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At least 901 records · Page 50Linked to original sources
PubMed2005

Xanthogranulomatous pyelonephritis due to calculi: report of 63 cases and review of literature.

OBJECTIVE: To examine the relationship between clinical history and results of renal investigations in patients with xanthogranulomatous pyelonephritis. METHODS: A retrospective review was conducted on 63 cases presenting with histopathological diagnosis of xanthogranulomatous pyelonephritis between 1995 to 2002, at the department of Urology, Bolan Medical College and Sandeman Provincial Teaching Hospital Quetta. RESULTS: There were 26 males and 37 females having an average follow up of two years. Positive findings on examination and investigations at presentation were fever and flank pain in 59 (93.6%) patients and pyuria in 34 (53.9%) patients. All the patients had renal and ureteric calculi with no or severe reduction in the function of the affected kidney on DTPA scan. Hypertrophy of the contra lateral kidney was seen in 56 (88.8%) patients. CONCLUSION: Xanthogranulomatous pyelonephritis is a common entity in this part of the world. Late referral leads to loss of the kidney. Pre-operative diagnosis of the condition is desirable and if surgery is mandatory then all infected tissues have to be removed.

Adolescent↗
PubMed2005

Tubercular ureteric strictures.

OBJECTIVE: To review the presentation of tubercular ureteric strictures and assesses the role of balloon dilatation and open surgical repair in their management. METHODS: This was a retrospective review of tubercular ureteric strictures managed between January 1993 and December 2002. The records were analyzed to assess clinical presentation and compare the results of balloon dilatation with open surgical repair. Success was defined as adequate drainage on imaging, no worsening of renal function, no recurrence of symptoms and no requirement of intervention on further follow up. The long term success rates were compared using the t-test for proportion. RESULTS: Of 73 strictures, 88% had lower urinary tract symptoms. Genital abnormalities suggestive of tuberculosis was observed in 40% male patients. Urine examination yielded aseptic pyuria in 85%, positive AFB smears in 36% and positive AFB cultures in 32%. A small capacity bladder and non-functioning renal units were the only consistent findings on intravenous urogram. Nephrectomy was performed in 37% cases due to non salvageable kidneys at presentation. The success rate of stenting fell from 93% on immediate follow up to 59% on a follow-up of 12 months. At 90% success rates on a follow-up of 7 months open surgical repair was superior (p 0.03). Long term success following balloon dilatation in renal units with good function was 78% compared to 25% for poorly functioning units. (p= 0.01) CONCLUSION: Open surgical repair is superior to balloon dilatation in the management of tubercular ureteric strictures. Renal function may predict the success of balloon dilatation.

Adolescent↗
PubMedDate not supplied

Premature with trichomoniasis: report of one case.

We report a case of an extremely-low-birth-weight premature infant with Trichomonas vaginalis infection of the vagina and urinary tract. Her mother is also infected with Trichomonas vaginalis but is asymptomatic. The patient's illness started as an asymptomatic pyuria and later on at early infancy developed profuse malodorous vaginal discharge. Her vaginal discharge was positive for Trichomonas vaginalis, both on wet mount and Papanicolaou smear, and the infection responded well to treatment with metronidazole. Infants with recurrent vaginal discharge presenting beyond the neonatal period may be attributed to T. vaginalis infection.

Adult↗
PubMedDate not supplied

Urinary tract infection and hyperbilirubinemia.

The aim of this study was to evaluate the incidence of urinary tract infection (UTI) in newborns with asymptomatic, unexplained indirect hyperbilirubinemia in the first two weeks of life. Jaundiced infants, otherwise clinically well, less than two weeks of ages, with a total bilirubin level above 15 mg/dl were eligible for the study. A bilirubin work-up including glucose-6-phosphate dehydrogenase (G-6 PD) level, as well as urinalysis and a urine culture were performed in all patients. Patients with UTI, defined as more than 10,000 colony-forming units per milliliter of a single pathogen obtained by bladder catheterization, were evaluated for sepsis. Renal function tests and renal ultrasound were performed in cases with UTI. During follow-up, voiding cystourethrogram (VCUG) and dimercaptosuccinic acid scintigraphy (DMSA) were performed as well. A total of 102 patients were enrolled. The bilirubin work-up of patients did not demonstrate any significant underlying disorder. None of the infants had a high direct bilirubin level. UTI was diagnosed in eight (8%) cases [Enterobacter aerogenes (3/8:38%), Enterococcus faecalis (2/8:25%), Klebsiella pneumoniae (2/8:25%) and Escherichia coli (1/8:12%)]. Of those eight patients, only four (50%) had pyuria. Bacteriuria was present in seven (88%) patients. The sepsis screen was negative in all but one case with a high C-reactive protein (CRP) level. None of the patients had a positive blood culture. Renal function tests were within normal levels in all patients. Renal ultrasound showed urinary tract abnormalities in three (38%) patients (hydronephrosis, n=1 and pelviectasis, n=2). VCUG was performed in all patients during the study period and one had unilateral grade 3-4 reflux, while only one patient had a diverticulum of the bladder. DMSA was performed in seven patients and none had renal scars. It is of importance that UTI can occur in asymptomatic, jaundiced infants even in the first week of life. Although it is well known that UTI is a common cause of prolonged jaundice, urine culture should be considered in the bilirubin work-up of infants older than three days of age with an unknown etiology.

