Clinicopathologic Spectrum and Outcomes of Infections Diagnosed on Graft Biopsies and Nephrectomy in Live Renal Allograft Recipients: An Institutional Experience.

OBJECTIVES: Modern immunosuppressive regimens have reduced rejection episodes in renal allograft recipients but have increased the risk of opportunistic infections. Infections are considered to be the second leading cause of death after cardiovascular complications in renal allograft recipients. Data on opportunistic infections affecting the allograft itself are scarce. The present study describes the spectrum of renal opportunistic infections and their outcomes diagnosed on renal allograft biopsies and nephrectomy specimens. MATERIALS AND METHODS: Our retrospective observational study was conducted from December 2011 to December 2021. We analyzed infectious episodes diagnosed on renal allograft biopsies or graft nephrectomy specimens. We obtained clinical, epidemiological, and laboratory details for analyses from hospital records. RESULTS: BK virus nephropathy was the most common opportunistic infection affecting the allograft, accounting for 47% of cases, followed by bacterial graft pyelonephritis (25%). Mucormycosis was the most common fungal infection. The diagnosis of infection from day of transplant ranged from 14 days to 39 months. Follow-up periods ranged from 1 to 10 years. Mortality was highest among patients with opportunistic fungal infection (62%), followed by viral infections, and graft failure rate was highest in patients with graft pyelonephritis (50%). Among patients with BK polyomavirus nephropathy, 45% had stable graft function compared with just 33% of patients with bacterial graft pyelonephritis. CONCLUSIONS: BK polyoma virus infection was the most common infection affecting the renal allograft in our study. Although fungal infections caused the highest mortality among our patients, bacterial graft pyelonephritis was responsible for maximum graft failure. Correctly identifying infections on histology is important so that graft and patient life can be prolonged.

Diabetes mellitus increases mortality in acute pyelonephritis patients: a population study based on the National Health Insurance Claim Data of South Korea for 2010-2014.

OBJECTIVE: Diabetes mellitus has been suspected to increase mortality in acute pyelonephritis (APN) patients and the goal of this study is to verify this suspicion with a large data set based on almost the entire population of South Korea. METHODS: A nationwide cohort study was conducted using a South Korean Health Insurance Review and Assessment Service claim database. We collected demographic and clinical information including comorbidities of patients with APN as the primary discharge diagnosis during 2010-2014. Then we compared the in-hospital mortality and recurrence of APN across the diabetes and non-diabetes groups. RESULTS: Among 845,656 APN patients, 12.4% had diabetes mellitus. The median age was 65 in the diabetes group, which was much higher than 47 in the non-diabetes group; the female proportion was 91-92% in both groups. The in-hospital mortality rate was higher in the diabetes group (2.6/1000 events in the diabetes group vs. 0.3/1000 in the non-diabetes group, P < 0.001). When covariates (age, sex, and the modified Charlson comorbidity index) were controlled with panel logistic regression, diabetes was still associated with a higher in-hospital mortality in APN patients (OR 2.66, 95% CI 2.19-3.23). The increasing effect of diabetes on in-hospital mortality of APN patients varied greatly with age: the effect was large for age 15-49 (OR 15.06, 95% CI 5.27-43.05), slightly smaller for age 50-64 (OR 12.17, 95% CI 5.71-25.92), and much smaller for age ≥ 65 (OR 2.10, 95% CI 1.72-1.92). CONCLUSIONS: Our data indicate that the mortality of APN is higher in the patients with diabetes and this effect becomes stronger for young patients.

Staphylococcus Aureus Osteomyelitis as an Inducer of Tolerance to Escherichia Coli Pyelonephritis: an Experimental Study.

