Çocuklarda Tekrarlayan İdrar Yolu Enfeksiyonlarının Serum ve İdrar Çinko Konsantrasyonları İle İlişkisi

Abstract

Amaç: Doğal immünite cevabındaki defekt ve ürotelyal bariyerdeki fonksiyon bozukluğu idrar yolu enfeksiyonu patogenezinin iki ana unsurunu oluşturmaktadır. Doğal immunite ve kazanılmış immunitenin fonksiyonları orta derecede çinko eksikliği durumlarında etkilenmektedir. Bu çalışmada çocuklarda serum çinko konsantrasyonu, idrar çinko/kreatinin oranı ve tekrarlayan idrar yolu enfeksiyonları arasındaki ilişkiyi değerlendirmeyi amaçladık. Yöntem: Tekrarlayan idrar yolu enfeksiyonu olan çocuklar ve sağlıklı çocuklar çalışmaya dahil edildi. Hasta grubu tekrarlayan idrar yolu enfeksiyonu alt gruplarına ayrıldı. Grup 1 en az iki veya daha fazla akut üst idrar yolu enfeksiyonu geçiren ya da bir kez üst idrar yolu yanında bir ya da daha fazla alt idrar yolu enfeksiyonu geçiren hastalardan oluşturuldu. Grup 2 ise sadece üç ve üçten fazla alt idrar yolu enfeksiyonu geçiren hastalardan oluşturuldu. Kontrol grubu ile tekrarlayan idrar yolu enfeksiyonu tanısı alan hastalar demografik özellikleri ve serum çinko ve idrar çinko/kreatinin oranlarıyla karşılaştırıldı. Bulgular: Otuz üç tekrarlayan idrar yolu enfeksiyonu olan hasta ve 33 sağlıklı çocuk çalışmaya dahil edildi. Ortalama serum çinko düzeyi ve ortalama idrar çinko/kreatinin oranı tekrarlayan idrar yolu enfeksiyonu olan hastalarda sırasıyla 6,6±1,66 umol/l ve 16,44±13,04 umol/g saptandı. Kontrol grubu ve hasta grubu arasında anlamlı istatistiksel fark saptanmadı. Grup 1 ve Grup 2 arasında anlamlı istatistiksel fark saptanmadı. Sonuç: Çinko eksikliğinin çocuklarda tekrarlayan idrar yolu enfeksiyonlarına etkisini saptamak için daha fazla çalışmaya ihtiyaç vardır.

Keywords

• Çinko
• tekrarlayan idrar yolu enfeksiyonu
• çocuk
• serum çinko konsatrasyonu
• spot idrar çinko/ kreatinin oranı

The Association Between Serum and Urine Zinc Concentrations and Recurrent Urinary Tract Infections in Children

Abstract

Objective: Two major host factors in the pathogenesis of urinary tract infection are a defect in innate immune responses and a decrease in urothelial barrier function (UTI). Even in the cases of moderate zinc deficiency, innate and adaptive immune system functions are impaired. The aim of this study was to assess the association between serum zinc concentration, urinary zinc/creatinine ratio, and recurrent UTIs in children. Methods: In this study, children with recurrent UTIs and healthy children were enrolled. The patient group was divided into subgroups based on the nature of recurrent UTIs. Group 1 consisted of patients who had had ≥2 acute upper UTIs or 1 episode of upper UTI plus ≥1 episode of lower UTI. Group 2 consisted of the patients who had had ≥3 acute lower UTIs but no acute upper UTIs. The demographic characteristics, serum zinc levels, and urine zinc/creatinine ratios of the patients with recurrent UTIs were compared to those of the control group. Results: Thirty-three patients with recurrent UTIs and 33 healthy children were enrolled in the study. The mean serum zinc level and mean urine zinc/creatinine ratio of patients with recurrent UTIs were 6.6±1.66 umol/l and 16.44±13.04 umol/g, respectively. There was no statistically significant difference between patients and controls and between patients in Group 1 and patients in Group 2 in terms of serum zinc concentration and urine zinc/creatinine ratio, respectively. Conclusion: Further studies are needed to identify the impact of zinc deficiency on the recurrence of UTI in children.

