Is baseline routine renal ultrasound indicated for all MS patients?

2019 ◽  
Vol 96 (1134) ◽  
pp. 194-196
Author(s):  
Igor B Títoff ◽  
Victoria Titoff ◽  
Thomas F Scott
Keyword(s):  
Urinary Tract ◽  
Upper Urinary Tract ◽  
Renal Ultrasound ◽  
Red Flags ◽  
Inclusion Criteria ◽  
Detrusor Sphincter Dyssynergia ◽  
History Of ◽  
Bladder Symptoms ◽  
Tract Infections

BackgroundMost patients with multiple sclerosis (MS) develop multiple urological complaints due to hyperactive or hypoactive bladder, and may have detrusor-sphincter dyssynergia. Routine renal ultrasound (RUS) screening has been recommended for both symptomatic and asymptomatic MS patients; however, there is little data to support this practice.MethodsProspectively screened consecutive MS clinic patients in 2016–2017 with functional systems scores (FSS) indicating moderate to severe neurogenic bladder symptoms (FSS bladder ≥2) were sent for RUS. We also screened for history of urinary tract infections.Results872 patients were screened between 3 September 2016 and 13 April 2017. 58 patients met inclusion criteria for RUS. 6 were excluded due to non-compliance with testing or unavailability of results; 52 patients were imaged. Only 3/52 patients were found to have renal pathology requiring follow-up. Of those three, one had known symptomatic nephrolithiasis, and one had subsequently normal findings, leaving one patient newly found to have valid abnormal upper urinary tract (UUT) findings. Multiple incidental findings were also discovered.ConclusionThe minimal yield for significant UUT pathology found in this enriched group of symptomatic MS patients indicates that RUS screening for asymptomatic MS patients without clear risk factors is not indicated. Red flags for high risk of UUT complications should be used as triggers for baseline RUS screening in MS patients.

Renal Ultrasound Evaluation of Urinary Tract Infections in Children

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 871-878
Author(s):  
Candice E. Johnson ◽  
Baz P. DeBaz ◽  
Paul A. Shurin ◽  
Rose DeBartolomeo
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Acute Infection ◽  
Upper Urinary Tract ◽  
Patient Acceptance ◽  
Renal Ultrasound ◽  
Intravenous Pyelogram ◽  
Ultrasound Evaluation ◽  
Tract Infections

Ultrasonography of the kidney may replace the intravenous pyelogram as the study of choice in identifying treatable abnormalities in children with urinary tract infection. In a series of 64 consecutive children with urinary tract infection in whom an intravenous pyelogram, renal ultrasound, and voiding cystogram were performed, only one treatable abnormality (calyceal dilation) was identified by intravenous pyelogram, and it was not detected by ultrasound. Eleven children showed vesicoureteral reflux on the cystogram. In an additional 43 children in whom intravenous pyelogram was done only if the ultrasound or cystogram were abnormal, there were five abnormal cystograms. Four treatable abnormalities were identified by ultrasound, and three were confirmed by the intravenous pyelogram. Ultrasound should replace the intravenous pyelogram in children with a normal cystogram because of its accuracy, safety, and high patient acceptance. We have also documented a significant volume increase with acute infection in one or both kidney(s) of those children having upper urinary tract infection. Fifteen of 18 children with upper urinary tract infection had volume increases of 30% on more in at least one kidney; whereas only four of 21 children with lower urinary tract infection had increases of greater than 30% (P < .005). Ultrasound volume measurements provide a new, noninvasive method for identifying the probable site of urinary tract infection.

scholarly journals Urinothorax Caused by Xanthogranulomatous Pyelonephritis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Waiel Abusnina ◽  
Hazim Bukamur ◽  
Zeynep Koc ◽  
Fauzi Najar ◽  
Nancy Munn ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Obstructive Uropathy ◽  
Xanthogranulomatous Pyelonephritis ◽  
Robot Assisted ◽  
Rare Form ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Tract Infections

