Nocturnal enuresis is defined as a wetting episode at nighttime in children over 5 years of
age and it is divided into primary and secondary types. Primary nocturnal enuresis refers to
cases who had never had a dry bed with a prevalence from 1.6% to 15% and it may continue
to adolescence. Ignoring the problem has some psychological consequences and a significant
impact on the quality of life. Conservative therapy and active intervention have been proposed
as the modality of treatment. This review address on the assessment of nocturnal enuresis,
sleep disorder, psychological impact, and the management of enuresis by considering the
causes of resistance to treatment.

Background and Aim: This study aims to evaluate the clinical and histopathological
profile in children with crescentic glomerulonephritis (CGN) and determine the predictors
of renal outcome.
Methods: In this retrospective study, we reviewed all native kidney biopsies performed in
patients <18 years over 9 years (2011-2019). Individuals with ≥20% crescents with follow-up
for at least 1 year were enrolled.
Results: This study included 34 patients. The most common variety was immune-complex
glomerulonephritis (GN) (type II CGN) (n=21; 62%), including patients with Henoch-
Schonlein purpura (n=6), lupus nephritis (n=6), post-infectious GN (n=3), C3GN (n=3),
and dense deposit disease (n=3). The second most common was pauci-immune GN (type
III CGN; n=12; 35%) followed by anti-glomerular basement membrane disease (type
I CGN; n=1; 3%). Hypertension (88%), hematuria (84.2%), and oliguria (64%) were the
most common presenting features. The outcome predictors for poor renal survival were
the presence of oliguria (HR-5.11, P=0.035), severe hypertension (HR-11.51, P=0.019),
estimated glomerular filtration rate <15 mL/min/1.73 m2 at presentation (HR-5.05, P=0.007),
percentage of crescents (HR-10.66, P=0.001), presence of fibrous crescents (HR-6.34,
P=0.001), and interstitial fibrosis and tubular atrophy (HR-8.88, P=0.0046). The overall
outcome of the study revealed complete recovery (n=12), partial recovery (n=6), chronic
kidney disease (n=3), and end-stage renal disease (n=13). The renal survival in patients with
≥50% crescents was poor (P=0.037) as compared to subjects with <50% crescents.
Conclusion: Renal survival can be predicted by the severity of presenting features and
histopathological markers. Two-thirds of patients had type II CGN with renal survival
outcomes similar to type III CGN. The percentage of crescents is the most important predictor
of renal survival.

Background and Aim: Hypertension (HTN) has become more prevalent among youngsters.
It is frequently under-recognized due to a lack of routine blood pressure measurement in many
health centers, partly owing to a shortage of devices and possibly because of the notion that it
is not the foremost disease in children. In Bangladesh, there is a scarcity of data on how doctors
view childhood HTN and their practice of measuring blood pressure in children. 
Methods: This cross-sectional mailed-based survey was done on pediatricians and approved by
the institutional review board of Dr. Khan Shishu Hospital & the Institute of Child Health from
June to December 2021. We obtained the email addresses of all pediatricians from the Bangladesh
Pediatric Association. 
Results: Of the 536 pediatricians in the mailing sample, 257 cases responded and the response
rate was 47.9%. The majority of respondents (62.4%) were general pediatricians and only 12.2%
were pediatric nephrologists. This survey revealed that 77.2% of pediatricians did not measure
blood pressure routinely among children 3-18 years of age, whereas 66% reported measuring
blood pressure if children had risk factors. 
Conclusion: The findings of our study point to a knowledge and practice gap among pediatricians,
who are primary health care providers, when diagnosing hypertension in children. For children
aged 3 to 18 years, most pediatricians reported no regular assessment of blood pressure. Most
pediatricians did not repeat blood pressure measurements for diagnosis, nor did they often use
blood pressure cuffs or charts for children. These issues need to be addressed for better diagnosis
and treatment of childhood HTN.

Background and Aim: Bedwetting or enuresis is not uncommon in children, although
its prevalence varies by age. Spontaneous remission of enuresis may occur at a rate of
approximately 15% per year, but treatment protocols should be carried out because of its
significant impact on a child’s family, emotional state, self-esteem, and totally on the quality
of life (QoL). Today, non-pharmacological therapy is an initial treatment for enuresis,
in which both the parents and children are motivated to take the behavioral management
approach. This study was done to determine the effectiveness of non-pharmacological
therapy in pediatrics with enuresis.
Methods: This prospective observational research was carried out in pediatrics aged 5
to 15 years with bedwetting who visited the outpatient department of Asgar Ali Hospital
from January 2021 to December 2021. They were categorized into two groups, primary
and secondary (monosymptomatic and non-monosymptomatic) enuresis according to the
definition of the international children’s continence society (ICCS). Also, our patients were
divided into different age groups: Group A: 5-7 years, group B: 8-10 years, and group C: >10
years, and the response was classified as no response: <50%, partial response: 50-99%, and
complete response: 100% reduction in baseline symptom frequency.
Results: Among the 74 patients, 28 cases (38%) were male and 46 cases (62%) were female,
with most of them having primary enuresis 72(97%), and only two patients had secondary
enuresis. Most patients were monosymptomatic 62(83.7%), and only 12 cases (16%) were
non-monosymptomatic. Among 32 patients (43%) of group A, 87.5% had complete response
within three months of follow-up, in group B, of a total of 20 patients (27%), 40% had
complete and 40% had partial response, and in group C, among 22 patients (30%), only 9%
had complete and 46% had partial response.
Conclusion: Non-pharmacological therapy in enuretic patients showed encouraging
recovery.