The high incidence of osteomyelitis in vulnerable populations like those with multiple injuries or elderly undergoing joint arthroplasties generates the question what may be their responses to subsequent infection by high virulent isolates. Rabbits were subject to two operations at three week intervals; sham osteomyelitis and sham pyelonephritis (group S); sham osteomyelitis and Escherichia coli pyelonephritis (group P); and Staphylococcus aureus osteomyelitis and E. coli pyelonephritis (group OP). Survival was recorded; cytokine stimulation of circulating mononuclear cells (PBMCs) and tissue myeloperoxidase (MPO) activity and bacterial growth were monitored. In some experiments, dalbavancin treatment was given before pyelonephritis. Healthy PBMCs were pre-treated with bone homogenate, S. aureus or both. Mortality of groups S, P and OP after induction of pyelonephritis was 0%, 50% and 8.3% respectively. Tumour necrosis factor-alpha (TNFα) production by PBMCs was significantly lower in the OP group at 48 hours. E. coli bacterial load was similar in groups P and OP at death or sacrifice whereas the MPO activity of group OP was decreased. Production of TNFα was further decreased among dalbavancin treated rabbits; in these rabbits tissue MPO was increased. TNFα production decreased when healthy PBMCs pre-treated with bone homogenate, S. aureus (HKSA) or both were stimulated with E. coli (HKEC); production was further decreased in the presence of anti-TLR4 and anti-TLR9. It is concluded that staphylococcal osteomyelitis modulated the innate immune responses of the host leading to protection from death by highly virulent E. coli. Tolerance to TLR ligands is the most likely mechanism of action.

Carbapenem-resistant Enterobacteriaceae: A retrospective review of treatment and outcomes in a long-term acute care hospital.

BACKGROUND: Long-term acute care hospitals (LTACHs) have a unique patient population, with multiple risk factors for carbapenem-resistant Enterobacteriaceae (CRE) colonization and infection. METHODS: We performed a retrospective analysis of patients in LTACHs who were diagnosed with and treated for CRE infections. Baseline data, antimicrobial treatment, and outcomes were collected in patients with bacteremia, health care-associated pneumonia, and complicated urinary tract infection/acute pyelonephritis due to CRE diagnosed between January 2017 and December 2017. RESULTS: A total of 57 cases of CRE infection were identified over the study period, including 12 cases of bacteremia, 20 cases of health care-associated pneumonia, and 25 cases of complicated urinary tract infection/acute pyelonephritis. Patient had significant comorbidities: 31.5% with diabetes, 40.4% with heart failure, 29.8% with kidney disease, and 10% with solid tumors. The majority (56) of 57 patients received empiric antibiotics known to have activity against gram-negative bacteria, but only 38.6% had in vitro activity against the CRE organism in cultured specimens. A total of 78.9% of patients received monotherapy. Overall outcome was poor, with 28-day mortality across all infection sites of 17.5% in patients but up to 25% in patients with bacteremia. CONCLUSIONS: In this retrospective analysis of our clinical experience treating CRE infections in an LTACH setting, we documented that CRE infections occur in patients with substantial comorbidities. Although clinical outcome remains of great concern, the 28-day mortality and rate of eradication of CRE in this study were comparatively better than other national estimates. Inappropriate empiric treatment may be one of many factors leading to overall poor treatment outcomes.

[Results of conservative management of emphysematous pyelonephritis]. / Résultats du traitement conservateur de la pyélonéphrite emphysémateuse.

