Urinary excretion of oxalate, citrate, glycosaminoglycans in children with urolithiasis

Analizirano je izlučivanje urinom oksalata, citrata i glikozaminoglikana u 83 djece s idiopatskom urolitijazom. Iz analize su isključene primarne hiperoksalurije i idiopatske hiperokslurije (HOGA 1) koje su uzrokovane mutacijama gena i enteričkom hiperoksalurijom. Kao varijable su uzete koncentracije oksalata, citrata i glikozaminoglikana te omjeri oksalati/citrati, oksalati/glikozaminglikani, oksalati/(citrati × glikozaminoglikani) i citrati/glikozaminoglikani. Od ispitanih varijabli jedino je omjer oksalati/(citrati × glikozaminoglikani) mmol/mol kreatinina razlikovao zdravu djecu od skupine djece s uirolitijazom. ROC analizom je utvrđeno da je vrijednost omjera > 0.0782 dijagnostički prihvatljiva za razlikovanje djece s urolitijazom od zdrave djece. Stoga se nalaz omjera oksalati/(citrati × glikozaminoglikani) iznad 0.0782 može se smatrati određujućim za djecu s urolitijazom.Urinary excretion of oxalate, citrate, glycosaminoglycans and the ratios oxalate/citrate, oxalate/glycosaminoglycans, oxalate/(citrate × glycosaminoglycans), and citrate/glycosaminoglycans were examined in 83 children with idiopathic urolithiasis. Gene mutations causing primary hyperoxaluria and idiopathic hyperoxaluria HOGA 1 were excluded. Only the variable oxalate/(citrate × glycosaminoglycans) mmol/mol creatinine was able to distinguish between children with urolithiasis and healthy children. ROC analysis showed that the value of the ratio > 0.0782 is adequate for diagnostic purpose. Therefore, we consider that the ratio oxalate/(citrate × glycosaminoglycans) above 0.0782 indicates urolithiasis in children

Urinary excretion of oxalate, citrate, glycosaminoglycans in children with urolithiasis

Analizirano je izlučivanje urinom oksalata, citrata i glikozaminoglikana u 83 djece s idiopatskom urolitijazom. Iz analize su isključene primarne hiperoksalurije i idiopatske hiperokslurije (HOGA 1) koje su uzrokovane mutacijama gena i enteričkom hiperoksalurijom. Kao varijable su uzete koncentracije oksalata, citrata i glikozaminoglikana te omjeri oksalati/citrati, oksalati/glikozaminglikani, oksalati/(citrati × glikozaminoglikani) i citrati/glikozaminoglikani. Od ispitanih varijabli jedino je omjer oksalati/(citrati × glikozaminoglikani) mmol/mol kreatinina razlikovao zdravu djecu od skupine djece s uirolitijazom. ROC analizom je utvrđeno da je vrijednost omjera > 0.0782 dijagnostički prihvatljiva za razlikovanje djece s urolitijazom od zdrave djece. Stoga se nalaz omjera oksalati/(citrati × glikozaminoglikani) iznad 0.0782 može se smatrati određujućim za djecu s urolitijazom.Urinary excretion of oxalate, citrate, glycosaminoglycans and the ratios oxalate/citrate, oxalate/glycosaminoglycans, oxalate/(citrate × glycosaminoglycans), and citrate/glycosaminoglycans were examined in 83 children with idiopathic urolithiasis. Gene mutations causing primary hyperoxaluria and idiopathic hyperoxaluria HOGA 1 were excluded. Only the variable oxalate/(citrate × glycosaminoglycans) mmol/mol creatinine was able to distinguish between children with urolithiasis and healthy children. ROC analysis showed that the value of the ratio > 0.0782 is adequate for diagnostic purpose. Therefore, we consider that the ratio oxalate/(citrate × glycosaminoglycans) above 0.0782 indicates urolithiasis in children

