Development Of Renal Scarring Research Articles

Evaluation of the Diagnostic Performance of the LINEAR Cromatest and Laboquick URS 10-T Dipsticks Among Urinary Tract Infection Suspects in Addis Ababa, Ethiopia: A Cross-Sectional Study.

Urinary tract infections (UTIs) bring a significant and serious health-related problem. Repeated infections may lead to the development of renal scarring and end-stage renal dysfunction. Therefore, balancing the choices of UTI diagnostic tools depending on the costs versus accuracy can minimize false results that may subject patients to wrong treatments. The objective of the study was to evaluate the diagnostic performance of LINEAR cromatest and Laboquick URS 10-T dipsticks against conventional urine culture at Arsho Advanced Medical Laboratory (AAML), Addis Ababa, Ethiopia. A similar cohort of UTI-suspected patients from our previous study, who were prospectively enrolled from Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia, were considered for this analysis. Data analysis was performed using SPSS version 26. The sensitivity, specificity, and predictive value of different dipsticks were calculated using culture as a gold standard. ROC curve analysis was also used to determine diagnostic performance. A test with a P-value of <0.05 was considered statistically significant. Out of 446 urine samples processed, bacterial growth was observed in 141 (31.6%). Of this figure, 105/141 (74.5%) and 36/141 (25.5%) were from female and male participants, respectively. The sensitivity and specificity of the LINEAR Cromatest dipstick were 83.7% and 67.9%, respectively (P-value <0.001). The Laboquick URS 10-T dipstick showed sensitivity and specificity of 87.9% and 68.5%, respectively (P-value <0.001). The ROC analysis showed an AUC of >0.7 for both dipsticks. In a setting where there is no access to urine culture, the urine dipstick may be considered an alternative diagnostic tool in the diagnosis of UTIs.

MP70-03 THE ROLE OF CIRCUMCISION IN PREVENTING URINARY TRACT INFECTIONS IN CHILDREN WITH ANTENATAL HYDRONEPHROSIS: SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP70-03 THE ROLE OF CIRCUMCISION IN PREVENTING URINARY TRACT INFECTIONS IN CHILDREN WITH ANTENATAL HYDRONEPHROSIS: SYSTEMATIC REVIEW AND META-ANALYSIS Justin Chan, Adree Khondker, Min Joon Lee, Jin Kyu Kim, Michael Chua, Joana Dos Santos, Natasha Brownrigg, Juliane Richter, Armando Lorenzo, and Mandy Rickard Justin ChanJustin Chan More articles by this author , Adree KhondkerAdree Khondker More articles by this author , Min Joon LeeMin Joon Lee More articles by this author , Jin Kyu KimJin Kyu Kim More articles by this author , Michael ChuaMichael Chua More articles by this author , Joana Dos SantosJoana Dos Santos More articles by this author , Natasha BrownriggNatasha Brownrigg More articles by this author , Juliane RichterJuliane Richter More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , and Mandy RickardMandy Rickard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Circumcision has been reported to reduce the risk of urinary tract infection (UTI) in boys with congenital urinary tract anomalies, a diverse group of conditions that includes hydronephrosis. Our aim was to specifically compare the rates of UTIs in circumcised vs. uncircumcised boys with antenatal hydronephrosis by conducting a systematic review and meta-analysis. METHODS: A comprehensive search was performed until December 2021. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed measures included UTIs, continuous antibiotic prophylaxis (CAP) use, renal function, development of cortical scarring, as well as circumcision complications. Odds ratios (OR) and mean difference with 95% confidence interval (CI) were extrapolated from available data. Random-effects meta-analysis were performed, and confounders were assessed with subgroup analysis. RESULTS: Sixteen studies describing 7,503 boys with antenatal hydronephrosis were identified, including 4,116 boys who were uncircumcised and 3,387 boys who were circumcised. The median follow-up time was 24.0 months (range: 6.0 - 152.4 months). Uncircumcised and circumcised boys were found to have UTI rates of 19.1% and 6.1%, respectively. This translates to a number needed to treat (NNT) of 8. Overall effect estimates demonstrate that circumcised boys have a significantly reduced odds of developing any UTI [OR 0.23, 95% CI 0.17, 0.31; p<0.001]. Furthermore, there was a significantly reduced odds of developing UTI on CAP [OR 0.18, 95% CI 0.11, 0.32; p<0.001]. When stratifying by etiology of antenatal hydronephrosis, circumcision reduced the odds of UTI in boys with vesicoureteral reflux [OR 0.24, 95% CI 0.12, 0.47; p<0.00001], or posterior urethral valve [OR 0.29, 95% CI 0.13, 0.64; p=0.002]. Long term renal function, development of renal scarring, and postoperative complications were not consistently reported, which prohibited pooling. Most studies had moderate risk of bias. CONCLUSIONS: Current evidence suggests that circumcision reduces the frequency of UTIs in boys with antenatal hydronephrosis. Based on these findings, circumcision should be considered in boys with antenatal hydronephrosis to prevent the risk of developing UTI. Further research is warranted to individualize the prophylactic role of circumcision for patients with different etiologies and grade of hydronephrosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1003 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Chan More articles by this author Adree Khondker More articles by this author Min Joon Lee More articles by this author Jin Kyu Kim More articles by this author Michael Chua More articles by this author Joana Dos Santos More articles by this author Natasha Brownrigg More articles by this author Juliane Richter More articles by this author Armando Lorenzo More articles by this author Mandy Rickard More articles by this author Expand All Advertisement PDF downloadLoading ...

