| 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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| 11. |
- Brandström, Per, 1959, et al.
(författare)
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The Swedish Reflux Trial in Children: III. Urinary Tract Infection Pattern.
- 2010
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Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 184:1, s. 286-291
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We evaluated the difference in the febrile urinary tract infection rate in small children with dilating vesicoureteral reflux randomly allocated to 3 management alternatives, including antibiotic prophylaxis, endoscopic treatment or surveillance only as the control. MATERIALS AND METHODS: At 23 centers a total of 203 children were included in the study, including 128 girls and 75 boys 1 to younger than 2 years. Vesicoureteral reflux grade III in 126 cases and IV in 77 was detected after a febrile urinary tract infection (194) after prenatal screening (9). Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. The febrile urinary tract infection rate was analyzed by the intent to treat principle. RESULTS: We noted a total of 67 febrile recurrences in 42 girls and a total of 8 in 7 boys (p = 0.0001). There was a difference in the recurrence rate among treatment groups in girls with febrile infection in 8 of 43 (19%) on prophylaxis, 10 of 43 (23%) with endoscopic therapy and 24 of 42 (57%) on surveillance (p = 0.0002). In girls the recurrence rate was associated with persistent reflux after 2 years (p = 0.0095). However, reflux severity (grade III or IV) at study entry did not predict recurrence. CONCLUSIONS: In this randomized, controlled trial there was a high rate of recurrent febrile urinary tract infection in girls older than 1 year with dilating vesicoureteral reflux at study entry but not in boys. Antibiotic prophylaxis and endoscopic treatment decreased the infection rate.
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| 12. |
- Brandström, Per, 1959, et al.
(författare)
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The Swedish Reflux Trial in Children: IV. Renal Damage.
- 2010
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Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 184:1, s. 292-297
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We compared the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance as the control group. MATERIALS AND METHODS: Included in the study were 128 girls and 75 boys 1 to younger than 2 years with grade III-IV reflux. Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. Febrile urinary tract infections were recorded during followup. Data analysis was done by the intent to treat principle. RESULTS: New renal damage in a previously unscarred area was seen in 13 girls and 2 boys. Eight of the 13 girls were on surveillance, 5 received endoscopic therapy and none were on prophylaxis (p = 0.0155). New damage was more common in children with than without febrile recurrence (11 of 49 or 22% vs 4 of 152 or 3%, p <0.0001). CONCLUSIONS: In boys the rate of new renal damage was low. It was significantly higher in girls and most common in the control surveillance group. There was also a strong association between recurrent febrile UTIs and new renal damage in girls.
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| 13. |
- Brandström, Per, 1959, et al.
(författare)
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The Swedish reflux trial: Review of a randomized, controlled trial in children with dilating vesicoureteral reflux.
- 2011
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Ingår i: Journal of pediatric urology. - : Elsevier BV. - 1873-4898 .- 1477-5131.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate prophylaxis and endoscopic injection for children with dilating vesicoureteral reflux (VUR) compared to surveillance, regarding urinary tract infection (UTI) recurrence, new renal damage, VUR outcome, and impact of lower urinary tract (LUT) dysfunction on these outcomes. PATIENTS AND METHODS: 203 children (128 girls and 75 boys), aged 1 to <2 years, with VUR grade III or IV were randomized to antibiotic prophylaxis (n=69), endoscopic injection (n=66) or surveillance (n=68). Voiding cystourethrography, dimercaptosuccinic acid scintigraphy and optional LUT function assessment were performed before randomization and after 2 years. RESULTS: There were 67 febrile UTIs in 42 girls and 8 in 7 boys (p=0.0001). In girls, recurrence rate was 19% on prophylaxis, 23% with endoscopic treatment and 57% on surveillance (p=0.0002). In boys, there was no difference between treatment groups. New damage was seen in 13 girls: 8 on surveillance, 5 in the endoscopic group and none on prophylaxis (p=0.0155), and in 2 boys. In 13 children with no or non-dilating VUR after 1 injection, dilating VUR reappeared at the 2-year follow up. LUT dysfunction at follow up was associated with persistence of VUR. CONCLUSION: In girls, prophylaxis reduced the rate of UTI recurrence and new renal damage, and endoscopic injection the rate of UTI recurrence. Boys did not benefit from active treatment.
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| 14. |
- Brandström, Per, 1959, et al.
