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Pishdad R, Auwaerter PG, Kalyani RR. Diabetes, SGLT-2 Inhibitors, and Urinary Tract Infection: a Review. Curr Diab Rep 2024; 24:108-117. [PMID: 38427314 DOI: 10.1007/s11892-024-01537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to focus on epidemiology, pathogenesis, risk factors, management, and complications of UTI in people with diabetes as well as reviewing the association of SGLT-2 inhibitors with genitourinary infections. RECENT FINDINGS Individuals diagnosed with T2DM are more prone to experiencing UTIs and recurrent UTIs compared to individuals without T2DM. T2DM is associated with an increased risk of any genitourinary infections (GUI), urinary tract infections (UTIs), and genital infections (GIs) across all age categories. SGLT2 inhibitors are a relatively new class of anti-hyperglycemic agents, and studies suggest that they are associated with an increased risk of genitourinary infections. The management of diabetes and lifestyle modifications with a patient-centric approach are the most recognized methods for preventing critical long-term complications including genitourinary manifestations of diabetes. The available data regarding the association of SGLT-2 inhibitors with genitourinary infections is more comprehensive compared to that with UTIs. Further research is needed to better understand the mechanisms underlining the association between SGLT-2 inhibitors and genital infections and UTIs.
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Affiliation(s)
- Reza Pishdad
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Endocrinology, Diabetes, and Metabolism, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Paul G Auwaerter
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Owusu E, Adjei H, Afutu E. Similarities in Bacterial Uropathogens and Their Antimicrobial Susceptibility Profile in Diabetics and Their Non-Diabetic Caregivers at a National Diabetes Management and Research Centre, Accra-Ghana. Diseases 2022; 10:diseases10040124. [PMID: 36547210 PMCID: PMC9777486 DOI: 10.3390/diseases10040124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/15/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes mellitus has some damaging effects on the genitourinary system and has been found to have adverse effects on the host immune system, resulting in higher risk of infections including urinary tract infections (UTI). Incidences of UTI caused by bacteria have been increasingly reported globally and the abuse of antibiotics leading to evolving resistant strains of antibiotics is a public health challenge for the management of this condition. Information on the difference in types of bacterial agents causing UTI in diabetic patients and non-diabetic individuals, and their susceptibility profiles, will facilitate effective management among these groups of patients. Therefore, this study aimed at determining the difference in prevalence of UTI, the causative bacteria, and their antimicrobial susceptibility profiles in diabetic patients and non-diabetic individuals at a diabetes management center. METHODS This was a prospective cross-sectional study conducted amongst 100 diagnosed diabetic patients and 100 non-diabetic individuals. Urine sample was collected aseptically and analyzed microbiologically for the presence of urinary tract bacterial pathogens. Drug susceptibility testing was conducted on the isolates by the Kirby Bauer method to ascertain the antibiotic susceptibility patterns. RESULTS Among the diabetic and non-diabetic individuals, urinary tract bacterial pathogens were observed in 28.0% and 26.0% of samples, respectively. The organisms were in the following proportions for diabetic and non-diabetic individuals, respectively: E. coli (14/28, 50% and 8/26, 30.7%), S. aureus (2/28, 7.1% and 4/26, 15.4%), K. pneumoniae (4/28, 14.3% and 8/26, 30.7%), K. ozoenae (2/28, 7.14% and 0/26, 0%), K. oxytoca (0/28, 0% and 4/26, 15.4%) and C. urealyticum (6/28, 21.4% and 2/26, 7.69%). The difference between the proportions of bacteria isolated was, however, not statistically significant (p-value = 0.894). Bacteria isolated from both diabetic and non-diabetic individuals were highly susceptible to most of the antibiotics tested, especially nitrofurantoin, cefuroxime, ceftriaxone, and cefotaxime. CONCLUSION This study has shown that similarities exist in prevalence of UTI, the causative bacteria, and their antimicrobial susceptibility patterns amongst diabetic patients and non-diabetic individuals at a diabetes management center. These data will help in the management of UTI among these individuals.
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Affiliation(s)
- Enid Owusu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 00233, Ghana
- Correspondence: (E.O.); (E.A.); Tel.: +233-0508-917-569 (E.O.)
| | - Henrietta Adjei
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 00233, Ghana
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 00233, Ghana
| | - Emmanuel Afutu
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 00233, Ghana
- Correspondence: (E.O.); (E.A.); Tel.: +233-0508-917-569 (E.O.)
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Salari N, Karami MM, Bokaee S, Chaleshgar M, Shohaimi S, Akbari H, Mohammadi M. The prevalence of urinary tract infections in type 2 diabetic patients: a systematic review and meta-analysis. Eur J Med Res 2022; 27:20. [PMID: 35123565 PMCID: PMC8817604 DOI: 10.1186/s40001-022-00644-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Urinary tract infection is the most common infection in type 2 diabetic patients. Various studies have reported different outbreaks of urinary tract infections in type 2 diabetic patients. Therefore, the present study aimed to determine the prevalence of urinary tract infections in type 2 diabetic patients during a systematic review and meta-analysis in order to develop interventions to reduce the incidence of urinary tract infections in type 2 diabetic patients.
Methods
In this study, systematic review and meta-analysis of study data related to the prevalence of urinary tract infection in type 2 diabetic patients were conducted using keywords including type 2 diabetes, urinary tract infection, diabetes, prevalence, meta-analysis and their English equivalents in SID, MagIran, IranMedex, IranDoc, Google Scholar, Cochrane, Embase, Science Direct, Scopus, PubMed and Web of Science (WoS) databases from 1993 to 2020. In order to perform the analysis of qualified studies, the model of random-effects was used, and the inconsistency of studies with the I2 index was investigated. Data analysis was performed with Comprehensive Meta-Analysis (Version 2).
Results
Based on a total of 15 studies with a sample size of 827,948 in meta-analysis, the overall prevalence of urinary tract infection in patients with type 2 diabetes was 11.5% (95% confidence interval: 7.8–16.7%). The prevalence of urinary tract infections in diabetic Iranian patients increased with increasing number of years of research, (p < 0.05), and with increasing age of participants (p < 0.05), but however the prevalence decreased with increasing sample size (p < 0.05).
Conclusion
This study shows that urinary tract infections are highly prevalent in patients with type 2 diabetes. Therefore, due to the growing prevalence of diabetes and its complications such as urinary tract infections, the need for appropriate screening programs and health care policies is becoming more apparent.
