Nese Karaaslan Biyikli

The protective effect of oxytocin on renal ischemia/reperfusion injury in rats

AIM Oxytocin was previously shown to have anti-inflammatory effects in different inflammation models. The major objective of the present study was to evaluate the protective role of oxytocin (OT) in protecting the kidney against ischemia/reperfusion (I/R) injury. MATERIALS AND METHODS Male Wistar albino rats (250-300 g) were unilaterally nephrectomized, and subjected to 45 min of renal pedicle occlusion followed by 6 h of reperfusion. OT (1 mg/kg, ip) or vehicle was administered 15 min prior to ischemia and was repeated immediately before the reperfusion period. At the end of the reperfusion period, rats were decapitated and kidney samples were taken for histological examination or determination of malondialdehyde (MDA), an end product of lipid peroxidation; glutathione (GSH), a key antioxidant; and myeloperoxidase (MPO) activity, an index of tissue neutrophil infiltration. Creatinine and urea concentrations in blood were measured for the evaluation of renal function, while TNF-alpha and lactate dehydrogenase (LDH) levels were determined to evaluate generalized tissue damage. Formation of reactive oxygen species in renal tissue samples was monitored by chemiluminescence technique using luminol and lucigenin probes. RESULTS The results revealed that I/R injury increased (p<0.01-0.001) serum urea, creatinine, TNF-alpha and LDH levels, as well as MDA, MPO and reactive oxygen radical levels in the renal tissue, while decreasing renal GSH content. However, alterations in these biochemical and histopathological indices due to I/R injury were attenuated by OT treatment (p<0.05-0.001). CONCLUSIONS Since OT administration improved renal function and microscopic damage, along with the alleviation of oxidant tissue responses, it appears that oxytocin protects renal tissue against I/R-induced oxidative damage.

Oxytocin alleviates oxidative renal injury in pyelonephritic rats via a neutrophil-dependent mechanism

BACKGROUND Urinary tract infection (UTI) may cause inflammation of the renal parenchyma and may lead to impairment in renal function and scar formation. Oxidant injury and reactive oxygen species (ROS) have been found responsible in the pathogenesis of UTI. The neurohypophyseal hormone oxytocin (OT) facilitates wound healing and is involved in the modulation of immune and inflammatory processes. We investigated the possible therapeutic effects of OT against Escherichia coli induced pyelonephritis in rats both in the acute and chronic setting. METHODS Twenty-four Wistar rats were injected 0.1 ml solution containing E. coli ATCC 25922 10(10) colony forming units/ml into left renal medullae. Six rats were designed as sham group and were given 0.1 ml 0.9% NaCl. Pyelonephritic rats were treated with either saline or OT immediately after surgery and at daily intervals. Half of the pyelonephritic rats were decapitated at the 24th hour of E. coli infection, and the rest were followed for 7 days. Renal function tests (urea, creatinine), systemic inflammation markers [lactate dehydrogenase (LDH) and tumor necrosis factor alpha (TNF-alpha)] and renal tissue malondialdehyde (MDA) as an end product of lipid peroxidation, glutathione (GSH) as an antioxidant parameter and myeloperoxidase (MPO) as an indirect index of neutrophil infiltration were studied. RESULTS Blood urea, creatinine, and TNF-alpha levels were increased, renal tissue MDA and MPO levels were elevated and GSH levels were decreased in both of the pyelonephritic (acute and chronic) rats. All of these parameters and elevation of LDH at the late phase were all reversed to normal levels by OT treatment. CONCLUSION OT alleviates oxidant renal injury in pyelonephritic rats by its anti-oxidant actions and by preventing free radical damaging cascades that involves excessive infiltration of neutrophils.

Comparison of direct radionuclide cystography and voiding cystourethrography in detecting vesicoureteral reflux.

Background: Fluoroscopic voiding cystourethrography (VCUG) is a widely used imaging test for the diagnosis of vesicoureteral reflux (VUR). However, high gonadal radiation and intermittent imaging are the main disadvantages of VCUG. Direct radionuclide cystography (DRC) has been advocated for the detection of VUR with increased sensitivity and low radiation doses, however, having the disadvantage of providing less anatomical details for urethral evaluation. In this study, DRC has been compared with standard fluoroscopic VCUG for detection of VUR.

Contradictory supranormal function in hydronephrotic kidneys: fact or artifact on pediatric MAG-3 renal scans?

