Antibiotic treatment for acute ‘uncomplicated’ or ‘primary’ pyelonephritis: a systematic, ‘semantic revision’

Consiglio, Valentina; Colla, Loredana; Mesiano, Paola; Magnano, Andrea; Burdese, Manuel; Marcuccio, Cristina; Mezza, Elisabetta; Veglio, Valerio; Piccoli, Giorgina Barbara

doi:10.1016/j.ijantimicag.2006.05.017

Cited by 30 publications

(30 citation statements)

References 55 publications

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“…Furthermore, in adults, APN is differently defined with regard to imaging or clinical criteria and information on the relationship between imaging and clinical data is limited (21). The literature demonstrates that different diagnostic and treatment pathways are followed for adults compared with children even though Talner and et al underlined the importance of standardizing the definition of APN about 20 y ago (22,23). The quest to improve accurate rapid diagnosis of APN is an area of intense research (24).…”

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Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

et al. 2015

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Background:The identification of acute pyelonephritis (APN) is still a challenge. Methods: Patients admitted for their first urinary tract infection (UTI) were enrolled. Plasma neutrophil gelatinaseassociated lipocalin (NGAL) levels were measured at admittance and after treatment. Laboratory, clinical, and imaging results were compared between children with and without APN. results: A total of 123 patients were enrolled (53 APN and 70 lower UTI). After adjusting for age and gender, plasma NGAL levels were higher in the APN group than in the lower UTI group (233 (129-496) ng/ml vs. 71 (50.8-110) ng/ml, P < 0.001). NGAL levels were correlated with the serum levels of leukocytes, C-reactive protein, and creatinine, as well as fever duration (P < 0.05). Multivariable analysis revealed that logtransformed plasma NGAL was an independent predictor of APN (P < 0.05). Receiver operating curve analysis showed a good diagnostic profile of NGAL for identifying APN (area under the curve 0.864) with a best cut-off value of 102.5 ng/ml. The NGAL levels in both two groups decreased after treatment compared to levels before treatment (P < 0.001). conclusion: Plasma NGAL can be a sensitive predictor for identifying APN and monitoring the treatment response of pediatric UTI. u rinary tract infections (UTIs) are among the most common bacterial infections in children (1). Early detection and proper management of UTIs is important since UTIs involving the kidney may cause permanent renal scarring and be a risk factor for future development of renal insufficiency (2). Establishing the diagnosis of acute pyelonephritis (APN) requires imaging with 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy to view renal parenchymal involvement (3). Although a DMSA scan is considered to be very sensitive in the assessment of renal damage, it is expensive, not readily available in all centers, and exposes the patients to radiation (4). Therefore, a more practical and accessible tool to determine the presence of renal parenchymal involvement could be helpful for the timely management of UTIs.Neutrophil gelatinase-associated lipocalin (NGAL), as a member of the lipocalin superfamily, is produced from the nephron in response to tubular epithelial damage (5). It has been identified as one of the earliest and potentially one of the most indicative biomarkers of acute kidney injury (AKI) from a diverse array of conditions and can differentiate between prerenal and intrinsic causes (6,7). Urinary NGAL (uNGAL) levels increase in patients with different causes of nephropathies (8,9) and might be a valuable tool in monitoring the treatment response of various renal diseases (10,11).As an iron-carrier protein derived from human neutrophils, NGAL also plays an important role in the innate immune response to bacterial infection (12). Experimentally, NGAL was capable of blocking Escherichia coli growth under ironpoor conditions, but NGAL with siderophore iron was not (13). NGAL-knockout mice demonstrated substantially increased mortality after intraperitoneal i...

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Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

et al. 2015

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“…L'approccio terapeutico e il follow up cambiano in maniera consistente nei pazienti affetti da IAVU non complicata o primitiva, in presenza o meno di localizzazione renale dimostrabile radiologicamente. La cistopielite (IAVU senza coinvolgimento parenchimale renale) è un'infezione realmente superficiale, e si verifica in un punto anatomico in cui facilmente si ottengono elevate concentrazioni di antibiotici 3 . L'infezione renale parenchimale coinvolge invece il tessuto profondo, nel quale le difese naturali sono rese meno efficaci da un ambiente fisico-chimico ostile e la L La a p pi ie el lo on ne ef fr ri it te e a ac cu ut ta a i in n D DE EA A 3 .…”

Section: Introduzioneunclassified

“…La cistopielite (IAVU senza coinvolgimento parenchimale renale) è un'infezione realmente superficiale, e si verifica in un punto anatomico in cui facilmente si ottengono elevate concentrazioni di antibiotici 3 . L'infezione renale parenchimale coinvolge invece il tessuto profondo, nel quale le difese naturali sono rese meno efficaci da un ambiente fisico-chimico ostile e la L La a p pi ie el lo on ne ef fr ri it te e a ac cu ut ta a i in n D DE EA A 3 . Il tipo e la durata della terapia antimicrobica necessaria per eradicare l'infezione sono, quindi, diversi per l'infezione pielitica e per quella parenchimale renale.…”

