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Medicina (Kaunas, Lithuania) Apr 2023A 34-year-old nulliparous gravid female presented with acute bilateral pyelonephritis at 29 + 5 weeks gestation. The patient was relatively well until two weeks ago when...
A 34-year-old nulliparous gravid female presented with acute bilateral pyelonephritis at 29 + 5 weeks gestation. The patient was relatively well until two weeks ago when a slight increase in amniotic fluid was noted. Further investigation revealed myoglobinuria and significantly elevated levels of creatine phosphokinase. The patient was subsequently diagnosed with rhabdomyolysis. Twelve hours after admission, the patient noted reduced fetal movements. A non-stress test revealed fetal bradycardia and non-reassuring variability in fetal heart rate. An emergency cesarean section was performed, and a "floppy" female child was delivered. Genetic testing revealed congenital myotonic dystrophy, and the mother was also diagnosed with myotonic dystrophy. Rhabdomyolysis has a very low incidence in pregnancy. Herein, we report a rare case of myotonic dystrophy with rhabdomyolysis in a gravid female with no history of myotonic dystrophy. Acute pyelonephritis is a causative agent of rhabdomyolysis that results in preterm birth.
Topics: Child; Pregnancy; Humans; Infant, Newborn; Female; Adult; Pregnant Women; Myotonic Dystrophy; Pregnancy Complications; Cesarean Section; Premature Birth; Rhabdomyolysis; Pyelonephritis
PubMed: 37241056
DOI: 10.3390/medicina59050824 -
BMC Nephrology May 2023The terms "renal regenerating nodule" and "nodular compensatory hypertrophy" are used in the literature to describe functioning pseudo-tumors (FPT) in the setting of an... (Review)
Review
BACKGROUND
The terms "renal regenerating nodule" and "nodular compensatory hypertrophy" are used in the literature to describe functioning pseudo-tumors (FPT) in the setting of an extensively scarred kidney. FPTs are usually discovered incidentally during routine renal imaging. Differentiating these FPTs from renal neoplasms is critical but can be challenging in the setting of chronic kidney disease (CKD) given the limitations related to using contrast-based imaging.
CASE SUMMARIES
We report a pediatric case series of 5 CKD patients, with history of urinary tract infections, in which tumor-like lesions evolved in scarred kidneys and were incidentally discovered on routine renal imaging. These were diagnosed as FPT by utilizing dimercaptosuccinic acid (DMSA) imaging and showed stable size and appearance upon follow-up with ultrasound and MRI.
CONCLUSION
FPTs can be picked up on routine imaging of pediatric patients with CKD. Although larger cohort studies are needed to confirm these conclusions, our case series supports the evidence that DMSA scan showing uptake at the site of the mass can be a useful tool to suggest the diagnosis of FPTs in children with kidney scarring, and that SPECT DMSA scan adds more precision in picking up and accurately localizing FPTs compared to planar DMSA.
Topics: Humans; Child; Infant; Pyelonephritis; Technetium Tc 99m Dimercaptosuccinic Acid; Kidney; Urinary Tract Infections; Renal Insufficiency, Chronic; Kidney Neoplasms; Cicatrix
PubMed: 37237327
DOI: 10.1186/s12882-023-03113-5 -
Frontiers in Cellular and Infection... 2023Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae pose a huge threat to human health, especially in the context of complicated urinary tract infections...
Efficacy and safety of piperacillin-tazobactam compared with meropenem in treating complicated urinary tract infections including acute pyelonephritis due to extended-spectrum β-lactamase-producing .
INTRODUCTION
Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae pose a huge threat to human health, especially in the context of complicated urinary tract infections (cUTIs). Carbapenems and piperacillin-tazobactam (PTZ) are two antimicrobial agents commonly used to treat cUTIs.
METHODS
A monocentric retrospective cohort study focused on the treatment of cUTIs in adults was conducted from January 2019 to November 2021. Patients with a positive urine culture strain yielding ≥ 103 colony-forming units per milliliter (CFU/mL), and sensitive to PTZ and carbapenems, were included. The primary endpoint was clinical success after antibiotic therapy. The secondary endpoint included rehospitalization and 90-day recurrence of cUTIs caused by ESBL-producing Enterobacteriaceae.
