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Kidney International Sep 2016Immune checkpoint inhibitors (CPIs), monoclonal antibodies that target inhibitory receptors expressed on T cells, represent an emerging class of immunotherapy used in...
Immune checkpoint inhibitors (CPIs), monoclonal antibodies that target inhibitory receptors expressed on T cells, represent an emerging class of immunotherapy used in treating solid organ and hematologic malignancies. We describe the clinical and histologic features of 13 patients with CPI-induced acute kidney injury (AKI) who underwent kidney biopsy. Median time from initiation of a CPI to AKI was 91 (range, 21 to 245) days. Pyuria was present in 8 patients, and the median urine protein to creatinine ratio was 0.48 (range, 0.12 to 0.98) g/g. An extrarenal immune-related adverse event occurred prior to the onset of AKI in 7 patients. Median peak serum creatinine was 4.5 (interquartile range, 3.6-7.3) mg/dl with 4 patients requiring hemodialysis. The prevalent pathologic lesion was acute tubulointerstitial nephritis in 12 patients, with 3 having granulomatous features, and 1 thrombotic microangiopathy. Among the 12 patients with acute tubulointerstitial nephritis, 10 received treatment with glucocorticoids, resulting in complete or partial improvement in renal function in 2 and 7 patients, respectively. However, the 2 patients with acute tubulointerstitial nephritis not given glucocorticoids had no improvement in renal function. Thus, CPI-induced AKI is a new entity that presents with clinical and histologic features similar to other causes of drug-induced acute tubulointerstitial nephritis, though with a longer latency period. Glucocorticoids appear to be a potentially effective treatment strategy. Hence, AKI due to CPIs may be caused by a unique mechanism of action linked to reprogramming of the immune system, leading to loss of tolerance.
Topics: Acute Kidney Injury; Adult; Aged; Antibodies, Monoclonal; Antineoplastic Agents; Biopsy; Creatinine; Female; Glucocorticoids; Humans; Immunologic Factors; Immunotherapy; Kidney; Kidney Function Tests; Male; Middle Aged; Neoplasms; Nephritis, Interstitial; Renal Dialysis; Thrombotic Microangiopathies
PubMed: 27282937
DOI: 10.1016/j.kint.2016.04.008 -
Clinical Kidney Journal Oct 2015Granulomatous interstitial nephritis (GIN) is a rare entity detected in ∼0.5-0.9% of all renal biopsies. GIN has been linked to several antibiotics such as... (Review)
Review
Granulomatous interstitial nephritis (GIN) is a rare entity detected in ∼0.5-0.9% of all renal biopsies. GIN has been linked to several antibiotics such as cephalosporins, vancomycin, nitrofurantoin and ciprofloxacin. It is also associated with NSAIDs and granulomatous disorders such as sarcoidosis, tuberculosis, fungal infections, and granulomatosis with polyangiitis. Renal biopsy is critical in establishing this diagnosis, and the extent of tubular atrophy and interstitial fibrosis may aid in determining prognosis. Retrospective data and clinical experience suggest that removal of the offending agent in conjunction with corticosteroid therapy often results in improvement in renal function. We describe a patient with a history of multiple spinal surgeries complicated by wound infection who presented with confusion and rash with subsequent development of acute kidney injury. Urinalysis demonstrated pyuria and eosinophiluria, and renal biopsy revealed acute interstitial nephritis with granulomas. These findings were attributed to doxycycline treatment of his wound infection. This review explores the clinical associations, presentation, diagnosis, and treatment of this uncommon cause of acute kidney injury.
PubMed: 26413275
DOI: 10.1093/ckj/sfv053 -
The American Journal of Clinical... Jun 2016Urinary tract infections (UTIs) are among the most common bacterial infections and are often treated with antibiotics. Concerns about multidrug-resistant uropathogens... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Urinary tract infections (UTIs) are among the most common bacterial infections and are often treated with antibiotics. Concerns about multidrug-resistant uropathogens have pointed to the need for safe and effective UTI-prevention strategies such as cranberry consumption.
OBJECTIVE
We assessed the effects of the consumption of a cranberry beverage on episodes of clinical UTIs.
DESIGN
In this randomized, double-blind, placebo-controlled, multicenter clinical trial, women with a history of a recent UTI were assigned to consume one 240-mL serving of cranberry beverage/d (n = 185) or a placebo (n = 188) beverage for 24 wk. The primary outcome was the clinical UTI incidence density, which was defined as the total number of clinical UTI events (including multiple events per subject when applicable) per unit of observation time.
RESULTS
The dates of the random assignment of the first subject and the last subject's final visit were February 2013 and March 2015, respectively. The mean age was 40.9 y, and characteristics were similar in both groups. Compliance with study product consumption was 98%, and 86% of subjects completed the treatment period in both groups. There were 39 investigator-diagnosed episodes of clinical UTI in the cranberry group compared with 67 episodes in the placebo group (antibiotic use-adjusted incidence rate ratio: 0.61; 95% CI: 0.41, 0.91; P = 0.016). Clinical UTI with pyuria was also significantly reduced (incidence rate ratio: 0.63; 95% CI: 0.40, 0.97; P = 0.037). One clinical UTI event was prevented for every 3.2 woman-years (95% CI: 2.0, 13.1 woman-years) of the cranberry intervention. The time to UTI with culture positivity did not differ significantly between groups (HR: 0.97; 95% CI: 0.56, 1.67; P = 0.914).
