Retrospective analysis of APN and follow up

• Main Authors: Jia-Jung Lee, 李佳蓉
• Other Authors: 陳鴻鈞
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/38277822484117949079

碩士 === 高雄醫學大學 === 醫學研究所碩士班 === 94 === Urinary tract infection (UTI) is one of the most common infectious diseases in human. There are important medical and financial implications associated with UTIs. Acute pyelonephritis (APN) is clinical syndrome of flank pain, renal tenderness, fever, and chills, accompanied by bacteriuria, and represent severe form of UTIs. It may combined bacteremia and can progress to the systemic inflammatory response syndrome, septic shock, and death. Research during the last few decades has established that the site of infection and the disease severity are influenced by bacterial virulence. Other anatomic, behavior, and environment host risk factors had also been discussed. Confirmed by murine UTI model, neutrophil-dependent “innate” defense mechanisms are more important than specific immunity for resistance to UTI. Interleukin (IL)-8 is the critical chemotatic factor. Neutrophil recruitment is the pivotal pathophysiological event underlying the bacterial clearance but also tissue damage and renal scarring associated with UTI. In mIL-8Rh KO mice, the neutrophil influx was delayed and neutrophils failed to transverse the epithelium. These mice were shown to develop acute, lethal disease accompanied by bacteremia. Survived animals developed chronic infection and progressively destructive inflammation of the kidneys. And UTI-prone children have reduced neutrophil IL-8R expression. In our study, we use retrospective APN data collection and a follow up examination try to answer: is any host factors, such as IL-8R (CXCR1, CXCR2) expression, or other clinical parameter associated with APN acute disease severity or follow up chronic renal damage. Method: We enrolled community-acquired, non-obstructive, adult, female who had been hospitalized for APN at KMUH during 200401-200412, and a age-matched, control group who had no APN history to participate the study. We will retrospectively record date during hospitalization, and analyze what clinical parameter associated with acute APN severity (longer hospital days, longer febrile days after treatment, combined bacteremia). With the follow up visit, we performed blood, urine, and renal sonographic examination, The analysis focused on chronic renal damage (low creatinine clearance, more urine albumin/creatinine ratio, persist bacteriuria ). Renal interlobar artery resistive index (RI) were measured by sonography. And neutrophil’s CXCR1 and CXCR2 expression were checked by flow cytometry. Result: total 26 APN cases and 32 volunteers were examined. Retrospective study showed: DM patients had longer hospital stay than non-diabetic patient. Bacteremia had higher CRP level at admission than patient without bacteremia. Follow up study showed: acute pyelonephritis patients’ in their follow up examination: lower creatinine clearance and higher urine albumin/creatinine ratio were associated with urine protein during acute APN. Positive follow-up urine culture (possible indicated persist chronic infection) associated with diabetic mellitus and bacteremia during acute APN. Mean RI, CXCR1 and CXCR2 expression showed no significant between APN group and volunteers. Conclusion: community-acquired, non-obstructive, culture-proven APN has good acute disease survival. But when APN patient has significant proteinuria, combined with bacteremia, or had diabetic mellitus, serial follow up should be performed due to increase chances of chronic renal damage and persistent bacteriuria. Is adult baseline neutrophil CXCR1 and CXCR2 expression has association with APN? It may be need more case number and further study.