Abordarea clinică a copiilor cu reflux vezico-ureteral – prezentare generală

Vesicoureteral reflux is the most common urinary tract ab­nor­ma­lity among children, estimated to be present in ap­pro­xi­mately 1-2% of them. There are various possibilities of evolution, from asymptomatic forms with spontaneous re­mis­sion to recurrent acute pyelonephritis, reflux ne­phro­pathy, or even end-stage chronic kidney disease. Therefore, the early diagnosis, with a correct staging, is essential, al­lo­w­ing the optimal therapeutic approach. The most com­mon clinical situations requiring imaging investigation of vesi­coureteral reflux are repeated urinary tract infections, fetal hydronephrosis, familial vesicoureteral reflux, blad­der bowel dysfunction, and complex uropathies. The the­ra­peu­tic management is decided according to the reflux se­ve­rity, the clinical manifestations, and the pa­tient’s age. The main objectives of the treatment are to pre­vent uri­na­ry tract infections, the development of renal scars, and the progression toward chronic kidney disease. The the­ra­peu­tic approach may involve active follow-up, con­ti­nuous antibiotic prophylaxis, or surgical intervention. Ac­tive follow-up applies to asymptomatic patients with an in­creased likelihood of spontaneous remission. Antibiotic pro­phy­laxis is the most frequently adopted approach, used in patients with previous urinary tract infections and high-grade reflux. The surgical approach is reserved for cases with a low probability of spontaneous remission and for those with unfavorable evolution under conservative treat­ment. The surgical methods used are represented by en­do­sco­pic injection of an antireflux substance, classical or robotically assisted surgery, with similar success rates. Cur­rently, there is no consensus regarding the therapeutic ap­proach to these patients, the pediatrician being the one who must evaluate each case and propose and in­di­vi­dua­l­ized therapeutic management adapted to the needs of each patient.

Clinical Profiles and Outcomes of Renal Scarring in Children Underwent Dimercaptosuccinic Acid (DMSA) Renal Scan in A Tertiary Hospital

Introduction: Renal scarring, which can be detected by DMSA renal scan, has been demonstrated to cause hypertension, proteinuria and chronic kidney disease (CKD). We reviewed the proportion of renal scarring, risk factors and outcomes among children who were referred for DMSA scan in a tertiary teaching hospital. Methods: All records of children less than 18 years old who underwent DMSA scan over a ten-year period, were reviewed. Among children whose renal cortical defects were confirmed by DMSA scan, data of their risk factors and its outcome were collected manually. Results: Out of 92 children referred for DMSA scan, half were detected to have renal scarring. Vesico-ureteric reflux (VUR) was significantly associated with the development of renal scarring. CKD (27.1%) and hypertension (12.5%) were the commonest complications. The median duration between diagnosis of the complications and detection of renal scarring was 1 year. Conclusion: A high proportion of children undergoing DMSA scans had renal scarring and early development of serious complications was common.

Renal scars in children with febrile urinary tract infection - Looking for associated factors

