Course Of Acute Pyelonephritis Research Articles

Features of the course of acute pyelonephritis in children with an experience of a new coronavirus infection (COVID-19)

Purpose. To determine the clinical and laboratory features of the course of acute pyelonephritis in children with a history of COVID-19 and to determine the risk of developing chronic kidney disease.Material and methods. The main cohort consisted of 36 patients with the debut of acute pyelonephritis, who had previously suffered COVID-19, the average age was 7,5 years. The comparison group included 47 patients with the onset of acute pyelonephritis and a normal level of IgG antibodies to SARS-CoV-2, the average age was 7,0 years. Laboratory tests included full blood count and urinalysis, blood biochemistry, procalcitonin, urine microalbumin, urine creatinine, Zimnitsky urine test, bacteriological urine test, glomerular filtration rate, coagulogram, and Lipocalin-2 associated with neutrophil gelatinase (NGAL) in the urine.Results. Patients with a history of COVID-19, at the onset of acute pyelonephritis, demonstrated a higher incidence of apostematous pyelonephritis, a higher degree of damage to the tubulointerstitial kidney tissue, a high frequency and a higher level of hematuria, proteinuria, hyperfiltration, hypostenuria, as well as a more significant increase in fibrinogen, CRP, procalcitonin, and uNGAL/Cr levels than children of the comparison group. It was shown that almost half of the children with acute pyelonephritis who had had COVID-19 retained urinary syndrome during examination 3–4 months after the onset of the disease.Conclusion. Thus, long-term effects of the SARS-CoV-2 virus on the renal parenchyma were confirmed, even in asymptomatic children. The high level of uNGAL/Cr in children with acute pyelonephritis who had had COVID-19, which was almost 8 times higher than in the comparison group, reflects more pronounced damage to the tubulointerstitial kidney tissue. The risk of developing chronic kidney disease in this group was 3,5 times higher.

EVALUATION OF THE EFFECTIVENESS OF PYELOVESICAL BYPASS IN THE TREATMENT OF PYELONEPHRITIS

Based on the widespread incidence of acute pyelonephritis, which is one of the most common inflammatory diseases of the urinary system, it is important to conduct searching for improved treatment methods, which would ensure higher effectiveness of clinical regression of the process and minimize the extent of manipulations and pharmacotherapy. Pyelovesical bypass is one of these methods. The aim of this study is to investigate the efficacy of pyelovesical drainage of the urinary tract in the course of acute pyelonephritis in comparison with conservative methods of treatment in order to identify its advantages and disadvantages. To assess the effect of urinary tract drainage, we analyzed the clinical findings of patients with acute obstructive pyelonephritis, who underwent pyelovesical stenting and compared them with standard conservative treatment methods. According to the data obtained, we can conclude that pyelovesical stenting procedure in cases of acute obstructive pyelonephritis provides a statistically significant acceleration of the regression of clinical manifestations of kidney inflammation, such as hyperthermic reaction, pain syndrome, inflammatory changes in the blood and urine, parameters of ultrasonic dynamics. Thus, in the presence of clinical indications, appropriate technical conditions, devices and qualified surgeons to perform stenting, we can recommend this method as an effective means of integrated treatment for this renal pathology.

An Unusual Presentation of Pyelonephritis: Is It COVID-19 Related?

In severe cases of COVID-19, late complications such as coagulopathy and organ injury are increasingly described. In milder cases of the disease, the exact time frame and causal path of late-onset complications have not yet been determined. Although direct and indirect renal injury by SARS-CoV-2 has been confirmed, hemorrhagic renal infection or coagulative problems in the urinary tract have not yet been described. This case report describes a 35-year-old female without relevant medical history who, five days after having recovered from infection with SARS-CoV-2, had an unusual course of acute pyelonephritis of the right kidney and persistent fever under targeted antibiotic treatment. A hemorrhagic ureteral obstruction and severe swollen renal parenchyma preceded the onset of fever and was related to the developing pyelonephritis. Sudden thrombotic venous occlusion in the right eye appeared during admission. Symmetrical paresthesia in the limbs in combination with severe lower back pain and gastro-intestinal complaints also occurred and remained unexplained despite thorough investigation. We present the unusual combination of culture-confirmed bacterial hemorrhagic pyelonephritis with a blood clot in the proximal right ureter, complicated by retinal vein thrombosis, in a patient who had recovered from SARS-CoV-2-infection five days before presentation. The case is suspect of a COVID-19-related etiology.

