Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute renal failure (ARF) is an uncommon but alarming complication of idiopathic nephrotic syndrome. The renal failure could be secondary to causes evident from the history and evaluation, such as severe intravascular volume depletion, acute tubular necrosis, allergic interstitial nephritis, bilateral renal vein thrombosis, acute pyelonephritis, or rapid progression of the original glomerular disease. It may be termed idiopathic if the underlying cause is undetermined. We present three children with idiopathic nephrotic syndrome who were admitted with acute renal failure. One case was due to drug-induced allergic interstitial nephritis. The other two were idiopathic in nature. Improvement in renal function occurred in the three patients over a variable period of 10 days to 4 weeks. After careful exclusion of well-known causes of acute renal failure, idiopathic acute renal failure (IARF) should be considered as a diagnostic possibility in these patients. The exact pathophysiology of IARF is not understood. Possible proposed explanations include interstitial edema, tubular obstruction, altered glomerular permeability, and unrecognized hypovolemia.
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PMID:Acute renal failure in children with idiopathic nephrotic syndrome. 1457 39

Xanthogranulomatous pyelonephritis (XGP) is a rare entity characterized by the formation of inflammatory renal masses rich in macrophages loaded with lipids. It is usually secondary to repeated urinary infections and urinary obstruction due to stones, which produce slow destruction of the renal parenchyma, requiring nephrectomy. It may sometimes be associated to secondary amyloidosis that leads to the appearance of a nephrotic syndrome. We have conducted a search in the Medline database between the years 1967 and 2003 and we only found 6 cases in adults and 3 cases in pediatric patients with amyloidosis secondary to xanthogranulomatous pyelonephritis. During this same period, there are more than 570 citations that include more than 1,000 patients with isolated XGP, so that we estimate that amyloidosis that complicates a XGP should be less than 1% of all the XGP cases. We present a case of XGP in a 51 year old female patient associated to amyloidosis that initiated with nephrotic syndrome, analyzing the clinical characteristics of the 9 previous cases. We compared their clinical characteristics with those of 51 patients with xanthogranulomatous pyelonephritis without amyloidosis of a large classical series in order to characterize this clinical picture better.
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PMID:[Amyloidosis secondary to xanthogranulomatous pyelonephritis: a case report and review of the literature]. 1730 60

The chemokine SDF-1alpha is involved in migration, survival, and development of multiple cells, most notably of hematopoietic stem cells (HSC) expressing its ligand CXCR4. Recently, we have shown engraftment of human HSC in the ischemically injured murine kidney, presumably mediated by SDF-1alpha. To further investigate a possible role of SDF-1alpha in the recruitment of CXCR4(+) cells in human renal disease of varying etiologies, we immunostained human biopsies of immunoglobulin (Ig)A nephropathy, minimal-change nephrotic syndrome, focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, chronic pyelonephritis, and acute tubular necrosis (ATN) for SDF-1alpha, CXCR4, and CD45, a pan-hematopoietic marker. Irrespective of the diagnosis, intense SDF-1alpha immunoreactivity was localized to distal tubules and collecting ducts, whereas CXCR4 showed intense staining in both distal and proximal tubules. In addition, whereas varying degrees of CD45(+) cell infiltrates were observed in all biopsies, we found focal infiltrates of CXCR4(+) cells mostly localized to the corticomedullary junction only in ischemic ATN. This correlated with more extensive staining for SDF-1alpha in these sites. In all investigated renopathologic conditions, CD45+ leukocyte recruitment to the kidney seems not to be driven by SDF-1alpha/CXCR4 interaction. A contribution of SDF-1alpha for influx of CXCR4(+) cells in the vicinity of arcuate vessels is suggested only in human ATN.
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PMID:Expression of SDF-1/CXCR4 in injured human kidneys. 1797 9

