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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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Devrim F, Besin D, Colak R, Kantar A, Sorguc Y, Gülfidan G, Dincel N, Oral A, Calkavur S, Ağın H, Hosgör M, Bayram N, Devrim İ. Ultrasonographic evaluation of the children with candiduria for the fungal ball: Is It necessary? J Pediatr Urol 2021; 17:738.e1-738.e5. [PMID: 34389232 DOI: 10.1016/j.jpurol.2021.07.022] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Imaging of the urinary tract by ultrasonography (USG) or computerized tomography scanning is recommended for detecting structural abnormalities, hydronephrosis, abscesses, emphysematous pyelonephritis, or fungus ball formation. Limited studies on the epidemiology and the imaging results of candiduria were present in the children. AIM This study aimed to evaluate the results of renal ultrasonography imaging in hospitalized pediatric patients with candiduria. STUDY DESIGN In this descriptive study, we reviewed our ultrasonography findings with hospitalized children and infants who with candiduria. The study included the period between January 2012 and December 2019. Demographic data, the previous medical history, the clinical features of the patients, ultrasonographic findings of the urinary tract system, presence of an indwelling urinary catheter, type of urinary samplings, type of candida species were retrospectively recorded. The study was approved by Institutional Review Board with the registration number 2019/366. RESULTS During the study period, 220 children with nosocomial candiduria were evaluated. The most common isolated candida species was Candida albicans (68.2%) and followed by C. tropicalis (9.1%). Among all patients, 2 (0.9%) had renal fungal balls associated with C. Albicans. Twenty-five patients (11.4%) had findings including internal echogenicity in the bladder (n = 12), uroepithelial thickening of the kidney (n = 10), and sediments in the renal pelvis (n = 3). DISCUSSION Candida albicans was the most prominent candida isolated from the patients. The fungal ball is an uncommon infection especially in children and predominantly caused by Candida species. Fungal ball in the kidney was reported as case reports especially in neonates, in immunosupressed patients, and in patients who had undergone surgical procedures. In our study, none of the patients with the fungal ball were in the neonatal period, however, the patients with fungus ball had underlying disease or condition. Our study has several limitations including a retrospective study, and the USG were not performed by a single radiologist. Besides these limitations, our findings are important to give information about the place of USG for diagnosis of the renal fungal ball in children adding valuable information to a topic in which data came from mainly case reports. CONCLUSIONS Despite the low incidence of fungal balls reported, considering the high consequences of missing a fungal ball and elimination of it, a non-invasive method such as the renal bladder USG is still necessary for detection of fungal ball especially. More prospective studies are required for high risk groups to establish the diagnostic value of renal USG.
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Affiliation(s)
- Fatma Devrim
- Department of Pediatric Nephrology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Dorukhan Besin
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Rüya Colak
- Department of Neonatology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Aslı Kantar
- Department of Pediatric Nephrology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Yelda Sorguc
- Department of Microbiology and Clinical Microbiology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Gamze Gülfidan
- Department of Microbiology and Clinical Microbiology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Nida Dincel
- Department of Pediatric Nephrology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Akgün Oral
- Department of Pediatric Surgery, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Sebnem Calkavur
- Department of Neonatology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Hasan Ağın
- Department of Pediatric Intensive Care Unit, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Münevver Hosgör
- Department of Pediatric Surgery, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Nuri Bayram
- Department of Pediatric Nephrology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - İlker Devrim
- Department of Pediatric Nephrology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey.
