Ureteral diameters were estimated on films from intravenous urography in 194 children (100 boys and 94 girls) aged 0-16 years. Children with signs of urinary tract infection, calculi, obstruction, duplication or malformation were... more
Ureteral diameters were estimated on films from intravenous urography in 194 children (100 boys and 94 girls) aged 0-16 years. Children with signs of urinary tract infection, calculi, obstruction, duplication or malformation were excluded. Films obtained without abdominal compression were used for measurements, including only ureters visualized over 50 per cent of their lengths. A good correlation was demonstrated between ureteral diameter and age (r = 0.69) and between ureteral diameter and the length of a segment of the lumbar spine (r = 0.73). The widest part of the ureter was most often located just above the crossing of the iliac vessels. The right ureter was slightly wider than the left one. No difference between boys and girls was noted. The results are in good agreement with those of others obtained at autopsy. Bearing in mind the possible physiologic variations, it would seem that measuring the ureteral diameter can be of value for a more objective differentiation between dilated and non-dilated ureters.
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Different pad tests were compared in 50 incontinent children. In a 2-hour ward test with standardized activities and fluid provocation 70% were positive. In a simple 12-hour home test with 30 children 68% were positive; when a fluid... more
Different pad tests were compared in 50 incontinent children. In a 2-hour ward test with standardized activities and fluid provocation 70% were positive. In a simple 12-hour home test with 30 children 68% were positive; when a fluid provocation period was included in the home test with 20 children the frequency increased to 80%. Pad tests are easy to perform with children in the home and are valuable as screening instruments. Further, the simultaneous registration of events gives a more complete picture of the incontinence pattern.
Research Interests: Urology, Adolescent, Urinary incontinence, Methods, Humans, and 5 moreChild, Female, Male, Exploration, and Clinical Sciences
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Three hundred and forty-three E. coli strains isolated from the urine of patients with asymptomatic bacteriuria (ABU), symptomatic cystitis, or pyelonephritis were analysed with regard to O group distribution and sensitivity to the... more
Three hundred and forty-three E. coli strains isolated from the urine of patients with asymptomatic bacteriuria (ABU), symptomatic cystitis, or pyelonephritis were analysed with regard to O group distribution and sensitivity to the bactericidal effect of normal serum. Strains of O groups 1, 2, 4, 6, 7, 16, 18 and 75 were found in 31.3% in ABU, in 58.7% in cystitis and in 79.8% in pyelonephritis. Spontaneous agglutination was noted in 45.2% of ABU, 6.5% of cystitis and 1.7% of pyelonephritis strains. The strains from patients with ABU were significantly more sensitive to the bactericidal effect of normal serum than were those from patients with symptomatic urinary tract infection. In some patients with untreated ABU, changes in the characteristics of the urinary strains isolated were noted. The strains tended to become spontaneously agglutinating as well as more sensitive to the bactericidal activity of normal serum. The strains found in patients with ABU probably had an altered cell wall compared with those found in patients with symptomatic infections such that they produce fewer symptoms and possibly be less virulent.
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This study analyzed the interleukin 6 (IL-6) response in 114 children with suspected urinary tract infection (UTI). Urine and serum samples were obtained at the time of enrollment. There were 90 children with UTI, 41 with and 49 without a... more
This study analyzed the interleukin 6 (IL-6) response in 114 children with suspected urinary tract infection (UTI). Urine and serum samples were obtained at the time of enrollment. There were 90 children with UTI, 41 with and 49 without a temperature > or = 38.5 degrees C. The remaining 24 children did not have bacteriuria; 11 were febrile and 13 were not. The urinary IL-6 concentrations were higher in the children with UTI (mean, 129 units/ml) than in the children without bacteriuria (mean, 7 units/ml, P < 0.01). In contrast the serum IL-6 did not differ between children with or without UTI or between children with or without a temperature > or = 38.5 degrees C. The urinary IL-6 response was higher in children who were infected with P fimbriated Escherichia coli than in other children with UTI (P < 0.05). There was a correlation of urinary IL-6 with the degree of proteinuria, hematuria and urinary leukocyte counts (P < 0.001, P < 0.05, P < 0.05, respectively) but not with serum IL-6, CRP or temperature, and of serum IL-6 to C-reactive protein (P = 0.053) and renal concentrating capacity (P < 0.05). The results demonstrate that infections of the urinary tract activate an IL-6 response in children and that the magnitude of the IL-6 response is influenced by the properties of the infecting strain.