The Study of the Functional State of Rat’s Kidneys in Acute Pyelonephritis Against Diabetes Mellitus under Conditions of Drug Exposure in an Experiment

The most sensitive indicators of the functional state of the kidneys are the glomerular filtration rate and the level of creatinine in the blood, which is practically independent of extrarenal factors and does not lend itself to significant daily fluctuations. The search for new possibilities of correcting drug exposure on the course of acute pyelonephritis and concomitant diabetes mellitus seems to be promising in order to prevent the development of pathomorphological changes in functional renal disorders. Evaluation of the effectiveness of etiotropic drug exposure to drugs and their combination with the pathogenetic effect on the creatinine content in blood plasma and urine and its clearance in acute pyelonephritis and concomitant diabetes mellitus type I and II in the experimental conditions was the aim of our study. The obtained experimental data revealed a more pronounced increase in creatinine in blood plasma compared with its content in urine: in blood plasma by 83.6 % and in urine by 25.1 %, respectively, in relation to the norm, which indicates a significant decrease in glomerular level filtering. The clearance of cretinin in acute pyelonephritis was reduced by 15.2 %, and with concomitant diabetes mellitus, more distinct changes were observed, for type II diabetes there was a decrease of 27.3 %, and for type I diabetes by 36.4 % in relation to normal. The use of etiotropic exposure for type I and II diabetes contributed to a moderate improvement in this indicator, and the use of ethiopathogenetic effects caused a significant increase in creatinine clearance, the level of which differed from normal only by 9.1 % in type II diabetes and by 15.2 % with type I diabetes. Etio-pathogenetic drug intervention has led to the prevention and deterrence of nephrosclerotic changes, which should be associated with the complex effect of antibacterial, membrane-protective and metabolism correcting effects.

The role of carbohydrate-protein metabolism products during acute pyelonephritis with concomitant diabetes mellitus in an experiment

The results of experimental work on rats are analyzed in the study, by determining the possibilities for correcting the level of glycosylation products and the state of the functional ability of proteins at an early stage of the infectious inflammatory process in the kidneys. The intensity of the formation of methylglyoxal in acute pyelonephritis complicated by concomitant diabetes is due to the development of oxidative stress, which is confirmed by an increase in the level of protein carbonyl groups in the tissues studied. The presented data allow deeper to lower the features of the pathogenetic mechanisms underlying the development and course of acute pyelonephritis complicated by diabetes mellitus, and the use of multivector drug products reduced the severity of pathological abnormalities in blood and kidney tissues to a greater extent in diabetes mellitus type II, which creates conditions to improve the morphofunctional state of the kidneys.

PATHOMORPHOLOGICAL CHANGES IN RENAL PARENCHYMA, AFTER MODELING OF ACUTE PYELONEPHRITIS IN MICE, DEPENDING ON THE ABILITY OF BACTERIA TO FORM BIOFILMS.

Urinary tract infection is one of the most common infectious diseases that affects people of any age and sex. The purpose of our study was to determine morphological changes in acute pyelonephritis, depending on the ability of bacteria strains to form biofilms.
 Materials and methods. The model of acute pyelonephritis was reproduced by ascending urinary infection model of laboratory mice with clinical isolates of E.coli with low biofilm formation ability (group # 1) and high biofilm formation ability (group # 2), the material was taken on day 7 of the experiment, histological sections were analyzed in comparison with control (group # 3).
 Results. In group # 1, leukocyte infiltration of the medulla of the kidney with the presence of edema of the stroma was observed. In group # 2, hyperinfiltration of all parts of the kidney was observed, together with the presence of extravasates and severe edema of the stroma.
 Discussion. Changes revealed by histological examination may indicate that biofilm formation leads to an ineffective immuneresponse, which in turn leads to increased secondary alteration.
 Conclusions. Biofilm formation is an important factor in the pathogenicity of microorganisms, which affects the course of acute pyelonephritis.

Вызывают ли неклостридиальные анаэробные бактерии острый пиелонефрит при мочеточниковой обструкции?

