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Ramirez-Amoros C, San Basilio M, Amesty V, Rivas S, Lobato R, Fernandez-Camblor C, Lopez-Pereira P, Martinez-Urrutia MJ. Long-term outcome of pediatric renal transplantation with donors younger than 6 years. Pediatr Transplant 2024; 28:e14761. [PMID: 38628086 DOI: 10.1111/petr.14761] [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: 05/16/2023] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Renal transplantation is currently the best treatment option for patients with end-stage renal disease. However, the use of kidneys from donors under 6 years of age as a possibility to increase the organ pool in pediatric recipients remains a controversial matter. We aimed to investigate whether donor age is associated to the long-term functionality of the renal graft. Likewise, we analyzed the adaptation of the graft to the ascending functional requirements in the pediatric patient. METHODS Retrospective study of the results obtained in pediatric recipients transplanted with grafts from donors between 3 and 6 years of age, comparing them with those of grafts from donors older than 6 years. Among the variables compared are cumulative graft survival, renal size, need for antiproteinuric therapy, GFR, incidence of rejection, pyelonephritis, renal failure and surgical or tumor complications. RESULTS A total of 43 transplants were performed with donors aged 3-6 years, and 42 transplants with donors older than 6 years. Cumulative graft survival at 5 years was 81% for the younger donor group compared to 98% for the older donor group (p < .05). At 8 years, cumulative graft survival for donors <6 years was 74%. As for the mean estimated graft survival, it was 11.52 years for the younger donor group and 14.51 years for older donors. During follow-up, the younger donor group presented greater renal enlargement and need for antiproteinuric therapy. The older donors group had a higher GFR during the first year of follow-up, which then equalized in both groups. There were no statistically significant differences in the incidence of acute or chronic rejection, acute pyelonephritis, acute renal failure or surgical or tumor complications. CONCLUSIONS Renal transplants of grafts equal to or less than 6 years old have good short-term and acceptable long-term results in pediatric patients.
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Affiliation(s)
- Carla Ramirez-Amoros
- Department of Paediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
| | - Maria San Basilio
- Department of Paediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
| | - Virginia Amesty
- Department of Paediatric Urology, La Paz Children's University Hospital, Madrid, Spain
| | - Susana Rivas
- Department of Paediatric Urology, La Paz Children's University Hospital, Madrid, Spain
| | - Roberto Lobato
- Department of Paediatric Urology, La Paz Children's University Hospital, Madrid, Spain
| | | | - Pedro Lopez-Pereira
- Department of Paediatric Urology, La Paz Children's University Hospital, Madrid, Spain
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Budhiraja P, Butterfield R, Gea-Banacloche J, Swaminathan S, Smith ML, Khamash HA, Me HM, Kodali L, Mour GK, Nair S, Misra S, Heilman RL. Outcomes of asymptomatic histologic pyelonephritis of kidney transplant. Clin Transplant 2023; 37:e15125. [PMID: 37705388 DOI: 10.1111/ctr.15125] [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: 04/26/2023] [Revised: 07/10/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Urinary Tract Infections are the most common post-transplant infection and can have varied presentations. This study aimed to describe the outcomes of kidney transplant recipients with asymptomatic histologic pyelonephritis on allograft biopsy. Histologic Pyelonephritis was defined as neutrophil cast or neutrophilic tubulitis, interstitial infiltrates with predominant neutrophils, and no evidence of rejection or glomerulonephritis on biopsy. METHODS The study included 123 kidney transplant recipients, of whom 95 underwent protocol biopsies, and 28 had biopsies for elevated creatinine within the first 2 years of a kidney transplant. RESULTS The mean age of the cohort was 55.3 years, with 52% females and 78% deceased donor transplants. The risk factors for asymptomatic histologic pyelonephritis were recipient female sex (OR 1.89, 1.3-2.7, diabetes mellitus (OR 2.479, 1.687-3.645), and deceased donation (OR 1.69, 1.098-2.63). The incidence of asymptomatic pyelonephritis on protocol biopsy was 1.7%, with 52% having positive urine cultures and Escherichia coli being the most common bacteria. Subjects with asymptomatic pyelonephritis had inferior graft survival compared to the matched cohort HR 1.88 (1.06-3.35), p = .0281. In addition, of these 123 subjects, 68 (55%) subsequently developed pyelonephritis, and 34 subjects had pyelonephritis within 6 months after this episode. Subjects with recurrent infections exhibited lower survival HR 2.86 (1.36-6.02) and a trend toward higher rejection risk. CONCLUSION Asymptomatic histologic pyelonephritis can occur in kidney transplant recipients and is associated with inferior graft survival.
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Affiliation(s)
- Pooja Budhiraja
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Juan Gea-Banacloche
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | - Maxwell L Smith
- Department of Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Hassan A Khamash
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Hay Me Me
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Lavanya Kodali
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Girish K Mour
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sumi Nair
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Suman Misra
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Grammatico-Guillon L, Laurent E, Fuhrman J, Gaborit C, Vallée M, Dinh A, Sotto A, Bruyere F. Factors associated with urinary diversion and fatality of hospitalised acute pyelonephritis patients in France: a national cross-sectional study (FUrTIHF-2). Epidemiol Infect 2023; 151:e161. [PMID: 37721009 PMCID: PMC10600899 DOI: 10.1017/s0950268823001504] [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: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
Acute pyelonephritis (AP) epidemiology has been sparsely described. This study aimed to describe the evolution of AP patients hospitalised in France and identify the factors associated with urinary diversion and fatality, in a cross-sectional study over the 2014-2019 period. Adult patients hospitalised for AP were selected by algorithms of ICD-10 codes (PPV 90.1%) and urinary diversion procedure codes (PPV 100%). 527,671 AP patients were included (76.5% female: mean age 66.1, 48.0% Escherichia coli), with 5.9% of hospital deaths. In 2019, the AP incidence was 19.2/10,000, slightly increasing over the period (17.3/10,000 in 2014). 69,313 urinary diversions (13.1%) were performed (fatality rate 6.7%), mainly in males, increasing over the period (11.7% to 14.9%). Urolithiasis (OR [95% CI] =33.1 [32.3-34.0]), sepsis (1.73 [1.69-1.77]) and a Charlson index ≥3 (1.32 [1.29-1.35]) were significantly associated with urinary diversion, whereas E. coli (0.75 [0.74-0.77]) was less likely associated. The same factors were significantly associated with fatality, plus old age and cancer (2.38 [2.32-2.45]). This nationwide study showed an increase in urolithiasis and identified, for the first time, factors associated with urinary diversion in AP along with death risk factors, which may aid urologists in clinical decision-making.
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Affiliation(s)
- Leslie Grammatico-Guillon
- Public Health and Prevention Department, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Medical School, University of Tours, Tours, France
| | - Emeline Laurent
- Public Health and Prevention Center, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Research Team “Education, Ethics and Health”, University of Tours, Tours, France
| | - Joseph Fuhrman
- Public Health and Prevention Department, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Medical School, University of Tours, Tours, France
| | - Christophe Gaborit
- Public Health and Prevention Department, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Tours, France
| | - Maxime Vallée
- Service of Urology, Teaching Hospital of Poitiers, Medical School, University of Poitiers, Poitiers, France
| | - Aurélien Dinh
- Service of Infectious Diseases, AP-HP, Medical School, University of Paris, Paris, France
| | - Albert Sotto
- Service of Infectious Diseases, Teaching Hospital of Nimes, Medical School, University of Nimes, Nimes, France
| | - Franck Bruyere
- Service of Urology, Teaching Hospital of Tours, Medical School, University of Tours, Tours, France
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Hewitt IK, Montini G, Marks SD. Vesico-ureteric reflux in children and young people undergoing kidney transplantation. Pediatr Nephrol 2023; 38:2987-2993. [PMID: 36279046 PMCID: PMC10432351 DOI: 10.1007/s00467-022-05761-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Abstract
Vesico-ureteric reflux (VUR) into transplanted kidneys in children and young people is a common occurrence, found in 19 to 60% of those who had an anti-reflux procedure and up to 79% in the absence of such a procedure. While VUR is unlikely to be of concern without evidence of symptomatic urinary tract infections, less certainty exists regarding outcomes when the VUR is associated with urinary tract infection (UTI) and transplant pyelonephritis. Issues explored will include additional risk factors that might predispose to UTI, any effect of pyelonephritis on acute and long-term kidney allograft function and practical strategies that may reduce the prevalence of infection.
