Reviews


Fluid Replacement Therapy in Different Medical Conditions in Children

Manijeh Tabrizi, Marjaneh Zarkesh, Mohsen Pourebrahimi, Seyyedeh Azade Hoseini Nouri

Journal of Pediatric Nephrology, Vol. 10 No. 1 (2022), , Page 1-6
https://doi.org/10.22037/jpn.v10i1.36447

Vascular access and Intravenous Fluid (IVF) administration are essential issues in children
who are admitted to the emergency wards. Despite the common use of maintenance IVF,
there are a lot of variations in fluid administration methods and no definite guidelines for IVF
and electrolyte monitoring. Because hypotonic fluids cause hyponatremia in many children,
isotonic fluids are indicated, according to recent studies, as an accepted method in pediatric
IVF therapy to prevent hyponatremia. This narrative review aims to provide an evidencebased
approach for selecting the most appropriate IVFs in patients aged 1 day to 18 years.
Data showed that the basis of fluid therapy in children varies according to the type of disease
and the underlying conditions of children. Depending on each case, the clinicians should
decide on what and how fluid and electrolytes be used.

Original Research Papers


Pediatric Renal Admission: Clinical Spectrum and Outcome, the Experience of Two Semi-urban, Secondary Hospitals in Cameroon

Denis Georges Teuwafeu, Alex Mambap, Frank Foin, Yolande Puepi, Ronald Gobina

Journal of Pediatric Nephrology, Vol. 10 No. 1 (2022), , Page 7-16
https://doi.org/10.22037/jpn.v10i1.36263

Background and aim: There is limited data on renal diseases in paediatric admissions in Cameroon. The aim was to describe the clinical spectrum and outcomes of renal diseases among admitted children in two regional hospitals in Cameroon.


 


Materials and Methods: we reviewed archived records of children admitted with renal disease from the 1st January 2017 to 31st December 2019 for renal diseases and outcomes.


Results: In all, 148 (1.98%) of the 7457 admitted children had a renal disease. Their median age was 7.5 years (IQR 4-12) and 63.5% were females with 32.4% less than 5years. Urinary tract infection (51.4%), Acute kidney injury (21.6%), Nephrotic syndrome (12.2%), chronic kidney disease (12.2%) and renal mass (2.6%) were frequently described. Complicated UTI was observed in 9.2% of children with UTI whereas initiation of corticotherapy (83.3%) was the most common reason for admission in children with nephrotic syndrome. Malaria (40.6%) and sepsis (40.6%) were the most common aetiology of AKI whereas chronic GN was the most common aetiology of CKD. Out of the 32 children with AKI, 50% had an indication for dialysis with 87.5% having access to the therapy. Nine (75%) of the 12 children with non-dialysed CKD-5 needed dialysis with 55.5% (5/9) having access to it. Out of the 148 children, 07 (4.7%) died. Deaths were due to AKI and CKD; with specific death rates of 12.5% and 16.7% respectively.


 


Conclusion: Renal diseases are uncommon among admitted children. Overall in-hospital mortality was low.

The Relationship Between Prenatal Hydronephrosis and Vesicoureteral Reflux in Children With a History of Prenatal Hydronephrosis in the Third Trimester of Pregnancy

Zahra Pournasiri, Abbas Madani, Pegah Moshki, Atena Seifi, Ramin Pouriran, Mohammad Amin Shahrbaf

Journal of Pediatric Nephrology, Vol. 10 No. 1 (2022), , Page 17-22
https://doi.org/10.22037/jpn.v10i1.36303

