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

A urographic pattern of renal clubbing and scarring was found in 182 scarred kidneys of 110 adult patients. Homolateral vesicoureteric reflux was demonstrated by reliable techniques in 90/135 scarred kidneys. Urinary tract infections occurred in 75 patients. Hypertension developed in 20 patients with normal renal function and was not related to the extent of scarring. Chronic renal failure occurred in 30 patients with diffuse bilateral scarring. Four patients showed histologic changes of chronic pyelonephritis. Two hypertensive patients had a typical histologic pattern of Ask-Upmark kidney (segmental hypoplasia). Development of renal scars in adulthood was demonstrated in 2 cases.
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PMID:Renal clubbing and scarring in adults: a retrospective study of 110 cases. 55 64

In 17 girls and 5 women with urinary tract infection and low-pressure reflux we performed 23 bladder-washout-tests. 12 were interpreted as supravesical, 11 as vesical bacteriurias. All patients with vesical bacteriurias had a normal IVP. The majority of patients with supravesical bacteriurias had clubbing and scarring. The possibility of interpreting the supravesical bacteriurias as a sign for pyelitis rather than pyelonephritis is discussed.
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PMID:[Localizationstudies in female patients with recurrent urinary tract infection. II. Patients with ureterovesical reflux (author's transl)]. 90 43

Bladder wash-out tests were performed in a series of patients after successful antireflux surgery. The majority (65.5%) of infections were localized in the bladder, even if the IVP demonstrated signs of pyelonephritis (renal scarring and calcieal clubbing). 21.3% of the tests demonstrated a participation of the upper urinary tract. The bladder bacteriurias were interpreted as reinfections, and also some of the supravesical bacteriurias. In other cases, this differentiation could not be made.
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PMID:[Localization of urinary infection after antireflux surgery (author's transl)]. 96 48

Two hundred seventy-eight female children with urinary tract infections have been evaluated at Stanford division of urology. All children were followed up for a period of not less than twelve months. Age of onset of infection, clinical presentation, and nature of infecting organisms were observed. The group consisted of 144 children without ureteral reflux and 134 children with ureteral reflux. Sixty-one of the female children with ureteral reflux had ureteral reimplantation, while 73 received medical treatment alone. A study of infection rates in each of the three groups of children indicated a similar infection rate, although those children with reflux experienced a higher incidence of clinical pyelonephritis. Correction of ureteral reflux did not alter the infection rate; however, infections after surgical correction were generally of a type usually associated with children without reflux. Twenty-nine children had urethral dilatation, and the infection rate prior to and following urethral dilatation indicated a similar rate of infection pre- and posturethral dilatation. One hundred nonrefluxing kidneys were observed radiologically: 97 were normal and 3 showed clubbing and scarring. Of 110 refluxing renal units observed, 62 were clubbed and scarred and 48 were normal. Following surgical correction of reflux, renal clubbing and scarring were not observed in previously normal renal units. Of those renal units found to be abnormal at time of surgery, 66 per cent showed progression of clubbing and scarring after surgical correction of reflux. It was observed that the greater the degree of reflux present, the higher the incidence of renal damage. This study suggests that children who experience recurrent urinary tract infections who do not have ureteral reflux are seldom at renal risk; similar children who do have ureteral reflux are at risk unless the infections are controlled or the reflux either disappears or is corrected surgically.
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PMID:Management of children with urinary tract infections: the Stanford experience. 109 66

An adult patient is described with recurrent urinary tract infections who developed renal scarring while under observation. Intravenous urography (I.V.U.) and renal arteriography were performed during an initial attack of pyelonephritis and I.V.U.s were repeated at intervals during follow-up, when the patient was having recurrent infections. Over 2 years the right kidney size diminished from 10.5 to 7.0 cm, the cortex became irregular and calyceal clubbing occurred. During a further 2 years, when on regular treatment, attacks became less frequent but left-sided symptoms predominated. Repeat I.V.U. at the end of this period showed that the left kidney size had reduced from 12 to 10 cm, again with the development of cortical irregularity and calyceal clubbing. Biochemical evidence of renal impairment developed. At no time were obstruction, reflux or associated pathology demonstrated and there was no history of analgesic abuse. Recurrent infection is suggested as the etiology of the scarring.
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PMID:Development of renal scarring in an adult with recurrent urinary tract infection. 127

