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Correlation of antibody-coated bacteria with intravenous pyelogram in children with refluxing and nonrefluxing units
Insights
A new fluorescent antibody test aids in identifying upper urinary tract infections in children. Positive results correlate strongly with kidney damage, especially in patients with vesicoureteral reflux or ileal conduits.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Diagnostic Immunology
Background:
- Urinary tract infections (UTIs) are common in children.
- Differentiating upper from lower UTIs is crucial for appropriate management.
- Intravenous pyelogram (IVP) is used to assess renal damage.
Purpose of the Study:
- To evaluate a fluorescent antibody technique for detecting immune globulins on urinary bacteria.
- To correlate positive bacterial fluorescence with renal changes seen on IVP in pediatric patients.
- To assess the diagnostic utility of this method in various urinary tract conditions.
Main Methods:
- A fluorescent antibody technique was employed to detect immune globulins on bacteria from urine samples.
- Seventy-nine pediatric patients were studied, including those with ileal conduits and vesicoureteral reflux.
- Urine cultures and IVPs were performed concurrently with fluorescent antibody determinations.
Main Results:
- Good correlation was observed between bacterial fluorescence and positive renal changes in patients with significant bacteriuria.
- Correlation was highest in patients with ileal conduits (88%), followed by those with vesicoureteral reflux (71%), and lowest in those without reflux (38%).
- False positive and false negative rates were approximately 10% each.
Conclusions:
- Positive bacterial fluorescence combined with UTI indicates upper tract deterioration.
- This finding is most frequent in patients with urinary reflux, suggesting a need for aggressive therapy.
- The fluorescent antibody technique shows promise in identifying significant UTIs and associated renal damage.
Abstract:
A fluorescent technique for detecting immune globulins on the surface of urinary bacteria has been used to differentiate upper from lower urinary tract infections. In an attempt to correlate positive fluorescence with deteriorative changes on the intravenous pyelogram, a total of 79 pediatric patients was studied. Twenty-three had ileal conduits with freely refluxing urine. The remaining 56 children had intact urinary tracts. Thirty of these had vesicoureteral reflux. Urine cultures were studied in conjunction with fluorescent antibody determinations. In patients with significant bacteriuria good correlation was seen with the presence of bacterial fluorescence and positive renal changes. This correlation was 88 per cent in patients with bowel conduits, 71 per cent in patients with vesicoureteral reflux, and 38 per cent in patients without reflux. Possible false positive and false negative results were relatively low, each occurred in 10 per cent of the specimens examined. It is concluded that the combindation of urinary tract infection and positive bacterial fluorescence is seen when upper tract deterioration has occurred and is seen most frequently in association with urinary reflux. In these instances aggressive therapy is often indicated.