Recurrent Pyelonephritis Research Articles

Vesico-ureteral reflux diagnosis after initial kidney abscess: Results from a Paediatric Tertiary Hospital.

Guidelines regarding voiding cystourethrogram (VCUG) indications following a paediatric kidney abscess are lacking. This study evaluates vesicoureteral reflux (VUR) prevalence and outcome after a first kidney abscess. This retrospective study included all children presenting to a tertiary paediatric reference centre with de-novo kidney abscesses from 2011 to 2022, diagnosed through imaging (ultrasonography or computed tomography). VCUG's clinical utility was assessed by exploring outcomes related to interventions. Among the 17 patients (median age 9 months, IQR; 6 months-6 years), VCUG identified VUR in 7 (41%; 95% CI: 18-65%), including two with grade IV-V. Median abscess size was 19 mm (IQR; 14-27). 7/8 (88%) children with DMSA scan presented scars, including 4 with hypofunctioning (20%-44%), and one with a non-functioning kidney. Scarring on the DMSA scan was similar regardless of identified VUR. Six children had subsequent pyelonephritis. Three of the remaining 11 had grade I-III and two IV-V VUR. Surgery was required in four children overall: three for recurrent pyelonephritis and one for high-grade VUR and scars. Among initial kidney abscess cases, 41% had VUR, similar to children experiencing their first uncomplicated pyelonephritis. VCUG results guided antibiotic prophylaxis but not surgical decisions. We suggest considering VCUG following recurrent pyelonephritis/kidney abscess and/or kidney scarring.

The role of nuclear medicine techniques; Tc-99m-labeled dimercaptosuccinic acid, diethylenetriaminepentaacetic acid, and mercaptoacetyltriglycine scintigraphies in pediatric surgery

The purpose of this review is to highlight the pivotal role of nuclear medicine in pediatric surgery, specifically in the diagnosis and management of nephro-urological conditions. This review focuses on the applications and advantages of three key nuclear medicine techniques: Tc-99m dimercaptosuccinic acid (DMSA), Tc-99m diethylenetriaminepentaacetic acid (DTPA), and Tc-99m mercaptoacetyltriglycine (MAG3) scintigraphies. These imaging modalities are crucial for providing detailed anatomical and functional information with minimal invasiveness, essential for evaluating congenital anomalies, urinary tract infections, and obstructive uropathies in children. DMSA Scintigraphy is established as the gold standard for detecting renal cortical scarring and assessing functional renal parenchymal damage. It offers superior sensitivity and specificity compared to other imaging techniques, making it indispensable for identifying renal scars from recurrent urinary tract infections or pyelonephritis. DTPA Scintigraphy is critical for measuring glomerular filtration rate (GFR) and analyzing renogram curves, providing quantitative assessments of renal function. It effectively evaluates renal perfusion and identifies perfusion defects and renal ischemia, essential for managing conditions like renal artery stenosis and unilateral kidney disease. MAG3 Scintigraphy excels in dynamic renal scintigraphy, particularly in patients with impaired renal function. It provides high-quality images and superior diagnostic capability, making it invaluable for assessing ureteropelvic junction obstruction and other obstructive uropathies in pediatric patients. The review concludes by emphasizing the integration of these scintigraphy techniques with SPECT/CT, enhancing diagnostic accuracy and providing comprehensive anatomical and functional insights. Despite concerns regarding radiation exposure, measures such as dose optimization and advanced imaging techniques ensure safety and efficacy in pediatric applications.