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Özdemir K, Yilmaz E, Dincel N, Bozabali S, Apaydin S, Gun ZH, Sozeri B, Mir S. Association of clearance of middle- and large-molecular-weight substance with arterial stiffness and left ventricular mass in children receiving renal replacement therapy. Minerva Pediatr (Torino) 2017; 69:495-502. [DOI: 10.23736/s0026-4946.16.04253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kaplan Bulut I, Kara OD, Ozdemir K, Dincel N, Yilmaz E, Bulut MO, Sozeri B, Bicer H, Mir S. Are we late for the diagnosis of acute kidney injury in the intensive care units in pediatric patients? A preliminary, retrospective observational study among 66 patients. Minerva Pediatr 2016; 68:256-261. [PMID: 25411948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The purposes of this study were to emphasize the importance of Risk, Injury, Failure, Loss, and End-Stage (RIFLE) classification in early diagnose and prognosis of acute kidney injury (AKI), and to evaluate the practicability of the RIFLE criteria in intensive care units. METHODS Sixty-six patients applied acute peritoneal dialysis were included into the study. Patients having acute peritoneal dialysis within the first 24 hours of intensive care unit admission were named group 1, between 24-48 hours group 2, and those who had acute peritoneal dialysis 48 hours or more after admission to the intensive care unit were named group 3. Retrospectively, we evaluated patients by RIFLE criteria at the consultation time, and patients who had been just in AKI were called late referral patients. The mean interval time between the onset of AKI and the consultation time was defined as delay time in late referral patients. RESULTS There were 20 patients in group 1, 15 were in group 2 and 31 in group 3. In total there were 18/66 patients in risk, 13/66 in injury while 35/66 in failure. There was statistically difference between delay times of in risk and failure class in group 3 (P<0.05). Also delayed patient numbers of both risk and failure class were found statistically highly significant (P<0.001). CONCLUSIONS Most of the patients were in failure class at the time of consultation. We guess that if they would have been diagnosed earlier, prognosis might have been better. Therefore early diagnosis of AKI with RIFLE criteria and early initiation of acute peritoneal dialysis would probably improve prognosis.
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Affiliation(s)
- Ipek Kaplan Bulut
- Department of Pediatric Nephrology, Ege University Faculty of Medicine Izmir, Izmir, Turkey -
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Özdemir K, Dincel N, Kara OD, Yılmaz E, Gözüoğlu G, Mir S. Effect of treatment choice on survival in a case with meningococcemia and multiorgan failure. Dicle Med J 2016. [DOI: 10.5798/diclemedj.0921.2016.01.0664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mir S, Sozeri B, Deveci M, Ozdemir K, Gun ZH, Dincel N, Gozuoglu G, Yilmaz E, Kaplan Bulut I. Cardiovascular functional and structural changes in children with primary hypertension. Minerva Pediatr 2016; 68:27-35. [PMID: 25411943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Primary hypertension in children is not a benign condition because of end-organ damage. Early investigations of cardiovascular effects rely on vascular structural and functional changes. We aimed to determine presence of early cardiovascular involvement in children with primary hypertension. For this purposes, we investigated functional and morphological changes in vascular system. METHODS Seventy-five consecutive patients with primary hypertension and 35 healthy children comparable for age and gender were studied. Patients were classified according to the stages of blood pressure. Intima-media thickness of the carotid arteries (cIMT), carotid-femoral pulse wave velocity (PWVcf) and Pulse Wave Augmentation Index (AIx) and Left Ventricular Mass Index (LVMi) were investigated. RESULTS PWVcf and AIx were higher in patients (5.87±0.87 m/s vs. 5.29±0.67 m/s, P=0.02; 9.41±8.54% vs. 8.36±3.59%, P=0.04, respectively) than in controls. cIMT was evaluated significantly higher in study group than controls (0.46±0.06 mm vs. 0.35±0.12 mm, respectively, P=0.01). The mean LVMi was higher in patients (32.9±11.5 vs. 28.8±1.55, P=0.01). CONCLUSION Our results demonstrated that vascular findings were more sensitive for target organ changes than the more frequently utilized LVMi in patients with pre-hypertension.
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Affiliation(s)
- Sergi Mir
- Department of Pediatric Nephrology, Faculty of Medicine, Ege University, Izmir, Turkey -
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Kara OD, Dincel N, Kaplan Bulut I, Yilmaz E, Ozdemir K, Gozuoğlu G, Bicer H, Mir S. Success of continuous veno-venous hemodiafiltration treatment in children monitored in the intensive care units. Ren Fail 2015; 36:1411-5. [PMID: 25246342 DOI: 10.3109/0886022x.2014.950932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION As intensive care units (ICU) have improved, presence of multiple-organ dysfunctions in majority of patients with acute renal failure (ARF) has become clearer. To facilitate multi-organ support, continuous renal replacement therapy (CRRT) techniques have been developed. This study is the one that reports the experience on children including newborns receiving CRRT monitored in ICU. MATERIALS AND METHODS The study was performed retrospectively in children who had Continuous Veno- Venous Hemodiafiltration (CVVHDF) as a CRRT modality in ICU. Clinical data, primary cause, consultation time, duration and initiation time of CVVHDF were recorded. Patients were classified as cardiac and non-cardiac in respect to primary dysfunction. Stage of renal failure was evaluated according to pRIFLE criteria. Outcome was identified as primary and secondary. Primary outcome was accepted as the composite correction of uremia and metabolic parameters, and regression of fluid overload, while secondary outcomes were assessed as improvement of hemodynamic instability and survival. RESULTS A total of 36 patients' files were scanned. There were 10 cases in cardiac group and 26 cases in non-cardiac group. There were statistically better differences between primary and secondary outcome rates of cardiac cases. Although there was no difference between cardiac and non-cardiac cases in terms of primary outcome, secondary outcome was statistically significant. Timing of consultation and CVVHDF was not found to have an effect on the outcome. CONCLUSION Our results indicated that CVVHDF treatment was successful even in cardiac patients with high mortality and in patients at their later stage of ARF.
