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

A case of emphysematous pyelonephritis is presented and a review of literatures is made. A 67-years-old woman with diabetes mellitus, complained of severe left flank pain and high fever and was referred from the department of gastroenterology. A computed tomography film demonstrated gas in the left renal parenchyma and a diagnosis of emphysematous pyelonephritis was made. She was in a state of shock and died after 4 days of conservative treatment. Emphysematous pyelonephritis is a rare, life-threatening disorder and 85 cases in the world have been reported to date. Our case is the 18th one in Japan. Its etiology, symptomatology, treatment and prognosis are discussed.
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PMID:[Emphysematous pyelonephritis complicated by liver cirrhosis and diabetes mellitus: a case report and a review of the literature]. 331 33

Emphysematous pyelonephritis is a rare, life-threatening suppurative infection of the renal parenchyma and perinephric tissues. The disease is encountered primarily in patients with diabetes mellitus or ureteral obstruction associated with perinephric and intrarenal gas. Causative organisms are those normally found in the urinary and gastrointestinal tracts; however, anaerobic bacteria have been demonstrated in only 1% of cases. We describe a case of emphysematous pyelonephritis, which presented as an acute abdomen with pneumoperitoneum in a nondiabetic patient. No visceral injury was found at laparotomy. Multiple gas-producing organisms, including Clostridium ramosum (not previously reported, to our knowledge), were the cause of the free intraperitoneal and perinephric air. Subsequent radical nephrectomy revealed a xanthogranulomatous kidney. An aggressive surgical approach combined with intensive antibiotic therapy, after aerobic and anaerobic culture of excised tissue, is lifesaving.
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PMID:Emphysematous pyelonephritis in a xanthogranulomatous kidney. An unusual cause of pneumoperitoneum. 334 17

The beta2-microglobulin (beta2-MCG) test was done in 115 patients with an insulin dependent type of diabetes mellitus: 30 of them were without renal pathology, 58 had diabetes mellitus with diabetic nephropathy (DN), and 27 had concomitant chronic pyelonephritis. The effect of glucosuria and proteinuria on the beta2-MCG level was revealed. DN development and progress resulted in an increase in the beta2-MCG concentration in the blood that correlated with a decrease in the glomerular filtration. beta2-MCG urinary excretion grew in a clinically manifested DN stage only. Concomitant pyelonephritis in diabetes mellitus patients resulted mostly in a rise of the beta2-MCG level in the urine. Its concentration in the urine during the exacerbation of pyelonephritis exceeded the indices of the control group, on an average, by 467.9%. The beta2-MCG test is a valuable additional criterion in the differential diagnosis of DN in diabetes mellitus patients.
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PMID:[Beta 2-microglobulin in the diagnosis of kidney lesions in diabetes mellitus patients]. 351 58

The causative agent in nonobstructive pyelonephritis has been shown most often to be P-fimbriated Escherichia coli, mainly because receptors for these fimbriae are found in the bladder, ureter, and the kidney tubules. Age and sex are factors leading to differences in the presentation of the disease, and early diagnosis followed by intensive therapy lessens the chance of renal damage. Renal abscess, perinephric abscess, and pyonephrosis all follow pyelonephritis in the host who is compromised by the presence of stone, obstruction, diabetes, or immunosuppression.
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PMID:Pyelonephritis, cortical abscess, and perinephric abscess. 353 6

Emphysematous pyelonephritis is a severe infection characterized by the presence of gas within the renal parenchyma and perirenal tissues. Two cases of this disease are presented. They were the 16th and 17th case reported in Japan. Case 1 was a 63-year-old woman with diabetes mellitus and liver cirrhosis. She was hospitalized for abdominal pain and anuria. Renal X-rays showed a gas shadow in and around the left kidney, but no evidence of upper urinary tract obstruction. Although hemodialysis was done, she died of heart failure. Case 2 was a 54-year-old man with diabetes mellitus was admitted with the complaint of fever and left abdominal pain. Renal X-rays showed a gas shadow in and around the left kidney but no evidence of upper urinary tract obstruction. He was treated with intensive antibiotic therapy, control of blood sugar, intravenous drips and percutaneous drainage. Clinical features improved, but deteriorated after 40 days of therapy. The gas shadow remained unchanged on CT scanning, and aortography showed the occlusion of the left renal artery. Nephrectomy was done after 50 days. Seventeen cases of emphysematous pyelonephritis in the literature including our cases are reviewed, especially the choice of the treatment is discussed.
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PMID:[Two cases of emphysematous pyelonephritis--considerations on the choice of treatment]. 359 89

