title: Encrusted pyelitis of native kidneys.
abstract: 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.
authors.affiliation: Department of Nephrology, Necker Hospital, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Hertig
authors.affiliation: Department of Nephrology, Val de Grace Hospital, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Duvic
authors.affiliation: Department of Urology, Necker Hospital, Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Chretien
authors.affiliation: Department of Nephrology, Necker Hospital, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Jungers
authors.affiliation: Department of Nephrology, Necker Hospital, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Grünfeld
authors.affiliation: Department of Nephrology, Necker Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rieu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003352:Corynebacterium / Q000302:isolation & purification; D003460:Crystallization; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry*; D017616:Magnesium Compounds; D008297:Male; D008875:Middle Aged; D010710:Phosphates; D011702:Pyelitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D012307:Risk Factors; D000069877:Struvite; D014057:Tomography, X-Ray Computed; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D017616:Magnesium Compounds; D010710:Phosphates; D014640:Vancomycin; D000069877:Struvite