Validity of neutrophil gelatinase associated lipocaline as a biomarker for diagnosis of children with acute pyelonephritis

Purpose: Novel biomarkers have been investigated for various renal disorders, including urinary tract infection (UTI). The aim of this study was to assess whether urine neutrophil gelatinase associated lipocaline (NGAL), could represent a reliable biomarker for diagnosis and treatment of children with acute pyelonephritis (APN). Materials and Methods: A total of 37 children (32 females, 5 males) with APN were included in this prospective study. Urine NGAL was measured before and 5-7 days after antibiotic treatment in the UTI group, using ELISA kit and compared with 26 (8 females, 18 males) control group children admitted for other bacterial infections. Results: Mean age of the UTI group was 39 � 28 months, compared to 43.6 � 31.5 months for the control group with no statistically significant difference. Median urine NGAL level was significantly higher in patients with APN than the other subjects 0.48 (interquartile range (IQR): 0.15-0.72) vs. 0.065 (0.01-0.24), P = .001, and decreased significantly after antibiotic treatment (P = .002). Using a cutoff of 0.20 ng/mL, sensitivity and specificity of urine NGAL were 76% and 77% for prediction of APN, respectively. The area under the ROC curve (AUC) for urine NGAL was 0.75 (CI= 0.61-0.88), suggesting urine NGAL as a relatively good predictive biomarker of APN. Conclusion: Urine NGAL is a good biomarker for diagnosis and treatment monitoring of APN in children

The effect of continuous care model on parents’ knowledge and controlling symptoms and recurrence in children with nephrotic syndrome

Background and aims: Nephrotic syndrome is the most common manifestation of glomerular damage in children. Due to being a chronic disease as well as the need to continuing the provision cares to reduce the recurrence of disease, this research was aimed to determine the effect of continuous care model on parents’ knowledge and controlling symptoms and recurrence in children with nephrotic syndrome. Methods: This research is an experimental study which 66 children with nephrotic syndrome qualified for inclusion in the study, were randomly classified into 2 groups: Case and control. Data were collected by a researcher-designed questionnaire, and checklist for recording blood pressure, weight, blood lipids and the presence or absence of recurrence in children in the 2 groups before and after intervention. Continuous care model was carried out on test group for 6 months. Data were analyzed by SPSS software using descriptive statistics, Chi-square, and Independent t-test and McNamara tests. Results: The proportion of disease recurrence after the intervention in both case and control groups showed no significant difference (P=0.787), but mean of systolic blood pressure in both groups after the intervention showed significant differences (P=0.011). Also, the level of parents' knowledge ratio in both groups after the intervention showed significant differences (P=0.0001). Conclusion: According to the study results, it is suggested that children care needs with nephrotic syndrome will be met by using the implementation of continuous care mode

The role of employment in dualistic economic development models

Traditionally employment and output have been the major two criteria for evaluating aggregate performance in a dual economic model for less developed countries. This has been mainly discussed by transferring labor from the agricultural sector to non-agricultural use. Most models are specified in such a manner that the migrated agricultural workers will be absorbed in non-agricultural jobs. In reality though, the transformation of labor to the non-agricultural sector (i. e., industrial or urban) has created an unemployment problem in that sector. The purposes of this paper are (1) to study some of the relevant common characteristics of less developed countries, (2) to review the literature related to labor employment, and (3) to demonstrate the importance of the efficiency of employment and output in dualistic development models. This paper has reviewed three classes of models. First, this study has considered the Fei-Ranis model of economic development which has drawn heavily from W. A. Lewis’s model of economic development with unlimited supplies of labor (Fei-Ranis is primarily a classical model). Second, the Jorgenson’s model of development of a dual economy has been presented. This model is based on Harrod-Domar's concept of steady growth, Third, this study looks at a more recent model, the Todaro model, which considered the practical problem of urban (industrial) unemployment. The problem of urban-unemployment is not considered by the first two models. Todaro's approach to the development of a dual economy may be the beginning of a new trend in the literature. On the basis of findings of this work it was concluded that: (1) The transformation of an agricultural surplus labor economy to an industrial surplus labor economy, can only be justified by a careful consideration of the production possibilities of each case, and the demand for the products of each sector. (2) The rate of growth of each sector will be dictated by the optimum growth path. This is the locus of optimum combination of output and employment of resources in each sector in the given time period. Because production possibilities and demand considerations operate to determine the optimum growth path, this path will rarely if ever coincide with the straight-line balanced growth path prominent in the Fei-Ranis model

On the state and parameter estimation of stochastic bilinear systems : a sub-optimal filtering approach

Bilinear systems due to their variable structure properties offer more versatility in modelling of nonlinear processes than linear systems. The state estimation problem for a continuous bilinear system with a continuous observation model is studied and the results are extended to the case where the observations are of a discrete nature. It is shown that the optimal filter is of infinite dimension and a suboptimal solution based on the use of the conditional best estimate of the state in the multiplicative term, rather than the actual state, is proposed. The filter dimension is reduced to two and the mean and the variance equations are provided. A recursive maximum likelihood procedure operating on the proposed filter is used for the parameter identification. Both the likelihood functional and the gradient equations are provided. Computation of the gradient is dependent on computing the partial derivatives of the proposed filter equations with respect to the parameters. Simulation of the sample functions of bilinear systems using closed form solutions is discussed and a complete solution for the scalar case is provided. Parametric conditions for obtaining closed form solutions to the vector cases are supplied. A number of numerical examples illustrating the feasibility and performance of the proposed filter and parameter identification schemes are included. Both scalar and multivariable computational examples are considered