Anti-IL12p40 autoantibodies in a teenage girl with multiple recurrent abscesses

More frequent among adults, phenocopies may be caused by somatic mutations or anti-cytokine autoantibodies, mimicking the phenotypes of primary immunodeficiencies. A fourteen-year-old girl was referred for a two-year history of weight loss and multiple recurrent abscesses, complicated recurrent pneumonia, pyelonephritis, osteomyelitis, and septic shock, without fever. She had started with nausea, hyporexia, and weight loss, then with abscesses in her hands, knee, ankle, and spleen. She also developed a rib fracture and left thoracic herpes zoster. The patient was cachectic, with normal vital signs, bilateral crackles on chest auscultation, tumefaction of the knee joint, and poorly healed wounds in hands and chest, oozing a yellowish fluid. Chest computed tomography revealed multiple bilateral bronchiectases. Laboratory workup reported chronic anemia, leukocytosis, neutrophilia, mild lymphopenia, thrombocytosis, pan-hypergammaglobulinemia, and elevated acute serum reactants. Lymphocyte subsets were low but present. Mycobacterium tuberculosis was detected via polymerase chain reaction in a bone biopsy specimen from ankle osteomyelitis. Whole-exome sequencing failed to identify a monogenic defect. Interleukin-12 was found markedly elevated in the serum of the patient. Phosphorylation of STAT4, induced by increasing doses of IL-12, was neutralized by patient serum, confirming the presence of anti-IL12 autoantibodies. IL-12 and IL-23 are crucial cytokines in the defense against intracellular microorganisms, the induction of interferon-gamma production by lymphocytes, and other inflammatory functions. Patients who develop neutralizing serum autoantibodies against IL12 manifest late in life with weight loss, multiple recurrent abscesses, poor wound healing, and fistulae. Treatment with anti-CD20 monoclonal antibodies was effective.

Nephropathology of infectious disease

Infections can affect the kidney via different pathways. Urinary tract infections can directly involve the renal tissue by spreading along pre-existing canalicular structures. Such an ascending infection can manifest as ahighly active and purulent or even abscessing interstitial nephritis or as achronic-fibrosing process in recurrent pyelonephritis. Viral infections can also use the canalicular route as in polyomavirus nephropathy or spread via the blood stream in ahematogenous manner as in the case of cytomegalovirus or hantavirus infections. Likewise, bacterial infections can reach the kidney via the blood in the case of systemic infection. Another large group of nephropathies taking place as asequel of infections includes infection-related glomerulonephritides (IRGN), which are mediated by aseries of immunological mechanisms. These IRGN can be subdivided according to their temporal association with the infectious process, occurring either after the infection has healed (postinfectious) or accompanying the ongoing infectious process (parainfectious). The latter, in particular, is of increasing importance in the daily practice of nephropathologists, especially in older patients. Anumber of other glomerulonephritis forms, i.e., membranous or membranoproliferative forms, can occur as aconsequence of infection. In addition, infections can trigger nephropathies, such as thrombotic microangiopathy. The present article gives an overview of morphologic changes in renal parenchyma that take place as aconsequence of infectious processes, with particular focus on IRGN.

Clinical and microbiological characteristics of female patients with acute pyelonephritis who experienced urinary tract infections within the previous year

BackgroundThis study aimed to examine the clinical and microbiological characteristics of female patients with recurrent acute pyelonephritis (APN). MethodsA retrospective cohort study was conducted at a tertiary care hospital in South Korea from July 2019 to December 2021. All female patients aged ≥ 19 years who were diagnosed with community-acquired APN on admission were enrolled. The recurrent group included patients with APN who experienced urinary tract infections within the previous year. The clinical characteristics, types of causative organisms, major antibiotic resistance, and molecular characteristics of Escherichia coli strains were compared between the recurrent and non-recurrent groups. ResultsA total of 285 patients with APN were analyzed, including 41 (14.4%) in the recurrent group. Compared to the non-recurrent group, the recurrent group had a higher Charlson Comorbidity Index (1.8 ± 2.1 vs. 1.1 ± 1.5; P = 0.01) and a higher proportion of bladder abnormalities, such as neurogenic bladder (12.2% vs. 2.0%; P = 0.001) and urinary catheterization (12.2% vs. 1.6%; P < 0.001). Escherichia coli was the most common causative organism in both groups. The proportion of Klebsiella pneumoniae (17.1% vs. 4.7%; P = 0.007) and Pseudomonas aeruginosa (5.7% vs. 0.5%; P = 0.014) as a causative organism was higher in the recurrent group. Regarding the microbiological characteristics of Escherichia coli, there were no significant differences in the proportion of antibiotic resistance, phylogenetic groups, resistance genes, and virulence factors between the two groups. Multivariable analysis showed that neurogenic bladder and a history of admission or antibiotic use during 1 year prior to inclusion were significantly associated with recurrent APN. ConclusionsThe proportion of causative organisms except Escherichia coli was higher in the recurrent group than in the non-recurrent group. Neurogenic bladder and a history of admission or antibiotic use during 1 year prior to inclusion were risk factors for recurrent APN.

