Renal Tract Disease Research Articles

Newborn Hospitalizations Before and During COVID-19 Pandemic in Poland: A Comparative Study Based on a National Hospital Registry.

Objectives: There are limited data on the impact of the COVID-19 outbreak in Poland on newborn health. The aim of the study is to show recent information on hospitalizations of newborns in Poland in the pre-pandemic and COVID-19 pandemic era. Methods: A retrospective, population-based study was conducted using data from hospital discharge records of patients hospitalized in 2017-2021. Results: The data on which the study was based consisted of a substantial number of 104,450 hospitalization records. Annual hospitalization rate was estimated to be 50.3-51.9 per 1,000 in 2017-2019, 56 per 1,000 in 2020 and it rose to 77.7 per 1,000 in 2021. In comparison to the pre-pandemic period, in the COVID-19 era, we observed significantly more hospitalization cases of newborns affected by maternal renal and urinary tract diseases (p < 0.001), syndrome of infant of mother with gestational diabetes (p < 0.001), maternal complications of pregnancy (p < 0.001). In the COVID-19 era, the prevalence of COVID-19 among newborns was 4.5 cases per 1,000 newborn hospitalizations. Conclusion: The COVID-19 pandemic outbreak could significantly contribute to qualitative and quantitative changes in hospitalizations among newborns.

Ultrasonography in pediatric renal and urinary tract disease

Ultrasonography in pediatric renal and urinary tract disease

Pattern of Renal and Urinary Tract Diseases Among Children Admitted to A General Ward Over One Year

Pattern of Renal and Urinary Tract Diseases Among Children Admitted to A General Ward Over One Year

Seroprevalence of Infection with Feline Morbilliviruses Is Associated with FLUTD and Increased Blood Creatinine Concentrations in Domestic Cats.

Feline morbilliviruses (FeMV) are fairly newly discovered paramyxoviruses found in cats. The first description indicated an association with widely distributed chronic kidney disease (CKD) in the host species. In various studies, a global prevalence and a further genotype, designated FeMV-2, and the involvement of other organ systems in infected individuals were shown. Using an immunofluorescence assay, we detected an overall seroprevalence of FeMV in almost half of the cats investigated (n = 380), with a significantly increased proportion in younger animals. In comparison to European Shorthair cats, the rate of seropositivity is higher in pedigree cats. Regardless of the breed, FeMV infection was associated with increased blood creatinine concentrations, suggesting an association with CKD. Further analysis indicated that this association was the strongest in animals having high IFA titers against FeMV-2. In addition, a significant association between FeMV-positive status and the prevalence of feline lower urinary tract disease (FLUTD, or idiopathic cystitis) was detected. This association was dominated by cats having antibodies against FeMV-1 only. To further evaluate the positive correlation between FeMV seroprevalence and CKD as well as FLUTD, consideration of additional clinical characteristics and laboratory parameters is warranted, and controlled infection studies with both FeMV genotypes are necessary. Clinicians should, however, be aware of a possible link between renal and lower urinary tract disease and FeMV infections.

Cellular Senescence in Renal and Urinary Tract Disorders.

Cellular senescence is a state of cell cycle arrest induced by repetitive cell mitoses or different stresses, which is implicated in various physiological or pathological processes. The beneficial or adverse effects of senescent cells depend on their transitory or persistent state. Transient senescence has major beneficial roles promoting successful post-injury repair and inhibiting malignant transformation. On the other hand, persistent accumulation of senescent cells has been associated with chronic diseases and age-related illnesses like renal/urinary tract disorders. The deleterious effects of persistent senescent cells have been related, in part, to their senescence-associated secretory phenotype (SASP) characterized by the release of a variety of factors responsible for chronic inflammation, extracellular matrix adverse remodeling, and fibrosis. Recently, an increase in senescent cell burden has been reported in renal, prostate, and bladder disorders. In this review, we will summarize the molecular mechanisms of senescence and their implication in renal and urinary tract diseases. We will also discuss the differential impacts of transient versus persistent status of cellular senescence, as well as the therapeutic potential of senescent cell targeting in these diseases.

