Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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The Relationship between Thymic Size and Vesicoureteral Reflux in Infants with Febrile Urinary Tract Infection

발열성 요로감염 영아에서 방광요관역류와 연관된 흉선의 크기

  • Jung, Seong-Kwan (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Park, Kyu-Hee (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Yim, Hyung-Eun (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Yoo, Kee-Hwan (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Hong, Young-Sook (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Lee, Joo-Won (Department of Pediatrics, Guro Hospital, Korea University)
  • 정성관 (고려대학교 구로병원 소아청소년과) ;
  • 박규희 (고려대학교 구로병원 소아청소년과) ;
  • 임형은 (고려대학교 구로병원 소아청소년과) ;
  • 유기환 (고려대학교 구로병원 소아청소년과) ;
  • 홍영숙 (고려대학교 구로병원 소아청소년과) ;
  • 이주원 (고려대학교 구로병원 소아청소년과)
  • Published : 2009.10.31
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Abstract

Purpose : Thymus is a lymphoproliferative organ that changes size in various physiological states in addition to some pathological conditions. Thymus is susceptible to involution, and shows a dramatic response to severe stress. Thymic measurements may be helpful in various diseases. UTI (urinary tract infection) is most common bacterial infection in infants and VUR (vesicoureteral reflux) is a common abnormality associated with UTI. In our study, the size of thymus was compared on the premise that a greater stress is exerted on the body when UTI is accompanied by VUR, than when occurs on its own. Methods : Thymic size was measured on standard chest anteroposterior radiographs and expressed as the ratio between the transverse diameter of the cardiothymic image at the level of the carina and that of the thorax (CT/T). The medical records of 99 febrile urinary tract infection infants without other genitourinary anomalies except VUR were reviewed retrospectively. Results : Among 99 patients with febrile UTIs, 25 were febrile UTI without VUR and 74 with VUR. For the UTI with VUR group, there was a significant decrease in the thymic size compared to the those without VUR group ($0.382{\pm}0.048$ vs $0.439{\pm}0.079$, P<0.05). However, there were no differences in the duration of fever and WBC, CRP between the UTI with VUR and UTI without VUR. In addition, there were no differences in the cardiothymic/thoracic ratios between renal defects and renal scars in febrile UTI patients. Conclusion : The results of this study show that the shirinkage of thymus was more frequently found in the UTI patients with VUR. Therefore, awareness of the risks associated with thymic size is important for the appropriate work up and management of UTI patients.

목적 : 흉선은 여러 생리학적, 병리학적 상태에 따라 크기가 변하는 면역학적 림프기관이다. 흉선은 스트레스 등에 의해 퇴축되는 반응을 보이며 흉선의 크기를 측정하는 것은 체내 스트레스를 유발하는 여러가지 질병에 대한 정보를 제공해준다. 요로감염은 영아에서 가장 흔한 세균성 감염이며 방광요관역류는 반복적인 요로감염과 연관성이 있다. 이번 연구에서는 요로감염 환아에서 방광요관역류가 동반되어 있을 때 요로감염이 단독으로 존재하는 경우보다 신체에 더 큰 스트레스로 작용할 것이라는 가정하에 흉선의 크기를 비교하였다. 방법 : 방광요관역류이외의 다른 생식기 기형을 동반하지 않은 발열성 요로감염 환아 99명의 자료를 후향적으로 분석하였다. 발열 기간, 방광요관역류 유무, 신결손, 신반흔 및 C반응성 단백과 백혈구수와 심흉선/흉곽의 크기와의 상관관계를 조사하였다. 결과 : 99명의 발열성 요로감염 환아 중 25명은 방광요관역류가 없었고 74명은 방광요관역류가 존재하였다. 방광요관역류가 있는 환아군에서 방광요관역류가 없는 환아군에 비해 심흉선/흉곽 비율이 적었다 ($0.382{\pm}0.048$ vs $0.439{\pm}0.079$, P<0.05). 반면, 방광요관역류가 있는 환아군에서 발열 기간, C반응성 단백과 백혈구수의 차이가 통계적으로 유의하지 않았다. 또한, 신결손 및 신반흔 유무에 따라 분류한 두 환아군에서는 심흉선/흉곽 비율의 차이는 없었다. 결론 : 요로감염 환아의 경우 방광요관역류를 동반하고 있는 경우가 있는데 방광요관역류를 가지고 있지 않은 환아들에 비해 흉선의 크기가 작아져 있는 것으로 관찰된다. 이에 흉선의 크기가 작아져 있는 요로감염 환아에게서 방광요관역류를 확인하기 위한 충분한 검사 및 치료가 필요하다.

