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Lipocalin and cystatin of urine in pneumococcal pneumonia in children
Raimkulova Dilnoza Farkhoddinovna, Senior scientific assistant, applicant of Tashkent Medical academy
E-mail: [email protected]
Lipocalin and cystatin of urine in pneumococcal pneumonia in children
Abctrast: Concentration of lipocalin and even more cystatin C can be used as prognostic factors of the development of complications in children with pneumococcal pneumonia. Maximal cellular response to acute lesion of kidneys is observed in children of the first year of life, while expression of renal dysfunctions increases with aging. Keywords: pneumonia, renal lesion, lipocalin, cystatin C, children.
Due to its significant prevalence, poly etiology and severe progress pneumonia is mean to be a central problem in pediatrics and infectious pathology. bacterial toxins and endo toxins circulating in blood of the patients with pneumococcal pneumonia damage cell membranes by means of disorder of the functional status of organs and systems. One of organs the most sensitive to toxic effect is kidney [1; 7].
Cystatin C — non-glycolized protein of the inhibitors of cysteine proteinases. Being one of the biomarkers of acute renal damage (ARD) at the modern time, cystatin C of urine reflects the parameters of glomerular filtration speed, but not parenchymatous lesion. We can judge about the status of channel epithelium according to the concentration of cystatin C in urine [2; 6].
Among early markers of ARD the informative one, even in pediatric practice, is considered to be definition of neutrophil gelati-nase-associated lipocalin (NGAL), lipocalin 2, siderocalin). Earlier performed studies determined that hyper excretion of NGAL was noted 10 hours before the rise of cystatin C in blood [4; 3]. In case of acute damage of kidney its concentration in blood and excretion with urine increases prior to the increase of creatinine concentration and changes of diurrhesis for 24-48 hours [5].
Thus, it is possible to use definition of these values in urine of new-born babies without taking blood sample as a biologic marker of pneumonia, as for monitoring of the quality of therapy.
The objective of the research was definition of cystatin C and lipocalin concentration in urine of children suffering Streptococcal pneumonia, and study of the possibility of prognostic application of the aforesaid markers.
Material and methods. The study involved 200 children hospitalized because of pneumococcal pneumonia. The diagnosis was verified on the basis of clinical picture, roentgenography of thoracic cage and bacteriologic test of sputum. All children were divided to groups dependently on their age (4 age groups). Besides that, every age group had sub-groups with complicated progress of pneumonia and without complications. For the control group we checked 40 healthy children (10 in each age category).
First day at the reception all patient had measurement of ARD markers' concentration in urine: lipocalin (mg/l) and cystatin C (mg/l). for the definition of cystatin C we used "Cystatin C FS set, "TruCal Cystatin C" calibrators set and control material of 2 levels: "TruLab Cystatin C." (produced by "DiaSys Diagnostic Systems", Germany). NGAL was determined with the help ofhard-phase IEA method "NGAL Rapid ELISA Kit" (produced by "BioPorto Diagnostics A/S", Denmark).
Statistical processing of the obtained results for the significance of statistical differences 0.95 was performed using Excel package.
Results of the study and discussion. 98 patients had uncom-plicat5ed progress ofpneumonia with typical periods ofthe disease (compl -), in the rest 102 cases there were various complications of pneumonia (compl +). Average fever period was 16.02±0.39 days.
And patients with uncomplicated progress had fever period equal just to 12.24±0.30 days, and it was reliably lower than in the patients with complicated progress of pneumonia (19.65±0.49 days, p<0.001).
Concentration of lipocalin in urine of the children with pneumococcal pneumonia was reliably higher than the concentration in the control group (0.87±0.02 versus 0.64±0.03, p<0.001) because of the patients with complicated progress of the disease (1.03±0.03 in the patients with complicated pneumonia versus 0.70±0.02 in the patients with uncomplicated progress, p<0.001). And the concentration of lipocalin in urine of the children with uncomplicated progress was compatible with the value characteristic for healthy children (0.64±0.03, 0.70±0.02 respectively).
