Is there a relationship between renal scarring and neutrophil-to-lymphocyte ratio in patients with vesicoureteral reflux?

Objectives: Vesicoureteral reflux (VUR) exacerbates the risk of renal scarring by establishing a ground for pyelonephritis. It is known that the inflammatory process is more influential than the direct damage caused by bacterial infection in the development of renal scars after pyelonephritis. Therefore, the present study aims to investigate the relationship between renal scarring and systemic inflammatory markers in patients with VUR.Material and methods: Hundred and ninety-two patients (116 females, 76 males) diagnosed with VUR were divided into two groups based on the presence or absence of renal scarring and into three groups according to the grade of VUR (low, moderate and high). Neutrophil count, lymphocyte count, mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) were compared among the groups.Results: Of the 192 patients, 102 had renal scarring. The age and gender distribution did not differ significantly between the groups with and without renal scarring (p > 0.05). However, the grade of reflux and lymphocyte count were significantly higher in the group with renal scarring (p < 0.05), and the NLR was significantly lower in the group with renal scarring (p < 0.05). The lymphocyte count was significantly higher (p < 0.05) and NLR was significantly lower in the high-grade VUR group (p < 0.05). However, MPV values did not differ significantly (p > 0.05) between the groups. Conclusions: NLR can be used to predict renal scarring in patients with VUR, especially in the period of 3-6 months after the first attack of infection, and may even serve as a candidate marker for treatment selection. However, larger series and prospective studies are needed.

Retrospective Analysis of Antimicrobial Susceptibility of Uropathogens Isolated from Pediatric Patients in Tertiary Hospital at Al-Baha Region, Saudi Arabia

Introduction: Prompt diagnosis and initiation of treatment are essential in preventing long-term renal scarring. However, increasing antibiotic resistance may delay the initiation of appropriate therapy. Methodology: A retrospective chart review was performed for patients admitted to the pediatric department with urinary tract infection (UTI) diagnosis in a large tertiary care hospital in Al Baha, Saudi Arabia, from May 2017 to April 2018. The study included children of both sexes under the age of 14 years. Results: Out of 118 urinary bacterial samples, Escherichia coli was the main etiologic agent in the community- and hospital-acquired infections. The infection rate was higher in girls (68.64%) than in boys (31.36%). The commonest isolates were Escherichia coli (44.07%), extended-spectrum beta-lactamase-producing Escherichia coli (11.86%), Klebsiella pneumoniae (9.32%), Enterococcus faecalis (7.63%), methicillin-resistant Staphylococcus epidermidis (4.24%), and coagulase-negative Staphylococci (3.39%). The current study demonstrates that nitrofurantoin (19%) was the most commonly prescribed medication in the inpatient and outpatient departments, followed by trimethoprim/sulfamethoxazole (16%), amoxicillin/clavulanic acid (15%), cefuroxime (10%), azithromycin (8%), ceftriaxone (7%), and ciprofloxacin (4%), while amikacin, amoxicillin, ampicillin, cefepime, imipenem, phenoxymethylpenicillin were prescribed less commonly due to the high resistance rate. Conclusion: The microbial culture and sensitivity of the isolates from urine samples should be routine before starting antimicrobial therapy. Current knowledge of the antibiotic susceptibility patterns of uropathogens in specific geographical locations is essential for choosing an appropriate empirical antimicrobial treatment rather than reliance on recommended guidelines.

Artificial Intelligence assessment of Renal Scarring (AIRS study)

Background: The goal of the Artificial Intelligence in Renal Scarring (AIRS) study is to develop machine learning tools for non-invasive quantification of kidney fibrosis from imaging scans. Methods: We conducted a retrospective analysis of patients who had one or more abdominal computed tomography (CT) scans within 6 months of a kidney biopsy. The final cohort encompassed 152 CT scans from 92 patients which included images of 300 native kidneys and 76 transplant kidneys. Two different convolutional neural networks (slice-level and voxel-level classifiers) were tested to differentiate severe vs mild/moderate kidney fibrosis (≥50% vs <50%). Interstitial fibrosis and tubular atrophy scores from kidney biopsy reports were used as ground-truth. Results: The two machine learning models demonstrated similar positive predictive value (0.886 vs 0.935) and accuracy (0.831 vs 0.879). Conclusions: In summary, machine learning algorithms are a promising non-invasive diagnostic tool to quantify kidney fibrosis from CT scans. The clinical utility of these prediction tools, in terms of avoiding renal biopsy and associated bleeding risks in patients with severe fibrosis, remains to be validated in prospective clinical trials.

