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Anterior lenticonus is reported in a 20-year-old female who had perceptive deafness, albuminuria, microscopic haematuria, pyuria, primary amenorrhoea, aplasia of the uterus and poorly developed external genitalia. Chromosomal study revealed 45 XO pattern. It is suggested that the gene for anterior lenticonus is recessive and is carried in the short term of the X chromosome.
Urinary tract infections activate a mucosal inflammatory response, which includes cytokine secretion and neutrophil influx. The mechanisms involved in the neutrophil influx have not been identified. Interleukin-8, a potent chemoattractant for neutrophils, is produced by urinary tract epithelial cell lines in vitro. This study analyzed the human IL-8 response to deliberate Escherichia coli infection of the urinary tract. Urine and serum samples were obtained before and after intravesical instillation of E. coli. Neutrophil numbers were determined on uncentrifuged urine, and IL-8 levels were measured by ELISA. A urinary IL-8 response was found in all patients after bacterial instillation, but no serum IL-8 was detected. There was a strong correlation between urinary IL-8 levels and urinary neutrophil numbers. The same E. coli strains used to colonize the patients stimulated IL-8 production in urinary tract epithelial cells. The level of IL-8 secreted by epithelial cell lines was influenced by the fimbrial properties of the E. coli. These results demonstrated that E. coli elicit a mucosal IL-8 response in humans, and suggested that IL-8 is involved in the onset of pyuria. Epithelial cells may be an important source of IL-8 during urinary tract infection.
OBJECTIVE: To report a case of possible cloxacillin-induced acute tubulo interstitial nephritis (AIN). CASE SUMMARY: A 15-year-old male patient presented with hypertension, edema, lumbar pain, sterile pyuria, eosinophiluria (ten percent), and severe renal dysfunction three months after the ingestion of cloxacillin. A renal biopsy revealed diffuse edema and inflammatory infiltrate of the interstitium (five percent eosinophils). He received four sessions of peritoneal dialysis with dramatic improvement in urinary output and renal function. His biochemical parameters returned to normal values 21 days after admission, without the use of glucocorticosteroids. DISCUSSION: Published case reports on AIN induced by penicillin and related drugs are reviewed and compared. The role of interstitial edema in acute renal failure associated with drug-induced AIN is mentioned. CONCLUSIONS: AIN is a rare but significant complication of therapy with penicillin and related drugs. The clinical picture is similar for all of these drugs, but skin rash and fever are absent in AIN induced by cloxacillin and cloxacillin-related drugs. Dialysis improved the patient's urinary output and renal function. Beta-lactam antibiotics should be avoided in patients with cloxacillin-induced AIN.
A 32-year-old Japanese man developed polyarthritis with mild fever and conjunctivitis. Clinical assessment indicated non-specific arthritis, aseptic pyuria induced by infection with Chlamydia, and conjunctivitis. He was diagnosed with reactive arthritis (Reiter's syndrome). Serotyping of human leucocyte antigen (HLA) class I and II revealed positivity for B51(5), A2, A33(19), B44(12), Cw1, DR4 and DR6, but B27 was negative. He was treated with a combination of doxycycline, oral prednisolone, diclofenac sodium and salazosulphapyridine. Fever and arthralgia improved and he became negative for anti-Chlamydia immunoglobulin (Ig) A and IgG antibodies. HLA-B51 may be involved in the pathogenesis of Reiter's syndrome in this Japanese patient.
