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Rometti M, Patel D, Bryczkowski C. Xanthogranulomatous Pyelonephritis: Case Report. J Emerg Med 2024; 66:e534-e537. [PMID: 38485571 DOI: 10.1016/j.jemermed.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND In the emergency department (ED), pyelonephritis is a fairly common diagnosis, especially in patients with unilateral flank pain. Xanthogranulomatous pyelonephritis (XGP) is a rare type of pyelonephritis that is associated with unique features, which may lead to its diagnosis. CASE REPORT A 30-year-old male patient presented to the ED for evaluation of right-sided abdominal pain that has been ongoing for the past 24 hours. He noted the pain was located predominantly in the right flank and described it as sharp in nature. The pain was nonradiating and was associated with scant hematuria. He stated that he had similar pains approximately 1 month earlier that resolved after a few days. The patient underwent a bedside ultrasound and a subsequent computed tomography (CT) scan of the abdomen and pelvis, which showed an enlarged, multiloculated right kidney with dilated calyces and a large staghorn calculus, findings that represent XGP. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights an unusual variant of pyelonephritis, a relatively common ED diagnosis. XGP should be considered in patients with recurrent pyelonephritis, as treatment for XGP may require surgical intervention in addition to traditional antibiotic management.
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Affiliation(s)
- Mary Rometti
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Depesh Patel
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Kayano S, Yanagisawa T, Yata Y, Miyajima K, Hara S, Iwatani K, Sasahara T, Imai Y, Murakami M, Hata K, Yamamoto T, Kimura T. Impact of timing of urinary drainage on clinical outcomes in patients with obstructive pyelonephritis associated with upper urinary tract stones: a propensity score-matched analysis. World J Urol 2024; 42:147. [PMID: 38478082 DOI: 10.1007/s00345-024-04871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/08/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE We aimed to assess the impact of the timing of urinary drainage on clinical outcomes in patients with obstructive pyelonephritis (OPN) associated with upper urinary tract (UUT) stones. METHODS We retrospectively evaluated the multicenter dataset of 240 patients with OPN associated with UUT stones who underwent urinary drainage. We divided the patients into two groups depending on the timing of urinary drainage; emergency drainage, defined as within 12 h from admission, and delayed drainage, defined as between 12 and 48 h from admission. The outcomes were the length of hospital stay, time to leukocyte normalization, and time to body temperature normalization. One-to-two propensity score matching (PSM) was applied to minimize the effect of confounders between the two groups. Subsequently, predictive patient factors for emergency drainage were analyzed using the logistic regression model. RESULTS Only the time from admission to normal body temperature was significantly shorter in the emergency drainage group when compared with the delayed drainage group (median: 2 vs. 3 days; p = 0.02), while there was no difference in time from drainage to body temperature normalization between the two groups. On multivariable analysis, high pretreatment C-reactive protein (CRP) was associated with implementing emergency drainage within 12 h. CONCLUSIONS The timing of urinary drainage was only associated with the duration of high fever, but it did not affect the postdrainage course. Emergency urinary drainage is more likely to be performed in severe patients, such as high pretreatment CRP.
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Affiliation(s)
- Sotaro Kayano
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Ota Memorial Hospital, Gunma, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan.
| | - Yuji Yata
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, JR Tokyo General Hospital, Tokyo, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
| | - Shuhei Hara
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
| | - Taishiro Sasahara
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Machida Municipal Hospital, Tokyo, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Fuji City General Hospital, Shizuoka, Japan
| | - Masaya Murakami
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Fuji City General Hospital, Shizuoka, Japan
| | - Kenichi Hata
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Atsugi City Hospital, Kanagawa, Japan
| | - Toshihiro Yamamoto
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Tokyo-Kita Medical Center, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
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Chia JCH, Chong CJ, Yong YR, Tan PY. Wunderlich syndrome in a patient with pyelonephritis. BMJ Case Rep 2024; 17:e257325. [PMID: 38442961 PMCID: PMC10916142 DOI: 10.1136/bcr-2023-257325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
An elderly female patient with left pyelonephritis developed worsening left flank pain, hypotension and a drop in haemoglobin (Hb) from 97 g/L to 67g/L on the third day of her admission. There was no recent trauma, history of coagulopathy or risk factors for renal malignancy or vascular disease.A contrasted CT scan of the kidneys revealed a 3.8 cm left renal subcapsular haematoma with no active contrast extravasation. Her atraumatic subcapsular haematoma fulfils two out of three clinical features of Lenk's triad (acute flank pain, hypovolaemic shock), suggestive of Wunderlich syndrome. Urine and blood cultures grew Klebsiella pneumoniae and she was managed conservatively with culture-directed antibiotics, fluids and blood products.Wunderlich syndrome is a rare complication of pyelonephritis and should be considered in patients with pyelonephritis who develop acute severe flank pain, Hb drop and haemodynamic instability. Appropriate medical and surgical therapies need to be instituted early to ensure good outcomes.
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Affiliation(s)
| | | | - Yan Rong Yong
- Department of Radiology, Changi General Hospital, Singapore
| | - Poh Yong Tan
- Department of Internal Medicine, Singapore General Hospital, Singapore
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Kumar R, Chandran SK, Dangi AD, Kumar S. Emphysematous pyelonephritis with progression to necrotising fasciitis of the posterior cervical region and the retropharyngeal space. BMJ Case Rep 2024; 17:e257014. [PMID: 38320824 PMCID: PMC10859996 DOI: 10.1136/bcr-2023-257014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
A man in his 50s with diabetes presented with backache, left flank pain and fever. On evaluation, he was found to have emphysematous pyelonephritis of the left kidney with a paranephric abscess extending into the posterior abdominal wall and superiorly up to the posterior chest wall and inferiorly extending up to the posterior superior iliac spine. The management involved the initiation of broad-spectrum antibiotics and percutaneous drainage of the abscess. However, as he continued to worsen symptoms-wise, he underwent computed-enhanced CT of the abdomen and thorax. The imaging revealed the presence of a purulent collection in the left lumbar region with an extension along the posterior cervical region and the retropharyngeal space. He underwent a fasciotomy of the lumbar region. The occurrence of emphysematous pyelonephritis along with necrotising fasciitis is uncommon and requires early aggressive management with broad-spectrum antibiotics and adequate drainage. This emphasises the need for early reimaging if the patient does not settle with antibiotics or percutaneous drainage.
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Affiliation(s)
- Rakesh Kumar
- Urology, CMC Vellore, Vellore, Tamil Nadu, India
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Yang W, He C. Klebsiella-caused Bilateral Emphysematous Pyelonephritis and Emphysematous Cystitis in a Patient with Type 2 Diabetes. Balkan Med J 2024; 41:76-77. [PMID: 37815233 PMCID: PMC10767784 DOI: 10.4274/balkanmedj.galenos.2023.2023-8-77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023] Open
Affiliation(s)
- Wei Yang
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chendong He
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
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Zhan Z, Lin X, Li G, Zeng J, Su D, Liao J, Shen Q. Renal abscess complicating acute pyelonephritis in children: Two cases report and literature review. Medicine (Baltimore) 2023; 102:e36355. [PMID: 38050281 PMCID: PMC10695508 DOI: 10.1097/md.0000000000036355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/26/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE To describe the diagnostic and treatment approaches of renal abscesses complicated with acute pyelonephritis in children. PATIENT CONCERNS Two children presented with fever, vomiting, and abdominal pain with no typical manifestations, like frequent urination, urgency, dysuria, hematuria, foam urine, and lumbago. Renal abscess complicating acute pyelonephritis was diagnosed by B-ultrasound and computed tomography enhancement. Moreover, inflammatory markers were elevated significantly, but routine blood and urine cultures were repeatedly negative. The empirical anti-infection therapy had no obvious effect. A pathogenic diagnosis was confirmed in case two, and macro gene detection in blood and urine guided the follow-up treatment. DIAGNOSES Both children were diagnosed with acute gastroenteritis on admission, but renal abscess complicating acute pyelonephritis were diagnosed by imaging examination. INTERVENTIONS Both children were given anti-infection therapy of third-generation cephalosporin, which had no obvious effect. Routine blood and urine cultures were repeatedly negative. Case one was changed to piperacillin sodium tazobactam. We further carried out blood and urinary metagenomic next-generation sequencing detection for case two. Meanwhile, meropenem and linezolid anti-infection treatment was given. The results showed overlapping infection with Escherichia coli and Enterococcus faecalis. According to the genetic test results, amoxicillin clavulanate potassium combined with nitrofurantoin were prescribed after discharge. OUTCOMES Clinical symptoms of the 2 children disappeared, the infection was controlled, and imaging showed that renal abscess complicated with acute pyelonephritis disappeared. LESSONS The clinical spectrum of renal abscess complicating acute pyelonephritis is vague, with no specific manifestations, and can be easily misdiagnosed. B-ultrasound and computed tomography enhancement are helpful in making a definite diagnosis. Moreover, the sensitivity of routine culture is low, and metagenomic next-generation sequencing might be helpful to detect pathogenic microorganisms and guided treatment. Early treatment with broad-spectrum antibiotics might have favorable outcomes.
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Affiliation(s)
- Zhuqin Zhan
- Department of Nephrology, Children’s Hospital of Fudan University Xiamen Branch (Xiamen Children’s Hospital), Xiamen, Fujian, China
| | - Xiaoliang Lin
- Department of Respiratory, Children’s Hospital of Fudan University Xiamen Branch (Xiamen Children’s Hospital), Xiamen, Fujian, China
| | - Guangbo Li
- Department of Nephrology, Children’s Hospital of Fudan University Xiamen Branch (Xiamen Children’s Hospital), Xiamen, Fujian, China
| | - Jinhua Zeng
- Department of Nephrology, Children’s Hospital of Fudan University Xiamen Branch (Xiamen Children’s Hospital), Xiamen, Fujian, China
| | - Dequan Su
- Department of Nephrology, Children’s Hospital of Fudan University Xiamen Branch (Xiamen Children’s Hospital), Xiamen, Fujian, China
| | - Jianying Liao
- Department of Nephrology, Children’s Hospital of Fudan University Xiamen Branch (Xiamen Children’s Hospital), Xiamen, Fujian, China
| | - Qian Shen
- Department of Nephrology, Children’s Hospital of Fudan University, Shanghai, China
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Bibi M, Chaker K, Ouanes Y, Baccouch R, Madani MA, Mediouni H, Mosbahi B, Mourad Dali K, Rahoui M, Nouira Y. Comparison of prognosis of five scoring systems in emphysematous pyelonephritis patients requiring intensive care. Int Urol Nephrol 2023; 55:3045-3050. [PMID: 37556105 PMCID: PMC10611593 DOI: 10.1007/s11255-023-03733-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Our study aimed to evaluate the performance of Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Systemic Inflammatory Response Syndrome (SIRS), and Global Research in the Emphysematous Pyelonephritis group (GREMP) in predicting the need of admission in intensive care units (ICU) for emphysematous pyelonephritis (EPN) patient. PATIENTS AND METHODS In this retrospective study, we reviewed 70 patients admitted to our department from January 2008 to October 2022. Data on clinical presentation and EPN management were noted. The five scoring systems were calculated by one investigator. Univariate and multivariate analyses were used to assess predictive factors of severe sepsis and mortality. Statistical analysis was made using SPSS version 22. RESULTS Mean age was 61.83 years with 65.7% diabetes. As per Huang and Tseng classification, 41 patients had class I EPN, 7 had class II EPN, 8 had class IIIa, 6 class IIIB EPN, and 8 had class IV EPN. Seventeen patients (24.28%) were admitted to ICU with an 18.57 mortality rate. Univariate analysis showed that ICU admission was significantly associated with higher respiration rate and heart rate, lower systolic blood pressure, confusion, CRP, lactate and creatinine serum (p = 0.0001, p = 0.0001, p = 0.001, p = 0.007, p = 0.004, p = 0.001, p = 0.001, respectively). All five scores and Huang and Tseng classification were significantly predictive of admission to ICU. All five scores showed good results under the area curves to predict ICU entry with 0.915, 0.895, 0.968, 0.887, and 0.846 for qSOFA, MEWS score, NEWS score, SIRS, and GREMP score, respectively. CONCLUSION NEWS score seemed to be the best performing physiologic score among the five scoring systems studied and may help with biological and radiological findings to quickly identify EPN patients that need intensive care unit.
