| 1. |
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| 2. |
- Abrahamsson, Kate, 1959, et al.
(författare)
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Estimation of renal function in children and adolescents with spinal dysraphism.
- 2008
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Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 179:6, s. 2407-9
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: In children with spinal dysraphism such as myelomeningocele the relation between muscle mass and body composition varies considerably. Therefore, it is difficult to evaluate the relevance of renal function assessments done with serum creatinine. Since serum cystatin C has been suggested to be independent of body size and composition, this evaluation was compared to chromium(51) edetic acid clearance. MATERIALS AND METHODS: Simultaneous measurements of cystatin C and chromium(51) edetic acid clearance were performed prospectively in 65 patients 2 to 19 years old with spinal dysraphism. RESULTS: Cystatin C values were within the normal range in all patients, while chromium(51) edetic acid clearance was reduced in 10. A significant relation was seen. CONCLUSIONS: Using chromium(51) edetic acid clearance as a gold standard, children with spinal dysraphism and slightly to moderately reduced renal function may remain undiagnosed if cystatin C is used for evaluation.
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| 3. |
- Abrahamsson, Kate, 1959, et al.
(författare)
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Reference interval for serum creatinine in children and adolescents with myelomeningocele.
- 2009
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Ingår i: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 43:3, s. 233-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In children and adolescents with myelomeningocele (MMC), the relation between muscle mass and body composition varies considerably, making it difficult to evaluate the relevance of renal function assessments done with serum (s)-creatinine. Therefore, a reference interval for enzymic s-creatinine in individuals with MMC was constructed. MATERIAL AND METHODS: Patients with MMC aged 1.5-18 years who consistently had chromium-51-labelled edetic acid clearance within normal limits (88-132 ml/min/1.73 m(2)) were selected for the study. Included were 52 girls and 71 boys with a total of 471 s-creatinine determinations. Children with normal body composition were used as controls. RESULTS: The mean s-creatinine concentration at the age of 1.5 years was 22 micromol/l in girls and 21 micromol/l in boys and increased to 38 micromol/l in girls and 58 micromol/l in boys at the age of 18 years. There was no difference between the genders until the age of 12. From the age of 3 years, there was a significantly lower median s-creatinine concentration in the MMC children compared with a healthy age-matched population. The median concentration of the MMC children was equivalent to the 2.5 percentile of the control group. CONCLUSION: From the age of 3 years, the reference interval for children and adolescents with MMC showed a lower median concentration for enzymic s-creatinine and a greater interindividual variation compared with the healthy age-matched population.
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| 4. |
- Abrahamsson, Kate, 1959, et al.
(författare)
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Ultrasonography and renography to visualize upper urinary tract in children with meningomyelocele - A prospective study.
- 2012
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Ingår i: Journal of pediatric urology. - : Elsevier BV. - 1873-4898 .- 1477-5131. ; 8:2, s. 174-176
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Ultrasonography (US) is commonly used to visualize the upper urinary tract in children and adolescents with meningomyelocele (MMC). The aim of this investigation was to prospectively evaluate US in those with spinal angulation or obesity and compare it to the corresponding results obtained by mercaptoacetyltriglycine renography. PATIENTS AND METHODS: Twenty-five children and adolescents with MMC and pronounced angulation of the spine or obesity, were prospectively investigated with both US and renography during the period 2006 to 2008. RESULTS: In 13 (52%) patients the kidneys could not be fully evaluated; in 4 (16%) neither renal size nor pelvic dilation, in 12 (48%) renal length and in 5 (20%) dilation was not accessible. In 23 individuals where dilatation could be evaluated uni- or bilaterally, US was compared to OEE% (%outflow excretion efficiency) at renography. In 1 of these individuals there was normal OEE% while slight dilatation on US was noticed. In 2/15 individuals, split function at renography did not correlate with renal length on US. CONCLUSION: Severe spinal angulation and obesity in individuals with MMC reduced the possibility to evaluate the urinary tract by US. However, it seems that renography could be a reliable alternative to evaluate renal condition in those patients where US is insufficient.
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| 5. |
- Abrahamsson, Kate, 1959, et al.
(författare)
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Ultrasonography to visualize the upper urinary tract in children with meningomyelocele
- 2006
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Ingår i: BJU Int. - 1464-4096. ; 98:4, s. 858-60
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the frequency of difficulties when using ultrasonography (US, commonly used to visualize the upper urinary tract) to evaluate renal length and dilatation in children and adolescents with meningomyelocele (MMC), who have excessive obesity or a distorted spine. PATIENTS AND METHODS: The records of all children with MMC investigated during 1996-2002 were assessed retrospectively and the last investigation used for analysis. In addition to the US results, the body mass index (BMI) and angulation of the spine were recorded. RESULTS: Of the 160 children investigated, US was not evaluable in 46 (29%), i.e. in 35 (22%) for renal length, in one (1%) for dilatation and in 10 (6%) for both. In 99 patients with a straight spine and mild to moderate angulation, renal length was not measurable in 14 (14%), while dilatation was not evaluable in two (2%). In 61 patients with a severely angled spine, the corresponding values were 31 (51%) and nine (15%), respectively. In eight patients with a BMI of >or= 27 kg/m2 and a straight spine, four of the investigations were not completely evaluable, while six were not in the eight patients with both a BMI of >or= 27 kg/m2 and severe angulation. CONCLUSION: Both severe spinal angulation and a BMI of >or= 27 kg/m2 significantly reduced the possibility of evaluating the urinary tract by US. However, in an unselected group of children with MMC, dilatation could be evaluated in >90% and renal length in approximately 70%.
