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Background: Acute urinary tract infection (UTI) is a common disease in pediatrics, with around 8% of girls and 2% of boys experiencing a UTI by age 7y/o. UTIs can range from asymptomatic bacteriuria to acute pyelonephritis (APN) in severe cases involving renal parenchymal infection. UTI patients admitted to the pediatric ward usually have more severe clinical presentation, compared to those treated in the outpatient settings. Therefore, it will be helpful to have markers that predict the severity of the disease and the likelihood of having APN. Methods: We performed a retrospective review on all pediatric UTI/APN patients treated in the inpatient setting at a Medical Center from October 2012 to September 2022. Patients were assigned to the "hyponatremia" or "eunatremia" group according to their serum sodium concentrations. Detailed information, including renal echo, blood, and urine test results, were collected for the analysis of multivariable logistic regression model. Results: The study included 344 patients, of which 99 (28.8%) had hyponatremia, and 245 (71.2%) had normal serum sodium levels. The hyponatremia group had higher APN frequency, renal echo abnormality, and higher CRP level. In multivariable analysis, hyponatremia was independently associated with increased serum glucose (OR: 1.01, 95% CI: 1.00-1.03, p = 0.0365) and CRP levels (OR: 1.00, 95% CI: 1.00-1.01, p = 0.0417), without a significant increase in APN frequency as the final diagnosis. Conclusions: Our findings suggest that hyponatremia in pediatric UTI patients may indicate a more severe disease, such as APNs, higher CRP levels, or renal echo abnormalities. The complex mechanisms underlying hyponatremia and its predictive value for disease severity warrant further investigation. [ABSTRACT FROM AUTHOR]

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Abstract Background Acute urinary tract infection (UTI) is a common disease in pediatrics, with around 8% of girls and 2% of boys experiencing a UTI by age 7y/o. UTIs can range from asymptomatic bacteriuria to acute pyelonephritis (APN) in severe cases involving renal parenchymal infection. UTI patients admitted to the pediatric ward usually have more severe clinical presentation, compared to those treated in the outpatient settings. Therefore, it will be helpful to have markers that predict the severity of the disease and the likelihood of having APN. Methods We performed a retrospective review on all pediatric UTI/APN patients treated in the inpatient setting at a Medical Center from October 2012 to September 2022. Patients were assigned to the “hyponatremia” or “eunatremia” group according to their serum sodium concentrations. Detailed information, including renal echo, blood, and urine test results, were collected for the analysis of multivariable logistic regression model. Results The study included 344 patients, of which 99 (28.8%) had hyponatremia, and 245 (71.2%) had normal serum sodium levels. The hyponatremia group had higher APN frequency, renal echo abnormality, and higher CRP level. In multivariable analysis, hyponatremia was independently associated with increased serum glucose (OR: 1.01, 95% CI: 1.00-1.03, p = 0.0365) and CRP levels (OR: 1.00, 95% CI: 1.00-1.01, p = 0.0417), without a significant increase in APN frequency as the final diagnosis. Conclusions Our findings suggest that hyponatremia in pediatric UTI patients may indicate a more severe disease, such as APNs, higher CRP levels, or renal echo abnormalities. The complex mechanisms underlying hyponatremia and its predictive value for disease severity warrant further investigation.

Abstract Background 99mTc-DMSA scan plays an important role in assessing functional abnormalities in kidneys. As a promising network for deep learning (DL), Mask R-CNN has the capability of simultaneously segmenting and classifying objects in images. In this study, we tested the feasibility and accuracy of Mask R-CNN in diagnosing acute pyelonephritis (APN) and segmenting kidneys in 99mTc-DMSA scintigraphic images. Two hundred and sixty patients with suspected APN were recruited for DMSA scan, of which 358 kidneys were diagnosed as APN. Of the recruited patients, 210 were randomly selected for training and validating Mask R-CNN, and the other 50 patients’ images were used for model testing. Accuracy of the results was assessed by comparing against references from human experts. Results In the validation phase, the trained model provided segmentation masks with intersection over union (mask IoU, for segmentation accuracy) of 86.6%, and classifications with mean average precision at the bounding box IoU ≥ 50% (mAP50, for classification accuracy) of 86.2%. In testing with the 50 independent patients, mask IoU of the model’s segmentation was 90.3%±2.2%, and in classifying the kidneys for APN, the trained model showed accuracy of 89.0%, sensitivity of 84.8% and specificity of 97.0%. In identifying patients with any APN kidney, 3 out of 50 patients were mis-diagnosed, achieving accuracy of 94.0%. Conclusions Mask R-CNN, designed to perform both segmentation and classification for images, showed much promise in analyzing 99mTc-DMSA images for both accurate diagnosis of APN and kidney segmentation.

Nephroblastoma tumor is the most common renal tumor in children aged 1 to 5 years, typically presenting as an abdominal mass. However, other nonspecific signs may also reveal the disease. An unusual presentation, such as acute pyelonephritis or a subcapsular renal hematoma, is rarely an initial warning sign and should prompt investigation of an underlying cause, especially in the absence of trauma history. We report here a particular case of Wilms tumor, revealed by acute pyelonephritis and complicated by a subcapsular hematoma in a 6-year-old girl. We emphasize the importance of considering the diagnosis of Wilms tumor in any child presenting with renal hemorrhage, to improve prognosis and initiate therapeutic management as early as possible.

Background: Acute pyelonephritis (APN) is a common renal disorder in children. The manage ment is controversial and has generated a lot of debate globally. There is no consensus on the strategies for its investigation and treatment in Nigeria. Objective: To determine the attitude of Nigerian paediatricians towards the management of acute pyelonephritis in children. Materials and Methods: The management attitude of Nigerian paediatricians towards children with acute pyelonephritis was investigated during an annual paediatric conference, using a ques tionnaire containing a brief description of a clinical case of APN in a three-year old female. Results: Out of 195 questionnaires issued to registered paediatricians, 115 (59.0 percent) were retrieved and analysed. Ninety five (82.6 percent) of the 115 responders were based in tertiary hospitals. All the paediatricians would perform a urine culture and 98 (85.2 percent), including the eight paediatric nephrologists, would request a renal ultrasound during the acute phase of pyelonephritis. Twelve (10.4 percent) respondents would request an intravenous pyelogra (IVU). Fourteen percent and 36 percent respectively, were of the opinion that micturating cystourethrography (MCU) and 99M TC-dimercaptosuccinic acid scintigraphy (DMSA) scan were indicated. Those working in tertiary hospitals would perform both the MCU and DMSA less frequently than those working in private/company hospitals (p>0.05). Significantly more doc tors who graduated in the 1990s would ask for MCU and DMSA scan than those who graduated earlier (p

Non-specific symptoms and difficulty in collecting urine specimens make diagnosis of urinary tract infection (UTI) challenging in young children. However, timely diagnosis and initiation of therapy are essential to prevent complications. Children with recurrent UTIs require detailed evaluation and follow-up for optimal management. We report key updates from revised evidence-based practice guidelines of the Indian Society of Pediatric Nephrology for urinary tract infections and primary vesicoureteric reflux. [ABSTRACT FROM AUTHOR]

