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At least 19 recordsLinked to original sources
PubMed1988

[A clinical study of xanthogranulomatous pyelonephritis with special emphasis on the differential preoperative diagnosis between xanthogranulomatous pyelonephritis and renal cell carcinoma].

An accurate preoperative diagnosis of xanthogranulomatous pyelonephritis is difficult because of its clinical and radiological similarities to renal cell carcinoma. We report two cases of xanthogranulomatous pyelonephritis. Furthermore, in an attempt to clarify the clinical distinction between this entity and renal cell carcinoma, we summarize the clinical characteristics of 143 cases with xanthogranulomatous pyelonephritis in the literature and 126 cases with renal cell carcinoma experienced in our clinic. According to the clinical reviews, several characteristics of xanthogranulomatous pyelonephritis were revealed. 1) Presence of history of pyelonephritis. 2) gamma-globulinemia in blood chemistry. 3) Non-visualizing kidney on the excretory urogram. 4) Hypovascular or avascular features and dilatation of renal capsular arteries on angiogram. 5) Heterogenous renal mass and thickness of Gerota's fascia on computed tomogram. 6) Positive uptake of renal mass in Ga-scintigram. When some of these features are found in the renal mass, the case could be of xanthogranulomatous pyelonephritis and therefore a kidney preserving operation should be considered.

Carcinoma, Renal Cell↗
PubMed1982

Pyelonephritis in pregnancy: its role in the production of maternal infective calculi and infantile pyelonephritis.

A review of 910 cases is presented, with regard to the late consequences of pyelonephritis in pregnancy affecting both the mother and the child. Late recurrences of pyelonephritis in the mother and pyelonephritis in the child have been likewise registered. According to statistical figures, pyelonephritis in pregnancy greatly increases the hazard of calculus formation. The necessity for a long-term follow-up of mother and child after pyelonephritis in pregnancy is stressed. The significance of the measures to be taken in case of asymptomatic bacteriuria is pointed out.

Female↗
PubMed1989

[A case of emphysematous pyelonephritis combined with xanthogranulomatous pyelonephritis].

A case of emphysematous pyelonephritis, xanthogranulomatous pyelonephritis histologically, is reported. A 49-year-old female patient was referred to our department from the department of internal medicine because abdominal ultrasonography demonstrated left renal swelling with gas echo. Computed tomographic scan showed much emphysema in the left kidney. Although aggressive treatment with broad spectrum antibiotics and immunoglobulin had been performed, subfever and left lumbago continued. Thereafter, she underwent left nephrectomy, and histological findings revealed xanthogranulomatous pyelonephritis. In the Japanese literature 27 cases of emphysematous pyelonephritis have been reported. Many cases are in middle-aged females and 85% of these cases complicated with diabetes mellitus. E. coli and Klebsiella was the main causative organism. The mortality of this disease was 26%. This report is the first case combined with xanthogranulomatous pyelonephritis in Japan. We recommend adequate chemotherapy and timely surgical treatment for good results.

Diabetes Complications↗
PubMed1974

Immunization against retrograde pyelonephritis. I. Production of an experimental model of severe ascending Escherichia coli pyelonephritis without bacteremia in rats.

Retrograde pyelonephritis was produced in rats by introducing into the bladder a small refluxing inoculum of Escherichia coli that would enter the renal pelvis but not the blood stream. At the same time the left ureter was partially obstructed for 18 hours. This model differs from previous attempts to produce E coli pyelonephritis with large (0.6 ml) volumes infused into the bladder, because such large volumes cause bacteremia and hematogeneous pyelonephritis. Since retrograde E coli pyelonephritis in patients is not accompanied by positive blood cultures, the model described in this report is believed to accurately mimic human pyelonephritis and to allow a realistic approach to the study of immunity against retrograde infection in the urinary tract.

Animals↗
PubMedDate not supplied

Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial.

