The Prevalence of Shiga toxin-producing Escherichia coli in Patients with Gastroenteritis and Sources of Infections in Iran: A Systematic Review Study Protocol

Nakysa Hooman, Roxana Mansour-Ghanaei, Mohsen Yaghoubi, Shahrbanoo Nakhaie

Journal of Pediatric Nephrology, Vol. 4 No. 3 (2016), 22 December 2016, Page 82-85

Hemolytic Uremic Syndrome (HUS) is a leading cause of acute kidney injury in infants and children. The majority of HUS in children is secondary to Shiga toxin induced Escherichia Coli (STEC). Many countries have a strategy to identify the source of infection and annually estimate the rate of this infection but there is no prevention strategy to identify this infection in Iran.

The aim of this study is to find the percentage of STEC identified in various samples, in addition to find the outcome of STEC infected patients in Iran.

We will search PubMed, EMBASE, Google Scholar, Google, OVID, SCOPUS, Web of Sciences, IranMedex, MagIran, and SID, dociran, PDFiran, ganj.irandoc, and all online university database for thesis, and abstract books of regional or international congresses  between January 1985 and January 2016.

One author will do the search screen for potentially eligible studies and two authors independently assess whether the studies meet the inclusion criteria. Discrepancies between the two authors will be resolved through discussion and arbitration by a third author. Data from the selected studies shall be extracted using a data collection form. The methodological quality of studies will be assessed using the STORBE checklist and risk of bias assessment tool developed by Hoy et al for assessing risk of bias for epidemiological studies. We will use random effects models to assess inter-study heterogeneity. Dichotomous data will be analyzed using relative risk and continuous will be assessed with data mean differences, both with 95% CIs.

Keywords: Gastroenteritis; Humans; Iran; Prevalence; shiga Yoxin 2; shiga-Toxigenic Escherichia coli.

Original Research Papers

Renal Diseases in Children Attending Pediatric Nephrology Centers of Dhaka City

md. Abdul Qader, Golam Muin Uddin, Habibur Rahman, Mohammed Hanif, Ranjit Ranjan Roy, Afroza Begum, Anwar Hossain Khan, Shireen Afroz, Syed Saimul Hoque

Journal of Pediatric Nephrology, Vol. 4 No. 3 (2016), 22 December 2016, Page 86-91

Introduction: Renal diseases in children can be congenital or acquired. In Bangladesh, pediatric nephrology care is available for last 2 decades, but there was no epidemiological study to see the pattern of renal diseases in children of the country. So, this study was carried out to observe the pattern of renal diseases in children of pediatric nephrology centers of Dhaka city.

Materials and Methods: The children aged 1 day to 18 years with renal problems attended at selected four pediatric nephrology centers of Dhaka city (BSMMU, DMCH, DSH and NIKDU).

Results: Among 6453 patients, 1123 were admitted in IPD and 5330 were visited at OPD. Mean age was 5.8±3.5 years in IPD patients and 6.90±1.37 years in OPD patients. In IPD among 1123 patients, 720 (64.1%) were male and 403 (35.8%) were female and in OPD among 5330 patients 3336 (62.59%) were male and 1994 (37.4%) were female. Nephrotic Syndrome (76% in IPD and 74% in OPD) was the most common disease followed by chronic kidney disease (CKD 6%) in IPD and urinary tract infections (UTI 9.4%)in OPD were the next common disease. Common presentations were proteinuria (27.6%), oliguria or anuria (26.2%) and edema (25.7%).

Conclusions: The current pattern of renal diseases shows, that the most common renal diseases are NS followed by CKD and UTI. In the study male patients are more common than female.


Keywords: Nephrotic Syndrome; Chronic Kidney Disease; Congenital Anomalies of Kidney and Urinary Tract; Acute kidney injury.

Comparison of the Incidence of Postoperative Hyponatremia after Infusion of Hypotonic Versus Isotonic Intravenous Solutions in Children

Mastaneh Moghtaderi, Abdolmohammad Kajbafzadeh, Hamid Arshadi, Mojtaba Gorji, Ahmad AleEsmail, Amirhossein Mahboobi, Bahar Behzad Tahmouresi

Journal of Pediatric Nephrology, Vol. 4 No. 3 (2016), 22 December 2016, Page 92-96

Introduction: Hyponatremia is the most common electrolyte disorder in patients following surgical interventions (19-50%). Hospital acquired hyponatremia is often due to using hypotonic solution s and can be lethal.