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Affiliation(s)
- Ian K Hewitt
- Perth Children's Hospital, Monash Avenue, Nedlands, WA, Australia
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via della Commenda 9, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
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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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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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Berezhnoi AG, Dunaevskaya SS. [Blebbing of plasma membrane of lymphocytes in infectious complications of urolithiasis]. Urologiia 2022:34-38. [PMID: 36382815] [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 About 200 thousand operations for urolithiasis are performed annually in Russia, but the frequency of postoperative complications reaches 30%. Infectious complications occur with a frequency of up to 40% in the form of various forms of pyelonephritis, urosepsis is recorded in 3% of patients. The aim of the study determine the intensity of blebbing of the plasma membrane of lymphocytes in infectious complications of urolithiasis. MATERIALS AND METHODS A prospective study examined 1,240 patients with urolithiasis. Inflammatory complications were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. Complications of infectious nature were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. During the study, complications of an infectious nature were detected in 148 patients, which amounted to 11,93% of cases. The control group consisted of - 25 persons with urolithiasis and a favorable course of the postoperative period. Lymphocyte membrane condition was evaluated by phase contrast microscopy. RESULTS Changes in plasma membrane structure were more frequently reported in patients with postoperative purulent pyelonephritis and urosepsis. When assessing the presence of circulating microparticles, the highest number was recorded in patients with urolithiasis complicated by purulent pyelonephritis or urosepsis - 1318 [982; 2007] and 1531 [1028; 1963], respectively. A relationship was established between the degree of severity of terminal blebbing of the plasma membrane of lymphocytes and the nature of inflammatory complications in urolithiasis.
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Affiliation(s)
- A G Berezhnoi
- Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Road hospital at the station Krasnoyarsk Russian Railways, Krasnoyarsk, Russia
| | - S S Dunaevskaya
- Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Road hospital at the station Krasnoyarsk Russian Railways, Krasnoyarsk, Russia
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Barinov EF, Malinin YY, Grigoryan KV. [Risk factors and mechanisms of acute pyelonephritis development after contact ureterolithotripsy]. Urologiia 2022:29-33. [PMID: 36382814] [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
AIM of the study is to identify risk factors for the development of acute pyelonephritis after contact urethrolithotripsy (URLLT) and to establish the mechanisms for maintaining inflammation after the withdrawal of NSAIDs. MATERIAL AND METHODS The study included 21 patients who underwent contact ureterolithotripsy (URLT). The severity of leukocyturia was assessed 1 day after URLT, 2 days (the last appointment of NSAIDs, the total duration of the drug was 9 days) and 3 days (24 hours after NSAID discontinuation). The number of circulating platelet-leukocyte aggregates (PLA) was calculated by microscopy of stained blood smears. Analysis of the functional activity of platelet receptors involved in the modulation of the acute inflammatory response was performed by the turbidimetric method on a ChronoLog analyzer (USA).Statistical analysis was performed using the MedCalc package. RESULTS After URSL, when NSAIDs were prescribed to patients, the level of leukocyturia decreased (p<0.05) compared to that at the time of hospitalization. A similar dynamics was found by analyzing the amount of TLA in the blood. Similar dynamics was found in the analysis of the amount of TLA in the blood. After 24 hours of NSAIDs cancellation, an increase in the severity of leukocyturia was detected (p<0.001). At the same time, normoreactivity of the 2-adrenergic receptor, GPVI receptor, AT1 receptor, PAT receptor, P2X1 receptor and A2A receptor, as well as hyporeactivity of the 2-adrenergic receptor and P2Y receptors, were revealed. An analysis of correlations made it possible to establish that the 2-adrenoreceptor, AT1 receptor, and GPVI receptor play a key role in the formation of TPA. Incubation of blood cells in vitro with agonists made it possible to establish that the maximum effect of TLA formation was reproduced during the interaction of the 2-adrenergic receptor and the AT1 receptor. CONCLUSION With the abolition of NSAIDs, activation of the sympathetic-adrenal and renin-angiotensin systems, as well as remodeling of the basement membrane of the vascular wall are risk factors for the development of acute pyelonephritis after URLS.
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Affiliation(s)
- E F Barinov
- State educational organization of higher professional education M. Gorky Donetsk National Medical University, Donetsk, Donetsk Peoples Republic
| | - Y Yu Malinin
- State educational organization of higher professional education M. Gorky Donetsk National Medical University, Donetsk, Donetsk Peoples Republic
| | - Kh V Grigoryan
- State educational organization of higher professional education M. Gorky Donetsk National Medical University, Donetsk, Donetsk Peoples Republic
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Martov AG, Dutov SV, Andronov AS, Mishugin SV, Mantcaev AB. [X-ray endoscopic treatment in patients with ureteral anastomotic obliteration after orthotopic neobladder formation]. Urologiia 2022:44-51. [PMID: 36098589] [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: 06/19/2023]
Abstract
INTRODUCTION Strictures and obliterations of ureteral anastomosis after radical cystectomy with orthotopic neobladder reconstruction occur in 8-13% of cases, mainly in the first 2 years after surgery. According to the European Association of Urology guidelines, open reconstruction is considered the "gold standard" for the treatment of those patients. At the same time, according to various publications, X-ray endoscopic treatment of ureteral anastomotic strictures can be performed, especially in patients who have undergone orthotopic neobladder reconstruction. MATERIALS AND METHODS Three clinical cases of endoscopic treatment of ureteral anastomotic obliteration after orthotopic neobladder formation are presented. In all patients, nephrostomy tube was initially put due to acute pyelonephritis. Obliteration of the ureteral anastomosis was diagnosed by contrast-enhanced multispiral computed tomography and antegrade pyelography. The length of obliteration in all patients did not exceed 1.0 cm. The recurrence of the bladder cancer was excluded. After percutaneous opacification of the pelvicalyceal system and advancement of two guidewires ("working" and "safety") to the level of ureteral obliteration, a catheter with a built-in fiber optic light source was put in antegrade fashion along the "working" guidewire to the area of obliteration. During transurethral inspection of the reservoir, the distal end of the light source was visualized and the reservoir wall was cut "to the light" using electrosurgery (n=2) and a thulium fiber laser (one case). For adequate kidney drainage, two internal stents of 6 Fr were put for a period of 6 months in two patients and for 2 months in another case. RESULTS All patients had an adequate diameter of the ureteral anastomosis after removal of the stents. In two cases, an adequate passage of the contrast agent through both ureters was maintained for 42 and 37 months after procedure (according to the follow-up computed tomography and excretory urography). One patient had an attack of acute pyelonephritis 2 months after the removal of internal stents due to recurrent stricture. After repeated endoscopic ureteral recanalization with putting of two internal stents for a period of 6 months, no recurrence of the stricture was observed during 28 months of follow-up. CONCLUSION Endoscopic treatment of both primary and recurrent short ureteral anastomotic obliterations in patients with orthotopic neobladder allows for adequate ureteral patency, provided that two internal stents are left in place for 6 months.
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Affiliation(s)
- A G Martov
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
| | - S V Dutov
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
| | - A S Andronov
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
| | - S V Mishugin
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
| | - A B Mantcaev
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
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Yano T, Takada T, Fujiishi R, Fujii K, Honjo H, Miyajima M, Takeshima T, Hayashi M, Miyashita J, Azuma T, Fukuhara S. Usefulness of computed tomography in the diagnosis of acute pyelonephritis in older patients suspected of infection with unknown focus. Acta Radiol 2022; 63:268-277. [PMID: 33508952 DOI: 10.1177/0284185120988817] [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: 11/15/2022]
Abstract
BACKGROUND In older adults, the diagnosis of acute pyelonephritis is challenging because of non-specific symptoms and false-positive urine test results. Few studies have investigated the diagnostic performance of computed tomography (CT) signs. PURPOSE To evaluate the diagnostic performance of CT signs for acute pyelonephritis in older patients suspected of infection with unknown focus. MATERIAL AND METHODS This cross-sectional study was conducted between 2015 and 2018. Patients aged ≥65 years who underwent blood cultures, urine culture, and non-contrast or contrast-enhanced CT on admission were included. Cases with clinically presumable infection focus before CT were excluded. Two radiologists blinded to clinical information independently reviewed five CT signs: perirenal fat stranding; pelvicalyceal wall thickening and enhancement; renal enlargement; thickening of Gerota's fascia; and area(s) of decreased attenuation. The final diagnoses were made by a clinical expert panel. RESULTS Among 473 eligible patients, 61 were diagnosed with acute pyelonephritis. When the laterality of findings between the left and right kidneys were considered, the positive and negative likelihood ratios of perirenal fat stranding were 4.0 (95% confidence interval [CI] = 2.3-7.0) and 0.8 (95% CI = 0.7-0.9) in non-contrast CT, respectively. The other signs in non-contrast CT showed similar diagnostic performance with positive and negative likelihood ratios of 3.5-11.3 and 0.8-0.9, respectively. CONCLUSION CT signs can help physicians diagnose acute pyelonephritis in older patients suspected of infection with unknown focus.
