the subsequent RS are still controversial. We evaluated the changes in renal cortical defects on the Tc-99m DMSA scan and the relationship between RS and risk factors. Patients were 143 children (age < 5 yrs) with first APN documented by the presence of fever (< 38.5 .deg. C ), and abnormal DMSA scan from 1994 to 2000. We performed a follow-up DMSA scan at 6 months. RS was defined as persistent or partially reversible abnormalities on the follow-up scan. Nine were excluded due to recurrent infection, and 58 who were lost to follow-up. A total of 76 (m/f =38/38) were available for the study (mean age : 1.19 yr, range: 47 day - 5.0 yr). Of 152 kidneys, DMSA was abnormal in 90. Initial defect was completely recovered in 52, partially recovered in 30, and persistent in 8 (38 RS). Univariate analysis revealed that duration of fever, C-reactive protein, and vesicoureteral reflux (VUR) were associated with RS. Multivariate analysis showed that duration of fever and VUR were independent predictors of RS. However, in patients with unilateral defect, only duration of fever (p=0.027) and relative function (p=0.002) were independent predictors. The severity and extent of acute inflammatory response may determine RS. DMSA may be of value because it provides information on the extent of initial parenchymal damage.

  7. Cicatriz renal detectada mediante cintigrama renal DMSA en niños con primera pielonefritis aguda: estudio de factores de riesgo

    OpenAIRE

    Donoso R,Gilda; Lobo S,Gabriel; Arnello V,Francisca; Arteaga V,María Paz; Coll C,Claudia; Hevia J,Pilar; Rosati M,Pía; Lagos R,Elizabeth; Wolff F,Carlos; Pérez R,Andrés; Jiménez J,César

    2006-01-01

    Background: Acute pyelonephritis in children can leave a kidney scar that eventually can lead to hypertension or renal failure. 99mTc-dimercaptosuccinic acid renal scintigraphy (RC DMSA) is a widely accepted technique to assess children with acute pyelonephritis. Aim: To evaluate the presence of residual kidney scars detected through RC DMSA, in children with a first episode of acute pyelonephritis. Patients and methods: Clinical records of children with a first episode of acute pyelonephriti...

  8. Resultados de dois esquemas de tratamento da pielonefrite durante a gravidez e correlação com o desfecho da gestação Results of two treatment regimens for pyelonephritis during pregnancy and correlation with pregnancy outcome

    Directory of Open Access Journals (Sweden)

    Saron Souza Calegari

    2012-08-01

    Full Text Available OBJETIVO: Determinar o perfil epidemiológico das gestantes internadas por infecção do trato urinário, bem como verificar os agentes mais prevalentes e a resposta à antibioticoterapia. MÉTODOS: Estudo retrospectivo, que incluiu 106 gestantes internadas para tratamento de infecção do trato urinário no período entre janeiro de 2007 a dezembro de 2010. A avaliação constituiu-se de análise de prontuários dessas gestantes, observando-se informações sobre a internação e a gestação, bem como seu desfecho. Foi realizada a análise estatística por meio do programa Statistical Package for the Social Science, versão 15.0. Foram utilizados, para análise dos dados, o teste bilateral exato de Fisher e o teste t de Student, bem como métodos de estatística descritiva. RESULTADOS: Uroculturas positivas foram encontradas em 60,5% das gestantes internadas por infecção do trato urinário. O agente infeccioso mais frequente foi Escherichia coli e não houve diferença quanto à resistência, à recorrência ou a complicações entre os agentes etiológicos mais frequentes. Gestantes com infecção do trato urinário prévia tiveram maior risco de recorrência (OR=10,8; pPURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

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

    Directory of Open Access Journals (Sweden)

    G.O. Lezhenko

    2014-06-01

    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.

  10. 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

  11. Bacteriuria and antimicrobial susceptibility pattern of bacterial ...

    African Journals Online (AJOL)

    The prevalence of asymptomatic UTI has been previously reported to be 2% to ... cause complications such as pyelonephritis, hypertensive disease of pregnancy, .... to first-line antibiotics in Mexico City: a multicenter susceptibility analysis.

  12. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... internal organs, small bowel and colon, such as: infections such as appendicitis , pyelonephritis or infected fluid collections, ... invasive diagnostic procedures. When pain is caused by infection and inflammation, the speed, ease and accuracy of ...

  13. Research Paper ISSN: 2006-0165©2009

    African Journals Online (AJOL)

    pyelonephritis and adverse pregnancy outcomes such as prematurity and low ... disk on Mueller Hinton agar (MH) and isolates with zone diameter of inhibition ≤ ... confirmed by positive urease test and fermentation of maltose, sucrose and ...

  14. 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 ...

  15. Renal scar formation after urinary tract infection in children

    OpenAIRE

    2012-01-01

    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 nephrop...

  16. Cintigrama renal DMSA en niños con primera pielonefritis aguda: correlación con exámenes de laboratorio, ecografía y la presencia de reflujo vésico ureteral

    OpenAIRE

    Donoso R,Gilda; Lobo S,Gabriel; Arnello V,Francisca; Arteaga V,María Paz; Hevia J,Pilar; Rosati M,Pía; Lagos R,Elizabeth; Wolff F,Carlos; Pérez R,Andrés; Jiménez J,César

    2004-01-01

    Tc99m DMSA (dimercaptosuccinic acid) scintigraphy has a high sensitivity for the detection of cortical kidney damage. Aim: To evaluate the Tc99m DMSA renal scintigraphy in children with a first episode of acute pyelonephritis and its association with laboratory parameters, kidney ultrasound and vesicoureteral reflux. Patients and methods: We studied 143 children (age range 8 days, 12 years, 66% female) hospitalized with the clinical diagnosis of acute pyelonephritis (first episode) with a pos...

  17. Emphysematous pyelitis

    Directory of Open Access Journals (Sweden)

    Onur Karsli

    2016-03-01

    Full Text Available Emphysematous pyelonephritis is a rare life -threatening suppurative necrotizing infection of kidney parenchyma or perirenal tissue characterized by the formation of gas. In the present case, Emphysematous pyelitis is a less common variant of emphysematous pyelonephritis and describes the conservative treatment options. The purpose of this paper is to show that a serious condition with emphysematous pyelitis may regress with aggressive medical therapy. [Cukurova Med J 2016; 41(0.100: 63-65

  18. Hemagglutinin, urease, and hemolysin production by Proteus mirabilis from clinical sources.

    Science.gov (United States)

    Mobley, H L; Chippendale, G R

    1990-03-01

    Proteus mirabilis, a common cause of urinary tract infection, can lead to serious complications including pyelonephritis. Adherence factors, urease, and hemolysin may be virulence determinants. These factors were compared for bacteria cultured from 16 patients with acute pyelonephritis and 35 with catheter-associated bacteriuria and for 20 fecal isolates. Pyelonephritis isolates were more likely (P less than .05) to express the mannose-resistant/Proteus-like (MR/P) hemagglutinin in the absence of mannose-resistant/Klebsiella-like (MR/K) hemagglutinin than were catheter-associated or fecal isolates. Pyelonephritis isolates produced urease activity of 63 +/- 27 (mean +/- SD) mumol of NH3/min/mg of protein, not significantly different from catheter-associated or fecal isolates. Hybridization of Southern blots of P. mirabilis chromosomal DNA with two urease gene probes demonstrated that urease gene sequences were conserved in all isolates. Geometric mean of reciprocal hemolytic titers for pyelonephritis isolates was 27.9; for urinary catheter isolates, 18.0; and for fecal isolates, 55.7 (not significantly different, P greater than .1). Although in vivo expression of urease and hemolysin may not be reliable indexes of virulence, MR/P hemagglutination in the absence of MR/K hemagglutination may be necessary for development of pyelonephritis.

  19. Identification of DNA sequences from a second pathogenicity island of uropathogenic Escherichia coli CFT073: probes specific for uropathogenic populations.

    Science.gov (United States)

    Rasko, D A; Phillips, J A; Li, X; Mobley, H L

    2001-10-15

    Uropathogenic Escherichia coli is the leading cause of urinary tract infection and hospital visits in North America. Cystitis and acute pyelonephritis, infection of the bladder and kidney, respectively, are the two most common syndromes encountered in patients with urinary tract infection. We sequenced and annotated 71,684 bases of a previously unidentified pathogenicity-associated island (PAI) from E. coli strain CFT073. This PAI contained 89 open-reading frames encoding a pap operon, iron-regulated genes, mobile genetic elements, and a large proportion of unknown or unidentified open-reading frames. Dot blot analysis with 11 DNA sequences from this PAI demonstrated that 7 sequences were more prevalent among uropathogens: 2 probes were more prevalent among cystitis and pyelonephritis isolates, 2 among pyelonephritis isolates only, and 3 among cystitis isolates only than among fecal isolates. These data suggest that groups of uropathogens have genetic differences that may be responsible for the different clinical outcomes.

  20. Ertapenem versus Ceftriaxone Followed by Appropriate Oral Therapy for Treatment of Complicated Urinary Tract Infections in Adults: Results of a Prospective, Randomized, Double-Blind Multicenter Study

    OpenAIRE

    Tomera, Kevin M.; Burdmann, Emmanuel A.; PAMO REYNA, OSCAR G.; Jiang, Qi; Wimmer, Wendy M.; Woods, Gail L.; Gesser, Richard M.

    2002-01-01

    The efficacy and safety of intravenous (i.v.) ertapenem (1 g once a day) with the option to switch to an oral agent for treatment of adults with complicated urinary tract infections (UTIs) were compared with that of i.v. ceftriaxone (1 g daily) with the same oral switch option in a multicenter, double-blind, prospective, randomized study. At entry, 592 patients were assigned to one of two strata: acute pyelonephritis or other complicated UTI without acute pyelonephritis. After a minimum of 3 ...

  1. 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.

  2. Congenital Malformations of the Urinary System in Infants and Syndrome of Undifferentiated Connective Tissue Dysplasia

    Directory of Open Access Journals (Sweden)

    N.S. Lukianenko

    2017-02-01

    Full Text Available The article presents the data on the frequency of phenotypic and clinical signs of undifferentiated connective tissue dysplasia (UCTD in infants with congenital malformations of the urinary system (CMUS complicated by pyelonephritis. The considerable incidence of connective tissue dysfunction among the examined children has been shown, especially among the children with anomalies of the renal tissue formation and differentiation. The authors draw the conclusion about the necessity of early verification of UCTD among young children with pyelonephritis against the CMUS. This will allow ground and perform metabolic correction of connective tissue dysfunction, which should raise the treatment efficiency in such children

  3. URINARY TRACT INFECTIONS IN PREGNANCY

    Directory of Open Access Journals (Sweden)

    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.

  4. Two Stage Complex Embolization of an Arteriovenous Fistula between the Right Common Iliac Artery and the Inferior Vena Cava

    Directory of Open Access Journals (Sweden)

    Marc Gingell Littlejohn

    2009-01-01

    Full Text Available

    We  present an interesting case of a symptomatic high flow AV fistula between the right common iliac artery (CIA and the inferior vena cava (IVC, successfully treated by endovascular coil embolization. The patient was found to have a right lower polar renal artery crossing the ipsilateral ureter arising from the CIA, causing pelvi-ureteric junction (PUJ obstruction and recurrent pyelonephritis.  It is hypothesized that this fistula arising from the lower polar renal artery and entering the IVC, may have occurred as a result of trauma during a previous pyeloplasty, or a pathologically induced process of angiogenesis stemming from recurrent pyelonephritis.

  5. Urinary tract infections during pregnancy.

    Science.gov (United States)

    Gilstrap, L C; Ramin, S M

    2001-09-01

    Urinary tract infections are relatively common in pregnancy and may result in significant morbidity for the pregnant woman and fetus. The authors recommend that all pregnant women be screened for the presence of bacteriuria at their first prenatal visit. Failure to treat bacteriuria during pregnancy may result in as many as 25% of women experiencing acute pyelonephritis. Women with acute pyelonephritis may sustain significant complications, such as preterm labor, transient renal failure, ARDS, sepsis and shock, and hematologic abnormalities. Pregnant women with urinary tract infections should be followed up closely after treatment because as many as one third will experience a recurrence.

  6. 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

    Energy Technology Data Exchange (ETDEWEB)

    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)

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Effects of a Mutation in the gyrA Gene on the Virulence of Uropathogenic Escherichia coli

    DEFF Research Database (Denmark)

    Sánchez-Céspedes, Javier; Sáez-López, Emma; Frimodt-Møller, N

    2015-01-01

    in the gyrA gene (S83L) was found to lose the capacity to cause cystitis and pyelonephritis mainly due to a decrease in the expression of the fimA, papA, papB, and ompA genes. The levels of expression of the fimA, papB, and ompA genes were recovered on complementing the strain with a plasmid containing...... the virulence of the bacteria, likely in association with the effect of DNA supercoiling on the expression of several virulence factors and proteins, thereby decreasing their capacity to cause cystitis and pyelonephritis....