Xanthogranulomatous Pyelonephritis: Case Report

BackgroundIn the emergency department (ED), pyelonephritis is a fairly common diagnosis, especially in patients with unilateral flank pain. Xanthogranulomatous pyelonephritis (XGP) is a rare type of pyelonephritis that is associated with unique features, which may lead to its diagnosis. Case ReportA 30-year-old male patient presented to the ED for evaluation of right-sided abdominal pain that has been ongoing for the past 24 hours. He noted the pain was located predominantly in the right flank and described it as sharp in nature. The pain was nonradiating and was associated with scant hematuria. He stated that he had similar pains approximately 1 month earlier that resolved after a few days. The patient underwent a bedside ultrasound and a subsequent computed tomography (CT) scan of the abdomen and pelvis, which showed an enlarged, multiloculated right kidney with dilated calyces and a large staghorn calculus, findings that represent XGP. Why Should an Emergency Physician Be Aware of This?This case report highlights an unusual variant of pyelonephritis, a relatively common ED diagnosis. XGP should be considered in patients with recurrent pyelonephritis, as treatment for XGP may require surgical intervention in addition to traditional antibiotic management.

Bacterial profile and prevalence of urinary tract infections in pregnant women in Latin America: a systematic review and meta-analysis

BackgroundGiven the physiological changes during pregnancy, pregnant women are likely to develop recurrent urinary tract infections (UTIs) and pyelonephritis, which may result in adverse obstetric outcomes, including prematurity and low birth weight preeclampsia. However, data on UTI prevalence and bacterial profile in Latin American pregnant women remain scarce, necessitating the present systematic review to address this issue.MethodsTo identify eligible observational studies published up to September 2022, keywords were systematically searched in Medline/PubMed, Cochrane Library, Embase, Web of Science, and Bireme/Lilacs electronic databases and Google Scholar. The systematic review with meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the quality of studies was classified according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The meta-analysis employed a random-effects method with double-arcsine transformation in the R software.ResultsDatabase and manual searches identified 253,550 citations published until September 2022. Among the identified citations, 67 met the inclusion criteria and were included in the systematic review, corresponding to a sample of 111,249 pregnant women from nine Latin American countries. Among Latin American pregnant women, the prevalence rates of asymptomatic bacteriuria, lower UTI, and pyelonephritis were estimated at 18.45% (95% confidence interval [CI]: 15.45–21.53), 7.54% (95% CI: 4.76–10.87), and 2.34% (95% CI: 0.68–4.85), respectively. Some regional differences were also detected. Among the included studies, Escherichia coli (70%) was identified as the most frequently isolated bacterial species, followed by Klebsiella sp. (6.8%).ConclusionPregnant women in Latin America exhibit a higher prevalence of bacteriuria, UTI, and pyelonephritis than pregnant women globally. This scenario reinforces the importance of universal screening with urine culture during early prenatal care to ensure improved outcomes. Future investigations should assess the microbial susceptibility profiles of uropathogens isolated from pregnant women in Latin America.Trial registrationThis research was registered at PROSPERO (No. CRD42020212601).

Ureteral obstruction following transurethral resection of bladder cancer within the Hutch's diverticulum.

Here, we report a rare case of bladder cancer within the left congenital periureteral diverticulum, termed the Hutch's diverticulum. Following transurethral resection of the bladder tumor, repeated pyelonephritis was caused by stricture of the diverticulum orifice and ureter. We attempted transurethral dilation and ureteral stenting, but the obstruction did not improve. The patient's renal dysfunction showed gradual progression due to recurrent left pyelonephritis as well as the ureteral obstruction. Therefore, we finally performed a partial cystectomy, involving stricture and ureteral reimplantation. No tumor recurrence was observed over 39months, and renal dysfunction did not progress following partial cystectomy.