Fifty-five adult patients with acute uncomplicated pyelonephritis were investigated in an open, prospective, randomized comparative study in which 31 patients were allocated to receive 1000 mg cefetamet pivoxil twice daily (or 2000 mg once daily) and 24 to receive 1000 mg cefadroxil twice daily, given orally for 10 to 15 days. Both groups were comparable for age, sex and body weight. Clinical signs and symptoms, i.e. flank tenderness, dysuria, urgency and pyuria, subsided somewhat more rapidly with cefetamet pivoxil, while defervescence was obtained by Day 3 +/- 1 in both groups. Twenty-nine of the cefetamet pivoxil patients were assessed bacteriologically. The pathogens isolated prior to treatment were E. coli (22), Proteus mirabilis (5), P. vulgaris (1) and P. stuartii (1). All 29 patients had sterile urine at treatment end. In the 22 assessable patients in the cefadroxil group, the pathogens isolated before treatment were E. coli (17), P. mirabilis (3), and K. pneumoniae (2). Six patients had relapsed at treatment end (5 E. coli and 1 P. mirabilis). Patients were re-assessed at follow-up, usually 2 to 4 weeks after the end of treatment. Four of the 29 patients in the cefetamet pivoxil group showed relapse (3 E. coli and 1 P. mirabilis) as did a further 3 in the cefadroxil group (2 E. coli and 1 P. mirabilis). The overall therapeutic outcome was considered as successful, i.e. cure or improvement, in 89.7% of the cefetamet pivoxil patients and 72.7% of those who had received cefadroxil. Tolerability was satisfactory for both trial drugs and there were only a few mild to moderately severe adverse events reported.(ABSTRACT TRUNCATED AT 250 WORDS)
Cefetamet pivoxil, an oral third generation cephalosporin, was evaluated in 218 hospitalized patients with complicated urinary tract infections. Among these patients, 28 (13.1%) were suffering from concomitant diabetes: 25 of these patients were matched with 25 non-diabetic patients and for each pair, the age +/- 2 years, sex, complicating factors, etc. had to be identical. All patients received 2000 mg cefetamet pivoxil daily for 10 days. The predominant pathogen was E. coli; 18 in the diabetic group, 15 among non-diabetics. Comparison of the therapeutic results showed that the bacteriological eradication rate was similar in diabetic and non-diabetic patients, 92% and 87.5%, respectively. There was a similar improvement in pyuria, and therapeutic response was equal in diabetic patients as in non-diabetic patients. No unwanted effects on renal function were observed in the high-risk diabetic group.
BACKGROUND: It is known that there is significant morbidity associated with urinary tract infection and with renal dysfunction in sickle cell disease (SCD). However, it is not known if there are potential adverse outcomes associated with asymptomatic bacteriuria (ASB) infections in sickle cell disease if left untreated. This study was undertaken to determine the prevalence of ASB, in a cohort of patients with SCD. METHODS: This is a cross-sectional study of patients in the Jamaican Sickle Cell Cohort. Aseptically collected mid-stream urine (MSU) samples were obtained from 266 patients for urinalysis, culture and sensitivity analysis. Proteinuria was measured by urine dipsticks. Individuals with abnormal urine culture results had repeat urine culture. Serum creatinine was measured and steady state haematology and uric acid concentrations were obtained from clinical records. This was completed at a primary care health clinic dedicated to sickle cell diseases in Kingston, Jamaica. There were 133 males and 133 females in the sample studied. The mean age (mean +/- sd) of participants was 26.6 +/- 2.5 years. The main outcome measures were the culture of > or = 10(5) colony forming units of a urinary tract pathogen per milliliter of urine from a MSU specimen on a single occasion (probable ASB) or on consecutive occasions (confirmed ASB). RESULTS: Of the 266 urines collected, 234 were sterile and 29 had significant bacteriuria yielding a prevalence of probable ASB of 10.9% (29/266). Fourteen patients had confirmed ASB (prevalence 5.3%) of which 13 had pyuria. Controlling for genotype, females were 14.7 times more likely to have confirmed ASB compared to males (95% CI 1.8 to 121.0). The number of recorded visits for symptomatic UTI was increased by a factor of 2.5 (95% CI 1.4 to 4.5, p < 0.005) but serum creatinine, uric acid and haematology values were not different in patients with confirmed ASB compared with those with sterile urine. There was no association with history of gram negative sepsis. CONCLUSION: ASB is a significant problem in individuals with SCD and may be the source of pathogens in UTI. However, further research is needed to determine the clinical significance of ASB in SCD.
