Urinary interleukin 6 and 8 concentrations in children with acute pyelonephritis, before and after treatment

Urinary tract infections [UTI] are common cause of morbidity and mortality especially in young children around the world. Pyelonephritis can lead to scar formation, and subsequent hypertension and renal failure. Interleukins play a major role in renal scar formation following febrile pyelonephritis. The aim of this study was to investigate the level of urinary interleukin-6 [UIL-6] and UIL-8 concentrations during the acute phase of pyelonephritis and after two kinds of treatment. UIL-6 and UIL-8 concentrations were determined by enzyme immunoassay in 34 children with acute pyelonephritis who were treated with Ceftriaxone plus steroids [case group] and in 20 patients treated with antibiotic alone [control group]. Cases and controls were age and sex matched. Urine samples were obtained at the time of presentation prior to drug administration and at follow-up 72 hours after initiation of medication. Creatinine concentrations were also determined, and cytokine/creatinine ratios were calculated. The differences between the cytokine/creatinine ratios in the initial urine samples and the follow-up samples were significant in the case group [p < 0.001], but not for the controls. In addition, combined antibiotic and steroids significantly decreased UIL-6 and UIL-8 concentrations compared with antibiotic alone [p < 0.05]. We conclude that steroids combined with antibiothics significantly decrease UIL-6 and UIL-8 levels in patients with acute pyelonephritis. This result can suggest that the clinical use of corticosteroids may prevent scar formation following pyelonephritis

[Diagnostic value of urinary N-Acetyl Glucose Aminidase in pyelonephritic patients]

Urinary tract infection [UTI] is one of the most common bacterial infections among children and its prevalence is between 5-7% in females and 1-1.6% in males.Urosepsis, febrile seizure, renal insufficiency and hypertension are common complications of acute pyelonephritis in children. The aim of this study was to evaluate the diagnostic value of urinary NAG in pyelonephritic patients. This is a Quasi Experimental study conducted between April 2005 and May 2006 on 72 children admitted in Mofid Hospital due to pyelonephritis. The first sample [fresh random urine] was obtained and its levels NAG and Creatinin were measured. The second one was obtained on 48th hour of after-treatment period. We examined pyelonephritic children [75% female] with mean age of 43 +/- 39 months. Post-treatment urinary NAG lavel was significantly higher than pre-treatment. Urinary NAG revealed to have a sensitivity of 78% and specificity of 72% in diagnosis of pyelonephritis. There was no significant correlation between urinary NAG level and CBC, ESR, CRP, Urinary WBC, Ultrasonography, DMSA scan and VCUG. We concluded that Urinary NAG is a sensitive and specific test in diagnosis of pyelonephritis

[Assessment of fever, WBC, ESR and CRP in the first urinary infection]

Background: urinary tract infection is one of the most popular infections in childhood, and pyelonephritis with delayed and improper treatment results in renal scarving

Objective: the present study was done for evaluation of the most important parameters in differentiating pyelonephritis from cystitis

Methods: this cross sectional study was done in Mofid children's hospital from 1999 for 3 years in about 96 children with the first U.T.I. Acute pyelowphritis diagnosed by D.M.S.A. scan. Parameters such as fever, E.S.R., C.R.P. and W.B.C. were searched in differentiation between these two diseases

Findings: 75% of patients were younger than 5 years old, and the most common symptoms were dysuria or urinary frequency, urinary incontinence and flank pain. The most isolated germ, was E.coli. C.R.P. [qualitative] was positive in 40 cases of pyelonephritis and 6 of cystitis. Fever, E.S.R., and W.B.C. are not important statistical parameters in differentiation between pyelonephritis and cystitis

Conclusion: C.R.P. is the most valuable parameter in differentiating pyelonephritis from cystitis, that has low sensitivity and specificity comparing D.M.S.A. scan