Comparison of Hepcidin and Other Acute Phase Reactants in Patients Diagnosed With Pyelonephritis
Abstract
Üriner sistem enfeksiyonu, üriner sistemi oluşturan yapıların herhangi bir yerinde mikroorganizmanın yerleşmesi ile oluşan klinik tablodur. Tüm yaş gruplarında, toplumdan edinilmiş enfeksiyonlar arasında, üst solunum yolu enfeksiyonlarından sonra ikinci sırada yer alırken, hastane ve sağlık bakım merkezlerinde edinilmiş enfeksiyonlar arasında birinci sırada yer alır. Akut piyelonefrit, üst üriner sistemin, özellikle de renal parankim ve toplayıcı sistemin enfeksiyonu olarak tanımlanır. Hafif bir tablodan sepsise kadar değişebilen geniş bir yelpazede ortaya çıkabilir. Sık görülen klinik bulguları idrar yaparken yanma (dizüri), sık idrara çıkma (pollaküri), yan ağrısı, üşüme-titreme ve ateştir. Hepsidin son dönemlerde keşfedilmiş peptid yapıda bir hormondur. Hepsidinin demir metabolizmasındaki rolü netlik kazanmasına rağmen enflamasyondaki rolü belirsizliğini korumaktadır. Yapılan insan ve hayvan çalışmalarında hepsidin sentezinin enfeksiyon durumlarında arttığı gösterilmiştir. Piyelonefrit tedavi edilmediği takdirde sepsis gelişebilir ve kesin bir tanı kriteri yoktur. Tanı klinik bulgular ve fizik muayene ile konulur, laboratuvar ve görüntüleme yöntemleri ile desteklenir. Ancak bazı olgularda tanı koymak zor olabilir. Kesin bir tanısı olmayan piyelonefritte hepsidin, tanıya yardımcı erken bir marker olabilir. Böylelikle tanı daha erken konulabilir, mortalite ve morbidite oranları düşürülebilir ve artan maliyet oranları azaltılabilir. Materyal ve Metod: Prospektif olarak tasarlanan bu çalışma, Mart 2021-Mart 2022 tarihleri arasında Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi Dursun Odabaş Tıp Merkezi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji kliniğine başvuran 18 yaş üstü pyelonefrit tanısı alan 60 hasta ve benzer yaş ve cinsiyette herhangi bir sağlık problemi olmayan 40 erişkin birey kontrol grubu ile yapılmıştır. Hastalarda tedavi öncesi ve tedavi sonrası hepsidin, prokalsitonin, C-reaktive protein, hemogram ve sedimantasyon düzeylerine bakıldı. Kontrol grubundan hepsidin için serum örnekleri alındı Bulgular: Çalışmamıza dahil edilen piyelonefrit grubundaki hastaların tedavi öncesi ortanca hepsidin düzeyi 1393,43 (1131,76-2069,96) pg/ml, tedavi sonrası ortanca hepsidin düzeyi 1221,11 (931,78-2023,16) pg/ml ve sağlıklı kontrol grubundaki ortanca hepsidin düzeyi 1114,74 (774,35-1678,51) pg/ml olarak tespit edildi. Piyelonefrit hasta grubunun tedavi öncesi ile tedavi sonrası hepsidin düzeyleri arasında istatistiksel olarak anlamlı fark tespit edildi (p=0,014). Piyelonefrit hasta grubunun tedavi öncesi ile sağlıklı kontrol grubunun serum hepsidin düzeyleri arasında da istatistiksel olarak anlamlı fark bulundu (p=0,005) ancak piyelonefrit hasta grubunun tedavi sonrası ile sağlıklı kontrol grubu arasında istatistiksel olarak fark tespit edilmedi (p=0,23). Sonuç: Hepsidinin enfeksiyondaki rolü netlik kazanmamıştır. Toplumda önemli bir mortalite ve morbidite nedeni olan akut piyelonefrit tanısında kullanılacak spesifik bir belirtecin olmadığı göz önüne alındığında hepsidinin bu hastalarda tanıda yardımcı bir biyobelirteç olarak kullanılabilme potansiyelinin göz önünde bulundurulması gerektiği kanaatindeyiz.