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Affiliation(s)
- Mokhtar Bibi
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia.
| | - Kays Chaker
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia
| | - Yassine Ouanes
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia
| | - Ramla Baccouch
- Department of Emergency, La Rabta Hospital, Tunis, Tunisia
| | | | | | | | | | - Moez Rahoui
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia
| | - Yassine Nouira
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia
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Otiniano A, Tassin C, Serris A, Guennouni N, Lanternier F, Servais A, Parize P, Guinebert S, Van Huyen JPD, Bodard S, Boudhabhay I. Emphysematous pyelonephritis in a diabetic patient. J Nephrol 2023; 36:2621-2624. [PMID: 37193924 DOI: 10.1007/s40620-023-01639-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/03/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Armelle Otiniano
- Department of Nephrology and Transplantation, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, 149 rue de Sèvres, 75015, Paris, France
| | - Claire Tassin
- Department of Pathology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Alexandra Serris
- Department of Infectious and Tropical Diseases, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
- Université Paris Cité, 75006, Paris, France
| | - Nadia Guennouni
- Department of Microbiology, Parasitology and Mycology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Fanny Lanternier
- Department of Infectious and Tropical Diseases, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
- Université Paris Cité, 75006, Paris, France
| | - Aude Servais
- Department of Nephrology and Transplantation, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, 149 rue de Sèvres, 75015, Paris, France
| | - Perrine Parize
- Department of Infectious and Tropical Diseases, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Sylvain Guinebert
- Université Paris Cité, 75006, Paris, France
- Department of Adult Radiology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Jean Paul Duong Van Huyen
- Department of Pathology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
- Université Paris Cité, 75006, Paris, France
| | - Sylvain Bodard
- Université Paris Cité, 75006, Paris, France
- Department of Adult Radiology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
- Sorbonne Université, CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Paris, France
| | - Idris Boudhabhay
- Department of Nephrology and Transplantation, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, 149 rue de Sèvres, 75015, Paris, France.
- Université Paris Cité, 75006, Paris, France.
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Tada K, Shibata R, Nakamura T, Kawaguchi Y, Nakano Y, Ishii H, Ura K, Yamada H, Maekawa S, Ito K, Masutani K. Severe disseminated infection by hypermucoviscous Klebsiella pneumoniae successfully treated by intensive therapy with continuous hemodiafiltration using AN69ST: A case report and review of the literature. J Infect Chemother 2023; 29:1075-1080. [PMID: 37451619 DOI: 10.1016/j.jiac.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/09/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Klebsiella pneumoniae (Kpn) is one of the most common gram-negative bacilli causing lung, urinary tract, and biliary tract infections. However, as a distinct entity from classic Kpn, hypervirulent Kpn causing liver abscess, endophthalmitis, and lung abscess with poor prognoses has been reported mainly in East and Southeast Asia since the mid-1980s. Although the definition of hypervirulent Kpn is unclear, the hypermucoviscosity of Kpn is considered an important feature of hypervirulence. We present a case of emphysematous pyelonephritis accompanied by septic shock and acute kidney injury caused by hypermucoviscous Kpn infection that was successfully treated by intensive treatment. A 70-year-old woman with type 2 diabetes mellitus was diagnosed with emphysematous pyelonephritis, and string test-positive Kpn was detected in blood and urine cultures and percutaneous catheter drainage fluid from the renal pelvis. The patient was treated with intensive therapies including antibiotics, ventilator management, and continuous hemodiafiltration (CHDF) using AN69ST, which can absorb cytokines. During the course of treatment, the infection was complicated by pyogenic spondylitis, which was cured by antimicrobial therapy, and the patient was transferred to another hospital for rehabilitation on day 119 after admission. Hypermucoviscous Kpn infection often has a severe course, and it is important to initiate multidisciplinary treatment at an early stage, including rifampicin, which is expected to inhibit the viscosity of hypermucoviscous Kpn. In the current case, immediate CHDF using AN69ST was also considered a life-saving treatment because it improved both volume overload and neutrophil-activated hypercytokinemia.
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Affiliation(s)
- Kazuhiro Tada
- Department of Nephrology, Saiseikai Futsukaichi Hospital, Fukuoka, Japan.
| | - Ryoko Shibata
- Department of Nephrology, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Tsubasa Nakamura
- Department of Nephrology, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | | | - Yuki Nakano
- Department of Pharmacy, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Hidehiro Ishii
- Department of Diabetology, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Kazuya Ura
- Department of General Internal Medicine, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Hiroyoshi Yamada
- Department of Respiratory Medicine, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Shinichi Maekawa
- Department of General Thoracic Surgery, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Kenji Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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McCallin S, Kessler TM, Leitner L. Management of uncomplicated urinary tract infection in the post-antibiotic era: select non-antibiotic approaches. Clin Microbiol Infect 2023; 29:1267-1271. [PMID: 37301438 DOI: 10.1016/j.cmi.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/29/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Given the high frequency of patients presenting with urinary tract infections (UTIs) and the ensuing high degree of antibiotic prescription, UTI is a critical point of intervention for non-antibiotic treatments to curb the further development of antimicrobial resistance and provide risk-appropriate care for patients. OBJECTIVES To highlight several select non-antibiotic therapies for the treatment of uncomplicated UTI and relevant indications (prevention and complicated UTI) from recent literature. SOURCES PubMed, Google Scholar, and clinicaltrials.gov were searched for clinical trials published in the English language corresponding to non-antibiotic treatments for UTI. CONTENT The focus of this narrative review centres on a limited number of non-antibiotic therapies for the treatment of UTI based on (a) herbal extracts or (b) antibacterial strategies (e.g. bacteriophage therapy and D-mannose). The experience of treatment with non-steroidal anti-inflammatory drugs is also used to fuel discussion on the risk of developing pyelonephritis without antibiotics-compared with the projected harms of continuing their widespread use. IMPLICATIONS Non-antibiotic treatment strategies for UTI have shown varying results in clinical trials, and the current evidence does not yet indicate a clear, better alternative to antibiotics. However, the collective experience with non-antibiotic treatments suggests that there is a need to weigh the actual benefits/risks of unfettered, non-culture-confirmed antibiotic use in uncomplicated UTI. Given the different mechanisms of action of proposed alternatives, more in-depth knowledge on microbiological and pathophysiological factors influencing UTI susceptibility and prognostic indicators are highly needed to stratify patients most likely to benefit. The feasibility of alternatives in clinical practice should also be considered.
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Affiliation(s)
- Shawna McCallin
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Fukunaga S, Naito Y, Hoshino Y, Oba M, Kawanishi M, Yoshikane K, Egawa M, Ito T, Tanabe K. Indications for Percutaneous Drainage in Patients with Huang Class 3B Emphysematous Pyelonephritis: A Case Report and Literature Review. Intern Med 2023; 62:2871-2876. [PMID: 36792198 PMCID: PMC10602843 DOI: 10.2169/internalmedicine.0694-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023] Open
Abstract
Emphysematous pyelonephritis (EPN) is a severe urinary tract infection common in patients with diabetes. Nephrectomy is recommended when the Huang classification is ≥3B. We herein report a case in which nephrectomy was avoided using antimicrobial agents and percutaneous drainage (PCD). A 59-year-old man was diagnosed with EPN (Huang classification 3B). The causative bacteria were Escherichia coli. Despite high-risk factors, EPN was cured with kidney preservation and PCD because the emphysema and abscess were not extensive. Thus, PCD should be considered in patients with Huang Class 3B EPN and high-risk factors if emphysema and abscess are not extensive.
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Affiliation(s)
| | - Yumi Naito
- Division of Nephrology, Shimane University Hospital, Japan
| | - Yuki Hoshino
- Division of Nephrology, Shimane University Hospital, Japan
| | - Masafumi Oba
- Division of Nephrology, Shimane University Hospital, Japan
| | | | | | - Masahiro Egawa
- Division of Nephrology, Shimane University Hospital, Japan
| | - Takafumi Ito
- Division of Nephrology, Shimane University Hospital, Japan
| | - Kazuaki Tanabe
- Department of Internal Medicine IV, Faculty of Medicine, Shimane University, Japan
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Ansaldi Y, Martinez de Tejada Weber B. Urinary tract infections in pregnancy. Clin Microbiol Infect 2023; 29:1249-1253. [PMID: 36031053 DOI: 10.1016/j.cmi.2022.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are the most common infection among pregnant women and have been associated with maternal and foetal complications. Antimicrobial exposure during pregnancy is not without risk. International guidelines recommend a single screen-and-treat approach to asymptomatic bacteriuria (ASB); however, this approach has been questioned by recent studies. OBJECTIVES The aim of this narrative review was to assess the pathophysiology, current risk factors and management of UTI during pregnancy, its impact on pregnancy outcomes, and to develop recommendations on the best use of antimicrobials. SOURCES PubMed, Cochrane database, and ClinicalTrials.gov. CONTENT Owing to the physiological changes related to pregnancy, pregnant women are at higher risk of UTI. All types of UTIs combined have been estimated to affect approximately 2% to 15% of women. ASB affects 2% to 7% of pregnant women. Recent studies do not provide good-quality evidence for an association between ASB and acute pyelonephritis if ASB is untreated. There is low-to-moderate-quality evidence that treatment of ASB results in a reduction in the incidence of low birth weight and preterm birth, which justifies screening practices for ASB with only a single urine culture in the first trimester. If the clinician opts for treatment, a short course of β-lactams, nitrofurantoin, or fosfomycin should be favoured. Studies on cystitis during pregnancy are limited. Acute pyelonephritis has been shown to be associated with increased maternal complications and in some studies has also been associated with preterm delivery and low birth weight. Preferred antimicrobials for the management of pyelonephritis are amoxicillin combined with an aminoglycoside, third-generation cephalosporins, or carbapenems. Studies on recurrent UTIs during pregnancy are limited, making it difficult to draw conclusions regarding prophylactic measures. IMPLICATIONS Further research is required to understand the true incidence of ASB-related complications and the benefit and modalities of screening for ASB and to further explore prophylactic measures.