OBJECTIVE: To compare the onset of symptomatic urinary tract infection in individuals with spinal cord injury in a rehabilitation setting who are randomized to clean or sterile intermittent catheterization technique. DESIGN: Randomized controlled design. SETTING: Spinal cord rehabilitation units in western Canada. SUBJECTS: Thirty-six patients with cervical spinal cord injuries requiring intermittent catheterization by nursing staff were recruited. None had a previous history of voiding dysfunction or urinary tract infections. INTERVENTIONS: Subjects were randomized to either clean or sterile intermittent catheterization technique. Protocols for both clean and sterile techniques were standardized and followed by nursing staff and caregivers. MAIN MEASURES: Primary outcome measure was symptomatic urinary tract infection as diagnosed by urine culture > or = 10(5) colony-forming units/mL, pyuria (> or =10 leukocytes on high-power field), and accompanying symptoms. RESULTS: A total of 189 urine specimens from 36 subjects were cultured. Of the 36 subjects, 15 (43%) developed a symptomatic urinary tract infection: 6/16 (37%) from the clean group; 9/20 (45%) from the sterile group (P> 0.05). Mean time to onset for symptomatic urinary tract infection for the clean group was 3.0 (standard deviation (SD) 2.4) weeks and for the sterile group, 3.6 (SD 1.3) weeks (P> 0.05). The most common urinary organisms at onset of symptomatic urinary tract infection were Enterococcus species followed by Klebsiella. CONCLUSION: Clean intermittent catheterization in the rehabilitation setting does not appear to place the patient with spinal cord injury at increased risk for developing symptomatic urinary tract infection, and has significant cost and time saving benefits for the health care system, as well as enhancing the transition for the patient from rehabilitation to community.
A young woman who presented with loin pain and pyuria after a prolonged period of investigations and treatment, finally having a nephrectomy for non-functioning kidney, was revealed to have schistosomial infestation with an adult worm in the ureter. Unusually, she only developed bladder manifestations later.
We assessed the Sysmex UF-50 for reproducibility of results and carryover rate by performing between- and within-run precision analyses on 315 urine samples, evaluated the feasibility of using the UF-50 to measure urinary cellular and noncellular components by comparing results from the UF-50 with results of manual urinalysis using the Kova system, and performed side-by-side comparison of the within-run reproducibility from the UF-50, the UF-100, and the Kova system. Results from the UF-50 and UF-100 were highly reproducible, and the carryover rate was 0.5% or less for the urinary components. In between-run precision assays, the coefficients of variation for UF-50 results for all cellular components were less than 10%. The agreement (gamma statistics) between values from the UF-50 and the Kova system was excellent for RBC, WBC, and bacterial counts. The cell counts from the UF-50 for RBCs, WBCs, epithelial cells, and bacteria were 52%, 63%, 54%, and 110%, respectively, of those measured by manual urinalysis. The UF-50 performed quantitative analysis in 72 seconds, compared with 330 seconds for manual methods. The UF-50 is suitable for the first screening to detect hematuria, pyuria, and bacteriuria.
Suppurative mediastinitis occurred in 68 of 9,965 patients (0.7 percent) who underwent median sternotomy at Emory University Hospital from 1973 through 1982. Case-control methodology was used to identify preoperative, intraoperative, and postoperative risk factors for the development of poststernotomy mediastinitis. The following 12 individually significant risk factors were identified by univariate analysis: preoperative factors: history of chronic obstructive pulmonary disease (COPD), history of prior sternotomy, pyuria, low ejection fraction, and high left ventricular end-diastolic pressure; intraoperative factors: valvular or aortic aneurysm surgery, prolonged bypass pump time, repeat placement on bypass, duration of surgery; and postoperative factors: surgical reexploration due to postoperative hemorrhage, cardiopulmonary resuscitation in the immediate postoperative period, prolonged time (greater than 48 hours) on mechanical ventilation. By logistic regression analysis, three of these factors were found to be associated independently with increased odds of developing mediastinitis: duration of surgery, history of COPD, and prolonged postoperative mechanical ventilation.
Erythema induratum of Bazin is a disease that usually affects women, in whom erythematous subcutaneous nodules and plaques appear on the posterior part of the lower extremities, some of which ulcerate. In many countries, tuberculosis is still the main etiologic factor. We report a case of a 40-year-old woman who presented a course of protracted and recurrent episodes over five years of cutaneous lesions on her legs. These tend to involute, but new crops appear at irregular intervals. It was painful, erythematous-violaceous nodules, some of which drained a reddish secretion. The histopathologic features of the lesions demonstrated inflammatory infiltration, with predominance of neutrophils in dermis and hypodermis, necrotizing vasculitis in the arterioles and septal fibrosis. There was no granuloma. The Ziehl-Neelsen stain did not revealed acid-fast bacilli, and the culture of biopsy specimen was negative. The tuberculin skin test was strongly positive (17 mm). The chest X-ray was normal. Few months later she presented adynamia and urinary complaints, such as polacyuria and dysuria. It has been done an urynalysis, which demonstrated acid pH urine, sterile pyuria and microscopic hematuria. It was then raised the diagnostic hypothesis of renal tuberculosis. The urine culture for M. tuberculosis was positive in two out of ten samples. The treatment was instituted with rifampin, isoniazid and pyrazinamide, with complete regression. This case illustrates a clear association between erythema induratum and renal tuberculosis, demonstrated by the remission of the cutaneous lesions after the treatment of the renal tuberculosis.
