Urine endothelin-1 levels as a predictor of renal scarring in children with urinary tract infections.

AIMS: Endothelin-1 (ET-1) contributes to renal fibrogenesis in several manners such as increasing collagen synthesis in mesangium, decreasing extracellular matrix (ECM) degradation by mesangial cells and stimulating mesangial contraction. The aim of our study was to investigate whether urine level of ET-1 (uET-1) could represent a useful biomarker of renal scarring and if so, to determine the optimal cutoff level for uET-1 to predict a renal scar. METHODS: 44 children with renal scarring and 32 children without renal scarring were enrolled in the study. Urine ET-1 was measured by enzyme-linked immunosorbent assay. RESULTS: Mean uET-1 level was significantly higher in the scar group than in controls (2.75 ± 1.35 fmol/ml vs. 0.68 ± 0.41 fmol/ml, p = 0.001). The optimal cut-off level was 1.064 fmol/ml for uET-1 to predict renal scarring. Using this cut-off point, sensitivity and specificity were 97.73% and 93.91%, respectively. AUC was found 0.975 (95% CI 0.917 - 0.996) for uET-1. Mean urine Endothelin-1/Creatinine ratio (uET-1/Cr) was also significantly higher in the scar group than in the control group (4.04 ± 2.29 fmol/mg Cr vs. 1.09 ± 0.67 fmol/mg Cr, p = 0.0001). Using 1.67 fmol/mgCr as optimal cut-off level, sensitivity and specificity were 95.45% and 84.09%, respectively. AUC was 0.945 (95% CI 0.875 - 0.982) for uET-1/Cr. CONCLUSION: Our study suggests that both uET-1 and uET-1/Cr can be used for prediction of renal scarring in children with normal renal function. Measuring urine level of ET-1 can help us to avoid unnecessary DMSA studies if the patient's uET-1 level is found to be under the determined cut-off point.

Incidence assessment of rotavirus and adenovirus associated acute gastroenteritis cases in early childhood.

This study was undertaken to give an insight into the incidence of acute gastroenteritis cases of rotaviral/adenoviral aetiology in patients presenting to the emergency room of an inner-city government teaching hospital. Group A rotavirus and adenovirus serotype 40-41 antigen results were obtained via immunochromatography. In 2007, there were 1543 patients with gastroenteritis between 0-5 years of age whose stool samples were tested for rota and adenovirus, of whom 386 (25%) had positive stool samples for rotavirus, and 133 (8.6%) for adenovirus serotype 40-41. The majority of rotavirus (74.6%) and adenovirus (73%) cases were between 0-2 years of age. The peak season for rotavirus gastroenteritis was January (44%) and February (50.6%), whereas July (9.7%) and August (9%) were months of low incidence. For enteric adenoviral infections summer was the peak season, with August (20.9%) and July (17.3%) being the foremost months. Among the viral gastroenteritis cases, rotavirus infections were in the majority. A seasonal trend emerges for viral gastroenteritis: Rota virus infections are most frequently seen in winter whereas adenoviral infections prefer summer months. Both viruses mostly affect children up to 2 years.

Exertional rhabdomyolysis after influenza A (H3N2) infection in a basketball player boy.

A 14-year-old professional basketball player developed symptoms of influenza which was subsequently confirmed to be caused by influenza A (H3N2). He was given a 5-day course of oseltamivir. Two days after completing the course, he resumed basketball and developed rhabdomyolysis associated with acute renal failure and disseminated intravascular coagulation. This appears to be the first report of exercise-induced rhabdomyolysis associated with influenza A (H3N2).