The effect of primary renal disease upon outcomes after renal transplant.

BACKGROUND: This study investigated whether nature of primary renal disease affects clinical outcomes after renal transplantation at a single center in the United Kingdom. METHODS: This was a retrospective cohort study of 961 renal transplant recipients followed up at a large renal center from 2000 to 2020. Separation of diseases responsible for end-stage kidney disease included glomerulonephritis, diabetic kidney disease, hypertensive nephropathy, autosomal dominant polycystic kidney disease, unknown cause, other causes and chronic pyelonephritis. Outcome data included graft loss, cardiovascular events, malignancy, post-transplant diabetes mellitus and death, analyzed according to primary disease type. RESULTS: The mean age at transplantation was 47.3 years. During a mean follow-up of 7.6 years, 18% of the overall cohort died corresponding to an annualised mortality rate of 2.3%. Death with a functioning graft occurred at a rate of 2.1% per annum, with the highest incidence observed in in patients with diabetic kidney disease (4.1%/year). Post-transplant cardiovascular events occurred in 21% of recipients (2.8% per year), again highest in recipients with diabetic kidney disease (5.1%/year) and hypertensive nephropathy (4.5%/year). Post-transplant diabetes mellitus manifested in 19% of the cohort at an annualized rate of2.1% while cancer incidence stood at 9% with an annualized rate of 1.1% . Graft loss occurred in 6.8% of recipients at the rate of1.2% per year with chronic allograft injury, acute rejection and recurrent glomerulonephritis being the predominant causative factors. Median + IQR dialysis-free survival of the whole cohort was 16.2 (9.9 - > 20) years, being shortest for diabetic kidney disease (11.0 years) and greatest for autosomal dominant polycystic kidney disease (18.2 years) .The collective mean decline in eGFR over time was -1.14ml/min/year. Recipients with Pre-transplant diabetic kidney disease exhibited the fastest rate of decline(-2.1ml/min/year) a statistically significant difference in comparison to the other native kidney diseases with Autosomal dominant polycystic kidney disease exhibiting the lowest rate of decline(-0.05ml/min/year) CONCLUSION: Primary renal disease can influence the outcome after renal transplantation, with patients with prior diabetic kidney disease having the poorest outcome in terms of dialysis-free survival and loss of transplant function. Autosomal polycystic kidney disease, other cause and unknown cause had the best outcomes compared to other primary renal disease groups.

[Computer morphometry of peripheral blood lymphocytes in elderly patients with chronic pyelonephritis.]

The aim of the study was to investigate the peculiarities of morphometric parameters of peripheral blood lymphocytes in chronic pyelonephritis in elderly patients in comparison with young and middle-aged patients. A total of 81 patients with chronic pyelonephritis in the exacerbation phase were examined. All patients were divided into three age groups according to WHO recommendations: the 1st - 42patients of young age (18-44 years); the 2nd - 17 patients of middle age (45-59 years); the 3rd - 22 elderly patients (60-74 years). Computer morphometry of lymphocytes was performed in all examined patients. In elderly patients with chronic pyelonephritis the size and сytoplasmic-nuclear ratio of lymphocytes increase. This indicates the preservation of lymphocyte defense responses at this age. In male patients with chronic pyelonephritis in the 1st and 2nd age groups the size of lymphocytes increases, and in female patients - decreases. The сytoplasmic-nuclear ratio increases in males of these age groups, while it remains unchanged or decreases in females. Indirect indications of reduced immunity in young and middle-aged women with chronic inflammation in the kidneys have been obtained.

Protective role for C3aR in experimental chronic pyelonephritis.

Emerging evidence suggest that C3aR plays important roles in homeostasis, host defense and disease. Although it is known that C3aR is protective in several models of acute bacterial infections, the role for C3aR in chronic infection is largely unknown. Here we show that C3aR is protective in experimental chronic pyelonephritis. Global C3aR deficient (C3ar-/- ) mice had higher renal bacterial load, more pronounced renal histological lesions, increased renal apoptotic cell accumulation, tissue inflammation and extracellular matrix deposition following renal infection with uropathogenic E. coli (UPEC) strain IH11128, compared to WT control mice. Myeloid C3aR deficient (Lyz2-C3ar-/- ) mice exhibited a similar disease phenotype to global C3ar-/- mice. Pharmacological treatment with a C3aR agonist reduced disease severity in experimental chronic pyelonephritis. Furthermore, macrophages of C3ar-/- mice exhibited impaired ability to phagocytose UPEC. Our data clearly demonstrate a protective role for C3aR against experimental chronic pyelonephritis, macrophage C3aR plays a major role in the protection, and C3aR is necessary for phagocytosis of UPEC by macrophages. Our observation that C3aR agonist curtailed the pathology suggests a therapeutic potential for activation of C3aR in chronic infection.