Febrile urinary tract infection (UTI) is a common childhood infection related to renal scarring and potentially long-term complications like chronic kidney disease. It would be of great benefit to find a correlation between easy-accessible factors in the acute phase of a febrile UTI and the development of renal scar formation and/or decreased renal function in order to identify children at risk of future complications. The aim of this study was to identify factors associated with the development of decreased split renal function (DSRF) and/or permanent renal scar formation in children with febrile UTI. The medical records of 212 Children aged 0 months to 15 years with febrile UTI admitted to The Pediatric Department of Lillebaelt Hospital, Kolding from January 2011 to September 2014 were systematically reviewed. We analyzed clinical, laboratory, and radiologic findings. Statistical analysis was performed to identify factors associated with renal scar formation and DSRF on nuclear imaging at 6 months follow-up. A total of 113 medical records were eligible for further analysis, 99 girls and 14 boys, 34 patients younger than 12 months. In total 30 patients (26.5%) had an abnormal follow-up imaging (DSRF less than 45% and/or renal scarring). Nine patients (8%) had renal scarring. Four patients (3.5%) had renal scarring only, 21 patients (18.6%) had DSRF only, and five patients (4.4%) had both renal scarring and DSRF. Patients with renal scar formation on follow-up imaging had significantly higher C-reactive protein (CRP) than patients with no scarring (p<0.01). CRP and absolute neutrophil count (ANC) was significantly higher in patients with abnormal follow-up imaging (p<0.01 and p=0.010), and these patients more often had positive nitrite in urine dipstick compared to patients with normal kidneys on follow-up (p=0.048). Temperature above 38.5°C and CRP >50mg/L in combination were also associated with a higher risk of abnormal follow-up imaging (p=0.016). This study contributes with further knowledge to the ongoing debate regarding renal scarring but also reveals the possibility of associated factors for the development of DSRF following a febrile UTI in children. However, due to the retrospective design as well as the small number of events in our study definite conclusions on whether the above-mentioned factors are indeed prognostic for the development of renal scarring or DSRF following a febrile UTI can not be drawn.

Tekrarlayan İdrar Yolu Enfeksiyonu Olan Çocuklarda Tuvalet Alışkanlıklarının Değerlendirilmesi ve Böbrek Hasarı Gelişmesinde Rol Oynayan Risk Faktörlerinin Araştırılması

Objective: Urinary tract infection is one of the common infections in children. The patients with recurrent infection are at risk for permanent renal damage in later life. In this study, it was aimed to investigate the toilet habits and risk factors for renal scarring in children with recurrent urinary tract infection without congenital anomalies of the kidney and urinary tract.Materials and Methods: Patients between the ages of 6 and 18 with a diagnosis of recurrent urinary tract infection who were toilet trained were included in this study. Data of patients with congenital anomalies of kidney and urinary tract were excluded from the study. The detailed information on the voiding postponement, infrequent voiding, holding maneuvers and renal scarring were obtained from file records.Results: The 208 patients (146 girls, 62 boys) were included in this study. The more than half of the patients (n=132, 63.5%) had a habit voiding postponement, and one third (n=65, 31.3%) had holding maneuver. There was infrequent voiding in 47 (22.6%) patients. Renal scarring was determined in 38 (18.3%) patients. The frequencies of voiding postponement, holding maneuver and infrequent voiding were higher in patients with renal scarring than those of without [30 (78.9%)/102 (60%), p=0.048; 12 (31.6%)/53 (21.2%), p=0.039; 15 (39.5%)/32 (18.8%), p=0.009, respectively]. It was determined a significant positive association between renal scarring and voiding postponement with infrequent voiding [Odds ratio=3.21, p=0.011; Odds ratio=1.46, p=0.021; Odds ratio=3.43, p=0.001, respectively]. Conclusion: Toilets habits should be questioned in routine follow-up program in children with recurrent urinary tract infection. The development of true toilet habits may be useful to prevent the development of renal scarring in children.

Protective Effects of Omega-3 Fatty Acids Supplementation Against Renal Parenchymal Scarring in Children with Acute Pyelonephritis: Results of a Pilot Clinical Trial.

This trial aimed to determine if supplementation with omega-3 fatty acids as an adjunct therapy to antibiotic treatment can have protective effects against renal scar formation after acute pyelonephritis (APN) in pediatric patients. Current evidence points out that besides antibiotic treatment, early administration of antioxidant and anti-inflammatory compounds may be effective in reducing the occurrence of renal damage following APN in children. The main endpoint of the trial was the comparison of the development of renal scarring formation after APN in an omega-3 fatty acids-treated group and in a control-treated group. This prospective randomized, controlled trial study was conducted from March 2016 to May 2018 on 60 children with a diagnosis APN in a tertiary hospital in Iran. After the diagnosis of APN based on the clinical signs and symptoms, urine analysis, urine culture, and dimercaptosuccinic acid renal scan (DMSA scan), the patients were randomly allocated into either the control group (n=30 patients: received standard antibiotic treatment only) or the intervention group (n=30 patients: received standard antibiotic-treatment in combination with oral omega-3 fatty acids based on the children's weight for three consecutive days). A second DMSA scan was performed for the patients at a minimum of six months after treatment. The development of renal scars was evaluated by comparing the baseline DMSA scan lesions with the follow-up DMSA scan lesions. Fifty patients, including 26 and 24 individuals in the control and intervention groups, respectively, completed the entire course of the study. Renal parenchymal involvement based on the baseline DMSA scan was similar in the two groups (p-value =0.85, 0.90, and 0.53 regarding the right, left, and both kidney units together, respectively). Although comparison of the follow-up DMSA scan lesions to the baseline DMSA scan lesions considering the right and left kidneys as separate units between two groups did not reach the significant level, when considering both left and right kidney units together, results showed a statistically significant difference between groups in favor of the intervention group (p-value =0.04). Although preliminary, the results of this study showed that administration of omega-3 fatty acids, a natural supplement with well-known anti-inflammatory and antioxidant properties, as an adjunct therapy to standard antibiotic treatment might significantly reduce the incidence of the occurrence renal scarring following APN in children. Confirmation of these results requires further studies.

