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PubMed1995

Sonographic measurement of renal enlargement in children with acute pyelonephritis and time needed for resolution: implications for renal growth assessment.

OBJECTIVE: Failure of a kidney to grow satisfactorily in childhood is evidence of renal disease. Because kidneys may enlarge during an episode of acute pyelonephritis, concomitant renal length measurements cannot be used as baselines for growth assessment. This study was designed to determine the degree of renal enlargement in children with acute pyelonephritis and the time the enlargement takes to resolve after treatment is started to find the optimum time for obtaining baseline measurements. SUBJECTS AND METHODS: In a cohort study, 180 children younger than 5 years old with their first proven acute urinary tract infection, with or without pyelonephritis, had renal scintigraphy and sonography within 15 days of starting treatment. The presence of cortical defects on scintigrams indicated pyelonephritis. The lengths of kidneys with and without scintigraphic defects (i.e., with and without pyelonephritis) were compared, adjusting for age and sex, and the length of kidneys with defects was related to time elapsed between the start of treatment and sonography. RESULTS: Ninety-nine kidneys (28%) in 77 children (43%) had scintigraphic defects. Kidneys with defects were an average of 3.2 mm longer than kidneys without defects. Length and time interval between treatment and sonography in kidneys with defects correlated negatively, with mean length approaching that of kidneys without defects by 10-11 days. CONCLUSION: Kidneys with acute pyelonephritis initially increase in length but return to normal on average by the 11th day of treatment. If poor renal growth is used as an indication of renal disease, sonography should be delayed or repeated at least 2 weeks after the start of treatment to determine the length of the uninflamed kidney.

Acute Disease↗
PubMed1997

Acute pyelonephritis focusing on perfusion defects on contrast enhanced computerized tomography(CT) scans and its clinical outcome.

OBJECTIVES: Many cases of acute pyelonephritis show renal perfusion defects on contrast enhanced computerized tomography (CT) imaging studies. The purpose of this study is to show the frequency of renal perfusion defects in uncomplicated acute pyelonephritis and to compare the clinical responses of patients who had perfusion defects or not. METHODS: We studied patients who had symptoms and signs of acute pyelonephritis through CT examinations with contrast enhancement. We identified 21 cases who had perfusion defects among 35 patients who had undergone CT imaging studies and compared the clinical data in the two groups of patients who had perfusion defects on CT (group 1) and who had not (group 2). RESULTS: Nearly all patients had typical symptoms and signs of acute pyelonephritis such as high fever and chill, flank pain and costovertebral angle tenderness. Combined clinical problems were septic shock (one case, 4.8%) and disseminated intravascular coagulation (DIC) (one case, 4.8%) in group 1. Laboratory findings were not different between the two groups. All patients were treated with antibiotics and had successful recoveries. The duration of recovery of pyuria in group 1 (5.2 +/- 9.6 days) was not longer than that in group 2 (3.1 +/- 2.9 days) (p > 0.05). The length of defeverscence in group 1 (7.0 +/- 4.6 days) was longer than in group 2 (3.5 +/- 2.7 days) (p < 0.05). There were no differences between group 1 and group 2 in the rate of predisposing factors. Thirteen of 21 cases (61.9%) in group 1 and five of 14 cases (35.7%) in group 2 had positive urine culture results which are relatively low probably due to the administration of antibiotics prior to our emergency room visit. Perfusion defects on CT were very frequent findings (60.0% of the clinical acute pyelonephritis patients). We classified CT findings of group 1 as focal unilateral (2 cases, 9.5%), multifocal unilateral (14 cases, 66.7%) and multifocal bilateral (5 cases, 23.8%), and there were no differences between the subgroups of group 1 in the duration of defeverscence. CONCLUSION: Those patients who had perfusion defects on CT showed relatively severe clinical courses but responses to early antibiotics were very good. Contrast enhanced CT scans may be very sensitive for the detection of acute renal parenchymal inflammatory disease and for defining the extent of disease, but it is clinically not essential to perform in the early uncomplicated acute pyelonephritis because CT diagnosis does not change management. Clinical use of contrast enhanced CT scan may be appropriate in case of persistence of fever and leukocytosis for more than seven days despite antibiotic treatment.

