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

Renal processing of insulin was studied over plasma insulin levels of 5-80 mU/l by renal vein catheterization in 14 patients. Kidneys of patients with a normal GFR removed around 30% of the insulin from arterial plasma. In 6 patients having unilateral renal artery stenosis but only moderately impaired renal blood flow and unchanged PAH-extraction, a higher or unchanged fractional insulin extraction was seen in all but one, compared with the contralateral kidney. Due to the high fractional extraction of insulin by the kidneys with renal artery stenosis, a preserved total insulin uptake by these kidneys was seen. In 4 patients with renal hypoplasia (2 of them had renal artery stenosis) low values for insulin extraction and insulin uptake were seen on the affected side. One patient with chronic pyelonephritis and uremia had an extremely low renal insulin extraction and uptake. The results suggest that estimation of renal insulin extraction may be an important renal functional test in renovascular patients.
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PMID:Renal degradation of insulin in patients with renal hypertension. 634 75

In an effort to study whether previous data obtained from animal studies showing decreased blood ketone body concentration and suggesting a shut-off of ketone body production in acute infection are valid also for man, 14 previously healthy patients, suffering from pyelonephritis, pneumonia, serous meningitis or upper respiratory tract infection were investigated. There were great interindividual differences in the ketone body response, which seems to be insulin dependent. The results indicate that in man there is probably no general inhibition of ketone body production in the liver in acute infection.
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PMID:Great interindividual insulin dependent variation in ketone body metabolism in human infection. 636 81

Escherichia coli-induced pyelonephritis was studied in untreated alloxan-diabetic rats, insulin-treated diabetic rats, glucose water-drinking (diuresing) nondiabetic rats, and tap water-drinking (nondiuresing) nondiabetic rats following injection of E. coli either into the emptied urinary bladder, into the left kidney, or intravenously. For prevention of an ascending infection in the right kidney, the right ureter was ligated and transected immediately prior to bladder or intrarenal inoculation. These experiments established that in normal rats ascending renal infection alone occurred following introduction of small inocula into the bladder--and then only when facilitated by diuresis. In diabetic rats both ascending and hematogenous renal infection occurred following introduction of small inocula into the bladder. Insulin treatment that reduced hyperglycemia also reduced glycosuria and restored urinary antibacterial activity against small inocula of E. coli but only partially reduced polyuria and prevented hematogenous but not ascending infection. Thus, hyperglycemia was probably the major factor promoting hematogenous renal infection, whereas polyuria--and therefore vesicoureteral reflux--was the major factor promoting ascending infection.
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PMID:Effect of insulin treatment on the susceptibility of the diabetic rat to Escherichia coli-induced pyelonephritis. 638 97

A 68-year-old female on two-year chronic hemodialysis for chronic renal failure due to chronic pyelonephritis, was admitted to hospital for weakness, dulled sensorium and dizziness. On examination the patient was in a state of circulatory collapse, the electrocardiogram showed an accelerated idioventricular rhythm and laboratory analysis revealed extreme hyperkalemia (K+ 10.1 mmol/l). There were no common causes of shock, such as hypovolemia, sepsis, heart failure and presence of vasodilator drugs. The patient was treated with calcium gluconate, sodium bicarbonate and sodium chloride (to oppose the effects of hyperkalemia on the cell membrane to minimize cardiac and neuromuscular toxicity), insulin and dextrose (to increase the transport of K+ from the extracellular to the intracellular compartment), and hemodialysis (to remove K+ from the body). At the end of the hemodialysis session, the patient was in a clinically good condition, blood pressure was 160/90 mm Hg and the serum K+ concentration was normal. The case appeared to suggest that extreme hyperkalemia may have direct effects on vascular resistance, causing hypotension and shock.
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PMID:A life-threatening complication of extreme hyperkalemia in a patient on maintenance hemodialysis. 748 41