Evaluation of the Relationship of the Time of Vesicoureteral Reflux Between Renal Scar Development and Endoscopic Treatment Success in Early Childhood

INTRODUCTION: Vesicoureteral reflux (VUR) is an important cause of urinary tract infection and chronic renal disease. Voiding cystourethrography (VCUG) is the gold standard diagnostic test in the diagnosis of VUR. In recent years, new parameters related to VCUG have been more objectively studied to evaluate the clinical prognosis. It is aimed to evaluate the effect of reflux time in primary VUR in terms of predicting endoscopic treatment success and treatment timing in VUR management. METHOD: In our study, the records and imaging findings of children with primary VUR who underwent VCUG examination between 2012 and 2019, who were treated with endoscopic injections, were retrospectively reviewed. Forty one children (67 renal units) were included in our study. Patients with preoperative VCUG, urinary ultrasonography, dimercaptosuccinic acid (DMSA) renal scan, and post-operative control VCUG were included in this study. RESULTS: Patients with preoperative VUR grade 1-2 were divided into two groups as “low grade” and patients with stage 3-4-5 as “high grade”. In the general patient population, endoscopic success rates in terms of renal unit deficit were found to be 46.3% (31/67). When the subgroup was analyzed, the endoscopic treatment success rate was 72.2% (13/18) in the low-grade group, versus 36.7% (18/49) in the high-grade group (p = 0.010). In the multivariate logistic regression analysis performed to identify independent predictors of scarring, reflux degree and reflux time were found to be independent predictors of scarring. CONCLUSION: In our study, we found that in VCUG evaluated preoperatively, VUR time as well as VUR grade were effective on endoscopic success rate and scar development. Based on these results, it could be thought that VUR time may be effective in selecting the best candidates for surgery and in the management and timing of treatment of VUR patients.

Is there a relationship between renal scarring and neutrophil-to-lymphocyte ratio in patients with vesicoureteral reflux?

Vesicoureteral reflux (VUR) exacerbates the risk of renal scarring by establishing a ground for pyelonephritis. It is known that the inflammatory process is more influential than the direct damage caused by bacterial infection in the development of renal scars after pyelonephritis. Therefore, the present study aims to investigate the relationship between renal scarring and systemic inflammatory markers in patients with VUR. Hundred and ninety-two patients (116 females, 76 males) diagnosed with VUR were divided into two groups based on the presence or absence of renal scarring and into three groups according to the grade of VUR (low, moderate and high). Neutrophil count, lymphocyte count, mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) were compared among the groups. Of the 192 patients, 102 had renal scarring. The age and gender distribution did not differ significantly between the groups with and without renal scarring (p > 0.05). However, the grade of reflux and lymphocyte count were significantly higher in the group with renal scarring (p < 0.05), and the NLR was significantly lower in the group with renal scarring (p < 0.05). The lymphocyte count was significantly higher (p < 0.05) and NLR was significantly lower in the high-grade VUR group (p < 0.05). However, MPV values did not differ significantly (p > 0.05) between the groups. NLR can be used to predict renal scarring in patients with VUR, especially in the period of 3-6 months after the first attack of infection, and may even serve as a candidate marker for treatment selection. However, larger series and prospective studies are needed.

