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Journal of Medical Case Reports Apr 2023A pyosalpinx is the acute inflammation of the fallopian tube, which fills up and swells with pus. It commonly results from inadequate or delayed treatment of pelvic...
BACKGROUND
A pyosalpinx is the acute inflammation of the fallopian tube, which fills up and swells with pus. It commonly results from inadequate or delayed treatment of pelvic inflammatory disease.
CASE PRESENTATION
We report the case of a 54-year-old Africain female patient, who presented with sustained high-grade fever, right flank pain, and severe acute storage low-urinary-tract symptoms. Computed tomography showed signs of acute obstructive pyelonephritis with a right tubular juxtauterine mass with complex internal fluid and thick enhancing walls exerting a mass effect on the right ureter. A drainage of the right excretory cavities by a JJ stent was performed. An ultrasound-guided aspiration of the collection was also performed.
CONCLUSION
A pyosalpinx can then exert a mass effect on the excretory cavities, thus causing an acute obstructive pyelonephritis. A double drainage coupled with an effective antibiotic therapy is then necessary.
Topics: Humans; Female; Middle Aged; Pyelonephritis; Salpingitis; Ureter; Fallopian Tubes; Pelvic Inflammatory Disease
PubMed: 37095582
DOI: 10.1186/s13256-023-03900-6 -
Internal Medicine (Tokyo, Japan) Dec 2023
Topics: Humans; Ureter; Pyelonephritis; Ureteral Obstruction; Calculi; Ureteral Calculi
PubMed: 37062743
DOI: 10.2169/internalmedicine.1658-23 -
BMC Urology Apr 2023Xanthogranulomatous pyelonephritis (XGP) is a rare chronic pyelonephritis that often mimics other renal diseases, when combined with autosomal dominant polycystic kidney...
BACKGROUND
Xanthogranulomatous pyelonephritis (XGP) is a rare chronic pyelonephritis that often mimics other renal diseases, when combined with autosomal dominant polycystic kidney disease(ADPKD), preoperative diagnosis is exceedingly difficult. It is important for clinicians to be aware of an XGP with ADPKD since a misdiagnosis can lead to unnecessary surgical intervention.
CASE PRESENTATION
Here, we report a case of a 66-year-old female with a history of bilateral ADPKD and urinary tract infection admitted to our hospital due to right flank pain, feeble, and low-grade fever. Contrast-enhanced ultrasound revealed a malignant mass of the right kidney suspected to be a cystic renal cell carcinoma with polycystic kidney disease. In addition, contrast-enhanced computed tomography (CT) and fluorine 18 fluorodeoxyglucose PET/CT (F FDG PET/CT) showed similar results. Subsequently, the patient underwent a right radical nephrectomy, but histopathological examination revealed XGP with ADPKD. On the follow-up, the patient's symptoms were relieved.
CONCLUSIONS
XGP should be kept in mind during the differential diagnosis of renal masses with ADPKD even in the absence of characteristic clinical symptoms and imaging manifestations.
Topics: Female; Humans; Aged; Carcinoma, Renal Cell; Pyelonephritis, Xanthogranulomatous; Polycystic Kidney, Autosomal Dominant; Positron Emission Tomography Computed Tomography; Kidney Neoplasms; Polycystic Kidney Diseases; Diagnosis, Differential
PubMed: 37038156
DOI: 10.1186/s12894-023-01224-7 -
PloS One 2023This study aimed to assess the feasibility of contrast-enhanced ultrasound (CEUS) for the diagnosis of acute pyelonephritis (APN) in pediatric patients with febrile...
PURPOSE
This study aimed to assess the feasibility of contrast-enhanced ultrasound (CEUS) for the diagnosis of acute pyelonephritis (APN) in pediatric patients with febrile urinary tract infection (UTI).
MATERIALS AND METHODS
Between March 2019 and January 2021, study participants with suspected UTI were assessed for APN using ultrasound. Parenchymal echogenicity changes, renal pelvis dilatation, and the presence of a focal suspected lesion were assessed using conventional grayscale ultrasound. The presence and location of a decreased perfusion area were evaluated using color Doppler ultrasound (CDUS) and CEUS. Agreement between each ultrasound examination and a 99mTc‒dimercaptosuccinic acid (DMSA) scan was assessed using the κ value, and the most visible period of the lesion was evaluated using CEUS.
RESULTS
This study enrolled 21 participants (median age, 8.0 months; range, 2.0-61.0 months) with isolated urinary tract pathogens. Five increased parenchymal echotextures (11.9%) and 14 renal pelvic dilatations (33.3%) were confirmed, but no focal lesions were detected on the grayscale images. CDUS and CEUS showed decreased local perfusion suggestive of APN in two and five kidneys, respectively. DMSA scan showed substantial agreement with CEUS findings (κ = 0.80, P = 0.010), but other grayscale and CDUS findings did not agree with DMSA scan results (P > 0.05). All lesions were best observed in the late parenchymal phase on CEUS.