CONCLUSION
The consumption of a cranberry juice beverage lowered the number of clinical UTI episodes in women with a recent history of UTI. This study was registered at clinicaltrials.gov as NCT01776021.
Topics: Adult; Aged; Beverages; Double-Blind Method; Female; Fruit; Humans; Middle Aged; Phytotherapy; Placebos; Pyuria; Urinary Tract Infections; Vaccinium macrocarpon
PubMed: 27251185
DOI: 10.3945/ajcn.116.130542 -
Clinical Infectious Diseases : An... Apr 2021Asymptomatic bacteriuria and pyuria in healthy women often trigger inappropriate antimicrobial treatment, but there is a paucity of data on their prevalence and... (Observational Study)
Observational Study
BACKGROUND
Asymptomatic bacteriuria and pyuria in healthy women often trigger inappropriate antimicrobial treatment, but there is a paucity of data on their prevalence and persistence.
METHODS
To evaluate the prevalence and persistence of asymptomatic bacteriuria and pyuria in women at high risk of recurrent urinary tract infection, we conducted an observational cohort study in 104 healthy premenopausal women with a history of recurrent urinary tract infection with daily assessments of bacteriuria, pyuria, and urinary symptoms over a 3-month period.
RESULTS
The mean age of participants was 22 years, and 74% were white. Asymptomatic bacteriuria events (urine cultures with colony count ≥105 CFU/mL of a uropathogen on days with no symptomatic urinary tract infection diagnosed) occurred in 45 (45%) women on 159 (2.5%) of 6283 days. Asymptomatic bacteriuria events were most commonly caused by Escherichia coli, which was present on 1.4% of days, with a median duration of 1 day (range, 1-10). Pyuria occurred in 70 (78%) of 90 evaluable participants on at least 1 day and 25% of all days on which no symptomatic urinary tract infection was diagnosed. The positive predictive value of pyuria for E. coli asymptomatic bacteriuria was 4%.
CONCLUSIONS
In this population of healthy women at high risk of recurrent urinary tract infection, asymptomatic bacteriuria is uncommon and, when present, rarely lasts more than 2 days. Pyuria, on the other hand, is common but infrequently associated with bacteriuria or symptoms. These data strongly support recommendations not to screen for or treat asymptomatic bacteriuria or pyuria in healthy, nonpregnant women.
Topics: Adult; Bacteriuria; Escherichia coli; Female; Humans; Pyuria; Urinalysis; Urinary Tract Infections; Young Adult
PubMed: 32179902
DOI: 10.1093/cid/ciaa274 -
Clinical Infectious Diseases : An... Jun 2023Pre-existing lower urinary tract symptoms (LUTS), cognitive impairment, and the high prevalence of asymptomatic bacteriuria (ASB) complicate the diagnosis of urinary...
BACKGROUND
Pre-existing lower urinary tract symptoms (LUTS), cognitive impairment, and the high prevalence of asymptomatic bacteriuria (ASB) complicate the diagnosis of urinary tract infection (UTI) in older women. The presence of pyuria remains the cornerstone of UTI diagnosis. However, >90% of ASB patients have pyuria, prompting unnecessary treatment. We quantified pyuria by automated microscopy and flowcytometry to determine the diagnostic accuracy for UTI and to derive pyuria thresholds for UTI in older women.
METHODS
Women ≥65 years with ≥2 new-onset LUTS and 1 uropathogen ≥104 colony-forming units (CFU)/mL were included in the UTI group. Controls were asymptomatic and classified as ASB (1 uropathogen ≥105 CFU/mL), negative culture, or mixed flora. Patients with an indwelling catheter or antimicrobial pretreatment were excluded. Leukocyte medians were compared and sensitivity-specificity pairs were derived from a receiver operating characteristic curve.
RESULTS
We included 164 participants. UTI patients had higher median urinary leukocytes compared with control patients (microscopy: 900 vs 26 leukocytes/µL; flowcytometry: 1575 vs 23 leukocytes/µL; P < .001). Area under the curve was 0.93 for both methods. At a cutoff of 264 leukocytes/µL, sensitivity and specificity of microscopy were 88% (positive and negative likelihood ratio: 7.2 and 0.1, respectively). The commonly used cutoff of 10 leukocytes/µL had a poor specificity (36%) and a sensitivity of 100%.
CONCLUSIONS
The degree of pyuria can help to distinguish UTI in older women from ASB and asymptomatic controls with pyuria. Current pyuria cutoffs are too low and promote inappropriate UTI diagnosis in older women. Clinical Trials Registration. International Clinical Trials Registry Platform: NL9477 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL9477).
Topics: Humans; Female; Aged; Pyuria; Urinary Tract Infections; Bacteriuria; Sensitivity and Specificity; ROC Curve
PubMed: 36806580
DOI: 10.1093/cid/ciad099 -
Urology Annals 2023Epididymo-orchitis (EO) is a common urological condition. In endemic areas, EO may be the presenting picture of brucellosis. Early suspicion and proper diagnosis is...
