Diagnostic procedures in children with urinary tract infections

Infekcije mokraćnog sustava (IMS) su značajan uzrok pobola s mogućim trajnim posljedicama i jedan su od najčešćih razloga primjene antimikrobnih lijekova. To je heterogena skupina bolesti obzirom na dob, spol, kliničku sliku, lokalizaciju upale i obzirom na prisutnost anomalija mokraćnog sustava. Infekcije mokraćnog sustava mogu biti simptomatske ili bez simptoma. Ponekad je samo prva infekcija simptomatska, a druge prolaze bez ili s vrlo malo simptoma. Ovo je vrlo važno znati u patogenezi bolesti jer i asimptomatske IMS mogu uzrokovati bubrežno oštećenje. Zamijećeno je da trećina djece s IMS ima anomaliju mokraćnog sustava. U dijagnostici IMS najvažniji je pregled urina pomoću probirnih testova (nitritni test, leukocitna esteraza), mikroskopskog pregleda sedimenta na leukocite (L) i bakterije te kultura urina. Kada se urin prikuplja vrećicom za urin i tehnikom ‘’srednjeg čistog mlaza’’ značajan je broj bakterija ≥105 CFU/mL, za urin uzet kateterom ≥103 CFU/mL, a za suprapubičnu aspiraciju značajan je svaki broj bakterija. Važni su i nalazi iz krvi: C-reaktivni protein, L i prokalcitonin. Slikovne pretrage u dijagnozi IMS su ultrazvuk mokraćnog sustava i statička scintigrafija bubrega Tc99mDMSA. Zlatni standard za dijagnozu akutne upale bubrežnog parenhima i ožiljnih promjena bubrega kod djece je statička scintigrafija bubrega.Urinary tract infections (UTI) make a significant count of infections in children with potentially permanent consequences. This is a heterogeneous group of diseases considering age, gender, clinical picture, localisation of infection and potential anatomy anomalies of urinary tract. Urinary tract infections can be symptomatic or asymptomatic. Sometimes, only the first infection is symptomatic, and others have none or few symptoms. The later can also cause renal injury. In diagnostics, the most important step is a urinalysis (nitrite tests and leukocyte esterase), microscopic exam of urine sediment (Leukocytes and bacteria), and urine culture. Depending on the sampling technique, significant bacteriuria is ≥105 CFU/mL for clean catch technique and midstream technique. For sampling using urine catheter, significant bacteriuria is ≥103 CFU/mL and for suprapubic aspiration technique, any count of bacteria is significant. Blood samples are also important: C-reactive protein, leukocytes, procalcitonin. Imaging methods in UTI are ultrasound of urinary tract and static scintigraphy of kidney with Tc99mDMSA. The golden standard for the diagnosis of acute pyelonephritis and kidney scars is static scintigraphy

Prognostic Indicators for First and Repeated Hospitalizations in Heart Failure Patients with Reduced Left Ventricular Ejection Fraction

Heart failure with reduced ejection fraction (HFrEF) is a progressive clinical syndrome defined by changes in the myocardial structure, which lead to predominant systolic myocardial function impairment, with a left ventricle ejection of fraction ≤40%. The rehospitalization burden in HFrEF patients (pts) remains very high, with poor quality of life, increased mortality and large healthcare expenditures. In this research project, we investigated the risk factors for first and repeated hospitalization in pts with HFrEF. This retrospective study included 50 adult pts with a diagnosis of HFrEF and who were within the age range of 55 to 89 years old and of both sexes. Demographic and clinical data (HFrEF etiology, renal function parameters, complete blood count, markers of inflammation, electrocardiogram, troponin I, NTproBNP, echocardiographic parameters and comorbidities data) were collected from the pts’ medical histories. Statistical analysis was performed via Fischer’s exact test, the Shapiro-Wilk test and the Spearman correlation coefficient. This study included 70% male and 30% female HFrEF pts. Males were younger in both group of pts and had a higher incidence of rehospitalization. The most important HFrEF etiologic risk factors are arterial hypertension (82%), coronary heart disease (54%), atrial fibrillation (52%) and diabetes mellitus (40%). The most important noncardiac comorbidity related with the first HFrEF hospitalization is pneumonia (P=0.03), while progression of left ventricle systolic and diastolic dysfunction is related to rehospitalization risk (left ventricle end systolic diameter, P=0.003; diastolic dysfunction degree, P=0.04). The troponin level was associated with an increased risk of rehospitalization, but this was not statistically significant at this sample size (troponin I, p=0.10). Following the first and repeated hospitalizations of HFrEF pts, comorbidities, ageing and gender difference are crucial to HFrEF development, while echocardiographic parameters and biomarkers critically affect HFrEF rehospitalization risk

VALIDITY OF THE DETERMINATION OF URINARY LIPOCALIN ASSOCIATED WITH NEUTROPHIL GELATINASE IN THE DIAGNOSIS OF ACUTE PYELONEPHRITIS IN CHILDREN

