| 1. |
- Sjöström, Sofia, 1968, et al.
(författare)
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Bladder/bowel dysfunction in pre-school children following febrile urinary tract infection in infancy.
- 2021
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Ingår i: Pediatric nephrology (Berlin, Germany). - : Springer Science and Business Media LLC. - 1432-198X .- 0931-041X. ; 36, s. 1489-1497
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Tidskriftsartikel (refereegranskat)abstract
- An association between bladder-bowel dysfunction (BBD) and urinary tract infection (UTI) is well-known. However, a question less explored is whether children with UTI early in life also have increased prevalence of BBD after they are toilet-trained. In this study, consecutively selected children with pyelonephritis during their first year of life were assessed for BBD at pre-school age.Ninety-two children (51 boys) hospitalized due to pyelonephritis during their first year of life were assessed for BBD at median age 5.4years. A validated BBD questionnaire, along with urine flow and residual volume measurements, was used for diagnosing BBD. During follow-up, the group was well-characterized regarding renal status, vesicoureteral reflux (VUR), and recurrent UTI.BBD was diagnosed in 35/92 (38%), of which the majority was sub-diagnosed with dysfunctional voiding (DV). There was a strong association between BBD and recurrent UTI during follow-up (p<0.0001), but only a slight association with VUR status at presentation. Nevertheless, in the group with both BBD and VUR, recurrent UTI was four times higher (12/13, 92%) than in children who had neither VUR nor BBD (23%), (p=0.0008). BBD was also associated with kidney damage (p=0.017).In children with pyelonephritis during the first year of life, 38% had BBD at pre-school age, regardless of whether they had VUR or not. The study shows an important association between BBD and recurrent UTI, so an assessment of BBD is therefore recommended for pre-school children with UTI, especially when they have history of pyelonephritis during infancy.
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| 2. |
- Bergdahl, Ebba, et al.
(författare)
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Longitudinal follow-up on vascular morphology and function in children with kidney transplants.
- 2022
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Ingår i: Acta paediatrica (Oslo, Norway : 1992). - : Wiley. - 1651-2227 .- 0803-5253. ; 112:3, s. 557-568
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Tidskriftsartikel (refereegranskat)abstract
- Our aim was to evaluate cardiovascular risk profile in 42 children with kidney transplants (KT) at the Queen Silvia Children's Hospital, Gothenburg Sweden.Forty-two children (7.1-18years) with KT, time from transplantation 3.5 (0.9-13) years, were examined at inclusion and annually for three consecutive years. Eighteen matched controls were examined once. Cardiovascular phenotyping included ultra-high frequency ultrasound (UHFUS), pulse wave velocity (PWV) and endothelial function.Children with KT had higher body mass index (BMI) z-score and blood pressure (BP) z-score than healthy controls (BMI z-score: 0.4 ±1.0 and -0.2 ±0.9, respectively, p=0.02; SBP z-score: 0.5 ± 0.9 and -0.8 ± 0.7; DBP z-score: 0.7 ± 0.7 and -0.3 ± 0.5, respectively, p<0.001). BP z-score decreased significantly over three years, other vascular markers remained unchanged. PWV and Carotid intima thickness (IT) was higher in children with KT compared to healthy controls. Children with preemptive KT had lower radial IT and dorsal pedal media thickness (MT) compared to children with preceding dialysis.Children with KT show increased cardiovascular risk parameters, not increasing over time. Children on dialysis before KT have more pronounced vascular changes than those with preemptive KT, suggesting preemptive transplantation more beneficial for cardiovascular health.
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| 3. |
- Brandström, Per, 1959, et al.
(författare)
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How Swedish guidelines on urinary tract infections in children compare to Canadian, American and European guidelines
- 2021
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 110:6, s. 1759-1771
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Forskningsöversikt (refereegranskat)abstract
- Urinary tract infections (UTI) are common in children and the guidelines focus on preventing kidney damage. We compared the 2013 national Swedish guidelines on UTIs in children with the guidelines from America, Canada, UK, Spain, Italy and European urologists. This showed that urinalysis and urine cultures are endorsed by all the guidelines, but sampling techniques and bacteria levels differ. They all recommend initial oral treatment and renal ultrasound to detect major anomalies in infants. The Swedish guidelines are more liberal on antibiotic prophylaxis. Conclusion Differences in diagnostic criteria, workup and accepted methods for urine sampling were noted and are discussed.
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| 4. |
- Brandström, Per, 1959, et al.
(författare)
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Long-term, low-dose prophylaxis against urinary tract infections in young children.
