Plazma Nötrofil Jelatinaz İlişkili Lipocalin Düzeyleri Komplike Olmayan İdrar Yolu Enfeksiyonunda Tanısal mıdır?

Amaç: Akut komplike olmayan alt üriner sistem enfeksiyonları acil servislerde sıklıkla karşılaşılan ve ampirik antibiyotik reçete edilen hastalıklardandır. Bu çalışmada nötrofil jelatinaz ilişkili lipokalin (NGAL) molekülünün serum düzeylerinin akut komplike olmayan idrar yolu enfeksiyonlarının tanı ve takibinde öneminin olup olmadığının ortaya konması amaçlandı. Gereç ve Yöntem: Bu çalışma prospektif kesitsel bir çalışma olup 15 Eylül 2013-15 Nisan 2014 tarihinde yapıldı. Bu çalışmaya akut komplike olmayan alt üriner sistem enfeksiyonu semptomları olan, tam idrar tetkikinde piyüri saptanan ve ampirik antibiyotik tedavisi acil serviste planlanan 18-65 yaş arası 80 hasta ve kontrol grubu olarak sağlıklı 40 kişi dahil edildi. Tüm hastalardan tedavi öncesinde ve sonrasında lökosit, nötrofil, C-reaktif protein (CRP), eritrosit sedimentasyon hızı ve NGAL ölçümü yapıldı ve aralarındaki korelasyon araştırıldı. Bulgular: Hasta grubunda, plazma lökosit, nötrofil ve CRP’ye ait tedavi öncesi değerlerin tedavi sonrası değerlerine oranla daha yüksek olduğu görüldü (p

Are Plasma Neutrophil Gelatinase Associated Lipocalin Levels Diagnostic in Uncomplicated Urinary Tract Infections?

Objectives: Acute uncomplicated lower urinary tract infections are among the most common causes for emergency department visits and empiricalantibiotic prescriptions. The purpose of this study was to determine whether the serum levels of the neutrophil gelatinase associated lipocalin(NGAL) molecule were important in the diagnosis and follow-up of non-complicated lower urinary tract infections.Materials and Methods: This was a cross-sectional, prospective study conducted from September 15, 2013 to April 15, 2014 in an academicemergency department. Eighty patients were enrolled in the study group and 40 healthy subjects in the control group. The patients had acuteuncomplicated lower urinary tract infections with pyuria detected in a complete urinary test. All of the patients had their leukocyte, neutrophil,C-reactive protein (CRP), erythrocyte sedimentation rate, and NGAL levels evaluated before and after the treatment, and correlation among theseparameters were investigated.Results: In the study group, the plasma leukocyte, neutrophil, and CRP levels before the treatment were significantly higher compared to the aftertreatmentperiod (p

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1. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2011;52:e103-120.
2. Grigoryan L, Trauther BW, Gupta K. Diagnosis and management of urinary tract infections in the outpatient setting: a review. JAMA. 2014;312:1677- 1684.
3. Bolignano D, Donato V, Coppolino G, et al. Neutrophil Gelatinase - Associated Lipocalin (NGAL) as a Marker of Kidney Damage. American J Kidney Diseases. 2008;52:595-605.
4. Hatipoğlu S, Sevketoğlu E, Gedikbaşı A, et al. Urinary MMP-9/NGAL complex in children with acute cystitis. Pediatr Nephrol. 2011;26:1263-1268.
5. Decavele C, Dhondt L, De Buyzere M, et al. Increased urinary neutrophil gelatinase associated lipocalin in urinary tract infections and leukocyturia. Clin Chem Lab Med. 2011;49:999-1003.
6. Yılmaz A, Sevketoğlu E, Gedikbaşı A, et al. Early prediction of urinary tract infection with urinary neutrophil gelatinase associated lipocalin. Pediatr Nephrol. 2009; 24:2387-2392.
7. Sean M, Bennett M, Haase M, et al. Plasma and urine neutrophil gelatinaseassociated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med. 2010;36:452-461.
8. Tsai H, Su P, Lee T, et al. Significant elevation and correlation of plasma neutrophil gelatinase associated lipocalin and its complex with matrix metalloproteinase-9 in patients with pelvic inflammatory disease. Clinica Chimica Acta. 2011;412:1252-1256.
9. Miyamoto T, Asaka R, Suzuki A, et al. Immunohistochemical detection of a spesific receptor for lipocalin 2 and its prognostic significance in endometrial carcinoma. Experimental and Molecular Pathology. 2011;91:563-568.
10. Hanley JA and McNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1983;143:29-36.
11. Arinzon Z, Peisakh A, Shuval I, et al. Detection of urinary tract infection (UTI) in long-term care setting: Is the multireagent strip an adequate diagnostic tool? Arch Gerontol Geriatr. 2009;48:227-231.
12. Zhu W, Liu M, Wang G, et al. Urinary neutrophil gelatinase-associated lipocalin, a biomarker for systemic inflammatory response syndrome in patients with nephrolithiasis. Journal of Surgical Research. 2014;187:237- 243.
13. Sim JH, Yim HE, Choi BM, et al. Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections. Pediatr Res. 2015;78:48-55.
14. Kumpers P, Hafer C, Lukasz A, et al. Serum neutrophil gelatinase-associated lipocalin at inception of renal replacement therapy predicts survival in critically ill patients with acute kidney injury. Crit Care. 2010;14:R9.
15. Bauer M, Eickhoff JC, Gould MN, et al. Neutrophil gelatinase-associated lipocalin (NGAL) is a predictor of poor prognosis in human primary breast cancer. Breast Cancer Res. Treat. 2008;108:389-397.
16. Miyamoto T, Kashima H, Suzuki A, et al. Laser-captured microdissectionmicroarray analysis of the genes involved in endometrial carcinogenesis: stepwise up-regulation of lipocalin2 expression in normal and neoplastic endometria and its functional relevance. Hum. Pathol. 2011;42:1265-1274.
17. Smith ER, Zurakowski D, Saad A, et al. Urinary biomarkers predict brain tumor presence and response to therapy. Clin Cancer Res. 2008;14:2378- 2386.
18. Villalva C, Sorel N, Bonnet ML, et al. Neutrophil gelatinase-associated lipocalin expression in chronic myeloid leukemia. Leuk Lymphoma. 2008;49:984-988.
19. El-Gamal YM, Hasan ZE, Saad AA, et al. Serum neutrophil gelatinaseassociated lipocalin as a biomarker of disease activity in pediatric lupus nephritis. Egypt J Pediatr Allergy Immunol. 2011;9:15-20.
20. Zachwieja J, Soltysiak J, Fichna P, et al. Normal-range albuminuria does not exclude nephropathy in diabetic children. Pediatr Nephrol. 2010;25:1445- 1451.