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Your search term(s) "pyelonephritis" returned 49 results.
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Urinary Tract Infections. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 663-671.
This chapter on urinary tract infections (UTI) is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the symptoms of acute cystitis and acute pyelonephritis; the diagnostic tests used to confirm UTI in women and in men; the causative pathogens for uncomplicated UTIs, including Escherichia coli, Staphylococcus saprophyticus, Klebsiella spp., and Enterococcus faecalis; the common practice of empiric treatment of acute uncomplicated cystitis in women, using a 3-day course of trimethoprim-sulfamethoxazole (TMP-SMX); and the treatment of acute uncomplicated pyelonephritis on an outpatient basis with an oral fluoroquinolone unless there is persistent high fever, in ability to tolerate oral intake, nausea and vomiting, or high white blood cell count. The chapter concludes with a list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 2 figures. 2 tables. 23 references.
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Overview of the Evaluation, Diagnosis, and Management of Urinary Tract Infections in Infants and Children. Urologic Nursing. 25(3): 185-191. June 2005.
Urinary tract infection (UTI) is the most common serious bacterial infection in infants and children. This article provides an overview of the evaluation, diagnosis, and management of UTIs in infants and children. UTIs are considered an infection of the lower urinary tract (including bladder), the upper urinary tract (including the kidneys), or both. Topics included are asymptomatic bacteriuria, cystitis versus pyelonephritis, incidence, etiology, pathogenesis, diagnostic tests (including radiologic diagnosis of UTI), treatment options, and the importance of patient and family education. The authors note that controversies in this area include recognizing the diagnosis, obtaining an accurate urine specimen, recommended length of treatment, delivery of antibiotics, and use of prophylaxis. They conclude that proper urine collection, prompt diagnosis, effective antimicrobial treatment, and follow-up evaluation are necessary to successfully treat UTIs with low morbidity. The ultimate goal of treatment is to decrease the incidence of infection in order to protect the kidneys. The principals of treatment include the proper collection of uncontaminated urine, identifying the infecting microorganism(s), choosing among appropriate antimicrobials to eradicate the bacteria, and minimizing drug toxicity, resolving symptoms, and preventing reinfection. 43 references.
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Pathology of Kidney Allografts. In: Medical Management of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 473-484.
This chapter on the pathology of kidney allografts is from a textbook on the medical management of kidney transplant patients. The chapter is designed for the nonpathologist professionals involved in the treatment of renal transplant patients, in an attempt to help them become familiar with the main histopathological concepts. The authors stress that the continuous clinical, surgical, and pharmacological advances in renal transplantation depend heavily on the routine analysis of graft biopsies. Topics covered include specimen adequacy, routine and main ancillary studies, the morphological features of acute rejection, the morphological features of chronic rejection and graft sclerosis, the Banff scheme for grading acute and chronic rejection, differential diagnoses in the inflamed renal allograft biopsy, and differential diagnosis in the renal allograft biopsy with minimal or no inflammation. Conditions to be included in the differential diagnosis include acute rejection, acute pyelonephritis, Epstein-Barr virus related lymphoproliferative disorders, BK polyoma virus-associated nephropathy, cytomegalovirus infection, allergic interstitial nephritis, chronic rejection, acute tubular necrosis, antibody-mediated rejection, and calcineurin inhibitor toxicity. Two final sections consider de novo (new) or recurrent glomerular disease and donor-related issues. 14 figures. 3 tables. 39 references.
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Once Daily, Extended Release Ciprofloxacin for Complicated Urinary Tract Infections and Acute Uncomplicated Pyelonephritis. Journal of Urology. 171(2): 734-739. February 2004.
This article reports on a study that assessed the effectiveness and safety of 1,000 milligrams of extended release ciprofloxacin orally once daily (n = 517) versus conventional 500 milligrams of ciprofloxacin orally twice daily (n = 518), each for 7 to 14 days, in patients with a complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis (AUP). Of these patients, 435 were efficacy valid (cUTI in 343 and AUP in 92). For efficacy valid patients (cUTI and AUP combined), bacteriological eradication rates at test of cure were 89 percent versus 85 percent and clinical cure rates were 97 percent versus 94 percent for extended release versus twice daily ciprofloxacin. Eradication rates for Escherichia coli, which accounted for 58 percent of pathogens, were 97 percent or greater per group. Drug related adverse event rates were similar for extended release and twice daily ciprofloxacin (13 percent and 14 percent, respectively). The authors conclude that extended release ciprofloxacin at a dose of 1,000 milligrams once daily was as safe and effective as conventional treatment. This regimen provides a convenient, once daily, empirical treatment option. 4 tables. 20 references.
