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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of infection in the renal transplant patient is directly related to the net immunosuppressive effect achieved and the duration of time over which this therapy is administered. A second major factor in the causation of infections in this population is the nosocomial hazards to which these patients are exposed, ranging from invasive instrumentation to environmental contamination with Aspergillus species, Legionella pneumophila, Pseudomonas aeruginosa and other microbial pathogens. Careful surveillance is necessary to identify and eliminate such nosocomial sources of infection. The major types of infection observed can be categorized according to the time period post-transplant in which they occur: postsurgical bacterial infection in the first month after transplantation; opportunistic infection, with cytomegalovirus playing a major role, and transplant pyelonephritis in the period one to four months post-transplant; and a mixture of conventional and opportunistic infections in the last post-transplant period. Conventional infection in this late period occurs primarily in patients with good renal function who are receiving minimal immunosuppressive therapy; opportunistic infection occurs primarily in patients with poor renal function who are receiving higher levels of immunosuppression.
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PMID:Infection in the renal transplant recipient. 625 32

Ceftizoxime (FK 749, CZX) was evaluated in 24 children with a suspicion of bacterial infection. Of the 17 confirmed bacterial infections, 16 were shown to be effective (effective rate, 94.1%). The diagnosis included acute pharyngitis (2), pneumonia (6), staphylococcal empyema (1), cervical purulent lymphadenitis (2), acute enterocolitis (2), acute pyelonephritis (1), SSSS (1) and suspected septicemia (2). The etiological pathogens recovered were Streptococcus anginosus (1), Streptococcus pneumoniae (1), Staphylococcus aureus (2), Haemophilus influenzae (3), enteropathogenic Escherichia coli (1) etc. A case of suspected Pseudomonas aeruginosa septicemia was not effectively treated with CZX. The serum half-life of CZX was 1.36 hours after intravenous bolus infection. A cerebrospinal fluid level of CZX was 6.2 mcg/ml 1 hour after intravenous bolus injection of 1 g (23.8 mg/kg) in a child with inflamed meninges. No severe adverse reaction was encountered with the CZX therapy. The data suggest that CZX is an excellent candidate for the first choice parenteral antibiotic in the pediatric infections.
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PMID:[Clinical evaluation of ceftizoxime in the pediatric infections (author's transl)]. 627 2

Patients with acute pyelonephritis may present with a spectrum of clinical signs and symptoms. There are few noninvasive diagnostic studies, however, to confirm or exclude this diagnosis. A small number of patients, generally those with severe disease, will demonstrate radiographic changes on excretory urography, but the lack of sensitivity of the IVP in early, acute pyelonephritis is well documented. Several radionuclide techniques have been proposed to assist in the earlier detection of this clinical problem including imaging with Mercury-197 chlormerodrin, Gallium-67 citrate, Technetium-99m glucoheptonate. Technetium-99m DMSA, and, more recently, Indium-111 labeled white blood cells. The success of the renal cortical imaging agents as well as those which localize in infection are described in this report. There appears to be a complimentary role or the cortical imaging agents and the radiopharmaceuticals which localize in bacterial infection. Cortical agents offer the advantage of specific assessment of functioning renal tissue and a convenient, rapid method for following the response to treatment in a noninvasive manner. A pattern is described which may be diagnostic; correlation with Gallium-67 citrate of Indium-111 WBCs may increase the probability of infection as the cause for the cortical abnormality. The measurement of differential renal function using cortical agents provides additional information to assist the clinician in predicting the late effects of infection. Improved sensitivity and specificity, and a reproducible method for following the response to therapy in patients with acute pyelonephritis are the advantages of the techniques described.
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PMID:Nuclear renal imaging in acute pyelonephritis. 628 55

