BACKGROUND: Despite the burden of pyelonephritis after kidney transplantation, there is no consensus on initial empirical antibiotic management. METHODS: We surveyed clinicians throughout the world on their practice and opinions about the initial empirical therapy of post-transplant pyelonephritis, using clinical vignettes. A panel of experts from 19 countries on six continents designed this survey, and invited 2145 clinicians to participate. RESULTS: A total of 721 clinicians completed the survey (response rate: 34%). In the hypothetical case of a kidney transplant recipient admitted with pyelonephritis but not requiring intensive care, most respondents reported initiating either a 3rd-generation cephalosporin (37%) or piperacillin-tazobactam (21%) monotherapy. Several patient-level factors dictated the selection of broader-spectrum antibiotics, including having a recent urine culture showing growth of a resistant organism (85% for extended-spectrum ß-lactamase-producing organisms, 90% for carbapenemase-producing organisms, and 94% for Pseudomonas aeruginosa). Respondents attributed high importance to the appropriateness of empirical therapy, which 87% judged important to prevent mortality. Significant practice and opinion variations were observed between and within countries. CONCLUSION: High-quality studies are needed to guide the empirical management of post-transplant pyelonephritis. In particular, whether prior urine culture results should systematically be reviewed and considered remains to be determined. Studies are also needed to clarify the relationship between the appropriateness of initial empirical therapy and outcomes of post-transplant pyelonephritis.

• Klíčová slova
• antimicrobial stewardship, kidney transplantation, questionnaire, urinary tract infection,
• MeSH
• antibakteriální látky * terapeutické užití   MeSH
• beta-laktamasy MeSH
• cefalosporiny terapeutické užití   MeSH
• dospělí MeSH
• kombinace léků piperacilin a tazobactam terapeutické užití   MeSH
• lékařská praxe - způsoby provádění statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• příjemce transplantátu statistika a číselné údaje   MeSH
• průzkumy a dotazníky MeSH
• Pseudomonas aeruginosa účinky léků   izolace a purifikace   MeSH
• pyelonefritida * farmakoterapie   mikrobiologie   MeSH
• transplantace ledvin * škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antibakteriální látky * MeSH
• beta-laktamasy MeSH
• cefalosporiny MeSH
• kombinace léků piperacilin a tazobactam MeSH

The cases of horseshoe kidney presented by xanthogranulomatous pyelonephritis are very rare. In this study, the case of XGP developing in HSK in a young female patient was presented due to its rare incidence and the previously reported cases were reviewed, as well. The patient, who has end-stage renal disease and was under treatment, admitted to the clinic for preemptive kidney transplantation. Bilateral open en bloc nephrectomy was performed before the kidney transplantation. The histopathological examination of the specimen was reported as XGP. Eight months later, living-donor organ transplantation was performed to the patient with the kidney obtained from her father. XGP can present as a complication of HSK. Moreover, HSK may rarely be manifested by end-stage renal disease in young patients. In such cases, who would undergo kidney transplantation, it is important to examine the HSK in detail and perform bilateral nephrectomy to prevent complications after transplantation.

• Klíčová slova
• bilateral nephrectomy, end-stage renal disease, horseshoe kidney, xanthogranulomatous pyelonephritis,
• MeSH
• chronické selhání ledvin komplikace   chirurgie   MeSH
• fúze ledvin komplikace   chirurgie   MeSH
• lidé MeSH
• nefrektomie MeSH
• transplantace ledvin * MeSH
• xantogranulomatózní pyelonefritida etiologie   chirurgie   MeSH
• žijící dárci MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

