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PubMed1988

Dipstick screening for urinary tract infection.

In screening for urinary tract infection the leucocyte esterase test will detect almost all samples with significant pyuria and bacteriuria, but is relatively nonspecific. The nitrite test is more specific but less sensitive and about one-third of the urinary tract infections in a large group of children were missed. The combination of screening tests results in greater overall accuracy both in the diagnosis and exclusion of urinary tract infection. Almost all cases of urinary tract infection were detected when either the leucocyte esterase or the nitrite screening test or both were positive. If both tests are negative, urinary tract infection is virtually excluded and unless the child is symptomatic, further urinalysis is unnecessary. Laboratory urinalysis is, however, necessary if any one screening test for leucocyte esterase or nitrite (or protein or haemoglobin) is positive. Combined biochemical screening for urinary tract infection with dipstick test strips is reliable and allows early diagnosis and management. By avoiding unnecessary urinalysis it is cost-effective for the patient and will significantly reduce the laboratory workload.

Adolescent↗
PubMed1988

Urinalysis in the diagnosis of urinary tract infections.

Urinary tract infection is the commonest human bacterial infection. Bacteriuria alone does not appear to produce progressive renal damage or hypertension. However, it can produce considerable morbidity. Urinalysis is a simple, relatively sensitive, and reliable way of diagnosing urinary tract infection. It is not clear that routine screening should be performed in all patients, but pregnant females, patients with known anatomic abnormalities, and patients with recent genitourinary instrumentation should be screened. The major determinant of therapeutic success in patients with urinary tract infections is the anatomic site of infection. Superficial mucosal infection of the bladder is well treated with a single dose of an appropriate antibiotic, whereas deep tissue infection of the kidney or prostate should be treated with a prolonged and intensive course of therapy. Urinalysis is an insensitive tool in the localization of infection. However, the presence of white cell casts on the examination of the urinary sediment is pathognomonic of upper tract infection and would lead one to pursue an aggressive course of therapy. Examination of the concentrating ability is of limited help in this regard because of the wide range of overlap of concentrating ability in patients with upper and lower tract infections. In selected instances, urinalysis is of help in guiding therapy of urinary tract infections. This is particularly true of the patients with acute urethral syndrome where therapy is guided by the presence or absence of pyuria. Urinalysis, a simple front-line test, is of paramount importance in the evaluation and management of the patient with urinary tract infection.

Antibody-Coated Bacteria Test, Urinary↗
PubMed1988

The importance of closed bladder irrigation in prostatectomy.

Closed bladder irrigation in transvesical prostatectomy is an important factor in arresting bleeding and preventing or diminishing bacterial infection. A bladder irrigation of appropriate intensity may ensure that the blood clots be removed rapidly from the bladder and thereby the formation of larger clots and bladder tamponade can be avoided. The bacteriological examination of the eluents of 82 patients revealed that the longer the patient is maintained on a catheter, the longer bacteriuria and pyuria will persist. Two days are considered by the authors to be the optimal time of maintaining a closed bladder irrigation.

Bacteriological Techniques↗
PubMed1988

[A case of polycystic kidney with bilateral nephrectomy].

A 56-year-old woman in chronic hemodialysis had been suffering from uncontrollable fever for the past 7 months. Her original disease was diagnosed as familial polycystic kidney and three of her five brothers were found to have the same disease. Her chromosome was 46,XX,21P+ and laboratory examination revealed severe anemia, malnutrition, liver dysfunction, pyuria and candidiasis of urine. Abdominal echogram and CT scan revealed polycystic kidneys and multiple liver cysts. She was admitted to our hospital and was diagnosed as having pyelonephritis of the right kidney. As her condition was not improved by conservative therapy right nephrectomy was performed. One month later, spiking fever and left tenderness reappeared. Those symptoms could not be controlled by conservative therapy and left nephrectomy was performed again. Pathological examination on nephrectomized kidneys showed interstitial nephritis, hyaline degeneration and proliferative change of glomeruli, microabscess, colloid of tubules and calcification of parts of Henle's loops. Nephrectomy has been performed in 1.6 to 10.0% of polycystic kidneys due to references since 1952. Eight of the 22 polycystic kidneys (36.3%) seen at our hospital during the past 10 years have been removed.

