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We present an exceptional case of testicular seminoma metastasis in intraluminal ureter, manifested by obstruction of the lumen with pyonephrosis. We review the literature and only two previous cases are recorded.
A 2-month-old infant died of xanthogranulomatous pyelonephritis. Preoperatively pyonephrosis was suspected, because the child presented with a number of inflammatory, septic symptoms. Nephrectomy was performed and histopathology showed the kidney to be affected by xanthogranulomatous pyelonephritis. Postoperatively the child developed persistent attacks of fever and bronchopneumonia that led to his death with signs of pulmonary insufficiency.
A case of xanthogranulomatous pyelonephritis (Stage-I: Nephric) with ureteral involvement is described. The patient had undergone right nephrectomy with the working diagnosis of calculus pyonephrosis and non-functioning kidney. Histopathological examination of the nephrectomy specimen revealed xanthogranulomatous pyelonephritis confined to the kidney and non-contiguous involvement of ureter. Post-operative recovery was uneventful and there had been no evidence of disease recurrence till one year's follow-up.
This is the case of a 35-year old woman who suffers from a chronic form of spinal muscular atrophy and who has successfully completed four pregnancies between 1982 and 1987. After a short discussion of etiology, pathology, heredity and the differential diagnosis we describe the obstetric problems of our patient. The pregnancies were mainly aggravated by recurrent cystitis. In all the four deliveries the patient had to undergo cesarean section followed by severe lung problems. After the third pregnancy the patient had a nephrectomy cause of a pyonephrosis. We could not see an aggravation of the disease at it is described in some cases of Charcot-Marie-Tooth disease or polyneuritis. Three of the four children showed a striking muscular hypotonia post partum that disappeared soon after the neonatal period.
Nephro-intestinal fistulas involve the GI tract and the kidney or pyelocalyceal system. The main causes may be urologic or digestive, the site diverse. Reno-colic fistulas, although rare, are more frequently observed. We describe a case of left reno-colic fistula secondary to lithiasic pyonephrosis that presented as sepsis. Diagnosis was confirmed by retrograde pyelography. Treatment was by surgery (left nephrectomy, closure of the fistula, and colonorhaphy).
Based on 8 personal cases, pseudo-tumoral xanthogranulomatous pyelonephritis is reviewed with emphasis on diagnosis. The condition is a particular form of chronic renal suppuration of histologic definition (combined lesions of chronic pyelonephritis and xanthogranulomatous foam cells). Two forms are recognized: one diffuse, fairly frequent form corresponding to a pyonephrosis, and a pseudo tumoral focal form, the only type discussed in this report, which raises the problem of diagnosis of a renal mass that requires the application of all currently available exploration means to define its true nature. Intravenous urography, ultrasound and CT scan imaging show a non-specific mass of variable character. Selective renal arteriography sometimes shows inflammatory type vascularization, a valuable aid but again non-specific. Puncture biopsy has been used by few authors. However, the presence of a renal mass associated with a chronic pyelonephritis, lithiasis and recurrent episodes of urinary infection should suggest the diagnosis and make use of imaging techniques to detect the affection and adapt therapy, major oncologic surgery being of no utility. Perhaps NMR imaging will provide a step forward in tissue characterization, but it is too early to say.
A case of primary adenocarcinoma of the ureter, associated with severe hypocalcemia in a 73-year-old man is reported. The patient had undergone left nephrectomy for pyonephrosis due to a ureteral stone, 29 years previously. On November 4, 1986, he visited the hospital with dysuria and overflow incontinence as the chief complaints. He was admitted with suspicion of prostatic carcinoma, but prostatic stones and chronic prostatitis were proven. However, urine cytology showed adenocarcinoma cells, and a ureteral tumor was found at the right ureterovesical junction. On December 10, right partial ureterectomy, total cystectomy and right ureterocutaneostomy were performed. Moderately differentiated, invasive adenocarcinoma was found at the right ureteral end, 1.5 cm in length and in part poorly differentiated transitional cell carcinoma was present continuously to the adenocarcinoma. Hypocalcemia was cured easily with activated vitamin D3. The patient, 9 months after the operation, is apparently free of the ureteral tumor.
