[Balloon dilation treatment of primary obstructive megaureter in children].

PURPOSE: Investigation of the results of ureteral stricture single balloon dilation in children with primary obstructive megaureter. MATERIALS AND METHODS: Since 2012 to 2020 79 children (65 boys and 15 girls) with primary obstructive megaureter of II and III grades who had 92 affected ureters were operated on by method of ureteral stricture balloon dilation. Duration of postoperative stenting period was Me=68 [48; 91] days, bladder catheterization period - Me=15 [5; 61] days. Follow-up was from 1 to 10 years. RESULTS: There were no intraoperative complications in the group of investigation. Pyelonephritis exacerbation in the early postoperative period occurred in 15 cases (18,98%). Control comprehensive examination revealed that urodynamics of 63 children (79,74%) tended to normalization what persisted in the future. There was no positive dynamics in 16 cases (20,25%). Vesico-ureteral reflux was revealed in 4 cases. DISCUSSION: Assessment of impact of various predictors (passport, urodynamic, infectious, anatomic, operation and postoperative period characteristics) on the treatment results proved that the effectiveness of the procedure depends on the following factors: ureteral stricture length (M-U Test U=202,5 p=0,0002) and features of the stricture rapture during ballooning (Fisher exact p=0,0006). There was significant difference in results in the group of up to 10 mm inclusive stricture length and the longer stricture group (Fisher exact p=0,00001). High activity of pyelonephritis in postoperative period was the predictor of adverse outcome (Fisher exact p=0,00001). CONCLUSION: Practically 80% of children with primary obstructive megaureter may be reliably cured by the method of ureteral stricture balloon dilation. The risk of intervention failure is greatly increased in case of the stricture length is more than 10 mm and technical difficulties of ballooning indicating a high resistance of the narrowed portion of the ureter to dilation.

Predictors of ultrasound abnormalities among women treated for community-onset acute pyelonephritis: a prospective study.

OBJECTIVES: Acute pyelonephritis (AP) is a common but potentially severe infection. It may be complicated by pyelocaliceal dilatation which requires emergency urine drainage. In outpatient care, ultrasound (US) appears to be the easier way to diagnose pyelocaliceal dilatation, though most APs will not be complicated and do not require immediate ultrasound. We aimed to identify predictors of ultrasound abnormalities in an outpatient AP cohort. METHODS: A prospective study was conducted from April 2006 to September 2019 in an outpatient care network. Patients aged 15 and over treated for AP were included. Men, pregnant women, patients with solitary kidney, and patients without data on their management were excluded. A common algorithm ensured the same approach from diagnosis to treatment. Data were collected prospectively in an anonymized database. We described the characteristics of the patients. Univariate and then multivariate analyses were performed to identify predictors of ultrasound abnormalities. RESULTS: 2054 women were treated for AP. Among them, 32.5% (n = 667) had a history of urinary tract infections and 5.8% (n = 120) of uropathy. The most frequent uropathogen was E. coli (n = 1,432; 69.7%); Extended-Spectrum Beta-Lactamases (ESBLs) were found in 39 (1.9%) urine cultures. Ultrasound was abnormal in 7.3% (n = 149). Age over 55 years (OR = 2.23; 95% CI 1.58‒3.15; p < 0.0001) and uropathy (OR = 3.69; 95% CI 2.26‒6.01; p < 0.0001) were independently identified as predictors of ultrasound abnormalities. The risk increased by 1.8% (95% CI 1.0‒2.6) with each additional year of age. CONCLUSIONS: This study identified age and uropathy as independent predictors of abnormal ultrasound in women treated with community-onset AP.

[Two Cases of Emphysematous Pyelonephritis Successfully Treated by Transurethral Catheterization].

