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Schinköthe J, Gerlach K, Ulrich RG, Brehm W. Pyelonephritic end-stage kidney and ureterocutaneous fistula in a Shetland pony. J Vet Diagn Invest 2023; 35:577-580. [PMID: 37408505 PMCID: PMC10467461 DOI: 10.1177/10406387231186134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
A 12-y-old Shetland Pony was presented with a mucus-secreting fistula in the right paralumbar fossa. Surgery was performed to unravel the origin of the fistula. The horse died under anesthesia and was forwarded to autopsy. The right kidney was markedly atrophic and fibrotic, consistent with unilateral end-stage kidney. The right ureter was markedly thickened, but with luminal continuity leading into the urinary bladder where a partial obstruction caused by nodular para-ureteral fat necrosis was evident. The lumen of the cutaneous fistula was continuous with the right ureter; therefore, we diagnosed the lesion as a ureterocutaneous fistula. Anomalies of the ureter are uncommon, and ureterocutaneous fistula formation in equids has not been reported previously to our knowledge.
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Affiliation(s)
- Jan Schinköthe
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, Germany
| | - Kerstin Gerlach
- Department for Horses, Faculty of Veterinary Medicine, Leipzig University, Germany
| | - Reiner G. Ulrich
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, Germany
| | - Walter Brehm
- Department for Horses, Faculty of Veterinary Medicine, Leipzig University, Germany
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Asymptomatic Bacteriuria is Harmless and Even Protective: Don't Treat if You Don't Have a Very Specific Reason. Eur Urol Focus 2018; 5:15-16. [PMID: 30030090 DOI: 10.1016/j.euf.2018.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 11/22/2022]
Abstract
Symptom-free bacterial colonization of the lower urinary tract in an otherwise healthy individual was long misunderstood. Our current understanding is based on solid research proving that asymptomatic bacteriuria (ABU) is harmless and even protective against symptomatic urinary tract infection episodes. Thus, ABU should not be treated in patients with the exception of before endosurgery and, until we have accumulated more knowledge, in pregnant women.
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Affiliation(s)
- W Brumfitt
- St Mary's Hospital, London, and Edgware General Hospital, Middlesex
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Distinctive renal cell tumor simulating atrophic kidney with 2 types of microcalcifications. Report of 3 cases. Ann Diagn Pathol 2014; 18:82-8. [DOI: 10.1016/j.anndiagpath.2013.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 12/13/2013] [Indexed: 01/08/2023]
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Affiliation(s)
- C M Kunin
- Department of Internal Medicine, Ohio State University College of Medicine and Public Health, Rm M110 Starling Loving Hall, 320 West 10th Ave., Columbus, OH 43210, USA.
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BRUMFITT W, PERCIVAL A. PATHOGENESIS AND LABORATORY DIAGNOSIS OF NON-TUBERCULOUS URINARY TRACT INFECTION: A REVIEW. J Clin Pathol 1996; 17:482-91. [PMID: 14207779 PMCID: PMC480801 DOI: 10.1136/jcp.17.5.482] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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HICKLER RB, BIRBARI AE, HOWARD FH, CROCKER DW, LAULER DP, HARRISON JH, CRANE C, VAGNUCCI AI. A COMPARISON OF UNILATERAL PYELONEPHRITIS AND RENAL ARTERY STENOSIS ASSOCIATED WITH HYPERTENSION. Am J Surg 1996; 109:715-23. [PMID: 14283328 DOI: 10.1016/s0002-9610(65)80041-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The recommendations for evaluation and management of pediatric patients with UTIs are summarized in Table 5. These recommendations were designed to minimize the risk of kidney damage in children with UTIs based on current perceptions of the pathogenesis of renal injury. The children at greatest risk for kidney damage are the infants and young children with febrile UTIs in whom effective treatment is delayed, those with gross VUR, and those with anatomic or neurogenic urinary tract obstruction. These recommendations likely will be modified as more is learned about the pathogenesis of renal injury associated with UTIs, as new therapeutic approaches are developed, and as imaging technology improves.