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| 6. |
- Andersson, Lena, 1980, et al.
(författare)
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Urinary proteins in children with urinary tract infection
- 2009
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Ingår i: Pediatric Nephrology. - : Springer Science and Business Media LLC. - 0931-041X .- 1432-198X. ; 24:8, s. 1533-1538
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Tidskriftsartikel (refereegranskat)abstract
- Abstract The aim of this study was to test our hypothesis that the urinary excretion of C-reactive protein (CRP), alpha 1-microglobulin (A1M), retinol-binding protein (RBP) and Clara cell protein (CC16) is increased in children with urinary tract infection (UTI) and relates to renal damage as measured by acute dimercaptosuccinic acid (DMSA) scintigraphy. Fifty-two children <2 years of age with UTI were enrolled in the study, 44 of whom were febrile. The control group consisted of 23 patients with non-UTI infection and elevated serum CRP (s-CRP) levels. Thirty-six patients had abnormal DMSA uptake, classified as mild, moderate or severe damage (DMSA class 1, 2, 3, respectively). There was a significant association between DMSA class and the excretion of urinary RBP (u-RBP) and u-CC16. There was also a significant difference in u-CRP levels between children with UTI and control children with non-UTI infections, although u-CRP excretion was not significantly correlated to DMSA class. In conclusion, the urinary excretion of the low-molecular-weight proteins RBP and CC16 showed a strong association with uptake defects on renal DMSA scans. The urinary level of CRP seems to distinguish between children with UTI and other febrile conditions. A combination of these biomarkers may be useful in the clinical assessment of children with UTI.
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| 7. |
- 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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| 8. |
- 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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| 9. |
- 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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| 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. |
- Fischer, Hans, et al.
(författare)
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Pathogen specific, IRF3-dependent signaling and innate resistance to human kidney infection.
- 2010
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Ingår i: PLoS pathogens. - : Public Library of Science (PLoS). - 1553-7374 .- 1553-7366. ; 6:9
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Tidskriftsartikel (refereegranskat)abstract
- The mucosal immune system identifies and fights invading pathogens, while allowing non-pathogenic organisms to persist. Mechanisms of pathogen/non-pathogen discrimination are poorly understood, as is the contribution of human genetic variation in disease susceptibility. We describe here a new, IRF3-dependent signaling pathway that is critical for distinguishing pathogens from normal flora at the mucosal barrier. Following uropathogenic E. coli infection, Irf3(-/-) mice showed a pathogen-specific increase in acute mortality, bacterial burden, abscess formation and renal damage compared to wild type mice. TLR4 signaling was initiated after ceramide release from glycosphingolipid receptors, through TRAM, CREB, Fos and Jun phosphorylation and p38 MAPK-dependent mechanisms, resulting in nuclear translocation of IRF3 and activation of IRF3/IFNβ-dependent antibacterial effector mechanisms. This TLR4/IRF3 pathway of pathogen discrimination was activated by ceramide and by P-fimbriated E. coli, which use ceramide-anchored glycosphingolipid receptors. Relevance of this pathway for human disease was supported by polymorphic IRF3 promoter sequences, differing between children with severe, symptomatic kidney infection and children who were asymptomatic bacterial carriers. IRF3 promoter activity was reduced by the disease-associated genotype, consistent with the pathology in Irf3(-/-) mice. Host susceptibility to common infections like UTI may thus be strongly influenced by single gene modifications affecting the innate immune response.
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| 15. |
- Gebäck, Carin, et al.