Emphysematous pyelonephritis (EPN) is a severe necrotic urinary tract infection accompanied by retention of gas in the kidney and areas around it. Formerly, emergency nephrectomy was the primary treatment, but the trend is shifting to treatment with maximum conservation of the kidney. In this report, two cases of EPN successfully treated by transurethral drainage are presented. The first case was in a 63-year-old woman with a history of poorly controlled diabetes. She arrived at the hospital by ambulance with primary symptoms of vomiting and trembling of the hands, and computed tomography (CT) revealed gas in the right renal calix. The second case was in a 61-year-old woman who arrived by ambulance with difficulty of body movement as the primary symptom, and CT revealed a calculus in the right ureter accompanied by right hydronephrosis and retention of gas in the right renal pelvis and right upper ureter. Both patients were diagnosed with EPN and treated by transurethral drainage rather than percutaneous drainage or nephrectomy because of their poor general condition. The treatment was successful. Along with percutaneous drainage, transurethral drainage is considered to be an option of surgical treatment for EPN.

[Risk Factors for Febrile Urinary Tract Infection after Transurethral Ureterolithotripsy : ANALYSIS of Treatment Outcomes of 1,235 Patients at a Single Center].

Recently, ureteroscopic lithotripsy remains the standard treatment for urolithiasis, with postoperative febrile upper urinary tract infection (fUTI) being one of its most significant complications. The current study sought to investigate the treatment outcomes of ureterorenoscopy (URS), morbidity and risk factors of postoperative fUTI at our hospital. A total of 1,235 patients who underwent URS (including those who underwent only semi-rigid URS) for upper urinary tract stones at our hospital between October 2011 and December 2019 were retrospectively analyzed. Patients had a median age of 63 years and a median stone length of 11.4 mm. F-URS was performed in 1,188 cases (96.2%) among whom 92.1% were stone-free or had stones that fractured into dust. Postoperative fUTI and sepsis occurred in 127 (10.3%) and 18 (1.5%) patients, respectively. Multivariate analysis identified female sex, American Society of Anesthesiologists (ASA) score ≥ 3, calculus length ≥ 20 mm, history of diabetes mellitus, and history of obstructive pyelonephritis as risk factors for postoperative fUTI. The scoring system (range 0-4) were positively correlated with the postoperative fUTI rate (score 0 : 3.1%, 1 : 12.4%, 2 : 14.1%, 3 : 23.7%, 4 : 40%). A significant difference in the rates was noted between those with a score of 0 (low-risk group), 1-2 (intermediate-risk group), and 3-4 scores (high-risk group). In conclusion, the overall incidence of postoperative fUTI was 10.3%, which was associated with sex, poor ASA scores, stone size, presence of diabetes mellitus, and history of pyelonephritis. The scoring system created using these factors can be useful in predicting postoperative fUTI.

[Diagnosis and treatment for emphysematous pyelonephritis: analysis of 14 cases from a single centre].

Objective: To examine the modalities of treatment and clinical outcomes of emphysematous pyelonephritis (EPN), in order to improve the survival rate of EPN patients. Methods: Totally 14 patients diagnosed as EPN between October 2011 and November 2020 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this article. Data collection including patient demographics, clinical manifestations, management and clinical outcomes were conducted by retrospective charts review, after receiving the institutional review board's approval. There were 11 females and 3 males with a median age of 59 years (range: 52 to 73 years). The lesions were located on the left side in 10 patients and right side in 4 patients. All the 14 patients suffered from fever, and present with severe sepsis or septic shock. The median time from symptom onset to admission to hospital was 3 days(range: 2 to 5 days). All cases had diabetes mellitus. Escherichia coli was the most common organism been cultured (11 cases), while Klebsiella pneumonia was the second (3 cases). CT scan showed bubbly or located gas in the renal parenchyma in 5 cases and presence of steaky or mottled gas in the renal parenchyma in 9 cases. All patients had been admitted to ICU for anti-septic shock therapy. Three patients had undergone percutaneous catheter drainage along with broad-spectrum antibiotics therapy while 3 patients had immediate nephrectomy, the other 8 cases had a combination of an initial percutaneous catheter drainage and second stage nephrectomy. Results: In this case series, 3 patients were died from EPN while the other 11 were survived. The median ICU stay time was 6 days (range: 3 to 11 days). Of the 3 patients died from EPN, 2 had undergone percutaneous catheter drainage along and 1 had received immediate nephrectomy. Among the 11 patients who were survived, only 1 had received percutaneous catheter drainage while the other 10 received nephrectomy (8 patients had staged nephrectomy). Follow-up was performed 6 months after discharge. Of the 11 surviving patients, 2 were lost to follow-up, and the remaining 9 patients had an creatine level of (118.4±29.4) µmol/L (range: 89 to 176 µmol/L). Conclusions: For patients coupled with diabetes who were initially diagnosed as acute pyelonephritis, the possibility of EPN should be considered when the disease progressed rapidly especially septic shock occurred. On the basis of empirical broad-spectrum antibiotics therapy and standardized anti-septic shock treatment, a combination of an initial percutaneous catheter drainage and second stage nephrectomy could be efficacious.