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Affiliation(s)
- S Hellerstein
- Department of Pediatrics, University of Missouri School of Medicine, Children's Mercy Hospital, Kansas City, USA
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Abstract
Reflux nephropathy is the cause of 5%-10% of dialysed end-stage renal failure. Once scarring has occurred, the prognosis depends on the severity of initial damage and the presence of proteinuria, which reflects the development of glomerulosclerosis. It is independent of ongoing reflux or infection. Histological appearances highly suggestive of reflux nephropathy can occur in radiologically normal kidneys. Duplex Doppler scans of ureteric orifices suggest these patients may have lateral insertion, suggesting past reflux. Glomerular hypertrophy correlates well with reduced renal function and severe renal scarring, but poorly with focal and segmental glomerulosclerosis, which correlates with proteinuria. Increasing attention is being paid to the tubulo-interstitium and the relationships between the cellular infiltrates (mainly T4 cells) and glomerular, tubular and vascular damage. Control of hypertension, hyperphosphataemia and a low-protein diet are the only currently widely accepted treatments for slowing progression.
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Affiliation(s)
- G J Becker
- Department of Nephrology, Royal Melbourne Hospital, Victoria Australia
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Affiliation(s)
- C M Kunin
- Department of Internal Medicine, Ohio State University, Columbus
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Abstract
Our current knowledge of the long-term outcome of uncomplicated urinary tract infections in women is based on a re-evaluation of the criteria for defining pyelonephritis at autopsy, careful description of the causes of renal disease among patients entering dialysis and transplant programs, long term observation of patients, and epidemiologic studies which have attempted to determine the association of bacteriuria with mortality. The weight of the evidence favors the conclusion that although urinary tract infections can produce severe impairment of renal function, this is rare in the absence of a major predisposing factor such as obstruction, calculus, reflux, abnormalities of the voiding mechanism or diabetes. The predisposing lesions, however, may go undetected until heralded by episodes of acute pyelonephritis or by renal failure. Unfortunately, urinary tract infections are so common that it is difficult to distinguish the population at greatest risk. The possible role of renal damage produced by autoimmune mechanisms following infection needs continued study.
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Affiliation(s)
- C M Kunin
- Department of Medicine, Ohio State University College of Medicine, Columbus 43210
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Laberke HG, Klingebiel T, Quack G. A contribution to the morphology and pathogenesis of thyroid-like lesions in the kidney. Pathol Res Pract 1983; 176:284-96. [PMID: 6856520 DOI: 10.1016/s0344-0338(83)80018-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The morphological variations of thyroid-like lesions in the kidney in 15 cases with chronic destructive interstitial nephritis as the basic alteration were examined with light microscopy and immunohistological methods. Reflux pyelonephritis was present in some cases. Thyroid-like lesions can develop at any age. "Mature" thyroid-like lesions possess large follicular structures and solid tubular epithelial cell complexes, whereas the follicular structures in "young" thyroid-like lesions are small. The hyaline casts are Tamm-Horsfall protein positive in between one- and two-thirds of the follicles. IgA is present in all follicular lumina. The thyroid-like lesions are the result of a regenerative process. They develop after subtotal parenchymal destruction of remaining tubular epithelial cells from the ascending limb of the loop of Henle, the distal convoluted tubules and the collecting ducts. They are pathognomonic for healed destructive bacterial interstitial nephritis, but can also be observed in analgesic nephropathy, hydronephrosis, and nephronophthisis when these basic diseases are preceded by pyelonephritis.
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Moreau JF, Grenier P, Grünfeld JP, Brabant J. Renal clubbing and scarring in adults: a retrospective study of 110 cases. UROLOGIC RADIOLOGY 1980; 1:129-36. [PMID: 554364 DOI: 10.1007/bf02926616] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A urographic pattern of renal clubbing and scarring was found in 182 scarred kidneys of 110 adult patients. Homolateral vesicoureteric reflux was demonstrated by reliable techniques in 90/135 scarred kidneys. Urinary tract infections occurred in 75 patients. Hypertension developed in 20 patients with normal renal function and was not related to the extent of scarring. Chronic renal failure occurred in 30 patients with diffuse bilateral scarring. Four patients showed histologic changes of chronic pyelonephritis. Two hypertensive patients had a typical histologic pattern of Ask-Upmark kidney (segmental hypoplasia). Development of renal scars in adulthood was demonstrated in 2 cases.
