nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2012-16-4-69-74nefr-629Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSПРОКАЛЬЦИТОНИН В МОЧЕ – КАК МАРКЕР ТЯЖЕСТИ ПОВРЕЖДЕНИЯ ПОЧЕЧНОЙ ТКАНИ У ДЕТЕЙ С ПУЗЫРНО-МОЧЕТОЧНИКОВЫМ РЕФЛЮКСОМPROCALCITONIN IN URINE – AS A MARKER OF RENAL TISSUE SEVERE DAMAGE IN CHILDREN WITH VESICOURETERAL REFLUXЗайковаН. М.ZaikovaN. M.

г.Кишинев, Буребиста, 93, Тел. + 37322523558б

nataliazaikova@mail.ruДлинВ. В.DlinV. V.СиницынаЛ.SinitsinaL.

Кишинев

Научно-исследовательский институт охраны материнства и детстваRussian FederationНИИ педиатрии и детской хирургииRussian Federation2012100420121646974Copyright © Зайкова Н.М., Длин В.В., Синицына Л., 20122012Зайкова Н.М., Длин В.В., Синицына Л.Zaikova N.M., Dlin V.V., Sinitsina L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/629

ЦЕЛЬ ИССЛЕДОВАНИЯ. Установить клиническое значение определения прокальцитонина (ПКТ) в моче у детей с пузырно-мочеточниковым рефлюксом (ПМР) и рефлюкс-нефропатией (РН). МАТЕРИАЛЫ И МЕТОДЫ. Обследовали 25 детей с инфекцией мочевой системы (ИМС) в возрасте от 6 до 10 лет (средний возраст 6,34±4,67), в том числе 17 девочек и 8 мальчиков. Верификация диагноза проводилась на основании данных анамнеза заболевания и уронефрологического обследования больных. I степень ПМР диагностирована у 2 детей (8%), ПМР II степени – у 7 детей (28%), ПМР III степени – у 3 (12%), ПМР IV–V степени – у 13 детей (52%). В зависимости от наличия и степени тяжести РН по данным ДМСА-сцинтиграфии все дети были распределены на 2 группы: 1-я группа – 6 детей с ПМР без очагов склероза, 2-я группа – 19 детей с РН, в том числе 11 детей с I–II степенью РН (тип А и В) и 8 пациентов с III–IV степенью РН (тип С и D). Все дети, включенные в исследование, не имели обострения ИМС в период сбора мочи на ПКТ и при проведении ДМСА-сцинтиграфии. ПКТ изучали в утренней моче иммунохроматографическим тестом (метод Brachms PCT-Q). РЕЗУЛЬТАТЫ. Установлено, что уровень мочевой экскреции ПКТ у детей с ПМР отражает наличие и выраженность РН. Наиболее высокий уровень ПКТ в моче наблюдался у детей с III–IV степенями РН и был почти в 6 раз выше, чем у детей без РН по данным ДМСА-сцинтиграфии. ЗАКЛЮЧЕНИЕ. Полученные результаты позволяют рекомендовать исследование ПКТ в моче в качестве дополнительного неинвазивного маркера повреждения паренхимы почек, в том числе, вероятно, и для определения латентного воспаления в почечной паренхиме при ПМР.

THE AIM. To evaluate the clinical relevance of procalcitonin (PCT) determination in urine in children with vesicoureteral reflux (VUR) and reflux nephropathy (RP). MATERIALS AND METHODS. 25 children aged 6 to 10 years (average age 6,34±4,67) with urinary tract infection (UTI), including 17 girls (68%) and 8 boys were examined. Diagnosis verification was carried out on the basis of anamnesis data and uronephrological patient examination. VUR I degree was diagnosed in 2 children (8%), VUR II degree – in 7 (28%), VUR III degree – in 3 (12%), VUR IV-V degree – in 13 children (52%). Depending on existence and severity of RP under results of the DMSA-scan all children were divided into 2 groups: 1 group – 6 (24%) children with VUR without sclerosis focuses, 2nd group – 19 children with RP, including 11 children with I-II degree of RP (type A and B) and 8 patients with III-IV degree of PN (type C and D). All children included in research had no UIT at PCT and DMSA-scan. PCT was inspected in first void urine by immunoassay (Brachms PCT-Q method). RESULTS. It is established that urine PCT excretion level in children with VUR reflects existence and intensity of RP. The highest PCT level in urine was observed in children with RP III-IV degree and was practically 6 times higher than in children without RP according to DMSA-scan data. CONCLUSION. Findings allow to recommend PCT research in urine as an additional noninvasive marker of renal parenchyma injury and also, possibly, for diagnosis latent inflammation in kidney parenchyma at VUR.

