1/25. Pyelo-ureteritis cystica associated with a urinary tract infection due to a coagulase-negative staphylococcus. A young female presenting with a history suggestive of renal colic was found by intravenous pyelography to have Pyeloureteritis Cystica. In association with this condition she had a urinary tract infection due to a coagulase-negative staphylococcus. Following a two week course of appropriate antibiotic therapy, her urine became sterile and repeat pyelography revealed no abnormality. ( info) |
| OBJECTIVE: Hemorrhagic cystitis is a well-known complication of cyclophosphamide therapy but extensive involvement of the entire urinary tract is far less common. We report here a patient who developed severe hemorrhagic pyelitis, ureteritis, and cystitis after one cycle of cyclophosphamide-containing combination chemotherapy. METHOD: A patient with synchronous carcinoma of the ovary and the uterus developed severe hemorrhagic pyelitis, ureteritis, and cystitis leading to bilateral hydronephroses and acute renal failure after one cycle of combination chemotherapy containing cyclophosphamide. The blood clots in the upper urinary tract were aspirated endoscopically and bilateral internal ureteric stents were inserted. RESULT: She underwent a prolonged diuretic phase with several episodes of hypokalemia, hypomagnesemia, and hypocalcemia and required intensive fluid and electrolytes replacement. Subsequently, she recovered fully with the ureteric stents removed 26 days later. CONCLUSION: In contrast to previous reports, where 2.8 g of cyclophosphamide was estimated to be the minimum cumulative dose required to cause hemorrhagic cystitis, this case illustrates that severe hemorrhagic complication can occur even after a low dose of cyclophosphamide (600 mg/m(2), total dose of 846 mg). Prompt diagnosis and intervention may be life-saving. ( info) |
3/25. Encrusted pyelitis of native kidneys. This study reports the first four cases of encrusted pyelitis involving native kidneys. The clinical features, management, and outcome of these patients were analyzed. Predisposing factors were underlying urologic disease and/or urologic manipulations, debilitating diseases, hospitalization, and prolonged antibiotic therapies. Presenting symptoms were renal failure in three patients with ureteroileal urinary diversion and manifestations of cystitis in one patient. Computed tomography scan of the urinary tract was critical for diagnosis. Presence of struvite was demonstrated by crystalluria and infrared spectrophotometry analysis of the encrusted material. corynebacterium urealyticum urinary infection was identified in one case. Surgery (one patient) and palliative ureteral diversion (one patient), respectively, led to death and end-stage renal failure. Successful dissolution of encrusted pyelitis was obtained in two patients treated with intravenous vancomycin and local acidification of the renal collecting system. Clinical observation shows that encrusted pyelitis is a threatening disorder that destroys the native kidneys and may lead to end-stage renal failure. Successful treatment of the disease by chemolysis and antibiotics depends on correct and early diagnosis. Diagnosis required recognition of the predisposing factors, computed tomography imaging of the urinary tract, crystalluria, and identification of urea-splitting bacteria with prolonged culture on selective medium. ( info) |
4/25. Emphysematous pyelitis presenting as an acute abdomen in an end-stage renal disease patient treated with peritoneal dialysis. Emphysematous pyelitis is air in the renal collecting system in patients with urinary tract infections. This entity is uncommon and seen primarily in patients with diabetes mellitus. We report a case of a patient with end-stage renal disease treated with peritoneal dialysis who developed emphysematous pyelitis who presented with signs and symptoms that were more consistent with appendicitis. The spectrum of infections causing air in the urinary tract and the method by which end-stage renal disease patients are treated are discussed. patients receiving dextrose peritoneal dialysis are at risk for emphysematous pyelonephritis, pyelitis, and cystitis. ( info) |
5/25. Pyeloureteral filling defects associated with systemic anticoagulation: a case report. The etiology of pyeloureteritis cystica has long been attributed to chronic infection and inflammation. A case is presented that is unique in that the acute onset and the rapid resolution of pyeloureteral filling defects in this patient were documented by radiography. There is no evidence of antecedent or concurrent infection in this patient. The disease occurred subsequent to the initiation of heparin therapy for suspected pelvic thrombophlebitis and cleared rapidly subsequent to its discontinuation. The rate of resolution of the radiographic findings may be helpful in distinguishing between true pyeloureteritis cystica and submucosal hemorrhage. ( info) |