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Lacerda Mariano L, Ingersoll MA. The immune response to infection in the bladder. Nat Rev Urol 2020; 17:439-458. [PMID: 32661333 DOI: 10.1038/s41585-020-0350-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
The bladder is continuously protected by passive defences such as a mucus layer, antimicrobial peptides and secretory immunoglobulins; however, these defences are occasionally overcome by invading bacteria that can induce a strong host inflammatory response in the bladder. The urothelium and resident immune cells produce additional defence molecules, cytokines and chemokines, which recruit inflammatory cells to the infected tissue. Resident and recruited immune cells act together to eradicate bacteria from the bladder and to develop lasting immune memory against infection. However, urinary tract infection (UTI) is commonly recurrent, suggesting that the induction of a memory response in the bladder is inadequate to prevent reinfection. Additionally, infection seems to induce long-lasting changes in the urothelium, which can render the tissue more susceptible to future infection. The innate immune response is well-studied in the field of UTI, but considerably less is known about how adaptive immunity develops and how repair mechanisms restore bladder homeostasis following infection. Furthermore, data demonstrate that sex-based differences in immunity affect resolution and infection can lead to tissue remodelling in the bladder following resolution of UTI. To combat the rise in antimicrobial resistance, innovative therapeutic approaches to bladder infection are currently in development. Improving our understanding of how the bladder responds to infection will support the development of improved treatments for UTI, particularly for those at risk of recurrent infection.
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Affiliation(s)
- Livia Lacerda Mariano
- Department of Immunology, Institut Pasteur, Paris, France.,Inserm, U1223, Paris, France
| | - Molly A Ingersoll
- Department of Immunology, Institut Pasteur, Paris, France. .,Inserm, U1223, Paris, France.
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Saito H, Ito T, Omachi K, Inugami A, Yamaguchi M, Tsushima M, Mariya Y, Kashiwakura I. Effectiveness of the smoothing filter in pediatric 99mTc-dimercaptosuccinic acid renal scintigraphy. Radiol Phys Technol 2020; 13:104-110. [PMID: 31993983 DOI: 10.1007/s12194-020-00553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 11/27/2022]
Abstract
The present study aimed to evaluate whether the use of a smoothing filter would improve the image quality in pediatric 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy. We retrospectively reviewed 31 kidneys in 16 consecutive pediatric patients aged 10 months to 14 years. The administered dose was calculated using a weight-based method. Two reviewers randomly evaluated the original planar posterior images and smoothing filter image; they assessed image quality and performed defect evaluations. The evaluation of visual image quality yielded significantly better results for the smoothing filter images than for the original images. Although the smoothing filter images were slightly inferior to the original images in terms of edge sharpness, no significant difference was observed in the defect evaluation. We confirmed that 99mTc-DMSA scintigraphy with a smoothing filter yielded reduced image noise, while maintaining defect evaluation performance and improving image quality.
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Affiliation(s)
- Hitoshi Saito
- Department of Radiology, Akita Kousei Medical Center, 1-1-1 Iijima Nishibukuro, Akita, 011-0948, Japan.
| | - Teruhiro Ito
- Department of Radiology, Akita Kousei Medical Center, 1-1-1 Iijima Nishibukuro, Akita, 011-0948, Japan
| | - Koichi Omachi
- Department of Radiology, Akita Kousei Medical Center, 1-1-1 Iijima Nishibukuro, Akita, 011-0948, Japan
| | - Atsushi Inugami
- Department of Radiology, Akita Kousei Medical Center, 1-1-1 Iijima Nishibukuro, Akita, 011-0948, Japan
| | - Masaru Yamaguchi
- Department of Radiological Life Sciences, Hirosaki University Graduate School of Health Science, 66-1 Hon-cho, Hirosaki, Aomori, 036-8564, Japan
| | - Megumi Tsushima
- Department of Radiological Life Sciences, Hirosaki University Graduate School of Health Science, 66-1 Hon-cho, Hirosaki, Aomori, 036-8564, Japan
| | - Yasushi Mariya
- Department of Radiology, Mutsu General Hospital, 1-2-8 Kogawamachi, Mutsu, Aomori, 035-8601, Japan
| | - Ikuo Kashiwakura
- Department of Radiological Life Sciences, Hirosaki University Graduate School of Health Science, 66-1 Hon-cho, Hirosaki, Aomori, 036-8564, Japan
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Kishore N, Modi S, Khanduri S, Kakati B. Urinary tract infection in critically ill patients with diabetes mellitus: Spectrum of uropathogens and antimicrobial susceptibility pattern. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_97_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sahu M, Bhagat Z. Pervasiveness of urinary tract infection in diabetic patients and their causative organisms with antibiotic sensitivity pattern. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mata-Cases M, Franch-Nadal J, Real J, Cedenilla M, Mauricio D. Prevalence and coprevalence of chronic comorbid conditions in patients with type 2 diabetes in Catalonia: a population-based cross-sectional study. BMJ Open 2019; 9:e031281. [PMID: 31662386 PMCID: PMC6830642 DOI: 10.1136/bmjopen-2019-031281] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To evaluate the prevalence and coprevalence of several chronic conditions in patients with type 2 diabetes in a Mediterranean region. DESIGN A cross-sectional study. SETTING Two hundred and eighty-six primary care teams of the Catalonian Health Institute (Catalonia, Spain). PARTICIPANTS We included patients aged ≥18 years with a diagnosis of type 2 diabetes by 31 December, 2016, who were registered in the Information System for the Development of Research in primary care (SIDIAP) database. We excluded patients with a diagnosis of type 1 diabetes, gestational diabetes mellitus and any other type of diabetes. PRIMARY AND SECONDARY OUTCOME MEASURES We collected data on diabetes-related comorbidities (ie, chronic complications, associated cardiovascular risk factors and treatment complications). Diagnoses were based on the International Classification of Diseases, 10th Revision codes recorded in the database or, for some entities, on the cut-off points for a particular test result or a specific treatment indicated for that entity. The presence and stage of chronic kidney disease (CKD) were based on the glomerular filtration rate, the CKD Epidemiology Collaboration creatinine equation and the urine albumin-to-creatinine ratio. RESULTS A total of 373 185 patients were analysed. 82% of patients exhibited ≥2 comorbidities and 31% exhibited ≥4 comorbidities. The most frequent comorbidities were hypertension (72%), hyperlipidaemia (60%), obesity (45%), CKD (33%), chronic renal failure (CRF)(28%) and cardiovascular disease (23%). The most frequently coprevalent pairs of chronic conditions were the combination of hypertension with hyperlipidaemia (45%), obesity (35%), CKD (28%), CRF (25%) or cardiovascular disease (19%), as well as the combination of hyperlipidaemia with obesity (28%), CKD (21%), CRF (18%) or cardiovascular disease (15%); other common pairs of comorbidities were obesity/CKD, obesity/CRF, hypertension/retinopathy, hypertension/albuminuria, hypertension/urinary tract infection, CVD/CRF and CVD/CKD, which were each present in more than 10% of patients. CONCLUSION Patients with type 2 diabetes have a high frequency of coprevalence of metabolic risk factors, cardiovascular disease and CKD and thus require an integrated management approach.