INTRODUCTION
Epididymo-orchitis (EO) is a common urological condition. In endemic areas, EO may be the presenting picture of brucellosis. Early suspicion and proper diagnosis is necessary for patient recovery.
OBJECTIVE
The aim of our study is to identify early predictors of EO.
PATIENTS AND METHODS
We retrospectively collected the data of all patients who were treated at the Urology Unit, Farwaniya Hospital, with acute EO above the age of 12 years between April 2017 and February 2019. Data from electronic and hardcopy files were gathered and analyzed. The diagnosis of acute EO was based on clinical, laboratory, and radiological findings. A total of 120 patients under the diagnosis of EO, epididymitis, and orchitis were reviewed. Thirty-one patients were tested for based on the history of animal contact, ingestion of unpasteurized dairy products, or persistent fever for more than 48 h. of those patients, 11 tested positive for orchitis.
RESULTS
A comparison between -positive and -negative patients regarding age, presence of fever, complete blood count (CBC) parameters, pyuria, and abscess formation was made. In the group, 72% of the patients had a history of animal contact compared to 33% in non- group ( = 0.006). When comparing CBC parameters in the two groups, group had statistically significant lower total leukocytic count and neutrophil count (mean ± standard deviation [SD]) 13.07 ± 4.22, 6.4 ± 9.98 versus negative group 17.35 ± 5.28, 7.8 ± 10.53, and values were 0.037 and 0.004, respectively. group showed lymphocytosis (mean ± SD) 25.95 ± 9.78 versus non- group 13.22 ± 8.05 and < 0.01.
CONCLUSION
orchitis constituted 9% of the orchitis patients treated in our hospital. Patients with a history of animal contact, EO with lymphocytosis, and relative neutropenia should raise the suspicion for orchitis in endemic areas.
PubMed: 37304522
DOI: 10.4103/ua.ua_178_21 -
The New England Journal of Medicine Mar 2015
Review
Topics: Bacterial Infections; Colony Count, Microbial; Diagnosis, Differential; Female; Humans; Infections; Male; Mycoses; Pyuria; Sexually Transmitted Diseases; Urine; Virus Diseases
PubMed: 25760357
DOI: 10.1056/NEJMra1410052 -
Therapeutic Advances in Urology Oct 2015Sterile pyuria is a common entity. Yet there are no guidelines to address this issue. We have conducted a systematic review over 20 years and reviewed the results.... (Review)
Review
Sterile pyuria is a common entity. Yet there are no guidelines to address this issue. We have conducted a systematic review over 20 years and reviewed the results. Guidelines for assessment, diagnosis and management are developed based on these results.
PubMed: 26425144
DOI: 10.1177/1756287215592570 -
World Journal of Clinical Pediatrics May 2015Kawasaki disease (KD) is an acute, febrile vasculitis that predominantly develops in children ≤ 5 years of age and can lead to multiple organ injuries including the... (Review)
Review
Kawasaki disease (KD) is an acute, febrile vasculitis that predominantly develops in children ≤ 5 years of age and can lead to multiple organ injuries including the kidneys. Of these injuries, pyuria is a common feature of patients with KD, occurring in 30%-80% of patients. Sterile pyuria is most common in KD patients ≤ 1 year of age. KD patients with sterile pyuria exhibit more severe inflammatory reactions and may have sub-clinical renal injuries. Sterile pyuria in KD is associated with mononuclear cells (not neutrophils) in the urine. Although sterile pyuria in KD was at one time thought to be due to urethritis caused by a non-specific vasculitis of the urethra, recent studies suggest that sterile pyuria in KD originates from the urethra, the kidney as a result of mild and sub-clinical renal injuries, and/or the bladder due to cystitis. Pyuria is not always sterile in KD, but can result from a urinary tract infection (UTI). As causative pathogens, Escherichia coli and Klebsiella oxytoca have been reported. The clinical phenotypes do not differ between those with or without UTI. Because some KD patients with UTIs have urinary tract abnormalities such as vesicoureteral reflux, a complete UTI workup including renal ultrasound, voiding cystourethrogram and/or dimercaptosuccinic acid renal scan recommended in KD patients with UTIs.
PubMed: 26015877
DOI: 10.5409/wjcp.v4.i2.25 -
The Journal of Pediatrics Jan 2023Acute kidney injury occurs frequently during pediatric diabetic ketoacidosis (DKA). We reviewed urinalyses from 561 children with DKA; pyuria was detected in 19% overall... (Review)
Review
Acute kidney injury occurs frequently during pediatric diabetic ketoacidosis (DKA). We reviewed urinalyses from 561 children with DKA; pyuria was detected in 19% overall and in 40% of children with more comprehensive urine testing (≥3 urinalyses) during DKA.
Topics: Child; Humans; Diabetic Ketoacidosis; Pyuria; Diabetes Mellitus, Type 1; Acute Kidney Injury
PubMed: 36084731
DOI: 10.1016/j.jpeds.2022.08.054