Female↗
PubMed2006

Septic monoarthritis and osteomyelitis in an elderly man following Klebsiella pneumoniae genitourinary infection: case report.

INTRODUCTION: Klebsiella pneumoniae septic arthritis and osteomyelitis, albeit uncommon in adults, are important sites of disseminated infection. Many case reports have shown K. pneumoniae as a cause of nosocomial transmitted septic arthritis in neonates and children. We report a rare case of an elderly patient with K. pneumoniae genitourinary infection spreading to the liver and other extra hepatic sites like the prostate and peripheral joint. CLINICAL PICTURE: The patient presented with a short history of general malaise, fever and urinary symptoms, associated with an acute monoarthritis of the ankle. On admission, he was in septic shock. Investigations suggested an infective cause, as evidenced by raised total white cell count and pyuria. K. pneumoniae was cultured from both urine and ankle synovial fluid. Imaging confirmed multiple liver and prostatic abscesses, as well as osteomyelitis of the foot bones adjacent to the ankle. TREATMENT: Treatment in this case included surgical drainage of the affected joint and surrounding soft tissue structures, in addition to a 6-week course of systemic antibiotics. OUTCOME: The patient had good clinical response following treatment. In addition, we noted a normalisation of his laboratory parameters and resolution of the intraabdominal and pelvic abscesses. CONCLUSION: This case emphasises the importance of timely and accurate diagnosis followed by appropriate treatment in disseminated K. pneumoniae infection to prevent significant morbidity and mortality.

Aged↗
PubMed2006

[A case report: Bilharzial schistosomiasis in the urinary bladder presented with gross hematuria].

A 31-year-old Japanese man who had been in Africa for two years presented with gross hematuria. He had been swimming in Lake Malawi during this period. Urinary specimen consisted of hematuria and pyuria. Cystoscopy showed tumors resembling Bilharzial tubercles located in the trigone, left lateral and posterior wall and dome. Further urine examination demonstrated eggs of schistosome haematobium. The patient was highly suspected of having Bilharzial schistosomiasis in the urinary bladder. Transurethral resection of bladder tumors was performed for diagnosis. Pathological examination revealed granuloma with many eggs of schistosome haematobium. He was diagnosed with Bilharzial schistosomiasis and was treated with 3,600 mg of praziquantel daily for two days. There have been no signs of recurrence during the one-year follow up except for excretion of degenerated eggs of schistosome haematobium in the urine specimens.

Adult↗
PubMed2006

Clinical experiences of the infections caused by extended-spectrum beta-lactamase-producing Serratia marcescens at a medical center in Taiwan.

CTX-M-3 has become the most common extended-spectrum beta-lactamase (ESBL) produced by Serratia marcescens in Taiwan. An expanded effort to detect ESBL among 123 nonrepetitive isolates of S. marcescens was made and 15 (12%) ESBL-producers were identified, all revealing CTX-M-3. Without routinely detecting the ESBL for S. marcescens in clinical laboratories, 80% of the ESBL-producers were reported to be susceptible to cefepime. The clinical spectrum of ESBL-producing S. marcescens-related infections included febrile urinary tract infection (n = 3); afebrile pyuria (n = 2); pneumonia (n = 3); spontaneous bacterial peritonitis (n = 3); secondary bacteremia (n = 2) and one each with primary bacteremia and colonization of the central catheter tip. Overall, the 30-day mortality rate was 33.3% (5/15) and the outcome depended on the severity of the underlying disorder and infection per se. In conclusion, although our case numbers were limited, due to the substantial incidence and associated mortality of ESBL-producing S. marcescens and its potential treatment failure by an apparently susceptible cephalosporin, we recommend that the detection and report of ESBL production for S. marcescens in clinical laboratories be made mandatory.

