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

Acute pyelonephritis is one of the most common indications for antepartum hospitalization. When acute pyelonephritis is diagnosed, conventional treatment includes intravenous fluid and parenteral antibacterial administration. There are limited data by which to assess the superiority of one antibacterial regimen over the other in terms of efficacy, patient acceptance and safety for the developing fetus; however, it is important to consider antimicrobial resistance patterns in the local community when choosing an agent. Moreover, there are growing public health concerns regarding antimicrobial resistance to commonly prescribed medications for urinary tract infections in pregnancy. There is a small body of evidence to support the ambulatory treatment of pregnant women with pyelonephritis in the first and early second trimesters, but the majority of women will be managed as inpatients. This article provides a suggested algorithm for the treatment of pyelonephritis during pregnancy.
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PMID:Pyelonephritis in pregnancy: an update on treatment options for optimal outcomes. 2073 73

Acute pyelonephritis is a common bacterial infection in children. The recommended treatment in Denmark is intravenous ampiciline and gentamycin for at least three days followed by oral antibiotics. The available evidence indicates that oral antibiotics may be as effective as initial intravenous treatment of children with a first attack of pyelonephritis. However, there are no Danish microbiological studies covering broad-spectrum oral antibiotics to children with pyelonephritis. This impedes generalisation to Danish practice.
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PMID:[Oral versus intravenous antibiotic therapy for pyelonephritis in the paediatric patient--a survey of a Cochrane review]. 2082 32

Acute pyelonephritis is a common bacterial infection of the renal pelvis and kidney most often seen in young adult women. History and physical examination are the most useful tools for diagnosis. Most patients have fever, although it may be absent early in the illness. Flank pain is nearly universal, and its absence should raise suspicion of an alternative diagnosis. A positive urinalysis confirms the diagnosis in patients with a compatible history and physical examination. Urine culture should be obtained in all patients to guide antibiotic therapy if the patient does not respond to initial empiric antibiotic regimens. Escherichia coli is the most common pathogen in acute pyelonephritis, and in the past decade, there has been an increasing rate of E. coli resistance to extended-spectrum beta-lactam antibiotics. Imaging, usually with contrast-enhanced computed tomography, is not necessary unless there is no improvement in the patient's symptoms or if there is symptom recurrence after initial improvement. Outpatient treatment is appropriate for most patients. Inpatient therapy is recommended for patients who have severe illness or in whom a complication is suspected. Practice guidelines recommend oral fluoroquinolones as initial outpatient therapy if the rate of fluoroquinolone resistance in the community is 10 percent or less. If the resistance rate exceeds 10 percent, an initial intravenous dose of ceftriaxone or gentamicin should be given, followed by an oral fluoroquinolone regimen. Oral beta-lactam antibiotics and trimethoprim/sulfamethoxazole are generally inappropriate for outpatient therapy because of high resistance rates. Several antibiotic regimens can be used for inpatient treatment, including fluoroquinolones, aminoglycosides, and cephalosporins.
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PMID:Diagnosis and treatment of acute pyelonephritis in women. 2261 42

Urinary tract infection (UTI) is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Until now, vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However, reflux nephropathy is not always acquired; rather, it reflects reflux-associated congenital dysplastic kidneys. The viewpoint that chronic kidney disease results from renal maldevelopment-associated VUR has led to questioning the utility of any regimen directed at identifying or treating VUR. Despite the recognition that underlying renal anomalies may be the cause of renal scarring that was previously attributed to infection, the prevention of renal scarring remains the goal of all therapies for childhood UTI. Therefore, children at high risk of renal scar formation after UTI should be treated and investigated until a large clinical study and basic research give us more information.
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PMID:Renal scar formation after urinary tract infection in children. 2313 82

Acute pyelonephritis complicates 1-2% of pregnancies and causes significant maternal and fetal morbidity and mortality. The diagnosis of renal tuberculosis (TB) is often delayed and commonly presents with sterile pyuria or along with other pyogenic organisms. We report a case where the diagnosis of renal TB was missed in a pregnant woman when she presented with acute pyelonephritis, septic shock, and acute renal failure. There was clinical recovery with antibiotics, but bilateral psoas and perinephric abscesses (TB, Enterococcus sp., and E. coli) were diagnosed when she presented with loin pain and palpable left renal angle swelling. Bilateral psoas abscess due to TB in the absence of skeletal TB and human immunodeficiency virus infection is rare. The presentation of renal TB in pregnancy, its complications, and its management are discussed.
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PMID:Bilateral psoas and bilateral perinephric abscesses complicating acute pyelonephritis in pregnancy. 2358 Aug 9

