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Acute Pyelonephritis

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Enrique Casalino – One of the best experts on this subject based on the ideXlab platform.

  • Plasmatic presepsin (sCD14-ST) concentrations in Acute Pyelonephritis in adult patients
    Clinica Chimica Acta, 2017
    Co-Authors: Yann-erick Claessens, Eloise Trabattoni, Sophie Grabar, Laurent Quinquis, Guillaume Der Sahakian, Marine Anselmo, Jeannot Schmidt, Jean-emmanuel De La Coussaye, Patrick Plaisance, Enrique Casalino
    Abstract:

    INTRODUCTION: Presepsin (sCD14-ST) is an emerging biomarker for infection. We hypothesized that presepsin could specifically increase during Acute Pyelonephritis and correlate with severity. METHODS: We compared presepsin values in patients with Acute Pyelonephritis and controls, and we assessed its capacity to predict bacteraemia and admission in patients. RESULTS: In 312 patients with Acute Pyelonephritis (median age 33years), presepsin concentrations were higher than in controls (476 vs 200ng/L, p

  • Plasmatic presepsin (sCD14-ST) concentrations in Acute Pyelonephritis in adult patients.
    Clinica chimica acta; international journal of clinical chemistry, 2016
    Co-Authors: Yann-erick Claessens, Eloise Trabattoni, Sophie Grabar, Laurent Quinquis, Guillaume Der Sahakian, Marine Anselmo, Jeannot Schmidt, Jean-emmanuel De La Coussaye, Patrick Plaisance, Enrique Casalino
    Abstract:

    Abstract Introduction Presepsin (sCD14-ST) is an emerging biomarker for infection. We hypothesized that presepsin could specifically increase during Acute Pyelonephritis and correlate with severity. Methods We compared presepsin values in patients with Acute Pyelonephritis and controls, and we assessed its capacity to predict bacteraemia and admission in patients. Results In 312 patients with Acute Pyelonephritis (median age 33 years), presepsin concentrations were higher than in controls (476 vs 200 ng/L, p p p p  = 0.87) and less accurate than PCT (AUC = 0.78, p p  = 0.26) and PCT ( p  = 0.18). Conclusion Presepsin is a valuable biomarker to detect patients with Acute Pyelonephritis. However, it presents mild performance to predict bacteraemia and the need for admission, and offers no advantage as compared to CRP and PCT.

Massoud Majd – One of the best experts on this subject based on the ideXlab platform.

  • Renal cortical scintigraphy in the diagnosis of Acute Pyelonephritis.
    Seminars in nuclear medicine, 1992
    Co-Authors: Massoud Majd, H. Gil Rushton
    Abstract:

    Comparative clinical studies have shown renal cortical scintigraphy, using technetium-99m ( 99m Tc)-labeled glucoheptonate or dimercaptosuccinic acid (DMSA), to be significantly more sensitive than either intravenous pyelography or renal sonography in the diagnosis of Acute Pyelonephritis. However, due to uncertainties about the diagnostic accuracy of the clinical and laboratory parameters used in these studies, true sensitivity of renal cortical scintigraphy was unknown. Therefore, we evaluated the accuracy of [ 99m Tc]DMSA scintigraphy in the diagnosis of experimentally induced Acute Pyelonephritis in piglets using strict histopathologic criteria as the standard of reference. The sensitivity and specificity of the DMSA scan for the diagnosis of Acute Pyelonephritis were 91% and 99%, respectively, with an overall 97% agreement between the scintigraphic and histopathologic findings. Based on the results of this experimental study, we used the [ 99m Tc]DMSA scan as the standard of reference for the diagnosis of Acute Pyelonephritis, and conducted a prospective clinical study of 94 children hospitalized with the diagnosis of Acute febrile urinary tract infection (UTI). The aims of this study were (1) to determine the relationship among vesicoureteral reflux, P-fimbriated Escherichia coli , Acute Pyelonephritis, and renal scarring, and (2) to evaluate the diagnostic reliability of the clinical and laboratory parameters commonly used in the diagnosis of Acute Pyelonephritis. We documented Acute Pyelonephritis in 62 (66%) of 94 patients. Vesicoureteral reflux was demonstrated in 29 (31%) of the total group and in only 23 (37%) of 62 patients with Acute Pyelonephritis. The prevalence of P-fimbriae in the E coli isolates was 64% in the patients with Acute Pyelonephritis and 78% in those with a normal DMSA scan. Even in patients without reflux, P-fimbriae were found in 71% of isolates from the patients with Acute Pyelonephritis and in 75% of those with a normal renal scan. Follow-up DMSA scans were obtained in 33 patients with Acute Pyelonephritis in 38 kidneys. We found complete resolution of the Acute inflammatory changes in 58% of the involved kidneys and renal scarring in the remaining 42%, including 40% of the kidneys associated with reflux and 43% of those without reflux. The results of these experimental and clinical studies show the following: (1)[ 99m Tc]DMSA renal cortical scintigraphy is a highly sensitive and reliable technique for the diagnosis of Acute Pyelonephritis; (2) the diagnosis of Acute Pyelonephritis in children based on clinical and laboratory observations is unreliable; (3) Acute Pyelonephritis in the absence of reflux is common; (4) the presence of P-fimbriae alone does not fully explain the pathogenesis of Acute Pyelonephritis in the absence of reflux; (5) although high grades of reflux may be a risk factor for Acute Pyelonephritis, the risk of Pyelonephritis in patients with lower grades of reflux is the same as in those with no reflux; and (6) once Acute Pyelonephritis occurs, subsequent renal scarring is independent of the presence or absence of reflux. We conclude that DMSA renal cortical scintigraphy is a valuable diagnostic tool for investigating UTI, particularly in children. More precise diagnosis of Acute Pyelonephritis allows for newer insights into the pathophysiology of the disease and prevention of its sequelae, and in the future it may change the approach to the imaging evaluation and management of children with UTI.

