تغييرات شمارش گلبول هاي سفيد خون محيطي، شمارش سلولي تفاضلي (diff)، ESR و CRP در عفونت ادراري تب دار

دكتر ميترا ناصري - استاديار گروه اطفال ، دانشگاه علوم پزشكي مشهد ، فوق تخصص كليه و مجاري ادرار

هدف :

اين مطالعه با هدف ارزيابي سودمندي پارامترهاي آزمايشگاهي شامل شمارش گلبول هاي سفيد خون محيطي، ESR،CRP و شمارش سلولي تفاضلي، جهت تعيين سطح عفونت در بيماران با عفونت ادراري تب دار ( پيلونفريت) صورت گرفت.

روش مطالعه

در اين مطالعه كه بصورت گذشته نگر انجام شد، 61 كودك با عفونت ادراري تب دار و درجه حرارت زير بغل بيشتر يا مساوي c 38 كه در يك مقطع زماني 5 ساله ( 1384-1379) در بخش اورژانس بيمارستان دكتر شيخ بستري شده بودند، مورد ارزيابي قرار گرفتند.

در تمام بيماران، ارزيابي كلينيكي جهت تعيين كانون عفونت و بررسيهاي آزمايشگاهي شامل شمارش گلبول هاي سفيد خون محيطي بوسيله دستگاههاي آناليزر لكوسيتي خودكار، بررسي شمارش سلولي تفاضلي بوسيله رنگ آميزي گيمسا و در گروهي از بيماران اندازه گيري ESR با روش وسترگرين و CRP با روشي كيفي CRP-latex انجام شده بود.

نمونه هاي ادراري در شيرخواران و كودكان كوچك با كيسه ادراري و در كودكان بزرگتر بوسيله روش ميداستريم جمع آوري شده بود. براي مقايسه نتايج، از تست Chi² غير پارامتريك استفاده شد و مقادير 05/0P< از لحاظ آماري معني دار تلقي شد.

نتايج

شمارش گلبول هاي سفيد خون محيطي در 6 بيمار (8/9 % ) نرمال، در 1 مورد (6/1 %) لكوسيتوز با غلبه لنفوسيت ها و در 25 بيمار (41%) لكوسيتوز با غلبه نوتروفيل ها را نشان داد. در 27 بيمار (5/47 %)، شمارش گلبول هاي سفيد خون محيطي نرمال اما شمارش سلولي تفاضلي (diff) غلبه با نوتروفيل ها را نشان داد. ( نوتروفيلي نسبي )

لكوسيتوز با غلبه لنفوسيت ها به ميزان قابل توجه در درصد كمي از بيماران و نوتروفيلي شامل موارد نسبي و مطلق، به ميزان قابل توجه در درصد بالائي از بيماران مشاهده شد. ( 05/0P<)

لكوسيتوز در 26 بيمار (42%) و شمارش گلبول هاي سفيد بيشتر از 15000 در ميكروليتر در 34 بيمار (55%) مشاهده شد. از مجموع 41 بيمار، در 30 بيمار (2/73 %)، مقادير ESR بالا يا مساوي 30mm/h وجود داشت كه ESR³30mm/h به ميزان معني دار در بيماران شايعتر بود. (003/0 P=). از مجموع 36 بيمار، در 13 بيمار (1/36 %) CRP منفي و در 23 بيمار (9/63 %) CRP مثبت مشاهده شد. (096/0P=)

نتيجه گيري

مطالعه فوق نشان داد كه ESR و شمارش سلولي تفاضلي دو تست ارزشمند در بيماران با عفونت ادراري تب دار بوده كه مي توانند به تعيين سطح عفونت كمك نمايند، اما شمارش گلبول هاي سفيد خون محيطي و اندازه گيري CRP به روش كيفي در تعيين سطح عفونت در بيماران با عفونت ادراري كمك كننده نيست. همچنين تعداد زيادي (در حدود 50 % ) از بيماران با عفونت ادراري تب دار ممكن است لكوسيتوز نداشته باشند.

واژه هاي كليدي

عفونت ادراري تب دار، شمارش گلبول هاي سفيد خون محيطي، شمارش سلولي تفاضلي، CRP، ESR

 

 

Correlation between prognosis and response to treatment in children with FSGS

Mitra Naseri, MD. Pediatric nephrologists, Mashhad University of Medical Sciences

Nephrology department

Dr. sheikh children’s hospital

Abas Madani MD. Pediatric Nephrologist

Nephrology department, Tehran University of Medical Sciences

Pediatric Medical center, Dr Gharib St, Tehran, Iran

Nematolah Attaii MD. Pediatric Nephrologist

Nephrology department, Tehran University of Medical Sciences

Pediatric Medical center, Dr Gharib St, Tehran, Iran

Abstract:

Objective: To determine prognostic value of response to treatment in patients with focal segmental glomerulo-sclerosis.

