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)

Vesicoureteral reflux is an anatomic abnormality, mostly affecting a pediatric population, which may be the second leading cause of end-stage renal failure. Most cases of reflux are due to abnormalities in the insertion of the ureters into the bladder, either congenital or acquired. Most commonly, VUR is discovered during routine evaluation of urinary tract infections, but may also be present in patients with severe hypertension or chronic renal failure. The diagnosis is confirmed radiologically, utilizing either voiding cinecystography or radioisotopic methods. VUR can result in renal failure through scarring secondary to 'chronic pyelonephritis' or through a glomerulopathy, possibly immune in origin. In most series, the glomerulopathy is felt to be the cause of the end-stage renal failure. Treatment of VUR includes conservative (medical) management with the hope that maturation of the ureterovesical junction will cure reflux. Surgical therapy is reserved for those patients in whom this maturation is not expected to occur or in those whose urinary infections cannot be controlled. In those patients who have developed the glomerulopathy secondary to VUR, surgery may not halt the progression of the renal disease. VUR in a transplanted kidney may result in a higher risk of loss of the graft due to glomerulopathy or chronic rejection.
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PMID:Vesicoureteral reflux and reflux nephropathy. 676 61

A retrospective study of 1,100 consecutive renal transplantations done on 959 patients revealed postoperative pyelonephritis in 15 patients, 14 of whom were women. Sixteen of the 20 episodes of pyelonephritis were caused by Escherichia coli and only 4 episodes occurred within the first year after transplantation, thus revealing the crucial differentiation from a rejection episode. When the etiology of the original renal failure was pyelonephritis the incidence of pyelonephritis in the transplanted kidneys was high. This high incidence also was true for cases associated with post-transplantation urological complications. When the etiology of renal failure was diabetes or polycystic renal disease, or when urologic abnormalities pre-existed the incidence of pyelonephritis was low. No transplant or patient loss was caused by post-transplantation pyelonephritis, probably because of prompt, correct diagnosis and a low urological complication rate.
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PMID:Post-transplantation pyelonephritis: factors producing low patient and transplant morbidity. 698 76

The frequency of chronic terminal renal failure (CTRF) (serum creatinine greater than or equal to 4,5 mg/dl) in an unselected autopsy material was about 1.7% from 1968 to 1976. Based on this figure, the estimated yearly incidence is 160 to 200/10(6) inhabitants of the Basel area. In inhabitants of Basel, analgesic nephropathy (42.2%) was the most important cause of CTRF (excluding obstructive nephropathy). Pyelonephritis (without evidence of analgesic abuse) represented only 25.7%. All other nephropathies were less common: glomerulonephritis 14.6%, diabetic nodular glomerulosclerosis 11.6%, cystic kidney disease and vascular nephropathies (each 4.5%). By contrast, in patients treated by hemodialysis and renal transplantation glomerulonephritis (28.7%) is the most important cause of CTRF, followed by analgesic nephropathy (20%), pyelonephritis (15%) and cystic disease of the kidney (12.5%). The difference between the two groups can be explained by the lower mean age of patients treated by hemodialysis and transplantation. Incidence and disease course can be affected significantly only in analgesic nephropathy. It is therefore very important to prohibit legally the use of phenacetin or paracetamol containing analgesics without medical prescription. In addition, these drugs should be replaced by other analgesic compounds.
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PMID:[Phenacetin abuse II. Chronic renal insufficiency in Basle autopsies]. 698 31

Special problems peculiar to urinary tract infections (UTIs) in the female include higher frequency than in males, recurrent infections, restrictions on antibiotic use during pregnancy, and the "urethral syndrome." Current concepts in the management of UTI include recognition of significant infection with total count of less than 100,000 organisms per milliliter; awareness that untreated UTI usually does not lead to progressive renal failure; importance of differentiating between upper and lower UTI; use of antibody coating of bacterial for distinguishing upper from lower UTI; evidence that 1-day (or single-dose) therapy may be adequate for cystitis, whereas pyelonephritis usually requires treatment beyond 2 weeks; evidence of effective prophylaxis; and indications that Chlamydia may be responsible for some cases of urethral syndrome.
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PMID:Urinary tract infections in the female. 699 Mar 31

Significant glomerular changes occur in a substantial number of renal cadaver allotransplants. Transplant glomerulopathy and recurrent glomerulonephritis account for most of the lesions whereas the development of de novo glomerulonephritis is a rare event. Only a few cases of membranous glomerulonephritis in the graft have been documented. The four patients presented all developed heavy proteinuria of 11.5 to 14 g/day 5 months to 1 year after transplantation. Three cases of de novo membranous glomerulonephritis were transplanted because of renal failure due to chronic pyelonephritis, chronic glomerulonephritis and medullary sponge kidney. One patient has recurrent membranous glomerulonephritis. Transplant biopsy revealed only minimal glomerular changes by light microscopy in all cases. Immunofluorescence and electron microscopy demonstrated typical membranous glomerulonephritis.
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PMID:Recurrent and de novo membranous glomerulonephritis in renal cadaver allotransplants. 699 Nov 85

