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Children (Basel, Switzerland) Feb 2024Hematuria is a worrisome symptom in children and is sometimes associated with urinary tract infections (UTIs). This study aimed to identify useful clinical factors that...
INTRODUCTION
Hematuria is a worrisome symptom in children and is sometimes associated with urinary tract infections (UTIs). This study aimed to identify useful clinical factors that can predict UTIs in hematuria patients without pyuria in the pediatric emergency department (ED).
METHODS
We retrospectively recruited patients with hematuria from the pediatric ED. Clinical symptoms, urine biochemistry and microscopic examination results, and blood laboratory tests were analyzed to identify the predictors of UTIs. Patients were divided into the verbal group (age ≥ 2 years) and non-verbal group (age < 2 years) for identifying predictors of UTIs. Causes of hematuria were also investigated.
RESULTS
A total of 161 patients with hematuria without pyuria were evaluated. Among symptoms, dysuria was significantly correlated with UTIs. Regarding urine biochemistry data, urine esterase and urine protein > 30 mg/dl were found to be significant parameters for predicting UTIs, while urine esterase and urine nitrite showed significant differences in children with age < 2 years. In the urine microscopic examinations, urine red blood cells (RBC) > 373/µL in children aged ≥ 2 years and urine RBC > 8/µL in children aged < 2 years were associated with UTIs. In addition, UTIs and urinary tract stones were found to be the top two causes of hematuria.
CONCLUSIONS
Dysuria, urine esterase, urine nitrite, and urine protein may be useful parameters for predicting UTIs in pediatric patients with hematuria but no pyuria in the ED. In addition, a UTI was the most commonly identified etiology of hematuria without pyuria, followed by urinary tract stones.
PubMed: 38397360
DOI: 10.3390/children11020248 -
Annals of Medicine and Surgery (2012) Oct 2023It is rare for calcium oxalate renal stone, presented mainly in sterile urine, to result in urinary tract infection. The stone-related infection could develop...
INTRODUCTION AND IMPORTANCE
It is rare for calcium oxalate renal stone, presented mainly in sterile urine, to result in urinary tract infection. The stone-related infection could develop spondylodiscitis, causing neurological deficits. To date, there are no reports about calcium oxalate partial staghorn stone and spondylodiscitis.
CASE PRESENTATION
A 62-year-old male suffered from haematuria, fever, and flank pain. He came to the urology outpatient department, where acute pyelonephritis was diagnosed, and a left partial staghorn stone was seen on computed tomography. Oral antibiotics were prescribed with improvement. Two weeks after antibiotics treatment, he developed bilateral lower limb weakness and numbness under the nipple level. He was brought to the emergency department, where the spine MRI revealed T2-T3 spondylodiscitis with epidural abscess and spinal cord compression. He underwent T2-T3 spine operation with improvement in muscle power and hypesthesia. The culture of the surgical lesion yielded Citrobacter koseri, the same as the urine culture obtained at his first visit. Left-side percutaneous nephrolithotomy was performed 1 month after with successful stone removal and resolution of pyuria. Stone analyses reported calcium oxalate. Follow-up MRI showed marked improvement with resolution of spondylodiscitis.
CLINICAL DISCUSSION
Urinary tract infection resulting from partial staghorn stone, with additional hematogenous spread causing spondylodiscitis, is scarcely discussed. The authors illustrated a case with calcium oxalate stone, belonging to sterile Jensen's classification type 1. However, a urinary tract infection could be seen in urine stasis or obstruction.
CONCLUSION
With accurate diagnosis and essential interventions, the patient had immediate neurological improvement and reached disease-free status.
PubMed: 37811066
DOI: 10.1097/MS9.0000000000001202 -
BMC Urology Jun 2024Neurogenic bladder dysfunction is a major problem for spinal cord injury (SCI) patients not only due to the risk of serious complications but also because of the impact... (Comparative Study)
Comparative Study
BACKGROUND
Neurogenic bladder dysfunction is a major problem for spinal cord injury (SCI) patients not only due to the risk of serious complications but also because of the impact on quality of life. The main aim of this study is to compare the rate of urinary tract infection (UTI) associated with hydrophilic-coated catheters versus uncoated polyvinyl chloride (PVC) catheters among SCI patients presenting with functional neurogenic bladder sphincter disorders.
METHODOLOGY
This was a retrospective cohort study from 2005 to 2020 including adult male or female patients who have an SCI at least more than 1 month ago with neurogenic bladder dysfunction and were using intermittent catheterization (single-use hydrophilic-coated or the standard-of-care polyvinyl chloride uncoated standard catheters) at least 3 times a day to maintain bladder emptying.
RESULTS
A total of 1000 patients were selected and recruited through a stratified random sampling technique with 467 (47.60%) patients in the uncoated catheter arm and 524 (52.60%) in the coated catheter groups. The three outcome measures, namely: symptomatic UTI, Bacteriuria, and pyuria were significantly higher in the group using uncoated polyvinyl chloride (PVC) catheters compared to hydrophilic-coated catheters at the rate of 79.60% vs.46.60%, 81.10% vs. 64.69, and 53.57% versus 41.79% respectively. Males, elder patients, longer duration, and severity of SCI were associated with increased risk of symptomatic UTI.