This study presents a comprehensive review of the literature regarding the use of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a diagnostic tool for urinary tract infection (UTI) in children. Meta-analysis was conducted to evaluate the effectiveness of uNGAL in diagnosing UTI and differentiating acute pyelonephritis (APN) from other sites infection in pediatric patients. We searched PubMed, Web of Science, the Cochrane Library and EMBASE for reports published up to January 2023. We only included published literature that addressed the diagnosis of UTI and APN with the use of uNGAL in children aged 0-18 years. Two authors independently reviewed the included studies and extracted the corresponding data according to the inclusion and exclusion criteria. The sensitivity, specificity and area under the curve for each study were pooled by using a bivariate mixedeffects model. A total of 13 studies met the inclusion criteria for this review: 8 reported on uNGAL diagnosis of UTI, 2 on uNGAL diagnosis of APN, and 3 on both UTI and APN. Among all included studies, uNGAL had good sensitivity (0.88, 95% CI 0.79-0.94) and good specificity (0.86, 95% CI 0.78-0.92) for the diagnosis of UTI. The sensitivity and specificity of uNGAL for the diagnosis of APN were 0.79 (95% CI 0.72-0.85) and 0.78 (95% CI 0.50-0.93), respectively. uNGAL has good sensitivity and specificity in the diagnosis of UTI in children and is a promising marker. However, the use of uNGAL still does not provide significant advantages in the diagnosis of APN in children. Consequently, there is a need to optimize and further explore the assay for improved diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections (UTIs) are very common bacterial infections in children. Early detection of renal parenchymal involvement in this setting can help clinicians make more effective treatment choices. The aim of this pilot study was to assess the ability of plasma and urinary neutrophil gelatinase-associated lipocalin (pNGAL and uNGAL) levels, measured using an automated system, to accurately predict renal parenchymal involvement in children with febrile UTIs. Methods: This prospective single-center study included 28 children aged ≥ 4 years with a first episode of febrile UTIs. All patients underwent magnetic resonance imaging. pNGAL, uNGAL, procalcitonin, C-reactive protein (CRP), and white blood cells were measured before antibiotic therapy. Results: The receiver operating characteristic (ROC) area under the curve for predicting acute pyelonephritis was 0.6 for pNGAL, 0.8 for CRP, 0.4 for PCT, and 0.4 for uNGAL. The ROC analyses showed an optimal cutoff of 141.0 ng/mL for pNGAL (sensitivity, 54.2%; specificity, 75.0%; positive predictive value, 92.9%; and negative predictive value, 21.4%). Conclusion: pNGAL and uNGAL did not effectively aid the early prediction of renal parenchymal involvement in children ≥ 4 years with febrile UTIs. The novelties of this study were the use of MRI as the gold standard and an automated biochemical method to measure NGAL. [ABSTRACT FROM AUTHOR]

Background and objectives: The importance of hematological parameters has started to be explored with increased interest in many fields lately, with different studies finding an association between those parameters and inflammatory status, atherosclerosis, comorbidities, malnutrition, neoplasia and even a faster progression of chronic kidney disease (CKD). On the other hand, CKD itself presents as an inflammatory condition, in which a lot of pathways are modified and the response to an infectious agent could be less than expected. Regarding the latter aspect, in this study we aim to explore the differences between the hematologic response during a lower versus upper urinary tract infection in patients with CKD. Materials and methods: We analyzed 70 patients with chronic kidney disease and either cystitis or pyelonephritis considering the hematologic parameters, the classical inflammatory ones as well as the etiology of CKD. Results: Neutrophils, neutrophils/lymphocytes ratio (NLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and fibrinogen were higher in patients with pyelonephritis (PNA), while albumin was significantly lower. In a binary logistic regression model that explained 80.2% of the variability of PNA diagnosis and correctly predicted it in 92.9% of cases, NLR, CRP and fibrinogen were the independent predictors. Conclusions: Hematologic parameters can serve not only as an indicator of the inflammatory status, but also as a laboratory biomarker for PNA in patients with CKD. [ABSTRACT FROM AUTHOR]

Abstract Urinary tract infection (UTI) is the most prevalent urological condition worldwide. Choosing appropriate antibiotics for patients who have fever before receiving a culture result is challenging. This retrospective study enrolled patients 394 patients hospitalized at Gangneung Asan Hospital for UTI from May 2017 to April 2021. Fever at 48 h of hospitalization was the analysis point, as this is when the response to antibiotic therapy manifest, although the results of antibiogram are not available. Multivariate analysis was performed to assess the correlation between ESBL producing bacteria (EPB) and fever at 48 h. Overall, 36.3% of patients had EPB and 27.9% had fever at 48 h. In multivariate analysis, a significant positive association was found between EPB and fever (odds ratio 1.17, 95% CI 1.05–1.30, P = 0.004) Female had negative association with multivariate model (OR 0.83, 95% CI 0.73–0.94, P = 0.004). Diabetes did not demonstrate a significant association with EPB. (OR 1.10, 95% CI 0.99–1.22, P = 0.072). Fever at 48 h is associated with EPB and could be considered a predictive factor for EPB infection in patients with UTI. Antibiotic escalation may be considered in patients with fever at 48 h.

Background and Objective: Kidney stone disease is a common issue in urology practice. UTI is often associated with KSD, both as a cause (e.g. struvite and carbonate apatite stones) and as a possible consequence (e.g. obstructive pyelonephritis, post-operative UTI). It is worth mentioning that a significant portion of the financial burden produced by KSD is mostly focused on stones associated with infection. Our research aims to explore the outcomes of URS after OAPN in a large patient group. Furthermore, we sought to assess possible risk variables such as RIRS and the time gap between OAPN and URS. The ultimate objective was to enhance the care of patients who required stone removal after OAPN. Materials and Methods: The research lasted one year and took place in a Department of General Surgery at a Tertiary Care Teaching Institute in India. A data analysis was performed on patients who were sent to the Study Hospital and diagnosed with OAPN due to urinary calculi. The research focused on those who had emergency drainage during the last three years. Patient records were reviewed to acquire critical information on numerous variables that might lead to postoperative problems. These variables were age, sex, body mass index (BMI), diabetes mellitus, leucocyte counts, and C-reactive protein at OAPN presentation, type of preoperative drainage, days from drainage to surgery, operating time, and stone considerations. Results: Twelve patients had supplementary shockwave lithotripsy. There were no fatalities during the perioperative phase. Several characteristics were identified as possible risk factors for postoperative UTI, including diabetes mellitus, a one-month interval between drainage and surgery, a high stone load, simultaneous RIRS, and an operation length of more than 75 minutes. These results were statistically significant, with a p-value of <0.05. Conclusion: People who had previously had OAPN were more likely to have postoperative infectious problems. Diabetes mellitus, a delay of more than one month between drainage and surgery, and concurrent RIRS were all identified as significant predictors of postoperative UTI. Our studies revealed a possible link between. [ABSTRACT FROM AUTHOR]