RESULTS
Of the 195 patients included in this study, 110 were treated with PTZ while 85 were administered meropenem. The rate of clinical cure was similar between the PTZ and meropenem groups (80% vs. 78.8%, p = 0.84). However, the PTZ group had a lower duration of total antibiotic use (6 vs. 9; p < 0.01), lower duration of effective antibiotic therapy (6 vs. 8; p < 0.01), and lower duration of hospitalization (16 vs. 22; p < 0.01).
DISCUSSION
In terms of adverse events, the safety of PTZ was higher than that of meropenem in the treatment of cUTIs.
Topics: Adult; Humans; Meropenem; Piperacillin; Retrospective Studies; beta-Lactamase Inhibitors; Penicillanic Acid; Anti-Bacterial Agents; Piperacillin, Tazobactam Drug Combination; Urinary Tract Infections; Pyelonephritis; Enterobacteriaceae; Carbapenems; beta-Lactamases; Enterobacteriaceae Infections
PubMed: 37207190
DOI: 10.3389/fcimb.2023.1093842 -
JNMA; Journal of the Nepal Medical... Feb 2023Pyonephrosis is a severe complication of pyelonephritis leading to rapid progression to sepsis and loss of renal function resulting in nephrectomy. Early identification...
INTRODUCTION
Pyonephrosis is a severe complication of pyelonephritis leading to rapid progression to sepsis and loss of renal function resulting in nephrectomy. Early identification of pyonephrosis based on clinical or radiological characteristics amongst pyelonephritis is paramount. This study aimed to determine the prevalence of pyonephrosis among patients with pyelonephritis admitted to the Department of Nephrology and Urology of a tertiary care centre.
METHODS
This descriptive cross-sectional study was done in a tertiary care centre among patients with pyelonephritis from 1 July 2016 to 31 Jan 2021. Ethical approval was obtained from Institution Ethics Committee (Reference number: IEC/56/21). The available clinical, demographic and laboratory parameters were recorded from the hospital records in a predesigned proforma. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated.
RESULTS
Among 550 pyelonephritis patients, the prevalence of pyonephrosis was 60 (10.9%) (8.3-13.5, 95% Confidence Interval). The mean age was 54.62±12.14 years, and 41 (68.33%) were males. The most common clinical symptom was flank pain with or without fever in 46 (76.66%) patients. Escherichia coli was the most common offending organism in 20 (33.33%). Ultrasonography showed classical echogenic debris with floaters and internal echoes in 44 (73.33%) patients. Double J stenting was successfully done in 44 (73.33%) patients. Percutaneous nephrostomy was done in the remaining 16 (26.66%) patients.
CONCLUSIONS
The prevalence of pyonephrosis in pyelonephritis is similar to previous studies done in similar settings.
KEYWORDS
pyelonephritis; pyonephrosis; kidneys.
Topics: Male; Humans; Adult; Middle Aged; Aged; Female; Pyonephrosis; Cross-Sectional Studies; Nephrology; Tertiary Care Centers; Urology; Pyelonephritis; Escherichia coli
PubMed: 37203981
DOI: 10.31729/jnma.8015 -
Transplantation Direct Jun 2023Ureteric encrustation and lithiasis after renal transplantation are rare but not without risk of obstruction and graft loss. Patients are usually asymptomatic, and a...
Ureteric encrustation and lithiasis after renal transplantation are rare but not without risk of obstruction and graft loss. Patients are usually asymptomatic, and a majority present with graft dysfunction with imaging demonstrating hydronephrosis and rarely with acute graft pyelonephritis. We compare a case of transplant lithiasis with encrusted pyelitis and highlight key differences in their presentation and workup. A key focus for transplant physicians is to recognize when dealing with transplant hydronephrosis that the presence of a high urine pH and pyuria should be a key indicator to suspect ureteric encrustation to look for a urease-producing organism, recognizing that such organisms require prolonged incubation with urine culturing for up to 72 h.
PubMed: 37197017
DOI: 10.1097/TXD.0000000000001468 -
Antimicrobial Agents and Chemotherapy Jun 2023Tebipenem pivoxil hydrobromide (TBP-PI-HBr) is an oral (PO) carbapenem pro-drug that is converted to the active moiety tebipenem in the enterocytes. Tebipenem has...