All of the recorded twin live births in Washington State birth certificates between 1984 and 1988 were used a retrospective cohort study to determine the risk of zygosity on pregnancy complications and birth outcomes (n = 3458). Relative risks comparing different sex (DS) twins to same sex (SS) twins were corrected to relative risks relating dizygotic (DZ) to monozygotic (MZ) twins, using the Weinberg rule. A higher proportion of DS twin pregnancies (3.5%) than SS pregnancies (1.6%) were complicated by gestational diabetes, resulting in an estimated risk for DZ twin pregnancies relative to MZ pregnancies of 8.6 (95% CI = 3.5-21.0). DZ twin pregnancies were at a lower risk for complications of polyhydraminios (RRDZ/MZ = 0.2, 95% CI = 0.1-0.4) and of pyelonephritis, (RRDZ/MZ = 0.3, 95% CI = 0.1-0.8). MZ twins were more likely to have low birthweight and to have shorter gestations. The proportion of first-born babies of MZ twin pairs who died during their first year was similar to that of first twins of DZ pairs; however, the second-born of MZ twins were more likely to die in infancy than were second-born DZ pairs. First twins of DZ pairs were more likely to die of SIDS (sudden infant death syndrome) than the first of MZ twins (RRDZ/MZ = 1.5, 95% CI = 0.4-5.1). In contrast, DZ second-born were less likely to die of SIDS than were MZ second-born twins (RRDZ/MZ = 0.1, 95% CI = 0.1-0.7). DZ twins were less likely to have adverse newborn conditions or malformations. The high risk for gestational diabetes for DZ twin mothers is possibly due to the presence of two placentas which may support the development of greater insulin antagonism than the single placenta in the mother of MZ twins. The reduced risk of DZ relative to MZ twins for selected adverse birth outcomes may result from the increased tendency of MZ twins to be premature.
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PMID:Zygosity as a risk factor for complications and outcomes of twin pregnancy. 765

The analysis of clinical, diagnostic and treatment efficacy data has been made for 160 diabetes mellitus patients (50 cases of insulin-dependent and 110 of noninsulin-dependent) with acute purulent pyelonephritis (APP). A diffuse form of the disease was detected in 100 patients (62.5%), purulent-destructive one in 60 patients (37.5%). Intoxication, resistant to insulin decompensation of diabetes mellitus, sepsis may be resultant from latent APP. Nondestructive forms of APP were responsive to antibacterial and detoxication therapy combined with catheterization of the urinary tracts. On demand, conservative therapy was reinforced with renal drainage by nephrostomy. Primary nephrectomy was recommended in purulent-destructive forms and purulent para-nephritis. Radical surgery in intensive and advanced purulent-destructive pyelonephritis produced a decrease in postoperative lethality by 26.8%. Adequate therapeutic policy provided positive results in 80% of the patients. Lethal outcomes (20%) were due to grave diabetes mellitus and APP.
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PMID:[The treatment of acute suppurative pyelonephritis in diabetes mellitus patients]. 829 30

Kidneys from 74 consecutively autopsied primarily non-insulin-dependent diabetes cases and 59 age-, sex-, and ethnic group-matched controls were examined qualitatively and semiquantitatively to determine whether focal mesangiolyses (FMs), Kimmelstiel-Wilson (KW) nodules, and glomerular capillary microaneurysms (GCMs) were related lesions, to determine their extent and pathogenic sequence, and to look for associations with structural and functional factors. Light microscopic examination of serial sections, immunohistochemical stains, image analysis, and electron microscopy were used. Focal mesangiolyses, KW nodules, and GCMs occurred in 31 of the 74 diabetes cases (27 had FMs, 29 had KW nodules, and nine had GCMs) and were positively correlated with each other semiquantitatively (r = .71, .70, and .68, respectively). Numerous FMs were found, involving 62% and 78% of the glomeruli in the two most severely affected cases. Most FMs were located at the periphery of KW nodules, but de novo FMs were documented in six cases. Glomerular capillary microaneurysms were deemed occasional complications of FMs because they were much less common, and 25 of the 27 GCMs identified were contiguous with FMs. Focal mesangiolyses and GCMs were deemed transient lesions, being absent in end-stage kidneys. Both FMs and KW nodules consisted of a spectrum of lesions. For the sake of clarity they were arbitrarily divided into two types: edematous and proliferative FMs and simple and complicated KW nodules. Their characteristics suggested the following pathogenic sequence: edematous FM-->proliferative FM-->focal nodular mesangial expansion-->simple KW nodule-->recurrent FM-->complicated KW nodule. Complicated nodules were associated with marked alterations in the lobular capillary. The number of mesangial cells was increased in FMs and they were thought to be responsible for increased matrix production. Focal mesangiolyses and KW nodules were positively associated with diabetes, proteinuria, and hyalinization of afferent and efferent arterioles, but were weakly or not associated with hypertension, arcuate and interlobular artery stenosis, hydroenphrosis, acute pyelonephritis, renal arterial atheromatous emboli, glomerular platelet-fibrin thromboemboli, and congestive heart failure.
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PMID:Focal mesangiolysis and the pathogenesis of the Kimmelstiel-Wilson nodule. 841 16