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Abstract
Nephrotic syndrome (NS) in the first year of life is uncommon and makes up a heterogeneous group of disorders. Subsequent studies have further defined the phenotype associated with mutations in the NPHS2 gene, revealing that patients usually develop NS from birth to 6 years of age. We report a child aged 4 months with steroid-resistant NS who had polymorphism of NPHS1 (E117K) and mutation of NPHS2 (P118L). Our patient was carrying a polymorphic NPHS1 mutation, while phenotypically she had a poor prognostic NPHS2 mutation. However, it must be questioned whether this polymorphic change (E117K) alters the signaling pathways of the podocytes and leads to P118L mutation, thus making it behave differently. Perhaps, this would be called a genetic modifier in future.
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Affiliation(s)
- Nida Dincel
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
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Sozeri B, Dincel N, Yilmaz E, Mir S. PW01-017 – Urine MMP-3 level as a biomarker for in FMF attack. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952635 DOI: 10.1186/1546-0096-11-s1-a70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dincel N, Resorlu B, Unsal A, Tepeler A, Silay MS, Armağan A, Diri A, Sancaktutar AA, Ziypak T, Mir S. Are small residual stone fragments really insignificant in children? J Pediatr Surg 2013; 48:840-4. [PMID: 23583144 DOI: 10.1016/j.jpedsurg.2012.07.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/21/2012] [Accepted: 07/23/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To assess the significance of asymptomatic residual stone fragments of less than 4mm (clinically insignificant residual fragments [CIRFs]) after shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) in children. PATIENTS AND METHODS Eighty-five children were followed up for 6 to 50months (median 22). Outcomes measured were fragment re-growth, stone events (emergency department visits, hospitalization, or additional interventions) and spontaneous fragment passage. RESULTS During follow-up, 22 children (25.8%) passed residual fragments spontaneously. Highest spontaneous passage rate was found for renal pelvis stones and the lowest for the lower pole stones (57.1% vs. 16.1%; p<0.001). When the number of the fragments increased, the chance of the spontaneous passage decreased (30% vs 20%; p<0.05). Symptomatic episodes including renal colic, hematuria, or urinary tract infection were documented in 34 (40%) patients, and re-growth of fragments was observed in 18 (21.2%). Stone size had no significant effect on spontaneous passage (p=0.079), stone growth (p=0.528), and symptomatic episodes (p=0.402). Twenty-five patients (29.4%) required secondary intervention for stone re-growth or stone related events and the remaining 20 patients (23.5%) needed medical treatment for bothersome symptoms or complications. CONCLUSIONS Our results suggest that 40% of children with CIRFs will become symptomatic and 20% will develop stone re-growth over the following 6months. Only one fifth of the fragments will pass spontaneously without any complications. Therefore, the use of the term "CIRF" is not appropriate for postoperative residual fragments in children.
