Atualização da abordagem de infecção do trato urinário na infância / Update on the approach of urinary tract infection in childhood

Resumo Objetivo: A infecção do trato urinário (ITU) é a infecção bacteriana mais comum na infância. A ITU pode ser o evento sentinela para alteração renal subjacente. Ainda há muitas controvérsias com relação ao tratamento adequado da ITU. Neste artigo de revisão, discutimos as últimas recomendações para diagnóstico, tratamento, profilaxia e imagiologia da ITU na infância, com base em comprovação e, na sua ausência, no consenso de especialistas. Fonte de dados: Os dados foram coletados após uma revisão da literatura e pesquisa no Pubmed, Embase, Scopus e Scielo. Resumo dos dados: No primeiro ano de vida, as ITUs são mais comuns em meninos (3,7%) do que em meninas (2%). Os sinais e sintomas da ITU são muito inespecíficos, principalmente em neonatos e durante a infância. A febre é o único sintoma em muitos casos. Conclusões: O histórico clínico e exame físico podem sugerir ITU, porém a confirmação deve ser feita por urocultura. Antes da administração de qualquer agente antimicrobiano, deve ser feita coleta de urina. Durante a infância, a coleta de urina adequada é essencial para evitar resultados falso-positivos. O diagnóstico e o início do tratamento imediatos são importantes na prevenção de cicatriz renal de longo prazo. Neonatos febris com ITUs devem ser submetidos a ultrassonografia renal e da bexiga, Agentes antibacterianos intravenosos são recomendados para neonatos e neonatos jovens. Recomendamos também a exclusão de uropatias obstrutivas o mais rapidamente possível e posterior refluxo vesico-ureteral, caso indicado. A profilaxia deve ser considerada em casos de elevada susceptibilidade a ITU e risco elevado de danos renais.

Abstract Objective: Urinary tract infection (UTI) is the most common bacterial infection in childhood. UTI may be the sentinel event for underlying renal abnormality. There are still many controversies regarding proper management of UTI. In this review article, the authors discuss recent recommendations for the diagnosis, treatment, prophylaxis, and imaging of UTI in childhood based on evidence, and when this is lacking, based on expert consensus. Sources: Data were obtained after a review of the literature and a search of Pubmed, Embase, Scopus, and Scielo. Summary of the findings: In the first year of life, UTIs are more common in boys (3.7%) than in girls (2%). Signs and symptoms of UTI are very nonspecific, especially in neonates and during childhood; in many cases, fever is the only symptom. Conclusions: Clinical history and physical examination may suggest UTI, but confirmation should be made by urine culture, which must be performed before any antimicrobial agent is given. During childhood, the proper collection of urine is essential to avoid false-positive results. Prompt diagnosis and initiation of treatment is important to prevent long-term renal scarring. Febrile infants with UTIs should undergo renal and bladder ultrasonography. Intravenous antibacterial agents are recommended for neonates and young infants. The authors also advise exclusion of obstructive uropathies as soon as possible and later vesicoureteral reflux, if indicated. Prophylaxis should be considered for cases of high susceptibility to UTI and high risk of renal damage.

Update on the approach of urinary tract infection in childhood.

OBJECTIVE: Urinary tract infection (UTI) is the most common bacterial infection in childhood. UTI may be the sentinel event for underlying renal abnormality. There are still many controversies regarding proper management of UTI. In this review article, the authors discuss recent recommendations for the diagnosis, treatment, prophylaxis, and imaging of UTI in childhood based on evidence, and when this is lacking, based on expert consensus. SOURCES: Data were obtained after a review of the literature and a search of Pubmed, Embase, Scopus, and Scielo. SUMMARY OF THE FINDINGS: In the first year of life, UTIs are more common in boys (3.7%) than in girls (2%). Signs and symptoms of UTI are very nonspecific, especially in neonates and during childhood; in many cases, fever is the only symptom. CONCLUSIONS: Clinical history and physical examination may suggest UTI, but confirmation should be made by urine culture, which must be performed before any antimicrobial agent is given. During childhood, the proper collection of urine is essential to avoid false-positive results. Prompt diagnosis and initiation of treatment is important to prevent long-term renal scarring. Febrile infants with UTIs should undergo renal and bladder ultrasonography. Intravenous antibacterial agents are recommended for neonates and young infants. The authors also advise exclusion of obstructive uropathies as soon as possible and later vesicoureteral reflux, if indicated. Prophylaxis should be considered for cases of high susceptibility to UTI and high risk of renal damage.

Inflammation and oxidative stress in viper bite: an insight within and beyond.

Though systemic and local manifestations of snakebite are considered serious, the relevance of oxidative stress in viper bite pathology is largely denied. However, over the past decade, studies have provided substantial evidence for the presence of persistent oxidative stress in viper bite victims. This review aims at highlighting the disturbances in redox homeostasis soon after viper envenomation and its implications in the pathomechanism of secondary/long term complications including thrombocytopenia, hypopituitarism, infertility, renal abnormalities and persistent local tissue degradation. Both enzymatic and non-enzymatic components of viper venom play a pivotal role in bringing redox turbulence in victims. Venom-induced hemorrhage and necrosis with subsequent release of damage associated molecular pattern (DAMPs) molecules also contribute to sustained oxidative stress and inflammation. Studies have demonstrated that along with anti-venom therapy an antioxidant treatment during the early stages of viper bite and also long term treatment could help to reduce the occurrence of secondary/long term complications. Further, proper knowledge regarding the pathophysiology will allow for exploration of new avenues in the treatment of viper bite.

