Original Research Papers


Evaluation of Acute Kidney Injury and Its Risk Factors in Children Admitted with Diagnosis of Nephrotic Syndrome

Anita Kumari, Lehar Sahai, Sanjay kumar, Ruchika Bhatnagar

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021, Page 1-7
https://doi.org/10.22037/jpn.v9i4.35143

Background and Aim: Acute Kidney Injury (AKI) is an important complication of Nephrotic Syndrome (NS) associated with adverse outcomes. The frequency of AKI has increased to almost double in the last decade. This study was conducted to determine the incidence of AKI, risk factors, and its association with outcomes in hospitalized children with NS.

Methods: All children aged 1-18 years with a diagnosis of NS from 01 November 2018 to 31 May 2020 were enrolled in the study. AKI was diagnosed using the KIDIGO 2012 guidelines and classified according to the pediatric RIFLE definition.

Results: The mean age of the children was 4.7± 2.8 years. Complications were observed in 67% of the cases. The most frequent complication was anemia (25%) followed by infection (21%). The incidence of AKI was 18.6% in hospitalized children with NS.  According to the pRIFLE criteria, 11.6% of the children met stage 1 (risk) criteria, 4.6% met stage 2 (injury) criteria, and 2.3% met stage 3 (failure) criteria. Among all NS children, 53% received nephrotoxic drugs during the hospital stay. On applying multivariate logistic regression analysis, only male gender, associated anemia, and vancomycin use were significant independent risk factor for AKI in nephrotic syndrome patients.

Conclusion: AKI is more frequent in the first episode of NS rather than in any type of relapses. Although nephrotoxic drugs and male gender are known independent risk factors for development of AKI, associated anemia is still not considered as an independent risk factor for AKI in children with NS.

Long-Term Outcome of Kidney Transplantation in Children According to Type of Transplantation in Mashhad, Iran

Yalda Ravanshad, Alireza Ghodsi, Mohaddeseh Golsorkhi, Anoush Azarfar, Sahar Ravanshad, Samaneh Heidarzadeh, Hamidreza Ghodsi, Aida Tasbandi

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021, Page 1-5
https://doi.org/10.22037/jpn.vi.34617

Background and Aim: Kidney transplantation is the preferred treatment modality for end-stage renal disease (ESRD) in children. Despite its benefits and advances that have been accomplished, pediatric kidney transplantation remains a challenge in terms of achieving a satisfactory outcome. We sought to evaluate the outcome of pediatric kidney transplantation in Mashhad.

Methods: Data were acquired retrospectively from children below 18 years old who underwent kidney transplantation in three main hospitals of Mashhad from 2000 to 2014. After obtaining written informed consent from parents, data were collected using a questionnaire and analyzed with the SPSS software.  

Results: Of 52 children, 51.9% were boys and 48.1% were girls with a mean age of 13.3 ± 4.3 years. Among them, 8 (15.4%) children received transplants from relative live donors, 16 (30.8%) from non-relative live donors, and 28 (53.8%) from deceased donors. The most common etiology leading to ESRD in these children was reflux nephropathy in 18 (34.6%) patients. After a 5-year follow-up period, the graft survival rate was 69.2% with infection being the most common cause of transplant rejection. Moreover, 13.5% of children died, mostly due to surgical complications.

Conclusion: We found that to increase the survival rate of pediatric kidney transplantation in Mashhad, first the surgical methods should be enhanced as they were recognized as the most common cause of death. In addition, infection control in children, as the most common cause of transplant rejection, should be improved.

Proportion of urinary tract infection in neonatal sepsis

Parvez Ahmed, Mohd Ashraf, Syed Ashiq Nisar Andrabi, Asma wani, Sayar Ahmed Bhat, Naseer Yousuf Mir

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021,
https://doi.org/10.22037/jpn.v9i4.35709

Background: Urinary tract infection (UTI) in neonates might be associated with bacteremia and congenital anomalies of the kidney and urinary tract (CAKUT), that in complicated situations can lead to renal parenchymal scarring and chronic kidney disease. Aim: To determine occurrence of UTI in neonatal sepsis. Methods: This cross sectional study was conducted on 500 term, extramural hospitalized neonates, suspected to have infection underwent, a detailed history, physical examination and a comprehensive sepsis workup. The diagnosis of neonatal UTI was based, on positive urine culture, obtained by suprapubic aspiration (SPA).  Results: Out of 500 neonates included in our study (324 boys and 176 girls), blood culture was positive in 84 (36.5%) neonates in early-onset sepsis group (n=230), while in late-onset sepsis group (n=270) blood culture was positive in130 (48.1%), p-value < 0.05. In both early-onset sepsis (EOS) and late-onset sepsis (LOS) groups, blood culture was found to be positive in a greater proportion of male (41.3%) than female (29.3%) patients, p-value <0.05.  The most common organism isolated from blood and urine culture was Klebsiella, followed by E-coli. Urine culture was positive in 34 (6.8%) patients, among whom 29 (85%) culture-positive cases were from the LOS group, a p-value of <0.05.  Conclusions: UTI is not uncommon among the hospitalized neonates, and UTI evaluation among septic neonates can prove beneficial for the prevention of long-term sequelae of neonatal UTI.

