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Journal of Veterinary Internal Medicine 2023Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO).
BACKGROUND
Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO).
HYPOTHESIS
Describe clinical characteristics and outcome of MM of BUO.
ANIMALS
Seventy-two client-owned cats with 103 obstructed kidneys.
METHODS
Medical records of cats diagnosed with BUO between 2010 and 2021 that received >72 hours of MM were retrospectively reviewed. Clinical data, treatment, and outcome were reviewed. Outcome was classified as success, partial success, or failure based on ultrasound findings. Factors associated with outcome were assessed.
RESULTS
Seventy-two cats with 103 obstructed kidneys were enrolled. The causes of obstruction were uroliths in 73% (75/103), strictures in 13.5% (14/103), and pyonephrosis in 13.5% (14/103) of affected kidneys. Median serum creatinine concentration at presentation was 4.01 mg/dL (range, 1.30-21.3 mg/dL). Outcome after MM was considered a success in 30% (31/103), partial success in 13% (13/103), and failure in 57% (59/103) of kidneys. Success was reported in 23% (17/75) of kidneys with uroliths, 50% (7/14) with pyonephrosis, and 50% (7/14) with strictures. Median time to a successful outcome was 16 days (range, 3-115 days). Distal and smaller uroliths (median length, 1.85 mm) were significantly associated with success (P = .05 and P = .01, respectively). Median survival times were 1188 days (range, 60-1700 days), 518 days (range, 7-1812 days), and 234 days (range, 4-3494 days) for success, partial success, and failure, respectively.
CONCLUSIONS AND CLINICAL IMPORTANCE
We found a higher success rate for MM of BUO than previously reported. Smaller distal uroliths (<1-2 mm) were more likely to pass.
Topics: Cats; Animals; Ureteral Obstruction; Pyonephrosis; Retrospective Studies; Constriction, Pathologic; Kidney; Creatinine; Urinary Calculi; Cat Diseases
PubMed: 37073892
DOI: 10.1111/jvim.16709 -
Diagnostics (Basel, Switzerland) Feb 2021Urinary tract infections (UTIs) are the most frequent community-acquired and healthcare-associated bacterial infections. UTIs are heterogeneous and range from rather... (Review)
Review
Urinary tract infections (UTIs) are the most frequent community-acquired and healthcare-associated bacterial infections. UTIs are heterogeneous and range from rather benign, uncomplicated infections to complicated UTIs (cUTIs), pyelonephritis and severe urosepsis, depending mostly on the host response. Ultrasound and computed tomography represent the imaging processes of choice in the diagnosis and staging of the pathology in emergency settings. The aim of this study is to describe the common ultrasound (US) and computed tomography (CT) features of pyonephrosis. US can make the diagnosis, demonstrating echogenic debris, fluid/fluid levels, and air in the collecting system. Although the diagnosis appears to be easily made with US, CT is necessary in non-diagnostic US examinations to confirm the diagnosis, to demonstrate the cause and moreover to stage the pathology, defining extrarenal complications. In emergency settings, US and CT are differently used in the diagnosis and staging of pyonephrosis.
PubMed: 33671431
DOI: 10.3390/diagnostics11020331 -
Seminars in Interventional Radiology Mar 2020Pyonephrosis is gross accumulation of pus within an obstructed renal collecting system that, if left untreated, can lead to potentially fatal septic shock. Treatment... (Review)
Review
Pyonephrosis is gross accumulation of pus within an obstructed renal collecting system that, if left untreated, can lead to potentially fatal septic shock. Treatment requires urgent decompression coupled with systemic antibiotics. Percutaneous nephrostomy (PCN) placement, first described in 1976 for the treatment of pyonephrosis, is now widely utilized for emergent decompression in these patients. When performed by an experienced interventional radiologist, PCN is a safe procedure with technical success rates of over 96 to 99%. This article will address the clinical presentation of pyonephrosis, and will discuss the indications, technique, complications, and outcomes of emergent PCN placement. Additionally, the expanded indications for PCN placement in nonemergent scenarios will also be described.
PubMed: 32139973
DOI: 10.1055/s-0039-3401842 -
Medicina (Kaunas, Lithuania) Jan 2021There are many acute and chronic infections affecting the urinary tract including bacterial, fungal and viral infections. Urinary tract infections (UTIs) can present in... (Review)
Review
There are many acute and chronic infections affecting the urinary tract including bacterial, fungal and viral infections. Urinary tract infections (UTIs) can present in many different patterns with variable degrees of severity varying from asymptomatic and uncomplicated forms to life threatening complicated infections. Cross-sectional imaging techniques-including both computed tomography (CT) and magnetic resonance imaging (MRI)-have become very important tools not only for evaluation of UTIs, but also for detection of associated complications. Selection of either CT or MRI in the UTI evaluation depends on several factors such as the presence of contraindication, experience, cost and availability. CT and MRI help in early detection and management of UTIs that reduce the prevalence and severity of complications. In this article we will present the radiologic findings at CT and MRI in different types of upper and lower UTIs including acute pyelonephritis, intrarenal and perinephric abscesses, pyonephrosis, chronic pyelonephritis, emphysematous UTIs, xanthogranulomatous pyelonephritis, tuberculosis (TB), bilharziasis, fungal infection, corynebacterium infection, ureteritis, cystitis, prostatitis, prostatic abscess and urethritis.
