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Kamei J, Yamamoto S. Complicated urinary tract infections with diabetes mellitus. J Infect Chemother 2021; 27:1131-1136. [PMID: 34024733 DOI: 10.1016/j.jiac.2021.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
Patients with diabetes mellitus (DM) sometimes exhibited impaired immune function and aggravated infectious diseases. Urinary tract infection (UTI) is one of the major complications of DM. A systematic literature search was performed in PubMed and Cochrane Library using the following keywords: diabetes mellitus, urinary tract infection, asymptomatic bacteriuria, emphysematous pyelonephritis, emphysematous cystitis, renal papillary necrosis, and sodium-glucose co-transporter 2 (SGLT2) inhibitors. The treatment of UTI in DM patients is not different from that in non-DM patients, and asymptomatic bacteriuria should not be screened or treated. Emphysematous pyelonephritis is a life-threatening renal infection with gas in the renal parenchyma or perirenal space, and 95% of affected patients had DM. Abdominal computed tomography is useful for diagnosis and determining treatment strategies. Medical management and percutaneous drainage are standard initial treatment, and subsequent nephrectomy for non-responders is considered. Nephrectomy, as an initial treatment, should be limited to a selected group of patients with severe conditions. In contrast, antibiotics, glycemic control, and bladder drainage are adequate treatment for most cases of emphysematous cystitis. SGLT2 inhibitors significantly increased the incidence of genital tract infection, but not that of UTI, pyelonephritis, or urosepsis. Here, we present cumulative evidence about etiology and management for complicated UTI with DM, but there was little information about racial differences and further evidence focusing on Asian population will be needed.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan.
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
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Ribera-Montes MDC, Pascual-Pérez R, Orozco-Beltrán D, Pérez-Barba C, Pedrera-Carbonell V. [Risk factors for the development and persistence of asymptomatic bacteriuria in patients with type 2 diabetes]. Med Clin (Barc) 2005; 125:606-10. [PMID: 16287569 DOI: 10.1157/13080826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To study the risk factors for the development and persistence of asymptomatic bacteriuria (AB) in type 2 diabetes mellitus (DM) patients from our health zone. PATIENTS AND METHOD Observational and laboratory prospective cohort study. INCLUSION CRITERIA women and men with type 2 DM from the 2 health centers of Petrer (Alicante). DATA questionnaire including particular and epidemiological data. Laboratory values: biochemistry, glycosylated hemoglobin A1C, microalbuminuria, urinary sediment and urine culture. RESULTS A total of 457 patients with type 2 DM were included; 63.2% women and 36.8% men. The prevalence of AB at baseline was 19.9% (25.6% in women vs 10.1% in men). 78.02% had persistence of AB after the twelve months of follow-up; 21.7% developed symptomatic urinary tract infection (UTI) and 35.2% were treated with antimicrobial agents for any reason different from UTI during the follow-up period. The persistence of AB at the end of the study was 15.5%. Female sex (p = 0.04), leukocyturia (p = 0.008), urinary incontinence (p = 0.04) and elevated C reactive protein concentration (p = 0.009) remained significant risk factors for the presence and the persistence of AB when the multivariate logistical regression analysis was done. The presence of UTI within one year before the study started (p= 0.024) and previous antibiotic treatments (p = 0.04) were also independent significant factors associated with persistent AB. 84.5% of diabetic patients with persistent AB had the same infective organism in the urine culture as those found during the initial AB. CONCLUSIONS In patients with type 2 diabetes, female sex, urinary incontinence, leukocyturia, and elevated C reactive protein concentration were associated with development of AB. The same occurred with obesity in women and prostatic syndrome in men. The persistence of AB with the same species of isolated microorganisms as those found in AB at study entry is frequent, but it remains to be known if eradication of pathogens is more difficult in diabetic patients or, alternatively, if AB episodes are transient.