Short-Term Outcomes of Pediatric Renal Transplantation in Nigeria; A Single-Center Experience

Emmanuel Ademola Anigilaje, Olalekan Olatise , Maduadi Kextero, Igbokwe Martins

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021, Page 1-9
https://doi.org/10.22037/jpn.v9i4.35429

Background and Aim: Renal transplantation (RT) is the preferred treatment modality for children with end-stage kidney disease (ESKD). Unfortunately, RT remains inaccessible for children with ESKD in resource-constrained countries. This case-series describes a short-term follow-up of RT in three children in the Zenith Medical and Kidney Centre (ZMKC), Abuja, Nigeria. 

Methods: The immediate allograft function (IAF), allograft functions and recipients’ survival at 6-24 months of follow-up of three pediatric ESKD patients from January 2018 to January 2020 were described. Allograft functions were assessed using serum creatinine and Doppler ultrasound scan. RT involved the use of basiliximab and thymoglobulin for induction therapy and oral prednisolone, tacrolimus and mycophenolate mofetil for maintenance immunosuppressive therapy. 

Results: Recipients including two males and one female were 9-17 years (mean age: 12 years). Primary steroid-resistant focal segmental glomerulosclerosis nephrotic syndrome, congenital posterior urethral stricture and lupus nephritis were the causes of ESKD in recipients seen over 24 months, 6 months, and 6 months, respectively. The female recipient had lupus nephritis. The IAF was excellent in all the cases. All the three children are alive with good allograft functions at the end of their respective follow-up period. 

Conclusion: This case-series showed that a successful pediatric RT program is feasible in a resource-constrained setting like Nigeria.

Comparison between the prevalence of iron deficiency anemia in children with urinary tract infections and without urinary tract infections in Hazrat Masoumeh Hospital of Qom in 2019-2020

Mohammad Reza Razavi, Mohsen Akhavan Sepahi, Kamal Eshagh Hoseini, Amir Hamta, Mohammad Ali Shariatifar

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021, Page 1-5
https://doi.org/10.22037/jpn.v9i4.35847

Background and Aim: Research into the association between anemia and urinary tract infections (UTIs) is not adequate and only a few studies are available in this regard. Therefore, the aim of this study was to investigate the relationship between iron deficiency anemia and urinary tract infections in children presenting to Hazrat Masoumeh Hospital, Qom, Iran.

Methods: The medical records of pediatric patients with and without UTI hospitalized in Qom Hazrat Masoumeh Hospital were evaluated.  Then, the anemia profile was evaluated in the two groups (e.g. hemoglobin, ferritin, transferrin, etc.)

Results: There were 32 patients (64%) in the urinary tract infection group and 26 patients (52%) in the non-urinary tract infection group. Twenty-eight patients (56%) in the urinary tract infection group and 20 patients (40%) in the non-urinary tract infection group had iron deficiency anemia, but no significant relationship was found between the two groups (P value = 0.08). The mean hemoglobin concentration was 11.19 ± 1.73 in patients with urinary tract infection and 11.56 ± 1.89 in the non-infected group. Regarding anemia profile variables, no significant relationship was found between the two groups (P values: Hb = 0.15 SI = 0.21 TIBC = 0.90 Ferritin = 0.05 Transferrin sat = 0.132).

Conclusion: No statistically significant difference was found in anemia between the two groups of children with and without urinary tract infections. However, the indicators of anemia were lower in children with urinary tract infections compared to the control group and these children are prone to anemia.

Prevalence of renal complications of levetiracetam in neonates with seizures in Qom from 2015 to 2020

Alireza Saadati, Mohsen Akhavan Sepahi, Masoud Hassanvand Amouzadeh, Amir Hamta , Shahab Ahmadi

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021, Page 1-5
https://doi.org/10.22037/jpn.v9i4.35762

  Introduction: Spasms or seizures during the first month of life are the most common clinical manifestations of central nervous system failure in infants and occur due to overactivity of a group of nerve cells in the brain and excessive electrical stimulation of neurons. The purpose of the present study was to evaluate the prevalence of renal complications of Levetiracetam in neonates with seizures.

Methods: This descriptive-analytical and retrospective study was performed on creatinine level, blood urea and duration of levetiracetam use for all neonates studied and only renal ultrasound was performed for cases where their creatinine was elevated. Finally, the obtained information was used for statistical analysis.

Results: According to the results, there was no statistically significant differences in neonatal subgroups,   especially in infants on levetiracetam, except transient increased creatinine and urea. During 6 months follow-up, only three cases with increased creatinine above 1.4 was observed. This 3 cases had normal genitourinary ultrasound.  Also, in neonates diagnosed with choroid cyst on ultrasound, in one case the creatinine level was more than 1.4 and in the other cases the serum creatinine level was less than 1.4.