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Affiliation(s)
- Manel Mata-Cases
- DAP-Cat Group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Jordi Real
- DAP-Cat Group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | | | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Al-Asoufi A, Khlaifat A, Tarawneh AA, Alsharafa K, Al-Limoun M, Khleifat K. Bacterial Quality of Urinary Tract Infections in Diabetic and Non Diabetics of the Population of Ma'an Province, Jordan. Pak J Biol Sci 2017; 20:179-188. [PMID: 29023074 DOI: 10.3923/pjbs.2017.179.188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The patients with Diabetes Mellitus (DM) have malfunction in bladder which prompt urine accumulation in its pool which serves a decent situation to the microbes to be develop and cause Urinary Tract Infection (UTI). The UTI is the most infectious disease that affects both males and females. This study was designed to detect the bacterial species responsible for UTI in both diabetic and non-diabetic patients in Ma'an province, Jordan. MATERIALS AND METHODS One hundred sixteen urine samples were investigated to determine UTI-causing bacteria. These samples distributed unequally between diabetic male (12) and diabetic female (25) and also non-diabetic male (13) and non-diabetic female (66). RESULTS It was observed that E. coli is responsible for large proportion (44.8%) of UTI in both diabetic (15.5%) and non-diabetic (29.3%) patients. This study showed inequality in the bacterial species that were isolated from both diabetic and non-diabetic samples. However, five bacterial species including E. aerogenes, E. cloacae, C. freundii, A. baumannii and B. subtilis did not exist in all diabetic samples. Treatment of UTI in both diabetic and non-diabetic patients with chloramphenicol (30 μg), ciprofloxacin (5 μg) and vancomycin (30 μg) resulted in more favorability than other antibiotics. At the same time cephalothin (30 μg) was not recommended. CONCLUSION Escherichia coli was the prevailing bacterial infections among those which were isolated from patients with UTI. Certain forms of bacterial infections inclined to be extra common in diabetic patients than others and other infections may be more severe in people with diabetics than in non diabetics.
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Affiliation(s)
- Ali Al-Asoufi
- Department of Biology, Al-Hussein Bin Talal University, Ma'an, Jordan
| | - Ali Khlaifat
- Department of Nursing, Faculty of Prince Aysha for Applied Health and Nursing, Al-Hussein Bin Talal University, Ma'an, Jorda
| | - Amjad Al Tarawneh
- Prince Faisal Center for Dead Sea, Environmental and Energy Research, Mu'tah University, Jordan
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Eichler TE, Becknell B, Easterling RS, Ingraham SE, Cohen DM, Schwaderer AL, Hains DS, Li B, Cohen A, Metheny J, Tridandapani S, Spencer JD. Insulin and the phosphatidylinositol 3-kinase signaling pathway regulate Ribonuclease 7 expression in the human urinary tract. Kidney Int 2016; 90:568-79. [PMID: 27401534 DOI: 10.1016/j.kint.2016.04.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/12/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
Diabetes mellitus is a systemic disease associated with a deficiency of insulin production or action. Diabetic patients have an increased susceptibility to infection with the urinary tract being the most common site. Recent studies suggest that Ribonuclease 7 (RNase 7) is a potent antimicrobial peptide that plays an important role in protecting the urinary tract from bacterial insult. Because the impact of diabetes on RNase 7 expression and function are unknown, we investigated the effects of insulin on RNase 7 using human urine specimens. The urinary RNase 7 concentrations were measured in healthy control patients and insulin-deficient type 1 diabetics before and after starting insulin therapy. Compared with controls, diabetic patients had suppressed urinary RNase 7 concentrations, which increased with insulin. Using primary human urothelial cells, the mechanisms by which insulin stimulates RNase 7 synthesis were next explored. Insulin induced RNase 7 production via the phosphatidylinositide 3-kinase signaling pathway (PI3K/AKT) to shield urothelial cells from uropathogenic E. coli. In contrast, uropathogenic E. coli suppressed PI3K/AKT activity and RNase 7 production. Thus, insulin and PI3K/AKT signaling are essential for RNase 7 expression and increased infection risks in diabetic patients may be secondary to suppressed RNase 7 production. Our data may provide unique insight into novel urinary tract infection therapeutic strategies in at-risk populations.
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Affiliation(s)
- Tad E Eichler
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Brian Becknell
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; Division of Nephrology, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA
| | - Robert S Easterling
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Susan E Ingraham
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; Division of Nephrology, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA
| | - Daniel M Cohen
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA
| | - Andrew L Schwaderer
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; Division of Nephrology, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA
| | - David S Hains
- Innate Immunity Translational Research Center, Department of Pediatrics, Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Birong Li
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Ariel Cohen
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Jackie Metheny
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Susheela Tridandapani
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA; Department of Molecular Virology, Immunology, and Medical Genetics, Comprehensive Cancer Center, The Ohio State University James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
| | - John David Spencer
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; Division of Nephrology, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA.
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11
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Wu H, Zhu S, Yu S, Ding G, Xu J, Li T, Qiao L, Chen Y, Yan J, Cheng X, Wan SP, Li G. Early Drastic Decrease in White Blood Count Can Predict Uroseptic Shock Induced by Upper Urinary Tract Endoscopic Lithotripsy: A Translational Study. J Urol 2015; 193:2116-22. [PMID: 25619454 DOI: 10.1016/j.juro.2015.01.071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Haiyang Wu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shibin Zhu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shicheng Yu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Guoqing Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jun Xu
- Department of Urology, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Tao Li
- Department of Urology, Fujian Provincial Hospital, Fuzhou, People's Republic of China
| | - Ludong Qiao
- Department of Urology, Tongren Hospital of Peking University, Beijing, People's Republic of China
| | - Yue Chen
- Department of Urology, Ningbo First Hospital, Ningbo, People's Republic of China
| | - Jiajun Yan
- Department of Urology, Shaoxing People's Hospital, Shaoxing, People's Republic of China
| | - Xin Cheng
- Department of Urology, Second Hospital of Jiaxing, Jiaxing, People's Republic of China
| | - Shaw P Wan
- Department of Urology, First People's Hospital of Xiaoshan, Hangzhou, People's Republic of China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
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Bunn F, Kirby M, Pinkney E, Cardozo L, Chapple C, Chester K, Cruz F, Haab F, Kelleher C, Milsom I, Sievart KD, Tubaro A, Wagg A. Is there a link between overactive bladder and the metabolic syndrome in women? A systematic review of observational studies. Int J Clin Pract 2015; 69:199-217. [PMID: 25495905 DOI: 10.1111/ijcp.12518] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/07/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To conduct a systematic review to determine whether there is an association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) or overactive bladder (OAB) in women. METHODS We systematically reviewed English language observational studies on the effect of MetS (or component factors) on the presence of OAB or LUTS in women. We searched PubMed, Web of Science and The Cochrane Library with no date restrictions, checked reference lists and undertook citation searches in PubMed and Google Scholar. Studies were assessed for risk of bias. Because of heterogeneity, results were not pooled, but are reported narratively. RESULTS Of 27 included studies, only three looked at the link between MetS and OAB. The rest looked at links between OAB and components of MetS such as obesity or insulin resistance (n = 10), between MetS and urinary symptoms (n = 3) and between urinary symptoms and components of MetS, such as obesity (n = 14). Evidence is currently limited, but it does suggest that there may be important links between MetS and OAB and components of MetS such as obesity. CONCLUSIONS The literature on MetS and OAB or LUTS in women is limited, and poor quality. However, the evidence available on obesity appears to support MetS as a contributor and predictor of LUTS in women. Many of the women with LUTS will be overweight and will have features of the MetS, if looked for. This provides not only an opportunity to encourage weight loss as an adjunct to therapy for the OAB symptoms but also a window of opportunity to address cardiovascular risk factors and prevent future cardiovascular morbidity and mortality.
