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1.
Sabasińska A Zoch-Zwierz W Wasilewska A Porowski T 《Pediatric nephrology (Berlin, Germany)》2007,22(8):1173-1179
The study objective was to assess serum and urine fibronectin (FN) levels in children with vesicoureteral reflux (VUR) depending
on reflux grade and urine osmolality. The study group (1) consisted of 54 VUR children, median age 4.28 (range 0.6–15) years:
subgroup A, 19 children with grade II; subgroup B, 19 with grade III; and subgroup C, 16 with grade IV or V VUR. The control
group (2) included 27 healthy children. The immunoenzymatic method enzyme immunoassay (EIA) was used to determine serum soluble
and urine FN levels, with an osmometer to measure urinary osmolality. The median urine FN in VUR children was 224.1 (15.4–3537)
ng/mg creatinine (Cr), compared with the control group: 137.9 (20.3–670.6) ng/mg Cr (p < 0.05), whereas median serum FN was 395.0 (13.0–779.9) ng/ml and 121.9 (25–345.1) ng/ml (p < 0.05), respectively. A detailed analysis showed that only in subgroup C was the level of urinary FN significantly higher
than in the control group (p < 0.01). However, serum concentration was elevated in all VUR children (A–C) compared with controls (p < 0.01). Reduced osmolality, below 800 mOsm/kg H2O, was observed in subgroup C. Negative correlation between urinary osmolality and urinary FN was found (r = −0.426, p < 0.01). In children with VUR, serum FN increased with reflux grade, whereas its urinary level was elevated only in grade
IV and V reflux with impaired urine concentration. 相似文献
2.
Yilmaz A Bilge I Kiyak A Gedikbasi A Sucu A Aksu B Emre S Sirin A 《Pediatric nephrology (Berlin, Germany)》2012,27(3):435-441
The aim of this study was to investigate whether urine levels of matrix metalloproteinase 9 (uMMP9) and tissue inhibitor of
metalloproteinase 1 (uTIMP1) are novel biomarkers of vesicoureteral reflux (VUR) and to determine the optimal cut-off levels
of these enzymes to predict VUR in children. The study group consisted of 67 children with VUR and 20 healthy children. Urine
MMP9 and TIMP1 levels were measured by an enzyme-linked immunosorbent assay. Children with VUR had significantly higher uMMP9
(1,539.8 vs. 256.4 pg/mL; p = 0.0001) and uTIMP1 (182 vs. 32.6 pg/mL; p = 0.0001) levels than healthy children. For the prediction of VUR, the sensitivity of uMMP9 was 67%, with a specificity of
85% [cut-off value 1,054 pg/mL; area under the curve (AUC) 0.77], and the sensitivity of uTIMP1 was 74%, with a specificity
of 65% (cut-off value 18.7 pg/mL; AUC 0.73). Both uMMP9 and uTIMP1 levels were significantly higher in patients with renal
scar (uMMP9: 3,117.3 vs. 1,234.15 pg/mL; p = 0.0001; uTIMP1: 551.05 vs. 128.64 pg/mL; p = 0.0001). Urine MMP9 levels had a sensitivity of 81.2%, with a specificity of 85% to predict renal scar in the VUR group
(cut-off 1,054 pg/mL; AUC 0.88). The sensitivity of uTIMP1 was 75%, with a specificity of 90% to predict renal scar (cut-off
243.7 pg/mL; AUC 0.82). Based on these results, we suggest that uTIMP1 may be a useful marker to predict renal scarring with
a different cut-off value from VUR and a high specificity at this cut-off point. Although uMMP9 seemingly cannot distinguish
renal scar from VUR, the simultaneous increase in the level of both markers may indicate ongoing renal injury due to VUR. 相似文献
3.