пузырно-мочеточниковый рефлюкспрокальцитонинрефлюкс-нефропатияvesicoureteral refluxprocalcitoninreflux nephropathyReferencesOberhoffer M, Russwurm S, Bredle D. et al. Discriminative power of inflamatory markers for prediction of tumor necrosis factor-alfa and interleukin-6 in ICU patients with systemic inflammatory response syndrome (SIRS) or sepsis at arbitary time points. Intensive Care Med 2000; 26: 170-174Oberhoffer M, Russwurm S, Bredle D. et al. Discriminative power of inflamatory markers for prediction of tumor necrosis factor-alfa and interleukin-6 in ICU patients with systemic inflammatory response syndrome (SIRS) or sepsis at arbitary time points. Intensive Care Med 2000; 26: 170-174Rosenfeld MG, Mermod JJ, Amara SG. et al. Production of novel neuropeptide encoded by the calcitonin gene via tissuespecific RNA processing. Nature 1983; 304: 129-135Rosenfeld MG, Mermod JJ, Amara SG. et al. Production of novel neuropeptide encoded by the calcitonin gene via tissuespecific RNA processing. Nature 1983; 304: 129-135Adema GJ, Baas PD: A Novel Calcitonin-encoding mRNA is Produced by Alternative Procesing of Calcitonin/Calcitonin Gene-related Peptide-I. The Journal of Biological Chemistry 1992; 267: 7943-7948Adema GJ, Baas PD: A Novel Calcitonin-encoding mRNA is Produced by Alternative Procesing of Calcitonin/Calcitonin Gene-related Peptide-I. The Journal of Biological Chemistry 1992; 267: 7943-7948Ghillani PP, Motte P, Troalen F. et al. Identification and measurment of calcitonin precursors in serum of patient with malignant deseases. Cancer Res 1989; 49: 6845-6851Ghillani PP, Motte P, Troalen F. et al. Identification and measurment of calcitonin precursors in serum of patient with malignant deseases. Cancer Res 1989; 49: 6845-6851Assicot M, Gendrel D, Carsin H. et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341 :515 –518Assicot M, Gendrel D, Carsin H. et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341 :515 –518Старовойтова ЕВ, Федоров АМ, Ботвиньева ВВ, Таточенко ВК. Значение маркеров бактериального воспаления при дифференциальной диагностике бактериальных и вирусных инфекций у лихорадящих детей. Детские инфекции 2007; 6 (2): 20-25Старовойтова ЕВ, Федоров АМ, Ботвиньева ВВ, Таточенко ВК. Значение маркеров бактериального воспаления при дифференциальной диагностике бактериальных и вирусных инфекций у лихорадящих детей. Детские инфекции 2007; 6 (2): 20-25Gürgöze MK, Akarsu S, Yilmaz E. et al. Proinflammatory cytokines and procalcitonin in children with acute pyelonephritis. Pediatric Nephrology 2005; 20 (10): 1445–1448Gürgöze MK, Akarsu S, Yilmaz E. et al. Proinflammatory cytokines and procalcitonin in children with acute pyelonephritis. Pediatric Nephrology 2005; 20 (10): 1445–1448Tuerlinckx D, Vander Borght T. Is procalcitonin a good marker of renal lesion in febrile urinary tract infection? European Journal of Pediatrics 2005; 164 (10): 651–652Tuerlinckx D, Vander Borght T. Is procalcitonin a good marker of renal lesion in febrile urinary tract infection? European Journal of Pediatrics 2005; 164 (10): 651–652Leroy S, Gervaix A. Procaltitonin: A key marker in children with urinary tract unfection. Advances in urology 2011; 2011: 397618Leroy S, Gervaix A. Procaltitonin: A key marker in children with urinary tract unfection. Advances in urology 2011; 2011: 397618Zaffanello M, Brugnara M, Franchini M, Fanos V. Is serum procalcitonin able to predict long-term kidney morbidity from urinary tract infections in children? Clinical Chemistry and Laboratory Medicine 2008; 46 (10), 1358–1363Zaffanello M, Brugnara M, Franchini M, Fanos V. Is serum procalcitonin able to predict long-term kidney morbidity from urinary tract infections in children? Clinical Chemistry and Laboratory Medicine 2008; 46 (10), 1358–1363Mantadakis E, Plessa E, Vouloumanou EK. et al. Serum procalcitonin for prediction of renal parenchymal involvement in children with urinary tract infections: a meta-analysis of prospective clinical studies. The Journal of Pediatrics 2009; 155 (6): 875–881Mantadakis E, Plessa E, Vouloumanou EK. et al. Serum procalcitonin for prediction of renal parenchymal involvement in children with urinary tract infections: a meta-analysis of prospective clinical studies. The Journal of Pediatrics 2009; 155 (6): 875–881Meisner M, Lohs T, Huettemann E. et al. The plasma elimination rate and urinary secretion of procalcitonin in patients with normal and impaired renal function. European Journal of Anaesthesiology 2001; 18 (2): 79–87Meisner M, Lohs T, Huettemann E. et al. The plasma elimination