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Renal Lesions in Acute Rheumatic Fever
0022-534 7/82/1273-0608$02.00/0 Vol. 127, March
THE JOURNAL OF UROLOGY
Copyright© 1982 by The Williams & Wilkins Co.
Printed in U.S.A.
ABSTRACTS INFECTIONS AND ANTIBIOTICS Acute Focal Bacterial Nephritis in Children: Significance of Ureteral Reflux C. M. GLASIER, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
M. J. SIEGEL AND
Amer. J. Roentgen., 137: 257-260 (Aug.) 1981 Acute focal bacterial nephritis is considered an inflammatory renal mass without drainable purulent material and usually is seen in adults without vesicoureteral reflux. The usual etiology is that of gram-negative bacteria. The authors report on 4 children with acute focal bacterial nephritis, 3 of whom had vesicoureteral reflux. Thus, the possibility of the ascending route of such an infection is proposed. Also, the radiographic and ultrasonographic findings of acute focal bacterial nephritis mimic that of solid tumors, such as Wilms tumor or renal abscess. The 4 children were girls from 5 to 17 years old. Three of the children had infections caused by gram-negative rods, whereas 1 patient with diabetes mellitus had infection caused by Staphylococcus aureus. The latter patient did not have a cystogram. Urographic changes seen in acute renal infection include diffuse enlargement, delayed caliceal filling, dilated calices and a diminished nephrogram. Thus, the finding of a focal mass as in acute focal bacterial nephritis is much less common. The echographic pattern includes a poorly defined mass with echoes of lower amplitude than the normal renal cortex. The corticomedullary junction often is disrupted and areas of liquefaction may appear as anechoic. Followup studies in 2 of the 4 children revealed focal cortical scarring. Percutaneous needle aspiration is indicated if the renal ultrasound study is not diagnostic of acute focal bacterial nephritis. The authors stress the need to rule out vesicoureteral reflux in children with acute renal infection and this procedure should be done when the urine has become sterile on antibiotic therapy. J. D. S. 4 figures, 7 references
Renal Lesions in Acute Rheumatic Fever R.
GIBNEY, H.J. REINECK, G.
A.
BANNAYAN AND J. H. STEIN,
Departments of Medicine and Pathology, University of Texas Health Science Center, San Antonio, Texas Ann. Intern. Med., 94: 322-326 (Mar.) 1981 Acute rheumatic fever and acute glomerulonephritis share a common pathogenetic basis, both being a consequence of streptococcal infections. Clinical evidence of renal disease has been reported to occur in up to 51 per cent of patients with acute rheumatic fever. The authors describe 4 patients seen in the last 4 years with acute rheumatic fever who underwent percutaneous renal biopsies because of evidence of significant renal involvement. They noted distinctly different renal lesions, including focal glomerulonephritis, classic acute exudative poststreptococcal glomerulonephritis, mesangioproliferative glo-
merulonephritis and severe interstitial nephritis. In each case the clinical abnormalities were transient. E. D. W. 5 figures, 13 references
Reversal of Long-Standing Renal Insufficiency by Captopril in a Patient With Relapsing Hemolytic Uremic Syndrome Due to an Oral Contraceptive
s.
E. J. L. PRINS, A. J. SMIT AND A. J. M. State University Hospital Groningen, Groningen, The Netherlands J. HOORNTJE,
DONKER,
Ann. Intern. Med., 94: 355-357 (Mar.) 1981 The authors review a case in which reversal of hypertension and renal failure occurred after use of captopril in a patient with hemolytic uremic syndrome and in whom a second attack occurred during treatment shortly after the patient accidentally reinstituted use of the same oral contraceptive that she had used before the first attack. The authors believe that hyperreninemia resulting in high angiotensin II levels may have been an important factor in the serious course of the first crisis. Captopril may have had a protective role in the second attack. In conclusion the authors state that captopril is still an experimental drug. However, its outstanding effect in hyperreninemic patients with vascular and renal crises makes it an ideal agent for these conditions. E. D. W. 1 table, 10 references
V ancomycin Therapy in Patients With Impaired Renal Function: A Nomogram for Dosage R. C.
MOELLERING,
JR.,
D.
J.
KROGSTAD
AND
D.
J.
Infectious Disease and Clinical Pharmacology Units, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts GREENBLATT,
Ann. Intern. Med., 94: 343-346 (Mar.) 1981 The authors studied the relationship between vancomycin clearance and renal function in 22 patients between 12 and 78 years old with various degrees of renal functional impairment and in 4 normal volunteers. Clearance of vancomycin and creatinine was highly correlated (r = 0.92) among 17 persons not on dialysis. In 5 dialysis patients vancomycin clearance averaged 0.086 Inl. per minute per kg. body weight (± standard error of mean = 0.025). As a result of these data the authors constructed a nomogram for vancomycin dosage adjustment (based on a mean steady-state serum vancomycin concentration of 15 µ.g./Inl.) in patients with various degrees of renal functional impairment. E. D. W. 2 figures, 21 references
Propranolol Alters Renin Release During Nitroprussidelnduced Hypotension and Prevents Hypertension on Discontinuation of Nitroprusside H.J. KHAMBATTA, J. G. STONE AND
608
E.
