-
International Urology and Nephrology Jun 2024
Comparative Study
Topics: Humans; Pyelonephritis; Emphysema; Prognosis; Critical Care; Severity of Illness Index
PubMed: 38185702
DOI: 10.1007/s11255-024-03945-6 -
BMJ Open Jan 2024In older patients, the diagnosis of acute pyelonephritis (APN) is challenging. The aim was to evaluate the added value of CT to history, physical examination and...
Added value of non-contrast CT for the diagnosis of acute pyelonephritis in older patients with suspected infection with an unknown focus: a retrospective diagnostic study.
OBJECTIVES
In older patients, the diagnosis of acute pyelonephritis (APN) is challenging. The aim was to evaluate the added value of CT to history, physical examination and urinalysis for the diagnosis of APN in older patients with suspected infection with an unknown focus.
DESIGN
Retrospective diagnostic study.
SETTING
Department of General Medicine in an acute care hospital in Japan.
PARTICIPANTS
Patients aged ≥65 years who underwent blood cultures, a urine culture, and chest and abdominal CT to detect the focus of infection were included.
PRIMARY OUTCOME MEASURES
Two radiologists independently reviewed four non-contrast CT signs: perirenal fat stranding, pelvicalyceal wall thickening, enlargement of the kidney and thickening of Gerota's fascia. Findings on contrast-enhanced CT could not be evaluated due to an insufficient number of patients in whom contrast-enhanced CT was performed. An expert panel was used as the reference standard for APN. The added value of CT findings was quantified by comparing the diagnostic performance between a model based on 10 predictors available before CT and an extended model including the CT findings.
RESULTS
Of 473 patients, 61 (14.8%) were diagnosed with APN. When the laterality of the CT findings was taken into account, the model fit was not improved by adding them. In the laterality-insensitive analysis, the model performance was significantly improved by adding the CT signs (likelihood-ratio test p=0.03; c-index 0.89 vs 0.91, p=0.03). However, their clinical utility was only to improve the classification of 11.5% of patients with APN.
CONCLUSIONS
The added value of non-contrast CT findings to history, physical examination and urinalysis was limited for the diagnosis of APN in older patients with a suspected infection with an unknown focus.
Topics: Humans; Aged; Retrospective Studies; Acute Disease; Tomography, X-Ray Computed; Pyelonephritis; Kidney
PubMed: 38171629
DOI: 10.1136/bmjopen-2023-076678 -
Urologiia (Moscow, Russia : 1999) Dec 2023Since 2019, more than 600 million cases of the new coronavirus infection Covid-19 have been reported worldwide. According to various studies, the development of a...
INTRODUCTION
Since 2019, more than 600 million cases of the new coronavirus infection Covid-19 have been reported worldwide. According to various studies, the development of a systemic inflammatory response and "cytokine storm" play an important role in the pathogenesis of kidney damage, which leads to impaired microcirculation, increased thrombus formation and the development of ischemic areas in the parenchyma.
AIM
To study the frequency and possible causes of purulent forms of pyelonephritis in patients who have had a new coronavirus infection Covid-19.
MATERIALS AND METHODS
The prospective and retrospective study included the results of 403 patients with acute non-obstructive pyelonephritis in the pre-Covid period and those with a history of a new coronavirus infection.
RESULTS
In patients with acute non-obstructive pyelonephritis without past urological history who had a new coronavirus infection, an increase in purulent-destructive forms from 5.0 to 17.0% was noted. One of the reasons is increased antibiotic resistance and the emergence of pan-resistant uropathogens due to irrational use of antibacterial drugs.
CONCLUSION
The use of reserve antibacterial drugs in patients with acute pyelonephritis as empirical therapy and anticoagulants in order to improve microcirculation and prevent thrombosis is pathogenetically justified.
Topics: Humans; Prospective Studies; Retrospective Studies; COVID-19; Acute Disease; Pyelonephritis; Anti-Bacterial Agents
PubMed: 38156682
DOI: No ID Found -
European Journal of Radiology Jan 2024OBJECTIVES: To determine optimal window settings for conspicuity of abdominal inflammatory processes on 50 keV low-monoenergetic images derived from dual-energy...
BACKGROUND
OBJECTIVES: To determine optimal window settings for conspicuity of abdominal inflammatory processes on 50 keV low-monoenergetic images derived from dual-energy spectral CT (DECT).
METHODS
A retrospective study of 30 patients with clinically proven pancreatitis (15/30) or pyelonephritis (15/30) with inflammatory lesions visible on DECT scans were selected to serve as reference populations. 50 keV low-monoenergetic images in the portal venous phase were iteratively evaluated by 6 abdominal radiologists in twenty-one different windows (7-350HU center; 120-580HU width), selected using a simplex optimization algorithm. Each reader graded the conspicuity of the parenchymal hypodense lesions and image background quality. Three-dimensional contour maps expressing the relationship between overall reader grade and window center and width were constructed and used to find the ideal window for inflammatory pancreatic and renal processes and the image background quality. Finally, 15 appendicitis cases were reviewed on optimal pancreas and kidney windows and the manufacturer recommended conventional abdominal window settings for conventional imaging.