Objectives: Contradictory supranormal renal function (SRF) in unilateral hydronephrosis is a debatable subject resulting from the methodology of nuclear renography or the characteristics of the patient. In this study, we aimed to investigate the frequency and comparison of SRF with MAG-3 scans by 8 different technical analyses in pediatric hydronephrosis. Methods: We reviewed Tc-99m MAG-3 scans in 82 children with unilateral hydronephrosis (52 male, 30 female, mean age: 47.7 ± 64.5 months). Of 82, 34 also had Tc-99m DMSA scans. Data were reprocessed with 4 different regions of background activity (subrenal, perirenal C-type, perirenal ring, and lateral) at 2 different time intervals (1–2 and 2–3 minute), and 8 different estimates of MAG-3 differential renal function (DRF) were obtained in 67 patients. SRF was defined as DRF greater than 55% in the hydronephrotic kidney. Results: The routine processing protocol showed only 3 renal units with SRF, and all were on the right side (3.6%). After reprocessing, a total of 10 dilated kidneys had SRF in 1 or more of DRF estimates (5.2% of all estimations). These cases were significantly younger (8.1 ± 6.7 vs. 42.5 ± 52.5, P < 0.05) and had a larger renal area ratio (1.25 ± .24 vs. 1.07 ± .21, P < 0.05). There was no SRF with DMSA. In comparison between MAG-3 and DMSA DRF in 20 children who underwent both tests within 3 months, the best correlation was obtained when C-type correction was used for both agents at 2 time intervals (r: .86 and .84 for early and late time intervals, P < 0.00001, respectively). Conclusions: SRF in unilateral hydronephrosis is, at least, in part, technical in origin in this particular pediatric patient population with tubular immaturity (ie, physiological high background activity) and asymmetric kidney size.

Urinary tract pathogens and their antimicrobial resistance patterns in Turkish children

Urinary tract infections (UTIs) are among the most common bacterial diseases in childhood affecting approximately 3–5% of girls and 1% of boys [1]. There is growing concern regarding the resistance of urinary pathogens to commonly used antibiotics because of the increasing number of therapeutic failures after empiric treatment [2]. To ensure appropriate treatment, knowledge of the organisms that cause UTI and their antibiotic susceptibility is mandatory [3]. They need to be constantly reevaluated to achieve maximal clinical response before the antibiotic susceptibility of the isolate is known. The aim of this study was to assess the susceptibility of urinary pathogens to commonly used antibiotics in Turkish children with community-acquired UTI. Children who were admitted with the first episode of UTI to the Pediatric Outpatient Clinic and consulted to the Pediatric Nephrology Department between 2001 and 2003 were included in the study prospectively. UTI was defined as the growth of a single pathogen of greater than 100,000 colony-forming units/ml by a properly collected urine specimen in children with febrile disease or urinary symptoms. Transurethral catheterisation was chosen for children who were not toilet trained (387 children, 75.4% of all cases) and clean midstream specimen collection was preferred for toilet trained children. Antimicrobial susceptibility of the isolates was tested by the automatized identification technique called VITEK (bioMerieux, France). Five hundred thirteen uncomplicated community-acquired UTIs were detected in children aged 0–16 years (mean age 3.0 years); 271 (52.8%) of the children were female. The isolated microorganisms were Escherichia coli in 277 (54.0%), Klebsiella spp. in 88 (17.2%), Proteus spp. in 62 (12.1%), Staphylococci spp. in 31 (6.0%), Pseudomonas spp. in 15 (2.9%), Enterococcus spp. in 15 (2.9%), Enterobacter spp. in 13 (2.5%), and others in 12 (2.4%). Gram-positive cocci were isolated in 48 (9.3%) of UTIs. No vancomycin-resistant Enterococcus spp. were isolated. The antibiotic resistance patterns of different gram-negative pathogens are shown in Table 1. A high proportion of the isolates were resistant to ampicillin (69%), amoxicillin/ clavulanate (44%), cefazolin (39%) and trimethoprim– sulfamethoxazole (TMP-SMX) (32%). The most effective drugs against all the isolates were found to be cefepime (99%), cefixime (99%), ceftriaxone (90%), nitrofurantoin (83%) and cefuroxime (79%). There was no antimicrobial resistance to ciprofloxacin and aminoglycosides except in one case. In our study nearly half of the pathogens were resistant to amoxicillin/clavulanate and one-third of them were resistant to TMP-SMX which shows that empiric treatment with TMP-SMX and amoxicillin/clavulanate is inadequate. The results showing 21% resistance to cefuroxime, 17% resistance to nitrofurantoin and 1% resistance to cefixim led us to recommend these drugs for common treatment of UTI in Turkish children. Parenteral treatment options for treatment are second and third generation cephalosporins and aminoglycosides. Our results showed that resistance rates for these drugs are tolerable. Only 10% of the microorganisms displayed resistance to ceftriaxone and none of them showed resistance to aminoglycosides.