Urinary tract infection (UTI) is the most prevalent urological condition worldwide. Choosing appropriate antibiotics for patients who have fever before receiving a culture result is challenging. This retrospective study enrolled patients 394 patients hospitalized at Gangneung Asan Hospital for UTI from May 2017 to April 2021. Fever at 48 h of hospitalization was the analysis point, as this is when the response to antibiotic therapy manifest, although the results of antibiogram are not available. Multivariate analysis was performed to assess the correlation between ESBL producing bacteria (EPB) and fever at 48 h. Overall, 36.3% of patients had EPB and 27.9% had fever at 48 h. In multivariate analysis, a significant positive association was found between EPB and fever (odds ratio 1.17, 95% CI 1.05–1.30, P = 0.004) Female had negative association with multivariate model (OR 0.83, 95% CI 0.73–0.94, P = 0.004). Diabetes did not demonstrate a significant association with EPB. (OR 1.10, 95% CI 0.99–1.22, P = 0.072). Fever at 48 h is associated with EPB and could be considered a predictive factor for EPB infection in patients with UTI. Antibiotic escalation may be considered in patients with fever at 48 h. [ABSTRACT FROM AUTHOR]

Acute pyelonephritis (APN) is most frequently caused by uropathogenic Escherichia coli (UPEC), which ascends from the bladder to the kidneys during a urinary tract infection. Patients with APN have been reported to have reduced renal concentration capacity under challenged conditions, polyuria, and increased aquaporin-2 (AQP2) excretion in the urine. We have recently shown increased AQP2 accumulation in the plasma membrane in cell cultures exposed to E. coli lysates and in the apical plasma membrane of inner medullary collecting ducts in a 5-day APN mouse model. This study aimed to investigate if AQP2 expression in host cells increases UPEC infection efficiency and to identify specific bacterial components that mediate AQP2 plasma membrane insertion. As the transepithelial water permeability in the collecting duct is codetermined by AQP3 and AQP4, we also investigated whether AQP3 and AQP4 localization is altered in the APN mouse model. We show that AQP2 expression does not increase UPEC infection efficiency and that AQP2 was targeted to the plasma membrane in AQP2-expressing cells in response to the two pathogen-associated molecular patterns (PAMPs), lipopolysaccharide and peptidoglycan. In contrast to AQP2, the subcellular localizations of AQP1, AQP3, and AQP4 were unaffected both in lysate-incubated cell cultures and in the APN mouse model. Our finding demonstrated that cellular exposure to lipopolysaccharide and peptidoglycan can trigger the insertion of AQP2 in the plasma membrane revealing a new regulatory pathway for AQP2 plasma membrane translocation, which may potentially be exploited in intervention strategies. NEW & NOTEWORTHY: Acute pyelonephritis (APN) is associated with reduced renal concentration capacity and increased aquaporin-2 (AQP2) excretion. Uropathogenic Escherichia coli (UPEC) mediates changes in the subcellular localization of AQP2 and we show that in vitro, these changes could be elicited by two pathogen-associated molecular patterns (PAMPs), namely, lipopolysaccharide and peptidoglycan. UPEC infection was unaltered by AQP2 expression and the other renal AQPs (AQP1, AQP3, and AQP4) were unaltered in APN. [ABSTRACT FROM AUTHOR]

Infections of the urinary tract are more common during pregnancy due to physiological and immunological changes. This review aims to highlight the importance of prevention and early detection of asymptomatic bacterial urinary infection, their appropriate treatment hence prevention of further serious issues during pregnancy. Asymptomatic bacterial infections if not treated properly can progress to upper parts of the urinary system and the kidney resulting in symptomatic infections of the urinary system and pyelonephritis. Severe and potentially life threatening complications can arise from these conditions. Education and health promotion of primary care in view of the risk factors thus screening for asymptomatic bacterial infection can evidently improve the prenatal care and pregnancy outcomes, therefore declining the prevalence of the urinary tract infections, including kidney infections as well. Multidisciplinary approach and keeping up an adequate treatment of the urinary tract infections thus early detection of impaired kidney function is essential for successful treatment outcome as well as avoidance of the complications during pregnancy. [ABSTRACT FROM AUTHOR]

Recent European Association of Urology (EAU) guidelines and a clinical prediction rule developed by Van Nieuwkoop et al. suggest simple criteria for performing radiological imaging for patients with a febrile urinary tract infection (UTI). We analysed the records of patients with a UTI from four hospitals in Switzerland. Of 107 UTI patients, 58% underwent imaging and 69% (95%CI: 59–77%) and 64% (95%CI: 54–73%) of them were adequately managed according to Van Nieuwkoop's clinical rule and EAU guidelines, respectively. However, only 47% (95%CI: 33–61%) and 57% (95%CI: 44–69%) of the imaging performed would have been recommended according to their respective rules. Clinically significant imaging findings were associated with a history of urolithiasis (OR = 11.8; 95%CI: 3.0–46.5), gross haematuria (OR = 5.9; 95%CI: 1.6–22.1) and known urogenital anomalies (OR = 5.7; 95%CI: 1.8–18.2). Moreover, six of 16 (38%) patients with a clinically relevant abnormality displayed none of the criteria requiring imaging according to Van Nieuwkoop's rule or EAU guidelines. Thus, adherence to imaging guidelines was suboptimal, especially when imaging was not recommended. However, additional factors associated with clinically significant findings suggest the need for a new, efficient clinical prediction rule. [ABSTRACT FROM AUTHOR]

Abstract Introduction This study compared the clinical characteristics and antimicrobial susceptibility of uncomplicated acute pyelonephritis (APN) caused by Escherichia coli and Klebsiella pneumoniae. Methods We retrospectively reviewed the medical records of patients with uncomplicated APNs caused by E. coli and K. pneumoniae admitted to Keimyung University Dongsan Hospital between February 2014 and December 2021. Results We enrolled 497 patients (372 with E. coli infection, 125 with K. pneumoniae infection). Male, healthcare-associated infection, solid tumors, liver cirrhosis, chronic renal disease, solid organ transplantation, and antibiotic usage within the last 3 months were more strongly associated with K. pneumoniae uncomplicated APNs than with E. coli. Bacteremia and fever occurred more frequently in E. coli uncomplicated APNs. Antimicrobial resistance rates to piperacillin/tazobactam and carbapenem were higher in K. pneumoniae. Antimicrobial resistance rates to aztreonam and ciprofloxacin were lower in K. pneumoniae. Thirty-day mortality was more observed in K. pneumoniae group in univariate analysis, but this difference was not observed after adjustment. Male sex, ultimately fatal disease in McCabe, and prior antibiotic use within 3 months were more associated with K. pneumoniae. Conclusions Male, underlying diseases, and prior antibiotic use was more associated with K. pneumoniae. Further study will be needed that microbiome of each situation and the related with the distribution of the strains.