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Abstract
Although the prevalence of nephrotoxicity in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs) is relatively low, the extensive use profile of these agents implies that many persons are at risk. At basal states of normal renal function, the role of renal prostaglandin production for maintenance of stable renal hemodynamic function is relatively limited. Nonetheless, in the clinical setting of reduced renal perfusion as seen in various forms of cardio-renal disease, dehydration, and the aging kidney, the adequacy of renal prostaglandin production mediated predominantly by cyclooxygenase-1 (COX-1) and, potentially, by COX-2 enzyme activity becomes of major significance in the activation of compensatory renal hemodynamics. Inhibition of renal prostaglandin production by the use of NSAIDs in these circumstances can potentially lead to the emergence of several distinct syndromes of disturbed renal function. These include fluid and electrolyte disorders, acute renal dysfunction, nephrotic syndrome/ interstitial nephritis, and renal papillary necrosis. In addition, by blunting the homeostatic renal effects of prostaglandins, NSAIDs can adversely influence blood pressure control, particularly during the use of angiotensin-converting enzyme (ACE) inhibitors, diuretics, and beta blockers. This is a matter of considerable public health concern, in that some 12 million US citizens are concurrently treated with NSAIDs and antihypertensive drugs. Finally, the risk of congestive heart failure is significantly increased when NSAIDs are given to patients receiving diuretic therapy who have cardiovascular risk factors. Physiologic factors, clinical presentations, diagnostic modalities, and clinical management strategies appropriate to these NSAID-induced renal syndromes are described.
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Affiliation(s)
- A Whelton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abe K, Ozono Y, Miyazaki M, Furusu A, Shioshita K, Sasaki O, Tsukasaki S, Harada T, Kohno S. Prostaglandin E1 for renal papillary necrosis in a patient with diabetes mellitus. J Int Med Res 1999; 27:90-5. [PMID: 10446696 DOI: 10.1177/030006059902700206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of renal papillary necrosis with diabetes mellitus which was treated with prostaglandin E1. An intravenous infusion of 40 mg/day prostaglandin E1 was given for 14 days in an attempt to improve renal circulation. Treatment resulted in an improved creatinine clearance, renal plasma flow and renogram, and proteinuria was decreased. The administration of prostaglandin E1 produced an improvement in renal haemodynamics and can be considered as a possible therapy for renal papillary necrosis in diabetic patients.
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Affiliation(s)
- K Abe
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan
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Abstract
Diabetes mellitus has a number of long-term effects on the genitourinary system. These effects predispose to bacterial urinary tract infections in the patient with diabetes mellitus. Bacteriuria is more common in diabetic women than in nondiabetic women because of a combination of host and local risk factors. Upper tract infection complications are also more common in this group. Diabetic patients are at higher risk for intrarenal abscess, with a spectrum of disease ranging from acute focal bacterial pyelonephritis to renal corticomedullary abscess, to the renal carbuncle. A number of uncommon complicated urinary tract infection complications occur more frequently in diabetics, such as emphysematous pyelonephritis and emphysematous pyelitis. Because of the frequency and severity of urinary tract infection in diabetic patients, prompt diagnosis and early therapy is warranted. A plain abdominal radiograph is recommended as a minimum radiographic screening tool in the patient with diabetes presenting with systemic signs of urinary tract infection. Ultrasonography or further radiographic studies such as CT scanning may also be warranted, depending on the clinical picture, to identify upper urinary tract complications early for appropriate intervention.
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Affiliation(s)
- J E Patterson
- Department of Medicine (Infectious Diseases), University of Texas Health Science Center at San Antonio, USA
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Korzeniowski OM. Host defense mechanism in the pathogenesis of UTI and UTI in immunocompromised patients. Int J Antimicrob Agents 1994; 4:101-6. [PMID: 18611596 DOI: 10.1016/0924-8579(94)90041-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/1993] [Indexed: 10/27/2022]
Abstract
Defects in the immune system determine the clinical manifestations and severity of urinary tract infections (UTI) and the rates of complication but they only have an indirect role in influencing susceptibility to infection. The rates of UTI in diabetics, renal transplant, recipients, neutropenic patients, and patients with AIDS are primarily determined by the degree and duration of urinary tract manipulation and the higher perineal prevalence of potential pathogens that result from frequent hospitalization and antimicrobial use. Prompt recognition and treatment of established infections is critical to prevent life-threatening complications (e.g. bacteremia, emphysematous pyelonephritis) but routine screening for asymptomatic bacteriuria is indicated only in kidney recipients less that 3 months post-transplantation.