Administration of progestins in the dog may result in overproduction of growth hormone, suppression of the hypothalamic-pituitary-adrenocortical axis, and insulin resistance. In this paper we present a comparison of the histological findings in control dogs and dogs treated with either medroxyprogesterone acetate (MPA) or proligestone (PROL). Depot preparations of MPA or PROL were administered (SC) at 3-week intervals in two groups of seven ovariohysterectomized beagle dogs, after which three dogs of each group were killed. After a 6-month period without hormone treatment during which recovery was studied, the remaining dogs received five additional injections at the same interval and were subsequently killed. Tissue samples of four intact female beagle dogs served as controls. Progestin treatment resulted in atrophy of the adrenal cortex. In both MPA- and PROL-treated dogs, the thickness of the combined zona fasciculata and reticularis was significantly smaller than in control animals. In the mammary glands of progestin-treated dogs there were well developed alveoli and normal ducts adjacent to foci of hyperplastic ductular epithelium. Five dogs in each treatment group had developed benign mammary tumours which varied from simple tubular and papillary adenomas to benign complex and mixed tumours, whereas no mammary tumours were observed in the control animals. In each treatment group, steroid-induced hepatopathy was observed in the liver of three dogs. Vacuolation of the cells of the islets of Langerhans and the epithelium of the intercalated ducts was present in two dogs of each treatment group and was only observed after the second series of progestin administrations. Incidental findings included chronic pyelonephritis, aspecific dermatitis, and mucinous dysplasia of the gall bladder. No abnormalities were found in sections of spleen, lung, brain, or pituitary gland. There were no significant differences in the frequencies of the various abnormalities between MPA- and PROL-treated dogs. Our findings correspond with the clinical and biochemical results after treatment of dogs with MPA and PROL. The high incidence of mammary tumours might be associated with our recent finding that in the dog progestins induce ectopic production of growth hormone in the mammary gland. The dog might be a good model for further studies on hormonally induced breast cancers.
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PMID:Comparison of the histological changes in the dog after treatment with the progestins medroxyprogesterone acetate and proligestone. 875 Dec 73

Studies of the pathophysiology of renal disease in non-insulin-dependent diabetes mellitus (NIDDM) have been hindered by the lack of an appropriate experimental model. We examined the natural history of metabolic and renal changes in the partially inbred Zucker Diabetic Fatty Rat (ZDF/Drt-fa), a model that closely mimics the metabolic abnormalities of NIDDM. Lean nondiabetic littermates served as controls. Body weights in the obese rats were higher initially, but thereafter stabilized at values similar to those in lean controls. Blood glucose levels rose to overtly hyperglycemic levels in the obese group, stabilizing in the 300 to 400 mg/dL range. Serum insulin, cholesterol, and triglyceride levels were all elevated in the obese group, though insulin levels declined later in life. Values for systolic blood pressure rose slightly with age in both groups, but remained within the normal range, and did not differ between groups. Urinary albumin excretion values were higher in the obese group at all time points, and rose progressively throughout the study. Morphologic examination revealed the presence of severe hydronephrosis in almost all animals, affecting lean as well as obese rats. In some cases, complications were found, including tubular dilation, necrotizing granulomas, inflammatory changes, and pyelonephritis, some of which were fungal. Accordingly, the ZDF/Drt-fa rat appears to be an excellent model of the metabolic changes that characterize NIDDM. Unfortunately, the utility of this model for study of diabetic renal disease is compromised by the ubiquitous presence of other, nondiabetic renal lesions.
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PMID:Evolution of metabolic and renal changes in the ZDF/Drt-fa rat model of type II diabetes. 880 17

Emphysematous pyelonephritis, bilateral or in a solitary kidney, is a life-threatening condition that requires prompt diagnosis and early intervention. Reported mortality is high, despite desperate surgical measures often ending in loss of renal unit, but medical management, possibly combined with percutaneous drainage, is sometimes successful. We report two cases of emphysematous pyelonephritis, one bilateral and one in a solitary kidney, with successful conservative management. Predisposing factors were insulin-dependent diabetes mellitus and micronodular cirrhosis secondary to chronic alcoholism. Prompt sonographic diagnosis determined the success of conservative management. Escherichia coli was identified as causal factor. In the bilateral case the clinical picture improved within 48 h after control of diabetes and broad-spectrum antibiotic treatment. For the affected solitary kidney, percutaneous drainage and ureteric catheterization were required.
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PMID:Successful conservative management of emphysematous pyelonephritis, bilateral or in a solitary kidney. 916 86


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