[Modern algorithm of diagnosis and treatment of acute gestational pyelonephritis in a large industrial city].

THE PURPOSE OF THE STUDY: to develop a modern algorithm for the diagnosis and treatment of acute gestational pyelonephritis in a large industrial city and to study the possibilities of phytotherapy as an integral part of this algorithm. MATERIALS AND METHODS: The study consisted of two stages and included 629 patients treated over 12 years (2010-2021) in Perm city with a population of 1.1 million people. At the first stage, the developed algorithm for the diagnosis and treatment of acute gestational pyelonephritis in 440 pregnant women was tested. A city emergency center for patients with gestational pyelonephritis was created with 3 urologists and related specialists on duty around the clock, what accelerated hospitalization timelines by 2.1 times. The patients underwent a level 1 examination, which included ultrasound examination, urine bacteriology and other methods. Patients in serve condition underwent, a level 2 examination, which included magnetic resonance imaging (MRI), ultrasound Dopplerography (USDG) and extended laboratory tests. RESULTS: During an urgent examination, acute purulent pyelonephritis was diagnosed in 27 (6.1%) patients who underwent 13 open surgeries (11 organ-preserving, 2 nephroectomies) and 14 minimally invasive (percutaneous nephrostomy, puncture of a kidney abscess) within 2-5 hours from the moment of hospitalization. Serve obstructive pyelonephritis was diagnosed in 286 patients, the passage of urine was restored by the installation of a stent or catheterization of the ureter. Conservative antibacterial therapy was performed in 127 patients with serous non-obstructive pyelonephritis. Positive results of treatment were observed in 439 (99.8%) patients: recovery in 95%, significant improvement in 4.8%, with a mortality rate of 0.2%. Bed-day decreased by 30.4%. At the second stage, a comparative randomized study was conducted during 4 years with 189 pregnant women with acute serous pyelonephritis enrolled. In the group 1 (n=94) patients received standard therapy according to the implemented algorithm, in the group 2 (n=95) patients had 60-day use of Canephron N. In the group 2, treatment results were better: recovery was achieved in 96.8% of patients, improvement in 3.2%, the number of pregnant women with leukocyturia and bacteriuria decreased 4.1 times, which prevented the occurrence of repeated attacks of acute pyelonephritis. Compared with standard therapy, Canephron N increased glomerular filtration by 12,3%, diuresis by 14.2%, increased urea excretion function of the kidneys, sanitized the urinary tract at an earlier timelines, reduced the number of premature births and the birth of dead and premature babies. CONCLUSION: As a result of the development and implementation of an algorithm for the diagnosis and treatment of acute gestational pyelonephritis and creation of the treatment center for such patients, it was possible to reduce significantly the time of hospitalization and inpatient treatment and achieve good treatment results in 99.8% of patients. The inclusion of long-term phytotherapy with Canephron N in the treatment regimen increased the effectiveness of treatment, improved kidney function in patients, significantly reduced the number of pregnant women with leukocyturia and bacteriuria, and reduced the risk of a repeated attack of pyelonephritis.