(författare)
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Urinary Tract Infection in Children
- 2022
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Ingår i: Pediatric Clinics of North America. - : Elsevier BV. - 0031-3955. ; 69:6, s. 1099-1114
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Tidskriftsartikel (refereegranskat)
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| 15. |
- Ekman-Joelsson, Britt-Marie, 1956, et al.
(författare)
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Immunological differences between heart- and kidney-transplanted children: a cross-sectional study.
- 2023
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Ingår i: Cardiology in the young. - 1047-9511 .- 1467-1107. ; 33:5, s. 787-792
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Tidskriftsartikel (refereegranskat)abstract
- Post-transplantation lymphoproliferative is a potentially mortal complication after heart transplantation in children. As the immune system plays a crucial role in the development of lymphoma, we explored the influence of thymus function in relation to immunosuppressive treatment in organ-transplanted children and healthy control subjects. A prospective case-control study was performed at a single centre, in which 36 children who had undergone heart transplantation were compared to two control groups: 34 kidney-transplanted children and 33 healthy age- and sex-matched children. T- and B-lymphocyte subtypes and monocytes were analysed by flow cytometry, and T-cell receptor excision circles were assessed using quantitative polymerase chain reaction. Heart-transplanted children had a lymphocyte profile characterised by reduced or absent thymic function with low numbers of T-cell receptor excision circles and total and naïve T cells, together with immune activation against the allograft. Despite similar immunosuppressive treatment, the kidney-transplanted group showed an activated T-lymphocyte compartment.
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| 16. |
- Hansson, Sverker, 1946, et al.
(författare)
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Low bacterial counts in infants with urinary tract infection.
- 1998
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Ingår i: The Journal of pediatrics. - 0022-3476. ; 132:1, s. 180-2
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Tidskriftsartikel (refereegranskat)abstract
- We analyzed the number of colony-forming units in urine cultures obtained by suprapubic aspiration in a group of 366 unselected infants with symptomatic urinary tract infection to relate these findings to factors such as pyuria and vesicoureteric reflux. Seventy-three (20%) of 366 infants had fewer than 100,000 colony-forming units per milliliter. Such low counts were significantly related to low numbers of leukocytes in the urine. Vesicoureteric reflux was equally distributed among children, irrespective of the number of bacteria in quantitative culture. The findings emphasize the importance of sampling technique; in infants, the method of choice is suprapubic aspiration, or catheterization, which eliminates the risk that urinary tract infection is overlooked because of low bacterial counts.
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| 17. |
- Holmdahl, Gundela, 1956, et al.
(författare)
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The Swedish Reflux Trial in Children: II. Vesicoureteral Reflux Outcome.
- 2010
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Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 184:1, s. 280-285
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We compared reflux status in children with dilating vesicoureteral reflux treated in 3 groups, including low dose antibiotic prophylaxis, endoscopic therapy and a surveillance group on antibiotic treatment only for febrile urinary tract infection. MATERIALS AND METHODS: A total of 203 children 1 to younger than 2 years with grade III-IV reflux were recruited into this open, randomized, controlled trial. Endoscopic treatment was done with dextranomer/hyaluronic acid copolymer. The main end point was reflux status after 2 years. Data were analyzed by the intent to treat principle. RESULTS: Reflux status improved in all 3 treatment arms. Of patients in the prophylaxis, endoscopic and surveillance groups 39%, 71% and 47%, respectively, had reflux resolution or downgrading to grade I-II after 2 years. This was significantly more common in the endoscopic than in the prophylaxis and surveillance groups (p = 0.0002 and 0.0030, respectively). After 1 or 2 injections 86% of patients in the endoscopic group had no or grade I-II reflux but recurrent dilating reflux was seen in 20% after 2 years. CONCLUSIONS: Endoscopic treatment resulted in dilating reflux resolution or downgrading in most treated children. After 2 years endoscopic treatment results were significantly better than the spontaneous resolution rate or downgrading in the prophylaxis and surveillance groups. However, of concern is the common reappearance of dilating reflux after 2 years.
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| 18. |
- Joshi, S., et al.