Clinical, morphologic and histological features of chronic pyelonephritis: An 8-year review.

BACKGROUND: Urinary tract infection (UTI), especially pyelonephritis when inadequately treated may culminate in end-stage renal disease. The study aims to evaluate the risk factors for and clinico-pathologic features of chronic pyelonephritis (CPN) among patients in Aminu Kano Teaching Hospital, Kano, in North-Western Nigeria. MATERIALS AND METHODS: Data on cases diagnosed as CPN between 2010 and 2017 in the study centre were retrieved from archives and analysed for risk factors and clinic-pathologic features. RESULTS: Forty-three cases of CPN were diagnosed in the study period and comprised 24 males and 19 females, with a male: female ratio of 1.3:1. The ages ranged from 3 to 80 years with a mean age of 37.0 ± 19.6 years. Urinary tract obstruction, poorly treated UTI, HIV infection and polycystic kidney disease were the risk factors in 21 (49%), 15 (35%), 6 (14%) and 1 (2%) cases, respectively. Proteinuria was seen in 10 (23.3%) of the patients, hypertension in 7 (16.3%) and haematuria in 3 (7.0%) of cases. Nephrectomy was done in 17 (39.5%) of the 43 CPN cases, indications for surgery were pus-filled, non-functioning kidneys. The diameters of the removed kidneys ranged from 10 to 28 cm and they weighed between 140 g and 2500 g. Scarring, reported in 79.0% of patients, was the most common pathological finding, followed by pus casts in 48.8% and focal segmental glomerulosclerosis in 27.9%. No statistically significant difference was found between age or gender and aetiology or risk factors of the disease (P > 0.05). CONCLUSION: CPN with pus-filled and non-functioning kidneys is a common indication for nephrectomy. Urinary tract obstruction, poorly treated UTI, and HIV infection were major risk factors seen in this environment. To prevent this complication there is a need for better training of clinicians in the diagnosis and adequate treatment of UTI.

[Features of urolithiasis in patients of advanced and senile age.]

There were 105 patients of different gender of elderly and senile age with urolithiasis. The entire contingent of patients with ICD was divided into 2 groups: the main group (55 people aged 61-85 years) and the comparison group (50 people aged 40-60). All patients went throught a general clinical examination: a detailed history of the anamnesis, an objective examination, laboratory and instrumental methods of investigation. It was revealed that in patients of elderly and senile age the clinical picture is more worn out, the renal colic is less often registered; more significant metabolic disorders that can participate in stone formation. Among the concomitant pathology in patients of this age category, a special role is assigned to: hypertension, diabetes, gout, chronic pyelonephritis and benign prostatic hyperplasia. According to the data of echographic and X-ray studies of these patient groups, it is noted that in patients aged 61-85 years, the calculi of the kidneys reach large sizes in comparison with patients 40-60 years old, and the main localization of stones in the ureter is its lower third.

[The changes in urine microflora in patients with urinary stone disease].