Female↗
PubMedDate not supplied

Acute hemorrhagic cystitis due to Escherichia coli.

Acute hemorrhagic cystitis in children has been associated with adenovirus type 11 infection as well as with urinary tract infection due to Escherichia coli. In the United States, the incidence of hemorrhagic cystitis due to E. coli appears to be as high as, or higher than that due to adenovirus type 11, but few studies are available. We studied 14 episodes of acute hemorrhagic cystitis in 13 children aged 2-14 years (mean 6.2). Ten were female. Gross hematuria lasted 1-9 days (mean 2.2). Urine cultures were positive (greater than 10(5) colonies/ml) in 6 episodes (43%). One additional patient had a suspected infection. All children grew E. coli. Pyuria was present in 78.5% but did not correlate with positive cultures. IVP was normal in 82%. E. coli appears to be a much more common cause of acute hemorrhagic cystitis in children than heretofore reported.

Acute Disease↗
PubMed1986

Niridazole-induced red/brown urine pigment is associated with increased urinary beta-glucuronidase excretion and a bladder site of formation.

Niridazole caused red/brown urine pigment in a man during treatment for Schistosoma mansoni infection. The urine pigment has been observed during niridazole treatment of schistosomiasis, but has not been documented during treatment of other diseases. Urinary beta-glucuronidase (EC 3.2.1.31) concentration increased proportionately to the amount of red/brown pigment in the urine. Concurrently, sterile pyuria developed. The duration of the time urine was in the bladder was directly related to the concentration of beta-glucuronidase and to the intensity of the red/brown urine color, there being much more in infrequently than in frequently voided urine specimens. Pigment development appears to occur in the bladder. The associated and possibly contributing components appear to be niridazole or one of its metabolites, beta-glucuronidase from the kidneys or from urinary granulocytes, and possibly a schistosomal factor. Given time, this combination generated the red/brown pigment.

Adult↗
PubMed1985

Occurrence of gram negative bacteria in midstream bladder urine and their sensitivity to quinoline derivatives.

326 gram negative bacteria have been isolated and quantitative bacteria counts performed from midstream urine of as many patients affected with symptomatic and non symptomatic urinary tract infections. Susceptibility of bacteria to four quinoline derivatives (Norfloxacin, Oxolinic acid, Pipemidic acid and Nalidixic acid) was studied determining the minimal inhibitory concentrations (MICs) of each drug by a miniaturized dilution broth method. The frequency of bacterial species isolated, the frequency of symptoms and the frequency of bacterial counts were studied to establish a possible relationship between these data. It has been observed that patients affected with pyuria without any other subjective symptoms demonstrate a colony count ranging between less than 10(4) and greater than 10(5) bacterial/ml of urine and these bacteriuria were determined by several different bacterial species. E. coli was much more frequently responsible for low or high count bacterial infections of the urinary tract than other species. In fact E. coli was detected in 64.4% of patients, P. mirabilis in 15.9%, E. agglomerans in 5.2%, P. aeruginosa in 4.9. Other species were detected in much lower percentages. Norfloxacin proved to be the most effective drug in vitro, out of those under examination. Its MIC50 never exceeded 8 mcg/ml even against Pseudomonas and Serratia strains, which were resistant to all the other antimicrobial agents.

Adolescent↗
PubMed1988

Medical complications of eating disorders in adolescents.

Anorexia nervosa and bulimia are occurring with increased frequency among adolescents and preadolescents. To determine the range and severity of medical complications encountered in younger anorectic and bulimic patients, we reviewed the medical records of 65 adolescents and preadolescents, aged 10 to 20 years, who were observed in the Eating Disorders Clinic of the Children's Hospital at Stanford. Significant medical instability was present in the majority of our patients. A total of 55% of anorectic patients and 22% of bulimic patients required hospitalization for medical reasons during the study period. Cardiovascular abnormalities were frequent, including bradycardia, prolonged corrected QT intervals, dysrhythmias, and marked orthostatic pulse and BP instability. Hypothermia, with temperatures less than 35.5 degrees C, was common. Renal abnormalities included pyuria, hematuria, and proteinuria. Electrolyte derangements occurred in patients who vomited or purged. Hypokalemia was most common, but hypocalcemia, hypomagnesemia, and hypophosphatemia were also noted. The majority of our pediatric patients with eating disorders had evidence of physiologic derangement requiring medical intervention. The need for adolescents and preadolescents with eating disorders to receive ongoing medical monitoring in concert with psychiatric treatment and the need for therapists and medical practitioners to become familiar with the potential medical sequelae of eating disorders are underscored by our data.