(författare)
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Novel de novo AVPR2 Variant in a Patient with Congenital Nephrogenic Diabetes Insipidus
- 2017
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Ingår i: Case Reports in Nephrology and Dialysis. - : S. Karger AG. - 2296-9705. ; 7:3, s. 130-137
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Tidskriftsartikel (refereegranskat)abstract
- Early diagnosis and treatment of congenital nephrogenic diabetes insipidus (CNDI) are essential due to the risk of intellectual disability caused by repeated episodes of dehydration and rapid rehydration. Timely genetic testing for disease-causing variants in the arginine vasopressin receptor 2 (AVPR2) gene is possible in at-risk newborns with a known family history of X-linked CNDI. In this study, a Swedish male with no family history was diagnosed with CNDI at 6 months of age during an episode of gastroenteritis. We analyzed the coding regions of AVPR2 by PCR and direct DNA sequencing and identified an 80-bp duplication in exon 2 (GenBank NM_000054.4; c.800_879dup) in the proband. This variant leads to a frameshift and introduces a stop codon four codons downstream (p.Ala294Profs*4). The variant gene product either succumbs to nonsense-mediated decay or is translated to a truncated nonfunctional vasopressin V2 receptor. This variant was absent in four unaffected family members, including his parents, as well as in 100 alleles from healthy controls, and is thus considered a novel de novo disease-causing variant. Identification of the disease-causing variant facilitated precise diagnosis of CNDI in the proband. Furthermore, it allows future genetic counseling in the family. This case study highlights the importance of genetic testing in sporadic infant cases with CNDI that can occur due to de novo variants in AVPR2 or several generations of female transmission of the disease-causing variant. (C) 2017 The Author(s) Published by S. Karger AG, Basel
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| 19. |
- Ladfors, S. W., et al.
(författare)
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Longitudinal Follow-Up on Cardiopulmonary Exercise Capacity Related to Cardio-Metabolic Risk Factors in Children With Renal Transplants
- 2021
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Ingår i: Frontiers in Sports and Active Living. - : Frontiers Media SA. - 2624-9367. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Children with chronic kidney disease, including those treated with kidney transplantation (KT), have an increased risk of cardiovascular disease. The aim of this study was to examine the cardiopulmonary exercise capacity after KT compared to matched controls, to relate the results to physical activity, blood pressure and biochemical findings and to follow exercise capacity over time. & nbsp; Methods: Patients with KT (n = 38, age 7.7-18 years), with a mean time from transplantation of 3.7 years (0.9-13.0) and mean time in dialysis 0.8 years, were examined at inclusion and annually for up to three years. Healthy controls (n = 17, age 7.3-18.6 years) were examined once. All subjects underwent a cardiopulmonary exercise test, resting blood pressure measurement, anthropometry and activity assessment. Patients also underwent echocardiography, dual-energy X-ray absorptiometry (DXA), 24-h ambulatory BP measurements (ABPM), assessment of glomerular filtration rate (GFR) and blood sampling annually. & nbsp; Results: As compared to healthy controls, KT patients showed decreased exercise capacity measured both as VO2peak (34.5 vs. 43.9 ml/kg/min, p < 0.001) and maximal load (2.6 vs. 3.5 W/kg, p < 0.0001), similarly as when results were converted to z-scores. No significant difference was found in weight, but the KT patients were shorter and had higher BMI z-score than controls, as well as increased resting SBP and DBP z-scores. The patient or parent reported physical activity was significantly lower in the KT group compared to controls (p < 0.001) In the combined group, the major determinants for exercise capacity z-scores were activity score and BMI z-score (beta = 0.79, p < 0.0001 and beta = -0.38, p = 0.007, respectively). Within the KT group, low exercise capacity was associated with high fat mass index (FMI), low activity score, low GFR and high blood lipids. In the multivariate analysis FMI and low GFR remained predictors of low exercise capacity. The longitudinal data for the KT patients showed no change in exercise capacity z-scores over time. & nbsp; Conclusion: Patients with KT showed decreased exercise capacity and increased BP as compared to healthy controls. Exercise capacity was associated to GFR, physical activity, FMI and blood lipids. It did not improve during follow-up.
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| 20. |
- Machuca, Eduardo, et al.
(författare)
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Genotype-Phenotype Correlations in Non-Finnish Congenital Nephrotic Syndrome.