Quantitative criteria distinguish bacterial infection (or colonization) of the urine from contamination. These criteria depend on the fact that the density of bacteria in infected urine is usually several orders of magnitude higher than the density of bacteria in contaminated urine. Most research on quantitative definitions of infection has concerned Gram-negative rod infections in women. For asymptomatic bacteriuria, the most prevalent urinary tract infection, and for pyelonephritis, a criterion of 1 X 10(5) cfu/ml provides optimal separation of infection from contamination of voided urine. For acute dysuria and frequency, recent evidence supports the use of a colony count of 1 X 10(2) cfu/ml bacteria as the most useful criterion. For the diagnosis of catheter-associated urinary tract infection, the criterion of 1 X 10(5) cfu/ml has been used most commonly, although a lower threshold may be appropriate. Additional investigation is required to determine the most appropriate quantitative definition of infection in this and several other circumstances.
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PMID:Quantitative definition of bacteriuria. 634 44

The structural basis for the cross-reactivity between the Escherichia coli K13, K20 and K23 capsular polysaccharides is the ----)-beta-ribofuranosyl-(1----7)-beta-2-keto-3-deoxyoctonate polymer. Monoclonal antibodies against E. coli K13 which require O-acetyl-2-keto-3-deoxyoctonate for binding were further investigated. Such antibodies, of both the IgG and the IgM isotype, opsonized E. coli K13 in vitro and protected against intraperitoneal infection in mice as well as ascending pyelonephritis in rats. A monoclonal IgG1 anti-idiotype, specific for the K13 polysaccharide combining site of a protective IgM idiotype, primed for protection against intraperitoneal infection with live E. coli K13 following K13 injections at four as well as 12 weeks of age. the K13 polysaccharide alone did not immunize and protect. The monoclonal anti-K13 idiotype only primed for protection at four weeks of age. These findings suggest a strong effect of a single idiotype on the outcome of a bacterial infection.
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PMID:Studies on immunity against Escherichia coli K13 with monoclonal anti-K13 and anti-anti-K13. 638 95

1. MIC of 6059-S against 92 strains of clinically isolated bacteria were measured. The compound was active against most of Gram-negative rods, but was not active against Staphylococcus aureus. 2. 20 mg/kg of 6059-S (newly synthesized oxacephem antibiotics) was administered to the pediatric patients and its blood concentration was measured by agar well method using E. coli 7437 as a test organism. 3. The mean blood concentrations were maximum at 15 minutes after intravenous one-bolus injection. Maximum levels were 94.5 mcg/ml in the patients of below 5 years old and 98.7 mcg/ml above 6 years old. Their half-life of the blood levels were 95.4 and 110.6 minutes respectively. 4. The mean blood concentrations were highest at the end of the infusion in the cases of 60 minutes drip injection. Maximum levels were 85.0 mcg/ml in the patients of below 5 years old and 64.8 mcg/ml above 6 years old. 5. Clinical efficacy of 6059-S in 6 cases pyelonephritis, 2 cases of sepsis, 1 case of meningitis, 1 case of intraperitoneal abscess, 9 cases pneumonia and 2 case of tonsillitis was 100%. In the case of urinary tract infection, 4 patients were treated successfully by the administration of 20 mg/kg/day of 6059-S. Other bacterial infections were treated with 55 to 200 mg/kg/day. 6. 100% of the causative organisms were eliminated by 6059-S. They were E. coli, Klebsiella pneumoniae, Serratia marcescens, H. influenzae and beta-Streptococcus. 7. No remarkable side effect was noticed during administration.
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PMID:[Basic and clinical examinations of 6059-S in pediatrics (author's transl)]. 645 66

