deamino-arginine-vasopressin and Pyelonephritis

Topics: Deamino Arginine Vasopressin; Glomerular Filtration Rate; Humans; Kidney; Kidney Concentrating Ability; Kidney Diseases; Kidney Function Tests; Kidney Transplantation; Pyelonephritis; Radiography; Radioisotope Renography; Renal Agents; Renal Artery Obstruction; Renal Circulation; Ultrasonography

The risk of pyelonephritis in children with asymptomatic cystitis or bacteriuria, using desmopressin for primary nonpoliuric nocturnal enuresis, is not known. The aim of this study was to study whether there is a risk of pyelonephritis in rats with cystitis using desmopressin. Wistar rats (n = 28) were divided into four groups of cystitis (groups I-IV). DDAVP (2 microg daily) and saline (0.5 ml daily) were injected intramuscularly for 7 days in groups II and IV and groups I and III, respectively. The urinalysis, urine culture, and 24-h urinary volume (UV(24)) were assessed for all rats on days 1, 3, 5, and 7. In groups III and IV these studies were also performed on days 14, 21, and 28. Serum creatinine was determined on day 7 in all rats and on day 28 in groups III and IV. Groups I and II and groups III and IV were killed at the end of days 7 and 28, respectively. Kidneys and urinary bladders were graded subjectively for inflammation and fibrosis. Inflammation and fibrosis scores in kidney and bladder tissues were not different between DDAVP or saline-injected rats in cystitis groups at weeks 1 and 4. No fibrosis was found in any of the urinary bladders on histological examination. Ascendant pyelonephritis was detected in each of the four rats in DDAVP-administered and saline-administered cystitis groups. The histopathologic scores of the renal tissue with pyelonephritis showed no correlation with the daily urine volume, the positive test results for urine leukocyte esterase with dipstick test, the urine culture results for E. coli based on colony-forming unit per milliliter, or serum creatinine levels in cystitis groups. It was found that the administration of DDAVP to cystitis groups did not increase the risk of ascendant pyelonephritis.

Topics: Animals; Antidiuretic Agents; Carboxylic Ester Hydrolases; Creatinine; Cystitis; Deamino Arginine Vasopressin; Enuresis; Escherichia coli; Male; Pyelonephritis; Rats; Rats, Wistar; Risk Factors; Urine

The maximal urine concentration capacity was studied in patients with acute pyelonephritis and in patients with clinically diagnosed acute cystitis. In the former group renal concentration ability was reduced in 16 of 22 patients and improved in all but two patients. Among patients with symptoms of acute cystitis 6 of 22 had a concentration capacity below 2 SD of normal values. Several of these patients had raised acute phase proteins and increased their urine osmolality at follow-up indicating that cases of acute pyelonephritis could have been included. It is concluded that the wide overlap between the groups makes the maximal urinary concentration capacity a method of limited value for level diagnosis in acute UTI infection. The test should be reserved for follow-up to reveal permanent renal damage.

Topics: Acute Disease; Adolescent; Adult; Aged; Bacteriuria; Cystitis; Deamino Arginine Vasopressin; Female; Humans; Kidney Concentrating Ability; Kidney Tubules, Distal; Male; Middle Aged; Osmolar Concentration; Pyelonephritis; Urinary Tract Infections

To determine the value of screening for bacteriuria in infants with special emphasis on the natural course of untreated asymptomatic bacteriuria, renal growth, and renal damage.. Prospective six year follow up of infants with bacteriuria on screening in an unselected infant population.. Paediatric outpatient clinic.. 50 Infants (14 girls, 36 boys) with bacteriuria on screening verified by suprapubic aspiration from an unselected population of 3581 infants in a defined area of Gothenburg.. Children with asymptomatic bacteriuria and normal findings on initial urography were untreated, although other infections were treated.. Culture of urine and determination of C reactive protein concentration every six weeks for the first six months after diagnosis, every three months from six months to two years, and every six months between two and three years; thereafter yearly urine culture. Evaluation of renal concentrating capacity with a desmopressin test; radiological examination, including first and follow up urography and micturition cystourethrography without antibiotic cover; and measurement of renal parenchymal thickness and renal surface area.. Of the original 50 infants, 37 (12 girls, 25 boys) were followed up for at least six years. Two infants developed pyelonephritis within two weeks after bacteriuria was diagnosed; the others remained free of symptoms. 45 Infants were untreated; the bacteriuria cleared spontaneously in 36 and in response to antibiotics given for infections in the respiratory tract in eight. Recurrences of bacteriuria were observed in 10 of the 50 children, of whom one had pyelonephritis. No child had more than one recurrence. At follow up urography in 36 of the 50 children (9 girls, 27 boys) after a median of 32 months no child had developed renal damage. First samples tested for renal concentrating capacity showed significantly higher values than those from a reference population (mean SD score 0.50, 95% confidence interval 0.21 to 0.79; p less than 0.001), but the last samples showed no significant difference (mean SD score 0.08, -0.24 to 0.40; p greater than 0.05).. Mass screening for bacteriuria in infancy results primarily in detection of innocent bacteriuric episodes and is not recommended.

Topics: Algorithms; Bacteriuria; C-Reactive Protein; Cicatrix; Deamino Arginine Vasopressin; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Mass Screening; Prospective Studies; Pyelonephritis; Recurrence; Time Factors; Urography

Intranasal administration of DDAVP (1-deamino-8-D-arginine vasopressin), a synthetic analogue of vasopressin, followed by measurement of urine osmolaity 6 h afterwards, represents a convenient, reliable and simple method for the estimation of renal concentrating capacity in children. The DDAVP-test is as accurate and reproducible as the water deprivation test, irrespective of the degree of concentrating capacity. Mean urine osmolality after DDAVP in children without renal disease was found to be 984 +/- 218 mosmol/kg water (m +/- 2 SD). In children with recurrent pyelonephritis, urine osmolality after DDAVP was decreased. The values were significantly lower with bilateral changes than with unilateral changes of chronic pyelonephritis in the i.v. urograms. In chronic pyelonephritis the concentrating capacity appears to be earlier impaired than other parameters of renal function.

Topics: Adolescent; Arginine Vasopressin; Child; Child, Preschool; Chronic Disease; Deamino Arginine Vasopressin; Humans; Infant; Kidney Concentrating Ability; Osmolar Concentration; Pyelonephritis; Time Factors; Urinary Tract Infections; Urine