Русский
Predictors of perioperative complications in children with obstructive uropathy
DOI: https://dx.doi.org/10.18565/urology.2019.5.98-104
O.L. Morozova, D.A. Morozov, D.Y. Lakomova, L.O. Severgina, L.D. Maltseva, K.D. Morozov
1) Sechenov First Moscow State Medical University, Moscow, Russia; 2) Saratov State Medical University named after V.I. Razumovsky, Saratov, Russia
Aim: To identify predictors of perioperative complications in children with obstructive uropathy.
Materials and methods: A total of 178 patients with obstructive uropathy were divided into 3 groups. In Group 1 there were 108 children with hydronephrosis, while Group 2 included 47 children with ureterohydronephrosis and Group 3 consisted of 23 children with bladder outlet obstruction according to the results of clinical, laboratory, microbiological, X-ray and pathologic study. The evaluation of the urine level of pro- (IL-8) and anti-inflammatory (IL-10) cytokines was performed at two timepoints, prior to treatment (1 point) and on the 3-5th day after the surgery (2 point) using «Vector – Best» (Russia, Novosibirsk) (IL-8), «Bender Medsystems» (Austria) (IL-10) on the enzyme immunoassay analyzer Stat Fax 2010 (USA).
Results: The active phase of chronic pyelonephritis was shown in Groups 1, 2 and 3 in 38%, 36% and 100% of cases, respectively. Microbiological examination of urine allowed to identify a causative agent in 85% and 89% of biopsy specimens from the ureteropelvic and ureterovesical junction, respectively. In all groups, Escherichia coli was a main pathogen (40%). In 25% of patients of Groups 1 and 2, isolated pathogens in biopsy specimen and urine were different. According to the evaluation of cytokines in the urine, during the active phase of chronic pyelonephritis there was an increase in the level of IL8 (p<0.0001) at points 1 and 2 in all patients. In the latent phase of inflammation, there was an increase in the concentration of IL-8 (p<0.04) and IL-10 (p<0.002) at point 2 in Groups 1 and 2. Using the ratio of IL-8 and IL-10, an index of inflammation activity (IIA) was suggested, whose values were increased in all Groups at point 1 and 2. Based on the regression analysis of the changes in IIA level, a model for predicting perioperative complications and an algorithm for personalized patient management were developed.
Conclusion: Cytokines are indicators of latent inflammation in children with OU and may be predictors of perioperative complications.
Materials and methods: A total of 178 patients with obstructive uropathy were divided into 3 groups. In Group 1 there were 108 children with hydronephrosis, while Group 2 included 47 children with ureterohydronephrosis and Group 3 consisted of 23 children with bladder outlet obstruction according to the results of clinical, laboratory, microbiological, X-ray and pathologic study. The evaluation of the urine level of pro- (IL-8) and anti-inflammatory (IL-10) cytokines was performed at two timepoints, prior to treatment (1 point) and on the 3-5th day after the surgery (2 point) using «Vector – Best» (Russia, Novosibirsk) (IL-8), «Bender Medsystems» (Austria) (IL-10) on the enzyme immunoassay analyzer Stat Fax 2010 (USA).
Results: The active phase of chronic pyelonephritis was shown in Groups 1, 2 and 3 in 38%, 36% and 100% of cases, respectively. Microbiological examination of urine allowed to identify a causative agent in 85% and 89% of biopsy specimens from the ureteropelvic and ureterovesical junction, respectively. In all groups, Escherichia coli was a main pathogen (40%). In 25% of patients of Groups 1 and 2, isolated pathogens in biopsy specimen and urine were different. According to the evaluation of cytokines in the urine, during the active phase of chronic pyelonephritis there was an increase in the level of IL8 (p<0.0001) at points 1 and 2 in all patients. In the latent phase of inflammation, there was an increase in the concentration of IL-8 (p<0.04) and IL-10 (p<0.002) at point 2 in Groups 1 and 2. Using the ratio of IL-8 and IL-10, an index of inflammation activity (IIA) was suggested, whose values were increased in all Groups at point 1 and 2. Based on the regression analysis of the changes in IIA level, a model for predicting perioperative complications and an algorithm for personalized patient management were developed.
Conclusion: Cytokines are indicators of latent inflammation in children with OU and may be predictors of perioperative complications.
About the Autors
Corresponding author: Morozova O.L. – MD, professor, Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow, Russia; e-mail: morozova_ol@list.ru
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