(författare)
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Obstetrical outcome in women with urinary tract infections in childhood
- 2016
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Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - : Wiley. - 0001-6349. ; 95:4, s. 452-457
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionUrinary tract infections (UTI) during childhood can result in permanent renal damage, with possible implications for future pregnancies. The aim of this prospective study was to investigate pregnancy outcomes in women followed after their first UTI in childhood. Material and methodsA cohort of 72 parous women was followed from their first UTI in childhood up to a median age of 41 years. Clinical data were obtained from antenatal and hospital records. Renal damage was evaluated by a Tc-99m-dimercaptosuccinic acid scan. Pregnancy blood pressure (BP), complications and UTIs were compared between women with and without renal damage. ResultsAll women completed the investigations, 48 with and 24 without renal damage. No woman, irrespective of presence or absence of renal damage, was diagnosed with hypertension before the first pregnancy. Pregnancy-related hypertension was diagnosed in 10 of 151 pregnancies, all in women with renal damage. Preeclampsia occurred in four women. Women with renal damage had significantly higher systolic BP measured at the last antenatal visit of their first pregnancy, compared with women without renal damage (p = 0.005). During subsequent pregnancies both systolic and diastolic BP were significantly higher in women with than without renal damage (p = 0.02 and p = 0.03, respectively). ConclusionIn this population-based follow-up study we found a large proportion of women with renal damage after UTI in childhood. Women with renal damage had significantly higher BP during pregnancy compared with women without renal damage. Pregnancy-related hypertension was recorded only in women with renal damage. However, pregnancy complications, including preeclampsia, were few.
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| 16. |
- Gebäck, Carin, et al.
(författare)
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Renal function in adult women with urinary tract infection in childhood.
- 2015
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Ingår i: Pediatric nephrology (Berlin, Germany). - : Springer Science and Business Media LLC. - 1432-198X .- 0931-041X. ; 30:9, s. 1493-1499
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Tidskriftsartikel (refereegranskat)abstract
- The risk of deterioration of renal function in patients with urinary tract infection (UTI)-associated renal damage over several decades is incompletely known but of importance in regard to follow-up.
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| 17. |
- Gebäck, Carin, et al.
(författare)
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Urinary tract infection pattern in adult women followed from childhood.
- 2016
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Ingår i: Pediatric nephrology (Berlin, Germany). - : Springer Science and Business Media LLC. - 1432-198X .- 0931-041X. ; 31:7, s. 1107-1111
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the pattern of urinary tract infection (UTI) and bladder function in women who had experienced recurrent UTI in childhood, with and without consequent renal damage, and followed for three to four decades.
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| 18. |
- Hansson, Sverker, 1946, et al.
(författare)
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Dimercapto-succinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection.
- 2004
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Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 172:3
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We study the ability of dimercapto-succinic acid (DMSA) scintigraphy to predict the presence of dilating vesicoureteral reflux (VUR) in infants with urinary tract infection (UTI) to simplify the evaluation protocol. MATERIALS AND METHODS: A retrospective analysis of the records of 303 children younger than 2 years with initial UTI investigated with DMSA scintigraphy and voiding cystourethrography (VCU) within 3 months after UTI was performed. RESULTS: In 156 of the 303 children (51%) DMSA scintigraphy showed renal lesions. VUR was found in 80 patients (26%) and VUR grade significantly correlated with the presence of renal lesions. A normal DMSA scintigraphy and dilating VUR (grade III) occurred in 7 infants. At followup after 1 to 2 years, 6 of these 7 patients had normal DMSA scans and 1 had a scarred duplex kidney. VUR resolved spontaneously in 5 and improved spontaneously to grade 1 in 2 patients. None of the 7 children had recurrent UTI. CONCLUSIONS: DMSA scintigraphy in infants with UTI may replace VCU as a first line investigation. A strategy to perform VCU in only patients with renal lesions is proposed. In this study 147 of 303 VCUs would have been unnecessary as only 1 child with a damaged kidney was missed.
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| 19. |
- 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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| 20. |
- Hansson, Sverker, 1946, et al.
(författare)
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Urinary tract infection caused by Haemophilus influenzae and Haemophilus parainfluenzae in children.
- 2007
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Ingår i: Pediatric nephrology (Berlin, Germany). - : Springer Science and Business Media LLC. - 0931-041X .- 1432-198X. ; 22:9, s. 1321-5
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Tidskriftsartikel (refereegranskat)abstract
- There are few reports on urinary tract infections caused by Haemophilus influenzae or Haemophilus parainfluenzae in children. The true incidence is not known, since bacteria of Haemophilus species do not grow in standard urine culture media. With the objective of investigating the occurrence and character of urinary tract infections (UTIs) caused by Haemophilus bacteria in children, we searched the files of our UTI clinic. Over a 24-year period 36 children with Haemophilus spp. bacteriuria were identified out of a total of more than 5,000 UTI episodes. There was a significant gender difference in that Haemophilus influenzae dominated in girls and Haemophilus parainfluenzae in boys. With one exception, all children had important urinary tract abnormalities, such as malformation, gross reflux or bladder dysfunction. Permanent renal damage was seen in 25. We conclude that growth of Haemophilus bacteria in urine is associated with serious urinary tract abnormalities. The inability of bacteria of the Haemophilus species to grow in standard media commonly used for culture of uropathogens suggests that the true frequency of these strains as a cause of urinary tract infections is underestimated.
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| 21. |
- Hellström, Anna-Lena, 1946, et al.
(författare)
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Association between urinary symptoms at 7 years old and previous urinary tract infection.