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Affiliation(s)
- Tetsuhiro Yano
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Graduate School of Medicine, Fukushima Medical University. Fukushima City, Fukushima, Japan
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuto Fujiishi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Kotaro Fujii
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Hiroshi Honjo
- Department of Radiology, Shirakawa Kosei General Hospital, Shirakawa City, Fukushima, Japan
| | - Masayuki Miyajima
- Department of Radiology, Shirakawa Kosei General Hospital, Shirakawa City, Fukushima, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Michio Hayashi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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11
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Park MG, Cho SY, Kwon SY, Choi H, Lee JW. Clinical and microbiological characteristics of men with nonobstructive acute pyelonephritis: A multicenter retrospective observational study. Medicine (Baltimore) 2021; 100:e27386. [PMID: 34622842 PMCID: PMC8500611 DOI: 10.1097/md.0000000000027386] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
To investigate the differences in clinical and microbiological features in men hospitalized with community-acquired (CA) and healthcare-associated (HA) nonobstructive acute pyelonephritis (APN), as well as the predictive factors associated with bacteremia.Men discharged from urological centers with nonobstructive APN were identified using an electronic medical records system. We compared the clinical and microbiological data between subjects with CA-APN and HA-APN.Of the 245 men with nonobstructive APN, 175 had CA-APN, and 70 had HA-APN. The HA group was significantly older, had a longer hospital stay, and had more underlying diseases, bacteremia, and intensive care unit admissions than the CA group. The most commonly cultured microorganism was Escherichia coli. The susceptibility of the cultured bacteria to fluoroquinolone was 68.7% in the CA group and 45.3% in the HA group (P = .005). The proportion of extended-spectrum beta-lactamase-producing bacteria was 22.7% for CA and 53.5% for HA (P < .001). The sensitivity to piperacillin/tazobactam was 94.9% for CA and 90.0% for HA, and the sensitivity to amikacin was more than 95% for both groups. The multivariate analysis revealed that an age ≥65 years and chronic liver disease were independent predictive factors for bacteremia.The incidence of antibiotic resistance and bacteremia was higher in the HA group than in the CA group. However, resistance to fluoroquinolone and the presence of extended-spectrum beta-lactamase-producing bacteria were high in both groups. Piperacillin/tazobactam and amikacin may be suitable treatment options in men with nonobstructive APN.
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Affiliation(s)
- Min Gu Park
- Department of Urology, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Se Yun Kwon
- Department of Urology, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hoon Choi
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jeong Woo Lee
- Department of Urology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
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12
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Kogan MI, Ivanov SN, Naboka YL. [Current issues of epidemiology, etiology, risk factors and predisposing conditions of acute pyelonephritis (review part I)]. Urologiia 2021:109-115. [PMID: 33960169] [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
A growing body of research indicates an upward trend in the incidence of urinary tract infections (UTIs) around the world. Acute pyelonephritis (AP), which is dangerous by the development of complex, life-threatening conditions, is no exception. Today the demographic portrait, as well as the characteristics of the causative agents and predisposing conditions of this disease are a global issue for the entire scientific community. In order to assess the data available in the global literature on the issues of epidemiology, etiology and predisposing factors for the development of AP, the search for publications was performed in the medical literature databases The Cochrane Database, MEDLINE/PubMed Database, eLIBRARY, ClinicalKey. The presented material includes, among others, 43 sources over the past 10 years, of which 31 publications over the past 5 years: the largest and most representative studies reflecting the current situation with AP in the population among patients in certain areas and under various exogenous and endogenous conditions. This study opens a series of three reviews on the problem of AP, involving discussion of key aspects of pathogenesis AP. Analysis of the literature indicates fragmentation and limited data when comparing the incidence of AP in different countries and different periods of time. The complexity of the intranosological structure of the varieties of acute pyelonephritis today dictates the advisability of updating approaches to research in this area, and the disease itself dynamically evolves along with its etiological agents, the nature of social behavior of people and environmental conditions in general.
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Affiliation(s)
- M I Kogan
- Dept. of Urology and Human Reproductive Health Rostov State Medical University, Rostov-on-Don, Russia
| | - S N Ivanov
- Dept. of Urology and Human Reproductive Health Rostov State Medical University, Rostov-on-Don, Russia
- Dept. of Microbiology and Virology 1 Rostov State Medical University, Rostov-on-Don, Russia
| | - Y L Naboka
- Dept. of Microbiology and Virology 1 Rostov State Medical University, Rostov-on-Don, Russia
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13
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Yamauchi Y, Kameda H, Omori K, Tani M, Cho KY, Nakamura A, Miyoshi H, Tanaka S, Atsumi T. Severe infection including disseminated herpes zoster triggered by subclinical Cushing's disease: a case report. BMC Endocr Disord 2021; 21:84. [PMID: 33906651 PMCID: PMC8077829 DOI: 10.1186/s12902-021-00757-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/26/2021] [Accepted: 04/20/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Subclinical Cushing's disease (SCD) is defined by corticotroph adenoma-induced mild hypercortisolism without typical physical features of Cushing's disease. Infection is an important complication associated with mortality in Cushing's disease, while no reports on infection in SCD are available. To make clinicians aware of the risk of infection in SCD, we report a case of SCD with disseminated herpes zoster (DHZ) with the mortal outcome. CASE PRESENTATION An 83-year-old Japanese woman was diagnosed with SCD, treated with cabergoline in the outpatient. She was hospitalized for acute pyelonephritis, and her fever gradually resolved with antibiotics. However, herpes zoster appeared on her chest, and the eruptions rapidly spread over the body. She suddenly went into cardiopulmonary arrest and died. Autopsy demonstrated adrenocorticotropic hormone-positive pituitary adenoma, renal abscess, and DHZ. CONCLUSIONS As immunosuppression caused by SCD may be one of the triggers of severe infection, the patients with SCD should be assessed not only for the metabolic but also for the immunodeficient status.
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Affiliation(s)
- Yuki Yamauchi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiraku Kameda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Kazuno Omori
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michio Tani
- Department of Cancer Pathology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Kyu Yong Cho
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akinobu Nakamura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideaki Miyoshi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Division of Diabetes and Obesity, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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14
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Chen S, Luo X, Zhao Z. Renal Urothelial Carcinoma Complicated by Inferior Vena Cava Tumor Thrombus and Acute Pyelonephritis. Urology 2020; 148:e1-e2. [PMID: 33373702 DOI: 10.1016/j.urology.2020.12.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/05/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022]
Abstract
Renal urothelial carcinoma (UC) with inferior vena cava tumor thrombus is rare, especially when it is concomitant with acute pyelonephritis. In this report, a 70-year-old diabetic man with right flank pain, intermittent painless gross hematuria, and recurrent high fever was described. On the basis of the symptoms, physical examination, cytology and imaging results, renal UC with extension into inferior vena cava, and acute pyelonephritis was established. The patient was unresponsive to antimicrobial chemotherapy. Nephroureterectomy, lymphadenectomy, thrombectomy, and bladder cuff excision were performed. Postoperative histopathological examination revealed high grade UC and lymph node metastasis.