Acute Disease↗
PubMed2006

[Renal scars after one year of follow up in children with a first episode of acute pyelonephritis].

BACKGROUND: Acute pyelonephritis in children can leave a kidney scar that eventually can lead to hypertension or renal failure. 99mTc-dimercaptosuccinic acid renal scintigraphy (RC DMSA) is a widely accepted technique to assess children with acute pyelonephritis. AIM: To evaluate the presence of residual kidney scars detected through RC DMSA, in children with a first episode of acute pyelonephritis. PATIENTS AND METHODS: Clinical records of children with a first episode of acute pyelonephritis that were assessed within seven days of the episode with RC DMSA were reviewed. Children were considered eligible if they did not have a new episode of acute pyelonephritis and a second RC DMSA, one year after the first episode, was performed. The presence or absence of a renal scar after one year was associated to demographic, scintigraphy and laboratory variables. RESULTS: Fifty nine children, aged 1 month to 10 years, 35 females, were studied. Thirty nine percent had a renal scar in the scintigraphy perfomed after one year of follow up. The presence of a scar was correlated with a C reactive protein over 130 mg/dl and an altered relative renal function (below 44%), during the acute phase. CONCLUSIONS: A high C reactive protein and alterations of relative renal function during the acute phase of acute pyelonephritis in children, may be risk factors for the development of renal scars in the long term follow up.

Acute Disease↗
PubMed1999

[Role of IL-8 and defensins in pathogenesis of chronic glomerulonephritis and pyelonephritis].

AIM: The study of interleukine-8 (IL-8) and defensines contribution to pathogenesis of chronic glomerulonephritis (CGN) and pyelonephritis (PN). MATERIALS AND METHODS: 122 patients were assigned to three groups: 42 CGN patients with isolated urinary syndrome (group 1); 60 patients with chronic pyelonephritis (CP) with normal nitrogen-excretory function (group 2); 20 patients with CGN and chronic renal failure (CRF) (group 3). 24 healthy volunteers served control. IL-8 and defensines were measured in urine and plasm of all the patients and controls using enzyme immunoassay. RESULTS: IL-8 in urine and plasm of controls was not found, in plasm of patients was found in 45%, the differences between the groups being insignificant. The highest IL-8 urine concentration was found in group 2. It was significantly higher than in group 1 and 3 (p < 0.001). Mean IL-8 urine concentration in patients with secondary pyelonephritis was significantly higher than in those with primary pyelonephritis (p < 0.05). In primary pyelonephritis, urinary IL-8 was higher than in patients of groups 1 and 3 (p < 0.001). Mean urinary IL-8 was significantly higher in patients of group 3 than 1 (p < 0.005). IL-8 urinary concentrations of group 3 patients tended to an increase with growing severity of renal failure. Plasm defensines were present in 46.5% of patients without marked differences between the groups. Urine defensines were the highest in group 2 being significantly higher than in group 1, 3 and controls (p < 0.001). Urine defensines in group 1 were slightly higher than in controls and significantly reduced vs group 3 (p < 0.005). Urine defensines concentrations rose with CGN stage. A strong positive correlation was established between IL-8 and defensines in urine (r = 0.62), leukocyturia and IL-8 in urine (r = 0.52). A weak positive correlation (r = 0.38) existed between proteinuria and urine IL-8 only in group 3 patients. A week later concentrations of IL-8 and defensines were low in group 2. In group 1 they rose, fell or remained unchanged. CONCLUSION: IL-8 and defensines may be of the same pathogenetic importance both in infectious and non-infectious inflammation in the kidneys. Cytotoxic action of defensines can be related to location of the inflammation in the kidney. IL-8 urine tests can be used in monitoring of inflammation activity and diagnosis of latent glomerulonephritis and pyelonephritis.

Adolescent↗
PubMed2001

The management of acute pyelonephritis in adults.