Acute pyelonephritis is not considered a common cause of renal vein (RVT) and inferior vena caval thrombosis (IVCT). Apart from malignancy, RVT is not an uncommon condition amongst patients with nephrotic syndrome, most commonly seen in patients with membranous glomerulonephritis. However, RVT occurring in association to acute pyelonephritis is rare. Clinically, it is difficult to distinguish between acute pyelonephritis and RVT because both present with fever, flank pain, and hematuria. We report a case of acute pyelonephritis with RVT and IVCT with underlying hyperhomocysteinemia. The patient was treated with systemic anticoagulation, antibiotics, and B complex therapy. At 3 months follow-up, there was complete resolution of thrombus but the left kidney was nonfunctioning.
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PMID:Acute pyelonephritis with renal vein and inferior vena cava thrombosis in a case of hyperhomocysteinemia. 1837 93

Mesangioproliferative glomerulonephritis (MesPGN) consists 10% of the total renal biopsy of glomerulonephritis. Aim of the present study was to find out clinicopathological changes in MesPGN and differences between diffuse and focal variety. MesPGN was seen mostly in young adults with mean age of 28.63 years for males and 26.3 years for females. Male predominance was noted (M:F ratio - 1.4:1). About 70.83% patient presented with edema feet, followed by hypertension (29.19%), fever (16.66%), oliguria, nausea and vomiting (10.41%). Urine analysis in 50 patients revealed that 70% patients presented with nephrotic-range proteinuria, 36% patients with microscopic hematuria and 56% patients with leukocyturia. Statistically, no significant difference was found in clinical features of diffuse and focal MesPGN. Microscopic comparison between diffuse and focal variety showed that significant increase of focal glomerular basement membrane thickening, focal endothelial cell proliferation, focal smooth muscle hyperplasia, hyaline sclerosis and vasculitis was more common in diffuse variety. In focal variety, Capillary loop congestion, periglomerulitis, cloudy swelling and vacuolar degeneration in tubules were significantly more as compared to diffuse variety. Details of the clinical features, special laboratory tests and histological details revealed that diffuse variety had systemic diseases, which included Wegner's granulomatosis, microscopic polyangitis, Henoch's schonlein purpura, systemic lupus erythematosus (two cases) and one case each of Kimura's disease, pyelonephritis and tuberculosis. Only one case of focal MesPGN showed tuberculosis. Thus, our study concludes that MesPGN is an important cause of nephrotic syndrome among young adults. Secondly, search for some other diseases should be made and thirdly, if biopsy shows focal mesangial cell proliferations in minimal change glomerulonephritis (MCGN), it should be diagnosed as focal MesPGN rather than MCGN because these cases show recurrences.
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PMID:Mesangioproliferative glomerulonephritis: an important glomerulonephritis in nephrotic syndrome of young adult. 1872 53

Urinary lactic dehydrogenase, alkaline phosphatase and lysozyme determinations were performed on 70 patients with various kidney diseases such as acute and chronic pyelonephritis, acute and chronic glomerulonephritis, idiopathic nephrotic syndrome, diabetic nephropathy, nephrosclerosis, lupus nephritis, analgesic nephropathy, gouty nephropathy, renal tuberculosis, renal lithiasis, and polycystic kidneys. Fifty-three of these patients had elevated levels of urinary lactic dehydrogenase, but this was not of any value in determining the etiology of the renal disease. Similarly, the elevation of alkaline phosphatase in 23 of the 70 had no etiological significance. Neither of these determinations was significant in indicating the degree of renal functional impairment or prognosis. The urinary lysozyme was significantly elevated in only five of the 70 patients and was of no value in indicating the presence or the seriousness of the underlying renal disease.
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PMID:Urinary lactic dehydrogenase, alkaline phosphatase and lysozyme studies in renal disease. 2032 65

Proteinuria originates from the kidney and occurs as a result of injury to either the glomerulus or the renal tubule or both. It is relatively common in the general population with reported point prevalence of up to 8% but the prevalence falls to around 2% on repeated testing. Chronic glomerular injury resulting in proteinuria may be secondary to prolonged duration of diabetes or hypertension. A tubular origin of proteinuria may be associated with inflammation of renal tubules triggered by prescribed drugs or ingested toxins. In the absence of obvious clues to the cause of persistent proteinuria on history or clinical examination it is worthwhile reviewing the patient's prescribed drugs to identify any potentially nephrotoxic agents e.g. NSAIDs. NICE guidelines recommend screening for proteinuria in individuals at higher risk for chronic kidney disease (CKD). These include patients with diabetes, hypertension, cardiovascular disease, connective tissue disorders, a family history of renal disease and those prescribed potentially nephrotoxic drugs. Patients with sudden onset of lower limb oedema and associated proteinuria should have a serum albumin level measured to exclude the nephrotic syndrome. Renal tract ultrasound will measure kidney size, and detect scarring associated with chronic pyelonephritis or prior renal stone disease which can cause proteinuria.
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PMID:Tracking down the cause of proteinuria in primary care. 2357 16