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Affiliation(s)
- Shulian Chen
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xu Luo
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zeju Zhao
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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15
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Affiliation(s)
- Colin Andrew Hinkamp
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Neil Keshvani
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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16
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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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17
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Otaola Arca H, Rodríguez Sánchez L, Páez Borda Á. Acute pyelonephritis and renal abscess due to ureteral stone. ARCH ESP UROL 2019; 72:441-442. [PMID: 31070143] [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: 06/09/2023]
Affiliation(s)
- Hugo Otaola Arca
- Hospital Universitario de Fuenlabrada. Fuenlabrada. Madrid. España. Universidad Rey Juan Carlos. Madrid. España
| | - Lara Rodríguez Sánchez
- Hospital Universitario de Fuenlabrada. Fuenlabrada. Madrid. España. Universidad Rey Juan Carlos. Madrid. España
| | - Álvaro Páez Borda
- Hospital Universitario de Fuenlabrada. Fuenlabrada. Madrid. España. Universidad Rey Juan Carlos. Madrid. España
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18
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Imaizumi K, Fujita K, Ishikawa K, Noguchi T, Nakajima A, Saitou K, Shimizu F, Horie S. [MAKING OF THE DISEASE SEVERITY PREDICTION INDEX FOR ACUTE PYELONEPHRITIS ASSOCIATED WITH URINARY OBSTRUCTION DUE TO URETERAL CALCULI]. Nihon Hinyokika Gakkai Zasshi 2019; 110:100-105. [PMID: 32307376 DOI: 10.5980/jpnjurol.110.100] [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: 06/11/2023]
Abstract
(Purpose) Both administration of antibiotics and drainage of urine are necessary for the treatment of acute pyelonephritis associated with urinary obstruction by the ureteral calculi. Though most patients get better after the treatment, some patients deteriorate accompanying with low blood pressure, and need the intensive care. Such patients sometimes visit small hospital, even at night with a few medical staffs. It is sometimes difficult to predict the patient's outcome. The disease severity prediction index for the patients was investigated. (Object and method) We examined 134 patients, who visited our hospital from 2001 to 2013, retrospectively. Ureteral stenting or nephrostomy was undergone within 24 hours in principle. If the blood pressure became under 90 mmHg, or lowered more than 40 mmHg than usual, the case was defined as serious. Blood data and physical findings were compared between serious and non-serious cases. The factors affecting the seriousness were found. Multiple logistic analysis was done to make a disease severity prediction index. (Result) 42 cases were judged as serious and 92 cases as non-serious. Six factors consisting of heart rate, serum creatinine, platelets, ages, PS and CRP affected the consequence significantly (p<0.05), however, white blood cells did not.Multiple logistic analysis was done, four factors consisting of serum creatinine, platelets, PS and CRP affected the consequence significantly (p<0.05), and the standardizing coefficients of each points were found to be 2, 2, 1, 1, respectively.The disease severity prediction index was proposed. If the index was 4 or more, the sensitivity and specificity were found to be 73.8% and 82.6%, respectively. (Conclusion) This index is useful and reliable for the prediction of the outcome of the disease.
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Affiliation(s)
| | - Kazuhiko Fujita
- Department of Urology, Juntendo University, Shizuoka Hospital
- Department of Urology, Juntendo University, Graduate School of Medicine
| | | | | | - Akiko Nakajima
- Department of Urology, Juntendo University, Shizuoka Hospital
| | - Keisuke Saitou
- Department of Urology, Juntendo University, Shizuoka Hospital
- Department of Urology, Juntendo University, Graduate School of Medicine
| | - Fumitaka Shimizu
- Department of Urology, Juntendo University, Nerima Hospital
- Department of Urology, Juntendo University, Graduate School of Medicine
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine
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19
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An L, Patel P, Ho CH. Five-day fever · elevated creatinine levels · kidney transplant 10 months prior · Dx? J Fam Pract 2019; 68:E12-E14. [PMID: 30724910] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Lucia An
- Department of Pediatrics, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Pruthul Patel
- Department of Internal Medicine and Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA.
| | - Cynthia H Ho
- Department of Internal Medicine and Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
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20
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Horii S, Iwanishi T, Kishimoto N, Kobayashi M, Ono Y. [A Case of Polyarteritis Nodosa Diagnosed from Pathological Findings of Refractory Epididymitis]. Hinyokika Kiyo 2018; 64:515-518. [PMID: 30831669 DOI: 10.14989/actauroljap_64_12_515] [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: 06/09/2023]
Abstract
A 54-year-old man was admitted to internal medicine due to unidentified fever persisting for 3 months, and was examined. Then, he was referred to our department for suspected pyelonephritis. Although he was initially being treated for pyelonephritis, right epididymitis occurred during the course of treatment. Antibiotics were ineffective, and symptoms such as weakness and subctaneous nodules also appeared. We performed epididymectomy to differentiate this intractable epididymitis from other systemic diseases. Pathological findings were fibrinoid necrotic vasculitis of middle and small arteries. Of the diagnostic criteria for polyarteritis nodosa, 4 major symptoms and histological findings were satisfied. After we started oral administration of predonin, the fever went down and the creative protein level decreased immediatately.
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Affiliation(s)
- Sayaka Horii
- The Department of Urology, Higashiosaka City Medical Center
| | | | | | | | - Yutaka Ono
- The Department of Urology, Higashiosaka City Medical Center
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21
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Wang Q, Sun M, Ma C, Lv H, Lu P, Wang Q, Liu G, Hu Z, Gao Y. Emphysematous pyelonephritis and cystitis in a patient with uremia and anuria: A case report and literature review. Medicine (Baltimore) 2018; 97:e11272. [PMID: 30407278 PMCID: PMC6250534 DOI: 10.1097/md.0000000000011272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/27/2023] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) or cystitis (EC) is a severe infection of the urinary tract with high mortality. EPN is uncommon among the patients of end stage of renal failure (ESRD) CASE PRESENTATION:: A 38-year-old male with uremia and anuria who was on hemodialysis was found to have gas formation in the bilateral pelvis, ureters, and urinary bladder by CT scan. The diagnosis was emphysematous pyelonephritis and cystitis. And Foley catheter was placed and bladder irrigation was performed. Escherichia coli infection was identified in urine culture and antibiotic was prescribed accordingly. Gas disappeared completely and the patient recovered uneventfully. CONCLUSION This is the first case report of asymptomatic EPN and EC in uremic patient, and conservative management was optimistic in this condition. More attention should be paid to EPN and EC happening to ESRD patients.
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Affiliation(s)
- Qiang Wang
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Meifeng Sun
- Department of Rehabilitation, Affiliated Hospital of Qingdao University, PR China
| | - Chengjun Ma
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Hailin Lv
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Peng Lu
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Qi Wang
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Guangyi Liu
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Zhao Hu
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Yanxia Gao
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
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22
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Abstract
We investigated whether antinatriuretic phenomena [decreases in urinary sodium (uNa) and fractional excretion of sodium (FENa)] seen in children with acute pyelonephritis (APN) are associated with the renin-angiotensin-aldosterone system (RAAS).We examined 114 children experiencing their first episode of febrile urinary tract infection (fUTI) consecutively admitted to our hospital from July 2012 to June 2014. Blood tests [C-reactive protein, white blood cell count, erythrocyte sedimentation rate, and aldosterone (Aldo)] and urine tests [uNa, urine potassium (uK) and FENa] were performed upon admission. All enrolled children underwent a 99m-dimercaptosuccinic acid renal scanning (DMSA) at admission. Areas with cortical defects (AreaCD) and uptake counts (UptakeCD) on their DMSA scans were calculated. Data were compared between children with positive DMSA results (APN), lower urinary tract infection (L-UTI), and controls; and between children with high and low Aldo levels.uNa, uNa/K, and FENa negatively correlated with AreaCD%, UptakeCD, and Aldo; were significantly lower in APN patients than in LUTIs and controls regardless of Aldo level; were lower in the high Aldo group than in the low Aldo group. However, there is no difference in AreaCD% and UptakeCD between APN children with the high and low Aldo level.Decreases in uNa, uNa/K, and FENa in children with APN may result from an antinatriuretic effect of RAAS and be related to the activation of the intrarenal RAAS.
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Affiliation(s)
| | - Su Jin Jang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
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Roider L, Abdelaziz A, Gaballah AH. CHARGE Syndrome with High Bifurcation of the Abdominal Aorta and a Horseshoe Kidney: A Case Report. J Vasc Interv Radiol 2018; 29:1288-1290.e1. [PMID: 30146198 DOI: 10.1016/j.jvir.2018.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Laura Roider
- School of Medicine, University Hospital, One Hospital Drive, Columbia, MO 65212
| | - Amr Abdelaziz
- Division of Radiology, University Hospital, One Hospital Drive, Columbia, MO 65212
| | - Ayman H Gaballah
- Division of Radiology, University Hospital, One Hospital Drive, Columbia, MO 65212; Division of Body Imaging, University Hospital, One Hospital Drive, Columbia, MO 65212
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Satyanarayan A, Kavoussi NL, Carmel ME. Congenital Duplication of the Urogenital Sinus in an Adult Female. Urology 2018; 122:19-23. [PMID: 30092302 DOI: 10.1016/j.urology.2018.07.037] [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: 05/16/2018] [Revised: 07/06/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Arthi Satyanarayan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nicholas L Kavoussi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Maude E Carmel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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25
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Efetov SK, Kochetkov VS, Sorokin NI, Pavlov PV, Tsarkov PV. [A case of sigmoid cancer occurring after uretero-sigmoid anastomosis]. Urologiia 2018:100-103. [PMID: 29901302] [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: 06/08/2023]
Abstract
Colonic neoplasia occurring in an uretero-sigmoid anastomosis is a rare case of colon cancer in the clinical practice of Russian colorectal surgeons and urologists. The article presents a case of sigmoid adenocarcinoma causing obstructive pyelonephritis.
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Affiliation(s)
- S K Efetov
- I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia
| | - V S Kochetkov
- I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia
| | - N I Sorokin
- I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia
| | - P V Pavlov
- I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia
| | - P V Tsarkov
- I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia
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26
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Garrido-Jareño M, Frasquet-Artes J, Tasias-Pitarch M, López-Hontangas JL. First case of renal abscess by Parvimonas micra. Enferm Infecc Microbiol Clin 2018; 37:140-141. [PMID: 29631929 DOI: 10.1016/j.eimc.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Marta Garrido-Jareño
- Servicio de Microbiología, Hospital Universitario y Politécnico la Fe, Valencia, España.
| | - Juan Frasquet-Artes
- Servicio de Microbiología, Hospital Universitario y Politécnico la Fe, Valencia, España
| | - María Tasias-Pitarch
- Unidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico la Fe, Valencia, España
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Lee JW, Her SM, Kim JH, Lee KH, Eisenhut M, Park SJ, Shin JI. D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection. Pediatr Nephrol 2018; 33:631-637. [PMID: 29306986 DOI: 10.1007/s00467-017-3843-9] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/15/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND D-dimer, as well as other biomarkers related to coagulation, is significantly increased during severe bacterial infection and sepsis. The aim of this study was to evaluate the usefulness of serum D-dimer as a biological marker in diagnosing acute pyelonephritis (APN) and in predicting vesicoureteric reflux (VUR) in infants with urinary tract infection (UTI). METHODS We retrospectively analyzed the data of 177 young infants (<2 years) with febrile UTI between 2005 and 2014, grouped as APN and lower UTI groups. Conventional inflammatory markers (white blood cell count (WBC), erythrocyte sedimentation rates (ESR), C-reactive protein (CRP)), and D-dimer were measured. RESULTS The WBC counts (P = 0.002), ESR (P < 0.0001), CRP (P < 0.0001), D-dimer levels (P = 0.006) and the presence of VUR (P < 0.0001) were significantly higher in the APN group than in the lower UTI group. Multiple logistic regression analyses showed that D-dimer (odds ratio [OR]:1.003, 95% CI: 1.001-1.006, P = 0.002) was an independent predictive factor for VUR in young children with UTI. The area under the curve (AUC) value from the receiver operating characteristic (ROC) curve of D-dimer (0.621, P = 0.046, 95% CI: 0.499-0.743) for prediction of VUR was higher than other inflammatory markers, but was inferior to CRP in predicting APN. CONCLUSIONS Our results demonstrate that D-dimer can be used as an inflammatory marker in infants with febrile UTI in addition to other inflammatory markers.
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Affiliation(s)
- Jung Won Lee
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Sun Mi Her
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea
| | - Ji Hong Kim
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, South Korea
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Michael Eisenhut
- Department of Pediatrics, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Se Jin Park
- Department of Pediatrics, Geoje Children's Hospital, Ajou University School of Medicine, Geoje, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea.
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, South Korea.
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Elvas AR, Pereira BJ, Carrega F, Vicente L. [Fulminant Emphysematous Pyelonephritis Secondary to Urothelial Neoplasia with Reno-Colic Fistula]. ACTA MEDICA PORT 2018; 31:129-132. [PMID: 29596773 DOI: 10.20344/amp.8869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/20/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022]
Abstract
The emphysematous pyelonephritis is a uncommon and potentially fatal entity. The recognition of this condition enables the early correct management of patients. Diabetes and ureteral obstruction are the main risk factors identified. We present the case of a patient with no relevant risk factors or prior medical history, in which the reason of admission to the emergency department was back pain, eventually evolving into septic shock in the early hours. The imaging tests identified the presence of peri-renal and subcutaneous gas which guided the medical team to the right diagnosis (emphysematous pyelonephritis secondary to fistulized urothelial neoplasia) and the optimal surgical treatment. However, in the post-operative period the patient died, as the clinical condition and laboratory test results performed during the admission were predicting. It should also be mentioned that this same case illustrated a bacteraemia by Sphingomonas Paucimobilis (acquired in the community) with cavitated damage to lungs (probable septic embolism).
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Affiliation(s)
- Ana Rita Elvas
- Serviço de Medicina. Centro Hospitalar Cova da Beira. Covilhã. Portugal
| | | | - Filipa Carrega
- Serviço de Medicina. Centro Hospitalar Cova da Beira. Covilhã. Portugal
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Hussein A, Saad K, Askar E, Zahran AM, Farghaly H, Metwalley K, Elderwy AA. Functional variants in intercellular adhesion molecule-1 and toll-like receptor-4 genes are more frequent in children with febrile urinary tract infection with renal parenchymal involvement. Acta Paediatr 2018; 107:339-346. [PMID: 29028278 DOI: 10.1111/apa.14118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/31/2017] [Revised: 09/16/2017] [Accepted: 10/09/2017] [Indexed: 02/05/2023]
Abstract
AIM We studied the functional polymorphisms of intercellular adhesion molecule-1 (ICAM-1) and toll-like receptor-4 (TLR-4) genes and risk of acute pyelonephritis (APN) in children attending Assiut University Children's Hospitals, Egypt, from 2011 to 2015. METHODS Urinary tract infections (UTIs) were diagnosed in 380 children: 98 had APN and 282 had lower UTIs. Four single-nucleotide polymorphisms in ICAM-1 and TLR-4 genes were genotyped in all subjects: ICAM-1 rs1799969 Gly241Arg, ICAM-1 rs5498 Glu469Lys, TLR-4 rs4896791 Thr399Ile and TLR-4 rs4896790 Asp299Gly. RESULTS Patients with APN were significantly more likely to have AA genotype of the ICAM-1 rs5498 (1462 A/G) polymorphism (p = 0.04) than children with lower UTIs and the TLR-4 Asp299Gly GG genotype (p = 0.002) and G allele (p = 0.006) than healthy controls. The association with the ICAM-1 Glu469Lys (1462A/G) was less evident. The GG genotype was associated with a modest relative risk of 1.4 (p = 0.1) of developing APN, but was not an independent odds ratio, at 1.2 (p = 0.48). CONCLUSION Functional variants in ICAM-1 and TLR-4 genes were increasingly common in children with febrile UTIs with renal parenchymal involvement, but the ICAM-1 Glu469Lys (1462A/G) association was less evident. TLR4 Asp299Gly might independently increase renal parenchymal infection rather than renal scarring.
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Affiliation(s)
| | - Khaled Saad
- Children Hospital, Assiut University, Assiut, Egypt
| | - Eman Askar
- Children Hospital, Assiut University, Assiut, Egypt
| | - Asmaa M Zahran
- Clinical Pathology, SECI, Assiut University, Assiut, Egypt
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Harsch IA, Langer K, Abramowski C, Konturek PC. Emphysematous pyelonephritis - a rare complication of diabetes mellitus. Wiad Lek 2018; 71:917-921. [PMID: 30099435] [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: 06/08/2023]
Abstract
Emphysematous pyelonephritis is a rare form of acute necrotizing pyelonephritis. It is a gas-producing, necrotizing infection involving the renal parenchyma and surrounding tissues. It is associated with high mortality and morbidity. In the majority of cases, patients with long-standing diabetes and poor glycemic control are affected. We report the case of a 67 yr old female who survived severe sepsis due to emphysematous pyelonephritis. Potential therapeutic strategies in the aftermath from a diabetologist's point of view are discussed.