Prevalence of urinary tract infection among pregnant women in a tertiary care hospital, Karnataka: Retrospective study

Background: Urinary tract infection (UTI) is a prevalent medical complication during pregnancy, affecting approximately 5–10% of all pregnancies. The risk of recurrent bacteriuria and acute pyelonephritis is heightened during pregnancy, posing significant risks to both mother and fetus. The prevalence of bacteriuria varies across different regions globally. Due to the physiological changes during pregnancy, clinical diagnosis of UTI can be challenging as it is often mistaken for regular pregnancy-related changes. This research aims to determine the prevalence of symptomatic UTI in pregnant women, analyze the bacteriological profile and antibiotic resistance, and identify the associated risk factors. Materials and methods: This cross-sectional retrospective study was conducted at the Kasturba Hospital from January 2017 to December 2021. Patient information was obtained from the medical records. Data analysis was carried out using Jamovi 2.3.26. The level of significance was set at 5% throughout the study. Results: The study included a total of 256 pregnant women, out of which 38 patients exhibited notable bacterial growth, resulting in an overall prevalence of 1.94%. Among the pregnant women, 84% presented with symptomatic bacteriuria. Conclusion: UTI during pregnancy has significant implications for the health of both the mother and the baby. Our findings indicate an incidence rate of 1.94% for UTI in pregnant women. Among the isolated organisms, Escherichia coli was the most commonly identified, with a higher prevalence rate observed in the third trimester of pregnancy. Pregnant women who develop UTI are at an elevated risk of experiencing adverse maternal and fetal outcomes.

MP70-12 THE WIDE URETER AND THE SMALL BLADDER, THE CUFF-NIPPLE REIMPLANTATION RATHER THAN URINARY DIVERSION

You have accessJournal of UrologyCME1 Apr 2023MP70-12 THE WIDE URETER AND THE SMALL BLADDER, THE CUFF-NIPPLE REIMPLANTATION RATHER THAN URINARY DIVERSION Moneer Hanna and Wael Abosena Moneer HannaMoneer Hanna More articles by this author and Wael AbosenaWael Abosena More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reimplantation of a dilated Ureter into an infantile small capacity bladder represents a surgical challenge. The surgical options for reflux megaureters who developed breakthrough urinary infections while on prophylaxis are temporary diversion (vesicostomy for bilateral and ureterostomy for unilateral megaureters). In cases of obstructed megaureter the options are ureterostomy and refluxing reimplantation. METHODS: Between 1995 and 2021, 46 infants aged 3 and 12 months were referred for surgical management following recurrent pyelonephritis while on prophylaxis (30 infants) and for worsening hydronephrosis (16 infants). There were 32 boys and 14 girls. The diagnosis was bilateral reflux megaureters in 18 and unilateral in 8 children. The other twenty children had bilateral obstructed megaureter in 9 and unilateral in 11 children. The radionuclide renal scan was performed in 43 children, and it showed reflux nephropathy in 35 kidneys with VUR and reduced function of more than 20% in 9/11 obstructed kidneys. A total of 73 megaureters were operated on. The ureteral tortuosity was straightened, and the caliber was reduced when indicated. Each ureter was reimplanted in a short (1 cm) submucosal tunnel, a cuff-nipple ureteral orifice was created in 62/73 ureters. Simple cuff-nipple without submucosal tunnelling in 11 ureters. RESULTS: The postoperative course was uneventful in all children and follow up US & VCUG were done at four months. Thereafter the follow-up continued by the pediatric nephrology service. The post operative US showed improved hydronephrosis in 59/73 kidneys and stable in 14 units. The VCUG showed no evidence of VUR in 58/62 (93%) of the group who had short tunnel and cuff-nipple reimplantation, in 4 ureters the VUR was downgraded to grade II. 10/11 (91%) of the ureters with the cuff-nipple without tunneling showed no evidence of VUR, and one ureter the VUR was grade II. 7 children had significant reflux nephropathy outgrew their renal function and underwent renal transplantation CONCLUSIONS: The time -tested Paquin dogma of tunnel length/width ratio of 5/1 was challenged by Lyons et.al, the latter contention was that the shape of the ureteral orifice (UO) is more important than the length of the tunnel for reflux prevention, (the cuff-nipple creates a volcano like UO). Recently Villaneuva et.al performed a parametric simulation study of ureteral collapse (LS-DYNA finite-element software). They confirmed Lyons observation. These observations would explain the high success rate which was achieved by the cuff-nipple technique. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1008 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Moneer Hanna More articles by this author Wael Abosena More articles by this author Expand All Advertisement PDF downloadLoading ...