The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections

Purpose: Urinary tract infection (UTI) is one of the important infectious diseases of childhood age. It causes serious late-term complications by leading to development of renal scarring in some pediatric patients. In the present study, it was aimed to determine the risk factors in development of renal damage in the pediatric patients that admitted with clinical of acute pyelonephritis. Materials and methods: In our study, the medical files of the patients were admitted to the pediatric nephrology polyclinic of Pamukkale University Medical Faculty and followed-up with the diagnosis of urinary tract infection were retrospectively evaluated. The study included 197 patients diagnosed with acute pyelonephritis (confirmed by urine culture and clinical evidence) and undergoing dimercaptosuccinic acid (DMSA) scintigraphic imaging. The clinical evidence (fever, recurrent UTI, voiding dysfunction etc.), laboratory evidence (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, polymorphonuclear leukocyte (PNL) count, mean platelet volume (MPV), platelet count, serum urea and creatinine levels) and imaging evidence (urinary tract system ultrasonography (USG), voiding cystourethrography (VCUG) and DMSA scintigraphy) of the patients detected at admission and obtained by anamnesis were evaluated. Results: The number of the female patients (n=153) was found significantly higher than number of the male patients (n=44) (p<0.001). It was detected that pretreatment fever of 38ºC and over, persisting clinical evidence for 2 days or longer, the presence of recurrent UTI and high levels of WBC, PNL, ESR and CRP significantly increased renal damage in the patients (p<0.001). It was determined that USG and VCUG have low sensitivity regarding prediction of renal damage. Conclusion: Determination of renal damage rate by clinical and laboratory data detected at patient admission may contribute to a reduction in morbidity and mortality rates by applying an appropriate follow-up and treatment modality.

Laboratory and Imaging Characteristics of Children Suffering from Urinary Tract Infection from Infancy to Age Five Years Who Were Hospitalized in Pediatric Department in Ziv Medical Center Safed Children's Hospital in 2010-2019 in North of Isreal

Background: Urinary tract infections (UTIs) are a common and potentially serious bacterial infection of childhood. UTI is the most common cause of hospitalization in children with high fever especially in infancy, which is more common to be the source for bacteremia in this age. In infancy, the disease is more common in boys and the incidence in girls increases with age, it has been found that uncircumcised children have a higher incidence of urinary tract infection. 30% of children who have had the first infection of pyelonephritis (inflammation of the kidney tissue) will develop a recurrent urinary tract infection when the infection occurs in the first year of life. The most common bacteria to cause these infections are Escherichia coli (E-coli), later Gram-negative bacteria (-) such as Klebsiella pneumonia and Proteus mirabilis, and gram-positive (+) bacteria such as Enterococci. ESBL + resistant bacteria have been found more as uropathogenic in recurrent urinary tract infections. Our aims in this study are to describe the epidemiological and microbiological properties and imaging of urinary tract infection in young children up to the age of five years. In our study, we examined the significance of reflux, its degree, and whether a cystography examination is necessary for any upper urinary tract infection. In addition, it was important to study different indices of inflammation (leukocytes, C-reactive protein test), renal ultrasound findings, and renal mapping of DMSA. Research methods: The study is retrospective that included infants and children up to the age of five who were hospitalized at Ziv Medical Center Safed in northern Israel in the pediatric department between 2010-2019, with the diagnosis of the first episode of urinary tract infection or recurrent episodes in the first five years of life. All children had symptoms and signs of urinary tract infection. The children underwent laboratory tests including cell blood count (CBC), kidney and electrolyte functions, C-reactive protein (CRP), blood culture, and urine sample. Following imaging of renal and urinary tract ultrasound, cystography was done after 4-6 weeks according to the protocol. Children underwent renal mapping with DMSA after 4 to 5 months of acute urinary tract infection. Results: The data showed a greater tendency for girls aged one year and older to have UTI. The average hospitalization time was 48 to 72 hours. We found no association with maternal smoking. Breastfed babies have lower rates of urinary tract infections in the first year. The most common uropathogens are E-coli, Klebsiella pneumonia, Proteus mirabilis, and Enterococci. Antibiotic resistance was observed in recurrent infections by E-Coli 20%, ESBL to 30%, And Klebsiella 45%. 30% to 40% developed recurrent urinary tract infections, recurrent infections were within two to four months after the first infection. In most children, empiric antibiotic therapy of Ampcilin and aminoglycoside was started. Most children underwent renal ultrasound, 35% had pathological imaging of hydronephrosis, and some with hydroureter. 40% of the children who underwent cystography had reflux with varying degrees, 60% of those who did mapping (DMSA) were pathological mapping (filling defect, scar). 18% of children with normal DMSA results had reflux. CRP, rates were found to be high in all children with pyelonephritis and reflux. Conclusion: Initiating empirical treatment of urinary tract infection is very important in preventing renal scar development. Recurrent urinary tract infections are characterized by various uropathogenic bacteria and a tendency to antibiotic resistance. Therefore, it is necessary to choose the appropriate antibiotic. As a renal ultrasound imaging available examination without radiation can be performed in the hospital. Cystography is not required in most cases of upper urinary tract infection. Kidney mapping by DMSA can reveal the additional value of kidney damage. Inflammatory indices including erythrocyte sedimentation rate (ESR) and CRP indicate the presence of renal tissue involvement such as Pyelonephritis. Keywords: Urinary tract infection; Pyelon

Neutrophil-Macrophage Imbalance Drives the Development of Renal Scarring during Experimental Pyelonephritis.

