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ISOLATING VIRAL AND BACTERIAL PATHOGENS IN BIOPSY MATERIAL FROM KIDNEYS OF CHILDREN WITH OBSTRUCTIVE UROPATHY
965
966
ISOLATING VIRAL AND BACTERIAL PATHOGENS IN BIOPSY MATERIAL FROM KIDNEYS OF CHILDREN WITH OBSTRUCTIVE UROPATHY
THE EXPRESSION OF INTERLEUKIN-6 AND ITS RECEPTORS IN THE DEVELOPING RAT KIDNEY
Kogan M., Naboka U., Kluka I., Bragina L., Suchkov I.
Ha U.S.1, Cha J.H.2, Choi J.Y.2, Cho D.H.3, Lee C.B.3 1
Rostov State Medical University, Department of Urology, Rostov on Don, Russia INTRODUCTION & OBJECTIVES: The role of Chlamydia and Mycoplasma has been investigated somewhat. However the role of viruses such as Herpes and Papilloma in obstructive uropathy of the upper tract in children is still unclear. MATERIAL & METHODS: A prospective study was carried out involving 34 children from 1998-2005. The age range was 1 month to 10 years and the children had been diagnosed with terminal stage hydronephrosis and undergone nephrectomy. Microbial cultures of the biopsy material form both the cortex and medulla of the kidney were then done under aerobic as well as anaerobic conditions . Chlamydia, Mycoplasma, Herpes Simplex type I and II (HSV I, HSV II) Epstein-Bar (EBV), Cytomegalovirus (CMV) and Human Papilloma Virus (HPV) were determined by means of PCR diagnostic. RESULTS: Microbiological analysis indicated that 70.5% of the biopsies had no bacterial growth. Bacteria were isolated as monoculture (11.8%) as well as mixed flora (17.6%). The monoculture showed the following picture: U.Urealyticum (8.9%); M.hominis (2.9%). 3component associations were : U.Urealyticum + S. Mitis + M.hominis (3 cases), M.hominis + S.aureus + Eubacterium Lentum (one case). The 5-component association was represented by: S.epidermidis + Corynebacterium sp + U.Urealyticum + S.intestinalis + P.anaerobius (2 cases). In 58.8% of biopsies the viruses under investigation were found with a predominance of HPV (50.0%) and EBV (40.0%). HSV II and CMV were less commonly and occurred in 30.0% and 20.0% of biopsies respectively. In 70.0% of cases the virus were single variant whilst the remaining 30.0% occurred as 2 or 3 component viral associations. HPV in many cases was in both medulla and cortex and occurred in medulla in 15.0% or cortex only in 5.0%. EBV was seen in either cortex or only medulla alone (20.0% each), HSV II was seen in the equal frequency in either the cortical biopsy, medulla or both. CMV similarly was seen with equal frequency (10.0%) in either the cortical biopsy, medulla or both. In 23.5% of cases the biopsy material had bacterio-viral associations that were dominated by Mycoplasma (Ureaplasma) and Human Papilloma virus. CONCLUSIONS: From the foregoing, it is clear that kidney biopsies often contain Papilloma and Herpes viruses and amongst bacterial pathogens Mycoplasma and Ureaplasma are predominant. Enterobacteriaceae as well as Chlamydia were not isolated. For most of the viruses under investigation complete persistence was seen in different layers of the kidneys. Most probably a transplacental infection by these viruses occurred leading to their persistence in the kidney tissues. It appears that children with the obstructive uropathy of the upper tract may also have viruses playing a key role in congenital anomalies of their urinary tract. The results have broadened our understanding of the etiology of obstructive uropathy and urinary tract infections in children.