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Affiliation(s)
- Nida Dincel
- Department of Pediatric Nephrology, Ege University, Faculty of Medicine, Izmir, Turkey
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Shi H, Wen J, LI Z, Elsayed M, Kamal K, LI Z, Wen J, Shi H, El Shal A, Youssef D, Caubet C, Lacroix C, Benjamin B, Bandin F, Bascands JL, Monsarrat B, Decramer S, Schanstra J, Laetitia DB, Ulinski T, Aoun B, Ozdemir K, Dincel N, Sozeri B, Mir S, Dincel N, Berdeli A, Mir S, Akyigit F, Mizerska-Wasiak M, Panczyk-Tomaszewska M, Szymanik-Grzelak H, Roszkowska-Blaim M, Jamin A, Dehoux L, Monteiro RC, Deschenes G, Bouts A, Davin JC, Dorresteijn E, Schreuder M, Lilien M, Oosterveld M, Kramer S, Gruppen M, Pintos-Morell G, Ramaswami U, Parini R, Rohrbach M, Kalkum G, Beck M, Carter M, Antwi S, Callegari J, Kotanko P, Levin NW, Rumjon A, Macdougall IC, Turner C, Booth CJ, Goldsmith D, Sinha MD, Camilla R, Camilla R, Loiacono E, Donadio ME, Conrieri M, Bianciotto M, Bosetti FM, Peruzzi L, Conti G, Bitto A, Amore A, Coppo R, Mizerska-Wasiak M, Roszkowska-Blaim M, Maldyk J, Chou HH, Chiou YY, Bochniewska V, Jobs K, Jung A, Fallahzadeh Abarghooei MH, Zare J, Sedighi Goorabi V, Derakhshan A, Basiratnia M, Fallahzadeh Abarghooei MA, Hosseini Al-Hashemi G, Fallahzadeh Abarghooei F, Kluska-Jozwiak A, Soltysiak J, Lipkowska K, Silska M, Fichna P, Skowronska B, Stankiewicz W, Ostalska-Nowicka D, Zachwieja J, Girisgen L, Sonmez F, Yenisey C, Kis E, Cseprekal O, Kerti A, Szabo A, Salvi P, Benetos A, Tulassay T, Reusz G, Makulska I, Szczepanska M, Drozdz D, Zwolnska D, Sozeri B, Berdeli A, Mir S, Tolstova E, Anis L, Ulinski T, Alber B, Edouard B, Gerard C, Seni K, Dunia Julienne Hadiza T, Christian S, Benoit T, Francois B, Adama L, Rosenberg A, Munro J, Murray K, Wainstein B, Ziegler J, Singh-Grewal D, Boros C, Adib N, Elliot E, Fahy R, Mackie F, Kainer G, Polak-Jonkisz D, Zwolinska D, Laszki-Szczachor K, Zwolinska D, Janocha A, Rusiecki L, Sobieszczanska M, Garzotto F, Ricci Z, Clementi A, Cena R, Kim JC, Zanella M, Ronco C, Polak-Jonkisz D, Zwolinska D, Purzyc L, Zwolinska D, Makulska I, Szczepanska M, Peco-Antic A, Kotur-Stevuljevic J, Paripovic D, Scekic G, Milosevski-Lomic G, Bogicevic D, Spasojevic-Dimitrijeva B, Hassan R, El-Husseini A, Sobh M, Ghoneim M, Harambat J, Bonthuis M, Van Stralen KJ, Ariceta G, Battelino N, Jahnukainen T, Sandes AR, Combe C, Jager KJ, Verrina E, Schaefer F, Espindola R, Bacchetta J, Cochat P, Stefanis C, Leroy S, Leroy S, Fernandez-Lopez A, Nikfar R, Romanello C, Bouissou F, Gervaix A, Gurgoze M, Bressan S, Smolkin V, Tuerlinkx D, Stefanidis C, Vaos G, Leblond P, Gungor F, Gendrel D, Chalumeau M, Rumjon A, Macdougall IC, Turner C, Rawlins D, Booth CJ, Simpson JM, Sinha MD, Arnaud G, Arnaud G, Anne M, Stephanie T, Flavio B, Veronique FB, Stephane D, Mumford L, Marks S, Ahmad N, Maxwell H, Tizard J, Vidal E, Amigoni A, Varagnolo M, Benetti E, Ghirardo G, Brugnolaro V, Murer L, Aoun B, Christine G, Alber B, Ulinski T, Aoun B, Decramer S, Bandin F, Ulinski T, Degi A, Degi A, Kerti A, Kis E, Cseprekal O, Szabo AJ, Reusz GS, Ghirardo G, Vidoni A, Vidal E, Benetti E, Ramondo G, Miotto D, Murer L. Paediatric nephrology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sozeri B, Mir S, Berdeli A, Dincel N, Sarsik B. Gene polymorphism of complement factor H in a Turkish patient with membranoproliferative glomerulonephritis type II. Iran J Kidney Dis 2012; 6:149-153. [PMID: 22388616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 09/19/2011] [Indexed: 05/31/2023]
Abstract
Membranoproliferative glomerulonephritis (MPGN) is characterized by proliferation of mesangial and endothelial cells and by thickening of the peripheral capillary walls. Type II of the MPGN is associated with complement abnormalities which are factor H deficiencies due to mutations in the complement factor H (CFH) gene. We report a 15-year-old boy diagnosed with MPGN II in whom genetic analyses of the CFH gene revealed that the patient was heterozygote for a polymorphism in exon 2 of the CFH (c.184G>A), heterozygote for a polymorphism in exon 9 of the CFH (c.1204C>T), and heterozygote for a polymorphism in exon 10 of the CFH (c.1419G>A). These data recapitulate a prototypical complement genetic profile, the presence of major risk factors for MPGN II, which support the hypothesis that these dense deposit diseases have a common pathogenic mechanism involving dysregulation of the alternative pathway of complement activation.
