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    COMPARISON OF ENDOSCOPIC AND CONSERVATIVE MANAGEMENT IN PEDIATRIC VESICOURETERAL REFLUX: A RETROSPECTIVE STUDY
    (Macedonian Association of Anatomists and Morphologists, 2025-11)
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    Kamiloski, Marijan
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    Ceku, Gani
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    Cvetanovska, Vesna
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    Lumani Bakjii, Njomza
    AbstractBackground:Vesicoureteral reflux (VUR) is a prevalent congenital urinary tract anomaly in children, often associated with recurrent urinary tract infections (UTIs), renal scarring, and long-term complications such as hypertension and chronic kidney disease. The optimal management of primary VUR—particularly in intermediate grades—remains debated, with both conservative and endoscopic treatments widely used.Objective:To compare clinical and functional outcomes of endoscopic injection therapy versus conservative management in pediatric patients with primary VUR, focusing on reflux resolution, UTI recurrence, renal scarring, and renal function.Methods:This retrospective study included 70 pediatric patients with primary VUR treated at a tertiary center between 2015 and 2018. Thirty-five patients underwent endoscopic subureteric injection with dextranomer/hyaluronic acid copolymer, and 35 received conservative management with antibiotic prophylaxis. Comparative analysis assessed changes in VUR grade, recurrence of UTIs, renal scarring (via technetium-99m dimercaptosuccinic acid [DMSA] scintigraphy), renal function by kidney side, and serum creatinine levels.Results:Endoscopic treatment achieved complete reflux resolution in 74.3% of cases. A significant reduction in reflux grade and improvement in right kidney function were observed in the intervention group (p < 0.001). The conservative group showed higher rates of recurrent febrile UTIs and no significant improvement in renal function. Renal scarring was present in both groups but slightly less frequent following endoscopic therapy. Post-treatment left kidney function was significantly higher in the conservative group (p = 0.020), likely reflecting baseline differences.Conclusions:Endoscopic injection therapy is a safe and effective treatment for moderate-to-high-grade VUR in children, associated with superior reflux resolution and better infection control compared to conservative management. Conservative therapy remains appropriate for select low-grade cases but may confer higher risk for recurrent infections and limited renal recovery. Individualized treatment selection is essential to optimize pediatric VUR outcomes
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    Value of sodium dodecyl sulfate polyacrilamide gel electrophoresis in evaluation of pediatric urinary tract infections
    (SHMSHM/AAMD, 2017)
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    Alulovska N.
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    Urinary tract infections (UTI) represent frequent health problem, especially in developing countries. Clinical signs are different based on the location of infection. An interesting ethical and professional question arises: how to treat febrile children who previously received antibiotic therapy and have sterile urine culture in presence of pyuria. Is that a pyelonephritis and are further invasive imaging studies needed? Objectives: To analyze the electrophoretic patterns of urinary proteins in children with proximal respectively distal UTI and to evaluate the value of sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) in acute febrile respiratory infections (AFRI) without signs and symptoms of UTI. Material and methods: The study included 79 children aged 1-16 years: 36 with proximal UTI (15 with culture positive APN, respectively 21 with culture negative APN), 23 with cystitis (7 with hemorrhagic cystitis) and 20 children with AFRI without symptoms of UTI. Separation of urinary proteins was performed by SDS-PAGE. Results: Children with culture positive and culture negative APN had incomplete tubular proteinuria (24-67 kDa) which was transient. Hemorrhagic cystitis was characterized by the typical presence of 28 kDa band (apolipoprotein A-1). In the group AFRI without symptoms of UTI, there was no observed pathological electrophoretograms. Conclusions: SDS-PAGE is useful laboratory technique for separating proteins by their molecular size. The presence of incomplete tubular proteinuria indicates the renal origin of the fever. Detection of apolipoprotein A-1 in children with hemorrhagic cystitis allows differentiation in relation to glomerular cause bleeding. Despite these facts, in the literature there are few reports on SDS-PAGE in diagnosis of various renal diseases including urinary tract infections.