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Affiliation(s)
- O M Korzeniowski
- Medical College Hospitals, Main Clinical Campus, Department of Medicine, Division of Infectious Diseases, 3300 Henry Avenue, Philadelphia, PA 19129, USA
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Abstract
The autopsy report of Ludwig van Beethoven written by Dr Johann Wagner in 1827 reveals that he had renal calculi that had not been diagnosed during his lifetime, together with perirenal fibrosis. The most comprehensive interpretation of this autopsy finding is that the regular calcareous deposits in every one of his renal calices represented calcified necrotic papillae. Severe urinary obstruction or diabetes as possible causes of papillary necrosis were not present. Analgesic abuse because of headaches, back pain, and attacks of rheumatism or gout may be presumed on the basis of Beethoven's uncontrolled way of taking medication. Salicin, a commonly used analgesic substance of that time (dried and powdered willow bark), is able to cause papillary necrosis. Perirenal fibrosis may be due to chronic infection or drug intake. Beethoven's other well-known diseases are deafness caused by otosclerosis of the inner ear, relapsing attacks of diarrhea as the symptoms of irritable bowel syndrome, and liver cirrhosis following viral hepatitis and chronic alcohol consumption. Liver cirrhosis also may cause papillary necrosis. In Beethoven's case, renal papillary necrosis was most probably the consequence of analgesic abuse together with decompensated liver cirrhosis. The autopsy report of Beethoven is the first case of papillary necrosis recorded in the literature.
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Affiliation(s)
- A Schwarz
- Department of Nephrology, Free University, Berlin, Germany
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Davies PJ. Beethoven's Nephropathy and Death: Discussion Paper. Med Chir Trans 1993. [DOI: 10.1177/014107689308600315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- P J Davies
- 12 Collins Street, Melbourne, Victoria 3000, Australia
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Abstract
In general, defects in phagocytosis and in humoral or cellular immunity do not appear to predispose to the acquisition of UTI but do influence the clinical manifestations and the severity, microbiology, and complications of infection once it is established. The incidence of UTI in immunosuppressed patients other than diabetics or renal transplant recipients is not higher than the incidence in nonimmunosuppressed individuals. The higher frequencies of infection seen in diabetics and in renal transplant recipients correlate best with the duration of bladder instrumentation rather than with glycosuria or immunosuppressive regimen. Neutropenia blunts the clinical manifestations of UTI and predisposes to bacteremia. Use of broad spectrum antibiotics results in alterations in indigenous flora, promotes urinary infections with resistant nosocomial pathogens, and predisposes to fungemia with hematogenous seeding of the urinary tract. Routine screening for detection of asymptomatic bacteriuria and prompt institution of antimicrobial therapy is indicated only in renal transplant recipients within 3 months of their surgery and not in any of the other diseases discussed.
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Affiliation(s)
- O M Korzeniowski
- Department of Medicine, Medical College of Pennsylvania, Philadelphia
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Abstract
Certain microorganisms have a propensity for causing urinary tract infection, and the route (either ascending or hematogenous) by which microorganisms contaminate the urinary tract from external sources is frequently characteristic of the microorganism. There are local defense mechanisms both in the urine and at each anatomic site in the urinary tract (urethra, bladder, ureter, and kidney). The defense mechanisms at one site may have opposing effects on microbial growth at other sites in the urinary tract. The outcome following entrance of microorganisms into the urinary tract is a result of competing forces, which consist of these local urinary defense mechanisms, the initial numbers of microorganisms contaminating the urinary tract, and microbial virulence factors.
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Affiliation(s)
- R E Measley
- Medical College of Pennsylvania, Philadelphia
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Abstract
Serious complications of urinary tract infection, such as papillary necrosis or perinephric abscess, occur more frequently in diabetic patients. However, severe bilateral renal parenchymal infection with multiple intrarenal abscesses is not well recognized. We described an 18-year-old insulin-dependent diabetic woman with such infection, in whom renal imaging showed progression to a major perinephric abscess, but only after 5 weeks of intensive antibiotic therapy. Complete recovery followed surgical drainage and no renal cortical scarring was present on computerized tomographic scan 18 months later.
