Pseudotuberculous Granulomatous Pyelitis.

We report a case of pseudotuberculous granulomatous pyelitis in an elderly female patient with hydronephrotic right kidney secondary to obstructing urinary stone. Pseudotuberculous granulomatous pyelitis is a rarely reported entity, characterized by severe granulomatous inflammation limited predominantly to the renal pelvis. It is associated with urinary (pelvicalyceal) obstruction, urolithiasis well as non- Mycobacterial urinary tract infection.

Histopathologic lesions in conventional pigs experimentally infected with Haemophilus parasuis serovar 5.

OBJECTIVE: In the present study various tissues of pigs were investigated for the presence of histopathologic lesions after an experimental infection with Haemophilus (H.) parasuis serovar 5. MATERIAL AND METHODS: Conventional pigs (n = 36) were divided into a control group B (n = 9) and a challenge group A (n = 27), which was infected intratracheally. Pigs that did not die prior to study termination were euthanized on day 14 post inoculation. Postmortem samples of the lung, heart, liver, kidney, spleen, left tarsal joint capsule and brain were collected. RESULTS: All but one pig with detectable histopathologic lesions (n = 11) showed typical macroscopic changes. Histopathologic examination of all tissue samples identified pyelitis (n = 10), synovitis (n = 7) and meningitis (n = 7) and all those animals were euthanized prior to study termination. No histopathologic lesions were found in pigs of the control group. The correlations between pyelitis and meningitis, pyelitis and synovitis and synovitis and meningitis were significant (p < 0.001). No significant correlation could be observed between the histopathologic and the clinical examination of the joints. The investigation of samples from the joints by PCR was not significantly correlated with the observed synovitis. The clinical observation of neurologic signs was significantly correlated with meningitis (p = 0.03). A significant correlation (p < 0.001) could be detected between meningitis and the detection of H. parasuis by PCR in brain samples. CONCLUSIONS: H. parasuis constantly causes clinical signs and pathologic lesions as soon as it infects the brain while it can infect the joints without causing histopathologic lesions. Pigs with histopathologic lesions do not always show typical clinical signs. Only few studies described the finding of kidney lesions in pigs with Glässer's disease and this is the first study to describe a pyelitis in pigs experimentally infected with H. parasuis. The observed pyelitis mainly occurred in acute cases.

Uropatía incrustante por Corynebacterium urealiticum: comentarios a partir de tres casos clínicos / Fouling uropathy by Corynebacterium urealyticum: Comments from three clinical cases

La uropatía incrustante es una enfermedad infecciosa del tracto urinario causada por la bacteria urealítica Corynebacterium urealyticum (CU). En nuestra serie (datos no publicados) sólo el 15% de las infecciones por CU produce uropatía incrustante. La formación de incrustaciones de estruvita y apatita en la pared del urotelio puede afectar a pelvis renal (pielitis), uréter, vejiga (cistopatía) y próstata, incluyendo la celda prostática después de resección ("celdopatía"). La pielitis es la más frecuente. La clínica corresponde a la triada orina alcalina, piuria y cristaluria de estruvita. Los pacientes suelen ser inmunodeprimidos o multioperados. El cultivo de orina debe estar dirigido al diagnóstico de CU. La TC es la prueba de imagen de elección. Muestra típicas imágenes de calcificación laminar. El tratamiento de la uropatía incrustante es multimodal. Incluye antibioterapia, acidificación de la orina y cirugía (algunos casos) (AU)

The encrustant uropathy is an infectious disease of the urinary tract caused by urealithic bacteria Corynebacterium urealyticum (CU). In our series (unpublished data) only 15% of CU infections caused encrustant uropathy. Formation of apatite and struvite on the wall of the urothelium can affect renal pelvis (pyelitis), urether, bladder (cystophatie) and prostate, including prostate cell after resection ("cellpathy"). Pyelitis is the most common. Clinical triad corresponds to alkaline urine, pyuria and struvite crystalluria. Patients are usually immunocompromised or or multiple previous surgeries. Urine culture should be directed to the diagnosis of UC. CT is the imaging test of choice. Shows typical images of laminar calcification. Treatment of encrusted uro pathy is multimodal. Includes antibiotics, acidification of urine and surgery (sometimes) (AU)

Chronic sclerosing pyelitis with an increased number of IgG4-positive plasma cells.