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy.

scholarly journals Antibacterial therapy for uncompleted upper urinary tract infections

2020 ◽  
Vol 9 (4) ◽  
pp. 37-40
Author(s):  
Adel S. Al-Shukri ◽  
Elena E. Zakharevich
Keyword(s):  
Antibacterial Activity ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Laboratory Tests ◽  
Upper Urinary Tract ◽  
Efficacy And Safety ◽  
Good Tolerance ◽  
High Antibacterial Activity ◽  
Tract Infections

To evaluate the efficacy and safety of the use of the drug Hileflox 750 (levofloxacin) in the treatment of uncomplicated infections of the upper urinary tract (pyelonephritis). 46 patients (9 men and 37 women) with uncomplicated pyelonephritis were observed. All patients were treated with Hileflox 750 mg orally once a day for 5 days. The drug showed high antibacterial activity, clinical efficacy and good tolerance. During follow-up for 6 months, not one patient showed abnormalities in laboratory tests, the development of complications or relapses of the disease. Conclusions: the results of the study showed the feasibility and effectiveness of the use of the drug Hayleflox 750 for the treatment of uncomplicated pyelonephritis in monotherapy.

scholarly journals Appendicovesical fistula presenting as hypokalaemic hyperchloraemic metabolic acidosis: a case report

2019 ◽  
Vol 101 (6) ◽  
pp. e131-e132
Author(s):  
S Keane ◽  
GD Tebala
Keyword(s):  
Urinary Tract ◽  
Past History ◽  
Iliac Fossa ◽  
Fistulous Tract ◽  
Emergency Laparotomy ◽  
Metabolic Derangement ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Tract Infections

A 52-year-old man was admitted with diarrhoea and faecaluria and referred recurrent urinary tract infections for over 20 years. He also reported a two-week hospital admission more than 20 years ago for right iliac fossa pain, which was managed conservatively. Computed tomography showed a fistulous tract extending from the bladder with an unclear connection to the bowel. Cystoscopy confirmed the presence of a vesical fistula and biopsy of the tract confirmed colonic mucosa. Flexible sigmoidoscopy was negative. A cystogram was requested as an outpatient procedure and the patient was discharged after antibiotic treatment. A few days after discharge the patient was readmitted as an emergency to critical care for severe hyperchloraemic hypokalaemic acidosis and a Glasgow Coma Score of 6/15. He was intubated and ventilated and his metabolic derangement was treated. As soon as his conditions improved, he underwent emergency laparotomy, which revealed the presence of a fistula between the caecal fundus and the bladder. The fistula was repaired and the patient recovered swiftly and completely and was discharged on postoperative day 5. At 12-month follow up the patient was completely symptoms-free, his bowel habits were normal and he has not had any urinary infection. Appendicovesical fistula is a rare and potentially lethal condition due to its metabolic consequences. Past history of right iliac fossa pain treated conservatively, diarrhoea and recurrent urinary tract infection must raise suspicion.

Hepatic Encephalopathy Treated With L-Dopa, Recovery Followed for 18 Months

PEDIATRICS ◽  
1973 ◽  
Vol 51 (6) ◽  
pp. 1105-1106
Author(s):  
A. R. Colón ◽  
D. H. Sandberg
Keyword(s):  
Case Report ◽  
Urinary Tract ◽  
Hepatic Encephalopathy ◽  
Urinary Tract Infections ◽  
Serum Electrolytes ◽  
Negro Girl ◽  
History Of ◽  
One Year ◽  
Tract Infections

Six cases of hepatic encephalopathy (HE) treated with L-Dopa have been described in the literature1-3 but no substantial follow-up is available regarding the surviving patients. We treated a young girl in HE with L-Dopa and have had an 18-month follow-up to date. Case Report A. 13-year-old Negro girl with a one-year history of recurrent urinary tract infections was admitted with anasarca and ascites. She was normotensive and neurologically stable. Hematuria was observed but serum electrolytes, blood urea nitrogen (BUN) and creatinine levels were normal.