RESULTS
Convergence to optimal windowing was achieved based upon a total of 3,780 reads (21 window settings × 6 readers × 15 cases for pancreas and kidney). Highest conspicuity grade (>4.5 ± 0.0) for pancreas inflammatory lesions was seen at 116HU/430HU, whereas hypodense pyelonephritis had highest conspicuity at 290HU/570HU. This rendered an ideal "compromise" window (>4 ± 0.2) of 150HU/450HU which differed substantially from conventional manufacturer recommended settings of 50HU/380HU (2.1 ± 1.0, p = 0.00001). Appendix mucosal enhancement was best visualized at manufacturer settings.
CONCLUSIONS
Optimal visualization of inflammatory processes in abdominal organs on 50 keV low-monoenergetic images may require tailored refinement of window settings.
Topics: Humans; Tomography, X-Ray Computed; Retrospective Studies; Radiography, Dual-Energy Scanned Projection; Algorithms; Pyelonephritis; Signal-To-Noise Ratio; Radiographic Image Interpretation, Computer-Assisted
PubMed: 38141262
DOI: 10.1016/j.ejrad.2023.111262 -
Journal of Infection and Chemotherapy :... Jun 2024We aimed to investigate the detection rate of causative organisms in stone-related pyelonephritis and to compare their distribution according to patient backgrounds.
INTRODUCTION
We aimed to investigate the detection rate of causative organisms in stone-related pyelonephritis and to compare their distribution according to patient backgrounds.
METHODS
We retrospectively identified patients with stone-related pyelonephritis. Clinical data were collected between November 2012 and August 2020 at Wakayama Medical University Hospital, including on patient backgrounds and causative organisms. Patients were categorized by Eastern Cooperative Oncology Group performance status (PS) as the good PS group (0, 1) and the poor PS group (2-4). Bacteria were divided into Gram-positive cocci (GPC) or non-GPC groups and logistic regression analysis was used to examine factors that predict detection of GPC.
RESULTS
Seventy-nine patients had stone-related pyelonephritis, 54 (68.4 %) in the good PS group and 25 (31.6 %) in the poor PS group. In the good PS group, Escherichia coli (67 %) was followed by Klebsiella species (9 %), while in the poor PS group, Escherichia coli (20 %) was followed by Enterococci and Staphylococci (12 %). GPC detection rate was significantly higher in the poor PS group than in the good PS group (40.0 % vs 14.8 %, p = 0.016), and multivariate logistic regression analysis showed that poor PS was an independent factor predicting detection of GPC (OR = 6.54, p = 0.02).
CONCLUSIONS
The distribution of the causative organisms in stone pyelonephritis was similar to that in common complicated urinary tract infections. Poor PS may be an independent predictor of GPC detection in patients with stone pyelonephritis.
Topics: Humans; Retrospective Studies; Pyelonephritis; Urinary Tract Infections; Risk Factors; Gram-Positive Cocci; Escherichia coli
PubMed: 38122843
DOI: 10.1016/j.jiac.2023.12.008 -
Saudi Journal of Kidney Diseases and... Jan 2023Pyelonephritis is a prevalent diagnosis of emergency department visits. It commonly presents as flank pain and costovertebral tenderness with urinary symptoms. However,...
Pyelonephritis is a prevalent diagnosis of emergency department visits. It commonly presents as flank pain and costovertebral tenderness with urinary symptoms. However, some cases occur without typical symptoms. Our study highlights the dubious presentation of pyelonephritis with lower urinary tract symptoms (LUTS) only. This study was conducted at a tertiary care hospital, where charts and files were reviewed from January 11, 2018 to February 28, 2019 for all the patients with a diagnosis of acute pyelonephritis from medical records. In our study, 521 patients were included and 492 (94%) of the participants were suffering from pyelonephritis. Approximately 22.8% of the patients showed the absence of both flank pain and costovertebral tenderness but were diagnosed with pyelonephritis based on computed tomography (CT) and magnetic resonance imaging (MRI). Moreover, 27% of the patients reported upper urinary tract symptoms only and were diagnosed by CT or MRI findings. Out of that only 24% and 16% of the patients reported flank pain and costovertebral tenderness, respectively. Insignificant associations with pyelonephritis were found for age, gender and other comorbidities. Our study showed a significant number of patients with pyelonephritis without any upper urinary tract symptoms. Patients with LUTS should be evaluated further by imaging if they belong to the high-risk population.
Topics: Humans; Flank Pain; Pyelonephritis; Lower Urinary Tract Symptoms; Risk Factors; Tomography, X-Ray Computed
PubMed: 38092714
DOI: 10.4103/1319-2442.391000 -
Microbiology Spectrum Jan 2024Untreated asymptomatic bacteriuria (ASB) has been associated with adverse pregnancy outcomes, including pyelonephritis, preterm labor, and low birth weight infants....
