1/12. bk virus as the cause of meningoencephalitis, retinitis and nephritis in a patient with AIDS.BACKGROUND: The two widely spread human polyomaviruses, bk virus (BKV) and jc virus (JCV) establish latency in the urinary tract, and can be reactivated in AIDS. JCV might cause progressive multifocal leucoencephalopathy, but although up to 60% of AIDS patients excrete BKV in the urine there have been few reports of BKV-related renal and/or neurological disease in AIDS. OBJECTIVE: To report on an AIDS patient with progressive renal and neurological symptoms involving the retina. DESIGN: Case report. SETTING: Venhalsan, Soder Hospital, Stockholm, sweden. methods: The brain, eye tissue, cerebrospinal fluid, urine and peripheral blood mononuclear cells were analysed by nested PCR for polyoma-virus dna. Macroscopical and microscopical examination were performed of the kidney and brain post mortem. Immunohistochemical stainings for the two BKV proteins, the VP1 and the agnoprotein, were performed on autopsy material and virus infected tissue culture cells. RESULTS: BKV could be demonstrated in the brain, cerebrospinal fluid, eye tissues, kidneys and peripheral blood mononuclear cells. CONCLUSION: During 6 years, approximately 400 cerebrospinal fluid samples from immunosuppressed individuals with neurological symptoms have been investigated by PCR for the presence of polyomaviruses. BKV dna has, so far, only been found in the case reported here. Although reports of BKV infections in the nervous system are rare, there is now evidence for its occurrence in immunocompromised patients and the diagnosis should be considered in such patients with neurological symptoms and signs of renal disease. The diagnosis is simple to verify and is important to establish.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
2/12. hypertension in Henoch-Schonlein purpura with minimal urinary findings.Though hypertension is a common feature of Henoch: Schonlein purpura (HSP) acute nephritis, it is seen only rarely and transiently if renal function is normal and abnormal urinary findings are minimal. We report a 3.4 year old girl who had the typical arthritis and rash of HSP, but also had significant hypertension with only minimal urinary findings. Imaging investigations revealed one normal kidney, and one that was almost destroyed from previous reflux nephropathy; her hypertension resolved after unilateral nephrectomy. Other causes of hypertension should be excluded in children with HSP and minimal urinary findings.- - - - - - - - - - ranking = 7keywords = urinary (Clic here for more details about this article) |
3/12. Preoperative diagnosis of xanthogranulomatous pyelonephritis.Preoperative diagnosis of xanthogranulomatous pyelonephritis may be correctly made in a significant proportion of affected patients thus preventing unnecessary radical surgery especially in the poor-risk patient. The diagnosis should be suggested in the patient with a history of chronic urinary tract infection and certain radiologic features. These include unilateral renal enlargement (either localized or diffuse), nonfunction on excretory urography, presence of renal and/or ureteral calculi, angiographic demonstration of avascular mass or masses with stretched, attenuated intrarenal vessels, prominent capsular and periureteric vessels, and an irregular impaired nephrogram with prominent avascular areas.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
4/12. Evolution of acute focal bacterial nephritis into a renal abscess.Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass without frank abscess formation, which may represent a relatively early stage of renal abscess. The pathogenesis of AFBN is thought to be hematogenous infection or ascending infection from the lower urinary tract. For the majority of children, the pathogenesis may be related to ascending infection, because pre-existing malformative uropathy, especially vesicoureteral reflux (VUR), is common in pediatric patients. Few clinical reports have demonstrated the evolution of this condition into renal abscess in children. We report a girl with AFBN associated with VUR that evolved into a renal abscess despite appropriate intravenous antibiotic therapy. We undertook serial radiological observation of its evolution. It is important to differentiate AFBN from renal abscess because the management of the two entities may be different, and follow-up studies are indispensable to determine appropriate therapy.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
