[The features of sclerotic development in junction-ureteral segment of children with congenital hydronephrosis].

A comprehensive clinical, laboratory, instrumental and morphological study of children with congenital hydronephrosis has been carried out. We compared the clinical features of pyelonephritis at children with primary pyelonephritis and congenital hydronephrosis. Bacterial inflammation was dominated symptom at the children with primary bacterial pyelonephritis, whereas children with hydronephrosis had low-grade clinical changes and significant renal functional impairment. Clinically and prognostically more frequent severe unilateral disease was left-side hydronephrosis. For the first time the morphological changes of junction-ureteral segment at the operated children with congenital hydronephrosis have been analyzed. We've established that the evolution of changes correlates with age. Dysplastic and hypoplastic changes take place mainly in muscle layers in younger 3 years old children, in elder children the phenomenon of atrophy and sclerosis dominates over the other pathologic changes. The hystologic picture depends on lateralization of lesions: dysplasia of muscle layers is on the left side, mucous inflammation--on the right.

Secondary stone formation 8 weeks after percutaneous nephrolithotomy treatment: A case report.

INTRODUCTION: This work reports a patient with recurrent renal calculi subjected to three surgeries in half a year to be in the same position, and the high-throughput sequencing data showed different species in the renal pus and urine samples, which suggested that partial renal infection or stone formation can be judged by the bacteria in urine. PATIENT CONCERNS: The female patient aged 43 years was referred to the authors' department on April 13, 2020, due to left waist pain and fever for 3 days. DIAGNOSIS: Kidney stones and hydronephrosis were determined by a urinary system computed tomography scan. INTERVENTIONS: On April 20, 2020 and June 15, 2020, the patient was successfully treated with left percutaneous nephrolithotomy twice under general anesthesia. An investigation on the health and eating habits of the patient within 6 months was completed at the last admission. The components of the second renal calculus sample were analyzed with an infrared spectrum analyzer. The third renal stone (renal pus, triplicates) was subjected to microbial metagenome sequencing, and urine samples before and after surgery were subjected to 16S RNA sequencing by SEQHEALTH (Wuhan, China). OUTCOMES: After percutaneous nephrolithotomy, the left kidney stones were basically cleared, stone analysis revealed that the main components were calcium oxalate monohydrate, silica, and a small amount of calcium oxalate dehydrate. Although the urine samples exhibited differences, the renal pus and urine sample shared a single species. CONCLUSION: It is not clear that the prospects of partial renal infection or stone formation can be judged by the bacteria in urine.

Obstructive uropathy as initial presentation of genitourinary tuberculosis and masquerading as a postsurgical complication.

A 46-year-old woman who had a recent total abdominal hysterectomy presented with a 1 month history of lower abdominal pain, 1 week of nausea and vomiting as well as decreased urinary output preceded by a year of significant unintentional weight loss. On renal imaging, she was found to have bilateral hydronephrosis and hydroureters in the setting of bilateral distal ureteric obstruction complicated with acute kidney injury and severe hyperkalaemia requiring haemodialysis. The initial concern was for ureteric injury, a known complication of abdominal hysterectomy procedures, however, a urological intervention, performed 9 months later to relieve the ureteric obstruction, revealed purulent material within the left ureter that was smear positive for acid fast bacilli. A GeneXpert test was positive for Mycobacterium tuberculosis She was diagnosed with genitourinary tuberculosis and responded well to antitubercular treatment and haemodialysis was discontinued after the surgery relieved her ureteric obstruction.

Actinomyces infection in female genital tract.

OBJECTIVES: To analyze clinical and laboratory characteristics of patients with pelvic actinomyces. STUDY DESIGN: We studied five patients with pelvic actinomyces who were admitted between January 1, 2002 and December 31, 2002. The initial complaints, diagnostic methods, therapeutic alternatives and results of the therapies were examined. RESULTS: The ages of the cases varied between 32 and 52 years old. All five patients had been using an intrauterine device. Three cases had hydronephrosis due to infection. Two patients were diagnosed postoperatively while the other three cases were diagnosed with cervical smear and endometrial biopsy; penicillin G was administered to all. The patients are still under surveillance, and without any problems. CONCLUSION: In patients with an intrauterine device, actinomyces should be remembered in differential diagnosis of pelvic infections. Preoperative diagnosis is of the utmost importance in order to prevent morbidity of this infiltrative infection. Long-term penicillin therapy proved to be successful. Complicated or resistant cases to medical therapy should be candidates for surgical therapy.