INTRODUCTION: Static renal scintigraphy is the gold standard for detection of inflammatory changes in the renal parenchyma in acute pyelonephritis. Our aim was to determine whether diffusion-weighted magnetic resonance imaging (DW-MRI) was comparable with static renal scintigraphy (DMSA-SRS) to demonstrate acute renal parenchymal lesions. OBJECTIVE: To compare 99mTc-dimercaptosuccinic acid static renal scintigraphy (DMSA-SRS) with diffusion-weighted magnetic resonance imaging (DW-MRI) for detecting acute inflammatory changes in the renal parenchyma in children with febrile urinary tract infection. METHODS: Thirty-one children (30 girls) aged 3-18 years with a first episode of febrile UTI without a previously detected congenital malformation of the urinary tract, were prospectively included. DMSA-SRS and DW-MRI were performed within 5 days of diagnosis to detect renal inflammatory lesions. The DW-MRI examination was performed without contrast agent and without general anesthesia. Late examinations were performed after 6 months using both methods to detect late lesions. RESULTS: DW-MRI confirmed acute inflammatory changes of the renal parenchyma in all 31 patients (100%), mostly unilateral. DMSA-SRS detected inflammatory lesions in 22 children (71%; p = 0.002). The lesions were multiple in 26/31 children (84%) on DW-MRI and in 9/22 (40%) on DMSA-SRS. At the control examination, scarring of the renal parenchyma was found equally by DW-MRI and DMSA-SRS in five patients (16%), three of whom were the same patients. The overall concordance of positive and negative late findings occurred in 87% of patients. There was correspondence in the anatomical location of acute and late lesions. DISCUSSION: The clinical significance of acute and late parenchymal findings on DWI-MR is yet to be determined. A limitation of our study is the age of the patients (older than 3 years) who are less sensitive to scar development; therefore, a smaller number of patients with scars could be analyzed during control examination. Further studies using the DW-MRI should confirm its reliability to detect acute and late lesions in younger children and infants and determine the clinical consequences. CONCLUSION: DW-MRI has higher sensitivity for detecting acute renal inflammatory lesions and multifocal lesions than DMSA-SRS. The incidence of scars was low and corresponded with the anatomical location of acute and late lesions.

• Klíčová slova
• (99m)Tc DMSA renal scintigraphy, Acute pyelonephritis, Diffusion-weighted magnetic resonance imaging (DW-MRI),
• MeSH
• akutní nemoc MeSH
• difuzní magnetická rezonance metody   MeSH
• dítě MeSH
• ledviny patologie   MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• pyelonefritida diagnóza   MeSH
• radiofarmaka farmakologie   MeSH
• radioisotopová scintigrafie metody   MeSH
• reprodukovatelnost výsledků MeSH
• technecium 99mTc dimerkaptojantarová kyselina farmakologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• radiofarmaka MeSH
• technecium 99mTc dimerkaptojantarová kyselina MeSH

OBJECTIVE: According to the World Health Organisation, sepsis is one of the four main causes of pregnancy-related mortality worldwide, together with hemorrhage, hypertensive disease and abortion. The main goal of this paper is an analysis of one case of septic shock in pregnancy. DESIGN: A case report. SETTING: Department of Obstetrics and Gynaecology of the First Faculty of Medicine and General Teaching Hospital, Prague. METHODS AND RESULTS: Authors would like to draw attention to the pitfalls of diagnosis and treatment of septic shock which developed in 25th week of pregnancy on the basis of pyelonephritis due to E. coli. CONCLUSIONS: Early diagnosis of sepsis and an interdisciplinary co-operation are the main prerequisities for successful treatment.

• Klíčová slova
• antenatal bacterial infection systemic inflammatory response syndrom., sepsis and pregnancy, septic shock, urinary tract infection,
• MeSH
• akutní nemoc MeSH
• infekce vyvolané Escherichia coli komplikace   MeSH
• infekční komplikace v těhotenství mikrobiologie   MeSH
• lidé MeSH
• mladý dospělý MeSH
• pyelonefritida komplikace   mikrobiologie   MeSH
• septický šok mikrobiologie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Beta-lactam-associated acute tubulointerstitial nephritis (ATIN) is a rare condition in childhood. We report the case of an infant with penicillin-associated ATIN and concomitant acute pyelonephritis resulting in the development of severe acute kidney injury (AKI). The treatment consisted of penicillin suspension and appropriate AKI management, which required a short period of dialysis. Finally, full recovery and normalization of laboratory parameters occurred. We present here the first case of oral penicillin-associated ATIN in childhood.

• Klíčová slova
• acute kidney injury, acute tubulointerstitial nephritis, penicillin,
• MeSH
• akutní nemoc MeSH
• akutní poškození ledvin chemicky indukované   diagnóza   terapie   MeSH
• antibakteriální látky aplikace a dávkování   škodlivé účinky   MeSH
• kojenec MeSH
• lidé MeSH
• peniciliny aplikace a dávkování   škodlivé účinky   MeSH
• peritoneální dialýza MeSH
• pyelonefritida komplikace   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antibakteriální látky MeSH
• peniciliny MeSH

