Background and Aim: Nephrotic syndrome (NS) is the most common glomerular disease
in children in Iran, with high relapse rates and steroid-related complications. Montelukast, a
leukotriene receptor antagonist, has shown potential as a steroid-sparing agent, but its renal
protective effects remain debated. This study aimed to compare the efficacy of prednisolone
monotherapy versus combined prednisolone-montelukast therapy in pediatric NS, focusing
on renal function, metabolic parameters, and safety.
Methods: A quasi-experimental study involving 66 children with NS was conducted at
Ali Bin Abi Taleb Hospital, Iran (2022). Participants were divided into two groups: Group
A (prednisolone+montelukast, n=33) and group B (prednisolone alone, n=33). Primary
outcomes included time to remission and 6-month relapse rates. Secondary outcomes were
serum albumin, urine protein-to-creatinine ratio (Upro/Cr), estimated glomerular filtration
rate, and adverse events.
Results: Both groups showed significant improvements in albumin, cholesterol, and
proteinuria (P<0.001). However, group A demonstrated superior renal protection, with a
significant reduction in serum creatinine (−0.08 mg/dL vs +0.11 mg/dL in group B, P=0.001).
Subgroup analysis revealed enhanced creatinine improvement in children <6 years (P=0.02).
No serious adverse events were reported, and safety profiles were comparable (gastrointestinal
symptoms: 12.1% vs 9.1%, P=0.7).
Conclusion: Adjunctive montelukast provides additional renal protection, particularly in
younger children, without compromising metabolic efficacy or safety. These findings support
its consideration in high-risk pediatric patients with NS, warranting further long-term studies.

Background and Aim: Inflammatory urinary tract infection (UTI) is a common infectious
disease in childhood, causing significant discomfort. Omega-3 fatty acids are well-known for
their anti-inflammatory properties, which may aid in decreasing UTI symptoms. This study
aimed to investigate the effects of omega-3 therapy in children with UTI.
Methods: This randomized clinical trial enrolled 100 children with UTIs, randomized into
placebo and intervention groups. In addition to standard treatment, the intervention group
received one omega-3 capsule daily. Symptoms were assessed at the baseline and again after
the treatment period.
Results: At baseline, no significant differences were observed between the two groups
in age, gender, or symptom prevalence. However, after the treatment period, omega-3
supplementation resulted in a significant decrease in dysuria and urinary frequency symptoms
compared to the placebo group.
Conclusion: Omega-3 supplementation as adjunct therapy can significantly improve the
severity of symptoms in children with UTIs.

Background and Aim: Urinary tract infection (UTI) is one of the most common infectious
diseases in children, which may cause certain complications, such as growth disorders,
hypertension, proteinuria, and chronic kidney failure. In addition to vitamin D’s vital role
in bone formation, it also contributes to the functioning of the immune system, and its low
levels are associated with increased susceptibility to infections. Given the role of vitamin D in
regulating the immune system, the present study was conducted to investigate the relationship
between serum vitamin D levels and recurrent UTI in children.
Methods: In this cross-sectional study, 90 children aged 2-15 years who were referred to the
Pediatrics Department of Hajar Hospital, Shahrekord, in 2022 were included and divided into
two groups: Cases (with UTI) and controls (not suffering from UTI). Children’s information
was recorded and blood samples were collected to measure 25-hydroxyvitamin D3 levels.
Data were analyzed using SPSS.
Results: The groups showed no significant difference in age and gender (P>0.05). The groups
showed a significant difference in the frequency of serum vitamin D levels (P<0.0001);
vitamin D deficiency and insufficiency were more common in children with UTI compared
to those without UTI (24.4% and 48.9% vs 8.9% and 15.6%, respectively).
Conclusion: Vitamin D deficiency is correlated with UTI in children, and its supplements are
a low-risk treatment of choice to prevent UTI.

