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PubMed1999

The conservative management of corynebacterium group D2 encrusted pyelitis.

OBJECTIVE: To evaluate the conservative management of encrusted pyelitis (EP), an infectious disease caused by urea-splitting micro-organisms (Corynebacterium group D2 being the most common), and characterized by stone encrustation of the collecting system. PATIENTS AND METHODS: Four patients (aged 17-62 years) with EP caused by Corynebacterium group D2 were treated conservatively with intravenous vancomycin and percutaneous acidification of the renal collecting system. Percutaneous nephrostomy tubes were placed to allow irrigation with Thomas' acid solution, the outflow being ensured by ureteric catheters. Patients were monitored and the results of and tolerance to treatment evaluated clinically, by biological assays, and by imaging techniques (ultrasonography, computed tomography and pyelography). RESULTS: No kidneys were lost and in all patients with initial renal failure, creatinine levels recovered to previous values. The adverse effects were moderate, consisting of flank pain or discomfort, and low-grade fever. Three patients developed asymptomatic fungal urinary tract infections requiring antifungal agents. The encrustations were treated effectively and almost disappeared in two patients, while the other two had no residual calcification. One transplanted-kidney recipient developed a ureteric stricture requiring surgical repair. Within a mean follow-up of 16 months, there was no recurrence of EP and the residual encrustation remained small. CONCLUSION: The conservative treatment of EP can avoid surgery in many cases, although there are some adverse effects of irrigation. The long-term follow-up and prevention of recurrent EP are nevertheless required.

Adolescent↗
PubMed1982

[Echographic investigation of the calyceal system in cases of pyelitis gravidarum].

Dilatation of the upper urinary tract can be found even in pregnancies of healthy women. The frequency of dilatations in patients with pyelitis gravidarum is higher. Comparing the symptoms -- costovertebral tenderness and significant bacteriuria -- with the nephrosonograms it can be demonstrated that urinary tract infections incline to reoccur in patients with dilated upper urinary tract despite adequate antibiotic therapy. Echographic examination of the calyceal system during pregnancy might therefore be useful in detecting risk patients who have to undergo intense urologic surveillance.

Adolescent↗
PubMed1993

Encrusted pyelitis and cystitis by Corynebacterium urealyticum (CDC group D2): a new and threatening complication following renal transplant.

We evaluated the pathogenic role of Corynebacterium urealyticum in the development of encrusted pyelitis (EP) and encrusted cystitis (EC), and their clinical consequences in renal transplant recipients. During a 4-year period, we studied seven renal transplant recipients with EP and two with EC. The records of 320 other renal transplant patients studied during the same period were used as a control group. C urealyticum (> or = 10(5) CFU/ml) was isolated from 4 patients with EP (urine 3, blood 1) and from 1 patient with EC (urine). Alkaline urines with struvite crystals, microscopic hematuria, and sterile conventional urine cultures were present in all our cases. All the patients with EP developed obstructive uropathy with deterioration of the renal function and pyelonephritis (4 patients) or renal abscesses (3 patients). Chronic urinary discomfort and macroscopic hematuria were present in the 2 patients with EC. Long-term vesical and ureteral catheterization were considered the most important risk factors for the development of EC and EP, respectively. Vancomycin was successfully used in 5 cases, but all the patients required a derivative procedure or a surgical resection of the incrustations to improve. We conclude that EP and EC should be investigated in renal transplant patients who develop pyelonephritis, obstructive uropathy, or chronic urinary symptoms. EP and EC could lead to the loss of their grafts. C urealyticum appears to have a pathogenic role in these entities.

Adult↗
PubMed1996

Emphysematous cystitis and pyelitis in a diabetic renal transplant recipient.

Emphysematous cystitis is a rare complication of urinary tract infection. Patients with diabetes mellitus, neurogenic bladder, bladder outlet obstruction, and recurrent urinary tract infection are at increased risk for the disease. We present a case of emphysematous cystitis and pyelitis in a diabetic renal transplant recipient. He was treated with antibiotics alone with complete clinical and radiologic resolution. The clinical course was benign, as described in most patients. The prognosis of emphysematous cystitis is good after early diagnosis and prompt treatment with appropriate antibiotics, blood glucose control, and adequate urinary drainage.

Cystitis↗
PubMed2001

Emphysematous pyelitis: findings in five patients.

Emphysematous pyelitis (EP) is a benign entity. To our knowledge, it has not been reported frequently in the radiology literature. Previous articles have not focused on EP but rather have included other gas-forming entities (eg, emphysematous pyelonephritis [EPN]). The authors describe imaging findings in EP and distinguish them from findings in EPN in five cases. Computed tomography is the current method for demonstrating isolated gas production inside the urinary collecting system. The prognosis is excellent, with rapid complete recovery after medical treatment.

Aged↗
PubMed2001

Encrusted cystitis and pyelitis.

Encrusted cystitis (EC) and encrusted pyelitis (EP) are rare chronic inflammatory diseases of the bladder and renal pelvis, respectively, and are characterized by mucosal inflammation with deposits of ammonium magnesium phosphate on the urothelium. Corynebacterium urealyticum is the pathogen responsible in the vast majority of cases. We report 4 cases of EC and 1 case of EP. In 1 case of EC Ureaplasma urealyticum was isolated as the microorganism responsible. To the best of our knowledge, U. urealyticum-induced EC has never been reported previously.

Adult↗
PubMed1994

Exploration and endoscopic treatment of unilateral primary haematuria: is non-specific diffuse pyelitis a real entity?