OBJECTIVE: To evaluate feasibility of unstented laparoscopic pyeloplasty in young children to prevent pyelonephritis and second anaesthesia. PATIENTS AND METHODS: During 2006-2013, 70 children (1-5 years old) underwent laparoscopic pyeloplasty for high grade hydronephrosis. Unstented repair was indicated in 34 children (GroupL1), double-J stent was placed in 21 patients (Group L2) and uretero-pyelostomy stent (Cook) in 15 patients (Group L3). Stenting was preferred in large thin-walled pelvis, thin ureter, kidney malrotation, and unfavourable course of crossing vessels. The outcome was compared with age-matched group of 52 children who had open surgery during 1996-2006 (Groups O1, O3). RESULTS: Operation times were significantly shorter in Groups L1 and L2 than in Group L3; the times were shorter in open repairs. Three patients with crossing vessels from Group L1 had urine leakage and one had obstruction (11.4%). In Group L2, one patient had obstruction, one incorrect placement of the stent, and one girl had serious pyelonephritis (14.3%). In Group L3, displacement of uretero-pyelostomy occurred in one patient (6.7%). There is no statistical difference between laparoscopic groups and between laparoscopic and open groups. CONCLUSION: Unstented laparoscopic pyeloplasty is a safe procedure in selected young children with favourable anatomical conditions preventing additional anaesthesia and stent-related complications.

• Klíčová slova
• Double-J stent in children, Laparoscopic pyeloplasty in children, Paediatric pyeloplasty, Unstented laparoscopic pyeloplasty, Ureteropelvic junction obstruction,
• MeSH
• délka pobytu MeSH
• dítě MeSH
• hydronefróza chirurgie   MeSH
• kojenec MeSH
• laparoskopie * MeSH
• ledvinná pánvička chirurgie   MeSH
• lidé MeSH
• obstrukce močovodu chirurgie   MeSH
• předškolní dítě MeSH
• protézy - design MeSH
• pyelonefritida prevence a kontrola   MeSH
• stenty * MeSH
• urologické chirurgické výkony metody   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Interleukin-10 (IL-10) is a potent inhibitor of leukocyte chemotaxis, bacterial killing in phagocytes and synthesis of pro-inflammatory cytokines and chemokines, and recent studies have suggested an important role for this immunoregulatory cytokine in the pathogenesis of urinary tract infections (UTIs). Therefore, the gene encoding IL-10 (IL10) is an attractive candidate for association studies attempting to identify susceptibility genes conferring risk of UTIs. In this case-control study, we aimed to investigate the association of single nucleotide polymorphisms (SNPs) in the promoter region of IL10 with acute pyelonephritis in the Slovak population. Polymerase chain reaction with sequence-specific primers was used to analyse IL10 -1082A/G (rs1800896), -819C/T (rs1800871) and -592C/A (rs1800872) SNPs in 147 children with acute pyelonephritis and 215 healthy controls. Comparison of patients with healthy controls using the logistic regression analysis revealed significantly increased risk of developing recurrent attacks of acute pyelonephritis for -1082 G allele in a dominant genetic model GG (GG + AG vs. AA, P = 0.019, odds ratio (OR) = 2.26). A similar tendency was also found when the recurrent acute pyelonephritis subgroup was compared to episodic pyelonephritis cases (GG + AG vs. AA, P = 0.009, OR = 3.38). In conclusion, our results suggest that IL10 -1082 A/G SNP is a susceptibility factor for development of recurrent attacks of acute pyelonephritis.

• MeSH
• alely MeSH
• dítě MeSH
• DNA chemie   genetika   MeSH
• dospělí MeSH
• genetická predispozice k nemoci MeSH
• genetická variace MeSH
• interleukin-10 genetika   MeSH
• jednonukleotidový polymorfismus MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• mladiství MeSH
• mladý dospělý MeSH
• polymerázová řetězová reakce MeSH
• předškolní dítě MeSH
• promotorové oblasti (genetika) MeSH
• pyelonefritida genetika   MeSH
• studie případů a kontrol MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Slovenská republika MeSH
• Názvy látek
• DNA MeSH
• IL10 protein, human MeSH Prohlížeč
• interleukin-10 MeSH

Rapid diagnosis of acute pyelonephritis is important because of its association with long-standing complications. This study was conducted to compare the reliability of serum procalcitonin (PCT) and interleukin-1 beta (IL-1β) with conventional laboratory parameters for diagnosis of acute pyelonephritis in children. Seventy nine children with urinary tract infection were divided into two groups based on the result of Tc-99m dimercaptosuccinic acid renal scan: acute pyelonephritis (n=33) and lower UTI (urinary tract infection) (n=46) groups. White blood cell (WBC) count, neutrophil count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), PCT and IL-1β concentrations of both groups were measured and compared. WBC count, neutrophil count, ESR, serum CRP, PCT and IL-1β concentrations were higher in acute pyelonephritis patients than in the lower UTI group (P<0.05). The sensitivity and specificity of serum PCT and IL-1β for diagnosis of acute pyelonephritis were 31, 84.7% and 27.2, 90% respectively (using a cut-point value of 0.5 ng/ml for PCT and 6.9 pg/ml for IL-1β). The sensitivity of PCT and IL-1β for diagnosis of acute pyelonephritis was less than that of conventional markers such as ESR and CRP. This study revealed that serum PCT and IL-1β are not good biologic markers for differentiating acute pyelonephritis from lower UTI. It seems that conventional inflammatory markers such as ESR and CRP besides the clinical findings are more reliable for the diagnosis of acute pyelonephritis in children.

