The Experts below are selected from a list of 42 Experts worldwide ranked by ideXlab platform
Fatemeh Ghafoorimehr - One of the best experts on this subject based on the ideXlab platform.
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Relationship of Urinary Tract Infection to Lower Urinary Tract Dysfunction and Kidney Scar Formation in Children.
International journal of preventive medicine, 2019Co-Authors: Soroosh Alizadeh, Mehdi Farhangian, Mastaneh Moghtaderi, Rasool Ghovvati, Zahra Noparast, Fatemeh GhafoorimehrAbstract:Background: Urinary tract infection (UTI) is the most common infection during childhood. Lower urinary tract dysfunction (LUTD) is a broad term that indicates an abnormal voiding pattern in a child without anatomical and neurological impairment. The purpose of this study was to determine the relationship between UTI and LUTD. Methods: This study was conducted at the Children Medical Center Hospital in 2014–2016. The inclusion criteria of this study were at least one UTI confirmed by a positive urine culture and active urine analysis in children who were well toilet-trained previously. Complete physical examination of the genitourinary and skeletal systems was performed to identify patients with anomalies in these systems. The patients with genitourinary system anomalies and obvious and prediagnosed neurological defects of the urinary system such as neurogenic bladder were excluded from the study. To confirm the presence of LUTD, the scoring system of Akbal et al. was applied. Results: A total of 260 patients including 9.2% of males and 90.8% of females were included in this study. The prevalence of LUTD was 63.8% (166 cases) in these patients. In this study, the prevalence of LUTD in patients with a single episode of UTI was 50.5%, while in patients with recurrence of UTI it was 88.9%. In patients with unilateral Kidney Scar formation, 90.9% had a recurrence of UTI (P = 0.003) which shows a strong correlation of unilateral Scar formation with recurrence of UTI. Conclusions: These data suggest that there is a significant relationship between UTI and LUTD in children, so evaluation of voiding dysfunction is necessary in this group. With early diagnosis and appropriate treatment, we can reduce the possible serious and permanent sequels of LUTD in patients with UTIs.
Anoush Azarfar - One of the best experts on this subject based on the ideXlab platform.
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Clinical Significance of Antibiotic Prophylaxis in Children Diagnosed with LowGrade (I-III) Vesicoureteral Reflux
Clinical and Experimental Investigations, 2020Co-Authors: Yalda Ravanshad, Mohadese Golsorkhi, Anoush Azarfar, Azam Ghezi, Sahar Ravanshad, Gholamreza Sarvari, Sepideh SeyedkaboliAbstract:Objective: The benefit of continuing and low-dose antibiotic therapy in urinary tract infection (UTI) prevention and renal injury for children diagnosed with primary vesicoureteral reflux (VUR) is not obvious. Materials and Methods: Patients aged between 2 to 71 months with VUR grade I–III with UTI proved microbiologically were randomly classified into two groups to receive either antibiotic prophylaxis (50 mg/kg cephalexin) daily or nothing at all for one year. The main outcome was symptomatic UTI confirmed by lab tests. Results: A total of 60 children diagnosed with VUR grade I through III were enrolled in this study; At least five (17%) symptomatic UTI reported in 29 patients receiving antibiotic prophylaxis and four (12%) in 31 patients receiving no antibiotics at all. Results revealed that continuing and low-dose antibiotic prophylaxis does not significantly reduce the risk of symptomatic UTI in children with mild to moderate VUR. Conclusion: The use of antibiotic prophylaxis in preventing recurrent infections and Kidney Scar formation in children with VUR grade I-III is not supported by this study.