Leonardo CR Filgueiras MF Vasconcelos MM Vasconcelos R Marino VP Pires C Pereira AC Reis F Oliveira EA Lima EM 《Pediatric nephrology (Berlin, Germany)》2007,22(11):1891-1896
Risk factors for renal scarring in children with lower urinary tract dysfunction (LUTD) were evaluated. The medical records
of 120 patients were assessed concerning gender, presence of vesicoureteric reflux (VUR), bladder capacity, detrusor overactivity,
residual urine, febrile urinary tract infection (UTI), bacteriuria, constipation, detrusor sphincter incoordination (DSI),
high detrusor pressure at maximal cystometric capacity (PMCC), low compliance, and thickness and trabeculation of the bladder
wall. Renal scarring was diagnosed by 99mtechnetium-dimercaptosuccinic acid renal scan (DMSA). Renal scarring was detected in 38 patients (31%). VUR, UTI, decreased
bladder capacity, urinary residue, and trabeculated and thick bladder wall were associated with scarring at univariate analysis.
Multivariate analysis showed VUR (P < 0.0001) as the independent risk factor for renal scarring. Thickness of the bladder wall was a marginal risk factor (P
= 0.07). Although UTI was not a risk factor, it was associated with VUR (P
= 0.03). In our analysis, VUR was the main risk factor; however, renal scarring was probably due to multifactorial causes,
as VUR was associated with UTI. 相似文献
4.
Bitsori M Karatzi M Dimitriou H Christakou E Savvidou A Galanakis E 《Pediatric nephrology (Berlin, Germany)》2011,26(11):2003-2007
Urine IL-8 concentrations are known to be elevated in urinary tract infection (UTI), as well as in vesicoureteral reflux (VUR)
even in the absence of infection. In this study we further investigated urine IL-8 in infants with congenital anomalies of
the kidneys and urinary tract and with antenatally diagnosed isolated pelvic dilatation. Urine IL-8 was measured in 159 infants
aged 1 month to 1 year with acute UTI (group A, n = 26), resolved UTI (group B, n = 16), VUR without recent UTI (group C, n = 44), non-VUR congenital urinary anomalies without recent UTI (group D, n = 30), isolated antenatal pelvic dilatation (group E, n = 14) and in infants without known urinary tract condition (control group F, n = 29). Median values of urine IL-8/creatinine levels were 61.5, 4.64, 15.5, 14.3, 1.06 and 4.19 pg/μmol in groups A, B, C,
D, E and F respectively. Compared with the control group, urine IL-8 was elevated in infants with acute UTI, VUR without acute
UTI and congenital anomalies without acute UTI (p < 0.0001; p < 0.005; and p = 0.027 respectively), but not in infants with resolved UTI or with antenatal pelvic dilatation. Urine IL-8 levels are elevated
in a variety of infectious and non-infectious urinary tract conditions, and hence may serve as a sensitive but not specific
screening biomarker of urinary tract diseases. 相似文献
5.
Probiotics, beneficial living microorganisms, have been proven to be effective in preventing gastrointestinal infections,
but their effect in preventing urinary tract infection (UTI) is inconclusive. A prospective randomized controlled study was
done to compare the preventive effect of probiotics with conventional antibiotics in children with persistent primary vesicoureteral
reflux (VUR). One hundred twenty children who had had persistent primary VUR after antibiotic prophylaxis for 1 year were
randomly allocated into a probiotics (Lactobacillus acidophilus 108 CFU/g 1 g b.i.d., n = 60) or an antibiotics (trimethoprim/sulfamethoxazole 2/10 mg/kg h.s., n = 60) prophylaxis group during the second year of follow-up. The incidence of recurrent UTI was 18.3% (11/60) in the probiotics
group, which was not different from 21.6%(13/60) in the antibiotic group (P = 0.926). The causative organisms of recurrent UTI were not significantly different between the two groups (P = 0.938). Even after stratification by VUR grade, age, gender, phimosis, voiding dysfunction and renal scar, the incidence
of recurrent UTI did not differ significantly between the two groups (P > 0.05). The development of new renal scar was not significantly different between the two groups (P > 0.05). In conclusion, probiotics prophylaxis was as effective as antibiotic prophylaxis in children with persistent primary
VUR. 相似文献
6.