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Affiliation(s)
- Yveline Ansaldi
- Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
| | - Begoña Martinez de Tejada Weber
- Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Confederat LG, Condurache MI, Alexa RE, Dragostin OM. Particularities of Urinary Tract Infections in Diabetic Patients: A Concise Review. Medicina (Kaunas) 2023; 59:1747. [PMID: 37893465 PMCID: PMC10608443 DOI: 10.3390/medicina59101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Diabetes mellitus is a chronic disease that, untreated or poorly controlled, can lead to serious complications, reducing life expectancy and quality. Diabetic patients are more likely to develop infections, including many common infections, but also pathognomonic ones such as emphysematous pyelonephritis, malignant otitis externa, mucormycosis and Fournier's gangrene. Considering the fact that diabetic patients experience more frequently urinary tract infections (UTIs) with a worse prognosis than non-diabetic people, we conducted a review study based on data in the literature, following the particularities of UTIs in this group of patients, the risk factors, the mechanisms involved and the challenges in their management. The findings highlight that UTI in diabetic patients have some particularities, including a more frequent evolution to bacteremia, increased hospitalizations, and elevated rates of recurrence and mortality than non-diabetic patients. The possible risk factors identified seem to be female gender, pregnancy, older age, UTI in the previous six months, poor glycemic control and duration of diabetes. The mechanisms involved are related to glucosuria and bladder dysfunction, factors related to bacterial strains and host response. The bacterial strains involved in UTIs in diabetic patients and their antibiotic susceptibility profile are, with some exceptions, similar to those in non-diabetic people; however, the antimicrobial agents should be carefully chosen and the duration of the treatment should be as those required for a complicated UTI. The data related to the risk of developing UTIs in patients treated with SGLT-2 inhibitors, a new class of oral hypoglycaemic agents with cardiovascular and renal benefits, are controversial; overall, it was evidenced that UTIs occurred at the initiation of the treatment, recurrent infection was uncommon and the majority of UTIs responded to treatment with standard antibiotics. Moreover, interruption or discontinuation of SGLT-2 inhibitor as a result of UTI was rare and SGLT-2 inhibitors did not increase the risk of severe infections such as urosepsis and pyelonephritis.
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Affiliation(s)
- Luminita-Georgeta Confederat
- Department of Biomedical Sciences, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Mihaela-Iustina Condurache
- Department of Biomedical Sciences, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Raluca-Elena Alexa
- “Sfântul Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania;
| | - Oana-Maria Dragostin
- Research Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania;
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Mason MM, Nackeeran S, Lokeshwar S, Carino Mason MR, Kohn T, Shah HN, Ramasamy R. A comparison of adverse pregnancy events between ureteral stents and percutaneous nephrostomy tubes in the treatment of nephrolithiasis during pregnancy: A propensity score-matched analysis of a large multi-institutional research network. World J Urol 2023; 41:1721-1726. [PMID: 35909212 DOI: 10.1007/s00345-022-04111-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/18/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To investigate rates of adverse pregnancy events associated with the use of percutaneous nephrostomy tubes (PCN) versus ureteral stents in the treatment of nephrolithiasis during pregnancy. METHODS We queried the TriNetX Diamond Network database to evaluate pregnant women (ICD-10 Z34, O09) with a history of nephrolithiasis (N20-23) who underwent a PCN (CPT 50432) or ureteral stent (52332) placement up to 6 months before delivery (O80-82). We controlled for the following potentially confounding variables through propensity score matching: age, race, ethnicity, acute pyelonephritis (N10), infections of the genitourinary tract in pregnancy (O23.0), and other sepsis (A41) at the time of stent or PCN placement. RESULTS We identified 2,999 pregnant women who underwent ureteral stent placement and 321 who underwent PCN. Following propensity score matching, we found there to be no significant difference in the rate of premature labor or delivery (aOR 1.08, 95% CI 0.735-1.588), premature rupture of membranes (0.889, 0.453-1.743), intrauterine infection (0.906, 0.379-2.165), or c-Sect. (0.825, 0.408-1.667). Within 6 months of their initial procedure, women with a ureteral stent experienced a significantly decreased rate of subsequent urinary tract infection (UTI) or pyelonephritis (0.52, 0.38-0.71), inpatient hospital stay (0.40, 0.26-0.64), emergency department visit (0.65, 0.48-0.89), and repeat exchange procedure (0.70, 0.51-0.96). CONCLUSION In the treatment of nephrolithiasis during pregnancy, PCN versus ureteral stent placement does not confer a significant difference in rates of adverse pregnancy events. However, ureteral stent placement was associated with a lower incidence of hospital admissions, emergency department visits, exchange procedures, and new UTIs or pyelonephritis.
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Affiliation(s)
- Matthew M Mason
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sirpi Nackeeran
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Soum Lokeshwar
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Taylor Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hemendra N Shah
- Department of Urology, Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1560, Miami, FL, 33136, USA
| | - Ranjith Ramasamy
- Department of Urology, Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1560, Miami, FL, 33136, USA.
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Datta P. Squamous cell carcinoma in kidney with chronic pyelonephritis and pyelonephrosis: a rare case. Pan Afr Med J 2023; 45:31. [PMID: 37545605 PMCID: PMC10403768 DOI: 10.11604/pamj.2023.45.31.39117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/20/2023] [Indexed: 08/08/2023] Open
Affiliation(s)
- Pragyamita Datta
- Department of Pathology, Jawaharlal Nehru Medical College (DMIHER), Sawangi, Wardha, Maharashtra, India
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Aggarwal D, Mandal S, Parmar K, Manoharan V, Singh S, Yadav AK, Kumar S, Sharma AP, Singh SK. Predictors of mortality and nephrectomy in emphysematous pyelonephritis: a tertiary care centre study. Ann R Coll Surg Engl 2023; 105:323-330. [PMID: 35617107 PMCID: PMC10066649 DOI: 10.1308/rcsann.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) is a deadly disease due to its associated morbidity and mortality. Attempts have been made to identify predictors of severity, mortality and need for nephrectomy in EPN with little success. METHODS We conducted an ambispective study of EPN patients between March 2014 and September 2019. Retrospective data were collected which included age, sex, comorbidities, symptoms, signs, laboratory investigations including imaging, need for dialysis, management and any complications. All patients were then followed prospectively for renal dynamic scan, stone surgery or nephrectomy. Univariate analysis was performed to identify factors affecting mortality and need for elective nephrectomy. RESULTS In total, 112 patients were included. Mean patient age was 50.01 years, 55% were female and 5% had bilateral involvement. Fever and flank pain were the most common symptoms. Diabetes was seen in 75% of cases and 30% of cases required haemodialysis at initial presentation. About 60% of patients improved with pigtail drainage. Need for nephrectomy was greater in Huang-Tseng stage 3a (14.8%). Huang-Tseng stages 3b and 4 had higher mortality rates (25%) than the other stages (2.2%). Twelve of 99 patients had non functional kidney on follow-up and underwent elective nephrectomy. Low platelet counts, high body mass index, septic shock, dialysis and higher Huang-Tseng stage were found to be predictive of mortality and renal parenchymal thickness on computed tomography scan was predictive of follow-up nephrectomy. CONCLUSIONS Thrombocytopaenia, high body mass index, septic shock, haemodialysis and higher Huang-Tseng stage are predictors of mortality and renal parenchymal thickness <5mm is a predictor of poor salvage of affected kidney on follow-up.
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Affiliation(s)
- D Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Mandal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Parmar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Manoharan
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - AK Yadav
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - AP Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - SK Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lukyanenko N, Lenha E, Spaska A, Klets T, Shevchenko T. Tactics for treating young children with pyelonephritis and vesicoureteral reflux associated with impaired fibrillogenesis. Mol Cell Biochem 2023; 478:531-538. [PMID: 35943657 DOI: 10.1007/s11010-022-04529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/12/2022] [Indexed: 10/15/2022]
Abstract
The purpose of this study is to substantiate the choice and evaluate the effectiveness of therapeutic tactics aimed at suppressing collagen formation and improving metabolic processes in the kidney parenchyma in young children with pyelonephritis against the background of vesicoureteral reflux associated with undifferentiated tissue dysfunction. 67 children from 2 weeks to 3 years old with pyelonephritis and vesicoureteral reflux were examined. All children during the period of remission of the inflammatory process were examined for the content of oxyproline in the urine. Urine crystallinity and urinary excretion were determined, and markers of the morphofunctional state of the cytomembranes of the renal epithelium were determined: calcification test-the presence of polar lipids in the urine and test for the presence of lipid peroxidation products in the urine. Children with high urinary hydroxyproline excretion prior to protocol treatment of pyelonephritis during the remission of the inflammatory process at the stage of maintenance therapy were recommended to receive metabolic preparations that can inhibit collagen formation and improve parenchyma metabolic processes during the month-vitamin E 10% and L-carnitine in age-related doses. After 6 months, a study was made on the functional state of the renal parenchyma in the dynamics of treatment. After metabolic antihypoxic and membrane-protective therapy, there was a significant positive dynamic of all markers of tissue hypoxia and membrane destruction in the kidney parenchyma, which confirms the inhibition of collagen formation processes and a decrease in tissue hypoxia with vitamin E and L-carnitine in age-related doses.
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Affiliation(s)
- Nataliia Lukyanenko
- Department of Clinical Genetics, Institute of Hereditary Pathology of the National Academy of Medical Sciences of Ukraine, 31a M. Lysenko Str., Lviv, 79008, Ukraine.
