Original Research Papers

Intra-Dialysis Hypotension in Patients Undergoing Hemodialysis

Mitra Naseri, Anoush Azarfar, Zahra Rasuli

Journal of Pediatric Nephrology, Vol. 6 No. 3 (2018), 19 February 2019 , Page 1-9

Introduction: Intra-dialysis hypotension occurs in 20- 55% of hemodialysis sessions. We aimed to define the prevalence and impact of pre-dialysis blood pressure, inter-dialysis weight gain, vasodilator agents, and characteristics of dialysis, serum calcium, and adjusted calcium, sodium, and albumin levels on intra-dialysis hypotension.

Materials and Methods: In an observational prospective study, 44 hemodialysis cases aged 4.8-25 years were evaluated in 552 dialysis sessions. A decrease in the mean arterial blood pressure ≥ 10 mm Hg was defined as intra-dialysis hypotension. The characteristics of the patients were compared between cases and those without intra-dialysis hypotension.

Results: Intra-dialysis hypotension was noted in 61.4% of the cases and 24.6% of the dialysis sessions. The duration of hemodialysis, weight gain between dialysis sessions, using vasodilator medications, serum sodium and adjusted calcium levels were compared between IDH + and IDH cases. No significant differences were found in these variables between the 2 groups (P> 0.05 for all). Intra-dialysis hypotension was significantly more prevalent in cases with normal versus high systolic and diastolic blood pressure (P=0.014 and P=0.005 respectively). Intra-dialysis hypotension was significantly more frequent in girls, anuric patients, and patients with a history of transplantation (p=0.022, 0.011 and 0.008 respectively). A Significantly lower serum albumin concentration was found in cases with intra –dialysis hypotension (P=0.021).

Conclusions: Intra-dialysis hypotension is a common complication of hemodialysis and is more prevalent in girls, normotensive patients, subjects with lower serum albumin concentrations, cases with a history of transplantation, and anuric patients.

Keywords: Hemodialysis; Blood Pressure; Hypotension; Serum Albumin; Serum Calcium.

Hypospadias Repair Using Transverse Preputial Island Flap (Modified Asopa Procedure)

Abhijeet Patil, Amit Sharma, Narsing Mane, Sandesh Parab, Mukund Andankar, Hemant Pathak

Journal of Pediatric Nephrology, Vol. 6 No. 3 (2018), 19 February 2019 , Page 1-7

Introduction: The modified Asopa's procedure for repair of hypospadias is well established and suited for patient characteristics for which Snodgrass urethroplasty cannot be done. We describe our experience with this procedure in 30 patients managed with this procedure highlighting the factors affecting outcome in this repair.

Materials and Methods: Data of 30 patients (age range 2.5-15 years) who underwent hypospadias repair in a tertiary care teaching institution from 2012 to 2015 with modified Asopa procedure (Hodgson XX technique) utilizing Transverse Preputial Island Flap by a single surgeon were reviewed and retrospectively analyzed according to age of patients, site of meatus, presence or absence or chordee, glans configuration and complications - fistula, glans dehiscence, meatal stenosis. These complications were further analyzed with respect to the various patient characteristics and GMS (Glans, Meatus and Shaft) score.

Results: The mean age of presentation was 5.5 years and mean follow-up period was 22 months. The mean total GMS score was 8.5; range being 11 to 5. In total, only six patients had complications (20%). The patients with low GMS score (7 or less) had no complications. The complication rate was more in proximal hypospadias repair (n= 5/24) when compared with distal hypospadias (n=1/6). There were more complications in patients with chordee (n=4/6) and those with conical glans (n=4/6).

Conclusion: Location of the meatus, presence/absence of chordee and glans configuration affect outcome in patients undergoing modified Asopa's procedure for hypospadias repair.

Keywords: hypospadias; Asopa's procedure; Child; Complications; Outcome.

High Volume Center Experience for Recurrent Primary Disease in Kidney Transplanted Pediatric

Azadeh Afshin, Mostafa Sharifian, Naser Simfroosh, Abbas Basiri, Saran Lotfollahzadeh, Nasrin Esfandiar

Journal of Pediatric Nephrology, Vol. 6 No. 3 (2018), 19 February 2019 , Page 1-7

Introduction: Over the past 3 decades, kidney transplantation has been recognized as the treatment of choice for children with End Stage Renal Disease (ESRD) and stage 5 of chronic kidney disease (CKD). One of the most important drawbacks to this treatment is the recurrence of the primary disease in the transplanted kidney, which is considered the third most common leading cause of graft failure.

Materials & Methods: In this study, the data of 550 patients below 18 years who underwent kidney transplantation during a 33-year period from 1985 to 2017 due to kidney failure or ESRD were included to fill out a standard questionnaire. Those who suffered from primary disease relapse were included in the study to investigate the association of relapse with factors such as gender, age, and donor type, time to relapse with type of disease, and post-transplant immunosuppressive drugs with severity of pre-transplant kidney injury.

