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

Circulating antibody to Tamm-Horstall protein (THP) was measured using a radioimmunoassay in forty-five patients on maintenance hemodialysis and compared to levels of antibody titers measured in sera from ten healthy controls. The etiology of the end-stage kidney disease in the patient population was polycystic kidney disease in thirteen, glomerulonephritis in fourteen, diabetic nephropathy in nine, interstial nephritis and chronic pyelonephritis in three each, multiple myeloma in two, and urinary tract obstruction in one. Four patients had significantly elevated titers of antibody to THP but shared no other unifying characteristics. The results also indicate that none of the groups studied had mean antibody titers significantly different from controls. Furthermore, no general trend was apparent between levels of antibody to THP and number of months on dialysis. Observations made during the study revealed that heparinized samples of blood had lower titers of antibody to THP than did non-heparinized samples from the same patient. This finding was repeated when other anti-coagulants, i.e., ethylenediaminetetraacetate (EDTA) and sodium citrate, were used. Titers returned toward normal when CaCl2 was added back to samples anticoagulated with EDTA and sodium citrate. This suggests that clotting factors, probably fibrinogen, interfered with the measurement of antibody titers. Therefore, only serum should be used in further investigations of THP antibody using this assay.
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PMID:Tamm-Horsfall protein antibody in patients with end-stage kidney disease. 739 72

Preliminary evidence suggests that the concentration of lactic acid in urine may be a good means of distinguishing lower urinary tract infection (cystitis) from upper urinary tract infection (pyelonephritis) and may be helpful in detecting urinary tract obstruction. To test this hypothesis the lactic acid concentrations in 291 urine samples from 250 children were tested. Sixty-four patients had no bacterial infection and served as the control group. A second group (153 patients) had cystitis, and the third group (24 patients) showed radiologic, clinical, and laboratory evidence of pyelonephritis. A fourth group of nine patients who had prolonged urinary tract retention was also analyzed. Patients in the control group, as well as those with cystitis, showed relatively; low concentrations of urinary lactic acid. All levels were less than 2 mg/dl; (mean, 0.8 mg/dl; range, 0.1-2 mg/dl). Patients who had clinical pyelonephritis had lactic acid concentrations of 3.3 mg/dl (mean, 11.4 mg/dl; range, 3.3 mg/dl-40.5 mg/dl). There was no overlap in lactic acid concentrations between the two groups. Furthermore, lactic acid concentrations in urine from patients who had pyelonephritis gradually declined after the initiation of therapy, attaining a level of less than 1 mg/dl by the end of the treatment. Recurrence of the pyelonephritis was consistently documented by a renewed increase of urinary lactic acid concentration. Lactic acid levels were also elevated in urine samples collected immediately after relief of obstruction in the nine patients who had urethral obstructions, showing a mean concentration of 15.8 mg/dl (range, 4.2-37.2 mg/dl).
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PMID:Lactic acid in urine of children with lower and upper urinary tract infection and renal obstruction. 745 19

The urographic nephrogram is an important indicator of underlying functional and structural renal disease. With expansions in use of cross-sectional imaging, the computed tomographic (CT) nephrogram (ie, contrast material enhancement within the renal parenchyma) has assumed a greater role in the evaluation of urinary tract disorders. Both quantitative and qualitative nephrographic abnormalities are well demonstrated by CT, including global or segmental absence or persistence of the nephrogram, slowed temporal progression, striated pattern, and rim pattern. Global absence is nearly always unilateral and is most often seen with blunt abdominal trauma with renal pedicle injury. Segmental absence is attributable to focal renal infarction, most likely due to arterial emboli. Global persistence, which is much more common than segmental persistence, may be unilateral (caused by renal artery stenosis, renal vein thrombosis, or urinary tract obstruction) or bilateral (due to systemic hypotension, intratubular obstruction, or abnormalities in tubular function). Striated nephrograms may be unilateral or bilateral and are caused by ureteric obstruction, acute pyelonephritis, contusion, renal vein thrombosis, tubular obstruction, hypotension, and autosomal recessive polycystic kidney disease. The rim pattern is most often associated with renal infarction and occasionally with acute tubular necrosis and renal vein thrombosis. Careful evaluation of the CT nephrogram is an integral part of the abdominal CT examination.
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PMID:The CT nephrogram: implications for evaluation of urinary tract disease. 750 51

Chronic renal infection (Chronic bacterial pyelonephritis) is a cause of tubulo-interstitial nephropathy (nephritis); TIN. The disorder causes end-stage renal failure in about 2% of the patients who are treated by dialysis. However, Chronic bacterial pyelonephritis is a relatively benign condition that seldom leads to renal function loss. The affected kidney shows non-specific histological pictures similar to that seen with other diseases producing TIN. Clinical symptoms are of ten vague. Obstructive uropathy (eg, stones, benign prostatic hyperplasia) is frequently present. The affected kidney, which is almost unilateral, shows atrophy and scarring of variable degree. Significant pyuria and bacteriuria may or may not be found. Depending on the stage of the disease, the serum creatinine and blood urea nitrogen may be normal or elevated. Contributing obstructive uropathy should be corrected. The patients must be followed closely, urinary tract infection must be controlled and complications (eg, hypertension, azotemia) must be identified promptly and treated adequately.
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PMID:[Interstitial nephropathy due to chronic bacterial pyelonephritis]. 756 35