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A rehabilitation program has been developed for children with functional, nonneurogenic bladder disturbance. The basis for the program is a bladder regimen supplemented by biofeedback training if needed. Results in the first 70 children... more
A rehabilitation program has been developed for children with functional, nonneurogenic bladder disturbance. The basis for the program is a bladder regimen supplemented by biofeedback training if needed. Results in the first 70 children (64 girls and 6 boys) are presented. After 1 and 3 years 36 and 53 children, respectively, had completely normalized voiding patterns, that is they were continent, had no urgency, voided 3 to 6 times a day and emptied the bladder completely in 1 portion with a normal flow rate. The training program is applicable in children with varying urodynamic diagnoses and it has been used in children as young as 4 years old.
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Three hundred and forty-three E. coli strains isolated from the urine of patients with asymptomatic bacteriuria (ABU), symptomatic cystitis, or pyelonephritis were analysed with regard to O group distribution and sensitivity to the... more
Three hundred and forty-three E. coli strains isolated from the urine of patients with asymptomatic bacteriuria (ABU), symptomatic cystitis, or pyelonephritis were analysed with regard to O group distribution and sensitivity to the bactericidal effect of normal serum. Strains of O groups 1, 2, 4, 6, 7, 16, 18 and 75 were found in 31.3% in ABU, in 58.7% in cystitis and in 79.8% in pyelonephritis. Spontaneous agglutination was noted in 45.2% of ABU, 6.5% of cystitis and 1.7% of pyelonephritis strains. The strains from patients with ABU were significantly more sensitive to the bactericidal effect of normal serum than were those from patients with symptomatic urinary tract infection. In some patients with untreated ABU, changes in the characteristics of the urinary strains isolated were noted. The strains tended to become spontaneously agglutinating as well as more sensitive to the bactericidal activity of normal serum. The strains found in patients with ABU probably had an altered cell wall compared with those found in patients with symptomatic infections such that they produce fewer symptoms and possibly be less virulent.
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In order to improve the accuracy of the grading of vesicoureteral reflux (VUR), reference values for ureteral diameter at micturition cystourethrography (MCUG) were established in infants and children with low-risk VUR. Low-risk VUR was... more
In order to improve the accuracy of the grading of vesicoureteral reflux (VUR), reference values for ureteral diameter at micturition cystourethrography (MCUG) were established in infants and children with low-risk VUR. Low-risk VUR was defined as VUR not associated with infection, obstruction, calculi, duplication, malformations (except for hypospadia) or neurogenic bladder disturbances. Forty-six children (age 1 day-14 years) were selected by examining the records of 12000 MCUG:s performed 1960-1983. Ureteral diameter was measured at the widest point of the ureter on the films from MCUG:s and urographies. Ureteral diameter was slightly larger at MCUG than at urography in the same individuals but the difference was not significant. The ureteral diameter at MCUG also correlated closely to normal values at urography in a previous study. It is proposed that the reference values obtained at MCUG in the present investigation can be used for the differentiation between dilatation and no dilatation in the grading of VUR.
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Three hundred and forty-three E. coli strains isolated from the urine of patients with asymptomatic bacteriuria (ABU), symptomatic cystitis, or pyelonephritis were analysed with regard to O group distribution and sensitivity to the... more
Three hundred and forty-three E. coli strains isolated from the urine of patients with asymptomatic bacteriuria (ABU), symptomatic cystitis, or pyelonephritis were analysed with regard to O group distribution and sensitivity to the bactericidal effect of normal serum. Strains of O groups 1, 2, 4, 6, 7, 16, 18 and 75 were found in 31.3% in ABU, in 58.7% in cystitis and in 79.8% in pyelonephritis. Spontaneous agglutination was noted in 45.2% of ABU, 6.5% of cystitis and 1.7% of pyelonephritis strains. The strains from patients with ABU were significantly more sensitive to the bactericidal effect of normal serum than were those from patients with symptomatic urinary tract infection. In some patients with untreated ABU, changes in the characteristics of the urinary strains isolated were noted. The strains tended to become spontaneously agglutinating as well as more sensitive to the bactericidal activity of normal serum. The strains found in patients with ABU probably had an altered cell wall compared with those found in patients with symptomatic infections such that they produce fewer symptoms and possibly be less virulent.