IgG4-related disease has been recently described. This disease occurs in various anatomic locations including pancreas, biliary tract, liver, retroperitoneum, kidney, breast, lung, thyroid gland, prostate, salivary gland, lacrimal gland, and lymph node. In this article, we report the first case of IgG4-related disease arising in the renal pelvis. A 49-year-old Japanese woman was found to show left hydronephrosis by a medical checkup. Histological examination of the renal pelvic tumor showed IgG4-related disease. Her postoperative serum IgG4 was elevated, and this was compatible with IgG4-related disease. Systemic examination showed swelling of major and minor salivary glands and the lacrimal glands, and biopsy of the minor salivary gland revealed the finding of IgG4-related disease. Finally, pathologists and clinicians should be aware of the possibility that the renal pelvis may be involved in IgG4-related systemic disease.

Granulomatous pyelitis associated with urinary obstruction: a comprehensive clinicopathologic study.

Urinary obstruction is rarely associated with a distinct granulomatous inflammation, which involves the pyelocalyceal system and closely simulates infectious conditions including tuberculosis. Its clinicopathologic features, however, have not been adequately studied since there are only seven isolated reported cases. In a comprehensive study of 112 kidney specimens with urinary obstruction, we identified five cases of granulomatous pyelitis. The features of these cases were detailed and compared with the previously reported cases. Among the five identified subjects, three patients had history of urolithiasis and two had ureteral stenosis and all had stent placement 7 weeks to 12 years before nephrectomy for relief of the unilateral urinary obstruction. The age distribution was between 38 and 81 years. Two had end-stage renal disease or chronic renal failure. The pyelocaliceal system showed frank hydronephrosis (1 case) or partial dilatation (4 cases) and contained cheesy and gritty material in its lumen. Each case showed severe granulomatous inflammation, which was limited to the pelvic wall and closely associated with calcified debris, necrotic inflammatory cells, and material consistent with Tamm-Horsfall protein. The kidney showed chronic tubulointerstitial nephritis but without granulomas. Cultures of urine, blood, and the renal pelvic content, and special stains of tissue sections did not show fungi or mycobacteria in any case. Many of these features were also observed in previously reported cases. Granulomatous pyelitis is a rare but distinct cliniocopathologic entity characterized by severe noninfectious granulomatous inflammation limited to the renal pelvis, which is uniformely asociated with urinary obstruction and pyelocalyceal dilatation and may develop in response to accumulated calcified material in the renal pelvis. Awareness of this entity and its characteristic clinicopathologic features also helps eliminate an infectious etiology with obvious treatment and prognostic implications.

Encrusted cystitis and pyelitis in children: an unusual condition with potentially severe consequences.

OBJECTIVES: To report our experience with the management of encrusted cystitis and pyelitis (EC and EP) in the pediatric population. EC and EP are well-known entities in adults but are rarely identified in children. They consist of mucosal encrustations and are due to specific microorganisms. METHODS: Between 1996 and 2001, 4 children with a mean age of 9 years (range 4 to 13) were treated for EC (n = 2), EP (n = 1), and EC and EP (n = 1). The latter was a kidney transplant recipient. We retrospectively evaluated the clinical characteristics of the patients and the results of conservative management. RESULTS: The delay between the beginning of the symptoms and the diagnosis was longer than 1 month in all cases. The diagnosis of EC was not evoked and was made during cystoscopy in all cases. EP was diagnosed during pyelotomy in 1 patient because it was evoked and confirmed by computed tomography scan in the kidney transplant recipient. Corynebacterium urealyticum was identified in the urine of all patients. EC was treated by antibiotics and endoscopic debulking, and EP was treated by antibiotics and local acidification. The duration of antibiotic therapy was between 1 and 6 months. The tolerance to local acidification of the kidneys was poor. Cure was achieved in 3 cases, but the treatment of EP failed in the kidney transplant recipient and graft removal was decided after 6 months of failed management because intractable febrile urinary tract infections became life threatening for the patient. CONCLUSIONS: EC and EP are uncommon in children; however, these diseases must be considered. They must be diagnosed rapidly and require, if possible, conservative management. Nevertheless, kidney loss can occur in transplant recipients with EP.

[Encrusted pyelitis in a transplanted kidney]. / Pielitis incrustante en riñón trasplantado.

OBJECTIVES: To emphasize the importance of early diagnosis of encrusted pyelitis in kidney transplant patients. METHODS: We report one case of encrusted pyelitis in a 10-year-old girl with a kidney graft who was treated by means of nephrostomy tube irrigation with an acidifier liquid substance. RESULTS: After 16 days of treatment there was a significant decrease of the size of the calcified pyelic plaque, keeping a good renal function afterwards. CONCLUSIONS: This disease should be thought of in every case of kidney transplant patient with negative urine cultures and alkaline pH, and the microbiologist should be alerted of the possibility of urinary tract infection by Corynebacterium.

Mortality from grossly encrusted bilateral pyelitis, ureteritis, and cystitis by Corynebacterium group D2.

