Xanthogranulomatous pyelonephritis in children: Analysis by diagnostic modalities

Xanthogranulomatous pyelonephritis (XGP), an uncommon chronic inflammatory renal disorder of middle-aged women, is rarely seen in childhood. We report the sonographic findings in a 2-year-old girl with the diffuse form of XGP and discuss the role of newer imaging modalities in the diagnosis and management of this disorder.     

B超诊断黄色肉芽肿性肾盂肾炎2例

例1女,28岁,右侧腰部、下腹部胀痛加重3天入院.B超检查:左肾体积增大,大小约17.4 cm×8.1 cm,皮质明显变薄,肾盏扩张,于肾中部可见范围约4.8 cm×3.8 cm的囊性回声,与肾盏肾盂相通,内部见密集细小的点状回声(图1),扩张的肾盏及肾盂内可见多个强回声,后方伴声影,最大直径2.6 cm,左侧输尿管上段扩张,内径1.0 cm,内透声差,可见一直径约1.4 cm的强回声,后方伴声影.     

急性肾盂肾炎的临床治疗研究

目的 观察中西医结合治疗急性肾盂肾炎的疗效.方法 将我院80例急性肾盂肾炎患者随机分为两组,治疗组采用中西医结合治疗,对照组采用西医常规治疗.结果 治疗组的总有效率为90%,优于对照组72.5%,两者之间差异有显著性(P＜0.01).结论 中西医结合治疗急性肾盂肾炎效果满意,可广泛应用于临床.     

Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review

BACKGROUNDEmphysematous pyelonephritis (EPN) is a rare but fatal necrotic infection of the kidney, which usually leads to septic shock. Therefore, early diagnosis and optimized therapy are of paramount importance. In the past two decades, point-of-care ultrasound (POCUS) has been widely used in clinical practice, especially in emergency and critical care settings, and helps to rapidly identify the source of infection in sepsis. We report a rare case in which a “falls” sign on POCUS played a pivotal role in the early diagnosis of EPN.CASE SUMMARYA 57-year-old man presented with fever and lumbago for 3 d prior to admission. He went to the emergency room, and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts. This imaging feature was like a mini waterfall. His blood and urine culture demonstrated Escherichia coli bacteremia, and EPN associated with septic shock was diagnosed. The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed. He subsequently underwent computed tomography-guided percutaneous catheter drainage, and fully recovered. We also review the literature on the sonographic features of POCUS in EPN.CONCLUSIONThis case indicates that a “falls” sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.     

线叶菊抗感染有效部位对大鼠肾盂肾炎的疗效

目的:探讨线叶菊抗感染有效部位抗炎及对肾盂肾炎大鼠的治疗作用。方法:采用小鼠耳肿胀法和棉球肉芽肿试验,分正常组、模型组、线叶菊总黄酮组,分别ig生理盐水、地塞米松(153.0 mg.kg-1)、线叶菊总黄酮(144.0,288.0,576.0mg.kg-1)连续3 d,观察其抗炎作用。采用大鼠单侧输尿管结扎并同时向膀胱内注射大肠杆菌的方法造成肾盂肾炎的病理模型,分模型组、线叶菊有效部位高、中、低剂量组和阳性药对照组。采用线叶菊抗感染有效部位高(403.2 mg.kg-1,相当于线叶菊生药5.6 g.kg-1)、中(201.6 mg.kg-1,相当于生药2.8 g.kg-1)、低剂量(100.8 mg.kg-1,相当于生药1.4 g.kg-1)组及头孢克肟胶囊(36.87 mg.kg-1)阳性对照组进行干预,空白对照组给同体积水(10 mL.kg-1)。观察给药前后大鼠尿N-乙酰-β氨基葡糖胺酶(NAG)/尿肌酐(UCr),给药后大鼠胸腺和脾脏的脏器指数及血清白介素-2(IL-2)的含量,并观察其肾脏病理改变。结果:线叶菊抗感染有效部位高、中、低剂量组对小鼠耳肿胀度抑制率分别为41.8%,20.20%,12.20%,降低棉球肉芽肿,抑制率分别为26.79%,16.39%,10.82%。线叶菊抗感染有效部位各组对大鼠尿NAG/尿肌酐变化无统计学意义,但高剂量组的左肾指数和血清IL-2值均高于模型组(P<0.05),说明线叶菊抗感染有效部位具有免疫促进作用。光镜观察结果亦显示线叶菊抗感染有效部位能明显改善大鼠肾脏的病理变化。结论:线叶菊抗感染有效部位具有抗炎作用;能减轻肾小球炎症损害,改善肾功能,对肾盂肾炎模型大鼠具有治疗作用,同时能够提高大鼠免疫能力,增强免疫系统的功能。     

Urinary tract infections in children after renal transplantation

Urinary tract infections (UTI) after pediatric kidney transplantation (KTX) are an important clinical problem and occur in 15–33% of patients. Febrile UTI, whether occurring in the transplanted kidney or the native kidney, should be differentiated from afebrile UTI. The latter may cause significant morbidity and is usually associated with acute graft dysfunction. Risk factors for (febrile) UTI include anatomical, functional, and demographic factors as well as baseline immunosuppression and foreign material, such as catheters and stents. Meticulous surveillance, diagnosis, and treatment of UTI is important to minimize acute morbidity and compromise of long-term graft function. In febrile UTI, parenteral antibiotics are usually indicated, although controlled data are not available. As most data concerning UTI have been accumulated retrospectively, future prospective studies have to be performed to clarify pathogenetic mechanisms and risk factors, improve prophylaxis and treatment, and ultimately optimize long-term renal graft survival.     

黄色肉芽肿性肾盂肾炎7例分析

目的探讨黄色肉芽肿性肾盂肾炎的临床诊断及治疗方法,减少误诊率,提高诊治水平。方法回顾性分析7例黄色肉芽肿性肾盂肾炎患者的诊治资料,7例均行手术治疗,4例行肾切除术,3例行肾根治切除术。结果 7例患者术中冰冻切片确诊1例,其余6例均为术后病理确诊,经手术治疗全部治愈,术后随访1～4年,未见复发。结论黄色肉芽肿性肾盂肾炎术前诊断困难,易误诊为其它肾脏疾病;晨尿离心沉渣涂片有泡沫细胞、CT值为低密度值为该病特点,确诊主要靠病理检查。术前诊断为肾脏恶性肿瘤的患者予术中行快速冰冻切片检查有指导意义。治疗上可根据临床分期、病变部位等采取肾切除术为主的治疗方式。     

Morphometric Parameters of Inflammatory Infiltration in Renal Tissue and Personality Characteristics of Patients at Risk of Pyelonephritis Attack after Percutaneous Nephrolithotomy

A correlation between personality traits and the type of inflammatory infiltration in the renal pelvicalyceal system was revealed in patients with nephrolithiasis. The study demonstrated the possibility of indirect evaluation of the inflammatory process in the pelvicalyceal system and preoperative prediction of acute pyelonephritis attack after percutaneous nephrolithotomy on the basis of patient's psychological status.