INTRODUCTION: Since the results of treatment of chronic pyelonephritis (CP) depend on timely and rationally selected targeted antibiotic therapy, when choosing a treatment regimen, it is necessary to rely on the local data obtained by monitoring the state of microflora in a particular hospital. AIM: to monitor the changes in urine microflora in patients with urinary stone disease. MATERIALS AND METHODS: A total of 598 isolated bacteria and yeast-like fungi from patients with urinary stone disease who were treated in the Department of Urology during different time periods (1997-1999, 2010-2014 and 2015-2017 yy) were analyzed. A comparison of the urine microbiota in patients with single kidney stone (n=154) and staghorn stone (n=147) for the period 2015-2017 yy. was carried out. RESULTS: The significant changes of gram-positive and gram-negative bacteria were found with a tendency to decrease in the proportion of the latter (from 80.6% to 50.6%, p<0.05) due to a decrease in the proportion of P. mirabilis and complete absence of Enterobacter spp, Serraciae spp and Citrobacter spp. as well as an increase in the number of gram-positive bacteria (from 18 to 48.7%, p<0.05) owing to increase in the proportion of E. faecium + E. faecalis. During observation period, E. Coli has remained the leading pathogen (26.4+/-0.32%). During observation period, a permanent fourfold prevalence of gram-negative bacteria in clinically significant concentrations (>104 CFU/ml) was found: E. coli (36.8+/-4.1%). The proportion of K. Pneumonia increased from 8.5% to 17.4%, and proportion of P. mirabilis decreased from 20.3 to 10.4%. Despite a significant increase in the proportion of Enterococcus spp. (from 4.6 to 26.6%) in the general population, the incidence of microorganisms in clinically significant concentrations during analyzed period remained unchanged and did not exceed 8.46+/-4.76%. In patients with single stones and patients with staghorn stones there was no significant difference in the proportion of analyses with clinically significant concentrations of bacteria fer (p>0.05). The percentage of analyses with clinically significant concentration was 70.06%, while in all patients with urolithiasis it was 59.7%. In patients under and over 60 years old, the largest number of bacterial pathogens were represented by E. coli. (29.7% and 32.1%, respectively). CONCLUSION: E. Coli remains the leading bacterial causative agent of calculous pyelonephritis, both in the general population and in analyses with clinically significant concentrations of bacteria. There were no significant differences in urine microflora in patients with staghorn and single stones.

[The nephroprotective potential of peloid therapy used for the rehabilitation of the patients presenting with chronic pyelonephritis]. / Nefroprotektivnyi potentsial peloidoterapii v reabilitatsii bol'nykh khronicheskim pielonefritom.

This review article presents the data on the mechanism of action of peloid therapy from the perspective of its defibrosing effect, the structure and functions of the extracellular matrix under the normal and pathological conditions. In addition, role of this treatment modality in the progression of tubulointerstitial fibrosis which determines the severity and prognosis of chronic pyelonephritis is considered. The researchers are currently carry out the extensive studies aimed at the search of the methods for the primary and secondary prevention of chronic pyelonephritis. A wide range of pharmacotherapeutic modalities are currently used for this purpose. Moreover the development of long-acting anti-relapse medications is currently underway along with the further improvement of high-tech reconstructive surgical methods for the intervention on the organs of the urinary system. At the same time, the nephroprotective potential of the natural physical factors, such as therapeutic muds, e.g. peloids, remains poorly explored even though their well apparent thermophysical properties, unique organic and mineral composition, and saturation with biologically active compounds are well known long ago. The systemic response to peloid therapy manifests itself as the changes in the metabolism of the intercellular matrix and collagen of the connective tissue associated with the alterations in the process of fibrogenesis and the development of tubulointerstitial disorders. The direct and indirect influence of peloids on the connective tissue is possible. The indirect effects are attributable to the peloid impact on the antioxidant status, immunity, hormonal regulation, and metabolic processes. These findings suggest the necessity of the relevant experimental and clinical studies for the evaluation of the influence of peloid therapy on the structure and metabolism of the connective tissue in the kidneys including dynamics of the markers of inflammation, proliferation and fibrogenesis, and the hormonal status of the patients suffering from chronic pyelonephritis based on the application of the modern technologies in accordance with the requirements of evidence-based medicine.

Surgical correction of multiple renoduodenal fistulas due to chronic pyelonephritis: a case report and literature review.

Renoduodenal fistulas are a rare and uncommon phenomenon that account for ˂1% of those found between the urinary and intestinal tracts. Precipitation of this pathologic tract can be caused by chronic inflammation, necrosis, or ischemia. This case illustrates a 72-year-old man presenting with flank pain discovered to have multiple renoduodenal fistulas and our approach that led to the resolution of his symptoms. We review the pathophysiology, management, and effects of these fistulous tracts on renal function. Patients with staghorn calculi should undergo immediate evaluation for removal of the stone. In cases complicated by fistula formation, need for radical nephrectomy should be investigated and surgical repair should be pursued.

Investigation on the Association of Cardiovascular Markers with Severity of Chronic Pyelonephritis.

