The Trail, 1988-09-08

https://soundideas.pugetsound.edu/thetrail_all/2487/thumbnail.jp

In vitro Antimicrobial Susceptibility of Urinary Tract Infection Pathogens in Children

Aim:Urinary tract infection (UTI) is one of the most common bacterial infections in children. Empirical treatment is commenced according to the patient’s characteristics and the antimicrobial susceptibility patterns in the region. Therefore, a determination of antimicrobial resistance patterns has a great importance in effective treatment. The aim of this study was to determine the pathogens which cause UTIs in patients admitted to a university hospital in Izmir and to determine their antimicrobial susceptibility pattern.Materials and Methods:The files of patients aged between 0-18 years, followed up with a diagnosis of UTI, vesicoureteral reflux and neurogenic bladder in Ege University Faculty of Medicine Paediatric Nephrology Unit between February, 2013 and November, 2018 were retrospectively reviewed.Results:A total of 1,126 positive urine cultures from 729 patients (65% female) were included in this study. Gram-negative pathogens constituted 88.2% of the cultures. Escherichia coli (E. coli) was the most commonly isolated bacteria with a prevalence of 59.1%, followed by Klebsiella pneumonia with 17.9%, and Enterococcus faecalis with 8.3% (n=93). Ampicillin, cefuroxime and trimethoprim-sulfamethoxazole with susceptibility rates of 18.6%, 39.6%, 49.0% respectively, constituted the highest resistant antimicrobials to Enterobacteriaceae. Enterococcus spp. showed the highest resistance to gentamycin with 50% resistance in tested cases. Pseudomonas spp. with 64.3% susceptibility showed the highest resistance to piperacillin-tazobactam.Conclusion:This study revealed that bacterial resistance to commonly used antimicrobials in UTI is an important and challenging problem which requires planning

Evaluation of Vascular Involvement in Children with Celiac Disease

Aim:Celiac disease is associated with an increased risk of cardiovascular disease due to inflammation and autoimmunity involved in its pathophysiology. We aimed to evaluate vascular involvement in children with celiac disease based on their augmentation index, carotid pulse wave velocity, carotid intima-media thickness, echocardiographic findings, and blood pressure.Materials and Methods:This cross-sectional and controlled study was performed at a single center between 2018 and 2019. The study population consisted of 44 patients with celiac disease who had been on a gluten-free diet for at least one year.Results:We compared celiac patients with a healthy group. While the celiac patients had significantly higher carotid intima media thickness and carotid pulse wave velocity values, there was no difference in the augmentation index values. There was no significant difference in carotid artery intimal medial thickness, augmentation index and carotid pulse wave velocity values between the diet-compliant and non-compliant groups.Conclusion:Although hypertension was not detected, arterial stiffness and carotid intima media thickness measurements were higher in the celiac disease patients compared to the healthy controls. This showed that these parameters can be used in early vascular damage assessment. These measurements, which are non-invasive and repeatable, can be a guide for the monitoring of the development of preclinical atherosclerosis in the follow-up of the pediatric patients diagnosed with celiac disease

Nephrotic syndrome in a patient with Glycogen Storage Disease Type IXb.

Introduction: Glycogen storage disorder (GSD) IXb is characterized by liver and muscle involvement. We present a GSD IXb patient with an incidental union of nephrotic syndrome. Case Report: A 4 year-old-patient was diagnosed with GSD IXb at 13 months of age with mildly elevated transaminases and hepatomegaly. During the follow-up period, there was no hypoglycemia. Development and growth were normal. In the last month, the onset of generalized edema was reported. Urinalysis showed a high protein level. He had low serum albumin, high serum triglycerides cholesterol. Complement levels were normal. The patient was diagnosed as minimal change disease with a renal biopsy. He was treated with oral prednisone. Discussion: Minimal Change Disease is the most common cause of idiopathic nephrotic syndrome cases in children and the first step for therapy is the usage of corticosteroids. This is the first report of nephrotic syndrome associated with GSD IXb disease