Keywords

• Children
• recurrent urinary tract infection
• serum zinc concentration
• spot urine zinc/creatinine ratio
• zinc

References

1. 1. Roohani N, Hurrell R, Kelishadi R, Schulin R. Zinc and its importance for human health: An integrative review. J Res Med Sci 2013;18(2):144-57. google scholar
2. 2. Yanagisawa H. Zinc deficiency and clinical practice--validity of zinc preparations. Yakugaku Zasshi 2008;128(3):333-9. google scholar
3. 3. Gupta S, Brazier AKM, Lowe NM. Zinc deficiency in low- and middleincome countries: prevalence and approaches for mitigation. J Hum Nutr Diet 2020;33(5):624-43. google scholar
4. 4. Wessels I, Fischer HJ, Rink L. Dietary and Physiological Effects of Zinc on the Immune System. Annu Rev Nutr 2021;41:133-75. google scholar
5. 5. Mahyar A, Ayazi P, Farzadmanesh S, Sahmani M, Oveisi S, Chegini V, et al. The role of zinc in acute pyelonephritis. Infez Med 2015;23(3):238-42. google scholar
6. 6. Tullus K, Shaikh N. Urinary tract infections in children. Lancet 2020;395(10237):1659-68. google scholar
7. 7. Becknell B, Schober M, Korbel L, Spencer JD. The diagnosis, evaluation and treatment of acute and recurrent pediatric urinary tract infections. Expert Rev Anti Infect Ther 2015;13(1):81- 90. google scholar
8. 8. Chowdhury P, Sacks SH, Sheerin NS. Minireview: functions of the renal tract epithelium in coordinating the innate immune response to infection. Kidney Int 2004;66(4):1334-44. google scholar