Increased Severe Adverse Outcomes and Decreased Emergency Room Visits for Pyelonephritis: First Report of Collateral Damage during COVID-19 Pandemic in Urology.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic is disrupting urology health-care worldwide. Reduced emergency room visits resulting in adverse outcomes have most recently been reported in pediatrics and cardiology. We aimed to compare patients with emergency room visits for pyelonephritis in 2019 (pre-COVID-19 era) and within the first wave of pandemic in 2020 (COVID-19 era) with regard to the number of visits and severe adverse disease outcomes. METHODS: We performed a retrospective multicentre study comparing characteristics and outcomes of patients with pyelonephritis, excluding patients with hydronephrosis due to stone disease, in 10 urology departments in Germany during a 1-month time frame in March and April in each 2019 and 2020. RESULTS: The number of emergency room visits for pyelonephritis in the COVID-19 era was lower (44 patients, 37.0%) than in the pre-COVID-19 era (76 patients, 63.0%), reduction rate: 42.1% (p = 0.003). Severe adverse disease outcome was more frequent in the COVID-19 era (9/44 patients, 20.5%) than in the pre-COVID-19 era (5/76 patients, 6.6%, p = 0.046). In detail, 7 versus 3 patients needed monitoring (15.9 vs. 3.9%), 2 versus no patients needed intensive-care treatment (4.5 vs. 0%), 2 versus no patients needed drain placement (4.5 vs. 0%), 2 versus no patients had a nephrectomy (4.5 vs. 0%), and 2 versus 1 patient died (4.5 vs. 1.3%). CONCLUSION: This report of collateral damage during CO-VID-19 showed that emergency room visits were decreased, and severe adverse disease outcomes were increased for patients with pyelonephritis in the COVID-19 era. Health authorities should set up information campaign programs actively encouraging patients to utilize emergency room services in case of severe symptoms specifically during the actual second wave of pandemic.

Catheterization Does Not Improve Course of Disease in Female Patients with Acute Cystitis or Pyelonephritis: Retrospective Analysis of >300 In-Hospital Treated Patients.

PURPOSE: Females with in-hospital treatment for acute cystitis (AC) or pyelonephritis may benefit from catheterization at admission. METHODS: All female patients with AC or pyelonephritis requiring in-hospital treatment at University Hospital Frankfurt (2004-2019) were retrospectively analyzed. Logistic regression models were used to predict the catheter value. RESULTS: Of 310 female patients, 40% harbored AC versus 60% pyelonephritis, of whom 62% and 74% received a catheter at admission: C-reactive protein (CRP) and white blood count (WBC) were significantly elevated in AC and pyelonephritis catheter versus no catheter patients (both p < 0.05). Time to CRP and WBC nadir did not differ between the AC catheter versus no catheter group (both p > 0.05). Conversely, time to CRP nadir was prolonged in pyelonephritis catheter patients. AC and pyelonephritis catheter patients exhibited a prolonged antibiotic treatment and length of stay (LOS, both p < 0.05). In multivariable analyses, CRP >5 ng/mL was a predictor for receiving a catheter in all patients. In AC, a positive urine culture and fever predicted, respectively, prolonged LOS or antibiotic treatment (all p < 0.05). CONCLUSION: Risk factors exist with regard to receiving a catheter and prolonged antibiotic treatment or LOS in females with AC or pyelonephritis. A catheter may not accelerate recovery or WBC nadir.

[Necrotizing Fasciitis of the Right Thigh Caused by Emphysematous Pyelonephritis Due to a Staghorn Stone : A Case Report].

We report a rare case of necrotizing fasciitis in the thigh induced by emphysematous pyelonephritis due to a staghorn stone. A 60-year-old female was diagnosed with a staghorn stone in the right kidney at another clinic. We referred her to another hospital for indication of percutaneous nephrolithotripsy. However, she chose not to visit the hospital. One year and three months later, she was transported to the emergencyward of our hospital because of a high fever and right hip joint pain. The diagnosis of right emphysematous pyelonephritis with a perinephric abscess was diagnosed by computed tomography. Transurethral ureteral stenting and percutaneous abscess drainage were performed and her condition improved. However, two weeks after the initial treatment, she developed swelling and pain in the right thigh. Computed tomographyrevealed multiple areas of gas in the right thigh and urgent debridement was performed. Escherichia coli was isolated from the cultures of urine and debrided tissues. The patient received several treatments, including two additional debridements, negative pressure wound therapy, and antimicrobial chemotherapy. Three months after the first debridement, the open wound of the right thigh was completely closed. Necrotizing fasciitis in the thigh due to emphysematous pyelonephritis is very rare. A favorable outcome was obtained byprompt debridement and negative pressure wound therapyin this case.

Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review.

