Yılmaz Tabel

Association of TLR2 gene Arg753Gln polymorphism with urinary tract infection in children.

The aim of this study is to investigate Arg753Gln allele polymorphisms of toll‐like receptor‐2 (TLR2) gene distribution, allele frequency in urinary tract infection (UTI) and genotype–phenotype association of TLR2 gene in children with UTI. The polymorphism was investigated in 124 children with UTI (22 boys and 102 girls; mean age 5.81 ± 3.47 years) with direct DNA sequencing‐based method. TLR2 gene Arg753Gln allele frequency was higher in the patient group when compared with control group (OR 3.14, 95%CI 1.53–6.44, P < 0.001). The frequency of the Arg753Gln allele was significantly higher in gram‐positive group than in gram‐negative group (OR 7.64, 95%CI 2.80–20.81, P < 0.001). The frequency of UTI was found significantly higher in the Arg753Gln allele carriers of TLR2 gene than the non‐carriers (OR 4.94, 95%CI 1.09–22.33, P < 0.05). Similarly, the incidence of asymptomatic UTI was also found significantly higher in the group carrying Arg753Gln allele (OR 3.73, 95%Cl 1.54–9.04, P < 0.05). As a result, we suggest that TLR2 gene could be the predisposing factor for urinary tract infection. Additionally, we observed that subjects carrying the TLR2 Arg753Gln allele had higher risk of urinary tract infection with gram‐positive pathogens, history of more than two attacks of UTI and asymptomatic UTI.

The Role of Ghrelin in Weight Gain and Growth in Epileptic Children Using Valproate

Ghrelin is a major hormone, regulating the energy balance of the body. Weight gain is a significant side effect of valproic acid, which has not been clearly identified pathogenetically. The aim of this study was to investigate the effect of valproic acid on ghrelin and its potential effects on weight gain and growth. Each patient and control group consisted of 35 children aged 3 to 15 years. Fasting serum glucose, insulin, C-peptide, leptin, ghrelin, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 levels were measured in patients treated with valproic acid before and at month 6 of treatment. A significant increase in body weight, body mass index, height, and height standard deviation scores was observed in all patients after 6 months of treatment. Significant increases in growth velocity and weight gain were observed in the patient group compared with controls at 6 months of therapy. A significant increase in serum ghrelin levels (P < .01) was detected at the same time in the study group. A negative correlation of ghrelin with insulin-like growth factor-1 and insulin-like growth factor binding protein-3 was detected. Serum ghrelin levels were significantly increased (P < .05), and insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels were significantly decreased ( P < .01 and P < .05, respectively) in the prepubertal group at 6 months of treatment, but no significant change was observed in the pubertal group. Consequently, ghrelin levels significantly increase in the prepubertal children treated with valproic acid. The weight gain in using valproic acid may be associated with the increase in ghrelin level in the early treatment period.

Urinary Neutrophil Gelatinase-Associated Lipocalin as an Early Biomarker for Prediction of Acute Kidney Injury in Preterm Infants

BACKGROUND Our aims are to determine whether the urinary neutrophil gelatinase-associated lipocalin (uNGAL) can predict acute kidney injury (AKI) development in nonseptic and nonasphyxiated but critically ill preterm infants. METHODS Fifty preterm infants, gestational age (GA) between 28 and 34 weeks, were included in this case control study. Blood and urine samples were taken for blood urea nitrogen, serum creatinine, and uNGAL on postnatal (PN) days 1 and 7. uNGAL levels were measured by enzyme-linked immunoassay. Clinical and laboratory characteristics of the AKI group were compared with the non-AKI group. RESULTS AKI was diagnosed in six infants during the first week. The median uNGAL levels were significantly higher in the preterm infants with AKI than those of the controls on PN days 1 and 7 (p = 0.006 and p = 0.023, respectively). Backward stepwise logistic regression analysis identified that 5-minute Apgar score and uNGAL levels were significantly associated with the development of AKI, even after controlling for GA, birth weight, gender, and 1-minute Apgar score in nonseptic and nonasphyxiated but critically ill preterm infants. CONCLUSIONS uNGAL can be useful as a predictive marker of AKI in nonseptic and nonasphyxiated but critically ill preterm infants.