Materials and Methods:Between January and December 2014, 190 children (1 month to 12 years) who were admitted in the urology department of Children’s Hospital Medical Center for elective surgical procedures were enrolled in the study. The patients were randomly divided into two groups: group I received 50 mEq/L sodium and 20 mEq/L potassium in D/W 5% and group II received 154 mEq/l sodium and 20 mEq/L potassium in D/W 5% at the maintenance dose for a period of 6 hours following the operation. The patients did not have any oral fluid intake 6 hours postoperatively. The incidence of hyponatremia before and after maintenance IV fluid therapy was analyzed. Other characteristics of the patients such as age, gender, duration of hospitalization, other concomitant electrolyte disturbances, and symptoms of hypervolemia were also evaluated. The incidence of fluid-IV therapy-induced hyponatremia was investigated and analyzed in different categories of patients.  

Results: One hundred and ninety patients were enrolled. The mean age was 3.75 years (ranging from 1 month to 12years).  One hundred and thirty-three patients (70%) were boys. The incidence of hyponatremia before and after maintenance IV fluid therapy was 9.5% and 36%, respectively. After the therapy, the incidence of hyponatremia was 54% and 17% in hypotonic and isotonic groups, respectively. Final multivariate logistic analysis showed that hyponatremia was common in patients that received hypotonic solution after surgery.

Conclusions: Hyponatremia was markedly induced in patients receiving hypotonic solution after surgery. It seems isotonic fluid therapy after surgery protects the patients from hyponatremia.

Keywords: Hyponatremia; Isotonic solutions; Hypotonic solutions; Child.

Comparison of the Voiding Cystourethrogram Results One and Three weeks after the First Urinary Tract Infection in 1-Month to 15-Year-Old Children

Hasan Golmakani, Fateme Ghane Sharbaf, Mohammad Esmaeili, Ali Alamdaran, Samaneh Soltani, Tooba Ahmadzadeh-saani, Majid Khademian

Journal of Pediatric Nephrology, Vol. 4 No. 3 (2016), 22 December 2016, Page 97-101

Introduction: To determine whether the timing of voiding cystoureterogram (VCUG) in the first or the third week after a diagnosis of urinary tract infection (UTI) is important in the diagnosis and severity of VUR.

Materials and Methods: In this case-control study, 72 children between 1 month and 15 years old diagnosed with their first episode of UTI were investigated over one year. The study population was divided into 2 groups of 36, early (VCUG in the first week after UTI) and late (VCUG 3 weeks after UTI), and compared the severity and incidence of reflux in both groups.

Results: The prevalence of VUR was 66.6%. Twenty-two cases in the first group (61%) and 26 cases in the second group (72.2%) presented with VUR. The peak age of the disease in both groups was 1-3 years with a female predominance. The most common germ detected was E-Coli and the most common presentations were fever (87.5%) and dysuria (26.3%).

Conclusions: As VUR following UTI is very common in children and is one of the most important risk factors of early hypertension and chronic renal failure, early diagnosis by VCUG seems to be useful in all UTI patients before discharge.


Keywords: Urinary Tract Infection; Vesico-Ureteral Reflux; VCUG; Child.

Frequency of Kidney Stone Different Compositions in Patients Referred to a Lithotripsy Center in Ilam, West of Iran

Sasan Nikpay, Kamran Moradi, Milad Azami, Mashallah Babashahi, Masoome Otaghi, Milad Borji

Journal of Pediatric Nephrology, Vol. 4 No. 3 (2016), 22 December 2016, Page 102-107

Introduction: Ilam is one of the provinces with the highest prevalence of kidney stone. The aim of this study was to calculate the frequency percentage of kidney stones by composition in Ilam.

Materials and Methods: This cross-sectional study was conducted on 160 patients referred to the lithotripsy center of Ilam for the treatment of kidney stones from 2014 to 2015 (9 months). A two-part questionnaire including demographic information and stone type was used for collecting data. Finally, the obtained data were analyzed with SPSS version 17.