Racionalno liječenje infekcija mokraćnog sustava kod djece u Hrvatskoj

Resistance to chemotherapeutics used in the treatment of urinary tract infection is increasing throughout the world. Taking into account clinical experiences, as well as current bacterial resistance in Croatia and neighboring countries, the selection of antibiotic should be the optimal one. Treatment of urinary tract infection in children is particularly demanding due to their age and inclination to severe systemic reaction and renal scarring. If parenteral antibiotics are administered initially, it should be switched to oral medication as soon as possible. Financial aspects of antimicrobial therapy are also very important with the main goal to seek the optimal cost/benefit ratio. Financial orientation must appreciate the basic primum non nocere as a conditio sine qua non postulate as well.Otpornost na antibiotike u liječenju infekcija mokraćnog sustava sve se više povećava. Optimalan izbor antibiotika postiže se objedinjavanjem kliničkog iskustva s poznavanjem otpornosti na uobičajene bakterijske uzročnike mokraćnih infekcija kako u Republici Hrvatskoj tako i u državama njenog okruženja. Liječenje mokraćnih infekcija u djece je naročito zahtjevno zbog njihove dobi i sklonosti prema sistemskoj reakciji i ožiljčenju bubrega. Ako je primijenjena, parenteralnu primjenu antibiotika potrebno je što prije zamijeniti oralnim antibiotikom. Također nije uputno zanemariti niti financijski aspekt liječenja kojega je cilj postizanje optimalnog učinka uz minimalnu cijenu liječenja. Pritom se nikako ne smije zanemariti osnovni medicinski postulat primum non nocere kao conditio sine qua non

Cystitis Cystica and Recurrent Urinary Tract Infections in Children

The pathogenesis of recurrent urinary tract infections (UTIs) in preschool children with anatomically correct urinary tract (UT) is rather obscure. In girls, the bladder wall changes of cystitis cystica (CC) may be per se responsible for UTIs recurrence. During the 20-year period, 127 preschool children (125 girls; median age: 6.1 years) with CC, in whom UT anomalies were excluded, were diagnosed. The mean duration of UTIs symptoms prior to diagnosis was 3.31±2.51 years. Cystoscopical findings were labelled as mild, moderate and severe in 22.8%, 39.4% and 37.8% of patients, respectively. Following the confirmation of CC, long-term chemoprophylaxis with sulfamethoxazole-trimethoprim/nitrofurantoin was administered. A one year UTI-free period after chemoprophylaxis discontinuation was defined as therapeutic success. With 2.5 years median duration of regular chemoprophylaxis this goal was achieved in 58 children mainly with mild/ moderate CC. Thirty children from »improved/unchanged« group taking regular prophylaxis had significant reduction of UTIs (»improved«). Only 12 children belonging to the same group taking regular prophylaxis and all children with irregular prophylaxis had approximately the same number of UTIs as before treatment (»unchanged«). The »improved/unchanged« outcomes were predominantly found in children with severe form of CC. Although urodynamic disturbances detected in more than 50% of patients in whom urodynamics was performed were not found influential on the disease outcome, they could be responsible for its development. The results of our study suggest that regular and long-lasting chemoprophylaxis remains a basis for successful treatment for majority of patients with CC, even those with severe forms. If not treated properly with chemoprophylactic agents and without fair compliance in taking drugs, the disease is prone to recurrent UTIs

Ultrasound Distinction between Simple Recurrent Urinary Tract Infections and a Specific Bladder Wall Inflammatory Entity called Cystitis Cystica

A specific representative of recurrent urinary tract infections (UTI) called cystitis cystica (CC) was assessed by ultrasound. The aim of the study was to delineate, by means of ultrasound measurement (US) of bladder wall thickness (BWT), the children with mere repeated UTI from those prone to frequent UTI due to CC. Two groups were compared, the control group of 30 with recurrent UTI without US CC BWT changes, and the group of 30 children with characteristic CC bladder wall thickening in whom cystoscopy was performed for verification the diagnosis of CC. BWT of >3 mm (>2.8 mm and >3.3 mm) was found as cut-of value for distinction of CC versus simple recurrent UTI. US BWT measurement is useful in diagnosing CC and therefore valuable in decision about need of UTI prophylaxis

Association of generalized psoriasis and mixed glomerulonephritis in a 10-year-old girl

Generalized psoriasis and renal function disorder were previously described in sporadic adult cases, revealing a new entity – psoriatic nephropathy. So far there have been only two cases describing this association in children. We present and discuss a case of 10-year-old girl with the unique biopsy findings of double glomerulonephritis associated with the simultaneous onset of generalized psoriasis. </p