Clinical and Demographic Characteristics of Children with Urolithiasis: Single-Center Experience from Eastern Turkey

Objective: To evaluate the clinical and demographic findings of children with urolithiasis in eastern Turkey. Methods: We retrospectively reviewed the medical records of 67 children with urolithiasis for clinical and laboratory data. Results: Mean age at the time of diagnosis was 39.1 ± 41.2 months. Complaints at admission were: urinary tract infection (29.9%), macroscopic hematuria (26.9%), abdominal or flank pain (19.4%), spontaneous passing of the stone (8.9%), growth and developmental delay (7.5%), and non-specific findings (8.9%). A family history of urolithiasis was positive in 50.7% of patients. Metabolic screening could be performed in 47 (70.1%) of patients due to socioeconomic problems and revealed hypercalciuria in 59.6%, infectious stone in 17%, cystinuria in 6.4%, hyperuricosuria in 10.6%, hyperoxaluria 4.3%, and hypocitruria in 2.1%. Stone analysis of patients (26.9%) revealed calcium oxalate in 38.9%, calcium phosphate in 22.2%, uric acid in 16.7%, cystine in 11.2%, struvite in 5.6% and mixed content in 5.6%. Conclusion: We believe early diagnosis with detailed metabolic screening and appropriate treatment and follow-up procedures and the contribution of urolithiasis to end-stage renal disease can be avoided.

Neuroimaging Findings in Hyperargininemia

In hyperarginenemia, there is a defect in argininase enzyme, which is a catalyzer of urea cycle. Though the pathogenesis of neuronal damage in hyperargininemia is not clear, high serum and cerebrospinal fluid arginine levels can be directly related with neuronal damage. In this study, our aim was to assess brain magnetic resonance images and magnetic resonance spectroscopy (MRS) patterns of two siblings with hyperarginenemia. We acquired single voxel MRS from the white matter to show the myelination pattern and to figure out any abnormal peak of metabolite stored due to enzymatic defect. We observed mild cerebral and cerebellar atrophy and infarct at bilateral posterior putamen and insular cortex localization on conventional images and elevated choline/creatine ratios and abnormal peak at 3.8 ppm, most likely representing arginine deposition. To the best of our knowledge, this is the first article revealing the brain MRS pattern of hyperargininemia. We reported the clinical and imaging findings of patients and discuss the correlation.

Reference intervals of serum cystatin C for determining cystatin C-based glomerular filtration rates in preterm neonates

Abstract Objective: The aim of this study is to determine the reference values of serum Cystatin C (CysC) and CysC-based estimated glomerular filtration rate (GFR) on the 3rd and 30th day of life in comparison with serum creatinine (Cr) and Cr-based estimated GFR. Methods: This prospective study was performed on 52 preterm neonates whose gestational ages were between 28 and 34 weeks. Preterm neonates were divided into three groups according to the gestational age as follows: gestational week of 28–29 (group 1), gestational week of 30–32 (group 2) and gestational week of 33–34 (group 3). Blood samples were obtained on the 3rd and the 30th days of life. CysC was determined by particle-enhanced nephelometric immunoassay. Results: The group 1 preterm neonates have higher CysC values (1.34 ± 0.1 mg/L) on the 3rd day of life than the group 2 (1.28 ± 0.2 mg/L) and the group 3 (1.24 ± 0.2 mg/L) but the differences were not significant (p > 0.05, for each). CysC values were independent of gestational age, birth weight and gender (p > 0.05, for each). No correlation was found between CysC and Cr on the 3rd day of life (p > 0.05). Conclusions: CysC is regarded as an alternative for assessing the renal function in preterm neonates.

Platelet Counts in Children With Henoch-Schonlein Purpura--Relationship to Renal Involvement.

The aim of this study is to identify the clinical and laboratory risk factors for renal involvement and to determine the relationship between platelet counts and renal involvement in (Henoch–Schönlein purpura) HSP patients.

Lack of association between macrophage migration inhibitory factor gene promoter (-173 G/C) polymorphism and childhood Henoch-Schönlein purpura in Turkish patients.