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The level of urinary endothelin in patients with urinary reflux
Journal of Nephropathology, 2017Co-Authors: Anoush Azarfar, Yalda Ravanshad, Sahar Ravanshad, Mohammad Esmaeeli, Mitra Naseri, Shapour Badiee Aval, Fatemeh Ghanee Sharbaf, Hassan Mehrad-majd, Sara MolkaraAbstract:Background: In different tissues, the endothelin is produced by vascular endothelium. They are potent vasoconstrictor peptides. There is a little information about the role of endothelin in reflux nephropathy. Objectives: The aim of this study is to evaluate urinary levels of endothelin in patients with vesicoureteral reflux (VUR). Patients and Methods: It was a cross-sectional study that conducted on 81 children who received voiding cystourethrogram (VCUG). Based on VCUG reports, patients were divided into two groups; with reflux (40 persons) and without reflux (41 persons). We got a urine sample from patients with mid-stream or urine bag method. The endothelin level was assessed with ELISA immunoassay. Data was analyzed using SPSS 16. Results: Based on VCUG reports, 40 patients (49.4) had urinary reflux, of them 20 cases suffered from unilateral urinary reflux and others from bilateral. Of 40 patients with reflux, 23 cases (57.5 of reflux group) had Kidney Scar and seven individuals (17.5) had abnormal Kidney sonography. Of patients with urinary reflux, 13 cases (32.5) had grade1 urinary reflux, 8 cases (20) grade 2, and 5 cases (12.5) grade 3 and finally 14 cases (35) grade 4. The UET-1 levels were significantly higher in VUR patients compared to the control group (P < 0.001). Comparison of mean endothelin levels between two groups was done using Mann-Whitney U test and was statistically significance (P < 0.001). We used Kruskal-Wallis for comparison of endothelin levels in different grades of reflux (P < 0.001). Conclusions: Urine endothelin-1 level can be considered as an alternative to VCUG for screening vesicourethral reflux. © 2017 The Author(s); Published by Society of Diabetic Nephropathy Prevention.
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Clinical course of children and adolescents with primary vesicoureteral reflux: A retrospective study of 958 patients
BANTAO Journal, 2016Co-Authors: Abbas Madani, Yalda Ravanshad, Anoush Azarfar, Sahar Ravanshad, Niloofar Hajizadeh, Nematollah Ataei, Zahra Adl, Zahra Pournasiri, Sepideh Bagheri, Elham SamazghandiAbstract:Introduction. Vesicoureteral reflux (VUR) is the most common pediatric urologic abnormality and since it can predispose to urinary tract infection and resultant Kidney Scar it is an important issue in pediatric nephrourology. Methods. A retrospective chart review and follow-up of 958 patients with primary VUR was performed in the Children's Medical Center, Tehran, Iran. Children with primary vesicoureteral reflux were included in the study and these parameters were studied: age, sex, clinical presentation, VUR grade, sonographic findings, DMSA changes, treatment modality (medical, surgical or endoscopic) and response to treatment, hypertension (presence/absence), urinary tract infection recurrence and development of new Kidney Scars in patients under medical treatment. Results. VUR was more prevalent in girls. Sonography was unable to detect VUR in many cases. Presence of renal Scars was strongly associated with degree of reflux. Medical management was effective in a substantial percentage of patients and they experienced full resolution of reflux. This was especially true for lower degrees of VUR. 17.6 of patients developed new Kidney Scars on followup which was associated with higher degrees of VUR. Hypertension and breakthrough urinary tract infection was an uncommon finding in our patients. Conclusion. Medical management, which means using prophylactic antibiotics for prevention of urinary tract infection, is effective in many cases of VUR especially in cases with lower degrees of VUR. Surgical and endoscopic procedures must be reserved for patients with higher degrees of VUR unresponsive to conservative management or in whom new Scars may develop.
Sara Molkara - One of the best experts on this subject based on the ideXlab platform.
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The level of urinary endothelin in patients with urinary reflux
Journal of Nephropathology, 2017Co-Authors: Anoush Azarfar, Yalda Ravanshad, Sahar Ravanshad, Mohammad Esmaeeli, Mitra Naseri, Shapour Badiee Aval, Fatemeh Ghanee Sharbaf, Hassan Mehrad-majd, Sara MolkaraAbstract:Background: In different tissues, the endothelin is produced by vascular endothelium. They are potent vasoconstrictor peptides. There is a little information about the role of endothelin in reflux nephropathy. Objectives: The aim of this study is to evaluate urinary levels of endothelin in patients with vesicoureteral reflux (VUR). Patients and Methods: It was a cross-sectional study that conducted on 81 children who received voiding cystourethrogram (VCUG). Based on VCUG reports, patients were divided into two groups; with reflux (40 persons) and without reflux (41 persons). We got a urine sample from patients with mid-stream or urine bag method. The endothelin level was assessed with ELISA immunoassay. Data was analyzed using SPSS 16. Results: Based on VCUG reports, 40 patients (49.4) had urinary reflux, of them 20 cases suffered from unilateral urinary reflux and others from bilateral. Of 40 patients with reflux, 23 cases (57.5 of reflux group) had Kidney Scar and seven individuals (17.5) had abnormal Kidney sonography. Of patients with urinary reflux, 13 cases (32.5) had grade1 urinary reflux, 8 cases (20) grade 2, and 5 cases (12.5) grade 3 and finally 14 cases (35) grade 4. The UET-1 levels were significantly higher in VUR patients compared to the control group (P < 0.001). Comparison of mean endothelin levels between two groups was done using Mann-Whitney U test and was statistically significance (P < 0.001). We used Kruskal-Wallis for comparison of endothelin levels in different grades of reflux (P < 0.001). Conclusions: Urine endothelin-1 level can be considered as an alternative to VCUG for screening vesicourethral reflux. © 2017 The Author(s); Published by Society of Diabetic Nephropathy Prevention.
