Background. The aim of the research was to study the content of 1,25(OH)2D3 and vitamin D-binding protein (DBP) in the blood serum of children with urinary tract infections, taking into account the clinical form of the disease, and to determine their pathogenetic role in the development of urinary tract infections. Materials and methods. The study groups consisted of 84 children (mean age — 10.0 ± 1.3 years). The main group was divided into subgroups: the first one — 17 children with acute pyelonephritis, the second one — 21 patients with chronic pyelonephritis, the third one — 16 children with acute cystitis, the fourth one — 10 patients with unspecified urinary tract infections. The control group consisted of 20 relatively healthy children. The content of 1,25(OH)2D3 and DBP was investigated by immunoenzymatic analysis. Results. It was found that the development of the inflammatory process in the urinary tract was accompanied by a statistically significant (p < 0.01) decrease in the level of 1,25(OH)2D3 in the blood serum of the children of the main group compared to the controls. The level of 1,25(OH)2D3 in patients of all subgroups was significantly lower than that of the control group (p < 0.01), but there was no statistical difference between them. Serum level of DBP in the main group was statistically significantly (p < 0.05) increased compared to the controls, but we did not find a statistically significant difference between the subgroups studied. Conclusions. The development of an acute inflammatory process in the urinary tract in children occurs against the background of a statistically significant decrease in the blood level of 1,25(OH)2D3 combined with high levels of vitamin D-binding protein. This serves as a pathogenetic basis for the need to develop therapeutic and prophylactic schemes for prescribing vitamin D to children with urinary tract infections.
The aim. To study the content of antimicrobial peptides in the serum of children with urinary tract infections depending on the clinical form of the disease and to establish their pathogenetic role in the development of various clinical forms of pathology. Materials and methods. The study groups consisted of 84 children (mean age – 10.0 ± 1.3 years). The main group was divided into subgroups: the first subgroup – 17 children with acute pyelonephritis, the second subgroup – 21 patients with chronic pyelonephritis, the third subgroup – 16 patients with acute cystitis, the fourth subgroup – 10 patients with unspecified urinary tract infections. The control group consisted of 20 relatively healthy children. The study of the content of cathelicidin, hepcidin and lactoferrin was performed by enzyme-linked immunosorbent assay. Results. The development of urinary tract infection was accompanied by a statistically significant increase in the content of cathelicidin (P < 0.05). The highest level of serum cathelicidin was registered in children of the first (P <0.05) and third subgroups (P < 0.05). In the other two subgroups, the level of LL-37 had only a trend towards increasing (P > 0.05). The level of hepcidin in the main study group was statistically lower than in the control group (P < 0.05). The development of chronic pyelonephritis and acute cystitis occurred amid a statistically significant decrease in hepcidin levels by 2.5 and 1.7 times (P < 0.01 and P < 0.05, respectively). The level of lactoferrin in the general group was within the control group figures (P > 0.05), however, there was a statistically significant decrease in serum lactoferrin in a subgroup of children with unspecified urinary tract infections (P < 0.05). We determined a relationship between hepcidin and lactoferrin levels in the investigated groups and found a clear direct relationship in a subgroup of children diagnosed with chronic pyelonephritis (r = 0.58, P < 0.01). Conclusions. Each nosological form of urinary tract infection has its own configuration of antimicrobial peptides. The analysis of the relationship between hepcidin and lactoferrin, the antimicrobial peptides that limit the access of the pathogens to serum iron, indicates the synchronization of the body’s defense mechanisms aimed at eliminating the pathogen.