- 1991
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Ingår i: Archives of disease in childhood. - 1468-2044. ; 66:2, s. 232-4
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Tidskriftsartikel (refereegranskat)abstract
- The association between current micturition habits and previous urinary tract infection was analysed among 3553 school entrants aged 7 years by means of a questionnaire. A high incidence of urinary infection, confirmed by urine culture, was found (145 (8.4%) in the 1719 girls and 32 (1.7%) in the 1834 boys). There was a significant association between current symptoms that were suggestive of disturbed bladder function and previous urinary tract infection, but only among girls who were over 3 years of age at the time the first episode was diagnosed.
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| 22. |
- Hellström, Anna-Lena, 1946, et al.
(författare)
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Micturition habits and incontinence at age 17--reinvestigation ofa cohort studied at age 7.
- 1995
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Ingår i: British journal of urology. - 0007-1331. ; 76:2, s. 231-4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the epidemiology of micturition disturbances in teenagers. SUBJECTS AND METHODS: A subsample of 1034 teenagers previously evaluated at age 7 years was reinvestigated 10 years later. A postal questionnaire was used and a response rate of 71% (736) obtained. Those who reported bladder symptoms were contacted by telephone for a detailed history concerning imperative urge, daytime incontinence, emptying difficulties and bedwetting. RESULTS: There was a general decrease in the frequency and intensity of symptoms from 7 to 17 years of age. At age 17 at least one symptom was reported by 5.9% of the girls and 0.9% of the boys. Overall the symptoms were regarded as mild or moderate. CONCLUSION: At age 17 years, micturition disturbances were reported infrequently and few subjects wanted medical help.
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| 23. |
- Hellström, Anna-Lena, 1946, et al.
(författare)
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Micturition habits and incontinence in 7-year-old Swedish school entrants.
- 1990
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Ingår i: European journal of pediatrics. - 0340-6199. ; 149:6, s. 434-7
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Tidskriftsartikel (refereegranskat)abstract
- The prevalence of incontinence in children has been extensively studied, but knowledge of other bladder symptoms is lacking in a healthy child population. The micturition habits of 3556 7-year-old school entrants were surveyed by a questionnaire supplemented by telephone interviews. One or more symptoms of a disturbed bladder function was reported in 26%, but most of these had moderate urgency as a sign of incomplete voluntary bladder control. Isolated bedwetting occurred in 2.8% of the girls and 7.0% of the boys, whereas nocturnal incontinence combined with daytime wetting was equally common in both sexes, 2.3% and 2.0% respectively. Diurnal incontinence was reported in 6.0% of the girls and 3.8% of the boys and was usually combined with other symptoms. The frequency of micturition in children without symptoms of bladder disturbance and with no previous urinary tract infection was 3-7 times per day.
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| 24. |
- Hellström, Anna-Lena, 1946, et al.
(författare)
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Pad tests in children with incontinence.
- 1986
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Ingår i: Scandinavian journal of urology and nephrology. - 0036-5599. ; 20:1, s. 47-50
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Tidskriftsartikel (refereegranskat)abstract
- Different pad tests were compared in 50 incontinent children. In a 2-hour ward test with standardized activities and fluid provocation 70% were positive. In a simple 12-hour home test with 30 children 68% were positive; when a fluid provocation period was included in the home test with 20 children the frequency increased to 80%. Pad tests are easy to perform with children in the home and are valuable as screening instruments. Further, the simultaneous registration of events gives a more complete picture of the incontinence pattern.
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| 25. |
- Hellström, Anna-Lena, 1946, et al.
(författare)
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Rehabilitation of the dysfunctional bladder in children: method and 3-year followup.
- 1987
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Ingår i: The Journal of urology. - 0022-5347. ; 138:4, s. 847-9
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Tidskriftsartikel (refereegranskat)abstract
- A rehabilitation program has been developed for children with functional, nonneurogenic bladder disturbance. The basis for the program is a bladder regimen supplemented by biofeedback training if needed. Results in the first 70 children (64 girls and 6 boys) are presented. After 1 and 3 years 36 and 53 children, respectively, had completely normalized voiding patterns, that is they were continent, had no urgency, voided 3 to 6 times a day and emptied the bladder completely in 1 portion with a normal flow rate. The training program is applicable in children with varying urodynamic diagnoses and it has been used in children as young as 4 years old.
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| 26. |
- Hellström, Anna-Lena, 1946, et al.
(författare)
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Terodiline in the treatment of children with unstable bladders.