5/12. Acute multifocal bacterial nephritis complicated with acute renal failure and thrombocytopenia.A 50-year-old woman was transferred to our hospital because of acute renal failure and thrombocytopenia. Due to rapid enlargement of the kidney, we first suspected that she had diffuse renal invasion of anaplastic carcinoma or lymphoma of the kidney. Anti-bacterial treatment for complicated urinary tract infection and hemodialysis treatment resulted in recovery of both renal function and thrombocytopenia. Serial CT study demonstrated disappearance of kidney swelling and multiple masses within the kidney. We finally made a diagnosis of acute multifocal bacterial nephritis. Timely initiation of dialysis therapy and appropriate anti-bacterial treatment was essential to rescue this case.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
6/12. Renal transplant patient with polyoma virus bladder infection and subsequent polyoma virus nephropathy.Polyoma virus nephropathy (PVN) is a significant cause of renal allograft dysfunction in transplant patients. A 58-year-old male received a cadaveric renal transplant and 12 weeks later presented with fever, diarrhea, and dysuria. He was diagnosed with a polyoma virus infection of the bladder by a transurethral bladder biopsy. One year post-transplant, he presented with renal allograft dysfunction and was diagnosed by biopsy with PVN of the non-native kidney. The diagnosis of a polyoma virus infection was confirmed by immunoreactivity to the polyoma T-antigen. We suggest that polyoma virus infection of the bladder be included in the differential diagnosis of urinary dysfunction in post-transplant patients, as such infections might be an under-recognized comorbidity in individuals with PVN.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
7/12. Histopathology and immunohistologic demonstration of the distribution of rickettsia typhi in fatal murine typhus.An 81-year-old woman had chills, fever, nausea, vomiting, and epigastric pain. On day 3 she had hematuria and was treated with trimethoprim-sulfamethoxazole. On day 5 she had a cough, hypotension, anemia, azotemia, and elevated hepatic enzyme levels. Her condition deteriorated with thrombocytopenia, anuria requiring dialysis, edema, and hypoalbuminemia. Treatment with chloramphenicol and doxycycline was started on day 10. By day 11, she was in hypotensive shock; on day 12 she had seizures and died. Murine typhus was diagnosed by demonstration of antibodies to rickettsia typhi by indirect immunofluorescence. Necropsy revealed interstitial pneumonia, pulmonary edema, hyaline membranes, alveolar hemorrhages, petechiae and vasculitis in the central nervous system, interstitial myocarditis, multifocal interstitial nephritis and hemorrhages, splenomegaly, portal triaditis, and mucosal hemorrhages in urinary tract. Immunofluorescent R. typhi were demonstrated in the lungs, brain, kidneys, liver, and heart. This unusual death occurred in an elderly patient without rash who was treated too late with antirickettsial drugs.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
8/12. levamisole in systemic lupus erythematosus.Two patients with systemic lupus erythematosus complicated with lupus nephritis were treated with levamisole, an immunomodulator. Clinical features, including urinary protein excretion and creatine clearance, were restored in one patient, also immunoparameters such as ANA, Ig-bearing cell number and PHA-skin test. The other patient did not respond to levamisole but did respond to cyclophosphamide.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
9/12. Transmission of tuberculosis by kidney transplantation.tuberculosis occurred in two patients, each of whom received a kidney from the same cadaver donor whose cerebrospinal fluid cultures grew Mycobacteria following organ donation. Although the degree of immunosuppression and graft function were similar in the recipients, one died of disseminated tuberculosis. Kidneys contaminated with certain pathogens, including Mycobacteria, should not be transplanted. Transplant recipients with tuberculosis require prompt antituberculous therapy, and may require transplant nephrectomy for persistent evidence of urinary tract tuberculosis.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
10/12. Abnormal renal uptake in indium-111-chloride scanning.A patient with severe alcoholic liver disease, in whom there was almost complete suppression of function of the reticuloendothelial system of the liver as noted on a 99mTc-SC scan is discussed. Obstructive biliary disease was suggested on 131I-rose bengal imaging. The depressed RES function was confirmed on 111In-chloride scan, showing abnormal uptake in the kidneys which could be secondary to inflammatory infiltration in the renal parenchyma from urinary tract infection with gamma enterococci.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
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