Interleukin (IL)-6 and -8 are important inflammatory cytokines in bacterial infections. Their serum and urine concentrations were measured in 27 neonates with urinary tract infection (UTI) at onset and the second week of therapy, as well as in 23 control neonates. Escherichia coli was isolated in 89% of cases. 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scans were performed between the 10th and 90th days after UTI and showed pyelonephritic changes in 15 neonates (56%). Increased IL-6 and IL-8 concentrations were found in urine but not in serum within the first 24 h after presumptive diagnosis of UTI (P=.036 and.010, respectively), suggesting that the neonatal urinary tract can respond to uropathogens by producing inflammatory cytokines. Urine concentrations of IL-6 correlated with findings of renal changes in 99mTc-DMSA scans (P=.012) and thus may serve as a marker of renal parenchymal outcome. All neonates exhibited undetectable urine cytokine levels during the second week of therapy.
The purpose of this study was to evaluate the bone mineral density (BMD) of 50 patients aged 9-28 years, with thalassemia major and to assess the alterations of bone density in a 4-year follow-up study. They were measured with a DPX densitometer at the lumbar spine and femur area and divided into three groups: preadolescents, adolescents, and adults. All patients received calcium and vitamin D supplements, and 8 of the 50 received hormone replacement therapy (HRT). All patients had a significantly lower BMD compared with healthy subjects. Mean values of lumbar BMD of the three groups were 1.3, 2, and 3 standard deviations (SDs) lower than those of healthy subjects of the same age. All adolescent patients with normal gonadal function and those who received HRT showed an increase in BMD during the period of the study. Adult patients also showed an increase in bone density as long as the treatment lasted. However, adolescent and adult patients who had hypogonadotropic hypogonadism but could not get therapy showed a decrease in bone density. BMD of patients with thalassemia major shows a good index of bone status which should be evaluated, especially for the determination and follow-up of therapy.
Urinary tract infection (UTI) is a frequent cause of morbidity during the first years of life and may lead to renal insufficiency. Transforming growth factor-beta1 (TGF-beta) is both immunoregulatory and an important mediator of interstitial fibrosis. TGF-beta was detected in the urine of 52% of 48 children aged 1-24 months with a first episode of UTI (94% due to Escherichia coli) and no obstructive nephropathy compared with 0 of 20 healthy young children (P<0.001). TGF-beta was detected in the urine only during the early stage (<1 day) after initiation of treatment. It was detected more frequently (P=0.06) and in significantly higher concentrations (P=0.046) in children with a normal (99m )Tc-dimercaptosuccinic acid scan compared with those with abnormal scans performed 3-14 days after the diagnosis of UTI, suggesting a regulatory role in fibrogenesis and outcome of pyelonephritis in childhood.
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