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Fourteen children, 10 boys and 4 girls, with chronic progressive renal failure were treated with a low-protein (0.4-2 g/kg body wt and maximum 20 g/day), high-energy diet (55-130 kcal/kg body wt) and supplemented with essential amino... more
Fourteen children, 10 boys and 4 girls, with chronic progressive renal failure were treated with a low-protein (0.4-2 g/kg body wt and maximum 20 g/day), high-energy diet (55-130 kcal/kg body wt) and supplemented with essential amino acids and histidine (0.21-0.5 g/kg body wt). The mean age at the onset of treatment was 9.9 years (5.5 months - 15.3 years), mean serum creatinine 461 mumoles/1 (167-1110) and mean BUN 60.2 mmoles/1 (20-83). Indications for treatment were incipient or manifest growth retardation. A 50% reduction of BUN was found after about 2 weeks of treatment while serum creatinine remained unchanged. BUN remained decreased during therapy despite further increase of serum creatinine. The mean duration of treatment was 21 months (range 4-48). Increasing appetite and vitality were found after introduction of the diet, which was well accepted by most of the children while their general condition remained satisfactory. The earlier decrease of growth rate was interrupted and a linear or almost linear growth within the SD-scores at onset of treatment was seen in 10 of the 14 children. Three children had a reduced growth rate and one child did not grow at all during treatment. Signs of osteodystrophy did not improve during the diet. It is speculated that the protein restriction has a detoxifying effect, which together with supplementation of amino acids and a high energy supply could in part correct the metabolic disturbances and provide an opportunity for anabolism and growth.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ureteral diameters were estimated on films from intravenous urography in 194 children (100 boys and 94 girls) aged 0-16 years. Children with signs of urinary tract infection, calculi, obstruction, duplication or malformation were... more
Ureteral diameters were estimated on films from intravenous urography in 194 children (100 boys and 94 girls) aged 0-16 years. Children with signs of urinary tract infection, calculi, obstruction, duplication or malformation were excluded. Films obtained without abdominal compression were used for measurements, including only ureters visualized over 50 per cent of their lengths. A good correlation was demonstrated between ureteral diameter and age (r = 0.69) and between ureteral diameter and the length of a segment of the lumbar spine (r = 0.73). The widest part of the ureter was most often located just above the crossing of the iliac vessels. The right ureter was slightly wider than the left one. No difference between boys and girls was noted. The results are in good agreement with those of others obtained at autopsy. Bearing in mind the possible physiologic variations, it would seem that measuring the ureteral diameter can be of value for a more objective differentiation between d...
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In order to improve the accuracy of the grading of vesicoureteral reflux (VUR), reference values for ureteral diameter at micturition cystourethrography (MCUG) were established in infants and children with low-risk VUR. Low-risk VUR was... more
In order to improve the accuracy of the grading of vesicoureteral reflux (VUR), reference values for ureteral diameter at micturition cystourethrography (MCUG) were established in infants and children with low-risk VUR. Low-risk VUR was defined as VUR not associated with infection, obstruction, calculi, duplication, malformations (except for hypospadia) or neurogenic bladder disturbances. Forty-six children (age 1 day-14 years) were selected by examining the records of 12000 MCUG:s performed 1960-1983. Ureteral diameter was measured at the widest point of the ureter on the films from MCUG:s and urographies. Ureteral diameter was slightly larger at MCUG than at urography in the same individuals but the difference was not significant. The ureteral diameter at MCUG also correlated closely to normal values at urography in a previous study. It is proposed that the reference values obtained at MCUG in the present investigation can be used for the differentiation between dilatation and no ...