Urinary system infection is the clinical status that occurs when the microorganism settles in any part of the structures forming the urinary system. While it ranks second after upper respiratory tract infections among community-acquired infections in all age groups, it ranks first among infections acquired in hospitals and health care centers. Acute pyelonephritis is defined as an infection of the upper urinary tract, particularly the renal parenchyma and collecting system. It can occur in a wide range, ranging from a mild status to sepsis. Common clinical findings are dysuria, pollakiuria, flank pain and fever. Hepcidin is a recently discovered peptide hormone. Although the role of hepcidin in iron metabolism has become clear, its role in inflammation remains unclear. In human and animal studies, hepcidin synthesis has been shown to increase in cases of infection. If pyelonephritis is not treated, sepsis may develop and there is no definite diagnostic criteria. Diagnosis is made by clinical findings and physical examination, supported by laboratory and imaging methods. However, it may be difficult to diagnose in some cases. Hepcidin may have the potential to be an early diagnostic marker in pyelonephritis without a definitive diagnosis. Thus, the diagnosis can be made earlier, mortality and morbidity rates and increasing cost rates can be reduced. Materials and Methods: This study was designed as a prospective study. Sixty patients over the age of 18 who were diagnosed with pyelonephritis and applied to the Infectious Diseases and Clinical Microbiology Clinic of Van Yüzüncü Yıl University, Faculty of Medicine, Dursun Odabaş Medical Center, between March 2021 and March 2022 were included in the study. A control group of 40 people who were similar in age and gender and had no health problems were also included in the study. Serum samples for hepcidin were obtained from the patient group before and after treatment. Serum samples for hepcidin were also taken from the control group. Procalcitonin, C-reactive protein, hemogram and sedimentation levels of the patients were measured before and after the treatment. Results: While the median hepcidin levels of the patients in the pyelonephritis group were 1393.43 (1131.76-2069.96) pg/ml before treatment and 1221.11 (931.78-2023.16) pg/ml after treatment. It was 1114.74 (774.35-1678.51) pg/ml in the healthy control group. A statistically significant difference was found between the hepcidin levels of the pyelonephritis patient group before and after treatment (p=0.014). A statistically significant difference was found between the serum hepcidin levels of the pyelonephritis patient group before treatment and the healthy control group (p=0.005). However, there was no statistically significant difference between the pyelonephritis patient group after treatment and the healthy control group (p=0.23). Conclusion: The role of hepcidin in infection is not clear. There is no specific marker to be used in the diagnosis of acute pyelonephritis, which is an important cause of mortality and morbidity in the community. For this reason, we believe that the potential of hepcidin to be used as an auxiliary biomarker in the diagnosis of these patients should be considered.
Urinary system infection is the clinical status that occurs when the microorganism settles in any part of the structures forming the urinary system. While it ranks second after upper respiratory tract infections among community-acquired infections in all age groups, it ranks first among infections acquired in hospitals and health care centers. Acute pyelonephritis is defined as an infection of the upper urinary tract, particularly the renal parenchyma and collecting system. It can occur in a wide range, ranging from a mild status to sepsis. Common clinical findings are dysuria, pollakiuria, flank pain and fever. Hepcidin is a recently discovered peptide hormone. Although the role of hepcidin in iron metabolism has become clear, its role in inflammation remains unclear. In human and animal studies, hepcidin synthesis has been shown to increase in cases of infection. If pyelonephritis is not treated, sepsis may develop and there is no definite diagnostic criteria. Diagnosis is made by clinical findings and physical examination, supported by laboratory and imaging methods. However, it may be difficult to diagnose in some cases. Hepcidin may have the potential to be an early diagnostic marker in pyelonephritis without a definitive diagnosis. Thus, the diagnosis can be made earlier, mortality and morbidity rates and increasing cost rates can be reduced. Materials and Methods: This study was designed as a prospective study. Sixty patients over the age of 18 who were diagnosed with pyelonephritis and applied to the Infectious Diseases and Clinical Microbiology Clinic of Van Yüzüncü Yıl University, Faculty of Medicine, Dursun Odabaş Medical Center, between March 2021 and March 2022 were included in the study. A control group of 40 people who were similar in age and gender and had no health problems were also included in the study. Serum samples for hepcidin were obtained from the patient group before and after treatment. Serum samples for hepcidin were also taken from the control group. Procalcitonin, C-reactive protein, hemogram and sedimentation levels of the patients were measured before and after the treatment. Results: While the median hepcidin levels of the patients in the pyelonephritis group were 1393.43 (1131.76-2069.96) pg/ml before treatment and 1221.11 (931.78-2023.16) pg/ml after treatment. It was 1114.74 (774.35-1678.51) pg/ml in the healthy control group. A statistically significant difference was found between the hepcidin levels of the pyelonephritis patient group before and after treatment (p=0.014). A statistically significant difference was found between the serum hepcidin levels of the pyelonephritis patient group before treatment and the healthy control group (p=0.005). However, there was no statistically significant difference between the pyelonephritis patient group after treatment and the healthy control group (p=0.23). Conclusion: The role of hepcidin in infection is not clear. There is no specific marker to be used in the diagnosis of acute pyelonephritis, which is an important cause of mortality and morbidity in the community. For this reason, we believe that the potential of hepcidin to be used as an auxiliary biomarker in the diagnosis of these patients should be considered.
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Keywords
Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji, Hepsidin, Piyelonefrit, Infectious Diseases and Clinical Microbiology, Hepcidin, Pyelonephritis
Turkish CoHE Thesis Center URL
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