RESUMEN
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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Infecciones Bacterianas , Cistitis/microbiología , Pielonefritis/microbiología , Infecciones Urinarias , Enfermedad Aguda , Infecciones Bacterianas/sangre , Infecciones Bacterianas/orina , Biomarcadores/análisis , Preescolar , Cistitis/sangre , Cistitis/diagnóstico , Cistitis/orina , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Masculino , Proyectos Piloto , Estudios Prospectivos , Pielonefritis/sangre , Pielonefritis/inducido químicamente , Pielonefritis/orina , Infecciones Urinarias/sangre , Infecciones Urinarias/orinaRESUMEN
La policitemia primaria es producida por una mutación adquirida o heredada en las células progenitoras de los glóbulos rojos, mientras que la poliglobulia secundaria está relacionada con un aumento de la eritropoyetina sérica como respuesta a la hipoxia tisular o a la producción autónoma tumoral. Hace más de medio siglo que se conoce que la hidronefrosis puede actuar como una rara causa de eritrocitosis debido al aumento de producción de eritropoyetina por un riñón que censa una disminución de oxígeno, mecanismo también observado en la estenosis de la arteria renal y en los quistes renales. Se describe a continuación el caso de un paciente de 38 años con poliglobulia atendido en el Hospital Italiano de San Justo (Argentina), que presenta como hallazgo una hidronefrosis unilateral severa y cuya resolución quirúrgica a través de una nefrectomía revierte el cuadro hematológico de base. (AU)
Primary polycythemia is produced by an acquired or inherited mutation in progenitor cells of red blood cells, while secondary polyglobulia is related to an increase in serum erythropoietin in response to tissue hypoxia or autonomous tumor production. Since the middle of the twentieth century, the hydronephrosis is known to be a rare etiology of secondary polycythemia, with increased erythropoietin production caused by diminished oxygen sensing by the kidney, also seen in renal artery stenosis and kidney cysts. We describe a case of a 38 year old patient with polycythemia studied in the "Hospital Italiano de San Justo" (Argentina) that presented an incidental severe unilateral hydronephrosis, and nephrectomy was carried out as a final resolution of the hematological disorder. (AU)
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Humanos , Animales , Masculino , Adulto , Persona de Mediana Edad , Policitemia/diagnóstico , Pielonefritis/diagnóstico , Infecciones Urinarias/complicaciones , Eritropoyetina/sangre , Hidronefrosis/diagnóstico , Nefrectomía/tendencias , Policitemia/complicaciones , Policitemia/etiología , Pielonefritis/sangre , Obstrucción de la Arteria Renal/patología , Dolor de la Región Lumbar , Hipoxia-Isquemia Encefálica/patología , Eritrocitos/fisiología , Enfermedades Renales Quísticas/patología , Disuria , Fiebre , Hidronefrosis/cirugía , Hidronefrosis/complicaciones , Anemia , Nefrectomía/métodosRESUMEN
INTRODUCTION: To investigate the role of initial procalcitonin (PCT) level as an early predictor of septic shock for the patient with sepsis induced by acute pyelonephritis (APN) secondary to ureteral calculi. MATERIALS AND METHODS: The data from 49 consecutive patients who met criteria of sepsis due to APN following ureteral stone were collected and divided into two groups: with (n=15) or without (n=34) septic shock. The clinical variables including PCT level for this outcome were retrospectively compared by univariate analysis, followed by multivariable logistic regression model. RESULTS: All subjects had hydronephrosis, and were hospitalized with the mean of 11.8 days (3-42 days). The mean size of the ureteral stones was 7.5mm (3-30mm), and 57% were located in upper ureter. At univariate analysis, patients with septic shock were significantly older, a higher proportion had hypertension, lower platelet count and serum albumin level, higher CRP and PCT level, and higher positive blood culture rate. Multivariate models indicated that lower platelet count and higher PCT level are independent risk factors (p=0.043 and 0.046, respectively). In ROC curve, the AUC was significantly wider in PCT (0.929), compared with the platelet count (0.822, p=0.004). At the cut-off of 0.52ng/mL, the sensitivity and specificity were 86.7% and 85.3%. CONCLUSION: Our study demonstrated elevated initial PCT levels as an early independente predictor to progress into septic shock in patients with sepsis associated with ureteral calculi.
Asunto(s)
Calcitonina/sangre , Pielonefritis/sangre , Choque Séptico/sangre , Cálculos Ureterales/sangre , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Progresión de la Enfermedad , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Valor Predictivo de las Pruebas , Pielonefritis/etiología , Curva ROC , Valores de Referencia , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Albúmina Sérica/análisis , Choque Séptico/etiología , Estadísticas no Paramétricas , Cálculos Ureterales/complicaciones , Adulto JovenRESUMEN
ABSTRACT Introduction: To investigate the role of initial procalcitonin (PCT) level as an early predictor of septic shock for the patient with sepsis induced by acute pyelonephritis (APN) secondary to ureteral calculi. Materials and Methods: The data from 49 consecutive patients who met criteria of sepsis due to APN following ureteral stone were collected and divided into two groups: with (n=15) or without (n=34) septic shock. The clinical variables including PCT level for this outcome were retrospectively compared by univariate analysis, followed by multivariable logistic regression model. Results: All subjects had hydronephrosis, and were hospitalized with the mean of 11.8 days (3–42 days). The mean size of the ureteral stones was 7.5mm (3–30mm), and 57% were located in upper ureter. At univariate analysis, patients with septic shock were significantly older, a higher proportion had hypertension, lower platelet count and serum albumin level, higher CRP and PCT level, and higher positive blood culture rate. Multivariate models indicated that lower platelet count and higher PCT level are independent risk factors (p=0.043 and 0.046, respectively). In ROC curve, the AUC was significantly wider in PCT (0.929), compared with the platelet count (0.822, p=0.004). At the cut-off of 0.52ng/mL, the sensitivity and specificity were 86.7% and 85.3%. Conclusion: Our study demonstrated elevated initial PCT levels as an early independent predictor to progress into septic shock in patients with sepsis associated with ureteral calculi.