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

In 116 patients with acute and chronic pyelonephritis and in 66 healthy persons the total proteolytic, trypsin-like, catheptic, BAEE-esterase activities and the content of trypsin inhibitor were determined in blood serum and kidney tissue. The total proteolytic and catheptic activities were distinctly increased in blood serum and, especially, in kidney tissue under acute pyelonephritis. In chronic pyelonephritis the activity of cathepsins was decreased in blood serum. The trypsin-like activity tended to decrease both in blood serum and kidney. The BAEE-esterase activity was increased in kidney, particularly in acute pyelonephritis, but in blood serum it was decreased. The inhibitor of trypsin was not found in kidney; in blood serum its content was slightly increased in acute pyelonephritis but there were only slight alterations in the chronic disease.
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PMID:[Activity of proteolytic enzymes and trypsin inhibitor in blood serum and kidney in pyelonephritis]. 121 70

In caring for women with acute dysuria, clinicians traditionally have relied on clinical findings to distinguish between acute pyelonephritis and "cystitis"; they have ordered urinalysis and urine culture regularly for patients with suspected acute pyelonephritis and ordered these tests inconsistently for patients with suspected "cystitis." Recent evidence indicates that "cystitis" may actually be any of six different clinical conditions, each of which is managed differently; subclinical pyelonephritis, lower urinary tract bacterial infection, chlamydial urethritis, other forms of urethritis, vaginitis, or dysuria without any urinary tract or vaginal infection. The distinction between these entities is made primarily from clinical findings. Urinalysis is also of great value in symptomatic patients; the presence of pyuria (and possibly indirect quantitation of pyuria by the leukocyte esterase test) is a reliable indicator of treatable infection, and its absence indicates infection is not present. In contrast, urine culture is of clear value only in patients with acute pyelonephritis or subclinical pyelonephritis.
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PMID:Urinalysis and urine culture in women with dysuria. 351 13

Urinary tract infection (UTI) is a common problem treated by emergency physicians. A midstream urine sample remains the most frequent method of culture collection. Although midstream urine culture growing more than 10(5) colony-forming units per milliliter (cfu/mL) has been considered diagnostic of UTI, high false-positive and false-negative rates as well as a lack of precision have been associated with this method of collection. Alternative methods of establishing the diagnosis of UTI have excellent sensitivity and may be utilized at the time of patient presentation. These include the detection of leukocyte esterase activity in urine and the presence of one or more bacteria on microscopic examination of an unspun urine sample. Women of child-bearing age represent the vast majority of patients seen with UTI. Uncomplicated infection of the urinary tract has a generally benign course in these patients, and is rarely associated with long-term complications. In addition, these patients are infected with a predictable spectrum of uropathogens that respond to the commonly used antibiotics. It appears that urine cultures provide little additional information in this patient population. Urine cultures should be obtained in patients at high risk for pyelonephritis or bacteremia/urosepsis, as well as in those expected to have uncommon or resistant organisms.
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PMID:Utility of urine cultures in the emergency department. 394 79

A total of 48 patients with calculous pyelonephritis were examined before and after surgery. A study was made of the fibrinolytic system (according to the status of XIIa kallikrein-dependent fibrinolysis, lysis of the plasma clots and euglobulin lysis) and of the kallikrein-kinin system of the plasma (according to kallikrein activity, kininogen content, kininase activity, spontaneous esterase activity and prekallikrein content). The patients with calculos pyelonephritis demonstrated KKS activation and fibrinolysis reduction related to both the lowering of the activator levels and elevation of antiplasmin levels, which in turn created the risk of thrombophilia in this group of patients.
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PMID:[Changes in the indicators of the fibrinolytic and kallikrein-kinin systems in patients with calculous pyelonephritis]. 656 90

