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

Diffuse xanthogranulomatous pyelonephritis is a rare chronic pyelonephritis. This study permitted us to notice the various histological, clinical, radiological, and the different means diagnoses of this affection. Retrospectively series of nine patients is reported. The median age was 43 years. The commonest clinical presentation was urinary tract infection, and lumbar pain. Urine culture identified a bacteria in seven cases (77%). Intravenous urography recovers silent kidney (five cases), hydronephrosis (two cases), chronic pyelonephritis (one case) and renal stones in six cases (67%). Treatment consisted of nephrectomy. No specific biological or radiological signs of this affection can be identifying this lesion in preoperative. The diagnosis was revealed by the histological examination of the removed kidney. The outcome is favorable after a follow-up of six months to four years. The clinical features of the pyelonephritis xanthogranulomatous is not specific. Magnetic resonance imaging can give a specificity to this affection. Only histological examination is able to established the definitive diagnosis.
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PMID:[Diffuse xanthogranulomatous pyelonephritis: clinical, anatomopathologic, and therapeutic features. Report ot 9 cases and review of the literature]. 1177 61

PURPOSE: To evaluate the indications for and the outcomes of extracorporeal shock wave lithotripsy (ESWL) of calyceal stones <5 mm, we prospectively studied a series of 25 patients scheduled for treatment. MATERIALS AND METHODS: Between January 1994 and June 1995, 15 males and 10 females with a mean age of 44 years (median 43; range 4 to 70 years) underwent ESWL of calyceal stones <5 mm using an unmodified HM3 Dornier lithotriptor. RESULTS: Indications for ESWL included 17 patients (68%) suffering from back and flank pain, 3 patients (12%) with gross hematuria and 1 patient (4%) with recurrent episodes of pyelonephritis. Six patients (24%) were asymptomatic. Evaluation 3 months after ESWL revealed that of the 17 patients with flank pain, 13 (76%) had complete resolution of pain and 4 (24%) had partial resolution of pain and there had been no further episodes of gross hematuria or pyelonephritis in the previously affected patients. At 3-month follow-up, of the 31 kidneys treated, plain radiography were available in 29; 20 (69%) were clear and 9 (31%) had small residual fragments. CONCLUSIONS: Calyceal stones <5 mm in maximum diameter can cause significant symptoms such as pain, hematuria and infection and should not be dismissed as inconsequential. When no other obvious cause is apparent, these small stones should be treated with a high likelihood of resolution of symptoms and clearance. ESWL should not be withheld in patients with small asymptomatic calculi who request or require treatment for fear of unexpected colic or stone growth.
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PMID:When is ESWL of small calyceal stones indicated? 1273 21

Gross hematuria, graft pain, and rising serum creatinine are classic signs of acute rejection, obstruction, or bacterial pyelonephritis for patients with renal transplants. This presentation often prompts percutaneous renal allograft biopsy. If subsequent evaluation fails to show evidence of acute rejection, obstruction, or bacterial infection, viral etiologies should be considered. We report a 14-year-old Hispanic female with a living-related renal transplant who had gross hematuria, graft tenderness, and increased serum creatinine, but did not have evidence of acute rejection, obstruction, or bacterial pyelonephritis. To our knowledge, this is the first report of adenovirus pyelonephritis in a transplanted kidney of a pediatric patient, with isolation of adenovirus in the urine and in the allograft using immunocytochemical techniques.
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PMID:Adenovirus pyelonephritis in a pediatric renal transplant patient. 1273 8

Diminutive kidney, hypoplasia or atrophic pyelonephritis, may be the cause of hypertension, lumbar or abdominal pain, obscure gastrointestinal symptoms or chronic urinary infection accompanied by chills and fever. A hypoplastic kidney is prone to infection and stone formation.Diagnosis includes meticulous x-ray examination and renal function studies employing the more accurate quantitative phenolsulfonphthalein test of each kidney. Nephrectomy is the treatment for unilateral disease causing symptoms; localized atrophic pyelonephritis is amenable to partial resection. Since urinary stasis invites infection, obstructing ureteral strictures should be dilated. Pyelectasis, secondary to ptosis, and ureteropelvic obstruction should be corrected by nephropexy or plastic repair. These conservative measures may prevent renal destruction.SIXTEEN PATIENTS WERE SUBJECTED TO NEPHRECTOMY: Six because of persistent pain and chronic infection and ten because of hypertension. The six with pain and chronic urinary infection were relieved. In six of the ten with hypertension, the disease recurred within six months to seven years.
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PMID:The diminutive kidney; congenital hypoplasia and atrophic pyelonephritis. 1328 42

The ureteroscopic approach to ureteral strictures has diminished morbidity because of smaller-caliber equipment, improved optics, Ho:YAG laser, and a better understanding of the risk factors for ureteral strictures. Direct visualization by means of retrograde ureteroscopy provides a safe and effective approach to treat ureteral strictures without the need for an open incision or percutaneous nephrostomy access. All patients with a ureteral stricture require an extensive evaluation and planning before treatment. Generally, patients with ureteral strictures and a history of carcinoma should undergo biopsy of the area of stricture. With recurrent cancer, patients may present with pain, nausea, vomiting, pyelonephritis, or loss of the ipsilateral renal unit. Malignant strictures tend to not respond well to balloon dilation alone. Open or laparoscopic resection and reconstruction may be indicated if there is a chance for cure. In patients who are not good surgical candidates or in those who have advanced disease, the urologist is left with the option of an indwelling stent or nephrostomy tube.
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PMID:Ureteroscopic management of ureteral and ureteroenteral strictures. 1504 Apr 7