CONCLUSION
CEUS can reveal renal perfusion defects in pediatric patients with suspected APN without radiation exposure or sedation; therefore, CEUS may be a feasible and valuable diagnostic technique.
Topics: Humans; Child; Infant; Feasibility Studies; Pyelonephritis; Urinary Tract Infections; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography
PubMed: 37018354
DOI: 10.1371/journal.pone.0284016 -
The Journal of Maternal-fetal &... Dec 2023Sepsis is a leading cause of maternal death, and its diagnosis during the golden hour is critical to improve survival. Acute pyelonephritis in pregnancy is a risk...
Sepsis is a leading cause of maternal death, and its diagnosis during the golden hour is critical to improve survival. Acute pyelonephritis in pregnancy is a risk factor for obstetrical and medical complications, and it is a major cause of sepsis, as bacteremia complicates 15-20% of pyelonephritis episodes in pregnancy. The diagnosis of bacteremia currently relies on blood cultures, whereas a rapid test could allow timely management and improved outcomes. Soluble suppression of tumorigenicity 2 (sST2) was previously proposed as a biomarker for sepsis in non-pregnant adults and children. This study was designed to determine whether maternal plasma concentrations of sST2 in pregnant patients with pyelonephritis can help to identify those at risk for bacteremia. This cross-sectional study included women with normal pregnancy ( = 131) and pregnant women with acute pyelonephritis ( = 36). Acute pyelonephritis was diagnosed based on a combination of clinical findings and a positive urine culture. Patients were further classified according to the results of blood cultures into those with and without bacteremia. Plasma concentrations of sST2 were determined by a sensitive immunoassay. Non-parametric statistics were used for analysis. The maternal plasma sST2 concentration increased with gestational age in normal pregnancies. Pregnant patients with acute pyelonephritis had a higher median (interquartile range) plasma sST2 concentration than those with a normal pregnancy [85 (47-239) ng/mL vs. 31 (14-52) ng/mL, < .001]. Among patients with pyelonephritis, those with a positive blood culture had a median plasma concentration of sST2 higher than that of patients with a negative blood culture [258 (IQR: 75-305) ng/mL vs. 83 (IQR: 46-153) ng/mL; = .03]. An elevated plasma concentration of sST2 ≥ 215 ng/mL had a sensitivity of 73% and a specificity of 95% (area under the receiver operating characteristic curve, 0.74; = .003) with a positive likelihood ratio of 13.8 and a negative likelihood ratio of 0.3 for the identification of patients who had a positive blood culture. sST2 is a candidate biomarker to identify bacteremia in pregnant women with pyelonephritis. Rapid identification of these patients may optimize patient care.
Topics: Adult; Child; Pregnancy; Female; Humans; Pregnant Women; Cross-Sectional Studies; Biomarkers; Bacteremia; Pyelonephritis
PubMed: 36997168
DOI: 10.1080/14767058.2023.2183470 -
Medicina (Kaunas, Lithuania) Mar 2023Microbiota of the urinary tract may be associated with urinary tract malignancy, including prostate cancer. We retrospectively collected patients with newly diagnosed...
Microbiota of the urinary tract may be associated with urinary tract malignancy, including prostate cancer. We retrospectively collected patients with newly diagnosed prostate cancer and subjects without prostate cancer from the National Health Insurance Research Database (NHIRD) in Taiwan between 1 January 2000 and 31 December 2016. A total of 5510 subjects were recruited and followed until the diagnosis of a primary outcome (urinary tract infection, pyelonephritis, cystitis, and prostatitis). : We found that the patients with prostate cancer had a significantly higher risk of urinary tract infections than those without prostate cancer. The adjusted hazard ratios for pyelonephritis, prostatitis, and cystitis were 2.30 (95% CI = 1.36-3.88), 2.04 (95% CI = 1.03-4.05), and 4.02 (95 % CI = 2.11-7.66), respectively. We clearly identified the sites of infection and associated comorbidities in the prostate cancer patients with urinary tract infections. In addition, we found that the patients receiving radiotherapy and androgen deprivation therapy had a lower risk of urinary tract infections than the patients in corresponding control groups. : Our study suggests that an abnormal urine microbiome could potentially contribute to the development of prostate cancer through inflammation and immune dysregulation. Furthermore, an imbalanced microbiome may facilitate bacterial overgrowth in urine, leading to urinary tract infections. These findings have important implications for the diagnosis and treatment of prostate cancer. Further research is needed to better understand the role of the urine microbiome in prostate cancer pathogenesis and to identify potential microbiome-targeted therapies for the prevention and treatment of prostate cancer.
Topics: Male; Humans; Prostatic Neoplasms; Prostatitis; Androgen Antagonists; Retrospective Studies; Urinary Tract Infections; Pyelonephritis; Cystitis
PubMed: 36984484
DOI: 10.3390/medicina59030483 -
Pediatric Nephrology (Berlin, Germany) Dec 2023Acute pyelonephritis (APN) in pediatric patients may lead to kidney scarring and is one of the main causes of permanent kidney damage. The incidence of kidney scarring... (Meta-Analysis)
Meta-Analysis Review
The efficacy and safety of corticosteroids in pediatric kidney scar prevention after urinary tract infection: a systematic review and meta-analysis of randomized clinical trials.
