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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical and diagnostic features of renal papillary necrosis (RPN) of 27 patients were studied. Diabetes mellitus was the most frequent (56%) condition associated with RPN. Analgesic abuse, sickle hemoglobinopathy and urinary tract obstruction were present in 4 patients each; in 6 of these 12 patients these conditions were present as a coexistent disease with diabetes mellitus. There was evidence of an acute or chronic infection of the urinary tract in 18 patients, as a coexistent condition with another underlying disease that itself can cause RPN in 14 patients and as the only cause of RPN in another 4. Thus, the presence of more than one diagnostic condition which might be implicated in the causation of RPN was present in 15 patients or 55% of the cases in this series. When infection was excluded, six patients or 22% of the cases had two coexisting diseases, each of which has been implicated as a cause of RPN. This observation underlines the multifactorial nature of this entity and might explain why RPN is not encountered more frequently in each of the various primary diseases with which it has been associated. The average age of the patients at the time of diagnosis was 53 years for women and 56 years for men. Only six of the patients were younger than 40 years, and three of these had sickle hemoglobinopathy. The diagnosis of RPN was based on x-ray findings in eight patients, on the histologic examination of papillary tissue in urine in one, and on autopsy findings in the rest. Papillary necrosis was bilateral in three-fourths of the cases. The clinical picture varied. Most of the patients (67%) presented with chills and fever. Flank pain and dysuria were present in 11 patients (41%). As a rule oliguria was rare and progressive uremia was uncommon. In cases diagnosed at post-mortem, the patients had succumbed to infection or to a primary severe extrarenal disorder with the possibility of RPN having been entertained clinically in only half these cases prior to autopsy.
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PMID:Renal papillary necrosis: an update. 703 74

A 32-year-old woman was hospitalized with the chief complaints of high fever and right flank pain. The patient had received treatment for diabetes mellitus and liver cirrhosis. The patient's laboratory data indicated pyuria, renal dysfunction and hyperglycemia. E. coli was detected in the blood, urine and pus. Plain abdominal X-ray revealed gas shadows at the right renal region. Abdominal CT scanning also showed gas shadows in the renal parenchyma of both sides. A diagnosis of bilateral emphysematous pyelonephritis was made. Chemotherapy and retroperitoneal drainage was performed. After therapy, the patient's laboratory data was improved and the abnormal gas shadows disappeared. We reviewed 77 cases of emphysematous pyelonephritis, including our case, from the Japanese literature.
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PMID:[A case of bilateral emphysematous pyelonephritis associated with diabetes mellitus and liver cirrhosis]. 808 61

Spontaneous perinephric hematoma is a rare condition that is usually caused by benign and malignant renal tumors, vascular abnormalities and inflammatory disorders. However, a few patients in whom there is no apparent underlying disease are described as having idiopathic spontaneous perinephric hematoma. We report on a middle-aged patient with diabetes mellitus who was hospitalized for sudden onset of right upper flank pain. A large tender mass was palpable in the right upper abdominal quadrant. The hematocrit decreased from 32% on admission to 23% during the following hours. Computerized tomography of the abdomen revealed a large perinephric mass, which was denser than the adjacent renal parenchyma and hypodense after intravenous iodine injection, findings which were compatible with perinephric hematoma. The patient underwent exploratory laparotomy because of hemodynamic instability. Uncontrollable bleeding from a discolored apical renal lesion led to nephrectomy. On pathological examination this apical lesion proved to be a renal infarct with considerable bloody inhibition of perirenal tissues. Extensive search for an underlying disease that led to the infarction was unsuccessful.
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PMID:Spontaneous perinephric hemorrhage in a middle-aged diabetic women. 812 42

We report a case of an infected renal cystic mass associated with bacterial meningitis in a 70-year-old woman who had had poorly-controlled diabetes mellitus for approximately 30 years. She suffered from bacterial meningitis due to Klebsiella pneumoniae, which was successfully treated with antimicrobial chemotherapy for 1 month. Approximately 2 weeks later she developed left flank pain and a high fever. A CT scan and an ultrasonogram revealed a left renal cystic mass, which was considered to be an infected renal cyst. Turbid and thick fluid was obtained by percutaneous aspiration which contained numerous white blood cells. Culture of this fluid yielded K. pneumoniae. The bacterial meningitis was considered to be a secondary infection of the septicemia which resulted from the infected renal cystic mass.
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PMID:Infected renal cystic mass associated with bacterial meningitis: a case report. 884 88

Primary renal mucormycosis is a rare infection capable of acute illness with sepsis. Few cases have been reported. We report a case of an acute primary renal mucormycosis and review the published reports. The incidence of primary renal mucormycosis has risen in recent years. The most frequently reported underlying predisposing disorders are human immunodeficiency virus infection, intravenous drug abuse, and diabetes mellitus. Primary renal mucormycosis should be suspected in patients with an immunocompromising illness or particular risk factors, when persistent flank pain and fever with sterile urine not responding to appropriate antibiotics are associated with enlarged heterogeneous kidneys.
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PMID:Primary renal mucormycosis. 980 Nov 27