Cilj: Izmjeriti visinu nalaza uNGAL-a i ispitati njegovu dijagnostičku vrijednost u dijagnozi AP-a. Ispitanici: Prospektivno presječno ispitivanje 127-ero djece s povišenom tjelesnom temperaturom podijeljenih u ispitivanu skupinu s 83-oje djece i kontrolnu skupinu s 44-ero djece s respiratornim i gastrointestinalnim upalnim bolestima. Materijal i metode: Svoj djeci učinjeni su CRP, PCT, L, uNGAL, sediment mokraće i kultura mokraće. Djeci s AP-om učinjeni su UZ mokraćnog sustava i statička scintigrafija bubrega Tc-99m DMSA. Rezultati: U ispitivanoj skupini djece s AP-om značajno je više ženske djece. Djeca s AP-om imaju statistički značajno više vrijednosti svih ispitivanih upalnih čimbenika: CRP-a, PCT-a i L. Također, djeca s AP-om imaju značajno više vrijednosti uNGAL-a od djece kontrolne skupine. Za dijagnozu AP-a izmjerene su granične vrijednosti upalnih čimbenika: uNGAL-a >29,4 ng/ml, CRP-a >45 mg/l, PCT-a >0,9 ng/ml. Najznačajniji u dijagnozi AP-a pokazao se uNGAL. Djeca dojenačke dobi i muška djeca s AP-om imala su značajno više vrijednosti uNGAL-a. Najčešće izolirana bakterija bila je E. coli (83,3 %). Leukociturija u mokraći bila je značajno više izražena kod djece ispitivane skupine. Zaključak: U ovom istraživanju utvrđeno je da su svi korišteni čimbenici upale značajno viših vrijednosti kod djece s AP-om. To su CRP, PCT, L te ispitivani novi biomarker upale, uNGAL. NGAL iz mokraće statistički je značajno viši kod djece koja su liječena zbog AP-a. U usporedbi s ostalim upalnim parametrima, uNGAL kod granične vrijednosti >29,4 ng/ml pokazao se najznačajnijim dijagnostičkim pokazateljem AP-a s osjetljivošću od 92,4 % i sa specifičnošću od 95,8 %. Mogao bi se koristiti kao rani i pouzdani biomarker u predviđanju dijagnoze AP-a. Tim više jer je analiza navedenog biomarkera jednostavna, neinvazivna i dovoljna je vrlo mala količina mokraće (150µl), a rezultat nalaza gotov je za 35 minuta. Analizom dobivenih rezultata zaključeno je da su, osim nalaza uNGAL-a u dijagnozi AP-a, isto tako važni i ostali upalni parametri kao što su CRP, PCT, leukociti u serumu, broj leukocita u sedimentu mokraće i mikrobiološki nalaz mokraće.Objective: The aim of this thesis is to measure the level of findings of the NGAL in urine and determine its diagnostic value in the diagnosis of AP in children. Participants: In the prospective cross-sectional study, 127 children with fever were divided into two groups. The first group of children consisted of 83 children with AP, while the second, the control group, consisted of 44 children with inflammatory diseases of the respiratory and gastrointestinal tracts. Material and methods: The following laboratory tests were done in all children: CRP, PCT, serum leukocytes, uNGAL, analysis of urine sediment, and urine culture. In children diagnosed with AP, an ultrasound of the urinary tract and static scintigraphy of the kidneys Tc-99m DMSA were performed. Results: In the treated group of children with AP, there are significantly more female children. There was a statistically significant difference in CRP, PCT, and serum leukocyte levels between the treatment and control groups of children. Cut-off values of inflammatory parameters were measured to predict the diagnosis of AP. At the cut-off value of uNGAL > 29.4 ng/ml, at the cut-off value of CRP > 45 mg/l, at the cut-off value of PCT > 0.9 ng/ml. The uNGAL value was most significant in children with AP. Infants with AP and male children had significantly higher uNGAL values. The most common isolated cause of urinary tract infection was E. coli, in 83.3% of cases. Urinary leukocyturia was significantly more prevalent in the treatment group than in the control group. Conclusion: In this study, it was found that all observed inflammatory parameters were significantly increased in children with acute pyelonephritis. These were CRP, PCT, serum leukocytes, and a new inflammatory biomarker uNGAL. Urinary NGAL was statistically significantly increased in children treated for AP. Compared to other inflammatory parameters, uNGAL proved to be the most important diagnostic indicator for AP at the cut-off value > 29.4 ng/ml, with a sensitivity of 92.4 % and a specificity of 95.8 %. The conclusion is that it could be used as an early and reliable biomarker for predicting the diagnosis of AP, especially because the analysis of this biomarker is simple and non-invasive, and a very small amount of urine, i.e., 150µl, is sufficient. The results are available within 35 minutes. The analysis of the obtained results showed that besides uNGAL, other inflammatory parameters such as CRP, PCT, serum leukocytes, number of leukocytes in urine sediment, and microbiological urine findings are also important in the diagnosis of AP

VALIDITY OF THE DETERMINATION OF URINARY LIPOCALIN ASSOCIATED WITH NEUTROPHIL GELATINASE IN THE DIAGNOSIS OF ACUTE PYELONEPHRITIS IN CHILDREN