INTRODUCTION: Emphysematous pyelonephritis (EPN) is a rare and severe, necrotizing infection of the kidney. Diagnosis should be precocious based on computed tomography (CT). Its management remains controversial and its treatment is currently increasingly conservative. The aim of this paper is to discuss the conservative treatment of this disease through our experience in 21 patients. MATERIAL AND METHODS: A retrospective analysis including 21 patients managed conservatively for an emphysematous pyelonephritis in our department from January 2010 to April 2015. Follow-up ranged from three to 24 months. RESULTS: Of the 24 patients, seven belonged to class 1, twelve to class 2 and two to class 4. Obstruction of the upper urinary tract was found in 16 cases. On the risk factor stratification, thrombocytopenia was found in five cases, renal function impairment in 10 cases and a septic shock in four cases. All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad-spectrum antibiotics. Drainage of the urinary tract was performed by double-J stent in 14 patients and with ureteral catheter in six patients. One patient had urinary distension secondary to a urethral stricture with bilateral emphysematous pyelitis. In this case, drainage consisted in suprapubic bladder catheter only. The outcome was favorable in 18 patients and the control CT showed a decline or complete disappearance of gas in urinary tract and/or renal parenchyma after an average period of 12 days. A secondary nephrectomy was performed in two cases. Specific mortality rate was zero. CONCLUSION: PNE remains a severe infection involving the vital prognosis. Computed tomography makes an early diagnosis. Treatment should be conservative based on the association of medical intensive care and drainage, percutaneous or endoscopic, urgently. Nephrectomy should be reserved for extensive forms with multiple organ dysfunction or failure of conservative treatment.

Esmolol: immunomodulator in pyelonephritis by Pseudomonas aeruginosa.

BACKGROUND: Based on previous animal studies showing promising immunomodulatory efficacy esmolol, a selective ß1-blocker, it was assumed that administration of esmolol in experimental pyelonephritis by multidrug-resistant Pseudomonas aeruginosa would prolong survival and modulate immune response. METHODS: Acute pyelonephritis was induced in 80 rabbits and assigned to eight groups receiving normal saline (controls), esmolol, amikacin, or both agents as pretreatment and as treatment. Blood was sampled for measurement of malondialdehyde and tumor necrosis factor alpha. Animals were followed up for survival, and after death quantitative tissue cultures were performed. The in vitro effect of esmolol on bacterial growth and on the oxidative burst of neutrophils of healthy controls and of sepsis patients was studied. RESULTS: Survival of pretreatment groups administered single esmolol or esmolol and amikacin was prolonged compared with that of controls (P = 0.018 and P = 0.014, respectively); likewise, survival of treatment groups administered single esmolol or both agents was prolonged compared with that of controls (P = 0.007 and P = 0.014, respectively). Circulating malondialdehyde was significantly lower in pretreated animals administered esmolol or esmolol and amikacin compared with that in controls and in treated animals administered both agents compared with in controls (P = 0.020). In these groups, the bacterial load of the lung was significantly lower compared with controls. Serum tumor necrosis factor alpha did not change. Amikacin was increased in serum of esmolol-treated animals at levels which inhibited the in vitro growth of the studied isolate. Esmolol did not modify the in vitro growth of P aeruginosa and the oxidative burst of neutrophils. CONCLUSIONS: It is concluded that esmolol prolonged survival after experimental infection by multidrug-resistant P aeruginosa. Survival benefit may be related with pleiotropic actions connected with modulation of pharmacokinetics and attenuation of inflammation.

Emphysematous infections of the kidney and urinary tract: a single-center experience.

Emphysematous pyelonephritis (EPN) is a group of potentially life-threatening conditions seen particularly in diabetics, leading to high morbidity and mortality. Our aim was to study the profile of emphysematous infections of the kidney and urinary tract and evaluate the effect of early surgical intervention on mortality. This is an observational study conducted in a tertiary care hospital between January 2009 and January 2013, in which the clinical, laboratory, microbiological and radiological profiles of patients with EPN (diagnosed based on clinical, laboratory and imaging findings) was studied. A total of 12 patients were studied, including 10 with diabetes. A total of 66.6% had pyelonephritis, 25% had both cystitis and pyelonephritis and 8.3% had only cystitis; involvement of the left kidney was more common and bilateral involvement was seen in two cases. The clinical features seen in the patients included fever (100%), features of urinary infection (66.6%) and flank pain (50%). Culture positivity was seen in only 50% of the cases. Ten patients underwent percutaneous drainage (PCD) within 24 h, and two of these patients required nephrectomy subsequently. All patients were followed-up for one month. There was one death (mortality 8.3%), and all other patients responded well and recovered. Our study suggests that EPN is a potentially life-threatening condition that requires aggressive and prompt medical therapy with early PCD to reduce morbidity and mortality. Nephrectomy should be reserved for cases that do not respond to PCD.

