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

Urinary tract infections are the most common bacterial infections experienced by elderly patients. These infections are often asymptomatic, although on occasion they produce discomfort for selective older patients (particularly those with obstructive uropathy), and present a risk for bacteremia, septic shock, adult respiratory distress syndrome, and death. The limited available data suggest that there are major differences with regard to pathogenesis, microbiology, clinical features, laboratory abnormalities, and therapy between young and elderly women who develop symptomatic pyelonephritis. There is a need to provide a standard antibiotic prophylaxis program to those elderly patients with specific cardiac conditions who are scheduled to undergo urinary procedures.
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PMID:Urinary tract infection. 142 35

On the fifth day of a course of antibiotic therapy for acute Klebsiella pyelonephritis, a 21-year-old pregnant woman developed adult respiratory distress syndrome. She improved rapidly on fluid restriction and intravenous furosemide and did not require mechanical ventilation. 17 weeks later, after 40 weeks of pregnancy, she spontaneously delivered a healthy male infant weighing 3280 g.
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PMID:[Adult respiratory distress syndrome complicating acute pyelonephritis in pregnancy]. 178 9

Two cases of ARDS as a complication of acute pyelonephritis during pregnancy are presented. The severity of the clinical condition necessitated treating both patients by mechanical ventilation with high positive-end expiratory pressure. The review of the only six other similar cases already reported (only one needing vigorous respiratory treatment) as well as the two cases presented in this report show that the pyelonephritic aetiology of ARDS in pregnancy is very rare. Nevertheless, any septic condition could be complicated by respiratory failure in pregnancy. ARDS must be suspected in those patients suffering from urinary tract infection in which signs of hypoxia appeared during the third trimester of pregnancy. Early recognition of the syndrome, closed monitoring and vigorous treatment can prevent maternal complications and/or fetal distress.
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PMID:Adult respiratory distress syndrome as a complication of acute pyelonephritis during pregnancy. 219 68

The first documented case of adult respiratory distress syndrome complicating acute pyelonephritis in pregnancy from the authors' institution is reported. The probable multiple causes for the development of pulmonary edema in this clinical setting are discussed, as well as the pitfalls in the patient's management.
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PMID:Adult respiratory distress syndrome as a complication of acute pyelonephritis during pregnancy: case report and discussion. 394 62

Adult respiratory distress syndrome (ARDS) is rarely encountered in association with pregnancy, but with the decline in other causes of maternal death, is an increasingly important cause of mortality in obstetric patients. ARDS may result from a variety of different types of pulmonary injury; uniquely obstetric causes include preeclampsia, amnionitis-endometritis, obstetric hemorrhage, and tocolytic therapy. Crucial management issues include support of maternal oxygenation and cardiac output, myriad interactions between the pulmonary process and its treatment, with maternal and fetal physiology, and decision making regarding delivery. Our review of the literature suggests that, for the patient requiring antepartum intubation for ARDS, except at a very early gestational age or when pyelonephritis or varicella pneumonia is a cause of respiratory compromise, delivery will likely be required for maternal and/or fetal indications, and an early decision for delivery may be beneficial. Postpartum management is similar to treatment of the nonpregnant patient with ARDS, with aggressive attention to potential surgically correctable causes for infection. Maternal mortality rates are affected little by duration of intubation, and therefore prolonged mechanical ventilation is justified and appropriate for mothers with ARDS.
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PMID:Adult respiratory distress syndrome in pregnancy: report of three cases and review of the literature. 917 12