Cilj: Izmjeriti visinu nalaza uNGAL-a i ispitati njegovu dijagnostičku vrijednost u dijagnozi AP-a. Ispitanici: Prospektivno presječno ispitivanje 127-ero djece s povišenom tjelesnom temperaturom podijeljenih u ispitivanu skupinu s 83-oje djece i kontrolnu skupinu s 44-ero djece s respiratornim i gastrointestinalnim upalnim bolestima. Materijal i metode: Svoj djeci učinjeni su CRP, PCT, L, uNGAL, sediment mokraće i kultura mokraće. Djeci s AP-om učinjeni su UZ mokraćnog sustava i statička scintigrafija bubrega Tc-99m DMSA. Rezultati: U ispitivanoj skupini djece s AP-om značajno je više ženske djece. Djeca s AP-om imaju statistički značajno više vrijednosti svih ispitivanih upalnih čimbenika: CRP-a, PCT-a i L. Također, djeca s AP-om imaju značajno više vrijednosti uNGAL-a od djece kontrolne skupine. Za dijagnozu AP-a izmjerene su granične vrijednosti upalnih čimbenika: uNGAL-a >29,4 ng/ml, CRP-a >45 mg/l, PCT-a >0,9 ng/ml. Najznačajniji u dijagnozi AP-a pokazao se uNGAL. Djeca dojenačke dobi i muška djeca s AP-om imala su značajno više vrijednosti uNGAL-a. Najčešće izolirana bakterija bila je E. coli (83,3 %). Leukociturija u mokraći bila je značajno više izražena kod djece ispitivane skupine. Zaključak: U ovom istraživanju utvrđeno je da su svi korišteni čimbenici upale značajno viših vrijednosti kod djece s AP-om. To su CRP, PCT, L te ispitivani novi biomarker upale, uNGAL. NGAL iz mokraće statistički je značajno viši kod djece koja su liječena zbog AP-a. U usporedbi s ostalim upalnim parametrima, uNGAL kod granične vrijednosti >29,4 ng/ml pokazao se najznačajnijim dijagnostičkim pokazateljem AP-a s osjetljivošću od 92,4 % i sa specifičnošću od 95,8 %. Mogao bi se koristiti kao rani i pouzdani biomarker u predviđanju dijagnoze AP-a. Tim više jer je analiza navedenog biomarkera jednostavna, neinvazivna i dovoljna je vrlo mala količina mokraće (150µl), a rezultat nalaza gotov je za 35 minuta. Analizom dobivenih rezultata zaključeno je da su, osim nalaza uNGAL-a u dijagnozi AP-a, isto tako važni i ostali upalni parametri kao što su CRP, PCT, leukociti u serumu, broj leukocita u sedimentu mokraće i mikrobiološki nalaz mokraće.Objective: The aim of this thesis is to measure the level of findings of the NGAL in urine and determine its diagnostic value in the diagnosis of AP in children. Participants: In the prospective cross-sectional study, 127 children with fever were divided into two groups. The first group of children consisted of 83 children with AP, while the second, the control group, consisted of 44 children with inflammatory diseases of the respiratory and gastrointestinal tracts. Material and methods: The following laboratory tests were done in all children: CRP, PCT, serum leukocytes, uNGAL, analysis of urine sediment, and urine culture. In children diagnosed with AP, an ultrasound of the urinary tract and static scintigraphy of the kidneys Tc-99m DMSA were performed. Results: In the treated group of children with AP, there are significantly more female children. There was a statistically significant difference in CRP, PCT, and serum leukocyte levels between the treatment and control groups of children. Cut-off values of inflammatory parameters were measured to predict the diagnosis of AP. At the cut-off value of uNGAL > 29.4 ng/ml, at the cut-off value of CRP > 45 mg/l, at the cut-off value of PCT > 0.9 ng/ml. The uNGAL value was most significant in children with AP. Infants with AP and male children had significantly higher uNGAL values. The most common isolated cause of urinary tract infection was E. coli, in 83.3% of cases. Urinary leukocyturia was significantly more prevalent in the treatment group than in the control group. Conclusion: In this study, it was found that all observed inflammatory parameters were significantly increased in children with acute pyelonephritis. These were CRP, PCT, serum leukocytes, and a new inflammatory biomarker uNGAL. Urinary NGAL was statistically significantly increased in children treated for AP. Compared to other inflammatory parameters, uNGAL proved to be the most important diagnostic indicator for AP at the cut-off value > 29.4 ng/ml, with a sensitivity of 92.4 % and a specificity of 95.8 %. The conclusion is that it could be used as an early and reliable biomarker for predicting the diagnosis of AP, especially because the analysis of this biomarker is simple and non-invasive, and a very small amount of urine, i.e., 150µl, is sufficient. The results are available within 35 minutes. The analysis of the obtained results showed that besides uNGAL, other inflammatory parameters such as CRP, PCT, serum leukocytes, number of leukocytes in urine sediment, and microbiological urine findings are also important in the diagnosis of AP