Results: The frequency of kidney stones was 68% in men and 31.8% in women. The prevalence of kidney stones was higher in men than women, but there was no significant relationship between gender and the stone type. The highest prevalence of the stone was in the age group 31-41 years (33.7%) and there was a significant relationship between age and the stone type (P=0.001). The frequency of calcium oxalate (CaOx), mixed, uric acid, and cysteine kidney stones was 61.25%, 36.25%, 1.9%, and 0.6%, respectively. The most prevalent mixed stone was uric acid together with calcium oxalate stones (21.8%) followed by CaOx together with calcium phosphate stones (10.6%).

Conclusions: The prevalence of CaOx and uric acid and CaOx stones was high. It is likely the increase in mixed stones in Ilam, especially uric acid and CaOx stones, is due to the nutritional pattern of subjects. More studies are required to determine the relationship between the stone type and diet in this area.

Keywords: Kidney stones; Nephrolithiasis; Urolithiasis; Calcium phosphate; Calcium oxalate; Struvite; Uric acid

Evaluation of the Parents' Functioning and Behavioral Disorders in Children with and without Vesicoureteral Reflux

Parsa Yousefichaijan, Milad Azami, Shoboo Rahmati, Bahman Salehi, Fatemeh Dorreh, Bahman Sadeqi Sadat, Rezvan Sharifi

Journal of Pediatric Nephrology, Vol. 4 No. 3 (2016), 22 December 2016, Page 108-112

Introduction: Vesicoureteral reflux is the backward flow of the urine from the bladder into the ureters or kidneys that may result in urinary tract infection. This paper aimed at evaluating this problem and its relationship with the children's mood, growth, and physical conditions as well as its influence on the family and school.

Materials and Methods: The study population consisted of 122 children aged 4-14 years old: 61 with and 61 without VUR. The Child Behavior Checklist (CBCL) and Global Assessment of Functioning (GAF) were used to assess the parents' behavior. The data were analyzed using descriptive statistics, Chi-square test, and t test.

Results: In this study, 23% of the children with and 4.9% of the children without VUR suffered depression (P value= 0.007). Moreover, 10.7% of the children with VUR showed offensive behaviors but there found no case among the children in the other group (P value=0.012). In addition, 16.4% of the children with and 1.7% of the children without VUR had intellectual problems (P value=0.008). Furthermore, 27.9% of the children with and 3.3% of the children without VUR had emotional problems (P value=0.001), and 4.9% of the parents of the children with VUR needed serious clinical measures but there were no such cases among children without VUR (P value=0.021).

Conclusions: Increased behavioral problems in children with VUR and declined parental functioning require prompt treatment to prevent future behavioral problems in children.

Keywords: Behavioral Problems; Vesico-Ureteral Reflux; Parents; Child.  

Case Reports

Unilateral Renal Tuberculosis Presenting as Persistent Pyuria

Mohd Irshad, Mohd Ashraf, Yasmeena Akhter, Javaid Ahmad Bhat

Journal of Pediatric Nephrology, Vol. 4 No. 3 (2016), 22 December 2016, Page 113-115

Despite being one of the major health problem globally, tuberculosis still remains an important, but under diagnosed and ignored cause of kidney damage especially in resource poor settings. Timely diagnoses and treatment can cure this otherwise devastating resource draining ailment. We report a 10-year-old girl who had persistent pyuria and dysuria despite receiving multiple drugs empirically before antitubercular therapy was initiated. 

Keywords: Child; Renal Tuberculosis; Urinary Tract infections.

Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) Misdiagnosed as Recurrent Urinary Tract Infection

Abolhassan Seyedzadeh, Mohammad reza Tohidi, Rahimpour Amiri

Journal of Pediatric Nephrology, Vol. 4 No. 3 (2016), 22 December 2016, Page 116-118

Recurrent fever is common in children and specific infections account for the fever in most cases. PFAPA is not an uncommon cause of periodic fever during childhood. On the other hand, in patients with vesicoureteral reflux (VUR), urinary tract infection usually presents with fever.

Here, we report two PFAPA cases in patients with VUR in whom recurrent episodes of fever were misdiagnosed as UTI.


Keywords: PFAPA Syndrome; Periodic Fever Syndrome; Vesico-Ureteral Reflux; Urinary Tract Infections; Child.