Background and Aim: Candida infections are rare in the neonatal period, but they are an
important cause of morbidity and mortality in neonatal intensive care units. Invasive fungal
infections are extremely difficult to diagnose. It is suggested to start empirical treatment
with antifungal therapy in high-risk, low-birth-weight infants who do not respond rapidly to
antibacterial therapy or in those who are in a septic state due to an unknown source, based
on regional guidelines. The aim of this study was to facilitate the earlier detection of at-risk
newborns to initiate antifungal therapy as soon as possible, thereby lowering mortality rates
and serious permanent disabilities.
Methods: This is a retrospective cross-sectional observational study on newborns admitted
to the neonatal intensive care unit (NICU) from March 2010 to February 2016. Risk factors,
such as birth weight, sex, route of delivery, the timing of oral feeding, total parental nutrition
(TPN), prescribed drugs (such as antibiotics, H2 blockers, methylxanthine, vasopressors, and
corticosteroids), underlying diseases, history of surgery, urinary catheter insertion, central
venous catheterization, and mechanical ventilation were extracted from patients’ files. Also,
we analyzed the blood groups of patients to find any possible relation to fungal infections.
Results: During the seven-year period, 2927 newborns were admitted to the NICU, of whom
32 patients (1.1%) were infected by fungal microorganisms. All but one of these neonates
were infected by C. albicans. Most of them had positive urine or blood cultures for C.
albicans (48.8% and 27.9%, respectively). All of our patients received amphotericin B as
standard therapy, resulting in a 75% recovery rate.
Conclusion: Surveillance of newborns with underlying risk factors aids in early decisionmaking
to start treatment for fungal infections in high-risk groups, thereby decreasing
mortality rates and long-term devastating complications.

Background and Aim: Urinary system stones, including kidney stones, are common diseases
of the kidney and urinary tract that have increased over time. The treatment of these patients,
especially in children, is of great importance. This study evaluated the effect of vitamin E on
the treatment of children with kidney stones.
Methods: This double-blind, randomized controlled trial (RCT) was conducted on children
between the ages of 2 and 18 years with a diagnosis of kidney stones. The samples were
randomly divided into two groups: The intervention group, which received vitamin E in
addition to standard treatment, and the control group, which received standard treatment.
This division was blinded to the evaluator and the patients. Information about the condition
of the stones before and after treatment was obtained from two sources and compared using
SPSS statistical software.
Results: The mean age (P=0.595) and frequency distribution of gender (P=0.685) showed
no statistically significant difference between the two groups. The mean number of stones
before treatment in the intervention group was 3.04±1.87, while in the control group, they
were 3.22±2.01, indicating no significant difference according to the independent t-test. After
treatment, values were 1.15±1.3 in the intervention group and 2.34±1.75 in the control group.
The mean size of the largest stone in the intervention group before treatment was 0.09±0.34
cm, and after treatment, it was 0.18±0.07 cm (P=0.964). In the control group, the size of the
largest stone before treatment was 0.10±0.32 cm, and after treatment, it increased to 0.25±0.1
cm, which was significantly smaller in the intervention group based on the independent t-test.
Conclusion: The use of vitamin E can reduce the size and number of kidney stones in
children.

Background and Aim: Urinary tract infection (UTI) is a common infection affecting
children. Besides microorganism pathogens, genetic background plays a pivotal role in the
pathogenesis of diseases. Vitamin D receptor (VDR) plays a crucial role in the pathogenesis
of some cancers and infectious diseases. This study aimed to evaluate the association between
polymorphisms in the VDR gene and risk of UTI.
Methods: In the current study, 127 children affected by UTI were referred to the pediatric
nephrology clinic in Zahedan, and 100 subjects with no history of infection were genotyped.
The genotyping was carried out by restriction fragment length polymorphism-polymerase
chain reaction (RFLP-PCR). SPSS software, version 22.0 was used for statistical analysis.
Results: The results revealed that rs2228570C>T (FokI), rs7975232A>C (ApaI), and
rs731236T>C (TaqI) increased the risk of UTI, whereas rs1544410G>A (BsmI) decreased
the risk of the disease.
Conclusion: The results suggest that the genetic variants in the VDR gene may play a role in
the pathogenesis of UTI.

