Complication Of Pyelonephritis Research Articles

Role of MRI in the evaluation of acute pyelonephritis in a high-risk population with renal dysfunction: a prospective study

This study aims to evaluate the (a) accuracy of conventional and diffusion-weighted-imaging (DWI) sequences in the diagnosis of acute pyelonephritis and (b) minimum apparent diffusion coefficient (ADC) values for the diagnosis of acute pyelonephritis and the differentiation of renal abscesses from acute pyelonephritis. Ultrasound, conventional MRI sequences, and DWI were used to evaluate the kidneys in 68 patients suspected to have acute pyelonephritis. Multiple similar regions of interest (ROIs) were placed over the renal parenchyma with visually identifiable diffusion restriction, over the non-diffusion-restricted renal parenchyma of affected kidneys and over the normal kidneys. Corresponding minimum ADCs were noted for analysis. Pyelonephritis was confirmed based on clinical criteria, laboratory findings, and by resolution/development of known complications of pyelonephritis. DWI showed the highest sensitivity(100%), while DWI read with T2-weighted imaging (both being positive) showed the highest specificity(100%) for the diagnosis of acute pyelonephritis in our population with a high baseline creatinine. The minimum-ADC of the nephritic diffusion-restricted area in patients with confirmed pyelonephritis was significantly lower than the minimum-ADC in patients without pyelonephritis [(0.934 ± 0.220, mean ± SD) vs (1.804 ± 0.404) × 10-3s/mm2] (p < 0.001). ROC cut-off of minimum-ADC for the diagnosis of acute pyelonephritis was 1.202 × 10-3s/mm2 (area under curve 0.978). The minimum-ADC of the abscesses were significantly lower when compared to the minimum-ADC of the nephritic diffusion-restricted portion of the same kidney [(0.633 ± 0.248) vs (0.850 ± 0.191) × 10-3s/mm2] (p < 0.001). DWI is an excellent stand-alone imaging tool that can be combined with conventional sequences for the diagnosis of APN even in patients with high serum-creatinine or other contraindications to intravenous contrast. Further, ADC values can be used to differentiate between renal abscesses and uncomplicated pyelonephritis.

PUK8 Water: A Prevention Strategy to Decrease the Economic Burden of Recurrent Cystitis Among Women in the United States of America

Urinary tract infections (UTI) are common, highly prevalent in women and represent a substantial economic burden to the healthcare system. In the present study, we estimated the budgetary impact of preventing UTI by increasing water intake in American women with low fluid intake and recurrent cystitis. A Markov model was developed to compare costs and clinical outcomes between usual fluid intake vs. an additional 1.5L/day of water in American women with low fluid intake and recurrent cystitis. Model assumptions included results from a randomized controlled trial reporting increasing water intake by 1.5L/day over usual fluid intake decreased by 48% the risk of developing cystitis in this target population. Outcomes were based on payer perspective and included both direct costs (general practitioner visit, dipstick, urinalysis, antibiotic treatment, pyelonephritis complications and water) and indirect costs (work loss). Costs were adjusted for inflation and updated to 2019 using the country-specific consumer price index and are reported in U.S. dollars ($). A 10-year follow-up period was considered to capture the impact of the prevention strategy on the long-term morbi-mortality resulting from UTI complications. Total UTI cost per person was $1,353, with direct costs of $676. Considering the target population, this corresponded to an annual budget impact of $806 million. Assuming a gradual increase in compliance with high water intake recommendation, from 10% in the first year to 80% after 10 years, 4,170,926 cystitis events and 250,256 pyelonephritis events could be prevented over 10 years, resulting in a cumulative cost saving of $1.5 billion. Even when considering 10% compliance, 89,449 fewer cystitis, 5,367 fewer pyelonephritis and an associated budget saving of $33 million would be expected. Increasing water intake can reduce the economic burden associated to cystitis, resulting in significant cost savings for the US payers.

