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

Diabetes mellitus associated with urinary tract infections and ureteral obstruction can be predisposing factors leading to emphysematous pyelonephritis. Fever, flank pains, and a palpable renal mass, associated with dehydration and hyperglycemia, were the most frequent presenting symptoms associated with emphysematous pyelonephritis. Computerized tomography (CT) scan is the best method to identify a renal or perirenal abscess and its ramifications. Intravenous antibiotic therapy is determined by blood and urine cultures. Mortality was zero in patients treated by nephrectomy. One patient who had incision and drainage of a renal abscess died of sepsis, and 1 patient died of sepsis following incision and drainage of a prostatic abscess. Patients with cystitis emphysematosa require antibiotic therapy and relief of bladder outlet obstruction. Prostatic abscess is best treated by perineal incision and drainage. Periurethral scrotal abscesses should be incised, drained, and the overlying necrotic skin debrided. Early diagnosis and aggressive medical and surgical management of gas-forming infections of the genitourinary tract are vital.
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PMID:Gas-forming infections in genitourinary tract. 155 45

A case is presented of an E. Coli emphysematous pyelonephritis in a 66 year old female diabetic patient who presented systemic sepsis with positive hemoculture. Diagnosis was obtained thanks to X-ray and the patient had a favorable evolution after left nephrectomy. This is a rare kidney disease (123 described cases) which evolves with necrosis of renal parenchyma and gas formation which frequently expands to the perirenal space and/or to the collector system. It presents a high mortality which can decrease according to the promptness of diagnosis based on X-ray. Thirty eight literature cases of the last decade are reviewed evaluating the efficiency of image diagnostic measures and surgical performance.
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PMID:[Emphysematous pyelonephritis: a case report and review of the literature]. 147 76

Advanced age is frequently considered a contraindication to radical exenterative surgery. We reviewed the outcomes of 63 patients age 65 years or older who underwent pelvic exenteration between 1960-1991 at The University of Texas M. D. Anderson Cancer Center. Sixty-three percent had preexisting medical illnesses. Major or potentially life-threatening complications were noted in 38% of the patients. An additional 38% experienced minor complications. Sixty percent experienced one or more infectious complications, including pyelonephritis, wound infection, sepsis, and flap necrosis. When both major and minor complications were considered, infectious morbidity was the single largest category. Although they are not life-threatening, nonspecific infectious morbidity and transient confusion were the most frequent individual complications, occurring in 26 and 24% of patients, respectively. Twenty-four percent of the patients experienced no complications. Thirty-four percent of the postoperative survivors suffered late major morbidity. Operative mortality was 11%; multisystem failure was the most frequent cause of death. After a mean follow-up of 4 years, 22 patients were alive with no clinical evidence of disease. Twenty-one patients died of recurrent disease, with a median time to recurrence of 9.6 months. The 5-year survival rate for the group was 46%. In comparison, 363 patients younger than age 65 who underwent exenteration during the same period experienced an operative mortality rate of 8.5% and a 5-year survival rate of 45%, neither of which were significantly different from the rates found for the older group (P = .51 and .52, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pelvic exenteration in the elderly patient. 156 64

A man aged 46 years with diabetes mellitus was admitted with acute right-sided renal symptoms. Pyelonephritis emphysematous without concretions was found. The patient was treated with insulin, fluids, electrolytes and antibiotics and nephrostomy was performed and, subsequently, an internal JJ-catheter in the ureter. The symptoms disappeared and he was discharged on a low dosage of sulphamethizol. After the planned removal of the JJ-catheter, sepsis running a lethal course developed. This emphasizes the importance of adequate prophylactic antibiotic therapy in connection with interventions in the urinary tracts.
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PMID:[Fatal emphysematous pyelonephritis]. 163 72

The risks of acute pyelonephritis in infants concern microbial invasion and parenchymal damage. There is a high rate of septicemia and of urinary malformations in children under 1 yr of age; in addition, the kidney is a growing organ with a high risk of scarring. Such parenchymal injury may lead to arterial hypertension, and renal failure when bilateral. Vesicoureteric reflux must be evaluated by ultrasound and cystogram; long-term renal scarring needs to be assessed by scintigraphy or pyelography when children are 7 yr old. Short- and long-term risks could be limited by early intravenous biantibiotherapy.
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PMID:[Urinary tract infections in infants: medical management]. 166 85