Recent European Association of Urology (EAU) guidelines and a clinical prediction rule developed by Van Nieuwkoop et al. suggest simple criteria for performing radiological imaging for patients with a febrile urinary tract infection (UTI). We analysed the records of patients with a UTI from four hospitals in Switzerland. Of 107 UTI patients, 58% underwent imaging and 69% (95%CI: 59–77%) and 64% (95%CI: 54–73%) of them were adequately managed according to Van Nieuwkoop’s clinical rule and EAU guidelines, respectively. However, only 47% (95%CI: 33–61%) and 57% (95%CI: 44–69%) of the imaging performed would have been recommended according to their respective rules. Clinically significant imaging findings were associated with a history of urolithiasis (OR = 11.8; 95%CI: 3.0–46.5), gross haematuria (OR = 5.9; 95%CI: 1.6–22.1) and known urogenital anomalies (OR = 5.7; 95%CI: 1.8–18.2). Moreover, six of 16 (38%) patients with a clinically relevant abnormality displayed none of the criteria requiring imaging according to Van Nieuwkoop’s rule or EAU guidelines. Thus, adherence to imaging guidelines was suboptimal, especially when imaging was not recommended. However, additional factors associated with clinically significant findings suggest the need for a new, efficient clinical prediction rule.

Background: This study aimed to examine the clinical and microbiological characteristics of female patients with recurrent acute pyelonephritis (APN). Methods: A retrospective cohort study was conducted at a tertiary care hospital in South Korea from July 2019 to December 2021. All female patients aged ≥ 19 years who were diagnosed with community-acquired APN on admission were enrolled. The recurrent group included patients with APN who experienced urinary tract infections within the previous year. The clinical characteristics, types of causative organisms, major antibiotic resistance, and molecular characteristics of Escherichia coli strains were compared between the recurrent and non-recurrent groups. Results: A total of 285 patients with APN were analyzed, including 41 (14.4%) in the recurrent group. Compared to the non-recurrent group, the recurrent group had a higher Charlson Comorbidity Index (1.8 ± 2.1 vs. 1.1 ± 1.5; P = 0.01) and a higher proportion of bladder abnormalities, such as neurogenic bladder (12.2% vs. 2.0%; P = 0.001) and urinary catheterization (12.2% vs. 1.6%; P

Abstract Background Fluoroquinolone resistance is an issue of concern amongst physicians worldwide. In urology, fluoroquinolones are often used in the treatment of acute pyelonephritis and prostatitis, as well as infections caused by multidrug‐resistant pathogens. Aims We aim to highlight the importance of antimicrobial stewardship and the need for ongoing biomedical research to discover novel agents in our losing battle against resistant pathogens. Materials and methods In this review, we survey the literature and summarise fluoroquinolone resistance as it pertains to pyelonephritis and prostatitis, as well as alternative treatment strategies and prevention of multidrug resistance. Results The rise of fluoroquinolone resistance in bacteria has reduced the available treatment options, often necessitating hospital admission for intravenous antibiotics, which places an additional burden on both patients and the healthcare system. Many countries such as Australia have attempted to limit fluoroquinolone resistance by imposing strict prescribing criteria, though these efforts have not been entirely successful. Solutions to overcome resistance include prevention, combination therapy and the development of novel antimicrobial agents. Conclusions Prevention of the proliferation of resistant organisms by antimicrobial stewardship is paramount, and urologists are obliged to be aware of responsible prescribing practices such as referring to local guidelines when prescribing. By reserving fluoroquinolones for infections in which they are truly indicated and by prescribing based on both patient and local environmental factors, we can preserve this effective resource for future use.

Aim: Febrile urinary tract infection is a common bacterial infection in childhood. The kidney damage after acute pyelonephritis (APN) could be related to the stimulation of the proinflammatory response. We aimed to investigate the role of inflammatory cytokines and the effect of dexamethasone after a first episode of APN. Methods: Subanalysis of the DEXCAR RCT in which children with confirmed APN (1 month–14 years) were randomly assigned to receive a 3 days course of either intravenous dexamethasone or placebo. Urinary cytokine levels at diagnosis and after 72 h of treatment were measured. Results: Ninety‐two patients were recruited. Younger patients, males and those with abnormalities in the ultrasound study or vesicoureteral reflux showed higher values of urinary cytokines. Patients with severe APN had higher Tumour Necrosis Factor (TNF)α levels (81.0 ± 75.8 vs. 33.6 ± 48.5 pg/mg creatinine, p = 0.015). Both intervention groups showed similar basal clinical characteristics, including urinary cytokine levels. Treatment reduced urinary cytokine levels irrespective of dexamethasone administration. Neither the intervention group nor the urinary cytokine levels modulated the development of kidney scars. Conclusion: Basal urinary cytokines were associated with age, abnormal ultrasound and vesicoureteral reflux. Patients with severe APN had higher TNFa urinary levels. Administration of dexamethasone in children with APN does not improve the control of the proinflammatory cytokine cascade. [ABSTRACT FROM AUTHOR]

Introduction: This study compared the clinical characteristics and antimicrobial susceptibility of uncomplicated acute pyelonephritis (APN) caused by Escherichia coli and Klebsiella pneumoniae. Methods: We retrospectively reviewed the medical records of patients with uncomplicated APNs caused by E. coli and K. pneumoniae admitted to Keimyung University Dongsan Hospital between February 2014 and December 2021. Results: We enrolled 497 patients (372 with E. coli infection, 125 with K. pneumoniae infection). Male, healthcare-associated infection, solid tumors, liver cirrhosis, chronic renal disease, solid organ transplantation, and antibiotic usage within the last 3 months were more strongly associated with K. pneumoniae uncomplicated APNs than with E. coli. Bacteremia and fever occurred more frequently in E. coli uncomplicated APNs. Antimicrobial resistance rates to piperacillin/tazobactam and carbapenem were higher in K. pneumoniae. Antimicrobial resistance rates to aztreonam and ciprofloxacin were lower in K. pneumoniae. Thirty-day mortality was more observed in K. pneumoniae group in univariate analysis, but this difference was not observed after adjustment. Male sex, ultimately fatal disease in McCabe, and prior antibiotic use within 3 months were more associated with K. pneumoniae. Conclusions: Male, underlying diseases, and prior antibiotic use was more associated with K. pneumoniae. Further study will be needed that microbiome of each situation and the related with the distribution of the strains. [ABSTRACT FROM AUTHOR]

This study aimed to examine the clinical and microbiological characteristics of female patients with recurrent acute pyelonephritis (APN). A retrospective cohort study was conducted at a tertiary care hospital in South Korea from July 2019 to December 2021. All female patients aged ≥ 19 years who were diagnosed with community-acquired APN on admission were enrolled. The recurrent group included patients with APN who experienced urinary tract infections within the previous year. The clinical characteristics, types of causative organisms, major antibiotic resistance, and molecular characteristics of Escherichia coli strains were compared between the recurrent and non-recurrent groups. A total of 285 patients with APN were analyzed, including 41 (14.4%) in the recurrent group. Compared to the non-recurrent group, the recurrent group had a higher Charlson Comorbidity Index (1.8 ± 2.1 vs. 1.1 ± 1.5; P = 0.01) and a higher proportion of bladder abnormalities, such as neurogenic bladder (12.2% vs. 2.0%; P = 0.001) and urinary catheterization (12.2% vs. 1.6%; P < 0.001). Escherichia coli was the most common causative organism in both groups. The proportion of Klebsiella pneumoniae (17.1% vs. 4.7%; P = 0.007) and Pseudomonas aeruginosa (5.7% vs. 0.5%; P = 0.014) as a causative organism was higher in the recurrent group. Regarding the microbiological characteristics of Escherichia coli , there were no significant differences in the proportion of antibiotic resistance, phylogenetic groups, resistance genes, and virulence factors between the two groups. Multivariable analysis showed that neurogenic bladder and a history of admission or antibiotic use during 1 year prior to inclusion were significantly associated with recurrent APN. The proportion of causative organisms except Escherichia coli was higher in the recurrent group than in the non-recurrent group. Neurogenic bladder and a history of admission or antibiotic use during 1 year prior to inclusion were risk factors for recurrent APN. [ABSTRACT FROM AUTHOR]

