Urodynamic Study in Children

Mastaneh Moghtaderi, Hamid Arshadi, Seyed Mohmmad Ghohestani, Nakisa Hooman

Journal of Pediatric Nephrology, Vol. 5 No. 2 (2017), 1 January 2018, Page 1-9

A b s t r a c t:

Urodynamic study (UDS) is a serial of clinical tests, like uroflowmetry, filling cystometry, pressure-flow studies and assessment of urethral closure pressure. These tests include urethral pressure profilometry and also measurement of the leak-point pressure of lower urinary system. UDS is one of the essential clinical studies in children complaining of voiding dysfunction, neurogenic bladder, urine incontinence, enuresis and another lower urinary tract symptom. The aim of proper bladder management in these patients is to maintain the lower urinary tract to have good capacity, low pressure, preventing infection and incontinence. Long term goal is preventing any undue damage to the upper urinary tracts and intact kidneys function. This review article of pediatric urodynamic study provides a classified diagnostic approach to bladder dysfunctions in children.

Original Research Papers

Are Boys at Risk of Low Immune Response to Recombinant Hepatitis B Virus Vaccine in Steroid Sensitive Nephrotic Syndrome?

Tahmina Jesmin, Md. Firoz Anjum, Abdullah Al Mamun, Fahmida Begum, Afroza Begum, Syed Saimul Huque, Md. Habibur Rahman, Ranjit Ranjan Roy, Golam Muinuddin, Mohammed Hanif

Journal of Pediatric Nephrology, Vol. 5 No. 2 (2017), 1 January 2018, Page 1-6

Introduction: This study was conducted to evaluate the immune response following vaccination with different doses and to compare the antigen specific antibody response to Hepatitis B Vaccine (HBVac) in Steroid Sensitive Nephrotic Syndrome (SSNS) patients between boys and girls.

Materials and Methods: This prospective study was conducted in 30 SSNS children at Bangladesh Institute of Child Health, Dhaka, Bangladesh from July 2012 to June 2013.Thirty patients who had all features of Minimal Change Nephrotic Syndrome (MCNS) according to International Study for Kidney Diseases for Children (ISKDC) and received oral prednisolone every alternate day and were HBsAg negative were enrolled in the study. The patients were randomly assigned to one of the two treatment group to receive either 0.5 ml (10μg) or double dose 1ml (20μg) of HB vaccine in a 0-1-2month schedule. After excluding hepatitis B virus infection, the vaccine was administered at a standard dose in group-A (0.5 ml or 10 microgram) and at a double dose (1 ml or 20 microgram) in group-B. After one month of the last dose, the seroprotection rate was measured and compared among sexes.

Results: The mean age of the participants in group-A was 5.81 ± 1.73 years with a boy to girl ratio of 9:6 and the mean age of the subjects in group-B was 5.65 ± 1.68 years with a boy to girl ratio of 8:7. The mean vaccine titer was 25.60 ±19.97 mIU/ml in group-A and 617.47 ±292.11 mIU/mlin group-B, with a significant difference (p<0.05) between the two groups. Irrespective of the dose, the mean vaccine titer was higher in girls (37.33 ± 19.45 mIU/ml) compared to boys (16.22 ± 14.81mIU/ml) and the difference was statistically significant in group-A. It was also observed that the mean vaccine titer was significantly higher in girls (743.00±252.34mIU/ml) compared to boys (394.88±246.63 mIU/ml) in group-B (p<0.05,t-test).

Conclusions: The results of our study showed a reduced response to HB Vaccine boys with SSNS in comparison to girls. As the study size was small, single center study and time limited follow-up, we cannot draw any valid conclusions.

Keywords: Immune deficiency; Sex differences; Steroid Sensitive Nephrotic Syndrome; Seroconversion.

Spectrum of Hospital Acquired Acute Kidney Injury in Critically ill Children in a Tertiary Level Hospitall

Syed Saimul Huque, Afroza Begum, Md Habibur Rahman, Golam Muin Uddin, Ranjit Ranjan Roy, Md Abdul Mannan, Md Afiqul Islam, Chowdhury Ali Kawser

Journal of Pediatric Nephrology, Vol. 5 No. 2 (2017), 1 January 2018, Page 1-7

Introduction: Although hospital acquired acute kidney injury (hAKI) is common and significantly increases the risk of hospital mortality, little is known about its frequency in developing countries where ICU facilities are limited. The purpose of this study was to investigate the frequency, cause, and outcome of hAKI in critically ill children in a tertiary level hospital.

Materials and Methods: In this prospective cross-sectional study, a total 36 critically ill patients with hAKI were analyzed. hAKI was diagnosed according to the AKIN criteria. The clinical data of the patients admitted to the Pediatrics and Allied Departments in this hospital from November 2014 to October 2015 were collected.

Results: A total of 3950 patients were admitted during the study period and 1103 (27.9%) were critically ill patients. Among the critically ill children, 36 (3.3%) were diagnosed with hAKI. Among different age groups, the highest incidence (5.05%) of hAKI was seen in children aged above 10 years. Sepsis was the major cause of hAKI accounting for 44.1% followed by antibiotics (27.1%), hypovolemia (13.6%), nephrotoxic agents (10.2%), and contrast agents (5.0%). Renal replacement therapy was required only in 8.3% of the cases.

Conclusions: In comparison to other studies, this study showed a low incidence of hAKI where ICU facilities are limited. Among the hospital admitted critically ill patients, a significant number of patients may develop AKI mostly due to sepsis and use of antibiotics.