Urinary metabolic abnormalities in children with idiopathic hematuria

Background: Hematuria, either macroscopic or microscopic, is an incidental finding of multiple nephrologic or urologic disorders. Disturbances of urine inhibitors or promotors have been suggested as the potential causes of isolated idiopathic hematuria in children and its recurrence. Meanwhile, appropriate treatment of these risk factors might improve secondary asymptomatic or macroscopic hematuria. Objectives: The aim of this study was to identify contribution of urinary biochemical abnormalities in children with isolated idiopathic hematuria. Methods: About 522 children with isolated hematuria were evaluated in a prospective cross-sectional study. Data such as clinical manifestations, family history, laboratory examinations, structural anomalies, and urine biochemistry were obtained. Patients with nephrolithiasis, nephrocalcinosis, tubulointerstitial disorder, genitourinary abnormality, urinary tract infection, and glomerular disorder were excluded from the study. Variables such as calcium, citrate, oxalate, phosphate, uric acid, cystine, and magnesium were measured in 24-h urine collection. In addition, serum levels of electrolytes, urea, creatinine, parathyroid hormone, and bicarbonate were identified. Results: Mean age at diagnosis was 5.9 years, and females outnumbered males (2/1). Of those, 88.5 had microscopic hematuria, and 12.6 experienced episodes of gross hematuria. Abdominal pain was the most common clinical manifestations. Urinary tract infection occurred in 30 of cases. Totally, 94 of patients had single or multiple metabolic abnormalities in 24-h urine excretion including hypocitraturia, 60.7; hypomagnesuria, 58.2; hyperuricosuria, 35.8; hypercalciuria, 33.7; hyperoxaluria, 33.7; and cystinuria, 0.76, respectively. About 8 of cases had mixed urine metabolic disturbances. Most patients had mild hematuria (red blood cell 30/hpf), with no statistical correlation to urine metabolic abnormalities. About 80 of patients had a history of nephrolithiasis in their relatives. Discussion: Decreased urinary inhibitor concentration followed by increased stimulator concentration were the most common abnormalities in patients with idiopathic hematuria. Accordingly, measurement of urinary biochemical concentration is highly recommended in children with isolated hematuria. In addition, investigating the therapeutic effect of potassium citrate supplements is highly recommended in these patients to prevent future stone formation and treatment of hematuria. Table presented © 201

Evaluation and comparison of urinary cytokines for the diagnosis of acute pyelonephritis

Background: The accurate diagnosis and management of febrile urinary tract infection (UTI) is a clinical challenge in the absence of specific clinical and laboratory findings in infants and young children. Objectives: The aim of this study was to identify and compare the diagnostic and therapeutic implications of recently introduced cytokines for the diagnosis of acute pyelonephritis (APN). Methods: This multicenter prospective study was performed on 37 (female/male = 6.5:1) children with symptomatic culture-proven APNand 37 (female/male = 1.6/1) age-matched febrile children without UTIs as the control group. Urine samples were obtained before antibiotic treatment in both groups and 3 - 4 days after treatment in the UTI group, and evaluated for interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor- α (TNF α), monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF) using an ELISA immunoassay kit. Results: Mean urinary IL-1 α, IL-4, IL-6, and IL-8 concentrations significantly increased in the acute phase of APN compared to the control group, and decreased following antibiotic treatment. Conclusions: We recommend routine urinalysis and urine culture for the diagnosis of children with APN. Urinary IL-4 was a relatively good cytokine for the prediction and treatment-monitoring of children with acute febrile UTI. © 2016, Pediartric Infections Research Center

Urine Neutrophil Gelatinase Associated Lipocalin as a Predictor of Vesicoureteral Reflux and Renal Parenchymal Damage: A Systematic Review

Background: Vesicoureteral reflux (VUR) is the most common congenital urinary tract abnormality in children. Renal parenchymal damage is the most devastating complication of severe undiagnosed VUR. Different diagnostic biomarkers have been introduced as alternatives for radiologic evaluation in these patients. This review article aimed to increase the knowledge about the role of urine neutrophil gelatinase-associated lipocalin (uNGAL) in children affected by primary VUR and renal parenchymal damage. Methods: A systematic review of PubMed, Scopus, Web of Science, ProQuest, and Ovid was conducted in September 2022 to retrieve studies that investigated the correlation between uNGAL or uNGAL/Cr excretion and primary VUR in male/female patients younger than 18 years of age. Patients with secondary VUR, age older than 18 years, infectious or inflammatory disorders, obstructive uropathies, and acute or chronic kidney diseases were excluded. Two reviewers independently screened the titles and abstracts of the search results and then assessed the full texts selected from the pertinent studies.  Results: Eighteen research articles with a total sample of 699 patients were found to measure uNGAL in VUR or renal scarring. UNGAL or uNGAL/Cr had increased excretion in the majority of children with primary VUR or RPD, with a positive or no correlation to the severity of VUR.  Conclusions: Several studies addressed uNGAL and uNGAL/Cr as putative biomarkers for the prediction of VUR or reflux-associated RPD