Innate immunity is essential for the anti-microbial defense, but excessive immune activation may cause severe disease. In this study, immunotherapy was shown to prevent excessive innate immune activation and restore the anti-bacterial defense. E. coli-infected Asc−/− mice develop severe acute cystitis, defined by IL-1 hyper-activation, high bacterial counts, and extensive tissue pathology. Here, the interleukin-1 receptor antagonist (IL-1RA), which inhibits IL-1 hyper-activation in acute cystitis, was identified as a more potent inhibitor of inflammation and NK1R- and substance P-dependent pain than cefotaxime. Furthermore, IL-1RA treatment inhibited the excessive innate immune activation in the kidneys of infected Irf3−/− mice and restored tissue integrity. Unexpectedly, IL-1RA also accelerated bacterial clearance from infected bladders and kidneys, including antibiotic-resistant E. coli, where cefotaxime treatment was inefficient. The results suggest that by targeting the IL-1 response, control of the innate immune response to infection may be regained, with highly favorable treatment outcomes, including infections caused by antibiotic-resistant strains. [ABSTRACT FROM AUTHOR]

BackgroundAcute graft pyelonephritis (AGPN) is a relatively common complication in kidney transplants (KTs); however, the effects on allograft function, diagnostic criteria, and risk factors are not well established.MethodsRetrospective analysis of all consecutive adult KTs was performed between 01 January 2011 and 31 December 2018 (follow-up ended on 31 December 2019) to examine the association between the diagnosis of AGPN (confirmed with magnetic resonance imaging [MRI]) during the first post-transplantation year and graft outcomes.ResultsAmong the 939 consecutive KTs (≈50% with donors ≥60 years), we identified 130 MRI-confirmed AGPN episodes, with a documented association with recurrent and multidrug-resistant bacterial urinary tract infections (UTIs) (p

Background: Urinary tract infections (UTIs) are very common bacterial infections in children. Early detection of renal parenchymal involvement in this setting can help clinicians make more effective treatment choices. The aim of this pilot study was to assess the ability of plasma and urinary neutrophil gelatinase-associated lipocalin (pNGAL and uNGAL) levels, measured using an automated system, to accurately predict renal parenchymal involvement in children with febrile UTIs. Methods: This prospective single-center study included 28 children aged ≥ 4 years with a first episode of febrile UTIs. All patients underwent magnetic resonance imaging. pNGAL, uNGAL, procalcitonin, C-reactive protein (CRP), and white blood cells were measured before antibiotic therapy. Results: The receiver operating characteristic (ROC) area under the curve for predicting acute pyelonephritis was 0.6 for pNGAL, 0.8 for CRP, 0.4 for PCT, and 0.4 for uNGAL. The ROC analyses showed an optimal cutoff of 141.0 ng/mL for pNGAL (sensitivity, 54.2%; specificity, 75.0%; positive predictive value, 92.9%; and negative predictive value, 21.4%). Conclusion: pNGAL and uNGAL did not effectively aid the early prediction of renal parenchymal involvement in children ≥ 4 years with febrile UTIs. The novelties of this study were the use of MRI as the gold standard and an automated biochemical method to measure NGAL.

Introduction Megacalycosis is a rare disorder related to congenital underdevelopment of the renal papilla or structural defect of the renal calyces. Megacalycosis has a wide spectrum of clinical presentations ranging from simple variants without any significance on renal function to severe complications. Any prevention strategy is recommended yet since megacalycosis is mostly asymptomatic and usually discovered either accidentally or as result of its complications. Case presentation We observed megacalycosis progression in a young female with a single kidney toward progressive calyx dilatation for years, which ended in acute pyelonephritis. Conservative management, urinary drainage, and large‐spectrum antibiotics were unsuccessful and nephrectomy was required. Conclusion This rare case and literature review add evidence to identify prognostic factors to select patients with a high risk of complications (single kidney, bilateral disease, female gender, associated genetic syndromes, vesicoureteral reflux, and contralateral renal disorder). One o more factors should activate close monitoring and prophylactic therapy if needed.

Acute pyelonephritis (APN) is a relatively common community-acquired infection, particularly in women. The early appropriate antibiotic treatment of this potentially life-threatening infection is associated with improved outcomes. The international management guidelines for complicated urinary tract infections and APN recommend using oral antibiotics with <10% resistance among urinary pathogens. However, increasing antibiotic resistance rates among Escherichia coli and other Enterobacterales to fluoroquinolones, trimethoprim-sulfamethoxazole (TMP-SMX), and beta-lactams has left patients without reliable oral antibiotic treatment options for APN. This narrative review proposes using precision medicine concepts to improve empirical antibiotic therapy for APN in ambulatory settings. Whereas resistance rates to a particular antibiotic class may exceed 10% at the population-based level, the predicted antibiotic resistance rates based on patient-specific risk factors fall under 10% in many patients with APN on the individual level. The utilization of clinical tools for the prediction of fluoroquinolones, TMP-SMX, and third-generation cephalosporin resistance improves the ambulatory antibiotic management of APN. It may also reduce the need to switch antibiotic therapy later based on the in vitro antibiotic susceptibility testing results of bacterial isolates in urinary cultures. This approach may mitigate the burden of increasing antibiotic resistance in the community by ensuring that the initial antibiotic prescribed has the highest likelihood of treating APN appropriately. [ABSTRACT FROM AUTHOR]

BACKGROUND: Urinary tract infections (UTI) are the most common infectious complications after kidney transplantation (KTx) with highest incidence in the first three months of transplantation. UTI in transplant recipients increase morbidity and mortality, risk of graft failure and incidence of acute rejection episodes. According to published data, urinary tract infections significantly affect graft survival. The aim of our study was to identify possible risk factors for the development of UTI. MATERIAL AND METHODS: We retrospectively analyzed a cohort of patients who received kidney transplantation between January 2014 and December 2016 in the Transplant Center of Louis Pasteur University Hospital in Košice. One hundred and fifty-three patients after kidney transplantation were included in the study. RESULTS: A total of 47 Caucasian patients (30%) developed UTI, namely - acute pyelonephritis after KTx. We identified independent risk factors associated with UTI such as female gender OR (7.98, 95% CI 2.88-22.12, p < 0.001), diabetes mellitus (OR 5.26, 95% CI 2.01-13.74, p = 0.001; 95% CI 4.57-53.82, p < 0.001) urologic complication (OR 15.68, 95% CI 4.57-53.82; p < 0.001) and acute rejection episode (OR 3.15, 95% CI 1.13-8.76, p = 0.027). The most common microbiological agent was Escherichia coli. CONCLUSION: We identified the aforementioned risk factors of urinary tract infections in the files of our patients. Statistically, the most significant risk factors are the female gender, and presence of urological complications. The urological complications and BMI of the patients are considered modifiable factors. Based on our analysis, we confirmed a significantly higher number of ACR patients who overcame infection which is in accordance with the published data on association of UTI with the development of acute cellular rejection (ACR) (Tab. 2, Fig. 1, Ref. 15). [ABSTRACT FROM AUTHOR]