- 1989
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Ingår i: British journal of urology. - 0007-1331. ; 63:4, s. 358-62
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Tidskriftsartikel (refereegranskat)abstract
- A double-blind study of terodiline compared with placebo was performed in 58 children aged 6 to 14 years with urgency or urge incontinence. All had an unstable bladder at cystometry. A bladder regimen was emphasised during the study. Continence was improved according to micturition charting and a pad test in both groups. Terodiline at 25 mg/day, however, gave significantly better results than placebo. In patients with a subnormal bladder capacity (less than or equal to 150 ml), a significant increase in capacity was recorded on cystometry during medication with terodiline but not with placebo. The improved continence seen in the placebo group was probably due to the non-specific bladder training achieved by the child's increased awareness and adult involvement during treatment. The even better results attained in the terodiline group shows this drug to be a valuable adjunct to a bladder regimen in children with urge incontinence, particularly since no important adverse effects were noted during an 8-week period.
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| 27. |
- Hellström, Mikael, 1950, et al.
(författare)
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Urinary tract infections
- 2009
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Ingår i: Urogenital imaging – a problem-oriented approach. Editors: Morcos S and Thomsen HS.. - : Wiley-Blackwell Publishing Company. ; , s. 149-194
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 28. |
- 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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| 29. |
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| 30. |
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| 31. |
- Jodal, Ulf, 1938, et al.
(författare)
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Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Children
- 2006
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Ingår i: Pediatr Nephrol. - : Springer Science and Business Media LLC. - 0931-041X. ; 21:6, s. 785-92
-
Tidskriftsartikel (refereegranskat)abstract
- For the comparison of long-term outcome of the management of medical or surgical treatment of children with severe vesicoureteral reflux (VUR), children aged <11 years with non-obstructive grade III/IV reflux, previous urinary tract infection (UTI) and glomerular filtration rate (GFR) >or=70 ml/min per 1.73 m2 body surface area were recruited, and 306 were randomly allocated to receive antimicrobial prophylaxis or ureteral reimplantation. Primary endpoints were new renal scars and renal growth. Follow up, originally planned for 5 years, was extended to 10 years for 252 children, 223 of whom had follow-up imaging. Up to 5 years, 40 new urographic scars (medical 19, surgical 21) were seen. Between 5 years and 10 years, only two further scars were observed. Renal growth and UTI recurrence rate were similar, except that medically treated patients had more febrile infections. There was no difference in somatic growth, radionuclide imaging or renal function. A GFR <70 ml/min per 1.73 m2 was found in only one patient. Three patients developed hypertension requiring treatment. We conclude that, with close supervision and prompt treatment of recurrences, children entering the study with GFR >or=70 ml/min per 1.73 m2 progressed remarkably well under either medical or surgical management, emphasizing the importance of continued supervision and the entry level of renal function.
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| 32. |
- Lindehall, Birgitta, 1946, et al.
(författare)
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Complications of clean intermittent catheterization in boys and young males with neurogenic bladder dysfunction
- 2004
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Ingår i: J Urol. - 0022-5347. ; 172:4 Pt 2, s. 1686-8
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We evaluate the risk for urethral lesions and epididymitis in boys with neurogenic bladder dysfunction treated by clean intermittent catheterization (CIC) for a minimum of 10 years. MATERIALS AND METHODS: The medical records of 28 males with neurogenic bladder dysfunction followed from the start of CIC until the age of 15 to 20 years were reviewed. RESULTS: CIC had been performed for a median of 16 years (range 10 to 21). Overall CIC was used for 438 years (265 before and 173 after puberty). During 76% of the years a noncoated polyvinyl chloride catheter with lubrication was used and in 24% of years a hydrophilic coated polyvinyl chloride catheter was used. The catheter size was 12C or greater in 43% of the cases. Independence from self-catheterization occurred during 37% of the CIC years. Of the patients 19 experienced at least 1 episode of difficulty inserting the catheter and/or had macroscopic hematuria on a total of 42 occasions. Major urethral lesions were seen on cystoscopy in 7 patients on 9 occasions (5 false passages, 1 superficial recess, 2 meatal stenoses, 1 urethral stricture). Major urethral lesions were not associated with puberty and did not occur during self-catheterization or with use of catheters 12C or greater. Epididymitis was seen in only a 12 year-old boy. CONCLUSIONS: The overall rate of complications was low. The incidence of major urethral lesions did not increase during puberty. Self-catheterization and 12C catheter or greater seemed to be protective against major lesions.
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| 33. |
- Lindehall, Birgitta, 1946, et al.