The urographic findings of focal clubbing of the renal calices and associated parenchymal scarring usually prompt a diagnosis of chronic pyelonephritis, which is frequently thought to be due to ongoing or previous vesicoureteral reflux. However, we noticed that upper tract stone disease appeared to be the condition that most often preceded or accompanied caliceal clubbing and parenchymal scarring in adults. To test the hypothesis that stones were the most common cause of this renal abnormality, we analyzed the IV urograms in 1500 consecutive patients for evidence of upper tract stone disease, vesicoureteral reflux, and caliceal clubbing and scarring. Of 39 patients with clubbing and scarring, 67% had stone disease, but only 8% had a history of reflux. Of 90 patients with stone disease, 29% had clubbing and scarring. We conclude that, in adults, upper tract stone disease may be the most important etiologic factor in the production of renal caliceal clubbing and scarring.
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PMID:The relationship between renal scarring and stone disease. 326 68

Chronic non-obstructive pyelonephritis has been followed for periods ranging from 18 to 40 years (mean 25), by using series of urographies and clinical examinations. The patients studied were fifteen adults, and eight children who were between the ages of three months and eleven years at their initial examinations. Among the adults, progressive scarring was found in 3 patients with renal calculi, the others remaining unchanged during the follow-up period. Among the children, progressive scarring was found in all affected kidneys, the scarring progressing during early childhood and adolescence, and then remaining unchanged during adult life. This retrospective study indicates that calyceal clubbing and parenchyma scarring occur during childhood and seldom progress without the intrusion of superimposing factors, such as renal stone formation.
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PMID:Long-term follow-up in chronic non-obstructive pyelonephritis. A retrospective radiological study. 408 53

Of 134 girls with demonstrable ureterovesical reflux, 61 (105 ureters) had the reflux surgically corrected with an overall surgical cure rate of 97 percent. In the remaining 73 children (112 ureters), the reflux was treated conservatively with medical management alone. During the follow-up period no significant differences were demonstrated in the overall incidence of urinary tract infection; two years following corrective operation or medical treatment more than 50 percent of both medically and surgically treated children were still experiencing infections. A pronounced decrease, however, occurred in the incidence of clinical pyelonephritis among the surgically treated group. Following correction of reflux, the incidence of pyelonephritis was similar in both medically and surgically treated cases and was approximately the same as that found in a comparable group of children without reflux. In approximately two-thirds of refluxing renal units in which there was evidence of clubbing and scarring before medical or surgical therapy, deterioration progressed during the follow-up period. In most of these cases infection control was felt to be inadequate with episodes of clinical pyelonephritis occurring during the period of medical management, or, in the surgically treated group, occurring just before corrective operation and the scar appearing within two years after operation. The majority of renal units in which calyceal clubbing and parenchymal scarring was present had the most severe grades of reflux.
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PMID:Urinary tract infections in children. Part III--Treatment of ureterovesical reflux. 446 Mar 80

The thesis put forward by Hodson (1959) from radiological evidence that renal scars due to ischaemia show a narrowed parenchyma associated with a normal calyceal pattern, whereas in focal pyelonephritic scars the narrowed parenchyma is associated with clubbing of the calyx in the affected area, has been investigated anatomically. The thesis finds considerable support and the importance of careful examination of the calyceal system in scarred kidneys is stressed. In only one of 23 examples in which all the circumstantial evidence of the case pointed to an ischaemic scar was there any deformation of the renal calyx. In 13 of 14 examples in which the evidence pointed to chronic pyelonephritis there was clubbing of the calyx associated with the scar.
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PMID:The diagnosis of the scars of chronic pvelonephritis. 1398 65