Annukka Hannula Mika Venhola Marjo Renko Tytti Pokka Niilo-Pekka Huttunen Matti Uhari 《Pediatric nephrology (Berlin, Germany)》2010,25(8):1463-1469
The aim of this study was to estimate the prevalence of vesicoureteral reflux (VUR) and clinically significant ultrasonography
(US) abnormalities in a large group of children with proven and suspected urinary tract infection (UTI). The medical reports
on renal US and voiding cystouretrographies (VCUG) of 2,036 children were reviewed. Renal US was performed on all children
and VCUG on 1,185 children (58%). Based on the urine culture data, the UTI diagnoses were classified into five reliability
classes (proven, likely, unlikely, false and no microbial data). The UTI diagnose was considered proven in 583/2036 (28.6%)
and false in 145 (7.1%) cases. The prevalence of VUR was similar among those with proven and false UTI [37.4 vs. 34.8%; relative
risk (RR) 1.08, 95% confidence intervals (95% CI) 0.7–1.7, P = 0.75] and decreased with increasing age (P = 0.001). Clinically significant US abnormalities occurred in 87/583 (14.9%) cases with proven UTI and significantly less
often (11/145, 7.6%) in the false UTI class (RR 1.96, 95% CI 1.1–3.6, P = 0.02). Our finding supports the claim that VUR is not significantly associated to UTI and that its occurrence among children
even without UTI is significantly higher than traditional estimates. This challenges the recommendations of routine VCUG after
UTI. 相似文献
7.
Malcolm G. Coulthard Ian Verber Jagat C. Jani Geoffrey R. Lawson Catriona A. Stuart Venita Sharma William H. Lamb Micheal J. Keir 《Pediatric nephrology (Berlin, Germany)》2009,24(10):2059-2063
The aim of the study reported here was to determine whether kidney scarring after urinary tract infections (UTI) in children
can be prevented and to identify the risk factors for developing scars. We identified children in the Northern health region
of the UK who had been seen to develop scars, identified as new defects on dimercapto-succinic acid (DMSA) scanning. Risk
factors were sought by reviewing case-notes and interviews with parents. Twenty girls were identified whose new scarring was
strongly associated with having both vesicoureteric reflux (VUR) and a UTI (p = 0.0001); 19/23 (83%) of kidneys exposed to both of these factors developed scars. Children were much more likely to be
febrile (94 vs. 30%, p < 0.0001) or unwell (82 vs. 10%, p < 0.0001) during their earlier UTIs when they were of median age 2.8 years (range 0.3–5.0 years) and did not scar, compared
to their later UTIs at age 7.3 years (1.2–12.5 years), when they did scar. However, most patients were treated within 1 day
of their symptoms for their early UTIs, compared to a wait ≥7 days for later UTIs (p = 0.001). Being febrile or unwell during a UTI does not predict the development of scars, but prompt treatment appears to
prevent scarring in children with VUR. 相似文献
8.
Koyun M Güven AG Filiz S Akman S Akbas H Baysal YE Dedeoglu N 《Pediatric nephrology (Berlin, Germany)》2007,22(9):1297-1301
The methodologies to diagnose hypercalciuria have not yet been standardized. The aims of this study were to assess the correlation
between urinary calcium/creatinine ratio (UCa/Cr) ≥ 0.21 (mg/mg) and 24 h urinary calcium excretions and to determine the
reference values of the UCa/Cr ratio among a large population of schoolchildren in southern Turkey. Non-fasting, second morning
urine samples were collected from 2,143 children aged 7–14 years. In children with suspected hypercalciuria [UCa/Cr ≥ 0.21
(mg/mg)], 24 h urine samples were collected. The 95th percentile values of the UCa/Cr ratio for each age were calculated and
showed a decrease in value with advancing age. In all, 269 (12.5%) of the children had UCa/Cr ≥ 0.21 (mg/mg), of whom 66 (24.5%)
had daily urinary calcium excretion ≥4 mg/kg per day. A weak correlation was found between spot UCa/Cr ratios and daily urinary
calcium excretions in children with UCa/Cr ≥ 0.21 (r = 0.27). We conclude that a spot UCa/Cr ratio of 0.21 (mg/mg) as the upper limit of normal cannot be used universally to
define hypercalciuria. Age-specific reference values for UCa/Cr should be established for each population, to be used as a
screening test for hypercalciuria, and the definite diagnosis should be established with 24 h urinary calcium excretion whenever
possible. 相似文献
9.