Tebipenem pivoxil hydrobromide (TBP-PI-HBr) is an oral (PO) carbapenem pro-drug that is converted to the active moiety tebipenem in the enterocytes. Tebipenem has activity against multidrug-resistant Gram-negative pathogens, including extended-spectrum beta lactamase-producing Enterobacterales, and is being developed for the treatment of patients with complicated urinary tract infections (cUTI) and acute pyelonephritis (AP). The objectives of these analyses were to develop a population pharmacokinetic (PK) model for tebipenem using data from three phase 1 studies and one phase 3 study and to identify covariates that described the variability in tebipenem PK. Following construction of the base model, a covariate analysis was conducted. The model was then qualified by performing a prediction-corrected visual predictive check and evaluated by using a sampling-importance-resampling procedure. The final population PK data set was composed of data from 746 subjects who provided 3,448 plasma concentrations, including 650 patients (1,985 concentrations) with cUTI/AP. The final population PK model that best described tebipenem PK was found to be a two-compartment model with linear, first-order elimination and two transit compartments to describe the rate of drug absorption after PO administration of TBP-PI-HBr. The relationship between renal clearance (CL) and creatinine clearance (CLcr), the most clinically significant covariate, was described using a sigmoidal Hill-type function. No dose adjustments are warranted on the basis of age, body size, or sex as none of these covariates were associated with substantial differences in tebipenem exposure in patients with cUTI/AP. The resultant population PK model is expected to be appropriate for model-based simulations and assessment of pharmacokinetic-pharmacodynamic relationships for tebipenem.
Topics: Humans; Anti-Bacterial Agents; Prodrugs; Carbapenems; Monobactams; Urinary Tract Infections; Pyelonephritis; Administration, Oral
PubMed: 37191505
DOI: 10.1128/aac.01451-22 -
BMC Infectious Diseases May 2023Proteus spp. are widespread in the environment and comprise a part of the normal flora of the human gastrointestinal tract. Only six species in this genus, including...
BACKGROUND
Proteus spp. are widespread in the environment and comprise a part of the normal flora of the human gastrointestinal tract. Only six species in this genus, including Proteus mirabilis, Proteus vulgaris, Proteus terrae, Proteus penneri, Proteus hauseri, and Proteus faecis, have been isolated from human clinical specimens. However, there are no reports of Proteus alimentorum isolated from humans, and the clinical characteristics of P. alimentorum infection are unknown.
CASE PRESENTATION
An 85-year-old female patient with peritoneal cancer was hospitalized for complicated pyelonephritis and bacteremia caused by P. alimentorum. The patient received antimicrobial therapy and was discharged on day 7 of hospitalization. No recurrence was observed 14 days after the treatment. Various methods were used to identify the Proteus sp. Furthermore, the VITEK-2 GN ID card resulted in low discrimination between P. hauseri and P. penneri. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry showed P. hauseri with a spectral score of 2.22 as the best match. Nevertheless, the pathogen was identified as P. alimentorum based on genetic investigation using 16 S rRNA gene sequencing and biochemical tests.
CONCLUSION
Proteus alimentorum is a human pathogen, and its infection has an excellent therapeutic response to antimicrobials based on antimicrobial susceptibility. Genomic methods may be helpful for the precise identification of P. alimentorum.
Topics: Female; Humans; Aged, 80 and over; Neoplasms; Proteus; Pyelonephritis; RNA, Ribosomal; Proteus Infections
PubMed: 37189038
DOI: 10.1186/s12879-023-08296-8 -
Lung abscess with chronic cough secondary to xanthogranulomatous pyelonephritis: A rare case report.Medicine May 2023Xanthogranulomatous pyelonephritis (XGPN) is a form of chronic pyelonephritis caused by chronic calculus obstruction and bacterial infection, leading to the destruction...
RATIONALE
Xanthogranulomatous pyelonephritis (XGPN) is a form of chronic pyelonephritis caused by chronic calculus obstruction and bacterial infection, leading to the destruction of the renal parenchyma and calyces. Conservative treatment is usually not sufficient, and surgical intervention is still the main curative approach. XGPN with transdiaphragmatic extension and lung abscess formation is a rare condition.
PATIENT CONCERNS
We report a 64-year-old woman who presented with persistent productive cough.
DIAGNOSES
Lung abscess secondary to XPGN. Both nephrostomy urine and sputum cultures showed Proteus mirabilis infection with the same antibiotic sensitivity spectrum, but blood culture was negative.
INTERVENTIONS
Laparoscopic radical nephrectomy and prolonged antibiotic treatment.
OUTCOMES
The lung abscess and cough gradually resolved in 1 month after nephrectomy.