Background and Aim: Hyperlipidemia is typically detected in active nephrotic syndrome
(NS) and normalizes with the resolution of the proteinuria. This study assessed the lipid
profile of children with NS during active disease and remission.
Methods: This prospective observational study was conducted at ICMH, Bangladesh, from
July 2021 to June 2022. Sixty children with NS (1-18 years), including both first attack and
relapse cases, were enrolled. A detailed history and thorough clinical examination were carried
out. Serum fasting lipid profiles were measured during active disease and again 4 weeks
after achieving remission. After collecting all the required data, analysis was conducted using
SPSS software, version 24.0.
Results: The majority of children (70%) were relapse cases. The mean age of the study
participants was 5.15±2.97 years, with a predominance of males (61.7%). Mean serum
cholesterol, low-density lipoprotein (LDL), and triglycerides (TG) levels were elevated in
all groups, while high-density lipoprotein (HDL) levels were normal in all groups during
active disease. During remission, serum cholesterol, TG, and LDL levels were significantly
reduced in both first attack and relapse cases. LDL levels returned to normal in all groups,
but total cholesterol (TC) and TG remained high in the frequently relapsing NS (FRNS) and
steroid-dependent NS (SDNS) groups. Serum albumin levels were low in all groups, with
significantly lower levels observed in the FRNS group.
Conclusion: During active disease, serum cholesterol, TG, and LDL levels were elevated in
both first attack and relapse cases. Serum TC and TG remained persistently high in FRNS
and SDNS.

Background and Aim: Arteriovenous fistula (AVF) is an essential surgery for young
patients who need long-term access to hemodialysis (HD). Despite the widespread use of
AVFs in adult populations, there is a lack of research on their utilization and outcomes in
pediatric patients. The purpose of this study was to assess the outcomes of AVF development
in children, including the factors that affect success rates, complications, and long-term
outcomes.
Methods: This study was a retrospective cohort of patients with end-stage renal disease
(ESRD) who were aged under 18 years old and underwent an AVF surgery at our center
between December 2021 and January 2023. We collected demographic data from patients and
follow-up data at 1 week, 6 weeks, 6 months, 12 months, and 18 months. Details, such as the
type of access, its anatomical location, and complications, were also documented.
Results: During the study period, a total of 47 AVFs were created. We created brachiocephalic
AVF in 63.83% of cases (n=30), radiocephalic AVF in 14.89% (n=07), and brachiobasilic
transposition in 21.28% (n=10). The overall primary patency rate at 12 months was
78.72%. The median survival of the brachiocephalic fistula was much greater than that of
the radiocephalic and brachiobasilic fistulas (BBF). The primary patency rates at 1 week, 6
weeks, 6 months, 12 months, and 18 months were 87.23%, 85.11%, 82.97% and 74.47%,
and 66%, respectively.
Conclusion: AVF provides effective long-term HD access in the pediatric population with
ESRD. Thromosis was identified as the main cause of failure, underscoring the importance of
proactive monitoring and interventions to improve outcomes.     

Background and Aim: Correct and rapid diagnosis and timely treatment of acute poisoning
are of great importance, mainly in legally crucial drugs of abuse poisoning. Urine drug
toxicology (UDT) is an available, rapid, and cheap diagnostic tool. This study aims to
evaluate the results of this study in children with acute poisoning.
Methods: In this prospective descriptive cross-sectional study conducted on the urine
toxicology results of children admitted to Loghman-Hakim Hospital due to poisoning with
opioids and cannabis in 2021, UDT was performed for all patients. Demographic data, type,
method and time of poisoning, time of urine sample collection, urine pH and specific gravity
(SG), and urine toxicology results were collected and statically analyzed using SPSS version
26.
Results: A total of 137 children were evaluated. The mean age was 4.11±3.45 years, and
49.6% were boys. UDTs were positive in 106 of 137 patients (77.4%). The most common
poisoning was methadone (61.32%) followed by opium (19.71%). No significant statistical
difference was observed between the time of taking the urine sample as well as the type, pH,
and specific gravity (SG) (P>0.05). Of the 84 methadone-poisoned patients, 74 (88%) tested
positive for UDT. The positive results for opium, cannabis, and buprenorphine were 77.77%,
33.33%, and 50%, respectively.
Conclusion: In our study, methadone was the most common poisoning, with urine toxicology
showing a positive result in 88% of cases.