Acute pyelonephritis should be classified clinically at the time of presentation into either uncomplicated or complicated categories. The diagnostic workup includes history, physical examination, urinalysis (including a Gram stain), and urine culture. Patients with suspected complicated pyelonephritis require the standard assessment plus blood cultures and urinary tract imaging, preferably a computed tomography (CT) scan. Patients with moderate, uncomplicated pyelonephritis can be managed as outpatients with either a fluoroquinolone (7-14 days) or trimethoprim/sulfamethoxazole (at least 14 days). Patients with severe, uncomplicated pyelonephritis can be considered for short-term hospitalization and initial administration of intravenous antibiotics. Therapy for patients with complicated pyelonephritis should include initial hospitalization, supportive therapies, administration of wide spectrum intravenous antibiotic therapy, and relief of aggravating conditions. Such maneuvers could consist of simple bladder catheterization, percutaneous nephrostomy drainage, or definitive surgery. Patients with complicated pyelonephritis require longer duration of culture-specific antibiotic dosing, careful monitoring, long-term follow-up, and possible definitive management of their underlying condition.

Acute Disease↗
PubMed2001

[Procalcitonin in pyelonephritis and acute community-acquired pneumonia in adults].

OBJECTIVES: Procalcitonin (PCT) is an acute-phase protein involved in the specific inflammatory reaction to severe bacterial or fungal infections. This protein does however lack sensitivity in focal infections. PATIENTS AND METHODS: In this study, we investigated PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocytosis, and fibrinogen levels at admission among adult patients hospitalized for community-acquired pneumonia (n = 33) or pyelonephritis (n = 30) and in a control population (n = 27) of patients with viral infections and non-infectious inflammatory diseases. RESULTS: Median serum PCT in the control group (0.21 ng/ml) was significantly lower than in the pyelonephritis group (0.46 ng/ml, p < 0.0005) or the pneumonia group (0.88 ng/ml, p < 0.0005). In the control group, median CRP was 51.4 ng/l reaching 220 mg/l in the pyelonephritis and 198 mg/l in the pneumonia group (p < 0.0005 in both cases). The other markers of inflammation investigated (leukocytosis, ESR, fibrinogen) did not show such differences between the control group and the sepsis groups. The sensitivity of PCT (threshold 0.5 ng/ml) was 61% for the diagnosis of pneumonia and 44% for the diagnosis of pyelonephritis. Specificity was 92% in both cases. In comparison, the sensitivity of CRP (threshold 50 mg/l) was 94% and 91% for pyelonephritis and pneumonia respectively with a 33% specificity in both cases. CONCLUSION: PCT is a specific but poorly sensitive marker of community-acquired pneumonia and pyelonephritis among adults hospitalized in medical wards.

Adult↗
PubMed2002

Computed tomographic diagnosis of unsuspected pyelonephritis in children.

OBJECTIVE: To emphasize the utility of computed tomography (CT) in the diagnosis of pyelonephritis in children with complex comorbidities. METHODS: We retrospectively reviewed the CT imaging studies and medical records of 12 patients (8 girls, 4 boys; aged 2-18 years [mean 8.6 yr]) who did not have a classic presentation of pyelonephritis but were diagnosed by CT. All patients had fever at clinical presentation, and pyelonephritis was not suspected in any case. Two children had negative urine cultures before imaging. RESULTS: All 12 patients had wedge-shaped areas of hypoattenuation on CT, 7 bilaterally; 10 had enlargement of an involved kidney; 5 had perinephric fat stranding; and 3 had focal abscesses. CONCLUSIONS: Although classic and uncomplicated pyelonephritis is a clinical diagnosis that does not require imaging, sometimes the presentation may be equivocal and the diagnosis unsuspected. Pyelonephritis is one of several potential sources of fever that can be simultaneously evaluated using CT. Using. CT, the unsuspected diagnosis of pyelonephritis can be made and therapy initiated before the urine culture is positive.

Adolescent↗
PubMedDate not supplied

[Current radiation diagnosis of pyelonephritis].

