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

A hemodialysis patient with insulin-dependent diabetes mellitus and a non-functioning renal allograft in whom fever, low blood pressure, and confusion developed is reported. She underwent extensive evaluation and allograft nephrectomy for emphysematous pyelonephritis that was diagnosed by the presence of air in the collecting system of the transplanted kidney during computerized tomography of the abdomen. In nine patients with emphysematous pyelonephritis in renal allografts reported previously, this is the first instance of emphysematous pyelonephritis in a renal allograft with coagulase-negative staphylococcus.
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PMID:Emphysematous pyelonephritis in a nonfunctioning renal allograft of a patient undergoing hemodialysis. 936 42

A 74-year-old woman with diabetes mellitus had a high fever, and was treated with antibiotics and insulin in another hospital. She was referred to our department, because CT scan showed the right hydronephrosis and the abnormal gas shadow in the right renal calyces. Ureteral catheterization was performed on the right side and cloudy urine was drained. Urine culture yielded E. coli. Since submucosal emphysematous changes were demonstrated in the bladder mucosa by cystoscopy, she was diagnosed with emphysematous pyelonephritis with emphysematous cystitis associated with diabetes mellitus. Administration of antibiotics and insulin and the ureteral catheter drainage improved her condition immediately. Abnormal gas shadow on CT scan and submucosal emphysema on cystoscopy disappeared. We reviewed 110 cases of emphysematous pyelonephritis and 23 cases of emphysematous cystitis including our case in Japan, and report their clinical characteristics.
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PMID:[A case of emphysematous pyelonephritis with emphysematous cystitis]. 1054 Jul 9

A 51-year-old female patient was hospitalized in our department with high fever and left flank pain. Laboratory examination showed leukocytosis, increase of C-reactive protein (CRP), hyperglycemia and renal insufficiency. Enterobacter aerogenes grew out of the cultured urine. The radiograph and computerized tomographic (CT) scan revealed streaky gas in the destroyed left renal parenchyma with perirenal gas. She was diagnosed with left emphysematous pyelonephritis. Antibiotics therapy, treatment for sepsis and disseminated intravesicular coagulation was initiated resulting in mitigation of inflammation. High blood glucose initially required insulin therapy, but finally returned to normal levels through administration of oral antidiabetics. Although leukocytosis and low grade fever continued, the patient was discharged on day 53 with a negative CRP. CT scan indicated that the emphysematous change was localized after three months and almost resolved after four months. Renal scintigram indicated the residual function of the affected kidney. Because of the possibility of residual renal function and the cure by conservative therapy alone, the conservative therapy is preferred when the initial treatment is effective.
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PMID:[A case of emphysematous pyelonephritis improved with conservative therapy--indication for conservative therapy]. 1087 58

Fever, like metrorrhagia or pelvic pain, should be a danger signal alerting women with IUDs to seek medical attention without delay. If the temperature is elevated and the clinical signs suggest salpingitis or pelvic infalmmation, the patient should be hospitalized to obtain a diagnostic and therapeutic laparoscopy, intravenous polyantibiotic treatment, and bed rest. A temperature of about 38 degrees Celsius associated with metrorrhagia suggests salpingitis, regardless of other clinical findings, particularly if the patient is under 25, has had several sexual partners, is nulliparous, or is an insulin-dependent diabetic. The diagnosis should be confirmed by laparoscopy. If a virus or flu is as likely to be the cause as a gynecological infection, blood tests and assay of sedimentation rates should be obtained; over 10,000 polynuclear forms, mainly neutrophils, and a sedimentation rate elevated beyond that expected by the fever are significant in diagnosis. A sonogram can be used to rule out endometrial or tubal infection. If doubt persists, the IUD should be removed and a careful laparoscopy performed to assess the extent and nature of lesions. If the IUD is removed, effective replacement contraception should be prescribed. The physician should not ignore a fever in a patient using an IUD, and should be available for consultation immediately. Removal of the device without further treatment is insufficient in case of gynecological infection because of the danger posed to subsequent fertility. The IUD should not be removed without a short and intensive antibiotic treatment. The possibility of a partner with urethritis should not be ignored, and the fever should not be attributed to vaginitis, even if it is a severe case. The possibility of a pregnancy with the device in place should be ruled out. If the strings are not visible, a sonogram should be obtained to locate the device. In diagnosing febrile patients, the possibility of appendicitis and pyelonephritis should also be considered.
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PMID:[Dos...don'ts...in the case of unexplained high temperature in an IUD user (author's transl)]. 1233 2