Hatipoglu S Sevketoglu E Gedikbasi A Yilmaz A Kiyak A Mulazimoglu M Aydogan G Ozpacaci T 《Pediatric nephrology (Berlin, Germany)》2011,26(8):1263-1268
The matrix metalloproteinase-9 (MMP-9) and neutrophil gelatinase associated lipocalin (NGAL) are shown to increase in an inflammatory
situation. Based on our previous reports that NGAL can be detected in the urine of children with urinary tract infection (UTI),
we also asked whether MMP-9/NGAL complex could be detected in the urine of children with UTI. This multicenter, prospective
study was conducted between October 2009 and October 2010. Seventy-one patients with symptomatic culture proven UTI, 37 asymptomatic
children with contaminated urine and 37 healthy children were recruited. Mean uMMP-9/NGAL/Cr levels were significantly higher
in the UTI group than in the control group (p < 0.0001). According to ROC analysis, the optimal cut-off level was 0.08 ng/mg to predict UTI. Using a cut-off value, sensitivity
and specificity were 98.6 and 97.3%, respectively. The mean levels of uMMP-9/NGAL/cr in the UTI group were also significantly
higher than those in the contamination group (p < 0.0001). There was no statistically significant difference between contamination group and the control group (p = 0.21). The mean uMMP-9/NGAL/Cr in the UTI group were significantly higher before treatment than after treatment (p < 0.0001). The area under the curve was 0.997 (SE: 0.002, 95% CI: 0.993 to 1.001) for uMMP-9/NGAL/Cr. Urinary MMP-9/NGAL/Cr
level was also correlated with positive urine nitrite test, positive urine leukocyte esterase reaction and renal scarring
(p = 0.0001, p = 0.0001, p = 0.04, respectively) whereas was not correlated to leukocytosis and positive CRP level in serum. Urine MMP-9/NGAL/cr can
be used as a diagnostic biomarker for UTI in children. Identification of NGAL-MMP-9/cr levels in the urine of suspected UTI
patients may also be useful to differentiate between contamination and infection and for monitoring of treatment response
in children. 相似文献
10.
Fernández P Santos F Sotorrío P Mayordomo J Ferrero L 《Pediatric nephrology (Berlin, Germany)》2007,22(9):1303-1307
Increased intestinal calcium absorption may play an important role in the pathogenesis of idiopathic hypercalciuria in children.
Calcium absorption was assessed by an oral strontium load test in 22 prepubertal children (13 male) with idiopathic hypercalciuria,
urinary calcium excretion 6.48 ± 0.60 mg/kg per day (range 4.12–13.40 mg/kg per day), and ten healthy, young, normocalciuric
controls (six male). After administration of 2.65 mg/kg of strontium chloride (SrCl2), the serum concentrations of strontium at 30 min, 60 min, 120 min, 240 min, and the fraction of the absorbed dose (FAD%)
at 30 min, 60 min and 240 min, were similar in both groups. FAD% at 120 min was lower (P < 0.05) in hypercalciuric children than in controls (11.84 ± 0.96% vs 15.87 ± 1.77%). Values of the area under the curve
were not different between both groups. In children with idiopathic hypercalciuria, serum basal intact parathyroid hormone
(PTH) (r = −0.59, P = 0.004) and the 1,25-dihydroxyvitamin D/PTH ratio (r = 0.65; P = 0.001) were correlated with the serum concentration of strontium at 60 min. The study reported here provides, for the first
time, the results of a strontium oral load test in children with idiopathic hypercalciuria. With this method no major alterations
of intestinal calcium absorption were found in this disorder. 相似文献
11.