Amikacin↗
PubMedDate not supplied

Type B aortic dissection with early presentation mimicking acute pyelonephritis.

Aortic dissection is a life-threatening illness requiring early diagnosis and treatment. Uncommon early presentations mimicking various illnesses can delay diagnosis. This case study describes a 44-year-old woman with type B aortic dissection initially presenting as acute pyelonephritis (APN). Early clinical manifestations were sudden onset of left flank pain, fever, hematuria and pyuria, and following admission, severe abdominal pain, nausea, vomiting, reduced urine output and renal function deterioration. Abdominal computed tomography showed type B aortic dissection complicated with a small bowel infarct, ischemic ascending colon and left renal infarct. Emergency surgical interventions of small bowel resection, ileoduodenostomy and cholecystectomy were performed; a second laparotomy was subsequently performed for anastomosis leakage. The patient died due to septic shock with multiorgan failure. Aortic dissection initially mimicking APN is rare. Accurate early diagnosis of aortic dissection with indeterminate presentation is crucial. Early surgical intervention for visceral organ ischemia is important to preventing morbidity and mortality.

Adult↗
PubMedDate not supplied

Kidney disease in medieval Serbian manuscripts from the Chilandar monastery (Mount Athos, Greece).

In the Chilandar monastery (Mount Athos, Greece) library, a collection of medical texts written in the Old Serbian Slavonic language was discovered in 1952. Because of its size and comprehensiveness, this manuscript was named the Chilandar Medical Codex. The Collection contains several manuscripts, which according to modern medical terminology, the manuscripts can be classified as texts on Internal Medicine, Infectious diseases, Toxicology, Pediatrics, Pharmacology and Surgery, belonging to different time periods. The oldest part, Text on uroscopy, is considered to have been written in 13th or 14th century and consists of 35 text pages divided into 62 paragraphs. Following the popular uroscopy methodology of macroscopic examination of urine, this text contains detailed descriptions of urine characteristics (color, consistency, sediment, odor), as well as a convincing Hippocratic description of urine formation from the filtration of metabolic and waste materials (involving the four humors) rather than blood and fumes (toxic metabolites) according to the theory of Theophilus Protospatharius and Isaac Israeli. Precise descriptions of normal and pathological urine characteristics are provided. Although kidney anatomy and function is unclear, the urinary bladder is very undoubtedly described as an organ for urine collection. In the Chilandar Medical Codex, there are about one hundred descriptions of kidney and urinary tract diseases and disorders. Many symptoms and syndromes such as hematuria, dysuria, pyuria, renal colic, anuria, polyuria, edema and dropsy, urine retention and fever, are incorporated in the broader clinical pictures of lithiasis of the kidney and/or bladder, pyelonephritis, cystitis, necrotic renal disease indicative of renal tuberculosis and tumors, acute and chronic nephritis, renal failure, and gout. Specific pharmacological prescriptions, mostly simple or compound herbal medicines, are given for each of those renal ailments.

Greece↗
PubMed2006

Risk factors for nosocomial candiduria.

OBJECTIVE: To investigate the risk factors and the Candida species that cause candiduria in hospitalized patients via a case-control study. METHODS: We evaluated the results of the urine analysis of the specimens sent to the laboratories of Central Microbiology and the Department of Clinical Bacteriology and Infectious Diseases of Selcuk University Medical School, Konya, Turkey between January and December 2004. The urinary specimens, sent from hospitalized patients, obtained within 72 hours were evaluated. A total of 51 patients above 17 years of age, without any bacterial growth in urine specimens, with fever above 38 degrees celcius and pyuria were included in this study. A control group of 153 patients without any bacterial growth at 72 hours after hospitalization was present. The average age of the patients, the hospitalization period, and clinics resemble each other in the 2 groups. RESULTS: Risk for candiduria was increased by 4 folds (p=0.001; OR=4.020) in abdominal surgery, by 1.4 folds (p=0.335; OR:1.478) in corticosteroid and immune suppressive therapies and by 12 folds (p=0.000; OR=12.408) in urinary catheterization, antibiotic use increased the risk of candiduria by 6 folds (p=0.000; OR=6.00). The risk of candiduria was higher by 2 folds in diabetes mellitus patients than in the controls (p=0.044; OR=2.002). CONCLUSION: Candida albicans (68.62%) was the most commonly isolated agent in candiduria patients. We should decrease the use of urinary catheters and avoid excess use of antibiotics as much as possible in hospitalized patients.