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Affiliation(s)
- F Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Saleh Farghaly HR, Mohamed Sayed MH. Technetium-99m dimercaptosuccinic acid scan in evaluation of renal cortical scarring: Is it mandatory to do single photon emission computerized tomography? Indian J Nucl Med 2015; 30:26-30. [PMID: 25589802 PMCID: PMC4290062 DOI: 10.4103/0972-3919.147530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Renal cortical scintigraphy with technetium-99m (Tc-99m) dimercaptosuccinic acid (DMSA) is the method of choice to detect acute pyelonephritis and cortical scarring. Different acquisition methods have been used: Planar parallel-hole or pinhole collimation and single photon emission tomography (SPECT). This study compared planar parallel-hole cortical scintigraphy and dual-head SPECT for detection of cortical defects. Patients and Methods: We retrospectively reviewed 190 consecutive patients with 380 kidneys and 200 DMSA scans referred to rule out renal cortical scarring. The diagnoses were 52 vesicoureteric reflux, 61 recurrent urinary tract infection, 39 hydronephrosis, 20 renal impairment, and 18 hypertension. All patients were imaged 3 h after injection of Tc-99m DMSA with SPECT and planar imaging (posterior, anterior, left, and right posterior oblique views). For each patient, planar and SPECT images were evaluated at different sittings, in random order. Each kidney was divided into three cortical segments (upper, middle and lower) and was scored as normal or reduced uptake. The linear correlation coefficient for the number of abnormal segments detected between planner and SPECT techniques was calculated. Results: From 200 DMSA scans, 100 scans were positive for scar in SPECT images, from which only 95 scans were positive for scar in planner imaging. Out of the five mismatched scans, three scans were for patients with renal impairment and high background activity and two scans were for very small scars. No significant difference was seen in the average number of abnormal segments detected by planar versus SPECT imaging (P = 0.31). The average correlation coefficient between was high (r = 0.91 – 0.92). Conclusions: Tc-99m DMSA renal cortical scanning using SPECT offers no statistically significant diagnostic advantage over multiple views planar imaging for detection of cortical defect.
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Affiliation(s)
- Hussein Rabie Saleh Farghaly
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt ; Department of Radiology, Division of Nuclear Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Fu AZ, Iglay K, Qiu Y, Engel S, Shankar R, Brodovicz K. Risk characterization for urinary tract infections in subjects with newly diagnosed type 2 diabetes. J Diabetes Complications 2014; 28:805-10. [PMID: 25161100 DOI: 10.1016/j.jdiacomp.2014.06.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/21/2014] [Accepted: 06/10/2014] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the risk of urinary tract infections (UTI) in subjects with newly diagnosed type 2 diabetes mellitus (T2DM). METHODS Subjects aged ≥18years and diagnosed with T2DM between 1/1/10 and 12/31/10 were identified using the MarketScan® databases, which are representative of the commercially insured US population and those with both Medicare and supplemental coverage. The index date was the first T2DM diagnosis date in 2010 (date randomly selected for those without T2DM). Subjects without T2DM were matched (1:1) by index date, age, gender, urban/rural location, and region. All subjects had continuous enrollment for 12 months before (baseline) and after (follow-up) the index date. UTI diagnosis was defined using ICD-9-CM codes. Measurements of glycemic control and body weight were not available. An adjusted logistic regression model assessed the likelihood of UTI. RESULTS A total of 89,790 matched pairs were selected. During follow-up, a UTI diagnosis was more common in subjects with T2DM than without T2DM (9.4% vs. 5.7%; p<0.0001). Recurrence of UTI was also more likely with T2DM (1.6% vs. 0.6%; p<0.0001). In a logistic regression, subjects with T2DM had a greater likelihood of UTI during follow up (adjusted odds ratio [OR]=1.54 [95% CI: 1.47-1.60]). This relationship remained after stratifying by gender. CONCLUSION Subjects with T2DM were more likely to experience a UTI and recurrent UTIs than subjects without T2DM during follow-up.
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Affiliation(s)
- Alex Z Fu
- Georgetown University Medical Center, Washington, DC
| | | | - Ying Qiu
- Merck & Co., Inc., Whitehouse Station, NJ
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15
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Geerlings S, Fonseca V, Castro-Diaz D, List J, Parikh S. Genital and urinary tract infections in diabetes: impact of pharmacologically-induced glucosuria. Diabetes Res Clin Pract 2014; 103:373-81. [PMID: 24529566 DOI: 10.1016/j.diabres.2013.12.052] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/31/2013] [Accepted: 12/28/2013] [Indexed: 01/01/2023]
Abstract
Predisposition to genital infections and urinary tract infections (UTIs) in type 2 diabetes mellitus (T2DM) results from several factors such as glucosuria, adherence of bacteria to the uroepithelium and immune dysfunction. The tendency to develop these infections could be even higher in patients with T2DM treated with the emerging class of sodium-glucose cotransporter-2 (SGLT2) inhibitors. Studies have shown that pharmacologically-induced glucosuria with SGLT2 inhibitors raises the risk of developing genital infections and, to a relatively lesser extent, UTIs. However, a definitive dose relationship of the incidence of these infections with the SGLT2 doses is not evident in the existing data. Therefore, the precise role of glucosuria as a causative factor for these infections is yet to be fully elucidated.