- 2010
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Ingår i: Journal of the American Society of Nephrology : JASN. - 1533-3450. ; 184:1, s. 286-291
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Tidskriftsartikel (refereegranskat)abstract
- Mutations in NPHS1, which encodes nephrin, are the main causes of congenital nephrotic syndrome (CNS) in Finnish patients, whereas mutations in NPHS2, which encodes podocin, are typically responsible for childhood-onset steroid-resistant nephrotic syndrome in European populations. Genotype-phenotype correlations are not well understood in non-Finnish patients. We evaluated the clinical presentation, kidney histology, and disease progression in non-Finnish CNS cases by mutational screening in 107 families (117 cases) by sequencing the entire coding regions of NPHS1, NPHS2, PLCE1, WT1, LAMB2, PDSS2, COQ2, and NEPH1. We found that CNS describes a heterogeneous group of disorders in non-Finnish populations. We identified nephrin and podocin mutations in most families and only rarely found mutations in genes implicated in other hereditary forms of NS. In approximately 20% of cases, we could not identify the underlying genetic cause. Consistent with the major role of nephrin at the slit diaphragm, NPHS1 mutations associated with an earlier onset of disease and worse renal outcomes than NPHS2 mutations. Milder cases resulting from mutant NPHS1 had either two mutations in the cytoplasmic tail or two missense mutations in the extracellular domain, including at least one that preserved structure and function. In addition, we extend the spectrum of known NPHS1 mutations by describing long NPHS1 deletions. In summary, these data demonstrate that CNS is not a distinct clinical entity in non-Finnish populations but rather a clinically and genetically heterogeneous group of disorders.
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| 21. |
- Nevéus, Tryggve, et al.
(författare)
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Parental experiences and preferences regarding the treatment of vesicoureteral reflux.
- 2012
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Ingår i: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 1651-2065 .- 0036-5599. ; 46:1, s. 26-30
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. Dilating vesicoureteral reflux (VUR) has been linked to febrile urinary tract infection (UTI) and renal scarring. It is unclear, however, whether children with reflux should be treated surgically or medically, or just kept under close surveillance with prompt treatment of UTIs. This lack of evidence makes parental preferences a crucial factor in the choice of therapy. The Swedish Reflux Trial was set up to compare the three treatment alternatives prospectively. This paper focuses on parental experience and satisfaction after completing the trial. Material and methods. A group of 203 children aged 12-24 months with reflux grade III or IV were randomly assigned to antibiotic prophylaxis (n = 69), surveillance (n = 68) or endoscopic injection treatment (n = 66) and followed closely for 2 years. Afterwards, the families were interviewed by an investigator not involved in the care of the children about their experience of the study. Results. Parental satisfaction with the treatment given was high, with 53% scoring 5 and 35% 4 on a five-grade scale, with no difference between the three groups (p = 0.5). Recurrence of febrile UTI or new kidney scarring did not influence parental satisfaction. Even though the satisfaction was high regardless of therapy, parents of children in the prophylaxis group more often than others would have chosen another treatment if given a choice. Conclusions. As far as parental satisfaction and preferences are concerned, antibiotic prophylaxis, surveillance and injection treatment are equivalent treatment strategies in children with VUR.
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| 22. |
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| 23. |
- Nordenström, Josefin, et al.
(författare)
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The Swedish infant high-grade reflux trial: Study presentation and vesicoureteral reflux outcome.
- 2017
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Ingår i: Journal of pediatric urology. - : Elsevier BV. - 1873-4898 .- 1477-5131. ; 13:2, s. 130-138
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Tidskriftsartikel (refereegranskat)abstract
- High-grade vesicoureteral reflux (VUR) in infants is associated with congenital renal abnormalities, recurrent UTI, and bladder dysfunction. Endoscopic treatment (ET) is a well-established method in children with low to moderate reflux grades, but there is a lack of randomised controlled trials regarding the use of ET versus continuous antibiotic prophylaxis in infants with high-grade VUR.This study aimed to determine whether high-grade VUR in infants can be treated with endoscopic injection and whether ET is superior to antibiotic prophylaxis in the treatment of VUR.This prospective, randomised, controlled, multicentre, 1-year follow-up trial comprised 77 infants (55 boys, 22 girls) <8 months of age with VUR grade 4-5 (n=30/n=47). Of the infants, 52 (68%) had bilateral VUR. Thirty-nine were randomised to antibiotic prophylaxis and 38 to ET (with prophylaxis until resolution). Voiding cystourethrogram, ultrasound, renal scintigraphy, and free voiding observation were performed at study entry and after 1 year to evaluate VUR grade, and renal and bladder function.VUR grade ≤2 was seen in 22 (59%) infants in the endoscopy group and eight (21%) in the prophylaxis group at follow-up (p=0.0014). The success rate in the endoscopy group was 100% in unilateral grade 4, falling to 31% in bilateral grade 5 (p=0.0094). Correspondingly, the results in the prophylaxis group were 40% in grade 4 down to 0% in bilateral grade 5 (p=0.037) (Table). Logistic regression analyses identified ET, VUR grade 4, unilaterality, and low residual urine at baseline as positive predictors of VUR down-grading to ≤2 (area under ROC curve 0.88). In four patients with reflux resolution after one injection, dilating reflux recurred at the 1-year follow-up. One patient had a UTI possibly related to ET. In our material four patients required re-implantation, of whom one was obstructive after injection.The opportunity to offer even small infants with high-grade VUR an alternative, minimally invasive treatment option is a great advance in paediatric urology. In this high-risk group, bilateral VUR grade 5 stands out with its poor bladder function and low chance of resolution. The recurrence rate of dilating VUR aftersuccessful ET is consistent with previous studies. The limitations are the relatively small number of patients and the short follow-up.High-grade VUR in infants can be treated with injection therapy and the resolution rate is higher than that of prophylaxis treatment. The complication rate is low and VUR grade 4, unilaterality, and low residual urine are favourable for the resolution and down-grading of VUR.