A Case of Recurrent Bilateral Hydronpehrosis and Pyelonephritis Due to Pelvic Organ Prolapse

Although bilateral hydronephrosis caused by pelvic organ prolapse (POP) is not rare, it does not usually cause severe pyelonephritis or acute renal failure. Recurrence of POP accompanied with hydronephrosis and pyelonephritis following curative surgery for POP has been rarely reported. We describe a case of recurrent pyelonephritis due to POP. A 79-year-old woman visited our hospital with anorexia. She was diagnosed with right pyelonephritis, acute renal failure with bilateral hydroureteronephrosis, uterine prolapse, and cystocele. She underwent right nephrostomy and received antibiotics, and her condition then improved. Two months later, she revisited us with left pyelonephritis. She underwent left nephrostomy and received antibiotics. As POP seemed to cause bilateral ureteral obstructions, laparoscopic hysterectomy and uterosacral ligament suspension was performed. Although her POP and ureteral obstructions improved temporarily cystocele and ureteral obstructions with left pyelonephritis recurred two months later. Subsequent pessary treatment managed POP and ureteral obstructions during 1-year follow-up. Pyelonephritis in patients with POP is rare. In the review of literature, all of patients undergoing nephrostomy or ureteral stent survived whereas some of patients not undergoing such interventions died. Additionally, most of patients undergoing POP management survived whereas more than half of patients not undergoing POP management died. We encountered a case of recurrent bilateral hydronephrosis and pyelonephritis caused by POP. There was a clear association of POP occurrence with ureteral obstruction and pyelonephritis, suggesting the importance of managing POP and ureteral obstruction appropriately in such case.

Abordarea clinică a copiilor cu reflux vezico-ureteral – prezentare generală

Vesicoureteral reflux is the most common urinary tract ab­nor­ma­lity among children, estimated to be present in ap­pro­xi­mately 1-2% of them. There are various possibilities of evolution, from asymptomatic forms with spontaneous re­mis­sion to recurrent acute pyelonephritis, reflux ne­phro­pathy, or even end-stage chronic kidney disease. Therefore, the early diagnosis, with a correct staging, is essential, al­lo­w­ing the optimal therapeutic approach. The most com­mon clinical situations requiring imaging investigation of vesi­coureteral reflux are repeated urinary tract infections, fetal hydronephrosis, familial vesicoureteral reflux, blad­der bowel dysfunction, and complex uropathies. The the­ra­peu­tic management is decided according to the reflux se­ve­rity, the clinical manifestations, and the pa­tient’s age. The main objectives of the treatment are to pre­vent uri­na­ry tract infections, the development of renal scars, and the progression toward chronic kidney disease. The the­ra­peu­tic approach may involve active follow-up, con­ti­nuous antibiotic prophylaxis, or surgical intervention. Ac­tive follow-up applies to asymptomatic patients with an in­creased likelihood of spontaneous remission. Antibiotic pro­phy­laxis is the most frequently adopted approach, used in patients with previous urinary tract infections and high-grade reflux. The surgical approach is reserved for cases with a low probability of spontaneous remission and for those with unfavorable evolution under conservative treat­ment. The surgical methods used are represented by en­do­sco­pic injection of an antireflux substance, classical or robotically assisted surgery, with similar success rates. Cur­rently, there is no consensus regarding the therapeutic ap­proach to these patients, the pediatrician being the one who must evaluate each case and propose and in­di­vi­dua­l­ized therapeutic management adapted to the needs of each patient.

Risk factors for re-infection in patients after drainage of the upper urinary tract due to obstructive pyelonephritis

