Bladder Volume Wall Index In Children With Urinary Tract Infections

How to Cite This Article: Hooman N, Hallaji F, Mostafavi SH, Sharif MR, Tatarpoor P, Otukesh H. Bladder Volume Wall Index in Children with Urinary Tract Infections. J Ped. Nephrology 2013 July;1(1):18-22.Introduction: Few studies have focused on the correlation between bladder ultrasound and urinary tract infection. The aim of this study was to evaluate the bladder volume wall index in children with single or recurrent urinary tract infection.Materials & Methods: This case-control study was conducted between March 2008 and December 2009. The study was performed on one hundred children (8 boys, 92 girls) aged 4-15 years with a history of urinary tract infection and thirty-nine (20 males, 19 females) age- matched healthy children who had negative urine culture one month before investigation. The kidneys, ureters, and bladder sonography were performed in all children. Bladder volume wall index was calculated for each child and the result of 70-130 was presumed normal. Student T-test, chi-square, likelihood ratio, and risk ratio were used. P-value <0.05 was considered significant.Results: The mean bladder volume was 262.5 (±82) in recurrent urinary tract infection, 235 (±54) in single urinary tract infection, and 278 (±80) in controls (P<0.05). The bladder was thick (<70) in 37 (28 cases, 9 controls) and thin (>130) in 38 children (28 cases, 10 controls) (P>0.05). The median residual volume was not different between the two groups. The abnormal BVWI in children with vesicoureteral (VU) reflux was 75% as compared to 51% in those without VU reflux (P>0.05). There was no correlation between BVWI and age, gender, groups, vesicoureteral reflux status, or residual volume (P>0.05).Conclusions: According to our findings, the bladder volume wall index is not sensitive enough to discriminate children who are prone to urinary tract infection. Keywords: Urography; Urinary Tract Infections; Ultrasonography; Urinary Bladde

Učestalost hipertenzije i kardiovaskularnih rizika u djece s ožiljcima na bubrežnom tkivu nakon mokraćne infekcije

Hypertension is a late outcome of refl ux nephropathy and renal parenchymal scar secondary to urinary tract infection (UTI). We presumed that it might be detected much earlier after episodes of UTI and the associated cardiovascular risk factors assessed. Between 2009 and 2011, 85 (67 female and 18 male) children aged 5-15 years with a history of febrile UTI, followed-up for at least one year from the fi rst episode of febrile UTI, were enrolled in the study. The variables included 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, carotid sonography, renal 99mcTc-DMSA, glomerular fi ltration rate, and microalbuminuria. Masked hypertension was detected in 18.8%, hypertension in 7.1% and white coat hypertension in 9.4% of cases. Prehypertension was seen in 20% of children. Out of 85 cases, 43.5% were non-dippers. Out of 56 children with hypertensive and prehypertensive parameters on ABPM, 9.1% showed left ventricular mass index >51g/m2.7 (p>0.05). Signifi cant correlation was only recorded between abnormal blood pressure and the severity of renal parenchymal scar (p<0.05). In conclusion, ABPM is suggested for early detection of masked hypertension and abnormal blood pressure pattern in all normotensive children with a history of recurrent UTI.Hipertenzija je kasni ishod refl uksne nefropatije i ožiljaka na bubrežnom parenhimu koji nastaju nakon mokraćne infekcije. Pretpostavili smo da bi se to moglo otkriti znatno ranije nakon epizoda mokraćne infekcije te procijeniti pridružene kardiovaskularne čimbenike rizika. Od 2009. do 2011. godine, u ispitivanje je uključeno 85 (67 Ž, 18 M) djece u dobi od pet do 15 godina s anamnezom febrilne mokraćne infekcije koja su bila praćena najmanje jednu godinu od prve epizode febrilne mokraćne infekcije. Praćene su sljedeće varijable: 24-satno ambulatorno praćenje krvnog tlaka (ambulatory blood pressure monitoring, ABPM), ehokardiografi ja, karotidni ultrazvuk, 99mcTc-DMSA bubrega, glomerularna stopa fi ltracije i mikroalbuminurija. Maskirana hipertenzija otkrivena je u 18,8%, hipertenzija u 7,1% i hipertenzija “bijele kute” u 9,4% slučajeva. Prehipertenzija je zabilježena u 20% djece. Od 85 slučajeva 43,5% ih nije pokazalo odgovarajući pad krvnog tlaka tijekom noći (non-dipper). Od 56 djece s hipertenzivnim i prehipertenzivnim parametrima na ABPM 9,1% ih je imalo indeks lijeve ventrikularne mase veći od 51g/m2.7 (p>0,05). Značajna korelacija zabilježena je između nenormalnog krvnog tlaka i težine ožiljka na bubrežnom parenhimu (p<0,05). U zaključku, ABPM se može preporučiti za rano otkrivanje maskirane hipertenzije i nenormalnog kretanja krvnog tlaka kod sve normotenzivne djece s anamnezom opetovane mokraćne infekcij

Early Detection of Renal Scarring in Children With Suspected Pyelonephritis: Comparison of Diuretic MAG3 Scintigraphy (F0) and DMSAScan