CONTEXT: The optimal antimicrobial regimen and treatment duration for acute uncomplicated pyelonephritis are unknown. OBJECTIVE: To compare the efficacy and safety of a 7-day ciprofloxacin regimen and a 14-day trimethoprim-sulfamethoxazole regimen for the treatment of acute pyelonephritis in women. DESIGN: Randomized, double-blind comparative trial conducted from October 1994 through January 1997. SETTING: Twenty-five outpatient centers in the United States. PATIENTS: Of 378 enrolled premenopausal women aged at least 18 years with clinical diagnosis of acute uncomplicated pyelonephritis, 255 were included in the analysis. Other individuals were excluded for no baseline causative organism, inadequate receipt of study drug, loss to follow-up, no appropriate cultures, and other reasons. INTERVENTIONS: Patients were randomized to oral ciprofloxacin, 500 mg twice per day for 7 days (with or without an initial 400-mg intravenous dose) followed by placebo for 7 days (n = 128 included in analysis) vs trimethoprim-sulfamethoxazole, 160/800 mg twice per day for 14 days (with or without intravenous ceftriaxone, 1 g) (n = 127 included in the analysis). MAIN OUTCOME MEASURE: Continued bacteriologic and clinical cure, such that alternative antimicrobial drugs were not required, among evaluable patients through the 4- to 11-day posttherapy visit, compared by treatment group. RESULTS: At 4 to 11 days posttherapy, bacteriologic cure rates were 99% (112 of 113) for the ciprofloxacin regimen and 89% (90 of 101) for the trimethoprim-sulfamethoxazole regimen (95% confidence interval [CI] for difference, 0.04-0.16; P = .004). Clinical cure rates were 96% (109 of 113) for the ciprofloxacin regimen and 83% (92 of 111) for the trimethoprim-sulfamethoxazole regimen (95% CI, 0.06-0.22; P = .002). Escherichia coli, which caused more than 90% of infections, was more frequently resistant to trimethoprim-sulfamethoxazole (18%) than to ciprofloxacin (0%; P<.001). Among trimethoprim-sulfamethoxazole-treated patients, drug resistance was associated with greater bacteriologic and clinical failure rates (P<.001 for both). Drug-related adverse events occurred in 24% of 191 ciprofloxacin-treated patients and in 33% of 187 trimethoprim-sulfamethoxazole-treated patients, respectively (95% CI, -0.001 to 0.2). CONCLUSIONS: In our study of outpatient treatment of acute uncomplicated pyelonephritis in women, a 7-day ciprofloxacin regimen was associated with greater bacteriologic and clinical cure rates than a 14-day trimethoprim-sulfamethoxazole regimen, especially in patients infected with trimethoprim-sulfamethoxazole-resistant strains.

Acute Disease↗
PubMed1985

Experimental pyelonephritis in the monkey. VII. Ascending pyelonephritis in the absence of vesicoureteral reflux.

Six adult male nonrefluxing monkeys were experimentally infected by inoculation of P-fimbriated E. coli into the bladder. Eight control monkeys were inoculated with a non-P-fimbriated E. coli strain. Inoculation with the P-fimbriated E. coli resulted in marked leukocytosis, prolonged bacteriuria and loss of renal function with a 66 per cent incidence of pyelonephritis. Death secondary to bilateral pyelonephritis was seen in 2 monkeys inoculated with P-fimbriated E. coli. Pyelonephritis was not seen in any of the monkeys inoculated with non-P-fimbriated E. coli. The study shows that ascending pyelonephritis can occur in monkeys in the absence of vesicoureteral reflux.

Animals↗
PubMed1977

Immunization against retrograde pyelonephritis. III. Vaccination against chronic pyelonephritis due to Escherichia coli.