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| 24. |
- Nordenström, Josefin, et al.
(författare)
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The Swedish infant high-grade reflux trial: UTI and renal damage.
- 2017
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Ingår i: Journal of pediatric urology. - : Elsevier BV. - 1873-4898 .- 1477-5131. ; 13:2, s. 146-154
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Tidskriftsartikel (refereegranskat)abstract
- High-grade vesicoureteral reflux (VUR) in children is associated with recurrent urinary tract infection (UTI) and renal damage. Breakthrough UTI despite continuous antibiotic prophylaxis (CAP) during the first years of life is a matter of concern and evokes early intervention. We investigated whether early endoscopic treatment (ET) of VUR grade 4-5 can reduce the risk of UTI recurrence and renal scarring.This prospective, randomized, controlled, multicentre, 1-year follow-up trial comprised 77 infants, <8 months of age with VUR grade 4-5 (Table) randomized to CAP (n=39) or ET (with prophylaxis until resolution) (n=38). Voiding cystourethrogram, ultrasound, renal scintigraphy, and free voiding observation were performed at study entry and after 1 year. Parenchymal defects were seen in 67 (87%) children at entry, 39 (34 boys, 5 girls) of them characterized as generalized. At follow-up, renal deterioration (new scars or progress in old damaged area) and symptomatic UTIs were reported.There were 27 recurrent febrile UTIs in 6 (16%) children in the ET group and in 10 (26%) in the CAP group (p=0.43), in eight (36%) girls and eight (15%) boys (p=0.039). Successful VUR outcome (VUR 0-2) was seen in 22 (59%) in the ET and eight (21%) in the CAP group (p=0.0014). Multiple recurrences were only seen in patients with persistent dilating reflux at follow-up (p=0.019). Deterioration on scintigraphy was seen in eight children (9 kidneys) with no difference between treatment groups (p=0.48) or sex (p=0.17). Renal deterioration was associated with high bladder capacity (BC) and large residual volume (PVR) at 1 year (p=0.0092 and p=0.041). Six of the eight children with renal deterioration had a recurrent UTI (p=0.0032). Seven of nine renal units with deterioration were seen in children with persistent VUR 3-5 at follow-up. Univariable logistic regression identified female sex and high PVR as positive predictors for recurrent UTI (p=0.039 and 0.034) and high PVR tended to predict renal deterioration (p=0.053).No differences between the treatment groups regarding recurrent UTI and renal deterioration could be found. Increased PVR and female sex were positive predictors for UTI recurrences. VUR grade at follow-up was correlated to UTI recurrence and renal deterioration.This study did not show any difference between ET and CAP in reducing the risk of UTI recurrence or renal deterioration. The rate of VUR resolution was higher in the ET group and VUR grade at follow-up correlated with both UTI recurrence and renal deterioration.
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| 25. |
- Parasyri, M., et al.