Clinical characteristics predicting early clinical failure after 72 h of antibiotic treatment in women with community-onset acute pyelonephritis: a prospective multicentre study.

In patients with community-onset acute pyelonephritis (CO-APN), assessing the risk factors for poor clinical response after 72 h of antibiotic treatment (early clinical failure) is important. The objectives of this study were to define those risk factors, and to assess whether early clinical failure influences mortality and treatment outcomes. We prospectively collected the clinical and microbiological data of women with CO-APN in South Korea from March 2010 to February 2012. The numbers of cases in the early clinical success and early clinical failure groups were 840 (79.1%) and 222 (20.9%), respectively. Final clinical failure and mortality were higher in the early clinical failure group than in the early clinical success group (14.9% vs 2.3%, p <0.001; 6.8% vs 0.1%, p 0.001, respectively). In a multiple logistic regression model, the risk factors for early clinical failure among the total 1062 patients were diabetes mellitus (OR 1.5; 95% CI 1.1-2.1), chronic liver diseases (OR 3.3; 95% CI 1.6-6.7), malignancy (OR 2.2; 95% CI 1.1-4.4), Pitt score ≥2 (OR 2.5; 95% CI 1.6-3.8), presence of azotaemia (OR 1.8; 95% CI 1.2-2.7), white blood cell count ≥20 000/mm(3) (OR 2.5; 95% CI 1.6-4.0), serum C-reactive protein level ≥20 mg/dL (OR 1.7; 95% CI 1.2-2.4), and history of antibiotic usage within the previous year (OR 1.5; 95% CI 1.1-2.2). Analysing the subgroup of 743 patients with CO-APN due to Enterobacteriaceae, fluoroquinolone resistance of the uropathogen was another factor associated with early clinical failure (OR 1.7; 95% CI 1.1-2.5). Simple variables of underlying diseases, previous antibiotic usage and initial laboratory test outcomes can be used to decide on the direction of treatment in CO-APN.

Emphysematous pyelonephritis: an 8-year retrospective review across four acute hospitals.

OBJECTIVE: To retrospectively review our experience of managing patients with emphysematous pyelonephritis (EPN). METHODS: Case notes of patients with EPN were reviewed. The patients' demographic data, clinical presentation, investigation findings, treatment, and outcome were studied. RESULTS: Twelve patients were diagnosed with EPN. Majority (66.7%) of them had diabetes mellitus. All patients had been evaluated by computed tomography (CT). Using the classification proposed by Wan et al, five patients had type 1 EPN, whereas six, two, and four patients had Huang and Tseng CT class 2, 3a, and 3b EPN, respectively. Immediate nephrectomy was performed in six patients, whereas conservative treatment was adopted in the other six. In the nephrectomy group, one patient died of disseminated sepsis after a protracted course. Conservative treatment failed in three patients, who succumbed despite salvage nephrectomy in two of them. Analysis revealed that severe hyperglycemia and radiological CT class (both Wan and Huang systems) were significant predictors of mortality from EPN. CONCLUSION: Severe hyperglycemia and CT class of EPN are significant risk factors for death. CT is the investigation of choice for correct diagnosis of EPN. Additional intervention should be offered to EPN patients with Wan type 1 and Huang and Tseng class 3 CT features.

[Therapeutic morbidity rate among female military personnel, with exposure to occupational hazards in the period of service in the Armed Forces its influence on the course of pregnancy and fetal development].

The study was made into therapeutic incidence among female military personnel who had contact with various kinds of occupational hazards in the period of military service, its impact on pregnancy and fetal development. Special attention was also paid to long-term consequences of obstetric and therapeutic pathological comorbidity on the development of the child. It has been established, that in the spectrum of therapeutic morbidity among female military personnel chronic gastritis, pyelonephritis and autoimmune thyroiditis prevail and often have a chronic stress as a background for their development. Children born to mothers, who in the period of pregnancy showed the combination of chronic pyelonephritis, autoimmune thyroiditis and late gestosis are a group of high risk for the development of the intracranial hypertension in children and/or infectious diseases.

