Forms Of Pyelonephritis Research Articles

Блеббинг плазматической мембраны лимфоцитов при инфекционных осложнениях уролитиаза

About 200 thousand operations for urolithiasis are performed annually in Russia, but the frequency of postoperative complications reaches 30%. Infectious complications occur with a frequency of up to 40% in the form of various forms of pyelonephritis, urosepsis is recorded in 3% of patients. The aim of the study determine the intensity of blebbing of the plasma membrane of lymphocytes in infectious complications of urolithiasis.A prospective study examined 1,240 patients with urolithiasis. Inflammatory complications were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. Complications of infectious nature were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. During the study, complications of an infectious nature were detected in 148 patients, which amounted to 11,93% of cases. The control group consisted of - 25 persons with urolithiasis and a favorable course of the postoperative period. Lymphocyte membrane condition was evaluated by phase contrast microscopy.Changes in plasma membrane structure were more frequently reported in patients with postoperative purulent pyelonephritis and urosepsis. When assessing the presence of circulating microparticles, the highest number was recorded in patients with urolithiasis complicated by purulent pyelonephritis or urosepsis - 1318 [982; 2007] and 1531 [1028; 1963], respectively. A relationship was established between the degree of severity of terminal blebbing of the plasma membrane of lymphocytes and the nature of inflammatory complications in urolithiasis.

Диагностическая роль радионуклидных методов исследования у больных пиелонефритом

Острые и хронические формы пиелонефрита (ПН) являются наиболее распространенными заболеваниями мочевой системы во всех возрастных группах. Частота встречаемости острого ПН у детей составляет 19,1 на 1000, хронического ПН — 5–12,5 на 1000. В работе на основании ретроспективного анализа рассмотрена диагностическая роль радионуклидных методов визуализации при остром и хроническом ПН. Радионуклидные методы исследования благодаря высокой чувствительности позволяют определить у больных ПН степень функционально-топографических изменений каждой почки — секреторную функцию и характер пассажа индикатора через чашечно-лоханочную систему и мочеточник. Радионуклидные методы исследования являются чувствительными и точными методами лучевой визуализации при ПН, а также надежными методами динамического мониторинга в послеоперационном наблюдении пациентов. Применение радионуклидных методов визуализации позволяет установить причину и последствия ПН и разработать рациональный план лечения.

The intensity of endogenous intoxication syndrome and methods of its therapy for the urinary system infection in children

Endogenous intoxication syndrome is one of the leading syndromes in high urinary system infection activity in children. The study of clinical and laboratory manifestations of endogenous intoxication syndrome with the aim of optimizing its methods of therapy is topical. The examination was conducted in 52 children aged 3–7 years, including 22 children with active forms of pyelonephritis and 30 almost healthy children (control group). Endogenous intoxication syndrome was determined by clinical signs and by the level of leukocyte index of intoxication and medium-sized molecular peptides in blood plasma. Statistical analysis was carried out on the basis of Student’s t-test (p<0.05), the frequency of symptom occurrence (q) in relation to the totality in the group taken for 1 and the coefficients (Q) of the ratio of the comparable indicators in groups. In the control group, the leukocyte intoxication index did not exceed 1.0, the average molecular peptides— 0.24 conditional units. Most patients (q-0.73) had a moderately severe course, expressed symptoms of intoxication, pain abdominal syndrome (q-0.73), dysuria (q-0.73), high temperature (q-0.73). In complex therapy, prebiotic (complex fructoolygosaccharides, inulin and maltodextrin) was prescribed in age dosage for three weeks. Detoxification therapy contributed, first of all, to the positive dynamics of clinical manifestations of the intoxication syndrome. During the first two days, the temperature reaction decreased; on the 4-5th day, the general condition improved, other symptoms of intoxication disappeared; highly reliable (p<0.001) positive changes in the studied indicators were found within 3 weeks. They were characterized by the normalization of the level of leukocyte index of intoxication and medium-sized molecular peptides, which justifies the use of prebiotic products in the complex therapy of urinary system infection in children.