Vaccination with formalin-treated cells of Escherichia coli serotype O6 protected against unilateral retrograde pyelonephritis due to E. coli O6 in rats with partial ureteral obstruction. This protection was manifested not only by less parenchymal destruction and shrinkage of the pyelonephritic left kidney, but also by less secondary pyelonephritis and compensatory hypertrophy in the opposite right kidney. Vaccinated rats eliminated E. coli from the kidney more rapidly, but even when infection persisted in the kidney, the chronic pyelonephritis was less severe in vaccinated rats. High levels of antibody to E. coli lipopolysaccharide were found in vaccinated animals and may have contributed to protection. These results raise the question of whether vaccination ought to be considered for patients predisposed to chronic bacterial pyelonephritis.

Animals↗
PubMed1998

Cefepine vs. ceftazidime treatment of pyelonephritis: a European, randomized, controlled study of 300 pediatric cases. European Society for Paediatric Infectious Diseases (ESPID) Pyelonephritis Study Group.

BACKGROUND: Cefepime has been used in clinical therapeutic trials for meningitis, serious infection and febrile neutropenia, comprising more than 800 pediatric patients. This agent has also been used in patients 12 years of age and older with uncomplicated and complicated urinary tract infections including pyelonephritis, but not in younger patients. In this study the safety and efficacy of cefepime were compared with those of ceftazidime for treatment of pyelonephritis in pediatric patients younger than 12 years of age. METHODS: Two hundred ninety-nine pediatric patients (ages 1 month to 12 years) with pyelonephritis (300 episodes) were enrolled in a randomized, open label, multicenter trial. Individual results were evaluated by a blinded committee of experts. Cefepime was compared with ceftazidime, both administered parenterally at 50 mg/kg every 8 h. Patients were to receive the assigned study drug until at least 48 h after becoming afebrile. The i.v. treatment was then to be continued or replaced by oral trimethoprimsulfamethoxazole for a maximum of 12 to 14 days. RESULTS: The predominant causative pathogens were Escherichia coli, 88%; Proteus spp., 6%; Pseudomonas aeruginosa, 2%; and Klebsiella spp., 2%. Bacteriologic eradication was achieved in 96 and 94% of cefepime and ceftazidime patients, respectively, at the end of i.v. study drug treatment and was maintained in 94 and 91%, respectively, at the end of total study therapy. After study therapy bacteriologic eradication was maintained after 4 to 6 weeks in 86% of cefepime cases and in 83% of ceftazidime cases. A satisfactory clinical response occurred in 98 and 96% of cefepime and ceftazidime patients, respectively, at the end of i.v. treatment and in 93% at the end of total study therapy in both treatment arms. Drug-related clinical adverse events occurred in 14 cefepime patients (91%) and in 10 ceftazidime patients (7%). CONCLUSIONS: Cefepime and ceftazidime are equally safe and efficacious treatment for pyelonephritis in pediatric patients.

Administration, Oral↗
PubMed1985

Molecular basis of Escherichia coli colonization of the upper urinary tract in BALB/c mice. Gal-Gal pili immunization prevents Escherichia coli pyelonephritis in the BALB/c mouse model of human pyelonephritis.

Most human pyelonephritis Escherichia coli isolates express both mannose (MS)- and globoside (Gal-Gal)-binding pili. An ascending E. coli urinary tract infection model was established in the 16-wk-old female BALB/c mouse to compare the pathogenic significance of MS and Gal-Gal pili and their efficacy as vaccines for the prevention of pyelonephritis. The distribution and density of pilus receptor compounds in urogenital tissues and as soluble compounds in urine were determined with antibodies to the synthetic receptor analogues, alpha D-Gal(1----4) beta D-Gal and alpha D-Man(1----2) alpha D-Man. Both carbohydrates were detected in vagina, bladder, ureter, and renal pelvis epithelium and in collecting duct and tubular cells. A pilus receptor compound also was detected in urine. It competitively inhibited the binding capacity of MS pili and was found to be physically, chemically, and immunologically related to Tamm-Horsfall uromucoid. Infectivity and invasiveness were quantitatively and histologically characterized for four E. coli strains: J96, a human pyelonephritis strain that expresses both MS and Gal-Gal pili; two recombinant strains prepared from J96 chromosomal DNA encoding MS pili or Gal-Gal pili; and the nonpiliated K12 recipient. Intravesicular administration of J96 (10(6) colony-forming units [CFU]) resulted in renal colonization and invasion in each of nine mice. The Gal-Gal clone (10(6) CFU) colonized the kidneys in each of 10 mice but did not invade. In contrast, the MS clone (10(6) CFU) did not colonize renal epithelium or invade. This effect was superceded when larger doses (greater than or equal to 10(10) CFU) of the MS clone were administered in volumes that cause acute vesicoureteric reflux. The efficacy was determined of vaccines composed of pure MS or Gal-Gal pili or the lipopolysaccharide containing O somatic antigen of the challenge strain, J96. The Gal-Gal pilus vaccine blocked renal colonization in 19 of 22 mice and renal invasion in 10 of 11 mice. Gal-Gal pili may be useful immunogens for the prevention of pyelonephritis in anatomically normal urinary tracts.

