Incidence of Vesicoureteral Reflux for Prepuberty Patients in Daegu City and Gyeongbuk Area according to the Clinical Indications, Gender and Age / 대한비뇨기과학회지

PURPOSE: The prevalence of vesicoureteral reflux (VUR) in prepuberty children with urinary tract infection (UTI) varies among the different racial groups. The purpose of this study was to determine if the incidence of VUR is associated with age, gender and the clinical indications for the prepuberty children with UTI in Daegu city and the Gyeongbuk area, and we wanted to compare our findings to those reported findings for the other racial groups. MATERIALS AND METHODS: The medical records of all 2,474 prepuberty children who underwent a voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC) between 1998 and 2003 were retrospectively reviewed. Age, gender and the clinical indications were recorded for the first VCUG or RNC. For the children with UTI, the highest grade of VUR and the number of UTIs were also examined. We analyzed the data by using chi square test and calculating the odds ratio with using SAS version 8.12. RESULTS: There were 2,037 prepuberty children with UTI (82.5%) among the 2,474 total subjects. Among the participants, 718 (35.2%) were female and 1,306 (64.1%) were male, and 13 were missing data. The overall rate of VUR was 21.2% (432/2,037) with a rate of 22.6% (162/718) for the females and 20.4% (267/1,306) for the males, respectively. With respect to the age distribution, none were younger than 1, 1 was younger than 2, the 2-6 year-olds were 17.3% (257/1,485), and the 7-12 year olds were 35.9% (103/287). Referring to the frequency of UTI, the patients experiencing their first, second. third, fourth, and over five episodes were 16.8%, 34.2%, 36.7%, 42.9% and 56.1%, respectively. As the patients got older, the first VCUG was done for recurrent UTI (p<0.05). CONCLUSIONS: We investigated the rate of VUR based on the clinical indications, age and gender among Korean preadolescents. The rate of reflux was 21.2% for the patients suffering with UTI. The female had VUD 1.1 times more frequent than did the males. The older patient had a higher reflux rate, which suggested that prepuberty children over 1 year of age with recurrent UTI should undergo their first VCUG or RNC.

The Suppressive Effect of Selenium on Renal Inflammation in a Rat Model of Pyelonephritis with Delayed Treatment / 대한비뇨기과학회지

PURPOSE: Some investigators have noted that the renal scarring that occurs after pyelonephritis is closely related to the inflammation or the free oxygen radicals rather than to direct injury by the bacterial infection. We examined whether delayed administration of the antioxidant agent selenium only or its combined administration with antibiotics suppresses renal scarring in a rat model of pyelonephritis. MATERIALS AND METHODS: An inoculum of 1x10(8) colony-forming units/ 0.1ml of Escherichia coli was injected directly into the renal parenchyma of both kidneys of 12 rats (n=24). The control group with 2 rats (n=4 kidneys) received injections of isotonic saline instead of bacterial solution. Three days after surgery, the animals were given the following treatment. In the pyelonephritis group, 2 rats (n=4) received isotonic saline intramuscularly twice daily for 5 days. For the antibiotic treatment group (antibiotic only), 3 rats (n=6) were treated with only with an antibiotic, ciprofloxacin (intramuscular injection, 15mg/kg twice daily) for 5 days. For the selenium treatment only group (selenium only), 4 rats (n=8) were treated with selenium (intraperitoneal injection, 0.5mg/kg twice daily). For the combined group (selenium antibiotic), 3 rats (n=6) received selenium (0.5mg/kg, intraperitoneal injection twice daily) and ciprofloxacin (15mg/kg, intramuscular injection twice daily) together. Six weeks after the bacterial inoculation, all the rats were killed and all the kidneys were examined histopathologically for renal scarring by using an OLYMPUS BX 51 microscope and I-solution. RESULTS: Delayed treatment with antibiotics-only or selenium-only had no effect on scarring compared with the untreated controls. However, the addition of selenium to the delayed antibiotic therapy significantly inhibited renal scarring compared with the pyelonephritis group or the antibiotic treated-only group or the selenium-treated only group (p<0.0001). CONCLUSIONS: These results suggest that selenium is effective in preventing renal scar formation during pyelonephritis when the initiation of antimicrobial treatment is delayed in this rat model of pyelonephritis.