Introduction: FSGS includes 10-15% of idiopathic Nephrotic syndrome in children.

Bulk of evidence supports disease relationship with immune system. Unfortunately, responses to immunosuppressive drugs are not desirable and progression to end-stage renal disease is common.

Materials and Methods: We analyzed 62 out of 99 cases of biopsy proven idiopathic FSGS who were followed for at least 5-years or till renal failure occurred during study. Study design was historical cohort and patients were divided into two groups: exposed (resistant to treatment) and non-exposed (responsive to treatment).

Correlation between prognosis and response to treatment was statistically evaluated. P-value £ 0.05 and relative risk ³ 1 were considered significant.

Results: In 3 out of 25 steroid responsive patients (12%) and 22 out of 37 steroid resistant patients (59.5%), disease progressed to renal failure.

Disease progressed to renal failure in 2 out of 11 cyclophosphamide responsive patients (18.1%), 17 out of 23 cyclophosphamide resistant patients (74.3%), and 8 out of 14 cyclosporine resistant patients (57.1%). 2 patients who responded to cyclosporine had normal renal function at the time of the last follow up.

Conclusion: We concluded that favorable response to steroid and cyclophosphamide treatment is a protective factor against disease progression to end stage renal disease and resistance to these drugs implies a poor prognosis.

For making any definite conclusion concerning response to cyclosporine treatment and prognosis, similar studies with a larger sample are required.

Keywords: children, Nephrotic syn, FSGS, steroid responsive, steroid resistant, prognosis

 

 

Primary Vesicoureteral Reflux in Iranian Children

Fateme Ghane Sharbaf, Mohamad Hosein Fallahzadeh* Ali Reza Modaerresi, Mohamad Esmaeilli

From the Department of pediatric, Dr . Shikh Haspital, Mashhad University of Medical Science and Nemazee Hospital, Shiraz University of Medical Sciences, Iran

Background: Experience with vesicoureteral reflux (VUR) different centers and there are plenty of controversies. Objective: The aim of this study was to evaluate the outcome of primary VUR complications and the rate of recurrence of UTI.

Methods: The medical charts of all infants and children with primary VUR who were followed up by two nephrologists were reviewed. During 19 years (1985-2004),330 patients (271 females, 59 males) with 496 refluxing ureters were followed up as primary VUR.

Results: The patients age at diagnosis was 54 days to 16 years (Mean:4.1 years) and the mean duration of follow-up was 4.5 years. Urinary tract infection(UTI) was the presenting symptom in 95% and fever was recorded in 35% of and 12% for grades I to V, respectively. Recurrence of UTI in VUR of grades I to V, were 22.2% 18.1%, 20% 23.4%, 23.4% and 17.9% respectively. Follow-up voiding cystourethrogram revealed resolution of VUR in 55%, improvement in 27.5% , no change in 12% and deterioration in 5.5%.Comlocations such as chronic renal failure and hypertension were observed in 13 and 13 patients, respective that symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not related to the grade of VUR.

Keywords: Urinary tract, Vesicoureteral reflux

 

 

Effects of indomethacin on systemic and renal haemodynamics in conscious lambs

Kesavarao Kumar Ebenzar, Fatemeh Sharbef Ghane and Francine Gabriel Smith

Department of physiology & Biophysics, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada

Both prostaglandins (PGs) PGE₂ and PGI₂ can act as renal vasodilators, these effects being exacerbated when the rennin-angiotensin system is activated. Therefore, we hypothesized that PGs would play more predominant role in modulating renal haemodynamics in the newborn period, when the rennin-angiotensin system is activated. To this end, the role of endogenously produced PGs in modulating systemic and renal haemodynamics was investigated in two groups of conscious lambs aged~1 and~6 weeks. Arterial pressure, venous pressure and renal blood flow were measured for 5 min before (control) and for 20 min after intravenous injection of vehicle (experiment 1).Twenty-four hours later, this protocol was repeated with intravenous injection of the non-selective cyclo-oxygenase inhibitor indomethacin (1 mg kg^-1, experiment 2). Heart rate was calculated from the systolic peak of the arterial pressure waveform, and renal vascular resistance (RVR) was calculated from the measured variables. In response to indomethacin but not vehicle, in both age groups of lambs there was an increase in mean arterial pressure and pulse interval, as well as a marked increase in RVR. These responses to indomethacin were, however, transient, with baseline levels being resumed within minutes . Although the hypothesis that PGs play a greater role in modulating renal haemodynamics early in life is not supported, these data do provide evidence that endogenously produced PGs modulate systemic and renal haemodynamics during postnatal maturation . It is apparent, however, that other vasoactive factors must be rapidly recruited in order to the circulatory responses to removal of vasodilatory PGs in the developing newborn.