Is there a relationship between renal scarring and neutrophil-to-lymphocyte ratio in patients with vesicoureteral reflux?
https://doi.org/10.4081/aiua.2021.4.436
Accepted: October 28, 2021
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Objectives: Vesicoureteral reflux (VUR) exacerbates the risk of renal scarring by establishing a ground for pyelonephritis. It is known that the inflammatory process is more influential than the direct damage caused by bacterial infection in the development of renal scars after pyelonephritis. Therefore, the present study aims to investigate the relationship between renal scarring and systemic inflammatory markers in patients with VUR.
Material and methods: Hundred and ninety-two patients (116 females, 76 males) diagnosed with VUR were divided into two groups based on the presence or absence of renal scarring and into three groups according to the grade of VUR (low, moderate and high). Neutrophil count, lymphocyte count, mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) were compared among the groups.
Results: Of the 192 patients, 102 had renal scarring. The age and gender distribution did not differ significantly between the groups with and without renal scarring (p > 0.05). However, the grade of reflux and lymphocyte count were significantly higher in the group with renal scarring (p < 0.05), and the NLR was significantly lower in the group with renal scarring (p < 0.05). The lymphocyte count was significantly higher (p < 0.05) and NLR was significantly lower in the high-grade VUR group (p < 0.05). However, MPV values did not differ significantly (p > 0.05) between the groups.
Conclusions: NLR can be used to predict renal scarring in patients with VUR, especially in the period of 3-6 months after the first attack of infection, and may even serve as a candidate marker for treatment selection. However, larger series and prospective studies are needed.
Tekgül S, Riedmiller H, Hoebeke P, et al. European Association of Urology. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012; 62:534-42. DOI: https://doi.org/10.1016/j.eururo.2012.05.059
Sirin A, Emre S, Alpay H, et al. Etiology of chronic renal failure in Turkish children. Pediatr Nephrol. 1995; 9:549-52. DOI: https://doi.org/10.1007/BF00860926
Chertin B, Abu Arafeh W, Kocherov S. Endoscopic correction of complex cases of vesicoureteral reflux utilizing Vantris as a new nonbiodegradable tissue-augmenting substance. Pediatr Surg Int. 2014;30:445-8. DOI: https://doi.org/10.1007/s00383-014-3468-z
Anders HJ, Ryu M. Renal microenvironments and macrophage phenotypes determine progression or resolution of renal inflammation and fibrosis. Kidney Int. 2011; 80:915-925. DOI: https://doi.org/10.1038/ki.2011.217
Nikolic-Paterson DJ. CD4+ T cells: a potential player in renal fibrosis. Kidney Int. 2010; 78:333-5. DOI: https://doi.org/10.1038/ki.2010.182
Cendron M. Reflux nephropathy. J Pediatr Urol. 2008; 4:414-21. DOI: https://doi.org/10.1016/j.jpurol.2008.04.009
Jahnukainen T, Chen M, Celsi G. Mechanisms of renal damage owing to infection. Pediatr Nephrol. 2005; 20:1043-53. DOI: https://doi.org/10.1007/s00467-005-1898-5
Kapci M, Turkdogan KA, Duman A, et al. Biomarkers in the diagnosis of acute appendicitis. J Clin Exp Invest. 2014; 5:250-255 DOI: https://doi.org/10.5799/ahinjs.01.2014.02.0397
Turkmen K, Erdur FM, Ozcicek F, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013; 17:391-6. DOI: https://doi.org/10.1111/hdi.12040
Mantovani A, Cassatella MA, Costantini C, Jaillon S. Neutrophils in the activation and regulation of innate and adaptive immunity. Nat Rev Immunol. 2011; 11:519-31. DOI: https://doi.org/10.1038/nri3024
Bath P, Algert C, Chapman N, Neal B. PROGRESS Collaborative Group. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke. 2004; 35:622-6. DOI: https://doi.org/10.1161/01.STR.0000116105.26237.EC
Hains DS, Cohen HL, McCarville MB, et al. Elucidation of renal scars in children with vesicoureteral reflux using contrast-enhanced ultrasound: a pilot study. Kidney Int Rep. 2017; 2:420-4. DOI: https://doi.org/10.1016/j.ekir.2017.01.008
Blumenthal I. Vesicoureteric reflux and urinary tract infection in children. Postgrad Med J. 2006; 82:31-5. DOI: https://doi.org/10.1136/pgmj.2005.036327
Duckett JW, Bellinger MF. A plea for standardized grading of vesicoureteral reflux. Eur Urol. 1982; 8:74-7. DOI: https://doi.org/10.1159/000473484
