Nutrition in Pediatric Nephrotic Syndrome

Alireza Eskandarifar, Ahmad Fotoohi, Sayed yousef Mojtahedi

Journal of Pediatric Nephrology, Vol. 5 No. 3 (2017), , Page 1-3

Nephrotic Syndrome is a collection of symptoms due to glomerular damage, characterized by proteinuria ≥3.5g/day or a protein-creatinine ratio ≥2. From an etiological point of view, there are three forms of nephrotic syndrome, including congenital, primary, and secondary. The first sign of the disease is periorbital edema, especially in the morning. Diagnostic confirmation is done through evaluation of urine protein, serum electrolytes, BUN, Cr, Albumin, and cholesterol. The main treatment goals of nephrotic syndrome are decreasing proteinuria, preventing complications, and protecting the renal function via appropriate drugs and diet.

The main objective of this study was to review diets required in nephrotic syndrome in children: Protein at a diose of 0.8 mg/kg/day is the most effective diet in nephrotic patients. Low-fat diets (calorie intake <30% and cholesterol ≤200mg/day) can improve hyperlipidemia. Salt and water intake should be restricted in the range of less than 2 gr/day and 1-1.5 liters/day, respectively. Nephrotic syndrome patients have iron, copper, zinc, and calcium deficiency due to increased urine protein excretion or concomitant metabolic disorders.


Keywords: Nephrotic syndrome; Diet; Pediatrics; Nutrition.



Original Research Papers

Prevalence of Failure to Thrive in Iranian Children with Chronic Kidney Disease

Fahimeh Soheilipour, Nakysa Hooman, Parnian Ahmadvand

Journal of Pediatric Nephrology, Vol. 5 No. 3 (2017), , Page 1-6

Introduction: Malnutrition and inflammation are considered risk factors of morbidity, hospitalization, and mortality in chronic kidney disease (CKD) children. The aim of this study was to determine the prevalence and severity of failure to thrive (FTT) in children with moderate to severe CKD.

Materials and Methods: This cross-sectional study was conducted in 84 children with CKD (30 female, 54 males) aged 2-16 years old from June 2014 to June 2015.The inclusion criteria were eGFR less than 90 ml/min/1.73m2, being healthy in the month before the visit, and lack other chronic diseases except CKD. Anthropometric data including the body mass index, height, weight, and mid upper arm circumference were collected. Protein wasting energy was scored and the severity of failure to thrive was estimated using Gomez and Jelliffe classifications. P-values less than 0.05 were considered significant

Results: Glomerulopathy and hereditary tubulopathy were the main causes of underlying disease. About 79% of CKD children had FTT and the rate increased with a decline in the renal function (p-value< 0.05). Using modified PWE, 65.5% were identified to score ≥2, which was more frequent in eGFR less than 30 (P>0.05). A quarter of the patients with FTT were classified as no PWE and vice versa.

Conclusion: The majority of the children with moderate to severe chronic kidney disease had failure to thrive and protein wasting energy. There was no correlation between inflammatory markers and the severity of CKD or the presence of failure to thrive.

Keywords: Failure to Thrive; Renal Insufficiency; Chronic; Child.

Introduction: Urinary tract infection is a common health problem in children. Gram negative entericbacteria, mainly E –coli, are responsible uropathogens. We aimed to define the main etiologies of urinary tract infection in children considering gender and type of infection (febrile versus afebrile).

Materials and Methods: We assessed the infections etiology of 648 episodes. Type of infection and etiology were compared between genders. Also, for every uropathogen, a comparison was done between febrile and afebrile infections. Chi square was used for data analysis and P values ≤0.05 were considered as a significant difference.

Results: The majority of the infections by Proteus and Enterococcus species were febrile, in contrast to Citrobacter infections which were mostly afebrile. E-coli infections were significantly more prevalent in girls (P=0.0001). Proteus and Kelebsiella infections were more common in boys (P=0.115 and 0.154 respectively), whereas all Enterobacter infections were seen in girls (P=0.129). A comparison was done between females and males based on the type of infection. Although febrile infections were more frequent in boys, the difference was not statistically significant (P=0.059).

Conclusions: E-coli, Kelebsiella, Enterobacter and Citrobacter species (90.5%) were the main uropathogens. Infections caused by E-coli were significantly more prevalent in girls. Proteus and Kelebsiella infections were more common in boys, whereas Enterobacter species were more prevalent in girls. The majority of Proteus and Enterococcus infections (>2/3) presented as pyelonephritis, while the frequency of febrile and afebrile infections was similar for E-coli, Kelebsiella, Enterobacter and Staphylococcus species.

