Original Research Papers


Metabolic Evaluation in Pediatric Urolithiasis: Our Experience

Chetan Gadekar, Amit Sharma, Sandesh Parab, Narsing Mane, Mukund Andankar, Hemant Pathak

Journal of Pediatric Nephrology, Vol. 6 No. 1 (2018), 4 May 2018 , Page 1-5
https://doi.org/10.22037/jpn.v6i1.17630

Introduction: Pediatric urolithiasis is a morbid condition that is often associated with underlying metabolic disorders. It is essential to diagnose and manage the underlying metabolic disorder along with management of urolithiasis to prevent stone recurrence and decrease the morbidity.

Materials and Methods: This retrospective observational study was conducted in 50 patients below 15 years of age with urolithiasis. Urine collection was done for 24 hours in toilet-trained children and spot samples were taken from younger children. The urinary parameters that were evaluated included calcium, oxalate, citrate, uric acid, and total urine volume. The serum levels of calcium, phosphorus, creatinine, uric acid, electrolytes, parathormone, and albumin were also measured. Stone analysis was done whenever possible.

Results: There were 32 males and 18 females. Sixty-two percent of the patients had a low calcium intake and 70% of the children had a history of low water intake and had a low urine volume over 24 hours. Half of the children had serum metabolic abnormalities, including hypocalcaemia (n=19,38%), hypocalcaemia with hyperphosphatemia (n=2, 4%), hypercalcemia (n=2, 4%), and hyperuricemia (n=2,4%). Urinary abnormalities were detected in 42% of the children (n=21). These abnormalities included hypocitraturia in 11 patients (50%), hypercalciuria in 7 patients (30%), hyperoxaluria in 1 patient (6%), and hyperuricosuria in 2 patients (12%). Stone analysis was done in 18 patients. Fifteen patients (30%) had calcium oxalate stones, two patients (4%) had uric acid stones, and one patient had a mixed stone.

Conclusions: It is important to maintain an optimal blood calcium level and increase fluid intake to prevent stone formation in children.

Keywords: Urolithiasis; Pediatric; Metabolic Disorders.

Associated Factors of Primary Enuresis Among Children and Adolescents in Amhara Region, Northwest, Ethiopia, 2016

Tadele Amare, Bethelhem W/Michael, Birhane G/HIwot, Fisseha Zewde

Journal of Pediatric Nephrology, Vol. 6 No. 1 (2018), 4 May 2018 , Page 1-8
https://doi.org/10.22037/jpn.v6i1.18903

Introduction: Primary enuresis is the most common elimination disorder in children and adolescents aged 5-17 years worldwide. It often results in psychological, social, and financial problems. This disorder is understudied in less affluent countries.

Objective: This study was done to assess the prevalence and associated factors of primary enuresis in children and adolescents in Bahir-Dar Town, Ethiopia.   

Materials and Methods: This cross-sectional community-based study was conducted in children and adolescents from May to July 2016. A total of 1547 subjects were selected using a multistage sampling technique. Data were collected using DSM-5 criteria and the Strengths and Difficulties Questionnaire (SDQ).

Results: A total of 1520 participants were involved in the study with a response rate of 98.25%. The prevalence of primary enuresis was 8.6%. Age range 5-8 years [AOR=10.35, 95% CI (3.468, 30.875)], deep sleep [AOR=2.18, 95% CI (1.192, 3.983)], and conduct problems [AOR=5.98, 95% CI (3.341, 10.694)] were significantly associated with primary enuresis. 

Conclusions: Factors that affect primary enuresis are young age, deep sleep, snoring during sleep, sleeping more than two hours a day, and conduct problems. Therefore, special attention should be given to children and adolescents about primary enuresis prevention.

Keywords: Primary enuresis; Child; Adolescent

Single-center Experience of Histopathological Spectrum and Treatment Profile in Adolescent-onset Nephrotic Syndrome in India

Subal Kumar Pradhan, Saroj Kumar Satpathy, Shreesh Bhat, Akhil Krishnamoorthy

Journal of Pediatric Nephrology, Vol. 6 No. 1 (2018), 4 May 2018 , Page 1-4
https://doi.org/10.22037/jpn.v6i1.20566

Introduction: Guidelines suggest a biopsy-tailored treatment rather than glucocorticoids as initial therapy for adolescent-onset nephrotic syndrome (NS) as minimal change disease is more common in younger children. There is a paucity of data regarding the clinical course and renal histopathological findings in this population. This study analyzed the clinical course and histological spectrum of adolescent-onset NS. 