- Department of Propaedeutics of Pediatrics and Medical Genetics, Danylo Halytsky Lviv National Medical University, 69 Pekarska Str., Lviv, 79010, Ukraine.
| | - Evelina Lenha
- Department of Bioorganic and Biological Chemistry and Clinical Biochemistry, Bukovinian State Medical University, 2 Teatralnaya Sq., Chernivtsi, 58002, Ukraine
| | - Anastasiya Spaska
- College of Medicine, Ajman University, University Str., Al-Jurf, Ajman, United Arab Emirates
- Center of Medical and Bio-allied Health Sciences Research, Ajman University, University Str., Al-Jurf, Ajman, United Arab Emirates
| | - Tetiana Klets
- Department of Pediatrics No. 4, Bogomolets National Medical University, 13 Taras Shevchenko Blvd., Kyiv, 01601, Ukraine
| | - Tetiana Shevchenko
- Department of Pediatrics No. 4, Bogomolets National Medical University, 13 Taras Shevchenko Blvd., Kyiv, 01601, Ukraine
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Hsu CK, Tsai WW, Lai CC. Cefepime/Enmetazobactam vs Piperacillin/Tazobactam and Complicated Urinary Tract Infection or Acute Pyelonephritis. JAMA 2023; 329:684-685. [PMID: 36853255 DOI: 10.1001/jama.2022.22870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Chi-Kuei Hsu
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wen-Wen Tsai
- Department of Education, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
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Kumar LP, Khan I, Kishore A, Gopal M, Behera V. Pyonephrosis among Patients with Pyelonephritis Admitted in Department of Nephrology and Urology of a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2023; 61:111-114. [PMID: 37203981 PMCID: PMC10088997 DOI: 10.31729/jnma.8015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 11/13/2023] Open
Abstract
INTRODUCTION Pyonephrosis is a severe complication of pyelonephritis leading to rapid progression to sepsis and loss of renal function resulting in nephrectomy. Early identification of pyonephrosis based on clinical or radiological characteristics amongst pyelonephritis is paramount. This study aimed to determine the prevalence of pyonephrosis among patients with pyelonephritis admitted to the Department of Nephrology and Urology of a tertiary care centre. METHODS This descriptive cross-sectional study was done in a tertiary care centre among patients with pyelonephritis from 1 July 2016 to 31 Jan 2021. Ethical approval was obtained from Institution Ethics Committee (Reference number: IEC/56/21). The available clinical, demographic and laboratory parameters were recorded from the hospital records in a predesigned proforma. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. RESULTS Among 550 pyelonephritis patients, the prevalence of pyonephrosis was 60 (10.9%) (8.3-13.5, 95% Confidence Interval). The mean age was 54.62±12.14 years, and 41 (68.33%) were males. The most common clinical symptom was flank pain with or without fever in 46 (76.66%) patients. Escherichia coli was the most common offending organism in 20 (33.33%). Ultrasonography showed classical echogenic debris with floaters and internal echoes in 44 (73.33%) patients. Double J stenting was successfully done in 44 (73.33%) patients. Percutaneous nephrostomy was done in the remaining 16 (26.66%) patients. CONCLUSIONS The prevalence of pyonephrosis in pyelonephritis is similar to previous studies done in similar settings. KEYWORDS pyelonephritis; pyonephrosis; kidneys.
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Affiliation(s)
| | - Irshad Khan
- Command Hospital Central Command, Lucknow, Uttar Pradesh, India
| | - Amit Kishore
- Command Hospital Central Command, Lucknow, Uttar Pradesh, India
| | - Manoj Gopal
- Department of Nephrology, INHS Asvini, Mumbai, Maharashtra, India
| | - Vineet Behera
- Department of Nephrology, INHS Asvini, Mumbai, Maharashtra, India
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20
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Gala I, Baltesova T, Hulik S, Kalanin R, Adandedjan D, Katuchova J, Bena L. A single-centre report of acute pyelonephritis in a patient after kidney transplantation - analyses of risk factors. BRATISL MED J 2023; 124:748-751. [PMID: 37789790 DOI: 10.4149/bll_2023_114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Urinary tract infections (UTI) are the most common infectious complications after kidney transplantation (KTx) with highest incidence in the first three months of transplantation. UTI in transplant recipients increase morbidity and mortality, risk of graft failure and incidence of acute rejection episodes. According to published data, urinary tract infections significantly affect graft survival. The aim of our study was to identify possible risk factors for the development of UTI. MATERIAL AND METHODS We retrospectively analyzed a cohort of patients who received kidney transplantation between January 2014 and December 2016 in the Transplant Center of Louis Pasteur University Hospital in Košice. One hundred and fifty-three patients after kidney transplantation were included in the study. RESULTS A total of 47 Caucasian patients (30%) developed UTI, namely - acute pyelonephritis after KTx. We identified independent risk factors associated with UTI such as female gender OR (7.98, 95% CI 2.88-22.12, p < 0.001), diabetes mellitus (OR 5.26, 95% CI 2.01-13.74, p = 0.001; 95% CI 4.57-53.82, p < 0.001) urologic complication (OR 15.68, 95% CI 4.57-53.82; p < 0.001) and acute rejection episode (OR 3.15, 95% CI 1.13-8.76, p = 0.027). The most common microbiological agent was Escherichia coli. CONCLUSION We identified the aforementioned risk factors of urinary tract infections in the files of our patients. Statistically, the most significant risk factors are the female gender, and presence of urological complications. The urological complications and BMI of the patients are considered modifiable factors. Based on our analysis, we confirmed a significantly higher number of ACR patients who overcame infection which is in accordance with the published data on association of UTI with the development of acute cellular rejection (ACR) (Tab. 2, Fig. 1, Ref. 15).
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Akhmedov OR, Magomedov DM, Akhmedov SR, Sargsyan SM, Pulbere SA, Kotov SV. [The influence of pyelovenous reflux on the development of acute pyelonephritis in an experimental model]. Urologiia 2022:23-28. [PMID: 36382813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION currently, endoscopic methods are the main option for surgical treatment of patients with urolithiasis (ICD). The widespread use of these operations has led to the development of a number of specific complications associated with the technology of their implementation. One of the frequent complications is the development of postoperative acute pyelonephritis against the background of intraoperative pyelovenous reflux. THE PURPOSE OF THE STUDY to study under experimental conditions the severity of pathomorphological changes in the ureter and kidney tissue against the background of pyelovenous reflux in the presence and absence of bacterial flora. MATERIALS AND METHODS 32 mature female rabbits of the "White Giant" breed were selected as an experimental model. Experimental strain of the E. Coli microorganism 105 KOE/ml. Laboratory animals were divided into 4 groups, 1-3 experimental groups, 4 control group of observation without surgical intervention. In experimental groups, NaCl 0.9% 2.0 ml was injected into the ureteral lumen in group 1, E. Coli 1x105 CFU/ml 1.0 ml in group 2, NaCl 0.9% 1.0 ml + E. Coli 1x105 CFU/ml 1.0 ml in group 3. RESULTS Results: according to the results of the study, the pathomorphological evaluation of kidney and ureter preparations revealed pronounced inflammatory changes in group 3. CONCLUSIONS pyelovenous reflux does not independently lead to the development of acute pyelonephritis. The combination of reflux and microbial flora leads to inflammatory changes in the wall of the calyx-pelvic system with the development of acute pyelonephritis, which is confirmed by the results of pathomorphological examination of kidney and ureter tissue.
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Affiliation(s)
- O R Akhmedov
- Pirogov Russian National Research Medical University Ministry of Health of Russia, Moscow, Russia
- N.I. Pirogov City Clinical Hospital 1 of the Moscow Healthcare Department, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - D M Magomedov
- Pirogov Russian National Research Medical University Ministry of Health of Russia, Moscow, Russia
- N.I. Pirogov City Clinical Hospital 1 of the Moscow Healthcare Department, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - S R Akhmedov
- Pirogov Russian National Research Medical University Ministry of Health of Russia, Moscow, Russia
- N.I. Pirogov City Clinical Hospital 1 of the Moscow Healthcare Department, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sh M Sargsyan
- Pirogov Russian National Research Medical University Ministry of Health of Russia, Moscow, Russia
- N.I. Pirogov City Clinical Hospital 1 of the Moscow Healthcare Department, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - S A Pulbere
- Pirogov Russian National Research Medical University Ministry of Health of Russia, Moscow, Russia
- N.I. Pirogov City Clinical Hospital 1 of the Moscow Healthcare Department, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - S V Kotov
- Pirogov Russian National Research Medical University Ministry of Health of Russia, Moscow, Russia
- N.I. Pirogov City Clinical Hospital 1 of the Moscow Healthcare Department, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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22
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Takemori D, Satake H, Kobayashi S. [Two Cases of Emphysematous Pyelonephritis Successfully Treated by Transurethral Catheterization]. Hinyokika Kiyo 2022; 68:349-353. [PMID: 36458398 DOI: 10.14989/actauroljap_68_11_349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Emphysematous pyelonephritis (EPN) is a severe necrotic urinary tract infection accompanied by retention of gas in the kidney and areas around it. Formerly, emergency nephrectomy was the primary treatment, but the trend is shifting to treatment with maximum conservation of the kidney. In this report, two cases of EPN successfully treated by transurethral drainage are presented. The first case was in a 63-year-old woman with a history of poorly controlled diabetes. She arrived at the hospital by ambulance with primary symptoms of vomiting and trembling of the hands, and computed tomography (CT) revealed gas in the right renal calix. The second case was in a 61-year-old woman who arrived by ambulance with difficulty of body movement as the primary symptom, and CT revealed a calculus in the right ureter accompanied by right hydronephrosis and retention of gas in the right renal pelvis and right upper ureter. Both patients were diagnosed with EPN and treated by transurethral drainage rather than percutaneous drainage or nephrectomy because of their poor general condition. The treatment was successful. Along with percutaneous drainage, transurethral drainage is considered to be an option of surgical treatment for EPN.
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Jang YR, Won J, Han J, Chung W, Ahn SJ. Comparison of antimicrobial resistance in patients with obstructive pyelonephritis associated with ureteral stones and uncomplicated pyelonephritis. Medicine (Baltimore) 2022; 101:e30376. [PMID: 36042611 PMCID: PMC9410613 DOI: 10.1097/md.0000000000030376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the clinical outcomes of causative microorganisms in obstructive pyelonephritis associated with ureteral stones (OPU) and their antibiotic susceptibilities. This retrospective cohort study included female patients diagnosed with community-acquired acute pyelonephritis (APN) at a tertiary-care hospital between 2008 and 2017. A comparison of APN cases associated with the obstruction of the upper urinary tract by ureteral stones and APN cases without complications was performed. Propensity score (PS) matching was used to adjust the heterogeneity within each group. Of the 588 female patients with community-acquired APN, 107 were diagnosed with OPU and 481 with uncomplicated APN. After PS matching, Enterobacteriaceae strains isolated from OPU cases were more resistant to fluoroquinolones (51.9% vs 16.0%, P < .001). Extended-spectrum β-lactamase was detected in 22.2% and 21.0% of the Enterobacteriaceae strains isolated from OPU and uncomplicated APN cases, respectively (P = 1.000). The treatment failure rate was similar in OPU and uncomplicated APN groups (16.0% vs 21.0%, P = .545). Patients with OPU may be empirically treated with antibiotics in accordance with the treatment protocol for general pyelonephritis. Clinicians should exercise caution in prescribing fluoroquinolones for treating OPU.