Background and Aim: Febrile seizures (FS) represent the most prevalent type of convulsive
events in children. This study sought to explore the association between febrile convulsions
and acid-base disturbances in children.
Methods: This case-control study included 150 children aged 6 to 60 months with simple
FS and 150 febrile children without seizures. Blood gas analysis was performed to measure
pH, PCO2, and base excess (BE) among the children admitted to Amir Kabir Hospital in
Arak, Iran. Statistical analyses, including t-test, chi-square test, and Mann-Whitney test, were
conducted using SPSS software, version 18.
Results: The two groups did not differ significantly in mean fever (case: 38.46±0.51 vs
control: 38.45±0.59; P=0.48), pH (case: 7.49±0.06 vs control: 7.48±0.06; P=0.77), and BE
(case: -2.58±3.03 vs control: -2.41±3.42; P=0.48). Although the mean arterial PCO2 in the
case group was 25.1±3.51 mm Hg, which was lower than the control group’s 26±5.53 mm
Hg, there was no statistically significant difference between the two groups.
Conclusion: The mean venous and arterial pH values did not differ significantly in febrile
children with and without seizures. Although PCO2 in pediatric patients with FS was lower
than in the control group, this difference was not significant. However, due to the lack of
evidence, we recommend further studies in the future.

Background and Aim: Urinary incontinence represents a significant pediatric health concern
affecting children beyond the age of expected physiological control, with a substantial
impact on quality of life. Anemia, particularly iron deficiency, is a widespread global health
issue affecting a large proportion of children worldwide. This study aimed to evaluate the
association between non-hemolytic anemia and urinary incontinence in children over three
years of age.
Methods: This case-control study included 260 children aged 3-16 years, divided into two
equal groups: 130 children with non-hemolytic anemia (hemoglobin <11 g/dL) and 130 ageand
sex-matched healthy controls. Participants were assessed for various types of urinary
incontinence through structured interviews with parents using standardized questionnaires.
Statistical analysis included the chi-square test, descriptive statistics, and logistic regression
analysis to calculate odds ratios.
Results: While general urinary incontinence showed no significant association with anemia
(OR: 1.32; 95% CI, 0.81-2.16), monosymptomatic enuresis was significantly more prevalent
in the anemic group (30.8% vs. 6.2%, P<0.001), with an odds ratio of 6.77 (95% CI, 3.02-
15.18). Conversely, underactive bladder was less common in anemic children (10.0% vs.
19.2%, P=0.035, OR: 0.46, 95% CI, 0.22-0.95). Among anemic children with urinary
disorders, iron deficiency was the most common type, present in 49.4% of cases with urinary
incontinence and 52.5% of cases with monosymptomatic enuresis.
Conclusion: This study provides evidence for a significant association between nonhemolytic
anemia and monosymptomatic enuresis in children over three years of age.
Anemia screening should be considered in children presenting with monosymptomatic
enuresis, particularly in regions with high rates of iron deficiency. Future research should
explore the mechanisms behind these associations and assess whether treating anemia can
improve enuresis symptoms.