  • Diagnosis of Acute Pyelonephritis in children: comparison of sonography and 99mTc-DMSA scintigraphy.
    AJR. American journal of roentgenology, 1991
    Co-Authors: Eythor Bjorgvinsson, Massoud Majd, K. D. Eggli
    Abstract:

    Ninety-one children 1 week to 10 years old with culture-documented febrile urinary tract infection were evaluated with renal sonography and renal cortical scintigraphy by using 99mTc-labeled dimercaptosuccinic acid (DMSA). On the basis of previous experimental studies, DMSA scintigraphy was used as the standard of reference for the diagnosis of Acute Pyelonephritis. The DMSA scans showed changes consistent with Acute Pyelonephritis in 63% (57/91) of the patients. Sonograms showed changes consistent with Acute Pyelonephritis in 24% (22/91) of the whole group and in only 39% (22/57) of the patients with scintigraphically documented Acute Pyelonephritis. Pertinent sonographic findings were areas of increased cortical echogenicity in 14 patients and decreased echogenicity in eight, including three patients with renal abscesses. Dilatation of the renal collecting system was noted in nine patients and renal enlargement was noted in three. We conclude that renal sonography is a relatively insensitive test for th…

Yuan Yow Chiou – One of the best experts on this subject based on the ideXlab platform.

  • adjunctive oral methylprednisolone in pediatric Acute Pyelonephritis alleviates renal scarring
    Pediatrics, 2011
    Co-Authors: Ya Yun Huang, Mei Ju Chen, Nan Tsing Chiu, Hsin Hsu Chou, Kuang Yen Lin, Yuan Yow Chiou
    Abstract:

    OBJECTIVE: To determine if glucocorticoids can prevent renal scar formation after Acute Pyelonephritis in pediatric patients. METHODS: Patients younger than 16 years diagnosed with their first episode of Acute Pyelonephritis with a high risk of renal scar formation (ie, inflammatory volume ≥ 4.6 mL on technetium-99m–labeled dimercaptosuccinic acid scan [DMSA] or abnormal renal ultrasonography results) were randomly assigned to receive either antibiotics plus methylprednisolone sodium phosphate (1.6 mg/kg per day for 3 days [MPD group]) or antibiotics plus placebo (placebo group) every 6 hours for 3 days. Patients were reassessed by using DMSA 6 months after treatment. The primary outcome was the development of renal scars. RESULTS: A total of 84 patients were enrolled: 19 in the MPD group and 65 in the placebo group. Patient characteristics were similar between the 2 groups, including the Acute inflammatory parameters and the initial DMSA result. Renal scarring was found in 33.3% of children treated with MPD and in 60.0% of those who received placebo (P CONCLUSIONS: Adjunctive oral MPD therapy reduced the occurrence and/or severity of renal scarring after Acute Pyelonephritis in these hospitalized children who had a high risk of renal scar formation.

  • Bacterial Virulence Factors are Associated With Occurrence of Acute Pyelonephritis but Not Renal Scarring
    The Journal of urology, 2010
    Co-Authors: Yuan Yow Chiou, Mei Ju Chen, Nan Tsing Chiu, Ching-yuang Lin, Chin Chung Tseng
    Abstract:

    Purpose: We evaluated the influence of patient factors and virulence factors of uropathogenic EschEscherichiai on the occurrence of Acute Pyelonephritis and subsequent renal parenchymal scarring.Materials and Methods: We evaluated 80 boys and 45 girls 1 to 180 months old with febrile urinary tract infections who underwent renal scan to diagnose Acute Pyelonephritis and followup dimercapto-succinic acid scintigraphy at least 6 months later. Urinalysis, white blood cell count, uropathogenic E. coli genotype and vesicoureteral reflux were measured. Voiding cystourethrogram was investigated after Acute Pyelonephritis was confirmed by renal scan and Acute inflammation subsided, about 2 to 4 weeks later.Results: Acute Pyelonephritis was significantly more likely to develop in children with urinary tract infections and persistent fever before and after hospitalization, elevated C-reactive protein or positive renal ultrasound findings. E. coli strains with the papG II and iha genes were significantly more likely …

