Among urological diseases, the most relevant is infection of the urinary tract. Pyelonephritis is on the 5th place in kidney diseases, and obstructive pyelonephritis occurs in 84% of all pyelonephritis. In the world, among the adult population, 100 people per 100,000 of the population suffer from pyelonephritis. In addition, from year to year, there is an increase in purulent forms of acute pyelonephritis by 4–5 times. This pathology is a separated manifestation of such an important urological problem as complicated urinary tract infection, which accounts for 84–86% of all infections. In acute obstructive pyelonephritis, more severe complications such as bacteriotoxic shock and urosepsis may develop. The mortality rate from these dangerous complications reaches 70–90%. In addition, the number of patients with urosepsis and bacteriotoxic shock has increased 4–6 times in recent years. The review presents current literature data on acute obstructive pyelonephritis. The main causes and pathogenetic mechanisms of the disease development are presented.
BACKGROUND: The role of intestinal microflora translocation in the development of obstructive pyelonephritis has not been sufficiently studied. The urgency to develop a new model of acute obstructive pyelonephritis is due to the search for characteristics that are able to meet the criteria for reproducibility of microbial translocation from the intestine, the reversibility of the stages of the inflammatory process with further observation in the dynamics of development. AIM: The aim of the given research is to develop a model of acute obstructive pyelonephritis to study the pathogenetic role of bacterial translocation of Escherichia coli (hereinafter E. coli) from the gastrointestinal tract (GIT). METHODS: Twenty outbred male rabbits aged 3 months and weighing 3.0 ± 0.5 kg were used for the research. All the animals were randomly divided into two groups: Experimental (n = 10) and control (n = 10). In the experimental group, obstructive pyelonephritis was modeled by ligating the external opening of the urethra and injecting an antibiotic-resistant E. coli strain into the GIT using enteric capsules. In the control group, the strain was administered in the same way, but without forming a model of obstructive pyelonephritis. The animals were withdrawn from the experiment on the 3rd day by air embolism under general anesthesia. In both groups, the sizes of the kidney, pelvis, ureter, and the number of leukocytes in urine were assessed. RESULTS: In the experimental group, there was an increase in the size of the kidney, pelvis, as well as ureter with some pronounced leukocyturia observed, which indicates the development of obstructive pyelonephritis. In the control group, only one animal had leukocyturia. The statistically significant differences were revealed between the groups in all studied parameters. CONCLUSION: The results of this research demonstrated that the proposed model provided an opportunity to study the role of intestinal translocation of microorganisms in the development of acute obstructive pyelonephritis.
<b>Aim:</b> To study the role of <i>E. coli </i>intestinal translocation in the development of acute obstructive pyelonephritis in an experiment.<br /> <b>Material and methods:</b> An experimental study was conducted on 60 male rabbits weighing 3000±500 g. The animals were divided into 3 groups of 20 animals each: experimental, control and intermediate control group. The acute obstructive pyelonephritis with the ureter blocking by laparotomy and introduction of the strain into the intestine were simulated in the animals of the experimental group. In the control group, the model was performed anologically as in the experimental group, but without the ureter blocking. In the intermediate control group, laparotomy was performed, the ureter was isolated without blocking and without the introduction of a bacterial strain. 10 animals of each group were removed from the experiment on the 3<sup>rd</sup> and 5<sup>th</sup> days, kidney tissue and urine were intake. As a reference marker strain, the laboratory strain <i>E. coli</i> No. 49579 was used, which was obtained from a patient with a urological infection and had resistance to cefepime, ciprofloxacin and tetracycline. Biomaterials were studied by microbiological examination and subspecific typing of strains using the MALDI-TOF MS method, antibiotic sensitivity was determined.<br /> <b>Results: </b><i>E. coli</i> strain was isolated in all animals of the experimental group and in 2 animals of the control group on the 5<sup>th</sup> day. During subspecific typing by the MALDI-TOF MS method, the isolated strains were identical in ribosomal proteins, and also had the same sensitivity to the said antibiotics. When analyzing the amount of lg CFU <i>E.coli</i> in urine after the experiment between the experimental and control group, we found that, on day 3, there were statistically significant differences between the groups (p=0.005), and on day 5, the amount of lg CFU <i>E.coli</i> was 13 times greater (p=0.004).A comparative analysis of the lg CFU <i>E.coli</i> index in kidney tissue on 3 (p=0.004) and 5 (p=0.003) days revealed statistically significant differences between the experimental group and the control group.<br /> <b>Conclusion:</b> The results of identification and subspecific typing of isolated microorganisms confirmed that the strains isolated from the urinary tract were identical to the reference strain introduced into the gastrointestinal tract during the experiment, which confirms the role of translocation of intestinal microorganisms in the development of acute obstructive pyelonephritis.
Introduction. There are two main routes of urinary tract infection: ascending and hematogenous. In the ascending route, the infectious agent penetrates from the external environment through the external openings of the urinary organs. The role of bacterial translocation in the development of the inflammatory process in the urinary organs is still poorly understood. Materials and methods. We conducted an experiment on rabbits (n=45) and studied the structural changes in the kidneys and ureter depending on the pathogenesis of acute pyelonephritis. The animals were randomly divided into 5 groups: 2 experimental and 3 control. In experimental groups I and II , we modeled obstructive pyelonephritis by ligation of the ureter. In control groups III and IV, an infectious agent was administered similarly to that in the experimental groups, but without creating a model of obstructive pyelonephritis. In control group V, a laparotomy was performed without ligation of the ureter and without injection of bacteria. The morphological study was carried out with optical microscopy. Results. In group I, on day 3, the inflammatory infiltration was detected in 80% of cases and on day 5, in 100%. In group II , on days 3 and 5, the inflammatory process in the ureteral tissue developed in all cases. There were no morphological changes in the kidneys and ureter in groups III and V. In group IV, on days 3 and 5, the frequency of inflammatory infiltration was 80%. Conclusion. The nature of morphological changes in the kidneys and ureter in acute pyelonephritis depends on both the ways of infection and the timing of ureteral obstruction. In enterorenal translocation, the severity of morphological changes occurs later. Keywords: urinary tract obstruction, acute pyelonephritis, intestinal translocation, ascending infection
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.