PYELONEPHRITIS

To determine by retrospective review of 315 percutaneous nephrostomies, performed for pyonephrosis, whether this intervention has major clinical advantages. From 1977 to 1996, under the direct supervision of the senior author of this report (E.K.L.), at seven hospital sites, 315 patients (181 males, 134 females; 17 to 88 years of age) were treated with percutaneous nephrostomy and antibiotic therapy for infected hydronephrosis. Additional or disparate pathogens were identified in 116 (36.8%) of 315 patients, leading to a clinically significant change in, or addition of, antibiotics and/or antifungal agents in 84 (73%) of 116. Most notably, we often found a clinically important disparity between the results of cultures obtained from the nephrostomy and those obtained from bladder-urine specimens. This retrospective review confirms previously reported advantages of percutaneous upper urinary tract drainage as a potentially life-saving adjunct in the treatment of pyonephrosis. Several case studies highlight the advantage of this maneuver in difficult cases involving obstruction due to extensive fungus or debris. In particular, our review focuses attention on the clinically important insight that urine cultures from percutaneous nephrostomy drainage often identify pathogens that differ from those detected in concurrent bladder cultures.

The association of pyelonephritis and emphysematous cystitis is a rare pathology caused by gasogenic bacteria. the diagnosis is not easy and made by imaging. We report the case of a 63-year-old patient hospitalized in nephrology for acute renal failure discovered in a context of left hydronephrosis complicated by pyelonephritis. uroscanner revealed emphysematous pyelonephritis complicated by pyonephrosis and an emphysematous cyst. The patient receiving conservative treatment.

Urinary tract infections (UTIs) are more common and tend to have a more complicated course in patients with diabetes mellitus (DM). The mechanisms, which potentially contribute to the increased prevalence of both asymptomatic and symptomatic bacteriuriai in these patients are defects in the local urinary cytokine secretions and an increased adherence of the microorganisms to the uroepithelial cells. The need for treatment of asymptomatic bacteriuria remains controversial. No evidence is available on the optimal treatment of acute cystitis and pyelonephritis in patients with DM. Because of the frequent (asymptomatic) upper tract involvement and the possible serious complications, many experts recommend a 7-14-day oral antimicrobial regimen for bacterial cystitis in these patients, with an antimicrobial agent that achieves high levels both in the urine and in urinary tract tissues. Current data suggest that shorter regimens will lead to failure also in uncomplicated UTI in women. The recommended treatment of acute pyelonephritis does not differ from that in nondiabetic patients. Clinical trials specifically dealing with the treatment of UTIs in diabetic patients, comparing the optimal duration and choice of antimicrobial agent, are needed. Besides that, new approaches to preventive strategies must prove their value in this specific patient group.

Objective To determine the role of transrectal power Doppler ultrasonography (PDU) in the diagnosis of prostate cancer. To determine the role of transrectal power Doppler ultrasonography (PDU) in the diagnosis of prostate cancer.Patients and methods Thirty-six patients (mean age 66.4 years, sd 7.7, range 59–82) with possible prostate cancer, suspected from an abnormal digital rectal examination or elevated prostate specific antigen level, underwent transrectal ultrasonography, transrectal PDU and biopsy. The vascularity on PDU was graded on a scale of 0–2, where grade 1–2 was considered positive and grade 0 negative. Thirty-six patients (mean age 66.4 years, sd 7.7, range 59–82) with possible prostate cancer, suspected from an abnormal digital rectal examination or elevated prostate specific antigen level, underwent transrectal ultrasonography, transrectal PDU and biopsy. The vascularity on PDU was graded on a scale of 0–2, where grade 1–2 was considered positive and grade 0 negative.Results The vascularity was grade 2 in 11 patients, grade 1 in 11 and grade 0 in 14; 20 of the 36 (56%) patients had prostate cancer. Of the 22 patients positive on PDU, 18 had malignant disease and four benign; two of 20 patients with histopathologically confirmed malignancy had a normal PDU. The sensitivity of PDU was 90%, the specificity 75% and the positive predictive value 82%. The vascularity was grade 2 in 11 patients, grade 1 in 11 and grade 0 in 14; 20 of the 36 (56%) patients had prostate cancer. Of the 22 patients positive on PDU, 18 had malignant disease and four benign; two of 20 patients with histopathologically confirmed malignancy had a normal PDU. The sensitivity of PDU was 90%, the specificity 75% and the positive predictive value 82%.Conclusion Focal hypervascularity on PDU was associated with an increased likelihood of prostate cancer. Although ultrasonography alone cannot detect all cancers, even using PDU, the technique appears to increase the sensitivity and to help identify appropriate sites for biopsy. Focal hypervascularity on PDU was associated with an increased likelihood of prostate cancer. Although ultrasonography alone cannot detect all cancers, even using PDU, the technique appears to increase the sensitivity and to help identify appropriate sites for biopsy.

