History Of Febrile Urinary Tract Infection Research Articles

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.

MP44-08 IMAGING AFTER UTI IN OLDER CHILDREN AND ADOLESCENTS

You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Relux1 Apr 2014MP44-08 IMAGING AFTER UTI IN OLDER CHILDREN AND ADOLESCENTS Michael P. Kurtz, Jeanne S. Chow, Emilie K. Johnson, William Tan, Tanya Logvinenko, and Caleb P. Nelson Michael P. KurtzMichael P. Kurtz More articles by this author , Jeanne S. ChowJeanne S. Chow More articles by this author , Emilie K. JohnsonEmilie K. Johnson More articles by this author , William TanWilliam Tan More articles by this author , Tanya LogvinenkoTanya Logvinenko More articles by this author , and Caleb P. NelsonCaleb P. Nelson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives While the 2011 AAP guidelines for evaluation after urinary tract infection (UTI) focused on infants age 2-24 months, there are few guidelines or data regarding workup in older children. Both voiding cystourethrogram (VCUG) and renal and bladder ultrasound (RBUS) have been used in such patients, but the value of such tests is uncertain. We sought to determine the clinical yield of RBUS and VCUG among older children and adolescents after UTI. Methods We analyzed VCUG and RBUS findings and clinical history of 3995 patients who underwent both studies on the same date between 1/06-12/10, and selected patients age 5-18 years who underwent imaging for indication of UTI. Patients with prior postnatal GU imaging or history of prenatal hydronephrosis (PNH) were excluded. RBUS was defined as positive for any degree of hydronephrosis or hydroureter, renal parenchymal or bladder abnormalities. A positive VCUG was defined as VUR>GII and/or bladder or urethral anomalies (e.g. diverticulum). Results We identified a cohort of 141 patients, 77% were of age 5-8 years, 29% age 8-12, and 2.8% age 12-18. 76.6% were female. 78.7% patients had a history of febrile UTI; 53.9% had a history of recurrent UTI. RBUS findings among girls included 9.2% hydronephrosis, 2.8% with ureteral dilation, 13% with renal parenchymal findings, and 9.2% with bladder findings. Among boys, 6.1% had hydronephrosis, 9.1% had ureteral dilation, 12% had renal parenchymal findings, and 18% had bladder findings. No subjects had moderate or greater hydronephrosis. On VCUG, VUR was observed in 49/141 subjects (34%); 41/108 (38%) girls and 8/33 (24%) boys. Other bladder or urethral anomalies were seen in 12%. 6.4% of all subjects had grade I, 26.2% had grade II-III, and1.4% had grade >III VUR. One boy had concurrent upper tract obstruction (precluding VUR grading); no boys had VUR > grade II. One boy had a urethral anomaly. Among girls, 1.9% had VUR > grade III. The test characteristics (with 95% CI) of any RBUS abnormality for VUR > grade II (or bladder or urethral anomalies) were: sensitivity 0.53 (0.36-0.70), specificity 0.71 (0.62-0.79), PPV 0.33 (0.22-0.48), NPV 0.85 (0.76-0.91). For any VUR grade (or bladder or urethral anomalies), these were: sensitivity 0.49 (0.37-0.62), specificity 0.76 (0.66-0.84), PPV 0.58 (0.44-0.71), NPV 0.69 (0.59-0.77). Conclusions Among older children with a history of UTI, mild genitourinary anomalies are common, but the yield of diagnostic imaging high grade hydronephrosis or high-grade VUR is very low. Renal ultrasound is not reliable as a screening test for predicting VCUG findings such as VUR, regardless of grade. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e445-e446 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael P. Kurtz More articles by this author Jeanne S. Chow More articles by this author Emilie K. Johnson More articles by this author William Tan More articles by this author Tanya Logvinenko More articles by this author Caleb P. Nelson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

TLR-4 polymorphisms and leukocyte TLR-4 expression in febrile UTI and renal scarring

In this study, we aimed to determine the relation of TLR-4 Asp299Gly and Thr399Ile polymorphisms and monocyte/neutrophil TLR-4 expression to febrile urinary tract infection (UTI) and renal scar development in children. The study was performed in children with a history of febrile UTI. Patients with and without renal scarring were classified as group 1 and group 2, respectively, while the control cases in our previous study were used as the control group (group 3). All three groups were compared for the rate of TLR-4 Asp299Gly and Thr399Ile polymorphisms, and for basal and lipopolysaccharide-stimulated monocyte/neutrophil TLR-4 expression levels. There were 168 patients (86 in group 1, 82 in group 2) and 120 control cases. Monocyte/neutrophil TLR-4 expression levels were similar in groups 1 and 2. However, both groups had lower TLR-4 expression than group 3. The rate of TLR-4 Asp299Gly polymorphism was not different in all groups. TLR-4 Thr399Ile polymorphism was higher in groups 1 and 2 than in group 3 (14.0, 12.2, and 2.0 %, respectively), while group 1 and group 2 were not different. Furthermore, monocyte TLR-4 expression level was lower in those having TLR-4 Thr399Ile polymorphism than in those without this polymorphism. Patients with febrile UTI had more frequent TLR-4 Thr399Ile polymorphism and lower monocyte/neutrophil TLR-4 expression. These findings indicate that children carrying TLR-4 Thr399Ile polymorphism and/or having low level of monocyte/neutrophil TLR-4 expression have a tendency to develop febrile UTI. However, we could not show the association of TLR-4 polymorphisms and of TLR-4 expression level to renal scarring.