Pattern of pediatric renal diseases in a rural tertiary care hospital

Background: Spectrum of renal disease varies in different population, geographical location, and by environmental factors. The purpose of this study was to find out the occurrence of different pediatric renal diseases at a teaching hospital in the rural part of Maharashtra, India.Methods: All cases of renal diseases from one month to 12 years of age, admitted to the wards during the period of July 2018 to December 2019, were included in the study. Detailed clinical and laboratory evaluations were performed on all patients. Diseases were categorized as per standard definitions and managed with hospital protocols.Results: Renal diseases accounted to be 235 cases (2.8%) of total pediatric admissions during study period, of which (61.3%) were male and (38.7%) female. Nephrotic syndrome (NS), was the most common disorder (34%) followed by congenital anomalies of the kidney and the urinary tract (CAKUT) (24.7%), urolithiasis (11%), urinary tract infection (10.63%), chronic kidney disease (CKD) (7.66%) and acute kidney injury (AKI) (3.83%). The causes of AKI were dehydration, urosepsis, septicemia, and acute glomerulonephritis (AGN). Mortality was found in 3.4% of cases and the etiologies were AKI, NS and CKD.Conclusions: A substantial number of children are hospitalized with renal and urinary tract diseases. NS and congenital defects were the leading renal disorders in this study. These patients need comprehensive services for early identification and management.

Relationship between urinary β2 -microglobulin concentration and mortality in a cadmium-polluted area in Japan: A 35-year follow-up study.

The relationship between urinary β2 -microglobulin (β2 -MG) and the risk of all-cause mortality and cause-specific mortality in a cadmium (Cd)-polluted area was investigated in 3139 inhabitants (1404 men and 1735 women) of the Kakehashi River basin in Japan at 35-year follow-up. The subjects had been participants in the 1981-1982 health impact survey that assessed Cd-induced renal dysfunction, as measured by the urinary β2 -MG concentration. Hazard ratios were calculated to assess the risk of all-cause and cause-specific mortality according to the urinary β2 -MG concentrations. Risk ratios (RRs) were assessed using the Fine and Gray regression model to account for competing risks of cause-specific mortality. The mortality rate was significantly higher in participants with urinary β2 -MG concentrations >1000 μg/g creatinine (Cr) for men and >300 μg/g Cr for women. In the proportional hazard model, higher urinary β2 -MG concentrations were associated with higher risks of circulatory disease, digestive system diseases, and kidney and urinary tract diseases in men and women, and with senility for women. However, when competing risk was accounted for, the RRs were significantly higher only for kidney and urinary tract diseases in men and women (RR for each increment of 1000 μg/g Cr [95% confidence interval]: 1.02 [1.00-1.04] for men, and 1.01 [1.00-1.02] for women). The long-term prognosis of participants with renal tubular dysfunction was poor, most likely due to kidney and renal tract diseases.

Double false-negative traps in urine routine test: a case report

Abstract Background Urinalysis is one of the most commonly performed tests in clinical practice and supplies important information for a series of clinical conditions, including renal and urinary tract diseases. The clinical laboratory often completes urinalysis through the combined use of urinary dry-chemistry and formed-element analyzers. Urine red blood cell (RBC) morphology test is often used to discriminate the source of hematuria by manual microscopy. Case presentation In this case report, we describe a 39-year-old woman with chronic glomerulonephritis (CGN) who underwent both urine routine test and RBC morphology test. Her RBC count was in the normal range and the occult blood test was negative in routine test, while the RBC morphology test indicated the presence of non-homogeneous hematuria. Conclusions Therefore, we analyzed the causes of false-negative result on the urine chemical analyzer and the automatic microscope system, respectively.