Conclusion: According to the results of the present study, no serious renal complication was observed with Levetiracetam and its use can be recommended for patients.

Efficacy of Potassium Citrate Solution in the Treatment of Renal Microlithiasis in Children 1 Month to 15 Years-old

Saeed Mohajeri, Elham Emami, Roya Choopani, Afsaneh Malekpour, Razieh Mousavi

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021, Page 1-4
https://doi.org/10.22037/jpn.v9i4.34884

Abstract

Background and objective: The present research aims to determine efficacy of potassium citrate solution in the treatment of renal microlithiasis in children one month to 15 years old in   Shahrekord Pediatric Nephrology Clinic.

Methodology: In this clinical trial study, 60 children aged 1 month to 15 years referred to Shahrekord Pediatric Nephrology Clinic who had one or two (microlithiasis) less than 3 mm in ultrasound; They were included in the study by available sampling. Children were randomly divided into 2 groups receiving placebo (water) and receiving potassium citrate solution. After 3 months, the number and size of stones and the consequences of stones were recorded in both groups and analyzed using SPSS software and relevant statistical tests.

Results: Out of 60 children studied, 34 were male (56.7%) and 26 were females (43.3%) with a mean age of 61.62 47 47.54 months. After 3 months of intervention, the mean number and size of stones in each group had a significant decrease (P <0.001) and this amount was lower in the group receiving potassium citrate than the group receiving placebo, but this difference was not statistically significant (<0.05). P). Also, the consequences of kidney stones in both groups were similar and there was no significant difference (P <0.05).

Conclusion: The results of this study showed that potassium citrate solution has no effect on the treatment of one or two microlithiasis in children and in these patients the use of supportive therapy is still sufficient.

Keywords: Kidney stones, Microlithiasis, Children, Potassium citrate

Case Reports


Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis is a type of systemic autoimmune disease with blood vessels swelling and inflammation. Wegener's Granulomatosis (WG) is closely associated with antineutrophil cytoplasmic autoantibodies, particularly those directed to proteinase 3 (PR3). An 18-year-old boy with granulomatosis with polyangiitis (GPA) who was diagnosed 6 months back with scleritis and sinusitis at the onset of the disease. During his initial visits to Ear Nose Throat and ophthalmology departments lab tests was not performed on time due to lack of typical symptoms of kidney involvement. Half a year later, lab tests showed PR3-ANCA (Proteinase 3) positive and advanced renal dysfunction, and was finally diagnosed as sclerotic renal failure with fibrotic crescents based on renal biopsy. Scleritis may be the earliest manifestation in systemic vasculitis and is sometimes hard to diagnose at the onset. Delayed diagnosis and treatment will lead to irreversible renal dysfunction.

Bilateral Nephromegaly in a Child with Severe Iron-Deficiency Anemia

Danna Weizmann, Dominique S Genest, Catherine Litalien, Geneviève Benoit

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021, Page 1-3
https://doi.org/10.22037/jpn.vi.34772

Nephromegaly in childhood can result from a wide variety of causes, yet iron-deficiency anemia has not been previously described. We report a child with severe iron-deficiency anemia associated with transient bilateral nephromegaly. We hypothesize that increased renal production of erythropoietin as well as greater cardiac output with subsequent glomerular hyperfiltration secondary to critical anemia explained the observed nephromegaly. The normalization of kidney size following resolution of anemia supports this hypothesis. Our case report suggests an additional etiology of bilateral nephromegaly in the pediatric population and thus merits attention among physicians.

A Ten-Month Infant with Bladder Botryoid Sarcoma

Thirunavukkarasu Arun Babu, Padmapriya Balakrishnan, Vijayan Sharmila

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021, Page 1-3
https://doi.org/10.22037/jpn.v9i4.35638

Bladder tumors resulting in voiding difficulty in a child are rarely
encountered in clinical practice. There are various investigations that
help with preoperative diagnosis of bladder tumors and a systematic
approach is needed to draw an early diagnosis. We report a case of
the botryoid variant of rhabdomyosarcoma of the bladder in an infant
that presented with complaints of a lower abdominal mass, poor
urinary stream for three months and hematuria for one month.

Persistent Left Superior Vena Cava in a Hemodialysis Patient

Reza Dalirani, Mahbubeh Mirzaee, Paniz Porpashang, Atena Seifi

Journal of Pediatric Nephrology, Vol. 9 No. 4 (2021), 10 Aban 2021, Page 1-3
https://doi.org/10.22037/jpn.v9i4.38282

We report a case of end-stage renal disease with a persistent left superior vena cava (PLSVC) after placement of hemodialysis (HD) catheter through the left internal jugular vein as revealed on routine post-procedure chest X-ray. The diagnosis of PLSVC was confirmed by echocardiography and thorax computed tomography. This anomaly is rather rare, and few studies have evaluated the safety of PLSVC for HD. The catheter was used for 2 months under careful continuous monitoring with no complications. Physicians who place HD catheters in the left jugular/subclavian vein should be aware of the possibility of PLSVC.

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