Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 23 confirmed cases of pyonephrosis initially treated by percutaneous nephrostomy drainage were reviewed. Presentation was extremely variable, ranging from sepsis to asymptomatic bacteriuria. Fever, flank pain and leukocytosis were often absent. Ultrasonography was diagnostic in only 3 of 12 patients. In all, 17 patients had associated nephrolithiasis, and 5 patients ultimately required nephrectomy. Renal urine cultures were positive in 16 of 21 instances, with multiple organisms found in 8 of 21, and added bacteriological data not provided by bladder urine cultures in 11 cases. A pre-existing history of urinary tract infection, hypertension and malignancy was common. Percutaneous drainage was a safe, quick and effective diagnostic and therapeutic method.
 ...
PMID:Pyonephrosis: diagnosis and treatment. 145 Aug 41

Urinary tract infections are among the most common bacterial infections. To provide appropriate and cost-effective treatment, physicians need to stratify patients with urinary complaints into uncomplicated or complicated categories. This can be accomplished by the history, presenting symptoms, risk factors, and physical examination. Complicated urinary tract infections occur in patients with a history of recurrent infections, signs or symptoms of upper tract disease, or coexisting conditions such as pregnancy, immunosuppression, or structural anomalies of the urinary tract. Uncomplicated urinary tract infections occur in otherwise healthy women who have a history of lower tract symptoms of short duration. Symptoms of urinary tract infection include some combination of dysuria, frequency, urgency, hematuria, and suprapubic pain. An uncomplicated urinary tract infection is not accompanied by fever or flank pain. The microbiology of uncomplicated urinary tract infection is predictable, with Escherichia coli and other Enterobacteriaceae, Staphylococcus saprophyticus, and Enterococcus causing more than 90% of urinary tract infections. A history, brief physical examination, and urinalysis are all that is necessary to diagnose a urinary tract infection. Some of the specialized dipsticks and rapid screens are as accurate as microscopic examination in detecting urine white cells. A presumptive diagnosis can be made when a patient has clinical symptoms and some combination of pyuria, hematuria, or bacteriuria. Urine cultures are unnecessary in uncomplicated urinary tract infections and add substantially to the cost of therapy. Pitfalls in the diagnosis include other entities causing dysuria, such as vaginitis, vulvar lesions, physical or chemical irritants, and sexually transmitted diseases. Appropriate therapy requires selection of a drug and determination of the length of treatment. A minor infection should be treated with easy, safe, cost-effective therapy. For urinary tract infections, there are too many antibiotic options, ranging from a single, parenteral dose to a 14-day course of oral medication. Early optimism about single-dose oral therapy has been replaced by evidence suggesting that 3 days of therapy is probably the best. This will eradicate simple urinary tract infections in virtually all patients and decrease the incidence of relapse, whereas patients who are treatment failures usually have occult upper tract infection. Drug choices for short-course therapy include representatives from the penicillin, sulfa, and quinolone families. Selection of a specific drug requires consideration of costs, allergies, side effects, and spectrum of activity. A knowledge of local microbial sensitivity profiles and individual patient tolerance is helpful in guiding the clinician to the appropriate therapeutic regimen.
 ...
PMID:New directions in the diagnosis and therapy of urinary tract infections. 203 19

To evaluate diagnostic criteria for bacteriuria in acutely spinal cord injured patients undergoing intermittent catheterization, we studied paired urine specimens obtained by suprapubic aspiration and intermittent catheterization. Culture of suprapubic aspirate was used to define presence or absence of bacteriuria. Fifty patients were studied for an average of 5 consecutive days; bacteriuria occurred within the study period in 47 (94%). Low-level bacteriuria was frequent; thus, the traditional diagnostic criterion, greater than or equal to 10(5) cfu/ml of midcatheter urine, had unacceptably low sensitivity (gram-positive organisms 0.45; gram-negative organisms 0.65) for bacteriuria documented by suprapubic aspiration. The best diagnostic criterion for gram-positive bacteriuria was between greater than or equal to 10(1) cfu/ml (sensitivity 0.91, specificity 0.86) and greater than or equal to 10(2) cfu/ml (sensitivity 0.85, specificity 0.93). For gram-negative bacteriuria, greater than or equal to 10(1) cfu/ml was optimal (sensitivity 0.96, specificity 0.96); a more practical criterion, greater than or equal to 10(2) cfu/ml, retained excellent sensitivity (0.91). Suprapubic or flank pain and/or tenderness occurred in five of 47 bacteriuric subjects; nonspecific symptoms, possibly associated with bacteriuria, were seen in an additional 28 subjects. We conclude that, in this unique population, a criterion of greater than or equal to 10(2) cfu/ml of midcatheter urine should be used for diagnosis of bacteriuria.
 ...
PMID:Evaluation of diagnostic criteria for bacteriuria in acutely spinal cord injured patients undergoing intermittent catheterization. 318 Jul 5