Acute pyelonephritis is not considered a common cause of renal vein (RVT) and inferior vena caval thrombosis (IVCT). Apart from malignancy, RVT is not an uncommon condition amongst patients with nephrotic syndrome, most commonly seen in patients with membranous glomerulonephritis. However, RVT occurring in association to acute pyelonephritis is rare. Clinically, it is difficult to distinguish between acute pyelonephritis and RVT because both present with fever, flank pain, and hematuria. We report a case of acute pyelonephritis with RVT and IVCT with underlying hyperhomocysteinemia. The patient was treated with systemic anticoagulation, antibiotics, and B complex therapy. At 3 months follow-up, there was complete resolution of thrombus but the left kidney was nonfunctioning.

Date of Admission: March 29, 2021 @ 8: 35 am
Progress in the NICU (Day 1): You are a NICU student nurse of Simbulan Hospital taking care
of a neonate female delivered by Ceasarean Section, BW 3 kg AGA, Apgar 8, 9 on March 29,
2021; Roman Catholic, lives in P-5 South Poblacion Don Carlos Bukidnon. She is an Infant of
Diabetic Mother, Newborn affected by Maternal Infection (UTI) as her admitting diagnosis. The
neonate was given BCG and Hep B;
Delivery Details
Type of Delivery: CS; Wt: 3kg; Length: 49 cm; Head: 33 cm; Chest: 33.5 cm; Abd: 29 cm;
Temp: 36.4; HR: 139; RR: 45; OB: Dr. Bugan; Pedia: Dr. S. Nohr
History of present illness:
Mother is 27 y.o G2P2 on her term pregnancy, had history of on & off UTI with elevated sugar.
Ultrasound showed a preterm neonate, so Dexamethasone was given to the mother. Baby came
out with good cry, pinkish, not in respiratory distress, no meconium staining, no PROM
Physical Examination (pertinent findings per system)
General survey: awake and alert, good cry, pinkish, not in respiratory distress, APGAR 8, 9
VS: Temp 36.4, HR 139, RR 45, Wt. 3 kg (6.6 lbs)
HEENT: flat anterior fontanel
Chest/Lungs: no chest retractions, clear breath sounds
CVS: regular heart beat & rhythm, (-) murmur
Abd: globular abdomen, clean umbilical cord
U(IE): grossly female, labia majora large, labia minora small
Extremities: pinkish, no rashes, no deformities in all extremities, good reflexes
Progress in the Ward (Day 2)
The neonate has good sucking with pinkish in color; mother initiated breastfeeding

Xanthogranulomatous pyelonephritis (XGPN) is a very rare, unusual variant of pyelonephritis characterized by destruction of renal parenchyma. It usually occurs in adults with a history of recurrent urinary tract infections. The condition is rare in children and the disease can imitate renal tumors. Here, we describe a 12-year-old boy who presented with abdominal pain. He did not have any history of urinary tract infection. Computed tomography and magnetic resonance imaging showed a cystic lesion in the left upper kidney. The patient underwent radical nephrectomy with a provisional diagnosis of Wilms tumor however histopathological examination of specimen revealed XGPN. Xanthogranulomatous pyelonephritis should be kept in mind in the differential diagnosis of renal lesions in childhood, during surgery if any suspicion from the diagnosis, a frozen biopsy should have been taken.