Recent literature was reviewed to identify elements of antenatal care which are of proven benefit in preventing or ameliorating adverse outcomes in the mother such as bleeding, anemia, pre-eclampsia, sepsis and genitourinary infection, and obstructed labor. Recent trials indicate that while fewer routine visits for low-risk women do not jeopardize a positive pregnancy outcome, patients may be less satisfied. None of the many factors which can cause bleeding during pregnancy can be eliminated through antenatal care, although risk factors can be identified through history-taking. Counseling on what to do is the best option. Routine iron supplementation against anemia is not necessary in well-nourished populations, but circumstantial evidence suggests that iron and folate should be provided for every pregnant woman in areas of high anemia prevalence. Hemoglobin determination as a routine test is more important near week 30 of term rather than early in pregnancy. Recent trials do not support routine aspirin to prevent pre-eclampsia among low-risk women, nor is there evidence that anti-hypertensive treatment of mild pre-eclampsia will prevent more serious disease. Improved detection and care may, however, lead to better outcomes. Urine culture and dipstick for leucocyte esterase and nitrite with subsequent treatment of positive cases will reduce the risk of pyelonephritis and appear to be cost-effective. Serological screening and treatment of syphilis is inexpensive and cost-effective, while obstructed labor can be anticipated in multiparas based upon obstetrical history; hospital delivery should be secured.
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PMID:Scientific basis for the content of routine antenatal care. I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes. 903 38

There are approximately 250,000 cases of acute pyelonephritis each year, resulting in more than 100,000 hospitalizations. The most common etiologic cause is infection with Escherichia coli. The combination of the leukocyte esterase test and the nitrite test (with either test proving positive) has a sensitivity of 75 to 84 percent and a specificity of 82 to 98 percent for urinary tract infection. Urine cultures are positive in 90 percent of patients with acute pyelonephritis, and cultures should be obtained before antibiotic therapy is initiated. The use of blood cultures should be reserved for patients with an uncertain diagnosis, those who are immunocompromised, and those who are suspected of having hematogenous infections. Outpatient oral antibiotic therapy with a fluoroquinolone is successful in most patients with mild uncomplicated pyelonephritis. Other effective alternatives include extended-spectrum penicillins, amoxicillin-clavulanate potassium, cephalosporins, and trimethoprim-sulfamethoxazole. Indications for inpatient treatment include complicated infections, sepsis, persistent vomiting, failed outpatient treatment, or extremes of age. In hospitalized patients, intravenous treatment is recommended with a fluoroquinolone, aminoglycoside with or without ampicillin, or a third-generation cephalosporin. The standard duration of therapy is seven to 14 days. Urine culture should be repeated one to two weeks after completion of antibiotic therapy. Treatment failure may be caused by resistant organisms, underlying anatomic/functional abnormalities, or immunosuppressed states. Lack of response should prompt repeat blood and urine cultures and, possibly, imaging studies. A change in antibiotics or surgical intervention may be required.
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PMID:Diagnosis and management of acute pyelonephritis in adults. 1634 41

Urinary tract infection is the second commonest infection encountered in both the community and the hospital setting. In order to avoid complications and to minimize the unnecessary use of antibiotics, it is essential to have a useful and rapid screening test to identify urinary tract infection. The presence of nitrite and leukocyte esterase on urinalysis is such a test. Symptomatic bacteriuria requires prompt treatment and pyelonephritis should be treated for 10-14 days, whereas asymptomatic catheter and non-catheter bacteriuria should not be treated, except in the setting of pregnancy and in childhood.
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PMID:Complicated urinary tract infection. 1703 70

The risk of pyelonephritis in children with asymptomatic cystitis or bacteriuria, using desmopressin for primary nonpoliuric nocturnal enuresis, is not known. The aim of this study was to study whether there is a risk of pyelonephritis in rats with cystitis using desmopressin. Wistar rats (n = 28) were divided into four groups of cystitis (groups I-IV). DDAVP (2 microg daily) and saline (0.5 ml daily) were injected intramuscularly for 7 days in groups II and IV and groups I and III, respectively. The urinalysis, urine culture, and 24-h urinary volume (UV(24)) were assessed for all rats on days 1, 3, 5, and 7. In groups III and IV these studies were also performed on days 14, 21, and 28. Serum creatinine was determined on day 7 in all rats and on day 28 in groups III and IV. Groups I and II and groups III and IV were killed at the end of days 7 and 28, respectively. Kidneys and urinary bladders were graded subjectively for inflammation and fibrosis. Inflammation and fibrosis scores in kidney and bladder tissues were not different between DDAVP or saline-injected rats in cystitis groups at weeks 1 and 4. No fibrosis was found in any of the urinary bladders on histological examination. Ascendant pyelonephritis was detected in each of the four rats in DDAVP-administered and saline-administered cystitis groups. The histopathologic scores of the renal tissue with pyelonephritis showed no correlation with the daily urine volume, the positive test results for urine leukocyte esterase with dipstick test, the urine culture results for E. coli based on colony-forming unit per milliliter, or serum creatinine levels in cystitis groups. It was found that the administration of DDAVP to cystitis groups did not increase the risk of ascendant pyelonephritis.
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PMID:What is the risk of pyelonephritis due to desmopressin in rats with cystitis? 1723 15