In a study of bacteriuria in elderly (mean age 85 years, range 69 to 101), mostly middle- and upper-class Jewish subjects, attempts were made to determine if bacteriuria without dysuria is otherwise asymptomatic. Seventy-two subjects (59 women and 13 men) without dysuria were questioned about other urinary symptoms (incontinence, frequency, urgency, suprapubic pain, flank pain, fever) and symptoms indicating a lack of well-being (anorexia, difficulty in falling asleep, difficulty in staying asleep, fatigue, malaise, weakness) when they were with and without bacteriuria. Twenty-two subjects had bacteriuria that resolved spontaneously; bacteriuria subsequently developed in 24 nonbacteriuric subjects; and 26 subjects had bacteriuria that resolved with antimicrobial therapy. Subjects occasionally reported urinary symptoms (especially incontinence) and commonly reported symptoms indicating a lack of well-being when they were with and/or without bacteriuria. However, no differences in symptoms were found when bacteriuric subjects were compared with themselves when they were nonbacteriuric. Thus, bacteriuria without dysuria in the elderly appears to be asymptomatic.
 ...
PMID:Lack of association between bacteriuria and symptoms in the elderly. 379 58

Bacterial localization in potential transplant recipients with end stage renal disease and bacteriuria allowed for a significant decrease in the frequency of bilateral nephrectomy before transplantation. Lack of complications after transplantation showed the reliability of preoperative localization, especially if bacteriuria was localized substantially to the bladder despite flank pain and fever.
 ...
PMID:Bacterial localization in patients with end stage renal disease to avoid bilateral nephrectomy before renal transplantation. 634 33

We evaluated 27 patients with presumed acute pyelonephritis. The clinical criteria included flank pain, fever, bacteriuria and leukocytosis. When compared to excretory urograms renal scintillation camera studies confirmed the diagnosis in 19 patients, including 5 with normal excretory urograms, and disproved it in the remaining 8. This radionuclide study was found to be more precise. If the study is normal the diagnosis of pyelonephritis is excluded and further studies are not needed.
 ...
PMID:Clinical studies in acute pyelonephritis: is there a place for renal quantitative camera study? 712 May 44

A followup study on nonhospitalized spinal cord injury patients using clean intermittent catheterization was conducted to evaluate long-term clean intermittent catheterization for any genitourinary complications, and to institute and evaluate prompt management. A total of 50 patients (36 paraplegics and 14 quadriplegics) was followed for 3 months to 6.5 years (average followup 22 months). All patients had a baseline urodynamic study and renal scan before they were discharged from the hospital. Patients with a reflex bladder and sustained, high intravesical pressures (greater than 40 cm. water) were placed on anticholinergic medication to lower voiding pressures and maintain continence. Those on clean intermittent catheterization and condom drainage were also given alpha-blockers to achieve low pressure voiding and to control autonomic dysreflexia. Of 50 patients 43 (86%) acquired a total of 364 events of significant bacteriuria (10(4) or more colony-forming units per ml.) at a rate of 13.63 infections per 1,000 patient-days on clean intermittent catheterization. Subclinical symptoms for urinary tract infection were noted in 22 of the 43 patients (51%), whereas clinical symptoms for urinary tract infection were recorded in 16 of 43 (37%). These symptoms included fever in 8 patients, chills in 3, hematuria in 3 and flank pain in 2. There were 31 genitourinary complications in 21 patients noted during periodic diagnostic evaluations, with 6 classified as upper tract. Of 50 patients 4 (8%) required rehospitalization for urological problems. One patient died of questionable sepsis. Transurethral sphincterotomy was performed in 15 of the 50 patients (30%) and transurethral prostatectomy was done in 1 for multiple reasons, for example high intravesical voiding pressures, difficult catheterization, repeated symptomatic urinary tract infections or per patient request to discontinue clean intermittent catheterization. Of 7 patients who were catheterized by others 4 elected to discontinue long-term clean intermittent catheterization after an average of 13 months. Overall, 33 patients (66%) discontinued clean intermittent catheterization and 17 are still being followed on a long-term basis. Clean intermittent catheterization is a successful long-term option to drain bladders in spinal cord injury patients who can perform catheterization independently.
 ...
PMID:Clean intermittent catheterization in spinal cord injury patients: a followup study. 848 12

