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

Diabetes during pregnancy is associated with insulin resistance, an increase in insulin requirement, and a greater tendency to ketosis and ketoacidosis. Increased perinatal mortality is related to maternal hyperglycemia and can be decreased dramatically with strict control of plasma glucose during pregnancy and a smooth-working obstetrician-internist-neonatologist team. Bad prognostic signs include pyelonephritis, ketoacidosis, toxemia, and poor prenatal care. Timing of delivery is no longer arbitrary at 36 or 37 weeks, but is based upon signs of fetal lung maturation and estimates of fetal risk. Abnormalities in the infant, including congenital abnormalities, biochemical abnormalities, respiratory distress syndrome, and large body weight must be managed in a well-equipped newborn intensive care unit under the care of experienced neonatologists. Strict attention to these principles has resulted in viable infants in the last 36 pregnant diabetic patients delivered at Vanderbilt University Hospital. Therefore, close medical supervision, use of modern obstetric technics, and the availability of a well-equipped and staffed neonatal intensive care unit can result in a good outcome in this group of patients. Finally, the decision for pregnancy must be carefully considered by the diabetic patient, her husband, and her physician long before pregnancy occurs.
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PMID:Coordinated metabolic and obstetric management of diabetic pregnancy. 62

In 4 out of 9711 (= 1:2400) patients, lactice acidosis due to biguanides was diagnosed. Serum lactate concentration averaged 18.2 mmol/l and the pH value 6.87. All patients showed signs of renal insufficiency and three had congestive heart disease. In addition to treatment with biguanides, other factors might have contributed to the lactice acidosis in these patients: prolonged fasting, severe dehydration due to persistent vomiting, acute bronchopneumonia, and acute pyelonephritis. On addmission, two patients were in shock and all patients were semi-conscious or comatose. All patients were treated with bicarbonate and glucose/insulin. One patient was hemodialysed. Two of our four patients died. Oour four patients are compared with 179 patients in the literature with respect to mortality and prognosis of lactic acidosis due to biguanides.
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PMID:[Lactacidosis in biguanide therapy: diagnosis and therapy. 4 cases compared to 179 cases in the world literature]. 71 23

Insulin antagonism characterizes infection, but the mechanism is unknown. Previous studies have been performed during the acute catabolic stage of infection, and the resultant metabolic changes reflect this decreased food intake and weight loss. To delineate metabolic alterations due to infection itself, rats with pyelonephritis induced by tail-vein injection of 1 ml. of Streptococcus faecalis (10(9) bacteria per milliliter) were studied two weeks later during a period of near-normal weight gain and food intake. Fasting growth hormone concentrations (nanograms per milliliter) in the pyelonephritic rats were nearly five times normal (45.8 vs. 9.9). Intra-arterial glucose and insulin tolerance tests were impaired. Early glucose-induced insulin release was depressed. Fat pads from infected rats manifested higher basal lipolysis per cell. Glycerol-mediated gluconeogenesis by liver slices was decreased. This pathway was unaffected by insulin in infected rats but readily inhibited in control rats. The following metabolic parameters were similar in control and infected animals: (in vivo) fasting concentrations of plasma glucose, free fatty acids, triglycerides, total corticoids, creatinine, insulin, glucagon, molar ratios of insulin and glucagon, glucose and insulin responses to tolbutamide, and glucagon and free fatty acid suppression after glucose; (in vitro) glucose metabolism by muscle and fat, epinephrine- and theophylline-stimulated lipolysis and re-esterification by epididymal fat pads, fasting hepatic glycogen content, glucose production by liver slices with and without alanine. No plasma insulin antagonist was found in the infected rats. Metabolic alterations in infected rats can be demonstrated independently of the associated catabolism. Increased growth hormone secretion cannot explain all of these changes.
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PMID:Metabolic studies in the pyelonephritic rat. 117 60

A man aged 46 years with diabetes mellitus was admitted with acute right-sided renal symptoms. Pyelonephritis emphysematous without concretions was found. The patient was treated with insulin, fluids, electrolytes and antibiotics and nephrostomy was performed and, subsequently, an internal JJ-catheter in the ureter. The symptoms disappeared and he was discharged on a low dosage of sulphamethizol. After the planned removal of the JJ-catheter, sepsis running a lethal course developed. This emphasizes the importance of adequate prophylactic antibiotic therapy in connection with interventions in the urinary tracts.
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PMID:[Fatal emphysematous pyelonephritis]. 163 72

