Emphysematous pyelonephritis

A case of emphysematous pyelonephritis with perirenal gas is presented. This patient underwent vigorous medical treatment followed by nephrectomy and survived. This condition has a high mortality and should be distinguished from less severe infections where gas is confined to the collecting system. This case and others previously reported suggest that treatment should initially be medical, followed by early surgical intervention consisting of either drainage or nephrectomy depending upon the degree of renal involvement.     

Escherichia coli-specific T lymphocytes in experimental pyelonephritis

We have assessed the phenotype and specificity of infiltrating mononuclear cells in a model of unilateral ascending acute pyelonephritis induced in rats with nephritogenic Escherichia coli or Pseudomonas aeruginosa. Histologic examination showed a predominance of mononuclear cells in the interstitium at all periods examined (4, 8, 15, 21, and 25 days), although at 4 and 8 days neutrophils were also abundant. Most of the mononuclear cells had the morphologic appearance of large lymphocytes. Immunoperoxidase studies with mAb showed that most of the mononuclear cells were W3/25+; many were W3/13+ and a small proportion were OX8+. Many of the mononuclear cells were Ia+. T cells were propagated in IL-2-containing media from small fragments of renal tissue with pyelonephritic lesions. Most of the propagated cells were W3/25+; fewer than (10%) were OX8+ or Ia+. T cells propagated from kidneys infected with E. coli responded, in proliferation assays, to the infecting strain or other E. coli strains, but not to P. aeruginosa or enterococci. The response to non-p-pilus-bearing E. coli was as great or greater than to E. coli with adhesins. T cells derived from lesions induced by P. aeruginosa responded to the infecting organisms, but not to E. coli. The response to the infecting organism (E. coli or P. aeruginosa) was MHC restricted, as indicated by the requirement for syngeneic APC. The results show that large numbers of T lymphocytes, especially with the "helper/inducer" phenotype, accumulate in the lesions of acute pyelonephritis in rats. Among the infiltrating T lymphocytes are activated cells and cells with specific reactivity to the infecting bacteria (or related strains). The findings indicate that T lymphocytes play a role within the kidney in response to the invading bacteria.     

Antibacterial therapy of pyelonephritis in pregnant women

To determine the optimal schemes of rational antibacterial therapy of pyelonephritis gravidarum with ampicillin and cephuroxim, assays of the patient urine and studies on the pharmacokinetics of the drugs were performed. The bacteriurea levels were estimated in 264 women with Gould's method in modification of Ryabinsky and Rodoman. The causative agents of the disease were isolated from the urine of 92 pregnant women. Sensitivity of the isolates to 9 antibiotics was tested with the use of standard paper disks and the method of serial dilutions in solid media. The pharmacokinetics of ampicillin and cephuroxim in the blood and urine of 97 patients was studied for 6-8 hours after parenteral administration of the antibiotics in doses of 500 mg. Comparative analysis of the pharmacokinetic parameters of the antibiotics in the blood and urine of the patients, the antibiotic MICs for the disease causative agents and the clinical course of the disease suggests that pyelonephritis gravidarum should be treated with ampicillin and cephuroxim on doses of 500 mg injected intramuscularly 4 and 3 times a day respectively for 7-8 days in combination with antiinflammatory therapy.