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AI InsightIn all patients mean urinary NAG/creatinin ratio was higher than the control group (p
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Abstract
Introduction: Vesicoureteral reflux is the retrograde flow of the urine towards the kidneys. Renal injury occurs particularly because of reflux and infections. The relationship between renal parenchymal injury and reflux is well-known. The common reason of chronic renal failure in children and adult, the rate of 24%, is the vesicoureteral reflux. However, the rate of 90% of the hypertension among this population of patient, is due to the renal insufficiency, and also the reflux nephropathy is determined in the rate of 50% of them. In urological practice, creatinine clearance, blood urine nitrogen (BUN) and the protein levels of the urine are used to evaluate the failure of the renal function due to the reflux and the urinary infection. But the proteinuria has been confirmed at the late period of the renal insufficiency. Increased urine protein level is a good, but late indicator of the renal parenchymal injury. Increased excretion of the low molecular weight proteins and renal tubular enzymes indicate early tubular injury. NAcetyl β-D-Glycosaminidase is a lysosomal enzyme which indicates early tubular injury. In this study, we researched the relationship between the levels of NAG and NAG excretion rate in urine and renal parenchymal injury in patients who had urinary infection history. Materials and Methods: 55 children with urinary infections and 13 healthy children, who addressed to the outpatient Nephrology Department of the SSK Ankara Pediatric Hospital, have been assessed. For every children routine urine analysis, urine culture, renal ultrasonography, intravenous pyelography, voiding cystourethrography and renal scintigraphy with Tc99m dimercaptosuccinic acid (DMSA) were performed. In urine specimens, the levels of NAG, albumin, and creatinin have been determined. The study group has been evaluated as urinary infection free status at least 3 months (for this reason urine NAG, BM and LDH levels have been not effected) if infection determined only the trimethoprime- sulphametaxazole has been used however, the proteinuria and the hypertension have not confirmed. Results: 28 of 55 patients who have urinary infections history had VUR. 14 of 28 patients had renal scar. 7 of 27 patients without VUR had renal scar. Patients with renal scarring have been graded. The excreation of NAG in urine, not changed during the day so the spot urine evaluation has been performed. However, the NAG value has been divided to creatinine to decrease the effect of the diuresis. In all patients mean urinary NAG/creatinin ratio was higher than the control group (p
Özet
Vezikoüreteral reflü idrarın böbreğe doğru geri akımıdır. Böbrek parankimal hasar, reflü ve enfeksiyonlar sebebiyle oluşur. Böbrek parankimal hasar ve reflü arasındaki ilişki iyi bilinmektedir. İdrarda artmış protein, böbrek parankimal hasarı gösteren iyi, fakat geç bir bulgudur. Küçük moleküler ağırlıklı proteinler ve böbrek tübüler enzimlerin atılımının artışı erken tübüler hasarlanmayı gösterir. N-Asetil β-D-Glukozaminidaz erken tübüler hasarlanmayı gösteren lizozomal bir enzimdir. Bu çalışmada idrar yolu enfeksiyonu öyküsü olan hastalarda idrarda NAG atılımı ölçümü ve idrar NAG seviyesinin böbrek parankimal hasarlanmayla ilişkisi araştırıldı.Çalışmaya SSK Ankara Çocuk Hastalıkları Eğitim Hastanesi Nefroloji Kliniği’ne idrar yolu enfeksiyonu nedeniyle başvuran 55 çocuk ve sağlıklı 13 çocuk alındı. Her çocuğa tam idrar analizi, idrar kültürü, böbrek ultrasonografi, intravenöz piyelografi, voiding sistoüreterografi ve Tc99m dimerkaptosüksinik asit (DMSA) ile böbrek sintigrafi yapıldı. Ayrıca idrar örneklerinde NAG, ß2-mikroglobulin (BM), laktat dehidrogenaz (LDH), albumin ve kreatinin düzeyleri çalışıldı. Geçirilmiş idrar yolu enfeksiyonu öyküsü olan 55 hastanın 28’inde VUR saptandı. 28 hastanın 14’ünde de böbrek skarı vardı. Vezikoüreteral reflüsü olmayan 27 hastanın 7’sinde böbrek skarı saptandı. Böbrek skarı vakaları derecelendirildi. Tüm hasta gruplarında ortalama idrar NAG/kreatinin değerleri kontrol grubuna göre anlamlı derecede yüksek bulundu (p