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At least 217 records · Page 12Linked to original sources
PubMed1994

Pretransplant urologic evaluation.

OBJECTIVE: Although a number of pretransplant urologic evaluations have been recommended in the literature, their efficacy has not been validated. This study was undertaken to evaluate a standardized urologic diagnostic protocol for potential adult transplant recipients. METHODS: One hundred consecutive adult transplant candidates were prospectively evaluated with a complete history and physical examination, renal ultrasonography (US), voiding cystourethrography (VCUG), urinalysis, and urine culture. Other diagnostic studies including cystoscopy and retrograde pyelography were performed as indicated. RESULTS: Urologic malignancies were diagnosed in 3 patients that included Stage A2 prostate cancer, Stage TA transitional cell carcinoma of the bladder, and Stage II renal cell carcinoma. The only significant abnormality detected by renal US was renal cell carcinoma in 1 patient. Twenty-six individuals had VCUG abnormalities, but these could not be predicted based on patient characteristics. However, VCUG was normal in all nondiabetic patients without voiding symptoms or a history of urinary tract infections. Thirteen patients had hematuria and were evaluated with cystoscopy and retrograde pyelography. One individual (7.6%) had a significant abnormality (bladder tumor) detected during cystoscopy. Retrograde pyelography demonstrated no clinically significant abnormalities in this patient group. Eighteen patients had sterile pyuria and underwent similar endoscopic evaluation. Cystoscopic examination was normal in all these individuals, and retrograde pyelography showed either normal or clinically insignificant papillary necrosis. CONCLUSIONS: Although renal US has a low diagnostic yield, all adult transplant candidates should undergo this study because of the high prevalence of renal cell carcinoma in this cohort. VCUG also should be performed prior to transplantation, but it may be omitted in nondiabetic patients without voiding symptoms or a history of urinary tract infection. Transplant candidates with hematuria warrant an endoscopic evaluation, although this may not be necessary in individuals with sterile pyuria.

Adult↗
PubMed1992

Prophylactic ciprofloxacin for catheter-associated urinary-tract infection.

Patients receiving antibiotics during bladder drainage have a lower incidence of urinary-tract infections compared with similar patients not on antibiotics. However, antibiotic prophylaxis in patients with a urinary catheter is opposed because of the fear of inducing resistant bacterial strains. We have done a double-blind, placebo-controlled trial of prophylactic ciprofloxacin in selected groups of surgical patients who had postoperative bladder drainage scheduled to last for 3 to 14 days. Patients were randomly assigned to receive placebo (n = 61), 250 mg ciprofloxacin per day (n = 59), or 500 mg ciprofloxacin twice daily (n = 64) from postoperative day 2 until catheter removal. 75% of placebo patients were bacteriuric at catheter removal compared with 16% of ciprofloxacin-treated patients (relative risk [RR] [95% CI] 4.7 [3.0-7.4]). The prevalence of pyuria among placebo patients increased from 11% to 42% while the catheter was in place; by contrast, the rate of pyuria was 11% or less in patients receiving ciprofloxacin (RR 4.0 [2.1-7.3]). 20% of placebo patients had symptomatic urinary-tract infections, including 3 with septicaemia, compared with 5% of the ciprofloxacin groups (RR 4.0 [1.6-10.2]). Bacteria isolated from urines of placebo patients at catheter removal were mostly species of enterobacteriaceae (37%), staphylococci (26%), and Enterococcus faecalis (20%), whereas species isolated from urines of ciprofloxacin patients were virtually all gram-positive. Ciprofloxacin-resistant mutants of normally sensitive gram-negative bacteria were not observed. Ciprofloxacin prophylaxis is effective and safe in the prevention of catheter-associated urinary tract infection and related morbidity in selected groups of patients requiring 3 to 14 days of bladder drainage.

Adult↗
PubMed1990

Screening asymptomatic adolescent males for chlamydia.

Ninety-seven asymptomatic 16-21-year-old sexually active adolescent males were evaluated for gonorrhea and chlamydia by culture, chlamydia enzyme immunoassay, and an analysis of a random urine sample for pyuria using centrifuged urine and urine cytometer. The incidence of gonorrhea was 5.3% and chlamydia by culture 12.3%. Immunoassay was superior in sensitivity and specificity (75% and 99%, respectively) to centrifuged urine (sensitivity 58%, specificity 92%) or urine cytometer (58% and 91%) in identifying asymptomatic chlamydia urethritis. Chlamydia enzyme immunoassay is an acceptable, more rapid, and less expensive alternative to culture. The absence of pyuria in asymptomatic males cannot be assumed to indicate the absence of a sexually transmitted disease.

