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Host and Bacterial Markers that Differ in Children with Cystitis and Pyelonephritis.

Published on Jun 1, 2019in The Journal of Pediatrics3.739
· DOI :10.1016/j.jpeds.2019.01.012
Nader Shaikh24
Estimated H-index: 24
(University of Pittsburgh),
Judith M. Martin19
Estimated H-index: 19
(University of Pittsburgh)
+ 17 AuthorsTimothy R. Shope11
Estimated H-index: 11
(University of Pittsburgh)
Abstract
Objective To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis. Study design We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelonephritis. Renal scans were interpreted centrally by 2 experts. We measured inflammatory proteins in blood and urine using LUMINEX or an enzyme-linked immunosorbent assay. We evaluated serum RNA expression using RNA sequencing in a subset of children. Finally, for children with Escherichia coli isolated from urine cultures, we performed a polymerase chain reaction for 4 previously identified virulence genes. Results Urinary markers that best differentiated pyelonephritis from cystitis included chemokine (C-X-C motif) ligand (CXCL)1, CXCL9, CXCL12, C-C motif chemokine ligand 2, INF γ, and IL-15. Serum procalcitonin was the best serum marker for pyelonephritis. Genes in the interferon-γ pathway were upregulated in serum of children with pyelonephritis. The presence of E coli virulence genes did not correlate with pyelonephritis. Conclusions Immune response to pyelonephritis and cystitis differs quantitatively and qualitatively; this may be useful in differentiating these 2 conditions.
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References45
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#1Sebastian Schwab (University of Bonn)H-Index: 2
#2Katarzyna Jobin (University of Bonn)H-Index: 3
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#1Makoto Mizutani (Yamaguchi University)H-Index: 2
#2Shunji Hasegawa (Yamaguchi University)H-Index: 17
Last. Shouichiohga (Kyushu University)H-Index: 34
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Abstract Background Acute focal bacterial nephritis (AFBN) is a severe form of upper urinary tract infection (UTI) with neurological manifestations and focal renal mass lesions on computed tomography (CT). Prolonged antibiotic therapy may improve the renal outcome, but the early differential diagnosis of AFBN from acute pyelonephritis (APN) is challenging. We searched for effective biomarkers of AFBN based on the pathophysiology of upper UTIs. Methods Of 52 upper UTI cases treated at Yamaguchi U...
5 CitationsSource
#1Gretchen S. Selders (U of M: University of Memphis)H-Index: 2
#2Allison E. Fetz (U of M: University of Memphis)H-Index: 2
Last. Gary L. Bowlin (U of M: University of Memphis)H-Index: 48
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#1Birong Li (Nationwide Children's Hospital)H-Index: 13
#2Babitha Haridas (UB: University at Buffalo)H-Index: 1
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Acquired renal scarring occurs in a subset of patients following febrile urinary tract infections and is associated with hypertension, proteinuria, and chronic kidney disease. Limited knowledge of histopathology, immune cell recruitment and gene expression changes during pyelonephritis restricts the development of therapies to limit renal scarring. Here, we address this knowledge gap using immunocompetent mice with vesicoureteral reflux. Transurethral inoculation of uropathogenic Escherichia col...
11 CitationsSource
Urinary tract infections are one of the most frequent bacterial infections of mankind. In spite of this frequency, the study of the immune system in the urinary tract has not attracted much attention. This could, in part, be attributable to the widespread use of antibiotics and similar antimicrobial agents, which for many decades have been both highly effective and relatively inexpensive to administer. In light of the emergence of multidrug-resistant bacteria among urinary tract infection isolat...
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#1Yasuyuki Nagasawa (Osaka University)H-Index: 5
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Diagnosis of chronic glomerulonephritis (CGN) depends primarily on renal biopsy, which is expensive and requires hospitalization, creating a demand for noninvasive diagnostic method for this disease. We used DNA microarray analysis to search for genes whose expression levels in peripheral blood mononuclear cells (PBMCs) could distinguish between patients with CGN and healthy volunteers (HVs). We selected immunoglobulin A nephropathy (IgAN) and membranous nephropathy (MN) as typical forms of CGN....
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#1Ghasemi KH-Index: 1
#2Esteghamati MH-Index: 1
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Urinary tract infections (UTIs) are among the most prevalent infections in children and infants. Early and accurate detection of renal parenchymal involvement in UTI is necessary for decision making and determining treatment strategies. The aim of this study was to determine the predictive accuracy of urinary neutrophil gelatinase-associated lipocalin (NGAL) for renal parenchymal involvement in children with acute pyelonephritis.This descriptive, cross-sectional study was conducted in 2014 on ch...
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#1Joshua R. Watson (OSU: Ohio State University)H-Index: 3
#2David S. HainsH-Index: 19
Last. Andrew L. Schwaderer (OSU: Ohio State University)H-Index: 11
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Background Pediatricians frequently use urinalysis to diagnose urinary tract infection (UTI) while awaiting urine culture results, but sensitivity and specificity of urinalysis are limited. This study evaluated the diagnostic accuracy of the antimicrobial peptides human α-defensin 5 (HD5) and human neutrophil peptides (HNP) 1-3 as novel UTI biomarkers in children.
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3 CitationsSource
#1Martin HambitzerH-Index: 1
Urinvagsinfektioner (UVI) ar ett vanligt halsoproblem som drabbar miljontals manniskor. Den allvarligaste formen, akut pyelonefrit (APN) kan ge svara komplikationer. Urinvagspatogena Escherichia coli (UPEC) som orsakar APN uttrycker P fimbrier som specifikt binder till glykosphingolipider pa ytan av uroepitelceller. Det satter igang en toll-like receptor 4 (TLR4) beroende men LPS-oberoende immunreaktion. Den roll som interferon beta (IFN-β) spelar vid bakterieinfektioner ar inte helt klarlagd me...
1 Citations
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#1Ana Cristina Simões e Silva (UFMG: Universidade Federal de Minas Gerais)H-Index: 33
#2Eduardo A. Oliveira (UFMG: Universidade Federal de Minas Gerais)H-Index: 26
Last. Robert H. Mak (UCSD: University of California, San Diego)H-Index: 33
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Abstract Objective This review aimed to provide a critical overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, chemoprophylaxis, and complications of urinary tract infection in pediatric patients. Source of data Data were obtained independently by two authors, who carried out a comprehensive and non-systematic search in public databases. Summary of findings Urinary tract infection is the most common bacterial infection in children. Urinary tract infectio...
Source
#1Clayton D. Albracht (WashU: Washington University in St. Louis)H-Index: 1
#2Teri N. Hreha (WashU: Washington University in St. Louis)
Last. David A. Hunstad (WashU: Washington University in St. Louis)H-Index: 23
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Urinary tract infections (UTIs) are generally considered a disease of women. However, UTIs affect females throughout the lifespan, and certain male populations (including infants and elderly men) are also susceptible. Epidemiologically, pyelonephritis is more common in women but carries increased morbidity when it does occur in men. Among children, high-grade vesicoureteral reflux is a primary risk factor for upper-tract UTI in both sexes. However, among young infants with UTI, girls are outnumb...
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