Pathogen specific, IRF3-dependent signaling and innate resistance to human kidney infection.

The mucosal immune system identifies and fights invading pathogens, while allowing non-pathogenic organisms to persist. Mechanisms of pathogen/non-pathogen discrimination are poorly understood, as is the contribution of human genetic variation in disease susceptibility. We describe here a new, IRF3-dependent signaling pathway that is critical for distinguishing pathogens from normal flora at the mucosal barrier. Following uropathogenic E. coli infection, Irf3(-/-) mice showed a pathogen-specific increase in acute mortality, bacterial burden, abscess formation and renal damage compared to wild type mice. TLR4 signaling was initiated after ceramide release from glycosphingolipid receptors, through TRAM, CREB, Fos and Jun phosphorylation and p38 MAPK-dependent mechanisms, resulting in nuclear translocation of IRF3 and activation of IRF3/IFNß-dependent antibacterial effector mechanisms. This TLR4/IRF3 pathway of pathogen discrimination was activated by ceramide and by P-fimbriated E. coli, which use ceramide-anchored glycosphingolipid receptors. Relevance of this pathway for human disease was supported by polymorphic IRF3 promoter sequences, differing between children with severe, symptomatic kidney infection and children who were asymptomatic bacterial carriers. IRF3 promoter activity was reduced by the disease-associated genotype, consistent with the pathology in Irf3(-/-) mice. Host susceptibility to common infections like UTI may thus be strongly influenced by single gene modifications affecting the innate immune response.

Pielonefritis enfisematosa: reporte de dos casos y revisión de la literatura / Emphysematous pyelonephitis: report of two cases and review

Presentamos dos pacientes mujeres diabéticas con Pielonefritis enfisematosa bilateral atendidas en nuestro hospital. Ambas tenían más de 50 años de edad. El diagnóstico se realizó por la presencia de gas a nivel de amos riñones, en la tomografía axial computarizada (TAC) abdominal. Una de las pacientes fue sometida a nefrectomía bilateral y la otra a nefrectomía derecha. Ambas pacientes tuvieron mala evolución pese al tratamiento antibiótico y quirúrgico. Debido a su alta mortalidad hacemos énfasis en el diagnóstico y tratamiento precoz.

Pielonefrite enfisematosa / Emphysematous pyelonephritis

Pielonefrite enfisematosa é uma infecção necrotizante renal, mais freqüentemente diagnosticada em diabéticos. A taxa de mortalidade é elevada. Relatamos um caso de pielonefrite enfisematosa bilateral em paciente diabética que se apresentou em insuficiência renal aguda e choque séptico, evoluindo para óbito após seis dias de tratamento conservador.

Emphysematous pyelonephritis is a necrotizing renal infection most frequently seen in patients with diabetes mellitus that is associated with a high mortality rate. We report a case of bilateral emphysematous pyelonephritis who presented with renal failure and septic shock. The patient died after six days of conservative therapy.

Severe emphysematous pyelonephritis in diabetic patients: diagnosis and aspects of surgical management.