- 2015
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Ingår i: Pediatric nephrology (Berlin, Germany). - : Springer Science and Business Media LLC. - 1432-198X .- 0931-041X. ; 30:3, s. 425-32
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Tidskriftsartikel (refereegranskat)abstract
- Urinary tract infection (UTI) affects about 2 % of boys and 8 % of girls during the first 6 years of life with Escherichia coli as the predominant pathogen. Symptomatic UTI causes discomfort and distress, and carries a risk of inducing renal damage. The strong correlation between febrile UTI, dilating vesicoureteral reflux (VUR), and renal scarring led to the introduction of antibiotic prophylaxis for children with VUR to reduce the rate of UTI recurrence. It became common practice to use prophylaxis for children with VUR and other urinary tract abnormalities. This policy has been challenged because of a lack of scientific support. Now, randomized controlled studies are available that compare prophylaxis to no treatment or placebo. They show that children with normal urinary tracts or non-dilating VUR do not benefit from prophylaxis. Dilating VUR may still be an indication for prophylaxis in young children. After the first year of life, boys have very few recurrences and do not benefit from prophylaxis. Girls with dilating VUR, on the other hand, are more prone to recurrences and benefit from prophylaxis. There has been a decline in the use of prophylaxis due to questioning of its efficacy, increasing bacterial resistance, and a propensity to low adherence to medication. Alternative measures to reduce UTI recurrences should be emphasized. However, in selected patients carefully followed, prophylaxis can protect from recurrent UTI and long-term sequelae. 1. There is a strong correlation between UTI, VUR, and renal scarring. 2. Children with normal urinary tracts or non-dilating VUR do not benefit from prophylaxis. 3. Young children, mainly girls, with dilating VUR are at risk of recurrent UTI and acquired renal scarring and seem to gain from antibiotic prophylaxis. 4. Increasing bacterial resistance and low adherence with prescribed medication is a major obstacle to successful antibiotic prophylaxis.
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| 5. |
- Brandström, Per, 1959, et al.
(författare)
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Njurskada hos barn randomiserade till profylax, endoskopisk injektion eller observation. Resultat från Svenska Refluxstudien : Renal damage in childen randomized to prophylaxis, endoscopic injection or surveillance. Results from the Swedixh Reflux Study.
- 2009
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Ingår i: Konferensprogram, 43rd Annual Scientific Meeting of the European Society for Paediatric Nephrology. 2-5 september 2009, Birmingham, England..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives and Study: To compare the risk of renal damage in children with dilated vesicoureteral reflux (VUR) grade III-IV randomized to antibiotic prophylaxis, endoscopic injection or surveillance. Methods: Children 1-2 years of age with VUR III-IV were randomized to one of the three treatment arms. Voiding cystourethrography (VCUG) and DMSA scintigraphy were performed at entry and after 2 years. End points were febrile urinary tract infections (UTI), development of renal damage and VUR. Abnormality on DMSA was defined as a focal defect with split function of 45% or more (class 1), split funtion 40-44% irrespective of focal defects (class 2), or split funtion <40% (class 3). Progress of damage was defined as a decrease in split function of 3% or more, and new damage reduced uptake in a previously normal area of the kidney. Results: The included 203 children were allocated to prophylaxis (n=69), endoscopic treatment (n=66), and surveillance (n=68). At entry 123 patients had an abnormal DMSA; 18 of these were bilateral. At the 2 year DMSA, 23 showed progress of damage with no difference between treatment arms. Progress of renal damage was seen in 12 of 49 (24%) children with febrile recurrences as compared to 11 of 154 (7%) in those without febrile recurrences (p<0.001). New renal damage was seen in 10 of 49 (20%) children with febrile recurrences as compared to 4 of 154(2.5%) of those without febrile recurrences (p<0.0001). Conclusions: New damage occurred significantly more often in the surveillance and endoscopic groups than in the prophylaxis group. There was no difference in progress of renal damage between the three treatment arms. The risk of progress of renal damage as well as development of new renal damage was significantly correlated to the rate of recurrent febrile UTIs. In this study of small children with VUR grade III-IV antibacterial prophylaxis reduced the risk of new renal damage and recurrent UTI.
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| 6. |
- Brandström, Per, 1959, et al.