We describe a clinical case of two patients who received a cadaveric renal graft from the same donor in a multi-organ extraction procedure. The donor was a 39-years-old woman who died of intracranial tumour. A benign ganglioma was shown in biopsy. The two recipients received the same immunosuppressive regimen. Induction comprised cyclosporin A, steroids and basiliximab while cyclosporin A and steroids were used in maintenance immunosuppression. The A patient was a 53-year-old woman with chronic renal failure due to chronic pyelonephritis. She had been undergoing periodic haemodialysis for five years. She was hospitalised for sciatic pain refractory to rest and analgesics 35 days after transplantation. Two days later, her graft function deteriorated. Ultrasonography ruled out a urinary tract obstruction. Cyclosporine levels was normal. It was interpreted as an acute rejection episode and was treated with boluses of methylprednisolone (500 mg for 3 days). At the same time, her right leg began to show paraesthesia, coldness and a decreased arterial pulse. A spinal magnetic nuclear resonance was performed. It showed an aneurysm of right common iliac artery (fig. 1). An arteriography confirmed the existence of a pseudoaneurysm and an arteriovenous fistula to inferior vena cava (fig. 2). The B recipient was a 56-year-old woman with chronic renal failure due to chronic pyelonephritis. She required haemodialysis for two years. In the 4th month after transplantation her graft function deteriorated. Graft biopsy did not show acute cellular rejection, so she was kept on immunosuppressive treatment. A second graft biopsy was taken and no changes with the previous one was observed. Renal function deteriorated and haemodialysis was required. During the 6th month she began to show paraesthesia, coldness and decreased arterial pulse in her right leg. Ultrasonography showed pyelocaliectasis with an adjacent solid-liquid mass, abdominal CT scan confirmed. Arteriography proved the presence of a pseudoaneurysm of the right common iliac artery (fig. 3). Transplantectomy and pseudoaneurysm resection was performed in the two cases. Culture analysis revealed fungi identified as Aspergillus in both pseudoaneurysms. Medical treatment was started immediately with liposomal amphotericin B. The clinical evolution of the two recipients were different. While recipient A died, B patient recovered, requiring haemodialysis.
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PMID:[Vascular Aspergillus infection in two recipients of kidneys from the same donor]. 1521 65

Several conditions can clinically mimic renal colic. We assessed the accuracy of non-contrast-enhanced helical CT and of ultrasonography (US) in offering an alternative explanation for flank pain. In a 3-year period, 181 patients with acute flank pain underwent US and non-contrast-enhanced helical CT in a blinded sequence. Their efficacy in detecting both alternative causes of pain and additional findings unrelated to the pain was assessed in 160 cases with a confirmed diagnosis. An alternative cause was found in 23 cases (14%). US gave 4 false-negative results (1 acute appendicitis, 1 ovarian cyst torsion, 1 diverticulitis, and 1 papillary necrosis) and 2 false-positive results (1 acute pyelonephritis and 1 diverticulitis), with a 78% sensitivity and a 98% specificity for nonlithiasic causes. CT gave 5 false-negative results (1 complicated ovarian cyst, 1 pleuritis, 1 epididymitis, 1 acute pyelonephritis, and 1 papillary necrosis) and 1 false-positive (1 simple ovarian cyst described as a complicated lesion), resulting in a 74% sensitivity and a 99% specificity for diagnosing alternative causes. There were 130 additional US findings in 68 patients and 151 additional CT findings in 77 patients. A wide spectrum of findings can be identified in subjects imaged for flank pain. Non-contrast-enhanced helical CT and US have comparable accuracy in diagnosing causes other than stone disease.
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PMID:Acute flank pain: comparison of unenhanced helical CT and ultrasonography in detecting causes other than ureterolithiasis. 1529 May 74

We describe the occurrence of severe upper urinary tract complications during pregnancy in two women with an ileal conduit. The first patient developed several episodes of left pyelonephritis throughout the duration of her pregnancy but never received proper antibiotic prophylaxis. Intravenous urography performed after delivery documented bilateral staghorn kidney stones and a non-functioning left kidney. The second patient developed severe left loin pain and a high temperature during the fourth month of pregnancy after discontinuing antibiotic prophylaxis. An MRI urogram demonstrated compression of the ureter by the foetus. Symptoms were relieved as soon as the antibiotic prophylaxis was resumed and the pain remained under control with the occasional use of paracetamol until delivery. Based on these observations it appears that the left upper urinary tract may be more prone to dilatation in pregnant patients with an ileal conduit and antibiotic prophylaxis is mandatory throughout the duration of the pregnancy in order to minimize the risk of severe upper urinary tract complications.
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PMID:Upper urinary tract complications in pregnant women with an ileal conduit. Lessons learned from two cases. 1584 91

Acute pancreatitis is not an uncommon disease in an emergency department (ED). It manifests as upper abdominal pain, sometimes with radiation of pain to the back and flank region. Isolated left flank pain being the sole manifestation of acute pancreatitis is very rare and not previously identified in the literature. In this report, we present a case of acute pancreatitis presenting solely with left flank pain. Having negative findings on an ultrasound initially, she was misdiagnosed as having possible "acute pyelonephritis or other renal diseases". A second radiographic evaluation with computed tomography showed pancreatitis in the tail with abnormal fluid collected extending to the left peri-renal space. We performed a literature review and discussed this rare occurrence of acute pancreatitis. We also discussed the clinical pitfalls in this case.
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PMID:Left flank pain as the sole manifestation of acute pancreatitis: a report of a case with an initial misdiagnosis. 1591 61

The most frequently encountered urologic emergencies in daily practice include obstructive pyelonephritis, acute scrotal pain, acute urinary retention, urinary lithiasis and priapism. This article gives an overview on the pathogenesis, clinical presentation, diagnostic assessment and treatment strategies for each of these emergencies.
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PMID:[The urologic emergency--what should I not forget?]. 1599 33


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