On the basis of 6 cases of pyonephrosis due to renal stones successfully treated without surgery over a period of one year, the authors define their current therapeutic approach which consists of 2 phases: --1st phase: salvage of the kidney by ultrasound guided percutaneous nephrostomy under local anaesthesia. No hasty endoscopic procedures in an attempt to insert a ureteric catheter into the kidney; --2nd phase: elimination of the obstructing stone (on average, 8 days after the 1st phase), by percutaneous nephrolithotomy, descending ureteroscopy or ascending ureteroscopy.
Enzyme levels of lactate dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (HBDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured in the cytosol of renal cortex samples from either normal and pathologic kidney tissue. The mean enzyme activity values, expressed in Units per gram of cytosolic protein decreased in the following order: normal cortex (LDH = 4,299 +/- 654; AST = 522 +/- 101; ALT = 197 +/- 44). chronic pyelonephritis (LDH = 2,360 +/- 876; AST = 297 +/- 117; ALT = 90 +/- 48), hydronephrosis (LDH = 2,208 +/- 1,264; AST = 279 +/- 165; ALT = 82 +/- 61), pyonephrosis (LDH = 1,410 +/- 596; AST = 158 +/- 69; ALT = 23.4 +/- 16.4) and renal tuberculosis (LDH = 1,149 +/- 481; AST = 93 +/- 34; ALT = 5.6 +/- 2.8). The decrease in the enzyme activities paralleled tissue damage and it was shown to affect cellular functionality in relation with energy and amino acid metabolism.
Gamma-Glutamyltransferase activity was studied in a man presenting with recurrent septicemia owing to pyonephrosis and renal carcinoma. Increased activity in the urine was ascribable to administration of the aminoglycoside antibiotic, tobramycin. That the renal carcinoma did not contribute to the increased values was confirmed by homogenization and enzyme histochemistry of the tumor. Although the activity of this enzyme in serum was greater than normal, this persisted postoperatively, and thus was not related to the renal carcinoma.
A 66-year-old female with bilateral ureteral tumors associated with chronic renal failure is presented. She received pan-hysterectomy due to uterine cancer in 1957. She was first referred to our clinic to make internal shunt under a diagnosis of chronic renal failure. In 1979, the diagnosis of neurogenic bladder and bilateral vesicoureteral reflux (rt; grade 3, lt; grade 1) was made. She was admitted to our clinic with complaints of macroscopic hematuria and a temperature of 39 degrees C on April 28, 1983. Cystoscopically, pyuria from the right ureteral orifice was found. Right retrograde pyelography revealed severe dilatation of the right ureter and renal pelvis with some filling defects. For drainage of pus retaining in the right renal pelvis, right percutaneous nephrostomy was made under the guidance of ultrasonography. After her general condition improved, right nephroureterectomy was performed under the diagnosis of right pyonephrosis on June 8, 1983. Right pyelonephritis and right ureteral tumor, grade 3, were pathologically demonstrated. After the operation, an invasive bladder tumor was detected on cystoscopy and ultrasonography, subsequently a total of 3,900 rad irradiation was given to the bladder tumor. She died of pulmonary edema 7 months later. Autopsy demonstrated a transitional carcinoma, grade 3, of the left ureter. Bilateral urothelial tumors of the upper urinary tract is rare, and to our knowledge only 29 cases have been reported in Japan.
In addition to plain films and conventional excretory urography, ultrasound, computed tomography, and radionuclide scanning may contribute to the assessment of a wide spectrum of renal inflammatory diseases. This article discusses the role of contemporary imaging modalities in the diagnosis and management of patients with renal inflammatory lesions, including acute focal and diffuse bacterial infections, intra- and extrarenal abscess collections, pyonephrosis, xanthogranulomatous pyelonephritis, fungal infection, tuberculosis, and malakoplakia of the upper urinary tract.
A decade (1973-83) of surgical experience in the management of the diseases of horseshoe kidney is presented. Calculus disease was the major pathological entity (80%) followed by ureteropelvic junction obstruction, nephrocarcinoma and polycystic disease, respectively. Three patients with calculi had, in addition, pyonephrosis and squamous cell carcinoma. Aortography offers maximum information about abnormal vasculature and other anatomical details in proper planning of surgical intervention. It is felt that a symphysiotomy and nephropexy may be considered when the horseshoe kidneys are being operated for calculus disease.