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Yonezawa S. Immunopathology of the glomerular changes in chronic pyelonephritis. ACTA PATHOLOGICA JAPONICA 1979; 29:677-85. [PMID: 386707 DOI: 10.1111/j.1440-1827.1979.tb00936.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To investigate the presence of intraglomerular immunoprotein deposition in chronic pyelonephritis (CPN), 29 renal specimens from patients with various urological diseases were examined by immunofluorescence. The relationship between immunohistological findings and types of glomerular changes which were classified according to Heptinstall's criteria was studied. Only type 2 glomeruli, which were considered to be ischemic changes, demonstrated granular and globular depositions of IgM and C3 in the collapsed and solidified shrunken tufts. IgM was positive in 117 of 258 (45.3%), and C3 in 122 of 264 (46.2%) type 2 glomeruli. The distribution patterns of IgM and C3 were much the same. IgG and IgA were rarely observed and neither fibrinogen nor albumin was observed in the tufts of type 2 glomeruli. Normal glomeruli and other types of glomerular changes in CPN showed few or no intraglomerular immunoprotein deposition.
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Abstract
In children with reflux nephropathy renin-dependent hypertension may develop. Two girls with reflux nephropathy, hypertension, elevated plasma renin activity, but normal (Case I) and near normal (Case 2) serum creatinines are described. These cases suggest that reflux nephropathy can activate the renin-angiotensin system and that the renin inhibitors, methyldopa and propranolol, an useful in managing this type of hypertension.
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Abstract
Eighty-eight kidneys obtained at necropsy from normotensive subjects aged over 50 years were examined histologically and by post-mortem pyelography and angiography. Moderate or severe scarring was present in 50%. Its distribution and the absence of calyceal deformity make pyelonephritic scarrig unlikely. Its extent was related to the severity of change in the renal vessels, but not to age. On pyelograms, scarring was difficult to distinguish from fetal lobation. Kidneys with the most severe histological changes in the vessels tended to show the most marked angiographic distortion, though in general the two techniques examine different parts of the renal vascular bed. Total renal area and "cortical" area, measured from the angiograms, were not significantly correlated with age, thouth both tended to be smaller in older subjects. These dimensions, particularly cortical area, were significantly correlated with vascular changes, being smallest when vessels were most markedly affected. Results suggest that the loss of renal tissue which occurs in the elderly, particularly selective loss of cortex, is more closely related to events in the renal vasculature than to age itself.
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Abstract
Because of declining function of their immunologic and other organ systems, elderly individuals are more susceptible to certain types of infections of their heart valves, meninges, urinary tract, and skin. They may develop serious sepsis with subtle clinical signs and symptoms, which makes accurate diagnosis difficult. The antimicrobial agents of choice for use against the organisms most commonly responsible for these septic symdromes are listed in Tables 2, 3, and 4. Some methods of preventing these infections are discussed, but further studies to verify old techniques and establish new ones are needed.
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Armsen TR, Joppich R, Schubert G, Edel HH. Single nephron study of intrarenal urea handling in experimental pyelonephritis. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1975; 165:141-52. [PMID: 1224036 DOI: 10.1007/bf01854840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Micropuncture experiments were carried out in 20 rats with bilat. experimental chronic pyelonephritis. Inulin and urea concentrations were estimated in the late proximal, early distal and latte distal nephron segment. Proximal urea reabsorption did not differ from that in control animals. Fractional amount of filtered urea in the early distal segment was significantly lower in the pyelonephritic rats, urea reabsorption in the distal tubule approcimated zero. The data indicate that intrarenal urea recirculation is abolished by the experimental lesion, thus determining maximal urine urea concentration. It is suggested that the concentrating defect of experimental pyelonephritis is not only a result of an adaptational increase in individual nephron GFR; an additional intrinsic lesion seems to be present, located in the renal medulla.
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Stewart JH, McCarthy SW, Storey BG, Roberts BA, Gallery E, Mahony JF. Diseases causing end-stage renal failure in New South Wales. BRITISH MEDICAL JOURNAL 1975; 1:440-3. [PMID: 1090338 PMCID: PMC1672400 DOI: 10.1136/bmj.1.5955.440] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The nature of the original renal disease was determined in 403 consecutive cases of end-stage renal failure, in 317 of which the clinical diagnosis was corroborated by histological examination of the kidney. Five diseases accounted for 20 or more cases--glomerulonephritis (31% of the total), analgesic nephropathy (29%), primary vesicoureteral reflux (8%), essential hypertension (6%), and polycystic kidneys (5%). In only four cases did renal failure result from chronic pyelonephritis without a demonstrable primary cause. Greater use of micturating cystography and cystoscopy and routine urine testing for salicylate are advocated for earlier diagnosis of the major causes of "pyelonephritis". The incidence of end-stage renal failure in people aged 15-55 in New South Wales was estimated to be at least 34 new cases per million of total population each year.
