Sakhi Hamza, Join-Lambert Olivier, Goujon Anna, Culty Thibault, Loubet Paul, Dang Julien, Drouot Sylvain, de Bayser Hubert, Michaud Christophe, Ghislain Louise, Stehlé Thomas, Legendre Christophe, Joly Dominique, Meria Paul, Zaidan Mohamad
Department of Nephrology‒Transplantation, Hôpital Necker, APHP, Paris, France.
Department of Microbiology, Hôpital Necker, APHP, Paris, France.
Kidney Int Rep. 2020 Nov 4;6(1):179-186. doi: 10.1016/j.ekir.2020.10.034. eCollection 2021 Jan.
Encrusted pyelitis and cystitis are peculiar disorders characterized by the calcification of the vesical, the pyelic, and/or the ureteral walls. These calcifications are composed of struvite and calcium carbonate‒apatite due to the presence of .
We have identified the clinical features and outcomes of 17 patients with encrusted pyelitis (n = 15) or encrusted cystitis (n = 2). Diagnosis was based on computed tomography scan and sonography including thickening and calcified lesions of the urinary tract.
The main clinical presentation was suggestive of subacute urinary tract infection with fever and urologic symptoms, mostly gross hematuria. Biologic features were characterized by the presence of struvite crystals and alkaline urine. Acute kidney injury was reported in 70.6% of cases. Predisposing factors were mostly due to urologic background (82.4%) with a history of urologic procedure (71%) and prior exposure to antibiotics (59%). All patients received appropriate antibiotherapy and 15 were treated with topical urinary acidification. A significant reduction of encrusted calcifications was observed in 88% of cases. Renal function improved in 71% of the patients. Nevertheless, poor tolerance of the treatment and side effects were common, affecting 71% of patients, with Gram-negative bacilli urinary tract infections (53%) being the most frequent. At last follow-up, 4 patients (23.5%) progressed to end-stage renal disease and only 1 had a clinical relapse.
Encrusted urinary tract infections are rare, characterized by a severe renal and overall prognosis in the absence of appropriate treatment. Topical urinary acidification and appropriate antibiotherapy are efficient but may be burdened by significant adverse events.
结痂性肾盂炎和膀胱炎是特殊的疾病，其特征为膀胱、肾盂和/或输尿管壁钙化。这些钙化由鸟粪石和碳酸钙-磷灰石组成，这是由于存在……
我们确定了17例结痂性肾盂炎患者（n = 15）或结痂性膀胱炎患者（n = 2）的临床特征和预后。诊断基于计算机断层扫描和超声检查，包括尿路增厚和钙化病变。
主要临床表现提示为伴有发热和泌尿系统症状的亚急性尿路感染，主要为肉眼血尿。生物学特征表现为存在鸟粪石晶体和碱性尿液。70.6%的病例报告有急性肾损伤。诱发因素主要是泌尿系统背景（82.4%），有泌尿系统手术史（71%）和既往使用过抗生素（59%）。所有患者均接受了适当的抗生素治疗，15例接受了局部尿液酸化治疗。88%的病例观察到结痂性钙化明显减少。71%的患者肾功能有所改善。然而，治疗耐受性差和副作用很常见，影响了71%的患者，革兰氏阴性杆菌尿路感染（53%）最为常见。在最后一次随访时，4例患者（23.5%）进展为终末期肾病，只有1例出现临床复发。
结痂性尿路感染很少见，在没有适当治疗的情况下，其特征为严重的肾脏和整体预后。局部尿液酸化和适当的抗生素治疗是有效的，但可能会受到严重不良事件的影响。
