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

Diabetes during pregnancy is associated with insulin resistance, an increase in insulin requirement, and a greater tendency to ketosis and ketoacidosis. Increased perinatal mortality is related to maternal hyperglycemia and can be decreased dramatically with strict control of plasma glucose during pregnancy and a smooth-working obstetrician-internist-neonatologist team. Bad prognostic signs include pyelonephritis, ketoacidosis, toxemia, and poor prenatal care. Timing of delivery is no longer arbitrary at 36 or 37 weeks, but is based upon signs of fetal lung maturation and estimates of fetal risk. Abnormalities in the infant, including congenital abnormalities, biochemical abnormalities, respiratory distress syndrome, and large body weight must be managed in a well-equipped newborn intensive care unit under the care of experienced neonatologists. Strict attention to these principles has resulted in viable infants in the last 36 pregnant diabetic patients delivered at Vanderbilt University Hospital. Therefore, close medical supervision, use of modern obstetric technics, and the availability of a well-equipped and staffed neonatal intensive care unit can result in a good outcome in this group of patients. Finally, the decision for pregnancy must be carefully considered by the diabetic patient, her husband, and her physician long before pregnancy occurs.
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PMID:Coordinated metabolic and obstetric management of diabetic pregnancy. 62

Diabetes mellitus associated with urinary tract infections and ureteral obstruction can be predisposing factors leading to emphysematous pyelonephritis. Fever, flank pains, and a palpable renal mass, associated with dehydration and hyperglycemia, were the most frequent presenting symptoms associated with emphysematous pyelonephritis. Computerized tomography (CT) scan is the best method to identify a renal or perirenal abscess and its ramifications. Intravenous antibiotic therapy is determined by blood and urine cultures. Mortality was zero in patients treated by nephrectomy. One patient who had incision and drainage of a renal abscess died of sepsis, and 1 patient died of sepsis following incision and drainage of a prostatic abscess. Patients with cystitis emphysematosa require antibiotic therapy and relief of bladder outlet obstruction. Prostatic abscess is best treated by perineal incision and drainage. Periurethral scrotal abscesses should be incised, drained, and the overlying necrotic skin debrided. Early diagnosis and aggressive medical and surgical management of gas-forming infections of the genitourinary tract are vital.
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PMID:Gas-forming infections in genitourinary tract. 155 45

A case of emphysematous pyelonephritis is presented. A 66-year-old woman with diabetes mellitus was hospitalized for sudden pyrexia and left abdominal pain on January 13, 1987. She had shown preshock, pre-disseminated intravascular coagulation, hyperglycemia and renal dysfunction. Plain X-ray films of the abdomen and abdominal computer tomographic scanning showed a gas shadow in the left kidney. Retrograde pyelography demonstrated the left complete ureteral obstruction. A diagnosis was made of emphysematous pyelonephritis associated with diabetes mellitus and ureteral obstruction. Left nephrectomy was performed on January 17, 1987, and the pus obtained from the kidney yielded E. coli. After the operation, she has been doing well with diabetes mellitus under good control without insulin therapy. Thirty two cases of emphysematous pyelonephritis in the Japanese literature including our case are reviewed.
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PMID:[A case of emphysematous pyelonephritis--review of 32 cases in Japanese literature]. 269 28

We report a case of xanthogranulomatous pyelonephritis in a cadaver kidney allograft. The patient had diabetic glomerulosclerosis. The predisposing factors that led to this condition included hyperglycemia, a previous rejection reaction and Escherichia coli urinary infection. Persistent fever, pyuria, bacilluria and a nonfunctioning allograft resulted in allograft nephrectomy. The diagnosis was made on histological examination. Diagnostic criteria for xanthogranulomatous pyelonephritis in the allografted kidney are similar to those in the native kidney.
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PMID:Xanthogranulomatous pyelonephritis in a renal allograft. 305 33

Escherichia coli-induced pyelonephritis was studied in untreated alloxan-diabetic rats, insulin-treated diabetic rats, glucose water-drinking (diuresing) nondiabetic rats, and tap water-drinking (nondiuresing) nondiabetic rats following injection of E. coli either into the emptied urinary bladder, into the left kidney, or intravenously. For prevention of an ascending infection in the right kidney, the right ureter was ligated and transected immediately prior to bladder or intrarenal inoculation. These experiments established that in normal rats ascending renal infection alone occurred following introduction of small inocula into the bladder--and then only when facilitated by diuresis. In diabetic rats both ascending and hematogenous renal infection occurred following introduction of small inocula into the bladder. Insulin treatment that reduced hyperglycemia also reduced glycosuria and restored urinary antibacterial activity against small inocula of E. coli but only partially reduced polyuria and prevented hematogenous but not ascending infection. Thus, hyperglycemia was probably the major factor promoting hematogenous renal infection, whereas polyuria--and therefore vesicoureteral reflux--was the major factor promoting ascending infection.
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PMID:Effect of insulin treatment on the susceptibility of the diabetic rat to Escherichia coli-induced pyelonephritis. 638 97