Keywords: UTIs; Etiology; Gender; Pyelonephritis; Cystitis.

Introduction: Cryptorchidism is the most common congenital anomaly in male genitalia in newborns with a frequency of 3% in term and 30% in preterm male newborns. Cryptorchidism is also known as undescended testis (UDT), which can be bilateral or unilateral. The aim of the study was to evaluate all cases with UDT referred to our center during 5 years.

Materials and Method: All UDT cases that were referred to Children’s Medical Center during the last 5 years were included in our retrospective study. The data were collected from the patients’ records and one medical student entered the data in the questionnaire designed for the study.

Results: A diagnosis of UDT was made at the time of birth in 122 (62.2%) of 196 cases, until one year of age in 153 (78.06%) cases, until two years of age in 161 (82.14%), until six years of age in 186 (94.89%) cases, and until 11 years of age in 196 (100%) cases. The age at surgery was under 1 year in 52 (26.53%) cases, between 1 and 2 years in 42 (21.24%) cases, between 2 and 6 years in 68 (34.69%) cases, and over 6 years in 34 (17.34%) cases.

Conclusion: Age at diagnosis was significantly lower than the perfect age for operation in most cases and the age at surgery was higher than the perfect age for diagnosis in half of the cases. Therefore, collaboration between general practitioners and pediatric surgeons and pediatricians is necessary for perfect and timely management of UDT. 

Keywords: Undescended Testis; Cryptorchidism; Child; Newborn.

Etiology of Renal Tubulopathy in Iranian Children-A Nationwide Survey

Nakysa Hooman, Ali Derakhshan, Faezeh JavadiLarijani

Journal of Pediatric Nephrology, Vol. 5 No. 3 (2017), , Page 1-8

Introduction: Inherited and acquired renal tubular disorders including cystic Kidney disease, cystinosis, Bartter’s syndrome, Liddle syndrome, Gordon syndrome, nephrogenic diabetes insipidus, and drug-induced tubular injury are the frequent causes of end stage renal disease (ESRD) in children manifesting with chronic kidney disease (CKD). This is a report of the etiology and incidence of tubulopathies in a cohort of Iranian children across the country.

Materials and Methods: This descriptive observational study was conducted from March 2013 to October 2013. A list of tubulopathy disorders was emailed to 70 members of the Iranian Society of Pediatric Nephrology in different provinces of Iran practicing in both university affiliated and non-affiliated hospitals. They were requested to report the number of patients with specific International Classification of Disease (ICD-10) codes admitted to their hospitals between 2006 and 2013. Data are presented as numbers and percentages.

Results: Of 31 participating centers, 23 completed and returned the spreadsheets. Of the 2940 reported cases,the three most frequent tubulopathies were renal tubular acidosis (RTA) (33%), calcium disorders (27%), and cystic diseases (17%). Considering Tehran and Shiraz as referral centers, RTA and cystinosis were mostly reported from Kermanand Urmia, respectively. Furthermore, idiopathic hypercalciuria, cystinuria, and hyperoxaluria were the most common causes of hereditary kidney stone in 281 children reported from Bandarabas, Tabriz, and Shiraz, respectively

Conclusions: Our findings regarding the high incidence and different etiologies of inherited tubulopathies may provide a basis for designing targeted therapeutic interventions in the future and strategies for gene therapy of these complex disorders.

Keywords: Kidney Tubules; Disease; Acidosis; Renal Tubule; Kidney disease; Cyst; Diabetes Insipidus; Urolithiasis; Bartter syndrome.

Case Reports

Management of Renal Abscess in a 5-Year-Old Girl, A Case Report

Maryam Boroomand, Mastaneh Moghtaderi, Pooya Hekmati

Journal of Pediatric Nephrology, Vol. 5 No. 3 (2017), , Page 1-3

Renal abscesses are rare in children. They have vague manifestations and any delay in proper diagnosis and treatment could lead to morbidity and mortality. We present a5-year-old girl with multiple renal abscesses after pyelonephritis that lead to total nephrectomy due to multiple drug resistance. The renal abscess may have subtle symptoms. Early diagnosis and treatment strongly prevent undue mortality and morbidity. This case highlights the need for timely diagnosis and proper treatment. There must be a clinical suspicion of renal abscess if treatments do not affect the patient’s clinical condition.

Keywords: Acute Pyelonephritis; Renal Abscess; Child.