Introduction. Reinfection after drainage of obstructive pyelonephritis exacerbates the postoperative course of the disease and delays the possible surgical intervention aimed at eliminating the cause of obstruction.Objectives. To determine the percentage of re-infection in patients drained with double-J stent or nephrostomy catheter for obstructive pyelonephritis. To assess the relationship between the timing of drainage removal and development of re-infection. To establish risk factors for the development of re-infection.Materials and methods. Medical records from 1022 patients who were treated from January 2019 to December 2021 and underwent drainage for obstructive pyelonephritis. The data in patients after nephrostomy and stenting were evaluated separately. A retrospective analysis of the time and frequency of the development of re-infection, as well as the effect of diabetes mellitus on pyelonephritis relapse, was carried out.Results. Re-infection during drainage developed in 16 (4.8%) patients with a nephrostomy and 45 (6.5%) patients with a stent. Among those who had re-infection in the nephrostomy-group, 4 (25.0%) patients noted it within two weeks from the moment of drainage, and 11 (69.0%) at three-four weeks. In the stent-group, the number of patients who had a complication during the first two weeks was 15 (33.0%), and it was 22 (49.0%) during the next two weeks, The proportion of patients with diabetes mellitus was higher among those who developed pyelonephritis again.Conclusion. The percentage of patients hospitalized with clinical re-infection after drainage of the upper urinary tract was 6.0%. There was an increase in the number of hospitalizations with recurrent pyelonephritis in cases where the drainage period lasted more than two weeks (p &lt; 0.05).

Клинико-патогенетические аспекты лечения и профилактики пиелонефрита у детей

Treatment of pyelonephritis in children should be combined, long-term and individual-based. The success of the therapy in children largely depends on the prompt appointment and the correct choice of antimicrobial therapy.To evaluate the efficiency of the dietary supplement "Cystenium II" in a group of children aged 7 to 14 years with a diagnosis of acute and chronic recurrent pyelonephritis in the acute phase.A total of 60 children aged 7 to 14 years with a diagnosis of acute or chronic recurrent pyelonephritis in the acute stage were included in the study. The clinical group consisted of 30 patients (mean age 12.1+/-1.8 years), while the control group included 30 patients of mean age 11.2+/-1.7 years. In the control group patients received only standard antibiotic therapy, while in the clinical group it was combined with a dietary supplement "Cystenium II" 1 tablet 2 times a day with meals for 14 days. After the course of antibacterial treatment, the children in the clinical group continued to take the studied dietary supplement for another 14 days in order to prevent the recurrence of pyelonephritis. The results of treatment (patient's condition, presence of pain, dysuria, fever) were assessed on the 3rd, 7th, 14th day, 1 and 6 months after the start of treatment. A urinalysis was performed at the baseline, on the 7th and 14th days, as well as after 1 and 6 months. Urine culture was performed before and after antibiotic therapy at the baseline, on the 14th day, 1 and 6 months after the start of treatment.The main indicators of urinalysis (leukocytes, red blood cells, protein) returned to normal values in 26 (86.7%) patients of the clinical group and in 23 (76.7%) patients of the control group on the 7th day after the start of treatment. At the completion of the basic therapy (after 14 days) normal clinical parameters (absence of leukocyturia, microhematuria, proteinuria) were observed in all patients of the clinical group and in 28 (93.3%) patients of the control group. After a month of follow-up, the disturbances in urinalysis (leukocytes, red blood cells, protein) in the control group were again seen in 3 (10%) patients, as well as after 6 months. However, in the clinical group all patients had normal urinalysis (absence of leukocyturia, microhematuria, proteinuria) after 1 month and only in 1 (3.3%) case leukocyturia, as well as an increase in the number of red blood cells and protein was detected by 6 months.According to our results, the use of dietary supplements "Cystenium II" (manufactured by Akvion, Russia), due to the constituents of D-mannose (450 mg), cranberry fruit extract with a standardized activity of 500 mg (36 mg of proanthocyanidins) and vitamin C (60 mg), may cause anti-inflammatory and anti-adhesive effects (resolving of leukocyturia and bacteriuria). This allows to use the dietary supplement Cystenium II in children from 7 years of age in the combination therapy of acute pyelonephritis, as well as exacerbation of chronic pyelonephritis. The obtained results showed a high overall therapeutic efficacy of combination therapy using Cystenium II after 6 months from the start of treatment (relapse in 1 patient), in contrast to the control group (relapse in 6 patients).the use of dietary supplement "Cystenium II" allowed to reduce the number of repeated courses of antibiotic therapy in children during 6 months of follow-up and, most likely, reduced the frequency of development of chronic pyelonephritis after an acute inflammation. Therefore, the wide clinical use of dietary supplements "Cystenium II" for the combined treatment of acute and exacerbation of chronic pyelonephritis in children older than 7 years seems to be very reasonable.