A urinary tract infection (UTI) is an immune response of the urothelium to bacterial invasion, bacteriuria (presence of bacteria in urine) and pyuria (presence of white blood cells in urine) are characteristic indicators of UTI. Prompt and effective management of UTIs is crucial to prevent complications, such as kidney infections and recurrent infections, and to alleviate symptoms, improve quality of life, and minimize antibiotic resistance. The aim of this study was to investigate the incidence, antibiotic resistance, medical treatment, causative agents, diagnosis, and prevention of urinary tract infections (UTIs) in Sulaymaniah city. A total of 60 patients from Sulaymaniah Teaching Hospital were included in the study. The most commonly diagnosed conditions were acute pyelonephritis and cystitis. Various evaluations were conducted, including history taking, physical examination, and diagnostic tests. Mid-stream urine samples were collected for culture and sensitivity analysis. The duration of symptoms such as dysuria, fever, and frequency varied, ranging from 1 to 3 days. During medical examinations, suprapubic tenderness was the most commonly observed finding. Dysuria was reported as the predominant symptom by 19 patients. The majority of patients fell within the age range of 21-40 years. The study findings indicated a higher prevalence of UTIs among females. The most frequently identified causative microorganism was Escherichia coli (E. coli), which accounted for approximately 90% of cases. Gentamycin emerged as the most commonly used antibiotic due to its effectiveness against E. coli. The high prevalence of antibiotic resistance among other pathogens necessitates ongoing surveillance and appropriate antibiotic stewardship to combat UTIs effectively. In conclusion, this study provides valuable insights into the incidence, antibiotic resistance, and management of UTIs in Sulaymaniah city. It emphasizes the need for tailored treatment approaches considering the prevalent causative agents and their susceptibility patterns.

Background. An increase in a quantity of children with acute renal insufficiency associated with infectious diseases, including COVID-19 is a growing problem in nephrology. Such insufficiency is often expressed in pyelonephritis. Due to a lack of specific signs or obvious clinical symptoms and their correct interpretation, acute renal insufficiency against the background of COVID-19 is first identified in the period of steady worsening of the kidney functioning. An accurate non-invasive diagnostic test is yet to be fully developed, therefore, determination of the mechanisms of complications is considered to be challenging and can contribute to the formation of irreversible renal injury.Objective — to determine and evaluate characteristics of the renal status in children with acute pyelonephritis against the background of COVID-19.Methods. A retrospective observational cohort clinical study of 65 children with acute pyelonephritis was carried out. The study also included a control group of 20 healthy children, who were observed during routine health checkup. The patients were observed at the Nephrology Unit, Samarkand Regional Pediatric Multidisciplinary Medical Center, Uzbekistan. Laboratory examination was carried out on the basis of Clinical Diagnostic Laboratory, Samarkand Regional Pediatric Multidisciplinary Medical Center, Uzbekistan, and Laboratory of Innova Clinic, Uzbekistan. The study was conducted from January 2021 to December 2022 and involved participants with the history of COVID-19 before treatment. Thus, two cohorts were formed: group 1 comprised 30 children with acute pyelonephritis and without a history of COVID-19; group 2 consisted of 35 patients with acute pyelonephritis against the background of COVID-19. In order to evaluate the renal status, examination of the glomeruli, proximal and distal tubules was carried out. The study included investigation of “urinary syndrome” indicators — leukocyturia of neutrophil origin, microhematuria, proteinuria, and bacteriuria. The obtained laboratory data were analyzed using variance and given in SI System — the International System of Units. The calculations were carried out using StatPlus 7 (AnalystSoft Inc., USA).Results. Renal function is decreased in an acute period due to reduced functionality of concentration and distal tubule, which were more significantly affected in group 2. Inflammatory changes in the renal tissue due to the toxic effects of coronavirus infection underlie the abnormalities detected. The history of COVID-19 is reckoned from the date of admission and ranges from 3 weeks to 2 months. Renal insufficiency in children with COVID-19 history is manifested irrespective of their clinical polymorphism, due to impairment of its tubular structures (reabsorption, acidogenesis and ammoniogenesis, osmotic concentration) and glomerular filtration. A statistically significant reduction in acidogenesis (p = 0.001) was recorded in patients with acute COVID-associated pyelonephritis.Conclusion. Children with COVID-19 respiratory symptoms require monitoring their renal functions for early diagnosis and treatment. Long-term monitoring of patients with isolated urinary syndrome in the acute period is needed to detect the underlying renal disease.

Aim: To study the role of E. coli intestinal translocation in the development of acute obstructive pyelonephritis in an experiment. Material and methods: An experimental study was conducted on 60 male rabbits weighing 3000±500 g. The animals were divided into 3 groups of 20 animals each: experimental, control and intermediate control group. The acute obstructive pyelonephritis with the ureter blocking by laparotomy and introduction of the strain into the intestine were simulated in the animals of the experimental group. In the control group, the model was performed anologically as in the experimental group, but without the ureter blocking. In the intermediate control group, laparotomy was performed, the ureter was isolated without blocking and without the introduction of a bacterial strain. 10 animals of each group were removed from the experiment on the 3rd and 5th days, kidney tissue and urine were intake. As a reference marker strain, the laboratory strain E. coli No. 49579 was used, which was obtained from a patient with a urological infection and had resistance to cefepime, ciprofloxacin and tetracycline. Biomaterials were studied by microbiological examination and subspecific typing of strains using the MALDI-TOF MS method, antibiotic sensitivity was determined. Results: E. coli strain was isolated in all animals of the experimental group and in 2 animals of the control group on the 5th day. During subspecific typing by the MALDI-TOF MS method, the isolated strains were identical in ribosomal proteins, and also had the same sensitivity to the said antibiotics. When analyzing the amount of lg CFU E.coli in urine after the experiment between the experimental and control group, we found that, on day 3, there were statistically significant differences between the groups (p=0.005), and on day 5, the amount of lg CFU E.coli was 13 times greater (p=0.004).A comparative analysis of the lg CFU E.coli index in kidney tissue on 3 (p=0.004) and 5 (p=0.003) days revealed statistically significant differences between the experimental group and the control group. Conclusion: The results of identification and subspecific typing of isolated microorganisms confirmed that the strains isolated from the urinary tract were identical to the reference strain introduced into the gastrointestinal tract during the experiment, which confirms the role of translocation of intestinal microorganisms in the development of acute obstructive pyelonephritis.

The article presents historical aspects of the diagnosis and treatment of acute pyelonephritis. The features of surgical approaches and management tactics for patients with acute pyelonephritis in the 70-80s in the USSR and later in Russia are revealed. The author presents his view of the problem. The author presents the research data aimed at studying the pathophysiology of acute pyelonephritis, which cardinally changed the ideas of that time about the principles of disease management. The author's contribution to the issues and organization of care for patients with acute pyelonephritis is also reflected.