Research Interests:
A rehabilitation program has been developed for children with functional, nonneurogenic bladder disturbance. The basis for the program is a bladder regimen supplemented by biofeedback training if needed. Results in the first 70 children... more
A rehabilitation program has been developed for children with functional, nonneurogenic bladder disturbance. The basis for the program is a bladder regimen supplemented by biofeedback training if needed. Results in the first 70 children (64 girls and 6 boys) are presented. After 1 and 3 years 36 and 53 children, respectively, had completely normalized voiding patterns, that is they were continent, had no urgency, voided 3 to 6 times a day and emptied the bladder completely in 1 portion with a normal flow rate. The training program is applicable in children with varying urodynamic diagnoses and it has been used in children as young as 4 years old.
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A total of 124 children aged 0.2 to 6 years were enrolled in a study of first time febrile urinary tract infection. The patient population was stratified in groups according to the stringency of criteria for fever and bacteriuria and the... more
A total of 124 children aged 0.2 to 6 years were enrolled in a study of first time febrile urinary tract infection. The patient population was stratified in groups according to the stringency of criteria for fever and bacteriuria and the presence of concomitant disease. The major group of 88 patients consisted of children with fever greater than or equal to 38.5 degrees C measured at the hospital within 24 hours of diagnosis, bacteriuria verified by suprapubic bladder aspiration or repeated cultures of voided urine, but without concomitant disease. These children were mainly infected with attaching Escherichia coli specific for galactose alpha (1----4) beta galactose containing receptors and had laboratory evidence of inflammation. Another group of 11 children were distinguished with strictly defined bacteriuria and concomitant disease. These children were infected with nonattaching bacteria and had lower concentrations of C-reactive protein in serum and lower microsedimentation rat...
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ABSTRACT
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This study analyzed the interleukin 6 (IL-6) response in 114 children with suspected urinary tract infection (UTI). Urine and serum samples were obtained at the time of enrollment. There were 90 children with UTI, 41 with and 49 without a... more
This study analyzed the interleukin 6 (IL-6) response in 114 children with suspected urinary tract infection (UTI). Urine and serum samples were obtained at the time of enrollment. There were 90 children with UTI, 41 with and 49 without a temperature > or = 38.5 degrees C. The remaining 24 children did not have bacteriuria; 11 were febrile and 13 were not. The urinary IL-6 concentrations were higher in the children with UTI (mean, 129 units/ml) than in the children without bacteriuria (mean, 7 units/ml, P < 0.01). In contrast the serum IL-6 did not differ between children with or without UTI or between children with or without a temperature > or = 38.5 degrees C. The urinary IL-6 response was higher in children who were infected with P fimbriated Escherichia coli than in other children with UTI (P < 0.05). There was a correlation of urinary IL-6 with the degree of proteinuria, hematuria and urinary leukocyte counts (P < 0.001, P < 0.05, P < 0.05, respectively) but not with serum IL-6, CRP or temperature, and of serum IL-6 to C-reactive protein (P = 0.053) and renal concentrating capacity (P < 0.05). The results demonstrate that infections of the urinary tract activate an IL-6 response in children and that the magnitude of the IL-6 response is influenced by the properties of the infecting strain.
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Different pad tests were compared in 50 incontinent children. In a 2-hour ward test with standardized activities and fluid provocation 70% were positive. In a simple 12-hour home test with 30 children 68% were positive; when a fluid... more
Different pad tests were compared in 50 incontinent children. In a 2-hour ward test with standardized activities and fluid provocation 70% were positive. In a simple 12-hour home test with 30 children 68% were positive; when a fluid provocation period was included in the home test with 20 children the frequency increased to 80%. Pad tests are easy to perform with children in the home and are valuable as screening instruments. Further, the simultaneous registration of events gives a more complete picture of the incontinence pattern.