KHAN,
Department of
THE JOURNAL OF UROLOGY
Copyright© 1982 by The Williams & Wilkins Co.
Printed in U.S.A.
ABSTRACTS INFECTIONS AND ANTIBIOTICS Acute Focal Bacterial Nephritis in Children: Significance of Ureteral Reflux C. M. GLASIER, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
M. J. SIEGEL AND
Amer. J. Roentgen., 137: 257-260 (Aug.) 1981 Acute focal bacterial nephritis is considered an inflammatory renal mass without drainable purulent material and usually is seen in adults without vesicoureteral reflux. The usual etiology is that of gram-negative bacteria. The authors report on 4 children with acute focal bacterial nephritis, 3 of whom had vesicoureteral reflux. Thus, the possibility of the ascending route of such an infection is proposed. Also, the radiographic and ultrasonographic findings of acute focal bacterial nephritis mimic that of solid tumors, such as Wilms tumor or renal abscess. The 4 children were girls from 5 to 17 years old. Three of the children had infections caused by gram-negative rods, whereas 1 patient with diabetes mellitus had infection caused by Staphylococcus aureus. The latter patient did not have a cystogram. Urographic changes seen in acute renal infection include diffuse enlargement, delayed caliceal filling, dilated calices and a diminished nephrogram. Thus, the finding of a focal mass as in acute focal bacterial nephritis is much less common. The echographic pattern includes a poorly defined mass with echoes of lower amplitude than the normal renal cortex. The corticomedullary junction often is disrupted and areas of liquefaction may appear as anechoic. Followup studies in 2 of the 4 children revealed focal cortical scarring. Percutaneous needle aspiration is indicated if the renal ultrasound study is not diagnostic of acute focal bacterial nephritis. The authors stress the need to rule out vesicoureteral reflux in children with acute renal infection and this procedure should be done when the urine has become sterile on antibiotic therapy. J. D. S. 4 figures, 7 references
Renal Lesions in Acute Rheumatic Fever R.
GIBNEY, H.J. REINECK, G.
A.
BANNAYAN AND J. H. STEIN,
Departments of Medicine and Pathology, University of Texas Health Science Center, San Antonio, Texas Ann. Intern. Med., 94: 322-326 (Mar.) 1981 Acute rheumatic fever and acute glomerulonephritis share a common pathogenetic basis, both being a consequence of streptococcal infections. Clinical evidence of renal disease has been reported to occur in up to 51 per cent of patients with acute rheumatic fever. The authors describe 4 patients seen in the last 4 years with acute rheumatic fever who underwent percutaneous renal biopsies because of evidence of significant renal involvement. They noted distinctly different renal lesions, including focal glomerulonephritis, classic acute exudative poststreptococcal glomerulonephritis, mesangioproliferative glo-
merulonephritis and severe interstitial nephritis. In each case the clinical abnormalities were transient. E. D. W. 5 figures, 13 references
Reversal of Long-Standing Renal Insufficiency by Captopril in a Patient With Relapsing Hemolytic Uremic Syndrome Due to an Oral Contraceptive
s.
E. J. L. PRINS, A. J. SMIT AND A. J. M. State University Hospital Groningen, Groningen, The Netherlands J. HOORNTJE,
DONKER,
Ann. Intern. Med., 94: 355-357 (Mar.) 1981 The authors review a case in which reversal of hypertension and renal failure occurred after use of captopril in a patient with hemolytic uremic syndrome and in whom a second attack occurred during treatment shortly after the patient accidentally reinstituted use of the same oral contraceptive that she had used before the first attack. The authors believe that hyperreninemia resulting in high angiotensin II levels may have been an important factor in the serious course of the first crisis. Captopril may have had a protective role in the second attack. In conclusion the authors state that captopril is still an experimental drug. However, its outstanding effect in hyperreninemic patients with vascular and renal crises makes it an ideal agent for these conditions. E. D. W. 1 table, 10 references
V ancomycin Therapy in Patients With Impaired Renal Function: A Nomogram for Dosage R. C.
MOELLERING,
JR.,
D.
J.
KROGSTAD
AND
D.
J.
Infectious Disease and Clinical Pharmacology Units, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts GREENBLATT,
Ann. Intern. Med., 94: 343-346 (Mar.) 1981 The authors studied the relationship between vancomycin clearance and renal function in 22 patients between 12 and 78 years old with various degrees of renal functional impairment and in 4 normal volunteers. Clearance of vancomycin and creatinine was highly correlated (r = 0.92) among 17 persons not on dialysis. In 5 dialysis patients vancomycin clearance averaged 0.086 Inl. per minute per kg. body weight (± standard error of mean = 0.025). As a result of these data the authors constructed a nomogram for vancomycin dosage adjustment (based on a mean steady-state serum vancomycin concentration of 15 µ.g./Inl.) in patients with various degrees of renal functional impairment. E. D. W. 2 figures, 21 references
Propranolol Alters Renin Release During Nitroprussidelnduced Hypotension and Prevents Hypertension on Discontinuation of Nitroprusside H.J. KHAMBATTA, J. G. STONE AND
608
E.
KHAN,
Department of