CONTEXT: The association of primary carcinoma of the ureter and lithiasis is extremely rare. We report a rare case of a primary carcinoma of the ureter with corariform calculus. CASE REPORT: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years and had received treatment for urinary infections a number of times. The first clinical presentation was related to lithiasis and the tumor had not been shown up by excretory urography, cystoscopy or ultrasonography. Two months after the calculus had been eliminated, the patient began to have serious symptoms and a grade III transitional cell carcinoma of the ureter was discovered. Total nephroureterectomy and M.V.A.C. (Methotrexate + Vinblastina + Doxo Rubicina + Cisplatina) chemotherapy were tried unsuccessfully. In this report we emphasize the diagnostic difficulty caused by the concomitant presence of the two pathologies. In our opinion, the rapid evolution in this case is directly related to the high grade of the tumor.
Drug-induced interstitial nephritis can be caused by a plethora of drugs and is characterized by a sudden impairment of renal function, mild proteinuria, and sterile pyuria. For investigation of the possible pathomechanism of this disease, drug-specific T cells were analyzed, their function was characterized, and these in vitro findings were correlated to histopathologic changes that were observed in kidney biopsy specimens. Peripheral blood mononuclear cells from three patients showed a proliferative response to only one of the administered drugs, namely flucloxacillin, penicillin G, and disulfiram, respectively. The in vitro analysis of the flucloxacillin-reactive cells showed an oligoclonal immune response with an outgrowth of T cells bearing the T cell receptor Vbeta9 and Vbeta21.3. Moreover, flucloxacillin-specific T cell clones could be generated from peripheral blood, they expressed CD4 and the alphabeta-T cell receptor, and showed a heterogeneous cytokine secretion pattern with no clear commitment to either a Th1- or Th2-type response. The immunohistochemistry of kidney biopsies of these patients revealed cell infiltrations that consisted mostly of T cells (CD4+ and/or CD8+). An augmented presence of IL-5, eosinophils, neutrophils, CD68+ cells, and IL-12 was observed. In agreement with negative cytotoxicity assays, no cytotoxicity-related molecules such as Fas and perforin were detected by immunohistochemistry. The data indicate that drug-specific T cells are activated locally and orchestrate a local inflammation via secretion of various cytokines, the type of which depends on the cytokine pattern secreted and which probably is responsible for the renal damage.
A retrospective study was performed to determine the proportion of dogs with hyperadrenocorticism or diabetes mellitus or both that had urinary tract infection (UTI) and to describe clinical and laboratory findings. Dogs with these endocrine disorders were included if results of quantitative urine culture were available and dogs were not receiving antimicrobials. Dogs with positive urine cultures were considered to have UTI and dogs with negative urine cultures were used as controls. Information including history, clinical signs, physical examination findings, and results of laboratory tests and urine culture was extracted from all records. Findings in dogs with UTI were compared with control dogs. There were 101 dogs with hyperadrenocorticism or diabetes mellitus or both that met inclusion criteria; 42 (41.6%) had UTI and 59 (58.4%) did not. UTI was present in 46% of dogs with hyperadrenocorticism, 37% of dogs with diabetes mellitus, and 50% of dogs with both endocrine disorders. There was no association between endocrine group and occurrence of UTI. Escherichia coli was the most common bacteria isolated, and cultures from 29 dogs (69%) showed growth of this organism. Of dogs with UTI, <5% had stranguria, pollakiuria, or discolored urine, whereas 60% had pyuria and 69% had bacteriuria. We conclude that UTIs are common in dogs with hyperadrenocorticism, diabetes mellitus, or both diseases. Clinical signs of UTI, however, are uncommon and results of urinalysis may be normal. Therefore, it is appropriate to recommend urine culture as part of the evaluation of dogs with these endocrine disorders.
BACKGROUND: Primary renal tumors are diagnosed uncommonly in dogs. HYPOTHESIS: Signs and survival will differ among different categories of primary renal tumors. ANIMALS: Data were collected from the medical records of 82 dogs with primary renal tumors diagnosed by examination of tissue obtained by ultrasound-guided biopsy, needle aspiration, surgery, or at postmortem examination. METHODS: This was a multi-institutional, retrospective study. RESULTS: Forty-nine dogs had carcinomas, 28 had sarcomas, and 5 had nephroblastomas. The dogs were geriatric (mean 8.1 years; range: 1-17) with a weight of 24.9 kg (range: 4.5-80). Tumors occurred with equal frequency in each kidney with 4% occurring bilaterally. Initial signs included one or more of hematuria, inappetance, lethargy. weight loss, or a palpable abdominal mass. Pain was reported more frequently in dogs with sarcomas (5/28). The most common hematologic abnormalities were neutrophilia (22/63), anemia (21/64), and thrombocytopenia (6/68). Polycythemia was present in 3 dogs and resolved with treatment. Hematuria (28/49), pyuria (26/49), proteinuria (24/50), and isosthenuria (20/56) were the most frequently observed abnormalities on urinalysis. Pulmonary metastases were noted on thoracic radiographs in 16% of dogs at diagnosis. Seventy-seven percent of dogs had metastatic disease at the time of death. Median survival for dogs with carcinomas was 16 months (range 0-59 months), for dogs with sarcomas 9 months (range 0-70 months), and for dogs with nephroblastomas 6 months (range 0-6 months). CONCLUSIONS AND CLINICAL IMPORTANCE: Primary renal tumors in dogs are generally highly malignant with surgery being the only treatment that improves survival.
The extensive use of selective histamine H2 receptor antagonists provides a unique opportunity to describe very rare adverse drug reactions. Although mild elevation of serum creatinine level following the administration of cimetidine is relatively common, acute interstitial nephritis (AIN) is a rare hypersensitivity reaction. There have been 25 published reports of AIN associated with H2 antagonist therapy and we also identified 16 cases from the Australian Adverse Drug Reaction Advisory Committee (ADRAC) database. AIN was reported most commonly following cimetidine administration. AIN was supported by renal biopsy in 28 patients and by rechallenge in 6. H2 antagonist-induced AIN was more commonly reported in men older than 50 years. In the majority of cases the onset was within 2 weeks of initiation of therapy (1 day to 11 months). The clinical manifestations were nonspecific including sterile pyuria, elevated erythrocyte sedimentation rate, fatigue, proteinuria and leucocytosis whereas rash, arthralgia and flank pain were rarely reported. There were 170 cases of hepatotoxicity following H2 antagonist administration reported to ADRAC. These were more common following ranitidine and included cholestatic, hepatocellular and mixed reactions. Hepatotoxicity was proven following liver biopsy in several cases published in the literature and in 15 cases reported to ADRAC. Hepatotoxicity recurred upon rechallenge in 6 cases. Generally, renal and hepatic adverse effects resolved quickly after cessation of H2 antagonist therapy and did not require specific treatment. Nephrotoxicity and hepatotoxicity following administration of an H2 antagonist is rare and a high index of suspicion is necessary for early detection. Now that many H2 antagonists are available over the counter, awareness of these conditions and early detection with cessation of H2 antagonist therapy would appear paramount.
A 22-year-old Japanese man developed polyarthritis with fever and urethritis. He was diagnosed as Reiter's syndrome since he was found to have uveitis and persistent aseptic pyuria. Although, he was negative for HLA-B27 or any other HLA-B27 cross-reactive MHC class I antigens, he was positive for HLA-B51. The laboratory examination showed significant elevation of serum IgG and IgA anti-Chlamydia antibodies. He was successfully treated with a combination of doxycycline, naproxen, salazosulfapyridine and methotrexate with a decrease in IgG and IgA anti-Chlamydia antibodies. Previous studies provided evidence that HLA-B51 itself might be involved in the development of Behcet's disease, which shares common features with Reiter's syndrome, such as uveitis, skin lesions, and polyarthritis. It is therefore suggested that combination of Chlamydia infection and HLA-B51 might play a role in the pathogenesis of Reiter's syndrome in our patient.