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)

A 26 year old female, a case of chronic renal failure secondary to chronic pyelonephritis with renal osteomalacia, came with dimunition vision as the presenting complaint. She was found to have bilateral cataracts. All other known causes of cataract were excluded. Cataracts due to hypocalcaemia in chronic renal failure are a rare phenomenon.
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PMID:Bilateral cataracts as the presenting manifestation of chronic renal failure. 145 40

The term "renal osteodystrophy" is used to include skeletal disorders of patients with chronic renal failure: osteitis fibrosa, osteomalacia, osteosclerosis, osteoporosis and the frequently associated extraskeletal calcifications. It is the chronic glomerular disease with phosphate retention and resultant hyperphosphatemia on one hand and deficient 1,25 (OH)2 D3 and resultant hypocalcemia on the other to induce secondary hyperparathyroidism. The three most common causes of chronic renal failure in our patients are chronic glomerulonephritis, diabetic nephropathy, hypertensive nephropathy in decreasing frequency, polycystic renal disease occurs in five patients. Other miscellaneous causes include nephrotic syndrome, chronic pyelonephritis, systemic lupus erythematosus, periarteritis nodosa, interstitial nephritis and renal stones. The bone changes are similar in primary and secondary hyperparathyroidism and the incidence of brown tumor is about 3% in the former and 1.5 to 1.7% in the latter. We present one among the 94 dialyzed patients who has long-standing severe chronic renal failure from polycystic kidney disease and develops brown tumor in the mid ulna after 7 years on maintenance hemodialysis. The incidence of brown tumor in our series is about 1.1%. Because of increased longevity of the dialyzed patients, brown tumor from secondary hyperparathyroidism is now more commonly observed. Hyperphosphatemia with serum calcium-phosphate products exceeding plasma solubility of 60 to 75 mg/dl may induce soft tissue and vascular calcification. This explains the much higher incidence of soft tissue calcification in secondary than primary hyperparathyroidism; two of our patients with generalized Monckeberg's type arterial calcification and multiple periarticular calcifications in five patients have been observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal osteodystrophy. 164 77

Bone morphological parameters of renal osteodystrophy such as abundance of osteoid surface, osteoid seam width index, calcification fronts, osteoclast activity and trabecular bone volume were studied in 71 patients on maintenance hemodialysis and compared with bone densitometry, laboratory and clinical data. Increased osteoclast activity (hyperparathyroidism) was by far the most common bone morphological finding. Patients with chronic pyelonephritis or polycystic kidney disease had more than double the amount of osteoid than patients with chronic glomerulonephritis. The trabecular bone volume seemed to be increased in most patients in contrast to the cortical bone volume which was decreased, judged from bone densitometry and previously from X-ray. Despite that patients with polycystic kidney disease were older, their trabecular volume was larger than in patients with glomerulonephritis. The bone mineral content evaluated by bone densitometry was low in most patients, and more associated with bone morphological signs of osteomalacia than with secondary hyperparathyroidism. Serum phosphate (S-PO4) and serum parathyroid hormone (S-PTH) seemed to discriminate better between osteomalacia and secondary hyperparathyroidism than serum alkaline phosphatase (S-Alk. phosph.), which was elevated in both groups. Patients who had been bilaterally nephrectomized were no more abnormal than other patients, and they had lower S-Alk. phosph. The abundance of osteoclasts was found to be a predictor of future development of clinical secondary hyperparathyroidism.
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PMID:Studies of bone morphology, bone densitometry and laboratory data in patients on maintenance hemodialysis treatment. 397 74

Forty-six patients with end-stage renal failure were subjected to iliac crest biopsy before the initiation of a dialysis programme and regardless of the presence of skeletal symptoms. Quantitative studies of undecalcified sections showed osteoporosis in 11 patients, osteosclerosis in 10, and osteomalacia (alone or in combination with other lesions) in 14. Semiquantitative studies showed osteitis fibrosa (alone or in combination with other lesions) in 29. The various abnormalities occurred alone or in combination with one another and, to a large extent, independently of serum biochemistry.Radiological examination failed to diagnose the histological abnormality in 12 of 13 patients with osteomalacia and in 10 of 25 patients with osteitis fibrosa. These abnormalities were commoner in women, in patients with pyelonephritis, and in patients with documented renal failure of long standing. Bone volume changes could not be correlated with any clinical parameters.Skeletal findings in untreated patients should be taken into account when the effects of chronic dialysis or renal transplantation or both are being considered.
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PMID:Quantitative skeletal histology in untreated end-stage renal failure. 471 18

Of nine patients with uraemic osteomalacia, the underlying renal lesion was pyelonephritis in seven. All of the patients were characterized by impairment of acidifying power and severe metabolic acidosis. It is suggested that metabolic acidosis may be a definite factor in the pathogenesis of uraemic osteomalacia, possibly by reducing the proportion of trivalent phosphate in the plasma and/or by reducing plasma calcium.
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PMID:Role of acidosis in renal osteomalacia. 578 Apr 54

The case records of 327 patients who underwent bone biopsy in late or terminal renal failure, before any form of dialysis or transplantation, were examined for clues to the aetiology of renal osteomalacia and its manifestations. Fifty four per cent of the biopsies showed pure osteitis fibrosa, 34 per cent osteomalacia with osteitis fibrosa and 12 per cent showed neither abnormality. Osteomalacia was strongly associated with chronic pyelonephritis and obstructive uropathy as primary renal disease. In two matched groups of 100 each, and within the major primary diseases, it was associated with acidosis, hypocalcaemia and normophosphataemia (as opposed to hyperphosphataemia). There was no association with known length or uraemia and only a weak and inconsistent relationship with severity of uraemia. In the few patients studied, there was no relationship between osteomalacia and serum 25-hydroxycholecalciferol level. In contrast to the state of patients treated by haemodialysis, osteomalacia in this undialysed group was manifested by a higher level of serum alkaline phosphatase than pure osteitis fibrosa, serum iPTH did not differ between the groups, there was no predominance of symptoms in one group, other than proximal myopathy which had a weak association with osteomalacia, and Looser zones were more common than complete fractures. Our study shows that osteomalacia has different manifestations, and probably different causes, before and after the start of haemodialysis. These two stages of renal failure should be clearly distinguished in reports of renal bone disease.
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PMID:Osteomalacia in patients with chronic renal failure before dialysis or transplantation. 664 48

Bone biopsies taken from 327 patients before the start of dialysis have been correlated with clinical and biochemical findings to test various theories about the aetiology of osteomalacia. Two groups of patients, 100 with osteomalacia and 100 with pure osteitis fibrosa, have been compared in detail. Osteomalacia is associated with chronic pyelonephritis or obstruction as primary renal disease, and with acidosis, hypocalcaemia and normophosphataemia (as opposed to hyperphosphataemia). We have found no association between osteomalacia and known duration or severity of uraemia and in a small series of observations we have not confirmed previous reports of a close association between osteomalacia and depressed plasma 25(OH) cholecalciferol values.
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PMID:Osteomalacia in chronic renal failure before dialysis. 687 33