Introduction Endogenous Endophthalmitis is a rare ocular infection but with poor visual prognosis for most patients. Its most frequent etiology is Klebsiella spp., associated with hepatic abscesses and less frequently with perirenal abscesses. Case presentation We present a 61‐year‐old woman with a history of poorly controlled diabetes mellitus 2 that consulted several times for acute pyelonephritis with torpid evolution, associated with endogenous endophthalmitis in her right eye that required evisceration. Conclusion Adequate management of acute pyelonephritis can avoid local or distant complications, such as endogenous endophthalmitis, an infection with poor visual prognosis that requires high clinical suspicion for timely management with better visual outcomes and lower morbimortality.

Acute pyelonephritis is a common infection of the upper urinary tract that affects approximately 250,000 adults in the United States. Individuals with acute pyelonephritis require hospitalization and intravenous antimicrobial therapy. Diagnoses of acute pyelonephritis are made on the basis of clinical and laboratory findings. Individuals with complex or severe acute pyelonephritis undergo contrast-enhanced computed tomography (CT) for the diagnosis and assessment of perirenal abnormalities. However, extrarenal manifestations, such as periportal edema and gallbladder wall thickening, may complicate the diagnostic process. We report the case of a 42-year-old woman who presented with fever, dysuria, and flank pain—the hallmarks of urosepsis. CT results confirmed acute pyelonephritis accompanied by periportal edema and elevated levels of hepatic enzymes and C-reactive protein. Despite antibiotic intervention, febrile episodes persisted for 4 days and abated over a fortnight. The patient's blood and urine cultures yielded negative results, which may be attributed to her prior antimicrobial treatment. Recognition of extrarenal signs in acute pyelonephritis is crucial for obtaining accurate diagnoses and understanding their clinical implications. [ABSTRACT FROM AUTHOR]

Abstract Background Trueperella bernardiae is a coryneform, gram-positive bacterium that is a commensal of the skin and upper respiratory tract. It is treated as a contaminant and rarely causes infections. Blood, urine, and abscesses have been previously reported as the most common sites of infection. Infections caused by T. bernardiae are rarely reported in bedridden very old patients with reduced activities of daily living (ADL). In this report, we describe a case of sepsis due to acute pyelonephritis caused by T. bernardiae in a very old patient with impaired ADL. Case presentation A 94-year-old woman had a home visit from her local physician. She was bedridden and used diapers. On the day of admission, she presented with fever and dyspnea and was admitted with a diagnosis of sepsis associated with acute pyelonephritis. T. bernardiae was detected in blood and urine cultures; furthermore, multiple bacteria were detected in a urine culture. She was treated with ampicillin/sulbactam 3 g every 12 h on the day of admission. The fever was controlled, and inhaled oxygen 1 L/min via a nasal cannula was administered for dyspnea until hospitalization day 2. On hospitalization day 2, her fever resolved to 36 °C. Antimicrobials were de-escalated and changed to cephazolin and then to cephalexin on hospitalization days 9 and 16, respectively, and were continued until day 22. On hospitalization day 28, the urinary tract infection flared up; however, her fever resolved by hospitalization day 38 after the re-administration of antimicrobial agents. She was discharged on hospitalization day 60. Conclusions We encountered a rare case of sepsis following acute pyelonephritis caused by T. bernardiae infection. When bedridden, diaper-using, very old patients present with urinary tract infections caused by multiple bacteria, the presence of rare opportunistic organisms, such as T. bernardiae, should be considered.

Background: Acute kidney injury (AKI) associated with acute pyelonephritis (APN) is considered rare. This study is conducted to find out the occurrence and risk factors for AKI in patients hospitalized with acute pyelonephritis and their clinical outcomes. Materials and Methods: All inpatients with APN from December 2018 to May 2020 were included. Results: A total of 95 patients were included. Escherichia coli was the most common organism grown. At presentation, 79/95 (83.2%) patients had renal dysfunction. 31/79 (39.2%) patients required hemodialysis. AKI was 2.4 times common in men; P = 0.013. The mean duration of fever in patients with and without renal dysfunction was 8.30 ± 2.72 and 5.31 ± 0.91 days, respectively; P < 0.001. 73/79 (92.4%) patients with AKI had anemia as against 2/14 (14.2%) patients without AKI; P < 0.001. AKI developed in 100% of the patients with known chronic kidney disease (CKD) at baseline and 41.6% of the patients with normal baseline kidney function; P < 0.001. Diabetes mellitus was present in 29/79 (36.7%) patients with AKI and 6/16 (37.5%) patients without AKI; P = 0.31. Hospital stay in days was 11.65 ± 5.9 and 5.81 ± 0.91, respectively, in patients with and without renal dysfunction; P < 0.001. 6/95 (6.3%) patients died. All six patients had renal dysfunction. At 3 months, renal functions normalized in 38/79 (48.1%) patients and 8/31 (25.8%) patients remained dialysis-dependent. Conclusions: AKI is a common complication of APN. It is usually reversible with early and appropriate management. Male gender, anemia, bilateral pyelonephritis, baseline CKD, and delayed presentation to hospital are associated with increased risk of AKI. It is associated with an increased risk of dialysis, hospitalization days, and mortality.

Acute pyelonephritis (APN) is a bacterial infection causing inflammation of the kidneys. Diagnosis is usually based on clinical and laboratory findings. Imaging is required if a complication is suspected in acute pyelonephritis to assess the nature and extent of the lesions and to detect underlying causes. CT represents the current imaging modality of choice in clinical practice. CEUS is an alternative that has been proven to be equally accurate in the detection of acute pyelonephritis renal lesions. CEUS allows us to distinguish small simple nephritic involvement from abscess complications and to follow their evolution over time during antibiotic therapy. The absence of ionizing radiation and the lack of nephrotoxicity make CEUS an ideal tool in the study of pyelonephritis. [ABSTRACT FROM AUTHOR]

A 34-year-old nulliparous gravid female presented with acute bilateral pyelonephritis at 29 + 5 weeks gestation. The patient was relatively well until two weeks ago when a slight increase in amniotic fluid was noted. Further investigation revealed myoglobinuria and significantly elevated levels of creatine phosphokinase. The patient was subsequently diagnosed with rhabdomyolysis. Twelve hours after admission, the patient noted reduced fetal movements. A non-stress test revealed fetal bradycardia and non-reassuring variability in fetal heart rate. An emergency cesarean section was performed, and a "floppy" female child was delivered. Genetic testing revealed congenital myotonic dystrophy, and the mother was also diagnosed with myotonic dystrophy. Rhabdomyolysis has a very low incidence in pregnancy. Herein, we report a rare case of myotonic dystrophy with rhabdomyolysis in a gravid female with no history of myotonic dystrophy. Acute pyelonephritis is a causative agent of rhabdomyolysis that results in preterm birth. [ABSTRACT FROM AUTHOR]

Renal vein thrombosis is not a common manifestation in the context of acute pyelonephritis. We report the case of a 29-year-old female diabetic patient that was admitted to our department for an episode of complicated acute pyelonephritis. Initial imaging showed a left lower polar abscess of 27 mm and urine cultures grew community acquired K. Pneumoniae. Two days after the patient was discharged, she was readmitted with worsening symptoms. Repeat imaging showed stability in the size of the abscess and revealed a left lower segmental vein thrombosis. The patient responded favorably to antibiotics and heparin-warfarin therapy.

