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[This corrects the article DOI: 10.3389/fneph.2023.1194989.].
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Introduction: SARS-CoV-2 infection in the pediatric population can be associated with a multiorgan inflammatory syndrome called children's multisystem inflammatory syndrome (MIS-C). The kidneys can be affected by a broad spectrum of possible injuries, whose pathogenetic mechanisms are still unclear.Case report: We report the case of a 5-year-old boy with severe cardiac involvement in the context of MIS-C. After two weeks of hospitalization, an abdominal ultrasound showed massive bladder "debris", followed by the onset of normoglycemic glycosuria. Over time, there was a progressive increase in glycosuria, and the presence of a mat of amorphous phosphate crystals was evidenced on urinary sediment. Together with the findings of hypo-uricemia, increased urinary uric acid, and globally increased urinary amino acids, a clinical picture of kidney proximal tubular damage with secondary Fanconi-like syndrome took shape. Discussion: This case report describes the case of a patient with MIS-C with cardiac and kidney involvement characterized by proximal tubular damage, which slowly improved but still persisted at the 8-month follow-up. The pathogenesis of the damage is unclear and probably multifactorial.
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INTRODUCTION: Debris within the bladder is commonly seen on ultrasound. The etiology of bladder debris is varied and the likelihood that urinary debris represents positive urine culture is under investigation. We hypothesize that bladder debris will increase the likelihood that a urine culture is positive compared to those without bladder debris. METHODS: We performed a retrospective review on children aged 0-17 years who had a voiding cystourethrogram with a catheterized urinalysis or urine culture, and who also had a renal and bladder ultrasound up to 1 week prior, the day of, or up to 2 days after their urine studies. Presence of bladder debris and debris severity was recorded. Positive urine culture was defined as a single bacterial strain ≥50,000 cfu/mL. Demographic information, including findings of reflux and hydronephrosis were compared. Sensitivity, specificity, and risk ratios were calculated for predicting positive urine culture in patients with urinary debris on ultrasound. RESULTS: A total of 445 patients met inclusion criteria between January and December 2014. The positive urine culture rate was 20%, and the rate of bladder debris was 22%. The mean age for those with and without bladder debris was 6.6 and 5.5 years, respectively (p = 0.02). 23% of girls had bladder debris, compared to 12% of boys (p = 0.04, see results table). The sensitivity and specificity for bladder debris in detecting positive urine cultures was 52% and 86%, respectively. Forty-seven percent of those with bladder debris had positive cultures, compared with 12% of those without debris (p < 0.01). The relative risk of positive urine culture if debris is present is 3.90 (95% CI 2.73-5.55). Hydronephrosis or vesicoureteral reflux did not affect the relationship between bladder debris and positive urine cultures. CONCLUSIONS: Nearly half of pediatric patients undergoing urological evaluation found to have bladder debris on ultrasound will have a positive urine culture. Debris is noted more commonly in girls and at a slightly higher age. The presence of debris is associated with a fourfold increase in detecting a positive urine culture, regardless of debris severity, hydronephrosis, or vesicoureteral reflux. Given this, it is of value to routinely document and look for the presence of any amount of bladder debris seen on ultrasound, as this finding can be used to augment clinical decision-making and warrants strong consideration for obtaining urine culture.
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Ultrasonografía/métodos , Vejiga Urinaria/diagnóstico por imagen , Infecciones Urinarias/diagnóstico , Adolescente , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Hidronefrosis/diagnóstico , Lactante , Recién Nacido , Masculino , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Urinálisis , Infecciones Urinarias/orina , Reflujo Vesicoureteral/diagnósticoRESUMEN
BACKGROUND: Renal and bladder ultrasound (RBUS) is recommended in evaluation of children after an initial, febrile urinary tract infection. Although it is not uncommon to observe debris within the bladder lumen on sonography, the significance of this finding is uncertain. Debris may be interpreted as an indication of ongoing infection, but there have been no studies to date investigating the association of bladder debris with a positive culture. OBJECTIVE: The aim of this study was to evaluate the association of bladder debris noted at the time of RBUS with positive urine culture results obtained from a catheterized specimen, among patients undergoing RBUS and voiding cystourethrogram (VCUG) on the same day. STUDY DESIGN: We performed a retrospective cross-sectional study of 3995 patients who presented for same-day RBUS and VCUG. RBUS reports were reviewed for the presence of bladder debris, and analysis was limited to patients under 60 months of age with a catheterized urine specimen sent for culture at the time of the studies. Those with prior postnatal imaging or a diagnosis of prenatal hydronephrosis or other GU abnormalities were excluded. Thirty-four subjects with bladder debris on RBUS were identified and matched to 155 controls based on age, gender, circumcision status, and presence of vesicoureteral reflux. A positive urine culture was defined as ≥50,000 colony forming units per mL of at least one organism. A conditional logistic regression model was used to evaluate the association between debris on RBUS and positive urine culture results. RESULTS: In conditional logistic regression stratifying by matching age, gender, circumcision status, and presence of vesicoureteral reflux, there was a statistically significant association between bladder debris on RBUS and positive urine culture result collected on the same day during VCUG (OR 7.88, 95% CI 1.88-33.04, p = 0.0048). This corresponds to a 688% increase in odds of positive urine culture for patients with debris (Table). DISCUSSION: This is the first study to evaluate the association between bladder debris on RBUS and positive urine culture, and it should serve as a starting point for future investigations. The study is limited in its generalizability to the sampled population; further work should evaluate the predictive value of RBUS debris among children without UTI history, with prior imaging or known genitourinary anomalies, or older children. CONCLUSION: Among children younger than 60 months old undergoing initial imaging for history of UTI, there is a significant association between bladder debris and a positive urine culture.
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Vejiga Urinaria/diagnóstico por imagen , Infecciones Urinarias/diagnóstico por imagen , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Ultrasonografía , Vejiga Urinaria/patología , Infecciones Urinarias/microbiología , Infecciones Urinarias/patologíaRESUMEN
OBJECTIVES: The purpose of this study was to determine the significance of urinary bladder debris detected by sonography. METHODS: We conducted a retrospective analysis of urinalysis results in age-matched patients with and without bladder debris detected by transabdominal sonography. Patients were recruited from a radiology database search for bladder sonograms either with words suggesting echogenic debris or by a clinical history suggesting an infectious course. The sonograms were randomized and read by a single radiologist, who was blinded to case versus control. The urinalysis and sonographic results were analyzed by the Fisher exact test. RESULTS: There was no statistically significant correlation between the finding of debris on sonography and the frequency of abnormal urinalysis results, regardless of the quality of debris (layering versus floating). The only variable that was significantly associated with abnormal urinalysis results was a clinical history suggesting infection. CONCLUSIONS: A urinalysis should not be routinely recommended to work up the finding of urinary bladder debris on sonography.