Adolescent↗
PubMed1988

[Clinical evaluation of chorei-to and chorei-to-go-shimotsu-to in patients with lower urinary tract symptoms].

Chorei-to was administered orally to 30 patients who complained of lower urinary tract symptoms without pyuria. Efficacy rate of pollakisuria was 92.9%, miction pain 85.8%, and voiding discomfort 85.7%. Total efficacy rate was 76.0%. No untoward effect was observed. Therefore, Choreito was thought to be an effective drug for the patients with lower urinary tract symptoms. Patients with the same symptoms tried Choreito-go-shimotsu-to, and its efficacy rate turned out to be 80%, but untoward effect such as epigastraligia was observed on 2 patients. These 2 drugs are thought to be effective on patients suffering from lower urinary tract symptoms.

Adult↗
PubMed1988

Gardnerella vaginalis in the urinary tract: incidence and significance in a hospital population.

The significance of Gardnerella vaginalis in urine was studied by comparing urine culture results, urinalysis data, and clinical findings. Over a two-year period, G vaginalis was reported in 2.3% of all urine cultures. Of 72 patients with pure cultures (greater than 10(4) cfu/mL), 43 patients (59.7%) were found to have G vaginalis urinary tract infections. Furthermore, four of the infected patients had pyelonephritis. Symptoms associated with G vaginalis urinary tract infections varied, and pyuria was detected in only 58% of the cases. Conditions associated with G vaginalis urinary tract infection included a history of recurrent urinary tract infections and/or instrumentation and upper urinary tract disease.

Adolescent↗
PubMed1988

The acute scrotum.

Testicular torsion is characterized by the sudden onset of testicular pain associated with abdominal pain, nausea and vomiting. Fever is unusual and urinalysis is often normal. Fever, pyuria, dysuria and urethral discharge are characteristic of epididymitis. Radionuclide scanning and Doppler ultrasound are helpful in establishing the diagnosis. If the diagnosis is uncertain, the patient should be considered to have testicular torsion until it is proved otherwise. Undiagnosed torsion leads to testicular necrosis.

Acute Disease↗
PubMed1988

[Renal manifestations of sarcoidosis].

Renal manifestations of sarcoidosis are rare. In addition to calcium nephropathy, granulomatous interstitial nephritis and glomerulo-nephritis (GN) account for most cases. The latter two manifestations are described in 4 patients and in a detailed review of the literature. In comparison to a nonselected population of sarcoidosis patients, granulomatous interstitial nephritis is found more frequently in male patients above 40 years of age; it is associated more frequently with other extrathoracic manifestations of sarcoidosis; and it causes renal insufficiency of varying degree, which is at least partially reversible with steroid therapy. Predominant findings are silent microhematuria, sterile pyuria, mild proteinuria and a variety of tubular functional disorders. Glomerulonephritis (39 observations) has been described with increasing frequency in sarcoidosis. Because of the well known immunological abnormalities of sarcoidosis, frequent association of sarcoidosis with GN could be expected but this association has not yet been proven statistically. Sarcoidosis-associated GN includes a variety of histological forms, viz. membranous, proliferative and sclerosing GN. Glomerulonephritis may appear before sarcoidosis. Conversely, both diseases may appear simultaneously, or GN may follow all other manifestations of sarcoidosis with a latency period of many years.

Aged↗
PubMed1988

Renal histology of mucocutaneous lymph node syndrome (Kawasaki disease).

Renal involvement is well described in patients with mucocutaneous lymph node syndrome (MCLNS), or Kawasaki disease and is manifested by mild azotemia, hematuria, pyuria or cylinduria, and more often, proteinuria. Renal morphology during the acute stages of the illness has never been reported. In this paper we describe the renal histopathologic changes in a child with MCLNS. The glomerular histopathologic findings suggest immune complex damage to the kidney as a possible mechanism of nephrotoxicity in MCLNS. Presence of kidney lesions, which speak in favor of the injurious role of immune complexes in MLCNS may be relevant to the understanding of the pathogenesis of the vascular lesions that are characteristic of this disease.

