Original Research Papers

Kidney Size Assessment in Children with Severe Acute Malnutrition Under 5 Years of Age: A Comparative Stud

Praveen Kumar, Smita Gupta, Amar Jeet Mehta, Vivek Kumar Athwani

Journal of Pediatric Nephrology, Vol. 9 No. 3 (2021), 4 September 2021 , Page 1-7

Background and Aim: Malnutrition is a common disorder worldwide. Growth of visceral organs is affected by various factors including nutrition. Kidney size is an important parameter to assess renal growth. Kidney size in malnourished children is not well studied. We compared kidney size between severe acute malnourished (SAM) and normal children.

Methods: This prospective case control study was carried out at a tertiary care center in North India. Children with SAM (n=124) were enrolled as cases and 86 age and sex matched healthy children were enrolled as controls. All children were subjected to anthropometric and sonographic kidney size measurement. Various renal size parameters were compared between cases and controls. Linear correlation coefficients of kidney dimensions with anthropometric parameters were derived. P-values <0.05 were considered significant.

Results: The kidney length was significantly lower in malnourished cases compared to healthy controls. There was no difference in renal width and combined kidney volume (CKV) between the two groups. However, renal depth, combined relative kidney volume, CKV/body height ratio, and CKV/BSA ratio were significantly higher in malnourished child compared to healthy controls. Kidney size parameters (kidney length, width, depth, CKV) had significant correlations with anthropometric measurements in both groups but the correlations were stronger in healthy controls compared to malnourished children.

Conclusion: Malnourished children had a significantly smaller kidney length. This point should be remembered while evaluating kidney size in these children to avoid unnecessary invasive investigations.

Evaluation of Graft Outcome and Patient Survival in Children after Renal Transplantation: A Single Center Experience

Hadi Sorkhi, Abazar Akbarzadeh pasha, Farshid Oliaei , Mohammad Mahdi Rajabpour, Mustafa Taghavi

Journal of Pediatric Nephrology, Vol. 9 No. 3 (2021), 4 September 2021 , Page 1-5

Background and Aim: Quality of life has been improved by kidney transplantation (KT), especially in pediatric patients. Children have a higher risk of rejection and graft loss compared to adults. It is important to determine the pediatric graft outcome and prevent early graft loss, if possible. This study was done to evaluate graft and patient survival in pediatric patients after kidney transplantation.

Methods: This cross-sectional study was done on all children below 18 years old that underwent kidney transplantation in Shahid Beheshti Kidney Transplant Center. Sex, time of transplantation, serum creatinine, acute rejection, viral infection (cytomegalovirus), and graft survival and patient survival were recorded.

Results: Fifty-eight patients underwent kidney transplantation. The mean serum creatinine level was 0.89±0.88 mg/dl, 0.7±1.29 mg/dl, 058±0.92 mg/dl, 0.9±0.83 mg/dl and 1.32±0.91 mg/dl on day 1, 2, and 3 post KT, discharge day, and the last follow-up visit, respectively. Graft survival was 93.1%, 89.5% and 86.5% at 1, 5 and 10 years, respectively. During the study, five patients expired and therefore patient survival was 99.6%, 92.3% and 92.3% at 1, 5 and10 years, respectively.

Conclusion: This study, compared to other studies, showed that the graft and patient survival were acceptable. More attention should be paid to improve the outcome.

Comparative Study of the Efficacy of Oral and Intravenous Acetaminophen in Closure of Patent Ductus Arteriosus of Preterm Neonates

Semira Mehralizadeh, Shadi Adib, Mandana Kashaki, Atefe Talebi

Journal of Pediatric Nephrology, Vol. 9 No. 3 (2021), 4 September 2021 , Page 1-7

Background and Aim: Patent ductus arteriosus (PDA) is a condition in premature infants that can cause dangerous complications such as renal dysfunction, intracerebral hemorrhage, necrotizing enterocolitis, and pulmonary dysplasia. This study was conducted to compare the efficacy of oral and intravenous acetaminophen in PDA improvement in preterm infants.

Methods: This randomized clinical trial study was performed on 100 children. The patients were randomly divided into two groups. Group A received intravenous acetaminophen and group B was treated with oral acetaminophen  for three consecutive days. Echocardiography was performed before and 3 and 6 days after the intervention.  