In children, the acute pyelonephritis that can result from urinary tract infections (UTIs), which commonly ascend from the bladder to the kidney, is a growing concern because it poses a risk of renal scarring and irreversible loss of kidney function. To date, the cellular mechanisms underlying acute pyelonephritis-driven renal scarring remain unknown. We used a preclinical model of uropathogenic Escherichia coli-induced acute pyelonephritis to determine the contribution of neutrophils and monocytes to resolution of the condition and the subsequent development of kidney fibrosis. We used cell-specific monoclonal antibodies to eliminate neutrophils, monocytes, or both. Bacterial ascent and the cell dynamics of phagocytic cells were assessed by biophotonic imaging and flow cytometry, respectively. We used quantitative RT-PCR and histopathologic analyses to evaluate inflammation and renal scarring. We found that neutrophils are critical to control bacterial ascent, which is in line with previous studies suggesting a protective role for neutrophils during a UTI, whereas monocyte-derived macrophages orchestrate a strong, but ineffective, inflammatory response against uropathogenic, E. coli-induced, acute pyelonephritis. Experimental neutropenia during acute pyelonephritis resulted in a compensatory increase in the number of monocytes and heightened macrophage-dependent inflammation in the kidney. Exacerbated macrophage-mediated inflammatory responses promoted renal scarring and compromised renal function, as indicated by elevated serum creatinine, BUN, and potassium. These findings reveal a previously unappreciated outcome for neutrophil-macrophage imbalance in promoting host susceptibility to acute pyelonephritis and the development of permanent renal damage. This suggests targeting dysregulated macrophage responses might be a therapeutic tool to prevent renal scarring during acute pyelonephritis.

Trans IL-6 signaling does not appear to play a role in renal scarring after urinary tract infection

While inflammation is an important innate defense mechanism against infection, it can also lead to local tissue damage. The trans signaling pathway of interleukin (IL)-6 is a known mediator of inflammation. We hypothesized that the trans IL-6 signaling pathway is associated with the development of post febrile urinary tract infection (UTI) renal scarring. To compare soluble regulators of trans IL-6 signaling between patients with a history of febrile UTI who do or do not have renal scarring. After IRB-approval, we collected urine samples in pediatric patients with a history of febrile (≥38°C) UTI (urine culture >50K uropathogen) with documented presence or absence of renal scarring on imaging. Samples were collected at a time when patients were not actively infected. Enzyme-linked immunosorbent assays were performed on samples for markers of trans IL-6 signaling: IL-6, soluble (s) IL-6 receptor (R), and soluble (s)gp130, a buffer in trans IL-6 signaling. Values were normalized to urine creatinine. Results were analyzed by t-test or Mann-Whitney U. Spearman rank correlation was used. A p-value of <0.05 was considered significant. A total of 50 urines from patients with a history of febrile UTI were collected: 23 with and 27 without scarring. There was no difference between groups regarding age or gender. There was no significant difference in urine IL-6, sIL-6R, or sgp130 between those with and without scarring (Figure). While IL-6 values significantly correlated with sIL-6R and sgp130 in those without renal scarring, IL-6 did not correlate with sgp130 in those with scarring. Ratios of IL-6 to sgp130 and sIL-6R to sgp130 were not different between groups. The inflammatory response generated in response to infection is believed to be largely responsible for the development of renal scarring after UTI. IL-6 is a cytokine known to be induced during UTI with a pro-inflammatory pathway, known as trans signaling. This study investigated for differences in markers of trans IL-6 signaling between patients with a history of febrile UTI with and without renal scarring. There was no significant difference between the absolute values or ratio of these markers between groups. Markers of trans IL-6 signaling are not different between individuals with a history of febrile UTI with and without renal scarring in the non-acute setting.