• MeSH
• akutní nemoc MeSH
• biologické markery krev   MeSH
• C-reaktivní protein metabolismus   MeSH
• diferenciální diagnóza MeSH
• dítě MeSH
• infekce močového ústrojí krev   diagnóza   MeSH
• interleukin-1beta krev   MeSH
• kalcitonin krev   MeSH
• kojenec MeSH
• krevní sedimentace MeSH
• lidé MeSH
• neutrofily * MeSH
• peptid spojený s genem pro kalcitonin MeSH
• počet leukocytů MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• proteinové prekurzory krev   MeSH
• průřezové studie MeSH
• pyelonefritida krev   diagnóza   MeSH
• senzitivita a specificita MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery MeSH
• C-reaktivní protein MeSH
• CALCA protein, human MeSH Prohlížeč
• interleukin-1beta MeSH
• kalcitonin MeSH
• peptid spojený s genem pro kalcitonin MeSH
• proteinové prekurzory MeSH

A total of 145 Escherichia coli strains causing pyelonephritis in children were investigated for the prevalence of genes encoding the following virulence factors (VFs): P fimbria (67.6 %), S fimbria (53.8 %), AFA adhesins (2.8 %), cytotoxic necrotizing factor 1 (37.9 %), α-hemolysin (41.4 %), and aerobactin (71.7 %). One hundred and thirty-six (93.8 %) isolates harbored at least one of the virulence genes detected in the present study. Statistically significant co-occurrent presence of two VF genes was found for α-hly-cnf1, α-hly-sfa, cnf1-sfa (p<0.001), and α-hly-pap (p=0.001). Twenty-six profiles of VF genes were detected in this study. The combinations of aer-pap and aer-pap-sfa-α-hly-cnf1 were presented with the highest frequency-both of them in 28 isolates (19.3 %). All E. coli strains included in the study were susceptible to meropenem, amikacin, and tobramycin; the highest frequency resistance was found toward ampicillin (43.4 %), piperacillin (31.7 %), tetracycline (15.9 %), and trimethoprim/sulfamethoxazole (11.7 %). The resistance to the other tested antimicrobial drugs did not exceed 3 % incidence. Overall, 55.9 % strains were susceptible to all tested anti-infective agents. Antimicrobial resistance of E. coli strains toward trimethoprim/sulfamethoxazole statistically significantly correlated with the presence of α-hly (p<0.001), sfa (p<0.01), and cnf1 (p<0.05).

• MeSH
• bakteriální léková rezistence MeSH
• dítě MeSH
• dospělí MeSH
• Escherichia coli účinky léků   patogenita   MeSH
• faktory virulence genetika   fyziologie   MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• pyelonefritida mikrobiologie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• faktory virulence MeSH

Urinary tract infections (UTI) in pregnant women are a relatively frequent occurrence and the spectrum of these infections ranges from lower urinary tract disease (asymptomatic bacteriuria, acute cystitis) to upper urinary tract disease (acute pyelonephritis). Anatomical and functional changes in the urinary tract in pregnancy result in significantly higher susceptibility to progression of the infection from asymptomatic bacteriuria to the stage of acute pyelonephritis. Untreated asymptomatic bacteriuria in pregnancy leads, in as much as 40%, to the development of acute pyelonephritis with all the subsequent negative effects not only for the woman herself, but particularly for the fetus. Bacteriuria in pregnancy accounts for a significantly higher number of newborns with a low birth weight, low gestational age and higher neonatal mortality rate. Therefore, it is necessary to perform screening for bacteriuria in pregnant women and, when the finding is positive, to treat this bacteriuria. The selection of an appropriate antimicrobial agent to treat urinary tract infection in pregnancy is limited by the safety of a given drug not only for the woman, but particularly for the fetus. The article provides an overview of medications that can be safely used throughout the pregnancy or only in certain stages of pregnancy. The selection of an appropriate antibiotic should always be preceded by the result of urine culture. The article presents the principles and rules for treating asymptomatic bacteriuria, acute cystitis and acute pyelonephritis in pregnant women.

• MeSH
• bakteriurie farmakoterapie   MeSH
• cystitida farmakoterapie   MeSH
• infekce močového ústrojí farmakoterapie   MeSH
• infekční komplikace v těhotenství farmakoterapie   MeSH
• lidé MeSH
• pyelonefritida farmakoterapie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH