Encrusted pyelitis of native kidneys. (1/13)

This study reports the first four cases of encrusted pyelitis involving native kidneys. The clinical features, management, and outcome of these patients were analyzed. Predisposing factors were underlying urologic disease and/or urologic manipulations, debilitating diseases, hospitalization, and prolonged antibiotic therapies. Presenting symptoms were renal failure in three patients with ureteroileal urinary diversion and manifestations of cystitis in one patient. Computed tomography scan of the urinary tract was critical for diagnosis. Presence of struvite was demonstrated by crystalluria and infrared spectrophotometry analysis of the encrusted material. Corynebacterium urealyticum urinary infection was identified in one case. Surgery (one patient) and palliative ureteral diversion (one patient), respectively, led to death and end-stage renal failure. Successful dissolution of encrusted pyelitis was obtained in two patients treated with intravenous vancomycin and local acidification of the renal collecting system. Clinical observation shows that encrusted pyelitis is a threatening disorder that destroys the native kidneys and may lead to end-stage renal failure. Successful treatment of the disease by chemolysis and antibiotics depends on correct and early diagnosis. Diagnosis required recognition of the predisposing factors, computed tomography imaging of the urinary tract, crystalluria, and identification of urea-splitting bacteria with prolonged culture on selective medium.  (+info)

Experimental Escherichia coli O6 pyelonephritis in rabbits. Effect on O6 antibody quantity and avidity of prior immunization with E. coli O2 bacteria. (2/13)

Haematogenous pyelonephritis was induced in rabbits using Escherichia coli 06:K13:H1 bacteria and the amounts and avidities of antibodies to the 06 antigen were analysed by the ammonium sulphate precipitation technique of Farr. In a group of six animals preimmunized with E. coli 02:K2ab:H1, five developed pyelonephritis and one pyelitis, as determined by histological examination. All aminals showed a considerable antibody response to E. coli 06 antigen during the infection. The animal with pyelitis gave a slightly smaller response than the others. The antibody avidity showed a pronounced variation. In a second group of six rabbits not preimmunized, five animals developed pyelonephritis. The titres of antibodies against E. coli 06 antigen increased during the infection inall of the six animals. However, the increase was significantly smaller than for the animals preimmunized with E. coli 02:K2ab:H1 (P smaller than 0.01). The pattern of the antibody avidities in this group was also heterogenous. The results are consistent with previous findings that exposure to serologically heterologous E. coli bacteria can enhance the development of the homologous antibody titres. This could be of relevance for serological diagnostic work as well as in the determination of the protective capacity of the antibody.  (+info)

COMMON UROLOGICAL CONDITIONS IN THE FEMALE. (3/13)

Stress incontinence, urge incontinence, and pyelitis of pregnancy are common urological conditions in the female. Poor therapeutic results in the treatment of stress incontinence may be traced to errors in diagnosis. Accurate diagnosis is based on an accurate history, residual urine test, the stress test, cystometric studies (to rule out neurogenic disturbances), cystourethroscopy and cystourethrography. The most important factor in the production of urge incontinence is infection. Some pathological conditions which may be associated with urge incontinence are urethritis, cystitis, urethral stricture, bladder-neck obstruction, urethral diverticula, urethral caruncle and the urgencyfrequency syndrome. Therapy is directed toward the eradication of infection and treatment of the specific lesion. In pyelitis of pregnancy it is urged that, in cases of unusual bacterial virulence and poor ureteral drainage, early cystoscopic ureteral catheter drainage should be instituted in order to prevent permanent kidney damage. The closest co-operation of urologist, gynecologist and general physician is necessary for clarification of some of the more complex problems.  (+info)

Granulomatous pyelitis associated with urinary obstruction: a comprehensive clinicopathologic study. (4/13)

Urinary obstruction is rarely associated with a distinct granulomatous inflammation, which involves the pyelocalyceal system and closely simulates infectious conditions including tuberculosis. Its clinicopathologic features, however, have not been adequately studied since there are only seven isolated reported cases. In a comprehensive study of 112 kidney specimens with urinary obstruction, we identified five cases of granulomatous pyelitis. The features of these cases were detailed and compared with the previously reported cases. Among the five identified subjects, three patients had history of urolithiasis and two had ureteral stenosis and all had stent placement 7 weeks to 12 years before nephrectomy for relief of the unilateral urinary obstruction. The age distribution was between 38 and 81 years. Two had end-stage renal disease or chronic renal failure. The pyelocaliceal system showed frank hydronephrosis (1 case) or partial dilatation (4 cases) and contained cheesy and gritty material in its lumen. Each case showed severe granulomatous inflammation, which was limited to the pelvic wall and closely associated with calcified debris, necrotic inflammatory cells, and material consistent with Tamm-Horsfall protein. The kidney showed chronic tubulointerstitial nephritis but without granulomas. Cultures of urine, blood, and the renal pelvic content, and special stains of tissue sections did not show fungi or mycobacteria in any case. Many of these features were also observed in previously reported cases. Granulomatous pyelitis is a rare but distinct cliniocopathologic entity characterized by severe noninfectious granulomatous inflammation limited to the renal pelvis, which is uniformely asociated with urinary obstruction and pyelocalyceal dilatation and may develop in response to accumulated calcified material in the renal pelvis. Awareness of this entity and its characteristic clinicopathologic features also helps eliminate an infectious etiology with obvious treatment and prognostic implications.  (+info)

Successful treatment of Corynebacterium urealyticum encrusted cystitis: a case report and literature review. (5/13)

Encrusted cystitis is a very rare chronic inflammatory disease of the bladder characterized by precipitation and incrustation of phosphate and ammonium-magnesium salts on the vescical mucosa, caused by urinary infection due to urolithic microorganisms. Corynebacterium urealyticum or Corynebacterium group D2, a multiple antibiotic-resistant urea-splitting bacterium, is the most frequently incriminated aetiology. We report a case of a 57-year-old man affected by systemic erythematosus lupus with a long history of dysuria and suprapubic pain who underwent percutaneous nephrostomy drainage with urethral stenting for lupoid obstructive uropathy. Before the diagnosis of encrusted cystitis by Corynebacterium urealyticum was established, the patient underwent five cystoscopies to remove the plaques and multiple unsuccessful antibiotic treatment courses. Eventually the infection was definitively cured after a two-week course with intramuscular teicoplanin.  (+info)

Urinary tract infection due to Corynebacterium urealyticum in kidney transplant recipients: an underdiagnosed etiology for obstructive uropathy and graft dysfunction-results of a prospective cohort study. (6/13)

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Emphysematous pyelitis: epidemiological, therapeutic and evolutive features. (7/13)

AIM: Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis. METHODS: The data of six patients managed for emphysematous pyelitis were collected and analyzed. RESULTS: The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned -- dedifferentiated -- renal parenchyma. Outcome was good. CONCLUSION: Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy.  (+info)

Renal emphysema in diabetic patients: CT evaluation. (8/13)

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