Results: Before the intervention, the prevalence of a small PDA was 72% and 76% and the prevalence of a large PDA was 28% and 24%, in group A and B, respectively. The second echocardiography showed a significant PDA improvement in both groups (p<0.001). The third echocardiography showed that all patients (100%) in the oral acetaminophen were treated while only three patients (6%) in the IV acetaminophen group had a large PDA. Intravenous injection of acetaminophen significantly decreased LA/AO (Left Atrial/Aortic root diameter) ratio from 1.46 to 1.27 (p=0.043). Similarly, oral acetaminophen declined LA/AO ratio from 2.0 to 1.30 (p=0.018). At the end of the second course of treatment, the prevalence of complete cure was 100% and 94% in groups A and B, respectively.

Conclusion: Oral administration of acetaminophen improved PDA treatment without any adverse effects. Therefore, IV injection of acetaminophen can be replaced with oral acetaminophen for management of PDA in preterm infants.

Prognostic Role of Gestational Age and Birth Weight in Nephrotic Syndrome: A Retrospective Cross-Sectional Study

Khadijeh Ghasemi, Sahar Montazeri, Amirhossein Mokhtari

Journal of Pediatric Nephrology, Vol. 9 No. 3 (2021), 4 September 2021 , Page 1-5

Background and Aim: Nephrotic syndrome (NS) is a common disease in children characterized by proteinuria, hypoalbunemia and hyperlipidemia. In some cases, NS is resistant to steroid therapy and may have frequent relapses. The aim of this study was to determine the prognostic role of gestational age and birth weight in the clinical outcomes of NS.

Methods: This retrospective cross-sectional study was conducted on 77 patients. The patients’ data such as history of relapse and steroid resistance, birth weight, gestational age, and pathological variant were collected. Data was analysed using the SPSS software.

Results: Twenty-three patients were females and 54 were males. There was no significant association between the number of recurrences and premature birth (P value= 0.99). Mann-Whitney U test showed no significant difference between birth weight of patients who recurred less than two times during six months and those who recurred more than two times in six months (P= 0.336).  Besides, Fisher’s exact test showed no significant association between premature birth and the chance of developing steroid resistance (P value = 0.643). Moreover, there was no significant association between birth weight and steroid resistance (P-value = 0.768).

Conclusion: Low birth weight and premature birth did not have a role in the prognosis of nephrotic syndrome in our study population. Other factors including uterine-placental disorders, maternal underlying diseases, quality of weight gain in the first years of life, and ethnicity should also be examined in further investigations including larger samples of different ethnic groups.

Comparative Study of Prophylactic Antibiotic Twice a Week Versus Every Night in Recurrent Urinary Tract Infections in Children

Amin Taheri, Anoush Azarfar, Yalda Ravanshad, Azade Sahebkari

Journal of Pediatric Nephrology, Vol. 9 No. 3 (2021), 4 September 2021 , Page 1-5

Background and Aim: Urinary tract infection is one of the most common childhood diseases. The results of studies investigating discontinuation or continuation of antibiotics in children with recurrent urinary tract infections and urinary reflux are controversial. Therefore, this study was conducted to compare prophylactic antibiotic treatment twice a week versus every night in the recurrence of urinary tract infections in children.

Methods: This clinical trial was conducted using non-random simple sampling. Group A was given a single daily dose of cephalexin 10 mg/kg and group B was given cotrimoxazole at a dose of 5 mg/kg. Both groups were followed for ten months. Recurrences of urinary tract infections were compared between the two groups.

Results: The mean age of the participants was 3.53±2.04 years. Most of the subjects were female (n=37, 61.7%). Urinary reflux was unilateral in 65% of the cases (n=39) and bilateral in the rest. There was no significant difference in age distribution, sex, and type of reflux between groups A and B. The frequency of recurrent urinary tract infection was 8.3% in group A and 6.7% in group B indicating no significant difference (p = 0.500).

Conclusion: The results of this study showed that the frequency of recurrence of urinary tract infections in children who received prophylactic antibiotic treatment twice a week was not significantly different compared to the group of children who received continuous antibiotic prophylaxis.

Case Reports

Wegener's Granulomatosis Vasculitis and Granuloma: A Case Report

Mona Nasiri, Anoush Azarfar, Yalda Ravanshad, Malihe Saberafsharian , Sepideh Seyedkaboli

Journal of Pediatric Nephrology, Vol. 9 No. 3 (2021), 4 September 2021 , Page 1-3

A 13-year-old girl was admitted to our hospital because of fatigue, oliguria, and edema of lower extremities. Her laboratory workup showed an acute renal failure (BUN= 225 mg/dl, Creatinine= 13.25 mg/dl). She also had a massive proteinuria.