Paraoxonase 1 192 and 55 polymorphisms in nephrotic children

Human paraoxonase 1 (PON1) is a serum enzyme related to high-density lipoprotein which has a major role in preventing oxidative modification of low-density lipoprotein. Due to its amino acid substitution PON1 has two genetic polymorphisms. These polymorphisms are characterized by the location of glutamine (A genotype) and arginine (B genotype) at position 192, and leucine (L genotype) and methionine (M genotype) at position 55. Hyperlipidemia and increased lipid oxidation in nephrotic syndrome may lead to glomerulosclerosis and progression of the glomerular disease. In this study we aimed to investigate PON1 192 and PON1 55 polymorphisms in children with focal segmental glomerulosclerosis (FSGS) and control subjects. The study included 25 children with biopsy-proven FSGS and 30 healthy controls. We demonstrated a statistically significant difference between FSGS patients and control subjects with respect to the distribution of the PON1 polymorphism. The AA genotype was less frequent and the AB+BB genotype was more frequent in FSGS patients than in controls (48 versus 73% for AA genotype and 52 versus 27% for AB+BB genotype, p<0.05). Distributions of PON1 55 genotypes of FSGS and control subjects were also statistically different (76 versus 43% for LL genotype and 24 versus 57% for LM+MM genotype, p<0.05) (case-control study, dominant model, Fisher’s exact test). The distributions of both genotypes in subgroups of FSGS (stable renal function versus declining renal function) were not statistically different. We conclude in this preliminary study that presence of B allele and/or L allele may be risk factors for the development of FSGS in children.

Membranous nephropathy in Schimke immuno-osseous dysplasia

Schimke immuno-osseous dysplasia is a rare autosomal recessive multi-system disorder, with clinical features of growth retardation, spondylo-epiphyseal dysplasia, nephrotic syndrome and immunodeficiency beginning in childhood. Here, we report a new case, in a 10-year-old boy with characteristic symptoms of Schimke immuno-osseous dysplasia. The patient presented with short stature and, later, developed nephrotic syndrome and peritonitis. In addition, he had perinuclear anti-neutrophilic cytoplasmic antibody (p-ANCA)-positive arthritis. Renal pathology of the patients with this disease usually show focal segmental glomerulonephritis, whereas our patient had membranous nephropathy, which has not previously been reported.

Unusual cause of vaginal discharge

A 5.5-year-old girl was referred to the Pediatric Nephrology Department of Marmara University School of Medicine, Istanbul, Turkey for recurrent episodes of vaginal discharge. During the preceeding 12 months, she had yellowishbrownish foul smelling vaginal discharge, which became bloody 1 month prior to presentation. She had also disuria and dark-colored urine. She was seen in several hospitals with the same complaint and diagnosed as having urinary tract infection or vulvovaginitis and given antibiotics which led to the disappearance of the vaginal discharge. However, the disappearance lasted only for a month. Repeated urine cultures and vaginal smear cultures were sterile. The past history and family history was unremarkable. Physical examination revealed a healthy girl. Genitourinary examination in the frog-leg and prone positions revealed foul-smelling bloody discharge on the labia majora. Findings of trauma were not present. On rectal examination a round, firm mass was palpated. A thorough examination of the genital area was unsuccessful because of the anxiety of the patient. Laboratory investigations were normal including full blood count, C-reactive protein, renal function tests, coagulation markers and urinalysis. Abdominal, renal and pelvic ultrasonographies failed to demonstrate any anatomical abnormality or mass lesion. Abdominal and pelvic tomographies to visualize the suspected mass were planned as the second step of the investigation but before it was performed, genitourinary examination under general anesthesia was performed for detailed examination of the vagina. A plastic pencil cap was removed from the vagina during this examination (Fig. 1). Vaginoscopy was completed to rule out other foreign bodies and possible fistulas or strictures. There was no abnormality. On repeated questioning of the patient and the family the probability of insertion of the pencil cap while playing with an 8-year-old cousin was recalled by the family. After the occasion the patient had complained of genital discomfort and pain but external examination by the parents revealed no abnormality and the event was forgotten. The patient has been in good health since the discharge of the foreign body, with no complaint of discharge or disuria at regular Pediatric Nephrology visits over the past 2 years.