(författare)
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Renal damage in children randomized to prophylaxis, endoscopic injection, or surveillance
- 2010
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Ingår i: European Society for Paediatric Urology Annual Meeting, 28 april-1 maj 2010, Antalya, Turkiet.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- PURPOSE To compare the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance (control group). MATERIAL AND METHODS Included were 203 children, 128 girls and 75 boys, aged 1 to less than 2 years with reflux grade III to IV. Voiding cystourethrography and 99mTcdimercaptosuccinic acid scintigraphy were performed before randomization and after 2 years. Febrile urinary tract infections were recorded during the follow-up. Data analysis was performed according to the intention-to-treat principle. RESULTS New renal damage in a previously unscarred area was seen in 15 children, 13 girls and 2 boys. Eight of these 13 girls were in the surveillance, 5 in the endoscopic, and none in the prophylaxis group (p=0.0155). New damage was seen more often in children with (11/49, 22%) than without (4/152, 3%) febrile recurrence (p<0.0001). CONCLUSIONS In boys the rate of new renal damage was low. It was significantly higher in girls, being most frequent in the surveillance (control) group. There was also a strong association between febrile UTI recurrence and development of new renal damage in girls.
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| 7. |
- Brandström, Per, 1959, et al.
(författare)
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Swedish Reflux Trial in Children - Pattern of Urinary Tract Infections
- 2010
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Ingår i: European Society for Paediatric Urology Annual Meeting, 28 april-1 maj 2010, Antalya, Turkiet.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- PURPOSE To evaluate the difference in rate of febrile urinary tract infection in small children with dilating vesicoureteral reflux, randomly allocated to 3 management alternatives: antibiotic prophylaxis, endoscopic treament, or surveillance only (control group). MATERIAL AND METHODS From 23 centers, a total of 203 children were included, 128 girls and 75 boys aged 1 to less than 2 years. Vesicoureteral reflux grade III (n=126) or IV (n=77) was detected after a febrile urinary tract infection in 194 and after antenatal screening in 9. Voiding cystourethrography and dimercaptosuccinic acid scintigraphy were performed before randomization and after 2 years. The rate of symptomatic febrile urinary tract infections was analyzed according to the intention-to-treat principle. RESULTS There were 67 febrile recurrences in 42 girls and 8 recurrences in 7 boys (p=0.0001). There was a difference in recurrence rate between the treatment groups in girls, were febrile infection was seen in 8 of 43 (19%) girls in the prophylaxis, 10 of 43 (23%) in the endoscopic, and 24 of 42 (57%) in the surveillance group (p=0.0002). In girls there was no difference in recurrence rate between those with grade III and IV reflux at entry, but recurrence was associated with reflux grade at follow-up (p=0.0095). CONCLUSIONS In this randomized controlled trial there was a high rate of recurrent febrile urinary tract infections in girls over the age of 1 year with dilating vesicoureteral reflux, but not in boys. Both antibiotic prophylaxis and endoscopic treatment reduced the rate of infections.
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| 8. |
- Brandström, Per, 1959, et al.
(författare)
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The Swedish Reflux Study - an introduction
- 2008
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Ingår i: European Society for Paediatric Nephrology, 42nd annual meeting, Lyon, Frankrike, 11-14 september 2008.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives and study To evaluate three treatment options for vesicoureteral reflux (VUR) grade III-IV in children 1-2 years of age: cystoscopic Deflux injection, antibiotic prophylaxis, and observation with treatment of each UTI. Methods Open randomised multicentre study excluding children with major renal or urological malformations or neurogenic bladder dysfunction. Patients were randomised to the 3 treatment arms and followed for 24 months. Study endpoints are renal scarring at repeated DMSA scan and reflux status after 2 years, and rate of symptomatic urinary tract infections during follow-up. The influence of bladder dysfunction and the parents' experience of the management will also be studied. Follow-up will be completed by December 2008. Results 203 patients were included (75 boys and 128 girls). 51% of the boys and 69% of the girls had VUR grade III. Most children had a history of UTI before diagnosis of VUR. Non-E. Coli infections were more common in boys and in children with VUR grade IV. At randomisation the children were stratified according to sex, VUR grade, renal damage and centre. The 3 groups were comparable. At study entry there was no renal scarring in 52% of the children with VUR grade III, and in 25% of those with VUR grade IV. Conclusions The randomisation was successful in allocating the children to 3 comparable groups. The study will hopefully give answers to which treatment is best for young children with dilating VUR and may also give us valuable information on the impact of bladder dysfunction and about parental preferences.