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Affiliation(s)
- J S Bevan
- Department of Medicine, Royal Gwent Hospital, Newport, UK
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Abstract
End-stage renal disease develops in about 5 percent of patients with non-insulin-dependent diabetes mellitus (NIDDM). The large majority of diabetic patients have this form of the disease. Thus, end-stage renal disease is an important clinical problem in patients with NIDDM. Moreover, hypertension and its macrovascular sequelae are significant problems in patients with NIDDM and may be linked with renal disease. A review of the problem of nephropathy in NIDDM is attempted, pointing out, where data are available, the clinical and pathophysiologic differences from its presentation in insulin-dependent diabetes. The need for further studies of the impact of renal disease in this maturity onset form of diabetes is emphasized.
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Affiliation(s)
- P Tung
- Wadsworth Veterans Administration Medical Center, Los Angeles, California 90073
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Pablo NC, Churg J, Needle MA, Ganesharajah M. Renal papillary necrosis: relapsing form associated with alcoholism. Am J Kidney Dis 1986; 7:88-94. [PMID: 3942137 DOI: 10.1016/s0272-6386(86)80061-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Described is a patient with recurrent renal papillary necrosis and chronic alcoholism as a possible precipitating factor. The case also demonstrates excellent recovery of renal function, despite considerable scarring of the parenchyma secondary to repeated episodes of sloughing of the papillae.
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Pitts TO, Van Thiel DH. Urinary tract infections and renal papillary necrosis in alcoholism. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 1986; 4:341-55. [PMID: 3704222 DOI: 10.1007/978-1-4899-1695-2_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
An enhanced frequency and morbidity of urinary tract infections (UTI) have been observed in association with alcoholism and liver disease. The causes of these phenomena may relate, in part, to the defects in humoral and cellular immune mechanisms that occur in alcoholism. Urinary catheterization is the most common cause of UTI in hospitalized alcoholics. The severity of the sequelae of UTI in alcoholism is demonstrated by the unusually frequent occurrence of renal papillary necrosis (RPN) in conjunction with pyelonephritis in these patients. Indeed, in over 90% of the reported cases of RPN occurring with alcoholism or liver disease, pyelonephritis has been a contributing factor. The proclivity to medullary ischemia and RPN in this patient group may be, at least in part, a result of interstitial renal edema secondary both to infection and the effect of ethanol per se and to renal arterial vasoconstriction that occurs in cirrhosis. The frequency with which death due to sepsis or renal failure occurs in association with UTI in alcoholics obliges the physician to exercise caution in the prevention and treatment of UTI in these patients.
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Joyce DA, Matz LR, Saker BM. Renal failure and upper urinary tract obstruction after retrograde pyelography with potassium bromide solution. HUMAN TOXICOLOGY 1985; 4:481-90. [PMID: 4054912 DOI: 10.1177/096032718500400504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Two iodine-sensitive women in whom potassium bromide solution was used as a radiocontrast agent for retrograde pyelography developed similar clinical conditions culminating in renal failure. Renal failure was due to upper urinary tract obstruction from fibrosis and fat necrosis in each case. Similar histological findings have been described in rabbit bladder exposed to sodium bromide solution. Different patterns of exposure corresponded with different sites of major damage in the two cases. One patient, who had repeated studies of the pelvicalyceal system with potassium bromide developed papillary necrosis. Systemic exposure to bromide-releasing compounds (in animals) and to bromides (in humans) has also been associated with papillary necrosis.