We describe a case of a young female with lupus that complained about suprapubic pain, dysuria, fever and vomits, symptoms first interpreted as pyelonephritis, despite negative cultures and imaging studies showing hydroureteronephrosis with inflammatory changes. When she developed malar rash, anasarca and nephrotic syndrome, the diagnosis of lupus cystitis with stage IV nephropathy was made, and she started immunosuppressive induction treatment with three pulses of corticosteroids followed by oral prednisolone (60 mg/d) and mycophenolate (1.5 g/d). One month later she was admitted again with blood exams compatible with thrombotic microangiopathy, requiring aggressive immunosuppression and plasma exchange. After overcoming multiple complications, the patient gradually improved, and was discharged with close surveillance. This case poses the question: if the urogenital involvement had been recognized and treated in time, would it prevent the onset of lupus nephritis and other complications?
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PMID:Lupus cystitis and repercussions of delayed diagnosis. 2535 85

Annexin V (AnV) belongs to a cytoplasmic calcium binding protein family found in many body tissues, including distal tubule cells and glomerular epithelial cells. The biological role of this protein discovered so far is connected with apoptosis. AnV is considered as an early marker of that process and is used in one of the most frequently applied apoptosis detection methods, consisting in the detection of biochemical and morphological changes in cells. Measuring the AnV level may help understand many renal processes. Elevated AnV levels have been found in both acute and chronic renal conditions. Applying AnV to identify cells in the early phase of apoptosis in acute pyelonephritis caused by Escherichia coli showed that hemolysins of pathogenic bacteria stimulate the death of tubular cells and that the intensification of the process depends on the level of the toxin and its activity time. Studies on the mechanisms of reperfusion injury in acute renal injury have revealed protective activity of a synthetic AnV homodimer with regard to tubular cells. AnV was also used in diabetic nephropathy to study the influence of metabolic disorders on the intensification of apoptosis in renal tubular cells. Additionally, the suitability of AnV measurement as a biochemical marker of atherosclerosis in patients with a chronic renal condition was evaluated. It was also used to study the causes of immunodeficiency in patients diagnosed with the above-mentioned condition. There have been few papers published so far on the significance of AnV in children with renal conditions. The prognostic value of AnV and T cell apoptosis was evaluated in children with nephrotic syndrome.
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PMID:[Importance of annexin V in kidney diseases]. 2566 14

Renal Vein Thrombosis (RVT) is a rarely encountered condition. It occurs due to a hypercoagulable state in the body, caused by nephrotic syndrome and membranous nephropathy in the adults. Mode of presentation is variable. In chronic form, it may remain silent for a long time and presenting later with symptoms of pedal oedema, varicocele, proteinuria. In acute state, it manifests as flank pain, nausea or haematuria. We present a case of 25-year-old male, with left sided flank pain, haematuria and nausea for 4 days. Ultrasound showed enlarged kidney with altered echogenecity. No calculus was found on x-ray. Empirical antibiotics were started considering possibility of Acute Pyelonephritis (APN). With no improvement seen after 3 days along with no growth on urine culture, CT-urography was done. It revealed enlarged non-excreting left kidney with thrombus seen over left renal vein extending into Inferior Vena Cava (IVC). Immediate anticoagulant therapy was started. Patients recovered gradually and after 6 months, follow-up CT showed disappearance of thrombosis. Anticoagulants were withdrawn gradually. So we highlight the possibility of RVT as a differential diagnosis to APN or renal colic and its evaluation and management.
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PMID:Adult Idiopathic Renal Vein Thrombosis Mimicking Acute Pyelonephritis. 2779 May 18


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