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Relationship Between Acute Pyelonephritis, Renal Scarring, and Vesicoureteral Reflux: Results of a Coordinated Research Project. Pediatric Nephrology. 19(10): 1122-1126. October 2004.
Acute pyelonephritis (APN, inflammation of the kidney and its pelvis, usually due to bacterial infection) may produce permanent renal damage (PRD), which can subsequently lead to diverse complications. This article reports on a study that prospectively evaluated 147 females and 122 males (mean age 3.5 years) with APN in order to analyze the relationship between the presence of PRD, at the time of cortical renal scintigraphy, and age, gender, episodes of urinary tract infection (UTI), and presence of vesicoureteral reflux (VUR, the return of urine from the bladder back through the ureters to the kidneys). There were 152 children studied after the first proven UTI; VUR was present in 150 children; PRD was observed in 170 children. There were no significant differences between boys and girls. PRD was found in 36.4 percent of children younger than 1 year and in 70.1 percent of those older than 1 year. Of children with VUR, 72 percent had PRD compared with 52 percent of children without VUR. Of children with a first episode of UTI, 55.9 percent developed PRD as did 72.6 percent of those with recurrent UTI. The authors conclude that PRD in children with APN is important, especially in the presence of VUR, recurrent UTI, and older age.
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Screening for Vesicoureteral Reflux and Renal Scars in Siblings of Children with Known Reflux. Pediatric Nephrology. 19(10): 1127-1131. October 2004.
The incidence of vesicoureteral reflux (VUR, the return of urine from the bladder back through the ureters to the kidneys) in the general population is less than 1 percent, but it tends to run in families. The reported prevalence of VUR among siblings of index patients with reflux has ranged from 4.7 percent to 51 percent. Reflux carries an increased risk of pyelonephritis (inflammation of the kidney and its pelvis, usually due to bacterial infection) and long-term renal impairment. This article reports on a study undertaken to identify the age-related incidence and severity of reflux, and the frequency of associated renal parenchymal (kidney body) damage in siblings of children with reflux in order to assess the use of screening at different ages. Between October 1994 and February 2003, 40 siblings of 34 index patients were screened. Of 40 siblings, 17 had VUR, representing an incidence of 42.5 percent. The mean age at study entry of the 15 boys and 25 girls was 63 months. Reflux was unilateral (one side only) in 12 siblings and bilateral (both sides) in 5 siblings. Of the 17 refluxing siblings, 7 (41.2 percent) had a history of symptomatic urinary tract infection (UTI). The authors conclude that their data confirms a significant overall incidence of VUR and renal parenchymal damage in the siblings of patients with known reflux. The authors recommend that all siblings over 6 years of age should undergo a screening cystogram, even in the absence of UTI. 1 figure. 59 references.
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Imaging Studies after a First Febrile Urinary Tract Infection in Young Children. New England Journal of Medicine. 348(3): 195-202. January 16, 2003.
Guidelines from the American Academy of Pediatrics recommend obtaining a voiding cystourethrogram and a renal ultrasonogram for young children after a first urinary tract infection (UTI); renal scanning has also been endorsed by other authorities. This article reports on a study that investigated whether imaging studies altered management or improved outcomes in young children with a first febrile urinary tract infection. In the prospective trial involving 309 children (1 to 24 months old), an ultrasonogram and an initial renal (kidney) scan were obtained within 72 hours after diagnosis, contrast voiding cystourethrography was performed 1 month later, and renal scanning was repeated 6 months later. The ultrasonographic results were normal in 88 percent of the children (272 of 309); the identified abnormalities did not modify management. Acute pyelonephritis (kidney infection) was diagnosed in 61 percent of the children (190 of 309). Thirty-nine percent of the children who underwent cystourethrography (117 of 302) had vesicoureteral reflux (return of urine from the bladder to the kidney). Repeated scans were obtained for 89 percent of the children (275 of 309); renal scarring was noted in 9.5 percent of these children (26 of 275). The authors conclude that an ultrasonogram performed at the time of acute illness is of limited value. A voiding cystourethrogram for the identification of reflux is useful only if antimicrobial prophylaxis is effective in reducing reinfections and renal scarring. Renal scans obtained at presentation identify children with acute pyelonephritis and scans obtained 6 months later identify those with renal scarring. The routine performance of urinalysis, urine culture, or both during subsequent febrile (with fever) illnesses in all children with a previous febrile UTI will probably eliminate the need to obtain either early or late scans. 3 figures. 2 tables.