Section: Introduzioneunclassified

Acute pyelonephritis in ER

et al. 2007

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Materiale protetto da copyright. Non fotocopiare o distribuire elettronicamente senza l'autorizzazione scritta dell'editore. IntroduzioneLe infezioni delle alte vie urinarie (IAVU) non complicate rappresentano una possibile causa di danno renale permanente. La sintomatologia clinica di queste infezioni è spesso caratteristica, ma la distinzione tra forme a differente livello di coinvolgimento delle vie urinarie richiede il ricorso a sofisticati mezzi di diagnostica radiologica per immagini. Soprattutto in un ambiente come il DEA, la possibilità di distinguere infezioni delle alte vie urinarie con o senza coinvolgimento renale, è spesso una impresa ardua, e si rischia o di sottovalutare il livello di estensione dell'infezione oppure di sottoporre troppi pazienti con infezione limitata a inutili e costose procedure diagnostiche e terapeutiche 1 . Il danno renale da nefrite infettiva viene spesso non diagnosticato, e questo dato è preoccupante se si pensa che cicatrici parenchimali anche poco estese possono portare nel tempo a diversi gradi di insufficienza d'organo, soprattutto se concomitano altri fattori purtroppo non così rari, come l'abuso di analgesici o anomalie congenite 2 . L'approccio terapeutico e il follow up cambiano in maniera consistente nei pazienti affetti da IAVU non complicata o primitiva, in presenza o meno di localizzazione renale dimostrabile radiologicamente. La cistopielite (IAVU senza coinvolgimento parenchimale renale) è un'infezione realmente superficiale, e si verifica in un punto anatomico in cui facilmente si ottengono elevate concentrazioni di antibiotici 3 . L'infezione renale parenchimale coinvolge invece il tessuto profondo, nel quale le difese naturali sono rese meno efficaci da un ambiente fisico-chimico ostile e la L La a p pi ie el lo on ne ef fr ri it te e a ac cu ut ta a i in n D DE EA A

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“…Acute pyelonephritis is a serious complication and if treated improperly or inadequately may result in renal parenchymal scarring and permanent renal damage. Data on the prevalence of post-pyelonephritic renal scarring in adults are lacking mainly because of lack of long-term radiological follow-up, but this lesion was identified by imaging in up to 13.6-100% of children [5]. Although the clinical significance of renal scarring and its detrimental effect on overall renal function is contentious, there is clear evidence from transplantation research that once a substantial portion of the kidney is rendered functionless by any disease, the remaining healthy tissue inevitably and progressively deteriorates structurally and functionally very rapidly [2].…”

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“…These tests will therefore be discussed in more details. Radiological evaluation of upper urinary tract morphology is also mandatory if biochemical renal impairment is detected [1,3,5]. Noninvasive imaging by ultrasonography is initially sufficient but more detailed assessment using isotope scan, contrast techniques such as simple urography, computerized tomography scanning, and magnetic resonance imaging will be indicated if the ultrasound scan findings are equivocal.…”

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Female pelvic floor disorders and impaired renal function: an appraisal

Rizk

Obineche

2007

Int Urogynecol J

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The pelvis fulfils more extensive functions in the female body than in the male. In the female, it forms not merely the bony foundation of the trunk to which strong and numerous muscles are attached, but also shelters the largest part of the sexual apparatus in addition to the distal end of the intestinal canal and urinary passages and thereby assumes great importance in reproduction. Nature has placed the canal that opens at the lowermost part of the trunk in such a position that the pelvis can maintain the burden of the abdominal viscera and provide support and purchase for the enclosed organs." Carl Litzmann in his book "Die Foramen des Beckens" [The Foramen of the Pelvis], published in 1861.The study of female, as opposed to male, pelvic floor disorders is unique because it encompasses not only inappropriate urinary and fecal control, defective pelvic organ support, and sexual dysfunction but also prevention of long-term complications, namely, renal insufficiency, and hence, screening, detection, and management of impaired renal function. Pelvic floor disorders in women must thus be approached from a holistic physio-anatomical perspective that is not limited to the pelvic floor or lower urinary and intestinal tracts but with their adverse impact on the function of the upper urinary tract carefully considered.Female pelvic floor disorders may all interfere with renal function by back pressure, ascending infection or vesicoureteric reflux [1]. Renal damage can easily occur in these women without specific clinical signs and thus remain undetected [2]. The significance of renal insufficiency in women with pelvic floor disorders, however, has been relatively overlooked in recent literature being confined to only a few case reports. In the largest retrospective series, asymptomatic hydronephrosis diagnosed by preoperative renal ultrasound and/or intravenous pyelogram was not uncommon in patients with pelvic organ prolapse (7.7%). More importantly, 8% of these patients had evidence of renal insufficiency and the prevalence rose with increasing severity of prolapse particularly with uterine prolapse [3]. As not all women with pelvic floor disorders will undergo operative intervention and consequently preoperative evaluation, the prevalence of hydronephrosis is likely to be underestimated. There is also evidence that in reproductiveage women, primary or recurrent urinary incontinence independently increases the risk for acute pyelonephritis [4]. Acute pyelonephritis is a serious complication and if treated improperly or inadequately may result in renal parenchymal scarring and permanent renal damage. Data on the prevalence of post-pyelonephritic renal scarring in adults are lacking mainly because of lack of long-term radiological follow-up, but this lesion was identified by imaging in up to 13.6-100% of children [5]. Although the clinical significance of renal scarring and its detrimental effect on overall renal function is contentious, there is clear evidence from transplantation research that once a substantial port...

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Antibiotic treatment for acute ‘uncomplicated’ or ‘primary’ pyelonephritis: a systematic, ‘semantic revision’

Cited by 30 publications

References 55 publications

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

Acute pyelonephritis in ER

Female pelvic floor disorders and impaired renal function: an appraisal

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