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Aksu B, Afonso AC, Akil I, Alpay H, Atmis B, Aydog O, Bayazıt AK, Bayram MT, Bilge I, Bulut IK, Buyukkaragoz B, Comak E, Demir BK, Dincel N, Donmez O, Durmus MA, Dursun H, Dusunsel R, Duzova A, Ertan P, Gedikbasi A, Goknar N, Guven S, Hacihamdioglu D, Jankauskiene A, Kalyoncu M, Kavukcu S, Kenan BU, Kucuk N, Kural B, Litwin M, Montini G, Morello W, Obrycki L, Omer B, Oner HA, Ozdemir EM, Ozkayin N, Paripovic D, Pehlivanoglu C, Saygili S, Schaefer F, Schaefer S, Sonmez F, Tabel Y, Tas N, Tasdemir M, Teixeira A, Tekcan D, Topaloglu R, Tulpar S, Turkkan ON, Uysal B, Uysalol M, Vitkevic R, Yavuz S, Yel S, Yildirim T, Yildirim ZY, Yildiz N, Yuksel S, Yurtseven E, Yilmaz A. Urine soluble TLR4 levels may contribute to predict urinary tract infection in children: the UTILISE Study. Pediatr Nephrol 2024; 39:483-491. [PMID: 37462743 DOI: 10.1007/s00467-023-06063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND One of the most common bacterial infections in childhood is urinary tract infection (UTI). Toll-like receptors (TLRs) contribute to immune response against UTI recognizing specific pathogenic agents. Our aim was to determine whether soluble TLR4 (sTLR4), soluble TLR5 (sTLR5) and interleukin 8 (IL-8) can be used as biomarkers to diagnose UTI. We also aimed to reveal the relationship between urine Heat Shock Protein 70 (uHSP70) and those biomarkers investigated in this study. METHODS A total of 802 children from 37 centers participated in the study. The participants (n = 282) who did not meet the inclusion criteria were excluded from the study. The remaining 520 children, including 191 patients with UTI, 178 patients with non-UTI infections, 50 children with contaminated urine samples, 26 participants with asymptomatic bacteriuria and 75 healthy controls were included in the study. Urine and serum levels of sTLR4, sTLR5 and IL-8 were measured at presentation in all patients and after antibiotic treatment in patients with UTI. RESULTS Urine sTLR4 was higher in the UTI group than in the other groups. UTI may be predicted using 1.28 ng/mL as cut-off for urine sTLR4 with 68% sensitivity and 65% specificity (AUC = 0.682). In the UTI group, urine sTLR4 levels were significantly higher in pyelonephritis than in cystitis (p < 0.0001). Post-treatment urine sTLR4 levels in the UTI group were significantly lower than pre-treatment values (p < 0.0001). CONCLUSIONS Urine sTLR4 may be used as a useful biomarker in predicting UTI and subsequent pyelonephritis in children with UTI. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Bagdagul Aksu
- Department of Pediatrics Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey.
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey.
| | - Alberto Caldas Afonso
- Division of Pediatric Nephrology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ipek Akil
- Division of Pediatric Nephrology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Harika Alpay
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Bahriye Atmis
- Pediatric Nephrology, Erzurum Training and Research Hospital, Erzurum, Turkey
- Division of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ozlem Aydog
- Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Aysun Karabay Bayazıt
- Division of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Meral Torun Bayram
- Division of Pediatric Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ilmay Bilge
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Koc University, Istanbul, Turkey
| | - Ipek Kaplan Bulut
- Division of Pediatric Nephrology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Bahar Buyukkaragoz
- Division of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Elif Comak
- Division of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Belde Kasap Demir
- Division of Pediatric Nephrology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
- Division of Pediatric Nephrology, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Nida Dincel
- Division of Pediatric Nephrology, Dr. Behcet Uz Children Diseases Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Osman Donmez
- Division of Pediatric Nephrology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Mehmet Akif Durmus
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasan Dursun
- Division of Pediatric Nephrology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ruhan Dusunsel
- Division of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pelin Ertan
- Division of Pediatric Nephrology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Asuman Gedikbasi
- Department of Rare Diseases, Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Nilufer Goknar
- Division of Pediatric Nephrology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sercin Guven
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Duygu Hacihamdioglu
- Division of Pediatric Nephrology, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Mukaddes Kalyoncu
- Division of Pediatric Nephrology, Faculty of Medicine, Karadeniz Technic University, Trabzon, Turkey
| | - Salih Kavukcu
- Division of Pediatric Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Bahriye Uzun Kenan
- Division of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nuran Kucuk
- Division of Pediatric Nephrology, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Bahar Kural
- Department of Pediatrics, Health Science University Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mieczysław Litwin
- Division of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Lukasz Obrycki
- Division of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Beyhan Omer
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Adil Oner
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Ebru Misirli Ozdemir