Keywords: Hospital acquired AKI; Sepsis; Critically ill children; Incidence

Admission Dysnatremia in Citically ill Children

Mohammad Reza Navaeifar, Saeedeh Haghbin, Mitra Basiratnia, Zahra Serati Shirazi, Khashayar Aflaki, Ali Manafi Anari

Journal of Pediatric Nephrology, Vol. 5 No. 2 (2017), 1 January 2018, Page 1-7

Introduction: Many causes of admission to the pediatric intensive care unit (PICU) may potentially induce hyponatremia. This study was aimed at evaluating the incidence of admission dysnatremia in the PICU and its relationship with the underlying disease and demographic factors.
Materials and Methods: This observational prospective study was conducted in a 12-bed medical PICU in a tertiary governmental teaching hospital for six months. The study group comprised patients aged 1 month to 18 years. Patients who received intravenous fluid within 24 hours before admission were excluded. Serum sodium was checked on admission and concentrations below 135 and above 145 mEq/L were considered hyponatremia and hypernatremia, respectively.
Results: One hundred and ninety-five patients (117 males, 60%) were included in the study. The mean serum sodium level was 137.8 mEq/L ± 5.2. Forty-two patients (20.5%) were hyponatremic and 10 (5.1%) were
hypernatremic. The most prevalent diagnosis in hyponatremic patients
was pulmonary diseases followed by renal diseases, central nervous
system (CNS) diseases, diabetic ketoacidosis (DKA), gastrointestinal (GI)
diseases, and cardiovascular and hematologic-oncologic diseases. Fifty
percent of nephrologic patients were hyponatremic. Hyponatremia was
found in 26.5%, 23.5%, 20%, 16.6%, and 14.2%of the children with lung
diseases, DKA, hematologic-oncologic diseases, cardiovascular diseases,
and CNS and GI diseases, respectively. Moreover, 20%, 16.6%, 11.7%,
7.1%, and 2.9%of the patients with infectious diseases, cardiovascular
diseases, DKA, CNS diseases, and pulmonary diseases had
hypernatremia, respectively.
Conclusions: Hyponatremia is frequent in our PICU. Patients suffering from renal diseases, pulmonary problems, DKA, and hematologic-oncologic diseases have a higher chance of hyponatremia (≥20%).

Keywords: Sodium; Hyponatremia; Fluid Therapy; Children; Intensive Care.

Clinical Course of 250 Pediatric Cases of Vesicoureteral Reflux in Zahedan, Southeast of Iran

Simin Sadeghi-Bojd, Mahdi Mohammadi, Elham Zarifi

Journal of Pediatric Nephrology, Vol. 5 No. 2 (2017), 1 January 2018, Page 1-5

introduction: Although the incidence of primary reflux is 0.1-1.3% in the general population, it is much higher (29-50%) in children with urinary tract infection (UTI). This study aimed to evaluate the epidemiologic characteristics and outcome of vesicoureteral reflux (VUR) in Iranian children in Zahedan, southeast of Iran.

Materials and Methods: In this historical cohort study, we reviewed all records of 250 patients diagnosed with VUR who were referred to a Pediatric Nephrology Clinic in Zahedan, Iran between April 2008 and September 2009 and were followed until June 2011. The diagnosis of VUR was made by convectional voiding cystourethgraphy (VCUG). Following the diagnosis, patients received prophylactic low-dose oral antibiotic and were followed by radionuclide cystography (RNC) for 18 months.

Results: Of 250 patients with VUR, 153 (61.2%) were female with a mean age of 2.7 ±2.0 years at presentation. One hundred and thirty patients (52%) had unilateral VUR and 120 patients (48%) had bilateral VUR. In 54.4% of the patients, VUR was detected during the investigation for UTI and 13.2% had prenatal hydronephrosis. Voiding dysfunction was the most important condition with VUR (15.2%). Kidney ultrasound confirmed abnormal results in 73.2% of the patients.  Renal scaring secondary to VUR was detected in 85 (34%) patients at the time of VUR diagnosis.

Conclusions: Our data showed that VUR was significantly higher in female children and the frequency of abnormal renal scan was significantly higher in children with high–grade VUR. Further studies may be needed to determine the risk factors and apply effective interventions to minimize the progression of renal damage.

Keywords: Vesicoureteral reflux; Child; Zahedan.

Case Reports

Tethered Cord Syndrome Causing Chronic Kidney Disease in a Child: A rare event

Ranjit Ranjan Roy, SM Shamsul Haque, Abdullah Al Mamun, Md Habibur Rahamn

Journal of Pediatric Nephrology, Vol. 5 No. 2 (2017), 1 January 2018, Page 1-4

The fixing of the spinal cord, regardless of the underlying cause of the fixation, is called a tethered cord. Tethered cord syndrome is a group of diseases that develops as a result of the regression of the spinal cord due to congenital or acquired causes and is characterized by evaluative neurologic losses. In stretched tethered cord syndrome which is observed during childhood usually manifested by skin symptoms, motor losses, urologic symptoms, and evaluative spinal cord deformations such as scoliosis are more frequently observed while perinea and primal pain, urologic symptoms, and motor losses are more frequent in adults. Tethered cord complicating a neurogenic bladder in childhood is a rare disease. So, this case report is presented.                                   

Keywords: Tethered cord; Child; Chronic Kidney Disease; Neurogenic Bladder.

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