College of Medicine, The Catholic University of Korea, Department of Urology, Suwon, South Korea, 2College of Medicine, The Catholic University of Korea, Department of Anatomy, Seoul, South Korea, 3College of Medicine, The Catholic University of Korea, Department of Urology, Seoul, South Korea INTRODUCTION & OBJECTIVES: Interleukin-6 (IL-6) and its are presumed to play important roles in the developing nervous system. However, little is known about their potential role(s) in the developing kidney. To investigate this, we have studied the expression of IL-6 and its receptors, gp130, common receptor subunit of IL-6 family, and IL-6-specific ligand-binding subunit(IL-6R)in the developing rat kidney. MATERIAL & METHODS: Kidneys from 18- (F18), and 20-day-old (F20) foetuses, 1- (P1), 3- (P3), 7- (P7), 14- (P14), and 21-day-old (P21) pups, and adult rats were extracted. Renal expressions of IL-6 and its receptors were examined by immunohistochemistry and in situ hybridisation respectively. RESULTS: IL-6 protein already appeared in F18. The early stage of renal development before birth, IL-6 showed moderate immunoreactivity in the ureteric bud, metanephric mesenchymal cells (MMC) and developing glomerulus. In matured nephron after birth, IL-6 immunoreactivities were detected in glomelurus weakly, in distal tubules strongly, and collecting ducts moderately. Gp130 and IL6R hybridisation signals have already appeared in 18-day old fatal kidney. Before birth, both gp130 and IL-6R mRNAs were expressed in ureteric bud, MMC and developing glomerulus. In the matured nephron after birth, all receptors showed similar expressional pattern except that gp130 mRNA not IL-6R is detected in the descending thin limb. They were expressed in the thick ascending limb, distal tubules and collecting ducts. CONCLUSIONS: These results suggest that IL-6 and its receptors may be involved in regulation of nephron formation in nephrogenic zone of rat, and play a role in distal nephron after birth.
967
968
A SHIFT IN PRESENTATION AND TREATMENT IN CHILDREN WITH A PRIMARY NON-REFLUXING MEGAURETER Beetz R.1, Stein R.2, Schröder A.2, Wölfle S.1, Thüroff J.2 University of Mainz, Medical School, Department of Pediatrics, Mainz, Germany, 2University of Mainz, Medical School, Department of Urology, Mainz, Germany
1
INTRODUCTION & OBJECTIVES: Twenty years ago, most primary non-refluxing megaureter in children was detected only by clinical symptoms. After introduction of the ultrasound screening in the middle of the eighties, most megaureter is discovered in asymptomatic patients. Earlier, many primary non-refluxing megaureters were treated surgically, nowadays a shift to conservative management is observed. In this retrospective study, we studied complications and long-term outcome of children with primary non-refluxing megaureter treated at our institutions. MATERIAL & METHODS: Between 1986 and 2001, 109 patients (25 girls and 84 boys) with 129 primary megaureter were under medical care at our institutions. All patients had a distal ureter width > 6 mm and no other anomalies of the genitourinary tract. First we analysed the entire group, then, in order to detect a change in our therapeutically approach; we divided the patients into 3 groups of successive time periods of 4-5 years. RESULTS: Overall, 79% of the primary non-refluxing megaureter was asymptomatic, 90% were found within the first year of life. of the symptomatic patients, 17% presented with urinary tract infection (UTI), 4% with other symptoms. 104 megaureter were treated primarily conservatively (81%), 19 of those were operated later on because of recurrent infection (n=5) or deterioration of kidney function / increasing dilatation of the upper urinary tract (n=14). 11 of these patients required ureteroneocystostomy; in 2 a non-functioning kidney was removed. Primary supra vesical diversion was performed in the 21 ureters because of UTI or deterioration of kidney function. Primary ureteroneocystostomy was done in 4 ureters. Within the followup period (4 years (1-14)), ureteroneocystostomy was performed in a total of 33/129 primary megaureter (26%). Looking at the 3 successive time periods, 51% of the patients presenting in the first period (1986 – 1991) were treated conservatively, whereas in the subsequent period (1992 – 1996) 60%, and in the last period (1997 - 2001) 87.5% were successfully managed conservatively. UTIs were observed in 53/109 patients. 31/53 of the urinary tract infections (59%) occurred within the first year of life. 10/24 febrile UTI developed in absence of an antibiotic prophylaxis. CONCLUSIONS: Conservative management is the method of choice in patients with primary non-refluxing megaureter. Ureteroneocystostomy may be not necessary, even after a febrile UTI. During the first year of life the risk of urinary tract infection is high for which period an antibiotic prophylaxis is advisable.