At Asama General Hospital, we experienced six cases of urosepsis with septic shock during a period of five years between 1989 and 1993. All six patients, whose average age was 74 years old, recovered. In four patients, the condition was caused by obstructive uropathy. The remaining two cases were caused by renal inflammatory disease, which was complicated by diabetes mellitus. One of them was renal abscess with renal papillary necrosis, and the other was emphysematous pyelonephritis. The patients, who exhibited symptoms such as gram-negative bacteremia, severe hypotension, tachycardia, decrease of urine volume and mental disturbance, were diagnosed with urosepsis with septic shock. In all cases, symptoms such as a high fever of over 39 degrees C, hypoxemia and thrombocytopenia were observed. Renal dysfunction was found in 67%, and both liver dysfunction and disseminated intravascular coagulation (DIC) were found in 50% of the cases. Since no patients suffered from adult respiratory distress syndrome, a high survival rate was apparent. Anti-shock therapy and anti-coagulation therapy were ineffective for the patients who had septic shock due to urinary tract obstruction. Urinary tract drainage was required to treat the latter patients. Nephrectomy could not be avoided in renal parenchymatous inflammatory disease. In the future, what might be essential in therapeutics against urosepsis with septic shock, particularly to avoid nephrectomy, are the treatments such as immunotherapy against endotoxins and their mediators, and hemoperfusion for the removal of endotoxins.
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PMID:[Clinical study on 6 cases of urosepsis associated with septic shock]. 989 24

Urinary tract infections are relatively common in pregnancy and may result in significant morbidity for the pregnant woman and fetus. The authors recommend that all pregnant women be screened for the presence of bacteriuria at their first prenatal visit. Failure to treat bacteriuria during pregnancy may result in as many as 25% of women experiencing acute pyelonephritis. Women with acute pyelonephritis may sustain significant complications, such as preterm labor, transient renal failure, ARDS, sepsis and shock, and hematologic abnormalities. Pregnant women with urinary tract infections should be followed up closely after treatment because as many as one third will experience a recurrence.
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PMID:Urinary tract infections during pregnancy. 1151 2

The aim of this study is to report the extrarenal computerized tomography (CT) findings in patients with acute pyelonephritis (APN). Twenty-one CT examinations of 20 patients [19 women and one man, with ages ranging from 18 to 57 years (mean -35.2 years)], presenting either with a clinical diagnosis of APN (n=17) or with a suspected acute appendicitis, fever of unknown origin, and adult respiratory distress syndrome, one in each, were retrospectively reviewed. None had a known preexisting systemic disease. Results showed that renal abnormalities were seen on CT in all patients. In addition, ascites was detected in all women patients associated with subcutaneous edema in five of them. A thickened gallbladder wall was found in 19 cases, all were women, and periportal tracking and a dilated inferior vena cava in 17 CTs. Pleural effusion and thickened interlobular septa were present in 16 and 15 studies, respectively. Relevant laboratory findings included hypoalbuminemia in 14, elevated liver enzymes in 11, hypocholesterolemia in nine, and elevated LDH levels in six cases. In conclusion, radiologists should be familiar with the extrarenal imaging features of APN that may be seen on CT, and on ultrasonography as well, and should look for renal abnormalities to diagnose a clinically unsuspected APN. Alternatively, APN should be included in the differential diagnosis of systemic diseases that cause gallbladder wall thickening to avoid misdiagnosing it as acute cholecystitis.
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PMID:Extrarenal manifestations of severe acute pyelonephritis: CT findings in 21 cases. 1694 Nov 12

BACKGROUND Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is a technique used to provide prolonged cardiac and respiratory support to persons whose heart and lungs are unable to deliver adequate perfusion or gas exchange to sustain life. It is indicated in patients with severe ARDS, severe hypothermia, and cardiac and respiratory failure when other conventional methods fail. CASE REPORT We report the case of a 22-year-old gravid 2 Para 1 woman who presented to the Emergency Department with pyelonephritis, who subsequently developed sepsis that progressed to ARDS. She was managed successfully with extracorporeal membrane oxygenation [ECMO] for 5 days, with heparin used as an anticoagulant. After significant improvement, she was successfully de-cannulated and extubated. CONCLUSIONS The use of ECMO in pregnancy and post-partum can be associated with several complications to both mother and fetus. With appropriate patient selection, good knowledge of the procedure, and early initiation, successful outcomes can be attained.
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PMID:Venovenous Extracorporeal Membrane Oxygenation in a Gravid Patient with Acute Respiratory Distress Syndrome: A Case Report. 3109 81