Animals↗
PubMed1976

Experimental pyelonephritis: the effect of chronic active pyelonephritis on renal function.

In these experiments, renal function in chronic active pyelonephritis was investigated and the effect of antibiotic treatment and elimination of infection on the gross pathology, histopathology and renal function in animals with chronic pyelonephritis was determined. A severe loss of urine concentrating capacity was demonstrable when the maximum urinary osmolality of a group of animals with pyelonephritis was compared with control animals. Concentrating capacity decreased sharply over the first month but further loss over an eight-month period was minimal. A compensatory increase in the glomerular filtration rate (GFR) in the control, nonchallenged, group occurred after nephrectomy but no comparable compensation in the infected group was found. Antibiotic therapy had a marked effect on the urinary concentrating capacity and the defect in concentrating ability was significantly less in the treated animals during the first 30 days after challenge. Infection again prevented a compensatory increase in the GFR of pyelonephritic animals which was not reversed by antibiotic therapy. Blood urea concentrations in treated and nontreated animals were not significantly different nor did the eradication of infection affect the gross pathologic and histopathologic changes found at autopsy.

Animals↗
PubMed1972

Pyelonephritis. XIV. Effect of immunization on experimental Escherichia coli pyelonephritis.

Mice immunized subcutaneously with heat-killed Escherichia coli were protected from pyelonephritis produced by the intravenous route, but there was little or no protection from ascending infection. No significant protection from ascending or hematogenous pyelonephritis was demonstrated when immunization was accomplished by injecting heat-killed E. coli into the bladder. Heat-killed E. coli injected either subcutaneously or into the bladder protected mice from early endotoxic death after intravenous or bladder challenge.

Adjuvants, Immunologic↗
PubMed1989

Gal-Gal pili vaccines prevent pyelonephritis by piliated Escherichia coli in a murine model. Single-component Gal-Gal pili vaccines prevent pyelonephritis by homologous and heterologous piliated E. coli strains.

The initial pathogenic step in nonobstructive Escherichia coli pyelonephritis usually involves the binding of a bacterial adhesin with host uroepithelial glycoprotein receptors containing the D-Gal p alpha 1----4 D-Gal p beta 1 (Gal-Gal) moiety. In this study, groups of mice were immunized with Gal-Gal pili and challenged 2 wk later intravesicularly with E. coli strains expressing homologous or heterologous pili. 63 of 129 pili-immunized mice (49%) were protected from subsequent E. coli renal colonization compared with 5 of 85 control mice (6%). Among mice that had E. coli cultured from their right kidney, control mice had greater bacterial colony counts than pili-immunized animals (P less than 0.05). Light microscopic examination of kidneys demonstrated less histopathology among pili immunized mice than among control mice (P less than 0.05). Protection correlated with the presence of specific IgG antibodies in the urine and serum that bind to the major pilin structural polypeptide and not to the Gal-Gal pili tip adhesin per se. These results support the concept that immunization with a bacterial surface-coat constituent can prevent mucosal infection by interfering with colonization. Also Gal-Gal pili of E. coli represent a suitable candidate for immunoprophylaxis against pyelonephritis.