H. Gil Rushton – One of the best experts on this subject based on the ideXlab platform.

  • Renal cortical scintigraphy in the diagnosis of Acute Pyelonephritis.
    Seminars in nuclear medicine, 1992
    Co-Authors: Massoud Majd, H. Gil Rushton
    Abstract:

    Comparative clinical studies have shown renal cortical scintigraphy, using technetium-99m ( 99m Tc)-labeled glucoheptonate or dimercaptosuccinic acid (DMSA), to be significantly more sensitive than either intravenous pyelography or renal sonography in the diagnosis of Acute Pyelonephritis. However, due to uncertainties about the diagnostic accuracy of the clinical and laboratory parameters used in these studies, true sensitivity of renal cortical scintigraphy was unknown. Therefore, we evaluated the accuracy of [ 99m Tc]DMSA scintigraphy in the diagnosis of experimentally induced Acute Pyelonephritis in piglets using strict histopathologic criteria as the standard of reference. The sensitivity and specificity of the DMSA scan for the diagnosis of Acute Pyelonephritis were 91% and 99%, respectively, with an overall 97% agreement between the scintigraphic and histopathologic findings. Based on the results of this experimental study, we used the [ 99m Tc]DMSA scan as the standard of reference for the diagnosis of Acute Pyelonephritis, and conducted a prospective clinical study of 94 children hospitalized with the diagnosis of Acute febrile urinary tract infection (UTI). The aims of this study were (1) to determine the relationship among vesicoureteral reflux, P-fimbriated Escherichia coli , Acute Pyelonephritis, and renal scarring, and (2) to evaluate the diagnostic reliability of the clinical and laboratory parameters commonly used in the diagnosis of Acute Pyelonephritis. We documented Acute Pyelonephritis in 62 (66%) of 94 patients. Vesicoureteral reflux was demonstrated in 29 (31%) of the total group and in only 23 (37%) of 62 patients with Acute Pyelonephritis. The prevalence of P-fimbriae in the E coli isolates was 64% in the patients with Acute Pyelonephritis and 78% in those with a normal DMSA scan. Even in patients without reflux, P-fimbriae were found in 71% of isolates from the patients with Acute Pyelonephritis and in 75% of those with a normal renal scan. Follow-up DMSA scans were obtained in 33 patients with Acute Pyelonephritis in 38 kidneys. We found complete resolution of the Acute inflammatory changes in 58% of the involved kidneys and renal scarring in the remaining 42%, including 40% of the kidneys associated with reflux and 43% of those without reflux. The results of these experimental and clinical studies show the following: (1)[ 99m Tc]DMSA renal cortical scintigraphy is a highly sensitive and reliable technique for the diagnosis of Acute Pyelonephritis; (2) the diagnosis of Acute Pyelonephritis in children based on clinical and laboratory observations is unreliable; (3) Acute Pyelonephritis in the absence of reflux is common; (4) the presence of P-fimbriae alone does not fully explain the pathogenesis of Acute Pyelonephritis in the absence of reflux; (5) although high grades of reflux may be a risk factor for Acute Pyelonephritis, the risk of Pyelonephritis in patients with lower grades of reflux is the same as in those with no reflux; and (6) once Acute Pyelonephritis occurs, subsequent renal scarring is independent of the presence or absence of reflux. We conclude that DMSA renal cortical scintigraphy is a valuable diagnostic tool for investigating UTI, particularly in children. More precise diagnosis of Acute Pyelonephritis allows for newer insights into the pathophysiology of the disease and prevention of its sequelae, and in the future it may change the approach to the imaging evaluation and management of children with UTI.

Leif Svensson – One of the best experts on this subject based on the ideXlab platform.

  • renal scarring after Acute Pyelonephritis
    Archives of Disease in Childhood, 1994
    Co-Authors: Birgir Jakobsson, Ulla Berg, Leif Svensson
    Abstract:

    Seventy six children, 18 boys and 58 girls, aged 0-15.9 (median 1.0) years, with Acute Pyelonephritis were prospectively studied with a technetium-99m dimercaptosuccinic acid (DMSA) scan during infection and two months later. Fifty nine of these children were also studied two years after the infection. Seventeen children with a normal DMSA scan during infection or at two months after infection, or both, were not investigated by a DMSA scan at two years after Acute Pyelonephritis. A micturition cystourethrogram was performed in all the children after two months. Changes on the DMSA scan were found in 65 (86%) children during Acute Pyelonephritis, in 45 (59%) children at two months, and in 28 (37%) children at two years after infection. Vesicoureteric reflux (VUR) was found in 19 (25%) children at two months. Renal scarring was significantly correlated with the presence of gross VUR and recurrent Pyelonephritis, but 62% of the scarred kidneys were drained by non-refluxing ureters. Children with scars were older at the time of Acute Pyelonephritis than those without scars but no difference was found between the groups with regard to duration of illness, levels of C reactive protein and maximum white cell count, glomerular filtfiltratione, nor renal concentration capacity at the time of infection. It is concluded that renal scarring after Acute Pyelonephritis in children is more common than has been previously thought. Although children with gross VUR and recurrent Pyelonephritis are at the greatest risk, renal scarring is more often seen without these risk factors.