(författare)
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Renal Phenotype in Mitochondrial Diseases: A Multicenter Study
- 2022
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Ingår i: Kidney Diseases. - : S. Karger AG. - 2296-9381 .- 2296-9357. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Aims: This study aimed to investigate associations between renal and extrarenal manifestations of mitochondrial diseases and their natural history as well as predictors of renal disease severity and overall disease outcome. The secondary aim was to generate a protocol of presymptomatic assessment and monitoring of renal function in patients with a defined mitochondrial disease. Methods: A multicenter, retrospective cohort study was performed by the Mitochondrial Clinical and Research Network (MCRN). Patients of any age with renal manifestations associated with a genetically verified mitochondrial disease were included from 8 expert European centers specializing in mitochondrial diseases: Gothenburg, Oulu, Copenhagen, Bergen, Helsinki, Stockholm, Rotterdam, and Barcelona. Results: Of the 36 patients included, two-thirds had mitochondrial DNA-associated disease. Renal manifestations were the first sign of mitochondrial disease in 19%, and renal involvement was first identified by laboratory tests in 57% of patients. Acute kidney injury occurred in 19% of patients and was the first sign of renal disease in the majority of these. The most common renal manifestation was chronic kidney disease (75% with stage 2 or greater), followed by tubulopathy (44.4%), the latter seen mostly among patients with single large-scale mitochondrial DNA deletions. Acute kidney injury and tubulopathy correlated with worse survival outcome. The most common findings on renal imaging were increased echogenicity and renal dysplasia/hypoplasia. Renal histology revealed focal segmental glomerulosclerosis, nephrocalcinosis, and nephronophthisis. Conclusion: Acute kidney injury is a distinct renal phenotype in patients with mitochondrial disease. Our results highlight the importance to recognize renal disease as a sign of an underlying mitochondrial disease. Acute kidney injury and tubulopathy are 2 distinct indicators of poor survival in patients with mitochondrial diseases.
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| 26. |
- Schild, R., et al.
(författare)
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Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: an ESPN/ERA Registry study
- 2023
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Ingår i: Clinical Kidney Journal. - : Oxford University Press (OUP). - 2048-8505 .- 2048-8513. ; 16:4, s. 745-755
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Tidskriftsartikel (refereegranskat)abstract
- Background Data on comorbidities in children on kidney replacement therapy (KRT) are scarce. Considering their high relevance for prognosis and treatment, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT. Methods We included data from patients <20 years of age when commencing KRT from 2007 to 2017 from 22 European countries within the European Society of Paediatric Nephrology/European Renal Association Registry. Differences between patients with and without comorbidities in access to kidney transplantation (KT) and patient and graft survival were estimated using Cox regression. Results Comorbidities were present in 33% of the 4127 children commencing KRT and the prevalence has steadily increased by 5% annually since 2007. Comorbidities were most frequent in high-income countries (43% versus 24% in low-income countries and 33% in middle-income countries). Patients with comorbidities had a lower access to transplantation {adjusted hazard ratio [aHR] 0.67 [95% confidence interval (CI) 0.61-0.74]} and a higher risk of death [aHR 1.79 (95% CI 1.38-2.32)]. The increased mortality was only seen in dialysis patients [aHR 1.60 (95% CI 1.21-2.13)], and not after KT. For both outcomes, the impact of comorbidities was stronger in low-income countries. Graft survival was not affected by the presence of comorbidities [aHR for 5-year graft failure 1.18 (95% CI 0.84-1.65)]. Conclusions Comorbidities have become more frequent in children on KRT and reduce their access to transplantation and survival, especially when remaining on dialysis. KT should be considered as an option in all paediatric KRT patients and efforts should be made to identify modifiable barriers to KT for children with comorbidities. Lay Summary Kidney transplantation (KT) is considered the optimal treatment for children who suffer from permanent kidney failure, because it leads to a lower mortality and higher quality of life compared with dialysis. Children on dialysis frequently suffer from diseases of other organs (comorbidities) that can directly lower their life expectancy and could potentially represent a barrier for transplantation, posing an additional disease burden for these children. In this study we looked at data from a large multinational registry for children with kidney failure who require kidney replacement. Using these data, we studied whether these children suffered from comorbidities and whether these impact their life expectancy or their access to KT. We found that more and more children with kidney failure suffer from comorbidities when starting kidney replacement therapy. We also found that these children have a lower access to KT and a higher mortality on dialysis compared with children without comorbidities, especially in low-income countries. After KT, children with comorbidities have a similar mortality and graft survival compared with children without comorbidities. We concluded that reduced access to a kidney transplant might represent a modifiable barrier to KT in children with comorbidities, especially in low-resource countries. We suggest that children with comorbidities in need for kidney replacement therapy should be rapidly evaluated for eligibility for KT.
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| 27. |
- Selekman, R. E., et al.
