Cases reported "Pyelonephritis"

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1/9. nephrosis and papillary necrosis after pyelonephritis.

    We present a case of nephrotic syndrome complicating acute pyelonephritis in a 45-year-old man. His first attack of acute bacterial pyelonephritis had two unusual features: transient nephrotic syndrome and chronic recurrent episodes of papillary necrosis. The former, which lasted for two weeks, was characterized by edema, excretion of 7.7 g of urinary protein per 24 hours and hypoproteinemia (1.8 g per 100 ml). A percutaneous renal biopsy two weeks after the height of the nephrotic state showed normal glomeruli by light and electron microscopy and immunohistologic studies. Interstitial changes were noted. Over two years the patient has passed approximately 50 fragments, characterized as necrotic tissue containing tubular structures. He has no evidence of diabetes mellitus, urinary-tract obstruction or ureteral reflux, analgesic abuse or atypical vasculitis. He is afebrile but has recurrent bacteriuria despite antibiotics. This case demonstrates that acute pyelonephritis must be added to the list of diseases causing the nephrotic state.
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ranking = 1
keywords = bacteriuria
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2/9. Acute renal failure in adults with uncomplicated acute pyelonephritis: case reports and review.

    Acute renal failure is a rare complication of acute pyelonephritis in patients who do not have urinary obstruction. Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure nor is renal failure considered a likely consequence of bacteriuria. In this review, the cases of acute renal failure caused by acute pyelonephritis that have been reported in the last quarter century are examined. Including two new cases reported, only 12 cases of acute pyelonephritis resulting in acute renal failure were found. Three of these occurred in patients with a solitary kidney. All cases occurred in individuals who had no history of urinary tract infections, and all were caused by escherichia coli. In several cases, the administration of non-steroidal antiinflammatory drugs contributed to disease. Three cases occurred after catheter-acquired bacteriuria. Acute renal failure is an uncommon but serious consequence of uncomplicated acute pyelonephritis in adults.
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ranking = 2
keywords = bacteriuria
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3/9. Success of dna fingerprinting after failure of biotyping, antimicrobial susceptibility testing, and plasmid analysis to reveal clonality of multiple blood and urine isolates from a patient with escherichia coli urosepsis.

    Multiple isolates of escherichia coli from the blood and urine of a 60-year-old woman with acute pyelonephritis exhibited different biotypes, antimicrobial susceptibility patterns, and plasmid profiles, suggesting the presence of polymicrobial bacteriuria and leaving in question the origin of the bacteremia. Only after bacterial restriction endonuclease analysis of total bacterial DNA was it discovered that all isolates represented the same strain, with plasmid instability possibly accounting for the varied antimicrobial susceptibility patterns observed. We conclude that the biotype, antimicrobial susceptibility profile, and plasmid profile are sometimes inadequate to clarify the relationships between different clinical isolates of E. coli from a single patient and can lead to erroneous epidemiologic conclusions. dna fingerprinting can resolve dilemmas these less precise techniques leave unresolved.
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ranking = 1
keywords = bacteriuria
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4/9. Urinary tract infection caused by corynebacterium group D2: report of 82 cases and review.

    corynebacterium group D2 (CGD2) is a slow-growing, urea-splitting, multiantibiotic-resistant microorganism that is frequently isolated from urine samples and that, in certain circumstances, produces infection of the lower urinary tract (acute and chronic cystitis) and the upper urinary tract (pyelonephritis). This paper analyzes (by means of a retrospective and partially prospective clinical protocol) our experience with 82 patients with CGD2 bacteriuria. The infection was symptomatic in 62% of cases, and the clinical diagnoses included acute and chronic cystitis and pyelonephritis with or without bacteremia. Because CGD2 infection of the urinary tract may require specific antimicrobial treatment and because CGD2 is a fastidious microorganism, we recommend prolonged incubation of urine cultures (up to 48-72 hours), especially if the routine culture is negative, when patients are symptomatic, have alkaline urine, or have struvite crystals in the urine sediment.
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ranking = 1
keywords = bacteriuria
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5/9. Low urinary counts of P-fimbriated escherichia coli in presumed acute pyelonephritis.

