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

We present a case of nephrotic syndrome complicating acute pyelonephritis in a 45-year-old man. His first attack of acute bacterial pyelonephritis had two unusual features: transient nephrotic syndrome and chronic recurrent episodes of papillary necrosis. The former, which lasted for two weeks, was characterized by edema, excretion of 7.7 g of urinary protein per 24 hours and hypoproteinemia (1.8 g per 100 ml). A percutaneous renal biopsy two weeks after the height of the nephrotic state showed normal glomeruli by light and electron microscopy and immunohistologic studies. Interstitial changes were noted. Over two years the patient has passed approximately 50 fragments, characterized as necrotic tissue containing tubular structures. He has no evidence of diabetes mellitus, urinary-tract obstruction or ureteral reflux, analgesic abuse or atypical vasculitis. He is afebrile but has recurrent bacteriuria despite antibiotics. This case demonstrates that acute pyelonephritis must be added to the list of diseases causing the nephrotic state.
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PMID:Nephrosis and papillary necrosis after pyelonephritis. 118 37

A 7-year-old boy was admitted for recurrent pyelonephritis. Intravenous pyelography IVP showed right hydronephrosis and normal left kidney and ureter. Cystourethroscopy revealed no ureteral orifices in the bladder but bilateral ureteral openings adjacent to the seminal colliculus. Right retrograde pyelography showed severe hydroureter and hydronephrosis. The diagnosis was bilateral ectopic ureteral opening into proximal urethra. His abnormality of ureteral opening was classified as type II in Thom's classification. Bilateral ureterocystoneostomy was performed. Only 3 cases of bilateral ectopic ureter in males have been reported in the Japanese literature.
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PMID:[A case of bilateral ectopic ureter in a male]. 846 May 88

An adolescent with a history of pyelonephritis and renal scarring had antireflux surgery at the age of 2.5 years. His serum creatinine was high at the age of 14 years (133 micromol/l; glomerular filtration rate (GFR) 56 ml/min x 1.73 m(2)), and reflux nephropathy with chronic renal failure was diagnosed. Because of a fall in height velocity, endocrinological investigations were performed six months later which showed hypothyroidism caused by autoimmune thyroiditis. Substitution with thyroxine was started; renal function improved to normal six months later (GFR 108 ml/min x 1.73 m(2)). Metabolic changes of hypothyroidism led to a reduction of GFR in this patient and mimicked chronic renal failure.
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PMID:Hypothyroidism mimicking chronic renal failure in reflux nephropathy. 1095 48

Sequence comparisons have implied the presence of genes encoding enzymes of the mevalonate pathway for isopentenyl diphosphate biosynthesis in the gram-positive pathogen Staphylococcus aureus. In this study we showed through genetic disruption experiments that mvaA, which encodes a putative class II 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, is essential for in vitro growth of S. aureus. Supplementation of media with mevalonate permitted isolation of an auxotrophic mvaA null mutant that was attenuated for virulence in a murine hematogenous pyelonephritis infection model. The mvaA gene was cloned from S. aureus DNA and expressed with an N-terminal His tag in Escherichia coli. The encoded protein was affinity purified to apparent homogeneity and was shown to be a class II HMG-CoA reductase, the first class II eubacterial biosynthetic enzyme isolated. Unlike most other HMG-CoA reductases, the S. aureus enzyme exhibits dual coenzyme specificity for NADP(H) and NAD(H), but NADP(H) was the preferred coenzyme. Kinetic parameters were determined for all substrates for all four catalyzed reactions using either NADP(H) or NAD(H). In all instances optimal activity using NAD(H) occurred at a pH one to two units more acidic than that using NADP(H). pH profiles suggested that His378 and Lys263, the apparent cognates of the active-site histidine and lysine of Pseudomonas mevalonii HMG-CoA reductase, function in catalysis and that the general catalytic mechanism is valid for the S. aureus enzyme. Fluvastatin inhibited competitively with HMG-CoA, with a K(i) of 320 microM, over 10(4) higher than that for a class I HMG-CoA reductase. Bacterial class II HMG-CoA reductases thus are potential targets for antibacterial agents directed against multidrug-resistant gram-positive cocci.
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PMID:Essentiality, expression, and characterization of the class II 3-hydroxy-3-methylglutaryl coenzyme A reductase of Staphylococcus aureus. 1096 99

Systematic analysis of the entire two-component signal transduction system (TCSTS) gene complement of Staphylococcus aureus revealed the presence of a putative TCSTS (designated SrhSR) which shares considerable homology with the ResDE His-Asp phospho-relay pair of Bacillus subtilis. Disruption of the srhSR gene pair resulted in a dramatic reduction in growth of the srhSR mutant, when cultured under anaerobic conditions, and a 3-log attenuation in growth when analyzed in the murine pyelonephritis model. To further understand the role of SrhSR, differential display two-dimensional gel electrophoresis was used to analyze the cell-free extracts derived from the srhSR mutant and the corresponding wild type. Proteins shown to be differentially regulated were identified by mass spectrometry in combination with protein database searching. An srhSR deletion led to changes in the expression of proteins involved in energy metabolism and other metabolic processes including arginine catabolism, xanthine catabolism, and cell morphology. The impaired growth of the mutant under anaerobic conditions and the dramatic changes in proteins involved in energy metabolism shed light on the mechanisms used by S. aureus to grow anaerobically and indicate that the staphylococcal SrhSR system plays an important role in the regulation of energy transduction in response to changes in oxygen availability. The combination of proteomics, bio-informatics, and microbial genetics employed here represents a powerful set of techniques which can be applied to the study of bacterial gene function.
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PMID:The srhSR gene pair from Staphylococcus aureus: genomic and proteomic approaches to the identification and characterization of gene function. 1151 18

