Search

Author(s): Sohsaku Yamanouchi [sup.1] , Takahisa Kimata [sup.1] , Yuko Akagawa [sup.1] , Shohei Akagawa [sup.1] , Jiro Kino [sup.1] , Shoji Tsuji [sup.1] , Kazunari Kaneko [sup.1] Author Affiliations: [...], Background This study aimed to test the hypothesis that reduced urinary excretions of neutrophil gelatinase-associated lipocalin (NGAL) predispose children to recurrence of febrile urinary tract infection (fUTI). Methods Subjects were 38 children diagnosed with fUTI. To examine risk factors for recurrence of fUTI, the subjects were divided into a non-recurrent group and a recurrent group according to the presence or absence of fUTI over 3 years since the first episode. We measured the urinary NGAL levels in patients with fUTI at the non-infected stage in addition to age-matched healthy control children. Results In a multiple logistic regression analysis, significant differences between the groups were not observed for age, sex, the prevalence of kidney scarring and bladder bowel dysfunction, urinary [beta]2-microglobulin/creatinine (Cr) level, and serum levels of Cr and Cystatin C, while the recurrent group had significantly more cases with grade III or higher vesicoureteral reflux (p < 0.01). Furthermore, the urinary NGAL/Cr in the recurrent group (median, 3.60 [mu]g/gCr) was significantly lower than that in the non-recurrent group (median, 16.47 [mu]g/gCr; p < 0.01), and age-matched healthy control children (median, 14.14 [mu]g/gCr; p < 0.05). The area under the receiver operating characteristic curve of NGAL/Cr was 0.86 for predicting recurrence of fUTI. A cut-off value of 11.59 [mu]g/gCr had the best accuracy to predict recurrent fUTI yielding a specificity of 78% and a sensitivity of 93%. Conclusions Reduced levels of urinary NGAL, which protects against urinary infection, are a risk factor for recurrence of fUTI and could serve as a biomarker.

Author(s): Eugene Yu-Hin Chan [sup.1] [sup.2] Author Affiliations: (1) grid.417336.4, 0000 0004 1771 3971, Department of Paediatrics & Adolescent Medicine, Tuen Mun Hospital, , Tuen Mun, Hong Kong (2) Paediatric [...]

Introduction The risk of urinary tract infection (UTI) in a boy with an anatomically normal urinary tract is 1%. Circumcision in a normal boy will reduce the risk of UTI [...], The risk of urinary tract infection (UTI) in normal boys is 1%. This risk is significantly increased in boys with congenital abnormalities of the urinary tract, which includes such abnormalities as vesico-ureteric reflux, obstructive megaureter (VUJO) and posterior urethral valves. UTI in these boys can lead to urosepsis, a potentially life-threatening complication, and in the longer term renal scarring complicating pyelonephritis can lead to chronic renal impairment or even end-stage renal disease. Circumcision has been shown in normal boys to reduce the risk of UTI by 90%, and potentially could be a simple intervention to reduce the risk of urosepsis and renal scarring. In order to make this decision a clinician really needs to have the answers to two questions: 1) What is the risk of UTI in this particular boy? 2) What is the evidence of efficacy of circumcision in this particular condition? This article reviews what evidence exists to make a calculation of the risk/benefit ratio for circumcision in boys with abnormalities of the urinary tract. Keywords Circumcision * Complications * Vesicoureteric reflux * Megaureter * Vesicoureteric junction obstruction * Posterior urethral valves * Bladder outlet obstruction * Urinary tract infection

Byline: Marc Leone (1), Jacques Albanese (1), Franck Garnier (1), Christophe Sapin (2), Karine Barrau (2), Marie-Christine Bimar (1), Claude Martin (1) Keywords: Catheter-associated urinary tract infection; Bacteriuria; Risk factor; Intensive care unit Abstract: Objective To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU). Design Prospective cohort study. Setting Sixteen-bed polyvalent ICU in a French university hospital. Interventions Prospective patient surveillance of patients included in two successive studies of two urine drainage systems. Main outcome measures Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. Results The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: female sex, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization. Conclusion In our study, the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients, removal of the bladder catheter must be performed as soon as possible. Author Affiliation: (1) Intensive Care Unit and Trauma Center, Nord Hospital AP-HM, Bd P. Dramard, 13915, Marseille, France (2) Laboratory of Epidemiology and Statistics, Marseilles University Hospital System, Marseilles School of Medicine, Marseilles, France Article History: Received Date: 27/09/2002 Accepted Date: 06/03/2003 Online Date: 13/05/2003 Article note: An erratum to this article can be found at http://dx.doi.org/10.1007/s00134-003-2080-9