MO091BILATERAL EMPHYSEMATOUS PYELITIS: A CASE REPORT AND ULTRASONOGRAPHY FEATURES

Abstract Background and Aims Emphysematous pyelitis is a rare urinary infection with gas formation in the excretory system. Diabetes mellitus and urinary tract obstruction are the main risk factors. Most patients are women over 60 years old. The pathogenesis is unknown. Diabetes mellitus and the elevated glucose levels may create a favorable microenvironment for gas-forming microbes, but it does not exhaustively explain clinical and pathological symptoms. Escherichia Coli and Klebsiella Pneumoniae are the most involved bacteria. Clinical features are the same as other forms of pyelonephritis e.g. fever, chills, flank abdominal pain, nausea and vomiting. Ultrasonography, and especially computed tomography (CT) are important diagnostic tools for demonstration of gas within pelvicalyceal system, urethers or even in bladder. Use of parenteral antibiotic, relief of urinary tract obstruction if present, percutaneous catheter drainage of gas and purulent material and nephrectomy are the mainstays of therapy. This report introduces a case of bilateral emphysematous pyelitis with emphasis on its ultrasound presentation. This is one of the few cases of bilateral emphysematous pyelitis reported in literature. Method A 49-year-old female presented to the emergency with asthenia, epistaxis, orthostatic hypotension and nocturnal cramps. Two months before she was referred to Department of Nephrology for proteinuria. In that occasion, renal ultrasound showed normal kidneys and renal biopsy was performed. She started oral therapy with corticosteroid for ANCA-negative vasculitis and iatrogenic diabetes mellitus occurred. She was admitted again to our Department of Nephrology, blood test was performed and revealed: white cell count 20.500/ml; glucose 243 mg/dl; serum creatinine 2.3 mg/dl; C-reactive protein, 0.65 mg/dl ( < 0.5), procalcitonin 2.05 µg/l (nv < 0.5). Urine culture was positive for E. Coli. Results Renal ultrasound revealed the presence, in both kidney pelvises, of multiple and diffuse hyperechogenic images associated with some reverberation artefacts. The ultrasound findings were unusual and of doubtful interpretation: staghorn calculi, encrusted pyelitis, gas? (Fig. 1, 2). Reverberation artifacts give rise the suspicion of gas presence in kidney pelvises, usually absent in case of staghorn calculi and encrusted pyelitis. CT confirmed the diagnosis of bilateral emphysematous pyelitis due to the diffuse presence of gas within the renal calyces, also extending to the ureters and bladder lumen (Fig. 3). We promptly started parental antimicrobial therapy with cefalosporine. After one week we observed a clinical and laboratory improvement, and the renal ultrasound revealed the resolution of bilateral pelvises alteration (Fig. 4). Conclusion In emphysematous pyelitis, renal ultrasound is characteristic due to the presence of diffuse hyperechogenic images located in the renal pelvis associated with some reverberation artifacts, usually absent in case of renal stones. Therefore, the renal ultrasound in association with clinical and laboratory findings, especially in patient with positive urine culture, should arouse the suspicion of emphysematous pyelitis to start promptly antimicrobial therapy, even when CT examination is not immediately available.

Peloidotherapy in Pediatric Practice in the Conditions of a Ballogray Resort

Introduction. Currently, sulfide silt mud of Lake Saka has been widely used in both adult and pediatric practice, which has a positive effect in the treatment of various diseases. The effectiveness of peloidotherapy in the rehabilitation treatment of children with a number of chronic and disabling diseases has been established. The purpose of the review is to summarize and analyze the accumulated experience of applying peloidotherapy in children with various diseases. In order to achieve a targeted effect, it is necessary to study previously carried out scientific studies on the in-depth study of the mechanism of therapeutic action of natural factors. Data on methodology of application of peloidotherapy based on highly mineralized silt sulphide mud of Black Sea resorts are presented. It is necessary to take into account the response of the child body to peloidotherapy, which depend on the individual capabilities of the body, in connection with which the parameters of mud treatment methods in pediatrics should be justified. Indications for peloidotherapy for diseases of the cardiovascular system have been developed. The purpose of application method of peloidotherapy in the complex of sanatorium treatment of children with chronic bronchitis, pneumonia and other bronchopulmonary diseases is recognized in order to provide reparative and regenerative, anti-inflammatory, trophostimulating, anti-inflammatory, resolving effect, to improve bronchial permeability, ventilation function.. The dynamics of endothelial dysfunction indices in children with rheumatoid arthritis under the influence of spa treatment using mud applications, the results of complex spa treatment of children with different forms of pyelonephritis in clinical-laboratory remission against the background of application of Saki silt mud were studied. In children with celiac disease the efficiency of therapeutic complex of physical factors influence on pathogenetic links of the disease is shown. Extensive experience has been gained in mud treatment of children with cerebral palsy. Conclusion. In peloidotherapy, individual approaches to comprehensive rehabilitation are applied depending on the clinical picture of the disease with repeated treatment courses.

Иммунные нарушения при остром пиелонефрите. II часть

New information about typical changes in the immune status at both local and systemic level in various forms of acute pyelonephritis is provided in the second part of the review. The literature review and analysis of current national and foreign literature dedicated to immune disorders in various forms of acute pyelonephritis has been performed. The degree and nature of changes in systemic and local immunological parameters in nonobstructive and obstructive, serous and purulent forms are highlighted in details. In particular, it has been established that in patients with obstructive and purulent pyelonephritis, there are more pronounced changes in the serum and urine level of cytokines and complement factors in comparison with serous and non-obstructive pyelonephritis. Recommendations are given on monitoring of the immunological status in patients with various forms of acute pyelonephritis in order to optimize treatment approaches. In addition, the rationales for effective pathogenetic, including specific, immunotherapy drugs for various forms of pyelonephritis are presented.