Urinary calcium excretion in healthy Thai children 总被引:2,自引:0,他引:2
The objective of this study was to determine age-specific reference values for urinary calcium/creatinine ratios (UCa/Cr)
of children in southern Thailand. Non-fasting urine samples were collected from a random population of 488 healthy children
(282 males, 206 females) ranging in age from 17 days to 15 years. Samples were divided into six groups by age. Subjects whose
calcium levels exceeded the 95th percentile within each age group were classified as having hypercalciuria. Pyuria, hematuria,
proteinuria, urinary sodium, and potassium levels in children with normal UCa/Cr were compared with levels in children with
high UCa/Cr. The 95th percentiles for UCa/Cr (mg/mg) by age were: <6 months, 0.75; 6 months to <12 months, 0.64; 12 months
to <2 years, 0.40; 2 years to <5 years, 0.38; 5 years to <10 years, 0.29; and 10 years to <15 years, 0.26. Pyuria, hematuria,
and proteinuria were no more prevalent in the 22 children with hypercalciuria than in children with normal urinary calcium
levels. Urinary sodium/creatinine ratios (UNa/Cr) and urinary sodium/potassium ratios (UNa/K) were correlated with UCa/Cr
(r=0.41, P<0.0001 and r=0.24, P<0.0001, respectively). Urinary potassium/creatinine ratios (UK/Cr) were not (r=0.05, P>0.1)). Children with high UCa/Cr ratios also had higher UNa/Cr and UNa/K (5.6±7.1 vs. 2.6±1.5, P<0.001 and 5.4±2.3 vs. 2.5±0.23, P<0.05, respectively) The study established reference values for random, non-fasting UCa/Cr for healthy Thai children and indicated
that urinalysis is not a good indicator of hypercalciuria.
Received: 30 April 1999 / Revised: 19 August 1999 / Accepted: 19 August 1999 相似文献
12.
Polito C Apicella A Marte A Signoriello G La Manna A 《Pediatric nephrology (Berlin, Germany)》2012,27(1):101-107
Although pediatricians are frequently confronted with patients presenting urolithiasis symptoms without obvious stones, the
syndrome of occult urolithiasis may be still viewed with some skepticism. We have compared the clinical and metabolic features
of 197 children with obvious calculi, 189 with microcalculi (diameter ≤3 mm based on renal sonography), and 114 with symptoms
of urolithiasis and normal renal sonography findings. Only microcalculi and normal sonography subjects with a urinary abnormality
potentially leading to urolithiasis were included in the study. Age at presentation increased significantly (p = 0.0001) in the groups in the order normal sonography to microcalculi to calculi groups. There was no significant difference
among the three groups in terms of family history of urolithiasis, gender distribution, and degree of hypercalciuria, hyperuricosuria,
hyperoxaluria, or hypocitraturia. The average frequency of pain attacks of patients with recurrent abdominal pain (RAP) ranged
from 3.6 to 4.6 days of pain per month among the three groups, which is four to ninefold lower than that reported for children
with functional or organic gastrointestinal RAP. The consistency of many clinical and urinary metabolic characteristics indicates
a common underlying disorder in overt and occult urolithiasis. The increase of age at presentation from the normal sonography
to microcalculi and calculi groups may reflect progressive crystal accretion leading ultimately to overt stone formation. 相似文献
13.
Niko Kei-chiu Tse Sandy Lai-kei Yuen Man-chun Chiu Wai-ming Lai Pak-chiu Tong 《Pediatric nephrology (Berlin, Germany)》2009,24(9):1699-1703
This retrospective study aimed to evaluate the applicability of the selective approach of imaging infants < 6 months old with
urinary tract infection (UTI) according to the UTI guidelines of the National Institute for Health and Clinical Excellence
(NICE) 2007. Infants < 6 months old with their first UTI from January 2001 to December 2006 having undergone an ultrasound
examination of the urinary tract, a micturating cystourethrogram, and a late di-mercaptosuccinic acid (DMSA) scan, were included.