9. 9. Svanborg C. Urinary tract infections in children: microbial virulence versus host susceptibility. Adv Exp Med Biol 2013;764:205-10. google scholar
10. 10. Amoori P, Valavi E, Fathi M, Sharhani A, Izadi F. Comparison of Serum Zinc Levels Between Children With Febrile Urinary Tract Infection and Healthy Children. Jundishapur Journal of Health Sciences 2021;13. google scholar
11. 11. Mohsenpour B, Ahmadi A, Mohammadi Baneh A, Hajibagheri K, Ghaderi E, Afrasiabian S, et al. Relation between serum zinc levels and recurrent urinary tract infections in female patients: A casecontrol study. Med J Islam Repub Iran 2019;33:33. google scholar
12. 12. Noorbakhsh S, Nia S, Movahedi Z, Ashouri S. Does the Trace Element Deficiency (Vit A, D & Zinc) Have Any Role in Vulnerability to Urinary Tract Infection in Children: A Case-Control Study: Tehran, Iran. The Open Urology & Nephrology Journal 2019;12:23-6. google scholar
13. 13. Yousefichaijan P, Naziri M, Taherahmadi H, Kahbazi M, Tabaei A. Zinc Supplementation in Treatment of Children With Urinary Tract Infection. Iran J Kidney Dis 2016;10(4):213-6. google scholar
14. 14. Zabihi F, Mostafavi M, Esmaeili M, Issapour Cheshani M. Investigating the Effect of Zinc Deficiency on the Risk of Urinary Tract Infection in Children. International Journal of Pediatrics 2020;8(9):11959-66. google scholar
15. 15. National Collaborating Centre for Ws, Children’s H. National Institute for Health and Clinical Excellence: Guidance. Urinary Tract Infection in Children: Diagnosis, Treatment and Long- term Management. London: RCOG Press Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.; 2007. google scholar
16. 16. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis 1972;25(6):329-43. google scholar
17. 17. Fataki MR, Kisenge RR, Sudfeld CR, Aboud S, Okuma J, Mehta S, et al. Effect of zinc supplementation on duration of hospitalization in Tanzanian children presenting with acute pneumonia. J Trop Pediatr 2014;60(2):104-11. google scholar
18. 18. Sakulchit T, Goldman RD. Zinc supplementation for pediatric pneumonia. Can Fam Physician 2017;63(10):763-5. google scholar
19. 19. van Wouwe JP, van Gelderen HH, Bos JH. Subacute zinc deficiency in children with recurrent upper respiratory tract infection. Eur J Pediatr 1987;146(3):293-5. google scholar
20. 20. Zou TT, Mou J, Zhan X. Zinc supplementation in acute diarrhea. Indian J Pediatr 2015;82(5):415-20. google scholar
21. 21. World Health O. Clinical management of acute diarrhoea: WHO/UNICEF joint statement. Geneva: World Health Organization; 2004. google scholar
22. 22. Yousefichaijan P, Cyrus A, Dorreh F, Rafeie M, Sharafkhah M, Frohar F, et al. Oral Zinc Sulfate as Adjuvant Treatment in Children With Nephrolithiasis: a Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Iran J Pediatr 2015;25(6):e1445. google scholar
23. 23. Tewary K, Narchi H. Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics. World J Methodol 2015;5(2):13-9. google scholar
24. 24. Brown KH, Rivera JA, Bhutta Z, Gibson RS, King JC, Lönnerdal B, et al. International Zinc Nutrition Consultative Group (IZiNCG) technical document #1. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull 2004;25(1 Suppl 2):S99-203. google scholar
25. 25. Gammoh NZ, Rink L. Zinc in Infection and Inflammation. Nutrients 2017;9(6). google scholar
26. 26. Gaetke LM, McClain CJ, Talwalkar RT, Shedlofsky SI. Effects of endotoxin on zinc metabolism in human volunteers. Am J Physiol 1997;272(6 Pt 1):E952-6. google scholar
27. 27. Hambidge KM, Goodall MJ, Stall C, Pritts J. Post-prandial and daily changes in plasma zinc. J Trace Elem Electrolytes Health Dis 1989;3(1):55-7. google scholar
28. 28. Hotz C, Lowe NM, Araya M, Brown KH. Assessment of the trace element status of individuals and populations: the example of zinc and copper. J Nutr 2003;133(5 Suppl 1):1563s-8s. google scholar
29. 29. Katayama K, Kawaguchi T, Shiraishi K, Ito T, Suzuki K, Koreeda C, et al. The Prevalence and Implication of Zinc Deficiency in Patients With Chronic Liver Disease. J Clin Med Res 2018;10(5):437-44. google scholar
30. 30. Johnson PE, Hunt CD, Milne DB, Mullen LK. Homeostatic control of zinc metabolism in men: zinc excretion and balance in men fed diets low in zinc. Am J Clin Nutr 1993;57(4):557-65. google scholar
31. 31. de Portela ML, Weisstaub AR. Basal urinary zinc/creatinine ratio as an indicator of dietary zinc intake in healthy adult women. J Am Coll Nutr 2000;19(3):413-7. google scholar
32. 32. Prasad AS. Zinc deficiency. Bmj 2003;326(7386):409-10. google scholar
33. 33. Vuralli D, Tumer L, Hasanoglu A. Zinc deficiency in the pediatric age group is common but underevaluated. World J Pediatr 2017;13(4):360-6. google scholar
34. 34. Aras N, Nazli A, Zhang W, Chatt A. Dietary intake of zinc and selenium in Turkey. Journal of Radioanalytical and Nuclear Chemistry 2001;249:33-7. google scholar
35. 35. Gibson RS, Manger MS, Krittaphol W, Pongcharoen T, Gowachirapant S, Bailey KB, et al. Does zinc deficiency play a role in stunting among primary school children in NE Thailand? Br J Nutr 2007;97(1):167-75. google scholar
36. 36. Smit Vanderkooy PD, Gibson RS. Food consumption patterns of Canadian preschool children in relation to zinc and growth status. Am J Clin Nutr 1987;45(3):609-16. google scholar
37. 37. Morais JBS, Severo JS, Beserra JB, de Oiveira ARS, Cruz KJC, de Sousa Melo SR, et al. Association Between Cortisol, Insulin Resistance and Zinc in Obesity: a Mini-Review. Biol Trace Elem Res 2019;191(2):323-30. google scholar
38. 38. Suliburska J, Cofta S, Gajewska E, Kalmus G, Sobieska M, Samborski W, et al. The evaluation of selected serum mineral concentrations and their association with insulin resistance in obese adolescents. Eur Rev Med Pharmacol Sci 2013;17(17):2396-400. google scholar
39. 39. Tinkov AA, Skalnaya MG, Ajsuvakova OP, Serebryansky EP, Chao JC, Aschner M, et al. Selenium, Zinc, Chromium, and Vanadium Levels in Serum, Hair, and Urine Samples of Obese Adults Assessed by Inductively Coupled Plasma Mass Spectrometry. Biol Trace Elem Res 2021;199(2):490-9. google scholar
40. 40. Hess SY, Peerson JM, King JC, Brown KH. Use of serum zinc concentration as an indicator of population zinc status. Food Nutr Bull 2007;28(3 Suppl):S403-29. google scholar
41. 41. King JC, Brown KH, Gibson RS, Krebs NF, Lowe NM, Siekmann JH, et al. Biomarkers of Nutrition for Development (BOND)-Zinc Review. J Nutr 2015;146(4):858s-85s. google scholar