Haematuria and loin pain, could this be tuberculosis?

We report a case of an 18-year-old Caucasian male presenting with haematuria and loin pain while working as a locksmith. He was systemically well with normal vital signs. Peripheral blood testing demonstrated renal failure, secondary to hydronephrosis, caused by haemorrhagic cystitis with no obvious cause for the obstruction. The patient was diagnosed with a urinary tract infection and treated with antibiotics. He responded well and his renal function improved. Four months later he re-presented with the above symptoms, weight loss and night sweats, bladder wall biopsy at this point confirmed tuberculosis.

Visceral phaeohyphomycosis caused by Alternaria alternata offering a diagnostic as well as a therapeutic challenge.

Phaeohyphomycosis is a heterogeneous group of opportunistic infections caused by dematiaceous molds, which are distributed worldwide as plant pathogens but rarely cause human diseases. However, due to the growing populations of immunocompromised patients, these fungi are frequently recognized as important human pathogens. We are reporting this very rare, unique case for the first time from Islamabad, Pakistan, describing the association of visceral Phaeohyphomycosis caused by the opportunistic fungus Alternaria alternata, affecting the left kidney, with the immunocompromised state in a young incidentally detected patient with insulin-dependent type I diabetes. The case was diagnosed on the basis of a high index of clinical suspicion, microbial cultures, microscopy, imaging studies and endourological procedures. The patient did not respond well to the highly sensitive Amphotericin B, resulting in loss of the kidney. Therefore, we suggest that clinicians involved in treating immunocompromised patients should have a high degree of clinical suspicion for such opportunistic pathogens to allow timely initiation of the correct diagnostic and therapeutic work-up.

Isolation of Salmonella paratyphi A from a patient with nephrolithiases.

We describe a case of Salmonella paratyphi A isolated from urine of a 37-year-old Saudi patient who is a known case of nephrolithiasis and hydronephrosis with frequent admission for management of renal stones. History of enteric fever was not documented and urinary schistosomiasis in such a patient from endemic area is a strong possibility. Relevant literature was discussed.

Current concepts on pathogenesis of renal tuberculosis.

The pathogenesis of renal tuberculosis begins with the initial localization of the tubercle bacilli in the cortical glomeruli causing mechanical stress which lead to alteration in cell morphology, increased rate of protein synthesis and proliferation of resident glomerular cells as well as the infiltrating blood borne cells. The infection may remain localized to the renal parenchyma resulting in various forms of glomerulonephritides and/or gain access to the calyceal system causing pyelocalyceal destruction with subsequent ureteric and urinary bladder involvement. The disease may remain quiesent at the foregoing stage or progress to hydronephrosis and pyonephrosis as a result strictures and obstruction. This communication discusses the immunological responses and various specific lesions resulting from renal injury caused by mycobacterium tuberculosis.

[Hyperammonemia in hydronephrosis]. / Hyperammoniëmie bij hydronefrose.

A man aged 81 with bilateral hydronephrosis presented with lethargy deepening into coma caused by hyperammonaemia. The hyperammonaemia was most likely caused by excessive absorption of ammonia produced by Proteus mirabilis in the obstructed and dilated urinary tract. The patient died within a few hours.

[A rare cause of retroperitoneal fibrosis: actinomycosis]. / Une cause rare de fibrose rétropéritonéale: l'actinomycose.

The authors report a case of retroperitoneal fibrosis secondary to actinomycosis with consequences on the urinary tract. They insist on the difficulty of diagnostic, the antibiotic's sensibility and the evolution towards fibrosis which can lead to renal function deterioration.

[Experimental bladder stone production by human uropathogenic bacteria].