The paper deals with the current diagnosis of nonspecific and specific (tuberculosis) acute and chronic pyelonephritis. Having rather ample materials (308 patients with different forms of acute and chronic pyelonephritis), the authors compared different introscopic techniques (plain X-ray study, excretory urography, retrograde pyelography, ultrasonography, computed tomography and angiography) used in the diagnosis and monitoring of patients with pyelonephritis. Based on their own findings and on the data available in the literature, the authors described the symptomatology of pyelonephritis in detail by using a great variety of diagnostic techniques. The paper shows the place and potentialities of conventional X-ray in a variety of current diagnostic studies and the potentialities of imaging techniques in recognizing pyelonephritis, assessing their extent and the reserve potentialities of the diseased kidney. The authors show that the rational use of routine and current radiographic techniques is of great diagnostic and prognostic value, enhances the efficiency of therapy for pyelonephritis, shortens treatment periods, reduces the number of radical nephrectomies by using organ-sparing operations more widely, and decreases mortality rates.

Acute Disease↗
PubMed1989

[Clinical efficacy of ceftriaxone administered once daily against pyelonephritis].

Ceftriaxone (CTRX) was evaluated for clinical efficacy on uncomplicated and complicated pyelonephritis by administering 2 g once daily for 5 days to 16 female patients between 20 and 65 years old (average: 39.7 years); i.e., 3 with uncomplicated pyelonephritis and 13 with complicated pyelonephritis. The pathogens in all 3 cases of uncomplicated pyelonephritis were E. coli. All of them disappeared after the treatment. Twenty-two strains of 10 strains of bacteria were isolated from the 13 cases of complicated pyelonephritis. Twenty of the 22 (91%) strains disappeared. The clinical efficacy was evaluated according to the Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on UTI Japan in 15 cases except for 1 case of the complicated type where the CTRX administration was discontinued after the initial dose due to an adverse event. The efficacy rate was 100% in the 3 uncomplicated cases; 'excellent' in 1 case and 'good' in 2, and 92% in 12 of the complicated cases; 'excellent' in 9, 'good' in 2 and 'poor' in 1 (infection was with multiple pathogens including P. aeruginosa). No abnormal values were observed in any cases except for a slight increase in glutamic-pyruvic transaminase and alkaline phosphatase in one case and skin rash in another case which appeared following the initial dose and required the immediate withdrawal of the drug. CTRX is characterized by a long half-life and shows a strong antibacterial activity against GNRs, especially E. coli. The efficacy rate was high particularly following the initial dose in the acute stage of pyelonephritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1971

Bacteremia in the pathogenesis of retrograde E. coli pyelonephritis in the rat.

Female rats deprived of water overnight, and then given 1.0 ml of E coli 0111:B4 via the urethra, developed pyelonephritis. A nearly absolute association was found between the occurrence of bacteremia after the transurethral infusion and the development of pyelonephritis. An identical lesion was produced by a combination of forniceal damage and intravenous injection of E coli. The kidney damaged by reflux was shown to be more susceptible to hematogenous pyelonephritis than the obstructed kidney and the distribution of the infection was due to localization of bacteria in the damaged fornix but not to the route of infection. The induction of retrograde E coli pyelonephritis in the rat required a tear in the pelvic epithelium creating pyelovenous communications, and the resultant bacteremia produced pyelonephritis. The incidence of ureteral reflux and the volume of inoculum that refluxed to the renal pelvis was shown radiologically to be a function of bladder distensibility, which is reduced by withholding water for a few hours. In this system, retrograde E coli pyelonephritis developed from a combination of two factors: (1) reflux-induced damage to the renal pelvis so that E coli are introduced into the kidney and (2) hematogenous infection of the damaged kidney.

Animals↗
PubMed1980

[Diagnostic significance of lysozymuria in chronic pyelonephritis].

Lysozymuria was studied in 70 patients with chronic pyelonephritis with preserved renal function and two groups of 18 patients each with pyelonephritis, with chronic renal insufficiency (CRI) and glomerulonephritis without CRI. Elevated value of lysozyme in urine was obtained in 40% of the patients with chronic pyelonephritis with preserved renal function and in 66.6% of those with chronic pyelonephritis in the stage of a chronic renal insufficiency. Lysozyme level in urine is in a correlation dependence on serum creatinine level. Lysozymuria is more frequent among patients with pyelonephritis with significant bacteriuria as well as among patients not treated with uroantiseptics. Lysozymuris is present in two patients with nephrotic syndrome from the patient group with glomerulonephritis and in two with probable not complicated chronic pyelonephritis.