CONCLUSIONS
The results indicate a beneficial effect regarding clinical UTI when using hydrophilic-coated catheters in terms of fewer cases of symptomatic UTI. Bacteriuria is inevitable in patients with long-term catheterization, however, treatment should not be started unless the clinical symptoms exist. More attention should be given to the high-risk group for symptomatic UTIs.
Topics: Humans; Retrospective Studies; Spinal Cord Injuries; Male; Female; Urinary Tract Infections; Middle Aged; Adult; Urinary Bladder, Neurogenic; Urinary Catheters; Intermittent Urethral Catheterization; Hydrophobic and Hydrophilic Interactions; Polyvinyl Chloride; Cohort Studies; Aged; Urinary Catheterization; Catheter-Related Infections
PubMed: 38867233
DOI: 10.1186/s12894-024-01510-y -
Cureus Sep 2023Basal ganglia are highly metabolically active deep gray matter structures that are commonly affected by toxins, metabolic abnormalities, and systemic, degenerative, and...
Basal ganglia are highly metabolically active deep gray matter structures that are commonly affected by toxins, metabolic abnormalities, and systemic, degenerative, and vascular conditions. Basal ganglion affected by uremic encephalopathy can typically result in a "Lentiform fork sign" on T2-weighted imaging (T2WI) and a fluid-attenuated inversion recovery (FLAIR) sequence of magnetic resonance imaging (MRI). This sign represents bilateral symmetrical hyperintensities in the basal ganglia surrounded by a characteristic hyperintense rim demarcating the lentiform nucleus from surrounding structures. This finding is also reported in other conditions resulting in metabolic acidosis from any cause, e.g., diabetic ketoacidosis, organic acidemias, dialysis disequilibrium syndrome, and drugs like metformin. In an appropriate clinicopathological context, the presence of this sign helps in the accurate diagnosis of uremic encephalopathy. The peculiarity lies in the reversible nature of these lesions and their affective response to treatment. However, sometimes these lesions may not be reversible. We present the case of a 60-year-old female who presented to the ER with chief complaints of fever and altered sensorium. Laboratory workup revealed deranged renal function tests (RFTs) and leukocytosis with pyuria. MRI of the brain showed bilateral basal ganglion hyperintensities on T2WI/FLAIR images characteristic of the lentiform fork sign. Therefore, a diagnosis of uremic encephalopathy due to acute kidney injury (AKI) secondary to septic shock from urosepsis was made. The patient was managed conservatively with IV hydration and antibiotics. Remarkable clinical recovery was seen over three weeks. The patient was stable on a five-month follow-up. However, the repeat MRI did not show resolution of the lesions.
PubMed: 37809160
DOI: 10.7759/cureus.44850 -
BMJ Case Reports Jan 2024We report a case of multisystem inflammatory syndrome in children (MIS-C) in an East Asian toddler. He presented with a 2-day history of fever and pyuria, 5 weeks...
We report a case of multisystem inflammatory syndrome in children (MIS-C) in an East Asian toddler. He presented with a 2-day history of fever and pyuria, 5 weeks before that he had recovered from COVID-19. He was initially treated as urinary tract infection. On day 5 of fever, he was noted to have bilateral non-suppurative limbus-sparing conjunctivitis, red and cracked lips and erythematous extremities. Investigations showed raised inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), thrombocytopenia and a markedly elevated NT-proBNP. He received prompt and appropriate treatment inpatient; however, he still had mild coronary abnormalities at 9 months postdischarge. The aim of this paper is to describe the initial presentation and progress of a case of MIS-C. The unique features of this case are his initial presentation of pyuria and notably, his demography (young age, East Asian) which is more typical of Kawasaki disease than MIS-C.
Topics: Male; Child, Preschool; Humans; Pyuria; Aftercare; Patient Discharge; Fever; Systemic Inflammatory Response Syndrome; COVID-19; Conjunctivitis
PubMed: 38171640
DOI: 10.1136/bcr-2022-253756 -
BMC Urology Nov 2023Ectopic kidney and median arcuate ligament syndrome are both rare conditions. The clinical presentation and diagnosis of these conditions are not well studied. There are...
BACKGROUND
Ectopic kidney and median arcuate ligament syndrome are both rare conditions. The clinical presentation and diagnosis of these conditions are not well studied. There are no reports on the combination of these two rare conditions.
CASE PRESENTATION
We report a 24-year-old woman with fever, dysuria, urinary frequency and left flank pain for two days. The primary diagnoses in the clinic were left acute pyelonephritis and left hydronephrosis due to throbbing pain in the left costovertebral angle and pyuria. However, further computed tomography showed right ectopic pelvic kidney, left renal pelvis dilatation without definite ureteral lesion, good bilateral renal contrast enhancement, and compression of the celiac axis due to obstruction by the median arcuate ligament. Chronic abdominal symptoms were reported by the patient after repeat history taking. The patient's condition was fully explained and discussed with her and her family, but they refused further therapy. After the acute pyelonephritis began improving, the patient was discharged for follow-up at our outpatient clinic.