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Affiliation(s)
- Suzanne Geerlings
- Academic Medical Centre, Centre for Infection and Immunity, Amsterdam CINIMA, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Vivian Fonseca
- Section of Endocrinology, Tulane University Health Sciences Centre, 1430 Tulane Avenue-SL 53, New Orleans, LA 70112, USA
| | - David Castro-Diaz
- University Hospital of the Canary Islands, Carretera Cuesta Taco, S/N, 38320 San Cristobal de la Laguna, Tenerife, Spain
| | - James List
- Bristol-Myers Squibb, Global Development, Research and Development, Princeton, NJ, USA
| | - Shamik Parikh
- AstraZeneca, Global Medical Affairs, Diabetes and Metabolism, Wilmington, DE, USA
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16
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Swami YK, Singh DV, Gupta SK, Pradhan A, Rana YPS, Harkar S, Wani MS. Incidentally detected emphysematous pyelonephritis. Cent European J Urol 2012; 65:53-4. [PMID: 24578929 PMCID: PMC3921766 DOI: 10.5173/ceju.2012.01.art18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 11/20/2011] [Accepted: 12/15/2011] [Indexed: 11/22/2022] Open
Abstract
Emphysematous pyelonephritis (EP) is a rare, severe gas forming infection of renal parenchyma and its surrounding areas and potentially life threatening condition that requires prompt evaluation and treatment. Although it commonly present with a fulminant clinical picture of sepsis, relatively mild symptoms can also be encountered. To our knowledge, incidentally detected emphysematous pyelonephritis has not been reported so far. We report a case of EP that was incidentally detected during evaluation for diabetes.
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Affiliation(s)
- Yogesh Kumar Swami
- Department of Urology, Army Hospital Research and Referral, New Delhi, India
| | - Dharam Vir Singh
- Department of Urology, Army Hospital Research and Referral, New Delhi, India
| | - Sanjay Kumar Gupta
- Department of Urology, Army Hospital Research and Referral, New Delhi, India
| | - Aditya Pradhan
- Department of Urology, Army Hospital Research and Referral, New Delhi, India
| | - Yajvender P S Rana
- Department of Urology, Army Hospital Research and Referral, New Delhi, India
| | - Sandeep Harkar
- Department of Urology, Army Hospital Research and Referral, New Delhi, India
| | - M Shafi Wani
- Department of Urology, Army Hospital Research and Referral, New Delhi, India
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Janifer J, Geethalakshmi S, Satyavani K, Viswanathan V. Prevalence of lower urinary tract infection in South Indian type 2 diabetic subjects. Indian J Nephrol 2011; 19:107-11. [PMID: 20436730 PMCID: PMC2859475 DOI: 10.4103/0971-4065.57107] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study was done to determine the prevalence of lower urinary tract infection (UTI), the causative pathogens, their antimicrobial pattern, and the recurrence of infection in type 2 diabetic subjects. A total of 1157 (M: F 428: 729) type 2 diabetic subjects were selected for this study. Midstream urine specimens were collected and the culture tests were done by a quantitative method whereas antimicrobial sensitivity was determined by using the Kirby-Bauer method. A significant colony count was seen in 495 (42.8%) subjects and an insignificant count in 350 (30.3%) subjects; there were a few cases of recurrent UTI. Women (47.9%) had a significantly higher prevalence of UTI than men (34.1%) (χ2 = 20.3, P < 0.0001). Except for BMI, UTI was significantly associated with age, duration of diabetes, and poor glycemic control in both sexes. About 533 pathogens of gram positive and gram negative bacilli were isolated from 495 subjects in this study. Escherichea coli (E. coli) was the most commonly found organism. Gram negative pathogens were found to be highly sensitive to sulbactum / cefoperazone and piperacillin / tazobactum. The prevalence of UTI was significantly higher in women than men with E. coli being the major isolated pathogen. Gram negative pathogens were highly sensitive to sulbactum / cefoperazone and piperacillin / tazobactum.
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Affiliation(s)
- J Janifer
- Department of Microbiology, M.V. Hospital for Diabetes and Diabetes Research Centre, [WHO Collaborating Centre for Research Education and Training in Diabetes], Chennai - 600 013, India
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Yenilmez A, Kebapci N, Isikli B, Hamarat M, Donmez T. Morbidity after urodynamic study in diabetic patients. Acta Diabetol 2009; 46:197-202. [PMID: 18989612 DOI: 10.1007/s00592-008-0075-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
Abstract
The aim of this prospective study was to evaluate the morbidity of invasive urodynamic study (UDS) in type 2 diabetic patients. Study was conducted on 94 diabetic (59.4 +/- 0.8 years) and 110 non-diabetic (58.1 +/- 0.9 years) patients who had lower urinary tract symptoms. All patients underwent pressure-flow study. The major complication rate after UDS, including urinary tract infection, fever, urinary retention and gross hematuria, was 11.8% for non-diabetics and 22.3% for diabetics (p = 0.044). No significant differences were found between diabetics and non-diabetics according to gender with respect to dysuria, hematuria and pain (p > 0.05). Existence of pyuria before UDS was significantly higher in diabetic women with major complication than without major complication (p = 0.011). On the other hand, residual urine volume (p = 0.004) and diabetic cystopathy (0.005) were found significantly higher in diabetic men with major complication than without major complication. Our study demonstrated that UDS has an important role on the occurrence of high objective and subjective morbidity in diabetic and non-diabetic patients. Therefore, UDS indication should be carefully evaluated, especially in diabetic men who have high residual urine volume and diabetic women who have pyuria before UDS.
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Affiliation(s)
- Aydin Yenilmez
- Department of Urology, Eskisehir Osmangazi University, Medical Faculty, Eskisehir, Turkey.
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Abnormal immunological profile and vaginal microbiota in women prone to urinary tract infections. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2008; 16:29-36. [PMID: 19020112 DOI: 10.1128/cvi.00323-08] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The host determinants of susceptibility to recurrent urinary tract infections (UTI) are poorly understood. We investigated whether the susceptibility is associated with abnormalities in the immunological defense and further explored the linkage to vaginal microbiota. For this purpose, we compared vaginal, urine, and blood samples collected during a disease-free period from 22 women with recurrent UTI and from 17 controls. In UTI-prone women, interleukin-12 (IL-12) production in peripheral monocytes and myeloid dendritic cells (DCs) was significantly (P < 0.05) enhanced whether measured in relative numbers of IL-12-producing cells or in mean IL-12 production per cell. In contrast, no T-cell polarization was observed. Interestingly, it seemed that the cytokine production of DCs and monocytes did not translate into T-cell activation in the UTI-prone group in a manner similar to that seen with the controls. In vaginal mucosa, UTI-prone women had a lower concentration of tissue repair-associated vascular endothelial growth factor (VEGF) (P = 0.006) and less often had detectable amounts of the chief monocyte and DC chemoattractant, monocyte chemotactic protein 1 (P = 0.005), than the controls. The microbiota of UTI-prone women was characterized by a diminished lactobacillus morphotype composition, with an abnormally high (>3) mean Nugent score of 4.6 compared to 1.7 for the controls (P = 0.003). Normal lactobacillus composition was associated with increased IL-17 and VEGF concentrations in vaginal mucosa. In conclusion, immunological defects and a persistently aberrant microbiota, a lack of lactobacilli in particular, may contribute to susceptibility to recurrent UTI. Further studies of antigen-presenting-cell function and T-cell activation in recurrent UTI are called for.