- Department of Pediatrics, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Nese Ozkayin
- Division of Pediatric Nephrology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Dusan Paripovic
- Division of Pediatric Nephrology, University Children's Hospital, Belgrade, Serbia
| | - Cemile Pehlivanoglu
- Division of Pediatric Nephrology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Seha Saygili
- Division of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
| | - Susanne Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
| | - Ferah Sonmez
- Division of Pediatric Nephrology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Yilmaz Tabel
- Division of Pediatric Nephrology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Nesrin Tas
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Tasdemir
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Koc University, Istanbul, Turkey
- Department of Pediatric Nephrology, Istinye University, Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Ana Teixeira
- Division of Pediatric Nephrology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Demet Tekcan
- Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sebahat Tulpar
- Division of Pediatric Nephrology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozde Nisa Turkkan
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Berfin Uysal
- Division of Pediatric Nephrology, Dortcelik Children's Hospital, Bursa, Turkey
- Division of Pediatric Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Metin Uysalol
- Division of Pediatric Emergency, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Renata Vitkevic
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Sevgi Yavuz
- Division of Pediatric Nephrology, Department of Pediatrics, Kanuni Sultan Suleyman Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sibel Yel
- Division of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Tarik Yildirim
- Department of Pediatrics, Kanuni Sultan Suleyman Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Yuruk Yildirim
- Department of Pediatrics Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Nurdan Yildiz
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Selcuk Yuksel
- Division of Pediatric Nephrology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Eray Yurtseven
- Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alev Yilmaz
- Department of Pediatrics Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
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Uzun Kenan B, Demircioglu Kilic B, Akbalık Kara M, Taktak A, Karabay Bayazit A, Yuruk Yildirim ZN, Delibas A, Aytac MB, Conkar S, Kaya Aksoy G, Donmez O, Yel S, Saygili S, Akaci O, Buyukkaragoz B, Alpay H, Bakkaloglu SA. Evaluation of the Claria sharesource system from the perspectives of patient/caregiver, physician, and nurse in children undergoing automated peritoneal dialysis. Pediatr Nephrol 2023; 38:471-477. [PMID: 35562513 PMCID: PMC9106572 DOI: 10.1007/s00467-022-05563-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Automated peritoneal dialysis (APD) is increasingly preferred worldwide. By using a software application (Homechoice with Claria sharesource system (CSS)) with a mod-M added to the APD device, details of the home dialysis treatment become visible for PD nurses and physicians, allowing for close supervision. We aimed to evaluate the perceptions of patients/caregivers, PD nurses, and physicians about the advantages and disadvantages of CSS. METHODS Three different web-based questionnaires for patients/caregivers, nurses, and physicians were sent to 15 pediatric nephrology centers with more than 1 year of experience with CSS. RESULTS Respective questionnaires were answered by 30 patients/caregivers, 22 pediatric nephrologists, and 15 PD nurses. Most of the nurses and physicians (87% and 73%) reported that CSS improved patient monitoring. A total of 73% of nurses suggested that CCS is not well known by physicians, while half of them reported reviewing CSS data for all patients every morning. Sixty-eight percent of physicians thought that CSS helps save time for both patients/caregivers and healthcare providers by reducing visits. However, only 20% of patients/caregivers reported reduced hospital visits. A total of 90% of patients/caregivers reported that being under constant monitoring made them feel safe, and 83% stated that the patient's sleep quality improved. CONCLUSIONS A remote monitoring APD system, CSS, can be successfully applied with children for increased adherence to dialysis prescription by giving shared responsibility and may help increase the patient's quality of life. This platform is more commonly used by nurses than physicians. Its potential benefits should be evaluated in further well-designed clinical studies with larger patient groups. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Bahriye Uzun Kenan
- Department of Pediatric Nephrology, Gazi University School of Medicine, Besevler, Ankara, Turkey
| | | | | | - Aysel Taktak
- Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | | | | | - Ali Delibas
- Mersin University School of Medicine, Mersin, Turkey
| | | | - Secil Conkar
- Ege University School of Medicine, Izmir, Turkey
| | | | - Osman Donmez
- Uludag University School of Medicine, Bursa, Turkey
| | - Sibel Yel
- Erciyes University School of Medicine, Kayseri, Turkey
| | - Seha Saygili
- Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Okan Akaci
- Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Bahar Buyukkaragoz
- Department of Pediatric Nephrology, Gazi University School of Medicine, Besevler, Ankara, Turkey
| | - Harika Alpay
- Marmara University School of Medicine, Istanbul, Turkey
| | - Sevcan A Bakkaloglu
- Department of Pediatric Nephrology, Gazi University School of Medicine, Besevler, Ankara, Turkey.
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