Keywords

References

  1. Roitt I. essential immunology. 8th ed. London: Blackwell scientific publications 1994.
  2. Henry K. The thymus gland. In : Symmers WC, editor. Systemic pathology. 3rd ed. London : Churchill Livingstone 1992,V7:27-139.
  3. Dourov N. Thymic atrophy and immune deficiency in malnutrition. Curr Top Pathol 1986;75:127-32.
  4. Concordet JP, Ferry A. Physiological programmed death in thymocytes is induced by physical stress (exercise). Am J Physiol 1993;265:626-9.
  5. Seemayer TA, Bolande RP. Thymic involution mimickingthymic dysplasia. A consequence of transfusion-induced graft versus host disease in a premature infant. Arch Pathol Lab Med 1980;104:141-4.
  6. Suster S, Rosai J. Thymus, in Sternberg SS: Histology for Pathologists. New York: Raven Press 1992:261-77.
  7. Han BK, Babcock DS, Oestreich AE. Normal thymus in infancy: sonographic charactreristics. Radiology 1989;170:471-4.
  8. De Felice C, Toti P, Santopietro R, Stumpo M, Pecciarini L, Bagnoli F. Small thymus in very low birth weight infants born to mothers with subclinical chorioamnionitis. J Pediatr 1999;135:384-6. https://doi.org/10.1016/S0022-3476(99)70140-X
  9. De Felice C, Vacca P, Presta G, Rosati E, Latini G. Small thymus at birth and neonatal outcome in very-low-birth-weight infants. Eur J Pediatr 2003;162:204-6.
  10. Olesen AB, Andersen G, Jeppesen DL, Benn CS, Juul S, Thestrup-Pedersen K. Thymus is enlarged in children with current atopic dermatitis. A cross-sectional study. Acta derm venereal 2005;85:240-3.
  11. Toti P, De Felice C, Stumpo M, Schrfeld K, Di Leo L, Vatti R et al. Acute thymic involution in fetuses and neonates with chorioamnionitis. Human pathology 2000;31:1121-7. https://doi.org/10.1053/hupa.2000.16676
  12. Ha IS, Ko KW, Chi JG. Weight and Morphologic Development of Prenatal Human Thymus. J Korean Pediatr Soc 1991;34:1057-69.
  13. Chung SM, Kim WT. Thymus Size and Its Relationship to Perinatal Diseases; Respiratory Distress Syndrome and Intrauterine Growth Retardation. J Korean Pediatr Soc 2002;45:855-61.
  14. Stevens W, Bedke C, Dougherty TF. Effects of cortisol acetate on various aspects of cellular metabolism in mouse lymphatic tissue. J Reticuloendothel Soc 1967;4:254-83.
  15. Caffey J. The parent-infant traumatic stress syndrome. Am J Roentgenol Radium Ther Nucl Med 1972;114:218-29.
  16. Boyd RL, Tucek CL, Godfrey DI, Izon DJ, Wilson TJ, Davidson NJ et al. The thymic microenvironment. Immunol Today 1993;14:445-59. https://doi.org/10.1016/0167-5699(93)90248-J
  17. Selye H. Stress hormone, and cardiovascular disease. Recent Adv Stud Cardiac Struct Metab 1972;1:701-6.
  18. Ma DD, Ho AH, Hoffbrand AV. Effect of thymosin on glucocorticoid receptor activity and glucocorticoid sensitivity of human thymocytes. Clin Exp Immunol 1984;55:273-80.
  19. Naeye RL, Hartke HT, Blanc WA. Adrenal gland structures and the development of hyaline membrane disease. Pediatrics 1971;47:650-1.