Does endoscopic sclerotherapy in filarial chyluria affect renal function and morphology? A prospective study using dimercaptosuccinic acid renal scan

ObjectiveTo look for change in relative renal function and document renal scarring following endoscopic renal pelvic instillation sclerotherapy (RPIS) in patients with chyluria by dimercaptosuccinic acid (DMSA) renal scan. MethodsA prospective study was performed between November 2015 and September 2016. All patients with biochemically documented chyluria who underwent RPIS using either 1%-silver nitrate or 0.1%-povidine iodine were included. Patients received either 3-, 6- or 9-doses. DMSA renal scan was performed before and 2–3 months after sclerotherapy. ResultsOf the 34 patients, 22 were males. Mean age was 41.08 ± 16.64 years (range, 15–70 years). Thirty-two patients (94.1%) responded to therapy while two did not respond even after 9-doses. Average follow-up was 8.94 ± 3.70 months. The mean relative renal function (pre-instillation) of normal kidney was 50.76% ± 3.55% while that of affected renal unit (side of instillation) was 49.20% ± 3.44% (range, 43.0%–61.0%). After instillation therapy, the mean relative renal function of normal side was 52.26% ± 3.57% while that of affected renal unit was 47.50% ± 3.56% (range, 41.0%–54.0%). The relative renal function did not change >5% from the baseline value in any patient except one (in which the differential function increased paradoxically by 12%). Two patients developed renal scar in post-instillation renal scan. ConclusionEndoscopic sclerotherapy in chyluria is safe and effective. The relative renal function does not deteriorate by more than 5%. There is a small risk of development of renal scar. More studies involving larger number of patients are needed to answer this dilemma.

Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring.

This study evaluated the controversial relationship between the duration of fever before treatment initiation (FBT) for a febrile urinary tract infection (UTI), with renal scarring based on dimercaptosuccinic acid scintigraphy (DMSA) findings. The inpatient records of 148 children under two years of age with a first episode of febrile UTI were analysed. Acute and repeat DMSA findings, and clinical and laboratory parameters were evaluated. Acute DMSA showed that 76 of the 148 children with a febrile UTI had renal lesions: 20 were mild, and 56 were moderate or severe. Repeat DMSA showed renal scarring in 34 patients. The only factors associated with the development of renal scars in the repeat DMSA were FBT of more than 72 hours, the presence and severity of vesicoureteral reflux and increased procalcitonin levels and absolute neutrophil counts. Multiple regression analysis showed that an FBT above 72 hours was the only significant factor that predicted renal scars. Delay in treatment initiation of 72 hours or more was a risk factor for permanent renal scars after the first episode of febrile UTI. Other associated factors were increased procalcitonin and absolute neutrophil count on admission and the presence and severity of vesicouretal reflux.

Evaluation of abnormal radiological findings in children aged 2 to 36 months followed by recurrent urinary tract infection: a retrospective study

Our aim is to determine the rational usage of imaging techniques in order to prevent or minimize permanent renal damage in recurrent urinary tract infections (UTIs). This study was enrolled children aged between 2 and 36 months, following-up with the diagnosis of recurrent UTI. All children had ultrasonography (USG) and dimercaptosuccinic acid scanning, 39 of them had underwent on voiding cystourethrography. There were 133 children (87 girls, 46 boys) with the mean age of 32.82 ± 38.10 months included into the study. Forty-three kidney units were normal in ultrasonogram of which seven units had reflux whereas among 35 units with hydronephrosis 22 units had reflux. Sensitivity and specificity presence of hydronephrosis in ultrasonogram for prediction of reflux was 75.9% and 73.5%, respectively. There were 19 dilated ureters in ultrasonogram, and among them 14 had reflux. Sensitivity and specificity of presence with ureteral dilatation in ultrasonogram for prediction of reflux was found as 48.3% and 89.8%, respectively. The sensitivity of parenchymal thinning seen in ultrasonogram for the evaluation of renal parenchyma was 15.9%, whereas specificity was 98.2% .Sensitivity and specificity of dimercaptosuccinic acid for prediction of reflux was 51.6% and 72.3%, respectively. The normal ultrasonogram findings cannot rule out neither possibility of reflux presence nor development of renal scarring. Therefore, DMSA scanning has major role both in determination of parenchymal damage and prevention of scarring. Also we get an important result as ureteral dilatation seen in USG, related to presence of reflux.

Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring

Existing data regarding the association between delayed initiation of antimicrobial therapy and the development of renal scarring are inconsistent. To determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections (UTIs) is associated with the occurrence and severity of renal scarring. Retrospective cohort study that combined data from 2 previously conducted longitudinal studies (the Randomized Intervention for Children With Vesicoureteral Reflux trial and the Careful Urinary Tract Infection Evaluation Study). Children younger than 6 years with a first or second UTI were followed up for 2 years. Duration of the child's fever prior to initiation of antimicrobial therapy for the index UTI. New renal scarring defined as the presence of photopenia plus contour change on a late dimercaptosuccinic acid renal scan (obtained at study exit) that was not present on the baseline scan. Of the 482 children included in the analysis, 434 were female (90%), 375 were white (78%), and 375 had vesicoureteral reflux (78%). The median age was 11 months. A total of 35 children (7.2%) developed new renal scarring. Delay in the initiation of antimicrobial therapy was associated with renal scarring; the median (25th, 75th percentiles) duration of fever prior to initiation of antibiotic therapy in those with and without renal scarring was 72 (30, 120) and 48 (24, 72) hours, respectively (P = .003). Older age (OR, 1.03; 95% CI, 1.01-1.05), Hispanic ethnicity (OR, 5.24; 95% CI, 2.15-12.77), recurrent urinary tract infections (OR, 0.97; 95% CI, 0.27-3.45), and bladder and bowel dysfunction (OR, 6.44; 95% CI, 2.89-14.38) were also associated with new renal scarring. Delay in the initiation of antimicrobial therapy remained significantly associated with renal scarring even after adjusting for these variables. Delay in treatment of febrile UTIs and permanent renal scarring are associated. In febrile children, clinicians should not delay testing for UTI.

Do patients with neurogenic bladder treated with clean intermittentcatheterization need antibacterial prophylaxis?

In this study, we investigated the effectiveness of antibiotic prophylaxis (ABP) with respect to the incidence of symptomatic urinary tract infections (UTIs) and evaluated the development of renal scarring in patients treated with clean intermittent catheterization (CIC). A total of 22 patients were included in the study. The patients were administered ABP in the first year (the ABP-received period) but not in the second year (the ABP-discontinued period). Twenty-eight of all cultures taken in the ABP-received period (18.2%) and 25 (16.2%) of the ABP-discontinued cultures were considered to be indicative of symptomatic UTIs (P = 0.65). The multiple antibiotic resistance rate of microorganisms in cultures taken during the ABP-discontinued period (47; 30.5%) was lower than that in those taken in the ABP-received period (62; 40.3%), (P = 0.07). There was no difference between the ABP-received and ABP-discontinued periods with respect to the development of new lesions according to dimercaptosuccinic acid results (P = 0.14). Routine ABP usage is not protective against the development of symptomatic UTIs and new lesions in neurogenic bladder patients receiving CIC. Furthermore, the growth of resistant microorganisms increased in the ABP-received period.

Urodynamic disorders and renal scarring in pediatric patients with nonmonosymptomatic nocturnal enuresis.

In nonmonosymptomatic nocturnal enuresis (NMNE), the incidence of organic abnormality and urodynamic disorder is more frequent than the general population. The aim of this study is to identify urodynamic disorders and renal scarring in children with NMNE. This study evaluated the urodynamic disorders and renal scarring of a total of 30 patients who were diagnosed with NMNE. A video-urodynamic test and Tc-99m dimercaptosuccinic acid renal scintigraphy were applied. Records of 605 patients who had been diagnosed with enuresis were analyzed, and 215 (33.5%) of them had been diagnosed with NMNE. Thirty patients older than 6 years old with NMNE were included in the study. Detrusor overactivity was identified in 10 patients. Bladder capacity was low in 5 patients and bladder compliance was low in 2 patients. Renal scarring was identified in 1 patient. Unilateral vesicoureteral reflux was found in 4 patients. Bladder function disorder is also a significant risk factor for the development of renal scarring, besides other risk factors. Organic abnormalities are seen more often in patients with NMNE than patients with monosymptomatic nocturnal enuresis, so urodynamic studies should be remembered for patients with NMNE.

Probiotics prophylaxis in infants with primary vesicoureteral reflux.

In this era of increasing bacterial resistance to antimicrobial therapy, probiotics have great potential and yet they are a harmless alternative approach. This study is a prospective randomized uncontrolled trial to investigate the preventive effect of probiotic prophylaxis in infants with primary vesicoureteral reflux (VUR) and frequently recurring urinary tract infection (UTI) during the first follow-up year. One hundred and twenty-eight infants (aged 1 week to 12 months) with primary VUR were prospectively randomized into a probiotic (n = 64, Lactobacillus acidophilus, 1.0 × 10(8) CFU/g) or antibiotic (n = 64, trimethoprim/sulfamethoxazole, 2/10 mg/kg) group. The incidence of recurrent UTI in the probiotic group was slightly lower than in the antibiotic group without statistical significance (32.8 % [21 out of 64] vs 40.6 % [26/64]) (P = 0.348). Causative organisms of recurrent UTI, resolution rate of VUR, and development of renal scarring were not different between the probiotic and antibiotic prophylaxis groups. The incidences of antibiotic resistance of causative organisms in recurrent UTI were significantly lower in the probiotic group than in the antibiotic group. Probiotics could be considered a natural alternative regimen for prophylaxis in infants with primary VUR.