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Abstract
AIMS The prevalence of significant bacteriuria (SB) in diabetes mellitus has not been clearly established. Having previously investigated SB frequency in inpatient diabetic women, we now screened for SB (both asymptomatic and symptomatic forms) in outpatients. METHODS We examined 511 consecutive outpatients with Type 1 (T1D) or Type 2 diabetes (T2D), and 98 non-diabetic subjects. At least one uncontaminated midstream urine sample was available from 602 subjects: 64 T1D (37 female, age 49 +/- 13 years, diabetes duration 23 +/- 15 years), 441 T2D (212 female, 66 +/- 10 years, 12 +/- 10 years), and 97 healthy control subjects (39 female, 57 +/- 12 years). On the same day, we determined: blood cell count, fasting plasma glucose (FPG), glycated haemoglobin (HbA(1c)), plasma creatinine, urinary creatinine, and urinary albumin excretion (UAE; microg/mg urinary creatinine). RESULTS The rate of SB was 14.1% in T1D, 9.3% in T2D and 6.2% in control subjects (P = NS). The 50 diabetic patients with SB differed from the 455 diabetic patients without SB in gender (43 male vs. 206 female, P < 0.001), FPG (10.2 +/- 3.6 vs. 9.2 +/- 2.9 mmol/l, P < 0.05), HbA(1c) (7.8 +/- 1.1 vs. 7.5 +/- 1.3%, P < 0.05), and UAE (median 15.6 vs. 7.6 microg/mg, P < 0.01). Eleven diabetic patients with SB had symptoms (vs. 48 without SB, P < 0.05); UAE levels were higher in the 39 asymptomatic diabetic patients with SB than in the 11 symptomatic patients. CONCLUSIONS The prevalence of SB is similar in outpatient diabetic individuals and in non-diabetic subjects. The main risk factors for SB in diabetic patients were female gender and UAE. The likelihood of asymptomatic SB increased with UAE levels, i.e. with the presence of established microangiopathy. Poor glycaemic control is associated with bacteriuria, either as a cause or consequence of bacteriuria.
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Affiliation(s)
- E Matteucci
- Department of Internal Medicine, Pisa University, Pisa, Italy.
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Movahed MR, Hashemzadeh M, Jamal MM. Increased prevalence of infectious endocarditis in patients with type II diabetes mellitus. J Diabetes Complications 2007; 21:403-6. [PMID: 17967715 DOI: 10.1016/j.jdiacomp.2007.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Revised: 06/21/2007] [Accepted: 07/23/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with diabetes mellitus (DM) are at increased risk of infection. However, there are controversial reports about DM association with infectious endocarditis (IE). We evaluated the occurrence of IE in DM patients compared to a matched control. METHOD Treatment files of inpatients' admission that contained discharge diagnosis (ICD-9 codes) from Veterans Health Administration hospitals were used for this study. ICD-9 codes for DM (n=293,124) and a control group with ICD-9 codes for hypertension without DM (n=552,623) were utilized for comparison. The prevalence of IE was studied using ICD-9 codes for IE. Multivariate analysis was performed adjusting for chronic and acute renal failure and aortic and mitral valve disease. Continuous variables were analyzed by unpaired t tests. Binary variables were analyzed using the chi-square test and Fisher's Exact Tests. RESULTS IE was present in 1340 (0.5%) DM patients versus 1412 (0.3%) patients from the control group (relative increase of 40%). Using multivariate analysis adjusting for renal failure and valvular abnormalities, DM remained independently associated with IE (odds ratio=1.9; 95% confidence interval=1.8-2.1; P<.0001). CONCLUSION Patients with type II DM have significantly higher prevalence of IE independent of renal failure or valvular abnormalities consistent with increased vulnerability of DM patients for infections.
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Affiliation(s)
- Mohammad Reza Movahed
- Department of Medicine, Section of Cardiology, University of Arizona Sarver Heart Center, Tucson, AZ 85724, USA.
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Islekel H, Soylu A, Altun Z, Yis U, Turkmen M, Kavukcu S. Serum and urine cystatin C levels in children with post-pyelonephritic renal scarring: a pilot study. Int Urol Nephrol 2007; 39:1241-50. [PMID: 17846912 DOI: 10.1007/s11255-007-9260-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 07/16/2007] [Indexed: 02/05/2023]
Abstract
AIM We aimed to investigate in children with a history of acute pyelonephritis the influence of unilateral post-pyelonephritic renal scarring detected by DMSA scan on serum (S(CysC)) and urine cystatin C (U(CysC)) as well as upon other traditional markers of renal damage. METHODS Children with DMSA proven pyelonephritis (n = 28) were grouped as either scar [+] (n = 19, unilateral renal scarring) or scar [-] (no scarring, n = 9). The scar [+] group was further divided into scar-1 (differential DMSA uptake, Delta(DMSA) </= 10%; n = 8) and scar-2 (Delta(DMSA) > 10%, n = 11) subgroups. S(CysC), serum creatinine, urine NAG, microalbumin, protein, fractional sodium excretion (FE(Na)), tubular phosphate reabsorption (TPR), and U(CysC/Cr) were evaluated in all patients. RESULTS Neither S(CysC) nor U(CysC) were affected by age, height, and weight. scar [+] versus scar [-] groups and scar-1 versus scar-2 subgroups were not different with regard to all studied parameters. S(CysC) did not increase in children with post-pyelonephritic unilateral renal scarring. However, 11 children with slightly increased (>0.95 mg/l) S(CysC) levels in scar [+] group tended to have higher Delta(DMSA), albeit not significantly. Furthermore, U(CysC/Cr) correlated well with urine microalbumin, NAG, and FE(Na) in all children and the scar [+] group (P < 0.05). CONCLUSION S(CysC) and U(CysC) did not differ among pediatric patients with and without unilateral post-pyelonephritic renal scarring. However, Delta(DMSA) uptake between the two kidneys tended to be raised in children with S(CysC) levels higher than the reference ranges. Additionally, U(CysC/Cr) exhibits parallelism with tubular functions.