Their condition was evaluated against a set of risk features according to the UTI guidelines. Those having any one of these
were classified as atypical and those having none as typical. There were 134 infants reviewed, with a typical (98 infants)
to atypical (36 infants) ratio of 2.7 to 1. Girls were found to be relatively more represented in the atypical group [male
(M):female (F) = 1.3:1] than in the typical group (M:F = 4.4:1) (P < 0.004). There were significantly more infants with abnormal micturating voiding cystourethrograms (MCUGs) (P = 0.007), more refluxing ureters (P < 0.001) and more significant vesico-ureteral reflux (VUR) (≥ grade III) (P = 0.013) in the atypical group than in the typical group; while there was no significant difference in ultrasound (US) and
DMSA scan findings between the two groups. In the atypical group there was no difference in imaging studies (and, thus, the
results) between the conventional practice and the NICE UTI recommendation. In the typical group, if the recommendations of
the guidelines had been followed (i.e. only those with abnormal US would have been further investigated), 25 refluxing ureters
and 22 scarred kidneys would have been left undiagnosed. In conclusion, application of the suggested selective imaging approach
would leave a significant number of VUR and renal scars undiagnosed, and it may not be an optimal practice for infants less
than 6 months old with their first UTI. The best approach remains to be clarified. 相似文献
14.
Kiddoo DA Ajamian F Senthilselvan A Morgan CJ Pinsk MN 《Pediatric nephrology (Berlin, Germany)》2012,27(3):423-428
Vesicoureteral reflux (VUR) is commonly diagnosed in children presenting with urinary tract infections. Antibiotic prophylaxis
and ureteric surgery are standard treatments for these children. Our aim was to investigate whether health-related quality
of life (HRQOL) was altered in children treated for VUR. Children aged 1–5 years with grade III or higher VUR were identified
through electronic records at the Stollery Children’s Hospital. Parents of these children were mailed the TNO-AZL Netherlands
Organisation for Applied Scientific Research Academic Medical Centre Quality of Life (TAPQOL) questionnaire. QOL scores for
this group were compared with normative controls from the instrument’s creators using the Mann–Whitney U test. Thirty-two of the 96 (33%) mailed surveys were returned. Eight children had surgery, and 19 were treated with antibiotic
prophylaxis. When comparing the VUR group with the control group, we found that anxiety and social functioning scores were
significantly better in patients with VUR (p < 0.01). The VUR group had worse scores in problem behavior, stomach complaints ,and communication (p < 0.01). This study reveals that children with VUR have a reasonable QOL when compared with controls. However, the diagnosis
of VUR and its management does have an impact on gastrointestinal complaints, behavior, and communication, which may occur
as a result of chronic medical intervention. 相似文献
15.
Kimata T Kaneko K Takahashi M Hirabayashi M Shimo T Kino M 《Pediatric nephrology (Berlin, Germany)》2012,27(4):605-609
The administration of ceftriaxone is known to be associated with biliary pseudolithiasis, although the development of urolithiasis
has only rarely been reported. We treated a young male with bacterial meningitis complicated by urinary precipitates composed
of ceftriaxone–calcium salt, which prompted us to study whether ceftriaxone administration predisposes children to the formation
of urinary precipitates. The case–control study reported here included 83 children with bacterial pneumonia aged from 3 months
to 8.9 years. The children were divided into one group of 43 children who received ceftriaxone (group A) and a second group
of 40 children who received amoxicillin (group B). Paired samples of serum and urine before and after treatment were obtained
from the patients in each group. There were no significant differences in demographic characteristics and blood biochemistry
between the groups. However, the mean urinary calcium to creatinine ratio (uCa/Cr; mg/mg) was significantly higher in group
A patients than in group B patients after treatment (0.19 vs. 0.09, respectively; p < 0.001), and analysis of the paired urine samples revealed that the uCa/Cr significantly increased after treatment only
in group A patients(p < 0.001). There was a weak but non-significant relationship between the dose of ceftriaxone and the uCa/Cr in group A (p = 0.10, r = 0.24). Our results are the first to demonstrate that ceftriaxone has the potential to significantly increase urinary excretion
of calcium, which may be linked to ceftriaxone-related urolithiasis or sludge. We therefore suggest that it is worthwhile
monitoring the uCa/Cr levels in patients on ceftriaxone as they may be at greater risk for developing large stones and renal
damage. 相似文献
16.