Animals↗
PubMed1985

[Acute primary pyelonephritis or active phase of a latent form of chronic pyelonephritis?].

Analyzing the data of a comprehensive examination of 372 patients admitted to hospital with a distinct clinical picture of acute pyelonephritis, the author shows that out of these patients' population, 278 (74.8%) had an active form of chronic disease running a latent course. At the same time 40.4% of cases were diagnosed to have chronic renal failure (CRF), stages IB-IIB. To determine the genuine character of renal injury, the author thinks it necessary to regard the symptom-complex of acute pyelonephritis as a consequence of the pyelonephritic process itself. In complicated cases of the diagnosis, biopsy of the kidney concerned is required. In 176 patients the final diagnosis was established by uroradiological examination, in 59 by means of the use of laboratory methods, and in 137 by biopsy of the involved kidney. It is recommended that patients with renal pathology should be kept under prolonged dispensary observation, particularly those with an initial stage of CRF.

Acute Disease↗
PubMed1978

Experimental pyelonephritis. V. Functional characteristics of pyelonephritis.

Changes in renal and ureteral function were studied in monkeys with experimental pyelonephritis, and correlated with the findings of 131I Hippuran scintiphotos. During the acute phase, delayed excretion of radionuclide was found to be a combined result of prolonged intrarenal as well as ureteral transit times. During the chronic phase, scintiphoto studies revealed decreased renal uptake of radionuclide suggesting decreased renal blood flow. Subsequent individual renal function studies confirmed the decrease in renal function and provided data that strongly support the "intact nephron hypothesis" in chronic pyelonephritis.

Acute Disease↗
PubMed1984

Experimental pyelonephritis. The effect of T-cell deficiency on the course of hematogenous enterococcal pyelonephritis in the mouse.

The course of experimental hematogenous pyelonephritis due to Streptococcus faecalis was compared in athymic (nu/nu) mice and euthymic (nu/+) littermates. Up to 7 weeks following infection, there were no significant differences in renal microbial populations. At 63 and 107-131 days there was significant escalation of infection in nu/nu mice, while the nu/+ mice were decreasing their infections. There was no increase in gross abscess formation in nu/nu mice, but in late stages significantly more gross scarring occurred in nu/nu as compared with nu/+ mice. Microscopically there was also greater scarring in nu/nu mice late in the disease, except for calyceal lesions. The data suggest that immunologic factors (T cells) are involved in the pathogenesis of chronic pyelonephritis.

Agglutination Tests↗
PubMed1974

Pyelonephritis. 18. Effect of treatment on the pathology of enterococcal pyelonephritis in the rat.

The effect of antimicrobial therapy on the histopathologic progression of experimental hematogenous pyelonephritis induced in rats by Streptococcus faecalis was studied. Treatment sufficient to render the renal parenchyma sterile strikingly decreased the incidence and severity of calyceal lesions, delayed the progression of papillary lesions but had little effect on the severity of cortical interstitial and tubular alterations. L-forms could not be demonstrated to participate in the pathogenesis of these lesions. Kanamycin had an independent nephrotoxic effect which complicated interpretation of the effect of therapy in animals receiving this agent.

Animals↗
PubMed1974

Immunization against retrograde pyelonephritis. II. Prevention of retrograde Escherichia coli pyelonephritis with vaccines.

Vaccination with heat-killed or formalinized cells of E coli 0:111, or E coli 06 (Williams), prevented retrograde E coli pyelonephritis. Since there was no bacteremia and no urinary antibody, the vaccination appeared to protect by immune reactions operating in the kidney itself. The vaccine failed to protect against a highly virulent form of E coli 06 (Riffle), possibly because the amount of antibody to its lipopolysaccharide was inadequate. Since all three strains possessed K antigen in approximately equal amounts, the difference in results was not attributed to its presence.

Animals↗