Clean, Intermittent Catheterization of Infants With Neurogenic Bladder

PEDIATRICS ◽  
1989 ◽  
Vol 84 (1) ◽  
pp. 78-82
Author(s):  
David B. Joseph ◽  
Stuart B. Bauer ◽  
Arnold H. Colodny ◽  
James Mandell ◽  
Alan B. Retik
Keyword(s):  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Bladder Dysfunction ◽  
Upper Urinary Tract ◽  
Febrile Episode ◽  
Intermittent Catheterization ◽  
Early Age ◽  
Clean Intermittent Catheterization ◽  
Detrusor Sphincter Dyssynergia ◽  
Tract Infections

Clean, intermittent catheterization was instituted in 38 babies with myelodysplasia who were thought to be at risk for upper urinary tract deterioration because of neurogenic bladder dysfunction. There were 19 patients 2 weeks to 12 months of age, 11 were 1 to 2 years of age, and 8 were older than 2 years. Effectiveness of clean, intermittent catheterization was determined by maintenance of upper urinary tract stability. Upper urinary tracts improved or remained stable in 13 of 16 infants (81%) with reflux and 16 of 18 infants (89%) with detrusor-sphincter dyssynergia. Bacteriuria was present in 16 (42%), with only 2 infants (5%) having a febrile episode; no infant required hospitalization because of urinary tract infections. No further complications were identified in infants who were cleanly and intermittently catheterized. Most families found clean, intermittent catheterization of their infants easy to master and not stressful, and their children adjusted to it at an early age.

scholarly journals Microbiome recovery in adult females with uncomplicated urinary tract infections in a randomised phase 2A trial of the novel antibiotic gepotidacin (GSK140944)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrea Nuzzo ◽  
Stephanie Van Horn ◽  
Christopher Traini ◽  
Caroline R. Perry ◽  
Etienne F. Dumont ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Human Microbiome ◽  
Time Points ◽  
Pharyngeal Cavity ◽  
Adult Females ◽  
Microbiome Diversity ◽  
Antibiotic Drug ◽  
Tract Infections

Abstract Background With increasing concerns about the impact of frequent antibiotic usage on the human microbiome, it is important to characterize the potential for such effects in early antibiotic drug development clinical trials. In a randomised Phase 2a clinical trial study that evaluated the pharmacokinetics of repeated oral doses of gepotidacin, a first-in-chemical-class triazaacenaphthylene antibiotic with a distinct mechanism of action, in adult females with uncomplicated urinary tract infections for gepotidacin (GSK2140944) we evaluated the potential changes in microbiome composition across multiple time points and body-sites (ClinicalTrials.gov: NCT03568942). Results Samples of gastrointestinal tract (GIT), pharyngeal cavity and vaginal microbiota were collected with consent from 22 patients at three time points relative to the gepotidacin dosing regimen; Day 1 (pre-dose), Day 5 (end of dosing) and Follow-up (Day 28 ± 3 days). Microbiota composition was determined by DNA sequencing of 16S rRNA gene variable region 4 amplicons. By Day 5, significant changes were observed in the microbiome diversity relative to pre-dose across the tested body-sites. However, by the Follow-up visit, microbiome diversity changes were reverted to compositions comparable to Day 1. The greatest range of microbiome changes by body-site were GIT followed by the pharyngeal cavity then vagina. In Follow-up visit samples we found no statistically significant occurrences of pathogenic taxa. Conclusion Our findings suggest that gepotidacin alteration of the human microbiome after 5 days of dosing is temporary and rebound to pre-dosing states is evident within the first month post-treatment. We recommend that future antibiotic drug trials include similar exploratory investigations into the duration and context of microbiome modification and recovery. Trial registration NCT03568942. Registered 26 June 2018.

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