PURPOSE: Emphysematous pyelonephritis (EPN) is a rare, severe gas-forming infection of renal parenchyma and surrounding tissues seen mostly in diabetic patients. Diagnosis and adequate therapeutic regimen are controversial. We reviewed the clinical presentation, diagnosis and aspects of surgical management of patients presenting with severe EPN. PATIENTS AND METHODS: Patients with EPN managed in our unit between 1996 and 2004 were reviewed. Diagnosis was confirmed by CT scan appearance of gas in the renal or perirenal area in a very ill patient. We compared the outcome of immediate nephrectomy with drainage of perinephric abscesses in patients presenting with severe EPN. RESULTS: Seven patients were managed in our unit during the 8-year period. All patients were diabetic and women outnumbered men (6:1). Renogram in all 7 patients showed renal function of affected kidney to be less than 15% in 6 patients. Escherichia coli was isolated in all patients from either urine, blood or perinephric pus. Management consisted of intensive resuscitation, control of blood glucose and use of intravenous antibiotics. Emergency nephrectomy was performed in 3 patients, delayed nephrectomy after an initial period of percutaneous drainage in 2 patients, incision and drainage in one patient and immediate percutaneous drainage was performed in one patient. One patient died 5 days post-nephrectomy of myocardial infarction. Patients who had immediate nephrectomy recovered quicker (18-21 days) and had no postoperative complications. Patients who had incision and drainage, or percutaneous drainage presented with recurrent discharging sinuses or perinephric abscesses requiring further surgical interventions and spent longer time in hospital (28-37 days). CONCLUSION: Patients with severe EPN often present in extremis and require intensive medical treatment. The diagnosis must be entertained in diabetic women presenting with flank pain and septicemia. The function of the affected kidney is often very poor and early nephrectomy offers the best outcome. Percutaneous drainage or incision and drainage of the abscess may be performed in patients too ill for immediate formal nephrectomy.

Clarithromycin co-administered with amikacin attenuates systemic inflammation in experimental sepsis with Escherichia coli.

To assess the efficacy of clarithromycin as an immunomodulator in experimental sepsis with Escherichia coli, acute pyelonephritis was induced after ligation of the right ureter and injection of the test isolate into the renal pelvis in 40 rabbits. Four groups of treatment were applied with administration of therapy on advent of sepsis-associated pulmonary oedema, as follows: A: controls; B: clarithromycin; C: amikacin, D: both agents. Survival was recorded along with estimation of serum levels of endotoxins (LPS), of tumour necrosis factor-alpha (TNFalpha), malondialdehyde (MDA) and of bacterial counts. Mean survival of groups A, B, C and D was 2.51, 7.60, 10.25 and 11.40 days, respectively. Serum levels of TNFalpha and of MDA of group A increased over-time. Pulmonary oedema at 6 h after bacterial challenge was accompanied by increase of TNFalpha and MDA; administration of clarithromycin decreased their values. It is concluded that intravenous clarithromycin might constitute a promising immunomodulatory agent for the management of sepsis since its efficacy was proved after administration on presentation of sepsis-associated pulmonary oedema. The presented findings emphasise the need for further clinical research of the use of clarithromycin for the therapy of Gram-negative sepsis.

[Acute pyelonephritis in diabetes mellitus]. / Ostryi pielonefrit pri sakharnom diabete.

The authors present treatment policy in acute pyelonephritis (AP) associated with diabetus mellitus (DM) and analyse treatment efficacy basing on the material on 214 patients. A clinical course of AP in the presence of DM has some specific features. The disease manifests primarily with clinico-laboratory signs of DM decompensation. Lack of insulin therapy effect in DM decompensated patients indirectly points to acute, especially purulent, pyelonephritis. High temperature, abnormal leukocytic blood picture, leukocyturia, hypercreatininemia in patients with insulin-resistent DM demands urological examination. Renal and urinary pathology is prompted by x-ray picture of atonic dilation of the caliculopelvic system and ureter in neuropathy. Vesicoureteral reflux, tower-like deformation of the urinary bladder, ureterohydronephrosis in DM patients are readily diagnosed with cystography, excretory urography and ultrasonic investigation. Therapeutic policy must be based on pyelonephritis form, severity of DM and efficacy of conservative therapy. No response to therapy, increasing academia and intoxication show failure of conservative treatment and absolute necessity of surgery. In extended purulent acute pyelonephritis preference is given to primary nephrectomy. The differentiated policy of acute pyelonephritis treatment led to DM remission and therapeutic response in 84.6% patients. Total lethality was 15.4%. Its cause was a severe condition of the patients.

Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome.