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Affiliation(s)
- Hüray Islekel
- Department of Biochemistry, Dokuz Eylül University School of Medicine, Izmir, Turkey
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Kebapci N, Yenilmez A, Efe B, Entok E, Demirustu C. Bladder dysfunction in type 2 diabetic patients. Neurourol Urodyn 2007; 26:814-9. [PMID: 17455274 DOI: 10.1002/nau.20422] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS To reevaluate urodynamic findings of bladder dysfunction (BD) in type 2 diabetic patients with patient characteristics and concommittant chronic complications. METHODS Patients (M/F:27/27) with lower urinary tract symptoms (LUTS) underwent a detailed urodynamic investigation. Urodynamic findings were classified as diabetic cystopathy [DC, characterized by impaired bladder sensation, increased post-void residual urine (PVR) and increased bladder capacity and decreased bladder contractility], detrusor overactivity, bladder outlet obstruction (BOO), urge and stress urinary incontinence or BD in which one of the alterations was included. Glycated hemoglobin (HbA1C), diabetic retinopathy, nephropathy, sensorimotor, and autonomic neuropathies were evaluated. RESULTS BD was present in 74.07% of men (DC, 50%; BOO, 25%; detrusor overactivity, 25%) and in 59.26% of diabetic women (DC, 43.75%; detrusor overactivity, 31%; urge incontinence, 12.5%; stress urinary incontinence 12.5%). In men, age, duration of diabetes and HbA1C threshold values predicting BD were >64 years, >9 year, >7.9%, while in women, they were >56 years, >8 years, >7%, respectively. Prolongation of QTc, abnormal esophageal transit and gastric emptying times, diabetic retinopathy, and microalbuminuria were associated with an increased risk of PVR >or= 100 ml. CONCLUSIONS DC was the most frequent finding in patients. Ageing, duration of diabetes, worse metabolic control, PVR 100 ml, cardiac, esophageal and gastric parasympathetic autonomic neuropathies, retinopathy, and microalbuminuria provided a means to predict BD in patients in order to investigate by urodynamics. The establishment of DC in at least 8-9 years after the diagnosis of type 2 DM was an important parameter to inform our diabetic patients.
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Affiliation(s)
- Nur Kebapci
- Department of Endocrinology and Metabolism, Osmangazi University Medical Faculty, Eskişehir, Turkey.
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Ishay A, Lavi I, Luboshitzky R. Prevalence and risk factors for asymptomatic bacteriuria in women with Type 2 diabetes mellitus. Diabet Med 2006; 23:185-8. [PMID: 16433717 DOI: 10.1111/j.1464-5491.2005.01758.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS Asymptomatic bacteriuria (ASB) has been considered as a complication in diabetic women. The reported data on the prevalence and various risk factors for ASB appear to be conflicting. Consequently, we investigated the prevalence and major risk factors of ASB in women with Type 2 diabetes mellitus. METHODS A total of 411 non-pregnant women (aged 59.6 +/- 10.8 years) with Type 2 diabetes, and 160 women without diabetes (aged 53.3 +/- 15.1 years) assigned as controls, attending an outpatient endocrine clinic in a university-affiliated teaching hospital, were included. All participating women were interviewed and screened for the presence of ASB. In all participants, fasting blood glucose, HbA(1c) and renal function were measured. Complications of diabetes were also assessed. RESULTS Of the 411 diabetic women, 25 (6.1%) had ASB, compared with four of 160 (2.5%) in control women (P = 0.07). Independent risk factors for the presence of ASB were albuminuria > 150 mg/24 h [odds ratio (OR) 4.96 (95% CI 1.64-15.0, P = 0.005)] and serum creatinine [OR 3.5 (95% CI 1.4-8.8, P = 0.008)]. No significant association was evident with age, BMI, duration of disease, glycaemic control assessed by HbA(1c) or chronic complications of diabetes, namely macrovascular disease, neuropathy and retinopathy. CONCLUSIONS Women with Type 2 diabetes are not at higher risk of developing ASB than non-diabetic women. Independent and significant risk factors for ASB are macroalbuminuria and serum creatinine. The low prevalence of ASB found in this study may be as a result of the ethnic origin of these women and the circumcised state of their partners.
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Affiliation(s)
- A Ishay
- Institute of Endocrinology, Haemek Medical Center, Afula, Israel.
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25
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Miglani S, Goswami R, Tandon N, Dudha A, Kochupillai N. Glycaemic control and microvascular complication among patients with youth onset diabetes in India using differing types of insulin and methods of glucose monitoring. Diabetes Res Clin Pract 2004; 65:183-5. [PMID: 15223231 DOI: 10.1016/j.diabres.2004.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/23/2004] [Accepted: 01/26/2004] [Indexed: 11/19/2022]
Abstract
We assessed whether insulin types and monitoring methods were relevant to glycaemic control, microvascular complications as well as costs of management in 208 patients with youth onset diabetes in India. The type of insulin and monitoring method used made no difference to the glycaemic and complication status. Cost considerations support bovine insulin use along with urine glucose monitoring as an appropriate approach to diabetes self care in developing countries.
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Hernández C, Simó R. Albumin excretion rate is not affected by asymptomatic urinary tract infection: a prospective study. Diabetes Care 2004; 27:1565-9. [PMID: 15220229 DOI: 10.2337/diacare.27.7.1565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate whether asymptomatic urinary tract infection (UTI) significantly influences the level of albumin excretion rate (AER) in diabetic patients. RESEARCH DESIGN AND METHODS We screened prospectively for UTI and AER in 765 type 2 diabetic subjects. AER was determined before and after antimicrobial therapy in those patients in whom an asymptomatic UTI was diagnosed (n = 59). To interpret the clinical significance of AER changes, the coefficient of biological variation (CVb) of the AER (CVb-AER) was assessed in a control group of type 2 diabetic patients without UTI (n = 56). RESULTS AER did not change after antimicrobial treatment either in the whole group of patients with UTI (pre: 13.8 microg/min [0.1-195] vs. post: 8.5 microg/min [0.1-185]; P = 0.1) or in those patients in whom the infection was eradicated (pre: 11.7 microg/min [0.1-195] vs. post: 7.1 microg/min [0.1-185]; NS). The CVb-AER was 64% in the control group and was inversely correlated with AER (r = -0.44; P = 0.001). The decrease of AER after antimicrobial therapy (55%) did not exceed the biological variation of AER (64%). Finally, UTI did not significantly influence the classification of diabetic patients as normo- or microalbuminuric. CONCLUSIONS Asymptomatic UTI does not increase AER in type 2 diabetic patients. Therefore, our results suggest that testing for UTI is not necessary when AER is measured in diabetic patients.