Discontinuation of RAAS Inhibition in Children with Advanced CKD

Background and objectives Although renin-angiotensin-aldosterone system inhibition (RAASi) is a cornerstone in the treatment of children with CKD, it is sometimes discontinued when kidney function declines. We studied the reasons of RAASi discontinuation and associations between RAASi discontinuation and important risk markers of CKD progression and on eGFR decline in the Cardiovascular Comorbidity in Children with CKD study. Design, setting, participants,& measurements In this study, 69 children with CKD(67% male, mean age 13.7 years, mean eGFR 27 ml/min per 1.73m(2)) who discontinued RAASi during prospective follow-up were included. Initial change in BP, albuminuria, and potassium after discontinuation were assessed (median time 6 months). Rate of eGFR decline (eGFR slope) during a median of 1.9 years before and 1.2 years after discontinuation were estimated using linear mixed effects modeling. Results Physician-reported reasons for RAASi discontinuation were increase in serum creatinine, hyperkalemia, and symptomatic hypotension. After discontinuation of RAASi, BP and albuminuria increased, whereas potassium decreased. eGFR declined more rapidly after discontinuation of RAASi (23.9 ml/min per 1.73m2 per year; 95% confidence interval, 25.1 to 22.6) compared with the slope during RAASi treatment (21.5 ml/min per 1.73 m(2) per year; 95% confidence interval, 22.4 to 20.6; P=0.005). In contrast, no change in eGFR slope was observed in a matched control cohort of patients in whom RAASi was continued. Conclusions Discontinuation of RAASi in children with CKD is associated with an acceleration of kidney function decline, even in advanced CKD

Serum indoxyl sulfate concentrations associate with progression of chronic kidney disease in children

The uremic toxins indoxyl sulfate (IS) and p-cresyl sulfate (pCS) accumulate in patients with chronic kidney disease (CKD) as a consequence of altered gut microbiota metabolism and a decline in renal excretion. Despite of solid experimental evidence for nephrotoxic effects, the impact of uremic toxins on the progression of CKD has not been investigated in representative patient cohorts. In this analysis, IS and pCS serum concentrations were measured in 604 pediatric participants (mean eGFR of 27 ± 11 ml/min/1.73m2) at enrolment into the prospective Cardiovascular Comorbidity in Children with CKD study. Associations with progression of CKD were analyzed by Kaplan-Meier analyses and Cox proportional hazard models. During a median follow up time of 2.2 years (IQR 4.3-0.8 years), the composite renal survival endpoint, defined as 50% loss of eGFR, or eGFR <10ml/min/1.73m2 or start of renal replacement therapy, was reached by 360 patients (60%). Median survival time was shorter in patients with IS and pCS levels in the highest versus lowest quartile for both IS (1.5 years, 95%CI [1.1,2.0] versus 6.0 years, 95%CI [5.0,8.4]) and pCS (1.8 years, 95%CI [1.5,2.8] versus 4.4 years, 95%CI [3.4,6.0]). Multivariable Cox regression disclosed a significant association of IS, but not pCS, with renal survival, which was independent of other risk factors including baseline eGFR, proteinuria and blood pressure. In this exploratory analysis we provide the first data showing a significant association of IS, but not pCS serum concentrations with the progression of CKD in children, independent of other known risk factors. In the absence of comorbidities, which interfere with serum levels of uremic toxins, such as diabetes, obesity and metabolic syndrome, these results highlight the important role of uremic toxins and accentuate the unmet need of effective elimination strategies to lower the uremic toxin burden and abate progression of CKD

Kronik böbrek yetersizliği olan çocuk hastalarda kardiyovasküler belirteç olarak suPAR ve SIRT1'in değerlendirilmesi