Steven D. Crowley - One of the best experts on this subject based on the ideXlab platform.
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Twist1 in Infiltrating Macrophages Attenuates Kidney Fibrosis via Matrix Metallopeptidase 13-Mediated Matrix Degradation.
Journal of the American Society of Nephrology : JASN, 2019Co-Authors: Jiafa Ren, Jiandong Zhang, Nathan P. Rudemiller, Robert I. Griffiths, Yi Wen, Jamie R. Privratsky, Michael D. Gunn, Steven D. CrowleyAbstract:Background Following an acute insult, macrophages regulate renal fibrogenesis through the release of various factors that either encourage the synthesis of extracellular matrix synthesis or the degradation of matrix via endocytosis, proteolysis, or both. However, the roles of infiltrating versus resident myeloid cells in these opposing processes require elucidation. The transcription factor Twist1 controls diverse essential cellular functions through induction of several downstream targets, including matrix metalloproteinases (MMPs). In macrophages, Twist1 can influence patterns of cytokine generation, but the role of macrophage Twist1 in renal fibrogenesis remains undefined. Methods To study Twist1 functions in different macrophage subsets during Kidney Scar formation, we used two conditional mutant mouse models in which Twist1 was selectively ablated either in infiltrating, inflammatory macrophages or in resident tissue macrophages. We assessed fibrosis-related parameters, matrix metallopeptidase 13 (MMP13, or collagen 3, which catalyzes collagen degradation), inflammatory cytokines, and other factors in these Twist1-deficient mice compared with wild-type controls after subjecting the animals to unilateral ureteral obstruction. We also treated wild-type and Twist1-deficient mice with an MMP13 inhibitor after unilateral ureteral obstruction. Results Twist1 in infiltrating inflammatory macrophages but not in resident macrophages limited Kidney fibrosis after ureteral obstruction by driving extracellular matrix degradation. Moreover, deletion of Twist1 in infiltrating macrophages attenuated the expression of MMP13 in CD11b+Ly6Clo myeloid cells. Inhibition of MMP13 abrogated the protection from renal fibrosis afforded by macrophage Twist1. Conclusions Twist1 in infiltrating myeloid cells mitigates interstitial matrix accumulation in the injured Kidney by promoting MMP13 production, which drives extracellular matrix degradation. These data highlight the complex cell-specific actions of Twist1 in the pathogenesis of Kidney fibrosis.
Yalda Ravanshad - One of the best experts on this subject based on the ideXlab platform.
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Clinical Significance of Antibiotic Prophylaxis in Children Diagnosed with LowGrade (I-III) Vesicoureteral Reflux
Clinical and Experimental Investigations, 2020Co-Authors: Yalda Ravanshad, Mohadese Golsorkhi, Anoush Azarfar, Azam Ghezi, Sahar Ravanshad, Gholamreza Sarvari, Sepideh SeyedkaboliAbstract:Objective: The benefit of continuing and low-dose antibiotic therapy in urinary tract infection (UTI) prevention and renal injury for children diagnosed with primary vesicoureteral reflux (VUR) is not obvious. Materials and Methods: Patients aged between 2 to 71 months with VUR grade I–III with UTI proved microbiologically were randomly classified into two groups to receive either antibiotic prophylaxis (50 mg/kg cephalexin) daily or nothing at all for one year. The main outcome was symptomatic UTI confirmed by lab tests. Results: A total of 60 children diagnosed with VUR grade I through III were enrolled in this study; At least five (17%) symptomatic UTI reported in 29 patients receiving antibiotic prophylaxis and four (12%) in 31 patients receiving no antibiotics at all. Results revealed that continuing and low-dose antibiotic prophylaxis does not significantly reduce the risk of symptomatic UTI in children with mild to moderate VUR. Conclusion: The use of antibiotic prophylaxis in preventing recurrent infections and Kidney Scar formation in children with VUR grade I-III is not supported by this study.