A renal biopsy showed cellular crescentic glomerulonephritis and positive C-ANCA. The serum Creatinine level decreased after treatment with high-dose methylprednisolone, rituximab and plasmapheresis. She did not require dialysis.

This is a report of a rare case of GPA presenting with 100% cellular crescentic glomerulonephritis.

Coronavirus disease 2019 (COVID-19) may present as acute abdomen although the pathophysiology remains obscure. This is a report of an 11-year-old boy, presented to the emergency department at our hospital with myalgia and gastrointestinal symptoms including non- bloody diarrhea and abdominal pain associated with nausea and intractable vomiting during the course of the disease. He also had a fever and dry cough.

On initial evaluation, his vital signs were unremarkable. Oxygen saturation was 92% in the room air. His temperature was 38˚C and his respiratory rate was 17/min. An initial physical examination showed abdominal tenderness in the right lower quadrant. Laboratory analysis revealed leukocytosis and a high ESR and CRP. Therefore, he underwent appendectomy and was discharged after a few days in good condition by observing health protocols.

Hemolytic Uremic Syndrome Following Influenza A (H1N1) pdm09 Virus in a 14-Month-Old Girl

Sema Yıldırım Arslan, İpek Kaplan Bulut, Can Balkan, Sait Şen, Candan Çiçek, Süleyman Caner Kabasakal

Journal of Pediatric Nephrology, Vol. 9 No. 3 (2021), 4 September 2021 , Page 1-5

Hemolytic Uremic Syndrome (HUS) is characterized by the clinical triad of microangiopathic non-immune hemolytic anemia, thrombocytopenia, and acute renal failure. There are infections, genetic causes, malignancies, autoimmune diseases, drugs, and many unexplained causes in the etiology of HUS. The most common cause of HUS in children is Shiga toxin-producing Escherichia coli (STEC). In the literature, few influenza A (H1N1) pdm09 virus-related HUS cases are reported. In this case report, a case with hemolytic uremic syndrome associated with influenza A (H1N1) pdm09 virus infection is presented.

Cerebral Salt Wasting Syndrome: A Complication of Meningitis in Hydrocephalus with VP Shunt

Pallavi Wadhawan, Prithi Inamdar, Rajdeep Pal, Neelu Elon, Rajesh Rai

Journal of Pediatric Nephrology, Vol. 9 No. 3 (2021), 4 September 2021 , Page 1-5

Cerebral salt wasting syndrome (CSWS) is an important cause of persistent hyponatremia in children admitted to the intensive care unit. It needs to be promptly differentiated from the syndrome of inappropriate antidiuretic hormone (SIADH) secretion as a cause of hyponatremia in pediatric neurological patients. These two entities often have similar presenting symptoms however the treatment of both can be drastically different, which makes the distinction critical. We present a 6-month-old male child with hydrocephalus secondary to aqueductal stenosis, a blocked VP shunt, meningitis, and hyponatremia. A diagnosis of CSWS was considered and fludrocortisone was started. The patient improved gradually with a reduction in urine output and a gradual increase in serum sodium levels. A diagnosis of CSWS should be strongly considered in hyponatremic pediatric patients with significant natriuresis and suitable treatment should be initiated promptly to prevent long-term neurologic sequelae.

Anaplastic Wilms’ Tumor Mimicking a Rhabdoid Tumor: A Diagnostic Challenge

Smita Singh , Kiran Agarwal , Amrita Anand , Neha Suman

Journal of Pediatric Nephrology, Vol. 9 No. 3 (2021), 4 September 2021

Rhabdoid tumor of the kidney (RTK) mimics other renal tumors
histologically, but a rhabdoid tumor mimicking an anaplastic Wilms’
tumor has been rarely reported. Wilms’ tumor classically comprises
three histological components, including a blastema, epithel
ium, and stroma. The degree of maturation of these components makes the
histological appearance of this tumor unique. Anaplasia is defined by
the presence of extreme nuclear and mitotic atypia. Most of these
lesions can be differentiated on the basis of light microscopic
histological investigations. Herein we report a case of pediatric
anaplastic Wilms’ tumor that was difficult to differentiate from a mesenchymal lesion histologically.
The application of immunohistochemistry and extensive sampling of the lesion was critical for accurate diagnosis.
Wilm’s Tumor; Child; Rhabdoid Tumor.