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Affiliation(s)
- Cristina Hernández
- Diabetes Research Unit, Division of Endocrinology, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, Barcelona, Spain
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Pugia MJ, Sommer RG, Kuo HH, Corey PF, Gopual DL, Lott JA. Near-patient testing for infection using urinalysis and immuno-chromatography strips. ACTA ACUST UNITED AC 2004; 42:340-6. [PMID: 15080569 DOI: 10.1515/cclm.2004.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractUrinary tract infections require costly confirmatory tests such as a urine culture to establish the diagnosis. Elimination of the culture step would save resources; diagnosis and treatment could begin in hours rather than days. We tested a new dip-and-read strip that uses immuno-chromatography (IC) to detect infectious agents in urine. We used a goat-derived polyclonal antibody with reactivity to the cell-wall proteins of
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Affiliation(s)
- Michael J Pugia
- Near Patient Testing Segment, Diagnostic Business Group, Bayer Healthcare, Elkhart, Indiana, USA
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Brown WW, Peters RM, Ohmit SE, Keane WF, Collins A, Chen SC, King K, Klag MJ, Molony DA, Flack JM. Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2003; 42:22-35. [PMID: 12830453 DOI: 10.1016/s0272-6386(03)00405-0] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Early identification of persons at risk for kidney disease provides an opportunity to prevent or delay its progression and decrease morbidity and mortality. Our hypothesis was that implementation of a targeted screening program in communities with high-risk populations would detect previously unidentified persons with or at high risk for chronic kidney disease (CKD) with a prevalence that exceeds that predicted for CKD in the general population. METHODS Persons with hypertension or diabetes or a first-order relative with hypertension, diabetes, or kidney disease were screened for kidney disease risk factors. Blood pressure, blood glucose level, serum creatinine level, hemoglobin level, microalbuminuria, hematuria, pyuria, body mass index, and estimated glomerular filtration rate (EGFR) were evaluated. RESULTS Six thousand seventy-one eligible persons were screened from August 2000 through December 2001: of these persons, 68% were women, 43% were African American, 36% were white, 10% were Hispanic, and 5% were Native American. Most reported high-school education or more (84%) and health insurance coverage (86%). Twenty-seven percent met the screening definitions for diabetes; 64%, for hypertension; 29%, for microalbuminuria; 8%, for anemia; 18%, for hematuria; 13%, for pyuria; 5%, for elevated serum creatinine level; 16%, for reduced EGFR; and 44%, for obesity. Among participants without a reported history of specified conditions, screening identified 82 participants (2%) with diabetes, 1,014 participants (35%) with hypertension, 277 participants (5%) with elevated serum creatinine levels, 839 participants (14%) with reduced EGFRs, and 1,712 participants (29%) with microalbuminuria. Thirty-five percent of participants with a history of diabetes had elevated serum glucose levels at screening (> or =180 mg/dL [10 mmol/L]), and 64% with a history of hypertension did not have blood pressure controlled to less than 140/90 mm Hg. Only 18% of participants with a history of diabetes and 31% with a reduced EGFR had blood pressure controlled to less than 130/80 mm Hg and less than 135/85 mm Hg, respectively. CONCLUSION Targeted screening is effective in identifying persons with previously unidentified or poorly controlled kidney disease risk factors, as well as persons with a moderately decreased EGFR.
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Affiliation(s)
- Wendy Weinstock Brown
- Division of Nephrology, St Louis VA Medical Center, St Louis University School of Medicine, St Louis 63106-1621, USA.
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Chang CH, Shiau YC, Lin CC, Kao CH, Hsu CH. Using Tc-99m DMSA renal scan to detect renal damage in Taiwanese women with Type 2 diabetes--a preliminary report. Endocr Res 2003; 29:1-7. [PMID: 12665313 DOI: 10.1081/erc-120018671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
UNLABELLED In this preliminary study, we compared control women and Type 2 diabetes mellitus (DM) women for the prevalence and type of renal damage as revealed by technetium-99m dimercapto-succinic acid (Tc-99m DMSA) renal scan. METHODS A total of 20 control women and 60 women with Type 2 DM received Tc-99m DMSA renal scan were included in this study. The 60 women with Type 2 DM were separated into three groups: 20 women without UTI history, 20 patients with cystitis histories only, and 20 with pyelonephritis histories. RESULTS All of the control women had normal Tc-99m DMSA renal scan findings. However, 38.3% of Type 2 DM wonmen had abnormal Tc-99m DMSA renal scan findings. Type 2 DM women without UTI history had no abnormal scan findings. The prevalence of abnormal renal scan findings was significantly higher in Type 2 DM women with pyelonephritis (90.0%) than with cystitis alone (25.0%). Renal scar findings were found only in Type 2 DM women with pyelonephritis (40.0%). CONCLUSIONS Compared with control women, women with Type 2 DM, especially if they had UTI and pyelonephritis histories, have a significantly higher prevalence of abnormal Tc-99m DMSA renal scan findings.
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Affiliation(s)
- Chao-Hsiang Chang
- Department of Urology, China Medical College Hospital, Taichung, Taiwan
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Wu HC, Huang WS, Lin CC, Lee CC, Kao A, Huang WS. Objective evidence of a high prevalence of renal damage in women with type 2 diabetes by technetium-99m DMSA renal cortex scan findings. Urology 2003; 61:50-4. [PMID: 12559263 DOI: 10.1016/s0090-4295(02)02111-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To compare control women with men and women with type 2 diabetes mellitus (DM) for the prevalence and type of renal damage due to urinary tract infections (UTIs) using technetium-99m dimercapto-succinic acid (99mTc DMSA) renal scanning. Women with DM have UTIs more often than do women without DM. It is unknown, however, what the prevalence and type of renal damage due to UTI are in these women. METHODS Three groups of patients: 28 control women without type 2 DM and a history of UTIs, 25 male patients with type 2 DM but without a history of UTIs, and 103 female patients with type 2 DM underwent 99mTc DMSA renal scan. The 103 women with type 2 DM were separated into three groups: 36 women without a history of UTIs, 34 patients with a history of cystitis only, and 33 with a history of pyelonephritis. RESULTS All the control women and male patients with type 2 DM without a history of UTIs had normal 99mTc DMSA renal scan findings. However, 39.8% of women with type 2 DM had abnormal 99mTc DMSA renal scan findings. Women with type 2 DM without a history of UTI had a significantly lower prevalence of abnormal renal scan findings than did those with a history of cystitis only or pyelonephritis. In addition, the prevalence of abnormal renal scan findings was significantly higher in women with type 2 DM with pyelonephritis than in those with a history of cystitis only. Renal scars on 99mTc DMSA renal scans were found in women with type 2 DM and a history of pyelonephritis. CONCLUSIONS Compared with control women and men with type 2 DM, women with type 2 DM, especially if they had a history of UTIs, had a significantly higher prevalence of abnormal 99mTc DMSA renal scan findings.
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Affiliation(s)
- Hsi-Chin Wu
- Department of Urology, China Medical College Hospital, Taichung, Taiwan
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