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

From 1986 to 1992 the authors treated 160 patients with acute purulent pyelonephritis (APP) associated with diabetes mellitus (DM). 100 patients were diagnosed to have diffuse-purulent pyelonephritis (DPP), 60 patients (37.5%) had purulent-destructive pyelonephritis (PDP). The authors carried on two different surgical policies: in 1986-1988 a conservative approach was followed (7 out of 21 patients underwent nephrectomy, 14 underwent nephrostomy and other organ-sparing operations), in 1989-1992 a radical approach was used. After the nephrostomy there were 7 lethal outcomes (53.8%) and 6 cures. Histological examination of the kidneys from the latter patients revealed DPP with major renal pelvic involvement. Lethal outcomes were caused by intoxication resultant from progressive purulent destruction in the operated on kidney in the presence of uncorrectable hyperglycemia with ketoacidosis. In view of mutual aggravation observed in APP and DM and ineffectiveness of nephrostomy in PDP, indications to radical removal of the inflammation focus (nephrectomy) are of vital character. This explains why the conservative approach was changed for the radical one according to which nephrectomy was conducted in 37 (94.8%) of the surgical patients. Lethal outcomes of nephrectomy under the radical approach reached 27%. The employment of active radical policy reduced postoperative lethality by 26.8%. It is inferred that in DPP conservative methods including nephrostomy are valid. IN PDP primary nephrectomy in justified. Overall positive results were achieved in 80% of the patients. A 20% lethality was due to severe DM, APP form and imperfect therapeutic policy.
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PMID:[The characteristics of the treatment procedure in acute suppurative pyelonephritis in diabetic patients]. 816 Mar 11

Diabetic nephropathy is the third cause of renal failure after pyelonephritis and glomerulonephritis. Lately, many efforts have been made for the early identification (on the silent stage) of patients with a high risk of developing this disease. On these initial stages, therapeutic attitude has changed very much, emphasizing nowadays the importance of glucose levels control, avoiding maintained conditions of hyperglycemia and maintaining blood pressure within the limits, by using the therapeutic store available, basically calcium antagonists and angiotensin-converting enzyme inhibitors.
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PMID:[Considerations on the treatment of incipient diabetic nephropathy (lst of 2 parts)]. 944 91

A 66-year old female was admitted to our ICU in septic shock with accompanying signs of gastroenteritis and diabetic-related hyperglycemia. Computer tomography of the abdomen revealed the rare diagnosis of emphysematous pyelonephritis. Immediate nephrectomy led to a favourable outcome in this dramatic case. Although abscess drainage and broad-based antibiotic therapy are generally the first-line therapy today, emergency surgery would seem to be indicated in selected cases.
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PMID:[Emphysematous pyelonephritis--a rare cause of sepsis]. 982 59

A 51-year-old female patient was hospitalized in our department with high fever and left flank pain. Laboratory examination showed leukocytosis, increase of C-reactive protein (CRP), hyperglycemia and renal insufficiency. Enterobacter aerogenes grew out of the cultured urine. The radiograph and computerized tomographic (CT) scan revealed streaky gas in the destroyed left renal parenchyma with perirenal gas. She was diagnosed with left emphysematous pyelonephritis. Antibiotics therapy, treatment for sepsis and disseminated intravesicular coagulation was initiated resulting in mitigation of inflammation. High blood glucose initially required insulin therapy, but finally returned to normal levels through administration of oral antidiabetics. Although leukocytosis and low grade fever continued, the patient was discharged on day 53 with a negative CRP. CT scan indicated that the emphysematous change was localized after three months and almost resolved after four months. Renal scintigram indicated the residual function of the affected kidney. Because of the possibility of residual renal function and the cure by conservative therapy alone, the conservative therapy is preferred when the initial treatment is effective.
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PMID:[A case of emphysematous pyelonephritis improved with conservative therapy--indication for conservative therapy]. 1087 58


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