  20. De Felice C, Latini G, Toti P, D'Addario V, Petraglia F, Bagnoli F. Small thymus at birth and gestational age. Eur J Pediatr 2002;161:362-3. https://doi.org/10.1007/s00431-002-0948-2
  21. M. Kizilcan, P, Bilaloglu, N.I. Tamac. Changes in normal thymus size during infancy: sonographic evaluation. Eur.Radiol 1995;5:55-9.
  22. Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis : a multicenter, randomized, controlled study. Pediatrics 2006;111:626-32. https://doi.org/10.1542/peds.111.3.626
  23. Maruyama T, Hayashi Y, Nakane A, Sasaki S, Kohri K. Intermittent pressure-loading increases transforming growth factor-beta-1 secretion from renal tubular epithelial cells: in vitro vesicoureteral reflux model Urol Int 2005;75:150-8. https://doi.org/10.1159/000087170
  24. Kagami S, Border WA, Miller DE, Noble NA. Angiotensin II stimulates extracellular matrix protein synthesis through induction of transforming growth factor-beta expression in rat glomerular mesangial cells. J Clin Invest 1994;93:2431-7. https://doi.org/10.1172/JCI117251
  25. Yim HE, Bae IS, Yoo KH, Hong YS, Lee JW. Genetic control of VEGF and TGF-beta1 gene polymorphisms in childhood urinary tract infection and vesicoureteral reflux Pediatr Res 2007;62:183-7. https://doi.org/10.1203/PDR.0b013e31809871f1
  26. Wilkinson-Berka JL, Kelly DJ, Rong P, Campbell DJ, Skinner SL. Characterisation of a thymic rennin-angiotensin system in the transgenic m (Ren-2) 27 rat. Molecular and cellular endocrinology 2002;194:201-9. https://doi.org/10.1016/S0303-7207(02)00217-4
  27. F.M.A. Correa, AM. De Oliveira, M. Viswanathan, J.M. Saavedra. Autoradiographic localization and characterization of angiotensin II receptor subtypes in the rat thymus. Peptides 1994;15:821-4. https://doi.org/10.1016/0196-9781(94)90036-1
  28. Quy ND, Li JS, Ernesto LS. In vivo study of AT1 and AT2 angiotensin receptors in apoptosis in rat blood vessels. Hypertension 1999;34:617-24. https://doi.org/10.1161/01.HYP.34.4.617
  29. Yerkes E, Nishimura H, Miyazaki Y, Tsuchida S, Brock JW 3rd, Ichikawa I. Role of angiotensin in the congenital anomalies of the kidney and urinary tract in the mouse and the human. Kidney Int. 1998;101:755-60.
  30. Yim HE, Jung MJ, Choi BM, Bae IS, Yoo KH, Hong YS, Lee JW, Kim SK. Genetic polymorphism of the renin-angiotensin system on the development of primary vesicoureteral reflux. Am J Nephrol 2004;24:178-87. https://doi.org/10.1159/000076620
  31. H. Hasselbalch, M.D.M. Engelmann, A.K. Ersboll, D.L. Jeppesen, K. Fleischer-Michaelsen. Breast-feeding influences thymic size in late infancy. Eur J Pediatr 1999;158:964-7. https://doi.org/10.1007/s004310051258
  32. Gewolb IH, Lebowitz RL, Taeusch HW. Thymus size and its relationship to the respiratory distress syndrome. J Pediatr 1979;95:108-11. https://doi.org/10.1016/S0022-3476(79)80099-2
  33. Chen GM, Yu KY, Lin HC, Yeh GC, Hsu HH. Thymus size & its relationship to perinatal events. Acta Pediatr 2000;89:975-8. https://doi.org/10.1080/080352500750043468