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PubMed1976

Hydronephrosis of pregnancy.

This review was done because most texts and some recent reviews do not recognize the obstructive cause. It is important only because of the high incidence of acute pyelonephritis during pregnancy. This is so common that it has been given a special name, "pyelitis of pregnancy". We have shown in the monkey that bacteria when introduced into the ureter under low pressure does not often cause pyelonephritis unless associated with ureteral obstruction. The presence of bacteria even with partial ureteral obstruction increases the chances of acute pyelonephritis. Care must thus be taken to eradicate bacteriuria during pregnancy to prevent acute pyelonephritis as has been shown by Kass, especially since vesicoureteral reflux occurs more frequently in the pregnant than nonpregnant primate. When we understand the obstructive cause of hydronephrosis of pregnancy and the effect of positional change, therapy will be more effective. The left lateral position then will not only relieve the pain of acute hydronephrosis of pregnancy but will also greatly assist in the therapy of acute pyelonephritis of pregnancy since it will relieve the associated ureteral obstruction.

Acute Disease↗
PubMed2005

[Infective lithiasis].

"Infection Lithiasis" refers to calculi that occur with persistent urinary tract infection. Stones composed of magnesium ammonium phosphate (struvite) and carbonate apatite, called "triple phosphate" stones, are the more common type of infection lithiasis. These stones are also called "staghorn" calculi because they may grow rapidly and fill the entire collecting system. They form during urinary infection with urea-splitting micro-organism. They may originate de novo or complicate a lithiasis when pre-existing stones are colonized with urea-splitting bacteria. They represent about 2-3% of stones referred for laboratory analysis. This article reviews the epidemiology, pathogenesis, clinical features, and management of struvite stones. A singular pathologic entity recently described, called "encrusted cystitis or encrusted pyelitis", mainly caused by Corynebacterium urealyticum is also review. Infection lithiases caused by non-urease-producing bacteria may also occur and are examined in this article. Finally, the controversial role of nanobacteria in nephrolithiasis is discussed.

Humans↗
PubMed2004

Clofibric and ethacrynic acids prevent experimental pyelonephritis by Escherichia coli in mice.

Interfering Escherichia coli attachment to the urinary tract, using P-fimbriation inhibitors, can prevent pyelonephritis. Clofibric and ethacrynic acids are organic compounds structurally related, but with different pharmacological uses. These agents are potentially active in the urinary tract due to its elimination in an unaltered form by the renal route. This study described a pyelonephritogenic E. coli strain, grown in the presence of sub-inhibitory concentrations of clofibric or ethacrynic acids (0.1 and 1 mM, respectively), which exhibits inhibition of P1 erythrocytes agglutination and a drastic decrease in fimbriation, using electron microscopy and quantitative analyses of superficial proteins (decrease to a 17-25% in comparison with the control). In vivo assays were performed using ascending urinary tract infection in mice. The treatment with therapeutic doses of the drugs, administered 2 days before the bacterial challenge and daily until the end of the experiment (22 days), abolished renal infection after 7-10 days of drug exposure. Within this period clofibric acid did not produce adverse effects on the renal parenchyma. However, ethacrynic acid caused pyelitis and tubular cellular desquamation. These results suggested that clofibric acid might be useful in the short-term prophylaxis of urinary tract infection.

Animals↗
PubMed2003

Comparison of excretory phase, helical computed tomography with intravenous urography in patients with painless haematuria.

AIM: To compare excretory phase, helical computed tomography (CT) with intravenous (IV) urography for evaluation of the urinary tract in patients with painless haematuria. MATERIALS AND METHODS: Ninety-one out-patients had IV urography followed by helical CT limited to the urinary tract. Both IV urograms and CT images were evaluated for abnormalities of the urinary tract in a blinded, prospective manner. The clinical significance of abnormalities was scored subjectively and receiver operator characteristic curve analysis was performed. RESULTS: In 69 of 91 patients (76%), no cause of haematuria was identified. In 22 of 91 patients (24%), the cause of haematuria was identified as follows: transitional cell cancer of the bladder (n=15), urinary tract stones (n=3), cystitis (n=2), haemorrhagic pyelitis (n=1) and benign ureteral stricture (n=1). With IV urography, there were 15 true-positive, seven false-negative and three false-positive interpretations. With CT, there were 18 true-positive, four false-negative and two false-positive interpretations. There was no significant difference between IV and CT urography for the significance of the positive interpretations (n=0.47). CONCLUSION: Excretory phase CT urography was comparable with IV urography for evaluation of the urinary tract in patients with painless haematuria. However, the study population did not include any upper tract cancers.