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Affiliation(s)
- Igor Alexander Harsch
- Thuringia Clinic Saalfeld "Georgius Agricola", Department Of Internal Medicine Ii, Division Of Endocrinology And Metabolism, Teaching Hospital Of The University Of Jena, Saalfeld/Saale, Germany
| | - Kai Langer
- Thuringia Clinic Saalfeld "Georgius Agricola", Department Of Urology, Teaching Hospital Of The University Of Jena Saalfeld/Saale, Germany
| | - Christiane Abramowski
- Thuringia Clinic Saalfeld "Georgius Agricola", Department Of Pathology Saalfeld/Saale, Germany
| | - Peter Christopher Konturek
- Thuringia Clinic Saalfeld "Georgius Agricola" , Department Of Internal Medicine Ii, Division Of Gastroenterology, Teaching Hospital Of The University Of Jena, Saalfeld/Saale, Germany
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31
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Ćosić I, Ćosić V. [COMPLICATED URINARY TRACT INFECTIONS IN THE ELDERLY]. Acta Med Croatica 2016; 70:249-255. [PMID: 29087140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Urinary tract infections (UTI) are the most common bacterial infections involving lower (cystitis, prostatitis) or upper (pyelonephritis, renal abscess, perinephric abscess) urinary tract. Differentiation of complicated and uncomplicated UTI is usually based on the presence of structural or functional urinary tract abnormalities, which can increase the risk of treatment failure and development of serious complications. Factors that increase the risk are foreign bodies, stones, obstruction, neurogenic bladder, kidney transplantation, immunosuppression, and pregnancy. Complicated UTI includes a spectrum of conditions that increase the risk of treatment failure, as well as of serious complications such as bacteremia and sepsis, perinephric abscess, renal impairment and emphysematous pyelonephritis. To avoid the potentially devastating outcomes, appropriate diagnostic procedures, antibiotic and surgical treatment, and appropriate follow-up are required. The incidence of complicated UTI will grow in the future due to general aging of the population, increasing incidence of diabetes, and ever growing number of immunocompromised and immunosuppressed patients. It is of key importance to recognize complicated UTI on time, and treat it wisely and aggressively to reduce duration of the disease and the risk of antibiotic resistance.
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Köhler J, Thysell H, Tencer J, Forsberg L, Hellström M. Long-term follow-up of reflux nephropathy in adults with vesicoureteral reflux – radiological and pathoanatomical analysis. Acta Radiol 2016; 42:355-64. [PMID: 11442458 DOI: 10.1080/028418501127346981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To study the long-term development of urographic renal morphology in adults with vesicoureteral reflux, to investigate the relationship between renal damage and reflux grade, and to analyse the association between the long-term urographic outcome and the occurrence of acute pyelonephritis and reflux during follow-up. The purpose was also to try to distinguish between acquired and developmental renal damage, based on analyses of renal histological specimens and urographic features, and to analyse associated congenital urogenital abnormalities and family history of reflux, reflux nephropathy, urological malformation or death from end-stage renal disease. Material and Methods: Renal damage was identified in 100 (83 women) of 115 adults, selected because of documented reflux. Eighty-seven patients had two urographies done (median interval 14.3 years). The extent and progression of renal damage were assessed and features of developmental renal damage were determined. Histological renal specimens were available in 23 patients with renal damage. Results and Conclusions: The extent of renal damage correlated positively with the severity of reflux. No renal damage developed during the follow-up in 45 previously undamaged kidneys and progression of renal damage was rare (4 of 120 previously damaged kidneys), despite persisting reflux in half of the cases and episodes of acute pyelonephritis during follow-up. Thus, repeated renal imaging is rarely justified in adults with reflux nephropathy. Histological examination showed "chronic pyelonephritis" in all 23 cases and co-existing renal dysplasia in 1 case. The detailed urographic analysis did not reveal support for developmental renal damage. High frequencies of associated congenital urogenital abnormalities and of a positive family history were found. Thus, congenital and/or hereditary factors cannot be discarded as background factors for the development of renal damage.
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Affiliation(s)
- J Köhler
- Department of Nephrology, University Hospital, Lund, Sweden
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33
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Grigorev NA, Zaitsev AV, Kharchilava RR. [Acute pyelonephritis]. Urologiia 2016:4-10. [PMID: 28247613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Zaitsev AV, Kasyan GR, Kharchilava RR. [Chronic pyelonephritis]. Urologiia 2016:11-17. [PMID: 28247614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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35
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Kogan MI, Naboka YUL, Gudima IA, Bedjanyan SK. [Experimental modeling of acute pyelonephritis]. Urologiia 2016:110-113. [PMID: 28247737] [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: 06/06/2023]
Abstract
Acute pyelonephritis (AP) predominates among inflammatory infection kidney affections. In accordance to international classifications, AP is an upper urinary tract infection, subdivided into non-complicated (non-obstructive) and complicated (obstructive) forms. The clinical significance of AP presently is defined by the conditions frequent occurrence and its progression into chronic kidney disease. For a limited number of pathogens the involvement in AP is considered proven: representatives of the Enterobacteriaceae family (E.coli, Klebsiella spp., Proteus spp., etc.), Pseudomonas spp., a number of gram-positive microorganisms (S.aureus, Enterococcus spp.). Beside that, over the last 3 decades there have been rare publications in the world literature describing clinical cases of AP caused by microorganisms not readily cultivated on standard mediums (mostly anaerobic). This was accompanied by an idea that AP might develop in case of kidney invasion not only by aerobic, but also by anaerobic microorganisms, which is practically not taken into account in current clinical practice. In this regard it was deemed feasible to perform an analysis of experimental disease models to refine the discussion points of the disease etiology, to do so an attempt of all-encompassing study in the Russian and English literature databases (linical Key, MEDLINE, PubMed, HighWire Press, The Cochrane Library, BioMed Central, Central scientific medical library of the I.M. Sechenov Moscow medical academy, Russian State Library). A total of 356 literature sources have been studied, of which 41 were selected for the current review.
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Affiliation(s)
- M I Kogan
- Chair of urology and human reproductive health with child urology andrology course of the FPK and PPS GBOU VPO RostGMU, Russian Federation Ministry of Health RostGMU Russian Federation Ministry of Health
| | - Y U L Naboka
- Chair of urology and human reproductive health with child urology andrology course of the FPK and PPS GBOU VPO RostGMU, Russian Federation Ministry of Health RostGMU Russian Federation Ministry of Health
| | - I A Gudima
- Chair of urology and human reproductive health with child urology andrology course of the FPK and PPS GBOU VPO RostGMU, Russian Federation Ministry of Health RostGMU Russian Federation Ministry of Health
| | - S K Bedjanyan
- Chair of urology and human reproductive health with child urology andrology course of the FPK and PPS GBOU VPO RostGMU, Russian Federation Ministry of Health RostGMU Russian Federation Ministry of Health
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36
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Davidov MI. [A giant fecalith complicated by acute urinary retention, hydronephrosis and acute obstructive pyelonephritis]. Urologiia 2016:109-111. [PMID: 28247672] [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: 06/06/2023]
Abstract
The article reports a rare case of a 30-year-old man with Hirschsprung's disease, who developed a giant fecalith in the rectum and sigmoid (weight 3.5 kg, the largest diameter 20 cm). The fecalith impaired urine flow by compressing urinary tract, thereby causing acute urinary retention and right-sided hydronephrosis with acute obstructive pyelonephritis. Removing fecalith resulted in the patient recovery and normal functioning of genitourinary system.
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Affiliation(s)
- M I Davidov
- E.A. Vagner Perm State Medical Academy, Perm
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Singh R, Bemelman FJ, Hodiamont CJ, Idu MM, Ten Berge IJM, Geerlings SE. The impact of trimethoprim-sulfamethoxazole as Pneumocystis jiroveci pneumonia prophylaxis on the occurrence of asymptomatic bacteriuria and urinary tract infections among renal allograft recipients: a retrospective before-after study. BMC Infect Dis 2016; 16:90. [PMID: 26912326 PMCID: PMC4766656 DOI: 10.1186/s12879-016-1432-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The international guidelines recommend the administration of trimethoprim-sulfamethoxazole (TMP-SMX) as Pneumocystis jiroveci pneumonia (PJP) prophylaxis for six months after transplantation. The aim of this study is to evaluate the influence of TMP-SMX prophylaxis on the occurrence of asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) as cystitis and allograft pyelonephritis (AGPN) and its impact on the antimicrobial resistance pattern of causative microorganisms. METHODS We have conducted a retrospective before-after study in adult renal allograft recipients with one year follow-up after transplantation. We compared the ("after") group that received TMP-SMX as PJP prophylaxis to the ("before") group that did not receive it. RESULTS In total, 343 renal allograft recipients were analysed, of whom 212 (61.8 %) received TMP-SMX as PJP prophylaxis. In this study, 63 (18.4 %) did only develop ASB without UTI, 26 (7.6 %) developed cystitis and 43 (12.5 %) developed AGPN. The remaining 211 (61.5 %) renal allograft recipients did not develop any bacteriuria at all. Multivariable Cox proportional regression analysis indicated that TMP-SMX as PJP prophylaxis was not associated with reduced prevalence of ASB (Hazard ratio (HR) = 1.52, 95 % CI = 0.79-2.94, p = 0.213), nor with reduced incidence of cystitis (HR = 2.21, 95 % CI = 0.76-6.39, p = 0.144), nor AGPN (HR = 1.12, 95 % CI = 0.57-2.21, p = 0.751). Among the group receiving TMP-SMX as PJP prophylaxis there was a trend was observed in increase of both amoxicillin (86 % versus 70 %) and TMP-SMX (89 % versus 48 %) resistance which already appeared within the first 30 days after TMP-SMX exposure. CONCLUSIONS Among renal allograft recipients, administration of TMP-SMX as PJP prophylaxis does not prevent ASB nor UTI, however it is associated with tendency towards increased amoxicillin and TMP-SMX resistance.