(författare)
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Complications of clean intermittent catheterization in young females with myelomeningocele: 10 to 19 years of followup
- 2007
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Ingår i: J Urol. - 0022-5347. ; 178:3 Pt 1, s. 1053-5
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We evaluated the rate of complications associated with catheterization and the risk of urethral lesions in girls with myelomeningocele treated with clean intermittent catheterization for a minimum of 10 years. MATERIALS AND METHODS: We examined the medical records of 31 females with myelomeningocele followed from the start of clean intermittent catheterization until age 11 to 20 years. Catheterization had been performed for a median of 15 years (range 10 to 19). Altogether, catheterization was used for a total of 459 patient-years. Noncoated polyvinyl chloride catheters were used in all cases. Anticholinergic treatment was given during 176 of the patient-years. RESULTS: Complications of catheterization were recorded in 13 patients on 20 occasions. Macroscopic hematuria was seen in 4 individuals. In 2 patients the hematuria was caused by urethral polyps that were cured by resection. Difficulties with catheterization occurred in 12 patients. The problems were solved by temporary use of lubrication or by other minor changes in management. There were no difficulties recorded after puberty. The risk of difficulties at catheterization doubled with the use of a Ch8 to Ch10 catheter compared to a Ch12 or larger catheter, and doubled during assisted clean intermittent catheterization compared to clean intermittent self-catheterization. CONCLUSIONS: There were remarkably few problems associated with clean intermittent catheterization in these females with myelomeningocele, despite long treatment periods and use of noncoated polyvinyl chloride catheters. Clean intermittent self-catheterization and large size catheters were associated with few complications.
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| 34. |
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| 35. |
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| 36. |
- Müller, Lennart, 1959, et al.
(författare)
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Ultrasonography as predictor of permanent renal damage in infants with urinary tract infection.
- 2009
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Ingår i: Acta paediatrica (Oslo, Norway : 1992). - : Wiley. - 1651-2227 .- 0803-5253. ; 98:7, s. 1156-61
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate the ability of ultrasound (US) in infants (<1 year) with acute urinary tract infection (UTI), to identify those with permanent renal damage (PRD) at scintigraphy 1 year later. METHODS: US, dimercaptosuccinic acid scintigraphy and voiding cystourethrography were performed in 191 infants. RESULTS: US was abnormal in 46 infants (24%). PRD was found in 46 infants (24%); 19 of these had abnormal US (sensitivity 41%). In 145 infants without PRD, 27 had abnormal US (specificity 81%). Dilating reflux or verified obstruction occurred in 21 (11%) infants, of whom 18 (86%) had PRD while 28 of 170 (16%) without such diagnoses had PRD. Of 16 infants with dilating reflux, 9 (sensitivity 56%) had abnormal US and 14 (88%) PRD. Dilatation at US was seen in 27 children; 7 of these had dilating reflux and 5 verified obstruction. CONCLUSION: US performed in association with acute UTI had limited ability to identify children with PRD at (99m)Tc-dimercaptosuccinic acid (DMSA) 1 year later, although abnormal renal size was a strong indicator of renal damage. The ability of US to identify children with dilating reflux was also limited. However, once detected at US, dilatation of the urinary tract was associated with dilating reflux or obstruction in half of the cases. Our study confirms that dilating reflux and obstruction are strong indicators of PRD but only half of those who developed PRD had such diagnoses.
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| 37. |
- Mårild, Staffan, 1945, et al.
(författare)
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Ceftibuten versus trimethoprim-sulfamethoxazole for oral treatment of febrile urinary tract infection in children
- 2009
-
Ingår i: Pediatric Nephrology. - 0931-041X. ; 24:3, s. 521-6
-
Tidskriftsartikel (refereegranskat)abstract
- A randomized, open, coordinated multi-center trial compared the bacteriological and clinical efficacy and safety of orally administered ceftibuten and trimethoprim-sulfamethoxazole (TMP-SMX) in children with febrile urinary tract infection (UTI). Children aged 1 month to 12 years presenting with presumptive first-time febrile UTI were eligible for enrollment. A 2:1 assignment to treatment with ceftibuten 9 mg/kg once daily (n = 368) or TMP-SMX (3 mg + 15 mg)/kg twice daily (n = 179) for 10 days was performed. Escherichia coli was recovered in 96% of the cases. Among the E. coli isolates, 14% were resistant to TMP-SMX but none to ceftibuten. In the modified intention-to-treat population, the bacteriological elimination rates at follow-up did not differ significantly between patients treated with ceftibuten and those treated with TMP-SMX [91 vs. 95%, with a 95% confidence interval (CI) for difference of -9.7 to 1.0]. However, the clinical cure rate was significantly higher among those treated with ceftibuten (93 vs. 83%, with a 95% CI for difference of 2.4 to 17.0). Adverse events were similar for both regimens and consisted mainly of gastrointestinal disturbances. In conclusion, ceftibuten is a safe and effective drug for the empirical treatment of febrile UTI in young children.
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| 38. |
- Mårild, Staffan, 1945, et al.