To investigate the formation of infection stones by 5 bacterial species isolated from patients with urinary calculi, such as Proteus mirabilis, Staphylococcus saprophyticus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli, a zinc disc was implanted and 10(6) bacteria were surgically inoculated at the same time into the bladder of male Wistar rats (10 rats per group). Urinary pH was measured on days 1, 3, 5 and 7. The rats were killed on day 7 and the bladder examined for the formation of infection stones. Infection stones were formed in all rats inoculated with P. mirabilis (mean stone weight 29.7 mg), and in 60% of those inoculated with S. saprophyticus (9.7 mg). Small bladder stones were formed in 30% of the rats inoculated with K. pneumoniae and 25% of those inoculated with P. aeruginosa. No bladder stones were formed in the rats inoculated with E. coli. Urinary pH was increased by P. mirabilis and S. saprophyticus but was unaffected by the other species. In conclusion, P. mirabilis and S. saprophyticus play a significant role in the formation of infection stones.

[Hydronephrosis in course of actinomycosis of female reproductive organs]. / Wodonercze w przebiegu promienicy zenskich narzadów plciowych.

OBJECTIVES: Pelvic actinomycosis is a chronic suppurative granulomatous disease caused by an anaerobic Gram positive germ, Actinomyces. The most difficult task was to obtain the diagnosis in a patient with an intrauterine device and poor general health, signs of infection and a pelvic syndrome. RESULTS: This is a report of a case of hydronephrosis in course of actinomycosis of female reproductive organs in a patient aged 46 years with the intrauterine contraceptive device admitted to The Department of Gynecology & Obstetric in Hospital of Slupsk. Symptoms were presented as an acute abdomen associated with painful epigastric and mass in right adnexa. A pre-operative diagnosis of the right hydronephrosis, on ovarian tumor and uterus myoma were detected which lead to an extensive and difficult surgery. The pathologic process infiltrated the retroperitoneal space simulated sarcoma or lymphoma. The disease was serious and required hysterectomy with salpingo-oophorectomy and intra-abdominal drainage. Actinomycosis was confirmed by the postoperative histopathologic examination, and the patient was successfully treated with penicillin. The patient was completely free of symptoms two months within the operation. CONCLUSIONS: In patients who have intrauterine contraceptive devices or who have had them removed recently, abdominal pain, recurrent vaginal bleeding or adnexal masses should prompt a thorough search for potentially pathogenic actinomyces in the genital tract.

[Renal candidiasis following treatment of infantile osteomyelitis]. / Csecsemökori osteomyelitis kezelését követó renalis candidiasis.

Systemic candidiasis with renal complications is a rather rare phenomenon in young infants. Authors report on a 4.5 month-old baby (preterm) who, during an antibiotic therapy of wide spectrum--because of osteomyelitis--acquired a mycotic infection causing bilateral pyelon and pyeloureteral obstruction. In addition to systemic antimycotic therapy surgical intervention was needed to eliminate the mycotic bezoar.

Acute pyelonephritis and secondary bacteraemia caused by Veillonella during pregnancy.

We report a case of pyelonephritis and secondary bacteraemia caused by Veillonella species during pregnancy. Veillonella is part of the normal flora from the oral cavity, gut and vagina. However, because Veillonella is usually isolated from cultures of clinical specimens as part of commensal flora, it is frequently regarded as a contaminant. In the present case, Veillonella was isolated from the patient's urine and blood samples that showed evidence of pyelonephritis and secondary bacteraemia. We found that ureteral stenting is an extremely effective therapeutic option for pregnant woman with hydronephrosis and clear signs and symptoms of urosepsis.

Bilateral psoas abscesses and vertebral osteomyelitis in a patient with sickle cell disease.

The authors present a case of a patient with sickle-ß thalassaemia (Sß(0) Thal) who had bilateral psoas abscesses on a background of splenectomy in early childhood. The patient also turned out to have vertebral osteomyelitis and hydronephrosis on the side of the larger abscess. The only organism recovered from the patient was a Bacteroides species. The patient was managed with percutaneous drainage and intravenous antibiotics and made a full recovery.