CONCLUSION
We present an extremely rare case of a combination of two rare conditions: ectopic kidney and median arcuate ligament syndrome. No study to date has reported on the relationship between the two diseases. Given the rarity of the two conditions, no evidence or even a hypothesis exists to explain the possible etiology of their combination. More reports are required to enhance the understanding of these rare conditions.
Topics: Female; Humans; Young Adult; Celiac Artery; Kidney; Kidney Diseases; Ligaments; Median Arcuate Ligament Syndrome; Pyelonephritis
PubMed: 37980517
DOI: 10.1186/s12894-023-01361-z -
The Canadian Veterinary Journal = La... Jan 2024A 3-year-old spayed female Rottweiler dog was brought to a veterinary clinic because of weakness, lethargy, and hair coat changes. Hematology and clinical chemistry...
A 3-year-old spayed female Rottweiler dog was brought to a veterinary clinic because of weakness, lethargy, and hair coat changes. Hematology and clinical chemistry assessments revealed anemia, hypoalbuminemia, hyperglobulinemia, and hypothyroid. After persistent pyuria, an ultrasound-guided cystocentesis was completed, which revealed a large abdominal mass. A presumptive diagnosis of canine lymphoma with renal spread was made. Due to a poor prognosis, the dog was euthanized.
Topics: Dogs; Animals; Female; Dog Diseases; Ultrasonography; Lymphoma; Ultrasonography, Interventional
PubMed: 38164385
DOI: No ID Found -
Lupus Science & Medicine Oct 2023Tissue damage in lupus nephritis (LN) is mediated by activation of the classical complement pathway. Complement-mediated upregulation of endothelial cell adhesion... (Observational Study)
Observational Study
OBJECTIVE
Tissue damage in lupus nephritis (LN) is mediated by activation of the classical complement pathway. Complement-mediated upregulation of endothelial cell adhesion molecules is seen in dermal blood vessels of non-lesional skin of patients with active lupus. In diseases with systemic complement activation, extensive microvascular C5b-9 deposition is seen in non-lesional skin. In this study, we assess the presence of systemic complement pathway activation as determined by non-lesional skin microvascular C5b-9 deposition in patients with LN.
METHODS
Eight patients with active LN and eight patients without active LN underwent non-lesional skin biopsies. Using a diaminobenzidine technique, specimens were evaluated for microvascular C5b-9 consistent with systemic complement pathway activation.
RESULTS
Five of eight patients with active LN and one of eight patients without active LN demonstrated positive C5b-9 staining in non-lesional skin (p=0.04). Positive non-lesional C5b-9 staining has greater specificity, 87.5%, for active LN than pyuria, low complements, elevated double-stranded DNA (dsDNA) and proteinuria. Urine protein creatinine ratio was significantly higher in patients with positive non-lesional C5b-9 deposition (5.18 vs 1.20; p=0.04). C5b-9 deposition was not associated with a higher NIH Activity Index, interstitial fibrosis, dsDNA or lower complements.
CONCLUSION
This is the first study to demonstrate evidence in non-lesional skin of microvascular C5b-9 indicative of systemic complement pathway activation in LN. C5b-9 deposition is statistically more common and demonstrated greater specificity than most historical biomarkers for active LN. The findings support a potential role for microvascular C5b-9 assessment in non-lesional skin as a biomarker for LN activity.
Topics: Humans; Lupus Nephritis; Complement Membrane Attack Complex; Lupus Erythematosus, Systemic; Complement System Proteins; Complement Activation; Biomarkers
PubMed: 37879755
DOI: 10.1136/lupus-2023-000996 -
Cureus Mar 2024A 53-year-old man with diabetes mellitus presented to the emergency department with a fever and impaired mobility. A preliminary diagnosis of urinary tract infection was...
A 53-year-old man with diabetes mellitus presented to the emergency department with a fever and impaired mobility. A preliminary diagnosis of urinary tract infection was made based on dysuria and pyuria. History-taking revealed a history of gait disturbance and difficult urination. A thorough physical examination suggested a spinal abnormality. MRI scan revealed a narrow spinal canal due to ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal hyperostosis. Throughout the diagnostic process, we employed both vertical tracing to investigate the causes of urinary tract infection and horizontal tracing to explore comorbidities such as diabetes. Additionally, we introduced appropriate social security and support systems under the name of diagnostic excellence.
PubMed: 38571861
DOI: 10.7759/cureus.55475 -
Antimicrobial Stewardship & Healthcare... 2023The optimal management of bacteriuria/pyuria of clinically undetermined significance (BPCUS) is unknown. Among 220 emergency department patients prescribed antibiotics...
The optimal management of bacteriuria/pyuria of clinically undetermined significance (BPCUS) is unknown. Among 220 emergency department patients prescribed antibiotics for BPCUS, we found frequent readmissions, which were mitigated by outpatient follow-up visits. Observation and follow-up for an unknown diagnosis should be emphasized over antibiotics due to high likelihood of readmissions.
PubMed: 37502236
DOI: 10.1017/ash.2023.204