rate and urinary secretion of procalcitonin in patients with normal and impaired renal function. European Journal of Anaesthesiology 2001; 18 (2): 79–87Piepsz A, Colarinha P, Gordon I. et al. Peadiatric Committee of the European Association of Nuclear Medicine. Guidelines for 99-mTc-DMSA scintigraphy in children. Eur J Nucl Med 2001; 28:37-41Piepsz A, Colarinha P, Gordon I. et al. Peadiatric Committee of the European Association of Nuclear Medicine. Guidelines for 99-mTc-DMSA scintigraphy in children. Eur J Nucl Med 2001; 28:37-41Benador N, Siegrist C-A, Gendrel D. et al. Procalcitonin is a marker of severity of renal lesions in pyelonephritis. Pediatrics.1998; 102:1422–1425Benador N, Siegrist C-A, Gendrel D. et al. Procalcitonin is a marker of severity of renal lesions in pyelonephritis. Pediatrics.1998; 102:1422–1425Gervaix A, Galletto-Lacour A, Gueron T. Usefulness of procaltitonin and C-reactive protein rapid tests for the management of children with urinary tract infection. Peadiat Infec Di J 2001; 20: 507-511Gervaix A, Galletto-Lacour A, Gueron T. Usefulness of procaltitonin and C-reactive protein rapid tests for the management of children with urinary tract infection. Peadiat Infec Di J 2001; 20: 507-511Pecile P, Romanello C. Procaltitonin and pyelonephriris in children. Curr Opin Infect Dis 2007; 20 (1):83-87Pecile P, Romanello C. Procaltitonin and pyelonephriris in children. Curr Opin Infect Dis 2007; 20 (1):83-87Gurgoze MK, Akarsu S, Yilmaz E. et al. Pro inflammatory cytokines and pro calcitonin in children with acute pyelonephritis. Pediatr Nephrol 2005; 20:1445-1448Gurgoze MK, Akarsu S, Yilmaz E. et al. Pro inflammatory cytokines and pro calcitonin in children with acute pyelonephritis. Pediatr Nephrol 2005; 20:1445-1448Preas HL, Nylen ES, Snider RH. Effects of anti-inflammatory agents on serum levels of calcitonin precursors during human experimental endotoxemia. J Infect Dis 2001; 184:373-376Preas HL, Nylen ES, Snider RH. Effects of anti-inflammatory agents on serum levels of calcitonin precursors during human experimental endotoxemia. J Infect Dis 2001; 184:373-376Nikfar R, Khotaee G, Ataee N, Shams S. Usefulness of procalcitonin rapid test for the diagnosis of acute pyelonephritis in children in the emergency department. Pediatrics International 2010; 52 (2): 196–198Nikfar R, Khotaee G, Ataee N, Shams S. Usefulness of procalcitonin rapid test for the diagnosis of acute pyelonephritis in children in the emergency department. Pediatrics International 2010; 52 (2): 196–198Захарова ИН, Кучерова ВВ. Роль прокальцитонина в дифференциальной диагностике микробно-воспалительных заболеваний почек. Актуальные проблемы детской нефрологии. Материалы Международной школы и научнопрактической конференции по детской нефрологии Оренбург; 2010: 130Захарова ИН, Кучерова ВВ. Роль прокальцитонина в дифференциальной диагностике микробно-воспалительных заболеваний почек. Актуальные проблемы детской нефрологии. Материалы Международной школы и научнопрактической конференции по детской нефрологии Оренбург; 2010: 130Bressan S, Andreola B, Zucchetta P, Montini G. Procaltitonin as a predictor of renal scarring in infants and young children. Pediatr. Nephrology 2009; 24: 1199-1204Bressan S, Andreola B, Zucchetta P, Montini G. Procaltitonin as a predictor of renal scarring in infants and young children. Pediatr. Nephrology 2009; 24: 1199-1204Kotoula A, Gardikis S, Tsalkidis A. Procaltitonin for the early prediction of renal parenchymal involvement in the children with UTI: preliminary results. International Urology and Nephrology 2009; 41 (2):393-399Kotoula A, Gardikis S, Tsalkidis A. Procaltitonin for the early prediction of renal parenchymal involvement in the children with UTI: preliminary results. International Urology and Nephrology 2009; 41 (2):393-399Karavanaki K, Haliotis F A, Haliotis F.A. DMSA scintigraphy in febrile urinary tract infections could be omitted in children with low procalcitonin levels. Infectious Diseases in Clinical Practice 2007; 15 (6): 377–381Karavanaki K, Haliotis F A, Haliotis F.A. DMSA scintigraphy in febrile urinary tract infections could be omitted in children with low procalcitonin levels. Infectious Diseases in Clinical Practice 2007; 15 (6): 377–381Аничкова ИВ, Папаян АВ. Рефлюкс-нефропатия. Клиническая нефрология детского возраста СПб.: Левша СанктПетербург 2008: 452-457Аничкова ИВ, Папаян АВ. Рефлюкс-нефропатия. Клиническая нефрология детского возраста СПб.: Левша СанктПетербург 2008: 452-457

The authors declare that there are no conflicts of interest present.