Background and Aim: Prenatal hydronephrosis is found in 1%-5% of pregnancies. Without
well-timed diagnosis and treatment, it can lead to irreversible outcomes. Because little
information is available on the indication of Vesicoureteral Reflux (VUR) regarding the
antenatal diameter of the kidney pelvis, the current study aimed to determine the association
between prenatal hydronephrosis and the VUR.
Methods: This cross-sectional study was conducted from 2011 to 2016 on 200 neonates
with hydronephrosis detected in fetal life ultrasounds in the third trimester of pregnancy.
We assessed the prenatal and postnatal kidney ultrasonography of 400 kidneys and Voiding
Cystourethrogram (VCUG). We employed the Spearman correlation coefficient for
determining the association between study variables. The obtained data were analyzed using
SPSS 16.0 software at a significance level of less than 0.05.
Results: Of 200 infants, 71.5% were males and 28.5% were females. No significant
relationship was found between the degree of antenatal hydronephrosis and the VCUG
severity (r=0.098, P=0.106). Despite antenatal hydronephrosis, the degree of postnatal
hydronephrosis and the VCUG severity was correlated (r= 0.255, P=0.001).
Conclusion: There is no correlation between the severity of fetal hydronephrosis and VUR
severity or the presence of a greater correlation between postnatal hydronephrosis and
degree of VUR. Thus in cases of mild prenatal hydronephrosis, we suggest urinary tract
ultrasonography three to seven days after birth and then cystography if postnatal sonography
showed moderate or severe or progressive hydronephrosis.

Background and Aim: Urinary tract infection is one of the most common infections in
childhood. The disease should not be overlooked because it has long-term complications such
as renal scarring and failure. We aimed to determine the relationships between radiological
findings in children under five years with acute pyelonephritis and its long-term complications.
Methods: In this retrospective study, we reviewed the medical records of all children
hospitalized with acute pyelonephritis in a two-year period. We studied, extracted, and
analyzed the imaging and demographic data of the patients.
Results: Out of 210 available cases, 54 children with acute culture-positive pyelonephritis
were included. All the included cases had undergone ultrasound, Radionuclide Cystogram
(RNC), Voiding Cystourethrography (VCUG) (for urinary reflux), and late DMSA
(Dimercaptosuccinic Acid) scintigraphy. We found that 46.2% had Vesicoureteral Reflux
(VUR), and 57.4% had an abnormal ultrasound, with hydronephrosis being the most
common finding (74.1%). We also found a significant correlation between ultrasound and
VUR (P=0.002). About 37% also had abnormal DMSA scintigraphy. However, in those with
normal ultrasound results, 20% suffered from VUR, with one being severe. Seven cases also
had abnormal DMSA scintigraphy.
Conclusion: We demonstrated that a normal urinary ultrasound does not rule out the
possibility of VUR or the risk of progression to renal parenchymal dysfunction and scarring.
Therefore, we suggest further utilizing the available radiologic techniques to diagnose and
minimize subsequent renal complications in the disease promptly.

Half Saline or Normal Saline Maintenance Intravenous Fluid Therapy in Children

Alireza Eskandarifar, Peyman Taherkhani

Journal of Pediatric Nephrology, Vol. 10 No. 1 (2022), , Page 32-38
https://doi.org/10.22037/jpn.v10i1.37291

Background and Aim: Electrolyte disorders in hospitalized children have several causes.
One of the most important and common causes is using inappropriate maintenance
intravenous fluids. This study aimed to investigate the effect and type of maintenance of
intravenous fluids on the incidence of electrolyte disturbance in hospitalized children.
Methods: This research is a prospective cohort study. Non-surgical hospitalized children
were divided into two groups based on the type of intravenous fluid received (normal saline
[0.9% NaCl] or half saline [0.45% NaCl]). After matching two groups in terms of age and
gender, the incidence of electrolyte disturbances (sodium and potassium) was evaluated in the
two groups on the second and third days of the study.
Results: A total of 163 patients were included in this study. About 55.5% of the children were
boys, and 44.5% were girls. The Mean±SD age of the children was 48.42±36.35 months, and
their mean weight was 19.49±10.88 kg. Also, 50.6% of patients were in the half saline group
and 49.4% in the normal saline group. Initially, serum sodium and potassium levels were
normal in both groups. On the second and third days of the study, the incidence of serum
sodium and potassium disorders was higher in patients who received half saline fluid, but this
higher incidence was not statistically significant (P>0.05).
Conclusion: There is no significant difference between normal saline and half saline in
terms of electrolyte disturbance if the patient’s clinical condition is judged correctly and an
appropriate volume of fluids is prescribed.