Adolescent↗
PubMedDate not supplied

Absence of factors associated with significant urinary tract infections caused by coagulase-negative staphylococci.

Coagulase-negative staphylococci, excluding Staphylococcus saprophyticus, have recently been implicated as pathogens in urinary tract infections, especially in catheterized patients. In order to evaluate any laboratory markers for significant isolates of coagulase-negative staphylococci, we prospectively studied 72 patients with significant, indeterminant, or contaminant urine isolates of coagulase-negative staphylococci. Patients in the three categories did not differ by age, sex, presence of a urinary catheter, or other instrumentation or likelihood of nosocomial acquisition. The isolates from these three groups of patients were similar in antibiotic susceptibility and ability to produce slime. Overall, slime-producing coagulase-negative staphylococci were more likely to be S. epidermidis than any other species, but slime production was not associated with presence of pyuria, symptomatic urinary tract infection, instrumentation, nosocomial acquisition, or multiple antibiotic resistance. In this prospective study, no demographic characteristics or laboratory markers of coagulase-negative staphylococci were associated with clinical significance, as defined by symptoms or the presence of pyuria.

Bacteriuria↗
PubMed1981

The role of anaerobic bacteria in the pathogenesis of urinary tract infections.

Because of the rarity of anaerobic infections of the urinary tract and the difficulty of establishing these organisms as pathogens, anaerobic culture is not included as part of routine urine bacteriological examination. Pyuria was found during examination of a 41-year-old man with a chronic renal allograft rejection reaction. Aerobic urine cultures failed to yield any pathogens. Urine cytology demonstrated intracellular organisms that proved to be Fusobacterium nucleatum on anaerobic culture. The serotypically identical organism was isolated from a needle biopsy specimen of the renal allograft. In the presence of pyuria the finding of micro-organisms in the urine sediment that fail to grow on routine aerobic cultures should lead to examination for anaerobic bacterial infection of the urinary tract.

Adult↗
PubMed1990

Detection of endotoxiuria in polycystic kidney disease patients by the use of the Limulus amebocyte lysate assay.

Urinary tract infections (UTI) due to gram-negative bacteria are a serious complication in patients with polycystic kidney disease (PKD). Endotoxin, a component of the cell wall of gram-negative bacteria, has been reported to be pro-cystogenic in experimental animals. Because endotoxin levels in urines (endotoxiuria) from PKD patients have not been reported, the Limulus amebocyte lysate (LAL) assay, which detects picogram quantities of endotoxin, was used to probe for this cyst-promoting chemical. Fifteen PKD patients (seven females, eight males), asymptomatic for UTI, were tested and compared with 10 female and 10 male controls. All urines were assessed for (1) evidence of aerobic bacteria by routine quantitative cultures, (2) bacteria and pyuria by microscopic examination of gram-stained urine, and (3) bacterial endotoxin by the LAL assay. LAL tests were positive in 73% (11/15) of PKD patients, but only 25% (5/20) of controls (P = 0.0058). There was no significant difference in test positivity between PKD females (71%) and males (75%). There was no correlation of age, degree of renal dysfunction, or urine osmolality with endotoxiuria. Routine quantitative cultures were negative for gram-negative bacteria in PKD patients and all controls (except one female), as were microscopic findings for intact bacteria and pyuria. Thus endotoxiuria, in the absence of classical signs, symptoms, and microbiological findings of UTI, raises the possibility that endotoxin is available intrarenally to promote cystogenesis even before a potential susceptibility of PKD patients to classical UTI is manifested. Sources of urinary endotoxin observed in PKD patients, such as cryptic intrarenal sites or leakage from the gastrointestinal (GI) tract, remain to be defined.

Adult↗
PubMed1990

Ureteric catheterization in the diagnosis of pyelonephritis--an experimental evaluation.