Adult↗
PubMed2000

Percutaneous nephrostomy in infants and children.

RATIONALE AND OBJECTIVES: The purpose of this study was to review the authors' experience with percutaneous nephrostomy during an 11-year period, paying special attention to indications and outcomes. MATERIAL AND METHODS: The records of 71 percutaneous nephrostomy procedures performed on 59 children at the authors' institution from January 1987 through December 1997 were retrospectively reviewed. In these children, ultrasonography was used for puncture and fluoroscopy for catheter insertion. Local anesthesia with sedation was used and later replaced by general anesthesia. Loop-end catheters were employed. The smallest patient weighed 1,200 g, and the mean patient age was 3.4 years. RESULTS: The mean duration of drainage was 60 days, and the longest time was 11 months. Indications were mainly obstructions, with congenital obstruction (n = 28) and postoperative obstruction (n = 26) being the most common. Obstructive pyelitis, malignancy, stone, renal cystic disease, trauma, and neurogenic bladder disturbance were also indications. No complications such as loss of the kidney, serious infection, or hemorrhage of clinical importance were observed. Obstruction was successfully relieved in all patients, but 12 kidneys and five hemikidneys did not recover function and were eventually removed. CONCLUSION: The percutaneous nephrostomy procedure is a safe technique that can be used successfully for short- and longterm drainage in all children, even in small infants and those with solitary kidneys, and is a valuable adjunct to surgery.

Child↗
PubMedDate not supplied

Experimental evaluation of urinary bladder marsupialization in male goats.

OBJECTIVE: To evaluate the outcome of urinary bladder marsupialization in male goats. STUDY DESIGN: Prospective, experimental study. ANIMALS: Six healthy mixed-breed male goats. METHODS: After experimentally induced urethral obstruction, 6 male goats had urinary bladder marsupialization. Renal ultrasonography, complete blood count, and serum biochemical analysis were evaluated preoperatively (day 0), at 7 postoperative days, and then at 30-day intervals until 180 days. Stomal diameter was recorded immediately postoperatively and at each postoperative interval. Necropsy examination was performed on day 180 or when stomal stricture or death occurred. RESULTS: Stomal stricture occurred in 1 goat at 120 days. Another goat was found dead at 150 days; severe, suppurative cystitis was identified on necropsy. All goats had mild urine scald dermatitis. Serum biochemical values remained within normal limits, but significant decreases in white blood cell count, serum creatinine concentration, and stomal diameter occurred. At necropsy, all bladders were tubular in shape. Histological evidence of chronic suppurative cystitis and chronic, mild lymphoplasmacytic pyelitis occurred in all goats. Bacterial culture of renal tissue yielded growth in 3 goats, and bladder mucosal swabs yielded bacterial growth in all goats. CONCLUSIONS: Although clinical signs of ascending urinary tract infection were not observed in goats with patent stomata, urinary bladder marsupialization may result in ascending urinary tract inflammation or infection. CLINICAL RELEVANCE: Based on our results, urinary bladder marsupialization should be recommended with caution as the primary method for management of urinary tract obstruction in clinical cases.

Animals↗
PubMed1979

[The value of renal phlebography in the differential diagnosis of arteriographically hypo- or avascular lesions in the kidney (author's transl)].

The present paper is an investigation into the diagnostic value of renal phlebography for differentiating between arteriographically hypo- and avascular malignant lesions in the kidney and benign renal masses. In three examinations carried out on eight patients with renal masses, phlebography was of crucial diagnostic importance. In ten renal cysts a presumptive diagnosis made by arteriography was confirmed by phlebography. In another eight renal cysts, a case of haemorrhagic pyelitis and in two cases of unilateral pseudotumerous pyelonephritis, phlebography was of no value.

Adenocarcinoma↗
PubMedDate not supplied

[Pregnancy and labor in 12 to 14-year-old girls].

This retrospective study reports on the course of pregnancy and delivery in 12- to 14-year old girls during a period of 8 years. At the time of delivery 44 mothers (0.3%) out of 13,178 had not finished their 15th year; this adolescent primiparae were compared to a group of equal size including primiparae between 20 and 30 years of age. Whereas other studies report a higher risk of several pregnancy-related complications, our investigation mainly found a higher percentage of premature deliveries (13.6%). A significantly shorter duration of pregnancy resulted in lower birth weights in the adolescent group. Furthermore we noted a higher frequency of pyelitis gravidarum in this group. Operative delivery had to be performed in 9.1% of the cases (3 X cesarean sections, 1 X forceps), compared to 13.6% in the control group (3 X cesarean sections, 3 X forceps). In the adolescent group no other obstetric complications occurred; whereas a higher incidence of puerperal infections (endometritis) was noted. 26 adolescent mothers were foreigners of southern European descendence; in only 8 cases the putative father was notified; a third of the young mothers decided to enter their child in the state adoption program.

Adolescent↗
PubMed1988

Acute pyelonephritis associated with bacteriuria during long-term catheterization: a prospective clinicopathological study.

Bacteriuria is virtually universal in long-term catheterized patients. This blinded autopsy study of 75 aged nursing home patients demonstrated that acute inflammation of the renal parenchyma was present in 38% of patients with a urinary catheter in place at death versus 5% of noncatheterized patients (P = .004). Of a number of clinical and demographic variables studied, only catheterization was significantly related to acute renal inflammation. Acute cystitis was uncommon, but each case was associated with inflammation of at least one kidney. The majority of kidneys showing acute inflammation (21 [68%] of 31) were not accompanied by acute pyelitis. Acute renal inflammation with or without pelvic inflammation is a common finding in nursing home patients dying with urethral catheters in place. This finding provides additional support for the development of alternatives to the indwelling urethral catheter.

Acute Disease↗
PubMed2004

Urinary tract and genito-urinary suppurative infections due to anaerobic bacteria.

Anaerobes have been involved in many different types of urinary tract infection. This review describes the microbiology, diagnosis and management of urinary tract and genito-urinary suppurative infections caused by anaerobic bacteria. The types of infections of the urinary tract in which anaerobes have been involved include para- or periurethral cellulitis or abscess, acute and chronic urethritis, cystitis, acute and chronic prostatitis, prostatic and scrotal abscesses, periprostatic phlegmon, ureteritis, periureteritis, pyelitis, pyelonephritis, renal abscess, scrotal gangrene, metastatic renal infection pyonephrosis, perinephric abscess, retroperitoneal abscess and other infections. The anaerobes recovered in these studies were Gram-negative bacilli (including Bacteroides fragilis and pigmented Prevotella and Porphyromonas sp.), Clostridium sp., anaerobic Gram-positive cocci and Actinomyces sp. In many cases, they were recovered mixed with coliforms or streptococci. The recovery of anaerobes requires the administration of antimicrobial therapy that is effective against these organisms. These antimicrobials include metronidazole, chloramphenicol, clindamycin, a carbapenem, cefoxitin and the combination of a penicillin and a beta-lactamase inhibitor. Percutaneous drainage, open surgical drainage or nephectomy might be indicated for abscesses.

Abscess↗
PubMed2007

Use of capecitabine to prevent acute renal allograft rejection in dog erythrocyte antigen-mismatched mongrel dogs.

OBJECTIVE: To assess efficacy and toxicity of a capecitabine (CAP)-based regimen for preventing rejection of renal allografts in dog erythrocyte antigen (DEA)-mismatched mongrel dogs. STUDY DESIGN: Prospective, pilot study. ANIMALS: Eight healthy, unrelated, DEA mismatched, adult mongrel dogs. METHODS: All dogs received CAP, starting at 50 mg/m2 PO b.i.d. 4 days preoperatively, increasing to 200 mg/m2 PO b.i.d. by the day of surgery. All dogs received cyclosporine-A (CsA) and prednisolone starting 2 days preoperatively. Standard heterotopic renal transplantation with native nephrectomy was performed. After 90 days, surviving dogs were euthanatized and histopathologic examination was performed. RESULTS: Two of 8 dogs developed acute neurotoxicity leading to death or euthanasia within 5 days of surgery. For the 6 remaining dogs, there were no statistically significant changes in complete blood count or serum biochemical values. No opportunistic infections developed during the study period. Five of 6 dogs had no to minimal evidence of graft rejection. Two of 6 dogs developed superficial and pigmentary keratitis. Significant histopathologic findings in all dogs included mild lymphoplasmacytic gastroenteritis, steroid hepatopathy, and corneal epithelial thinning. One dog had moderate interstitial nephritis and pyelitis. CONCLUSIONS: In this experimental model, a CAP-CsA-prednisolone immunosuppressive regimen was effective in preventing rejection of allografts in DEA-mismatched dogs. Severe, unpredictable neurotoxicity and variable ocular toxicity significantly limit clinical applications at this time. CLINICAL RELEVANCE: A CAP-CsA-prednisolone protocol is an effective, oral immunosuppressive regimen for prevention of allograft rejection in DEA-mismatched mongrel dogs. For clinical application, identification of patients susceptible to toxic side effects would be necessary.

Administration, Oral↗
PubMed1977

Experimental model of corynebacterium renale pyelonephritis produced in mice.

Corynebacterium renale type I (strain 115), 1.7 X 10(7) to 4.5 X 10(7) organisms, introduced intravenously into mice disappeared from the blood less than 24 h after inoculation and did not produce pyelonephritis. The same strain, 1 X 10(7) to 5 X 10(7) organisms, inoculated into the urinary bladder of mice was not recovered from the blood in any of the mice, but caused pyelonephritis accompanied by ureteritis and cystitis in 16 of 21 (76%) mice. Pyelonephritis and cystitis in mice were histopathologically similar to those found in cows. The antibody response was observed only in the mice with pyelonephritis or pyelitis, but not in those with only cystitis or in those without lesions, as found in cows. Similar diseases were produced in mice by C. renale types II and III but less frequently than by type I. It is suggested, therefore, that mice may be useful in the study of bovine C. renale infection.

Animals↗
PubMed1993

Contribution of Proteus mirabilis urease to persistence, urolithiasis, and acute pyelonephritis in a mouse model of ascending urinary tract infection.

Proteus mirabilis, a significant cause of bacteriuria and acute pyelonephritis in humans, produces urease. This high-molecular-weight, multimeric, cytoplasmic enzyme hydrolyzes urea to ammonia and carbon dioxide. To assess the role of urease in colonization, urolithiasis, and acute pyelonephritis in an animal model of ascending urinary tract infection, we compared a uropathogenic strain of P. mirabilis with its isogenic urease-negative mutant, containing an insertion mutation within ureC, the gene encoding the large subunit of the enzyme. Mice challenged transurethrally with the parent strain developed significant bacteriuria and urinary stones. The urease-negative mutant had a 50% infective dose of 2.7 x 10(9) CFU, a value more than 1,000-fold greater than that of the parent strain (2.2 x 10(6) CFU). The urease-positive parent strain reached significantly higher concentrations and persisted significantly longer in the bladder and kidney than did the mutant. Indeed, in the kidney, the parent strain increased in concentration while the mutant concentration fell so that, by 1 week, the parent strain concentration was 10(6) times that of the mutant. Similarly, the urease-positive parent produced significantly more severe renal pathology than the mutant. The initial abnormalities were in and around the pelvis and consisted of acute inflammation and epithelial necrosis. By 1 week, pyelitis was more severe, crystals were seen in the pelvis, and acute pyelonephritis, with acute interstitial inflammation, tubular epithelial cell necrosis, and in some cases abscesses, had developed. By 2 weeks, more animals had renal abscesses and radial bands of fibrosis. We conclude that the urease of P. mirabilis is a critical virulence determinant for colonization, urolithiasis, and severe acute pyelonephritis.

Acute Disease↗
PubMed1993

Bacterial flora of the urinary tract of pigs associated with cystitis and pyelonephritis.

Twenty-three cases of porcine cystitis and pyelonephritis were examined bacteriologically. Eubacterium suis was found in 21 cases. The isolation of large numbers of Escherichia coli in the upper urinary tract was associated with linear renal scarring. An unidentifiable streptococcus and Enterococcus faecalis were isolated from a case of purulent ureteritis, pyelitis and pyelonephritis. The bacterial flora from cases of cystitis and pyelonephritis was different from that isolated from sows with asymptomatic bacteriuria.

Animals↗
PubMed1996

Genitourinary tract gas: imaging evaluation.

Gas-forming infections of the genitourinary tract may manifest as life-threatening conditions, often requiring aggressive medical and surgical management. Accurate interpretation of the radiologic studies is essential for early and accurate diagnosis of gas within the renal parenchyma or collecting system, bladder, uterus, and scrotum. Three distinct entities are associated with renal or perirenal gas: emphysematous pyelonephritis, emphysematous pyelitis, and gas-forming perirenal abscess. Gas in the bladder may occur secondary to emphysematous cystitis or a vesicoenteric fistula and must be differentiated from air introduced by means of instrumentation. Uterine gas usually indicates an underlying infection or a neoplasm. Gas in the scrotum is most commonly due to an infectious process or bowel herniation into the scrotal sac. Before institution of a specific therapeutic regimen, an effort should be made to establish the exact location of gas in the genitourinary tract. Plain radiography, including tomography, and ultrasonography are useful screening modalities. Although in some cases urography, barium enema studies, and other contrast material-enhanced studies enable a diagnosis to be made, in many patients computed tomography is the definitive diagnostic technique.

Adult↗
PubMed1992

Right-sided segmental infarction of the omentum: clinical, US, and CT findings.

Clinical, ultrasound (US), and computed tomographic (CT) findings at hospital admission and follow-up were retrospectively studied in seven patients with right-sided segmental infarction of the omentum. In all patients, the presumptive clinical diagnosis was appendicitis, although in three patients cholecystitis and pyelitis were also considered. US revealed an ovoid or cakelike, moderately hyperechoic, noncompressible lesion adherent to the peritoneum and located at the level of the umbilicus, anterolateral to the right half of the colon. On CT scans, a corresponding, better defined area of fat interspersed with hyperattenuating streaks was found. No abnormality of bowel or appendix was seen. The clinical symptoms and abnormalities on US scans gradually disappeared in all patients. Because no patient underwent surgery, no histologic proof was obtained. In all patients, however, the clinical, US, and CT findings were similar and consistent. They corresponded to the abnormality called right-sided segmental omental infarction in the surgery and radiology literature and enabled exclusion of appendicitis, thus preventing unnecessary surgery.

Adolescent↗
PubMed1973

Regulation of cholesterol metabolism in the dog. II. Effects of complete bile diversion and of cholesterol feeding on pool sizes of tissue cholesterol measured at autopsy.

In six adult pedigreed dogs the effects of high-cholesterol diets or bile diversion on the sizes of body cholesterol pools were studied at autopsy. Total body cholesterol was determined by measuring the cholesterol content of discrete organs and of the eviscerated carcass: neither cholesterol feeding nor bile diversion had altered total body cholesterol or the cholesterol content of individual organs and tissues. These results validated the conclusion based on sterol balance data obtained during life, that high-cholesterol feeding did not lead to substantial expansion of tissue cholesterol pools. THE TOTAL AMOUNT OF EXCHANGEABLE CHOLESTEROL IN THE ANIMALS WITH AN INTACT ENTEROHEPATIC CIRCULATION, WHEN ESTIMATED FROM ISOTOPIC DATA, WAS ESSENTIALLY THE SAME AS THAT MEASURED CHEMICALLY: this indicated that there was little or no nonexchangeable cholesterol in these dogs, except in skin and nervous tissue, regardless of the cholesterol content of the diet. This correspondence of estimates was not obtained in the bile-diverted dogs: we propose that the defect in the isotopic estimates was due to the accelerated rate of cholesterol synthesis in these animals. Gross and microscopic morphology of all organs and tissues was examined. Abnormal findings were limited to the biliary tract and the urinary collecting system of the two bile-diverted dogs: multiple bilirubinate gallstones were found, and mild pyelitis and ureteritis were present on the side of the bilio-renal shunt, but the urinary bladder was normal. Histologic evidence of moderate degree of cholangitis was found in one of the two bile-shunted dogs, but in neither dog was there evidence of impedance of bile flow.

Adipose Tissue↗
PubMedDate not supplied

Renal toxicity of a nondopaminergic antipsychotic agent, trimethyl imidazopyrazolopyrimidine, in rats.

A nondopaminergic antipsychotic agent, 5-ethyl-1,3,8-trimethyl-1H-imidazo]1,2-c]pyrazolo[3,4-e]pyrimidine (TIPP; PD 112488), has been tested for potential toxicity in rats. As part of a preclinical safety evaluation, 10 Wistar rats per sex were administered TIPP as a dietary admixture, receiving doses of 0, 5, 10, 20, 25, 50, 100, and 200 mg/kg for 2 wk. In addition, 3 groups of 6 male Wistar rats were administered TIPP (PD 114877 and PD 117498, acid hydrolysis products of TIPP) at 100 mg/kg by gavage for 5 days. All animals given 200 mg/kg were euthanatized in moribund condition or found dead after 1 wk of treatment. Clinical evidence of renal toxicity was noted and included emaciation, hematuria, urinary incontinence, and enlarged kidneys at doses of 10 mg/kg and higher. Plasma urea levels were higher than those of controls in all TIPP-treated groups. Significant pathologic changes of the urothelium were evident at all doses and were characterized by necrotizing pyelitis and cystitis. Necrosis and inflammation of the urothelium resulted in secondary hydronephrosis. No renal toxicity was noted with the acid hydrolysis products. The urothelial changes with oral administration of TIPP in rats is species-specific, and the specificity may be related to the metabolism and excretion of the drug.

Administration, Oral↗