Chronic kidney disease (CKD) is an established independent risk factor for cardiovascular disease (CVD) and is caused by chronic pyelonephritis (CP). This study aimed to investigate the effect of the association of cardiovascular markers with the course of CP on the comorbidity of CP with ischemic heart disease. The study participants included 125 patients with CP without symptoms of urinary tract obstruction who were divided into three groups. The first group (n=45) consisted of patients with recurrent CP (CPr) three or more times per year. The second group (n=42) included patients with active phase pyelonephritis (CPa), with a frequency of two times or less per year, with concomitant pathology (stable coronary artery disease, functional class I - II), and the third group (n=38) included patients with an inactive phase of the disease (CPi), with a history of pyelonephritis of at least five years. The patients' carotid artery augmentation index (AI %) and the change in the diameter of the brachial artery (D %) in CPi, CPa, and CPr groups were 8.44±1.76, 15.47±4.00, 11.71±1.70, 13.81±3.06, 12.75±2.55 and 6.54±3.27, respectively. The left ventricular ejection fraction (EF) index in the three study groups was estimated to be 68.92±3.76, 64.76±2.75, and 66.28±3.45%, respectively. An analysis of the results showed the most significant changes in the parameters of the cardiovascular system in patients with a comorbid and relapsing course of CP. The results showed a significant increase in pulmonary artery diameter, EF, left ventricular pressure and volume, pulse wave velocity in the aorta, and vascular resistance index.

Xanthogranulomatous pyelonephritis, and emphysematous pyelonephritis: Two rare conditions in one patient.

INTRODUCTION: What makes this case unique are combined features of two rare renal disease processes in one patient within one kidney which are Xanthogranulomatous pyelonephritis,and emphysematous pyelonephritis. CASE PRESENTATION: The patient had main general symptoms like fever, chills, fatigue,and right abdominal pain. He had urea = 77, White Blood Cells = 15,46, and urine culture was positive for Klebsiella. He had right total nephrectomy as a therapeutic intervention. CONCLUSION: It is important to note that it could we have two diseases or more in one case related to one systemic organ so, we have to evaluate all possible causes of current status of the patient.

Spontaneous nephrocutaneous fistula due to xanthogranulomatous pyelonephritis with secondary enterocutaneous fistula: a rare case report.

Chronic infection, especially in the setting of obstruction like calculous disease, may result in the fistula tract development of fistula tract from kidney to the other proximal organs. However, nephrocutaneous fistula is a rare complication, and the primary cause of its development is previous surgical intervention, trauma, or malignancy. Our case was a 26-year-old Afghan man with xanthogranulomatous pyelonephritis (XGP) resulted in spontaneous nephrocutaneous fistula. The patient underwent radical nephrectomy. Our case shows that previous surgery is not the only cause of fistula. After surgery, he presented with secondary enterocutaneous fistula due to surgery or chronic underlying inflammation. After systemic antibiotic therapy and total parenteral nutrition, he became well and discharged from the hospital. As a result, XGP is a rare subtype of chronic pyelonephritis that requires immediate evaluation and early diagnosis. Patients should be considered for possible complications such as fistulas. Physicians should be aware of this issue for appropriate diagnosis and treatment.

Nonasthmatic Churg-Strauss syndrome superimposed on chronic pyelonephritis: a case report.

Churg-Strauss syndrome (CSS) is a granulomatous small-vessel vasculitis. Asthma is seen in the majority of patients with CSS, but atypical nonasthmatic forms of CSS are also being recognized. We herein describe a 67-year-old woman with a history of chronic pyelonephritis and drug allergy reactions who was admitted to our hospital because of worsening renal function preceded by fever, purpura, sinusitis, and a positive urine culture that confirmed a urinary infection. She was initially treated with pipemidic acid for 7 days, followed by clarithromycin for sinusitis. Laboratory tests on admission showed an absolute eosinophil count of 1750 cells/µL and serum creatinine concentration of 4.72 mg/dL. Urine and blood cultures showed no growth. Kidney biopsy revealed crescent formations with diffuse interstitial fibrosis and foci of eosinophil infiltration. An atypical form of CSS was diagnosed based on tissue eosinophilia, peripheral eosinophilia, and sinusitis. Intravenous methylprednisolone and cyclophosphamide pulse therapy together with hemodialysis treatment improved the patient's clinical condition but did not resolve the kidney damage. The onset of an atypical form of CSS in our patient manifested as symptoms and signs mimicking those of chronic pyelonephritis and drug allergy reactions. The patient's chronic kidney disease finally progressed to dialysis dependence.