SUN-139 COMMUNITY-BASED SCREENING FOR OCCULT RENAL DISEASES AMONG FEMALE EMPLOYEES OF MANSOURA UNIVERSITY, EGYPT

Kidneys and Women's Health was the theme of World Kidney Day (WKD) in 2018 (WKD). Females are more vulnerable to develop renal diseases. Thus, Screening For Occult Renal Diseases (SCORED) is a crucial issue of utmost importance. SCORED is a simple screening tool with greater accuracy and predictive power in identifying individuals with a high likelihood of occult kidney diseases and at high-risk for chronic kidney disease (CKD). Herein, we report the screening results of female employee at our University. This was carried out as a part of our university campaign during WKD event, 2018. This cross section study included 100 females working in four faculties (medicine, dentistry, pharmacy and veterinary). They were interviewed by well-trained medical students via through history taking suggestive of renal and urinary tract diseases as well as history of hypertension, diabetes, ischemic heart disease (IHD), heart failure and peripheral arterial diseases. Clinical examination included measurement of weight, height in order to calculate body mass index (BMI) and blood pressure. Urine analysis was performed using dipstick. The study population were classified according to SCORED into two groups, risky (score >4) and non-risky (score <4). The mean age of the recruited females was 40.5±9.9years (range18- 60 years). Mean BMI was 32.5±6.3 kg/m2. Prevalence of diabetes, hypertension, IHD, stroke, heart failure and peripheral arterial disease were 13%, 33%, 17%, 4%, 2% and 2% respectively. Asymptomatic urine abnormalities in the form of pyuria (22%), hematuria (18%), proteinuria (9%) and glycosuria (3%) were encountered. Twenty-six percent of the included females had score of >4 and hence had 1in 5 chance of having CKD. Females with risk of developing kidney disease were more frequently diabetics with higher BMI (32.9±6.5 kg/m2 in risky group vs 31.6±4.7 kg/m2 in non-risky group); however, the difference was statstically insignificant. Hypertension was significantly higher in the risky group (42.4% vs 19.5%, p=0.01). SCORED risk score ≥4 was observed in 40% of women aged > 50 years in 23.1% of those aged <50 years. Diabetes, hypertension and proteinuria were significantly more frequently observed among women aged 50 years or more (22.7%, 54.5% and 10% respectively) vs (10.3%, 26% and 4.5% respectively) in group aged less than 50 years. While the prevalence of presence of pyuria was comparable in the two age groups (22.7% in women age ≥ 50 vs 21.8% in women < 50 years). Risk of developing CKD is not uncommon in women. Asymptomatic hypertension and urinary tract infection are the most prevalent risk factors for CKD among females and should be early detected allowing early interventions to prevent the development of CKD.

Role of Urinary Transforming Growth Factor Beta-B1 and Monocyte Chemotactic Protein-1 as Prognostic Biomarkers in Posterior Urethral Valve.

Background:Posterior Urethral Valves (PUV) are the most common cause of congenital LUT obstruction in males. Biomarkers of glomerular or tubular injury may be of particular value in predicting the need for surgical intervention or in tracing progression of chronic kidney disease. Measurement of biomarker in urine is relatively easy.Aim:To evaluate the changes in values of urinary Transforming Growth Factor Beta 1(TGF-B1) and Monocyte Chemotactic Protein (MCP-1) before and after valve ablation and its prognostic value in Posterior urethral valve.Material and Method:This prospective study was conducted from September 2016 to August 2018. The study group included 20 consecutive male babies with the diagnosis of PUV treated and followed up versus equal numbers of age matched control without any renal or urinary tract disease. Pre-operative urine samples were collected in Operative room. Cystoscopy and valve ablation was done. Follow up was done clinically by urinary stream and radiologically with VCUG. Follow-up was planned at 1 month, 3 months and 6 months following cystoscopic valve ablation. All collected urine samples were centrifuged at 10,000 rpm for 20 minutes. Supernatant was collected and two divided aliquots were stored at -200c to be thawed on the day of assay. Optical density of each well was recorded at 450 nm and 540 nm A p-value of <0.05 was considered to be statistically significant.Result and Discussion:Out of 20 cases of PUV, 14 (70%) cases were 1st born males of their family. The median age at the time of valve ablation in PUV cases was 2.5 (1.20-3.87) years.. Most common symptoms are fever and UTI. The preoperative median serum creatinine level was 1.65 mg/dl(1.22-2.42) pre-ablation, and fall significantly after ablation. Median eGFR level (calculated) was 25.635 (16.38-35.40) and after 6 months was 71.490 (45.44-96.93). Preoperative median MCP1 in PUV cases was 147.2 (82.8-512.5) and significant difference was also found in 1st, 3rd and 6th months after surgery (p<0.001, p=0.004 and p=0.002).Preoperative median TGF-B1 level was 197.8 pg/ml (79.9-386.4). There was no statistically significant change in TGF-B1 level at preoperative to 1 month and preop to 3 months after surgery but at 6 months after surgery the median TGF-B1 level significantly decreased as compared with preoperative TGF-B1 level.Conclusion:TGF β1 and MCP1 can be considered as prognostic urinary biomarkers in patients of PUV and can be used to specify and counsel patient's attendant regarding possibility of ESRD and need for further intervention.