OBJECTIVES: To examine the pattern of urinary tract infection (UTI) in boys < 5 years admitted to general pediatric wards and to identify the approach to imaging investigations. DESIGN: During the period from January 2002 through December 2002, 34 boys < 5 years of age were admitted to Farwania Hospital with UTI. Age at diagnosis, presenting features, urinalysis, pathogens, acute phase reactants and imaging procedures were reviewed for these patients. RESULTS: All 34 patients in this study were less than one year. Fever was the most common presenting feature and was seen in 70.6% of patients. Pyuria was found in 77% , positive leukocyte esterase (LE) test in 85.7% and positive nitrite test in 45.7% of patients. Significant leukocytosis was found in 39.3%, high C-reactive protein (CRP) in 46.8% and high erythrocyte sedimentation rate (ESR) in 50% of children. Escherichia coli (E.coli) were the most common pathogen affecting 77.1% patients. Radiological investigations were recommended as follows: ultrasound scan (US) for all patients (94.2% did the test, 46.8% had normal scans and 43.7% had dilatation of pelvicalyceal system); Early-scheduled (99m)Tc dimercaptosuccinic scan (DMSA) was done in seven patients. Five or 71% had evidence of acute pyelonephritis; Late-scheduled DMSA was recommended for 25 patients. Only 52% did the test and out of those 46% had evidence of chronic involvement of the kidney(s); Micturating cystourethrogram (MCUG) was advised for 32 patients. 43.8% failed to carry out the procedure. Vesicoureteric reflux (VUR) was found in 38.8% of those who performed the test. CONCLUSION: Unexplained fever in young boys should suggest UTI. Absence of fever does not exclude UTI, if other suggestive features exist particularly in the very young. UTI is commonly suggested by findings on urinalysis, on the other hand, negative urinalysis should not exclude the infection. Empiric antibiotics should cover gram-negative bacilli. Innovative strategies to ensure compliance to radiological investigations are needed.
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PMID:Urinary Tract Infection in Boys Less Than Five Years of Age: A General Pediatric Perspective. 1943 May 82

Serotypes of group B streptococcus (GBS) that cause urinary tract infection (UTI) are poorly characterized. We conducted a prospective study of GBS UTI in adults to define the clinical and microbiological characteristics of these infections, including which serotypes cause disease. Patients who had GBS cultured from urine over a 1-year period were grouped according to symptoms, bacteriuria, and urinalysis. Demographic data were obtained by reviewing medical records. Isolates were serotyped by latex agglutination and multiplex PCR-reverse line blotting (mPCR/RLB). Antibiotic susceptibilities were determined by disc diffusion. GBS was cultured from 387/34,367 consecutive urine samples (1.1%): 62 patients had bacteriuria of >10(7) CFU/liter and at least one UTI symptom; of these patients, 31 had urinary leukocyte esterase and pyuria (others not tested), 50 (81%) had symptoms consistent with cystitis, and 12 (19%) had symptoms of pyelonephritis. Compared with controls (who had GBS isolated without symptoms), a prior history of UTI was an independent risk factor for disease. Increased age was also significantly associated with acute infection. Serotyping results were consistent between latex agglutination and mPCR/RLB for 331/387 (85.5%) isolates; 22 (5.7%) and 7 (1.8%) isolates were nontypeable with antisera and by mPCR/RLB, respectively; and 45/56 (80.4%) isolates with discrepant results were typed by mPCR/RLB as belonging to serotype V. Serotypes V, Ia, and III caused the most UTIs; serotypes II, Ib, and IV were less common. Nontypeable GBS was not associated with UTI. Erythromycin (39.5%) and clindamycin (26.4%) resistance was common. We conclude that a more diverse spectrum of GBS serotypes causes UTI than previously recognized, with the exception of nontypeable GBS.
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PMID:Diversity of group B streptococcus serotypes causing urinary tract infection in adults. 1943 33


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