Complications of Pyelonephritis with Chronic Renal Stone Disease

Complications of Pyelonephritis with Chronic Renal Stone Disease

Urinary tract infections in adults with diabetes

Urinary tract (UTI) is a major disease burden for many patients with diabetes. Asymptomatic bacteriuria is several-fold more common among women and acute plyelonephritis is five to ten times more common in both sexes. The complications of pyelonephritis are also more common in patients with diabetes. These complications include acute papillary necrosis, emphysematous pyelonephritis, and bacteremia with metastatic localization to other sites. The management of urinary infection in patients with diabetes is essentially the same as patients without diabetes. Most infections should be managed as uncomplicated except when they occur in a milieu with obstruction or other factors that merit a diagnosis of complicated UTI. Strategies to prevent these infections and reduce morbidity should be a priortity for research.

Continent urinary undiversion to modified ureterosigmoidostomy in bladder extrophy patients.

The objectives of urinary diversion are expanding from merely preserving kidney functions to enabling the patient to have a good quality of life while maintaining an acceptable certain body image. During the new era of continent urinary diversion the psychological drawbacks of noncontinent skin stoma in young adolescents cannot be overlooked. Ureterosigmoidostomy has been the technique of choice for continent urinary diversion in bladder extrophy patients when bladder reconstruction is not feasible or has failed. Although it provides a good daytime continence it is associated with a high rate of nighttime incontinence and delayed complications of pyelonephritis and hyperchloremic acidosis. We managed five male bladder extrophy patients with noncontinent skin stoma (sigmoid colon conduit in three and ileal conduit in two) including two patients who had previously had complicated classic ureterosigmoidostomy. They underwent urinary undiversion to the valved and augmented rectum (three patients) and the valved S-shaped rectosigmoid pouch (two patients) with some modifications. The conduit was used in the construction, and the ureters were implanted behind an isolated intussusception ileal nipple valve. Tube cecostomy and total parenteral nutrition was used for 7 to 10 days instead of a temporary defunctioning transverse colostomy. With a mean follow-up of 19.8 months (range 9-36 months) all the patients are fully continent during the day and night, with an emptying intervals of 3 to 6 hours. Follow-up intravenous pyelography and renal scans revealed improvement or stabilization of the function and configuration of the upper tracts in all renal units. No prophylactic alkali therapy was given. No clinical evidence of acidosis or symptomatic urinary tract infection was observed. Modified ureterosigmoidostomy is a good alternative for continent urinary undiversion even in those who have previously had complicated classic ureterosigmoidostomy. Our modification of using tube cecostomy and parenteral nutrition instead of a temporary transverse colostomy warrants attention; it made the technique simpler and more attractive.

Hemoglobinopathy With Prolonged Bacteremia

Prolonged Escherichia coli bacteremia occurred as a complication of pyelonephritis in two patients with abnormal hemoglobins (SC and SS), despite appropriate antibiotic therapy. Careful investigation in each case failed to account for the persistent sepsis. Pyogenic arthritis ultimately developed in both patients. ( JAMA 234:718-721, 1975)

Pyelonephritis in Young Women

Follow-up was conducted on 74 of 163 women admitted to hospitals in Madison, Wis, for pyelonephritis. Admission occurred between 1950 and 1960 when the women were from 15 to 35 years old. Clinical illness in most patients began in association with marriage, pregnancy, or the postpartum period. Repeat episodes of infection occurred within three years of follow-up in 29 (40%) of the patients and within six months in 16 (23%). Twelve (17%) were bacteriuric at the time of follow-up. Twenty-one (28%) had had an operative urologic procedure; 17 (23%) had a history of renal stone. Elevated blood pressure was found in only 10 (14.5%). One patient had died of complications of pyelonephritis, one had required renal transplantation for end-stage renal disease, and two other patients had azotemia. Seven patients had undergone unilateral nephrectomy for pyelonephritis, but most were doing well at the time of follow-up.