Is there a correlation between the size of the BCG scar and renal scar of urinary tract infections in children?

Yıl 2013, , 8 - 12, 01.03.2013

Salih Kavukcu Demet Alaygut Belde Kasap Alper Soylu Gamze Çapakaya Mehmet Atilla Turkmen

https://doi.org/10.5799/ahinjs.01.2013.01.0226

Öz

Objective: Pyelonephritis cause cellular death, and de­velopment of scars in kidneys. The aim of this study is to demonstrate a correlation (if any) between renal scar, and size of the scar induced by BCG vaccine in children who had experienced urinary tract infections. In case of detec­tion of any correlation, BCG scar formation can be used as a determinative marker of renal scars, which develop following urinary tract infection. Methods: Patients with a history of urinary tract infection at least 4 months old who had undergone 99mTcDMSA scanning were included in this study. Vertical and hori­zontal diameters of BCG scars of the patients in the study group were measured. For statistical analysis the greatest diameter was taken into consideration, and the patients were divided into 2 subgroups based on the greatest di­ameter of their BCG scars (Subgroups 1, ≤5 mm, and 2, >5 mm). The patients were also evaluated in 2 groups as those with (Group 1) or without (Group 2) scars. Both groups were compared with subgroups with the largest scar diameters of ≤ 5mm or >5 mm Results: Study population included 108 (82 girls) pa­tients. DMSA detected scars in a total of 51 patients. Mean ages of the patients with and without scars were not different (p=0.414). No significant difference was found in size of the BCG scars between renal scar positive and negative groups (p>0.05). Conclusion: No correlation was found between develop­ment of renal scar and the size of BCG scar in children after urinary tract infection. J Clin Exp Invest 2013; 4 (1): 8-12

Anahtar Kelimeler

BCG scar, renal scar, urinary tract infection, children

Çocuklarda idrar yolu enfeksiyonu sonrası gelişen renal skar ile BCG skarı boyutu arasında bir ilişki var mıdır?

Öz

Amaç: Pyelonefrit böbreklerde hücre ölümü ve skar geli­şimine neden olmaktadır. Bu çalışmanın amacı, idrar yolu enfeksiyonu geçiren çocuklarda oluşan renal skar ile BCG skar boyutu arasında herhangi bir korelasyon olup olma­dığını göstermektir. Bir korelasyon bulunması durumunda BCG skarı idrar yolu enfeksiyonu sonrası gelişen renal skarda belirleyici bir marker olarak kullanılabilecektir. Yöntemler: En az 4 ay önce idrar yolu enfeksiyonu geçir­miş, 99mTcDMSA sintigrafisi çekilmiş olan çocuk hastalar bu çalışmaya alındı Çalışma grubundaki hastaların BCG skarı vertikal ve horizontal çapta ölçüldü. İstatistiksel ana­liz için en büyük çap dikkate alındı ve ≤5 mm ve >5 mm olarak iki gruba ayrıldı. Hastalar renal skarı olanlar (Grup 1) ve renal skar geliştirmeyenler (Grup 2) olmak üzere iki grupta toplandı. Her iki grup, BCG skar boyutu ≤5 mm veya >5 mm olan gruplar ile karşılaştırıldı. Bulgular: 108 (82 kız) hasta çalışmaya dahil edildi. DM­SA\'da skar olan toplam 51 hasta vardı. Skarı olan ve ol­mayan hastaların ortalama yaşları farklı değildi. (p=0,414) Renal skar bulunan ve bulunmayan gruplar arasında BCG skar boyutu bakımından istatistiksel olarak anlamlı bir fark bulunmadı (p>0,05). Tartışma: İdrar yolu enfeksiyonu geçiren çocuklarda re­nal skar gelişimi ile BCG skar boyutu arasında bir kore­lasyon bulunmadı.

