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Lactic dehydrogenase isoenzyme in urinary tract infection
Volume 94 Number 4
assaults on the task of cognitive development is a stern challenge. The job of the Center for Disease Control (CDC) is to set guidelines to prevent lead poisoning. The job of the Ad Hoc Committee was to advise CDC as to the appropriate screening and diagnostic tests to accomplish this in 1978. We were well aware that no epidemiologlc study of lead is without flaw. The paper cited by Dr. Varga may be confounded by parental education, but the authors did at the same time control for socioeconomic status. The Committee's judgment did not depend on that single paper, but on the cumulative weight of evidence in the literature. This evidence clearly indicates that impaired biologic function occurs at levels below those associated with frank symptoms. Effective preventive action must precede complete and final knowledge. Herbert L. Needleman, M.D. Children's Hospital Medical Center 300 Longwood A re. Boston, MA 02115 Vernon H. Houk, M.D. Centerfor Disease Control
Lactic dehydrogenase isoenzyme in urinary tract infection To the Editor: I read with interest the article in the November, 1978, issue, "Urinary lactic dehydrogenase isoenzyme IV and V in the differential diagnosis of cystitis and pyelonephritis." We reported the first controlled study regarding the value of isoenzyme V in differentiating kidney from bladder infection? I was dismayed because of the similarity of Devaskar and Montgomery's article to the one we wrote' (in some areas adverbum) despite no acknowledgement of our original publication or subsequent writings.3., We have used urinary lactic dehydrogenase (U-LDH) isoenzyme assays in a routine fashion since 1974, and regard it the simplest, most accurate, inexpensive and practical method to localize the site of infection in the urinary tract. Certain questions have remained unanswered, such as: Where does U-LDH isoenzyme V come from? Why does kidney parenchymal infection stimulate its synthesis? How do WBC contribute to its excretion in urine? How can we best assay for U-LDH isoenzyme in patients receiving antibiotics? Can we store, freeze, or thaw human urine without altering its LDH isoenzyme composition? The purpose of this note is to make your readers aware of the existence of prior well-controlled publications and stimulate their interest to answer some of the unresolved questions. Hugo F. Carvaja~ M.D. Associate Professor of Pediatrics University of Texas Medical Branch Chief of Pediatrics Shriners Burns Institute Galveston, TX 77550
Editorial correspondence
681
REFERENCES I.
Carvajal HF, Passey RB, Berger M, Travis LB, and Lorentz WB: Urinary lactic dehydrogenase isoenzyme 5 in the differential diagnosis of kidney and bladder infections, Kidney International 8:176-184, 1975. 2. Cunningham RJ III, Carvajal HF, and Passey RB: Urinary LDH isoenzyme 5 excretion in experimental pyelonephritis, Br J Exp Pathol 58:220, 1977. 3. Bnrchardt VonVff, Mantel E, and Krebbel I: Die diagnostische Aussagefahigkeit yon LDH-Isoenzymbestimmungen im Ham, Z Inn Med 32:285, 1977. 4. Carvajal HF: Kidney and bladder infections, Adv Pediatr 25:383, 1978.
Rep To the Editor: Dr. Carvajal, who is a pioneer in this area of research, has appropriately raised many questions that need to be answered. We undertook the study in reference to his original observations published in 1974,~ to which we referred to in our article. I had read his article published in 1975,' with interest, but did not refer to it to keep the references to a minimum for this section of THE JOURNAL. Since our observations were slightly different, we reported our findings. I am very grateful to Dr. Carvajal for bringing other references to my attention as I was unaware of them. U. P. Devaskar, M.D. Bldg. A-I 7, Dept. of Perinatology Harbor-UCLA Medical Center Torrance, CA 90509 REFERENCES 1. Carvajal H, and Travis L: Urinary tract infection in children, Curt Prob Pediatr 3:25, 1974. 2. Carvajal HF, Passey RB, Berger M, Travis LB, and Lorentz WB: Urinary Lactic dehydrogenase isoenzyme 5 in the differential diagnosis of kidney and bladder infections, Kidney Int 8:176, 1975.