Experimental models of renal infections have been used to determine the accuracy with which the cellular and microbiologic components of ureteric and voided urine reflected the pathologic status of the kidney in pyelonephritis. In acute pyelonephritis, the composition of the ureteric urine reflected the pathologic status of the kidney, although in a few cases ureteric samples were either sterile or cell free. Animals with chronic pyelonephritis in which the lesions were either infected or sterile commonly had sterile ureteric urine. Pyuria, however, was demonstrable in both these situations. In subclinical pyelonephritis, ureteric samples from infected kidneys were variably culture positive, although pyuria was a common observation. Discriminate function analysis based on actual renal status and ureteric data gave an overall correct classification rate of 67% and demonstrated at least 80% agreement in four of the five classification groups.

Animals↗
PubMed1994

Laboratory evaluation of urinary tract infections in an ambulatory clinic.

A 4-month evaluation of ambulatory patients with a suspicion of a urinary tract infection was performed. Specific objectives included assessment of five urinary screening methods, reevaluation of the necessity of the phenylethyl alcohol plate (PEA), and cost-effectiveness of screening for low colony count bacteriuria. Urine samples were collected as midstream, clean-caught specimens. A total of 142 samples, 87 from 79 symptomatic patients and 55 negative controls, were evaluated. All urine specimens were cultured using a 0.01 mL loop and a 0.001 mL loop onto Columbia sheep blood agar, MacConkey agar, and PEA agar. Twenty-four specimens (17%) were sterile, 64 (45%) were contaminated, and 54 (38%) were infected. Five urine screening methods were performed. These tests and their associated sensitivity and specificity are as follows. The Chemstrip 9 (Behring, Inc., Somerville, NJ) for leukocyte esterase and nitrate, 67%, 98%; microscopic analysis on spun urine, 79%, 93%; methylene blue stain for pyuria, 60%, 99%; Gram stain for pyuria, 45%, 93%; Gram stain for bacteriuria, 65%, 75%; and the URISCREEN (Analytab Products, Plainview, NY), 92%, 89%. Inclusion of a PEA plate for isolation of gram-positive organisms provided no additional information. Routine culture of urine samples at 10(-2) mL increased the contamination rate by 19%.

Ambulatory Care↗
PubMedDate not supplied

Asymptomatic Chlamydia trachomatis urethritis in men.

Ten men with asymptomatic urethritis due to Chlamydia trachomatis were identified through culture screening and were treated with ceftriaxone (1 g given intramuscularly). Seven of the eight men who were followed for at least 21 days before and after therapy remained asymptomatic but culture-positive. One originally asymptomatic man had onset of symptomatic non-gonococcal urethritis 18 days after his first positive culture. Among asymptomatic men with positive cultures, pyuria was present in urine specimens obtained at 17 of 18 visits, while the leukocyte count on the urethral gram stain was above normal at ten of 29 visits (P less than .01). Therefore, one may conclude that ceftriaxone (1 g given intramuscularly) was ineffective therapy for chlamydial urethritis; male urethral infection with C. trachomatis can remain asymptomatic for 21-45 days; and in this population pyuria detected by urinalysis correlates better with infection than does a urethral gram stain.

Ceftriaxone↗
PubMed1986

Urinary tract and renal findings in acute Yersinia infections.

We studied 71 patients with acute Yersinia infection for the occurrence of pathologic urinary and renal findings. Transient proteinuria and/or microhematuria was found in 17 patients (24%) and slightly elevated serum creatinine in seven patients (10%). Renal biopsy was done in two patients and revealed mild mesangial glomerulonephritis in both cases. One of these patients had IgA glomerulonephritis and Reiter's syndrome. Pyuria occurred in 16 patients (23%) and was frequently associated with Reiter's syndrome. Seventy-three patients with acute intrinsic renal failure were studied for the occurrence of acute Yersinia infection by determining Yersinia antibodies by ELISA. One out of 13 patients with acute glomerulonephritis but none of 60 patients with acute tubulointerstitial renal disease had acute Yersinia infection. Acute Yersinia infection seems to be rarely an etiologic factor in acute intrinsic renal failure. Our results indicate that transient proteinuria, microhematuria, pyuria or impaired renal function are frequent findings in patients with acute Yersinia infections. However, glomerulonephritis seems to be a rather infrequent and mild complication of acute Yersinia infection.