Byline: Marc Leone (1), Jacques Albanese (1), Franck Garnier (1), Christophe Sapin (2), Karine Barrau (2), Marie-Christine Bimar (1), Claude Martin (1) Keywords: Catheter-associated urinary tract infection; Bacteriuria; Risk factor; Intensive care unit Abstract: Objective To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU). Design and setting Prospective cohort study in a 16-bed polyvalent ICU in a French university hospital. Interventions Prospective patient surveillance of patients included in two successive studies of two urine drainage systems. Measurements and results Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: sex female, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization. Conclusions In our study the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients removal of the bladder catheter must be performed as soon as possible. Author Affiliation: (1) Intensive Care Unit and Trauma Center, Nord Hospital AP-HM, Marseilles University Hospital System, Marseilles School of Medicine, 13915, Marseille cedex 20, France (2) Laboratory of Epidemiology and Statistics, Marseilles University Hospital System, Marseilles School of Medicine, 13915, Marseille cedex 20, France Article History: Received Date: 27/09/2002 Accepted Date: 06/03/2003 Online Date: 09/04/2003 Article note: An erratum to this article can be found at http://dx.doi.org/10.1007/s00134-003-2080-9

Byline: Eduardo H. Garin (1), Alfonso Campos (1), Yves Homsy (2) Keywords: Key words: Vesicoureteral reflux; Pyelonephritis; Asymptomatic bacteriuria; Urinary antibiotic prophylaxis Abstract: The well-known association between vesicoureteral reflux and urinary tract infection is the basis for pathophysiological and therapeutic implications which have dominated the literature on the subject for the last 2 decades. We critically review the following issues: (1) does urinary tract infection cause reflux? (2) does reflux predispose to infection? (3) does reflux predispose to pyelonephritis? (4) does reflux predispose to a renal parenchymal scar? (5) does long-term urinary antibiotic prophylaxis prevent renal damage in patients with reflux? We conclude that none of the reviewed issues have been rigorously proven or validated and that the role of vesicoureteral reflux in urinary tract infections needs to be redefined through well-designed, multicenter, prospective, randomized, controlled studies using state of the art renal imaging techniques. Author Affiliation: (1) Nephrology Division, Department of Pediatrics, University of South Florida, Tampa, Florida, USA, US (2) Pediatric Urology Division, University of South Florida, Tampa, Florida, USA, US Article note: Received May 9, 1997 received in revised form December 3, 1997 accepted December 4, 1997

Byline: A. Vanderfaeillie (1), P. Flamen (2), A. Wilikens (1), B. Desprechins (3), A. Piepsz (1) Keywords: Key words:a Dimercaptosuccinic acid; Urinary tract infection; Acute pyelonephritis; Diagnostic strategy Abstract: We retrospectively evaluated the frequency of renal scintigraphic abnormalities in children over 5 years admitted with a first symptomatic urinary tract infection (UTI). Among 261 children investigated, we found only 23 over 5 years having had technetium-99m-dimercaptosuccinic acid scintigraphy during the acute phase of a first UTI. Obvious scintigraphic abnormalities were detected in 14 children (15 kidneys): 12 kidneys showed focal cortical defects and 3 were small and deformed. Ultrasound was normal in 7 of the 15 kidneys with abnormal scintigraphy and in all the kidneys with normal scintigraphy. Among the 12 kidneys with focal cortical lesions, 8 kidneys returned to normal or improved considerably 2a--a12 months after initial work-up. In conclusion, in children over 5 years admitted with a first symptomatic UTI, the frequency of scintigraphic abnormalities is high and a strategy based only on ultrasound data would miss about 50% of the abnormal kidneys. Author Affiliation: (1) Department of Pediatrics, A.Z.-V.U.B. Free University, Brussels, Belgium, BE (2) Department of Nuclear Medicine, A.Z.-V.U.B. Free University, Brussels, Belgium, BE (3) Department of Pediatric Radiology, A.Z.-V.U.B. Free University, Brussels, Belgium, BE Article note: Received July 8, 1997 received in revised form January 14, 1998 accepted January 22, 1998

Byline: H. Kalhoff (1) Keywords: Urinary tract infection; Dietary factors Author Affiliation: (1) Pediatric Clinic, Beurhausstrasse 40, 44137 Dortmund, Germany Article History: Registration Date: 16/07/2004 Online Date: 20/08/2004 Article note: A reply to this letter is available at http//dx.doi.org/10.1007/s00467--004--1577-y