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Affiliation(s)
- Young Rock Jang
- Department of Infectious Disease, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Division of Infectious Disease, Department of Internal Medicine, Incheon Medical Center, Incheon, Korea
- *Correspondence: Young Rock Jang, Division of Infectious Disease, Department of Internal Medicine, Incheon Medical Center, Incheon, Korea, 217 Bangchuk-ro, Dong-gu, Incheon 22532, Korea (e-mail: ) and Su Joa Ahn, Department of Radiology, Gil Medical Center, Gachon University College of Medicine, ADD 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Korea (e-mail: )
| | - Jeongyeon Won
- Department of Infectious Disease, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jung Han
- Department of Urology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Wookyung Chung
- Department of Nephrology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Su Joa Ahn
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- *Correspondence: Young Rock Jang, Division of Infectious Disease, Department of Internal Medicine, Incheon Medical Center, Incheon, Korea, 217 Bangchuk-ro, Dong-gu, Incheon 22532, Korea (e-mail: ) and Su Joa Ahn, Department of Radiology, Gil Medical Center, Gachon University College of Medicine, ADD 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Korea (e-mail: )
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Takahashi T, Somiya S, Ito K, Haitani T, Higashi Y, Yamada H, Kanno T. [Risk Factors for Febrile Urinary Tract Infection after Transurethral Ureterolithotripsy : ANALYSIS of Treatment Outcomes of 1,235 Patients at a Single Center]. Hinyokika Kiyo 2022; 68:171-178. [PMID: 35850505 DOI: 10.14989/actauroljap_68_6_171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Recently, ureteroscopic lithotripsy remains the standard treatment for urolithiasis, with postoperative febrile upper urinary tract infection (fUTI) being one of its most significant complications. The current study sought to investigate the treatment outcomes of ureterorenoscopy (URS), morbidity and risk factors of postoperative fUTI at our hospital. A total of 1,235 patients who underwent URS (including those who underwent only semi-rigid URS) for upper urinary tract stones at our hospital between October 2011 and December 2019 were retrospectively analyzed. Patients had a median age of 63 years and a median stone length of 11.4 mm. F-URS was performed in 1,188 cases (96.2%) among whom 92.1% were stone-free or had stones that fractured into dust. Postoperative fUTI and sepsis occurred in 127 (10.3%) and 18 (1.5%) patients, respectively. Multivariate analysis identified female sex, American Society of Anesthesiologists (ASA) score ≥ 3, calculus length ≥ 20 mm, history of diabetes mellitus, and history of obstructive pyelonephritis as risk factors for postoperative fUTI. The scoring system (range 0-4) were positively correlated with the postoperative fUTI rate (score 0 : 3.1%, 1 : 12.4%, 2 : 14.1%, 3 : 23.7%, 4 : 40%). A significant difference in the rates was noted between those with a score of 0 (low-risk group), 1-2 (intermediate-risk group), and 3-4 scores (high-risk group). In conclusion, the overall incidence of postoperative fUTI was 10.3%, which was associated with sex, poor ASA scores, stone size, presence of diabetes mellitus, and history of pyelonephritis. The scoring system created using these factors can be useful in predicting postoperative fUTI.
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Affiliation(s)
| | - Shinya Somiya
- The Department of Urology, Ijinkai Takeda General Hospital
| | - Katsuhiro Ito
- The Department of Urology, Ijinkai Takeda General Hospital
| | - Takao Haitani
- The Department of Urology, Ijinkai Takeda General Hospital
| | | | - Hitoshi Yamada
- The Department of Urology, Ijinkai Takeda General Hospital
| | - Toru Kanno
- The Department of Urology, Ijinkai Takeda General Hospital
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Yogo A, Yamamoto S, Sumiyoshi S, Iwamoto N, Aoki K, Motobayashi H, Tochitani K, Shimizu T, Murashima T, Nishikawa N, Segawa T. Two cases of pyelonephritis with bacteremia by Staphylococcus epidermidis in male patients with nephrolithiasis: Case reports and a literature review. J Infect Chemother 2022; 28:1189-1192. [PMID: 35525700 DOI: 10.1016/j.jiac.2022.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/24/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Staphylococcus epidermidis is a common cause of health care-associated bacteremia, especially in patients with an indwelling medical device. However, S. epidermidis is an uncommon causative organism in catheter-associated urinary tract infection, and rare pyelonephritis without any indwelling urinary device. To our knowledge, there are few cases reported of bacteremia secondary to urinary tract infection. We report two cases of pyelonephritis with bacteremia by S. epidermidis in male patients with unilateral nephrolithiasis and review prior case reports. CASE PRESENTATION Case 1: 74-year-old man with a history of diabetes and overactive bladder had fever and pyuria with a right nephrolithiasis on abdominal CT scan. Case 2: 79-year-old man with a history of diabetes and post-myocardial infarction status had fever with a left nephrolithiasis on abdominal CT scan. In both cases, both the urine culture collected at ureteral stenting and blood culture were positive for S. epidermidis. We initiated intravenous antibiotics in these patients in addition to ureteral stenting. CONCLUSIONS S. epidermidis is acknowledged as an uncommon pathogen that can cause bacteremia secondary to pyelonephritis without an indwelling urinary device. Clinicians should consider the possibility of pyelonephritis due to S. epidermidis if the pathogen is identified in blood and urine in patients with nephrolithiasis.
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Affiliation(s)
- Aoi Yogo
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan.
| | - Shungo Yamamoto
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
| | - Shougen Sumiyoshi
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
| | - Nobuki Iwamoto
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
| | - Kazuaki Aoki
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
| | | | - Kentaro Tochitani
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
| | - Tsunehiro Shimizu
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
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26
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Samuel SV, George TK, Gopinathan VR, Abraham OC. Community-acquired fungal pyelonephritis with renal infarction and gangrene of the colon: an uncommon diagnosis. BMJ Case Rep 2022; 15:e241685. [PMID: 35131766 PMCID: PMC8823032 DOI: 10.1136/bcr-2021-241685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 12/26/2022] Open
Abstract
A 54-year-old male farmer with a history of long-standing uncontrolled type 2 diabetes mellitus (HbA1c 10.8) presented with a 3-week history of fever, intermittent vomiting, malaise and left flank pain for which he was treated with broad-spectrum antibiotics and oral antifungals for Candida isolated from urine culture. CT of the abdomen revealed predominant involvement of the left kidney and retroperitoneal structures. Nephrectomy was performed due to worsening abdominal pain and features of bowel perforation found on imaging. Pus culture from the necrotic kidney grew aseptate fungal hyphae, and the histopathological examination was suggestive of zygomycosis. He received amphotericin B postoperatively, but his condition deteriorated and he succumbed to nosocomial gram-negative septicaemia.
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Affiliation(s)
- Stephen Varghese Samuel
- Geriatric Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Tarun K George
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | | | - O C Abraham
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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27
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Desai R, Batura D. A systematic review and meta-analysis of risk factors and treatment choices in emphysematous pyelonephritis. Int Urol Nephrol 2022; 54:717-736. [PMID: 35103928 DOI: 10.1007/s11255-022-03131-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/25/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Emphysematous pyelonephritis (EPN) is an acute, severe necrotising infection of the kidney. There has been a shift from early nephrectomy to conservative methods. We conducted a meta-analysis to assess the impact of risk factors and treatment choices on outcomes in EPN. METHODS We conducted a database search of all studies in English, reporting more than 12 patients of EPN from 1980 to 2020. We compiled the demographics, clinical presentations, risk factors, critical diagnostic results, treatment modalities and outcomes, including mortality. RESULTS We identified 37 observational studies, 32 retrospective and 5 prospective. The studies reported on 1146 patients, of which 790(68.9%) were female, and 946 (82.5%) were diabetic. In addition, 184 (16.1%) patients had stones, and 235 (20.5%) had obstructive uropathy. Fever and flank pain were the most frequent symptoms. The most common clinical features were pyuria, fever, flank tenderness, and tachycardia. E. coli, Klebsiella pneumoniae and Proteus were the most frequent organisms isolated. X-ray KUB and ultrasound were used as initial diagnostic modalities, but CT scan was the usual diagnostic and confirmatory investigation. Confusion, shock, thrombocytopenia, sepsis, emergency nephrectomy and hyponatremia were significantly associated with mortality. In particular, confusion and hyponatremia were associated with a sevenfold increase in mortality risk. There was no evidence that diabetes, stones, obstructive uropathy, AKI or proteinuria was associated with higher mortality. Nevertheless, 143 of the total 1146 patients died (12.5%). While 26% of the patients who had upfront emergency nephrectomy died, only 9.7% and 10% of patients with medical management and medical management plus minimally invasive treatments died. However, patients that failed medical and minimally invasive treatments and needed salvage emergency nephrectomy had a mortality of upwards of 27%. CONCLUSION The risk factors for mortality in emphysematous pyelonephritis are shock, thrombocytopenia, confusion, hyponatremia and emergency nephrectomy. Conservative and minimally invasive treatment should be the initial management strategy for emphysematous pyelonephritis as they carry lesser mortality risks. The presence of risk factors may help predict the subset of patients who need aggressive treatment and minimally invasive treatment modalities or early nephrectomy.
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Affiliation(s)
- Rajeev Desai
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Deepak Batura
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
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28
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Lobanov LS, Lobanov YS, Shapovalov KG, Lobanov SL, Filev AP. [Retroperitoneal drainage for apostematous pyelonephritis in a patient with severe COVID-19 infection and diabetes mellitus type 1]. Khirurgiia (Mosk) 2022:90-92. [PMID: 35080833 DOI: 10.17116/hirurgia202201190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The authors report successful surgical treatment of apostematous pyelonephritis complicated by sepsis in an 18-year-old patient with severe COVID-19 pneumonia (CT-2) and diabetes mellitus type 1. Active surgical approach with retroperitoneal drainage and decapsulation of the right kidney ensured positive dynamics in the treatment of destructive pyelonephritis, course of diabetes mellitus and elimination of sepsis. These aspects determined favorable outcome of disease.
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Affiliation(s)
| | | | | | | | - A P Filev
- Chita State Medical Academy, Chita, Russia
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29
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Pliquett RU, Tannapfel A, Daneschnejad SS. Renal allograft-related inflammation complicated by acute coronary syndromes: A case report. Medicine (Baltimore) 2021; 100:e28205. [PMID: 34967354 PMCID: PMC8718196 DOI: 10.1097/md.0000000000028205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Persistent systemic inflammation is considered to be predictive for future cardiovascular events. Here, in a patient with pyelonephritis of his failed renal allograft, consecutive coronary angiograms proved that coronary artery disease progressed within 3 weeks, when infection was uncontrolled. PATIENT CONCERNS A 52-year-old male type 2 diabetic with a failed renal allograft suffering from hematuria, leukocyturia, and chest pain at rest was hospitalized. DIAGNOSES An acute coronary syndrome in presence of pyelonephritis was diagnosed. Besides pyelonephritis, the histological examination of the kidney transplant revealed signs of chronic rejection and the presence of a renal cell carcinoma in situ. INTERVENTIONS A percutaneous coronary intervention was performed, and an elective surgery for allograft removal was scheduled. However, within 5 weeks after discharge, two more surges of infection coincided with episodes of unstable angina. OUTCOMES Once the renal allograft has been removed, systemic inflammation was contained. The patient was not re-hospitalized for acute-coronary syndrome within the next 12 months. CONCLUSION Surges of systemic inflammation due to infection were paralleled by instability of coronary plaques as documented by repeat coronary angiograms.