Background and Aim: Sickle cell disease (SCD) is a crucial and growing global health
problem. Kidney damage is one of the most common complications of SCD. This study
aimed to determine the prevalence of acute kidney injury (AKI) in children with SCD.
Methods: This cross-sectional and analytical study was conducted from January 2022 to
September 2022. It included children with SCD aged 6 months to 17 years during their steady
state. We measured the estimated glomerular filtration rate (eGFR) using the combined
creatinine and cystatin C formula for kids (CKiDScr-Cys C). Univariate analyses were performed
to measure the relationship between variables and AKI and eGFR, followed by a multivariate
analysis using logistic regression.
Results: Of the 137 children, 82 (60%) were boys and 55 (40%) were girls. The mean eGFR
was 112±45.3 mL/min/1.73 m2. A total of 36 subjects, or 26.3% (95% confidence level [CI],
18.9, 33.6%), had acute AKI. Comparison of characteristics by AKI status showed significant
differences in the number of transfusions (P<0.01) and hemoglobin level (P<0.027). eGFR
was negatively correlated with the number of transfusions (r=-0.308; 95% CI, -0.477%,
-0.117%; P<0.01). Multivariate analysis showed that nutritional status was a protective factor
for AKI (P<0.01), and the number of transfusions was a predictive factor of AKI in SCD
(P<0.001).
Conclusion: The results of our study are an urgent call to implement existing management
programs for SCD, from screening to universal access to hydroxyurea, to reduce complications
and mortality related to this pathology.

Background and Aim: Continuous ambulatory peritoneal dialysis (CAPD) is a conventional
treatment for children with end-stage kidney disease. All infectious and non-infectious
complications should be detected early and managed because they may cause ultrafiltration,
or Soult failure, or catheter failure. This study aims to investigate infectious and noninfectious
complications of CAPD, such as mechanical and metabolic issues, at a children’s
medical center between 2020 and 2022.
Methods: A retrospective cross-sectional study was performed on pediatric patients with
end-stage renal disease (ESRD) undergoing peritoneal dialysis at Children’s Medical Center
in 2020-2022. Data were collected from the medical records and files and entered into SPSS
software, version 26 for analysis.
Results: The study included 30 participants with an average age of 5.89±1.2 years. Twothirds
of the participants were boys. Among the girls, 70% (7 of 10) and 80% of the boys (16
of 20) developed peritonitis. Bacterial infections were mostly observed in girls more than 2
times. Tunnel infections were observed in 10% of patients, three girls and one boy. Exit-site
infection occurred in eight boys and one girl. Non-infectious complications, such as seizures,
were observed in approximately 40% of patients. An inguinal hernia was observed in all male
patients.
Conclusion: In our experience, the most common infectious complication observed in CAPD
patients was bacterial peritonitis caused predominantly by staphylococcus aureus. Tunnel
infection and exit site infection were also common, while the predominant non-infectious
complication was hernia.

Background and Aim: Diagnosing urinary tract infection (UTI) in children is difficult due
to its non-specific clinical manifestations, difficulty obtaining a clean urine sample, and risk
of renal scarring complications in the future. Urine culture is the gold standard for diagnosing
UTI, but it requires 48-72 hours to report, causing delays in treatment. This study aims to
evaluate the effectiveness of urine dipstick nitrite and leukocyte esterase tests in detecting
UTIs in children.
Methods: This cross-sectional, observational study was conducted on 79 children clinically
suspected of UTI. The test results, urine dipstick test (nitrite and leukocyte esterase tests),
pyuria in urine microscopy, and urine culture were checked for their sensitivity, specificity,
positive predictive value, and negative predictive value.
Results: Among 79 children, fever was the most common clinical manifestation, and
Escherichia coli was the most common uropathogen. Compared to urine culture, the
sensitivity and specificity of leukocyte esterase and nitrite tests were 83.87%, 45.83%,
9.68%, and 91.67%, respectively. The sensitivity, specificity, positive predictive value (PPV),
and negative predictive value (NPV) of the combined test were 9.68%, 93.75%, 50.00%,
and 61.64%, respectively. Similar sensitivities and specificities were calculated, considering
pyuria in urine microscopy as the gold standard in rural areas.
Conclusion: The leukocyte esterase test is reliable for diagnosing UTIs in children, showing
good sensitivity. Higher leukocyte esterase grades indicate a higher likelihood of infection.
Due to its feasibility and effectiveness, this test can replace urine microscopy for pyuria in
rural areas. Nitrite tests, or their combinations, have poor sensitivity but high specificity,
making them suitable for proving urinary infections in children.