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Imaging Studies for Childhood Urinary Infections. (editorial). New England Journal of Medicine. 348(3): 251-252. January 16, 2003.
The question of whether to obtain imaging studies after a urinary tract infection (UTI) in a child is a challenging one. The potential long-term morbidity (complications or disease) associated with repeated bouts of pyelonephritis (kidney infection) or high-grade vesicoureteral reflux (return of urine from the bladder back to the kidney) has led to the routine radiographic evaluation of children with UTIs. This editorial considers this practice, noting that despite the intuitive rationale for obtaining renal imagine studies in this population, few well-designed studies have tested the value of this approach. The editorial also serves as an introduction to a study of imaging techniques in children with UTI, published elsewhere in the issue. The author concludes that renal (kidney) ultrasonographic examinations should still be considered for children with UTIs that do not respond to antibiotic therapy or that are associated with a palpable abdominal mass, passage of a calculus, or hydronephrosis on prenatal ultrasonography. Renal ultrasonography continues to be a safe and relatively cost-efficient means of assessing the anatomical features of the upper urinary tract, when the clinical situation demands this information. However, a UTI during the first 2 years of life may no longer be included in this category of conditions. 10 references.
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Recurrent Urinary Tract Infections and Related Conditions [for parents]. KidsHealth, Nemours Center for Children's Health Media, The Nemours Foundation. 2003. 5 p.
This brochure provides information about recurrent urinary tract infections (UTIs) and related conditions in children. From a health series for parents, the brochure notes that UTIs are common and recurrent UTIs can cause kidney damage if left untreated, especially in children younger than 6 years of age. The brochure helps parents recognize the signs of these repeated infections and get help for their child. Topics include common types of UTIs, including cystitis (bladder infection), urethritis, and pyelonephritis (kidney infection); related kidney conditions, including vesicoureteral reflux (return of urine from the bladder back into the kidney), and hydronephrosis (fluid accumulation in one or both kidneys); dysfunctional voiding; diagnosis and diagnostic tests, including ultrasound, renal scan, voiding cystourethrogram, cystoscopy, and intravenous pyelogram; symptoms of a UTI; and tips for preventing recurrent UTIs, including those regarding diet modifications, bathing, hygiene, bedwetting, and health care visits. The brochure is one of a series that explains just how each body system, part, and process is necessary for living.
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Kidney. In: MacLennan, G.T.; Resnick, M.I.; Bostwick, D.G.. Pathology for Urologists. New York, NY: Elsevier Science, Inc. 2003. p. 1-32.
This chapter on the kidney is from a pathology textbook that explores the full range of urology, including congenital, hereditary, inflammatory, degenerative, and benign and malignant neoplastic disorders found in the adrenal glands, kidney, renal pelvis, ureter, bladder, prostate, seminal vesicles, urethra, spermatic cord, testis, testicular adnexal, penis, and scrotum. The chapter includes full-color photographs of gross and microscopic pathologic specimens, representing virtually all of the common and rare entities seen in practice. Specific disorders covered are unilateral renal (kidney) agenesis, bilateral renal agenesis, hypoplasia, supernumerary kidney, simple ectopic kidney, crossed ectopic kidney, superior ectopic kidney, horseshoe kidney, hereditary cystic kidney diseases, acute pyelonephritis, chronic pyelonephritis, papillary necrosis, xanthogranulomatous pyelonephritis, malacoplakia, tuberculosis, renal adenoma, renal oncocytoma, metanephric adenoma, cystic nephroma, renal cell carcinoma (cancer), carcinoid tumor, small cell carcinoma, benign soft tissue neoplasms of kidney, renal sarcoma, lymphoma, tumors metastatic to the kidney, nephroblastoma (Wilms' tumor), cystic partially differentiated nephroblastoma, mesoblastic nephroma, clear cell sarcoma of kidney, and rhabdoid tumor of kidney. Each photograph is accompanied by a descriptive text section. The text also includes explanations of the most current neoplasm classification and staging systems. 82 figures. 1 table.
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