Relation of fluid intake to bronchopulmonary dysplasia To the Editor: Brown and associates ~in the June, 1978, issue of'I'HE JOURN.~ present evidence relating early fluid load to subsequent development of bronchopuLmonary dysplasia (BPD). However, several points in the analysis of the results are unclear. It is not explained why the pre-BPD group received significantly greater fluid loads than did the other patients. It is mentioned that there were no systematic differences in avenues of fluid loss, but the approach to fluid administration is not discussed. It would be helpful to know the circumstances that led to the large fluid loads received by the pre-BPD babies. Patients with respiratory distress syndrome (RDS) who devel-
assaults on the task of cognitive development is a stern challenge. The job of the Center for Disease Control (CDC) is to set guidelines to prevent lead poisoning. The job of the Ad Hoc Committee was to advise CDC as to the appropriate screening and diagnostic tests to accomplish this in 1978. We were well aware that no epidemiologlc study of lead is without flaw. The paper cited by Dr. Varga may be confounded by parental education, but the authors did at the same time control for socioeconomic status. The Committee's judgment did not depend on that single paper, but on the cumulative weight of evidence in the literature. This evidence clearly indicates that impaired biologic function occurs at levels below those associated with frank symptoms. Effective preventive action must precede complete and final knowledge. Herbert L. Needleman, M.D. Children's Hospital Medical Center 300 Longwood A re. Boston, MA 02115 Vernon H. Houk, M.D. Centerfor Disease Control
Lactic dehydrogenase isoenzyme in urinary tract infection To the Editor: I read with interest the article in the November, 1978, issue, "Urinary lactic dehydrogenase isoenzyme IV and V in the differential diagnosis of cystitis and pyelonephritis." We reported the first controlled study regarding the value of isoenzyme V in differentiating kidney from bladder infection? I was dismayed because of the similarity of Devaskar and Montgomery's article to the one we wrote' (in some areas adverbum) despite no acknowledgement of our original publication or subsequent writings.3., We have used urinary lactic dehydrogenase (U-LDH) isoenzyme assays in a routine fashion since 1974, and regard it the simplest, most accurate, inexpensive and practical method to localize the site of infection in the urinary tract. Certain questions have remained unanswered, such as: Where does U-LDH isoenzyme V come from? Why does kidney parenchymal infection stimulate its synthesis? How do WBC contribute to its excretion in urine? How can we best assay for U-LDH isoenzyme in patients receiving antibiotics? Can we store, freeze, or thaw human urine without altering its LDH isoenzyme composition? The purpose of this note is to make your readers aware of the existence of prior well-controlled publications and stimulate their interest to answer some of the unresolved questions. Hugo F. Carvaja~ M.D. Associate Professor of Pediatrics University of Texas Medical Branch Chief of Pediatrics Shriners Burns Institute Galveston, TX 77550
Editorial correspondence
681
REFERENCES I.
Carvajal HF, Passey RB, Berger M, Travis LB, and Lorentz WB: Urinary lactic dehydrogenase isoenzyme 5 in the differential diagnosis of kidney and bladder infections, Kidney International 8:176-184, 1975. 2. Cunningham RJ III, Carvajal HF, and Passey RB: Urinary LDH isoenzyme 5 excretion in experimental pyelonephritis, Br J Exp Pathol 58:220, 1977. 3. Bnrchardt VonVff, Mantel E, and Krebbel I: Die diagnostische Aussagefahigkeit yon LDH-Isoenzymbestimmungen im Ham, Z Inn Med 32:285, 1977. 4. Carvajal HF: Kidney and bladder infections, Adv Pediatr 25:383, 1978.
Rep To the Editor: Dr. Carvajal, who is a pioneer in this area of research, has appropriately raised many questions that need to be answered. We undertook the study in reference to his original observations published in 1974,~ to which we referred to in our article. I had read his article published in 1975,' with interest, but did not refer to it to keep the references to a minimum for this section of THE JOURNAL. Since our observations were slightly different, we reported our findings. I am very grateful to Dr. Carvajal for bringing other references to my attention as I was unaware of them. U. P. Devaskar, M.D. Bldg. A-I 7, Dept. of Perinatology Harbor-UCLA Medical Center Torrance, CA 90509 REFERENCES 1. Carvajal H, and Travis L: Urinary tract infection in children, Curt Prob Pediatr 3:25, 1974. 2. Carvajal HF, Passey RB, Berger M, Travis LB, and Lorentz WB: Urinary Lactic dehydrogenase isoenzyme 5 in the differential diagnosis of kidney and bladder infections, Kidney Int 8:176, 1975.
Relation of fluid intake to bronchopulmonary dysplasia To the Editor: Brown and associates ~in the June, 1978, issue of'I'HE JOURN.~ present evidence relating early fluid load to subsequent development of bronchopuLmonary dysplasia (BPD). However, several points in the analysis of the results are unclear. It is not explained why the pre-BPD group received significantly greater fluid loads than did the other patients. It is mentioned that there were no systematic differences in avenues of fluid loss, but the approach to fluid administration is not discussed. It would be helpful to know the circumstances that led to the large fluid loads received by the pre-BPD babies. Patients with respiratory distress syndrome (RDS) who devel-