Background and Aim: Studies on the prevalence of kidney stones in Iranian children
are limited. Children with nephrolithiasis have a high risk of recurrent stones; therefore, a
thorough evaluation is warranted. Due to the paucity of data on Iranian children, this study
aims to investigate the prevalence of kidney stones in this population.
Methods: This cross-sectional study examined the prevalence of kidney stones among
outpatients and inpatients at various university centers in Iran from March to December
2019. Twenty-six pediatric nephrologists from 13 centers participated and completed a
questionnaire on the total number of inpatients and outpatients and the number of patients
with kidney stones. The diagnosis was based on radiological results.
Results: A total of 97 912 patients were included, with 20327 hospitalized and 77585
outpatients. Of all patients, 2.86% had kidney stones, the prevalence of which was 1.5%
in inpatients and 3.2% in outpatients. This figure is about 1% more than Iran’s past reports.
Inpatient stones in Kerman City, Iran (3.65%) and outpatients in Zahedan City, Iran (16.4%) were the most common. The study lacked data on age and gender. The main results are the
total and setting-specific prevalences, and regional variations suggesting environmental and
genetic factors.
Conclusion: This large study examined kidney stone prevalence in Iranian children, the total
prevalence of which is 2.86%. Given the limited data and rising trend, more extensive studies
with the collaboration of additional centers are recommended. Demographic characteristics,
such as age, sex, stone composition, family history, and diet should be examined.

Background and Aim: The incidence rate of nephrotic syndrome (NS) is 2-7 children
per 100,000 children. Children with NS usually have some calcium homeostasis problems
leading to abnormal bone histology, hypocalcemia, reduced serum vitamin D metabolites,
and impaired intestinal absorption of calcium during their disease or following treatment.
Methods: This is a prospective study on patients with NS on their first visit before any
initial treatment. One hundred and three children aged 2-12 years referring to our nephrology
department from March 2018 to June 2019 were enrolled in this study. Serum concentrations
of calcium, phosphorus, albumin, 25(OH)2 vitamin D3, and creatinine were measured in all
patients. The correlation of 25(OH) vitamin D3 with the type of nephrotic syndrome, gender,
and age of the patients was evaluated.
Results: Sixty-two patients were male (60.2%) and 41 cases were female (39.8%). Vitamin
D deficiency (<20 ng/dL) was observed in 87 out of 103 patients (96.7%). Also, 24 patients
underwent kidney biopsy: ten patients were found with minimal change disease (41.7%),
seven patients (29.2%) showed focal segmental glomerulosclerosis, and seven cases had
diffuse mesangial proliferation. Mean serum levels of calcium, phosphorous, albumin, and
cholesterol were 7.512, 4.756, 1.932, and 450.68 mg/dL, respectively, and there was no
correlation between vitamin D levels and these parameters except albumin.
Conclusion: Because of the high prevalence of vitamin D deficiency and its serious
consequences in NS patients, it is recommended to measure the levels of this vitamin at the
first visit and treat this deficiency, if necessary, along with other specific treatments.

Multicystic dysplastic kidney (MCDK) is defined as a variant of renal dysplastic with
multiple non-communicating cysts separated by dysplastic parenchyma. Contralateral
vesicoureteral reflux (VUR) is the most frequent coincidence genitourinary anomaly
in children with unilateral MCDK. Here, we described a case of unilateral MCDK (right
side) with bilateral third-grade VUR who first, underwent conservative therapy because of
electrolyte disturbance and metabolic acidosis.

The infection with varicella-zoster virus in immune-deficient patients is an important
and complex challenge in treating patients and requires decisions on an individual basis.
Rituximab is an anti-CD20 positive B cells monoclonal antibody. Nowadays, it is frequently
used in patients with idiopathic nephrotic syndrome and makes them susceptible to various
infections. In this study, we report a 16-year-old male subject with steroid-resistant nephrotic
syndrome who developed a severe and generalized form of chicken pox following rituximab
administration.