Background:Screening for patients at risk of renal scarring is a challenge in children with acute pyelonephritis(APN).Diuretic Tc-99m mercaptoacetyltriglycine (MAG3) scintigraphy with zero time injection of furosemide (MAG3-F0) was observed to display focal parenchymal disorders.The advantages of MAG3 include: lower radiation dose and short duration of the test.The aim of this study was to compare the role of Tc-MAG3(F0)dynamic study and Tc-99m dimercaptosuccinic acid (DMSA) scan in early detection of renal scarring of children with suspected pyelonephritis in comparison to after-6-month Tc-DMSAscan as gold standard. Methods:28 patients (56 renal units) with their first urinary tract infection (UTI) episode were evaluated prospectively for renal scarring with radioisotope scan. The patients were divided into 2 groups: Group Aconsisted of patients who underwent MAG3 scintigraphy in acute phase of pyelonephritis and Group B consisted of patients who underwent DMSA scan in this phase for renal cortical assessment.Follow up DMSA scan was performed for all patients in both groups 4-6 months after UTI episode.Results: The accuracy of MAG3-F0 scintigraphy and DMSA scan in detecting parenchymal changes in acute pyelonephritic phase were 89.3% and 96.4%,respectively.Positive predictive value(PPV)of both MAG3-F0 and DMSA was 100%.Whereas,negative predictive values (NPV) of MAG3-F0 and DMSA scan were 62.5% and 75%,respectively.Conclusion:Conclusively, if the MAG3 parenchymal image is abnormal, then there is renal damage but if this image is normal, a focal defect has not been excluded. Thus an abnormal MAG3-F0 precludes the need for a Tc-DMSAscan for detection of persistent renal damage in acute phase of pyelonephritis

Glomerular Filtration Rate Estimation Based on Cystatin C Formulas among Neonates

Background: Glomerular filtration rate (GFR) is the best indicator to assess renal function; however, it is difficult to perform it, especially in neonates. Serum creatinine is the most commonly used marker of GFR; nevertheless, it has some limitations since it can be affected by factors other than renal function. Cystatin C, another endogenous marker used to estimate GFR, is not affected by non-renal factors. The results of some studies suggest that serum cystatin C levels are more accurate tests of kidney function than serum creatinine levels. This study aimed to estimate GFR with cystatin C-based formulas among neonates and determine the correlations between these methods and the Schwartz formula. Methods: The population of this research consisted of 99 neonates whose serum creatinine and cystatin C levels were measured concurrently. Moreover, the glomerular filtration rate was estimated using the Schwartz formula and 14 cystatin C-based formulas separately. Results: Based on the findings, all GFR values based on cystatin C formulas correlated significantly with each other (p 0.05). The only cystatin C formula that yielded values correlating with the Schwartz formula was CysCrEq, which used serum cystatin C and creatinine concomitantly. Conclusion: It can be concluded that since all GFR values based on cystatin C correlated significantly and cystatin Cwasindependent of non-renal factors, cystatin C reflected the real GFR more accurately than serum creatinine. Nonetheless, further studies with gold standard techniques are required to verify the usefulness of cystatin C-based formulas

CTNS molecular genetics profile in a Persian nephropathic cystinosis population

Purpose: In this report, we document the CTNS gene mutations of 28 Iranian patients with nephropathic cystinosis age 1–17 years. All presented initially with severe failure to thrive, polyuria, and polydipsia. Methods: Cystinosis was primarily diagnosed by a pediatric nephrologist and then referred to the Iran University of Medical Sciences genetics clinic for consultation and molecular analysis, which involved polymerase chain reaction (PCR) amplification to determine the presence or absence of the 57-kb founder deletion in CTNS, followed by direct sequencing of the coding exons of CTNS. Results: The common 57-kb deletion was not observed in any of the 28 Iranian patients. In 14 of 28 patients (50%), mutations were observed in exons 6 and 7. No mutation was detected in exon 5, and only one (3.6%) patient with cystinosis showed a previously reported 4-bp deletion in exon 3 of CTNS. Four patients (14.3%) had a previously reported mutation (c.969C>A; p.N323K) in exon 11, and five (18%) had novel homozygous deletions in exon 6 leading to premature truncation of the protein. These deletions included c.323delA; p.Q108RfsX10 in three individuals and c.257-258delCT; p.S86FfsX37 in two cases. Other frame-shift mutations were all novel homozygous single base pair deletion/insertions including one in CTNS exon 9 (c.661insT; p.V221CfsX6), and four (14.3%) in exon 4, i.e., c.92insG; p.V31GfsX28 in two and c.120delC; p.T40TfsX10 in two. In total, we identified eight previously reported mutations and eight novel mutations in our patients. The only detected splice site mutation (IVS3-2A>C) was associated with the insertion mutation in the exon 9. Conclusion: This study, the first molecular genetic analysis of non-ethnic-specific Iranian nephropathic cystinosis patients, may provide guidance for molecular diagnostics of cystinosis in Iran