  9. Luftudvikling i nyrer og urinveje som komplikation til urinvejsinfektion

    DEFF Research Database (Denmark)

    Redal-Baigorri, Ana Belén; Egfjord, Martin

    2010-01-01

    Emphysematous pyelonephritis (EPN) is a bacterial infection characterised by gas production in the renal parenchyma. We present a case with EPN caused by Klebsiella pneumoniae sepsis. The 74-year-old woman was admitted in septic shock. An acute computed tomography revealed gas bubbles bilaterally...

  10. URETERO-VESICAL ANASTOMOTIC COMPLICATIONS AFTER KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    S. V. Shkodkin

    2011-01-01

    Full Text Available This article presents statistical analysis of vesico-ureteric reflux and uretero-vesical obstruction incidence after kidney transplantation depending on technique mode. In this item prevalence of chronic pyelonephritis and spe- cies of causative agent data are analyzed. The necessity of effective methods to accomplish the uretero-vesical anastomosis is suggested. 

  11. Positive whole-body /sup 67/Ga scintigraphy in dermatomyositis

    Energy Technology Data Exchange (ETDEWEB)

    Smith, W.P.; Robinson, R.G.; Gobuty, A.H.

    1979-07-01

    Gallium-67 has proven useful in the evaluation of the extent of several malignancies, including bronchogenic carcinoma, Hodgkin's disease, and lymphoma. Many infectious processes also yield positive scans, including sarcoidosis, pneumonia, pyelonephritis, and active tuberculosis. We report a patient in whom whole-body /sup 67/Ga scintimaging led to the diagnosis of dermatomyositis.

  12. Research Concerning the Correlations Between Urinary Tract Infections and Congenital Malformations of the Renourinary System

    Directory of Open Access Journals (Sweden)

    Moréh Zsuzsanna

    2013-02-01

    Full Text Available Introduction: Congenital malformations of the urinary system are risk factors for the development of urinary tract infections (UTI. Besides the severity of the malformation, urinary infection is always associated with poor prognosis for these patients. Late discovery of the malformation background, after several urinary tract infection episodes, contributes to the development of chronic pyelonephritis that may lead to chronic renal failure.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Urinary tract infection due to salmonella in an otherwise healthy child.

    Science.gov (United States)

    Yousefichaijan, Parsa; Yosefi, Parsa; Dorreh, Fatemeh

    2014-03-01

    Salmonella species are a rare cause of urinary tract infection in children. They are associated with a high incidence of structural abnormalities or immunosuppressive status. We report the case of a healthy 7-year-old boy with pyelonephritis due to Salmonella group. He did not have a history of recent gastroenteritis.

  15. Characterization of adhesion associated surface properties of uropathogenic Escherichia coli.

    Science.gov (United States)

    Bartková, G; Ciznár, I; Lehotská, V; Kernová, T

    1994-01-01

    Escherichia coli was isolated from the urine of patients with pyelonephritis, with urinary tract infections other than pyelonephritis and with asymptomatic bacteriuria. Surface properties of the strains were analyzed by the salting-out aggregation test (SAT), hydrophobic interaction chromatography (HIC), Congo red binding (Crb), agglutination of erythrocytes (MRHA) and latex particles covered by digalactoside (PF) and by adherence to tissue culture cells. In addition, a DNA probe for the pap gene was used. The DNA probe detected the highest proportion of strains with pap gene in the group of patients with pyelonephritis, lower in the urinary tract infections other than pyelonephritis and the lowest in the group with asymptomatic bacteriuria. Tests for P-fimbriae (PF, MRHA) showed a similar distribution. Hydrophobicity measured by SAT and by HIC did not show differences among the tested groups of strains. The results suggest that factors other than the P-fimbriae and hydrophobicity may contribute to the persistence of E. coli in the urinary tract.

  16. Suspected transient pseudohypoaldosteronism in a 10-day-old quarter horse foal

    OpenAIRE

    Arroyo, Luis G.; Vengust, Modest; Dobson, Howard; Viel, Laurent

    2008-01-01

    A 10-day-old quarter horse colt was presented for signs of disorientation and inability to nurse. Hydronephrosis/hydroureters, with concomitant pyelonephritis and a severe electrolytes disturbance, were diagnosed. The clinical findings closely resembled those described for a syndrome of transient pseudohypoaldosteronism in human neonates.

  17. Suspected transient pseudohypoaldosteronism in a 10-day-old quarter horse foal.

    Science.gov (United States)

    Arroyo, Luis G; Vengust, Modest; Dobson, Howard; Viel, Laurent

    2008-05-01

    A 10-day-old quarter horse colt was presented for signs of disorientation and inability to nurse. Hydronephrosis/hydroureters, with concomitant pyelonephritis and a severe electrolytes disturbance, were diagnosed. The clinical findings closely resembled those described for a syndrome of transient pseudohypoaldosteronism in human neonates.

  18. Risk of Infections in Patients with Chronic Diseases

    DEFF Research Database (Denmark)

    Mor, Anil; Thomsen, Reimar W.

    2013-01-01

    of pyelonephritis may be 2 to 4 times increased. Treatment of asymptomatic bacteriuria in diabetes is generally not recommended. Diabetes duration and chronic complications including cystopathy appear to be more important risk factors than current glycemic control, but further evidence is needed. Modifiable risk...

  19. An unusual presentation of enzootic bovine leukosis.

    OpenAIRE

    Sparling, A M

    2000-01-01

    A 6-year-old, Holstein x Simmental cow diagnosed with pyelonephritis had increasing difficulty rising and became recumbent, despite treatment with antibiotics. A serological test for the bovine leukemia virus was positive; at necropsy, the left kidney and ureter and the myocardium showed lesions of lymphosarcoma, confirmed by histology.

  20. Pathological study of elective nephrectomies for a two year period

    Directory of Open Access Journals (Sweden)

    V. Vijay Sreedhar

    2015-06-01

    Conclusion: Inflammatory causes more commonly required a nephrectomy in the study population. Chronic calculous pyelonephritis was the most common underlying pathophysiology leading to a nonfunctioning kidney thus highlighting the early treatment of renal calculi. [Int J Res Med Sci 2015; 3(6.000: 1496-1500

  1. Asymptomatic bacteriuria and urinary tract infections among renal allograft recipients.

    Science.gov (United States)

    Singh, Ramandeep; Geerlings, Suzanne E; Bemelman, Frederike J

    2015-02-01

    Bacteriuria is common among renal allograft recipients. It can be categorized into asymptomatic bacteriuria (ASB) and urinary tract infection (UTI). However, in medical literature, the classifications of bacteriuria are often not clear or ASB is also classified as a UTI. This contributes to difficulties in interpretation of the incidence and risk factors of these two entities. In this review, we describe the epidemiology, risk factors, management and the impact on renal allograft function of these two entities separately according to the recent literature. Risk factors for ASB are not completely comparable to the risk factors of UTIs. Persistent ASB has been associated with development of acute rejection and allograft pyelonephritis. The available data suggest that treatment of ASB is not very effective. Prophylaxis with trimethoprim-sulfamethoxazole does not prevent UTIs such as allograft pyelonephritis. Blood stream infections and emphysematous allograft pyelonephritis are associated with renal allograft loss. ASB is the most common manifestation of bacteriuria after renal transplantation. More effective interventions are needed to prevent bacteriuria. Renal allograft recipients with persistent ASB should be closely monitored since they could be at risk for developing not only UTIs, such as allograft pyelonephritis, but also acute rejection.

  2. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... to help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel and colon, such as: infections such as appendicitis , pyelonephritis or infected fluid collections, also known as abscesses. inflammatory bowel disease such as ulcerative colitis or Crohn's ...

  3. STUDY OF VIRULENCE FACTORS IN UROPATHOGENIC ESCHERICHIA COLI

    OpenAIRE

    Vijayalakshmi; Hymavathi; Renuka Devi; Ramanamma; Swarnalatha; Surekha; Anitha Lavanya; Somasekhar

    2015-01-01

    Uropathogenic E. coli (UPEC) is a causative agent in the vast majority of Urinary Tract infections (UTIs), including Cystitis, Pyelonephritis which may result in renal failure in healthy individuals and in renal transplant patients. UPEC express a multitude of virulence factors to break the inertia of the mucosal barrier. PURPOSE: To study ...

  4. Urinary tract infections in women

    African Journals Online (AJOL)

    This article discusses currently recommended antimicrobial therapy for uncomplicated UTIs in ... pain) and nausea or vomiting.3,4 Pyelonephritis is a more serious infection than cystitis.3 .... clavulanate, cefixime or cefpodoxime.10 Intravenous therapy with a long-acting .... Nitrofurantoin 50-100 mg, stat stat: immediately.

  5. Research

    African Journals Online (AJOL)

    abp

    2017-01-30

    Jan 30, 2017 ... untreated, may lead to acute pyelonephritis, preterm labour, low birth weight foetus [3, ... increased treatment costs. A high proportion of ... methods according to Clinical and Laboratory Standard Institute. Guidelines [14]. ... Data analysis was descriptive and multinomial logistic regression analysis was done ...

  6. [Our experience in the use of prostatilen in urology].

    Science.gov (United States)

    Al'-Shukri, S Kh; Bobkov, Iu A; Gorbachev, A G; Kuz'min, I V; Tkachuk, V N

    2003-01-01

    Prostatilen was used in 1115 patients with chronic pyelonephritis and prostatitis. It is shown that prostatilen has a corrective effect on hemocoagulation and immunity disorders, restores microcirculation, suppresses inflammation in the kidney and prostate. Thus, prostatilen is a pathogenetically sound drug for treatment in urogenital inflammation while in chronic prostatitis it can be used as a basic therapy.

  7. Urinary tract infections in pregnancy.

    Science.gov (United States)

    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.

  8. [Application of Monural to treat pregnant women with asymptomatic bacteriuria and acute cystitis].

    Science.gov (United States)

    Michova, M; Ivanov, St; Batashki, I

    2009-01-01

    Asymptomatic bacteriuria (AB) and cystitis affect 4-9% of pregnancies and are associated with pyelonephritis and preterm labor. Screening for AB and adequate antimicrobal therapy prevent most of these serious complications. Twenty- nine pregnant patients, suffering from AB and 9 cases with cystitis were treated with single dose Monura (Fosfomycin trometamol) in a prospective study.

  9. Asymptomatic bacteriuria Escherichia coli strain 83972 carries mutations in the foc locus and is unable to express F1C fimbriae

    DEFF Research Database (Denmark)

    Hancock, Viktoria; Schembri, M.A.; Ulett, G.C.

    2006-01-01

    this adhesin. The data imply that E. coli 83972 has lost its ability to express this important colonization factor as a result of host-driven evolution. The ancestor of the strain seems to have been a pyelonephritis strain of phylogenetic group B2. Strain 83972 therefore represents an example of bacterial...

  10. Emphysema in the renal allograft

    Energy Technology Data Exchange (ETDEWEB)

    Potter, J.L.; Sullivan, B.M.; Fluornoy, J.G.; Gerza, C.

    1985-04-01

    Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.

  11. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty; a detailed observational cohort study

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jorgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis. CONCLUSION: The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due...

  12. A new cause of curvilinear renal calcification: calcified hydrocalycosis

    Energy Technology Data Exchange (ETDEWEB)

    Atakan, Irfan Hueseyin; Pekindil, Goekhan; Alagoel, Buelent; Inci, Osman

    2000-10-01

    Although many causes of curvilinear renal calcifications have been described, calcified hydrocalycosis mimicking hydatid cyst has not previously been reported. We report a case of hydrocalycosis which was appeared as a curvilinear calcified cystic lesion resulted from staghorn calculus associated with xanthogranolomatous pyelonephritis (XGPN) on intravenous pyelography (IVU) and computed tomography (CT)

  13. 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.

  14. The results of 15 years of consistent strategy in treating antenatally suspected pelvi-ureteric junction obstruction

    DEFF Research Database (Denmark)

    Thorup, J; Jokela, R; Cortes, D

    2003-01-01

    in the hydronephrotic kidney, with 49 followed for 1-10 years with no change in kidney function and no symptoms. Twelve patients in this group had later surgery (at 0.7-8 years old) because of pyelonephritis (four), pain and/or renal functional impairment (eight, three of whom had normal function afterward). Thirty...

  15. 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...

  16. Chronische pyelonefritis; een aantal klinische waarnemingen, met een studie van de diagnostische betekenis van antilichamen tegen colibacteriën bij urineweginfecties.

    NARCIS (Netherlands)

    Zeppenfeldt, Ewald

    1968-01-01

    In chapter I a number of important publications concerning chronic pyelonephritis are reviewed. The classical descriptions of the pathology of the disease by Staemmler and Dopheide (1930) and Weiss and Parker (1939) have been supplemented by Kimmelstiel (1961) who considers polymorphonuclear

  17. Funktion af neoblaere hos kvinder efter cystektomi

    DEFF Research Database (Denmark)

    Bigum, Lene Hyldgaard; Jensen, Jørgen Bjerggaard; Jensen, Klaus Møller-Ernst

    2008-01-01

    complications. Six patients (30%) had late complications. The most common complication was pyelonephritis. Fifteen patients (75%) were alive at the end of follow-up, and twelve patients (60%) were without recurrence. CONCLUSION: Neobladders in women after cystectomy function adequately. Patients achieve a high...

