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

Wilms' tumor (WT) is the most common renal malignancy in children. Its clinical and radiologic presentation may mimic other pediatric renal diseases, including pyonephrosis or renal abscess. The authors report a case of a 3-year-old girl presenting with pyelonephritis and right renal mass suggestive of a renal abscess, not responding to antibiotics. Further investigations were conducted, including a percutaneous renal needle core biopsy. A stage I fully necrotic WT was finally diagnosed. This amazing case of a fully necrotic WT at diagnosis demonstrates the importance of anatomopathologic analyses in pediatric renal masses, even when the infection is suspected.
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PMID:A Spontaneously Necrotic Wilms' Tumor Mimicking Renal Abscess: A Tricky Diagnosis not to Miss. 3168 42

Pyonephrosis is a rare condition in both adult and pediatric population. Here, the author presents a rare case of pyonephrosis induced by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a 12-month-old girl presenting with a picture of urosepsis. The patient presented with febrile urinary tract infection and was unresponsive to intravenous meropenem. Physical examination revealed huge, firm and irregular right renal swelling. Ultrasound and computed tomography imaging revealed severely hydronephrotic right kidney, and laboratory investigations showed elevated C-reactive protein level (22.9 mg/dl). Emergency percutaneous nephrostomy tube was inserted, pus was drained (20 ml) and intravenous vancomycin and amikacin were started. Her general condition improved, and urine culture was negative. Functional assessment with dimercaptosuccinic acid renal scan revealed that the split renal function was 5% on the right and 95% on the left side, and the bladder outline was smooth with no reflux in voiding cystourethrogram. A right nephrectomy was done a week later using the anterior subcostal approach. The postoperative course was smooth. Histopathological examination was diagnostic for xanthogranulomatous pyelonephritis. No adverse events were reported in the follow-up over 12 months. It can be concluded that a high degree of suspicion, rapid initiation of appropriate antibiotics and drainage of pus are crucial in the management of pyonephrosis.
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PMID:A Rare Case of Pyonephrosis in an Infant Induced by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae. 3258 99

Acute pyelonephritis is a bacterial infection of the renal parenchyma and collecting system. Diagnosis is based on clinical findings of fever, flank pain, and urinary tract infection. Computed tomography findings include renal enlargement with wedge-shaped heterogeneous areas of decreased enhancement, known as a "striated nephrogram." Imaging is primarily used to diagnose complications such as emphysematous pyelonephritis, renal abscess, and pyonephrosis. Chronic pyelonephritis can have varying appearances on imaging ranging from xanthogranulomatous pyelonephritis or, in extreme cases, renal replacement lipomatosis.
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PMID:Imaging of Renal Infections and Inflammatory Disease. 3279 23

BACKGROUND This study explored the risk factors for renal atrophy after percutaneous nephrolithotomy (PCNL), and provides a reference for clinical prevention of renal atrophy after PCNL. MATERIAL AND METHODS According to the inclusion and exclusion criteria, the clinical data of 816 patients who underwent PCNL in our hospital from May 2013 to February 2018 were retrospectively collected. Depending on whether the patient had kidney atrophy, they were divided into a renal atrophy group and a non-renal atrophy group. We collected and analyzed data on patient sex, age, kidney location, duration of disease, stone size, hydronephrosis, renal calculus position (renal ureteral junction or multiple pyelonephritis-associated stones), operation time, intraoperative blood loss, perfusion pressure, and pyonephrosis. The indicators with statistically significant differences were selected and multivariate logistic regression analysis was carried out to determine the risk factors for renal atrophy. RESULTS Among 816 patients, 49 had renal atrophy and the incidence rate was 6.01%. Univariate analysis and multivariate logistic regression analysis showed that independent risk factors for renal atrophy after PCNL were: duration of the disease longer than 12 months (OR=4.216, P=0.003, 95% CI: 1.714, 7.354), perfusion pressure >30 mmHg (OR=3.895, P=0.001, 95% CI: 1.685, 8.912), moderate and severe hydronephrosis (OR=5.122, P<0.001, 95% CI: 1.847, 9.863), stones located at the junction of the renal pelvis (OR=3.787, P=0.001, 95% CI: 1.462, 7.654), stones located in multiple calyces (OR=4.531, P=0.014, 95% CI: 1.764, 8.196), and pyonephrosis (OR=10.143, P<0.001, 95% CI: 2.214, 16.248). CONCLUSIONS The main risk factors for renal atrophy after PCNL are: course of disease more than 12 months, moderate and severe hydronephrosis, pyonephrosis, multiple calyceal stones, stones at the junction of the renal pelvis, and intraoperative high perfusion pressure.
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PMID:Clinical Assessment of Risk Factors for Renal Atrophy After Percutaneous Nephrolithotomy. 3298 88


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