Association of generalized psoriasis and mixed glomerulonephritis in a 10-year-old girl

Generalized psoriasis and renal function disorder were previously described in sporadic adult cases, revealing a new entity – psoriatic nephropathy. So far there have been only two cases describing this association in children. We present and discuss a case of 10-year-old girl with the unique biopsy findings of double glomerulonephritis associated with the simultaneous onset of generalized psoriasis. </p

Pozitivna povratna sprega cističnog cistitisa: uloga povratnih infekcija mokraćnog sustava u broju nodoznih čvorića u sluznici mokraćnog mjehura

The main purpose of this study was to demonstrate positive feedback loop between bladder wall nodules (nodules being one of the key diagnostic factors), bladder wall thickness, and recurrent urinary tract infections. Cystitis cystica was diagnosed in 115 prepubertal girls (mean age 7.79}3.05 years) by optic examination of bladder mucosal nodules and by ultrasonographic measurement of bladder wall thickness. Bladder wall thickness increased with the frequency of recurrent urinary tract infections as well as with the number of nodules on bladder wall mucosa (3.52}0.522 mm ≤5 nodules vs. 4.42}0.429 mm 6-10 nodules vs. 5.20}0.610 mm >10 nodules, respectively). Study results suggested that early control of urinary tract infections by chemoprophylaxis could prevent higher grades of bladder wall mucosal changes and consequently shorten the length of chemoprophylaxis.Osnovni cilj ove studije bio je prikazati pozitivnu povratnu spregu između broja nodula na sluznici mokraćnog mjehura (ključni čimbenik u dijagnozi), debljine sluznice mokraćnog mjehura i broja ponavljanih infekcija mokraćnog sustava. U 115 djevojčica srednje predpubertetske dobi od 7,79}3,05 godina dijagnoza cističnog cistitisa je postavljena cistoskopskim pregledom sluznice mokraćnog mjehura i ultrazvučnim mjerenjem njezine debljine. Debljina sluznice se progresivno povećavala s brojem nodula (3,52}0,522 mm ≤5 nodula prema 4.42}0.429 mm 6-10 nodula prema 5,20}0,610 mm >10 nodula) usporedno s povećenjem broja uroinfekcija. Smatramo da se ranom profilaksom uroinfekcija može spriječiti razvoj opsežnih promjena na sluznici mokraćnog mjehura s posljedičnim skraćenjem profilaktične primjene antibiotika/uroantiseptika

Cystitis Cystica and Recurrent Urinary Tract Infections in Children

The pathogenesis of recurrent urinary tract infections (UTIs) in preschool children with anatomically correct urinary tract (UT) is rather obscure. In girls, the bladder wall changes of cystitis cystica (CC) may be per se responsible for UTIs recurrence. During the 20-year period, 127 preschool children (125 girls; median age: 6.1 years) with CC, in whom UT anomalies were excluded, were diagnosed. The mean duration of UTIs symptoms prior to diagnosis was 3.31±2.51 years. Cystoscopical findings were labelled as mild, moderate and severe in 22.8%, 39.4% and 37.8% of patients, respectively. Following the confirmation of CC, long-term chemoprophylaxis with sulfamethoxazole-trimethoprim/nitrofurantoin was administered. A one year UTI-free period after chemoprophylaxis discontinuation was defined as therapeutic success. With 2.5 years median duration of regular chemoprophylaxis this goal was achieved in 58 children mainly with mild/ moderate CC. Thirty children from »improved/unchanged« group taking regular prophylaxis had significant reduction of UTIs (»improved«). Only 12 children belonging to the same group taking regular prophylaxis and all children with irregular prophylaxis had approximately the same number of UTIs as before treatment (»unchanged«). The »improved/unchanged« outcomes were predominantly found in children with severe form of CC. Although urodynamic disturbances detected in more than 50% of patients in whom urodynamics was performed were not found influential on the disease outcome, they could be responsible for its development. The results of our study suggest that regular and long-lasting chemoprophylaxis remains a basis for successful treatment for majority of patients with CC, even those with severe forms. If not treated properly with chemoprophylactic agents and without fair compliance in taking drugs, the disease is prone to recurrent UTIs