Increasing prevalence of diabetes mellitus and rising patient life expectancy are causing an accumulation of urologic late complications-despite or due to steadily improving medical health care. The prevalence of diabetic cystopathy (impaired bladder sensation, increased bladder capacity, sometimes accompanied by voiding difficulties and residual urine) is 25% in non-insulin-dependent diabetics and 48% in insulin-dependent diabetics. Autonomic and peripheral neuropathy lead to detrusor hyposensitivity, and chronic overstretching of the bladder causes myogenic detrusor hypocontractility. Since diabetic cystopathy often develops insidiously and asymptomatically, prevention of secondary complications such as recurrent urinary tract infections, vesicorenal reflux, nephrolithiasis, and pyelonephritis requires the urologist's full attention as well as early and repeated urodynamic diagnostics. Comorbidities can lead to a variety of urodynamic findings. Therapeutic options are generally conservative (timed voiding, micturition training, CIC, pharmacotherapy) and should be part of an integrated interdisciplinary health care approach since undiscovered complications involving non-urologic organ systems create a higher long-term socioeconomic burden than preventive support provided by other specialists.
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PMID:[Diabetes mellitus and bladder function. What should be considered?]. 1466 81

The authors present treatment policy in acute pyelonephritis (AP) associated with diabetus mellitus (DM) and analyse treatment efficacy basing on the material on 214 patients. A clinical course of AP in the presence of DM has some specific features. The disease manifests primarily with clinico-laboratory signs of DM decompensation. Lack of insulin therapy effect in DM decompensated patients indirectly points to acute, especially purulent, pyelonephritis. High temperature, abnormal leukocytic blood picture, leukocyturia, hypercreatininemia in patients with insulin-resistent DM demands urological examination. Renal and urinary pathology is prompted by x-ray picture of atonic dilation of the caliculopelvic system and ureter in neuropathy. Vesicoureteral reflux, tower-like deformation of the urinary bladder, ureterohydronephrosis in DM patients are readily diagnosed with cystography, excretory urography and ultrasonic investigation. Therapeutic policy must be based on pyelonephritis form, severity of DM and efficacy of conservative therapy. No response to therapy, increasing academia and intoxication show failure of conservative treatment and absolute necessity of surgery. In extended purulent acute pyelonephritis preference is given to primary nephrectomy. The differentiated policy of acute pyelonephritis treatment led to DM remission and therapeutic response in 84.6% patients. Total lethality was 15.4%. Its cause was a severe condition of the patients.
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PMID:[Acute pyelonephritis in diabetes mellitus]. 1470 39

Efficacy of treatment of 208 diabetic patients with acute pyelonephritis was analyzed. Surgical treatment was performed in 58 patients (43 with insulin-non-depended and 15 with insulin-depended types). All the patients were divided into 4 groups depending on forms of pyelonephritis: non-destructive (116 patients), purulent-destructive (58), calcllious (34), purulent-calculous (10). Algorithm of differential diagnosis between non-destructive and purulent-destructive forms of acute pyelonephritis in diabetic patients are presented. It is demonstrated that surgical treatment is the main method in complex therapy of purulent-destructive forms. Rational surgical policy is substantiated. In patient with diabetes and purulent pyelonephritis nephrectomy is more expediently. Nephrostomy may be used only in light forms of diabetes with local destructive forms ofapostematosic nephritis. Radical surgical policy permitted to achieve positive result of treatment in majority of patients. Lethal outcomes were seen in two-sided lesion of kidneys with apostems, and carbuncles.
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PMID:[Surgical policy in acute purulent pyelonephritis in patients with diabetes]. 1498 64