Obstructive uropathy causes tubular resistance to aldosterone and severe metabolic imbalance may be precipitated by an episode of pyelonephritis. In the last 3 years we investigated 52 episodes of pyelonephritis (positive urine culture, elevated C reactive protein, fever, elevated neutrophil count) in 50 children between 15 days and 15 months of age. Ultrasonography voiding cystography and renal scintiscan were performed in all cases and i.v. urography in some. A salt-losing syndrome with hyponatremia and hyperkalemia (Na < 125 meq/liter; K > 6.3 meq/liter) was observed in 17 infants < 3 months, accompanied by plasma aldosterone concentration of 5000 to 23,000 pg/ml (normal value, < 1000 pg/ml). All these children had a severe urinary tract (UT) malformation (ureteropelvic junction stenosis in 7 cases, vesicoureteral reflux in 7, posterior urethral valves in 2, double system in 1). Thirteen infants < 3 months, 7 with no urinary tract malformations, did not have electrolyte imbalance. Pyelonephritis was diagnosed in 20 other patients ages 4 to 15 months, including 16 with severe UT malformations; 4 had normal UTs. We conclude that a salt-losing syndrome with tubular resistance to aldosterone can occur during pyelonephritis in young infants with congenital UT malformation, that the risk diminishes considerably or disappears after 3 months of age and that in the absence of UT malformation pyelonephritis does not cause acute sodium loss of clinical relevance.
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PMID:Acute pyelonephritis as a cause of hyponatremia/hyperkalemia in young infants with urinary tract malformations. 771 92

Urinary tract infections in the elderly are common, often asymptomatic and usually benign. We report three patients who presented with acute renal failure due to acute pyelonephritis in the absence of clinical findings of infection or urinary tract obstruction. Blood and urine cultures grew Escherichia coli in two of the patients and in two patients renal biopsy confirmed acute pyogenic pyelonephritis. Antimicrobial therapy and haemodialysis led to improvement, though one patient subsequently died from an unrelated cause. We suggest that acute bacterial pyelonephritis should be considered as a cause of acute renal failure in the elderly. Clinical features of infection may be absent despite bacteraemia. Prompt diagnosis and intervention may avoid chronic renal failure in a group that has a less favourable outcome with long-term dialysis.
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PMID:Asymptomatic acute pyelonephritis as a cause of acute renal failure in the elderly. 849 36

Xanthogranulomatous pyelonephritis (XGP) is a specific form of chronic inflammatory kidney disease which may involve both sexes at any age. The disease presents either in the diffuse form or less commonly as a focal process which is almost impossible to differentiate from renal malignancy. XGP usually occurs in association with urinary tract obstruction, infection and/or renal stones. Symptoms are often vague and non-specific. The most common offending organisms are E. coli and Proteus mirabilis. In reviewing the literature we have found 197 cases in children during the last thirty years, and of these only 15 (7.6%) were of the focal form. A case of focal xanthogranulomatous pyelonephritis in a 6-year-old boy is reported which demonstrates the diagnostic difficulties encountered in this disease. We emphasize the importance of XGP in the differential diagnosis of renal tumours in children with recurrent or therapy-resistant urinary tract infection in spite of no evidence of renal stone, poorly or absent function in the kidney or urinary tract obstruction.
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PMID:Focal xanthogranulomatous pyelonephritis presenting as renal tumour in children. Case report with a review of the literature. 883 58

Upper urinary tract drainage in patients with chronic calculous pyelonephritis (CCP) results in not only successful anti-inflammatory and antibacterial treatment but also in more effective and safe ESWL. In 21 CCP patients with upper urinary tract drainage by means of catheter-stent, ESWL was performed using Lithostar-Plus (Siemens). Active inflammation with marked pyuria, bacteriuria and even moderate upper urinary tract dilation were indications for the upper urinary tract drainage with catheter-stent before and during ESWL in CCP patients. Upper urinary tract drainage with catheter-stent contributed to effective treatment of chronic pyelonephritis and allowed to perform ESWL. There were neither attacks of acute pyelonephritis nor upper urinary tract obstruction after catheter-stent removal. The catheter-stent allows to create closed drainage system with active evacuation function as it functions in physiological conditions. ESWL in patients with upper urinary tract drainage using catheter-stent is more effective and has lower risk of complications.
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PMID:[Drainage of the urinary tract as preparation for extracorporeal lithotripsy]. 972 11

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

Depending on the severity of the clinical syndrome, acute pyelonephritis may require more extensive imaging diagnostics. In the uncomplicated form of the disease, ultrasonography does not appear to be absolutely necessary. In clinically severe cases, however, which fail to respond to antibiotic therapy, ultrasound is the optimal procedure for ruling out urinary tract obstruction. Where there is clinical suspicion of complications proven risk factors, persistent fever and/or continuing pathological inflammation parameters (elevated C-reactive protein levels in serum)-ultrasonography is the primary imaging technique for the exclusion of pyonephrosis, as well as for other complicating factors such as calculi, etc. In cases of insufficient response to antibiotic therapy, we recommend performing a renal computed tomography scan with contrast medium, in order to rule out hypoenhancing zones as hints for severe tissue alterations. This procedure is in accordance with the suggestions of the Society for Uroradiology. In the future, DMSA scintigraphy might constitute an equivalent diagnostic method for the exclusion of these focal inflammatory changes. Above all, DMSA scintigraphy makes it possible to anticipate the development of scars following acute pyelonephritis.
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PMID:Rational diagnostic steps in acute pyelonephritis with special reference to ultrasonography and computed tomography scan. 1039 80


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