(författare)
-
Protective effect of breastfeeding against urinary tract infection
- 2004
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Ingår i: Acta Paediatr. - 0803-5253. ; 93:2, s. 164-8
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess the possible protective effect of exclusive breastfeeding against first-time febrile urinary tract infection (UTI) in children. METHODS: Two children's hospitals and local child health centres in the Goteborg area, Sweden, participated in a prospective case-control study. In total, 200 consecutive cases (89M, 111F), aged 0-6y, presenting with first-time febrile UTI were enrolled. The mean +/- SD age was 0.98 +/- 1.15 y. As control subjects, 336 children (147M, 189F) were recruited from the child health centre of the case, matched for age and gender and included consecutively for each case during the first days after diagnosis. The duration of exclusive breastfeeding was obtained from the case and controls by a standardized procedure. RESULTS: Ongoing exclusive breastfeeding gave a significantly lower risk of infection. A longer duration of breastfeeding gave a lower risk of infection after weaning, indicating a long-term mechanism. The protective role of breastfeeding was strongest directly after birth, then decreased until 7 mo of age, after which age no effect was demonstrated. CONCLUSION: A protective role of breastfeeding against UTI was demonstrated. The study provides statistical support to the view that breast milk is a part of the natural defence against UTI.
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| 39. |
- 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
-
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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| 40. |
- Plos, Kaety, 1944, et al.
(författare)
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Intestinal carriage of P fimbriated Escherichia coli and the susceptibility to urinary tract infection in young children.
- 1995
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Ingår i: The Journal of infectious diseases. - : Oxford University Press (OUP). - 0022-1899 .- 1537-6613. ; 171:3, s. 625-31
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Tidskriftsartikel (refereegranskat)abstract
- This prospective study analyzed the intestinal carriage of P fimbriated Escherichia coli as a host susceptibility factor in urinary tract infection (UTI). P fimbriation was defined by the pap and G adhesin (papG1A2, prsGJ96) genotypes. Children with UTI carried pap+ E. coli in the fecal flora more often than healthy controls both at diagnosis (86% vs. 29%) and during infection-free intervals (approximately 40%; P < .01). P1 blood group-positive children carried pap+ E. coli in the fecal flora more often (88%) than those with P2 blood group (40%; P < .05). A pap+ E. coli strain caused UTI in 53 of 55 patients who carried both pap+ and pap- strains in their fecal flora. These results suggest that persons who develop UTI have an increased tendency to carry pap+ E. coli in the large intestine and that these pap+ E. coli cause UTI more often than pap E. coli strains in the fecal flora of the same host.
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| 41. |
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| 42. |
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| 43. |
- Preda, Iulian, 1969, et al.
(författare)
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Value of ultrasound in evaluation of infants with first urinary tract infection.
- 2010
-
Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 183:5, s. 1984-1988
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We evaluated the role of ultrasound in diagnosing and treating infants with a first urinary tract infection with a focus on important structural abnormalities. MATERIALS AND METHODS: In a setting of limited prenatal ultrasound screening this population based, prospective, 3-year study included 161 male and 129 female infants. Ultrasound and dimercapto-succinic acid scintigraphy were performed as initial investigations and voiding cystourethrography was conducted within 2 months. RESULTS: Ultrasound revealed dilatation in 15% of patients and increased kidney length in 28%. Sensitivity for detecting scintigraphic abnormality was 48%. Renal length was significantly correlated to inflammatory parameters, including scintigraphic abnormalities. Important structural abnormalities were detected in 40 cases, with 30 on ultrasound, while 10 of 27 cases of dilating reflux (mostly grade III) were missed. Outside the study there were 28 additional cases of structural abnormality, of which 15 were detected prenatally. CONCLUSIONS: Ultrasound detected most structural abnormalities except grade III reflux. Since it is noninvasive, ultrasound has a place in the evaluation of infants with urinary tract infection, especially in the absence of prenatal ultrasound during late pregnancy. Kidney length in infants with acute infection correlated with inflammatory parameters, and the clinical importance of this finding needs to be studied further.
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| 44. |
- Ragnarsdottir, Bryndis, et al.
(författare)
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Toll-like receptor 4 promoter polymorphisms: common TLR4 variants may protect against severe urinary tract infection.
- 2010
-
Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 5:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Polymorphisms affecting Toll-like receptor (TLR) structure appear to be rare, as would be expected due to their essential coordinator role in innate immunity. Here, we assess variation in TLR4 expression, rather than structure, as a mechanism to diversify innate immune responses. METHODOLOGY/PRINCIPAL FINDINGS: We sequenced the TLR4 promoter (4,3 kb) in Swedish blood donors. Since TLR4 plays a vital role in susceptibility to urinary tract infection (UTI), promoter sequences were obtained from children with mild or severe disease. We performed a case-control study of pediatric patients with asymptomatic bacteriuria (ABU) or those prone to recurrent acute pyelonephritis (APN). Promoter activity of the single SNPs or multiple allelic changes corresponding to the genotype patterns (GPs) was tested. We then conducted a replication study in an independent cohort of adult patients with a history of childhood APN. Last, in vivo effects of the different GPs were examined after therapeutic intravesical inoculation of 19 patients with Escherichia coli 83972. We identified in total eight TLR4 promoter sequence variants in the Swedish control population, forming 19 haplotypes and 29 genotype patterns, some with effects on promoter activity. Compared to symptomatic patients and healthy controls, ABU patients had fewer genotype patterns, and their promoter sequence variants reduced TLR4 expression in response to infection. The ABU associated GPs also reduced innate immune responses in patients who were subjected to therapeutic urinary E. coli tract inoculation. CONCLUSIONS: The results suggest that genetic variation in the TLR4 promoter may be an essential, largely overlooked mechanism to influence TLR4 expression and UTI susceptibility.