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Affiliation(s)
- Ramandeep Singh
- Department of Internal Medicine, Renal transplant Unit, Division of Nephrology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Frederike J Bemelman
- Department of Internal Medicine, Renal transplant Unit, Division of Nephrology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Caspar J Hodiamont
- Department of Medical Microbiology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Mirza M Idu
- Department of Surgery, Division of Vascular Surgery, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Ineke J M Ten Berge
- Department of Internal Medicine, Renal transplant Unit, Division of Nephrology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center-University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
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Torres-Mercado LO, García-Padilla MÁ, Serrano-Brambila E, Maldonado-Alcaraz E, López-Sámano VA, Montoya-Martínez G, Moreno-Palacios J. [Prognostic factors of morbimortality in patients with emphysematous pyelonephritis]. Rev Med Inst Mex Seguro Soc 2016; 54 Suppl 2:S156-S161. [PMID: 27561019] [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: 06/06/2023]
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN. METHODS It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome. RESULTS 73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p <0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p <0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p < 0.001) were factors significantly associated with adverse outcome. CONCLUSION Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.
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Affiliation(s)
- León Octavio Torres-Mercado
- Servicio de Urología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Shimura S, Tabata KI, Koguchi D, Amano N, Nishi M, Fujita T, Matsumoto K, Satoh T, Iwamura M. [A Case of Emphysematous Pyelonephritis with Pneumoderma Treated by Open Surgical Drainage]. Hinyokika Kiyo 2015; 61:493-497. [PMID: 26790763] [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: 06/05/2023]
Abstract
Emphysematous pyelonephritis (EPN) is an acute, severe necrotizing infection of the renal parenchyma and perirenal tissue. A 72-year-old female patient with uncontrolled diabetes mellitus was admitted to a hospital with loss of consciousness and, fever. Laboratory data suggested acute inflammation and hyperosmolar hyperglycemic syndrome. The left EPN was accurately diagnosed after abdominal computed tomographic (CT) scan revealed renal parenchymal gas and fluid within the subcutaneous tissue and mediastinum. The patient was transferred to our institution and underwent emergent open surgical drainage. However, a CT scan performed 3 days after the drainage revealed the presence of fluid in the left perinephric space. CT-guided drainage of the left perinephric fluid was performed. The patient was finally discharged after complete recovery from severe inflammation.
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Affiliation(s)
- Soichiro Shimura
- The Department of Urology, Kitasato University School of Medicine
| | - Ken-ichi Tabata
- The Department of Urology, Kitasato University School of Medicine
| | - Dai Koguchi
- The Department of Urology, Kitasato University School of Medicine
| | - Noriyuki Amano
- The Department of Urology, Kitasato University School of Medicine
| | - Morihiro Nishi
- The Department of Urology, Kitasato University School of Medicine
| | - Tetsuo Fujita
- The Department of Urology, Kitasato University School of Medicine
| | | | - Takefumi Satoh
- The Department of Urology, Kitasato University School of Medicine
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Barr-Beare E, Saxena V, Hilt EE, Thomas-White K, Schober M, Li B, Becknell B, Hains DS, Wolfe AJ, Schwaderer AL. The Interaction between Enterobacteriaceae and Calcium Oxalate Deposits. PLoS One 2015; 10:e0139575. [PMID: 26448465 PMCID: PMC4598009 DOI: 10.1371/journal.pone.0139575] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [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: 06/24/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022] Open
Abstract
Background The role of calcium oxalate crystals and deposits in UTI pathogenesis has not been established. The objectives of this study were to identify bacteria present in pediatric urolithiasis and, using in vitro and in vivo models, to determine the relevance of calcium oxalate deposits during experimental pyelonephritis. Methods Pediatric kidney stones and urine were collected and both cultured and sequenced for bacteria. Bacterial adhesion to calcium oxalate was compared. Murine kidney calcium oxalate deposits were induced by intraperitoneal glyoxalate injection and kidneys were transurethrally inoculated with uropathogenic Escherichia coli to induce pyelonephritis Results E. coli of the family Enterobacteriaceae was identified in patients by calcium oxalate stone culture. Additionally Enterobacteriaceae DNA was sequenced from multiple calcium oxalate kidney stones. E. coli selectively aggregated on and around calcium oxalate monohydrate crystals. Mice inoculated with glyoxalate and uropathogenic E. coli had higher bacterial burdens, increased kidney calcium oxalate deposits and an increased kidney innate immune response compared to mice with only calcium oxalate deposits or only pyelonephritis. Conclusions In a murine model, the presence of calcium oxalate deposits increases pyelonephritis risk, likely due to preferential aggregation of bacteria on and around calcium oxalate crystals. When both calcium oxalate deposits and uropathogenic bacteria were present, calcium oxalate deposit number increased along with renal gene transcription of inner stone core matrix proteins increased. Therefore renal calcium oxalate deposits may be a modifiable risk factor for infections of the kidney and urinary tract. Furthermore, bacteria may be present in calcium oxalate deposits and potentially contribute to calcium oxalate renal disease.
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Affiliation(s)
- Evan Barr-Beare
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Vijay Saxena
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Evann E. Hilt
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Krystal Thomas-White
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Megan Schober
- Nationwide Children’s Hospital, Division of Urology, Columbus, Ohio, United States of America
| | - Birong Li
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Brian Becknell
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
- Nationwide Children’s Hospital, Division of Nephrology, Columbus, Ohio, United States of America
| | - David S. Hains
- Lebonheur Children’s Hospital, Division of Nephrology, Memphis, Tennessee, United States of America
| | - Alan J. Wolfe
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Andrew L. Schwaderer
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
- Nationwide Children’s Hospital, Division of Nephrology, Columbus, Ohio, United States of America
- * E-mail:
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41
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Rossi L, Lisi P, Vigo V, Lomonte C, Basile C. [An unusual cause of acute pyelonephritis: the retrocaval ureter]. G Ital Nefrol 2015; 32:gin/00218.7. [PMID: 26252261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Retrocaval ureter is a rare congenital malformation in which the proximal right ureter courses toward the midline on the posterior aspect of the inferior vena cava before emerging medial and anterior to this structure and then descending into the pelvis. This anatomical anomaly may be asymptomatic or manifest clinically, usually starting from the fourth decade of life, with flank pain, pyelonephritis, gross hematuria or other rarer signs. We describe the case of a young woman being hospitalized because of acute pyelonephritis; she had previously complained of flank pain associated with episodes of high fever. Computed tomography of the abdomen identified the malformation. The patient underwent surgical correction by laparoscopy and, at one year of follow-up, did not show any further clinical problem.
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Shinoda K, Taki H, Obayashi K, Ando Y, Watanabe A, Komiya A, Fuse H, Tsuneyama K, Tobe K. Wild-type ATTR amyloidosis of the ureter in a 56-year-old woman with rheumatoid arthritis and Sjögren's syndrome. Int J Clin Exp Pathol 2015; 8:8624-8627. [PMID: 26339445 PMCID: PMC4555773] [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] [Received: 04/20/2015] [Accepted: 06/26/2015] [Indexed: 06/05/2023]
Abstract
We present a case of acute pyelonephritis with right hydronephrosis in a middle-aged woman, who had suffered from rheumatoid arthritis and Sjögren's syndrome. She had successfully treated with antibiotics, however, ureteral stenosis sustained. She underwent ureteroscopy and stenting of right ureter. Biopsy specimen revealed submucosal amyloid deposition in the interstitium overlying a benign urothelium. Amyloid protein was positive for transthyretin (TTR) by immunohistochemistry and amyloid deposition was not demonstrated in other organs. The patient's TTR genes were wild type and she was diagnosed with wild-type ATTR (ATTR wt) amyloidosis. This is the first report about symptomatic ATTR wt amyloidosis, which was also called 'systemic senile amyloidosis (SSA)' in the ureter. We should aware that SSA can occur at younger age and cause symptomatic ureteral stenosis. Further investigation is needed to clarify the association of autoimmune diseases to develop ATTR wt amyloidosis.