It was revealed that the concentration of lipocalin in the urine of healthy children in the age 1 and 1-2 years old was stable, and later reliable gradually increased (p<0.01 difference reliability between the groups of 1 year and 2-5 years old and p<0,001 difference reliability in the rest comparisons). Children with uncomplicated progress of pneumonia during initial two years of life had stable high concentration of urine lipocalin reflecting involvement of renal parenchyma to systemic inflammation, and it significantly exceeded the concentration in the urine of healthy children (p<0.01 for children under 1 and p<0.001 for children 1-2 years old). Children above 2 (in the age groups 2-5 and 5-7 years old) with background uncomplicated pneumoniae had concentration of lipocalin compatible with the value of the control group. Same with the control group, the concentration of lipocalin in the children with uncomplicated pneumonia increased with aging, and achieved reliable difference in the children at the age of 5-7 years old in comparison with the younger age group (p<0.001 difference reliability 5-7 years old group with three younger groups). Complicated progress of pneumococcal pneumonia in all age groups was associated with reliably higher level of lipocalin compared both with healthy children and patients with uncomplicated progress of the disease (p<0.001 for both comparisons in all age groups). Though age dynamics of the value was paradoxal: in the children from 1 to 5-7 years old the concentration of lipocalin gradually reliably increased (not reliable to 2-5 years and reliable to 5-7 years old — p<0.001 in comparison with the elder age group with both medial ones). While in the youngest group the concentration of lipocalin was higher than in middle groups (p<0.001 in comparison with both middle groups) and it was compatible with the elder group.
The dynamics of the concentration of lipocalin in urine described by us testifies that in case of background pneumococcal pneumonia the most vulnerable for acute tubular damage were children under 1.
The concentration of cystatin C normally filtrated in glomerula and then metabolized in renal tubules forming amino acids which are later completely reabsorbed in the patients with pneumococcal pneumonia was significantly higher than in the control group
Section 6. Medical science
(1.03±0.04 versus 0.32±0.01, p<0.001), and meaningful increase of the concentration was noted not only in the group with complications (1.47±0.05, difference reliability with the CG — p<0.001), but also with the background uncomplicated progress of the disease (0.58±0.01, difference reliability with the control group and complicated progress group — p<0.001), and it proved lesion of kidneys even with background uncomplicated progress of the disease.
Distribution of the children according to age categories revealed that with the background pneumococcal pneumonia cystatin C concentration gradually increased with aging (p<0.05 between the groups of 5-7 years and 1-2, 5-7 years and 2-5; p<0.01 between the groups younger than 1 year old and 1-2 years old; and p<0.001 between the groups under 1 and 2-5 years old, under 1 and 5-7 years old), while cystatin C concentration in the urine of healthy children till 5 years old stayed stable and a little bit increased only to 5-7 years old in comparison with 2-5 years old group (p<0.05). That effect was also notable in patients with uncomplicated progress of pneumonia, where we observed higher values in the children above 2 years old (p<0.05 between the groups of 2-5 years old and under 1 year old and p<0.001between the groups of 2-5 and 1-2 years old and between the groups of 5-7 and 1-2 years old), and in case of the development of complications it became significantly expressed (p<0.001 for all pair comparisons, except 1-2 and
2-5 years old groups). Inside all age groups we revealed reliable differences both between the patients with pneumococcal pneumonia and both variants of the progress and the control group.
The revealed patterns testify that with background pneumococcal pneumonia there is disorder of tubular reabsorption of cystatin C which is manifestation of ARD. The renal function becomes more open to injure with the aging of children (from 0 to 7 years old).
We also performed correlation analysis of the interrelations of lipocalin and cystatic C concentrations in urine of the children hospitalized because of pneumococcal pneumonia with the values of fever period duration. Totally in the group of children from 0 to 7 years old we revealed reliable average positive link of the concentration of both studied ARD markers with the duration of fever (r=0.44 and 0.52 respectively).
Conclusion. Endogenic and bacterial intoxication cause acute renal damage the biomarker of which is increase of lipocalin and cystatin C amount in urine. The present study demonstrates that concentration of lipocalin and more cystatin C can be used as prognostic factors of complications development in children with pneumococcal pneumonia. Cellular response to ARD is maximal in children of the first year of life, then its activity decreases and increases again with aging, while expression of renal dysfunctions in ARD increases with aging.
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Rizaev Kamal Saidakbarovich, PhD Republic Research Center of Emergency Medicine, Tashkent, Uzbekistan,
Deputy Director General E-mail: [email protected] Makhamadaminov A. G., PhD 2-Tashkent Institute for Post-graduate Education of Doctors, Uzbekistan Khadjibaev Abdukhakim Muminovich, Phd, ScD, Professor Republic Research Center of Emergency Medicine, Tashkent, Uzbekistan,
Director General E-mail: [email protected] Muhamedjanova Nailya Nakipovna, Republic Research Center of Emergency Medicine, Tashkent, Uzbekistan
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