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Affiliation(s)
- Rainer U. Pliquett
- Department of Nephrology, Diabetology and Endocrinology, University Hospital Leipzig (RUP until June 2006)
- Department of Nephrology & Diabetology, Carl-Thiem Hospital Cottbus, Cottbus, Germany
| | - Andrea Tannapfel
- Institute of Pathology, University Hospital Leipzig, Leipzig, Germany
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
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30
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Stokes P, Keheila M, Alsyouf M, Gilbert Z, Hajiha M, Amasyali A, Belle J, Groegler J, Baldwin DD. Does qSOFA score predict ICU admission and outcomes in patients with obstructed infected ureteral stones? Can J Urol 2021; 28:10841-10847. [PMID: 34657657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Obstructing stones with infection represent a true urologic emergency requiring prompt decompression. Historically the systemic inflammatory response syndrome (SIRS) criteria has been used to predict outcomes in patients with sepsis. The quick Sequential Organ Failure Assessment (qSOFA) score has been proposed as a prognostic factor in patients with acute pyelononephritis associated with nephrolithiasis. However there has been limited application of qSOFA to patients undergoing ureteral stenting with obstructive pyelonephritis. The purpose of this study was to evaluate the predictive value of the qSOFA score for postoperative outcomes following renal decompression in this patient population. MATERIALS AND METHODS A retrospective review was conducted at three medical centers within one academic institution to identify patients with obstructive pyelonephritis secondary to ureteral stones. All patients underwent emergent ureteral stent placement for decompression. The primary outcome was the predictive value of preoperative qSOFA score ≥ 2 for intensive care unit (ICU) admission postoperatively. Univariate analysis and multivariate regression analysis were performed to identify factors associated with postoperative outcomes, with p < 0.05 considered significant. RESULTS Of the 289 patients who had ureteral stents placed, 147 patients met inclusion criteria. Twenty-four (16.3%) patients required ICU admission and there were 3 (2%) mortalities, all of these within the ICU admission group. The sensitivity and specificity of the qSOFA score ≥ 2 for ICU admission was 70.8% and 79.5% respectively which outperformed SIRS criteria, which had a sensitivity and specificity of 100% and 33.6% respectively. CONCLUSION A preoperative qSOFA score ≥ 2 was a significant predictor for postoperative ICU admission in patients undergoing ureteral stent placement for obstructive pyelonephritis. The qSOFA score can be used to determine which patients will require ICU admission.
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Affiliation(s)
- Phillip Stokes
- Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
| | - Mohamed Keheila
- Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
| | - Muhannad Alsyouf
- Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
| | - Zachary Gilbert
- Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
| | - Mohammad Hajiha
- Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
| | - Akin Amasyali
- Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
| | - Joshua Belle
- Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
| | - Jason Groegler
- Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
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31
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Liston K, Manecksha RP, Woods CP. Hyperglycaemic crisis secondary to emphysematous pyelonephritis. BMJ Case Rep 2021; 14:e242617. [PMID: 34380678 PMCID: PMC8359521 DOI: 10.1136/bcr-2021-242617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old woman presented to the emergency department acutely unwell. Initial investigations revealed hyperglycaemia, ketosis and an acute kidney injury precipitated by urosepsis. She was found to have a new diagnosis of diabetes mellitus (type 2) with a glycated haemoglobin (HbA1c) of 156 mmol/mol. CT imaging of the abdomen and pelvis revealed unilateral emphysematous pyelonephritis (EPN), radiologically classified as stage 3 severity with gas extending beyond the renal collecting system. Escherichia coli was grown on blood and urine cultures. This was sensitive to second-generation cephalosporin cefuroxime. The patient was managed with fluid resuscitation, intravenous antibiotics and renal system decompression with urinary catheter insertion. She was commenced on an intravenous insulin infusion for hyperglycaemic crisis. This case illustrates a rare presentation of hyperglycaemic crisis precipitated by EPN in a patient without a previously known diagnosis of diabetes, successfully treated with medical management alone. Close clinical and radiological follow-up was arranged to monitor the need for future nephrectomy.
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Affiliation(s)
- Katie Liston
- Endocrinology, HSE Library East, Naas, Ireland
- Endocrinology, Naas General Hospital, Naas, Kildare, Ireland
- Tallaght University Hospital, Dublin, Dublin, Ireland
| | - Rustom P Manecksha
- Urology, Tallaght University Hospital, Dublin, Dublin, Ireland
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Conor P Woods
- Endocrinology, Naas General Hospital, Naas, Kildare, Ireland
- Tallaght University Hospital, Dublin, Dublin, Ireland
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32
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Magallanes-Gamboa JO, Notario-Barba V, Herrero Domingo A, Marcos-Sánchez F. [Emphysematous cystitis and emphysematous pyelonephritis]. Rev Esp Geriatr Gerontol 2021; 56:364-367. [PMID: 34315613 DOI: 10.1016/j.regg.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/06/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022]
Abstract
Emphysematous cystitis and emphysematous pyelonephritis are rare entities, difficult to diagnose and with high morbidity and mortality. The non-specificity of the medical history and the little usefulness of laboratory tests contribute to diagnostic delay, which increases the possibility of therapeutic failure. We present 2 cases, one of cystitis and another of emphysematous pyelonephritis, who attended the emergency room due to severe urinary sepsis. Despite severity of the symptoms, conservative management was performed with bladder drainage and antibiotic treatment, without interventions or surgeries, presenting a favorable evolution and resolution of the infectious process. Each case must be individualized to offer the best possible therapeutic alternative.
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Affiliation(s)
| | - Verónica Notario-Barba
- Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
| | - Almudena Herrero Domingo
- Servicio de Medicina Interna, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
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33
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Kamei J, Yamamoto S. Complicated urinary tract infections with diabetes mellitus. J Infect Chemother 2021; 27:1131-1136. [PMID: 34024733 DOI: 10.1016/j.jiac.2021.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
Patients with diabetes mellitus (DM) sometimes exhibited impaired immune function and aggravated infectious diseases. Urinary tract infection (UTI) is one of the major complications of DM. A systematic literature search was performed in PubMed and Cochrane Library using the following keywords: diabetes mellitus, urinary tract infection, asymptomatic bacteriuria, emphysematous pyelonephritis, emphysematous cystitis, renal papillary necrosis, and sodium-glucose co-transporter 2 (SGLT2) inhibitors. The treatment of UTI in DM patients is not different from that in non-DM patients, and asymptomatic bacteriuria should not be screened or treated. Emphysematous pyelonephritis is a life-threatening renal infection with gas in the renal parenchyma or perirenal space, and 95% of affected patients had DM. Abdominal computed tomography is useful for diagnosis and determining treatment strategies. Medical management and percutaneous drainage are standard initial treatment, and subsequent nephrectomy for non-responders is considered. Nephrectomy, as an initial treatment, should be limited to a selected group of patients with severe conditions. In contrast, antibiotics, glycemic control, and bladder drainage are adequate treatment for most cases of emphysematous cystitis. SGLT2 inhibitors significantly increased the incidence of genital tract infection, but not that of UTI, pyelonephritis, or urosepsis. Here, we present cumulative evidence about etiology and management for complicated UTI with DM, but there was little information about racial differences and further evidence focusing on Asian population will be needed.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan.
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
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34
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Graversen HV, Nørgaard M, Nitsch D, Christiansen CF. Preadmission kidney function and risk of acute kidney injury in patients hospitalized with acute pyelonephritis: A Danish population-based cohort study. PLoS One 2021; 16:e0247687. [PMID: 33657169 PMCID: PMC7929569 DOI: 10.1371/journal.pone.0247687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/10/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Only few smaller studies have examined if impaired kidney function increases the risk of acute kidney injury in patients with acute pyelonephritis. Therefore, we estimated 30-day risk of acute kidney injury by preadmission kidney function in patients with acute pyelonephritis. Furthermore, we examined if impaired kidney function was a risk factor for development of acute kidney injury in pyelonephritis patients. METHODS This cohort study included patients with a first-time hospitalization with pyelonephritis from 2000 to 2017. Preadmission kidney function (estimated glomerular filtration rate (eGFR) <30, 30-44, 45-59, 60-89, and ≥90 ml/min/1.73 m2) and acute kidney injury within 30 days after admission were assessed using laboratory data on serum creatinine. The absolute 30-days risk of acute kidney injury was assessed treating death as a competing risk. The impact of eGFR on the odds of acute kidney injury was compared by odds ratios (ORs) with 95% confidence intervals estimated using logistic regression adjusted for potential confounding factors. RESULTS Among 8,760 patients with available data on preadmission kidney function, 25.8% had a preadmission eGFR <60. The 30-day risk of acute kidney injury was 16% among patients with preadmission eGFR ≥90 and increased to 22%, 33%, 42%, and 47% for patients with preadmission eGFR of 60-89, 45-59, 30-44, and <30 respectively. Compared with eGFR≥90, the adjusted ORs for the subgroups with eGFR 60-89, 45-59, 30-45, and <30 were 0.95, 1.32, 1.78, and 2.19 respectively. CONCLUSION Acute kidney injury is a common complication in patients hospitalized with acute pyelonephritis. Preadmission impaired kidney function is a strong risk factor for development of acute kidney injury in pyelonephritis patients and more attention should be raised in prevention of pyelonephritis in patients with a low kidney function.
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Affiliation(s)
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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35
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Affiliation(s)
- Michael D Weintraub
- Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Thomas C Winter Iii
- Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
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36
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Odajima K, Togashi R, Nemoto Y, Hayama Y, Asakawa S, Nagura M, Arai S, Yamazaki O, Tamura Y, Mochizuki M, Ohashi R, Shibata S, Fujigaki Y. Pyuria without Casts and Bilateral Kidney Enlargement Are Probable Hallmarks of Severe Acute Kidney Injury Induced by Acute Pyelonephritis: A Case Report and Literature Review. Intern Med 2021; 60:293-298. [PMID: 32893233 PMCID: PMC7872795 DOI: 10.2169/internalmedicine.5721-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/15/2020] [Indexed: 11/08/2022] Open
Abstract
The patient was a 38-year-old man who had experienced nausea and fever for a few days and presented with back pain, oliguria, and pyuria, suggesting acute pyelonephritis (APN). He showed acute kidney injury (AKI) with bilateral kidney enlargement and was using nonsteroidal anti-inflammatory drugs (NSAIDs). AKI-induced by APN was confirmed by kidney biopsy. The AKI was successfully treated with antibiotic therapy. A search of the relevant literature for reports on histopathologically-proven APN-induced severe AKI revealed that the key characteristics were bilateral kidney enlargement with pyuria without casts. Oligoanuria was frequently associated with APN-induced severe AKI, and NSAID use may be a possible risk factor. Prompt antibiotic treatment based on the clinical characteristics of APN-induced AKI can improve the renal outcome.
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Affiliation(s)
- Kohei Odajima
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Ryo Togashi
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yoshikazu Nemoto
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yuto Hayama
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Shinichiro Asakawa
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Michito Nagura
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Shigeyuki Arai
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Osamu Yamazaki
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yoshifuru Tamura
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Makoto Mochizuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Japan
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Japan
| | - Shigeru Shibata
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yoshihide Fujigaki
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
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Rodríguez GS, Gasque RA, Barrionuevo RJ, Vigilante GE. [Fulminant emphysematous pyelonephritis]. Medicina (B Aires) 2021; 81:482. [PMID: 34137715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Affiliation(s)
- Galo S Rodríguez
- Servicio de Cirugía General y Gastroenterología, Instituto de Enfermedades Digestivas, Córdoba, República Argentina. E-mail:
| | - Rodrigo A Gasque
- Servicio de Cirugía General y Gastroenterología, Instituto de Enfermedades Digestivas, Córdoba, República Argentina
| | - Roberto J Barrionuevo
- Servicio de Cirugía General y Gastroenterología, Instituto de Enfermedades Digestivas, Córdoba, República Argentina
| | - Gabriel E Vigilante
- Servicio de Cirugía General y Gastroenterología, Instituto de Enfermedades Digestivas, Córdoba, República Argentina
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Protoshchak VV, Sivakov AA, Babkin PA, Karandashov VK, Gorbynov AE, Lazutkin MV, Alentyev SA. [Emphysematous pyelonephritis: case of successful conservative treatment]. Urologiia 2020:118-121. [PMID: 33377689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Emphysematous pyelonephritis is rare form of pyelonephritis, which has mortality of nearly 80%. Conservative treatment can be successful in less than 30% of cases. Currently, in the guidelines there is no standard approach to conservative and surgical treatment of this entity. The clinical observation of successful conservative treatment of a patient with emphysematous pyelonephritis, associated with decompensated diabetes mellitus, from the diagnosis to recovery without performing nephrectomy in order to preserve kidney function, is described in the article.