A 59-year-old female was referred to our institute for urinary tract infection with septicemia, thrombocytopenia, and hyperglycemia. Plain abdominal X-ray and computed tomography (CT) showed emphysema at the left renal parenchyma and urinary tract along with the perirenal inflammatory changes. These findings suggested emphysematous pyelonephritis in the early phase of occurrence in a diabetic patient. Transurethral catheterization of the left ureter was immediately performed, and occluded cloudy urine was drained. Ureteral stent was left indwelt transurethrally for easy accession in case of occlusion. E. coli was cultured in drained urine. Administration of antibiotics, insulin, and anti-coagulant was performed, and drained urine became clear in several hours. General condition and laboratory findings were improved normally in a week, and CT did not reveal the emphysematous change of the left renal unit at the 11th hospital day.
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PMID:[A case of emphysematous pyelonephritis successfully treated by transurethral retrograde drainage]. 1523 83

The experience with 65 cases of purulent gestational pyelonephritis (PGP) is reviewed. The efficacy of PGP intensive therapy depends on early surgical elimination of the source of bacteriemia and sepsis. Choice of the surgical technique should be based both on extension of destructive changes in the kidney and severity of the complications. In some cases it is necessary to perform nephrostomy with sanation of the pyonecrotic foci in the kidney, in the other--it is necessary to perform urgent nephrectomy. Three basic components of pre- and postoperative intensive care should be considered: antibacterial treatment, infusion-transfusion therapy and efferent detoxication. Etiotropic therapy is conducted with three antibiotics injected intravenously and intramuscularly to provide effective concentrations of the drugs in the blood, urine and affected organs. PGP medication is based on inhibitor-defended penicillines and cephalosporines of the third-forth generation. Combined use of these antibiotics is effective in 95% cases. If the condition is life-threatening, carbapenems, fluoroguinolones, aminoglycosides and metronidasol can be applied. Detoxication is provided by 24-h infusion of crystalloids, concentrated glucose solutions (10-20%) with insulin, transfusion of fresh frozen plasm, albumin, protein. Plasmapheresis accelerates recovery, diminished nephrectomy rate by 14% and obstetric complications 1.8 fold, enables physiological term of delivery (37-39 weeks) in significant reduction of postnatal complications. Lethal outcomes were absent.
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PMID:[Intensive therapy in complicated forms of purulent gestational pyelonephritis]. 1857 62

Genetic mutations resulting in obesity and type 2 diabetes mellitus (T2D) are described for both inbred and outbred mice. However, no known mouse model completely recapitulates human T2D and its comorbidities. We identified a cohort of obese, male, outbred Swiss-Webster (SW) mice as polyuric, polydipsic, glucosuric, and hyperglycemic. Prevalence of glucosuria in the SW colony reached 60% (n=70) in males 8 weeks to 6 months of age. Despite severe obesity in some females, no females were diabetic. Pathologic findings in affected males included cachexia, dilated gastrointestinal tracts with poor muscular tone, pancreatic islet degeneration and atrophy with compensatory metaplasia and/or neogenesis, bacterial pyelonephritis, membranous glomerulopathy, and late-onset hepatic tumors with macrosteatosis, microsteatosis, and hydropic change in aged males. Serum insulin correlated with blood glucose in a nonlinear pattern, suggestive of islet exhaustion. Circulating leptin levels showed a weak inverse correlation with glucose. Diabetic males were bred with obese colony females to produce 20 male and 20 female offspring. Prevalence of diabetes in male offspring was 80% (16/20) with a median age of onset of 18 weeks. By contrast, no diabetic females were identified, despite being significantly more obese than males. Male predominance is likewise a feature of T2D in humans. To our knowledge, this is the first documentation of hepatocellular carcinoma and islet metaplasia and/or neogenesis in a spontaneous outbred mouse model of T2D. The SW availability and histopathologic features represent a promising new model for the study of T2D.
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PMID:Obesity and non-insulin-dependent diabetes mellitus in Swiss-Webster mice associated with late-onset hepatocellular carcinoma. 1866 86


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