BACKGROUND: The management of emphysematous pyelonephritis (EPN) includes conservative medical treatment, percutaneous drainage, and surgical resection of the involved kidney. EPN with diabetic ketoacidosis(DKA) is very rare, in which the clinical management of refusing surgical drainage is inexperienced. CASE PRESENTATION: A 34-year-old woman presented with abdominal pain, chills, fever, nausea, vomiting, chest tightness, and shortness of breath. Blood test results were consistent with diabetic ketoacidosis. Urinary computed tomography scan showed multiple stones in the right kidney and lower ureter, with right hydronephrosis. Blood culture demonstrated Escherichia coli bacteremia, and EPN was diagnosed. Considering the need for a second percutaneous nephrolithotomy, the patient refused percutaneous drainage. After continuous intravenous infusion of small doses of insulin and antibiotic treatment, the ketoacidosis resolved. The patient's temperature returned to normal and abdominal pain was alleviated, and liver and kidney functions were also back to normal. After hospital discharge, the patient underwent two percutaneous nephrolithotomy in the department of urology. CONCLUSIONS: EPN with diabetic ketoacidosis should be diagnosed as soon as possible. For patients with Class 1 and Class 2 EPN with diabetic ketoacidosis and urinary tract obstruction, if surgical drainage is refused, it is particularly important to rapidly correct diabetic ketoacidosis and intravenous use of sensitive antibiotics, so as to create conditions for follow-up percutaneous nephrolithotomy.

[Retroperitoneoscopic approach for treatment of acute obstructive calculous pyelonephritis. Alternative or a method of choice?]

AIM: to compare the results of treatment of patients with acute obstructive calculous pyelonephritis, who underwent to retroperitoneoscopic procedure, with patients, who underwent to drainage of the collecting system by means of ureteral stent or nephrostomy tube as the first stage. MATERIALS AND METHODS: A total of 121 patients were treated from 2011 to 2019. Of these, 78 patients were included in the main group. The stones were located in the ureteropelvic junction (n = 20) and the upper and middle ureter (n = 58). The average size of the stone was 12.9 +/- 4.8 mm. Preliminary upper urinary tract drainage was not carried out and the stone was removed completely. The group 2 consisted of 26 people. The stones were located in the upper (n = 18) and the middle ureter (n = 8); the average size was 9 +/- 2.8 mm. Renal drainage was done using ureteral stent and when pyelonephritis resolved, ureterolithotripsy was performed. The group 3 was represented by 17 patients. All stones were located in the ureteropelvic junction. The average size was 20.3 +/- 10.7 mm. Renal drainage was done using percutaneous nephrostomy; when there were no inflammatory changes, percutaneous nephrolithotripsy was performed. RESULTS: In the main group, normalization of body temperature and resolution of inflammatory changes in the blood and urine occurred earlier. The stone was removed completely and there were no residual fragments. Period of rehabilitation was are also significantly shorter than in groups 2 and 3. The retroperitoneoscopic method was more effective and safer for the treatment of patients with acute obstructive pyelonephritis caused by large stones located in the upper or middle ureter and ureteropelvic junction.

[Emphysematous pyelonephritis: case of successful conservative treatment].

Emphysematous pyelonephritis is rare form of pyelonephritis, which has mortality of nearly 80%. Conservative treatment can be successful in less than 30% of cases. Currently, in the guidelines there is no standard approach to conservative and surgical treatment of this entity. The clinical observation of successful conservative treatment of a patient with emphysematous pyelonephritis, associated with decompensated diabetes mellitus, from the diagnosis to recovery without performing nephrectomy in order to preserve kidney function, is described in the article.

Emphysematous pyelonephritis in renal allograft related to antibody-mediated rejection: A case report and literature review.