Kanellopoulos TA Salakos C Spiliopoulou I Ellina A Nikolakopoulou NM Papanastasiou DA 《Pediatric nephrology (Berlin, Germany)》2006,21(8):1131-1137
In an attempt to evaluate first urinary tract infection (UTI) in neonates and infants, we estimated retrospectively in 296 patients (62 neonates and 234 infants) clinical and laboratory findings, occurrence of vesicoureteral reflux (VUR), urinary tract abnormalities and pyelonephritis. First UTI occurred more often in male than female neonates, whereas male and female infants/young children were affected at an equal rate. The pathogens isolated in urine cultures of neonates and infants did not statistically significantly differ (P>0.05); Escherichia coli predominated. Gram-negative bacteria other than E. coli affected boys more often than girls (P=0.0022). Fever was the most frequent symptom. Neonates had lower-grade fever of shorter duration than infants (P<0.05). The incidence of reflux and urinary tract abnormalities did not differ between neonates and infants, male and female neonates and infants (P>0.05). Pyelonephritis affected neonates and infants at an equal rate; it was more prevalent among female patients (P=0.038) and patients with VUR or urinary tract abnormalities other than VUR (P<0.0001). Neonates with reflux were more often affected by Gram-negative bacteria other than E. coli than were neonates without reflux (P=0.0008). 相似文献
17.
Sabasiñska A Zoch-Zwierz W Wasilewska A Porowski T 《Pediatric nephrology (Berlin, Germany)》2008,23(5):769-774
High-grade vesicoureteric reflux (VUR) promotes the development of renal nephropathy (RN) due to scar formation. This process
involves transforming growth factor beta-1 (TGF beta1), which stimulates production of the extracellular matrix proteins, including laminin (LN). The aim of the study was to assess
LN and TGF beta1 concentration according to VUR grade. The study group (1) consisted of 54 patients aged 6.23 ± 4.15 years with VUR, including:
A, 19 with grade II; B, 19 with grade III; and C, 16 with grades IV or V reflux. The control group (2) contained 27 healthy
patients aged 6.76 ± 4.02 years. LN and total TGF beta1 concentrations in serum and urine were determined by the immunoenzymatic (EIA) method. To assess total serum TGF beta1 levels, we used a solid-phase enzyme-linked immunosorbent assay (ELISA). Both serum and urinary levels of LN and TGF beta1 in VUR patients were higher compared with controls (p < 0.05). The highest urinary concentration of LN and TGF beta1 was found in subgroup C. A positive correlation was noted between urinary TGF beta1 and LN. Increased TGF-beta1 and LN levels in urine of high-grade VUR children suggests a potential role in fibrogenesis. Further trials are needed to
investigate the role of serum and urinary LN level in VUR children. 相似文献
18.
Peru H Bakkaloglu SA Soylemezoglu O Buyan N Hasanoglu E 《International urology and nephrology》2009,41(4):947-951
Early determination of renal scar development risk in children following first urinary tract infection (UTI) and early detection
and treatment of vesicoureteral reflux (VUR) are important to prevent renal functional impairment. The aim of this study was
to determine the prevalence of VUR and associated renal scar formation, in children who had acute pyelonephritis (APN), first
afebrile UTI, and recurrent afebrile UTIs. Patient records of 642 children having UTI were scrutinized and 278 out of 642
were enrolled in this study. The patients were divided into three groups: Group 1, patients with APN (n = 73); Group 2, patients with the first afebrile UTI (n = 88); and group 3, patients with recurrent afebrile UTIs (n = 117). Among these groups, VUR prevalence did not differ significantly (group 1: 24.6%, group 2: 22.7%, and group 3: 26.4%.