The problem of etiology and pathogenesis of acute obstructive pyelonephritis remains an outstanding issue in modern urology. The infectious nature of acute destructive renal processes presently remains disputed. Etiologic agents of pyelonephritis may be both gram-negative and gram-positive opportunistic bacteria, the majority of which is part of normal human microflora. Presently, several publications delegated that role to non-clostridial anaerobic microorganisms, found in tissue substrates in as much as 99.0 % of cases. But their contribution to the etiology and pathogenesis of urinary tract infections is presently not sufficiently investigated. The experiment studies the morphologic specifics of acute obstructive pyelonephritis caused by various taxa of non-clostridia anaerobic bacteria. The data obtained changed the existing views on the detection and influence of said group of microorganisms upon the course of acute pyelonephritis in ureter obstruction.

Clinical Value of Acute Pyelonephritis Grade Based on Computed Tomography in Predicting Severity and Course of Acute Pyelonephritis

This study aimed to evaluate the efficacy of computed tomography (CT)-based acute pyelonephritis (APN) grades for predicting clinical severity and disease course. This study involved the analysis of the data of 204 consecutive patients with APN who underwent a CT examination at admission. Patients who had undergone prior treatment and those with ureteral calculi or an abscess by CT were excluded. Computed tomographic findings were divided into 4 grades according to renal parenchymal involvement, as follows: no renal parenchyma involvement (grade 1), less than 25% involvement (grade 2), 25% to 50% involvement (grade 3), and greater than 50% (grade 4). Patients with these grades were compared with respect to APN severity index (highest body temperature, initial C-reactive protein, and leukocytosis) and recovery index (hospital stay, fever duration, and leukocytosis duration). A total of 204 patients of mean age 39.3 years were included. Acute pyelonephritis severity indices and recovery indices increased with APN grade. Mean highest body temperature values were 38.3°C and 38.9°C in grades 1 and 4, respectively (P = 0.002). Mean hospital stay increased from 5.7 days for grade 1 to 7.6 days for grade 4 (P < 0.001). Initial C-reactive protein, initial leukocytosis, fever duration, and leukocytosis duration also increased with APN grade. This study suggests that APN grades, as determined by CT examination, valuably predict the clinical course of APN.

Unilateral renal angiodysplasia in a girl with hypertension

We report a case of very unusual renal vascular anomaly: angiodysplasia. The patient suffered from acute pyelonephritis immediately after birth. Renal ultrasonography, performed at age 1 day, revealed an enlarged left kidney with heterogeneously increased echogenicity, which involuted rapidly in 3 months. At age 10 years, she presented with severe hypertension during a course of acute pyelonephritis. Peripheral plasma renin activity was high. Computed tomographic angiogram revealed a very small but functioning left kidney. A single, narrow, left renal artery did not have focal stenosis. Pathology examination revealed dysplastic arterioles at the subcapsular area. After left nephrectomy, the blood pressure and the plasma renin activity were normalized. In conclusion, this is an unusual case of renal angiodysplasia, which induced renin-dependent hypertension.

Elevated plasma renin activity in patients with acute pyelonephritis.

Thirty-three patients with acute pyelonephritis were studied with regard to the changes in plasma renin activity (PRA) along the clinical course of the disease. 1) Abnormally high PRA was found in 64% of patients in the active stage of acute pyelonephritis; they showed a decrease in urinary output of sodium, a reduction in creatinine clearance, and high indices of inflammatory activity. 2) The changes of PRA in the course of acute pyelonephritis were negatively correlated to the urinary sodium excretion and creatinine clearance, but positively to the activity of inflammation, serum sodium concentration and the number of E. coli in the urine. PRA returned to normal with the improvement of pyelonephritis. 3) Concerning the mechanism of hyperreninemia in the active stage of the disease, the following three factors may be considered; renal ischemia, negative sodium balance in the body, and inflammation. Of these, the negative sodium balance seems to be the most important. The patients could not take enough foods to maintain their energy and sodium balance because of fever and pain. 4) The significance of resting PRA in acute pyelonephritis might be to reflect the sodium status in the body, but not to be related to hypertension.

The Urographic Findings in Acute Pyelonephritis: Non-Obstructive Hydronephrosis

Excretory urography was performed on 4 patients early in the course of acute pyelonephritis. These studies showed dilatation of the involved collecting system without obstruction. The dilatation resolved after therapy in 3 patients and was not present on a previous excretory urogram in the fourth. Although previous studies have shown that the excretory urogram is usually normal in cases of acute pyelonephritis these cases demonstrate that this disease can produce dilatation of the collecting system and mimic obstruction.