Comparative Performance Analysis of Urised 3 and DIRUI FUS-200 Automated Urine Sediment Analyzers and Manual Microscopic Method.

Objective:Microscopic examination of urine sediment is necessary for evaluation of renal and urinary tract diseases. In this study, we evaluated and compared analytic and diagnostic performances of DIRUI FUS-200 and a new image-based automated urine sediment analyzer Urised 3.Method:A total of 440 urine samples, submitted to our laboratory, were evaluated by two automated urine sediment analyzers and a standardized manual microscopy. Precision, linearity and method comparison studies were performed according to CLSI guidelines.Results:Considering the red blood cell (RBC) and white blood cell (WBC) counts, strong correlations existed between FUS-200 and manual microscopy (r=0.993 vs 0.861), Urised 3 and manual microscopy (r=0.962 vs 0.818), FUS200 and Urised 3 (r=0.961 vs 0.961). Clinical non-concordance ranged from 7% to 14.16% among all methods.Conclusions:The concordance between the analyzers and manual microscopy for WBC was better than that of RBC. The concordance between the two analyzers was better for WBC and RBC, with respect to the manual microscopy. Although the Urised 3, FUS-200 and manual microscopy counts were in agreement; confirmation of the results of automated analyzers with manual microscopy is particularly helpful, for pathological samples with near cut-off values.

An End-to-End System for Automatic Urinary Particle Recognition with Convolutional Neural Network.

The urine sediment analysis of particles in microscopic images can assist physicians in evaluating patients with renal and urinary tract diseases. Manual urine sediment examination is labor-intensive, subjective and time-consuming, and the traditional automatic algorithms often extract the hand-crafted features for recognition. Instead of using the hand-crafted features, in this paper we propose to exploit convolutional neural network (CNN) to learn features in an end-to-end manner to recognize the urinary particle. We treat the urinary particle recognition as object detection and exploit two state-of-the-art CNN-based object detection methods, Faster R-CNN and single shot multibox detector (SSD), along with their variants for urinary particle recognition. We further investigate different factors involving these CNN-based methods to improve the performance of urinary particle recognition. We comprehensively evaluate these methods on a dataset consisting of 5,376 annotated images corresponding to 7 categories of urinary particle, i.e., erythrocyte, leukocyte, epithelial cell, crystal, cast, mycete, epithelial nuclei, and obtain a best mean average precision (mAP) of 84.1% while taking only 72 ms per image on a NVIDIA Titan X GPU.