Morozova O, Morozov D, Pervouchine D, et al. Urinary biomarkers of latent inflammation and fibrosis in children with vesicoureteral reflux. Int Urol Nephrol. 2020; 52:603-610. DOI: https://doi.org/10.1007/s11255-019-02357-1
Gordon I, Barkovics M, Pindoria S, et al. Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. J Am Soc Nephrol. 2003; 14:739-44. DOI: https://doi.org/10.1097/01.ASN.0000053416.93518.63
Bille J, Glauser MP. Protection against chronic pyelonephritis in rats by suppression of acute suppuration: effect of colchicine and neutropenia. J Infect Dis. 1982; 146:220-6. DOI: https://doi.org/10.1093/infdis/146.2.220
Roberts JA, Roth JK Jr, Domingue G, et al. Immunology of pyelonephritis in the primate model. V. Effect of superoxide dismutase. J Urol. 1982; 128:1394-400. DOI: https://doi.org/10.1016/S0022-5347(17)53516-8
Haraoka M, Matsumoto T, Takahashi K, et al. Suppression of renal scarring by prednisolone combined with ciprofloxacin in ascending pyelonephritis in rats. J Urol. 1994; 151:1078-80. DOI: https://doi.org/10.1016/S0022-5347(17)35187-X
Shaikh N, Shope TR, Hoberman A, et al. Corticosteroids to prevent kidney scarring in children with a febrile urinary tract infection: a randomized trial. Pediatr Nephrol. 2020; 35:2113-2120. DOI: https://doi.org/10.1007/s00467-020-04622-3
Yavuz S, Anarat A, Bayazıt AK. Interleukin-18, CRP and procalcitonin levels in vesicoureteral reflux and reflux nephropathy. Ren Fail. 2013; 35:1319-22. DOI: https://doi.org/10.3109/0886022X.2013.826137
Bolat D, Topcu YK, Aydogdu O, et al. Neutrophil to Lymphocyte Ratio as a predictor of early penile prosthesis implant infection. Int Urol Nephrol. 2017; 49:947-953. DOI: https://doi.org/10.1007/s11255-017-1569-z
Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001; 102:5-14.
Terradas R, Grau S, Blanch J, et al. Eosinophil count and neutrophil-lymphocyte count ratio as prognostic markers in patients with bacteremia: a retrospective cohort study. PLoS One. 2012;7:e42860. DOI: https://doi.org/10.1371/journal.pone.0042860
Sen V, Bozkurt IH, Aydogdu O, et al. Significance of preoperative neutrophil-lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy. Kaohsiung J Med Sci. 2016; 32:507-513. DOI: https://doi.org/10.1016/j.kjms.2016.08.008
Lee YJ, Lee JH, Park YS. Risk factors for renal scar formation in infants with first episode of acute pyelonephritis: a prospective clinical study. J Urol. 2012; 187:1032-6. DOI: https://doi.org/10.1016/j.juro.2011.10.164
Goldman M, Bistritzer T, Horne T, et al. The etiology of renal scars in infants with pyelonephritis and vesicoureteral reflux. Pediatr Nephrol. 2000; 14:385-8. DOI: https://doi.org/10.1007/s004670050779
Zaffanello M, Cataldi L, Brugnara M, et al. Hidden high-grade vesicoureteral reflux is the main risk factor for chronic renal damage in children under the age of two years with first urinary tract infection. Scand J Urol Nephrol.2009; 43:494-500. DOI: https://doi.org/10.3109/00365590903286663
Stokland E, Hellström M, Jacobsson B, et al. Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scintigraphy. J Pediatr. 1996; 129:815-20. DOI: https://doi.org/10.1016/S0022-3476(96)70024-0
Bandari B, Sindgikar SP, Kumar SS, et al. Renal scarring followingurinary tract infections in children. Sudan J Paediatr. 2019;19:25-30. DOI: https://doi.org/10.24911/SJP.106-1554791193
Jaukovic L, Ajdinovic B, Dopudja M, Krstic Z. Renal scintigraphy in children with vesicoureteral reflux. Indian J Pediatr. 2009;76:1023-6. DOI: https://doi.org/10.1007/s12098-009-0217-8
Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010; 126:1084-91. DOI: https://doi.org/10.1542/peds.2010-0685
Levtchenko E, Lahy C, Levy J, et al. Treatment of children with acute pyelonephritis: a prospective randomized study. Pediatr Nephrol. 2001; 16:878-84. DOI: https://doi.org/10.1007/s004670100690
Biassoni L, Chippington S. Imaging in urinary tract infections: current strategies and new trends. Semin Nucl Med. 2008; 38:56-66. DOI: https://doi.org/10.1053/j.semnuclmed.2007.09.005
Gordon I. Issues surrounding preparation, information and handling the child and parent in nuclear medicine. J Nucl Med. 1998;39:490-4.
Smith T, Gordon I, Kelly JP. Comparison of radiation dose from intravenous urography and 99Tcm DMSA scintigraphy in children. Br J Radiol. 1998; 71:314-9. DOI: https://doi.org/10.1259/bjr.71.843.9616242
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