This is the first report of death due to gross encrustations of the entire upper urinary tract and bladder by Corynebacterium group D2 in a man with no history of renal transplantation or prolonged catheterizations. This case demonstrates that debilitated patients with a prior endoscopic procedure are at risk for this disease process. Prolonged treatment with appropriate antibiotics, acidification of the urine, and removal of crusts is essential for proper management.

Microscopic and ultrastructural lesions of the ureter and renal pelvis in sows with regard to Actinobaculum suis infection.

Tissues from ureter and renal pelvis of 18 sows naturally (n = 15) and experimentally (n = 3) infected with Actinobaculum suis (former Actinomyces, Eubacterium suis) were studied using light and scanning as well as transmission electron microscopy. The results were compared with the findings from 11 clinically healthy sows as controls. The lesions in both the ureter and renal pelvis of naturally and experimentally infected animals were similar. In severe cases there were necrotizing ureteritis and pyelitis with accumulation of bacterial colonies in some cases. Several superficial epithelial cells were found phagocytosing necrotic debris. In mild cases the main lesions included epithelial cell hyperplasia, desquamation of the superficial epithelial cells and goblet cell metaplasia with intraepithelial cyst formation. The goblet cells were found in the superficial as well as in the intermediate cell layers. Generally, it was observed that severe purulent ureteritis and pyelitis/ pyelonephritis in sows were to be expected only in mixed infection of A. suis with other bacteria. The findings were compared and discussed with the changes in the infected urinary bladder of sows and the alterations induced by urinary tract infection in man.

[The effect of ultra high frequency electromagnetic fields on the intrarenal blood flow and kidney morphology in pyelonephritis (experimental study]. / Deistvie élektromagnitnykh polei sverkhvysokoi chastoty na vnutripochechnyi krovotok i morfologicheskoe sostoianie pochek pri pielonefrite (éksperimental'noe issledovanie).

The study was made of the action of electromagnetic decimetric waves (DMW) of mild and strong heat power and placebo on intraorganic circulation using functional polyrheography and morphological examination of the kidneys with infectious-inflammatory process. DMW of the above power have a marked hemodynamic action via stimulation of the circulation of the intermediary zone with an effect of redistribution of the intrarenal blood flow. Weak heat DMW in experimental pyelonephritis exhibit a distinct antiinflammatory effect while strong DMW impact aggravates vascular reaction associated with inflammation. This deteriorates the inflammation and gives rise to hyperimmune reactions. The findings provide pathogenetic grounds for DMW therapy. It is recommended for treatment of patients with chronic pyelonephritis with dynamic obstruction of the upper urinary tracts allowing for the power of the impact and activity of the inflammation.

[Multivisceral Kaposi's disease and encrusted pyelitis in a renal transplantation recipient]. / Maladie de Kaposi multiviscérale et pyélite incrustée chez un transplanté rénal.

Immunosuppression therapy carries inherent risks involving the occurrence of infections and neoplasms. Whereas therapeutic advancement have reduced its frequency, encrusted pyelitis reappears in kidney-transplanted patients and may lead to detransplantation. It is related to chronic urological infections and not inevitably favored by endoscopic explorations. Kaposi's sarcoma is the third cause of tumor in renal-transplanted patients. It is rarely multivisceral and develops exceptionally in the transplant. We report the case of a 60 year-old woman who developed an encrusted pyelitis and a Kaposi's sarcoma in a kidney which was transplanted 14 months earlier.

[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.

Helicobacter pylori induces inflammation in mouse urinary bladder and pelvis.

Helicobacter pylori was transurethrally inoculated into the mouse urinary tract. The organism established infection and induced inflammation in the urinary bladder and pelvis. During the infection, urinary pH was elevated, probably due to the production of NH3 by bacterial urease. H. pylori was recovered from the urinary bladder, kidney and urine of the infected mice. Histopathologically, severe neutrophil infiltration was observed in the mucosal layer of both organs. H. pylori was detected on the surface of the epithelial cells. These results indicate that low pH and bacterial flora were not essential factors in establishing the mucosal infection with H. pylori. This experimental system is useful to investigate the pathogenicity of H. pylori in mucosal organs.

Cytology of pyelitis glandularis cystica. A case report.

Cytologic findings that occur in association with proliferative lesions involving von Brunn's nests in the urinary tract are rare. Such lesions are probably far more common than recognized and are probably considered in the clinicoradiologic differential diagnosis when space-occupying lesions are found, particularly in the upper urinary tract. Reported here are the cytologic findings in a case of pyelitis glandularis cystica that presented as a renal pelvic lesion.