Adolescent↗
PubMedDate not supplied

[Pyelonephritis in children].

Fifty cases with pyelonephritis were found among 1314 histopathologic studies performed at Children's Hospital of Cordoba, Argentine from 1967 to 1976. Twenty-six had urologic abnormalities. Most of them were males over two years old. Eleven had unilateral pyelonephritis. Twenty-four had clinical and pathological signs of septicemia or infection. No sex difference was found and most of them were infants under two years of age. All patients had bilateral pyelonephritis. Twenty-four patients showed positive urine culture before death. They also showed clinical features, urinary concentration inability and pyelographic changes that suggest pyelonephritis. Our conclusions are that pyelonephritis is not common among children, and appeares only associated with systemic infection or urologic abnormalities. Clinical signs, urinary examination and intravenous pyelography are useful in the diagnosis of pyelonephritis.

Child↗
PubMed1995

[Results and substantiation of surgical strategy in acute suppurative-destructive pyelonephritis in pregnant women].

The effectiveness of treatment of acute purulent pyelonephritis in 2.256 pregnant women from 1986 to 1992 was analysed. 95-97% of them had diffuse purulent (nondestructive) pyelonephritis which was cured by drug treatment. Pyodestructive manifestations (apostematosis, carbuncle, abscess of the kidney) of uni- (84.8%) and bilateral (15.2%) pyelonephritis were found in 85 (3.8%) of the patients. Signs of pyoseptic intoxication predominated in the clinical picture. Antibacterial and detoxification therapy was applied in the pre- and postoperative periods. The choice of the surgical tactics and operative method was based on the peculiarities of the clinical course, the revealed complications, and the anatomical changes in the kidney. Nephrostomy and antibacterial therapy are sufficient for curing the apostematic form. Patients with a bilateral affection were treated by operative stage-by-stage kidney drainage (nephrostomy). When economical operations were ineffective clinically (9.4%), secondary nephrectomy was indicated. Primary nephrectomy is an adequate surgical intervention in cases of a total destructive process in the kidney, grave septic manifestations, and a toxic response of the liver. The high proportion of nephrectomies (37.6%) is explained by the clinicoanatomical severity of focal-purulent pyelonephritis and its complications (sepsis) which hazard the life in pregnancy. Pliant surgical tactics in the treatment of severe forms of pyodestructive pyelonephritis ensured clinical cure of 96.5% of patients and uneventful delivery in 91.8% of cases. Death occurred from sepsis and bacteriotoxic shock which developed due to purulent pyelonephritis of pregnancy.

Acute Disease↗
PubMed1993

[Bacteriology of urinary germs responsible of pyelonephritis].

Cytobacteriological examination of urine is indispensable in patients with acute or chronic pyelonephritis. Direct examination through the microscope is fundamental in acute pyelonephritis where immediate antibiotic therapy is mandatory. A significant bacteriuria points to an obstacle to urine flow. Escherichia coli is the most common pathogen in acute and chronic pyelonephritis. Isolating a Proteux strain suggests that lithiasis is present. Pseudomonas aeruginosa always has a nosocomial origin and is often responsible for chronic asymptomatic pyelonephritis. Staphylococci and enterococci may produce pyelonephritis, notably when it is associated with urinary stones. Since hospital- or community-acquired strains of E. Coli are strongly resistant to aminopenicillins and cotrimoxazole, these antibacterials must not be used as first-line treatment of pyelonephritis.

Acute Disease↗
PubMed1997

Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience.