Although the role of bacterial infection as the major determinant in the development of acute pyelonephritis has been well documented for years, the nature of the renal scarring typical of chronic "atrophic" pyelonephritis has been a matter of controversy for at least three decades. In the past, recurrent bacterial infection of the kidney was thought to be responsible for the pathologic entity of "chronic pyelonephritis." However, more recent studies suggest that recurrent bacteriuria, in the absence of some form of obstructive uropathy, rarely produces chronic pyelonephritis. The close association between vesicoureteral reflex and chronic pyelonephritis has also been firmly established and has been observed to occur frequently in the absence of urinary tract infection. However, the mechanism by which vesicoureteral reflux injures the kidney has not been firmly established. A number of observations have suggested that some normal component of urine, particularly Tamm-Horsfall protein, might serve as an antigenic determinant involved in the immunopathogenesis of renal scarring in vesicoureteral reflux. The present studies were designed to investigate the immunopathogenic role of Tamm-Horsfall protein in a rabbit model of tubulointerstitial nephritis, and in a swine model of reflux nephropathy. The immune responses to Tamm-Horsfall protein in patients with recurrent nephrolithiasis were also examined, as were the antigenic similarities between Tamm-Horsfall protein and protein-containing components of uropathic bacteria. The results of these studies indicate that autoimmune responses to Tamm-Horsfall protein may occur after exposure to Tamm-Horsfall protein by intravenous challenge in rabbits, and by urinary reflux in pigs, as well as in recurrent nephrolithiasis in man.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Autoimmune responses to Tamm-Horsfall protein in the pathogenesis of chronic pyelonephritis. 654 94

Thirty patients with focal renal masses were evaluated on a .12-Tesla resistive magnetic resonance unit using partial saturation and spin echo pulse sequences. A short repetition time (TR = 143 ms) was employed for partial saturation images and a spin echo was present in each case (TE = 10 ms). Additional pulse sequences through regions of interest were also obtained. Fifteen patients had cystic lesions, nine patients had renal cell carcinoma, two had metastatic lesions, one had an angiomyolipoma, and three had focal bacterial infection. Cystic lesions were well circumscribed and demonstrated a range of signal intensities. Small intra-parenchymal cysts were difficult to identify. Renal cell carcinomas demonstrated areas of increased signal using a partial saturation sequence (TR = 143-415 ms, TE = 10 ms). Magnetic resonance imaging accurately detected perinephric extension and vascular invasion in all patients. Metastatic disease to the kidney was uniformly low in signal, in contrast to primary renal cell carcinoma; an angiomyolipoma demonstrated very high signal intensity. Two masses resulting from acute focal bacterial nephritis were uniformly low in signal. One additional case of a more indolent pyelonephritis demonstrated high signal in regions of replacement lipomatosis and low signal in sites of active infection. Magnetic resonance imaging appears to be an accurate way of detecting, identifying, and staging focal renal masses.
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PMID:Focal renal masses: magnetic resonance imaging. 673 18

Ascending acute pyelonephritis was produced in monkeys by infusion of bacteria through a ureteral catheter to the point of intrarenal reflux. This led to a significant inflammatory response with death of renal tubular cells in the area of the tubular granulocytes and bacteria. We gave superoxide dismutase, and found that the inflammatory response was decreased and fewer tubular cells were killed. Ultrastructural change was also decreased in tubular cells adjoining phagocytosing neutrophils. This suggests that renal damage following a bacterial infection may be due to the production and release of superoxide into the tubular lumen during phagocytosis. We believe that it is the initial event which may lead to the eventual loss of renal tissue and function called chronic pyelonephritis.
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PMID:Immunology of pyelonephritis in the primate model. V. Effect of superoxide dismutase. 675 91

The importance of bacterial infection as a major cause of progressive renal failure has become less prominent as long-term studies have failed to show progressive renal disease in bacteriuric humans. Functional or anatomic abnormalities of the urinary tract are necessary to perpetuate infection and cause renal scars and renal failure. In children, the most common abnormality is reflux. Sterile reflux that extends into the renal collecting ducts may cause scars previously called atrophic pyelonephritis. This entity is now referred to as reflux nephropathy. Other predisposing factors may lead to end-stage disease in a small proportion of bacteriuric patients. The most common are obstructive uropathy and calculus disease. Bacteriuria is difficult to eradicate in maintenance hemodialysis patients and may require bilateral nephrectomy. In transplant recipients, bacteriuria is common and has been associated with rejection and loss of allograft.
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PMID:The role of urinary tract infection in chronic renal failure. 703 45


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