Acute pyelonephritis is a potentially life-threatening infection of the upper urinary tract. Inflammatory response and the accompanying oxidative stress can contribute to kidney tissue damage, resulting in infection-induced intoxication that can become fatal in the absence of antibiotic therapy. Here, we show that pyelonephritis was associated with oxidative stress and renal cell death. Oxidative stress observed in pyelonephritic kidney was accompanied by a reduced level of mitochondrial B-cell lymphoma 2 (Bcl-2). Importantly, renal cell death and animal mortality were both alleviated by mitochondria-targeted antioxidant 10(6'-plastoquinonyl) decylrhodamine 19 (SkQR1). These findings suggest that pyelonephritis can be treated by reducing mitochondrial reactive oxygen species and thus by protecting mitochondrial integrity and lowering kidney damage.
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PMID:Protective effect of mitochondria-targeted antioxidants in an acute bacterial infection. 2389 94

Acute pyelonephritis is a potentially organ-damaging and life-threatening infection. A 37-year old woman was admitted to Intensive Care Unit in septic shock and multi-organ failure due to acute pyelonephritis with systemic bacterial dissemination caused by a quinolone-resistant Escherichia coli. The patient, a previously healthy woman, reported recurrent episodes of urinary tract infection in the previous 3 years, which were treated with quinolones. Treatment course with broad-spectrum antimicrobial agents reversed her septic shock and multi-organ failure. However, pyelonephritis progressed to intrarenal and perirenal abscesses formation. The patient fully recovered after surgical removal of the infected kidney.
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PMID:Community acquired quinolone-resistant Escherichia coli pyelonephritis complicated with multiple renal abscesses: a case report. 2393 24

The aim of the present study was to demonstrate that the treatment outcome of transperitoneal ureterocutaneostomy using the transverse mesocolon is not inferior to that of conventional retroperitoneal ureterocutaneostomy. The enrolled subjects were 26 patients who underwent ureterocutaneostomy among a total of 160 cases of urinary diversion performed at our institution between March, 2004 and November, 2011. A total of 11 cases and 18 ureters were treated by transperitoneal ureterocutaneostomy via the transverse mesocolon, with 7 bilateral ureterocutaneostomy cases. All the cases of retroperitoneal ureterocutaneostomy were unilateral, totaling 15 patients and 15 ureters. Postoperative adverse events (ileus, acute pyelonephritis), catheter-free status and renal function [blood urea nitrogen (BUN) and serum creatinine (Cr) values] were retrospectively evaluated between the groups treated by the different surgical procedures. Ileus was only observed in 1 case and improvement was achieved through conservative therapy alone (P=0.827). Acute pyelonephritis developed in 3 (27.3%) transperitoneal and 8 (53.3%) retroperitoneal cases, with all the cases recovering following treatment with antibiotics alone (P=0.199). A catheter-free status was achieved in 3 cases (27.3%) and 4 ureters (22.2%) in the transperitoneal group and in 2 cases and 2 ureters (13.3%) in the retroperitoneal group (P=0.393). There was no significant change in renal function (BUN and serum Cr values) in the transperitoneal ureterocutaneostomy cases at the postoperative, early postoperative (1 month following surgery) or the final follow-up examination (P=0.739 and 0.078). In conclusion, transperitoneal ureterocutaneostomy allows for the construction of a cutaneous stoma using a shorter ureter, with a treatment outcome that is comparable to that of retroperitoneal ureterocutaneostomy.
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PMID:Clinical outcome of transperitoneal ureterocutaneostomy using the transverse mesocolon. 2464 35

Patients with fever, flank pain, and dysuria frequently are encountered in the emergency department. Acute pyelonephritis is the most likely diagnosis; however, its clinical and radiologic presentation consistently overlap with that of acute renal infarction. Ultrasound is unable to distinguish early infarction from nonabscessed acute pyelonephritis. Hence, computed tomography or magnetic resonance imaging are needed. We report the case of a 68-year-old woman who presented with fever, flank pain, and dysuria, along with respiratory distress and tachycardia. Elevated values for inflammatory indexes suggested a diagnosis of acute pyelonephritis, and subsequent contrast-enhanced computed tomography showed hypodense wedge-shaped areas in both kidneys. However, the presence of a thin rim of capsular enhancement (cortical rim sign), the absence of perirenal inflammatory changes, and the location of the lesions apart from defined calyces suggested the alternative diagnosis of renal infarction. The underlying cause was not identified until an episode of acute dyspnea revealed paroxysmal arrhythmia. Our case demonstrates that a thorough knowledge of the imaging findings of renal infarction and acute pyelonephritis is essential to correctly making the diagnosis.
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PMID:Renal infarction versus pyelonephritis in a woman presenting with fever and flank pain. 2476 80

Urinary tract infections frequently affect pregnant mothers. This problem causes significant morbidity and healthcare expenditure. Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis. Escherichia coli remains the most frequent organism isolated in UTIs. All pregnant mothers should be screened for UTIs in pregnancy and antibiotics should be commenced without delay. Urine culture and sensitivity is the gold standard in diagnosing UTIs. Without treatment, asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth retardation, low birth weight, maternal hypertension, pre-eclampsia and anaemia. Acute pyelonephritis can lead to maternal sepsis. Recurrent UTIs in pregnancy require prophylactic antibiotic treatment.
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PMID:Urinary tract infections in pregnancy. 2560 81


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