The causative agent in nonobstructive pyelonephritis has been shown most often to be P-fimbriated Escherichia coli, mainly because receptors for these fimbriae are found in the bladder, ureter, and the kidney tubules. Age and sex are factors leading to differences in the presentation of the disease, and early diagnosis followed by intensive therapy lessens the chance of renal damage. Renal abscess, perinephric abscess, and pyonephrosis all follow pyelonephritis in the host who is compromised by the presence of stone, obstruction, diabetes, or immunosuppression.
Analgesic nephropathy, its morphology, development and pathogenesis are described. The earliest analgesic-caused lesion is capillary sclerosis of the urinary tract mucosa. Later focal necroses can be found in the papillae surrounding the collecting ducts. Foci of necrosis progress and become confluent, resulting in complete papillary necrosis. Later renal cortical lesions develop due to retained areas of papillary necrosis. The cortical changes include chronic interstitial nephritis with cortical atrophy in the suprapapillary region as well as hypertrophy of the columnae Bertini with segmental, focal glomerulosclerosis. The analgesic-related lesions are the result of toxic damage to endothelial, tubular and interstitial cells. Analgesic-induced kidney and urinary tract changes are quite specific. Frequent complications include hypertension, pyelonephritis, hydro- or pyonephrosis and urinary tract tumors. The clinical picture is characterized by the consequences of distal tubular damage: impairment of urine concentrating capacity, acidosis, electrolyte loss. Analgesic nephropathy is an example of an absolutely preventable drug induced nephropathy. It is the most important single manifestation of the analgesic syndrome. It is recommended that prescriptions for mixed analgesics (multi-component analgesics) should be made obligatory. Monocomponent analgesics could be sold over-the-counter.
It is reported on a 59-year-old patient who towards the end of the Second World War suffered a shell-splinter injury and was admitted to hospital under the picture of an acute ureteric obstruction with pyonephrosis 40 years after the event. One year after the operative removal of the obstructing shell-splinter again normal contrast medium excretion of the kidney affected and subjective symptom-free state of the patient. The symptom-free interval of 4 decades is remarkable. The difficulties of the establishment of the primary diagnosis as well as possible early and late complications of bullet and splinter injuries of the urinary tract are discussed.
Since 1978, 90 patients with hydronephrosis due to ureteral obstruction have been treated with indwelling double-J ureteral stents (104 Renoureteral units). In cases of temporary treatment (e.g. infected hydronephrosis) splints were left in situ between 1 week and 19 months (mean 15 weeks). If permanent ureteral splinting was necessary as a palliative measure (e.g. progressive carcinoma of pelvic organs) stents were left in situ 6 months up to 5 years (mean 16 months). Replacement of the indwelling double-J stents was carried out in 4 to 12 weeks intervals. The all-over complication rate was near 11% including kidney stone formation in 6 cases and septicaemia due to a clogged stents and pyonephrosis in 3 cases. In two cases after pelvic radiotherapy severe hemorrhage occurred due to erosion of the commun iliac artery. The catheters had been left in situ for 28 and 30 months. Relief of obstruction by indwelling ureteral stents in the majority of the patients can simply be achieved usually without severe technical problems. Nevertheless, a 11% complication rate require restriction to indication especially in cases of long term treatment and after radiotherapy. Urinary diversion by percutaneous nephrostomy is the method of choice to avoid disadvantage of indwelling ureteral splinting.
This report gives a review of the few known collections of cases in the world literature. There is an incidence of 6% and 25% in CPN and pyonephrosis respectively. Morphologic sign of XGP is a high degree of destruction of parenchyma and replacement by characteristic granuloma. The function of these kidneys is always markedly and irreversibly damaged. Comprehensive description of special pathologic anatomy, pathogenesis, diagnostics, and operative indication. We show two typical cases in adults, setting an example, and report about five own cases in children, after examining all nephrectomy specimens from 1968 to 1983. We present the age distribution in all reported cases in children and suggest a morphologic and topographic staging classification of XGP.