Efficacy of botulinum toxin in a patient with neurogenic detrusor overactivity

Neurogenic detrusor overactivity is a dangerin terms of the formation of vesicoureteralreflux, pyelonephritis, and chronic kidney disease. The standard treatment for neurogenic detrusor overactivity is intermittent catheterization of the bladder in combination with M-cholinoblockers, which is not always sufficient. In the article, the authors briefly outlined the physiological basis of intradetrusor injections of botulinum toxin in neurogenic detrusor overactivity in patients with myelodysplasia who underwent surgery for spinal hernias, tumors of the spinal canal, as well as patients with spinal trauma. The technology of intradetrusor injections of botulinum toxin is shown, possible complications are described. The effectiveness of intradetrusor injections of botulinum toxin is shown by a specific clinical example — a description of the medical history of a child who has a history of surgical treatment for a spinal hernia in the newborn period. After the operation, neurogenic detrusor overactivity was revealed, insensitive to treatment with M-cholinoblockers. Complications were vesicoureteral reflux and recurrent pyelonephritis. The results of cystometry before and after double administration of botulinum toxin are shown. Detrusor hypertension was stopped, pyelonephritis remission was achieved, trabecularity of the bladder mucosa was stopped. Simultaneously with the introduction of botulinum toxin, endoscopic correction of vesicoureteral reflux was performed.

Role of Retrograde Intrarenal Surgery in the Management of Diabetic Renal Papillary Necrosis.

Introduction: It is challenging to diagnose diabetic renal papillary necrosis (RPN) radiologically due to the limitation in performing a contrast study in patients with compromised renal function. Endoscopic management by Double 'J' (DJ) stenting or percutaneous nephrostomy is the preferred treatment. The aim of our study was to analyze the role of retrograde intrarenal surgery (RIRS) in the management of RPN by retrieving necrosed papillae. Methods: This retrospective study included diabetic patients who presented with acute pyelonephritis or urosepsis at our institute. After evaluating with appropriate laboratory and radiological investigations, retrograde pyelography (RGP) and DJ stenting were performed in those who did not respond to intravenous antibiotic therapy. The RIRS was performed in patients who had filling defects in the pelvicaliceal system (PCS) on RGP after 3 weeks at the time of DJ stent removal. Patients with a minimum follow-up period of 6 months were included. Results: A total of 187 patients (81 female, 106 male) with diabetes with a mean age of 58.3 years were enrolled in this study. The mean serum creatinine was 2.7 mg/dL and mean estimated glomerular filtration rate was 32.8 mL/min/1.73 m2. One hundred twenty-six patients (67.3%) had hydroureteronephrosis (HUN), out of whom 74 (58.7%) had necrosed papillae in the PCS. In 61 (32.6%) patients, there was no HUN; however, 25 (41%) of these patients had necrosed papillae in PCS. Necrosed renal papillae were retrieved in 83 patients (46.1%) by RIRS. All the patients were followed up for a minimum period of 6 months; seven patients (3.8%) had recurrent pyelonephritis. Conclusions: The RIRS plays a significant role in the management of diabetic RPN. Retrieving necrosed papillae from the PCS after confirming their presence by RGP prevents ureteric obstruction, which leads to urosepsis, and presumptively prevents or delays future episodes of pyelonephritis.

Impact of Late and Recurrent Acute Graft Pyelonephritis on Long-Term Kidney Graft Outcomes.

BackgroundWhile Urinary tract infections are the most common infections in kidney transplant recipients, the impact of late acute graft pyelonephritis (AGPN) on graft outcomes remains unknown. Our study was performed to more precisely evaluate the long-term impact of AGPN.MethodsWe included 9052 kidney and combined kidney-pancreas recipients who underwent transplantation between 2008 and 2018 from a French multicenter cohort. The relationships between AGPN and patient and graft survival were analyzed with a time-dependent multivariate Cox model.ResultsThe cumulative incidence of AGPN was 20.9%. A first episode of early AGPN is associated with a non-significant increase in the risk of graft failure (hazard ratio [HR], 1.27; 95% confidence interval [95% CI], 0.90 to 1.79). Though, cumulative number of AGPN episodes (HR = 1.51; 95% CI, 0.89 to 2.57 for two episodes and HR = 2.08; 95% CI, 1.17 to 3.69 for three or more episodes) is associated with an increased risk of graft failure. In contrast, when the first episode of AGPN occurred late (i.e., 6 months post transplantation), the risk of graft failure is significantly increased (HR = 2.25; 95% CI, 1.65 to 3.07), and this risk remains relatively stable with the recurrence of late AGPN episodes. The onset of late AGPN were also associated with a higher risk of patient death. ConclusionThis analysis shows that late AGPN and recurrent AGPN are both risk factors for a poor long-term graft outcome and mortality. Late AGPN should not be considered benign infections in post-transplantation follow-up.