Long-term risk of renal and urinary tract diseases in childhood cancer survivors: A population-based cohort study

BackgroundChildhood cancer has been associated with long-term risk of urinary tract diseases, but risk patterns remain to be comprehensively investigated. We analysed the lifetime risk of urinary tract diseases in survivors of childhood cancer in the Nordic countries. MethodsWe identified 32,519 one-year survivors of childhood cancer diagnosed since the 1940s and 1950s in the five Nordic cancer registries and selected 211,156 population comparisons of a corresponding age, sex, and country of residence from the national population registries. To obtain information on all first-time hospitalizations for a urinary tract disease, we linked all study subjects to the national hospital registry of each country. Relative risks (RRs) and absolute excess risks (AERs) and associated 95% confidence intervals (CIs) for urinary tract diseases among cancer survivors were calculated with the appropriate morbidity rates among comparisons as reference. ResultsWe observed 1645 childhood cancer survivors ever hospitalized for urinary tract disease yielding an RR of 2.5 (95% CI 2.4–2.7) and an AER of 229 (95% CI 210–248) per 100,000 person-years. The cumulative risk at age 60 was 22% in cancer survivors and 10% in comparisons. Infections of the urinary system and chronic kidney disease showed the highest excess risks, whereas survivors of neuroblastoma, hepatic and renal tumours experienced the highest RRs. ConclusionSurvivors of childhood cancer had an excess risk of urinary tract diseases and for most diseases the risk remained elevated throughout life. The highest risks occurred following therapy of childhood abdominal tumours.

Spectrum of Renal and Urinary Tract Diseases in Kashmiri Children.

Definite paucity of data pertaining to spectrum of renal and urinary tract diseases in our state and in various parts of India forms the basis of this study. Available data has emphasized more on specific clinical syndromes and chronic renal diseases rather than over all spectrums of renal and urinary tract diseases, that too in adult population. The present study a retrospective analysis, forms one of the basic data of paediatric nephrology and urology related disorders in our state. Retrospective analysis of the case records of all the hospitalized patients with renal and urinary tract diseases between 2012 and 2013 were performed. Case records were analysed and categorized into various groups like; Urinary Tract Infections (UTI), Acute Kidney Injury (AKI), Acute Glomerulonephritis (AGN), Nephrotic Syndrome (NS), haematuria, Polycystic Kidney Disease (PCKD), Posterior Urethral Valve (PUV), Vesicoureteric Reflux (VUR), Chronic Kidney Disease (CKD), Congenital Anomalies of Kidney and Urinary Iract (CAKUT) and others. These groups were divided into subgroups to get more insight about the pattern of these diseases. Out of 28114 patients hospitalized between 2012 and 2013 years, 447 (232 males and 215 females) patients were diagnosed of renal and urinary tract diseases which forms 1.58% the total admitted patients. Among these patients 32.9% (147/447) were diagnosed Acute Kidney Injury (AKI); 24.1% (108/447): Urinary Tract Infection (UTI); 9.6% (43/447): Acute Glomerulonephritis (AGN); 5.6% (25/447): bilateral hydronephrosis with UTI; 4.47% (20/447): nephrotic syndrome (NS); 3.5% (16/447): haematuria; and 4% (18/447) were having CAKUT (Congenital Anomalies Of Kidney And Urinary Tract). In addition to this there were 17 cases of Renal Tubular Acidosis (RTA), 3 cases of Barter syndrome and one case of Liddle syndrome. A substantial number of children are hospitalized with renal and urinary tract diseases with delayed ages of presentation, which at times have suffered irreversible renal damage that could have been prevented or treated if diagnosed earlier. Our study indicates that majority of these renal and urinary tract diseases are preventable and treatable. Henceforth, there is a need to develop a comprehensive service for the children with renal and urinary tract diseases in Jammu & Kashmir (J&K) India.