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| 45. |
- Sandberg, Torsten, 1945, et al.
(författare)
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Urinvägsinfektioner
- 2005
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Ingår i: Läkemedelsboken 2005/2006. ; , s. 356-66
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
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| 46. |
- Sandberg, Torsten, 1945, et al.
(författare)
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Urinvägsinfektioner
- 2007
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Ingår i: Läkemedelsboken 2007/2008. ; , s. 369-78, s. 253-64
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 47. |
- Sandberg, Torsten, 1945, et al.
(författare)
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Urinvägsinfektioner
- 2009
-
Ingår i: Läkemedelsboken 2009/2010. ; , s. 395-404
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 48. |
- Sillén, Ulla, 1946, et al.
(författare)
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The Swedish Reflux Trial in Children: V. Bladder Dysfunction.
- 2010
-
Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 184:1, s. 298-304
-
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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| 49. |
- Sjöström, Sofia, 1968, et al.
(författare)
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Longitudinal development of renal damage and renal function in infants with high grade vesicoureteral reflux.
- 2009
-
Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 181:5, s. 2277-83
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We sought to study renal abnormality and renal function through time in infants with high grade vesicoureteral reflux. MATERIALS AND METHODS: This prospective observational study included 115 infants (80 boys and 35 girls) younger than 1 year with grade III to V vesicoureteral reflux. The diagnosis was made after prenatal ultrasound in 26% of the patients and after urinary tract infection in 71%. Patients were followed by renal scintigraphy, 51chromium edetic acid clearance and video cystometry. Median followup was 62 months. RESULTS: Renal abnormality, which was found in 90% of the children at followup, was generalized in 71% and focal in 29%. The abnormality was bilateral in 28% of the affected patients. Total glomerular filtration rate was less than 80% of expected in 30% of the patients. Single kidney function was less than 40% of expected total glomerular filtration rate in 71% of the patients. Renal status (parenchymal abnormality and function) remained unchanged through time in 84 of 108 available cases (78%), improved in 5 (5%) and deteriorated in 19 (18%). Predictive factors for deterioration were recurrent febrile urinary tract infection, bilateral abnormality and reduced total glomerular filtration rate. Deteriorated renal status was more common in cases diagnosed prenatally than in those detected after urinary tract infection. CONCLUSIONS: Among these infants with high grade vesicoureteral reflux renal abnormality was frequent and was associated with subnormal filtration of one of the kidneys. Decreased total glomerular filtration rate was seen in about a third of the patients. Overall deterioration of renal status was seen in only a fifth of the patients. Infection control seems to be an important factor to minimize the risk.
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| 50. |
- Sjöström, Sofia, 1968, et al.
(författare)
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Predictive factors for resolution of congenital high grade vesicoureteral reflux in infants: results of univariate and multivariate analyses.
- 2010
-
Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 183:3, s. 1177-84
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We studied variables with impact on cessation of congenital high grade vesicoureteral reflux in univariate analyses and provide a multivariate model for prediction of reflux resolution. MATERIALS AND METHODS: A total of 80 male and 35 female infants (median age 2.7 months) were included in this prospective observational study. Of the cases 71% were diagnosed after urinary tract infection and 26% after prenatal ultrasound. Reflux was bilateral in 70% of the patients and maximum grade was III in 16%, IV in 45% and V in 39%. The study protocol included repeat videocystometries, renal scintigrams, chromium edetic acid clearances and free voiding observations. Median followup was 36 months. RESULTS: Overall spontaneous reflux resolution, including cases downgraded to grade I to II, was 38%. Variables significantly negatively correlated to resolution were breakthrough febrile urinary tract infection, bladder dysfunction, higher grade of reflux at inclusion, renal abnormality, subnormal renal function, increased bladder capacity, residual urine and passive occurrence of reflux. Multivariate Cox proportional hazard model with stepwise selection identified 3 independent predictors--renal abnormality (hazard ratio 0.45, 95% CI 0.31-0.64, p <0.0001), bladder dysfunction (hazard ratio 0.43, 95% CI 0.29-0.64, p <0.0001) and breakthrough urinary tract infection (hazard ratio 0.38, 95% CI 0.18-0.78, p = 0.009). Performance of the model was evaluated by the receiver operating characteristic curve, with a calculated area under the curve of 83%. CONCLUSIONS: Overall resolution rate in congenital high grade vesicoureteral reflux is high during the first years of life. By multivariate analyses renal abnormality, bladder dysfunction and breakthrough febrile urinary tract infection were identified as strong independent negative predictive factors for reflux resolution.
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