CONCLUSION
Lung abscess secondary to transdiaphragmatic extension of XGPN is rare but should be considered in patients with lower lung infections that are unresponsive to treatment, especially infections due to unusual respiratory pathogens such as P mirabilis.
Topics: Female; Humans; Middle Aged; Pyelonephritis, Xanthogranulomatous; Lung Abscess; Cough; Kidney; Nephrectomy; Chronic Disease; Anti-Bacterial Agents
PubMed: 37171318
DOI: 10.1097/MD.0000000000033787 -
Archivos Espanoles de Urologia Mar 2023Kidney stone disease affects 5% of the population and is associated with non-negligible morbidity. Retrograde intrarenal surgery and percutaneous nephrolithotomy are the... (Review)
Review
PURPOSE
Kidney stone disease affects 5% of the population and is associated with non-negligible morbidity. Retrograde intrarenal surgery and percutaneous nephrolithotomy are the treatments of choice. We analyzed the results from our patients who underwent retrograde intrarenal surgery at controlled pressure.
MATERIALS AND METHODS
We conducted an observational, descriptive, retrospective study of 403 patients who underwent retrograde intrarenal surgery at the Hospital Clínico Universitario Lozano Blesa (Zaragoza, Spain) between January 2013 and December 2019.
RESULTS
The mean surgical time was 111.1 minutes, with a mean stone volume of 3.5 cm (maximum volume, 38.3 cm). A total of 70 patients (17.3%) developed postoperative Clavien-Dindo complications-64 minor (91.4%) and 6 major (8.6%). In addition, 28 patients (6.9%) presented with an early complication (<3 months), with urinary tract infection and pyelonephritis being the most common. The stone-free rate was 69.0%, with a retreatment rate of 4.7%.
CONCLUSIONS
Sex was statistically significantly related to the onset of minor Clavien postoperative complications ( = 0.001). Similarly, corticosteroid use was associated with the onset of major Clavien complications ( = 0.030). Neither surgical time nor stone volume was found to be statistically significantly related to the onset of Clavien postoperative complications or early complications.
Topics: Humans; Kidney Calculi; Nephrolithotomy, Percutaneous; Postoperative Complications; Pyelonephritis; Retrospective Studies; Treatment Outcome
PubMed: 37139615
DOI: 10.56434/j.arch.esp.urol.20237602.11 -
European Journal of Clinical... Jul 2023Pyelonephritis affects 1-2% of pregnant women, and is associated with significant maternal and fetal morbidity. Antenatal pyelonephritis has been associated with PPROM...
Pyelonephritis affects 1-2% of pregnant women, and is associated with significant maternal and fetal morbidity. Antenatal pyelonephritis has been associated with PPROM (preterm premature rupture of membranes), preterm labour, low birth weight (LBW) and prematurity. A three-year retrospective dual-centre cohort study of antenatal pyelonephritis cases was conducted in two neighbouring Irish maternity hospitals - the Rotunda Hospital (RH) and the National Maternity Hospital (NMH). Patient demographics, clinical presentation, investigations, management and maternal/neonatal outcomes were recorded. A total of 47,676 deliveries (24,768 RH; 22,908 NMH) were assessed. 158 cases of antenatal pyelonephritis were identified (n = 88 RH, n = 70 NMH), with an incidence of 0.33%. The median age was 28 years. The median gestation was 27 + 6 weeks, with 51% presenting before 28 weeks' gestation. Risk factors included; obesity (18.4%), diabetes mellitus (13.3%) and self-reported clinical history of recurrent urinary tract infection (28.5%). Rate of relapse with UTI in the same pregnancy was 8.2%. Renal ultrasound was performed in 30.4%. Predominant uropathogens were Escherichia coli (60%), Klebsiella pneumoniae (11%) and Proteus mirabilis (5%). 7.5% of cases had a concurrent bloodstream infection, 13.3% of cases were complicated by sepsis and 1.9% with septic shock. Complications including PPROM (6.3%), preterm delivery < 37 weeks' gestation (11%), LBW < 2,500 g (8.2%) were comparable between sites. Delivery within 72 hours of diagnosis was noted in 7% (n = 11) of patients, of which three were preterm and one had LBW. Appropriate and prompt investigation and management of antenatal pyelonephritis is essential given the associated maternal and neonatal morbidity.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Adult; Retrospective Studies; Premature Birth; Cohort Studies; Gestational Age; Sepsis; Pyelonephritis; Pregnancy Outcome
PubMed: 37126130
DOI: 10.1007/s10096-023-04609-6