Kidney involvement in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy in a Finnish cohort

Autoimmune tubulo-interstitial nephritis (TIN) is a rare complication of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). Previous data on TIN and other renal or urologic manifestations of APECED are sparse. We performed a retrospective study on the urinary and renal tract diseases in a cohort of 30 Finnish patients with APECED (mean age 40 years), with special emphasis on the clinical presentation and the immunologic characteristics of TIN. Clinical and laboratory findings, specific anticytokine and kidney-specific antibodies were analysed. Five of the 30 (17%) patients had moderate-to-severe renal failure, including 3 (10%) with TIN, leading to either transplantation, haemodialysis or immunosuppressive treatment. No other cause other than APECED was found for the TIN. All three patients with TIN had circulating antibodies against the distal part of the nephron, as did 30% of all cohort cases. Two had nephrocalcinosis, and two had renal tubular acidosis type 1. Immunosuppressive therapy with mycophenolate mofetil or rituximab in one pediatric case did not revert the TIN, however. Renal failure should raise concern for TIN in APECED. It discloses some specific features: no uveitis, no glycosuria and inconstant urinalysis anomalies. Regular renal monitoring for any APECED patient should be performed. Circulating antibodies against the distal part of the nephron are frequent and present in all TIN patients, but their pathologic significance is not yet known. Future studies will be needed to understand the triggers leading to overt clinical disease in these patients.

Abstract 617: Impact Of Pterostilbene On Blood Pressure and Other Metabolic Parameters In Adults

Objective: Pterostilbene is a polyphenol that is chemically related to resveratrol and commonly found in berries, such as blueberries. The purpose of this trial was to evaluate the effect of pterostilbene on metabolic parameters. METHODS: The trial was a prospective, randomized, double-blind, placebo-controlled study of patients with a total cholesterol ≥200 mg/dL and/or LDL ≥100 mg/dL. Patients were included if they were ≥18 years old and on either no cholesterol therapy or cholesterol medication at a stable dose for at least 2 months prior to baseline laboratory. Patients were excluded if they had significant hepatic, renal or GI tract disease or current overt cardiovascular disease; were receiving thiazolidinediones or fibric acids; were women who were pregnant or of reproductive potential. Eighty subjects were divided equally into one of four groups: (1) pterostilbene 125 mg twice daily; (2) pterostilbene 50 mg twice daily; (3) pterostilbene 50 mg + grape extract (GE) 100 mg twice daily; (4) matching placebo twice daily for 6-8 weeks. Patients received identical counseling on lifestyle intervention. Metabolic endpoints included blood pressure, body weight, and lipids. Linear mixed models were used to examine changes in metabolic parameters over time within treatment groups and compare changes over time across groups. Models were adjusted for age, sex and race. Results: The majority of patients completed the study (73/80; 91%). The average age was 54 years. The majority of patients were female (57/80; 71%), Caucasian (56/80; 70%), and had HTN (44/80; 55%). Both systolic (-7.8 mmHg; p&lt;0.01) and diastolic blood pressure (-7.3 mmHg; p&lt;0.001) were reduced with high dose pterostilbene. The only change in lipids was an increase in LDL with pterostilbene monotherapy (24.9 mg/dL; p&lt;0.001) which was not seen with GE combination (p=0.47). Presence of a baseline cholesterol medication appeared to attenuate LDL effects. Patients not on cholesterol medication (n=51) exhibited minor weight loss with pterostilbene (-0.59 kg/m2; p=0.014). Conclusion: Pterostilbene reduces blood pressure in adults. Future studies should evaluate high dose pterostilbene with GE in a hypertensive population. Clinicaltrials.gov identifier NCT 01267227.

Comparison of Urine Analysis Using Manual and Sedimentation Methods

Microscopic examination of urine sediment is an essential part in the evaluation of renal and urinary tract diseases. Traditionally, urine sediments are assessed by microscopic examination of centrifuged urine. However the current method used by the Georgetown Public Hospital Corporation Medical Laboratory involves uncentrifuged urine. To encourage high level of care, the results provided to the physician must be accurate and reliable for proper diagnosis. The aim of this study is to determine whether the centrifuge method is more clinically significant than the uncentrifuged method. In this study, a comparison between the results obtained from centrifuged and uncentrifuged methods were performed. A total of 167 urine samples were randomly collected and analysed during the period April-May 2010 at the Medical Laboratory, Georgetown Public Hospital Corporation. The urine samples were first analysed microscopically by the uncentrifuged, and then by the centrifuged method. The results obtained from both methods were recorded in a log book. These results were then entered into a database created in Microsoft Excel, and analysed for differences and similarities using this application. Analysis was further done in SPSS software to compare the results using Pearson ' correlation. When compared using Pearson's correlation coefficient analysis, both methods showed a good correlation between urinary sediments with the exception of white bloods cells. The centrifuged method had a slightly higher identification rate for all of the parameters. There is substantial agreement between the centrifuged and uncentrifuged methods. However the uncentrifuged method provides for a rapid turnaround time.