We report a case of giant psoas abscess with aggressive extension outside the muscles of the iliopsoas component. A 57-year-old man was admitted to our hospital, presenting with right flank pain and severe general malaise. He had been diabetic, but no treatment had been performed for diabetes. Leukocytosis, positive CRP and hyperglycemia were noted, but he was nearly afebrile on admission. Computerized tomography revealed a large multilocular mass in the right retroperitoneal space involving the ipsilateral psoas muscle. The diagnosis was not apparent until the 12th hospital day, when moderate grade fever was noted and brownish purulent fluid was obtained by percutaneous puncture of the mass. Staphylococcus aureus was isolated on culture. Antibiotic chemotherapy was started, and ultrasound-guided percutaneous drainage was then performed under the diagnosis of psoas abscess. At that time, the abscess was aggressively extending from the iliopsoas component into the pelvic floor, involving the rectus muscle, the gluteal muscles and formation of subucutaneous lesions. At 46 days after drainage, surgical resection of the abscess with removal of the adjucent tissue was performed because of persistent discharge of pus and multiple residual lesions. The postoperative course was uneventful, and there has been no recurrence. Many cases of psoas abscess have been reported in the Japanese literature. Prompt drainage, either percutaneously or surgically are required. Surgical resection of the abscess, with not only opening the cavity but also removal of the adjacent tissue, may be recommended in some cases, especially those diffuse or multilocular lesions.
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PMID:[Giant psoas abscess with aggressive extension: report of a case]. 1065 17

Fungal urinary tract infections are an increasing problem in hospitalized patients. Funguria may be a result of contamination of the urine specimen, colonization of hte urinary tract, or may be indicative of true invasive infection. In this study, we report the risk factors, clinical features, treatments and outcome in a group of 68 hospitalized patients (adults and children) with fungal isolates recovered from 103 urinary samples. Underlying medical conditions were present in most patients. In the pediatric group, urinary tract abnormalities (86%) and prematurity (19%)accounted for the majority of the cases. Diabetes mellitus (28%), nephrolithiasis, and benign prostatic hyperplasia were the most common diseases in adults. Indwelling urethral catheters were noted in 38% of the pediatric patients and in 43% of adults during hospitalization. Candida albicans strains were responsible for 97% and 75% of positive cultures in children and adults, respectively. Symptoms such as fever, dysuria, frequency and flank pain were generally absent in both groups. Fluconazole was the most frequent antifungal utilized (61%) in children and ketoconazole in the adult group (42%). Removing the urinary catheter was attempted in 6 pediatric patients (29%) and in only 8 adults (17%). One patient (4%) in the pediatric group died compared to 10 in the adult group (21%, p=0.04). Successful diagnosis and treatment of funguria depends on a clear understanding of the risk factors and awareness of fungal epidemiology.
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PMID:Hospital-associated funguria: analysis of risk factors, clinical presentation and outcome. 1198 May 93

A 72-year-old non-diabetic uremic woman underwent right nephrectomy for urolithiasis at the age of 50. Because pyuria, fever, chilliness and left flank pain developed during preparing for arteriovenous fistula, she was admitted to National Cheng Kung University Hospital. Renal cell carcinoma (RCC) complicated with emphysematous pyelonephritis (EPN) was diagnosed and immediately treated with antibiotics and CT-guided percutaneous catheter drainage. Cultures of pus and blood yielded Escherichia coli. She received left radical nephrectomy later for the control of persistent sepsis and removal of left renal tumor. The pathology of the tumor was composed of a glandular arrangement of granular cells with the occasional atypism, and renal parenchyma had been totally replaced by RCC. The non-tumor part of the kidney showed chronic pyelonephritis. Five months later, multiple metastases developed. We reported this first uremic case with EPN and RCC, but without diabetes mellitus and urinary tract obstruction. The gas formation may be due to large RCC, which caused impaired tissue perfusion and E. coli infection.
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PMID:Renal cell carcinoma complicated by emphysematous pyelonephritis in a non-diabetic patient with renal failure. 1218 10

A 48-year-old woman was referred to our hospital with high fever and left flank pain. She was diagnosed with diabetes mellitus (DM), and abdominal computed tomography (CT) revealed left perinephric abscess with much emphysema. She underwent drainage of the abscess by left flank incision after treatment with antibiotics and insulin. The pus culture revealed Escherichia coli. Immediately after drainage, the symptoms began to subside. At three months after drainage, abdominal CT revealed no emphysema around the left kidney. At 18 months after the discharge, left perinephric abscess was not seen and DM was well controlled with insulin.
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PMID:[Emphysematous perinephric abscess with diabetes mellitus: a case report]. 1240 80

A 67-year-old male had been maintained on hemodialysis for 13 years because of chronic renal failure secondary to diabetes mellitus. The patient was referred to our hospital with sudden right flank pain. Computed tomography revealed multiple cysts in both kidneys and a right massive perirenal hematoma. Although there was no definite evidence of a renal tumor, a right nephretomy was performed. Histological study revealed acquired cystic disease of the kidney (ACDK) with a hematoma containing papillary renal cell carcinoma. He has been free of recurrence for 2 months. To our knowledge, this case is the fourth report of renal cell carcinoma in ACDK manifested by spontaneous rupture in the Japanese literature.
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PMID:[Renal cell carcinoma in acquired cystic disease of the kidney manifested by spontaneous renal rupture]. 1278 22


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