Acute pyelonephritis is a common infection of the upper urinary tract that affects approximately 250,000 adults in the United States. Individuals with acute pyelonephritis require hospitalization and intravenous antimicrobial therapy. Diagnoses of acute pyelonephritis are made on the basis of clinical and laboratory findings. Individuals with complex or severe acute pyelonephritis undergo contrast-enhanced computed tomography (CT) for the diagnosis and assessment of perirenal abnormalities. However, extrarenal manifestations, such as periportal edema and gallbladder wall thickening, may complicate the diagnostic process. We report the case of a 42-year-old woman who presented with fever, dysuria, and flank pain—the hallmarks of urosepsis. CT results confirmed acute pyelonephritis accompanied by periportal edema and elevated levels of hepatic enzymes and C-reactive protein. Despite antibiotic intervention, febrile episodes persisted for 4 days and abated over a fortnight. The patient’s blood and urine cultures yielded negative results, which may be attributed to her prior antimicrobial treatment. Recognition of extrarenal signs in acute pyelonephritis is crucial for obtaining accurate diagnoses and understanding their clinical implications.

Pyelonephritis is an inflammation caused by bacteria that primarily effects the interstitial area and the renal pelvis or, less often, the renal tubules. It is one of the most common renal diseases. The main objective of the study is to know and to compare the bacterial species that cause pyelonephritis in its three types, acute, chronic and emphysematous for patients in Iraq, specifically in the Al-Najaf Governorate. 663 (82.88%) samples gave a positive result for bacterial growth, and they belonged to patients with acute pyelonephritis 128 samples, chronic pyelonephritis patients had 288 samples and 247 samples for pyelonephritis emphysematous patients. The chronic pyelonephritis type had the most diverse bacterial species (11) bacterial species, the acute pyelonephritis (9) bacterial species, and the emphysematous pyelonephritis (6) species only. Escherichia coli bacteria was the most widespread of all types pyelonephritis, with a percentage of 34.41% (53/ 154) .For the acute type, percentage of 49.83% (152/305) was for the chronic type and a percentage of 56.07% (157/280) for the emphysematous type. 15 types of antibiotics were tested, and the antibiotics Imipenem and Amikacin were the best for most isolated bacterial species. In terms of gender, age and residence of the patients, females were the most susceptibility 341 (51.43%), and the age group (41-55) years is the most influential 211 (31.83%) and the percentage of residents of urban areas 379 (57.16%) gave the highest percentage of residents of rural areas.

Background: For risk stratification and individualized treatment for children with urinary tract infection (UTI), they must be assessed for the presence of acute pyelonephritis (APN). Our study aimed to combine variables that can predict APN and establish a nomogram for clinical use. Methods: In total, 111 children 39 °C, serum procalcitonin (PCT) ≥ 0.52 pg/mL, C-reactive protein (CRP) ≥ 2.86 mg/dL, and abnormal RUBS findings were independent variables for predicting APN in children. The nomogram established using the aforementioned variables had an area under the receiver operating characteristic curve (AUC) of 0.89, which was higher than those of PCT and CRP alone (0.776 and 0.774, respectively). Conclusion: The combination of four variables had the highest power in predicting APN in children with UTI. The established nomogram is practical for clinical use.

Objective: To evaluate the association between the incidence of renal scarring on technetium-99 m dimercaptosuccinic acid (DMSA) renal scintigraphy and the severity of renal parenchymal infections, such as acute pyelonephritis (APN), acute focal bacterial nephritis (AFBN), and renal abscess, based on computed tomography (CT) diagnosis. Methods: Sixty-one children with renal parenchymal infections were included and classified into two groups: those with (renal scarring group) and without renal scarring (non-renal scarring group) on chronic-phase DMSA renal scintigraphy. The severity of renal parenchymal infection was classified into three grades using CT: APN, AFBN, and renal abscess as grades 1, 2, and 3, respectively. The severity of renal parenchymal infection, vesicoureteral reflux (VUR) grade, and intrarenal reflux occurrence during voiding cystourethrography (VCUG) were evaluated between the renal and non-renal scarring groups. Fisher's exact test and Mann–Whitney U test were used for statistical analysis. Results: Renal scars were detected in 28 (45.9%) of the 61 patients. We found that 2/9 (22.2%), 18/41 (43.9%), and 8/11 (72.7%) patients with APN (grade 1), AFBN (grade 2), and renal abscess (grade 3) had renal scarring, respectively. There was a significant difference in the grade of severity of renal parenchymal infection between the renal (median = 2 [interquartile range, 2–3]) and non-renal (median = 2 [interquartile range, 2–2]) scarring groups (p = 0.023). There was a significant difference in the grade of VUR between the renal (median = 3 [interquartile range, 0–4]) and non-renal (median = 0 [interquartile range, 0–2]) scarring groups (p = 0.004). No significant difference in intrarenal reflux occurrence was observed between the renal (present/absent: 3/25) and non-renal (present/absent: 0/29) scarring groups (p = 0.112). Conclusion: Our results showed that pediatric patients with renal scarring on chronic-phase DMSA renal scintigraphy tended to have a more severe renal infection. [ABSTRACT FROM AUTHOR]

Background: Trueperella bernardiae is a coryneform, gram-positive bacterium that is a commensal of the skin and upper respiratory tract. It is treated as a contaminant and rarely causes infections. Blood, urine, and abscesses have been previously reported as the most common sites of infection. Infections caused by T. bernardiae are rarely reported in bedridden very old patients with reduced activities of daily living (ADL). In this report, we describe a case of sepsis due to acute pyelonephritis caused by T. bernardiae in a very old patient with impaired ADL. Case presentation: A 94-year-old woman had a home visit from her local physician. She was bedridden and used diapers. On the day of admission, she presented with fever and dyspnea and was admitted with a diagnosis of sepsis associated with acute pyelonephritis. T. bernardiae was detected in blood and urine cultures; furthermore, multiple bacteria were detected in a urine culture. She was treated with ampicillin/sulbactam 3 g every 12 h on the day of admission. The fever was controlled, and inhaled oxygen 1 L/min via a nasal cannula was administered for dyspnea until hospitalization day 2. On hospitalization day 2, her fever resolved to 36 °C. Antimicrobials were de-escalated and changed to cephazolin and then to cephalexin on hospitalization days 9 and 16, respectively, and were continued until day 22. On hospitalization day 28, the urinary tract infection flared up; however, her fever resolved by hospitalization day 38 after the re-administration of antimicrobial agents. She was discharged on hospitalization day 60. Conclusions: We encountered a rare case of sepsis following acute pyelonephritis caused by T. bernardiae infection. When bedridden, diaper-using, very old patients present with urinary tract infections caused by multiple bacteria, the presence of rare opportunistic organisms, such as T. bernardiae, should be considered. [ABSTRACT FROM AUTHOR]