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The level of urinary endothelin in patients with urinary reflux
Journal of Nephropathology, 2017Co-Authors: Anoush Azarfar, Yalda Ravanshad, Sahar Ravanshad, Mohammad Esmaeeli, Mitra Naseri, Shapour Badiee Aval, Fatemeh Ghanee Sharbaf, Hassan Mehrad-majd, Sara MolkaraAbstract:Background: In different tissues, the endothelin is produced by vascular endothelium. They are potent vasoconstrictor peptides. There is a little information about the role of endothelin in reflux nephropathy. Objectives: The aim of this study is to evaluate urinary levels of endothelin in patients with vesicoureteral reflux (VUR). Patients and Methods: It was a cross-sectional study that conducted on 81 children who received voiding cystourethrogram (VCUG). Based on VCUG reports, patients were divided into two groups; with reflux (40 persons) and without reflux (41 persons). We got a urine sample from patients with mid-stream or urine bag method. The endothelin level was assessed with ELISA immunoassay. Data was analyzed using SPSS 16. Results: Based on VCUG reports, 40 patients (49.4) had urinary reflux, of them 20 cases suffered from unilateral urinary reflux and others from bilateral. Of 40 patients with reflux, 23 cases (57.5 of reflux group) had Kidney Scar and seven individuals (17.5) had abnormal Kidney sonography. Of patients with urinary reflux, 13 cases (32.5) had grade1 urinary reflux, 8 cases (20) grade 2, and 5 cases (12.5) grade 3 and finally 14 cases (35) grade 4. The UET-1 levels were significantly higher in VUR patients compared to the control group (P < 0.001). Comparison of mean endothelin levels between two groups was done using Mann-Whitney U test and was statistically significance (P < 0.001). We used Kruskal-Wallis for comparison of endothelin levels in different grades of reflux (P < 0.001). Conclusions: Urine endothelin-1 level can be considered as an alternative to VCUG for screening vesicourethral reflux. © 2017 The Author(s); Published by Society of Diabetic Nephropathy Prevention.
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Clinical course of children and adolescents with primary vesicoureteral reflux: A retrospective study of 958 patients
BANTAO Journal, 2016Co-Authors: Abbas Madani, Yalda Ravanshad, Anoush Azarfar, Sahar Ravanshad, Niloofar Hajizadeh, Nematollah Ataei, Zahra Adl, Zahra Pournasiri, Sepideh Bagheri, Elham SamazghandiAbstract:Introduction. Vesicoureteral reflux (VUR) is the most common pediatric urologic abnormality and since it can predispose to urinary tract infection and resultant Kidney Scar it is an important issue in pediatric nephrourology. Methods. A retrospective chart review and follow-up of 958 patients with primary VUR was performed in the Children's Medical Center, Tehran, Iran. Children with primary vesicoureteral reflux were included in the study and these parameters were studied: age, sex, clinical presentation, VUR grade, sonographic findings, DMSA changes, treatment modality (medical, surgical or endoscopic) and response to treatment, hypertension (presence/absence), urinary tract infection recurrence and development of new Kidney Scars in patients under medical treatment. Results. VUR was more prevalent in girls. Sonography was unable to detect VUR in many cases. Presence of renal Scars was strongly associated with degree of reflux. Medical management was effective in a substantial percentage of patients and they experienced full resolution of reflux. This was especially true for lower degrees of VUR. 17.6 of patients developed new Kidney Scars on followup which was associated with higher degrees of VUR. Hypertension and breakthrough urinary tract infection was an uncommon finding in our patients. Conclusion. Medical management, which means using prophylactic antibiotics for prevention of urinary tract infection, is effective in many cases of VUR especially in cases with lower degrees of VUR. Surgical and endoscopic procedures must be reserved for patients with higher degrees of VUR unresponsive to conservative management or in whom new Scars may develop.