Eur Urol Suppl 2006;5(2):264
WITHDRAWN
966
ISOLATING VIRAL AND BACTERIAL PATHOGENS IN BIOPSY MATERIAL FROM KIDNEYS OF CHILDREN WITH OBSTRUCTIVE UROPATHY
THE EXPRESSION OF INTERLEUKIN-6 AND ITS RECEPTORS IN THE DEVELOPING RAT KIDNEY
Kogan M., Naboka U., Kluka I., Bragina L., Suchkov I.
Ha U.S.1, Cha J.H.2, Choi J.Y.2, Cho D.H.3, Lee C.B.3 1
Rostov State Medical University, Department of Urology, Rostov on Don, Russia INTRODUCTION & OBJECTIVES: The role of Chlamydia and Mycoplasma has been investigated somewhat. However the role of viruses such as Herpes and Papilloma in obstructive uropathy of the upper tract in children is still unclear. MATERIAL & METHODS: A prospective study was carried out involving 34 children from 1998-2005. The age range was 1 month to 10 years and the children had been diagnosed with terminal stage hydronephrosis and undergone nephrectomy. Microbial cultures of the biopsy material form both the cortex and medulla of the kidney were then done under aerobic as well as anaerobic conditions . Chlamydia, Mycoplasma, Herpes Simplex type I and II (HSV I, HSV II) Epstein-Bar (EBV), Cytomegalovirus (CMV) and Human Papilloma Virus (HPV) were determined by means of PCR diagnostic. RESULTS: Microbiological analysis indicated that 70.5% of the biopsies had no bacterial growth. Bacteria were isolated as monoculture (11.8%) as well as mixed flora (17.6%). The monoculture showed the following picture: U.Urealyticum (8.9%); M.hominis (2.9%). 3component associations were : U.Urealyticum + S. Mitis + M.hominis (3 cases), M.hominis + S.aureus + Eubacterium Lentum (one case). The 5-component association was represented by: S.epidermidis + Corynebacterium sp + U.Urealyticum + S.intestinalis + P.anaerobius (2 cases). In 58.8% of biopsies the viruses under investigation were found with a predominance of HPV (50.0%) and EBV (40.0%). HSV II and CMV were less commonly and occurred in 30.0% and 20.0% of biopsies respectively. In 70.0% of cases the virus were single variant whilst the remaining 30.0% occurred as 2 or 3 component viral associations. HPV in many cases was in both medulla and cortex and occurred in medulla in 15.0% or cortex only in 5.0%. EBV was seen in either cortex or only medulla alone (20.0% each), HSV II was seen in the equal frequency in either the cortical biopsy, medulla or both. CMV similarly was seen with equal frequency (10.0%) in either the cortical biopsy, medulla or both. In 23.5% of cases the biopsy material had bacterio-viral associations that were dominated by Mycoplasma (Ureaplasma) and Human Papilloma virus. CONCLUSIONS: From the foregoing, it is clear that kidney biopsies often contain Papilloma and Herpes viruses and amongst bacterial pathogens Mycoplasma and Ureaplasma are predominant. Enterobacteriaceae as well as Chlamydia were not isolated. For most of the viruses under investigation complete persistence was seen in different layers of the kidneys. Most probably a transplacental infection by these viruses occurred leading to their persistence in the kidney tissues. It appears that children with the obstructive uropathy of the upper tract may also have viruses playing a key role in congenital anomalies of their urinary tract. The results have broadened our understanding of the etiology of obstructive uropathy and urinary tract infections in children.
