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

Urinary diversion by transplantation of both ureters into a reservoir constructed from 60 cm of jejunum was performed in six clinically normal dogs. The reservoir was connected to a stoma on the abdominal wall through a valve constructed from a short segment of intussuscepted bowel to provide continence. The reservoir was emptied three times daily by catheterization. One dog did not survive the surgical procedure and two dogs died within 1 week of surgical complications. The postoperative capacity of the reservoir in surviving dogs was 100 to 200 mL; it increased during the first month to 600 to 750 mL. Continence was excellent in two dogs. One dog was continent until month 2, when partial slippage of the intussusception occurred. A reversible hyponatremic, hypochloremic, hypokalemic metabolic acidosis developed. Bacteriuria was not responsive to systemic or local instillation of antibiotics. Ascending pyelonephritis, hydroureter, and hydronephrosis occurred in two dogs. Struvite urinary calculi formed in one dog. The procedure as described would be unsuitable for clinical use in dogs.
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PMID:Continent jejunal reservoir (Kock pouch) for urinary diversion in dogs. 162 96

Correction of vesicoureteral reflux at enterocystoplasty is often recommended to prevent the development of reflux nephropathy. Children with enterocystoplasty who require intermittent self-catheterization invariably have asymptomatic bacteriuria. In patients with persistent vesicoureteral reflux after enterocystoplasty the risk of renal damage from this asymptomatic bacteriuria is unknown. Detubularized ileocystoplasty was performed in 17 dogs with either direct nontunneled reimplantation or unroofing of the intramural tunnel and incision of the ipsilateral hemitrigone to create vesicoureteral reflux. Fluoroscopic urodynamic studies were performed 1 month later and unilateral vesicoureteral reflux was present in 6 dogs. All animals had low intravesical pressure and excretory urograms were performed to exclude obstruction. The 6 dogs with reflux were euthanized 3 months postoperatively and the kidneys were examined for histological evidence of pyelonephritis. In 5 of 6 dogs bacterial bladder colonization and subsequent renal pelvic colonization developed on the side of the vesicoureteral reflux. All of these animals had histological evidence of pyelonephritis in the refluxing kidney, whereas only 1 of 6 nonrefluxing control kidneys had any evidence of pyelonephritis (p = 0.031). Our results suggest that vesicoureteral reflux in association with enterocystoplasty leads to chronic upper tract infection and pyelonephritis in a majority of animals, despite creation of a low pressure urinary reservoir. Correction of vesicoureteral reflux at enterocystoplasty should be considered to prevent upper tract damage.
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PMID:Enterocystoplasty and reflux nephropathy in the canine model. 164 May 56

Multiple isolates of Escherichia coli from the blood and urine of a 60-year-old woman with acute pyelonephritis exhibited different biotypes, antimicrobial susceptibility patterns, and plasmid profiles, suggesting the presence of polymicrobial bacteriuria and leaving in question the origin of the bacteremia. Only after bacterial restriction endonuclease analysis of total bacterial DNA was it discovered that all isolates represented the same strain, with plasmid instability possibly accounting for the varied antimicrobial susceptibility patterns observed. We conclude that the biotype, antimicrobial susceptibility profile, and plasmid profile are sometimes inadequate to clarify the relationships between different clinical isolates of E. coli from a single patient and can lead to erroneous epidemiologic conclusions. DNA fingerprinting can resolve dilemmas these less precise techniques leave unresolved.
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PMID:Success of DNA fingerprinting after failure of biotyping, antimicrobial susceptibility testing, and plasmid analysis to reveal clonality of multiple blood and urine isolates from a patient with Escherichia coli urosepsis. 164 17

Catheter-associated bacteriuria is the most common infection occurring in hospitals, where urethral catheters are generally in place for a few days, and in nursing homes, where catheters may be in place for months or years. We developed murine models with intrabladder urinary catheters for studying complications of bacteriuria in short- and long-term catheterization. In the short-term model, a catheter segment was inserted transurethrally and lay free within the bladder lumen. Half of the animals expelled segments during a 2-to-7-day period, durations similar to catheterizations in hospitalized patients. For studies of long-term catheter use, the catheter segment was secured within the bladder by a single suture for up to 12 months. Antibiotics administered for 7 days after catheter placement and housing mice in cages with wire screen floors reduced spontaneous bacteriuria to an acceptably low incidence rate of only 7%. Proteus mirabilis bacteriuria of high concentration provoked the same complications that are common in patients with long-term catheters: acute pyelonephritis, chronic renal inflammation, and struvite stone formation. These models allow inoculation of the bacteria of interest and are suitable for studies of short- and long-term foreign body-associated bacteriuria and its complications.
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PMID:Mouse models of short- and long-term foreign body in the urinary bladder: analogies to the bladder segment of urinary catheters. 166 47