| This is the first report of death due to gross encrustations of the entire upper urinary tract and bladder by corynebacterium group D2 in a man with no history of renal transplantation or prolonged catheterizations. This case demonstrates that debilitated patients with a prior endoscopic procedure are at risk for this disease process. Prolonged treatment with appropriate antibiotics, acidification of the urine, and removal of crusts is essential for proper management. ( info) |
7/25. Cytology of pyelitis glandularis cystica. A case report. Cytologic findings that occur in association with proliferative lesions involving von Brunn's nests in the urinary tract are rare. Such lesions are probably far more common than recognized and are probably considered in the clinicoradiologic differential diagnosis when space-occupying lesions are found, particularly in the upper urinary tract. Reported here are the cytologic findings in a case of pyelitis glandularis cystica that presented as a renal pelvic lesion. ( info) |
8/25. Successful treatment of primary bilateral renal mucormycosis with bilateral nephrectomy. Bilateral invasive renal mucormycosis has previously been associated with a 100% mortality rate. We report a case of bilateral invasive renal mucormycosis in a patient treated with amphotericin b and bilateral nephrectomy who survived and is currently disease-free. ( info) |
9/25. Alkaline encrusted pyelitis. Alkaline encrusted pyelitis is an infectious disease characterised by encrustations in the wall of the upper urinary tract, surrounded by severe inflammation. Destruction of native kidneys and kidney grafts may occur, resulting in end stage renal failure. corynebacterium group D2, an urea splitting microorganism, is nearly exclusively associated with this disease. The most important predisposing factors are previous urological procedures and an immunosuppressed state. In a suggestive clinical context, diagnosis should be made with unenhanced computed tomography findings and bacteriologic isolation of the responsible microorganism. The treatment is threefold: appropriate antibiotic therapy, by preference with glycopeptides, acidification of urine and chemolysis, and if needed, surgical removal of encrustations. We report the case of a patient who was diagnosed with this rare condition and could escape maintenance dialysis after correct diagnosis was made and conservative treatment was started using antibiotics and combined oral and local acidification. ( info) |
10/25. Granulomatous pyelitis associated with urinary obstruction: a comprehensive clinicopathologic study. Urinary obstruction is rarely associated with a distinct granulomatous inflammation, which involves the pyelocalyceal system and closely simulates infectious conditions including tuberculosis. Its clinicopathologic features, however, have not been adequately studied since there are only seven isolated reported cases. In a comprehensive study of 112 kidney specimens with urinary obstruction, we identified five cases of granulomatous pyelitis. The features of these cases were detailed and compared with the previously reported cases. Among the five identified subjects, three patients had history of urolithiasis and two had ureteral stenosis and all had stent placement 7 weeks to 12 years before nephrectomy for relief of the unilateral urinary obstruction. The age distribution was between 38 and 81 years. Two had end-stage renal disease or chronic renal failure. The pyelocaliceal system showed frank hydronephrosis (1 case) or partial dilatation (4 cases) and contained cheesy and gritty material in its lumen. Each case showed severe granulomatous inflammation, which was limited to the pelvic wall and closely associated with calcified debris, necrotic inflammatory cells, and material consistent with Tamm-Horsfall protein. The kidney showed chronic tubulointerstitial nephritis but without granulomas. Cultures of urine, blood, and the renal pelvic content, and special stains of tissue sections did not show fungi or mycobacteria in any case. Many of these features were also observed in previously reported cases. Granulomatous pyelitis is a rare but distinct cliniocopathologic entity characterized by severe noninfectious granulomatous inflammation limited to the renal pelvis, which is uniformely asociated with urinary obstruction and pyelocalyceal dilatation and may develop in response to accumulated calcified material in the renal pelvis. awareness of this entity and its characteristic clinicopathologic features also helps eliminate an infectious etiology with obvious treatment and prognostic implications. ( info) |