Research Interests: Urology, Adolescent, Urinary incontinence, Methods, Humans, and 5 moreChild, Female, Male, Exploration, and Clinical Sciences
The aim of this study was to assess the possible relationship between secretor state and the inflammatory response to urinary tract infection (UTI). Girls with recurrent UTI were prospectively studied. They included 61 secretor and 23... more
The aim of this study was to assess the possible relationship between secretor state and the inflammatory response to urinary tract infection (UTI). Girls with recurrent UTI were prospectively studied. They included 61 secretor and 23 non-secretor individuals with 604 episodes of recurrent UTI. The response to each UTI episode was measured as the levels of C-reactive protein, erythrocyte sedimentation rate and the body temperature as well as renal concentrating capacity and pyuria. The levels of C-reactive protein, erythrocyte sedimentation rate and the body temperature were significantly higher in non-secretors than in secretors (p less than 0.04). As a consequence, non-secretors had an increased probability of being assigned a diagnosis of acute pyelonephritis rather than asymptomatic bacteriuria (p less than 0.05). The higher inflammatory response in non-secretors was independent of the Gal alpha 1-4Gal beta adhesin expression of the infecting Escherichia coli strains. The increased inflammatory response to UTI in non-secretors might explain the accumulation of these individuals among patients with renal scarring.
Research Interests: Infectious Diseases, Disease susceptibility, Prospective studies, Humans, Female, and 12 moreBlood groups, Urinary tract infection, Urinary Tract Infections, Infectious, Recurrence, Body Temperature, Clinical Sciences, C reactive protein, Retrospective Studies, PYELONEPHRITIS, Inflammatory response, and Acute Disease
Treatment of 17 children aged 2-9.5 years with a combination of pivmecillinam and pivampicillin (250-500 mumol 24 h-1) for more than 1 year resulted in a reduction of the free carnitine concentration in serum and muscle to less than 10%... more
Treatment of 17 children aged 2-9.5 years with a combination of pivmecillinam and pivampicillin (250-500 mumol 24 h-1) for more than 1 year resulted in a reduction of the free carnitine concentration in serum and muscle to less than 10% of the mean reference value. The decline in serum was slow, with an estimated half-life of about 5 months. Spontaneous replenishment occurred at about the same slow rate. Thus, there is no increase in endogenous carnitine synthesis as a response to increased demand of carnitine for detoxification. Supplementation with carnitine during treatment required at least a four-fold molar excess over pivalic acid to achieve and sustain a normal carnitine concentration. The replenishment of carnitine occurred with a half-life of 1.1-3.0 months. From determination of muscle-carnitine concentration in patients treated with pivaloyl-containing antibiotics and in patients with organic aciduris, we conclude that serum carnitine is a good predictor of carnitine stores in the body. Six non-supplemented patients with a serum free-carnitine concentration of 0.7-2.6 mumol l-1 had an inadequate ketone-body increase during a 24-h fast. Vomiting, nausea and tiredness occurred in three cases following the fasting period. After normalization of the serum-carnitine concentration, a normal response to fasting was observed. Thus, in some organic acidurias, for example medium-chain acyl-CoA dehydrogenase deficiency, a low liver concentration of carnitine may be an important contributing factor to hypoglycaemic and Reye-like attacks. We believe that prodrugs which contain pivalic acid should be avoided if acceptable alternatives exist. If used, supplementation with at least four-fold molar excess of carnitine is advisable.
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ABSTRACT
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The last decade has provided new insight into the mechanisms of host-parasite interactions in the urinary tract. Reduction of host resistance appears to reduce the requirement for bacterial virulence, whereas the resistant host becomes... more
The last decade has provided new insight into the mechanisms of host-parasite interactions in the urinary tract. Reduction of host resistance appears to reduce the requirement for bacterial virulence, whereas the resistant host becomes infected with bacteria of high virulence. In the resistant host, bacterial virulence can be defined as the sum of properties required to colonize the urinary tract and induce tissue reactions. The ability to attach to uroepithelial cells is the single property most frequently associated with pyelonephritogenic clones. Attachment to the Gal alpha 1-4Gal beta-containing receptors promotes localization of bacteria to the kidney and the induction of lipopolysaccharide-mediated inflammation. Other virulence factors, defined by increased frequency in acute pyelonephritis compared with asymptomatic bacteriuria, include haemolysin and aerobactin production. Among the factors which influence the natural resistance to urinary tract infection are urinary flow and reactivity to endotoxin. The resistance induced by natural exposure to infection or immunization may be protective in experimental models, but the importance of this is not yet defined. The localization, severity and sequelae of urinary tract infection are determined by the balance between bacterial virulence and host resistance. Although disease is a result of the interaction between bacterial virulence and host resistance, these components are discussed separately for clarity.