(författare)
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Uropathogen Resistance and Antibiotic Prophylaxis: A Meta-analysis
- 2018
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 142:1
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Limited data exist regarding uropathogen resistance in randomized controlled trials of urinary tract infection (UTI) prevention and antibiotic prophylaxis. OBJECTIVE: To assess the effect of prophylaxis on developing a multidrug-resistant first recurrent UTI among children with vesicoureteral reflux. DATA SOURCES: Cochrane Kidney and Transplant Specialized Register through May 25, 2017. STUDY SELECTION: Randomized controlled trials of patients 18 years of age with a history of vesicoureteral reflux being treated with continuous antibiotic prophylaxis compared with no treatment or placebo with available antibiotic sensitivity profiles. DATA EXTRACTION: Two independent observers abstracted data and assessed quality and validity per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Adjusted meta-analyses were performed by using a mixed-effects logistic regression model. RESULTS: One thousand two hundred and ninety-nine patients contributed 224 UTIs. Patients treated with prophylaxis were more likely to have a multidrug-resistant infection (33% vs 6%, P < .001) and were more likely to receive broad-spectrum antibiotics (68% vs 49%, P = .004). Those receiving prophylaxis had 6.4 times the odds (95% confidence interval: 2.7-15.6) of developing a multidrug-resistant infection. One multidrug-resistant infection would develop for every 21 reflux patients treated with prophylaxis. LIMITATIONS: Variables that may contribute to resistance such as medication adherence and antibiotic exposure for other illnesses could not be evaluated. CONCLUSIONS: Prophylaxis increases the risk of multidrug resistance among recurrent infections. This has important implications in the risk-benefit assessment of prophylaxis as a management strategy and in the selection of empirical treatment of breakthrough infections in prophylaxis patients.
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| 28. |
- Sillén, Ulla, 1946, et al.
(författare)
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Longitudinal follow-up of bladder function in children who participated in the Swedish Reflux Trial
- 2024
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Ingår i: JOURNAL OF PEDIATRIC UROLOGY. - 1477-5131 .- 1873-4898. ; 20:1, s. 118-126
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Tidskriftsartikel (refereegranskat)abstract
- Background Several publications have reported the coexistence of vesicoureteral reflux (VUR) and bladder dysfunction in children. Whether this dysfunction remains in the longer term is not yet known. Objective This study revisited children who participated in the Swedish Reflux Trial (SRT) with the primary aim of evaluating whether bladder and bowel dysfunction (BBD) in these patients persisted until adolescence. The secondary aim was to evaluate two BBD subgroups, and relations to recurrent urinary tract infections (UTI). Study design Of the 161 eligible children at SRT study -end, 73 children participated. Their bladder function was evaluated longitudinally using a validated BBD questionnaire with symptom score (cut -off >7) and uroflowmetry, at five (T2) and ten years (T3) after study -end. T1 was the SRT study -end. Besides BBD, the sub-diagnoses overactive bladder (OAB) and dysfunctional voiding symptoms (DVS) were calculated from symptom scores. Results BBD was diagnosed in 37% of children at mean age 3.7 years, which decreased with age to 23% of adolescents (mean age 15.7). DVS and OAB subgroups were equally common at T1, but only DVS was identified at the last follow-up (T3) (p = 0.0008). Recurrent UTIs were seen in 17% at T3 and were more common in patients with BBD (p = 0.038). The gender distribution of BBD also changed, from being equally common at the end of the SRT to affecting mainly adolescent girls at the last follow-up (p = 0.022). Information was available regarding VUR status after repeat VCUGs during follow-up in 22 patients, 12 of them after endoscopic treatment. An improvement in VUR grade was found in the 22, but during follow-up numbers with BBD or UTI did not differ between treated and non-treated groups. Discussion The prevalence of BBD decreased from 37% at 3-4 years of age to 23% in adolescence, when it was almost exclusively seen in girls. BBD and the subgroup DVS were associated with UTI. Even if epidemiological studies have established a predisposition to bladder symptoms and UTI in girls, little is known about bladder function in adolescents with a history of VUR during the first years of life. One limitation of the study was the number of patients participating. Also, the number of patients with kidney damage was more common in the cohort. Conclusion In this longitudinal follow-up of BBD in children with VUR, the number of children with BBD decreased with age. In adolescence, both BBD and recurrent UTIs mainly affected girls.
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| 29. |
- Sillén, Ulla, 1946, et al.
(författare)
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The Swedish Reflux Trial in Children: V. Bladder Dysfunction.