ANTIMICROBIAL RESISTANCE PATTERN OF VARIOUS UROPATHOGENIC ISOLATES CAUSING UTI: A STUDY FROM MEDICAL COLLEGE IN HIMACHAL PRADESH

BACKGROUND: Urinary tract infections (UTI) are one of the commonest community acquired and nosocomial infections encountered by clinicians in developing countries like India.Untreated UTI may lead to recurrence, renal scarring and renal failure. UTI is most often treated by empirical broad spectrum antibiotics.The main aim of this study was to identify the organism isolated from the urine and determine its antimicrobial resistance pattern so as to provide data for reference which may be of epidemiological and clinical importance regarding widespread multidrug resistance among uropathogens. MATERIAL AND METHODS: This study was conducted in the Department of Microbiology at DRPGMC Kangra at Tanda (Himachal Pradesh), India. Atotal of 3101 urine samples were collected from patients during a period of one and half year from April 2019 to September 2019.The urine samples were then cultured using a standard loop containing 0.01 ml of urine on CLED and MacConkey agar. The inoculated plates were incubated aerobically at 37°C for 18–24 hrs. Antimicrobial susceptibility was done on Mueller hinton agar plates that were incubated aerobically at 37°C for 18–24 hrs as per CLSI guidelines. RESULT: A total of 3101 clean catch samples were received in the Department of Microbiology,. Out of these only 640(20.64%) samples show signicant bacterial count. Among 640 samples with signicant bacterial count 178(27.81%) were from male and 462(72.19%) were from female patients.The common isolated Gram Negative bacteria were E. coli (68.3%) followed by Klebsiella spp. (11.7%). Susceptibility was seen in majority with fosfomycin, imipenem and nitrofurantoin. CONCLUSION: Escherichia coli remained the predominant isolate among enterobacterales and gram negative organisms, more commonly in females. Regular antimicrobial susceptibility is required to be carried out to see the current pattern of susceptibili

Evaluation of subclinical cardiovascular risk and cardiac function in children with vesicoureteral reflux: a prospective study

Background: Vesicoureteral reflux is a prominent congenital anomaly of the kidney and the urinary tract. Further, renal scarring is known to be related to chronic inflammation. However, there have been limited studies to date regarding the cardiovascular consequences of vesicoureteral reflux. Objective: The aim of this study is to evaluate the possible subclinical atherosclerosis and cardiovascular complications in children with vesicoureteral reflux. Methods: Patients with vesicoureteral reflux and age matched healthy controls were prospectively included in this case-control study. Patients were divided into two groups concerning renal scarring status. To assess cardiac functions, carotid artery intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses were evaluated. Results: There were 50 patients with vesicoureteral reflux; 26 patients without renal scarring and 24 patients with renal scarring, as well as 40 healthy controls. Myocardial performance indexes (Tei indexes) measured by tissue Doppler echocardiography from septum and left ventricle were significantly increased in study group (for all, p < 0.001). Also, intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses of the study groups were significantly higher than the control group (for all, p < 0.001). However, no statistical difference was observed between renal scarring (−) and renal scarring (+) groups. Conclusions: Results of our study showed early deterioration of cardiac systolic and diastolic functions in children with vesicoureteral reflux regardless of renal scarring. Also, diagnosis of vesicoureteral reflux is an important risk factor for subclinical atherosclerosis, independent of renal scarring, which should be considered in the follow-up of these patients.