Acute Disease↗
PubMed1990

Bacteriological state of the urine in symptom-free adult males.

Mid-stream urine specimens from 120 symptom-free males aged between 15 and 60 years were examined for cells and bacteria. Only 3 specimens showed pyuria, all of which yielded fastidious organisms. No specimen yielded a pure growth of an aerobe. Fastidious organisms in pure or mixed growth were isolated from 26% of the specimens, none in a count greater than 10(8)/l and the majority in counts less than 10(7)/l. It was concluded that pure growths of aerobes in any count in patients with symptoms are indicative of infection. Fastidious organisms should be sought in the urine of patients with symptoms or pyuria before more intensive and expensive investigations are pursued.

Adolescent↗
PubMed1982

Effects of ten milligrams of ampicillin per day on urinary tract infections.

A total of 20 patients with symptomatic urinary tract infections (greater than 10(5) colony-forming units of Escherichia coli per ml of urine in addition to pyuria) received 10 mg of ampicillin and 2 liters of fluid daily for 3 days. After 2 days, 16 patients had culture-negative urine without pyuria. A total of 18 similar patients received only 2 liters of fluid for 3 days. On day 4, all had greater than 10(5) colony-forming units of E. coli per ml of urine and greater than 10(4) leukocytes per mm3 of urine.

Adolescent↗
PubMed1984

Single-dose amoxicillin therapy of acute uncomplicated urinary tract infections in women.

Of 210 women who were experiencing dysuria, frequent urination, pyuria, and significant bacteriuria and who were treated with a single 3-g dose of amoxicillin, 165 (79%) were cured of their original infections. Patients with infections that were negative by antibody-coated-bacteria assay were cured at a significantly higher rate than those with infections that were positive by antibody-coated-bacteria assay (90 versus 59%; P less than 0.001). Similarly, those with infections caused by amoxicillin-susceptible organisms were cured at a significantly higher rate than those with infections caused by resistant organisms (85 versus 50%; P less than 0.001). Of 27 patients who had infections caused by amoxicillin-susceptible organisms and who had relapses after single-dose therapy, 14 (52%) had relapses again after a conventional 10-day course of therapy, although all responded to a 6-week course. An additional 27 patients experiencing dysuria, frequent urination, and pyuria but who had a lower number of uropathogens in the urine (10(2) to 10(4.5)/ml of urine) were treated with single-dose therapy, with a 100% eradication of organisms and an 89% rate of symptomatic relief.

Acute Disease↗
PubMed1993

Steroid-responsive renal insufficiency due to idiopathic granulomatous tubulointerstitial nephritis.

A 26-year-old male was admitted to our hospital having suffered from subfever, sterile pyuria and renal insufficiency for 1 year. There had been no apparent hematuria/proteinuria, and evidence of infection, allergy or intoxication was not demonstrated. Open renal biopsy revealed severe tubulointerstitial changes with granuloma accompanied by neither caseous necrosis nor giant cells. Infiltrating cells mostly consisted of CD4 and CD8 T cells, and some proximal tubular cells presented MHC class II antigen. Following the negative culture of biopsied specimen for acid-fast bacilli, diagnosis of idiopathic granulomatous tubulointerstitial nephritis was made, and steroid therapy was started. Two months later, pyuria disappeared and renal function improved significantly, proving the effectiveness of steroid on idiopathic granulomatous tubulointerstitial nephritis.

Adult↗
PubMed1980

Renal parenchymal malakoplakia presenting as acute oliguric renal failure.

A 47-year-old chronic alcoholic white male with previously normal renal function and no prior history of urinary tract infection developed the sudden onset of fever, bilateral flank pain, oliguria, and deterioration of renal function. Subsequent workup revealed massive pyuria, bilaterally enlarged kidney, and positive urine and blood cultures for E. coli. In spite of successful treatment with appropriate antibiotics and gradual improvement of the patient's clinical status, pyuria and renal failure persisted, necessitating institution of hemodialysis. 8 weeks after admission a renal biopsy revealed renal parenchymal malakoplakia.

Acute Kidney Injury↗
PubMed1992

Quantitation of urinary Tamm-Horsfall protein in children with urinary tract infection.