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Affiliation(s)
- Koichiro Shinoda
- First Department of Internal Medicine, University of ToyamaJapan
| | - Hirofumi Taki
- First Department of Internal Medicine, University of ToyamaJapan
| | - Konen Obayashi
- Department of Morphological and Physiological Sciences, Graduate School of Life Sciences, Kumamoto UniversityJapan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto UniversityJapan
| | | | - Akira Komiya
- Department of Urology, University of ToyamaJapan
| | - Hideki Fuse
- Department of Urology, University of ToyamaJapan
| | - Koichi Tsuneyama
- Department of Diagnostic Pathology, Graduate School of Medical and Pharmaceutical Sciences, University of ToyamaJapan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, University of ToyamaJapan
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Chen WL, Huang IF, Wang JL, Hung CH, Huang JS, Chen YS, Lee SSJ, Hsieh KS, Tang CW, Chien JH, Chiou YH, Cheng MF. Comparison of acute lobar nephronia and acute pyelonephritis in children: a single-center clinical analysis in southern taiwan. Pediatr Neonatol 2015; 56:176-82. [PMID: 25459491 DOI: 10.1016/j.pedneo.2014.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 03/17/2014] [Revised: 07/13/2014] [Accepted: 08/04/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with acute lobar nephronia (ALN) require a longer duration of antimicrobial treatment than those with acute pyelonephritis (APN), and ALN is associated with renal scarring. The aim of this study was to provide an understanding of ALN by comparing the clinical features of pediatric patients with ALN and APN. METHODS We enrolled all of the patients with ALN (confirmed by computed tomography) admitted to our hospital from 1999 to 2012 in the ALN group. In addition, each patient diagnosed with APN who was matched for sex, age, and admission date to each ALN patient was enrolled in the APN group. The medical charts of patients in these two groups were retrospectively reviewed and analyzed for comparison. RESULTS The fever duration after hospitalization in the ALN group and the APN group were 4.85 ± 2.33 days and 2.30 ± 1.47 days respectively. The microbiological distributions and the majority of susceptibilities were similar in the ALN and APN groups. The majority of clinical manifestations are nonspecific and unreliable for the differentiation of ALN and APN. The patients with ALN were febrile for longer after antimicrobial treatment, had more nausea/vomiting symptoms, higher neutrophil count, bandemia, and C-reactive protein (CRP) levels, and lower platelet count (all p < 0.05). In multivariate analysis, initial CRP levels, nausea/vomiting symptoms, and fever duration after admission were independent variables with statistical significance to predict ALN. Severe nephromegaly occurred significantly more in the ALN group than in the APN group (p = 0.022). CONCLUSION The majority of clinical manifestations, laboratory findings, and microbiological features are similar between patients with ALN and APN. Clinicians should keep a high index of suspicion regarding ALN, particularly for those with ultrasonographic nephromegaly, initial higher CRP, nausea/vomiting, and fever for > 5 days after antimicrobial treatment.
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Affiliation(s)
- Wan-Ling Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, Pingtung Branch of Kaohsiung Veterans General Hospital, Pingtung, Taiwan
| | - I-Fei Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jiun-Ling Wang
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chih-Hsin Hung
- Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Jer-Shyung Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Wan Tang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Hung Chien
- Department of Pediatrics, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ming-Fang Cheng
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Hussein A, Elderwy AA, Askar E, Afifi N, Askar G, Metwalley KA, Alsaeid M. Impact of common functional polymorphisms in renin angiotensin system genes on the risk of renal parenchymal scarring following childhood urinary tract infection. J Pediatr Urol 2015; 11:152.e1-7. [PMID: 25939993 DOI: 10.1016/j.jpurol.2015.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/24/2014] [Accepted: 02/27/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pathogenesis of renal parenchymal scarring (RPS) after acute pyelonephritis (APN) is unclear. The risk of RPS varies markedly among individuals, suggesting a genetic role. OBJECTIVE To investigate a possible role of common polymorphisms in renin angiotensin system genes in APN-associated RPS in children. PATIENTS AND METHODS This study included 104 APN children and 300 controls. APN was diagnosed by urine culture and typical findings on 99Tc-DMSA scans. Voiding cystourethrogram tested the presence of vesicoureteral reflux (VUR). Follow-up DMSA scans were performed 4-6 months later to identify new RPS. Angiotensin converting enzyme gene I/D, angiotensin II receptor type-1 A1166C and angiotensinogen M235T polymorphisms were genotyped. RESULTS New RPS developed in 44.2% (46/104) of children with APN. VUR was diagnosed in 35.6% (37/104) of APN cases. RPS developed in 73% of cases of VUR. The D allele of ACE gene I/D polymorphism was significantly more common in APN cases with RPS (73.91%) than non-RPS (58.6%) and controls (54.5%) (p = 0.021, p = 0.002, respectively). The AGTR-1 A1166C A allele was significantly more common in VUR than the non-reflux children (91.9% versus 76.1%; p = 0.005). VUR, in contrast to the D allele (OR 6.1, 95% CI 0.878-19.7; p = 0.05), was an independent risk factor for RPS. DISCUSSION ACE gene D allele is associated with a twofold increase in RPS risk, which could be a result of a functional effect to increase tissue levels and activity of ACE during APN. However, D allele failed to qualify as an independent risk and its RPS association could be dependent on other co-factors, such as TGFβ1 activation, or the D-allele might link with recently discovered functional polymorphisms at the 5' end of the ACE gene. Although VUR is an independent risk for RPS, it is not clear whether this is due to exposure of the kidneys to infected urine, or VUR-associated dysplasia. In contrast with published literature, we noted higher rates of RPS and high-grade VUR, suggesting a more aggressive VUR course or local unawareness of APN. Our study has its limitations; the small number of VUR children, and the clinical and ethical difficulties of testing VCUG and DMSA in controls. CONCLUSIONS ACE gene D allele is associated with, but cannot independently predict, RPS in children. VUR is an independent risk for post-pyelonephritic scarring. AGTR-1 1166A/C polymorphism is associated with occurrence, but not progression, of VUR.
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Affiliation(s)
- Almontaser Hussein
- Children Hospital, Assiut University, Egypt; Division of Pediatric Nephrology, Center for Children and Adolescent Medicine, University of Heidelberg, Germany.
| | | | - Eman Askar
- Children Hospital, Assiut University, Egypt.
| | - Noha Afifi
- Department of Microbiology and Immunology, Assiut University, Egypt
| | - Gamal Askar
- Children Hospital, Assiut University, Egypt.
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45
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Svenson SB, Källenius G, Korhonen TK, Möllby R, Roberts JA, Tullus K, Winberg J. Initiation of clinical pyelonephritis--the role of P-fimbriae-mediated bacterial adhesion. Contrib Nephrol 2015; 39:252-72. [PMID: 6146493 DOI: 10.1159/000409254] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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46
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Hodson CJ, Twohill SA. The time factor in the development of sterile renal scarring following high-pressure vesicoureteral reflux. Contrib Nephrol 2015; 39:358-69. [PMID: 6744879 DOI: 10.1159/000409263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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47
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Eknoyan G. The natural history of primary pyelonephritis. Contrib Nephrol 2015; 75:82-9. [PMID: 2697511 DOI: 10.1159/000417733] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- G Eknoyan
- Department of Medicine, Baylor College of Medicine, Houston, Tex
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48
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Affiliation(s)
- P Zucchelli
- Divisione di Nefrologia e Dialisi, Ospedale M. Malpighi, Bologna, Italy
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49
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Gusmano R, Perfumo F, Raspino M, Ginevri F, Verrina E, Ciardi MR. Natural history of reflux nephropathy in children. Contrib Nephrol 2015; 61:200-9. [PMID: 3359778 DOI: 10.1159/000415251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- R Gusmano
- Nephrology and Dialysis Department, G. Gaslini Institute, Genoa, Italy
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50
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Zucchelli P, Gaggi R, Zuccalà A. The natural history of reflux nephropathy. Contrib Nephrol 2015; 75:90-9. [PMID: 2627792 DOI: 10.1159/000417734] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- P Zucchelli
- Divisione di Nefrologia e Dialisi Malpighi, Ospedale S. Orsola Malpighi, Bologna, Italia
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