Results: Of 31 pediatric patients with primary disease recurrence (out of 550 transplanted kidney), 62.5% were male with a mean age of 10.55 (± 0.665) years. Totally, 10 cases showed recurrence of the primary disease 18 (± 22.95) months after transplantation on average. The final status of these 10 patients was significantly undesirable compared with that of the other 21 patients without recurrence (p= 0.002). Of these 10 patients, 8 had graft failure.

Conclusion: The results of this report confirm the necessity of follow-up considering the importance of the recurrence of the primary disease, especially FSGS, in children after kidney transplantation.

Percutaneous Nephrolithotomy in Pediatric age Group: Our Experience

Amit Sharma, Sandesh Parab, Gaurav Goyal, Sudarshan Jadhav, Mukund Andankar, Hemant Pathak

Journal of Pediatric Nephrology, Vol. 6 No. 3 (2018), 19 February 2019 , Page 1-4

Introduction: Pediatric urolithiasis is an uncommon disease with incidence varying widely throughout the world. We present our experience in pediatric PCNL in 20 pediatric patients with urolithiasis.

Materials and Methods: Case records of all patients under 14 years of age who presented with urolithiasis from 2016 March to February 2017 were retrospectively reviewed and analyzed with respect to demographic details, clinical presentation, stone characteristics, PCNL puncture site, number, stone clearance, ancillary procedures used, complications, and follow-up status of the children. Associated biochemical abnormalities were also reviewed.  

Results: There were 25 renal units in 20 patients (5 had bilateral stones). The mean age at presentation was 8.4 years. There were 15 males and 5 females. The most common presenting symptom was flank pain (n=19/20).

There were solitary stones in 17 renal units: 2 stones in 6 renal units and multiple stones in 2 renal units. The average stone size was 1.5cm. Four patients had staghorn calculi. Five patients required two punctures of whom 3 had bilateral disease and 2 had staghorn calculi. The sheath used ranged from 18 Fr to 22 Fr. The nephrostomy tube and DJ stent were kept in all patients.

The duration of the procedure at a single site ranged from 45 minutes to 75 minutes. Complete clearance was achieved in 19 patients while one patient required bilateral URS. Three patients had mild fever post-operatively. None of the patients required blood transfusion. Hypocalcaemia was detected in 7 patients.

Conclusions: PCNL is safe and effective for treating urolithiasis in children.


Keywords: PCNL; Urolithiasis; Pediatric.

Prevalence of Nephrolithiasis in 7-11 year-old Students: A Multicenter Study

Elham Pourbakhtyaran, Masoumeh Mohkam, Abdollah Karimi, Mohsen Akhavan- Sepahi

Journal of Pediatric Nephrology, Vol. 6 No. 3 (2018), 19 February 2019 , Page 1-4

Introduction: Renal diseases can be asymptomatic even in progressive disorders; therefore, detecting urine and ultrasound abnormalities may help facilitate early diagnosis and prevention of renal diseases. This study was conducted to investigate random urine parameters and urinary system ultrasonography findings in 7-11 year-old students.

Materials and Methods: Healthy students from Tehran and Qom, Iran were enrolled in a prospective descriptive study and their sex, age, weight, height, and BMI were measured. Then, a fresh clean urine sample was collected and ultrasonography of the urinary tract was done. The urine specimen was tested for urine Ca/Cr, urine oxalate/Cr, and urine citrate/Cr.

Results: Of 932 students, 47.9% were female and 52.1% were male. The age range of the students was 7-11 years with a mean age of9.08 years. A history of renal disease and UTI was positive in 1.1% and 9.9% of the students, respectively. Ultrasound was normal in78% and abnormal in 22% of the students. Abnormal findings included hydronephrosis in 1.1%, fullness of the urinary tract in 0.1%, urinary system duplication in 3%, urolithiases in 0.7%, decreased kidney size in 0.4%, increased bladder thickness in 8.9%, and other abnormal findings in 7.8% of the subjects. Abnormal urine findings included hypercalciuria, in 10.9%, urine hyperuricosuria in 5.4%, urine hyperoxaluria in 12.8%, and hypocitraturia in 96.9% of the students.

Conclusions: According to the results, nephrolithiasis may be due to hyperoxaluria, hypercalciuria, and hyperuricosuria in a normal population. Genetics and nutrition are more important risk factors. Therefore, some nutritional interventions for decreasing urine oxalate, calcium, and uric acid may be beneficial.


Keywords: Urinalysis; Ultrasonography; Hypercalciuria; Hyperuricosuria; Hyperoxaluria; Child.

Special Reports

Suprapubic Aspiration under Ultrasound Guidance (Educational Video)

Afagh Hassanzadeh Rad, Hamidreza Badeli, Sahab Jamshidi

Journal of Pediatric Nephrology, Vol. 6 No. 3 (2018), 19 February 2019 , Page 1-2

Urinary Tract Infections (UTIs) are common diseases during infancy. Urine exam and urine culture are definite diagnostic methods. 

Based on the latest American Academy of Pediatrics guideline, Catheterization or Suprapubic aspiration (SPA) are the methods of choice for urine culture and analysis.