Emphysematous pyelonephritis (EPN) is a rare condition which can rapidly progress to sepsis and multiple organ failure with high mortality. We experienced a rare case of EPN in a renal allograft related to antibody-mediated rejection (AMR). The patient received a deceased donor kidney transplant due to end-stage renal disease secondary to diabetes mellitus. Cross-match test was negative but she had remote history of anti-HLA-A2 antibody corresponding with the donor HLA. Surgery concluded without any major events. Anti-thymoglobulin was given perioperatively for induction. She was compliant with her immunosuppressive medications making urine of 2 L/d with serum creatinine of 1.9 mg/dL at discharge on post-operative day (POD) 6. She did well until POD 14 when she presented to the clinic with features of sepsis, pain over the transplanted kidney area and decline in urine volume with elevated serum creatinine. CT revealed extensive gas throughout the transplanted kidney. Renal scan revealed non-functional transplant kidney with no arterial flow. Based on these findings, a decision to perform transplant nephrectomy was made. At laparotomy, the kidney was completely necrotic. Pathology showed non-viable kidney parenchyma with the tubules lacking neutrophilic casts suggestive of ischemic necrosis. Donor-specific antibody (DSA) returned positive with high intensity anti-HLA-A2 antibody. This is the first case of early EPN in allograft considered to have occurred as a result of thrombotic ischemia secondary to AMR. This case suggests consideration of perioperative anti-B-cell and/or anti-plasma cell therapies for historical DSA and strict post-operative follow-up in immunologically high-risk recipients to detect early signs of rejection and avoid deleterious outcomes.

A case of bilateral emphysematous pyelonephritis caused by Candida albicans.

Emphysematous pyelonephritis (EPN) is a life-threatening renal infection characterized by the formation of gas within the renal parenchyma and collecting duct system, as well as perinephric tissues. We herein report a case of bilateral EPN accompanied by the urinary tract infection caused by spherical growth of Candida albicans in a patient with underlying diabetes mellitus and prostate cancer. The diagnosis was assisted by computed tomography, urography, and gram staining. Despite immediate percutaneous catheter drainage and a 4-week course of antifungal treatment, the C. albicans infection was refractory, as indicated by continuous isolation from the urine, and the patient eventually died. A local autopsy of urinary organs revealed C. albicans in the renal tissue. EPN caused by Candida species frequently occurs in men, and almost all cases have underlying poorly controlled diabetes. This condition is subject to delayed diagnosis, which may lead to extended disease and high mortality. Candida species should be considered as causative microorganism for refractory EPN in patients with poorly controlled diabetes who are receiving antibiotic treatment. Gram staining may contribute to an early diagnosis of EPN caused by Candida species, which may require long-term antifungal therapy.

Imaging in Acute Pyelonephritis: Utilization, Findings, and Effect on Management.

OBJECTIVES: To determine the frequency, timing, and types of imaging obtained in patients with a discharge diagnosis of acute pyelonephritis, and how often imaging findings affect therapy. METHODS: This was a retrospective chart review of 1062 adults with a diagnosis of acute pyelonephritis discharged from an urban, safety-net hospital between January 1, 2008 and December 31, 2012. From the 739 patients selected after exclusions, we determined the number and proportion of patients imaged within the first 24 hours of admission, stratified by risk factors for pyelonephritis complications, and the frequency of positive findings leading to invasive interventions. RESULTS: Of 739 patients, 468 (63%) were imaged within 24 hours of admission, 262/414 (63%) of whom had risk factors for complications and 206/325 of whom (63%) did not. Among these, studies were positive in 117/468 (25%), 78/262 (30%) in those with risk factors, and 39/206 (19%) of those without risk factors. Of the 117 patients with positive imaging findings within 24 hours of admission, 58 (50%) underwent invasive procedures, 47 (60%) with risk factors and 11 (28%) without. Among all of the patients, interventions were directed at relieving obstructions much more commonly than treating abscess (51 patients vs 8). CONCLUSIONS: Among this population, imaging is frequently done earlier than recommended. Because the majority of interventions targeted stone disease, ultrasound may be the preferred initial modality rather than contrasted tomography when obtaining imaging early. Current guidelines may need to be revisited.

Incidence, risk factors, and clinical outcomes of acute kidney injury associated with acute pyelonephritis in patients attending a tertiary care referral center.