Treatment of Occult Reflux Lowers the Incidence Rate of Pediatric Febrile Urinary Tract Infection

To examine whether vesicourethral reflux diagnosed by positioned instillation of contrast (PIC-VUR) shows clinical importance by comparing the incidence rates of febrile urinary tract infection (FUTI) before and after treatment of PIC-VUR. Beginning in 2001 we used a multi-institutional registry to prospectively enroll consecutive pediatric patients with a history of FUTI without VUR according to voiding cystourethrogram (VCUG) and yet who show PIC-VUR. Treatment of PIC-VUR was with prophylactic antimicrobials or antireflux surgery. The post-treatment occurrence of FUTI was tracked. A total of 14 centers enrolled 118 patients (mean age, 7.2 years; range, 0.5 to 20 years). Parents self-selected the treatment of PIC-VUR as endoscopic injection (104), ureteral reimplantation (3), or antimicrobial prophylaxis (11). Study intervals surveying for FUTI before PIC (mean, 12 months; range, 1 to 17 years) and after PIC treatment (mean, 11 months; range, 0 to 3 years) were not significantly different. Overall the incidence rate for FUTI decreased significantly from 0.16 per patient per month before PIC-VUR treatment to 0.008 per patient per month after treatment (rate ratio 20; 95% confidence interval 11 to 36). The post-treatment rate of FUTI in patients treated with antibiotics versus surgery was not significantly different (rate ratio 2.5; 95% confidence interval 0.33 to 27). The diagnosis of PIC-VUR is clinically important because children treated for PIC-VUR with either antimicrobial prophylaxis or surgery show a significant reduction in the incidence rate of FUTI. This is the basis for a current prospective study randomizing patients with PIC-VUR to treatment or observation.

Incidental Detection of Purulent Fluid in Kidney at Percutaneous Nephrolithotomy for Branched Renal Calculi

Some patients undergoing percutaneous nephrolithotomy (PCNL) have purulent fluid in the pelvicaliceal system at the time of puncture, although preoperative features are not suggestive of infection. We report the management and outcome of 19 such patients. Among the 639 patients who underwent PCNL at our center from July 2000 to October 2003, 19 had purulent fluid in the kidney at initial puncture. The preoperative findings, operative details, hospital course, and final outcome in these patients were analyzed. Twelve patients had stone removal at the first sitting (option 1), while seven had a nephrostomy tube placed initially with stone removal deferred for 3 to 7 days (option 2). With option 1, stones were cleared with one to three tracts in 45 to 120 minutes. Seven patients recovered smoothly, three had transient fever, while one had grade I and another had grade II sepsis. The purulent fluid grew E. coli in two cases and Proteus or Serratia in one case each and was sterile in eight. With option 2, stones were cleared using one to three tracts in 60 to 100 minutes. The fluid grew E. coli or Klebsiella in one case each and was sterile in five. Three patients had a smooth recovery, two had transient fever, one had grade I sepsis, and another had grade II sepsis. Risk factors for sepsis, irrespective of the option, were a recent history of febrile urinary-tract infection, borderline elevation of total leukocyte count, thick or foul pus as opposed to mere turbidity, the use of a single tube or tract or delayed creation of second tracts, and operating time >90 minutes. Despite normal preoperative urine and blood values, one may find purulence on puncture during PCNL, which is not always infected. If any one or more of the above risk factors is present, it is safer to drain the kidney initially, making sure that all blocked calices are drained, inserting multiple tubes if necessary.

P‐FIMBRIATED ESCHERICHIA COLI IN ADULTS WITH RENAL SCARRING AND PYELONEPHRITIS.

The commonest organism in urinary tract infections (UTI) is Escherichia coli. Pyelonephritogenic E.coli strains possess P-fimbriae which firmly attach to uroepithelial cells by recognition of a carbohydrate structure, alpha-D-Galp-(1-4)-beta-D-Galp, which is confined within all glycosphingolipids related to the human P-blood group antigens. Several investigators have studied virulence properties of E.coli and host resistance in relation to UTI. Uroepithelial cells from children and women with recurrent UTI have an increased capacity to bind E.coli. In contrast to previous studies the present one deals with patients with renal scarring, who constitute the major risk group among patients with UTI. P-fimbriae mediated binding to uroepithelial cells was studied and the risk of recurrent UTI in patients with renal scarring was determined. Ninety per cent of the E.coli isolates from female patients with acute non-obstructive pyelonephritis in this study possess P-fimbriae (I). The fecal E.coli colonies obtained from these patients were P-fimbriated in 55% compared to 11% of the fecal E.coli colonies from healthy controls. The P-blood group distribution in 56 female patients with renal scarring and a history of febrile UTI was the same as in a control group of 39 healthy subjects (II). A history of recurrent and/or early infections did not increase the percentage of the P1 blood group phenotype. Forty-nine female patients with renal scarring were prospectively investigated for the incidence of symptomatic UTI in relation to fecal colonization with P-fimbriated E.coli (III). Fifty-three per cent of the patients had altogether 65 episodes of symptomatic UTI during the three-year follow-up (0.036 infections per month). Eight patients (16%) had nine attacks of acute pyelonephritis and 4/5 of the tested E.coli strains from these patients were P-fimbriated. No relationship was demonstrated between the presence of P-fimbriated E.coli in the fecal flora and the development of subsequent acute pyelonephritis. The binding of P-fimbriated E.coli to uroepithelial cells from 19 female patients with renal scarring was studied with the fluorescence-activated cell sorting (FACS) analysis (IV). The uroepithelial cells from the patients with renal scarring exhibited a significantly higher binding capacity (p less than 0.01) than uroepithelial cells from healthy controls. Furthermore, uroepithelial cells from the patients with renal scarring and kidney insufficiency had a higher availability of P-fimbriae receptors on their uroepithelial cells than cells obtained from patients with renal scarring and normal renal function (r = -0.75, p less than 0.001) (V).(ABSTRACT TRUNCATED AT 400 WORDS)