PURPOSE: We investigated the effect of percutaneous drainage for the treatment of emphysematous pyelonephritis. MATERIALS AND METHODS: A retrospective analysis was done of 25 patients with emphysematous pyelonephritis who were treated initially with computerized tomography (CT) guided percutaneous drainage during a 10-year period. The patients were concomitantly treated with antibiotics, fluids, and correcting blood glucose and/or ureteral obstruction. We also compared our results of percutaneous drainage to CT findings. RESULTS: CT identified 12 patients with emphysematous pyelonephritis who had gas with little fluid and 13 who had gas with renal or perirenal fluid collections. In 20 of 25 patients (80%) antibiotic therapy combined with percutaneous drainage constituted the only treatment required. Three patients (12%) whose clinical status improved after percutaneous drainage subsequently underwent elective nephrectomy without further complications. Two patients (8%) died of multiple organ failure. There was no correlation between the gas patterns of emphysematous pyelonephritis and initial success with the antibiotics and percutaneous drainage. There were no recurrences and no complications during a followup of 1 to 10 years (mean 5). Mean duration of treatment was 5.54 weeks (range 1 to 12.6). CONCLUSIONS: CT is an efficient imaging method for diagnosis, guiding the drainage procedures and monitoring response to percutaneous drainage of emphysematous pyelonephritis. Antibiotic therapy combined with CT guided percutaneous drainage of emphysematous pyelonephritis is an acceptable alternative to antibiotic therapy with surgical intervention.

Adult↗
PubMedDate not supplied

[The level of interleukins (IL-1 and IL-2) and of IL-2R+ cells in patients with acute and chronic pyelonephritis].

It has been shown that in patients with acute pyelonephritis a spontaneous production of the interleukin IL-1 remains unchanged, while that stimulated with the aid of LPS is significantly below the norm. A spontaneous secretion of IL-2 in patients with chronic pyelonephritis has also been found unchanged, whereas in acute pyelonephritis this same parameter tends to rise above the level recordable in healthy donors. The production of this lymphokine stimulated with the aid of PhHA is significantly lower both in acute and chronic pyelonephritis. The level of cells carrying receptors to IL-2 is appreciably above the norm in patients with acute pyelonephritis, whereas in those presenting with the chronic process this parameter does not differ from that in the control group. The data obtained suggest distinctive features in the interleukin link of immunity (IL-1, IL-1, IL-2P) in patients with pyelonephritis.

Acute Disease↗
PubMed1994

Interleukin-6 and interleukin-8 in the urine of children with acute pyelonephritis.

Interleukin-6 (IL-6) and interleukin-8 (IL-8) are important mediators of the inflammatory response in serious bacterial infections. We studied the levels of these two cytokines (standardised for urinary creatinine) in the urine of infants and children during and 6 weeks after acute pyelonephritis and in non-renal febrile controls and healthy children without apparent infection. IL-6 was detected in the urine of 52% of children with pyelonephritis compared with 15% of other children (P < 0.001). The median urinary IL-6 level in acute pyelonephritis was 4 pg/mumol compared with undetectable levels in the control group (P < 0.001). IL-8 was detected in 98% of children with pyelonephritis and 42% of other children (P < 0.001). The median concentration of IL-8 was 188 pg/mumol in pyelonephritis; it was undetectable in controls (P < 0.001). IL-8 levels were higher in children less than 1 year of age (P < 0.001).

Acute Disease↗
PubMed1995

D-arabinitol versus mannan antigen and candidal protein antigen as a serum marker for Candida pyelonephritis.

To evaluate serum markers for the diagnosis of Candida pyelonephritis, levels of D-arabinitol, candidal mannan antigen and candidal protein antigen were measured using an enzymatic fluorometric assay, an enzyme immunoassay and a latex agglutination assay, respectively. The study group comprised 36 patients with candiduria (11 disseminated candidiasis, 9 Candida pyelonephritis and 16 colonization) and 27 without candiduria. The D-arabinitol/creatinine ratio was the only marker that differentiated between Candida pyelonephritis and colonization (p < 0.01). Using the cut-off values (1.4 mumol/mg of D-arabinitol/creatinine ratio, 0.28 of mannan/creatinine ratio (x 10(4)) and 1:4 of protein antigen titer) D-arabinitol/creatinine ratio showed the highest sensitivity in Candida pyelonephritis (77.8%) as compared to mannan/creatinine ratio (55.6%) and protein antigen titer (11.1%) although there were no differences in specificity, positive predictive value or negative predictive value. These results suggest that D-arabinitol/creatinine ratio is the most useful marker of Candida pyelonephritis.

Aged↗