  18. Luftudvikling i nyrer og urinveje som komplikation til urinvejsinfektion

    DEFF Research Database (Denmark)

    Redal-Baigorri, Ana Belén; Egfjord, Martin

    2010-01-01

    Emphysematous pyelonephritis (EPN) is a bacterial infection characterised by gas production in the renal parenchyma. We present a case with EPN caused by Klebsiella pneumoniae sepsis. The 74-year-old woman was admitted in septic shock. An acute computed tomography revealed gas bubbles bilaterally...

  19. Recurrent pancreatitis after trimethoprim-sulfamethoxazole rechallenge.

    NARCIS (Netherlands)

    Versleijen, M.W.J.; Naber, A.H.J.; Riksen, N.P.; Wanten, G.J.A.; Debruyne, F.M.J.

    2005-01-01

    We report a female patient who repeatedly developed pancreatitis after trimethoprim-sulfamethoxazole (TMP/SMX) use. During childhood she had undergone an ureterosigmoidostomy after which she had been on TMP/SMX 480 mg daily as prophylaxis for pyelonephritis for many years. The patient presented with

  20. Risk of Infections in Patients with Chronic Diseases

    DEFF Research Database (Denmark)

    Mor, Anil; Thomsen, Reimar W.

    2013-01-01

    of pyelonephritis may be 2 to 4 times increased. Treatment of asymptomatic bacteriuria in diabetes is generally not recommended. Diabetes duration and chronic complications including cystopathy appear to be more important risk factors than current glycemic control, but further evidence is needed. Modifiable risk...

  1. Asymptomatic bacteriuria Escherichia coli strain 83972 carries mutations in the foc locus and is unable to express F1C fimbriae

    DEFF Research Database (Denmark)

    Hancock, Viktoria; Schembri, M.A.; Ulett, G.C.

    2006-01-01

    this adhesin. The data imply that E. coli 83972 has lost its ability to express this important colonization factor as a result of host-driven evolution. The ancestor of the strain seems to have been a pyelonephritis strain of phylogenetic group B2. Strain 83972 therefore represents an example of bacterial...

  2. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jørgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis. CONCLUSION: The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due...

  3. Segmental dilatation of ureter: Report of two cases

    Directory of Open Access Journals (Sweden)

    Hemonta Kr. Dutta

    2014-01-01

    Full Text Available Segmental dilatation of ureter is a giant, focal segmental ureteral dilatation producing an elongated and distorted ureter. Two children presented with this condition, one had ipsilateral megacalycosis and contralateral vesicoureteric reflux. The other had duplication of the kidney. The non-functioning lower moiety showed structure of xanthogranulomatous pyelonephritis.

  4. 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

    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...

  5. P2X1, P2X4, and P2X7 Receptor Knock Out Mice Expose Differential Outcome of Sepsis Induced by α-Haemolysin Producing Escherichia coli

    DEFF Research Database (Denmark)

    Greve, Anne-Sofie; Skals, Marianne; Fagerberg, Steen K

    2017-01-01

    α-haemolysin (HlyA)-producing Escherichia coli commonly inflict severe urinary tract infections, including pyelonephritis, which comprises substantial risk for sepsis. In vitro, the cytolytic effect of HlyA is mainly mediated by ATP release through the HlyA pore and subsequent P2X1/P2X7 receptor...

  6. Resistive Index in Obstructive Uropathy

    NARCIS (Netherlands)

    A.A. Shokeir

    1999-01-01

    textabstractThe diagnosis of urinary tract obstruction is a difficult and perplexing problem particularly in children. Pyelocalyectasis is seen not only in obstruction but also in other conditions, such as residual dilatation afler relief of obstruction, vesicoureteral reflux and pyelonephritis.

  7. Individualized significance of the -251 A/T single nucleotide polymorphism of interleukin-8 in severe infections

    NARCIS (Netherlands)

    Georgitsi, M.D.; Vitoros, V.; Panou, C.; Tsangaris, I.; Aimoniotou, E.; Gatselis, N.K.; Chasou, E.; Kouliatsis, G.; Leventogiannis, K.; Velissaris, D.; Belesiotou, E.; Dioritou-Aggaliadou, O.; Giannitsioti, E.; Netea, M.G.; Giamarellos-Bourboulis, E.J.; Giannikopoulos, G.; Alexiou, Z.; Voloudakis, N.; Koutsoukou, A.

    2016-01-01

    Based on the concept of the individualized nature of sepsis, we investigated the significance of the -251 A/T (rs4073) single nucleotide polymorphism (SNP) of interleukin (IL)-8 in relation to the underlying infection. Genotyping was performed in 479 patients with severe acute pyelonephritis (UTI, n

  8. [Function of neobladders in women after cystectomy

    DEFF Research Database (Denmark)

    Bigum, L.H.; Jensen, J.B.; Jensen, K.M.

    2008-01-01

    complications. Six patients (30%) had late complications. The most common complication was pyelonephritis. Fifteen patients (75%) were alive at the end of follow-up, and twelve patients (60%) were without recurrence. CONCLUSION: Neobladders in women after cystectomy function adequately. Patients achieve a high...

  9. Toll-like receptor polymorphisms and susceptibility to urinary tract infections in adult women.

    Directory of Open Access Journals (Sweden)

    Thomas R Hawn

    Full Text Available BACKGROUND: Although behavioral risk factors are strongly associated with urinary tract infection (UTI risk, the role of genetics in acquiring this disease is poorly understood. METHODOLOGY/PRINCIPAL FINDINGS: To test the hypothesis that polymorphisms in Toll-like receptor (TLR pathway genes are associated with susceptibility to UTIs, we conducted a population-based case-control study of women ages 18-49 years. We examined DNA variants in 9 TLR pathway genes in 431 recurrent cystitis (rUTI cases, 400 pyelonephritis cases, and 430 controls with no history of UTIs. In the Caucasian subgroup of 987 women, polymorphism TLR4_A896G was associated with protection from rUTI, but not pyelonephritis, with an odds ratio (OR of 0.54 and a 95% confidence interval (CI of 0.31 to 0.96. Polymorphism TLR5_C1174T, which encodes a variant that abrogates flagellin-induced signaling, was associated with an increased risk of rUTI (OR(95%CI: 1.81 (1.00-3.08, but not pyelonephritis. Polymorphism TLR1_G1805T was associated with protection from pyelonephritis (OR(95%CI: 0.53 (0.29-0.96. CONCLUSIONS: These results provide the first evidence of associations of TLR5 and TLR1 variants with altered risks of acquiring rUTI and pyelonephritis, respectively. Although these data suggest that TLR polymorphisms are associated with adult susceptibility to UTIs, the statistical significance was modest and will require further study including validation with independent cohorts.

  10. IMMUNOLOGICAL STUDY IN CHILDREN WITH RENAL DISEASES LIVING IN REGIONS WITH UNFAVORABLE ENVIRONMENTAL CONDITIONS

    Directory of Open Access Journals (Sweden)

    M. V. Kudin

    2009-01-01

    Full Text Available Abstract. Seventy-nine children participated in the study including 33 children living in region with developed cement industry (12 with glomerulonephritis, and 21 with obstructive pyelonephritis. A group of comparison consisted of 46 children living in Moscow, including 17 subjects with glomerulonephritis and 29 children with obstructive pyelonephritis, and control group of 26 healthy children. ELISA method was used to perform immunological studies. The levels of sCD4, IL-2, IL-6, IL-10, sICAM-1, TNFα were evaluated in blood sera. The data obtained show significant increase of TNFα levels and decreased IL-6 levels (p < 0,05 in children with nephropathy living in regions with unfavorable environmental conditions as compared with control group. A seven-fold increase in TNFα levels, along with more than twofold decrease in IL-6 was revealed among children with obstructive pyelonephritis, as compared with control group (p < 0,05. In children with glomerulonephritis and obstructive pyelonephritis, a distinct increase of sCD4 , as well as decreased IL-2 level (p < 0,05 was registered, as compared with control group. Meanwhile, IL-10 contents in this group of patients was 22,4 times less than the in controls (p < 0,05. In the main group, no enhanced sICAM synthesis was found, both in children with glomerulonephritis and pyelonephritis. In children affected by adverse environmental pathogens, we have shown a prevailing immune inflammation due to hyperproduction of TNFα, IL-6, and activation of sCD4 helpers. Adverse environmental effects inhibit cytokine synthesis, thus reducing production of both pro- and anti-inflammatory cytokines.

  11. Urinary tract infections in adults with diabetes.

    Science.gov (United States)

    Ronald, A; Ludwig, E

    2001-04-01

    Urinary tract (UTI) is a major disease burden for many patients with diabetes. Asymptomatic bacteriuria is several-fold more common among women and acute plyelonephritis is five to ten times more common in both sexes. The complications of pyelonephritis are also more common in patients with diabetes. These complications include acute papillary necrosis, emphysematous pyelonephritis, and bacteremia with metastatic localization to other sites. The management of urinary infection in patients with diabetes is essentially the same as patients without diabetes. Most infections should be managed as uncomplicated except when they occur in a milieu with obstruction or other factors that merit a diagnosis of complicated UTI. Strategies to prevent these infections and reduce morbidity should be a priority for research.

  12. Pharmacological study of cefoxitin as an alternative antibiotic therapy to carbapenems in treatment of urinary tract infections due to extended-spectrum-β-lactamase-producing Escherichia coli.

    Science.gov (United States)

    Guet-Revillet, H; Emirian, A; Groh, M; Nebbad-Lechani, B; Weiss, E; Join-Lambert, O; Bille, E; Jullien, V; Zahar, J R

    2014-08-01

    Cefoxitin could be an alternative to carbapenems in extended-spectrum-beta-lactamase-producing Escherichia coli (ESBL-EC) infections. However, pharmacological and clinical data regarding cefoxitin are limited. Using a recent pharmacological model and the MICs of ESBL-EC collected from pyelonephritis, we determined the probabilities to reach four pharmacological targets: free cefoxitin concentrations above the MIC during 50% and 100% of the administration interval (T>MIC = 50% and T>MIC = 100%, respectively) and free cefoxitin concentrations above 4× MIC during 50% and 100% of the administration interval (T>4MIC = 50% and T>4MIC = 100%, respectively). Cefoxitin could be used to treat ESBL-EC pyelonephritis, but administration modalities should be optimized according to MICs in order to reach pharmacological targets.

  13. Application of biotinylated and 32P probes for detection of P-fimbriae in urinary E. coli.

    Science.gov (United States)

    Jusková, E; Ciznár, I

    1993-01-01

    Escherichia coli is the common causative agent of urinary tract infections. Twenty-six strains of Escherichia coli were isolated from children with pyelonephritis, symptomatic urinary tract infections and asymptomatic bacteriuria. Biotinylated and 32P-DNA probes were prepared for detection of P-fimbriae in the isolates. Of the 13 strains isolated from patients with pyelonephritis 11 were positive for the presence of the P gene by both probes. Strains isolated from cases of symptomatic urinary tract infections revealed the presence of P gene only in three samples of the total of nine isolated. None of the isolated E. coli strains from asymptomatic bacteriuria was found positive for the presence of the P gene. The biotinylated probe was simple and easily applicable in standard laboratory conditions and therefore the authors recommend it for use in diagnostic laboratories.

  14. [Extracorporeal shockwave lithotripsy on the Sonolith-3000 apparatus].

    Science.gov (United States)

    Tkachuk, V N; Veroman, V Iu; Komiakov, B K; Bannikov, V V; Sapelkin, A V; Ivanov, A O; Iudkevich, B A; Kalashian, R K

    1991-01-01

    The authors observed 812 patients with nephrolithiasis who underwent 876 sessions of shock-wave lithotripsy on Sonolith-3000 lithotriptor supplied with an ultrasonic system of the stone localization. The size of nephroliths ranged from 0.7 to 4.2 cm. Large-size nephroliths required repeated sessions and pretreatment establishment of the stent. The procedure proceeded without anesthesia. Subsequent renal colic was reported in 126 (15.5%), an exacerbation of pyelonephritis in 45 (5.5%), subcapsular hematoma in 4 (0.5%) of the patients. 790 patients showed clinical response (97.3%), with a complete destruction of the stone in 446 (54.9%) and partial one in 344 (42.4%) cases. 27 subjects were treated in outpatient setting. According to the authors, lithotripsy is contraindicated in urinary tract obstruction below the stone, renal failure, chronic pyelonephritis in the active phase of inflammation, marked impairment of cardiac rhythm.