Laparoscopic Management of a Misplaced Ureteral Stent in the Duodenum.

Background: Double-J stents (DJSs) are placed in the ureter to maintain urine flow from the kidney to the bladder. Extraurinary tract displacement of the stents is very rare, those observed in the literature are vascular displacement into inferior vena cava, into rectum after anticancer treatment of the cervix and a forgotten stent into third part of duodenum. We present a unique case of displaced DJS into the second part of the duodenum and its management laparoscopically. Case Presentation: A 59-year-old diabetic man on evaluation for right flank pain and intermittent episodes of fever with chills and rigors for 4 months was identified elsewhere on CT of kidney, ureter, and bladder (KUB) to have a retroperitoneal mass engulfing the right ureter with a small contracted kidney with mild hydronephrosis for which CT-guided retroperitoneal mass biopsy (reported as acute suppurative inflammation) and subsequent right Double-J stenting were done. He was lost to follow-up and presented to us 3 months later with similar complaints. On evaluation, CT of KUB with contrast revealed a shrunken, hydronephrotic, and poorly excreting right kidney but no mass. The right DJS was seen in the upper ureter and its proximal tip was seen to perforate the anterior wall of the right ureter, and it lay within the second part of the duodenum. The distal tip was seen in the bladder. Laparoscopic right nephrectomy was done with duodenal rent closure. During DJS retrieval, unfortunately, the smaller proximal end of the DJS slipped completely into the duodenum, but fortunately was expelled spontaneously by the patient (confirmed on postoperative day 10 with X-ray). Conclusion: It is ideal to place a DJS under fluoroscopic guidance or obtain a check X-ray to confirm its position postprocedure. Patients should always be counseled on the importance of follow-up and the complications of forgotten stents.

Urinary cytokines as markers of latent inflammation in children with chronic pyelonephritis and anorectal malformations.

INTRODUCTION: Anorectal malformations (ARMs) comprise a range of defects in the development of the lowest portion of the intestinal tract that are often associated with anomalies of the urinary tract. We hypothesize that ARMs may specifically predispose the patients to prolonged urinary tract infection (UTI) and transition from a state of active (clinically apparent) inflammation to a state of latent inflammation following antibiotic treatment. Yet diagnosis of latent inflammation in the urinary tract is problematic. OBJECTIVE: The aim was to investigate the urinary levels of proinflammatory (IL-1ß, IL-6, IL-8, and MCP-1), anti-inflammatory (IL-10), and proangiogenic (VEGF) cytokines in the clinical course of chronic pyelonephritis (CP) as potential biomarkers of latent inflammation in the urinary tract in children with ARM. PATIENTS AND METHODS: A total of 34 children (age range 4-120 months) with CP in the active phase of inflammation were divided into two groups: CP with ARM group included 20 patients and CP without ARM group included 14 patients. The control group included 20 healthy children similar by age and gender. Urine samples were collected at the time of enrollment, 5-7 days after institution of antibiotic treatment, and 1.5 months after enrollment. Cytokine concentrations were measured by ELISA. RESULTS: Upon enrollment, we detected increased urinary levels of IL-10 and MCP-1 and normal levels of IL-1ß, IL-6, IL-8, and VEGF in CP with ARM patients as well as normal levels of all of these cytokines in CP without ARM patients. After 5-7 days of antibiotic treatment, despite significant clinical and laboratory improvement observed in both patient groups, we documented a prominent increase in the urinary concentrations of all measured cytokines indicating ongoing inflammation in the urinary tract. Following 1.5 months of enrollment, in CP without ARM patients, IL-8 and MCP-1 were increased, IL-1, IL-6, and VEGF were close to control, and IL-10 was below the control level, indicating partial resolution of the inflammatory process. In contrast, in CP with ARM patients, IL-1ß, IL-6, IL-8, MCP-1, and VEGF were increased suggesting persistent inflammation in the urinary tract (Table). CONCLUSION: Based on the urinary cytokine profile, we conclude that presence of ARM may be associated with transition from active to latent inflammation in the urinary tract after antibiotic treatment for UTI. Follow-up monitoring of the urinary cytokines may provide a better assessment of inflammatory activity in the urinary tract in children with combined urological and anorectal pathologies.