Do Various Treatment Modalities of Vesicoureteral Reflux Have Any Adverse Effects in Pediatric Patients? A Meta-Analysis

<b><i>Purpose:</i></b> Vesicoureteral reflux (VUR) is a risk factor for various renal problems like recurrent urinary tract infections (UTIs), pyelonephritis, renal scarring, hypertension, and other renal parenchymal defects. The interventions followed by pediatricians include low-dose antibiotic treatment, surgical correction, and endoscopy. This meta-analysis aimed to assess the advantages and drawbacks of various primary VUR treatment options. <b><i>Search Strategy:</i></b> The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists of journals, and abstracts from conference proceedings were all used to find randomized controlled trials. The articles were retrieved from 1985 till 2020. Twenty articles were used for the data analysis. <b><i>Criteria for Selection:</i></b> Surgery, long-term antibiotic prophylaxis, noninvasive techniques, and any mix of therapies are also options for treating VUR. <b><i>Collection and Interpretation of Data:</i></b> Two authors searched the literature separately, determining research qualifications, assessing accuracy, and extracting and entering results. The odds ratio (OR) of these studies was used to construct the forest plot. The random-effects model was used to pool the data. Also, the random-effects model was used with statistical significance at a <i>p</i> value &#x3c; 0.05 to assess the difference in side effects after treatment of VUR using different modalities. <b><i>Results:</i></b> We found no statistically significant differences between surgery plus antibiotics and antibiotic alone-treated patients in terms of recurrent UTIs (OR = 0.581; 95% confidence interval [CI] 0.259–1.30), renal parenchymal defects (OR = 1.149; 95% CI 0.75–1.754), and renal scarring (OR = 1.042; 95% CI 0.72–1.50). However, the risk of developing pyelonephritis after surgical treatment of VUR was lesser than that in the conservative approach, that is, antibiotics (OR = 0.345; 95% CI 0.126–0.946.), positive urine culture (OR = 0.617; 95% CI 0.428–0.890), and recurrent UTIs were more common in the placebo group than in the antibiotic group (<i>p</i> &#x3c; 0.05; OR = 0.639; 95% CI 0.436–0.936) which is statistically significant. <b><i>Conclusion:</i></b> Based on current research, we recommend that a child with a UTI and significant VUR be treated conservatively at first, with surgical care reserved for children who have issues with antimicrobials or have clinically significant VUR that persists after several years of follow-up.

Protective effects of Omega-3 Fatty Acids supplementation against renal parenchymal scarring in children with acute pyelonephritis

Aim:: This trial aimed to determine if supplementation with omega-3 fatty acids as an adjunct therapy to antibiotic treatment can have protective effects against renal scar formation after acute pyelonephritis (APN) in pediatric patients. Background: Current evidence points out that besides antibiotic treatment, early administration of antioxidant and anti-inflammatory compounds may be effective in reducing the occurrence of renal damage following APN in children. Main: The main endpoint of the trial was the comparison of the development of renal scarring formation after APN in an omega-3 fatty acids-treated group and in a control-treated group. Methods: This prospective randomized, controlled trial study was conducted from March 2016 to May 2018 on 60 children with a diagnosis APN in a tertiary hospital in Iran. After the diagnosis of APN based on the clinical signs and symptoms, urine analysis, urine culture, and dimercaptosuccinic acid renal scan (DMSA scan), the patients were randomly allocated into either the control group (n=30 patients: received standard antibiotic treatment only) or the intervention group (n=30 patients: received standard antibiotic-treatment in combination with oral omega-3 fatty acids based on the children’s weight for three consecutive days). A second DMSA scan was performed for the patients at a minimum of six months after treatment. The development of renal scars was evaluated by comparing the baseline DMSA scan lesions with the follow-up DMSA scan lesions. Results: Fifty patients, including 26 and 24 individuals in the intervention and control groups, respectively, completed the entire course of the study. Renal parenchymal involvement based on the baseline DMSA scan was similar in the two groups (p-value =0.85, 0.90, and 0.53 regarding the right, left, and both kidney units together, respectively). Although comparison of the follow-up DMSA scan lesions to the baseline DMSA scan lesions considering the right and left kidneys as separate units between two groups did not reach the significant level, when considering both left and right kidney units together, results showed a statistically significant difference between groups in favor of the intervention group (p-value =0.04). Conclusions: Although preliminary, the results of this study showed that administration of omega-3 fatty acids, a natural supplement with well-known anti-inflammatory and antioxidant properties, as an adjunct therapy to standard antibiotic treatment might significantly reduce the incidence of the occurrence renal scarring following APN in children. Confirmation of these results requires further studies.