  15. Dynamic properties of bacterial pili measured by optical tweezers

    CERN Document Server

    Fallman, Erik; Schedin, Staffan; Jass, Jana; Uhlin, Bernt Eric; Axner, Ove

    2014-01-01

    The ability of uropathogenic Escherichia coli (UPEC) to cause urinary tract infections is dependent on their ability to colonize the uroepithelium. Infecting bacteria ascend the urethra to the bladder and then kidneys by attaching to the uroepithelial cells via the differential expression of adhesins. P pili are associated with pyelonephritis, the more severe infection of the kidneys. In order to find means to treat pyelonephritis, it is therefore of interest to investigate the properties P pili. The mechanical behavior of individual P pili of uropathogenic Escherichia coli has recently been investigated using optical tweezers. P pili, whose main part constitutes the PapA rod, composed of ~1000 PapA subunits in a helical arrangement, are distributed over the bacterial surface and mediate adhesion to host cells. We have earlier studied P pili regarding its stretching/elongation properties where we have found and characterized three different elongation regions, of which one constitute an unfolding of the quate...

  16. Genitourinary brucellosis: results of a multicentric study.

    Science.gov (United States)

    Erdem, H; Elaldi, N; Ak, O; Gulsun, S; Tekin, R; Ulug, M; Duygu, F; Sunnetcioglu, M; Tulek, N; Guler, S; Cag, Y; Kaya, S; Turker, N; Parlak, E; Demirdal, T; Ataman Hatipoglu, C; Avci, A; Bulut, C; Avci, M; Pekok, A; Savasci, U; Kaya, S; Sozen, H; Tasbakan, M; Guven, T; Bolukcu, S; Cesur, S; Sahin-Horasan, E; Kazak, E; Denk, A; Gonen, I; Karagoz, G; Haykir Solay, A; Alici, O; Kader, C; Senturk, G; Tosun, S; Turan, H; Baran, A I; Ozturk-Engin, D; Bozkurt, F; Deveci, O; Inan, A; Kadanali, A; Sayar, M S; Cetin, B; Yemisen, M; Naz, H; Gorenek, L; Agalar, C

    2014-11-01

    This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n=327, 83.8%), as epididymo-orchitis (n=204, 58%), orchitis (n=112, 31.8%) and epididymitis (n=11, 3.1%). In female patients, pyelonephritis (n=33/38, 86.8%) was significantly higher than in male patients (n=11/352, 3.1%; pbrucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.

  17. [Urological emergencies].

    Science.gov (United States)

    Danuser, H; Ackermann, D K; Studer, U E

    1993-04-17

    Every general practitioner has to deal with urologic emergencies. The most frequent illnesses are urinary retention, acute scrotum, priapism, macrohematuria, nephritic colic, obstructive pyelonephritis and pyonephrosis. Whereas urinary retention, as well as acute ureteric stone colic must generally be treated by the practitioner, the urologist must often be consulted in case of an acute scrotum or for priapism. Testicular torsion is one situation, where surgical treatment needs to be performed within 6 hours. Of utmost importance is his timely assistance with the obstructive pyelonephritis and pyonephrosis. These are initially often not recognized, especially because the first ultrasound examination of the intrarenal pyelone may not show a dilatation of the collecting system despite obstruction. If the adequate treatment with drainage and antibiotics is applied too late, this can result in serious and potentially lethal consequences.

  18. Septic Arthritis of the Shoulder Complicating Pregnancy

    Directory of Open Access Journals (Sweden)

    Sara Raiser

    2014-01-01

    Full Text Available Septic arthropathy leads to rapid joint destruction, impairment, and disability. Staphylococcus can be particularly virulent to bone and joints leading to adverse obstetric events. At 28 of weeks gestation, a patient presented with pyelonephritis and progressive left shoulder pain. Magnetic resonance imaging indicated early clavicular destruction and acromial involvement. Glenohumeral joint aspiration produced Staphylococcus aureus. The patient then had premature rupture of membranes and progressed rapidly to preterm delivery. Placental pathology revealed chorioamnionitis and microabscesses. Treatment of the infected joint required further surgical drainage and bone resection as well as extended antibiotics. It is important to remember that joint pain in pregnancy may indicate infective arthritis, and pyelonephritis can be a source of such an infection. Evaluation includes magnetic resonance imaging and consultation for joint aspiration. Prompt recognition and treatment are necessary to prevent joint destruction.

  19. Amount and avidity of antibody to Escherichia coli O antigen measured with the ammonium sulphate precipitation technique in children with urinary tract infections.

    Science.gov (United States)

    Ahlstedt, S; Jodal, U; Hanson, L A

    1975-01-01

    The antibody amounts and avidities were analyzed in 13 patients with acute primary pyelonephritis, 11 patients with acute primary cystitis, and one with ureterocele and recurrent infections, using the ammonium sulphate precipitation (ASP) technique. The ASP titrations did not discriminate as well between pyelonephritis and cystitis as do the determinations with the indirect hemagglutination technique. The increase of antibody titer and avidity detected by the ASP method in some of the cystitis patients suggested a deeper tissue involvement in some cases resulting in antibodies demonstrable with this technique. Since control patients also showed a somewhat heterogenous antibody response regarding titer and avidity it cannot be excluded that stimulation by Escherichia coli antigens in the gut is detected by the ASP method.

  20. Prevalence and risk factors of asymptomatic bacteriuria in pregnancy1

    Directory of Open Access Journals (Sweden)

    Ghafarnezhad M

    2000-07-01

    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.

  1. 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.

  2. Management of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid in Adults

    Science.gov (United States)

    Stark, Timothy W; Lacy, John M; Preston, David M

    2016-01-01

    A 74-year-old man presented for evaluation after discovery of a left bladder-wall tumor. He underwent transurethral resection of bladder tumor (TURBT) operation for treatment of low-grade, Ta urothelial cancer of the bladder. The patient developed recurrent disease and returned to the operating room for repeat TURBT, circumcision, and administration of intravesical mitomycin C. The patient developed balanitis xerotica obliterans 4 years post-circumcision, requiring self-dilation with a catheter. He subsequently developed 3 consecutive episodes of left-sided pyelonephritis. Further investigation with voiding cystourethrogram (VCUG) revealed Grade 3, left-sided vesicoureteral reflux (VUR). Due to existing comorbidities, the patient elected treatment with endoscopic dextranomer/hyaluronic acid injection. A post-operative VCUG demonstrated complete resolution of left-sided VUR. This patient has remained symptom free for 8 months post-injection, with no episodes of pyelonephritis. PMID:27162514

  3. 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.

  4. Local Immune Response to Upper Urinary Tract Infections in Children▿

    OpenAIRE

    Kantele, Anu; Palkola, Nina; Arvilommi, Heikki; Honkinen, Olli; Jahnukainen, Timo; Mertsola, Jussi; Kantele, Jussi M.

    2008-01-01

    Vaccines are needed against urinary tract infections (UTIs) in children, as episodes of pyelonephritis (PN) may cause renal scarring. Local immune mechanisms are regarded to confer protection, yet they have been poorly characterized for children. This study explores the local immune response in children by looking for newly activated pathogen-specific antibody-secreting cells (ASC), expected to appear transiently in the circulation as a response to UTI. Urinary tract-originating ASC specific ...

  5. A New Urease Inhibitor from Viola betonicifolia

    OpenAIRE

    Naveed Muhammad; Muhammad Saeed; Ajmal Khan; Achyut Adhikari; Abdul Wadood; Khalid Mohammed Khan; Vincenzo De Feo

    2014-01-01

    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 thi...

  6. 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...

  7. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial

    Science.gov (United States)

    Bleidorn, Jutta; Hummers-Pradier, Eva; Schmiemann, Guido; Wiese, Birgitt; Gágyor, Ildikó

    2016-01-01

    Background: Uncomplicated urinary tract infections (UTI) are common in general practice, and are usually treated with antibiotics. Recurrent UTI often pose a serious problem for affected women. Little is known about recurrent UTI and complications when uncomplicated UTI are treated without antibiotics. With ICUTI (Immediate vs. conditional antibiotic use in uncomplicated UTI, funded by BMBF No. 01KG1105) we assessed whether initial symptomatic treatment with ibuprofen could be a treatment alternative for uncomplicated UTI. The presented analysis aims to assess the influence of initial (non-)antibiotic treatment on recurrent UTI rates and pyelonephritis after day 28 up to 6 months after trial participation. Methods: This study is a retrospective long-term follow-up analysis of ICUTI patients, surveyed telephonically six months after inclusion in the trial. Recurrent UTI, pyelonephritis or hospitalizations were documented. Statistical evaluation was performed by descriptive and multivariate analyses with SPSS 21. Results: For the six months follow-up survey, 386 trial participants could be contacted (494 had been included in ICUTI initially, 446 had completed the trial). From day 28 until 6 months after inclusion in ICUTI, 84 recurrent UTI were reported by 80 patients. Univariate and multivariate analyses showed no effect of initial treatment group or antibiotic treatment on number of patients with recurrent UTI. Yet, both analyses showed that patients with a history of previous UTI had significantly more often recurrent UTI. Pyelonephritis occurred in two patients of the antibiotic group and in one patient in the non-antibiotic group. Conclusion: This follow-up analysis of a trial comparing antibiotic vs. symptomatic treatment for uncomplicated UTI showed that non-antibiotic treatment has no negative impact on recurrent UTI rates or pyelonephritis after day 28 and up to six months after initial treatment. Thus, a four week follow-up in UTI trials seems adequate

  8. A preliminary report on the susceptibility to aminoglycosides of Escherichia coli isolated from the community-acquired urinary tract infections in adults in south-east Poland

    OpenAIRE

    Fidecka-Skwarzynska Magdalena; Juda Marek; Maziarczyk Lucyna; Malm Anna

    2015-01-01

    World-wide, urinary tract infections (UTIs) are an important clinical problem. In such, the most frequently isolated uropathogen is Escherichia coli. In the treatment of uncomplicated UTIs, e.g. cystitis, the widely used antibiotics are nitrofurantoin, trimethoprim/sulfamethoxazole, fosfomycin trometamol or ciprofloxacin, while the treatment of pyelonephritis requires the usage of antibiotics with a broader spectrum of activity, such as cephalosporins of the 3rd and 4th generation, aminoglyco...

  9. Peculiarities of microelemental homeostasis at microbal-inflammatory nephropathies in children

    Directory of Open Access Journals (Sweden)

    I. A. Melnikova

    2012-01-01

    Full Text Available The content of essential (Zn, Se, Cu and toxic (Pb, Cd microelements in blood serum and daily urine of 120 children from 3 to 15years old with microbal-inflammatory nephropathies was determined. The deficit of essential (Zn, Se, Cu and excess of toxic (Pb microelements in children with acute and chronic pyelonephritis at different periods of the disease were revealed.

  10. 9. The Contribution of Animal Experiments to Kidney Transplantation

    OpenAIRE

    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...

  11. Assessment of urine solute and matrix effects on the performance of an enzyme-linked immunosorbent assay for measurement of interleukin-6 in dog urine

    OpenAIRE

    2011-01-01

    Measurement of cytokine concentrations within body fluids is a means of recognizing subclinical and/or unresolved, infectious and inflammatory states in patients. In the urinary tract, such information may be useful for identifying patients with pyelonephritis, asymptomatic bacteriuria, recurrent infections, and cystitis. One such cytokine, interleukin-6 (IL-6), is recognized as a primary cytokine that is produced following exposure of the urothelium to bacterial virulence factors. Complicati...

  12. Practical uses of a quantitative renal scintillation camera study. [/sup 131/I tracer techniques

    Energy Technology Data Exchange (ETDEWEB)

    Bueschen, A.J.; Lloyd, L.K.

    1976-10-01

    A quantitative renal scintillation camera study has been described for the evaluation of total renal function and the split function of the two kidneys by a noninvasive technic. It requires no patient preparation, is not affected by bowel gas, and no allergic reactions have been reported. Six cases are reported to illustrate its usefulness with renal tumors, neurogenic bladders, pyelonephritis, nephrolithiasis, congenital anomalies, and renal insufficiency.

  13. [Treatment of infection stones. I. Dissolution of experimental infection stones in rats].

    Science.gov (United States)

    Takeuchi, H; Tomoyoshi, T

    1983-03-01

    The in vivo solubility of struvite stones experimentally induced in rats was investigated. The struvite stones implanted into bladders of normal rats were reduced in weight; and, they were dissolved by oral administration of ammonium chloride. Cefmetazone cured pyelonephritis and dissolved the bladder stones when it was administered to rats with urinary tract infection caused by Proteus mirabilis. Normalization of urine by antibiotics and acidifying agents may dissolve struvite stones, and help treat infection stones.