This paper describes an experience gained with successful surgical correction of post-traumatic false aneurysm of the right kidney vessels in a 36-year-old patient operated on previously for knife wound and intrahepatic abscess. All-round examination (duplex scanning of the renal arteries, multispiral computed tomography, abdominal aortography, and ultrasonography of the kidneys) revealed a false aneurysm of the medium segment of the right kidney artery measuring 31x21x33 mm. The aneurysm was located downwards, to the rear and inwards from the artery, with marginal posteroinferior calcification drained to the venous collector (the right kidney vein) expanded to 36-40 mm. The preoperative diagnosis: a post- traumatic false arteriovenous aneurysm of the right kidney vessels; vasorenal hypertension; IIa stage circulatory insufficiency; chronic pyelonephritis, remission; hydronephrosis on the right; 0-I stage chronic renal insufficiency. In view of the failure of the attempts to accomplish endovascular intervention, progression of right ventricular heart insufficiency, the presence of vasorenal hypertension, and right kidney malfunction we performed operation which consisted in evacuation of the false arteriovenous aneurysm of the right kidney artery, plasty of the defect of the right kidney vein and of the defect of the right kidney artery by the aneurysmal wall. The postoperative period was uneventful. Control ultrasonography failed to discover arteriovenous shunting at the level of the right kidney arteries. Also, auscultation did not reveal any murmur in the projection of the renal vessels on the right and above the abdominal aorta. On the 14th postoperative day the patient was discharged from the clinic in a satisfactory condition. His laboratory and hemodynamic parameters were good.
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PMID:[A case of surgical treatment of post-traumatic false arteriovenous aneurysm of the right kidney vessels]. 1562 4

A 43-year-old nondiabetic man, 5 years post-renal transplantation, presented complaining of oliguria, fever and dysuria of 1-day duration. Graft ultrasound did not reveal any obstructive changes. Graft function did not improve in spite of 3 days of antibiotics. On the fourth day he passed fleshy material in urine subsequent to which his urine output improved and fever recovered. His graft function settled near to the previous baseline. Histological analysis of the material revealed necrosed renal papillary tissue. Renal papillary necrosis in allograft is uncommon and generally reported in the immediate postoperative phase, but it can still occur later in transplant follow-up. It is a potentially treatable cause for acute allograft dysfunction and should be suspected in transplant patients presenting with acute pyelonephritis but not getting relief from antibiotic therapy.
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PMID:An unusual cause of renal allograft dysfunction: graft papillary necrosis. 1734 85

A 48-year-old man was admitted under the care of urologists with acute renal failure and septicaemia secondary to pyelonephritis. Upon investigation, he was found to have renal stone disease secondary to a parathyroid adenoma. Further tests revealed high pituitary hormone and gastrin values, confirming the diagnosis of multiple endocrine neoplasia type 1 (MEN 1) and Zollinger-Ellison syndrome. Soon after this he experienced a series of renal complications due to his renal stone disease and multiple complications of his gastrinoma, including two gastrointestinal perforations and three episodes of significant upper gastrointestinal bleeds (two of which required laparotomies), and a full length oesophageal stricture-all within the span of 9 months. His complications were managed appropriately and the oesophageal stricture was treated with a full length metallic stent. He was discharged home in a reasonably good condition with normal swallowing, but unfortunately died of aspiration pneumonia 3 weeks later.
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PMID:The surgical management of pancreaticoduodenal tumours in multiple endocrine neoplasia type 1. 2168 42

A rare case of pan-subepithelial dystrophic calcium deposition and bone marrow formation in hydronephrosis secondary to obstructive urolithiasis is reported and discussed. An elderly gentleman presented with accelerated hypertension, a nonfunctioning left kidney secondary to obstructive nephrolithiasis with additional pancalyceal calcification. His left retroperitoneoscopic nephrectomy specimen revealed sterile hydronephrosis secondary to an impacted ureteropelvic junction stone and pan-subepithelial fibrocalcific lamellar deposition. Special stains confirmed end-stage renal disease with chronic pyelonephritis with subepithelial dystrophic calcium deposition and evidence of bone marrow formation.
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PMID:'Porcelain kidney': case report and review of the literature. 2241 54

Neurogenic bladder is a common cause of acute pyelonephritis (APN) in cauda equina syndrome (CES). Perirenal hemorrhage, a rare complication of APN, can be a life-threatening condition. To our knowledge, there is no previous report of perirenal hemorrhage as a complication of APN in CES. A 57-year-old male, diagnosed with CES, due to a L3 burst fracture 3 months earlier, was presented with fever and chills. His diagnosis was APN due to neurogenic bladder. After treatment for APN, he was transferred to the department of rehabilitation medicine for management of his CES. Because of large post-voiding residual urine volumes, he performed self-catheterization after voiding. However, he presented again with fever and chills, and recurrent APN was diagnosed. On the third day of antibiotic treatment, he had acute abdominal pains and hypovolemic shock. Abdominal computed tomography and angiography showed left APN and a perirenal hematoma with left renal capsular artery bleeding. After embolization of the left renal capsular artery, no further active bleeding occurred. Because APN due to neurogenic bladder can lead to critical complications, such as perirenal hemorrhage, the physician should pay attention to the early diagnosis and treatment of urinary tract infection and the management of neurogenic bladder after CES.
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PMID:Spontaneous perirenal hemorrhage in cauda equina syndrome: a case report. 2402 45


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