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Affiliation(s)
- V V Protoshchak
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - A A Sivakov
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - P A Babkin
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - V K Karandashov
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - A E Gorbynov
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - M V Lazutkin
- Department and Clinic of General Surgery of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - S A Alentyev
- Department and Clinic of General Surgery of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
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Shaikh KJ, Osio VA, Leeflang MM, Shaikh N. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev 2020; 9:CD009185. [PMID: 32911567 PMCID: PMC8479592 DOI: 10.1002/14651858.cd009185.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In children with urinary tract infection (UTI), only those with pyelonephritis (and not cystitis) are at risk for developing long-term renal sequelae. If non-invasive biomarkers could accurately differentiate children with cystitis from children with pyelonephritis, treatment and follow-up could potentially be individualized. This is an update of a review first published in 2015. OBJECTIVES The objectives of this review were to 1) determine whether procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) can replace the acute DMSA scan in the diagnostic evaluation of children with UTI; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other. SEARCH METHODS We searched MEDLINE, EMBASE, DARE, Web of Science, and BIOSIS Previews through to 17th December 2019 for this review. The reference lists of all included articles and relevant systematic reviews were searched to identify additional studies not found through the electronic search. SELECTION CRITERIA We only considered published studies that evaluated the results of an index test (PCT, CRP, ESR) against the results of an acute-phase 99Tc-dimercaptosuccinic acid (DMSA) scan (conducted within 30 days of the UTI) in children aged 0 to 18 years with a culture-confirmed episode of UTI. The following cut-off values were used for the primary analysis: 0.5 ng/mL for procalcitonin, 20 mg/L for CRP and 30 mm/hour for ESR. DATA COLLECTION AND ANALYSIS Two authors independently applied the selection criteria to all citations and independently abstracted data. We used the bivariate model to calculate pooled random-effects pooled sensitivity and specificity values. MAIN RESULTS A total of 36 studies met our inclusion criteria. Twenty-five studies provided data for the primary analysis: 12 studies (1000 children) included data on PCT, 16 studies (1895 children) included data on CRP, and eight studies (1910 children) included data on ESR (some studies had data on more than one test). The summary sensitivity estimates (95% CI) for the PCT, CRP, ESR tests at the aforementioned cut-offs were 0.81 (0.67 to 0.90), 0.93 (0.86 to 0.96), and 0.83 (0.71 to 0.91), respectively. The summary specificity values for PCT, CRP, and ESR tests at these cut-offs were 0.76 (0.66 to 0.84), 0.37 (0.24 to 0.53), and 0.57 (0.41 to 0.72), respectively. AUTHORS' CONCLUSIONS The ESR test does not appear to be sufficiently accurate to be helpful in differentiating children with cystitis from children with pyelonephritis. A low CRP value (< 20 mg/L) appears to be somewhat useful in ruling out pyelonephritis (decreasing the probability of pyelonephritis to < 20%), but unexplained heterogeneity in the data prevents us from making recommendations at this time. The procalcitonin test seems better suited for ruling in pyelonephritis, but the limited number of studies and the marked heterogeneity between studies prevents us from reaching definitive conclusions. Thus, at present, we do not find any compelling evidence to recommend the routine use of any of these tests in clinical practice.
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Affiliation(s)
- Kai J Shaikh
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Victor A Osio
- Department of General Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Nader Shaikh
- General Academic Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Abstract
Urinary tract infections (UTIs) in children are among the most common bacterial infections in childhood. They are equally common in boys and girls during the first year of life and become more common in girls after the first year of life. Dividing UTIs into three categories; febrile upper UTI (acute pyelonephritis), lower UTI (cystitis), and asymptomatic bacteriuria, is useful for numerous reasons, mainly because it helps to understand the pathophysiology of the infection. A single episode of febrile UTI is often caused by a virulent Escherichia coli strain, whereas recurrent infections and asymptomatic bacteriuria commonly result from urinary tract malformations or bladder disturbances. Treatment of an upper UTI needs to be broad and last for 10 days, a lower UTI only needs to be treated for 3 days, often with a narrow-spectrum antibiotic, and asymptomatic bacteriuria is best left untreated. Investigations of atypical and recurrent episodes of febrile UTI should focus on urinary tract abnormalities, whereas in cases of cystitis and asymptomatic bacteriuria the focus should be on bladder function.
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Affiliation(s)
- Kjell Tullus
- Renal Unit, Great Ormond Street Hospital for Children, London, UK.
| | - Nader Shaikh
- Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Chávez-Valencia V, Orizaga-de-La-Cruz C, Aguilar-Bixano O, Lagunas-Rangel FA. Coexistence of emphysematous cystitis and bilateral emphysematous pyelonephritis: a case report and review of the literature. CEN Case Rep 2020; 9:313-317. [PMID: 32328853 DOI: 10.1007/s13730-020-00479-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/12/2020] [Indexed: 01/04/2023] Open
Abstract
Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. We report a rare case of a 56-year-old diabetic male suffering from fever, headache and vomiting and in which a diagnosis of septic shock was established due to coexistence of EC and bilateral EPN. The emphysematous diseases improved with a conservative treatment approach using antibiotic therapy and glycemic control, we highlight that the nephrectomy was not necessary in our patient despite the fact that he presented risk factors that predict the failure of conservative treatment.
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Affiliation(s)
- Venice Chávez-Valencia
- Department of Nephrology, Hospital General Regional Hospital No 1, Instituto Mexicano del Seguro Social, Bosques de los Olivos No. 101. Av. La Goleta Mpo Charo, CP: 61301, Morelia, Michoacán, Mexico.
| | - Citlalli Orizaga-de-La-Cruz
- Department of Nephrology, Hospital General Regional Hospital No 1, Instituto Mexicano del Seguro Social, Bosques de los Olivos No. 101. Av. La Goleta Mpo Charo, CP: 61301, Morelia, Michoacán, Mexico
| | - Omar Aguilar-Bixano
- Department of Nephrology, Hospital General Regional Hospital No 1, Instituto Mexicano del Seguro Social, Bosques de los Olivos No. 101. Av. La Goleta Mpo Charo, CP: 61301, Morelia, Michoacán, Mexico
| | - Francisco Alejandro Lagunas-Rangel
- Department of Genetics and Molecular Biology, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV), Mexico, Mexico
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McAlpine K, Ryan SE, Roberts M, Vigil HR. Gas in the inferior vena cava from severe emphysematous pyelonephritis. Can J Urol 2020; 27:10195-10198. [PMID: 32333741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Emphysematous pyelonephritis is a life-threatening, urologic emergency. We present the case of a 54-yearold female who was found to have a large volume of air in her renal vein and inferior vena cava from severe emphysematous pyelonephritis. In this case report, the medical and operative management of this patient are reviewed, and the literature on the management of emphysematous pyelonephritis is summarized.
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Affiliation(s)
- Kristen McAlpine
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
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Lee JH, Yim HE, Yoo KH. Associations of Plasma Neutrophil Gelatinase-associated Lipocalin, Anemia, and Renal Scarring in Children with Febrile Urinary Tract Infections. J Korean Med Sci 2020; 35:e65. [PMID: 32174064 PMCID: PMC7073316 DOI: 10.3346/jkms.2020.35.e65] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/16/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Neutrophil gelatinase-associated lipocalin (NGAL), a bacteriostatic agent, is known to inhibit erythropoiesis leading to anemia. We aimed to investigate the associations of NGAL, anemia, and renal scarring in children with febrile urinary tract infections (UTIs). METHODS We retrospectively reviewed the medical records of 261 children with febrile UTIs. The relationship between the presence of anemia and plasma NGAL levels was investigated. NGAL performance in comparison with serum C-reactive protein (CRP) at admission and after 72 hours of treatment was also evaluated for the prediction of renal scarring as well as acute pyelonephritis (APN) and vesicoureteral reflux (VUR). RESULTS Plasma NGAL levels were elevated in patients with anemia compared with those without anemia. Multiple linear regression analysis showed an inverse relationship between NGAL levels and erythrocyte counts (standard β = -0.397, P < 0.001). Increased NGAL, but not CRP, was independently associated with the presence of anemia (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.07-5.27; P < 0.05). Receiver operating curve analyses showed good diagnostic profiles of pre- and post-treatment NGAL for identifying APN, VUR, and renal scarring (all P < 0.05). For detecting renal scars, the area under the curve of post-treatment NGAL (0.730; 95% CI, 0.591-0.843) was higher than that of post-treatment CRP (0.520; 95% CI, 0.395-0.643; P < 0.05). The presence of anemia and elevated NGAL at admission (> 150 ng/mL) were independent risk factors for renal scarring in children with febrile UTIs. With anemia, NGAL levels increased consecutively in children with febrile UTI without renal involvement, with APN without scar, and with APN with renal scarring. CONCLUSION Increased plasma NGAL levels may be associated with the presence of anemia and renal scarring in children with febrile UTIs.
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Affiliation(s)
- Jee Hyun Lee
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
| | - Hyung Eun Yim
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea.
| | - Kee Hwan Yoo
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
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Abstract
Emphysematous pyelonephritis (EPN) is a rare, severe necrotising infection of the renal parenchyma and surrounding tissues. It is usually life-threatening and should be promptly treated. Here, we report a clinical case of a 54-year-old male who presented with the left flank pains of 3-week duration. The flank pain was described as dull, constant with associated fever. He was diagnosed with diabetes mellitus (DM) while on admission. A clinical diagnosis of the left pyelonephritis was made. The abdominopelvic computed tomography scan confirmed bilateral EPN by showing a thin film of perinephric fluid (13.2 ml) in the left lower pole. He was managed conservatively with fluid therapy, adequate glycaemic control and intravenous antibiotics with no percutaneous drainage done. This highlights the importance of early initiation of appropriate medical treatment to avoid interventional urological procedures of nephrectomy. It also highlights the importance of clinical suspicion of EPN in patients presenting with symptoms of urinary tract infection and DM.