BACKGROUND
Acute pyelonephritis (APN) in pediatric patients may lead to kidney scarring and is one of the main causes of permanent kidney damage. The incidence of kidney scarring after one febrile urinary tract infection (UTI) is reported to range from 2.8 to 15%, with the percentage rising to 28.6% after ≥ 3 febrile UTIs. Corticosteroids may have a role in the reduction of kidney scar formation and urine cytokine levels. The possible benefit of adjuvant corticosteroid administration in the reduction of kidney scar formation in children with APN has been recently examined in randomized controlled trials (RCTs).
OBJECTIVES
The aim of this meta-analysis was to provide a summary of the current literature about the efficacy and safety of adjuvant corticosteroid administration in the reduction of kidney scar formation in children with APN.
DATA SOURCES
An extensive literature search through major databases (PubMed/MEDLINE and Scopus) was carried out for RCTs from inception until October 12, 2022, investigating the efficacy and safety of adjuvant corticosteroids in preventing kidney scarring in children with APN. A risk ratio with 95% CI was used for dichotomous outcomes.
RESULTS
In total, 5 RCTs with 918 pediatric patients with APN were included in the study. Adjuvant corticosteroid treatment revealed a statistically significant reduction in kidney scarring (95% CI 0.42-0.95, p = 0.03), without increasing the risk of adverse events like bacteremia, prolonged hospitalization, or recurrence of UTI.
LIMITATIONS
There were limitations regarding sample size (n = 498 children), different classes of corticosteroids (methylprednisolone or dexamethasone), different routes of corticosteroid administration (intravenous or oral), and different day courses (3-day or 4-day course).
CONCLUSIONS
Adjuvant corticosteroid administration seems to have a beneficial effect on kidney scar reduction in children with APN. Future studies should focus on the evaluation of the efficacy and safety of corticosteroids in kidney scarring reduction after APN to strengthen the results of our study. A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Child; Humans; Cicatrix; Randomized Controlled Trials as Topic; Urinary Tract Infections; Pyelonephritis; Adrenal Cortex Hormones; Kidney; Glomerulonephritis
PubMed: 36943468
DOI: 10.1007/s00467-023-05922-0 -
Asian Journal of Surgery Aug 2023
Topics: Humans; Cross Infection; Pyelonephritis; Diabetes Complications; Emphysema
PubMed: 36898920
DOI: 10.1016/j.asjsur.2023.02.108 -
The Turkish Journal of Pediatrics 2023Emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) are rare urinary tract infections. They have a wide spectrum of clinical manifestations; ranging from...
BACKGROUND
Emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) are rare urinary tract infections. They have a wide spectrum of clinical manifestations; ranging from asymptomatic to septic shock at presentation. In children, EC and EPN are rare complications of urinary tract infections (UTIs). Their diagnosis is based on clinical manifestations, laboratory results and characteristic radiological findings of gas within the collecting system, renal parenchyma and/or perinephric tissue. Computed tomography is the best radiological option in the diagnosis of EC and EPN. Despite the availability of various treatment modalities including medical and/or surgical treatment alternatives, these life-threatening conditions have high mortality rates reaching up to 70 percent.
CASE
Urinary tract infection was detected in the examinations of an 11-year-old female patient suffering from lower abdominal pain, vomiting and dysuria for two days. Air was detected in the bladder wall on X-ray. EC was detected in the abdominal ultrasonography. Air formations in the bladder lumen and calyces of both kidneys in abdominal computed tomography confirmed the presence of EPN.
CONCLUSIONS
Individualized treatment should be instituted according to the severity of EC and EPN, and the overall health condition of the patient.
Topics: Female; Child; Humans; Pyelonephritis; Cystitis; Kidney; Urinary Bladder; Abdominal Pain
PubMed: 36866996
DOI: 10.24953/turkjped.2022.181 -
Hinyokika Kiyo. Acta Urologica Japonica Feb 2023Castleman's disease is a rare lymphoproliferative disease, mostly found in the mediastinum. The number of Castleman's disease cases involving the kidneys is still...
Castleman's disease is a rare lymphoproliferative disease, mostly found in the mediastinum. The number of Castleman's disease cases involving the kidneys is still limited. We report a case of primary renal Castleman's disease sporadically detected during a regular health check-up as pyelonephritis with ureteral stones. In addition, computed tomography showed renal pelvic and ureteral wall thickening with paraaortic lymphadenopathy. A lymph node biopsy was performed, but it did not confirm either malignancy or Castleman's disease. The patient underwent open nephroureterectomy for diagnostic and therapeutic purposes. The pathological diagnosis was renal and retroperitoneal lymph node Castleman's disease with pyelonephritis.
Topics: Humans; Castleman Disease; Kidney; Pyelonephritis; Kidney Pelvis; Lymph Nodes; Bacterial Infections
PubMed: 36863871
DOI: 10.14989/ActaUrolJap_69_2_47