Abdomen↗
PubMedDate not supplied

Nonsurgical treatment of bilateral emphysematous pyelonephritis in a diabetic patient.

Bilateral emphysematous pyelonephritis is a rare life-threatening condition affecting almost exclusively patients with diabetes mellitus. Symptoms, which include fever, chills, abdominal and flank pain, nausea, vomiting, dysuria and pyuria, usually mimic those of classic pyelonephritis, and thus clinical suspicion for this urgent condition should be raised in every diabetic patient with similar presentation. Computed tomography (CT) remains the gold standard for the diagnosis demonstrating gas in the renal parenchyma, collecting system or perinephric tissue. Treatment, which should be aggressive, is classically surgical, and early nephrectomy is recommended. Percutaneous drainage associated with medical treatment might be an alternative. Successful exclusively medical treatment has been described but is infrequent and is reserved as an alternative for patients in whom surgical intervention is contraindicated. We report a case of bilateral emphysematous pyelonephritis in an 82-year-old female diabetic patient who presented with symptoms of typical pyelonephritis. Diagnosis was confirmed by CT, and Escherichia coli was identified as the causative factor. The patient was successfully treated medically with intravenous administration of cefepime and amikacin for 14 days and recovered fully. The therapeutical options for this severe but rare condition are discussed.

Aged, 80 and over↗
PubMed1996

Ureaplasma urealyticum as a causative organism of urinary tract infection stones.

Ureaplasma urealyticum is a fastidious organism which is not recovered by conventional bacterial cultures techniques, but special cultures are required for its isolation and identification. As it is a urease-producing organism, it is considered a risk factor for the formation of struvite calculi in the urinary tract. A total of 30 patients with urinary infection stones (19 of them with the 1st formation and 11 with recurrent stone formation) were included in the study. Both bladder urine specimen (cystoscopically obtained) and stones removed were subjected to conventional cultures and also to Ureaplasma specific cultures (A7 agar and U9 broth). The results of culture techniques revealed that 86.7% of patients had aerobic organisms (E. coli in 46.7%, Klebsiella in 30%, Proteus in 6.7% and Pseudomonas in 3.3%) and 26.7% showed U. urealyticum in mid stream urine. As regards stone cultures, they revealed aerobic organisms in 76.7%, and U. urealyticum in 20%. Sensitivity tests for U. urealyticum showed that minocycline was the most effective antimicrobial followed by tetracycline and ciprofloxacin. From these data, we conclude that U. urealyticum may be the causative organism for infection stone and should be searched for via its specific cultures, especially in patients with recurrent stones and with the so-called sterile pyuria.

Adult↗
PubMed1991

[Clinical study of a metallic prostatic stent].

Treatment using a metallic spiral was attempted on 22 patients. They had urinary retention in 16 cases and dysuria in 6. In 21 of them, the spiral was successfully placed under transrectal ultrasound control. In all 21 patients, voiding was possible immediately after placement of the spiral. As for urodynamic study, urine volume was 100-230 ml (mean: 172 ml), maximum flow rate was 13-21 ml/sec (mean: 17.3 ml/sec), and average flow rate was 4-12 ml/sec (mean: 8.2 ml/sec). Residual urine volume was less than 30 ml in 20 patients and 200 ml in one. As for complications, proximal migration of the spiral was observed in 6 patients. In 4 of them, the new spiral was placed. Perineal discomfort was seen in 3 patients, in 2 the spiral was removed. Pyuria associated with bacterial infection did not continue after the treatment in patients having a catheter. Severe urge incontinence and encrustation were never seen. The above findings suggest that, though a longterm study has not done, this treatment could be an effective treatment particularly for the elderly patients with general complications and/or who require removal of an indwelling catheter for clinical or social reasons.

Aged↗
PubMedDate not supplied

Urinalysis and electrolyte profiles in patients with acquired immunodeficiency syndrome.