The clinical records and computerized tomography (CT) scans of 14 patients who presented with pyelonephritis to the Children's Hospital of Buffalo between 1976-1985 have been reviewed. The CT findings were as follows: multifocal pyelonephritis (6), lobar nephronia (6), focal pyelonephritis (2). All patients were treated with intravenous antibiotics, and none was surgically drained. Significant underlying diseases were present in 8 patients: diabetes (6), von Gierke disease (1), hepatorenal syndrome (1). The diabetic children tended to have focal disease. Ten voiding cystourethrograms were performed and only four demonstrated reflux. All children became afebrile within a few days. Lobar nephronia was as clinically responsive as pyelonephritis to antibiotic therapy. Urine cultures were most often positive, although there was 1 patient in each category with negative cultures. Blood cultures were rarely positive in any group. Gram negative organisms predominated. CT scanning in children with clinical acute pyelonephritis reveals three major imaging patterns. While distinct radiographically, they behave in a similar clinical manner. Lobar nephronia does not imply a worse clinical prognosis. Intravenous antibiotic therapy alone was adequate for all patients.
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PMID:Computerized tomography and acute pyelonephritis in children. A clinical correlation. 381 Oct 89

A case of emphysematous pyelonephritis is presented. A 49-year-old male with diabetes mellitus complaining of high grade fever attack and right flank pain was referred from internal medicine. KUB demonstrated that the right ureter, pelvis and calyces were filled with gas. Anti-bioticus was given intensively and the abnormal gas shadow on plain film disappeared before RP was done, but high grade fever attack persisted and right nephrectomy was undergone. After this operation, the fever was relieved and the patient was discharged at the 30th day post-operatively. A search of available literature in Japan has disclosed only 17 reported cases. Diagnostic methods, treatment, complication and etiology are discussed.
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PMID:[Emphysematous pyelonephritis: report of a case]. 383 25

Our current knowledge of the long-term outcome of uncomplicated urinary tract infections in women is based on several things: a reevaluation of the criteria for defining pyelonephritis at autopsy, careful description of the causes of renal disease among patients entering dialysis and transplant programs, long-term observation of patients, and epidemiologic studies attempting to determine the association of bacteriuria with mortality. The weight of the evidence favors the conclusion that, although urinary tract infections can severely impair renal function, this is rare in the absence of a major predisposing factor such as obstruction, calculus, reflux, abnormalities of the voiding mechanism, or diabetes. The predisposing lesions, however, may go undetected until heralded by episodes of acute pyelonephritis or by renal failure. Unfortunately, urinary tract infections are so common that it is difficult to distinguish the population at greatest risk. The possible role of renal damage produced by autoimmune mechanisms following infection needs continued study.
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PMID:Does kidney infection cause renal failure? 388 49

A prospective study evaluated the utility of renal computed tomography (CT) and ultrasonography in 35 patients hospitalized for treatment of urinary tract infection. Renal computed tomograms were abnormal in 18 of 28 patients with acute pyelonephritis and three of four patients with urosepsis, showing findings consistent with pyelonephritis in 17 patients and intrarenal abscess or focal bacterial nephritis in four patients. Renal sonograms were abnormal in only eight patients, showing findings compatible with pyelonephritis in four and intrarenal abscess or focal bacterial nephritis in the other four. Flank tenderness was absent in only four patients with CT findings of pyelonephritis, of whom three were diabetic. We therefore found that (1) renal CT is a sensitive test for acute upper urinary tract infection, (2) ultrasonography detects focal bacterial nephritis and abscesses but is insensitive to uncomplicated upper urinary tract infection, and (3) painless pyelonephritis may be more common in patients with diabetes mellitus.
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PMID:Ultrasonography and computed tomography in severe urinary tract infection. 388 34

Most physicians believe that the diabetic patient is predisposed to infections and that infections complicate the control of the diabetes. Despite the lack of scientific proof, certain infections (such as tuberculosis, bacteriuria in females, malignant external otitis, rhinocerebral mucormycosis, emphysematous cholecystitis, emphysematous pyelonephritis, acute papillary necrosis etc) are widely regarded to be associated with the diabetic. Foot infections, infections of the respiratory tract and the urinary tract are very important in the diabetic. The reasons why diabetics are susceptible to infections are unclear: although the production of humoral antibody appear intact, defective function of the polymorphonuclear leucocytes has been demonstrated. Successful treatment of infections in the diabetic requires early and exact diagnosis, the exhibition of the correct antimicrobials, the treatment of the diabetic state and associated disorders and prompt surgical intervention where required. Good control of blood glucose in diabetic patients is a desirable goal in the prevention of certain infections and to ensure maintenance of normal host defense mechanisms that determine resistance and response to infection.
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PMID:Infections in diabetes with special reference to diabetics in Singapore. 389 79


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