Topics: Anti-Bacterial Agents; Cystitis; Humans; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed; Urinary Tract Infections
PubMed: 33401464
DOI: 10.3390/medicina57010032 -
Clinical Case Reports Dec 2020An infectious disease with obstructive hydronephrosis, pyonephrosis causes suppurative destruction of the renal parenchyma. In such cases, retrograde ureteric stenting...
An infectious disease with obstructive hydronephrosis, pyonephrosis causes suppurative destruction of the renal parenchyma. In such cases, retrograde ureteric stenting is considered a good choice for the drainage of pyonephrosis, as an alternative to percutaneous nephrostomy and nephrectomy. The complication rate is minimal in retrograde ureteric stenting compared with about 4% in percutaneous nephrostomy.
PubMed: 33363990
DOI: 10.1002/ccr3.3204 -
Saudi Journal of Kidney Diseases and... Aug 2022The morbidity and mortality rates of transplant nephrectomy are closely related to the indications of nephrectomy. This study evaluates the indications, etiology, and...
The morbidity and mortality rates of transplant nephrectomy are closely related to the indications of nephrectomy. This study evaluates the indications, etiology, and complications of graft nephrectomies for commercial kidney transplantation (CKT). Data were analyzed retrospectively for graft nephrectomies for CKT from January 2009 to December 2017 at the Royal Hospital, Muscat, Oman. Four hundred and three patients received CKT and 34 patients required a nephrectomy. Twenty-five patients had a nephrectomy within 10 weeks of CKT in the early group, and nine patients in the late group had the graft removed later than 10 weeks. Indications for nephrectomy in the early group were acute bleeding, infarcted kidney, and pyonephrosis in 7, 11, and 7 patients, respectively; in the late group, the indications were: pain, hematuria, fever, hypertension, and infection. Overall, seven patients had major blood loss, and those patients who had a pseudoaneurysm had tissue cultures that were positive for the fungus. Postoperative complications occurred in 26 patients. There was acute bleeding in three patients from the external iliac artery at the site of the previous anastomosis, and, in all three cases, the external iliac artery was ligated. There were 12 major wound infections, and three patients died from overwhelming sepsis and disseminated intravascular coagulation. Commercial transplants carry a high risk of immunological, vascular, and infectious complications, resulting in significant morbidity and mortality.
Topics: Humans; Retrospective Studies; Tourism; Kidney Transplantation; Nephrectomy; Aneurysm, False
PubMed: 37675744
DOI: 10.4103/1319-2442.384186 -
BMJ Case Reports Jan 2022Thrombocytopaenia is a commonly encountered finding in hospitalised patients. Many antibiotics, especially beta-lactams, are well known to cause thrombocytopaenia by an...
Thrombocytopaenia is a commonly encountered finding in hospitalised patients. Many antibiotics, especially beta-lactams, are well known to cause thrombocytopaenia by an immune-mediated mechanism. We present a 55-year-old woman who was admitted to the hospital with a complicated urinary tract infection resulting in right-sided pyonephrosis and pararenal abscess. She was observed to develop thrombocytopaenia after initiation of cefepime therapy. Following an extensive work-up for her new-onset thrombocytopaenia, she was diagnosed as a case of a drug (cefepime)-induced thrombocytopaenia. Her platelet count recovered back to normal levels after cessation of cefepime therapy. Based on our PubMed search, there are only a few cases of cefepime-induced thrombocytopaenia published in the literature. This paper illustrates that physicians should include cefepime among the possible aetiologies of thrombocytopaenia. Additionally, this article outlines the currently available approaches to the diagnosis and management of drug-induced thrombocytopaenia.
Topics: Anti-Bacterial Agents; Cefepime; Female; Humans; Middle Aged; Platelet Count; Thrombocytopenia; Urinary Tract Infections
PubMed: 35039337
DOI: 10.1136/bcr-2021-243749 -
Cureus Jul 2022Background The study aimed to determine the various indications for percutaneous nephrostomy (PCN) primarily in patients with a urinary tract infection and to determine...
Background The study aimed to determine the various indications for percutaneous nephrostomy (PCN) primarily in patients with a urinary tract infection and to determine the various complications arising in these patients due to the procedure. Materials and methods A retrospective study of five-year data based on registers of the Department of Urology was performed. Among 716 patients, 226 inpatient data were obtained, curated, and analyzed. Indications for PCN, the periprocedural complications, the PCN's duration, details of antibiotics, risk factors for UTI, development of acute kidney injury, and renal replacement therapy were recorded. Results Patients were mostly female (53.1%, n=120/226). Malignancy (n=109, carcinoma cervix=68/109) and nephrolithiasis (n=70) contributed to 79.2%. Infections such as pyelonephritis, renal abscess, perinephric abscess, and genitourinary tuberculosis were identified in 47. Infectious diseases were significantly associated with younger age, female gender, diabetes, and prior pyelonephritis. PCN was placed at a median of two days after admission, and bilateral PCN was placed in 36 (15.2%) patients. Hydroureteronephrosis (probably infected) was an indication for PCN in 164/226 patients. In 33 patients with an infectious disease, PCN was performed for an obstructed urinary system. One major and two minor complications gave a rate of 0.06% for patients with infections, which was less than the accepted threshold of 4%. Conclusions We intended to study the utility and problems with placing a PCN catheter in patients with complicated urinary infections. We conclude that PCN is a safe and effective procedure in urinary tract infections with obstructed drainage.
PubMed: 35949777
DOI: 10.7759/cureus.26682