Nephrocutaneous fistula as the initial manifestation of asymptomatic nephrolithiasis: A call for radical management.

Renal stones are a common affliction presenting in an acute setting. We report a case of asymptomatic renal stone in an elderly gentleman presenting initially as a discharging lumbar sinus managed by subcapsular nephrectomy and radical excision of the fistula tract. Nephrocutaneous fistula is most commonly associated with tuberculosis, xanthogranulomatous pyelonephritis, and rarely with complicated calyceal stones, and its occurrence with asymptomatic pelvic stones is rare. We present the points in favor of radical open surgery in the management of such patients.

Nephrectomy for Non-neoplastic Kidney Diseases.

This review discusses the pathology of non-neoplastic kidney disease that pathologists may encounter as nephrectomy specimens. The spectrum of pediatric disease is emphasized. Histopathologic assessment of non-neoplastic nephrectomy specimens must be interpreted in the clinical context for accurate diagnosis. Although molecular pathology is not the primary focus of this review, the genetics underlying several of these diseases are also touched on.

Xanthogranulomatous Pyelonephritis Can Simulate a Complex Cyst: Case Description and Review of Literature.

Xanthogranulomatous pyelonephritis is a rare and peculiar form of chronic pyelonephritis and is generally associated with renal lithiasis. Its incidence is higher in females. The peculiarity of this disease is that it requires a differential diagnosis, because it can often simulate dramatic pathologic conditions. In fact, in the literature are also described cases in association with squamous cell carcinoma of the kidney The radiologic clinical findings simulate renal masses, sometimes in association with caval thrombus. We describe a case of xanthogranulomatous pyelonephritis with radiologic aspects of a complex cyst of Bosniak class III in a man 40-year old.

Renal Infections.

This review discusses the various gross and histologic findings seen in renal infections due to bacteria, viruses, fungi, and mycobacteria. It is crucially important to separate infectious processes in the kidney from other inflammatory or neoplastic processes, as this will have a major impact on therapy. We describe the diagnostic features of renal infections with a specific focus on the differential diagnosis and other processes that may mimic infection. The topics discussed include acute bacterial pyelonephritis, chronic bacterial pyelonephritis, xanthogranulomatous pyelonephritis, malacoplakia, viral infections in the kidney, fungal pyelonephritis and mycobacterial infection of the kidney.

Effect of Compound Salvia injection combined with cefoperazone sulbactam sodium on renal function and renal interstitial fibrosis in elderly patients with chronic pyelonephritis / 中国生化药物杂志

Objective To study the influence of Compound Salvia injection combined with cefoperazone sulbactam sodium on renal function and renal interstitial fibrosis in elderly patients with chronic pyelonephritis (CPN).Methods From April 2013 to July 2014, 126 cases of CPN were divided into observation group ( n =63 ) and control group ( n =63 ) according to the order of admission to hospital.All patients were given cefoperazone sulbactam sodium, and patients in observation group were added Compound Salvia injection.The clinical efficacy of treatment were evaluated between two groups, renal function and TGF-β1 were observed and compared before and after treatment in two groups.Results After treatment, HE staining of nephridial tissue showed renal interstitial fibrosis in observation group obvious improved more.The overall response rate of observation patients (90.48%) was significantly higher (74.60%) than control group, and the relapse rate of observation group (1.59%) was significantly lower than control group (14.29%), and there were statistically significant differences (P<0.05).After treatment, urinary albumin (11.4 ±3.1) mg/L, BUN (5.7 ±0.5) mmol/L, and Scr (103.2 ±10.4)μmol/L of observation group were significantly lower than control group, respectively (P<0.05).After treatment, TGF-β1 level (103.4 ±32.5) ng/L of observation group was significantly lower than control group (202.4 ±35.2) ng/L(P<0.05).There was no significant difference in adverse reactions between two groups.Conclusions Compound Salvia injection combined with cefoperazone sulbactam sodium has good efficacy.can significantly improve renal function, delay renal interstitial fibrosis in treatment of elderly patients with chronic pyelonephritis.