The association of pyelonephritis and emphysematous cystitis is a rare pathology caused by gasogenic bacteria. the diagnosis is not easy and made by imaging. We report the case of a 63-year-old patient hospitalized in nephrology for acute renal failure discovered in a context of left hydronephrosis complicated by pyelonephritis. uroscanner revealed emphysematous pyelonephritis complicated by pyonephrosis and an emphysematous cyst. The patient receiving conservative treatment.

The purpose of this investigation was to study potential virulence factors associated with Escherichia coli urinary pathogens isolated from patients with urinary tract infection. These factors were compared with characteristics of normal-flora E. coli isolated from stool specimens of healthy individuals without a history of urinary tract infection. The potential virulence factor focused on in this study was hemagglutination (HA) of human type O erythrocytes by E. coli urinary pathogens. A total of 265 strains of E. coli isolated from patients with urinary tract infections were tested for their ability to hemagglutinate human type O erythrocytes; of these, 148 (56%) were HA positive. Only 6 of 36 fecal E. coli strains (17%) isolated from healthy controls were HA positive. This significant association of the presence of hemagglutinin on E. coli that causes urinary tract infections indicates the likelihood that HA is a marker of virulence. Only 12% (5 of 43) of Proteus mirabilis and 3%...

The urinary bladder of 10 clinically normal dogs was excised and the ureters were implanted into an isolated, vagotomized gastric segment derived from the fundic region of the stomach. The gastric segment was closed to form a conduit. Continence was maintained with a modified Kock "nipple valve" created from an isolated segment of ileum. Four dogs were euthanatized by day 30 because of complications related to the early onset of renal failure and electrolyte alterations. Six dogs were euthanatized on day 150. Ureteral dilatation, hydronephrosis, and decreased endogenous creatinine clearance rates were measured in all dogs at the end of the survival period. Pyelonephritis was diagnosed histologically in seven dogs. Positive renal cultures were obtained from seven dogs at necropsy. It was concluded that gastric conduit urinary diversion is unsatisfactory for long-term or short-term clinical use in dogs.

INTRODUCTION: The dissolution of urinary stones could be performed in the patients with urinary obstruction caused by phosphate, or uric acid stones, through the percutaneous nephrostomy (PCN). CASE REPORT: A 27-year-old woman with complete obstruction of the solitary left kidney due to uric acid stones is presented. The woman was admitted in emergency unit due to anuria. Five days after PCN, irrigation with 1.6% sodium bicarbonate solution was initiated. Due to complete ureteral obstruction, the "Y" extension with the valve was connected to PCN and to the urinary bag, which enabled the patient to perform intermittent self-irrigation. After 12 days of irrigation, all the stones dissolute and ceased. CONCLUSION: In the era of ESWL, PCNL and ureterorenoscopy, PCN-dissolution of urinary stones is rare procedure. However, this minimally invasive procedure could be successfully performed in selected cases.

Trehalose synthesis (RpoS-dependent) and betaine uptake mediated by transporters ProP and ProU contribute to the osmotolerance of Escherichia coli K-12. Pyelonephritis isolates CFT073 and HU734 were similar and diminished in osmotolerance, respectively, compared to E. coli K-12. The roles of RpoS, ProP and ProU in osmoregulation and urovirulence were assessed for these isolates. Strain HU734 expressed an RpoS variant which had low activity and a C-terminal extension. This bacterium accumulated very little trehalose and had poor stationary-phase thermotolerance. For E. coli CFT073, introduction of an rpoS deletion impaired trehalose accumulation, osmotolerance and stationary-phase thermotolerance. The rpoS defects accounted for the difference in osmotolerance between these strains in minimal medium of very high osmolality (1.4 mol kg(-1)) but not in medium of lower osmolality (0.4 mol kg(-1)). The slow growth of both pyelonephritis isolates in high-osmolality medium was stimulated by...