Samuel Goldflam (1852-1932) – promoter of modern neurology and his contribution to urology

The work of Samuel Goldflam is well known among urologists and nephrologists but his name also holds a special significance to the development of several specialist disciplines of modern medicine. A shaking symptom of the lumbar region (Goldflam's sign) described in 1900 is relevant to both urologic and internal medicines. The key importance of Goldflam's sign in the diagnosis of renal and urinary tract diseases emphasizes the outstanding contribution of this Polish researcher to the development of medicine.The aim of this study is to briefly present the rich curriculum vitae and achievements of Samuel Goldflam, the Polish neurologist who changed urology and internal medicine on a worldwide scale."Our endeavor is to obtain as many grounds as possible on which to facilitate the recognition of early periods of a disease. This is of great therapeutic importance”. (Samuel Goldflam)

Genitourinary Tract Involvement in Epidermolysis Bullosa

Involvement of the genitourinary tract has been described in many different types of epidermolysis bullosa (EB). Pathology may be broadly divided into problems resulting in obstruction, that may in turn lead to hydroureter or hydronephrosis, or disease primarily affecting the renal parenchyma. Left unrecognized and untreated, renal tract disease may lead to chronic renal failure, and consequent problems associated with providing renal replacement therapy. Management of the urogenital tract in EB should therefore focus on detecting symptoms suggestive of obstruction and regular monitoring to detect problems as early as possible.

A comparison of urinary tract pathology and morbidity in adult populations from endemic and non-endemic zones for urinary schistosomiasis on Unguja Island, Zanzibar

BackgroundRenal tract involvement is implicated in both early and late schistosomiasis leading to increased disease burden. Despite there being good estimates of disease burden due to renal tract disease secondary to schistosomiasis at the global level, it is often difficult to translate these estimates into local communities. The aim of this study was to assess the burden of urinary tract pathology and morbidity due to schistosomiasis in Zanzibar and identify reliable clinical predictors of schistosomiasis associated renal disease.MethodsA cross-sectional comparison of Ungujan men and women living within either high or low endemic areas for urinary schistosomiasis was conducted. Using urine analysis with reagent strips, parasitological egg counts, portable ultrasonography and a qualitative case-history questionnaire. Data analysis used single and multiple predictor variable logistic regression.ResultsOne hundred and sixty people were examined in the high endemic area (63% women and 37% men), and 101 people in the low endemic area (61% women and 39% men). In the high endemic area, egg-patent schistosomiasis and urinary tract pathology were much more common (p = 1 × 10-3, 8 × 10-6, respectively) in comparison with the low endemic area. Self-reported frothy urine, self-reported haematuria, dysuria and urgency to urinate were associated with urinary tract pathology (p = 1.8 × 10-2, p = 1.1 × 10-4, p = 1.3 × 10-6, p = 1.1 × 10-7, respectively) as assessed by ultrasonography. In a multi-variable logistic regression model, self-reporting of schistosomiasis in the past year, self-reporting of urgency to urinate and having an egg-positive urine sample were all independently associated with detectable urinary tract abnormality, consistent with schistosomiasis-specific disease. Having two or more of these features was moderately sensitive (70%) as a predictor for urinary tract abnormality with high specificity (92%).ConclusionHaving two out of urgency to urinate, self reporting of previous infections and detection of eggs in the urine were good proxy predictors of urinary tract abnormality as detected by ultrasound.