Clinicopathological study of vesicoureteral reflux (VUR)-associated pyelonephritis in renal transplantation

Abstract:  We retrospectively studied the occurrence of vesicoureteral reflux (VUR)-associated pyelonephritis using renal biopsies obtained from the transplanted kidneys, and correlated the histological changes with clinical parameters. Out of a total of 131 renal biopsies performed between 1990 and 2001 on renal transplant patients at the department of Urology of Nagasaki University Graduate School of Biomedical Sciences, 12 patients showed pyuria more than twice in a single year. Seven of these 12 patients were available for determining VUR by voiding cystourethrography (VCUG). Cystoureterography demonstrated VUR in three of seven studied patients with pyuria. A histopathological examination revealed dilatation of both proximal and distal tubules in renal biopsies of transplant patients with VUR, compared to renal biopsies of transplant patients without VUR, or non-transplanted patients with thin membrane disease. One of the patients with VUR showed advanced features of chronic pyelonephritis in four consecutive biopsies at different time points, suggesting a late stage of reflux nephropathy in the transplanted kidney. We conclude from our study that the occurrence of VUR-related pyelonephritis may be one of the important long-term complications in the survival of renal allografts.     

Emphysematous pyelonephritis and renal amoebiasis in a patient with diabetes mellitus

Emphysematous pyelonephritis is an uncommon and life-threatening infection of the kidney that is characterized by gas formation within or around the kidney and is associated with diabetes mellitus and urinary tract infection. Amoebiasis is a protozoal infection caused by Entamoeba histolytica. In its invasive forms, the disease is characterized by visceral abscess formations. We present a case of concomitant emphysematous pyelonephritis and renal amoebiasis in a 42-year-old female with uncontrolled diabetes mellitus. The patient did not respond well to initial supportive treatment and antibiotherapy. Therefore, nephrectomy was performed. She did extremely well after the operation and was discharged with antidiabetics and antibiotics.     

Coexistence of renal replacement lipomatosis with xanthogranulomatous pyelonephritis

We report on a case of coexistence of replacement lipomatosis with xanthogranulomatous pyelonephritis (XGP) in the same kidney associated with staghorn calculi. A 63-year-old man was admitted to hospital complaining of a right abdominal mass. Computed tomography (CT) showed renal parenchymal atrophy with extremely increased perirenal fat. Right nephrectomy was performed. Postoperative diagnosis was renal replacement lipomatosis with XGP. Renal replacement lipomatosis and XGP have several similarities in terms of clinical background and CT findings. Sometimes it is difficult to differentiate them from malignant diseases. It is extremely rare that both conditions coexist in the same kidney. To our knowledge, only one such case has been reported.     

益肾清利化瘀汤对急性肾盂肾炎大鼠病理改变的影响

目的 探讨益肾清利化瘀汤治疗尿路感染的实验室依据。方法 建立急性肾孟肾炎大鼠模型，以左氧氟沙星为对照，观察益肾清利化瘀汤对该模型的肾脏病理学改变的影响。结果 与模型组相比，益肾清利化瘀汤组和左氧氟沙星组肾孟炎症较轻，表现在肾脏纵切面仅见有粘膜充血，第7、15天肾孟粘膜病理和间质区较少的灶性淋巴细胞浸润；而模型组可见到肾包膜紧张和肾孟扩张，以及光镜下明显的灶性淋巴细胞浸润。结论 益肾清利化瘀汤能部分减轻该模型的急性肾孟炎症。     

Xanthogranulomatous pyelonephritis: MRI findings in the diffuse and the focal type

Two cases of xanthogranulomatous pyelonephritis (XGP) are presented with emphasis on MR appearances. One case is the diffuse type of XGP secondary to chronic obstruction caused by transitional cell carcinoma of the renal pelvis. The other case is the focal or “tumefactive” type of XGP which mimics renal cell carcinoma. Received: 15 February 1999; Revised: 14 June 1999; Accepted: 8 July 1999     

基于网络药理学探究血尿胶囊治疗急性肾盂肾炎的作用机制

目的:采用网络药理学和实验验证的方法探究血尿胶囊治疗急性肾盂肾炎(APN)的作用机制.方法:通过APN大鼠模型研究血尿胶囊对APN的作用效果.使用中药系统药理学数据库与分析平台(TCMSP),化学专业数据库,中医证候关联(SymMap)数据库检索菝葜、薏苡仁、棕榈子的化学成分,PharmMapper与SwissTarg...     

Unusual case of urothelial carcinoma disguised as xanthogranulomatous pyelonephritis and causing reno-colic fistula: Case report and review of literature

Xanthogranulomatous pyelonephritis is a rare and aggressive form of chronic pyelonephritis, it can occur at all age groups but is more common in women than in men, supposedly relating to the increased incidence of urinary tract infections and chronic nephrolithiasis in woman. Computed tomography (CT) findings are very helpful in making the correct diagnosis, but the definitive diagnosis is still based on histology, as there are many differential diagnoses such as renal cell carcinoma and renal tuberculosis. The complications of this type of pyelonephritis are due to the involvement of adjacent organs. The most frequent ones are Psoas abscess, perinephric abscess, and sepsis. Nephrocutaneous and renocolic fistulas are less common. We report a case of a 61-year-old male, who presented to emergency for left-sided lumbar pain for whom radiological investigations confirmed a renocolic fistula complicating xanthogranulomatous pyelonephritis. The diagnosis of XGP was proven by histopathological examination of the nephrectomy specimen slides, but there was also association with an underlying malignant squamous differentiation consistent with urothelial carcinoma, which was not evident on CT. XGP is a rare variant of chronic pyelonephritis with known imaging features. The treatment of choice is nephrectomy and histopathological examination is required for final diagnosis, as there may be associated renal malignancy.     

清炎颗粒治疗小鼠肾盂肾炎的实验研究

目的:探讨清炎颗粒治疗肾盂肾炎的作用机制。方法:采用孙建实方法改进造模,除空白组正常喂养外,治疗组给予清炎颗粒,模型组给予生理盐水,对照组给予至灵胶囊灌胃,分别喂养至3,7,15,30,60 d处死。取胸腺称重,计算胸腺指数,并取肾做病理分析。结果:清炎颗粒能提高不同时段小鼠的胸腺指数,并减轻相应时段的病理改变。结论:清炎颗粒通过提高小鼠的免疫功能来达到治疗肾盂肾炎的目的。     

The treatment of chronic pyelonephritis with carindacillin

Summary

Forty-two patients with a radiologically confirmed diagnosis of chronic pyelonephritis were treated with 1 g carindacillin every 6 hours over a period of 6 weeks. An underlying urological disease was present in 84% of the 38 patients for whom sufficient data were available for evaluation. The results of carindacillin treatment, as judged by bacteriological evaluation I month post-treatment, were good in 12 (32%) and moderate in 9 of the patients. This success rate was remarkable in that all of the patients had been treated previously with one or more other antibiotics and chemo-therapeutic agents with little or no response. The authors recommend that, because carindacillin has proved so valuable in treating chronic as well as acute urinary tract infections, its use should be limited to patients with serious disease who have not responded to other treatment.     

Nephrectomy for Non-neoplastic Kidney Diseases

This review discusses the pathology of non-neoplastic kidney disease that pathologists may encounter as nephrectomy specimens. The spectrum of pediatric disease is emphasized. Histopathologic assessment of non-neoplastic nephrectomy specimens must be interpreted in the clinical context for accurate diagnosis. Although molecular pathology is not the primary focus of this review, the genetics underlying several of these diseases are also touched on.