struvite and Pyelitis

Encrusted cystitis is a very rare chronic inflammatory disease of the bladder characterized by precipitation and incrustation of phosphate and ammonium-magnesium salts on the vescical mucosa, caused by urinary infection due to urolithic microorganisms. Corynebacterium urealyticum or Corynebacterium group D2, a multiple antibiotic-resistant urea-splitting bacterium, is the most frequently incriminated aetiology. We report a case of a 57-year-old man affected by systemic erythematosus lupus with a long history of dysuria and suprapubic pain who underwent percutaneous nephrostomy drainage with urethral stenting for lupoid obstructive uropathy. Before the diagnosis of encrusted cystitis by Corynebacterium urealyticum was established, the patient underwent five cystoscopies to remove the plaques and multiple unsuccessful antibiotic treatment courses. Eventually the infection was definitively cured after a two-week course with intramuscular teicoplanin.

Topics: Anti-Bacterial Agents; Apatites; Bacterial Proteins; Chemical Precipitation; Chronic Disease; Combined Modality Therapy; Corynebacterium; Corynebacterium Infections; Crystallization; Cystitis; Drug Resistance, Multiple, Bacterial; Humans; Hydronephrosis; Immunocompromised Host; Lupus Erythematosus, Systemic; Magnesium Compounds; Male; Nephrostomy, Percutaneous; Phosphates; Pyelitis; Remission Induction; Stents; Struvite; Teicoplanin; Urease

To report our experience with the management of encrusted cystitis and pyelitis (EC and EP) in the pediatric population. EC and EP are well-known entities in adults but are rarely identified in children. They consist of mucosal encrustations and are due to specific microorganisms.. Between 1996 and 2001, 4 children with a mean age of 9 years (range 4 to 13) were treated for EC (n = 2), EP (n = 1), and EC and EP (n = 1). The latter was a kidney transplant recipient. We retrospectively evaluated the clinical characteristics of the patients and the results of conservative management.. The delay between the beginning of the symptoms and the diagnosis was longer than 1 month in all cases. The diagnosis of EC was not evoked and was made during cystoscopy in all cases. EP was diagnosed during pyelotomy in 1 patient because it was evoked and confirmed by computed tomography scan in the kidney transplant recipient. Corynebacterium urealyticum was identified in the urine of all patients. EC was treated by antibiotics and endoscopic debulking, and EP was treated by antibiotics and local acidification. The duration of antibiotic therapy was between 1 and 6 months. The tolerance to local acidification of the kidneys was poor. Cure was achieved in 3 cases, but the treatment of EP failed in the kidney transplant recipient and graft removal was decided after 6 months of failed management because intractable febrile urinary tract infections became life threatening for the patient.. EC and EP are uncommon in children; however, these diseases must be considered. They must be diagnosed rapidly and require, if possible, conservative management. Nevertheless, kidney loss can occur in transplant recipients with EP.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Combined Modality Therapy; Corynebacterium; Corynebacterium Infections; Cystitis; Disease Susceptibility; Drug Therapy, Combination; Endoscopy; Female; Follow-Up Studies; Glycopeptides; Humans; Hydrogen-Ion Concentration; Isotonic Solutions; Kidney Transplantation; Magnesium Compounds; Male; Phosphates; Postoperative Complications; Pyelitis; Retrospective Studies; Struvite; Tomography, X-Ray Computed; Treatment Outcome; Urea; Urine

To emphasize the importance of early diagnosis of encrusted pyelitis in kidney transplant patients.. We report one case of encrusted pyelitis in a 10-year-old girl with a kidney graft who was treated by means of nephrostomy tube irrigation with an acidifier liquid substance.. After 16 days of treatment there was a significant decrease of the size of the calcified pyelic plaque, keeping a good renal function afterwards.. This disease should be thought of in every case of kidney transplant patient with negative urine cultures and alkaline pH, and the microbiologist should be alerted of the possibility of urinary tract infection by Corynebacterium.

Topics: Child; Female; Humans; Kidney Transplantation; Magnesium Compounds; Nephrostomy, Percutaneous; Phosphates; Postoperative Complications; Pyelitis; Struvite; Therapeutic Irrigation; Urothelium

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.

Topics: Aged; Anti-Bacterial Agents; Corynebacterium; Crystallization; Female; Humans; Kidney Calculi; Magnesium Compounds; Male; Middle Aged; Phosphates; Pyelitis; Risk Factors; Struvite; Tomography, X-Ray Computed; Vancomycin