It has been suggested that urinary Tamm-Horsfall protein (THP) prevents colonization of the urinary tract by binding uropathogens. We tested the hypothesis that low urinary THP levels may predispose to urinary tract infection (UTI) by measuring THP levels in children. We studied a cohort of 35 girls with uncomplicated recurrent UTI (group 1) that was compared with 27 patients with myelomeningoceles undergoing clean intermittent catheterization (group 2) and 16 female controls (group 3). We measured urinary THP in both aggregated (aTHP) and disaggregated form (dTHP), leukocyte esterase activity, urine chemistries and culture. No significant differences in dTHP or aTHP levels were seen between groups 1 and 3, but group-1 patients had higher dTHP levels than group-2 patients (p < 0.008). History of reflux or the presence of bacteriuria or pyuria at the time of urine collection did not affect dTHP levels; in contrast, pyuria or bacteriuria at the time of sampling was associated with markedly lower aTHP levels when compared with sterile samples (p < 0.0001). For all groups, measured quantities of dTHP did not correlate with aTHP levels. We conclude that excretion of dTHP in children with history of recurrent UTI is not reduced. In contrast, concentrations of aTHP are profoundly depressed in children during times of UTI, suggesting a role for THP in the pathogenesis of UTI. Assaying THP in its aggregated form may prove valuable when studying its physiologic function and merits further investigation.

Bacteriuria↗
PubMed1992

Metallothionein of prostatic tissues and fluids in rats and humans.

We analyzed metallothionein (MT) in rat prostates by gel filtration and radioimmunoassay. The concentration of MT in the prostate, kidney and liver of cadmium-induced rats was measured. The concentration of MT was also measured in normal prostate, benign prostatic hyperplasia, prostate cancer and the prostatic fluids from various prostatic diseases in humans. MT was detected in rat prostates by gel filtration and radioimmunoassay. The concentration of MT (micrograms/g wet tissue) was 0.3 +/- 0.1 (S.D.) in the ventral lobe, 30.4 +/- 24.0 in the lateral lobe, 5.2 +/- 0.9 in the dorsal lobe, 25.0 +/- 6.4 in the kidney and 2.0 +/- 1.5 in the liver of the rat control group. Change in MT content in CdCl2-induced organs increased quantitatively with the dose administered. The concentration of MT (micrograms/g wet tissue) in human prostate was 99.3 +/- 121.8 in the peripheral zone (PZ), 12.0 +/- 8.5 in the preprostatic region (PR), 7.3 +/- 3.1 in the central zone (CZ), 17.5 +/- 15.0 in benign hyperplastic nodules (A) and 4.2 +/- 0.5 in cancer tissue (CA). MT concentration in PZ was very high and that of CA, low (p less than 0.05). MT concentration in prostatic fluids (ng/mg protein) was 11.5 +/- 5.7 in normal patients, 3.8 +/- 2.3 in acute prostatitis, 6.5 +/- 3.7 in chronic prostatitis with pyuria, 39.6 +/- 3.9 in chronic prostatitis without pyuria and 16.9 +/- 3.0 in benign prostatic hyperplasia. We concluded that MT in the prostate is induced by heavy metals and secreted into prostatic fluid. Possibly, it is a marker of secretory function in the prostate.

Animals↗
PubMed1987

Open randomised comparison of ofloxacin and norfloxacin in the treatment of complicated urinary tract infections.

The efficacies of ofloxacin and norfloxacin in the treatment of chronic complicated urinary tract infections were compared. 30 adult outpatients suffering from underlying urinary tract disease, with pyuria of 10 or more WBC/hpf and bacteriuria of 10(4) or more viable organisms per millilitre, were randomly assigned to receive ofloxacin 200mg once daily or norfloxacin 400mg twice daily for 10 days. After treatment pyuria was cleared in 9 cases and decreased or unchanged in 6 cases in the ofloxacin group. The corresponding numbers were 10 and 5 in the norfloxacin group. Bacteriuria was eliminated in 12 patients, unchanged in 1 and replaced in 2 in the ofloxacin group. In the norfloxacin group bacteriuria was eliminated in 8 cases, unchanged in 1, decreased in 1 and replaced in 5. The overall effectiveness rate was 14 of 15 in the ofloxacin group and 12 of 15 in the norfloxacin group. Ofloxacin 200mg once daily was as effective as norfloxacin 400mg twice daily in this open study.

Adult↗