Antigen-Antibody Complex↗
PubMed1987

[Bilateral ureteral tumors associated with chronic renal failure: a case report].

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.

Aged↗
PubMed1988

Renal lesions associated with Borrelia burgdorferi infection in a dog.

Borrelia burgdorferi infection was diagnosed serologically in a dog with lethargy, stiffness, and anorexia. Treatment with ampicillin and chloramphenicol did not alleviate the signs. Azotemia, proteinuria, cylindruria, pyuria, and hematuria developed over a 3-month period. Antibody titer for B burgdorferi remained high (1:8,192) during this time. Renal histopathologic findings included severe, chronic, diffuse, membranoproliferative glomerulonephritis and moderate chronic, multifocal, interstitial nephritis. Borrelia burgdorferi organisms were identified in renal tissue and in urine by results of immunofluorescent studies and bacteriologic culture, respectively.

Animals↗
PubMed1987

[The clinical effect of fosfomycin on cystitis].

Fosfomycin (FOM) is an antibiotic which inhibits phospho(enol)pyruvic acid transferase. Fifty-five patients with cystitis were treated with the drug for 7 days, at oral doses of 1 g for 3 times a day. Adult females under 70 years of age, visiting the clinic within 2 weeks after the onset, were classified as cases with typical simple cystitis with confirming the bladder irritability, pyuria and bacteriuria. The treatment was effective for 95.0% of these cases. Two cases with atypical cystitis caused by Klebsiella pneumoniae poorly responded to the drug.

Administration, Oral↗
PubMed1987

[Clinical feature of male non-gonorrhoea urethritis and minocycline treatment of Chlamydia or Ureaplasma-infected urethritis].

Thirty-nine male patients with urethritis were studied for gonorrhoea or non-gonorrhoea infections. Only 2 patients were infected with N. gonorrhoeae, the other 37 patients were non-gonorrhoea urethritis (NGU). In 9 of these patients, C. trachomatis was identified and in 6 patients, U. urealyticum was isolated. No chlamydial urethritis was combined with ureaplasma. There was no clinical difference between chlamydia and ureaplasma infection, such as serous urethral discharge or mild pyuria. Minocycline was given orally at the dose of 200 mg daily for 7 to 42 days to these patients. Seven of the 9 patients (78%) with C. trachomatis and 7 of the 6 patients (67%) with U. urealyticum infection showed improvement of subjective and objective symptoms after minocycline. In no case, was an adverse reaction noted. Minocycline was effective in the treatment of both C. trachomatis and U. urealyticum urethral infection.

Adult↗
PubMed1987

[Clinical observation of bacterial isolates from urine specimens of outpatients].

Changes of bacterial isolates from urine specimens of outpatients with urinary tract infections (UTI) from 1977 through 1984 were studied. Organisms which were isolated from patients with bacteriuria of over 10(3) bacteria per ml of urine regardless of grade of pyuria were studied. The incidence of UTI, especially that of acute cystitis was decreased during the recent 8 years. E. coli was the most predominant isolate in acute UTI with an isolation frequency of over 70% every year, followed by S. epidermidis nearly every year. Citrobacter spp., Klebsiella spp., P. mirabilis and S. aureus were also isolated steadily every year. Bacterial isolates in acute UTI were generally composed of these six species of bacteria. Although many kinds of bacteria were isolated in chronic UTI, E. coli was the most frequent species with an isolation frequency of 17-37%, followed by E. faecalis except in 1981 and 1982. The tendency of gram-negative rods to increase in acute and chronic UTI was observed except in 1981 and 1982. A slight decrease in sensitivity of E. coli and P. mirabilis against ampicillin (ABPC) and sulbenicillin (SBPC) was observed in acute UTI. In chronic UTI, the tendency of the sensitivity of E. coli against ABPC, SBPC and nalidixic acid to recover and the tendency of the sensitivity of P. aeruginosa against dibekacin to decrease were observed. E. faecalis was estimated to be sensitive to gentamicin, cefazolin, minocycline and fosfomycin. However, unlike those species mentioned above, many strains of E. faecalis showed a positive disc sensitivity to these drugs.

Acute Disease↗