Tekrarlayan İdrar Yolu Enfeksiyonu ve Renal Skarı Olan Çocuklarda Serum Renalazın Değerlendirilmesi

Yıl 2024, ERKEN GÖRÜNÜMLÜ MAKALELER, 1 - 5

Melike Arslan , Umut Selda Bayrakçı , Halil İbrahim Yakut , Ali Ata Çerkezoğlu

https://doi.org/10.12956/tchd.1459460

Öz

Amaç: Tekrarlayan idrar yolu enfeksiyonları (İYE), böbrek skarlaşması için önemli bir risk faktörüdür. Çalışmanın amacı çocuklarda renalaz düzeyleri ile böbrek skarları arasındaki ilişkiyi değerlendirmekti.
Gereç ve Yöntemler: Çalışmaya tekrarlayan İYE geçiren 78 hasta ve 20 sağlıklı kontrol dahil edildi. Tüm hastalara işeme sistoüretrografisi ve dimerkaptosüksinik asit (DMSA) sintigrafisi çekildi. Tekrarlayan İYE geçiren çocuklarda ve kontrollerde serum renalaz düzeyi analiz edildi.Bulgular: Çalışmaya tekrarlayan İYE öyküsü olan 78 hasta (7 erkek, %9.0; 71 kız, %91.0) ve 20 sağlıklı çocuk (3 erkek, %15; 17 kız, %85) dahil edildi. Hastaların ve sağlıklı kontrollerin yaş ortalaması sırasıyla 11.71±0.91 yıl ve 12.35±1.83 yıldı. Hastaların %48.7’sinde (38/8) Vezikoüreteral reflü (VUR) tespit edildi. Tekrarlayan İYE’ lerin 45’inde skar, bunların da %71’inde VUR vardı. Tekrarlayan İYE grubunun renalaz düzeyi kontrol grubuna göre anlamlı olarak yüksek bulundu (p=0.014). Renalaz düzeyinin böbrek skarları ile anlamlı bir ilişkisi olduğu bulundu. Skarlı grubun ortalama renalaz düzeyi skarsız gruba göre anlamlı olarak yüksek bulundu (p=0.005). Skarlı çocukların renalaz ortalamaları arasında VUR olup olmamasına göre istatistiksel olarak farklılık olmadığı belirlendi (p=0.688).
Sonuç: Bu çalışma renalazın renal fibrozis ve skar oluşumunda önemli bir rol oynayabileceğini düşündürmektedir. Renalazın renal skarlaşmadaki rolünün aydınlatılmasının ardından tekrarlayan idrar yolu enfeksiyonu olan hastalarda fibrozis ve skar dokusu gelişiminin önlenmesinde yeni bir ajan olarak gündeme gelebilir.

Anahtar Kelimeler

Çocuklar, Tekrarlayan idrar yolu enfeksiyonu, Renalaz, Renal skar, Vezikoüreteral reflü

Evaluation of Serum Renalase in Children with Recurrent Urinary Tract Infection and Renal Scars

Öz

Objective: Recurrent urinary tract infections (UTI) are important risk factors for renal scarring. The aim of the study was to assess the relationship between renalase and renal scars in children.
Material and Methods: The study included 78 patients with recurrent UTI and 20 healthy controls. All patients had voiding cystourethrography and dimercaptosuccinic acid (DMSA) scintigraphy. Serum renalase level were analyzed in children with recurrent UTI and controls.
Results: The study included the 78 patients with a history of recurrent UTI (7 boys, 9.0%; 71 girls, 91.0%) and 20 healthy children (3 boys, 15%; 17 girls, 85%) were included in the study. The mean age of the patients and healthy controls were 11.71±0.91 years and 12.35±1.83 years, respectively. Vesicoureteral reflux (VUR) was detected in 48.7% of patients (38/78). Of 45 recurrent UTI with renal scar, 71% also had VUR. The renalase level of the recurrent UTI group was found to be significantly higher than the control group (p=0.014). Renalase level was found to have a significant relationship with renal scars. The mean renalase level of the scar group was found to be significantly higher than the scar-free group (p=0.005). It was found that there was no statistical difference between the renalase means of children with scars depending on whether they had VUR or not (p=0.688).
Conclusion: This study suggests that renalase may play an important role in the formation of renal fibrosis and scars. After clarifying the role of renalase in renal scarring, it might come up as a new agent to prevent fibrosis and scar tissue development in patients with recurrent urinary tract infections.