Mathematical Models for the Differential Diagnosis of Various Forms of Pyelonephritis by Expert Systems in Urology

Models for differential diagnosis of serous and purulent forms of pyelonephritis with identification of a transitional class of states were constructed. The diagnostic effectiveness of decisions was shown to exceed 0.9.

A Decision Support System for the Differential Diagnosis of Pyelonephritis in Pregnant Women Based on Immune and Oxidative Status

Application of modern mathematical methods and information technologies for accurate differential diagnosis of various forms of pyelonephritis in pregnant women is described. The differential diagnosis is based on indicators of the immune and oxidative status. The decision rules suggested in this work were verified on a control sample. The verification showed that the diagnostic efficiency of the proposed method reaches 93%, which is acceptable for use in medical practice.

Urodynamics recovery in pregnant patients with complicated forms of pyelonephritis

Urinary tract infections are serious threats to the health of mother and child. The most common of these is the pyelonephritis of pregnancy. This work contains results of examination and treatment of 110 pregnant women who had pyelonephritis with complicated hydronephrosis. Analysis of the results proved effectiveness in usage of internal stenting of kidney after preliminary washing of kidney cavity with isotonic dekasan combined with conservative therapy. Using this method allows rapid relief of symptoms, reduction in bed days.

Sekretorisches Immunglobulin A im Urin bei Harnwegsinfektionen im Kindesalter

The pathogenesis of urinary tract infections is not yet sufficiently explained despite of large progressions in this field. A special disposition for infections of the kidneys and the urinary tract more and more be seen not only as an anatomic and/or urodynamic but also as an immunologic problem. The secretory immunoglobulin A (S-IgA) in the urine is a measurable parameter for the function of the local immuno system of the mucous membranes in the urogenital system being subject of the present investigations. 87 children with different forms and stages of activity of the urinary tract infection and 59 healthy children have been chosen in order to measure the concentration and the excretion of S-IgA (mg S-IgA/g creatinine). The S-IgA is estimated by an enzyme immunoassay. We have found that the concentration, the excretion and the daily excretion of S-IgA are higher in all forms of pyelonephritis in an acute stage compared with healthy volunteers. There is a non-significant decrease of these values during an antibiotic therapy. It is evident that the values of patients with chronic pyelonephritis have been significantly diminished during the symptom-free interval compared with healthy volunteers (p less than 0.05). Considering the literature our results show that the function of the kidneys as well as inflammation and local immunity are in a close correlation.

Characteristics of microflora at different stages of surgical treatment of obstructive pyelonephritis in children

It is known that in pyelonephritis, E. coli is often isolated from the urine. However, in recent years, along with this classic pathogen, patients with pyelonephritis began to isolate other uromicroflora. Thus, a number of studies have reported an increasing role of Proteus and Pseudomonas aeruginosa in the etiology of pyelonephritis in children and adults. A characteristic tendency to change the bacterial microflora depending on the duration of the disease, intensity and method of treatment has also been noted. According to some authors, the change of microorganisms may occur both during instrumental examinations and surgical interventions on the urinary system organs, and under the influence of antibacterial drugs. A number of studies have shown an increasing and even leading role of staphylococcus aureus in the etiology of some forms of pyelonephritis in children. There is an opinion that staphylococcus represents the main danger as an infectant in bladder catheterization and urinary tract drainage operations. Thus, further study of the microbial etiology of pyelonephritis is an urgent task in pediatric urology.

Long-term nitrofurantoin treatment of post-operative secondary pyelonephritis

A group of 50 patients with secondary forms of pyelonephritis was treated with nitrofurantoin (FuradantinR, FuradantinR-retard). In all these patients, serious anatomical alterations and functional disorders had been corrected by operative procedures 6 months before onset of this treatment. After an initial high-dose treatment and subsequent low maintenance doses for some months, the secondary bacterial pyelonephritis was cured and relapses were prevented. The criteria adopted for the clinical cure of secondary pyelonephritis comprised the repeated finding of a sterile urine and the disappearance of the pyuria present before treatment, as well as normalization of the creatinine values and the ESR. Patients with creatinine values above 1.5 mg/100 ml were not included in this investigation. Since long-term treatment necessitates the use of a safe drug with the least possible subjective side effects, Furadantin-retard is highly suitable for this purpose.

CLINICAL DATA AND PROGNOSIS IN CASES OF CHRONIC PYELONEPHRITIS

Of the various lesions affecting the urinary tract in the adult, chronic pyelonephritis furnishes the greatest problem to the urologist. In a discussion of this disease it should be recognized that the cases should be divided into several definite clinical groups. Acute and subacute forms of pyelonephritis should not be confused with chronic bilateral pyelonephritis, since they are self-limiting and often unilateral. A common type of chronic urinary infection is characterized by recurring attacks of acute pyelonephritis accompanied by a febrile reaction, which subsides after several days, although frequency may persist for several weeks. When patients are examined in intervals between attacks they are usually free from any evidence of urinary infection, and cystoscopic examination and urine cultures may be negative. Such a negative phase may exist for months, to be followed by a recurrence in the acute form. Following removal of all foci of infection and after the development