  14. Experimental supratrigonal cystectomy: evaluation of long-term complications

    Directory of Open Access Journals (Sweden)

    Milton Barros

    2006-06-01

    Full Text Available OBJECTIVE: The present study aims at assessing the occurrence of pyelonephritis and long-term complications in rats submitted to surgical reduction of bladder capacity. MATERIALS AND METHODS: Sprague-Dawley rats were submitted to supratrigonal cystectomy (29 animals or sham operation (15 animals and sacrificed 2, 4 and 6 months after the surgical procedure. The arterial blood pressure and serum creatinine levels were assessed before the surgery and at the time of the sacrifice. After the sacrifice a careful inspection of the urinary apparatus was performed to the characterization of the hydronephrosis and for the detection of the presence of calculi. With sterile technique, the urine was aspirated from the bladder and the kidneys removed and sent to a microbiologic study. RESULTS: Pyelonephritis was frequent in animals submitted to supratrigonal cystectomy. The most frequent and isolated microorganisms were Staphylococcus sp. and E. coli. The presence of urinary calculi was correlated significantly to the presence of urinary tract infection (p < 0.003. Arterial hypertension was frequent amongst animals submitted to supratrigonal cystectomy. Serum creatinine was high in 72.4% of the animals in the group submitted to supratrigonal cystectomy. The presence of calculi and pyelonephritis were frequent in rats presenting renal insufficiency and in hypertensive rats. CONCLUSIONS: The long-term course of urinary infection in rats submitted to supratrigonal cystectomy was characterized by a high incidence of renal insufficiency and arterial hypertension that seem to be related to dysfunction and bladder obstruction induced by an extensive surgical procedure and the presence of urolithiasis and pyelonephritis.

  15. Identification of factors in human urine that inhibit the binding of Escherichia coli adhesins.

    OpenAIRE

    1988-01-01

    Earlier studies on the binding of Escherichia coli adhesins to the human urinary tract have indicated that the ability to recognize binding sites on the urinary tract epithelial cells is not a characteristic for P fimbriae only, but is also shared by some other adhesins that are not associated with pyelonephritis, especially S fimbriae. In the present study we have investigated whether human urine contains inhibitors of the binding of E. coli adhesins. Normal human urine was found to inhibit ...

  16. Urinary tract infections in pregnancy : studies in vivo and in vitro

    OpenAIRE

    2016-01-01

    The risk of urinary tract infection (UTI) in pregnant women is increased and predisposes them to acute pyelonephritis together with poor pregnancy outcomes. Increased frequency of micturition, nocturia and lower abdominal discomfort are common non-specific complaints during pregnancy, which render clinical diagnosis of UTI inaccurate. To prevent undesirable effects on the growing fetus, antimicrobial agents used in management of UTI during pregnancy should be carefully selected...

  17. Urinary tract infections at first antenatal check-up: a single centre prospective study

    OpenAIRE

    2016-01-01

    Background: Pregnant women with asymptomatic bacteriuria (ASB) are more likely to develop acute pyelonephritis, postpartum UTI, hypertensive disease, anemia, prematurity, low birth weight babies and prenatal death if untreated. Methods: Total 780 pregnant women attending for first antenatal check-up in a medical college were enrolled for the study. Those with any symptoms of UTI, like burning micturition, frequency, urgency, dysuria or fever were excluded from the study. All were subjected...

  18. PREVALENCE OF URINARY TRACT INFECTION IN PREGNANT W OMEN

    OpenAIRE

    Nawaz,; Siddesh; Sirwar

    2012-01-01

    ABSTRACT: Urinary tract infection is one of the most frequen tly seen medical complications in pregnancy. UTI in pregnancy is an important concern, as it possesses risk of complications such as acute and chronic pyelonephritis, toxaemia, anaemi a, hypertension, intrauterine growth retardation and increased perinatal mortality. The detection of bacteriuria allows an approach to be made for the prevention of chronic urinary dis ease in ...

  19. Role of Uropathogenic Escherichia coli Virulence Factors in Development of Urinary Tract Infection and Kidney Damage

    OpenAIRE

    Justyna Bien; Olga Sokolova; Przemyslaw Bozko

    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 triggere...

  20. Group B streptococcus cystitis presenting in a diabetic patient with a massive abdominopelvic abscess: a case report

    OpenAIRE

    Ulett, Kimberly B; Shuemaker, Jennifer H; Benjamin, William H.; Tan, Chee K.; Glen C. Ulett

    2012-01-01

    Introduction Streptococcus agalactiae or group B streptococcus is a Gram-positive pathogen that is typically associated with neonatal disease and infection in pregnant women. Group B streptococcus also causes invasive infections in non-pregnant adults including urinary tract infections. The spectrum of urinary tract infections caused by group B streptococcus includes cystitis, pyelonephritis, urosepsis and asymptomatic bacteriuria, which is particularly common among elderly individuals. A rar...

  1. Emphysematous liver abscess in diabetic patient: two cases report

    Energy Technology Data Exchange (ETDEWEB)

    Rhim, Hyun Chul; Koo, Ja Hong; Kim, Sung Tae; Kim, Yong Soo; Koh, Byung Hee; Cho, On Koo [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1995-07-15

    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.

  2. Transurethral contact ureterolithotripsy in gas (СО2) medium.

    Science.gov (United States)

    Korolev, Dmitry O; Glybochko, Peter V; Rapoport, Leonid M; Tsarichenko, Dmitry G

    2017-08-01

    Transurethral intracorporeal lithotripsy is the modality of choice for the endoscopic disintegration of large, long-standing, radiolucent or high-density stones. Despite several advantages and proven benefits of contact ureterolithotripsy/ureterolithoextraction (CULT), the application of irrigation carries significant risks of untoward perioperative events including retrograde stone migration and postoperative pyelonephritis. We describe a new technique - endoscopic intracorporeal lithotripsy in the gas (СО2) medium. It is a prospective randomized, single blinded pilot study that included total of (n = 60) patients with urolithiasis who were allocated to either experimental or control group. Out of the total pool of patients, 30 underwent treatment with the new approach (experimental group) and other 30 (control group) had contact ureterolithotripsy in a standard of care 0.9% NaCL medium. We included patients >18 years old, with known symptomatic renal calculi disease who were eligible and scheduled for CULT and free from significant coexisting pathologies of urinary tract. No retrograde migration of the stone fragments into the kidney was reported in the experimental group [complications rate 0%, confidence interval (CI): 0-11.6%]. In the control group, complications were observed in eight cases (complications rate 26.7%, CI: 14.7-42.3%); retrograde migration was in five patients (16.6%), and acute pyelonephritis/exacerbation of chronic pyelonephritis was seen in three (10%) patients. There was not any acute pyelonephritis in the experimental group. Reliability of frequency differences - p = 0.0023 (χ2). The novel method of contact ureterolithotripsy is a safe and promising alternative to the conventional contact ureterolithotripsy in a fluid medium in a carefully selected patient population.

  3. 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...

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

    OpenAIRE

    Kazemier Brenda M; Schneeberger Caroline; De Miranda Esteriek; Van Wassenaer Aleid; Bossuyt Patrick M; Vogelvang Tatjana E; Reijnders Frans JL; Delemarre Friso MC; Verhoeven Corine JM; Oudijk Martijn A; van der Ven Jeanine A; Kuiper Petra N; Feiertag Nicolette; Ott Alewijn; de Groot Christianne JM

    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...

  5. Asymptomatic bacteriuria among pregnant women

    OpenAIRE

    Sudha Biradar Kerure; Rajeshwari Surpur; Sheela S. Sagarad; Sneha Hegadi

    2013-01-01

    Background: Urinary tract infections (UTIs) are the most common bacterial infections during pregnancy. Asymptomatic bacteriuria (ASB) is a major risk factor for the development of urinary tract infections during pregnancy and with further risk of preterm birth & pyelonephritis if untreated. Aims & Objectives: This study was carried out to determine the prevalence of asymptomatic bacteriuria (ASB) in pregnant women & to isolate, identify and establish antimicrobial susceptibility of pathogens....

  6. Prevalence and outcome of asymptomatic bacteriuria in early pregnancy

    OpenAIRE

    Sreekumary Radha; Bindu Nambisan; Nisha Kizhekkepurakkal Prabhakaran; Shahida Jamal

    2016-01-01

    Background: Bacteriuria is a major risk factor for developing symptomatic urinary tract infection which is associated with significant maternal and fetal risks. Various studies have put a prevalence of asymptomatic bacteriuria between 2-10% in pregnancy. Maternal and fetal complications like gestational hypertension, anaemia, premature delivery, IUGR, and low birth weight are commonly associated with pyelonephritis which occurs as a result of undiagnosed or inadequately treated infections of ...

  7. Approach to a patient with urosepsis

    Directory of Open Access Journals (Sweden)

    Om Prakash Kalra

    2009-01-01

    Full Text Available Urinary tract infections can occur in all age groups and produce an exceptionally broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with Gram negative sepsis to septic shock. In approximately one-quarter of all patients with sepsis, the focus of infection is localized to the urogenital tract. This may lead to substantial morbidity and significant economic implications. We present a review of the current approaches to managing urospesis.

  8. Approach to a patient with urosepsis.

    Science.gov (United States)

    Kalra, Om Prakash; Raizada, Alpana

    2009-01-01

    Urinary tract infections can occur in all age groups and produce an exceptionally broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with Gram negative sepsis to septic shock. In approximately one-quarter of all patients with sepsis, the focus of infection is localized to the urogenital tract. This may lead to substantial morbidity and significant economic implications. We present a review of the current approaches to managing urospesis.

  9. Hafnia alvei Urosepsis in a Kidney Transplant Patient

    OpenAIRE

    Mario Stanic; Edgar Meusburger; Gabriele Hartmann; Karl Lhotta

    2015-01-01

    Hafnia alvei, a gram-negative facultative anaerobic, rod-shaped bacterium, is a rare cause of infection in humans. We report on a renal transplant patient who developed H. alvei pyelonephritis and urosepsis. The source of infection remains enigmatic but is most likely the intestinal tract. Appropriate antibiotic therapy with cefepime followed by oral ciprofloxacin brought about rapid resolution of symptoms and complete recovery. H. alvei may cause severe infection in transplant patients with...

  10. Abordaje terapéutico de las infecciones urinarias en la oficina de farmacia

    OpenAIRE

    Gutierrez, Andrea; Aldasoro, Pilar

    2016-01-01

    In Spain, they are the most common nosocomial infections, below respiratory infections; 50% of women may have a UTI throughout his life, becoming a pathology linked more females than males, which can be attributed to pregnancy, sexual activity and hormonal changes experienced by women. Urinary tract infection is colonization and microbial growth, usually bacterial, along the urinary system. Called pyelonephritis, cystitis, urethritis or prostatitis if affecting kidney and renal pelvis, bladde...

  11. Klebsiella Pneumoniae Multi-organ Abscesses not Accompanied by Liver Abscesses: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Taek; Park, Chul Hi; Hwang, Ho Kyung; Lee, Mi Ran; Lee, Dong Hoon; Kim, Min Ji [Dept. of Radiology, Seoul Medical Center, Seoul (Korea, Republic of)

    2012-06-15

    A Klebsiella pneumoniae infection has a tendency to spread to multiple organs. It is most commonly seen in patients with liver abscesses, but infection in more than three organs without liver abscesses is unusual. We report one case of a K. pneumoniae infection that presented acute pyelonephritis with left perirenal, anterior pararenal, left psoas, and prostate abscesses without liver abscesses in a diabetic patient. With effective antibiotics and ultrasound-guided percutaneous drainage, the patient recovered without significant sequelae.

  12. Hemiresective reconstruction of a redundant ileal conduit with severe bilateral ileal conduit-ureteral re fl ux.

    Science.gov (United States)

    Fujimura, Tetsuya; Minowada, Shigeru; Kishi, Hiroichi; Hamasaki, Kimihisa; Saito, Kiyoshi; Kitamura, Tadaichi

    2005-10-01

    A 58-year-old man was referred to our hospital with high fever and anuria. Since undergoing a total pelvic exenteration due to bladder-invasive sigmoid colon cancer, urinary tract infections had frequently occurred. We treated with the construction of a bilateral percutaneous nephrostomy (PCN), and chemotherapy. Although we replaced the PCN with a single J ureteral catheter after an improvement of infection, urinary infection recurred because of an obstruction of the catheter. Urological examinations showed that an ileal conduit-ureteral reflux caused by kinking of the ileal loop was the reason why frequent pyelonephritis occurred. We decided to resect the proximal segment to improve conduit-ureteral reflux for the resistant pyelonephritis. After the surgery, the excretory urogram showed improvement and the urinary retention at the ileal conduit disappeared. Three years after the operation, renal function has been stable without episodes of pyelonephritis. Here we report a case of open repair surgery of an ileal conduit in a patient with severe urinary infection.