Acute kidney injury (AKI) associated with acute pyelonephritis (APN) rarely has been reported. The aim of this study was to evaluate the incidence and risk factors of AKI associated with APN. We retrospectively reviewed the medical records of 403 patients over 18-year old age hospitalized for APN management from October 2009 to September 2014 in tertiary care referral center. Demographic data, clinical symptoms and signs, and laboratory findings were gathered from the medical records and analyzed. The mean age of patients was 57 years and APN commonly occurred in female (87.6%). AKI occurred in 253 patients (62.8%). As per the RIFLE classification, renal injury was graded as 'Risk' (62.1%), 'Injury' (26.5%), and 'Failure' (11.4%). AKI patients were more likely a male gender and had complicated APN. The AKI group had a significantly higher tendency to present with shock. The prevalence of underlying chronic kidney disease (CKD) was significantly higher in the AKI group. There was no difference in mortality between the AKI and non-AKI groups. Multivariate analysis revealed that age over 65 (OR 1.93, 95% CI 1.18-3.13, p= .008), complicated (OR 2.13, 95% CI 1.35-3.34, p= .001) and bilateral APN (OR 1.71, 95% CI 1.01-2.88, p= .045), and initial shock (OR 2.44, 95% CI 1.05-5.71, p= .039) were independent risk factors for the occurrence of AKI in patients with APN. Physicians should attempt to prevent, detect, and manage AKI associated with APN in patients with above conditions.

Bilateral Pyelonephritis in a Cat with Multiple Urinary Malformations Including Ureteral Pseudodiverticulosis.

Ureteral pseudodiverticulosis is an unusual acquired abnormality in humans and dogs. This report describes the first feline case of ureteral pseudodiverticulosis, associated with right retrocaval ureter and malposition of the uretero-vesical junctions, in the context of pyelonephritis. The coexistence of pseudodiverticulosis with other urinary abnormalities suggested that this lesion should be considered in other patients with urinary pathology.

Impact of Introduction of a Clinical Pathway for the Management of Pyelonephritis on Obstetric Patients: a Quality Improvement Project

Aim To determine whether the introduction of a clinical pathway for the treatment of pyelonephritis in obstetric patients would improve outcomes. Methods This was a retrospective study conducted in a maternity hospital using quantitative analysis methods. Patients who met laboratory and clinical criteria for pyelonephritis during data collection were included. Results The study included analysis of 23 patients pre-intervention and 19 post-intervention. Baseline and patient characteristics were similar for both groups. A statistically significant difference was seen in 3 of 7 outcome measures. Increased use of gentamicin (13% Vs 52% p=0.006), Increased number of renal ultrasounds (17% Vs 47%, p=0.04) and increased use of prophylaxis (21% Vs 68%, p=0.003). The proportion of patients receiving ≥ 10 days of IV antimicrobials decreased from 48% to 21% post-intervention (p=0.07). Discussion This study has shown that the introduction of a pathway for the treatment of pyelonephritis in pregnancy had a positive impact on several important clinical outcomes.

The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients. Part II: Therapy and Prevention.

BACKGROUND: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Results are published in 2 parts. Part 1 covers methods, the definition of patient groups, and diagnostics. This second publication focuses on treatment of acute episodes of cystitis and pyelonephritis as well as on prophylaxis of recurrent UTIs. MATERIALS AND METHODS: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010-2015. RESULTS: For the treatment of acute uncomplicated cystitis (AUC), fosfomycin-trometamol, nitrofurantoin, nitroxoline, pivmecillinam, and trimethoprim (depending on the local rate of resistance) are all equally recommended. Cotrimoxazole, fluoroquinolones, and cephalosporins are not recommended as antibiotics of first choice, for concern of an unfavorable impact on the microbiome. Mild to moderate uncomplicated pyelonephritis should be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For AUC with mild to moderate symptoms, instead of antibiotics symptomatic treatment alone may be considered depending on patient preference after discussing adverse events and outcomes. Primarily non-antibiotic options are recommended for prophylaxis of recurrent urinary tract infection. CONCLUSION: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.

The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients: Part 1.

OBJECTIVES: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. MATERIALS AND METHODS: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, -EMBASE, and the Cochrane Library to identify literature published in 2010-2015. RESULTS: We provide 75 recommendations and 68 statements in the updated evidence- and consensus-based national clinical guideline. The diagnostics part covers practical recommendations on cystitis and pyelonephritis for each defined patient group. Clinical examinations, as well as laboratory testing and microbiological pathogen assessment, are addressed. CONCLUSION: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.