Kronik Böbrek Hastalığı (KBH); böbrek fonksiyonlarının ilerleyici ve geri dönüşümsüz olarak kaybıyla sonuçlanan böbrek hasarıdır. Kardiyovasküler sistem hastalıkları KBH’da önemli bir morbidite ve mortalite nedenidir. Çözünebilir ürokinaz plazminojen aktivatör reseptörü (suPAR) bir inflamasyon biyobelirteci olup azalmış glomerüler filtrasyon hızıyla (GFR) ilişkisi bildirilmiştir. Sirtuin1 (SIRT1) ise oksidatif stres ve inflamasyona yanıtın araçlarındandır. Bu çalışmada, kronik böbrek hastalığı olan ve olmayan çocukların serum suPAR ve SIRT1 düzeylerinin karşılaştırılması; kalp ve damar etkilenmesi olan ve olmayanlar arasında fark olup olmadığının değerlendirilmesi amaçlandı. Materyal Metod: Bu çalışma Ege Üniversitesi Tıp Fakültesi Çocuk Nefroloji Bilim Dalında KBH tanısı olan toplam 49 hasta ve 20 sağlıklı çocuk olgu ile yapılmıştır. SIRT1 ve suPAR düzeyleri ELİSA yöntemi ile Ege Üniversitesi Tıp Fakültesi Tıbbi Biyoloji Anabilim Dalında çalışıldı. Sonuçlar: Çalışmaya dahil edilen 69 (49 hasta/20 kontrol) çocuğun 35’i erkek, 34’ü kızdı. Ortalama yaşları 14,6±5 yıldı. Kronik Böbrek Hastalığına neden olan primer hastalıklar değerlendirildiğinde; en sık neden ürolojik anormallikler (%40.8, n=20) olarak saptandı. Hastaların ortalama serum SIRT1 düzeyleri 8,01±5,03; suPAR düzeyleri 2,50±2,85 olup her iki parametre de kontrol grubu ile benzerdi (p=0.444, p=0.760). KBH tanılı hastaların SIRT1 ve suPAR düzeyleri kız ve erkek cinsiyette, ürolojik ve non-ürolojik nedenli kronik böbrek hastalarında benzerdi (p>0.05). Hastaların serum suPAR ve SIRT1 düzeyleri KBH evrelerine göre değerlendirildiğinde; KBH evresine göre serum suPAR ve SIRT1 düzeyleri arasında anlamlı fark yoktu. Hastalar diyaliz tedavisi alan ve almayanlar olarak gruplandırıldığında; her iki grup ortalama SIRT1, PWV (nabız dalga hızı) ve augmentasyon indeksi (Aix) değerleri benzerken (p>0.05); diyaliz tedavisi alan hastaların ortalama suPAR düzeyi almayanlara göre anlamlı düşük bulundu (p=0.029). Diyaliz tedavisi alan hastalar kontrol grup kıyaslandığında ise SIRT1 düzeyleri benzerken (p>0.05), ortalama suPAR düzeyleri diyaliz tedavisi alan grupta anlamlı düşük bulundu (p= 0.043). Diyaliz tedavisi almayan hastalar ile kontrol grubunun SIRT1 ve suPAR düzeyleri benzerdi (p>0.05). Sonuç olarak; KBH’lı çocuklarda serum suPAR ve SIRT1 düzeyleri kontrol grubu ile benzerdi. Ayrıca, serum suPAR düzeyleri diyaliz tedavisi alan grupta diyaliz almayanlara göre anlamlı olarak düşük olduğu bulundu. Bu konuda daha fazla hasta ve kontrol grubu içeren, ayrıca birden fazla ölçümün yapıldığı çalışmaların yararlı olabileceği kanısındayız.Chronic Kidney Disease (CKD) characterized by kidney damage, resulting in progressive and irreversible loss of renal function. Cardiovascular diseases are an important cause of morbidity and mortality in CKD. Soluble urokinase plasminogen activator receptor (suPAR) is an inflammation biomarker and its association with decreased glomerular filtration rate (GFR) has been reported. Sirtuin1 (SIRT1) plays a role in the response to oxidative stress and inflammation. The aim of this study was to compare serum suPAR and SIRT1 levels in children with and without chronic kidney disease and to evaluate whether there is a difference between patients with and without cardiovascular involvement. Material Method: This study was designed with total of 49 patients diagnosed with CKD and 20 healthy children in Ege University Faculty of Medicine, Department of Pediatric Nephrology. SIRT1 and suPAR levels were studied by ELISA method in Ege University Faculty of Medicine, Department of Medical Biology. Results: Of the 69 children (49 patients / 20 controls) included in the study, 35 were male and 34 were female. The mean age was 14.6 ± 5 years. The most common cause was urological abnormalities with a percent of 40.8% (n = 20) in terms of primary diseases causing chronic kidney disease. The mean SIRT1 levels of the patients were 8.01 ± 5.03; suPAR levels were 2.50 ± 2.85. Both parameters were similar to the control group (p = 0.444, p = 0.760). SIRT1 and suPAR levels of patients with CKD were similar in female and male sex and with urologic and non-urologic causes (p> 0.05). Serum suPAR and SIRT1 levels were similar according to CKD stages. When the patients were grouped as receiving and not receiving dialysis treatment; mean SIRT1, PWV (pulse wave velocity) and augmentation index (Aix) levels were similar in both groups (p> 0.05). The mean suPAR level of patients with dialysis was significantly lower than those without (p = 0.029). When the dialysis patients were compared with the control group, SIRT1 levels were similar (p> 0.05), while mean suPAR levels were significantly lower in the dialysis group (p = 0.043). SIRT1 and suPAR levels were similar in patients without dialysis and control group (p> 0.05). As a result; Serum suPAR and SIRT1 levels in children with CKD were similar to the control group. In addition, serum suPAR levels were significantly lower in the dialysis group compared to non- dialysis patients. We believe that studies involving more patients and control groups with multiple measurements may be useful