  13. Frequency of pap and pil operons in Escherichia coli strains associated with urinary infections.

    Science.gov (United States)

    Perugini, M R; Vidotto, M C

    1996-03-01

    Strains of E. coli isolated from patients with urinary tract infection were examined for P and type 1 adhesin production by colony hybridization with pap and pil operons. The P pili probe detected 45 (46.4%) of the total of 97 strains studied and the type 1 pili probe detected 83 (85.6%). The pap operon was detected in 39 (53.4%) of 73 strains isolated from urine of patients with urinary disease and in 6 (25.0%) of 24 strains isolated from feces of healthy individuals employed as controls (P = 0.029), and the pil operon was detected in 67 (91.8%) of the urinary strains and in 16 (66.6%) of the fecal strains (P = 0.007). Our data did not show significant differences in frequency of P pili among isolates from pyelonephritis (78.5%), cystitis (45.8%) and asymptomatic bacteriuria (54.5%). Type 1 pili were not associated with the different types of infection; the frequency of these pili was 100% in pyelonephritis and in asymptomatic bacteriuria, and 87.5% in cystitis. The incidence of pap operon in strains isolated from pyelonephritis and from asymptomatic bacteriuria was higher in 11- to 40-year old women. These data show a high frequency of pap and pil operons among uropathogenic strains of E. coli, which seems to be an important factor in the development of urinary infection.

  14. The Immediate Results of Surgical Treatment of Bladder Cancer

    Directory of Open Access Journals (Sweden)

    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.

  15. Incidence of renal carcinoma in non-functioning kidney due to renal pelvic stone disease

    Science.gov (United States)

    ZENGIN, KURSAD; TANIK, SERHAT; SENER, NEVZAT CAN; ALBAYRAK, SEBAHATTIN; EKICI, MUSA; BOZKURT, IBRAHIM HALIL; BAKIRTAS, HASAN; GURDAL, MESUT; IMAMOGLU, MUHAMMED ABDURRAHIM

    2015-01-01

    The objective of This study was to report our pathological findings in nephrectomy specimens from patients treated for non-functioning hydronephrotic kidney due to renal pelvic stone disease. A total of 97 patients who underwent nephrectomy for non-functioning hydronephrotic kidneys between January, 2011 and June, 2014 were retrospectively reviewed. A non-functioning kidney was defined as one having paper-thin parenchyma on urinary ultrasound or computed tomography, exhibiting no contrast visualization in the collecting duct system on intravenous urography and having a split renal function of <10% on nuclear renal function studies. Following pathological evaluation, 9 patients were diagnosed with xanthogranulomatous pyelonephritis, 9 with malignant tumors and 79 with chronic pyelonephritis. Of the patients with chronic pyelonephritis, 2 also had renal adenomas. The malignant tumors included 3 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC), 3 renal cell carcinomas (RCC) (1 sarcomatoid, 1 papillary and 1 clear cell RCC), whereas 1 patient had concurrent RCC and TCC. In conclusion, non-functioning kidneys, particularly those with kidney stones, should be managed as possible malignancies, due to the higher incidence of malignant tumors in such patients compared with the normal population. PMID:26171211

  16. The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria

    Science.gov (United States)

    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 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. PMID:27104571

  17. Comparison of the serum sensitivity of uropathogenic strains of Escherichia coli isolated from different diagnostic groups

    Directory of Open Access Journals (Sweden)

    J. Vraneš,

    2005-02-01

    Full Text Available The bactericidal activity of serum caused by complement system is an important defence mechanism protecting the host organism against infection. The capacity to resist bactericidal activity of normal human serum contributes to the virulence of many gram-negative pathogens. Serum resistance in bacteria has been attributed to their surface components, but exact mechanism of resistance which most likely involves multiple factors is not well understood. In this study, the capacity of Escherichia coli to resist the bactericidal action of serum was examined in 85 clinical isolates obtained from patients with acute pyelonephritis (n=23, acute cystitis (n=22, chronic pyelonephritis (n=22 and asymptomatic bacteriuria (n=18. Serum sensitivity was also examined in relation to the serogroup specificity and expression of the different adhesins of the strains.Bacterial susceptibility to serum killing was measured by assessing regrowth after incubation in serum according to Schiller and Hatch method. The adhesins of E. coli were determined by hemagglutination and inhibition of hemagglutiation, and serotyping was performed on glass slides and confirmed using a mechanized microtechnique.The significant correlation between serum resistance of uropathogenic strains of E. coli and expression of P-fimbriae and O6 serogroup was observed.Theincidence of serum-resistant E. coli strains was significantly higher in strains isolated from urine of patients with acute pyelonephritis, as compared to strains isolated in other diagnostic groups, which is in accordance with higher virulence and invasive potential of these strains.

  18. 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.

  19. 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

  20. Piperacillin/tazobactam as an alternative antibiotic therapy to carbapenems in the treatment of urinary tract infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae: an in silico pharmacokinetic study.

    Science.gov (United States)

    Guet-Revillet, Hélène; Tomini, Elise; Emirian, Aurélie; Join-Lambert, Olivier; Lécuyer, Hervé; Zahar, Jean-Ralph; Jullien, Vincent

    2017-01-01

    Piperacillin/tazobactam (TZP) as an alternative treatment to carbapenems for infections involving extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE) remains debated. In this study, the probabilities of pharmacodynamic (PD) target attainment with different TZP regimens in ESBL-producing Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp) were evaluated in the context of pyelonephritis. Minimum inhibitory concentrations (MICs) of 144 ESBL-Ec and 111 ESBL-Kp from pyelonephritis were measured, and two previously published population pharmacokinetic models were used to determine by Monte Carlo simulation the probabilities of reaching two PD targets (50%fT>MIC and 100%fT>MIC) with TZP doses of 4 g three times daily and 4.5 g four times daily given as short (1 h) or prolonged (4 h) infusions or as 12-18 g/day continuous infusions. Only MICs of the 133 ESBL-Ec and 74 ESBL-Kp strains susceptible to TZP according to inhibition zone diameter were considered for the simulations. Results were similar with the two models, and only prolonged and continuous infusions allowed to reach 50%fT>MIC with a probability of >90% irrespective of bacterial species. Continuous infusion and prolonged infusion combined with the maximum dosage were the only condition allowing to achieve 100%fT>MIC with a probability of >70% with this population of ESBL-Ec. A probability of >90% to reach 100%fT>MIC with ESBL-Kp could be obtained only with the 18 g/day continuous-infusion regimen. TZP may be used for treatment for mild pyelonephritis involving susceptible ESBL-Ec provided that administration modalities are optimised. Conversely, for ESBL-Kp the risk of treatment failure may be higher, supporting the use of continuous infusion.

  1. Epidemiology of urinary tract infections in Hiroshima

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    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.

  2. Pathogenicity island sequences of pyelonephritogenic Escherichia coli CFT073 are associated with virulent uropathogenic strains.

    Science.gov (United States)

    Kao, J S; Stucker, D M; Warren, J W; Mobley, H L

    1997-07-01

    Urinary tract infection is the most frequently diagnosed kidney and urologic disease, and Escherichia coli is by far the most common etiologic agent. Defined blocks of DNA termed pathogenicity islands have been found in uropathogenic strains to carry genes not generally found in fecal strains. We have identified one of these regions of DNA within the chromosome of the highly virulent E. coli CFT073, isolated from the blood and urine of a woman with acute pyelonephritis. This strain, which is cytotoxic for cultured renal cells and causes acute pyelonephritis in transurethrally infected CBA mice, contains two distinct copies of the pap operon and is hemolytic. One pap operon was localized on a cosmid clone which was used to identify three overlapping cosmid clones. By using restriction mapping, DNA hybridization, sequencing, and PCR amplification, a region of approximately 50 kb was found to be present in this uropathogenic strain and to have no corresponding sequences in E. coli K-12. This gene block also carries hemolysin genes hlyCABD. The pathogenicity island begins 7 bp downstream of dadX (catabolic alanine racemase; 26.55 min) and ends at a position in the K-12 genome 75 bp downstream of the metV tRNA gene (62.74 min); this suggests that a chromosomal rearrangement has occurred relative to the K-12 linkage map. The junctions of the pathogenicity island were verified by PCR amplification directly from the genomic DNA of strain CFT073. DNA sequencing within the boundaries of the junctions revealed genes not previously identified in E. coli or in some cases bearing no known homologs. When used as probes for DNA hybridization, these sequences were found significantly more often in strains associated with the clinical syndromes of cystitis (82%) and acute pyelonephritis (79%) than in fecal strains (19%; P < 0.001).

  3. Comparison of adhesin genes and antimicrobial susceptibilities between uropathogenic and intestinal commensal Escherichia coli strains.

    Science.gov (United States)

    Qin, Xiaohua; Hu, Fupin; Wu, Shi; Ye, Xinyu; Zhu, Demei; Zhang, Ying; Wang, Minggui

    2013-01-01

    The presence of adhesins is arguably an important determinant of pathogenicity for Uropathogenic Escherichia coli (UPEC). Antimicrobial susceptibilities were tested by agar dilution method, fifteen adhesin genes were detected by polymerase chain reaction, and multilocus sequence typing (MLST) was analyzed in 70 UPEC isolates and 41 commensal E. coli strains. Extended-spectrum β-lactamase (ESBL) was determined with confirmatory test. The prevalence of ESBL-producers in UPEC (53%, 37/70) was higher than the commensal intestinal isolates (7%, 3/41), and 97% (36/37) of the ESBL-producing UPEC harbored bla CTX-M genes. afa was present in 36% (10/28) UPEC isolates from recurrent lower urinary tract infection (UTI), and none in the acute pyelonephritis, acute uncomplicated cystitis or commensal strains (PUPEC isolates, while 5% (2/41) of the commensal strains were papG positive (P = 0.0025), and the prevalence of papG was significantly higher in acute pyelonephritis group (71%) than the other two UTI groups (PUPEC isolates than in the commensal strains. ESBL-producing UPEC showed a lower prevalence of adhesin genes compared with non-ESBL-producing strains. The MLST profiles were different between UPEC and commensal strains, with ST131 (19%, 13/70) and ST10 (20%, 8/41) being the most common MLSTs, respectively. This study demonstrated that several adhesin genes were more prevalent in UPEC isolates than in commensal E. coli, and afa may be associated with recurrent lower UTI whereas papG is more frequently associated with acute pyelonephritis.

  4. Resistance Patterns of Escherichia coli in Women with Uncomplicated Urinary Tract Infection Do Not Correlate with Emergency Department Antibiogram.

    Science.gov (United States)

    Hines, Michelle C; Al-Salamah, Tareq; Heil, Emily L; Mallemat, Haney; Witting, Michael D; Johnson, Jennifer K; Winters, Michael E; Hayes, Bryan D

    2015-12-01

    Urine cultures are not always performed for female Emergency Department (ED) patients with uncomplicated urinary tract infection (UTI). Accordingly, hospital, and even ED-specific, antibiograms might be skewed toward elderly patients with many comorbidities and relatively high rates of antimicrobial resistance, and thus do not accurately reflect otherwise healthy women. Our ED antibiogram indicates Escherichia coli resistance rates for ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX) of 42%, 26%, and 33%, respectively. This study aims to compare resistance rates of urinary E. coli from otherwise healthy women with uncomplicated UTI and pyelonephritis in the ED to rates in our ED antibiogram. Females > 18 years old with acute onset of urinary frequency, urgency, or dysuria with pyuria identified on urinalysis (white blood cell count > 10/high-power field) were prospectively enrolled in the ED of an urban, academic medical center. Exclusion criteria indicating a complicated UTI were consistent with Infectious Diseases Society of America guidelines. Susceptibility patterns of E. coli to ciprofloxacin, levofloxacin, and TMP-SMX in the study group were compared to our ED antibiogram. Forty-five patients grew E. coli. Pyelonephritis was suspected in nine (20%) subjects. Compared with the ED antibiogram, significantly lower rates of resistance to ciprofloxacin (2% vs. 42%, p < 0.001), levofloxacin (2% vs. 26%, p < 0.001), and TMP-SMX (16% vs. 33%, p = 0.016) were observed. Six patients grew non-E. coli uropathogens. All were susceptible to both levofloxacin and TMP-SMX. ED antibiograms may overestimate resistance rates for uropathogens causing uncomplicated UTIs. In cases where nitrofurantoin cannot be used, fluoroquinolones and possibly TMP-SMX may remain viable options for treatment of uncomplicated UTI and pyelonephritis in women. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

    Koehler, J.; Thysell, H.; Tencer, J. [Univ. Hospital, Lund (Sweden). Dept. of Nephrology; Forsberg, L.; Hellstroem, M. [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Diagnostic Radiology

    2001-03-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Spontaneous Perirenal Hemorrhage in Cauda Equina Syndrome: A Case Report

    OpenAIRE

    Seok, Hyun; Kim, Sang-hyun; Choi, Won Hyuck; Ko, Yong Jae

    2013-01-01

    Neurogenic bladder is a common cause of acute pyelonephritis (APN) in cauda equina syndrome (CES). Perirenal hemorrhage, a rare complication of APN, can be a life-threatening condition. To our knowledge, there is no previous report of perirenal hemorrhage as a complication of APN in CES. A 57-year-old male, diagnosed with CES, due to a L3 burst fracture 3 months earlier, was presented with fever and chills. His diagnosis was APN due to neurogenic bladder. After treatment for APN, he was trans...

  8. A new urease inhibitor from Viola betonicifolia.

    Science.gov (United States)

    Muhammad, Naveed; Saeed, Muhammad; Khan, Ajmal; Adhikari, Achyut; Wadood, Abdul; Khan, Khalid Mohammed; De Feo, Vincenzo

    2014-10-17

    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.

