Reconsideration of urine culture for the diagnosis of acute pyelonephritis in children: a new challenging method for diagnosing acute pyelonephritis / 소아과

Acute pyelonephritis (APN) should be detected and treated as soon as possible to reduce the risk of the development of acquired renal scarring. However, in the medical field, urine culture results are not available or considered when the prompt discrimination of APN is necessary and empirical treatment is started. Furthermore, urine culture cannot discriminate APN among children with febrile urinary tract infection (UTI) (pyelitis, lower UTI with other fever focus). Therefore, the usefulness of urine culture for diagnostic purposes is small and the sampling procedure is invasive. Congenital hypoplastic kidney is the most common cause of chronic kidney injury in children. Thus, it is desirable that a main target be detected as early as possible when imaging studies are performed in children with APN. However, if APN does not recur, no medical or surgical treatment or imaging studies would be needed because the acquired renal scar would not progress further. Therefore, the long-term prognosis of APN in young children, particularly infants, depends on the number of recurrent APN, not other febrile UTI. New methods that enable prompt, practical, and comfortable APN diagnosis in children are needed as alternatives to urinary catheterization for urine culture sampling.

Pielite enfisematosa unilateral: relato de caso / Unilateral emphysematous pyelitis: case report

The present report describes the case of a 22-year-old female patient admitted to the emergency room with acute low back pain, dysuria, vomiting and fever (38.5ºC). Urinalysis and computed tomography findings revealed urinary tract infection associated with presence of gas in the collecting system, characterizing unilateral emphysematous pyelitis caused by Gram-negative bacteria. The present case report emphasizes the occurrence of this disease as a urinary tract infection complication.

Relata-se um caso de paciente de 22 anos de idade, gênero feminino, que foi admitida no pronto-socorro com lombalgia aguda, disúria, vômitos e febre (38,5ºC). Os achados de exames de urina e tomografia computadorizada demonstraram infecção no trato urinário associada a gás no sistema coletor, configurando pielite enfisematosa unilateral por Gram-negativo. O presente relato enfatiza a ocorrência deste agravo como complicação de infecção no trato urinário.

Ileo-Pelvic Anastomosis and Augmentation Cystoplasty for Treatment of Encrusted Pyelitis in a Transplanted Kidney

Infection stones are more likely to form after urinary diversion as the result of urinary stasis. To prevent urinary stasis due to encrusted pyelitis in a transplanted kidney, we describe an alternative a surgical treatment: ileo-pelvic anastomosis. In our patient with a transplanted kidney, the ileal conduit had previously been anastomosed end-to-side owing to renal tuberculosis with an atrophied bladder; the transplanted ureter was anastomosed to the ileum in the left lower abdomen with an ileal conduit on the opposite side. Routine check-up revealed hydronephrosis with infected pyelitis and ureteritis in the transplanted kidney. We performed ileo-pelvic end-to-end anastomosis to prevent urinary stasis by lengthening the ileal conduit and performed augmentation cystoplasty to support the atrophied bladder following tuberculosis. We suggest that this approach may be useful in similar cases.

Two Cases of Bilateral Emphysematous Pyelitis in Patients with Diabetic Chronic Kidney Disease / 대한신장학회지

Emphysematous pyelitis (EP) is an acute bacterial renal infection characterized by the presence of gas localized to the renal collecting system, sparing the renal parenchyma. It is seen more commonly in women, often associated with underlying diabetes mellitus or obstructing stone disease. To our knowledge, EP has not been frequently reported in the Korean literature. We report here two cases of bilateral EP due to Escherichia coli in 55-year-old female and 44-year-old female patients with diabetic chronic kidney disease, were successfully treated with medical management including intravenous administration of antibiotics. Early diagnosis by means of abdominal computed tomography along with prompt antibiotic therapy may be effective in patients with bilateral EP.

A Case of Bilateral Emphysematous Pyelitis in a Diabetic End-stage Renal Disease Patient Undergoing Peritoneal Dialysis Therapy / 대한신장학회지

Emphysematous pyelitis is uniquely characterized by gas-forming infection restricted to the renal collecting system. This disease entity is uncommon, and shows preferred occurrence in patients with diabetes mellitus or urinary tract obstruction. We report a case of bilateral emphysematous pyelitis in a diabetic end-stage renal disease patient undergoing peritoneal dialysis therapy. The patient was treated by medical treatment only and then recovered from infection, and she has maintained peritoneal dialysis until today. The authors report this case as a successful medical treatment for emphysematous pyelitis accompanying multiple risk factors, such as diabetes mellitus, amorphous medullary kidney stones, and even underlying maintaining peritoneal dialysis.

Transureteroscopic Holium Laser Lithotripsy Treatment of Calculus Obstructive Pyonephrosis / 中国基层医药

Objective To summarize the experiences of treatment of calculus obstructive pyonephrosis with transureteroscopic holium laser lithotripsy. Methods There were 13 patients with flank pain and fever, all patients received antibacterial therapy and nutritional support before operation ,the patients of calculus obstructive pyonephrosis were treated using transureteroscopic holium laser lithotripsy. Results The ureteral calculus were cleared off in 10 cases, and in three cases, the stone moved to pelvis during operation that they needed additional procedure of ESWL, no severe complications were observed. Conclusion Transureteroscopic holium laser lithotripsy is safe,minimal in-vasive and effective method for treatment of calculus obstructive pyonephrosis and the therapeutic scheme can be the first choice.

Both Hydronephrosis Complicated with Emphysematous Pyelitis / 대한신장학회지

Emphysematous pyelonephritis is rare, severe, acute bacterial infection of the kidney characterized by the presence of gas within the renal parenchyma, collecting system or perinephric tissue and requires prompt diagnosis and the emergent intensive treatment. Emphysematous pyelitis is a distinct entity from emphysematous pyelonephritis and describes the presence of gas localized to the renal collecting system. Medical treatment is sufficient therapy if there is no obstruction. We report a case of both hydronephrosis complicated with emphysematous pyelitis which was occurred in 59-year-old diabetic patient. The patient was recovered by medical treatment alone.

A Case of Emphysematous Pyelitis in a Renal Transplant Recipient / 대한이식학회지

Emphysematous pyelitis (EP) is a rare complication of urinary tract infection, which has been defined as isolated gas production inside the excretory system. Contrary to emphysematous pyelonephritis, which is more severe, necrotizing infection of the renal parenchyma, EP is a benign entity. To our knowledge, it has not been reported in the Korean literature, particularly in renal transplant recipients. Herein we report a case of EP in a living renal transplant recipient. A 32-year-old man received a living related renal transplant 4 years earlier for end-stage renal disease secondary to chronic glomerulonephritis. The patient presented with a sudden onset of chills, nausea, vomiting and pain on graft area. He was diagnosed as EP by computerized tomography. Immunosuppressive agents were modified and he was successfully treated with parenteral antibiotics with complete disappearance of air in the renal pelvis.

Air in the kidney: between emphysematous pyelitis and pyelonephritis

Presence of air in the kidney can be problematic as the location of the air in different parts of the kidney greatly affects the subsequent management and outcome of the patient. We present here a case of a patient who had emphysematous pyelitis, in which CT scan was able to display presence of air only in the collecting system, thus differentiating this condition from the more fulminant emphysematous pyelonephritis. This leads to a more favourable prognosis and outcome to the patient.

A Case of Pyelitis and Ureteritis Cystica / 대한비뇨기과학회지

Pyelitis and ureteritis cystica which is characterized by cyst formations mucosa or submucosa of the ureter and renal pelvis caused by inflammation. We are reporting a case of ureteritis cystica with review of the literatures.