Acute Allograft Pyelonephritis: Vague Symptoms, Indeterminate Laboratory Results, and the Necessity of Indication Biopsy.

In this study, we examined the clinical and biochemical features of biopsy-proven acute pyelonephritis among 769 kidney transplant recipients. This cohort study was performed between January 2003 and December 2019 at the University of Health Sciences (Izmir, Turkey). Acute pyelonephritis refers to urinary tract infection with acute graft dysfunction. All patients with suspected acute pyelonephritis underwent diagnostic biopsy and received antibiotic treatment for an average of 14 to 21 days. Patients with acute pyelonephritis (18/769, 2.3%) were categorized into groups of 9 patients each: group 1 developed acute pyelonephritis in the first 6 months, and group 2 developed acute pyelonephritis >6 months posttransplant. All patients in group 1 had acute graft dysfunction; only 2 (22%) were symptomatic. All patients recovered baseline graft function after treatment. Patients in group 2 had at least 2 laboratory findings that included leukocytosis, neutrophilia, and high C-reactive protein values. Six patients had urine culture positivity. Recurrent pyelonephritis occurred in 3 patients. Four patients had graft loss. Over the mean follow-up of 48.0 ± 28.4 months, 14 patients (78%) were alive with a functioning graft. Diagnostic biopsy is of great importance in patients with urinary tract infection accompanied by acute graft dysfunction in the first 6 months after transplant.

Late diagnosis of posterior urethral valves: a case report and the literature review

Posterior urethral valves (PUV) are the most common cause of lower urinary tract obstruction in boys. They are usually suspected antenatally or soon after the birth as the cause of severe hydronephrosis, oligohydramnios, renal hypodysplasia, and kidney failure. In milder forms of PUV, the uncharacteristic symptoms occur later in childhood, adolescence, or even adulthood and cause diagnostic problems. The final diagnosis and causative treatment of PUV are possible due to cystourethroscopy. Nevertheless, as a consequence of the defect, valve bladder syndrome (VBS) occurs and requires long-term treatment. The authors present a case of a 14-year-old boy with a late diagnosis of PUV at the age of 7. Recurrent pyelonephritis and nonspecific voiding dysfunction were the first symptoms. Ultrasounds(US) were initially normal while videocystometry(VCM) showed the 3rd-grade right-sided vesicoureteral reflux (VUR), bladder diverticulum as well as discrete detrusor overactivity, and reduced bladder capacity without any signs of bladder obstruction. Bilateral post-inflammatory nephropathy completed the clinical picture. In urethrocystoscopy surprisingly PUV were found and incised. Due to recurrent urinary tract infections (UTIs) one year later the STING procedure was performed which resulted in the resolution of VUR. Despite this, the features of bladder dysfunction, requiring regular urodynamic evaluation and pharmacotherapy, persisted. Recurrent UTIs in boys may suggest urinary tract obstruction and PUV should be considered regardless of the patient's age. Early diagnosis and appropriate management may improve the prognosis.

Lower urinary tract dysfunction in diabetes mellitus: the forgotten disease

Diabetic cystopathy is a common complication in patients with diabetes mellitus. It may cause a variety of manifestations ranging from bladder hyperactivity to decreased bladder contractibility. However, the presence of bladder dysfunction in diabetic patients is often underdiagnosed by clinicians. We present a case report of a 54-year-old woman with a medical history of diabetes with recurrent lower urinary tract infections and pyelonephritis. Her bladder dysfunction was never assessed until she was admitted to our department. We identified an impaired sensation of bladder filling and an inability to voluntarily contract the detrusor. We provided pharmacological treatment to enhance bladder emptying and proposed a new bladder-emptying regimen. The patient remains with this therapeutic strategy with no evidence of further complications. This case aims to raise awareness among clinicians about diabetic bladder dysfunction.