Chronic unilateral primary haematuria is rare and raises difficult problems of diagnosis and treatment as most of the knowledge in this field has been based on a very limited number of patients. This clinical entity needs critical reevaluation as recent progress in endourological investigations has revealed that lesions other than the classical submucosal haemangioma are just as frequently responsible for unilateral primary haematuria. These endoscopic lesions have generally been poorly defined up to now and our data based on a retrospective review of 8 patients emphasises the persistent gaps in our understanding of the pathophysiology of this disease. Among the lesions responsible for unilateral primary haematuria, diffuse petachiae of the renal pelvis and cavities represent the most frequent endoscopic lesion described in our experience (50% of cases). Histologically, these diffuse lesions correspond to non-specific pyelitis, consisting of simple oedema of the lamina propria. In addition to its diagnostic role, endoscopy can also be used to effectively treat the lesions responsible for unilateral primary haematuria, using either electrocoagulation or nitrate cautery, provided a retrograde approach can be completed by a percutaneous approach, with an overall success rate of 75% of cases with a mean follow-up of 16 months.

Electrocoagulation↗
PubMedDate not supplied

Alkaline encrusted pyelitis.

Alkaline encrusted pyelitis is an infectious disease characterised by encrustations in the wall of the upper urinary tract, surrounded by severe inflammation. Destruction of native kidneys and kidney grafts may occur, resulting in end stage renal failure. Corynebacterium group D2, an urea splitting microorganism, is nearly exclusively associated with this disease. The most important predisposing factors are previous urological procedures and an immunosuppressed state. In a suggestive clinical context, diagnosis should be made with unenhanced computed tomography findings and bacteriologic isolation of the responsible microorganism. The treatment is threefold: appropriate antibiotic therapy, by preference with glycopeptides, acidification of urine and chemolysis, and if needed, surgical removal of encrustations. We report the case of a patient who was diagnosed with this rare condition and could escape maintenance dialysis after correct diagnosis was made and conservative treatment was started using antibiotics and combined oral and local acidification.

Aged↗
PubMed1997

Pyelitis cystica.

We present four cases of pyelitis cystica. Aetiology, pathogenesis, diagnoses, treatment and differential diagnosis are discussed. We recommend follow-up until malignant disease has been excluded.

Adult↗
PubMed1975

Frequency of pyelitis, pyelonephritis, renal perivasculitis, and renal infarction in dogs.

The frequency of pyelitis, renal perivasculitis, and renal cortical inflammation was determined in 104 apparently normal dogs, 50 dogs with disease that were necropsied, and 20 dogs with experimentally induced cystitis. Abnormalities occurred least often (19%) in the apparently normal group and most often (55%) in the cystitis group. The frequency of specific lesions was generally higher in males than in females. Bacteria were isolated from kidney and urine of some of the apparently normal dogs, but their relationship to the lesions observed was not established.

Animals↗
PubMedDate not supplied

[Encrusted pyelitis in patients with urinary diversion].

OBJECTIVE: This is a case of Encrusted Pyelitis (EP) caused by Corynebacterium urealyticum (CU) in a patient who had undergone a cystectomy and Bricker type urinary diversion 28 months beforehand. METHODS/RESULTS: After the immediate post-operative period no urinary catheterisation or any other urological procedure was performed on the patient. Before surgery, the patient presented non functional of the right kidney, secondary to a lithiasic obstructive uropathy. Clinical symptoms were deteriorated renal function, anuria, haematuria, pyrexia and left lumbar pain. It was suspected that the patient had this pathology and this was fundamental in diagnosis. Helicoid CT was the principal method used to show calcification plaques on the wall of the left renal pelvis, and selective culture of CU confirmed the diagnosis. Early commencement of treatment with vancomycin at an initial dosage of 500 mg/12 hours, and subsequent adjustment of dosage according to blood drug levels, achieved negative urine culture within a fortnight. Oral acidification was effected using acetohidroxamic acid 125 mg/12 hours, and it was continued until CT confirmed the disappearance or considerable reduction of the pyelic calcification plaques. CONCLUSION: The presence of EP in patients with urinary diversion is a matter worthy of consideration, even in patients who have not undergone recent urological procedures. Awareness of risk factors and early commencement of effective treatment may improve the prognosis of these patients.

Aged↗
PubMedDate not supplied

Cytology of pyelitis glandularis cystica. A case report.

Cytologic findings that occur in association with proliferative lesions involving von Brunn's nests in the urinary tract are rare. Such lesions are probably far more common than recognized and are probably considered in the clinicoradiologic differential diagnosis when space-occupying lesions are found, particularly in the upper urinary tract. Reported here are the cytologic findings in a case of pyelitis glandularis cystica that presented as a renal pelvic lesion.

Cysts↗
PubMed1980

[Pathogenetic significance of the passage of microorganisms into the upper urinary tract in female patients with recurring, nonobstructive urinary tract infections. II. Pyelitis].

With the help of three arguments which come from the data analysis of a special consulting hour is demonstrated the ascents of germs into the prevesical urinary tracts in female patients with relapsing, non-obstructive urinary infections not in the least in every case lead to a recognizable lesion of the kidney. The thesis is erected that the generally tabooed pyelitis by all means corresponds to a clinical reality. This thesis is discussed in the light of findings from animal experiments and clinical findings from literature.

Adolescent↗
PubMed1994

Co-existent renal replacement lipomatosis and pyelitis glandularis.

A 50 year old female was found to have a lump on the right side of abdomen with discharging wound on the same side and was ultrasonographically diagnosed as renal cell carcinoma. On histopathology, it showed replacement of the kidney by mature adipose tissue renal replacement lipomatosis, along with pyelitis glandularis which is a rare condition.

Female↗
PubMed1955

Pyelitis glandularis.

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Carcinoma, Squamous Cell↗