  9. [Acute fever in children].

    Science.gov (United States)

    Gras-Le Guen, Christèle; Launay, Élise

    2015-05-01

    Fever in children is a very common symptom associated most of the time with a viral infection. However, in 7% of children, fever without source is the first symptom of a serious bacterial infection such as pneumonia, meningitis, pyelonephritis or bacteremia. The key point in clinical examination of these children is the early identification of toxic signs. Because SBI prevalence is higher in very young children (1-3 month-aged), they required a specific management with some systematic complementary investigations and a broad indication of probabilistic antibiotherapy treatment.

  10. Septic abortion caused by Campylobacter jejuni bacteraemia.

    Science.gov (United States)

    Skuhala, Tomislava; Škerk, Višnja; Markotić, Alemka; Bukovski, Suzana; Desnica, Boško

    2016-08-01

    A 20-year-old female patient, 14 weeks pregnant, was admitted to hospital with anamnestic and clinical features of acute pyelonephritis. Clinical signs of septic abortion developed and after obstetric examination the therapy was changed to ampicillin, gentamicin and clindamycin. Campylobacter jejuni was isolated from blood cultures. Pathohistological findings confirmed diagnosis of purulent chorioamnionitis. After 2 weeks of ciprofloxacin administration the patient fully recovered. Campylobacter jejuni was not isolated from stool culture and no signs of acute enteritis were registered during the illness. Invasive forms of Campylobacter disease without enteritis are not unusual in immunocompromised hosts but they are restricted to C. fetus rather than C. jejuni isolates.

  11. Therapeutic ureteral occlusion in advanced pelvic malignant tumors

    Energy Technology Data Exchange (ETDEWEB)

    Kinn, A.C.; Ohlsen, H.; Brehmer-Andersson, E.; Brundin, J.

    1986-01-01

    A technique for ureteral occlusion, combining insertion of nylon plugs with injection of polidocanol, is described. The method was used in 15 patients with vesicovaginal fistulas after operation and irradiation for advanced gynecological malignancy, or with severe malfunction and fibrosis of the bladder after radiotherapy for bladder carcinoma. The urinary leakage ceased in 11 patients, was greatly diminished in 2 and was unchanged in 2. Migration of plugs to the renal pelvis was the most serious complication and may have been the cause of pyelonephritis in 1 case. The technique is recommended for patients with a short life expectancy and uncontrolled, distressing leakage of urine.

  12. [Complications of urinary calculi].

    Science.gov (United States)

    Joual, A; Fekak, H; Rabii, R; el Moussasoui, A; Benjelloun, S

    1996-01-01

    Urinary stones is a frequent disease whose renal complications can engage both functional and vital prognosis. We report 769 complicated cases observed 10 years. The diagnosis was made by intravenous urography and ultrasonography. 607 cases were mechanical complications, 582 hydronephrosis, 25 anuria, 262 were infectious complications, 82 chronic pyelonephritis, 60 pyonephrosis, 10 perinephric abscess. Treatment included adapted antibiotic therapy, ureteral catheter in case of anuria ; surgical extraction of the stone nephrectomy was performed in 100 patients. Results were generally good. 9 patients had endstage chronic renal failure. The high frequency of urinary stone complications is due to the fact that most patients consult late. The diagnosis must obviously be made.

  13. Ultrasonography of bovine urinary tract disorders.

    Science.gov (United States)

    Floeck, Martina

    2009-11-01

    Ultrasonography is a helpful diagnostic tool in cattle with urinary tract disorders. It can be used to diagnose pyelonephritis, urolithiasis, hydronephrosis, renal cysts, renal tumors, amyloidosis, cystitis, bladder paralysis, bladder rupture, bladder neoplasms, and, occasionally, nephrosis, glomerulonephritis, and embolic nephritis. This article describes the anatomy, scanning technique, indications, limitations, normal and pathologic sonographic appearance of the bovine urinary tract. References from horses and humans are included, especially when the sonographic findings in these species may complement the understanding of similar diseases reported in cattle.

  14. Rectal perforation from endometriosis in pregnancy:Case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Adolfo; Pisanu; Daniela; Deplano; Stefano; Angioni; Rossano; Ambu; Alessandro; Uccheddu

    2010-01-01

    This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy.A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of pyelonephritis,which persisted until 33 wk of gestation when delivery of a premature male baby was performed through a cesarean section. On postoperative day 2,an abdominal computed tomography showed free air in the peritoneal cavity and a pelvic abscess.Explorative celiotomy revealed a diffuse s...

  15. Nephrocutaneous fistula as the initial manifestation of asymptomatic nephrolithiasis: A call for radical management

    Directory of Open Access Journals (Sweden)

    Raman Tanwar

    2015-01-01

    Full Text Available Renal stones are a common affliction presenting in an acute setting. We report a case of asymptomatic renal stone in an elderly gentleman presenting initially as a discharging lumbar sinus managed by subcapsular nephrectomy and radical excision of the fistula tract. Nephrocutaneous fistula is most commonly associated with tuberculosis, xanthogranulomatous pyelonephritis, and rarely with complicated calyceal stones, and its occurrence with asymptomatic pelvic stones is rare. We present the points in favor of radical open surgery in the management of such patients.

  16. Indications and results of the unilateral /sup 123/I-hippurate-clearance in an ambulant urological-nephrological patients collective

    Energy Technology Data Exchange (ETDEWEB)

    Mariss, P.; Haubold, E.

    1988-02-01

    In 572 nephrological-urological ambulant patients 688 estimations of unilateral renal plasma flow were performed after application of 300 kBq/kg /sup 123/I-hippurate using a large field scintillation camera, external scintillation probe over the right shoulder and a computer system. The indications were patients with hypertension, chronic pyelonephritis, unilateral nephrocirrhosis, exclusion or approval of renal failure, furthermore diverse malformations of the urovesical system, nephrolithiasis and follow-up after urological operations. The unilateral renal clearance by /sup 123/I-hippurate represents an important diagnostic tool in urological-nephrological patients with special diseases in addition to morphological and microbiological methods.

  17. Management of renal disease in pregnancy.

    Science.gov (United States)

    Podymow, Tiina; August, Phyllis; Akbari, Ayub

    2010-06-01

    Although renal disease in pregnancy is uncommon, it poses considerable risk to maternal and fetal health. This article discusses renal physiology and assessment of renal function in pregnancy and the effect of pregnancy on renal disease in patients with diabetes, lupus, chronic glomerulonephritis, polycystic kidney disease, and chronic pyelonephritis. Renal diseases occasionally present for the first time in pregnancy, and diagnoses of glomerulonephritis, acute tubular necrosis, hemolytic uremic syndrome, and acute fatty liver of pregnancy are described. Finally, therapy of end-stage renal disease in pregnancy, dialysis, and renal transplantation are reviewed.

  18. A rare cause of anuria: Bilateral synchronous isolated mid-ureteric tubercular lesions

    Directory of Open Access Journals (Sweden)

    Anuj D Dangi

    2015-01-01

    Full Text Available A young female presenting with right flank pain, fever, raised creatinine and bilateral hydronephrosis was treated with antibiotics elsewhere, with presumptive diagnosis of bilateral pyelonephritis. She had partial relief in symptoms and her creatinine level showed an improvement. Three months later during evaluation at our center she had anuria, hypertensive crisis and pulmonary edema which were managed with emergency bilateral percutaneous nephrostomies. Cross-sectional imaging and ureteroscopy suggested bilateral synchronous intramural mid-ureteric lesions as underlying pathology. Histopathology of the ureteric segments during laparotomy revealed caseating granulomas suggestive of tuberculosis. This clinical presentation has not been previously described in urinary tuberculosis.

  19. 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.

  20. [Bacteria isolated from urine and renal tissue samples and their relation to renal histology].

    Science.gov (United States)

    Gökalp, A; Gültekin, E Y; Bakici, M Z; Ozdeşlik, B

    1988-01-01

    The bacteria from the urine and renal biopsy specimens of 40 patients undergoing renal surgery were isolated and their relations with renal histology investigated. The urine cultures were positive in 14 patients, the same organisms being isolated from the renal tissue in 7 cases. In 6 patients with negative urine cultures, bacteria were isolated from renal tissues. Of the 28 cases pathologically diagnosed as chronic pyelonephritis, bacteria were isolated from the renal tissue in 13 cases, the urine cultures being positive in only 11 cases. E. coli was the most commonly encountered bacteria in both the urine and renal tissues.

  1. Emphysematous epididymo-orchitis: A rare entity

    Directory of Open Access Journals (Sweden)

    Alok Mathur

    2011-01-01

    Full Text Available Emphysematous epididymo-orchitis is a rare cause of an acute scrotum and is a surgical emergency. Diagnosis is clinically difficult, and sonography with a high-frequency probe is useful to pick up gas shadows in the scrotal wall or testicular substance. A diabetic patient presented with fever, urinary tract infection, and an acute scrotal swelling. The patient needed orchidectomy and scrotal debridement. As in emphysematous pyelonephritis, this condition occurs in diabetics, and patients may need surgery. There is a need to perform sonography in all diabetic patients with an acutely inflamed scrotum, because detection of gas shadows makes surgical intervention more likely.

  2. Postpartum renal vein thrombosis.

    Science.gov (United States)

    Rubens, D; Sterns, R H; Segal, A J

    1985-01-01

    Renal vein thrombosis in adults is usually a complication of the nephrotic syndrome. Rarely, it has been reported in nonnephrotic women postpartum. The thrombosis may be a complication of the hypercoagulable state associated with both the nephrotic syndrome and pregnancy. Two postpartum patients with renal vein thrombosis and no prior history of renal disease are reported here. Neither patient had heavy proteinuria. In both cases, pyelonephritis was suspected clinically and the diagnosis of renal vein thrombosis was first suggested and confirmed by radiologic examination. Renal vein thrombosis should be considered in women presenting postpartum with flank pain.

  3. Hafnia alvei Urosepsis in a Kidney Transplant Patient.

    Science.gov (United States)

    Stanic, Mario; Meusburger, Edgar; Hartmann, Gabriele; Lhotta, Karl

    2015-01-01

    Hafnia alvei, a gram-negative facultative anaerobic, rod-shaped bacterium, is a rare cause of infection in humans. We report on a renal transplant patient who developed H. alvei pyelonephritis and urosepsis. The source of infection remains enigmatic but is most likely the intestinal tract. Appropriate antibiotic therapy with cefepime followed by oral ciprofloxacin brought about rapid resolution of symptoms and complete recovery. H. alvei may cause severe infection in transplant patients without predisposing factors such as hospitalization, invasive procedures, or antibiotic treatment.

  4. Hafnia alvei Urosepsis in a Kidney Transplant Patient

    Directory of Open Access Journals (Sweden)

    Mario Stanic

    2015-01-01

    Full Text Available Hafnia alvei, a gram-negative facultative anaerobic, rod-shaped bacterium, is a rare cause of infection in humans. We report on a renal transplant patient who developed H. alvei pyelonephritis and urosepsis. The source of infection remains enigmatic but is most likely the intestinal tract. Appropriate antibiotic therapy with cefepime followed by oral ciprofloxacin brought about rapid resolution of symptoms and complete recovery. H. alvei may cause severe infection in transplant patients without predisposing factors such as hospitalization, invasive procedures, or antibiotic treatment.

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

    Science.gov (United States)

    Sainaresh, Vv; Jain, Sh; Patel, Hv; Shah, Pr; Vanikar, Av; Trivedi, Hl

    2011-04-01

    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).

  6. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty; a detailed observational cohort study

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jorgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    BACKGROUND: Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: To describe the incidence and consequences of serious RU complications resulting in length...... postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis. CONCLUSION: The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due...

  7. The Army Ambulatory Care Data Base (ACDB) Study: Implementation and Preliminary Data

    Science.gov (United States)

    1988-09-01

    40111*A LC PULMONIC VALVE DISEASE - 41 BOMNL461 lBOK 3 EEROACJA ACDN 04243 3 1 PULMONIC REGURGITATION M0 0 4412 THORCICa 0 04431 CLAUOATID. INTRMITrTENT...DIALYSIS 111 628 INFERTILITY FEMALE ( 193 THYROID CANCER C, C- 5901 PYELONEPHRITIS ACUTE 9 964620 PREGNANCY 111 606 INFERTILITY MALE 246 21 THYROID MASS...L) 24091 GOITER 0 6L )8 11 GRANULOMA. NOS C0 550 ANAL FISSURE - )( 274 GOUT -C r0 0539 HERPES ZOISTIR 00 1540 CANCER . COLON W,/RECTUM 0 C0 7194

  8. A New Urease Inhibitor from Viola betonicifolia

    Directory of Open Access Journals (Sweden)

    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.