- 2010
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Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 184:1, s. 298-304
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We investigated the prevalence and types of lower urinary tract dysfunction in children with vesicoureteral reflux grades III and IV, and related improved dilating reflux, renal damage and recurrent urinary tract infection to dysfunction. MATERIALS AND METHODS: A total of 203 children between ages 1 to less than 2 years with reflux grades III and IV were recruited into this open, randomized, controlled, multicenter study. Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done at study entry and 2-year followup. Lower urinary tract function was investigated by noninvasive methods, at study entry with 4-hour voiding observation in 148 patients and at 2 years by structured questionnaire and post-void residual flow measurement in 161. RESULTS: At study entry 20% of patients had lower urinary tract dysfunction, characterized by high bladder capacity and increased post-void residual urine. At 2 years there was dysfunction in 34% of patients. Subdivision into groups characteristic of children after toilet training revealed that 9% had isolated overactive bladder and 24% had voiding phase dysfunction. There was a negative correlation between dysfunction at 2 years and improved dilating reflux (p = 0.002). Renal damage at study entry and followup was associated with lower urinary tract dysfunction at 2 years (p = 0.001). Recurrent urinary tract infections were seen in 33% of children with and in 20% without dysfunction (p = 0.084). CONCLUSIONS: After toilet training a third of these children with dilating reflux had lower urinary tract dysfunction, mainly voiding phase problems. Dysfunction was associated with persistent reflux and renal damage while dysfunction at study entry did not predict the 2-year outcome.
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| 30. |
- Westphal Ladfors, Susanne, et al.
(författare)
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Long-lasting chronic high load carriage of Epstein-Barr virus is more common in young pediatric renal transplant recipients.
- 2020
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Ingår i: Pediatric nephrology. - : Springer Science and Business Media LLC. - 1432-198X .- 0931-041X. ; 35:3, s. 427-439
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Tidskriftsartikel (refereegranskat)abstract
- Epstein-Barr virus (EBV) infections can induce post-transplant lymphoproliferative disorder (PTLD). A chronic high load (CHL), as indicated by long-term high EBV DNA levels after transplantation, has been associated with an enhanced risk of PTLD. We aimed to evaluate incidence, time of occurrence, risk factors, and outcome of EBV CHL carrier state after pediatric renal transplantation.A retrospective study of 58 children aged 1-17 years (median 10), who underwent renal transplantation between January 2004 and June 2017 at a single medical center. EBV IgG antibodies in serum were analyzed before and yearly after transplantation. EBV DNA in whole blood were analyzed weekly for the first 3 months post-transplant, monthly up to 1 year and then at least once yearly. CHL was defined as EBV DNA ≥ 4.2 log10 Geq/ml in > 50% of the samples during ≥ 6 months.At transplantation, 31 (53%) patients lacked EBV IgG and 25 (81%) of them developed primary EBV infection post-transplant. Of the 27 seropositive patients, 20 (74%) experienced reactivation of EBV. Altogether, 14 (24%) children developed CHL, starting at a median of 69 days post-transplant and lasting for a median time of 2.3 years (range 0.5-6.5), despite reduction of immunosuppression. Patients with CHL were younger and 11/14 were EBV seronegative at transplantation. No child developed PTLD during median clinical follow-up of 7.8 years (range 0.7-13).CHL was frequent, long lasting, and occurred mainly in young transplant recipients. The absence of PTLD suggests that monitoring of EBV DNA to guide immunosuppression was effective.
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| 31. |
- Yang, Stephen, et al.
(författare)
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Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children’s Continence Society
- 2018
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Ingår i: Pediatric Nephrology. - : Springer Science and Business Media LLC. - 0931-041X .- 1432-198X. ; 33:12, s. 2207-2219
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 IPNA Background: We present a consensus view from the International Children’s Continence Society (ICCS) on the evaluation and management of bladder bowel dysfunction (BBD) in children with urinary tract infection (UTI). The statement aims to highlight the importance of BBD in the development and recurrence of childhood UTI and its management to reduce its associated morbidity and sequelae. Methods: A systematic literature search was done on PubMed, Embase, and Scopus databases until August 15, 2016. Relevant publications concerning BBD and its relationship with UTI among children were reviewed and aggregated for statements of recommendation. Discussion by the ICCS Board and a multi-disciplinary core group of authors resulted in a document available on its website for all ICCS members to review. Insights and feedback were considered with consensus and agreement reached to finalize this position statement. Results: BBD in children with UTI is summarized. Details regarding epidemiology, pathophysiology, and recommendations for general and family practitioners and pediatricians relating to the evaluation and management of this condition are presented. Conclusions: This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI.
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