Association between maternal prenatal vitamin use and congenital abnormalities of the genitourinary tract in a developing country.

OBJECTIVE: To determine the association between prenatal multivitamin supplementation and congenital genitourinary tract anomalies in a group of Colombian newborn babies included in the Latin-American surveillance program (ECLAMC). STUDY DESIGN: We included all neonates born between January 2004 and August 2007 registered in the ECLAMC database. Maternal prenatal multivitamin use was assessed for 122 newborns with congenital genitourinary tract anomalies and then compared to 271 non-malformed controls. RESULTS: 46,850 births were registered and 122 (26/10,000) of them were identified to have a genitourinary tract anomaly. Prenatal multivitamin supplementation during the first, second, and third trimesters of pregnancy was associated with a reduction in the risk of these anomalies: OR 0.16 (0.08-0.31), OR 0.31 (0.19-0.52), and OR 0.38 (0.23-0.63) respectively. CONCLUSIONS: Maternal prenatal multivitamins may reduce the risk of congenital genitourinary tract anomalies, not only during the first 8 weeks of gestation but also later in pregnancy, in developing countries.

Seguimiento telefónico de pacientes con malformaciones del tracto genitourinario en sus primeros dos años de vidas / Telephonic follow-up of patients with genitourinary malformations in their first two years of life

Las malformaciones del tracto genitourinario (MTG) son una causa importante de morbilidad en la población pediátrica pudiendo llevar a los pacientes a falla renal severa o incluso a la muerte y dejando como posible discapacidad impotencia e infertilidad en el adulto. Es de vital importancia hacer un seguimiento a estos pacientes para determinar las complicaciones, pronóstico y posibles discapacidades secundarias a estas patologías congénitas. Por esta razón se realizó una encuesta telefónica de seguimiento a 40 pacientes con diagnóstico de MTG en la ciudad de Bogotá. Después de analizar múltiples variables se encontró que en nuestro medio, la mortalidad directamente relacionada con el defecto urogenital fue baja comparada con otros estudios y se relacionó directamente con malformaciones mayores. El 22 por cien de los pacientes que sobrevive requiere al menos una cirugía en los primeros dos años de vida, con buenos resultados. También se encontró que los pacientes son valorados en su mayoría de forma interdisciplinaria por más de un especialista. Para complementar estos resultados es necesario un sistema de seguimiento más exhaustivo que busque evaluar estos pacientes a más largo plazo para evaluar discapacidad en la adolescencia y edad adulta

[Folic acid and congenital malformation: scientific evidence and public health strategies]. / Acido folico e difetti congeniti: evidenze scientifiche e strategie di sanità pubblica.

In Italy at least 3% of babies are born with some congenital malformation. The intake of folic acid (FA) prior to conception and during the early stages of pregnancy plays an important role in preventing neural tube defects, severe anomalies of brain embryogenesis, and other malformations such as cardiac and urinary tract anomalies, oro-facial clefts and limb reduction defects. The Italian Network for Folic Acid Promotion, coordinated by the National Center on Rare Diseases of the Italian National Institute of Health, has elaborated and diffused a recommendation for the periconceptional FA supplementation: "Women of child-bearing age, are recommended to consume 0,4 mg/day of FA, to reduce the risk of congenital defects. The intake of folic acid should start at least one month before the conception and should continue for the first quarter of pregnancy". This paper discusses various strategies in order to promote FA intake during periconceptional period. Food fortification, adopted in several countries such as USA, has raised concerns about the risk of an excessive FA intake which may lead to adverse effect such as tumour promotion. Currently, periconceptional supplementation and healthy dietary habits promotion appear to be the most effective strategies.

Hungarian cohort-controlled trial of periconceptional multivitamin supplementation shows a reduction in certain congenital abnormalities.

BACKGROUND: The 1984-1991 Hungarian randomized controlled trial (RCT) of periconceptional multivitamin supplementation containing folic acid (0.8 mg) showed a significant reduction in the first occurrence of neural tube defects (NTDs), and of urinary tract and cardiovascular abnormalities, but no reduction in orofacial clefts. A controlled cohort trial was designed to confirm or deny these results. METHODS: Supplemented women were recruited from the Hungarian Periconceptional Service using the same multivitamin as the Hungarian RCT. Unsupplemented pregnant women were recruited in the standard regional antenatal care clinics and were matched to each supplemented pregnant woman on the basis of age, socioeconomic status, place of residence, and year of pregnancy. RESULTS: A total of 3056 informative offspring were evaluated in each cohort. The occurrence of congenital cardiovascular malformations (31 vs. 50) was reduced (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.38-0.96) in the supplemented cohort, accounted for mainly by ventricular septal defects (5 vs. 19; OR, 0.26; 95% CI, 0.09-0.72). There was no significant difference (14 vs. 19) in the occurrence of urinary tract defects between the two cohorts, but stenosis/atresia of pelvic-ureteric junction (2 vs. 13) showed a significant reduction (OR, 0.19; 95% CI, 0.04-0.86). The protective effect of the folic acid-containing multivitamin for NTDs (one offspring in the supplemented vs. nine in the unsupplemented cohort) was confirmed (OR, 0.11; 95% CI, 0.01-0.91). There was, however, no protective effect on orofacial clefts or on multiple congenital abnormalities. CONCLUSIONS: The results of this cohort-controlled trial support the findings of the previous Hungarian RCT. The primary prevention of some major structural birth defects by multivitamins containing folic acid or by folic acid has great public health importance.