Background and Aim:Chemotherapy plays an essential role in the treatment of hematologic
cancers. Vincristine is commonly used to treat leukemia in children. However, this drug has
many side effects, including acute kidney injury (AKI). Adjuvant therapy with antioxidant
agents, such as vitamin E, can be administered to reduce this complication
Methods: A randomized clinical trial of leukemia patients receiving vincristine was conducted
at Amir Kabir Arak Hospital. The patients were randomly divided into an intervention group
(400 mg vitamin E for ten days) and a control group. Creatinine levels, glomerular filtration
rate (GFR), and acute kidney injury were measured at baseline, 48 h, and seven days later.
Independent t-test and chi-square were used to compare data.
Objectives: This study aims to investigate the potential effect of vitamin E supplementation in
reducing acute kidney injury associated with vincristine treatment in patients with leukemia.
Results: Thirty-six children with leukemia, 47.2% of whom were girls, were equally divided
into intervention and control groups. The essential characteristics of the two groups were
not significantly different. The creatinine level at baseline (0.60±0.08 vs. 0.61±0.12), 48
hours (0.60±0.09 vs. 0.61±0.10), and seven days (0.66±0.16 vs. 0.66±0.13) were lower
for the intervention group than the control group, but this difference was not statistically
significant (P > 0.05). In contrast, the GFR at baseline (92.96±17.87 vs. 91.53±13.46), 48-
hour (92.82±18.27 vs. 85.35±15.25), and seven days (90.86±17.84 vs. 85.05±14.41) were
higher in the intervention group than in the control group. However, this was not significant.
Finally, only one patient in the control group developed AKI, while no cases of AKI were
observed in the intervention group.
Conclusion: Vitamin E’s impact on AKI reduction in patients with leukemia was not
statistically significant. However, it positively affected creatinine and GFR levels in the
intervention group. In addition, no AKI cases were observed in the intervention group.

The cystic kidney is one of the most common abnormalities detectable by ultrasound before
and after birth and is also a cause of hydronephrosis; therefore, ultrasound is necessary for
accurate diagnosis. Multicystic dysplastic kidney (MCDK) is a congenital disease in which
the kidney is filled with multiple cysts and does not function properly. This article describes
an article review of MCDK and new attention. This study aimed to increase awareness of
the importance of diseases that cause kidney cysts, especially dysplastic multicystic kidney
disease, to promote understanding of diagnostic methods before and after birth, and to
investigate its cause.

transplantation complications, and nephrolithiasis, pose significant global health challenges.
Current diagnostic tools often detect the disease at advanced stages, limiting opportunities for
early intervention. This narrative review evaluated the role of metabolomics in enhancing the
understanding, diagnosis, and management of major kidney disorders, drawing exclusively
on recent peer-reviewed studies. The review synthesized findings from comprehensive urine
and plasma metabolomic analyses using nuclear magnetic resonance (NMR) and mass
spectrometry (MS) platforms in pediatric and adult patients across multiple kidney settings.
Metabolomics reveals disease-specific metabolic signatures, enabling the early detection of
renal injury, differentiation between disease subtypes, and prediction of outcomes. In CKD,
altered profiles of amino acids, energy metabolites, and gut-derived compounds correlate
with disease progression. In AKI, early fluctuations in citrate, branched-chain amino acids,
and bile acids demonstrate diagnostic and prognostic potential. In kidney transplantation,
metabolomics aids in the detection of acute rejection and drug-induced toxicity. For
nephrolithiasis, changes in oxalate and citrate metabolism reveal insights into gut-kidney
axis interactions. The integration of metabolomics with other omics (genomics, proteomics,
and microbiomics) enhances mechanistic understanding and supports the development of
precision nephrology. Metabolomics is redefining kidney disease evaluation by providing
sensitive, real-time, and non-invasive insights into renal pathophysiology. Continued
advances in analytics, data integration, and clinical validation will be essential for translating
these findings into personalized nephrology practice.