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Lyrdal F, Olin T, Silseth C. Late effects on the kidney of selective infusion of adrenalin into the renal artery. An experimental study in the rabbit. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1974; 8:213-22. [PMID: 4428185 DOI: 10.3109/00365597409132132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Zimmerman SW, Uehling DT, Burkholder PM. Vesicoureteral reflux nephropathy. Evidence for immunologically mediated glomerular injury. Urology 1973; 2:534-8. [PMID: 4588163 DOI: 10.1016/0090-4295(73)90562-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Andersen HJ, Jacobsson B, Larsson H, Winberg J. Hypertension, asymmetric renal parenchymal defect, sterile urine, and high E. coli antibody titre. BRITISH MEDICAL JOURNAL 1973; 3:14-8. [PMID: 4577715 PMCID: PMC1587976 DOI: 10.1136/bmj.3.5870.14] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
During an 11-year period four children were seen with asymmetric renal parenchymal reduction, arterial hypertension, and sterile urine. The history and radio-logical or histological findings, or both, were consistent with "abacterial pyelonephritis" induced by bacterial infection in early childhood. All four had raised antibody titres to Escherichia coli. Three possibilities may explain the high antibody titres and insidious course of the renal damage-the presence of bacterial variants or amorphous bacterial antigen in the kidneys or the fact that because of cross-reactivity between certain E. coli O antigens and renal tissue the "E. coli antibodies" were, in fact, autoantibodies.
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Pasternack A. Causes and duration of renal failure and duration of working disability in dialysis candidates. A retrospective study of 104 patients. ACTA MEDICA SCANDINAVICA 1973; 1-2:17-21. [PMID: 4580321 DOI: 10.1111/j.0954-6820.1973.tb19408.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Rossmann P, Hurych J. Influence of preexistent pyelonephritis on the development and manifestations of acute fatal glomerulonephritis. Int Urol Nephrol 1973; 5:107-15. [PMID: 4771407 DOI: 10.1007/bf02081756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Mahran M, Fadel HE, Sabour MS, Saleh A. Renal pathologic findings in patients with the clinical diagnosis of pre-eclampsia. ARCHIV FUR GYNAKOLOGIE 1970; 209:149-61. [PMID: 5537779 DOI: 10.1007/bf00668181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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MacGregor M. Pyelonephritis lenta. Consideration of childhood urinary infection as the forerunner of renal insufficiency in later life. Arch Dis Child 1970; 45:159-72. [PMID: 4911741 PMCID: PMC2020277 DOI: 10.1136/adc.45.240.159] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Mowat AG, Hothersall TE, Gould JC. Urinary tract infection in patients with rheumatoid arthritis. Ann Rheum Dis 1970; 29:143-8. [PMID: 4913484 PMCID: PMC1010522 DOI: 10.1136/ard.29.2.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Certain problems of pyelonephritis. Int Urol Nephrol 1970. [DOI: 10.1007/bf02081624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Aoki S, Imamura S, Aoki M, McCabe WR. "Abacterial" and bacterial pyelonephritis. Immunofluorescent localization of bacterial antigen. N Engl J Med 1969; 281:1375-82. [PMID: 4982237 DOI: 10.1056/nejm196912182812501] [Citation(s) in RCA: 52] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Puri D, Bansal S. Percutaneous renal biopsy in children. Indian J Pediatr 1969; 36:71-4. [PMID: 5798092 DOI: 10.1007/bf02749368] [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: 01/16/2023]
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Butterworth ST. The identification and significance of polymorphonuclear leucocytes in the urine. BRITISH JOURNAL OF UROLOGY 1969; 41:40-50. [PMID: 4180187 DOI: 10.1111/j.1464-410x.1969.tb09906.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Marshall AG. Scars of the infant renal cortex. THE JOURNAL OF PATHOLOGY AND BACTERIOLOGY 1968; 95:225-31. [PMID: 5643453 DOI: 10.1002/path.1700950127] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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