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Affiliation(s)
- Bolanle Olajumoke Okunowo
- Department of Medicine, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olubukola Abeni Omidiji
- Department of Radiodiagnosis, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Emmanuel Ajibola Jeje
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Adetola Fasanmade
- Department of Medicine, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
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45
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Garro MM, Ibáñez S. [Emphysematous pyelonephritis in polycystic kidney]. Medicina (B Aires) 2020; 80:703. [PMID: 33254116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Affiliation(s)
- María Manuela Garro
- Servicio de Clínica Médica, Sanatorio Güemes, Buenos Aires, Argentina. E-mail:
| | - Soledad Ibáñez
- Servicio de Clínica Médica, Sanatorio Güemes, Buenos Aires, Argentina
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46
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Kurochkina ON. [Features of chronic kidney disease in elderly patients.]. Adv Gerontol 2020; 33:113-120. [PMID: 32362093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of the work is to study the characteristics of the course of chronic kidney disease in elderly patients based on the analysis of the register of chronic kidney disease (CKD) for 2015-2018. in the Department of Nephrology, the Komi Republican Clinical Hospital. There are 484 patients in the register, of whom 231 are men (47,7%), 253 women (52,3%). The average age is 58,8±15,8 years old. The patients were divided into 3 groups: persons under the age of 59 years old - 218 people (group 1); from 60 to 74 years old - 207 people (group 2); and over 75 years old - 59 people (group 3). Most patients are between the ages of 60 and 69 years old. In the 1st group, the chronic glomerulonephritis is the leading cause of CKD - 27,1%; in the 2nd group - the chronic tubulo-interstitial nephritis (TIN) - 21,7%, the diabetic nephropathy (DN) - 20,8% and the hypertensive nephropathy - 15,9%; in the 3d group - TIN (27,1%), the chronic pyelonephritis (PN) (15,9%) and DN (13,6%). With increasing age, the incidence of TIN (p<0,1), MO (p<0,05), coronary kidney disease (IBP) (p<0,05), gouty nephropathy (p<0,1) were raised. The average reduction in GFR is 3,99 ml/min/1,73 m2 per year of observation. The rate of decline in GFR in the 1st group is 3,36±1,8 ml/min/1,73 m2 per year, in the 2nd - 2,43±1,2 (p<0,001 between group 1 and 2), in the 3rd group - 1,82±1,1; with aging the negative correlation was observed (p<0,05). 39 patients received hemodialysis, including: in the 1st group - 20 people (9%), in the 2nd group - 18 (8,7%), in the 3rd group - 1 patient (1,7%). Making the register of the patients with CKD allows us to know the number of patients and the causes of CKD among the patients of elderly and senile ages, to assess the clinical situation, the rate of decline in GFR and treatment tactics in these patients.
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Affiliation(s)
- O N Kurochkina
- Pitirim Sorokin Syktyvkar State University, 55 Oktyabrsky pr., Syktyvkar 557001, Komi Republic, Russian Federation, e-mail:
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Berezhnoy AG, Sevryukov FA, Vinnik YY, Kapsargin FP. [Specific features of the immune status and blebbing of the plasmatic membrane of lymphocytes patients with urolithiasis complicated by the pyelonephritis]. Urologiia 2019:60-63. [PMID: 31808634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION According to the epidemiological studies, prevalence of urolithiasis is nearly 10% worldwide. The course of the disease is often complicated by the development of pyelonephritis, the pathogenesis of which is rather multifactorial. Along with urinary tract obstruction, increasing virulence of microorganisms and immune insufficiency in patients also plays a major role. AIM To define specific features of immune insufficiency in patients who develop pyelonephritis as a complication of urolithiasis. MATERIALS AND METHODS A total of 150 patients with urolithiasis complicated by pyelonephritis were prospectively enrolled into our study in order to develop a novel method. All patients were divided into two clinical groups. Group I consisted of 75 patients with urolithiasis complicated by serous pyelonephritis and Group II included 75 patients with urolithiasis complicated by purulent pyelonephritis. In all patients an evaluation of the immune status with a determination of CD3, CD4, CD8, CD16, CD19 level and phagocyte activity of immune system was carried out. The state of lymphocytes plasmatic membrane was evaluated by phase contrast microscopy. RESULTS It is established that development of pyelonephritis in patients with urolithiasis is accompanied by a lymphopenia, the decrease in relative contents T-helpers, natural killers, as well as a decrease in the immuno-regulatory index and an increase in indicators of terminal and total lymphocytes blebbing. The most pronounced changes were noted in purulent pyelonephritis, where suppressed immune status was confirmed by the high level of lymphocyte with terminal blebbing state.
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Affiliation(s)
- A G Berezhnoy
- Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Road hospital at the station Nizhny Novgorod Russian Railways, Nizhny Novgorod, Russia
| | - F A Sevryukov
- Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Road hospital at the station Nizhny Novgorod Russian Railways, Nizhny Novgorod, Russia
| | - Yu Yu Vinnik
- Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Road hospital at the station Nizhny Novgorod Russian Railways, Nizhny Novgorod, Russia
| | - F P Kapsargin
- Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Road hospital at the station Nizhny Novgorod Russian Railways, Nizhny Novgorod, Russia
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Bazaev VV, Dutov VV, Urenkov SB, O Mamedov EA, Romanov DV, Podoynicyn AA. [Bilateral acute purulent destructive pyelonephritis after retrograde ureteroscopy and lithotripsy]. Urologiia 2019:114-118. [PMID: 31808644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The problem of urinary stone disease and acute destructive pyelonephritis remains to be relevant in the current urologic practice. The acute pyelonephritis is the most common infectious and inflammatory complication after retrograde ureteroscopy. According to data of leading urologists in Russian Federation and worldwide, the incidence of acute purulent pyelonephritis ranges from 0.1 to 0.2%. Infectious and inflammatory complications of retrograde ureteroscopy often require urgent interventions. Acute pyelonephritis can result in destructive changes in the renal parenchyma. In case of ineffective conservative measures, pyelonephritis can progress into sepsis with the development of multiple organ failure. Therefore, infectious and inflammatory complications require to start combined antibacterial, anti-inflammatory and detoxification therapy, as well as to resolve any upper urinary tract obstruction. If acute pyelonephritis leads to destructive phase with a formation of a carbuncle or an abscess in the kidney, an open surgery is indicated. Despite being minimally-invasive, retrograde ureteroscopy can lead to serious complications requiring an open surgical intervention. In some cases, the severity of the patients condition may require nephrectomy.
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Affiliation(s)
- V V Bazaev
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - V V Dutov
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - S B Urenkov
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - E A O Mamedov
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - D V Romanov
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - A A Podoynicyn
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
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Lee EH, Kim SH, Shin JH, Park SB, Chi BH, Hwang JH. Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study. BMJ Open 2019; 9:e030438. [PMID: 31685503 PMCID: PMC6858199 DOI: 10.1136/bmjopen-2019-030438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Obstruction release from urolithiasis can be delayed with a lack of suggested time for preventing the deterioration of renal function. The objective of this study was to investigate the effect of obstruction duration, concomitant acute kidney injury (AKI) or acute pyelonephritis (APN) during the obstruction on the prognosis of renal function. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS 1607 patients from a urolithiasis-related obstructive uropathy cohort, between January 2005 and December 2015. OUTCOME MEASURES Estimated glomerular filtration rate (eGFR) decrease ≥30% and/or end-stage renal disease (ESRD), and eGFR decrease ≥50% and/or ESRD, according to obstruction duration, AKI and APN accompanied by obstructive uropathy. RESULTS When the prognosis was divided by obstruction duration quartile, the longer the obstruction duration the higher the probability of eGFR reduction >50% (p=0.02). In patients with concomitant APN or severe AKI during hospitalisation with obstructive uropathy, an eGFR decrease of >30% and >50% occurred more frequently, compared with others (p<0.001). When we adjusted for sex, age, hypertension, diabetes mellitus, APN, AKI grades and obstruction release >7 days for multivariate analysis, we found that concomitant APN (HR 3.495, 95% CI 1.942 to 6.289, p<0.001), concomitant AKI (HR 3.284, 95% CI 1.354 to 7.965, p=0.009 for AKI stage II; HR 6.425, 95% CI 2.599 to 15.881, p<0.001 for AKI stage III) and an obstruction duration >7 days (HR 1.854, 95% CI 1.095 to 3.140, p=0.001) were independently associated with an eGFR decrease >50%. Tree analysis also showed that AKI grade 3, APN and an obstruction duration >7 days were the most important factors affecting renal outcome. CONCLUSIONS In patients with urolithiasis-related obstructive uropathy, concomitant APN was strongly associated with deterioration of renal function after obstruction release. The elapsed time to release the obstruction also affected renal function.
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Affiliation(s)
- Eung Hyun Lee
- Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Su-Hyun Kim
- Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jung-Ho Shin
- Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Sung Bin Park
- Radiology, Chung-Ang University Hospital, Seoul, Korea
| | | | - Jin Ho Hwang
- Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
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Mishyna М, Marchenko I, Malanchuk S, Makieieva N, Mozgova Y. ABILITY TO FORM BIOFILMS BY PYELONEPHRITIS CAUSATIVE AGENTS IN CHILDREN. Georgian Med News 2019:132-136. [PMID: 31687965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The work is dedicated to the study of biofilms formation process by main pyelonephritis causative agents in children in vitro using methods of light, fluorescent and scanning microscopy. To study biofilms formation bacteria were cultivated in liquid substratum on glass in polystyrene Petri dishes d=40mm. The study demonstrated that all isolates formed biofilms. Adhesion of bacteria planktonic forms took place on the first stage, intracellular matrix formation took place on the second stage, and biofilms formation took place on the third stage. During the study of E. coli and Proteus sрр bacteria preparations with the use of scanning and light microscopy ordered bacteria arrangement was seen in the form of separate structures or tiny clusters of bacterial cells united by matrix. During the study of the ability to form P. aeruginosa isolates biofilms with the help of scanning microscopy it was stated that the adhesion of separate bacterial cells occurs by conglomerates formation surrounded by matrix with further biofilms formation. Bacterial cells in the form of dense elongated sticks were seen under the film. P. аeruginosa isolates daily biofilms were stated to have dense structure in the form of gel. Packed biofilms areas with cells clusters with good fluorescence were found with the help of fluorescent microscopy. During daily K.рneumoniae isolates biofilms study by methods of scanning and fluorescent microscopy it was found that K.рneumoniae biofilms were covered with dense matrix and riddled with multiple canals in the form of apertures. During morphological peculiarities study of E. faecalis isolates biofilms formation with the use of scanning and fluorescent microscopy it was found that bacterial cells were densely packed and united by intracellular matrix under which bacteria of spherical shape were seen. Thus biofilms, the nature of which depends on the type of bacteria, are formed on the surface of conglomerates consisting of bacterial cells. Peculiarities of course and appearance of pyelonephritis chronic form and relapses in children is explained by biofilms formation.
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Affiliation(s)
- М Mishyna
- Kharkiv National Medical University, 1D.P. Grynyov Department of Microbiology, Virology and Immunology
| | - I Marchenko
- Kharkiv National Medical University, 1D.P. Grynyov Department of Microbiology, Virology and Immunology
| | - S Malanchuk
- 3V.N. Karazin Kharkiv National University, Department of General and Clinical Immunology and Allergology, Ukraine
| | - N Makieieva
- Kharkiv National Medical University, 2Department of Pediatrics N2; Ukraine
| | - Yu Mozgova
- Kharkiv National Medical University, 1D.P. Grynyov Department of Microbiology, Virology and Immunology
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