During acute inflammatory processes, extracellular release of granulocyte elastase can contribute to subsequent tissue damage. To test our hypothesis that extracellular elastase release during acute pyelonephritis may contribute to subsequent renal parenchymal damage, we compared the intracellular and extracellular activities of the lysozyme elastase of human polymorphonuclear cells (PMN) when incubated in vitro with bacterial strains causing renal infection that led to either renal damage or no damage. Urine bacterial cultures were obtained from patients with acute pyelonephritis (flank pain, costovertebral angle tenderness, fever > 38 degrees C, bacteriuria, pyuria, and leukocytosis). Renal damage was demonstrated by cortical scarring on followup intravenous pyelography and/or diminished function on 131iodine hippuran renal scan. Mean extracellular elastase activity (mu units/PMN) was 0.15 for unstimulated PMN, 0.07 for PMN stimulated by bacteria not associated with renal damage, and 1.20 for the PMN stimulated by strains associated with renal damage. Mean intracellular elastase activity (mu units/PMN) was 3.73 for unstimulated PMN, 3.48 for PMN stimulated by bacteria not associated with renal damage, and 3.31 for the PMN stimulated by strains associated with renal damage. Extracellular granulocyte elastase activity was thus significantly higher (P = 0.0001) in PMN stimulated by bacterial strains associated with renal damage. Extracellular release of elastase may contribute to the pathogenesis of renal damage in pyelonephritis.
 ...
PMID:The possible role of granulocyte elastase in renal damage from acute pyelonephritis. 858 15

Urolithiasis during pregnancy, though rare, can be challenging both diagnostically and therapeutically. It is helpful if the physician is quick to suspect the presence of stones in the presence of appropriate signs and symptoms, particularly flank pain and tenderness, hematuria, or unresolved bacteriuria. Ultrasonography is the diagnostic imaging method of choice, but modified intravenous urography should be performed whenever this study is necessary for a prompt diagnosis. In the absence of sepsis, renal failure, or intractable pain, conservative management with hydration, analgesics, and (if infection is present) antibiotics is the favored initial approach. If conservative management fails, stent insertion or placement of a percutaneous nephrostomy tube may be appropriate. Ureteroscopy with stone manipulation for distal ureteral stones during pregnancy has also been reported in some cases. If these methods fail, open surgery should be used for stone removal.
 ...
PMID:Urinary calculi during pregnancy. When are they cause for concern? 885 87

Complications resulting from persistent and repeated urinary tract infections (UTIs) account for nearly 1 million hospital admissions annually. Cystitis, a localized bladder infection occurring in the lower tract, is recognized by a symptom complex of dysuria, frequency, urgency, and suprapubic tenderness; pyelonephritis, which refers to upper tract infection of the kidneys, classically manifests with flank pain and systemic as well as cystitis signs. An empiric 3-day antibiotic regimen has been shown to be more than 95% effective in curing cystitis. But for a subgroup of patients, a relapse of "cystitis" within 4 weeks can signal a subclinical, "silent," pyelonephritis. A 14-day course of antibiotics is indicated to treat the recurrent UTI. Follow-up urinalysis and urine cultures are then repeated 2 and 4 weeks after therapy. If symptoms and/or bacteriuria are again documented with the same organism, subclinical pyelonephritis is presumed; a prolonged 6-week course of antibiotics is then warranted to prevent prolonged problems and complications associated with UTIs. When the problem is reinfection with a microorganism different from that responsible for the last infection, short-course therapy for 3 days may be prescribed for each episode. When reinfection occurs more frequently than 2 to 3 times a year, however, antibiotic prophylaxis to prevent reinfections is warranted.
 ...
PMID:Can a Silent Kidney Infection or Genetic Predisposition Underlie Recurrent UTIs? 974 44


1 2 Next >>