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The medical history of infants and preschool children with their first known episode of pyelonephritis was obtained by questionnaire and compared with that of controls matched for age, sex and living area. Previous infection, medical... more
The medical history of infants and preschool children with their first known episode of pyelonephritis was obtained by questionnaire and compared with that of controls matched for age, sex and living area. Previous infection, medical consultation and antibiotic treatment were registered significantly more often in the patients. Furthermore a high proportion of cases had recently received antibiotic therapy, primarily penicillin V. Urinary tract infections were reported more often among first degree relatives of the cases. Exclusive breast-feeding was significantly shorter in the pyelonephritis patients, according both to the questionnaire and to the records from the Child Health Centers. The two populations were not shown to differ in birth weight or length, neonatal history, number of hospitalizations, previous episodes of fever or frequency of atopic disease in the families.
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Bacterial attachment to urinary-tract epithelium is important in the pathogenesis of urinary-tract infection. Most pyelonephritogenic Escherichia coli bind specifically to epithelial-cell receptors, which are glycolipids of the... more
Bacterial attachment to urinary-tract epithelium is important in the pathogenesis of urinary-tract infection. Most pyelonephritogenic Escherichia coli bind specifically to epithelial-cell receptors, which are glycolipids of the globoseries and also antigens in the P blood-group system. Among 36 girls with recurrent pyelonephritis who did not have vesicoureteral reflux, we found that attaching bacteria were common and the P1 blood-group phenotype was present in 97 per cent, as compared with 75 per cent of 84 age-matched children without urinary-tract infection (P less than 0.01). In 32 girls with recurrent pyelonephritis who had reflux, attaching bacteria were rare, and the frequency of the P1 phenotype was not significantly higher than in controls (82 per cent, P greater than 0.05). In the group of patients with the P1 phenotype, 68 per cent of the urinary bacterial isolates from those without reflux, but only 25 per cent of isolates from those with reflux, bound to globotetraosylceramide, as determined by a receptor-coating technique (P less than 0.001). Our data suggest that, in the absence of reflux, the P1 blood group contributes to susceptibility to recurrent pyelonephritis due to bacteria that bind to the glycolipid receptors of the globoseries. In the presence of reflux, uroepithelial attachment does not seem to confer an advantage to bacteria that infect the kidney.
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The ability to become attached to normal epithelial cells from the urinary tract was much greater in Escherichia coli bacteria isolated from the urine of patients with acute symptomatic pyelonephritis or cystitis than in those isolated... more
The ability to become attached to normal epithelial cells from the urinary tract was much greater in Escherichia coli bacteria isolated from the urine of patients with acute symptomatic pyelonephritis or cystitis than in those isolated from the urine of patients with asymptomatic bacteriuria. Attachment of the bacteria could be prevented by incubation in urine containing antibodies against the strain tested. The ability to attach to uroepithelial cells might be a virulence factor for E. coli strains which cause symptomatic urinary-tract infection.
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In sera from ten girls with acute pyelonephritis, antibodies of the IgG-class to Tamm-Horsfall protein were found in significantly increased titres; in contrast, titres in sera from six girls with acute cystitis did not differ from those... more
In sera from ten girls with acute pyelonephritis, antibodies of the IgG-class to Tamm-Horsfall protein were found in significantly increased titres; in contrast, titres in sera from six girls with acute cystitis did not differ from those of healthy controls. The results suggest that determination of Tamm-Horsfall antibodies may prove useful for differentiating between upper and lower urinary-tract infection.
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RENAL SCARRING AND NON-ATTACHING ESCHERICHIA COLI. By - Helena Lomberg, Mikael Hellström, Ulf Jodal, Catharina Svanborg Edén.