Anahtar Kelimeler

BCG skarı, renal skar, idrar yolu en­feksiyonu, çocuklar

Kaynakça

• Kisseleva T, Brenner DA. Fibrogenesis of parenchymal organs. Proc Am Thorac Soc 2008;5:338-342.
• Rossleigh MA. QJ Scintigraphic imaging of renal infec- tions. Nucl Med Mol Imaging 2009;53:72-77.
• Krege S, Giani G, Mayer R, et al. A randomized mul- ticenter trial of adjuvant therapy in superficial bladder cancer: Transuterhral resection plus bacillus Calmette Guerin J Urol 1996;156: 962-966.
• Grange JM. Complications of bacille Calmette Guerin (BCG) vaccination and immunotherapy and their man- agemnet. Commun Dis Publ Health 1998;1:84-88.
• Hocaoğlu AB, Erge DO, Anal O, et al. Characteristics of children with positive tuberculin skin test. Tuberk Toraks 2011;59:158-163.
• Rani SH, Vijayalakshmi V, Sunil K, et al. Cell mediated immunity in children with scar-failure following BCG vaccination. Indian Pediatr 1998;35:123-127.
• Soares AP, Scriba TJ, Joseph S, et al. Bacillus Calmette-Guerin vaccination of Human T Cells with Complex Newborns induces cytokine and Phenotypic Profiles. J Immunology 2008;1805:3569-3577.
• Madeleine A. Vernon, Mylonas KJ, Hughes J. Mac- rophages and Renal Fibrosis. Semin Nephrol 2010;30:302-317.
• Hugo C, Daniel C. Thrombospondin in renal disease. Nephron Exp Nephrol 2009;11:61-66.
• Tosa M, Murakami M, Ghazizadeh M, et al. Chrono- logic change of the maximum dimension of Bacillus Calmette-Guerin-induced keloids. Dermatol Surg 2009;35:189-194.
• Fine PE. Bacille Celmette- Guerin vaccines: a rough guide. Clin Infect Dis 1995;20:11-14.
• Floyd S, Ponnighaus JM, Bliss L, et al. BCG scars in northern Malawi: sensitivity and repeatability of scar reading, and factors affecting scar size. Int J Tuberc Lung Dis 2000;4:1133–1142.
• Santiago EM, Lawson E, Gillenwater K. A Prospective study of Bacillus Calmette-Guérin scar formation and tuberculin skin test reactivity in infants in Lima. Peru Pediatrics 2003;112:298-301.
• Camcıoğlu Y, Deniz G (2007) Temel İmmunoloji İstanbul: Medikal yayıncılık pp 83-103.
• Nikolic-Paterson DJ. CD4+ T cells: a potential player in renal fibrosis. Kidney Int 2010;78:333-335.
• Vernon MA, Mylonas KJ, Hughes J. Macrophages and renal fibrosis. Semin Nephrol 2010;30:302-317.
• Neilson EG. Mechanism of disease: Fibroblasts- a new look at an old problem. Nat Clin Pract Nephrol 2006;2:101-108.
• Ruiz-Ortega M, Puperez M, Esteban V, et al. Angio- tensin II: a key factor in the inflammatory and fibrotic responce in kidney diseases. Nephrol Dial Transplant 2006;21:16-20.
• Wang J, Hori K, Ding J, et al. Toll-like receptors ex- pressed by dermal fibroblasts contribute to hypertro- phic scarring. J Cell Physiol 2011; 226:1265-1273.
• Hussein A, Askar E, Elsaeid M, et al. Functional polymorphisms in transforming growth factor- beta- 1 (TGFbeta-1) and vascular endothelial growth fac- tor (VEGF) genes modify risk of renal parenchymal scarring following childhood urinary tract infection. Nephrol Dial Transplant 2010;25:779-785.
• Kuroda S, Solari V, Puri P. Association of transforming growth factor- beta 1 gene polymorphism with familial vesicoureteral reflux. J Urol 2007;178:1650-1653.