Background and Aim: Senior Loken syndrome describes patients with nephronophthisis
along with retinal dystrophy. The first signs of renal involvement include polyuria and
polydipsia, which occur due to impaired urinary concentration capabilities. Nephronophthisis
progresses to end-stage renal disease by the age of 20. Retinal abnormalities can range from
severe infantile retinal dystrophy to the more typical form of retinitis pigmentosa. Other
associated features of this syndrome include skeletal and dermatological abnormalities, as
well as cerebellar issues.
Case Presentation: Here, we reported a case of Senior‒Loken syndrome with polyuria,
polydipsia, and nocturnal enuresis followed by the features of advanced renal disease, such as
growth retardation and moderate anemia. He was also myopic and demonstrated tessellated
fundus during the fundoscopic examination.
Conclusion: To date, there are no case reports published in the Bangladeshi medical literature
regarding this rare autosomal recessive disorder among pediatric patients. Therefore, this
case report aims to increase awareness among clinicians to detect these patients early, as the
management implemented may prevent or delay the need for renal replacement therapy and
preserve eyesight

Background and Aim: Cytomegalovirus (CMV) infection is considered one of the most
common opportunistic infections and also a common cause of morbidity and mortality
among patients receiving renal transplantation. Pancreatitis is a rare complication of CMV
infection in renal transplant recipients, which can lead to death. Here,
Case Presentation: we presented a 10-year-old boy who underwent a nonrelative living
donor renal transplantation and was admitted due to early graft dysfunction two months
after transplantation. Diagnostic tests for modalities showed CMV infection. The patient was
treated with ganciclovir; however, he developed seizures and acute abdominal pain one week
later. The brain MRI revealed increased signal intensity in the cortex and subcortex of the
parieto-occipital lobe. Serum laboratory tests showed elevated levels of amylase and lipase.
The patient was treated for CMV infection and pancreatitis.
Conclusion: Finally, the patient died due to multi-organ failure caused by disseminated
CMV infection two weeks after admission. These findings suggest that disseminated CMV
infection and pancreatitis may occur after renal transplantation, with a high mortality rate.

Background and Aim: Gitelman syndrome (GS) is a rare tubulopathy with an autosomal
recessive inheritance pattern. Mutations in the thiazide-sensitive Na-Cl transporter gene lead
to hypokalemia, metabolic alkalosis, and hypomagnesemia.
Case Presentation: In this case report, we introduced a 6-year-old female who presented
with urinary tract infection symptoms and frequent vomiting. She suffered from carpopedal
spasm when blood sampling was done. At presentation, she had acute respiratory alkalosis
with complete metabolic compensation, mild hypokalemia, and hypomagnesemia. After
discharge, further studies, including genetic testing, were conducted, which identified an
SCL12A3 mutation—a homozygous pathogenic variant—that confirmed the diagnosis of
Gitelman syndrome. Oral supplementation of potassium and magnesium was initiated for
treatment.
Conclusion: The diagnosis of GS can be easily missed. Clinical Suspicion is the first step
toward confirming a diagnosis.

Background and Aim: Wasp stings can cause life-threatening conditions if not promptly
managed. Symptoms can vary from local reactions to severe multi-organ dysfunction, such
as acute kidney injury (AKI), acute liver failure (ALF), rhabdomyolysis, pulmonary edema,
respiratory failure, hematological and neurological involvement, and even death. Emergency
interventions are often needed. The purpose of this report was to increase awareness among
clinicians about possible complications of wasp stings in order to provide early detection and
proper management.
Case Presentation: A six-year-old girl had been suffering from multiple wasp stings. She
was diagnosed with multiple organ dysfunction syndrome (MODS), including hemolysis,
AKI, liver injury, and respiratory failure. She was managed with renal replacement therapy
and was ultimately discharged with normal renal function.
Conclusion: Children with multiple wasp stings should be referred earlier for the initiation of
proper management to improve the outcomes.