Anahtar Kelimeler

Children, Recurrent UTI, Renalase, Renal scar, Vesicoureteral reflux

Kaynakça

• Keren R, Shaikh N, Pohl H, Mueller LG, Ivanova A, Zaoutis L, et al. A. Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring. Pediatrics 2015; 136: e13-21.
• Simões E Silva AC, Oliveira EA, Mak RH. Urinary tract infection in pediatrics: an overview. J Pediatr (Rio J) 2020; 96 Suppl 1: 65-79.
• Khan A, Jhaveri R, Seed PC, Arshad M. Update on Associated Risk Factors, Diagnosis, and Management of Recurrent Urinary Tract Infections in Children. J Pediatric Infect Dis Soc 2019; 8: 152-9.
• Naseri M, Tafazoli N, Tafazoli N. Prevalence of Vesicoureteral Reflux in Children with Urinary Tract Infection. Saudi J Kidney Dis Transpl 2022;33:111-20.
• Bek K, Akman S, Bilge I, Topaloğlu R, Çalışkan S, Peru H, et al. Chronic kidney disease in children in Turkey. Pediatr Nephrol 2009;24:797-806.
• Larcombe J. Urinary tract infection in children: recurrent infections. BMJ Clin Evid 2015; 2015:0306. 
• Temiz Y, Tarcan T, Onol FF Alpay H, Şimşek F. The efficacy of Tc99m dimercaptosuccinic acid (Tc-DMSA) scintigraphy and ultrasonography in detecting renal scars in children with primary vesicoureteral reflux (VUR). Int Urol Nephrol 2006; 38: 149-52.
• Taranta-Janusz K, Roszkowska R, Wasilewska A. Renalase Levels in Children with Solitary Functioning Kidney. Indian Pediatr 2015;52: 1047-50.
• Skrzypczyk P, Okarska-Napierała M, Stelmaszczyk-Emmel A, Górska E, Pańczyk-Tomaszewska M. Renalase in children with chronic kidney disease. Biomarkers 2019; 24: 638-44.
• Williams G, Craig JC. Prevention of recurrent urinary tract infection in children. Curr Opin Infect Dis 2009; 22: 72-6.
• Millner R, Becknell B. Urinary Tract Infections. Pediatr Clin North Am 2019; 66: 1-13.
• Mori R, Lakhanpaul M, Verrier-Jones K. Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ 2007; 335: 395–7.
• Awais M, Rehman A, Baloch NU, Khan F, Khan N. Evaluation and management of recurrent urinary tract infections in children: state of the art. Expert Rev Anti Infect Ther 2015;13:209-31.
• Roupakias S, Sinopidis X, Tsikopoulos G, Spyridakis L, Karatza A, Varvarigou A. Dimercaptosuccinic acid scan challenges in childhood urinary tract infection, vesicoureteral reflux and renal scarring investigation and management. Minerva Urol Nefrol 2017; 69: 144-52.
• Rybi-Szumińska A, Michaluk-Skutnik J, Osipiuk-Remża B, Kossakowska A, Wasilewska A. Normal values for urine renalase excretion in children. Pediatr Nephrol 2014; 29: 2191-5.
• Malyszko J, Zbroch E, Malyszko JS, Koc-Zorawska E, Mysliwiec M. Renalase, a novel regulator of blood pressure, is predicted by kidney function in renal transplant recipients. Transplant Proc 2011;43: 3004-7.
• Zbroch E, Malyszko J, Malyszko J, Zorawska EK, Mysliwiec M. Renalase in peritoneal dialysis patients is not related to blood pressure, but to dialysis vintage. Perit Dial Int 2012; 32: 348-51.
• Desir GV. Regulation of blood pressure and cardiovascular function by renalase. Kidney Int 2009;76:366-70.
• Taranta-Janusz K, Roszkowska R, Wasilewska A. Renalase Levels in Children with Solitary Functioning Kidney. Indian Pediatr 2015;12:1047-50.
• Wisniewska M, Serwin N, Dziedziejko V, Marchelek-Mysliwiec M, Dołegowska B, Domanski L, et al. Renalase in Haemodialysis Patients with Chronic Kidney Disease. J Clin Med 2021;10:680.
• Vijayakumar A, Mahapatra NR. Renalase: a novel regulator of cardiometabolic and renal diseases. Hypertens Res 2022;45:1582-98.
• Wu Y, Wang L, Deng D, Zhang Q, Liu W. Renalase protects against renal fibrosis by inhibiting the activation of the ERK signaling pathways. Int J Mol Sci 2017;18:855.
• Wu Y, Bai Y, Feng Y, Zhang Q, Zongli D, Liu W. Renalase Prevents Renal Fibrosis by Inhibiting Endoplasmic Reticulum Stress and Down-Regulating GSK-3β/Snail Signaling. Int J Med Sci 2023; 20: 669-81.