Untreated asymptomatic bacteriuria (ASB) has been associated with adverse pregnancy outcomes, including pyelonephritis, preterm labor, and low birth weight infants. Thus, routine screening by standard urine culture (SUC) and treatment of ASB are currently recommended for all pregnant women. For this purpose, some researchers claim that vaginal swabs and urine samples can be used as proxies for each other. Because SUC often misses microbes, we used two more sensitive, recently validated detection methods to compare the composition of the urinary and vaginal microbiomes of pregnant females in their first trimester. Both methods yielded similar results. Vaginal and urinary microbial compositions for the same individual were significantly correlated; however, they were not equivalent. We argue that first trimester urinary and vaginal microbiomes are distinct enough to preclude their use as proxies for each other.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Pregnancy Trimester, First; Pregnancy Complications, Infectious; Bacteriuria; Urinary Tract; Pyelonephritis
PubMed: 38088549
DOI: 10.1128/spectrum.02638-23 -
Current Microbiology Dec 2023Antibiotic resistance of bacteria is causing clinical and public health concerns that are challenging to treat. Infections are becoming more common in the present era,... (Review)
Review
Antibiotic resistance of bacteria is causing clinical and public health concerns that are challenging to treat. Infections are becoming more common in the present era, and patients admitted to hospitals often have drug-resistant bacteria that can spread nosocomial infections. Urinary tract infections (UTIs) are among the most common infectious diseases affecting all age groups. There has been an increase in the proportion of bacteria that are resistant to multiple drugs. Herein is a comprehensive update on UTI-associated diseases: cystitis, urethritis, acute urethral syndrome, pyelonephritis, and recurrent UTIs. Further emphasis on the global statistical incidence and recent advancement of the role of natural products in treating notorious infections are described. This updated compendium will inspire the development of novel phycocompounds as the prospective antibacterial candidate.
Topics: Humans; Prospective Studies; Urinary Tract Infections; Anti-Bacterial Agents; Pyelonephritis; Cystitis
PubMed: 38063889
DOI: 10.1007/s00284-023-03535-2 -
Renal abscess complicating acute pyelonephritis in children: Two cases report and literature review.Medicine Dec 2023To describe the diagnostic and treatment approaches of renal abscesses complicated with acute pyelonephritis in children. (Review)
Review
RATIONALE
To describe the diagnostic and treatment approaches of renal abscesses complicated with acute pyelonephritis in children.
PATIENT CONCERNS
Two children presented with fever, vomiting, and abdominal pain with no typical manifestations, like frequent urination, urgency, dysuria, hematuria, foam urine, and lumbago. Renal abscess complicating acute pyelonephritis was diagnosed by B-ultrasound and computed tomography enhancement. Moreover, inflammatory markers were elevated significantly, but routine blood and urine cultures were repeatedly negative. The empirical anti-infection therapy had no obvious effect. A pathogenic diagnosis was confirmed in case two, and macro gene detection in blood and urine guided the follow-up treatment.
DIAGNOSES
Both children were diagnosed with acute gastroenteritis on admission, but renal abscess complicating acute pyelonephritis were diagnosed by imaging examination.
INTERVENTIONS
Both children were given anti-infection therapy of third-generation cephalosporin, which had no obvious effect. Routine blood and urine cultures were repeatedly negative. Case one was changed to piperacillin sodium tazobactam. We further carried out blood and urinary metagenomic next-generation sequencing detection for case two. Meanwhile, meropenem and linezolid anti-infection treatment was given. The results showed overlapping infection with Escherichia coli and Enterococcus faecalis. According to the genetic test results, amoxicillin clavulanate potassium combined with nitrofurantoin were prescribed after discharge.
OUTCOMES
Clinical symptoms of the 2 children disappeared, the infection was controlled, and imaging showed that renal abscess complicated with acute pyelonephritis disappeared.
LESSONS
The clinical spectrum of renal abscess complicating acute pyelonephritis is vague, with no specific manifestations, and can be easily misdiagnosed. B-ultrasound and computed tomography enhancement are helpful in making a definite diagnosis. Moreover, the sensitivity of routine culture is low, and metagenomic next-generation sequencing might be helpful to detect pathogenic microorganisms and guided treatment. Early treatment with broad-spectrum antibiotics might have favorable outcomes.
Topics: Child; Humans; Abscess; Pyelonephritis; Urinary Tract Infections; Kidney Diseases; Anti-Bacterial Agents; Escherichia coli; Tomography, X-Ray Computed; Peritoneal Diseases
PubMed: 38050281
DOI: 10.1097/MD.0000000000036355 -
BMJ Case Reports Nov 2023
Topics: Infant, Newborn; Humans; Pyelonephritis, Xanthogranulomatous; Tomography, X-Ray Computed; Diagnosis, Differential
PubMed: 38011955
DOI: 10.1136/bcr-2023-255258