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| 9. |
- Brandström, Per, 1959
(författare)
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The Swedish Reflux Trial
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Small children with dilated vesicoureteral reflux (VUR) run risk of recurrent uri¬nary tract infections (UTI) and to acquire renal damage. To protect them, antibiotic prophylaxis and surgery to eliminate VUR have been used. Endoscopic injection of bulking agent at the ure-teral orifice has evolved as alternative surgical method but with insufficient scientific support of long term effect on VUR and rate of renal damage and UTI recurrence. Regarding prophylaxis, there is increasing concern of bacterial resistance and reports of low protective effect. Aim The aim of the trial was to evaluate three management strategies for children with dilating VUR, prophylaxis, endoscopic injection and surveillance only. Specific aims were to describe VUR outcome at two year follow-up, pattern and rate of recurrent UTI and how this differs be¬tween the three treatment strategies, and to investigate if prophylaxis or endoscopic injection can reduce rate of progression of established renal defects or new damage. Patients and methods From 23 centers, 203 children, 128 girls and 75 boys, aged 1 to less than 2 years, with dilating VUR grade III or IV were randomized to antibiotic prophylaxis (n=69), endoscopic injection (n=66) or surveillance (n=68) and followed for 2 years by regular visits and telephone contacts with special attention to febrile UTIs. Voiding cystourethrography (VCU) and dimercaptosuccinic acid (DMSA) renal scintigraphy were performed before randomization and after 2 years. Endoscopic injection with dextranomer hyaluronic acid copolymer was fol¬lowed by postoperative control with ultrasound and VCU. All calculations were done according to the intent to treat principle. Results Resolution or downgrading to nondilating VUR was seen in 71% in the endoscopic group, more frequent than in the prophylaxis or surveillance groups, 39% and 47% respectively (p=0.0002 and 0.0030). In 13 children (20% of those in the endoscopy group) with no or non¬dilating VUR after 1-2 injections, dilating VUR reappeared at 2-year follow-up. There were 67 febrile UTIs in 42 girls, significantly more than the 8 infections in 7 boys (p=0.0001). In girls febrile recurrence rate was 8 of 43 (19%) on prophylaxis, 10 of 43 (23%) with endoscopic treat¬ment and 24 of 42 (57%) on surveillance (p=0.0002). The recurrence rate was associated with persistent VUR after 2 years (p=0.0095). In boys recurrence rate was not associated with treat¬ment group or VUR status at entry or follow-up. Renal uptake defect at entry was seen in 124 of 203 children (61%), in 69 of 128 girls (54%) and 55 of 75 boys (73%), being generalized in 30 girls (23%) and in 44 boys (59%) (p<0.0001). The 2-year DMSA scan was performed in 201 children. New renal damage in previously unscarred areas was seen in 13 girls and 2 boys. Of the girls, 8 were on surveillance, 5 in the endoscopic group and none on prophylaxis (p=0.0155). New dam¬age was more common in children with febrile recurrence than without (11 of 49 (22%) vs 4 of 152 (3%), p<0.0001). Conclusion In small children with VUR grade III-IV, endoscopic injection enhanced the down¬grading or resolution of VUR compared to antibiotic prophylaxis or surveillance only. In boys older than 1 year, new renal damage was rare and febrile UTI recurrence rate low with no differ¬ence between treatment groups. In girls the rates of new renal damage and UTI recurrence was higher, especially in the control group on surveillance. UTI recurrence was reduced by prophy¬laxis and endocopic injection. New renal damage was strongly associated with UTI recurrence and was reduced by prophylaxis.
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| 10. |
- Brandström, Per, 1959, et al.
(författare)
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The Swedish Reflux Trial in Children: I. Study Design and Study Population Characteristics
- 2010
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 184:1, s. 274-279
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Konferensbidrag (refereegranskat)abstract
- Purpose: We compared the rates of febrile urinary tract infection, kidney damage and reflux resolution in children with vesicoureteral reflux treated in 3 ways, including antibiotic prophylaxis, endoscopic therapy and surveillance with antibiotics only for symptomatic urinary tract infection. Materials and Methods: Children 1 to younger than 2 years with grade reflux were recruited into this prospective, open, randomized, controlled, multi-center study and followed for 2 years after randomization. The main study end points were recurrent febrile urinary tract infection, renal status on dimercaptosuccinic acid scintigraphy and reflux status. Outcomes were analyzed by the intent to treat principle. Results: During a 6-year period 128 girls and 75 boys entered the study. In 96% of cases reflux was detected after urinary tract infection. The randomization procedure was successful and resulted in 3 groups matched for relevant factors. Recruitment was slower than anticipated but after patients were entered adherence to the protocol was good. Of the children 93% were followed for the intended 2 years without a treatment arm change. All except 2 patients completed 2-year followup scintigraphy. Conclusions: Recruitment was difficult but a substantial number of children were entered and randomly assigned to 3 groups with similar basic characteristics. Good adherence to the protocol made it possible to address the central study questions.
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