  9. Bilateral Psoas Muscle Abscess Associated with Emphysematous Cystitis

    Directory of Open Access Journals (Sweden)

    Jae-Ki Choi

    2015-01-01

    Full Text Available Psoas muscle abscess associated with emphysematous urinary tract infection is very rare. There were very few reports about urinary tract infections such as renal abscess, perinephric abscess, and emphysematous pyelonephritis complicated with psoas muscle abscess; however, psoas muscle abscess associated with emphysematous cystitis has not yet been reported. Here, we report a case of bilateral posas muscle abscess following emphysematous cystitis in an 81-year-old nondiabetic man, who was treated successfully with prolonged antibiotic therapy and supportive care. Early recognition of psoas muscle abscess can prevent aggressive interventional procedure and warrant good prognosis.

  10. Genetics of innate immunity and UTI susceptibility.

    Science.gov (United States)

    Ragnarsdóttir, Bryndís; Lutay, Nataliya; Grönberg-Hernandez, Jenny; Köves, Bela; Svanborg, Catharina

    2011-07-12

    A functional and well-balanced immune response is required to resist most infections. Slight dysfunctions in innate immunity can turn the 'friendly' host defense into an unpleasant foe and give rise to disease. Beneficial and destructive forces of innate immunity have been discovered in the urinary tract and mechanisms by which they influence the severity of urinary tract infections (UTIs) have been elucidated. By modifying specific aspects of the innate immune response to UTI, genetic variation either exaggerates the severity of acute pyelonephritis to include urosepsis and renal scarring or protects against symptomatic disease by suppressing innate immune signaling, as in asymptomatic bacteriuria (ABU). Different genes are polymorphic in patients prone to acute pyelonephritis or ABU, respectively, and yet discussions of UTI susceptibility in clinical practice still focus mainly on social and behavioral factors or dysfunctional voiding. Is it not time for UTIs to enter the era of molecular medicine? Defining why certain individuals are protected from UTI while others have severe, recurrent infections has long been difficult, but progress is now being made, encouraging new approaches to risk assessment and therapy in this large and important patient group, as well as revealing promising facets of 'good' versus 'bad' inflammation.

  11. Urinary tract infections in the elderly.

    Science.gov (United States)

    Matsumoto, T

    2001-08-01

    The elderly population is now increasing in the world. A higher incidence of bacteriuria and urinary tract infection (UTI) is observed in elderly patients, in both long-term care facilities and at home. The management of elderly patients with UTI is increasing in clinical significance. Almost all of UTI in the elderly is complicated UTI. Control of the underlying diseases in the urinary tract is quite important in the management of UTIs in elderly patients. For pyelonephritis, switch therapy using aminoglycosides and fluoroquinolones, carbapenems, third-generation cephalosporines, or penicillins are selections of choice. The recommended duration of treatment for patients with pyelonephritis is 14 days. Seven to 10 days of treatment using fluoroquinolones or trimethoprim-sulfamethoxazole is recommended for the treatment of elderly patients with symptomatic cystitis. Although asymptomatic bacteriuria is quite common in the elderly population, antibiotic treatment has no benefit for such patients. Intravaginal estrogen replacement is one of choice for the prevention of recurrent UTIs in postmenopausal women.

  12. [Horseshoe kidney: not a simple fusion anomaly].

    Science.gov (United States)

    Caccetta, Francesco; Caroppo, Maurizio; Musio, Fernando; Mudoni, Anna; Accogli, Antonella; Zacheo, Maria Dolores; Burzo, Domenica; Bramato, Daniele; Carluccio, Giancamillo; Nuzzo, Vitale

    2015-01-01

    The horseshoe kidney is a congenital anatomical defect of the kidney that occurs in 0,25% of the population and is generally characterized by the fusion of the lower poles of the two kidneys through an isthmus and to which may be associated with urogenital and renal vascular anomalies. Asymptomatic in 1/3 of the cases and, most of time, accidentally discovered during a radiological examination, promotes nephrolithiasis, ureteropelvic junction obstruction, hydronephrosis, vesicoureteral reflux and pyelonephritis. We report two cases of patients with kidney horseshoe, characterized by the abrupt onset of a septic state with oligo-anuric acute renal failure, electrolyte and acid-base abnormalities, rapid decay of the general conditions, with detection of nephrolithiasis, hydronephrosis and acute pyelonephritis and whose clinical management resulted in a significant and synergistic nefro-urology involvment. The kidney horseshoe not represent so only a simple fusion anomaly but rather an important anatomical condition that, once diagnosed, it would be worthy of a careful clinical, radiological and laboratory surveillance, in order to prevent the potential complications that may be also particularly severe.

  13. Detection by molecular hybridization of pap, afa, and sfa adherence systems in Escherichia coli strains associated with urinary and enteral infections.

    Science.gov (United States)

    Archambaud, M; Courcoux, P; Labigne-Roussel, A

    1988-01-01

    The genetic determinants responsible for the adherence of Escherichia coli to uroepithelial cells have been identified in recent years by genetic and molecular methods. Specific DNA probes for each of the three operons which have been cloned so far (pap, afa, sfa/foc operons) have been used in colony hybridization experiments to detect the presence of each of these operons in the chromosomal DNA of 443 strains of E. coli; 186 strains were from patients with urinary tract infections (pyelonephritis, 106 strains; cystitis, 59; asymptomatic bacteriuria, 21) and 257 were strains from the stools of healthy subjects (61) or from patients with various enteral infections (196). E. coli strains harbouring the pap operon were found more frequently in the urine of patients with pyelonephritis (p less than 0.001) and cystitis (p less than 0.01) than in control stools. The presence of two operons (pap + afa) or (pap + sfa/foc) was only observed in uropathogenic strains (p less than 0.02). Pap and sfa/foc operons were never found in strains causing enteral infection; however, the afa operon was found in 7.6% of the enteropathogenic E. coli.

  14. Renal scar formation after urinary tract infection in children.

    Science.gov (United States)

    Park, Young Seo

    2012-10-01

    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 reflux-associated 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.

  15. [Kidney and urinary tract diseases in pregnancy].

    Science.gov (United States)

    Sulser, T; John, H; Zimmermann, R

    1999-10-01

    Management of urologic disorders in pregnant patients often increases the anxiety of all involved. Based on a thorough understanding of the physiologic changes seen in various organ systems the urologist has to assume the responsibility for the well-being of the mother and the fetus. Apart from the urinary tract infection, which occurs as frequent as in non-pregnant patients but has a significantly higher risk of acute bacterial pyelonephritis, it is mainly the pregnancy-associated symptomatic hydronephrosis and the urolithiasis which are complicating approximately 1 of every 1000-1500 pregnancies. Urinary tract infections should be treated in any case by antibiotics according to a antibiogram. High risk patients with history of vesicoureteral reflux or recurrent pyelonephritis should be treated prophylactically. Following parturition these patients should be investigated urologically to exclude structural abnormalities of the genitourinary system. In case of symptomatic hydronephrosis and calculous disease the first approach should be a watchful conservatism with symptomatic relief. If the symptoms persist insertion of a double-J-stent or in case of live-threatening situations (e.g. urosepsis) when urgent decompression and rapid evacuation is mandatory a percutaneous nephrostomy can be brought in place under sonographic monitoring completely thereby avoiding any radiation exposure.

  16. Comparison of renal ultrasonography and dimercaptosuccinic acid renal scintigraphy in febrile urinary tract infection.

    Science.gov (United States)

    Ayazi, Parviz; Mahyar, Abolfazl; Noroozian, Elham; Esmailzadehha, Neda; Barikani, Ameneh

    2015-12-01

    Accurate and early diagnosis and appropriate treatment of patient with urinary tract infection (UTI) are essential for the prevention or restriction of permanent damage to the kidneys in children. The aim of this study was to compare renal ultrasonography (US) and dimercaptosuccinic acid (DMSA) renal scan in the diagnosis of patients with febrile urinary tract infection. This study involved the medical records of children with febrile urinary tract infection who were admitted to the children's hospital in Qazvin, Iran. Pyelonephritis was diagnosed on the basis of clinical symptoms, laboratory tests and abnormal DMSA renal scans. The criteria for abnormality of renal US were an increase or a decrease in diffuse or focal parenchymal echogenicity, loss of corticomedullary differentiation, kidney position irregularities, parenchymal reduction and increased kidney size. Of the 100 study patients, 23% had an abnormal US and 46% had an abnormal DMSA renal scan. Of the latter patients, 15 had concurrent abnormal US (P value ≤ 0.03, concordance rate: 18%). Renal US had a sensitivity of 32%, specificity of 85%, positive predictive value of 65% and negative predictive value of 60%. Of the 77 patients with normal US, 31 (40.2%) had an abnormal DMSA renal scan. Despite the benefits and accessibility of renal US, its value in the diagnosis of pyelonephritis is limited.

  17. [Virulence factors and pathophysiology of extraintestinal pathogenic Escherichia coli].

    Science.gov (United States)

    Bidet, P; Bonarcorsi, S; Bingen, E

    2012-11-01

    Extraintestinal pathogenic Escherichia coli (ExPEC) causing urinary tract infections, bacteraemia or meningitis are characterized by a particular genetic background (phylogenetic group B2 and D) and the presence, within genetic pathogenicity islands (PAI) or plasmids, of genes encoding virulence factors involved in adhesion to epithelia, crossing of the body barriers (digestive, kidney, bloodbrain), iron uptake and resistance to the immune system. Among the many virulence factors described, two are particularly linked with a pathophysiological process: type P pili PapGII adhesin is linked with acute pyelonephritis, in the absence of abnormal flow of urine, and the K1 capsule is linked with neonatal meningitis. However, if the adhesin PapGII appears as the key factor of pyelonephritis, such that its absence in strain causing the infection is predictive of malformation or a vesico-ureteral reflux, the meningeal virulence of E. coli can not be reduced to a single virulence factor, but results from a combination of factors unique to each clone, and an imbalance between the immune defenses of the host and bacterial virulence.

  18. Renal scar formation after urinary tract infection in children

    Directory of Open Access Journals (Sweden)

    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.

  19. THE SPECTRUM OF RENALDISEASEIN IRAN A POST-MORTEM STUDY

    Directory of Open Access Journals (Sweden)

    K. ARMIN

    1974-07-01

    Full Text Available In order to study the incidence and histopathological aspects of renal disease and its role in the mortality rate in Iran, the protocols of 4463 autopsies, performed in the last 15 years at the Tehran University Hospitals were reviewed. Among 4463 autopsies there were 861 cases (20 % of various renal diseases including 282 cases (32.75 % of disease of the interstitium, 176 cases (20.44 % of renal lesions in tuberculous patients, 112 cases (13.0 I % of vascular disease, 101 cases (I L73 % of diseases of the glomeruli, 48 cases (5.57 % of rheumatic carditis, 30 cases (3.48 % of epithelial nephrosis, 78 cases (3.25 % of non tuberculous amyloidosis, 28 cases (3.25 % of congenital malformation, 20 cases (2.37 % of non tuberculous diabetes, 13 cases (L51 % of neoplastic disease, 10 cases (1.16 % os septicemia, 8 cases (0.93 % of eclampsia and 5 cases (0.58 % of myelomatous kidney. The underlying diseases in 35 cases of nephrotic syndrome were: tuberculosis, II cases (31 %; Non-tuberculous amyloidosis, 6 cases (17 ;;,; chronic glomerulonephritis, 5 cases (14 %; chronic pyelonephritis, 3 cases (10 %; and acute pyelonephritis, one case. The kidney was severely affected in systemic amyloidosis in 64 cases.

  20. The Escherichia coli phylogenetic group B2 with integrons prevails in childhood recurrent urinary tract infections.

    Science.gov (United States)

    Kõljalg, Siiri; Truusalu, Kai; Stsepetova, Jelena; Pai, Kristiine; Vainumäe, Inga; Sepp, Epp; Mikelsaar, Marika

    2014-05-01

    The aim of our study was to characterize the phylogenetic groups of Escherichia coli, antibiotic resistance, and containment of class 1 integrons in the first attack of pyelonephritis and in subsequent recurrences in young children. Altogether, 89 urine E. coli isolates from 41 children with urinary tract infection (UTI) were studied for prevalence and persistence of phylogenetic groups by pulsed-field gel electrophoresis (PFGE), antibacterial resistance by minimal inhibitory concentrations (MIC) and class 1 integrons by PCR. Phylogenetic group B2 was most common (57%), followed by D (20%), A (18%) and B1 (5%). Overall resistance to betalactams was 61%, trimethoprim-sulfamethoxazole 28%, and was not associated with phylogenetic groups. According to PFGE, the same clonal strain persisted in 77% of patients. The persistence was detected most often in phylogenetic group B2 (70%). Phylogenetic group B2 more often contained class 1 integrons than group A. Integron positive strains had higher MIC values of cefuroxime, cefotaxime, and gentamicin. In conclusion, phylogenetic group B2 was the most common cause of the first episode of pyelonephritis, as well as in case of the persistence of the same strain and contained frequently class 1 integrons in childhood recurrent UTI. An overall frequent betalactam resistance was equally distributed among phylogenetic groups. © 2013 APMIS. Published by John Wiley & Sons Ltd.