Henoch-Schönlein purpura (HSP) is a small-vessel vasculitis of autoimmune hypersensitivity with rash, arthritis, abdominal pain and renal involvements. Macrophage migration inhibitory factor (MIF) is a immunoregulatory proinflammatory cytokine, and a major mediator at the inflammatory sites. The pathogenesis of HSP has not been fully elucidated. Here we aimed to assess the influence of macrophage migration inhibitory factor gene (-173 G/C) polymorphism in the susceptibility and clinical expression of patients with Henoch-Schönlein purpura (HSP). HSP patients (n:139) and ethnically matched healthy controls (n:100) were genotyped by PCR-RFLP. Genotype analysis of both polymorphisms did not reveal a significant deviation from Hardy-Weinberg equilibrium in any group (p > 0.05). No significant difference was obtained in genotype distribution (p > 0.05) and allele frequencies (p > 0.05) between patients and controls. A statistically significant genotype-phenotype correlation was not obtained when HSP patients were stratified by the presence of certain systemic complications and the macrophage migration inhibitory factor gene (-173 G/C) polymorphism (p > 0.05). A significant risk was not observed in the subjects both with the GC+CC genotype (p = 0.06, OR: 0.5538, 95% CI: 0.2985-1.0274) and C allele (odds ratio: C vs. G: 1.799, 95% CI: 1.002-3.23, p = 0.05). Our findings suggest that MIF gene -173 G/C polymorphism is not associated with HSP in the present Turkish population.

The long-term outcomes of idiopathic hypercalciuria in children

OBJECTIVE Idiopathic hypercalciuria (IH) is a metabolic risk factor in patients with urinary calcium stones and implicated in 30%-50% of all urinary stone diseases. Clinical manifestations and distribution of types of IH are reviewed, as well as current treatment methods and long-term outcomes. PATIENTS A total of 131 patients (70 boys and 61 girls), aged 1-15 years (mean 7.9+/-3.19 years), were studied. Follow up was between 6 months and 16 years (mean 4.1+/-6.8 years). RESULTS Fifty-three patients (40%) were diagnosed following calcium challenge as renal type, and 51 (39%) as absorptive type of hypercalciuria. Whereas 72 patients (54.9%) had a family history of nephrolithiasis, 59 patients did not. Nephrolithiasis was found in 27 patients (20%) on admission (absorptive=9.9%, renal=4.5%, undetermined=6.1%), but developed in eight other patients (6.1%) (absorptive=2.2%, renal=0.7%, undetermined=3.8%). Urinary calcium excretion reversed in 65 patients with the suggested diet therapy; it recurred in 30 patients (22.9%) (absorptive=9.1%, renal=11.4%, undetermined=2.2%) but 35 returned to normal definitively (26.7%) (absorptive=11.4%, renal=12.9%, undetermined=2.2%). No change was seen in the status of 50 patients (38.1%) (absorptive=18.3%, renal=16%, undetermined=3.8%). CONCLUSION IH may be accompanied by nephrolithiasis; type must be determined and those patients with absorptive type should be followed for nephrolithiasis. Our results suggest that formation of new stones could be prevented with diet and thiazide therapies in IH.

Analysis of urine biomarkers for early determination of acute kidney injury in non-septic and non-asphyxiated critically ill preterm neonates

Abstract Objective: We designed the present study to test the hypothesis that urinary biomarkers might predict acute kidney injury (AKI) development in non-septic and non-asphyxiated critically ill preterm infants. We evaluated urine (u) sistatin–C (uCys-C), kidney injury molecule–1 (uKIM–1) and neutrophil gelatinase associate lipocaline (uNGAL) as markers of AKI. Methods: Sixty-four preterm infants with gestational age between 28 and 32 weeks were included in this study. Biomarkers were measured on day of life (DOL) 1, 3, and 7. Results: uNGAL levels in the AKI group were significantly higher than in no-AKI group on DOL 1, 3 and 7 (p = 0.016, p = 0.007 and p = 0.0014, respectively). Conclusions: uNGAL is sensitive, early, and noninvasive AKI biomarkers, increasing significantly in non-septic and non-asphyxiated critically ill preterm neonates.