Background. The purpose was stratification of factors that lead to the chronicity of inflammatory diseases of the urinary system in children, as well as creation of a mathematical model for predicting their course. Materials and methods. The research group consisted of 97 children (average age — 10.0 ± 1.3 years). The main group was divided into subgroups: the first one — 43 children with acute urinary tract infections (UTIs), the second one — 34 patients with chronic UTIs. The control group consisted of 20 conditionally healthy children. The content of 1,25(OH)2D3, vitamin D-binding protein, inducible nitric oxide synthase (NOS2), cystatin C, cathelicidin, hepcidin, lactoferrin, interleukins 6, 15 was investigated by immunoenzymatic analysis. The impact of factor characteristics on the process of UTI chronicity was evaluated using factor and cluster analyses. A logistic regression equation was used to predict the probability of developing chronic UTIs. The quality of the constructed model was assessed by its sensitivity and specificity, and receiver operator characteristic (ROC) analysis was also used. Results. It was found that 6 factors had the greatest significance: the factor of functional disorders of the urinary tract, the factor of comorbid conditions, the protective factor, the immune factor, chronic foci of the disease, and the NOS2 factor. According to the results of logistic regression, the model for predicting the probability of developing chronic UTI in children had the form of an equation that included 6 variables (early manifestation of the disease, vitamin D level, vesicoureteral reflux, dysmetabolic nephropathy, neurogenic bladder, UTI in the mother in childhood). The classification ability of the model was determined based on the data of the training sample and was 75.0 %. The sensitivity of the model was 78.3 %, and the specificity was 76.5 %. The area under the ROC curve that corresponded to our mathematical model was equal to 0.776. The Gini index was 55.2 %, which corresponds to the good quality of the model. Conclusions. The process of chronicity of the inflammatory process in the urinary system in children occurs under the conditions of the interaction of some pathological factors. The leading risk factors for the chronicity of the inflammatory process are the presence of functional disorders of the urinary tract, early manifestation of the disease, the level of vitamin D, intestinal dysfunction, and the presence of UTI in the mother in childhood.
The aim of the study was to investigate the main etiological factors of urinary tract infections in children, the role of nitric oxide synthase and cystatin C in the mechanisms of antimicrobial protection in children with acute and chronic urinary tract infections. Materials and methods. The study groups consisted of 84 children (mean age – 10.0 ± 1.3 years). The main group was divided into subgroups: the first subgroup – 17 children with acute pyelonephritis, the second subgroup – 21 patients with chronic pyelonephritis, the third subgroup – 16 patients with acute cystitis, the fourth subgroup – 10 patients with unspecified urinary tract infections. The control group consisted of 20 relatively healthy children. The levels of inducible NO-synthase (NOS2) and cystatin C were measured by enzyme-linked immunosorbent assay. The etiological pathogen was identified in the urine of 200 patients with urinary tract infections. Results. Escherichia coli was identified as the dominant pathogen in 46.7 % of cystitis patients and in 66.6 % of chronic pyelonephritis patients. The next most frequently detected etiological agent in children with acute (27.3 % of cases) and chronic (25.6 %) pyelonephritis and unspecified urinary tract infection (32.2 %) was Enterococcus faecium. Proteus mirabilis was found in 26.6 % of patients with cystitis. The level of NOS2 in all the studied subgroups was significantly higher than that in the control group (P < 0.01). A statistically significant increase in the level of cystatin C in the main group (P < 0.05) was determined. The cystatin C-to-NOS2 ratios in the studied subgroups were 1.5–2.0 times lower than those in the control group (P < 0.05). Conclusions. The change in the spectrum of pathogens has been determined, which was a premise of the need for constant bacteriological monitoring. The development of the primary inflammatory process in the urinary tract occurred amidst a certain dysfunction of the immune system, which was manifested in an insufficient quantitative response of cystatin C, as well as high serum levels of inducible NO-synthase in the patients.
Background. The purpose of the research: to study the content of interleukin-6 and interleukin-15 cytokines in the blood serum of children with urinary tract infection and to establish their pathogenetic role in the development of various clinical forms of the disease. Materials and methods. The study groups consisted of 84 children (mean age of 10.0 ± 1.3 years). The main group was divided into subgroups: the first one — 17 children with acute pyelonephritis, the second — 21 patients with chronic pyelonephritis, the third — 16 children with acute cystitis, the fourth subgroup — 10 patients with unspecified urinary tract infections. The control group included 20 relatively healthy children. The content of interleukin-6 and interleukin-15 was evaluated by enzyme-linked immunosorbent assay. Results. It was established that the development of acute urinary tract infections was accompanied by a high level of serum pro-inflammatory interleukin-6. We found the highest level in children with cystitis, which exceeded that of the control group by 2.8 times (р < 0.01). In children with acute pyelonephritis, this cytokine was 1.8 times higher (р < 0.05). However, patients with chronic pyelonephritis had only a tendency towards its increase (p > 0.05). Interleukin-15 in the main group was statistically higher than in controls (р < 0.05). In children of subgroups 3 and 4, its level did not differ from that of the control group (p > 0.05). However, in subgroups 1 (р < 0.05) and 2 (р < 0.01), we observed a statistically significant increase in interleukin-15 level. A direct correlation between interleukin-15 content and disease duration (r = 0.64, р < 0.05) was also found. Conclusions. The development of an acute inflammatory process in the urinary tract in children occurs against the background of a marked increase in the expression of interleukin-6, while a chronic inflammatory process develops with a statistically significant increase in the level of interleukin-15 in blood serum.
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