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Mitas JA, Higgenbottom PA, Handler J, Vasquez M, Stone RA. Renal papillary necrosis in thyroid carcinoma. Urology 1981; 17:177-80. [PMID: 7467024 DOI: 10.1016/0090-4295(81)90233-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A thirty-four-year-old man with progressive visual impairment was found to have thyromegaly and renal insufficiency at the time of admission. Subsequent evaluation demonstrated bilateral optic neuritis and a thyroid nodule which proved to be a follicular carcinoma. Nephrologic studies revealed bilateral papillary necrosis and chronic interstitial nephritis on biopsy. The patient's renal function stabilized and twenty-four-hour protein excretion diminished after hemithyroidectomy. Carcinoma-related protein production may have played a role in the development of the observed renal lesions. Carcinoma should be a consideration in patients with unexplained papillary necrosis.
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Tormey WP, Harrison RF. Brief report: primary amenorrhoea due to a Müllerian duct anomaly. Ir J Med Sci 1979; 148:23. [PMID: 761981 DOI: 10.1007/bf02938044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Cohen MS, Davis CP, McDonald DF, Warren MM. Infection and papillary necrosis. Scanning electron microscopic comparison with bladder infection. Urology 1979; 13:36-8. [PMID: 375534 DOI: 10.1016/0090-4295(79)90010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A case of papillary necrosis in a diabetic patient with Escherichia coli urinary tract infection is reported. Infectious contribution to the disease is presented, and the electron microscopic similarities of bladder response to infection are discussed.
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Abstract
We present a case of nephrotic syndrome complicating acute pyelonephritis in a 45-year-old man. His first attack of acute bacterial pyelonephritis had two unusual features: transient nephrotic syndrome and chronic recurrent episodes of papillary necrosis. The former, which lasted for two weeks, was characterized by edema, excretion of 7.7 g of urinary protein per 24 hours and hypoproteinemia (1.8 g per 100 ml). A percutaneous renal biopsy two weeks after the height of the nephrotic state showed normal glomeruli by light and electron microscopy and immunohistologic studies. Interstitial changes were noted. Over two years the patient has passed approximately 50 fragments, characterized as necrotic tissue containing tubular structures. He has no evidence of diabetes mellitus, urinary-tract obstruction or ureteral reflux, analgesic abuse or atypical vasculitis. He is afebrile but has recurrent bacteriuria despite antibiotics. This case demonstrates that acute pyelonephritis must be added to the list of diseases causing the nephrotic state.
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Strimer RM, Morin LJ. Phenacetin-induced renal papillary necrosis: pyonephros, anuria, and bilateral ureteral obstruction. Urology 1975; 5:780-3. [PMID: 1136090 DOI: 10.1016/0090-4295(75)90353-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A fifty-five-year-old man was seen with anuria. Retrograde pyelograms demonstrated bilateral ureteral obstruction subsequently shown to have resulted from sloughed renal papillae. A twenty-year history of phenacetin was obtained. Treatment included bilateral ureteral intubation, then ureterotomy on one side.
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Green CR, Ham KN, Tange JD. Kidney lesions induced in rats by p-aminophenol. BRITISH MEDICAL JOURNAL 1969; 1:162-4. [PMID: 5762279 PMCID: PMC1982329 DOI: 10.1136/bmj.1.5637.162] [Citation(s) in RCA: 76] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Necrosis of the terminal third of the proximal convulated tubule develops in rats after a single intravenous injection of p-aminophenol hydrochloride. As the tubules regenerate a chronic inflammatory reaction occurs in the interstitial tissue, and this reaction extends beyond the original zone of injury. These findings are additional evidence that some aromatic compounds are selectively nephrotoxic and may be particularly relevant to the problem of renal damage associated with heavy and prolonged doses of analgesics.
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Sanerkin NG. Chronic phenacetin nephropathy. (With particular reference to the relationship between renal papillary necrosis and "chronic interstitial nephritis"). BRITISH JOURNAL OF UROLOGY 1966; 38:361-70. [PMID: 5915057 DOI: 10.1111/j.1464-410x.1966.tb09722.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Case records of the Massachusetts General Hospital. Case 32-1966. N Engl J Med 1966; 275:159-63. [PMID: 5938864 DOI: 10.1056/nejm196607212750310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Case records of the Massachusetts general hospital. Case 8-1966. N Engl J Med 1966; 274:395-404. [PMID: 5903125 DOI: 10.1056/nejm196602172740708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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