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Affiliation(s)
- Betul Sozeri
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey.
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Abstract
Background Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis. Patients manifest variable clinical symptoms (eg, microhematuria) with preserved or progressive deterioration of renal function resulting in end-stage renal disease. The aim of this study was to evaluate patients from a single center to describe the clinical features, treatments, and follow-up results of those with the disease. Methods This is a retrospective data study of all children with IgAN. Patients who had a histopathologically proven diagnosis of IgAN and were followed up for at least 5 years were included in the study. Renal biopsy, graded as Hass classification, was performed on all patients. A total of 39 patients were included in the study. Results The mean follow-up time (± standard deviation) was 10.4 ± 3.51 (range 5–16) years. Twenty-nine patients (74.4%) were male and ten (25.6%) were female. Nineteen (48.7%) patients presented with recurrent macroscopic hematuria, ten (25.6%) with microscopic hematuria ± proteinuria, six (15.4%) with nephritic syndrome, and four (10.3%) with nephrotic syndrome. All patients underwent a renal biopsy, which was graded according to the Hass classification. At the end of follow-up time, 18 (46.1%) patients were normal, 15 (38.5%) had minor urinary abnormalities, three (7.7%) had active renal disease, and three (7.7%) developed renal failure. Conclusion The results of the present study are better than those from most other series. The majority of children with IgAN in this study were admitted with recurrent macroscopic hematuria and found to have a good prognosis. We suggest that children with IgAN have a good prognosis in the first 5-year follow-up period.
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Affiliation(s)
- Ipek Kaplan Bulut
- Ege University Faculty of Medicine Department of Pediatric Nephrology, Izmir
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Sozeri B, Mir S, Kara OD, Dincel N. Growth impairment and nutritional status in children with chronic kidney disease. Iran J Pediatr 2011; 21:271-7. [PMID: 23056801 PMCID: PMC3446188] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 10/16/2010] [Accepted: 11/03/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Malnutrition is closely linked to chronic kidney disease (CKD) in adult patients with poor outcome. But data on pediatric patients is inadequate. The aim of this study was to describe the prevalence of growth failure and malnutrition in pediatric CKD patients and explore the relationship of these parameters to each other and to other clinical parameters. METHODS This study included 42 patients and 29 healthy children matched for age and gender. Patients were classified firstly in age group and secondly in therapy modalities. Nutritional evaluations were performed according to the Kidney Disease Outcomes Quality Initiative guidelines, and we performed adjustments using values from children with the same chronological age as reference. FINDINGS In pubertal group, the mean height SDS was lower than in pre-pubertal period while it was higher than in early childhood (P=0.4 and P=0.03 respectively). In all groups, 45% of patients had malnutrition: 20 patients on predialysis, 22 patients with end stage renal disease (14 on hemodialysis, and 8 on peritoneal dialysis). The mean weight SDS was lower in end stage renal disease groups (P<0.001). The height SDS was lower in end stage renal disease groups (P<0.001). CONCLUSION Growth failure and malnutrition remain a significant clinical problem as age and therapy modalities are dependent in children with CKD.
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Affiliation(s)
- Betul Sozeri
- Corresponding Author: Address: Ege University Faculty of Medicine, Department of Pediatric Nephrology Bornova, Izmir, Turkey. E-mail:
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Musial K, Ciszak L, Kosmaczewska A, Szteblich A, Frydecka I, Zwolinska D, Kilic O, Balat A, Pehlivan S, Kilic BD, Sever T, Buyukcelik M, Kul S, Makulska I, Szczepanska M, Drozdz D, Zwolinska D, Ulmeanu A, Viorela N, Ulmeanu C, Monteverde ML, Chaparro AB, Balbarrey Z, Marcos Y, Ibanez JP, Turconi AF, Diaz M, Harambat J, van Stralen KJ, Verrina E, Schaefer F, Jager KJ, Wikiera-Magott I, Hurkacz M, Kubicki D, Zwolinska D, Sozeri B, Mir S, Dincel N, Kara OD. Paediatric nephrology. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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