Urinary tract infection due to Corynebacterium urealyticum in kidney transplant recipients: an underdiagnosed etiology for obstructive uropathy and graft dysfunction-results of a prospective cohort study.

BACKGROUND: Corynebacterium urealyticum is a cause of urinary tract infection and encrusting cystitis or pyelitis. Information about this infection in renal transplant recipients is based on case reports. We communicate the first prospective epidemiological study for this population. METHODS: We selected a cohort of 163 renal transplant recipients who were screened for urinary tract infection due to C. urealyticum. Long-term incubation and special media were used for culture of C. urealyticum. The cohort was observed for a mean of 26.2 months (standard deviation, 8.7; range, 1-36 months). Risk factors and outcomes were assessed. RESULTS: At baseline, 16 (9.8%) of 163 patients had C. urealyticum bacteriuria (6 were asymptomatic, 9 had acute cystitis, and 1 had encrusting pyelitis). Independent risk factors (assessed by multivariate analysis) for urinary tract C. urealyticum infection were: antibiotic administration during the previous month (odds ratio, 8.04; 95% confidence interval, 1.57-41.06; P = .012), history of nephrostomy (odds ratio, 51.59; 95% confidence interval, 3.62-736.06; P = .004), and skin colonization (odds ratio, 208.35; 95% confidence interval, 21.54-2015.22; P< .001). Presence of urinary tract infection symptoms for >1 month (odds ratio, 27.7; 95% confidence interval, 2.55-300.5; P = .006) and obstructive uropathy (odds ratio 25.9; 95% confidence interval, 4.43-152.31; P < .001) were more frequent during follow-up in patients with C. urealyticum bacteriuria. CONCLUSIONS: When specifically tested for, C. urealyticum bacteriuria is more prevalent than previously thought in renal transplant recipients, and it is closely related to obstructive uropathy. Future studies are necessary to establish the relevance of treating the infection during follow-up after renal transplantation.

Diagnóstico prenatal de la ectasia piélica. Evolución posnatal / Prenatal diagnosis of pyelectasis

Los objetivos de este estudio son conocer la prevalencia de recién nacidos con diagnóstico prenatal de ectasia piélica, determinar la frecuencia de sus distintos grados y analizar su evolución posterior. Se analizaron retrospectivamente las historias clínicas de los pacientes diagnosticados de ectasia piélica por ecografía prenatal. Se detectó ectasia piélica en la ecografía prenatal en un 6,4 por ciento de recién nacidos vivos (n= 54), con claro predominio masculino (un 80 por ciento). La mayoría de las ectasias detectadas fueron de grado leve. Una tercera parte de las ectasias diagnosticadas prenatalmente se normalizaron a los 6 meses de vida. Se detectó una baja frecuencia de enfermedad asociada: 4 casos de reflujo vesicoureteral, 3 de infección del tracto urinario y 3 que precisaron tratamiento quirúrgico (AU)

Pyelitis cystica.

We present four cases of pyelitis cystica. Aetiology, pathogenesis, diagnoses, treatment and differential diagnosis are discussed. We recommend follow-up until malignant disease has been excluded.

[The characteristics of acute infectious-inflammatory kidney diseases in pesticide exposure]. / Osobennosti ostrykh infektsionno-vospalitel'nykh zabolevanii pochki pri vozdeistvii pestitsidov.

The paper is concerned with ecological aspects of uronephrology. The epidemiological survey entering 1249 rural citizens revealed that the frequency of infectious inflammatory lesions of the kidneys is higher in subjects exposed to pesticides (7.9-13.4% against 1.5% in the controls). The experiments on 82 rabbits confirmed the relation of the renal infectious inflammation severity and incidence to exposure to chemicals used in agriculture. Basing on the analysis of 301 cases of acute renal infection, the authors came to distinguish 4 forms of the disease: pyelitis, pyelonephritis, nephropyelitis and purulent nephritis. The authors emphasize the urgent need in the regions of active pesticide application of taking prophylactic measures to reduce the contact with the toxic compounds, to actively detect and treat urinary infection including antidotes.

Encrusted pyelitis and cystitis by Corynebacterium urealyticum (CDC group D2): a new and threatening complication following renal transplant.

We evaluated the pathogenic role of Corynebacterium urealyticum in the development of encrusted pyelitis (EP) and encrusted cystitis (EC), and their clinical consequences in renal transplant recipients. During a 4-year period, we studied seven renal transplant recipients with EP and two with EC. The records of 320 other renal transplant patients studied during the same period were used as a control group. C urealyticum (> or = 10(5) CFU/ml) was isolated from 4 patients with EP (urine 3, blood 1) and from 1 patient with EC (urine). Alkaline urines with struvite crystals, microscopic hematuria, and sterile conventional urine cultures were present in all our cases. All the patients with EP developed obstructive uropathy with deterioration of the renal function and pyelonephritis (4 patients) or renal abscesses (3 patients). Chronic urinary discomfort and macroscopic hematuria were present in the 2 patients with EC. Long-term vesical and ureteral catheterization were considered the most important risk factors for the development of EC and EP, respectively. Vancomycin was successfully used in 5 cases, but all the patients required a derivative procedure or a surgical resection of the incrustations to improve. We conclude that EP and EC should be investigated in renal transplant patients who develop pyelonephritis, obstructive uropathy, or chronic urinary symptoms. EP and EC could lead to the loss of their grafts. C urealyticum appears to have a pathogenic role in these entities.

[Pyeloureteritis cystica diagnosed by using a ureteroscope: a case report].

We report a case diagnosed as pyeloureteritis cystica by ureteroscopic examination. A 70-year-old female was admitted to our hospital with microhematuria. Intravenous pyelography and retrograde pyelography demonstrated multiple filling defects in bilateral renal pelvis and ureters. Urinary cytology findings indicated class III on both side. Ureteroscope and cold cup biopsy were performed, and histological examination revealed chronic ureteritis. Forty-four Japanese cases including our case are herein reviewed.

Pregnancy in the overweight Nigerian.

One hundred pregnant patients weighing 80 kg or over at the 14th week of pregnancy were studied during their antenatal period and delivery. The incidence of pre-eclampsia, hypertension, pyelitis of pregnancy and operative delivery was higher in overweight patients than in an equivalent number of patients of average weight also studied. The age-related difference in antenatal weight gain in obese patients was confirmed. Two maternal deaths occurred among the overweight patients.

Frequency of pyelitis, pyelonephritis, renal perivasculitis, and renal infarction in dogs.

The frequency of pyelitis, renal perivasculitis, and renal cortical inflammation was determined in 104 apparently normal dogs, 50 dogs with disease that were necropsied, and 20 dogs with experimentally induced cystitis. Abnormalities occurred least often (19%) in the apparently normal group and most often (55%) in the cystitis group. The frequency of specific lesions was generally higher in males than in females. Bacteria were isolated from kidney and urine of some of the apparently normal dogs, but their relationship to the lesions observed was not established.