Background and Aim: Reversible posterior leukoencephalopathy syndrome (RPLS), also
known as posterior reversible encephalopathy syndrome (PRES), is an uncommon and varied
cliniconeuroradiological condition that can manifest with a range of clinical symptoms, such
as visual disturbances, altered consciousness, headaches, and seizures. Hypertension and
immunosuppression are two primary factors that increase the likelihood of developing RPLS.
Nevertheless, RPLS can also occur in the presence of other risk factors.
Case Presentation: A 10-year-old Asian boy diagnosed with nephrotic syndrome exhibited
symptoms of seizures and fever. His blood pressure (BP) was within the normal range, and
he received treatment with immunosuppressive medications.
Conclusion: In cases where patients with nephrotic syndrome develop an infection, it is
important to assess for symptoms of RPLS. Timely diagnosis and proper management of
RPLS can help prevent mortality and morbidity.

Background and Aim: Bardet-Biedl syndrome (BBS) is a rare autosomal recessive multisystemic
genetic disorder that may affect the centrosome and ciliary transport. Retinal
dystrophy, obesity, extremity deformities, mental retardation, and renal and genital system
anomalies characterize the disease. Renal involvement is a major cause of morbidity and
mortality.
Case Presentation: We report the case of a 16-year-old boy with BBS who had a history of
delayed diagnosis and features of glomerulonephritis leading to chronic kidney disease. He
underwent a renal biopsy, which revealed focal segmental glomerulosclerosis (FSGS) from
a histopathological study.
Conclusion: To our knowledge, only a few FSGS cases have been previously reported
in pediatric patients with this syndrome. We wish to alert clinicians to a wide variety of
renal abnormalities that can be observed in patients with this rare disorder and to provide
multidisciplinary management of BBS.

Background and Aim: Dengue viral infection has become a major public health concern
worldwide. This situation worsens when accompanied by other comorbidities. There is a
lack of published literature on dengue viral infection in pediatric patients with kidney failure
undergoing maintenance hemodialysis.
Case Presentation: We report the case of a child with kidney failure who underwent
maintenance hemodialysis and presented with dengue shock syndrome.
Conclusion: Prompt diagnosis, close monitoring, and individualized treatment regimens are
crucial for patient survival. A significant dilemma exists in managing such cases that may
guide physicians in the future.

Introduction: This report outlines the activities and findings from the one-week pediatric nephrology mentorship course held in Dushanbe, Tajikistan. 

Activities Overview: Throughout the week, our group conducted daily patient visits and also managed outpatient consultations. 

Clinical Highlights: We visited the ICU and  in hemodialysis unit, we noted the capability to perform dialysis on children weighing as little as 8 kg. We provided comprehensive care for a 16-year-old girl with glomerulonephritis. During our visit to the kidney and liver transplant section, we learned that biopsies are performed under ultrasound guidance with subsequent analysis by pathologist.

Educational Activities: Daily conferences were conducted, covering topics such as:

• Principles of fluid therapy in children.
• Fluid therapy in critical conditions and acutely ill children.
• Acid-base disorders in children.
• Diagnostic approaches to hypernatremia in children.
• Management of hypertensive crises in children.
• Diagnostic strategies for acute kidney injury in children.

We met with the Minister of Health Dr. Jamoliddin Abdullozoda. We presented several proposals to improve nephrology services, including:

• Updating scientific resources for medical students and professionals.
• Revising the educational curriculum and developing new guidelines.
• Conducting both online and in-person training sessions.
• Organizing separate training courses for hemodialysis.
• Addressing shortages of essential medications and laboratory supplies.
• Establishing a patient support association.
• Appointing a responsible party for acute peritoneal dialysis.
• Implementing a patient record system for outpatient care

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