College of Medicine, The Catholic University of Korea, Department of Urology, Suwon, South Korea, 2College of Medicine, The Catholic University of Korea, Department of Anatomy, Seoul, South Korea, 3College of Medicine, The Catholic University of Korea, Department of Urology, Seoul, South Korea INTRODUCTION & OBJECTIVES: Interleukin-6 (IL-6) and its are presumed to play important roles in the developing nervous system. However, little is known about their potential role(s) in the developing kidney. To investigate this, we have studied the expression of IL-6 and its receptors, gp130, common receptor subunit of IL-6 family, and IL-6-specific ligand-binding subunit(IL-6R)in the developing rat kidney. MATERIAL & METHODS: Kidneys from 18- (F18), and 20-day-old (F20) foetuses, 1- (P1), 3- (P3), 7- (P7), 14- (P14), and 21-day-old (P21) pups, and adult rats were extracted. Renal expressions of IL-6 and its receptors were examined by immunohistochemistry and in situ hybridisation respectively. RESULTS: IL-6 protein already appeared in F18. The early stage of renal development before birth, IL-6 showed moderate immunoreactivity in the ureteric bud, metanephric mesenchymal cells (MMC) and developing glomerulus. In matured nephron after birth, IL-6 immunoreactivities were detected in glomelurus weakly, in distal tubules strongly, and collecting ducts moderately. Gp130 and IL6R hybridisation signals have already appeared in 18-day old fatal kidney. Before birth, both gp130 and IL-6R mRNAs were expressed in ureteric bud, MMC and developing glomerulus. In the matured nephron after birth, all receptors showed similar expressional pattern except that gp130 mRNA not IL-6R is detected in the descending thin limb. They were expressed in the thick ascending limb, distal tubules and collecting ducts. CONCLUSIONS: These results suggest that IL-6 and its receptors may be involved in regulation of nephron formation in nephrogenic zone of rat, and play a role in distal nephron after birth.
967
968
A SHIFT IN PRESENTATION AND TREATMENT IN CHILDREN WITH A PRIMARY NON-REFLUXING MEGAURETER Beetz R.1, Stein R.2, Schröder A.2, Wölfle S.1, Thüroff J.2 University of Mainz, Medical School, Department of Pediatrics, Mainz, Germany, 2University of Mainz, Medical School, Department of Urology, Mainz, Germany
1
INTRODUCTION & OBJECTIVES: Twenty years ago, most primary non-refluxing megaureter in children was detected only by clinical symptoms. After introduction of the ultrasound screening in the middle of the eighties, most megaureter is discovered in asymptomatic patients. Earlier, many primary non-refluxing megaureters were treated surgically, nowadays a shift to conservative management is observed. In this retrospective study, we studied complications and long-term outcome of children with primary non-refluxing megaureter treated at our institutions. MATERIAL & METHODS: Between 1986 and 2001, 109 patients (25 girls and 84 boys) with 129 primary megaureter were under medical care at our institutions. All patients had a distal ureter width > 6 mm and no other anomalies of the genitourinary tract. First we analysed the entire group, then, in order to detect a change in our therapeutically approach; we divided the patients into 3 groups of successive time periods of 4-5 years. RESULTS: Overall, 79% of the primary non-refluxing megaureter was asymptomatic, 90% were found within the first year of life. of the symptomatic patients, 17% presented with urinary tract infection (UTI), 4% with other symptoms. 104 megaureter were treated primarily conservatively (81%), 19 of those were operated later on because of recurrent infection (n=5) or deterioration of kidney function / increasing dilatation of the upper urinary tract (n=14). 11 of these patients required ureteroneocystostomy; in 2 a non-functioning kidney was removed. Primary supra vesical diversion was performed in the 21 ureters because of UTI or deterioration of kidney function. Primary ureteroneocystostomy was done in 4 ureters. Within the followup period (4 years (1-14)), ureteroneocystostomy was performed in a total of 33/129 primary megaureter (26%). Looking at the 3 successive time periods, 51% of the patients presenting in the first period (1986 – 1991) were treated conservatively, whereas in the subsequent period (1992 – 1996) 60%, and in the last period (1997 - 2001) 87.5% were successfully managed conservatively. UTIs were observed in 53/109 patients. 31/53 of the urinary tract infections (59%) occurred within the first year of life. 10/24 febrile UTI developed in absence of an antibiotic prophylaxis. CONCLUSIONS: Conservative management is the method of choice in patients with primary non-refluxing megaureter. Ureteroneocystostomy may be not necessary, even after a febrile UTI. During the first year of life the risk of urinary tract infection is high for which period an antibiotic prophylaxis is advisable.
Eur Urol Suppl 2006;5(2):264
WITHDRAWN