One hundred and twenty six patients diagnosed as having AIDS had their urinalysis and electrolyte profiles studied. The commonest electrolyte abnormalities were a low serum bicarbonate in 56% of the patients and hyponatraemia in 48%. Possible aetiological factors are discussed. Significant pyuria was found in 10% of the patients and significant bacteriuria in 13%. Escherichia coli was the commonest isolated organism (56% of all the culture positive cases). Proteinuria above the upper limit of normal was detectable in 13% of the patients; of these, 25% had proteinuria in the nephrotic range. Of the patients 3% had clinical and biochemical evidence of renal insufficiency. It is concluded that significant bacteriuria occurs commonly in AIDS and that renal insufficiency and nephrotic syndrome may be associated with the disease. It is also noted that other electrolyte and acid-base abnormalities, in particular hyponatraemia and low bicarbonate levels may contribute to the morbidity and mortality in patients suffering from AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Dysuria in women.

Only 46% of 84 women with dysuria were found to have significant bacteriuria while 8% had gonorrhea, 1% had herpes progenitalis and 17% had monilia and Trichomonas vaginitis. The remainder were considered to have the urethral syndrome. Neither pyuria, microscopic bacteriuria, nor any single subjective or objective datum definitively predicted cystitis at the initial visit. Therefore, we advise formulating the problem as "dysuria" at the initial evaluation even though one treats with an antimicrobial. The initial workup should include a routine urinalysis, gram stain of the urinary sediment, urine culture, an examination of the urethra and labia as well as a urethral culture. Complete pelvic examination is useful in documenting gonorrhea, herpes progenitalis or vaginitis. If the pelvic examination is deferred and the initial urine culture is negative, reevaluation of the dysuria should include a pelvic examination.

Bacteriuria↗
PubMed1975

[Unilateral renal atrophy].

The authors report 45 cases of unilateral renal atrophy. The circumstances of discovery are related to the urological symptoms: pain, hematuria, pyuria. On the other hand, hypertension is rarely the reason for consultation. Women are more affected than men. Intravenous urography, retrograde cystography and arteriography are essential examinations to collect information concerning the etiology. Dynamic scintiscanning with measurement of the percentage of isotope fixed on the kidneys, has the advantage of permitting comparative evaluation of renal function on each side. In our study, obstruction of the urinary tract was more frequent than parenchymatous disease favoured by infection. Vascular abnormalities were rare. The etiological enquiry remained, however, negative in one third of cases. Surgical operation was necessary when a urological abnormality was the cause of persistence of severe symptoms. On the other hand, removal of the atrophic kidney does not seem to us advisable when decided simply to relieve hypertension. The latter point is particularly discussed.

Adult↗
PubMed1991

[The role of stagnancy of urinary flow in causing urinary tract infection].

A basic and clinical study was made on the significance of stagnancy of urinary flow as a factor causing urinary tract infections. A bacterial solution was inoculated into the bladder of untreated and diabetic mice with model ascending pyelonephritis. The longer the external urethral opening was clamped, the lower became the value of ID50, thus showing infection easily caused by urinary stagnancy in the bladder. Patients who had UTI within 6 months after prostatic operation were divided into two groups, one with residual urine and the other without residual urine. Then, the type of the causative organism, and the severity of pyuria and bacteriuria were determined. In the former, there were slightly more patients with infection caused by plural bacteria. However, no other differences were observed. The administration of cephem antibiotics revealed no differences in effectiveness between the two groups. In conclusion, stagnancy of urinary flow has been considered a factor easily causing infection. However, so far as residual urine is concerned, it is not an intractable factor in treatment.

Animals↗
PubMed1991

Bacterial attachment, inflammation and renal scarring in urinary tract infection.

E. coli cause greater than 90% of urinary tract infections (UTI) in childhood. The capacity to adhere to urinary tract epithelial cells characterizes E. coli strains that cause acute pyelonephritis. Galactose alpha 1-4Galactose beta is the minimal receptor for adhering uropathogenic E. coli. Gal alpha 1-4Gal beta-binding bacteria caused significantly higher body temperature, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), pyuria, and lower renal concentrating capacity than E. coli lacking this specificity. The binding bacteria thus appeared to be more potent inducers of acute inflammation. Since inflammation may lead to tissue damage, we examined the relationship of infection with Gal alpha 1-4Gal beta-positive bacteria to renal scarring. The frequency of renal scarring was 5% in boys with Gal alpha 1-4Gal beta-positive and 40% in boys with Gal alpha 1-4Gal beta-negative E. coli. Analysis of binding capacity with the help of a newly developed latex agglutination assay can thus be used as an effective predictor of risk for renal scarring.

Bacterial Adhesion↗