American journal of kidney diseases : the official journal of the National Kidney Foundation
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Differentiation of uncomplicated pyelonephritis versus complicated pyelonephritis has always been problematic. No clear physical signs or symptoms are diagnostic. To study differences between the two, we retrospectively reviewed charts of patients admitted to Charity Hospital, New Orleans, with febrile urinary tract infections. ⋯ The only significant contributing factor was the presence of diabetes mellitus, which was present in five of 11 emergent conditions and eight of 73 of the remainder (P = 0.003). US is inexpensive, easily obtainable in the emergency room, and sensitive enough to screen patients with pyelonephritis for complications. However, we believe it is mandatory in diabetics, because of the high incidence of abnormalities in this population.
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Ethical and legal issues affecting geriatric nephrology are conditioned more by individuals' status as elderly, sick people than by the distinctive characteristics of kidney disease or failure. Key ethical issues are the obligation to respect persons, in particular by recognizing competent persons' autonomy of medical choice and affording due protection to dependent or vulnerable individuals, by beneficence or doing good, and by acting with justice, treating like cases alike and avoiding unjust discrimination. The law reinforces ethical obligations through such legal concepts as informed consent and the duty to maintain appropriate confidentiality, which have special applications concerning medication and management of the elderly. Additional legal issues concern advanced care directives and terminal care decisions.
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Case Reports
Percutaneous cyst puncture in the treatment of cyst infection in autosomal dominant polycystic kidney disease.
Cyst infection in autosomal dominant polycystic kidney disease (ADPKD) poses a difficult diagnostic and therapeutic problem. We describe a serious indolent cyst infection due to Staphylococcus aureus, which was successfully diagnosed and treated with repeated percutaneous cyst drainage and intravenous (IV) antibiotic therapy. Cyst aspiration also permitted monitoring of cyst antibiotic levels and evidence of active infection.
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We describe two patients on hemodialysis who developed staphylococcal splenic abscesses. Both patients previously had staphylococcal septicemia secondary to infection at the dialysis access site. We postulate that access-site infections may predispose hemodialysis patients to splenic abscess, and that these patients should be investigated for a splenic abscess if they should develop unexplained fever.