Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnostic value of 99mtechnetium-dimercaptosuccinic acid (DMSA) scintigraphy, ultrasonography and renal functional parameters [urine N-acetyl-beta-D-glucosaminidase (NAG)/creatinine and urine albumin/creatinine quotients] in acute pyelonephritis (APN) were studied in 39 children (28 girls, 11 boys, median age 9 months, range 2 weeks to 9.4 years, 28 patients < 1 year, 11 patients > 1 year) with first-time urinary tract infection. Ultrasonography of the urinary tract was performed on admission and together with DMSA scintigraphy (< 10 days from admission). Urine NAG/creatinine and urine albumin/creatinine quotients were measured daily and after 6-8 weeks. Ultrasonography revealed abnormalities in 12 of 39 (31%) patients [11/32 patients (34%) with positive DMSA scintigraphy], while DMSA uptake defects were present in 32 of 39 (82%) patients [21/28 < 1 year (75%), 11/11 > 1 year (100%), P = 0.08]. Urine NAG/creatinine and urine albumin/creatinine quotients were significantly higher in children < 1 year with APN, as well as in non-renal fever controls, than in older children. However, in both age groups the urine NAG/creatinine and urine albumin/creatinine quotients were significantly higher in APN than in non-renal fever. The urine NAG and albumin excretion decreased rapidly after the initiation of antimicrobial therapy and had normalized at 6-8 weeks. The size and grade of the DMSA uptake defect (DMSA score) did not correlate with duration of disease at admission, maximum C-reactive protein or maximum fever. The urine NAG/creatinine quotient in the children < 1 year showed, however, a significant correlation with the DMSA score (r = 0.58, P < 0.05), while no correlation was found in the older children. We conclude that DMSA scintigraphy is a sensitive method to confirm the clinical diagnosis of APN, although a substantial number of infants appear to have normal scans. Early determination of the urine NAG/creatinine and albumin/ creatinine quotients may further improve the diagnostics in the infant.
 ...
PMID:Functional parameters and 99mtechnetium-dimercaptosuccinic acid scan in acute pyelonephritis. 769 7

A 34-year-old woman who 14 years previously had undergone a left nephrotomy for nephrolithiasis complained of pain in the left renal fossa which was reddened and painful on percussion. She had a fever of 38.2 degrees C. C-reactive protein was raised to 80 mg/l, the white cell count to 14,620/microliters (83% neutrophils). Protein and white cells were found in the urine together with a significant number of E. coli on urine culture. Plain film of the abdomen showed a staghorn calculus and ultrasonography demonstrated renal enlargement with a possible paranephritic abscess. The computed tomography diagnosis was xanthogranulomatous pyelonephritis, on the basis of renal enlargement, staghorn calculus, hypodense areas with typical density values (10-15 Hounsfield units), contrast enrichment and extrarenal extension of partly phlegmonous partly fused-together inflammatory changes. The abscessing parts were drained under computed tomography control. Starting 7 days pre-operatively the patient had been receiving ciprofloxacin (0.4 g daily) intravenously. A nephrectomy had to be performed subsequently. Antibiotic treatment was discontinued 2 weeks later and she was discharged symptom-free. The diagnosis of diffuse xanthogranulomatous Pyelonephritis was confirmed by histological examination of the surgical specimen.
 ...
PMID:[Xanthogranulomatous pyelonephritis with phlegmonous abdominal wall infiltration. Diagnosis and assessment of extent via computerized tomography]. 785 Dec 87

Blood serum levels of stage-specific antigens were measured by radioimmunoassay and immunodiffusion methods in patients with acute pyelonephritis at various stages of traditional antibacterial therapy and ultraviolet autoblood irradiation. Under study were ferritin, beta 2-microglobulin, C-reactive protein, transferrin, alpha 2-macroglobulin, and haptoglobin levels. Kinetics of the measured proteins was demonstrated and the possibility of applying their identification to assessment of treatment efficacy shown. The levels of these proteins are shown to be not only indicators of inflammation and destruction in pyelonephritis, but to reflect as well the repair reactions in the body which course most actively when UV irradiation of autoblood is added to multiple-modality treatment schemes.
 ...
PMID:[Serum antigens in the evaluation of the effectiveness of pyelonephritis therapy]. 795 3

This study examined the effect of pregnancy on the host response to acute pyelonephritis. Urine and serum samples were obtained at the time of diagnosis and after two weeks, from non-pregnant and pregnant women with acute pyelonephritis. The samples were analyzed for interleukin-6 (IL-6) and specific antibody activity to antigens extracted from the Escherichia coli strain infecting each patient. The host response to infection was further quantitated as fever, C-reactive protein, and renal concentrating capacity. Acute pyelonephritis in non-pregnant and pregnant women was accompanied by a significant serum and urine antibody response. The serum antibody response was significantly lower in the pregnant group. The IL-6 levels in serum and urine at diagnosis were significantly higher in the non-pregnant compared to the pregnant women. These results demonstrate that the immunosuppression of pregnancy includes the mucosal IL-6 and specific antibody responses to acute pyelonephritis caused by E. coli.
 ...
PMID:Suppressed antibody and interleukin-6 responses to acute pyelonephritis in pregnancy. 816 47

We designed a prospective study to evaluate the ability of dimercaptosuccinic acid cortical scintigraphy and ultrasonography to detect renal parenchymal lesions in children with pyelonephritis. One hundred eleven patients 1 week to 16 years of age (median 5.5 months) with a urine culture positive for pathogens were included in the study; cortical scintigraphy and ultrasonography were repeated in 25 children after a mean follow-up of 10.5 months. Cortical scintigraphy showed renal changes in 74 children (67%), and ultrasonography showed renal changes in 39 (35%) (p < 0.001); results of the two examinations were discordant in 49 patients (kappa = 0.19). Children more than 1 year of age had a higher incidence of renal lesions than did younger children (85% vs 66%; p = 0.04). The presence of inflammatory signs (erythrocyte sedimentation rate or C-reactive protein) had an 89% sensitivity and a 25% specificity in identifying renal lesions. Among children with renal changes, vesicoureteric reflux was present in 39%. At follow-up examination, 16 children (64%) had scars. Thus we found a high incidence of renal involvement in children with pyelonephritis. We found that cortical scintigraphy is more sensitive than ultrasonography in detecting renal changes, and we believe that it should be added to the initial examination of children with suspected pyelonephritis.
 ...
PMID:Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. 828 80

The 99mTc-DMSA scan is accepted as the most sensitive imaging modality for detecting areas of renal parenchymal scarring. More recently the DMSA scan has also been shown to be of value in imaging areas of renal parenchymal involvement in both children and adults with acute pyelonephritis. We assessed the acute DMSA scan findings in a consecutive series of 81 patients hospitalized with acute pyelonephritis. Acute pyelonephritis was diagnosed if the patient had a fever of > 37.8 degrees C, loin pain or tenderness and infected urine (99% Escherichia coli). Patients had a blood culture taken (8 positive), as well as a hematological (leukocytosis 75%) and biochemical screen, C-reactive protein (CRP) (increased in 57 of 66 [86%]) and urinary tract ultrasonography. If the initial DMSA scan was abnormal it was repeated after three months and in some instances again at six months. If persisting defects were noted an intravenous urogram was then undertaken. Of the 81 patients, 37 (46%) had an abnormality on the DMSA scan. Nineteen had a single defect, 12 multifocal defects, five features suggestive of pre-existing renal parenchymal scarring (all later shown to have reflux nephropathy) and one a shrunken kidney. Those patients with an abnormal scan had a higher CRP concentration than those with a normal scan. Of the 31 patients who had either a focal or multifocal defect on their initial DMSA scan there was adequate follow-up on 24 patients. In 18 of these the defects had resolved by six months (usually within three months), while of the remainder, three were shown to have reflux nephropathy, one had a large single renal cyst and another an area of parenchymal calcification. Fifty-three of 76 patients (70%) had normal ultrasonography. In adults with acute pyelonephritis, the DMSA scan may prove to be the most useful renal imaging procedure.
 ...
PMID:DMSA renal scans in adults with acute pyelonephritis. 886 86

Urinary tract infections activate both mucosal and systemic inflammatory responses reflected by elevation of cytokine concentrations in serum and urine. We determined urine and serum concentrations of tumour necrosis factor soluble receptors I and II (sTNFR I and sTNFR II) and interleukin-1 receptor antagonist (IL-1ra) in 41 women with acute pyelonephritis caused by Escherichia coli, 2 weeks after the infection, during a subsequent episode of cystitis or asymptomatic bacteriuria and also later when the same patients were free from bacteriuria. Concentrations of sTNFR I, sTNFR II and IL-1ra were related to the expression of five virulence markers of E. coli, glomerular filtration rate (GFR) and to the concentration of C-reactive protein (CRP) in serum. Patients with acute pyelonephritis had elevated serum concentrations of sTNFR I and sTNFR II compared to healthy women (P < 0.001 for both comparisons). The concentrations of sTNFR I and sTNFR II in urine were significantly higher in patients with acute pyelonephritis compared to controls (P < 0.001 in both cases). The concentration of sTNFR II in urine was higher in patients infected by E. coli producing haemolysin (P = 0.05) and in patients infected by E. coli expressing hydrophobic properties (P = 0.05) compared to patients infected by strains without these virulence traits. Patients who had high concentrations of sTNFR II in serum during acute pyelonephritis had lower GFR at follow-up (r = -0.48, P = 0.05). Patients who responded with a marked increase in CRP had higher sTNFR I and sTNFR II in urine (r = 0.58, P < 0.01 and r = 0.48, P < 0.01, respectively). The concentrations of sTNFR I and sTNFR II in serum and urine decreased during follow-up and were lower 2 weeks after the infection when all patients were free from bacteriuria. IL-1ra in serum was elevated during pyelonephritis (P < 0.001) while that in urine was significantly lower compared to controls (P < 0.001). It is concluded that the increased concentrations of TNF receptors may block the cytotoxic and inflammatory actions and reduce the sensibility of renal cells to TNF alpha-mediated effects.
 ...
PMID:Tumour necrosis factor soluble receptors I and II and interleukin-1 receptor antagonist in acute pyelonephritis in relation to bacterial virulence-associated traits and renal function. 894 80

We measured the platelet distribution width, the mean platelet volume, the volume percentage of platelets, and the platelet-to-large-cell ratio in 15 elderly patients with disseminated intravascular coagulation (DIC). Peripheral venous blood mixed with ehtylenediaminetetraacetic acid was analyzed with a Sysmex E-4000 analyzer. The underlying diseases were sepsis, pneumonia, pyelonephritis, and other inflammatory diseases. The mean duration of survival from the onset of DIC was 16.9 +/- 23.9 days. The distribution of red cell sizes before the onset of DIC did not differ significantly from that in patients without DIC, but fragmentation of erythrocytes on blood films was more common in the early stage of DIC (p < 0.01). Before the onset of DIC, the two groups did not differ significantly in the frequency of giant platelets on blood smears. At the onset of DIC, the platelet distribution width, the mean platelet volume, and the platelet-to-large-cell ratio were significantly higher than in patients without DIC. The concentration of glutamic-oxaloacetic transaminase and those of other serum enzymes did not change significantly, but the serum creatinine concentration and the blood urea nitrogen level increased as the platelet-to-large-cell ratio increased. No significant relation was evident between the levels of serum C-reactive protein and creatinine, between the platelet-to-large-cell ratio and the mean volume of red blood cells, or between the platelet-to-large-cell ratio and the distribution of red cell sizes. These data suggest that studies of platelets are more useful in the diagnosis of DIC at early stages of impaired organ function than are other indicators of inflammation such as the level of C-reactive protein.
 ...
PMID:[Changes in erythrocyte structure and in platelets in elderly patients with disseminated intravascular coagulation]. 899 5

A prospective, coordinated, randomized multicentre trial was conducted to determine whether tobramycin 160 mg intravenously (i.v.) once daily for 2 days would improve the efficacy of cefotaxime 1 g i.v. twice daily for 2 days followed by a 10-day course of oral cefadroxil 1 g twice daily, in the treatment of community-acquired acute pyelonephritis in women. Of 73 patients enrolled in the study, 51 could be evaluated according to the protocol. There were no significant differences in bacteriological cure rates between the combined treatment with tobramycin/cefotaxime and cefotaxime alone, either at short-term follow-up (63.0% vs 59.1%; 95% confidence interval (CI) for difference in proportions -23.4% to 31.2%), or up to 7 weeks after cessation of treatment (42.9% vs 52.2%; 95% CI, -18.0% to 36.6%). A modified intention-to-treat analysis showed no difference in clinical efficacy between the two regimens (68.6% vs 69.2%; 95% CI, -22.9% to 24.1%). Tobramycin seemed to enhance the resolution of inflammation by a more rapid decline in C-reactive protein levels. The high recurrence rates after treatment with beta-lactam antibiotics in this and previous studies of acute pyelonephritis may be explained by adverse ecological effects rather than failure to eradicate the infection.
 ...
PMID:Aminoglycosides do not improve the efficacy of cephalosporins for treatment of acute pyelonephritis in women. 918 55

An interleukin-6 (IL-6) response was detected in 81 patients with febrile urinary tract infections (UTIs). Bacteremic patients (n=24) had higher serum IL-6 at inclusion and throughout the first 24 h (P<. 01) and higher urine IL-6 from 6 h after start of therapy (P<.01) than did nonbacteremic patients (n=57). The serum and urine IL-6 responses remained elevated longer in the bacteremic group. Patients with clinical signs of pyelonephritis had higher serum and urine IL-6 concentrations than did other patients in the study population (P=.058, P<.01, respectively). IL-6 high responders had higher temperatures (P<.05) and C-reactive protein levels (P<.05, P<.01) than did low responders. The results demonstrate that IL-6 responses accompany febrile UTIs regardless of bacteremia and that the response reflects disease severity. The results suggest that IL-6 produced in the urinary tract can trigger the systemic host response in the absence of bacteremia.
 ...
PMID:Interleukin-6 and disease severity in patients with bacteremic and nonbacteremic febrile urinary tract infection. 984 36


<< Previous 1 2 3 4 5 6 7 8 9 Next >>