Uropathogenic strains of Escherichia coli are characterized by the expression of distinctive bacterial properties, products, or structures referred to as virulence factors because they help the organism overcome host defenses and colonize or invade the urinary tract. Virulence factors of recognized importance in the pathogenesis of urinary tract infection (UTI) include adhesins (P fimbriae, certain other mannose-resistant adhesins, and type 1 fimbriae), the aerobactin system, hemolysin, K capsule, and resistance to serum killing. This review summarizes the virtual explosion of information regarding the epidemiology, biochemistry, mechanisms of action, and genetic basis of these urovirulence factors that has occurred in the past decade and identifies areas in need of further study. Virulence factor expression is more common among certain genetically related groups of E. coli which constitute virulent clones within the larger E. coli population. In general, the more virulence factors a strain expresses, the more severe an infection it is able to cause. Certain virulence factors specifically favor the development of pyelonephritis, others favor cystitis, and others favor asymptomatic bacteriuria. The currently defined virulence factors clearly contribute to the virulence of wild-type strains but are usually insufficient in themselves to transform an avirulent organism into a pathogen, demonstrating that other as-yet-undefined virulence properties await discovery. Virulence factor testing is a useful epidemiological and research tool but as yet has no defined clinical role. Immunological and biochemical anti-virulence factor interventions are effective in animal models of UTI and hold promise for the prevention of UTI in humans.
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PMID:Virulence factors in Escherichia coli urinary tract infection. 167 63

The incidence of P-fimbriated E. coli from patients with pyelonephritis, cystitis and asymptomatic bacteriuria was 78.6%, 31.9% and 22.2%, respectively. Almost all of the P-fimbriated E. coli have also type-1 fimbriae. In the in vitro test, P-fimbriated E. coli attached to the uroepithelial cells in higher number than the type 1 fimbriated E. coli. The results of the adhesion inhibition test suggested that simultaneous presence of P-and type 1 fimbriae is the most significant virulence factor in urinary tract infections.
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PMID:[The role of fimbriae of Escherichia coli in urinary tract infections]. 168 48

A basic and clinical study was made on the significance of stagnancy of urinary flow as a factor causing urinary tract infections. A bacterial solution was inoculated into the bladder of untreated and diabetic mice with model ascending pyelonephritis. The longer the external urethral opening was clamped, the lower became the value of ID50, thus showing infection easily caused by urinary stagnancy in the bladder. Patients who had UTI within 6 months after prostatic operation were divided into two groups, one with residual urine and the other without residual urine. Then, the type of the causative organism, and the severity of pyuria and bacteriuria were determined. In the former, there were slightly more patients with infection caused by plural bacteria. However, no other differences were observed. The administration of cephem antibiotics revealed no differences in effectiveness between the two groups. In conclusion, stagnancy of urinary flow has been considered a factor easily causing infection. However, so far as residual urine is concerned, it is not an intractable factor in treatment.
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PMID:[The role of stagnancy of urinary flow in causing urinary tract infection]. 178 20

While acute pyelonephritis is known to elicit an antibody response, it is also known that a patient who has had pyelonephritis once is susceptible to recurrent renal infection. Using our experimental model of pyelonephritis in the monkey, we tested whether antibiotic therapy of the acute disease would affect the antibody response. We found that it did, because antibiotic therapy beginning 72 h after bacterial inoculation attenuated the antibody response so that rechallenge 3 months later produced acute pyelonephritis and prolonged bacteriuria. The animals with untreated infection had an antibody response that lasted a sufficient period of time to prevent acute pyelonephritis after renal challenge. We have confirmed that antibody titers against P fimbriae are protective, and to a degree, this protective effect may be abrogated by antibiotic therapy.
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PMID:Attenuation of antibody response to acute pyelonephritis by treatment with antibiotics. 180 7

The authors report about 12 cases of long ureteral calculi, 16 to 39 mm in size, observed over 10 years. They were all made of a mixture of ammonium-magnesium phosphate and calcium phosphocarbonate. Infection was the revealing symptom, either in the form of simple bacteriuria or as acute pyelonephritis or sepsis. These calculi, found in a lumbar or pelvic location, were very long, radiopaque but with a moderate radiological density, homogeneous and have regular contours. They were straight, sometimes slightly bent, rarely (one case out of 12) arciform. In 11 of 12 cases, the affected patient was female. In most cases, the urine was infected by Proteus mirabilis. In spite of their size, the calculi caused total obstruction in 3 of 12 cases only. They were or were not associated to ipsilateral coral calculi of the same chemical type. Destruction was easily achieved with physical agents. The etiological, radiological and therapeutic characteristics of these calculi give them a specific place among ammonium-magnesium phosphate calculi.
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PMID:[Long ureteral ammonium-magnesium phosphate (struvite) and calcium phospho-carbonate calculi]. 180 76

Infectious complications following urologic surgery include bacteriuria, bacteremia, sepsis, acute pyelonephritis, and wound infection. Antimicrobial prophylaxis reduces the risk of some of these complications and is recommended in transrectal core biopsy of the prostate, transurethral surgery, open prostatectomy, and stone surgery. Prophylaxis does not appear to be beneficial in patients undergoing transrectal needle or transperineal core biopsy of the prostate, cystoscopy, orchiectomy, hydrocelectomy, and simple nephrectomy. Patients with urinary tract infection preoperatively should receive antimicrobial treatment prior to surgery.
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PMID:[Perioperative antimicrobial preventive treatment in urology]. 181 98


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