PURPOSE: To correlate imaging findings of types I and II emphysematous pyelonephritis (EPN) with clinical course and prognosis. MATERIALS AND METHODS: The imaging studies and clinical outcome in 38 patients with EPN were retrospectively studied. The imaging studies performed included radiography (n = 33), computed tomography (n = 31), and ultrasonography (n = 35). RESULTS: Two types of EPN were identified. Type I EPN was characterized by parenchymal destruction with either absence of fluid collection or presence of streaky or mottled gas. Type II EPN was characterized as either renal or perirenal fluid collections with bubbly or loculated gas or gas in the collecting system. The mortality rate for type I EPN (69%) was higher than that for type II (18%). Type I EPN tended to have a more fulminant course with a significantly shorter interval from clinical onset to death (P < .001). CONCLUSION: Two distinct types of EPN can be seen radiologically, and the differentiation is important due to the prognostic difference.

[The surgical outcomes in complicated urolithiasis]. / Iskhody khirurgicheskogo lecheniia oslozhnennoi mochekamennoi bolezni.

Complicated nephrolithiasis and ureterolithiasis were surgically treated in 87 and 79 patients aged 18-80 years, respectively. Of them elderly patients constituted 62%. Unilateral calculi occurred in 90.9%, coral calculi in 21 patients. Of 195 complications observed acute purulent pyelonephritis (PP) developed in 150 patients. It proved to be the most threatening and frequent complication. Therapeutic policy and choice of surgery were decided upon with consideration of the stone location, anatomic and functional status of the kidneys, preexisting somatic pathology, age of the patient. Because most severe pyelonephritis was reported in patients with nephroliths and prepelvic ureter, these patients have undergone nephrectomy most often (47%). Conservative surgery has been performed in 53%, pyelolithotomy without renal drainage in 9 (5.4%) patients with non-destructive pyelonephritis. Calculous pyodestructive pyelonephritis should be treated early according to the scheme: cleaning of the purulent foci, removal of the stone and nephrostomy. Used in 23 (13.9%) patients, this scheme failed (lethal outcome) only once. PP in patients with ureteroliths required two-stage treatment. Early nephrostomy (stage 1) preserved the kidney and prevented septic complications in 37 patients. Extracorporeal lithotripsy of ureteroliths (stage 2) is beneficial in clinically cured pyelonephritis and is indicated only in functioning nephrostomy. Conventional ureterolithotomy is valid in cicatricial ureteral stenosis in need of plastic surgery. Renal drainage and surgical elimination of the obstruction in the urinary tracts or on-demand nephrectomy resulted in a 90.4% cure. Hospital lethality in septic complications of calculous PP was 9.6%.

[Organ-preserving surgeries and nephrectomy in pregnant women with severe forms of acute suppurative destructive pyelonephritis]. / Organosokhraniaiushchie operatsii i nefrékromiia u beremennykh s tiazhelymi formami ostrogo gnoino-destruktivnogo pielonefrita.

The results of surgical treatment of pyodestructive pyelonephritis in 105 (4.2%) pregnant women and puerperae out of 2506 ones treated in the urology department from 1986 to 1994 are analyzed. Uni- and bilateral apostematous nephritis, carbuncle and abscess of the kidney were diagnosed in 89 and 16 patients, respectively. Nephrostomy was the principal method of treatment of focal suppurative forms of acute pyelonephritis. Bilateral nephrostomy was carried out in 12 pregnant patients, in 3 of them secondary nephrectomy was performed. Nephrectomy is indicated in total destruction of the kidneys, it was made in 37 (35.2%) pregnant women and puerperae. Introduction of radical surgery into practical treatment of neglected forms of pyodestructive pyelonephritis led to almost total liquidation of postoperative mortality in pregnant women. The efficacy of treatment of pregnant women is provided by varying in extension surgical interventions on the kidneys. Organ-sparing and radical operations in grave purulent pyelonephritis were effective in 97.2% of pregnant patients.