Changes in Bacterial Resistance Patterns of Pediatric Urinary Tract Infections and Rationale for Empirical Antibiotic Therapy

Background: The causative agent spectrum and resistance patterns of urinary tract infections in children are affected by many factors. Aims: To demonstrate antibiotic resistance in urinary tract infections and changing ratio in antibiotic resistance by years. Study Design: Retrospective cross-sectional study. Methods: We analysed antibiotic resistance patterns of isolated Gram (-) bacteria during the years 2011-2014 (study period 2) in children with urinary tract infections. We compared these findings with data collected in the same centre in 2001-2003 (study period 1. Results: Four hundred and sixty-five uncomplicated community-acquired Gram (-) urinary tract infections were analysed from 2001-2003 and 400 from 2011-2014. Sixty-one percent of patients were female (1.5 girls : 1 boy). The mean age of children included in the study was 3 years and 9 months. Escherichia coli was the predominant bacteria isolated during both periods of the study (60% in study period 1 and 73% in study period 2). Bacteria other than E. coli demonstrated a higher level of resistance to all of the antimicrobials except trimethoprim-sulfamethoxazole than E. coli bacteria during the years 2011-2014. In our study, we found increasing resistance trends of urinary pathogens for cefixime (from 1% to 15%, p<0.05), amikacin (from 0% to 4%, p<0.05) and ciprofloxacin (from 0% to 3%, p<0.05) between the two periods. Urinary pathogens showed a decreasing trend for nitrofurantoin (from 17% to 7%, p=0.0001). No significant trends were detected for ampicillin (from 69% to 71%), amoxicillin-clavulanate (from 44% to 43%), cefazolin (from 39% to 32%), trimethoprim-sulfamethoxazole (from 32% to 31%), cefuroxime (from 21% to 18%) and ceftriaxone (from 10% to 14%) between the two periods (p>0.05). Conclusion: In childhood urinary tract infections, antibiotic resistance should be evaluated periodically and empiric antimicrobial therapy should be decided according to antibiotic sensitivity results.

Çocuklarda sünnetin idrar yolu enfeksiyonu sıklığı üzerine etkisi Özgün Araştırma

Ozet Amac: Cocuklarda yenidogan donemi sonrasi yapilan sunnetin idrar yolu enfeksiyonu sikligi uzerine etkisini degerlendirmektir nbsp; Gerec ve Yontem: Idrar yolu enfeksiyonu geciren yaslari 1 70 ay ortanca 5 ay arasinda 56 erkek cocuk calismaya alindi Tum hastalara bobrek ultrasonografisi ve dimerkaptosuksinik asit sintigrafisi basvuruda uygulandi ldquo;Iseme sistouretrografisi rdquo; secilmis hastalara yapildi Otuz uc hastada vezikoureteral reflu tespit edilmedi 23 hastada 1 3 dereceli vezikoureteral reflu vardi Hastalardan duzenli araliklarla idrar kulturleri alindi idrar yolu enfeksiyonu idrar kulturunde gt;105 cfu ml tek bir organizmanin uremesi olarak tanimlandi Idrar ornegi basina sayi ve takip suresi ay boyunca gecirilen idrar yolu enfeksiyonu sikligi sunnet oncesi ve sonrasi degerlendirilerek karsilastirildi nbsp; Bulgular: Idrar yolu enfeksiyonu sikligi kultur basina sunnet oncesi ortanca 0 33 IR; 0 21 ve sunnet sonrasi 0 0 IR; 0 50 bulundu Takip suresi boyunca gecirilen idrar yolu enfeksiyonu sikligi sunnet oncesi ortanca 0 37 IR; 0 51 ve sunnet sonrasi 0 0 rsquo;di IR; 0 0 Vezikoureteral reflusu olmayanlar ve dusuk dereceli reflusu olanlar icin ayri ayri analiz yapildiginda benzer sekilde sunnet sonrasi idrar yolu enfeksiyonu sikliginin her iki grupta azaldigi goruldu Cikarimlar: Bu calismada yenidogan donemi sonrasi yapilan sunnetin vezikoureteral reflusu olan ve olmayan hastalarda idrar yolu enfeksiyonu sikligini azalttigi gosterilmistir Turk Ped Ars 2010; 45: 137 40 Anahtar sozcukler: Cocuk idrar yolu enfeksiyonu sunnet