Arabinitol is a pentitol generated in large quantitites by several species of Candida, including Candida albicans. The level of arabinitol in the sera of infected animals and humans was determined by gas-liquid chromatography of an acetone extract of the serum. Experimentally infected mice with pyelonephritis due to C. albicans had elevated levels of arabinitol; rabbits with pyelonephritis did not have elevated levels, nor did rabbits with catheter-induce cystitis, but rabbits with endocarditis developed elevated levels of arabinitol shortly before death. A prospective study in patients clinically suspected of having invasive candidiasis failed to show elevated levels of arabinitol in most. Mice and patients not colonized or infected with yeasts but with renal failure had high serum levels of arabinitol. The data indicate that an elevated level of arabinitol in the serum of a patient without renal disease is suggestive of invasive candidiasis, but normal serum levels do not contradict the diagnosis.
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PMID:Serum levels of arabinitol in the detection of invasive candidiasis in animals and humans. 701 20

High pressure reflux may be a major cause of chronic renal failure both with and without associated urinary tract infection. The concept of reflux nephropathy includes not only the entity previously known as "chronic atrophic pyelonephritis," but other forms of renal disease such as the Ask-Upmark kidney, renal segmental hypoplasia, and the generalized changes that resemble those of obstructive nephropathy but which are secondary to reflux. Lobar and papillary anatomic variations play an important role in predisposing certain kidneys or parts of a kidney to damage from high pressure reflux, with or without infection. Prolonged high pressure sterile reflux can not only cause focal scarring in papillae susceptible to intrarenal reflux, but can cause the conversion of nonsusceptible papillae, so that scarring may then become generalized. The mechanisms of scar production induced by intrarenal reflux remain unclear, but mechanical immunologic, bacterial, and vascular factors are current subjects of investigation. There is mounting evidence that it is in infancy that a train of events starts which culminates in this renal damage and that much of this may be well under way quite early in childhood and remain clinically undetected until later in life, when the end results (i.e., hypertension and/or renal failure) become manifest.
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PMID:Neuhauser lecture. Reflux nephropathy: a personal historical review. 702 97

The importance of bacterial infection as a major cause of progressive renal failure has become less prominent as long-term studies have failed to show progressive renal disease in bacteriuric humans. Functional or anatomic abnormalities of the urinary tract are necessary to perpetuate infection and cause renal scars and renal failure. In children, the most common abnormality is reflux. Sterile reflux that extends into the renal collecting ducts may cause scars previously called atrophic pyelonephritis. This entity is now referred to as reflux nephropathy. Other predisposing factors may lead to end-stage disease in a small proportion of bacteriuric patients. The most common are obstructive uropathy and calculus disease. Bacteriuria is difficult to eradicate in maintenance hemodialysis patients and may require bilateral nephrectomy. In transplant recipients, bacteriuria is common and has been associated with rejection and loss of allograft.
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PMID:The role of urinary tract infection in chronic renal failure. 703 45

Chronic renal failure associated with hypercalcemia and hypophosphatemia was diagnosed in 6 horses. The renal lesions in 5 of the horses were classified as chronic glomerulonephritis and in the sixth, as chronic interstitial nephritis/pyelonephritis. There was no evidence of primary hyperparathyroidism or pseudohyperparathyroidism, thus suggesting that hypercalcemia associated with advanced renal failure in horses is related to a unique role of the equine kidney in calcium homeostasis.
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PMID:Paradoxic hypercalcemia and hypophosphatemia associated with chronic renal failure in horses. 706 1

Aminoglycoside antibiotics are useful--despite potential toxicity--for treating urinary tract infection when other antibacterial agents have failed to eradicate bacteriuria. That this is true of the recently introduced aminoglycoside netilmicin was shown by 16 cases of tenacious and frequently recurring urinary tract infection. In contrast to previous recommendations, but relying on well known pharmacokinetic data which show prolonged urinary excretion of aminoglycosides, netilmicin was administered according to the following dosage schedule: Intramuscular injections of 3 mg/kg in cases where renal function was unimpaired, and of 2 mg/kg where it was reduced, were administered at dosage intervals of 1 to 4 days. Peak serum levels of netilmicin measured 1 hour after intramuscular injection were within the expected range of 8-14 micrograms/ml (3 mg/kg) and 6-10 micrograms/ml (2 mg/kg). As a result of the long dosage intervals the serum trough levels were usually far below 1 microgram/ml except in patients with moderate renal failure. Urinary concentrations of netilmicin, however, remained for the most part above the limit of antibacterial activity throughout the dosage intervals of 1 to 4 days. One week after the usual three weeks treatment course, urinary concentrations were still between 1 and 5 mcg/ml, and slowly decreasing amounts of the drug could be detected at least in traces up to 3 months beyond the last dose. Considering the type of urinary tract infections selected to receive netilmicin, the response to treatment was satisfactory and seemed unaffected by the long dosage intervals. Bacteriological cure was achieved in 5 of 11 infections associated with chronic pyelonephritis or analgesic nephropathy and in 4 of 5 urinary infections in patients with renal transplants. Treatment failures could be accounted for by obstructive lesions, stones, and in one transplanted patient by infection localized to her own shrunken kidneys. No instance of ototoxicity or nephrotoxicity due to netilmicin could be detected. Netilmicin administered according to the dosage schedule described can be recommended for ambulatory treatment of tenacious, recurring urinary tract infections due to gram-negative bacteria and refractory to cure by the usual oral antibiotic therapy.
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PMID:[Netilmicin in refractory urinary tract infections. Good therapeutic effect in spite of long dosage intervals]. 711 61


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