title: Urinary cytokine response to asymptomatic bacteriuria in type 1 diabetic children and young adults.
abstract: It has been reported that urinary interleukin-6 (IL-6) and IL-8 levels are decreased in adult diabetic women with asymptomatic bacteriuria (ASB) when compared with non-diabetic women with ASB. Such impaired cytokine excretion might play a role in the higher prevalence of ASB among diabetic subjects. The aim of this study was to examine the urinary IL profile in children and young adults with type 1 diabetes mellitus (T1DM) with and without ASB. Midstream clean voiding urine samples were collected and cultured from 133 patients with T1DM (age: 15.6 +/- 5.7 yr) and 178 controls (14.1 +/- 4.7 yr) for two consecutive days. ASB was diagnosed in the case of >or=10(5) bacteria/mL. The urinary IL-6 and IL-8 concentrations were determined, and the presence of leukocyturia was also recorded. The prevalence of ASB was 16.5% in diabetic subjects and 2.8% in controls (p = 0.001). There was no difference between the diabetic and the control groups in the prevalence of 'IL-6-uria' (21.9 vs. 18.0%; p = 0.41), but IL-8 was more frequently detectable in the diabetic group (47.4 vs. 27.5%; p = 0.001). In individuals with ASB, the IL-8 level was similar in the diabetic (median: 70.0 pg/mg creatinine) and control group (42.3 pg/mg creatinine; p = 0.8). Indeed, the IL-8 levels were higher in diabetic subjects with ASB as compared with those without it (70.0 vs. <3.1 pg/mg creatinine; p = 0.001), and there was a significant association between the urinary IL-8 concentration and the bacterial count (p = 0.001). Diabetic patients with leukocyturia had higher IL-8 concentration than those without it (20.9 vs. <3.1 pg/mg creatinine; p = 0.003). Weak significant correlation was found between urinary IL-8 and hemoglobin A1c (HbA1c) (r = 0.4; p = 0.002). The sensitivity and specificity of leukocyturia were 50 and 89.9% in the whole population and those of IL-8 were 74.1 and 67.5%, respectively. In diabetic patients, 36.4% of the bacteriuria were gram-negative and 63.6% gram-positive. Our results suggest that diabetic children with ASB mount an IL-8 response to pathogens, which is comparable to non-diabetic children with bacteriuria. Thus, early in the natural history of diabetes, there are no significant changes in the IL response of children with ASB, as previously reported in adults.
authors.affiliation: Department of Paediatrics, University of Pécs, Pécs, Hungary. barnabas.rozsai@aok.pte.hu
authors.forename: Barnabás
authors.initials: B
authors.lastname: Rózsai
authors.forename: Eva
authors.initials: E
authors.lastname: Lányi
authors.forename: Tímea
authors.initials: T
authors.lastname: Berki
authors.forename: Gyula
authors.initials: G
authors.lastname: Soltész
mesh_terms: D000293:Adolescent; D000328:Adult; D001437:Bacteriuria / Q000150:complications* / Q000276:immunology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000276:immunology* / Q000652:urine; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D015850:Interleukin-6 / Q000652:urine*; D016209:Interleukin-8 / Q000652:urine*; D007964:Leukocytosis / Q000652:urine; D008297:Male; D012680:Sensitivity and Specificity
chemical_list: D006442:Glycated Hemoglobin; D015850:Interleukin-6; D016209:Interleukin-8