Obstetric complications recorded prospectively were assessed retrospectively in 150 women with gestational diabetes mellitus (GDM) and 305 control subjects matched for age, parity, and ethnicity. Intensive diet therapy and self-monitoring of capillary blood glucose were used to obtain postprandial euglycemia; 22% of GDM subjects required insulin. GDM and control subjects were grouped by body mass index to detect any influence of maternal prepregnancy weight on outcome. Polyhydramnios, preterm labor, and pyelonephritis were not more frequent in GDM, but hypertension without proteinuria (7.3 vs. 3.3%) and preeclampsia (8 vs. 3.9%) were more frequent in GDM. The frequency of hypertensive complications in GDM was not totally attributable to being overweight. Abnormalities of labor, birth trauma, and fetal macrosomia were not more common in GDM; 6.7% of the infants of mothers with GDM weighed greater than 4200 g at birth compared with 3.6% of control infants (NS), and 10% were large for gestational age and sex compared with 6.6% of control infants (NS). Despite this, cesarean delivery was more common in GDM (35.3 vs. 22%, P less than 0.01), mostly due to significantly more cesarean births without labor.
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PMID:Obstetric complications with GDM. Effects of maternal weight. 174 71

A case of emphysematous pyelonephritis is presented. A 66-year-old woman with diabetes mellitus was hospitalized for sudden pyrexia and left abdominal pain on January 13, 1987. She had shown preshock, pre-disseminated intravascular coagulation, hyperglycemia and renal dysfunction. Plain X-ray films of the abdomen and abdominal computer tomographic scanning showed a gas shadow in the left kidney. Retrograde pyelography demonstrated the left complete ureteral obstruction. A diagnosis was made of emphysematous pyelonephritis associated with diabetes mellitus and ureteral obstruction. Left nephrectomy was performed on January 17, 1987, and the pus obtained from the kidney yielded E. coli. After the operation, she has been doing well with diabetes mellitus under good control without insulin therapy. Thirty two cases of emphysematous pyelonephritis in the Japanese literature including our case are reviewed.
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PMID:[A case of emphysematous pyelonephritis--review of 32 cases in Japanese literature]. 269 28

Transfusions of ultraviolet-irradiated plasma were carried out in 30 pyelonephritis patients. Subjective sense of improvement, and relief of fever and intoxication were noted. The administration of ultraviolet-irradiated plasma had a controlling effect on lipid peroxidation and blood cortisol, aldosterone and insulin levels, contributed to the normalization of corticosteroid catabolism and stimulated energy metabolism and the antioxidant system. Products of plasma photochemical reaction to ultraviolet irradiation have immunomodulating effects. Treatment of pyelonephritis patients by ultraviolet-irradiated plasma transfusions has shortened the time of hospital stay.
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PMID:[The use of ultraviolet-irradiated blood plasma in the treatment of pyelonephritis patients]. 280 70

In a consecutive material of 652 E. coli bacteremia 70 episodes (11%) were found in 64 patients with diabetes mellitus. 10 patients had insulin-dependent and 54 had non-insulin-dependent diabetes. The E. coli strains were tested for adhesive properties as mediated by P-fimbriae, a virulence factor in human urinary tract infections. Half of the strains were P-fimbriated with a higher occurrence in women (26/42, 62%) than in men (9/27, 33%). Diabetic patients with a positive urine culture had a higher incidence of P-fimbriated E. coli strains (27/37, 73%) in blood culture than patients with negative or no urine culture taken (8/32, 25%). Furthermore, patients without compromising factors, regardless of their diabetes mellitus, had a higher incidence of P-fimbriated E. coli strains (19/29, 66%) than those with malignancies and other debilitating diseases (6/22, 27%). The high incidence of P-fimbriated E. coli strains in the non-compromised patients may depend on the ability of such bacteria to invade the urinary tract and cause acute pyelonephritis, which often precedes E. coli bacteremia. A lower incidence of P-fimbriated E. coli strains was found in patients with proteinuria prior to the bacteremic episode (10/31, 32%), compared to those without proteinuria (25/35, 71%). No correlation was noted between P-fimbriation and duration of diabetes or serum creatinine. The low incidence of P-fimbriated E. coli strains in patients with proteinuria indicates that nephropathy, or some concurrent complication, predisposes the diabetic patient to bacteremia with low virulent, non-P-fimbriated E. coli.
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PMID:Bacteremia with P-fimbriated Escherichia coli in diabetic patients: correlation between proteinuria and non-P-fimbriated strains. 289 4

The beta2-microglobulin (beta2-MCG) test was done in 115 patients with an insulin dependent type of diabetes mellitus: 30 of them were without renal pathology, 58 had diabetes mellitus with diabetic nephropathy (DN), and 27 had concomitant chronic pyelonephritis. The effect of glucosuria and proteinuria on the beta2-MCG level was revealed. DN development and progress resulted in an increase in the beta2-MCG concentration in the blood that correlated with a decrease in the glomerular filtration. beta2-MCG urinary excretion grew in a clinically manifested DN stage only. Concomitant pyelonephritis in diabetes mellitus patients resulted mostly in a rise of the beta2-MCG level in the urine. Its concentration in the urine during the exacerbation of pyelonephritis exceeded the indices of the control group, on an average, by 467.9%. The beta2-MCG test is a valuable additional criterion in the differential diagnosis of DN in diabetes mellitus patients.
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PMID:[Beta 2-microglobulin in the diagnosis of kidney lesions in diabetes mellitus patients]. 351 58

Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.
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PMID:Emphysema in the renal allograft. 388 23


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