    We report 6 children who showed clinical symptoms and laboratory signs of acute pyelonephritis but in whom bacteriuria was insignificant, with escherichia coli 10(4)/ml, or less. None of the children had symptoms of other disease. Three of the children who were at first treated inadequately or were not treated with antibiotics developed significant bacteriuria later on (10(5)/ml, or greater). Ultrasonic scanning to evaluate kidney involvement at the acute phase of disease showed transient changes in four of the 6 children--dilatation of one or both pelves or increased ecogenicity of the renal sinus, or both. The urinary E coli strains isolated from all 6 children were P-fimbriated, as determined by a P-fimbriae specific particle agglutination test (PPA test). P-fimbriate E coli are known to be strongly associated with acute non-obstructive pyelonephritis in children and we suggest that the finding of any number of P-fimbriated E coli in the urine of children with clinical evidence of acute pyelonephritis supports this clinical diagnosis.
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ranking = 2
keywords = bacteriuria
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6/9. Hemophilus influenzae as a cause of urinary tract infections in men.

    Hemophilus influenzae has rarely been reported to cause urinary tract infections, but media supportive of its growth are not routinely used for urine cultures. At two veterans Administration medical centers, H influenzae was isolated from the urine of eight men in the past four years. All had anatomic or functional genitourinary abnormalities, and half had had chronic pyelonephritis or recurrent urinary tract infections. Three patients had acute cystitis, two patients had pyelonephritis, two patients had prostatitis, and one patient had asymptomatic bacteriuria with pyuria. Cases were discovered by primary isolation on chocolate agar or sheep's blood agar, by "satelliting" around staphylococci, or by positive urine Gram's stains. urine Gram's stains disclosed organisms in all six nonprostatitis cases. Organisms were all nonserotypable, were of biotypes 2, 3, or 4, and were beta-lactamase negative. Hemophilus influenzae may be a more common uropathogen in adults than previously recognized.
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ranking = 1
keywords = bacteriuria
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7/9. Xanthogranulomatous pyelonephritis in renal transplant recipient.

    Xanthogranulomatous pyelonephritis is reported in the native kidney of a renal allograft recipient. Immunoglobulin deposition in the transplant kidney in the absence of cell-mediated rejection, accompanied by selective cultures showing escherichia coli from the native kidney, led to the diagnosis. Native nephrectomy resulted in resolution of the patient's chronic bacteriuria and creatinine elevation.
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ranking = 1
keywords = bacteriuria
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8/9. Unilateral chronic pyelonephritis and hypertension: coincidental or causal relationship?

    Three patients with well documented unilateral chronic pyelonephritis (UCP) of bacterial origin, one hypertensive and two normo-tensive, were presented. Removal of the contracted kidney in the hypertensive patient did not eradicate the hypertension. An attempt was made to define UCP as closely as possible. The clinical, roentgenologic, bacteriologic, functional and pathologic criteria of UCP was described. But, as other conditions may mimic the roentgenologic, functional and pathologic picture of UCP, a history of recurrent urinary tract infection accompanied by a documented unilateral renal bacteriuria is the basic requirement for a sustained diagnosis of UCP. In view of these more exacting criteria in the diagnosis of UCP, and its water and salt-losing functional pattern, UCP is a rare cause of hypertension, in the majority of cases the association of UCP with hypertension is merely coincidental.
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ranking = 1
keywords = bacteriuria
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9/9. Infections of the urinary tract during pregnancy: use of fluorescent antibody technic as an aid in patient evaluation.

    Over a 22-month period, the fluorescent antibody (FA) technic was used to evaluate 195 patients with urinary tract infections (UTI) during pregnancy. Postpartum intravenous pyelograms (IVP) were obtained for 86 patients. The results were correlated as to the site (upper or lower urinary tract) of infection. Regardless of the result of the FA test, results of IVP were abnormal in 40% to 41% of patients witn antenatal pyelonephritis. This was in contrast to only 9.4% abnormalities in patients with asymptomatic bacteriuria and negative FA tests.
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ranking = 1
keywords = bacteriuria
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