Digalactoside-binding (Gal-Gal) pili and alpha-hemolysin of Escherichia coli have been implicated as important virulence determinants in the pathogenesis of human ascending, nonobstructive pyelonephritis. The pathogenic significance of these determinants was evaluated in vitro and in the BALB/c mouse pyelonephritis model by employing wild-type, avirulent laboratory, and genetically defined cosmids, transformants, and recombinant strains. In vitro data suggest that the cytolytic activity of hemolysin is significantly (P less than 0.05) enhanced among digalactoside-binding strains which agglutinate erythrocytes. The basis of increased hemolysis is related presumably to more efficient delivery of the toxin to target lipid substrate in the host plasma membrane. Intravesicular administration of bacteria that express both digalactoside binding and hemolysin generally resulted in greater mortality and renal parenchymal injury in mice than strains that expressed none or only one of these determinants. Analyses convincingly demonstrate that digalactoside-binding pili are correlated with upper urinary tract colonization and that hemolysin is correlated with septicemia and renal parenchymal damage. These determinants collectively constitute the minimal virulence factors to produce disease in this model. Their efficacy as vaccines for the prevention of pyelonephritis was also assessed. A purified Gal-Gal pilus vaccine prevented (P less than 0.05) subsequent colonization by a challenge wild-type strain that exhibited homologous pili. The hemolysin vaccine did not abrogate subsequent bacterial renal colonization on challenge, but it did protect (P less than 0.05) mice which survived challenge from subsequent renal injury compared with those in the saline control group. The combination of these determinants was also protective. The combination of Gal-Gal pili and hemolysin in a vaccine preparation represents a potentially worthwhile strategy for human immunoprophylaxis against pyelonephritis by interdicting several steps in the pathogenesis of a bacterial mucosal infection.
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PMID:Alpha-hemolysin contributes to the pathogenicity of piliated digalactoside-binding Escherichia coli in the kidney: efficacy of an alpha-hemolysin vaccine in preventing renal injury in the BALB/c mouse model of pyelonephritis. 167 76

The authors report about 12 cases of long ureteral calculi, 16 to 39 mm in size, observed over 10 years. They were all made of a mixture of ammonium-magnesium phosphate and calcium phosphocarbonate. Infection was the revealing symptom, either in the form of simple bacteriuria or as acute pyelonephritis or sepsis. These calculi, found in a lumbar or pelvic location, were very long, radiopaque but with a moderate radiological density, homogeneous and have regular contours. They were straight, sometimes slightly bent, rarely (one case out of 12) arciform. In 11 of 12 cases, the affected patient was female. In most cases, the urine was infected by Proteus mirabilis. In spite of their size, the calculi caused total obstruction in 3 of 12 cases only. They were or were not associated to ipsilateral coral calculi of the same chemical type. Destruction was easily achieved with physical agents. The etiological, radiological and therapeutic characteristics of these calculi give them a specific place among ammonium-magnesium phosphate calculi.
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PMID:[Long ureteral ammonium-magnesium phosphate (struvite) and calcium phospho-carbonate calculi]. 180 76

Infectious complications following urologic surgery include bacteriuria, bacteremia, sepsis, acute pyelonephritis, and wound infection. Antimicrobial prophylaxis reduces the risk of some of these complications and is recommended in transrectal core biopsy of the prostate, transurethral surgery, open prostatectomy, and stone surgery. Prophylaxis does not appear to be beneficial in patients undergoing transrectal needle or transperineal core biopsy of the prostate, cystoscopy, orchiectomy, hydrocelectomy, and simple nephrectomy. Patients with urinary tract infection preoperatively should receive antimicrobial treatment prior to surgery.
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PMID:[Perioperative antimicrobial preventive treatment in urology]. 181 98

Many discriminative experimental animal models of infection have been utilized in the evaluation of newer fluoroquinolones. In vivo efficacy of many of the newer agents has been shown in experimental models of meningitis, endocarditis, pneumonia, urinary tract infections, pyelonephritis, osteomyelitis, abscesses of various types, septic arthritis, gastroenteritis, salmonellosis, listeriosis, tuberculosis, syphilis, sinusitis, prostatitis and burn wound sepsis, among others. This review focuses on recent developments in a few selected areas. Although the limitations of animal model studies are well described, these results provide a rationale for the appropriate clinical usage of the newer fluoroquinolones in humans.
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PMID:Evaluation of quinolones in experimental animal models of infections. 186 88

Acute gestational pyelonephritis infrequently leads to nonhydrostatic permeability pulmonary edema known clinically as acute respiratory distress syndrome (ARDS). In this form of ARDS, sepsis is considered the primary cause of pulmonary dysfunction. Decreases in colloid osmotic pressure, plasma fibronectin, and arterial oxygen saturation are associated with a worsening prognosis in septic conditions. We sought to investigate the changes in these parameters with acute gestational pyelonephritis to gain insight into the factors that may place the patient at risk for sepsis-related morbidity. Colloid osmotic pressure, plasma fibronectin, and arterial oxygen saturation via pulse oximetry were prospectively measured during the inpatient treatment of 17 pregnant patients with acute gestational pyelonephritis. All three parameters achieved their nadir within 24 hours of hospitalization and the initiation of therapy. Although no patient developed significant pulmonary dysfunction, we believe that patient susceptibility for pulmonary edema and general morbidity could be maximal in the first 24 hours after therapy. Future studies using a larger number of patients may identify one or more of these laboratory parameters as helpful in identifying gravid patients who are at risk of developing gestational ARDS.
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PMID:Acute gestational pyelonephritis: the impact on colloid osmotic pressure, plasma fibronectin, and arterial oxygen saturation. 202 86


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