Materials and Methods: In this retrospective study, we evaluated the medical records of patients with adolescent-onset NS who received treatment at the Department of Pediatrics, SVPPGIP & SCB Medical College, Cuttack, Orissa, India, between January 2010 and January 2017. Patients with congenital, infantile, childhood-onset, and secondary causes of NS were excluded. All children were treated as per the Indian Society of Pediatric Nephrology (ISPN) protocol.

Results: The data of 48 adolescents were analyzed. The median age at onset of disease was 12 years (range: 10-14 years), and 68.75% (33/48) of the patients were males. Steroid-dependent NS (SDNS, 43.7%, 21/48) was the most common clinical course followed by frequently relapsing NS (FRNS, 29.1%, 14/48). Prednisolone with tacrolimus (37.5%, 18/48) and mycophenolatemofetil (35.4%, 17/48) were the most commonly used treatments. Biopsy results showed that minimal change disease (MCD) was the most common histopathological subtype (37.5%, 18/48) closely followed by focal segmental glomerulosclerosis (FSGS, 31.2%, 15/48). Most of the cases responded to a combination of prednisolone with either MMF, cyclophosphamide, or tacrolimus (23%).

Conclusions: The most common underlying cause of adolescent-onset nephrotic syndrome as assessed histopathologically is MCD, closely followed by FSGS with most of the cases responding to a combination of prednisolone with either mycophenolatemofetil, cyclophosphamide or tacrolimus.

Keywords: Adolescent-onset nephrotic syndrome; Minimal change disease; Focal segmental glomerulosclerosis; Steroid; Histopathology.

Mycophenolate Mofetil versus Cyclosporine in Children with Frequent Relapse Nephrotic Syndrome

Md Azizur Rahman, Golam Muinuddin, Md Habibur Rahman, Ranjit Ranjan Roy, Afroza Begum, Syed Saimul Huque, Tahmina Jesmin

Journal of Pediatric Nephrology, Vol. 6 No. 1 (2018), 4 May 2018 , Page 1-6
https://doi.org/10.22037/jpn.v6i1.20904

Introduction: Children with frequently relapsing nephrotic syndrome (FRNS) frequently develop adverse effects of prednisolone and attempts to induce long term remission in such patients have varying degree of success.

 

Materials & Methods: We conducted a randomized clinical trial in a tertiary care level hospital to compare the efficacy and safety of a 1 year treatment with mycophenolate mofetil (MMF) and Cyclosporine (CsA) in 60 pediatric patients with FR-SSNS during one year period. We assessed the frequency of relapse as the primary end point and evaluated clinical and laboratory profile after 3 and 6 months of treatment.

 

Results: Mean number of relapse was 1.50 ± 1.44 in MMF group and 0.72 ± 1.30 in CsA group at 6 months (p=0.045). Diarrhoea was statistically significant in MMF group. Hypertrichosis & hypertension were statistically significant in CsA group. There was no significant difference between groups with Hb levels, lipid profile, eGFR.

 

Conclusion: The result of the study showed MMF is inferior to CsA in preventing relapse in patient with FRNS but less nephrotoxic.

Case Reports


Vancomycin Induced Eosinophilic Peritonitis, A Case Report

Nakysa Hooman, Fariba Jahangiry, Mina Asdaghi, Leila Ghafari

Journal of Pediatric Nephrology, Vol. 6 No. 1 (2018), 4 May 2018 , Page 1-3
https://doi.org/10.22037/jpn.v6i1.20914

Drug induced peritonitis is a rare but important complication of CAPD. Hereby, we report a case that developed eosinophilic peritonitis during intraperitoneal administration of vancomycin. With a suspicion of vancomycin-induced eosinophilic peritonitis, vancomycin was discontinued. Antihistamine started and the PD effluent two days after stopping the drug revealed a WBC count of 85/µl (10% Eosinophil, 71% Lymphocytes). Systemic signs improved dramatically in less than a week. In conclusion, drug induced peritonitis should be considered in different diagnosis of each patient on CAPD before considering administering another new antibiotic.

Keywords: Vancomycin; Peritonitis; Allergy and Immunology; Child. 

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