Renal scarring was detected in 19.3% of the patients and was remarkably lower in group 2 when compared with the other two
groups (P < 0.05). Renal scarring was found in 37.1% of the patients with VUR, whereas it was found in 14.3% of patients without VUR.
Renal scarring incidence was remarkably higher in patients with grades 4–5 VUR (61.5%) compared with those with grades 1–3
VUR (30.6%) (P = 0.055). In conclusion, since VUR was demonstrated in as many as one-quarter of patients with the first afebrile UTI and
VUR incidence did not differ significantly among the groups, all UTIs, lower and upper ones, should be carefully evaluated. 相似文献
19.
Oberritter Z Somogyi R Juhasz Z Pinter AB 《Pediatric nephrology (Berlin, Germany)》2008,23(5):775-778
A relationship between the Teflon deposit, visible with ultrasound, and long-term success of subureteric Teflon injection
(STING) treatment was investigated. The study included only those patients with primary vesicoureteral reflux (VUR), in whom
the reflux had disappeared and the Teflon deposits were visible 6 weeks following STING treatment. Cessation of VUR was proven
by voiding cysto-urethrography (VCUG) in 99 patients (143 ureters). Average follow-up time was 9 (4–12) years. Patients were
divided into two groups: group I, deposits visible with ultrasound [deposit (+)], and group II, no visible deposits at the
end of the follow-up period [deposit (−)]. Reflux recurrence, the occurrence of urinary tract infection (UTI), and pyelonephritis
were investigated, and technetium scintigraphy scans were examined. The deposit (+) group included 43 patients (65 ureters),
and the deposit (−) group contained 56 patients (78 ureters). In the deposit (+) group there were no recurrences of VUR; however,
17 recurrences were found in the deposit (−) group (P < 0.05). Dimercaptosuccinic acid (DMSA) scintigraphy scans and occurrence of UTI showed significant difference between the
groups (P < 0.05). A close relationship was found between the disappearance of the Teflon deposit and the recurrence of VUR. Disappearance
of the Teflon deposit and repeated bacteriuria is a warning sign of the recurrence of VUR; therefore, VCUG might be warranted
for these patients. 相似文献
20.
Prelog M Schiefecker D Fille M Wurzner R Brunner A Zimmerhackl LB 《Pediatric nephrology (Berlin, Germany)》2008,23(4):597-602
The aim of this study was to characterize the pathogens and their antibiotic susceptibilities in defined groups of children
(total number 694) with urinary tract infection (UTI) regarding age, first UTI (FUTI) or recurrent UTI (RUTI), renal abnormalities
or vesico-ureteric reflux (VUR) in order to optimize empirical antibiotic therapy and prophylaxis. In patients aged between
1 month and 24 months with a first febrile UTI (FUTI; n = 205) the leading pathogen was Escherichia coli (E. coli) (83.4%). In comparison with patients with FUTI, those with RUTI (n = 24) had more Enterococcus and Enterobacter infections and higher resistance rates of E. coli against trimethoprim (TMP), trimethoprim/sulfamethoxazole (SXT) or ampicillin (AMP). Boys with ultrasound-detected renal
abnormalities (n = 71) showed 14.2% Pseudomonas and 59.1% E. coli infections versus girls (n = 48) (2.1% Pseudomonas and 93.7% E. coli). Of 390 patients who underwent voiding cysto-urethrography, 31.5% had VUR. Of them, 45.5% received antimicrobial prophylaxis
with SXT (n = 30) or cefazolin (n = 26). There was no difference between girls (n = 242) and boys (n = 148) regarding the frequency of VUR and pathogens. There were more TMP- and SXT-resistant E. coli cultures from patients with VUR (37.8%) than from those without VUR (25.8%). Treatment with TMP, SXT and AMP alone appeared
to be insufficient in many cases because of high resistance rates of E. coli and other uropathogens. 相似文献