Case Reports


Liddle’s-Like Syndrome Associated With Nephrotic Syndrome in a Pediatric Patient

Nisreen Sinada, Rajendra Bhimma

Journal of Pediatric Nephrology, Vol. 10 No. 1 (2022), , Page 39-46
https://doi.org/10.22037/jpn.v10i1.36352

Nephrotic syndrome, especially the steroid-resistant form, is often complicated by hypertension
in childhood. The syndrome is common in black children. However, the histopathological
finding of membranous nephropathy in children with nephrotic syndrome is rare. Liddle’s
syndrome is a rare genetic abnormality that presents with salt-sensitive hypertension caused
by constitutive activation of the amiloride-sensitive epithelial sodium channel. The epithelial
sodium channel comprises homologous α, β, and γ subunits that share similar structures.
Gene mutations associated with Liddle’s syndrome occur in either the β or γ subunits and
disturb or truncate a conserved proline-rich sequence (i.e., PY motif), leading to constitutive
activation of the epithelial sodium channel. The association of nephrotic syndrome with
Liddle’s syndrome has only been described in an adult patient. We present here the first case
of these two syndromes (nephrotic syndrome and Liddle’s-like syndrome) co-existing in a
child with membranous nephropathy in his histopathological finding on kidney biopsy.

A Very Rare Complication of Ethanol Consumption: Non-Traumatic Unilateral Raccoon Eye

Elham Emami, Gholamali Dorooshi, Keyvan Nouri, Shiva Samsamshariat

Journal of Pediatric Nephrology, Vol. 10 No. 1 (2022), , Page 47-49
https://doi.org/10.22037/jpn.v10i1.36358

Ethanol is a chemical that is easily absorbed in all parts of the gastrointestinal tract. This
feature increases the risk of poisoning by ingesting this chemical at any amount; the signs
and symptoms depend on the poisoned individual. Common symptoms of ethanol poisoning
include sedation, poor coordination, vomiting, slurred speech, ataxia, respiratory depression,
coma, and death. A rare manifestation of alcohol consumption is the raccoon eye. This article
presents a 5-year-old girl who gradually showed a unilateral raccoon eye following ethanol
consumption.

Crescentic Glomerulonephritis in A Child With Tea- Colored Urine: A Case Report

Elham Vahhab, Mohammad Hossein Fallahzadeh, Anahita Dehghani, Babak Shirazi Yeganeh, Leila Malekmakan

Journal of Pediatric Nephrology, Vol. 10 No. 1 (2022), , Page 50-53
https://doi.org/10.22037/jpn.v10i1.36933

A 12-year-old girl was admitted with tea-colored urine for 24 hours. She had normal blood
pressure and no edema with a rapid and progressive increase in serum creatinine, so one session of hemodialysis was done. The condition got worse by a thrombus formation in the heart.  Urinalysis showed proteinuria and hematuria. The kidney biopsy revealed crescentic glomerulonephritis. Treatment with 3 pulses of methylprednisolone and cyclophosphamide, and antithrombotic drugs were given with rapid recovery to normal serum creatinine and decrease in proteinuria. C3 was normalized after 2 months, and the clot disappeared, while hematuria and proteinuria continued as 1+ after 5 months. Due to the continuous proteinuria, Myfortic was continued for one year. Then, after stopping Myfortic, proteinuria did not return, and only microscopic hematuria continued.
In conclusion, severe crescentic glomerulonephritis may have minimal symptoms and be
complicated by heart thrombosis but with excellent response to medical therapy.