The Role of Ischemia Reperfusion Damage on Renal Transplant, what are the new treatments?

Hasan Otukesh, Rozita Hoseini, Nahid Rahimzadeh, Sara Hosseini, Pedram Ahmadpoor, Faezeh Javadilarijani

Journal of Pediatric Nephrology, Vol. 1 No. 1 (2013), 24 July 2013, Page 8-17

How to Cite This Article: Otukesh H, Hoseini R, Rahimzadeh N, Hosseini S, Ahmadpoor P, Javadi Larijani F. The role of Ischemia reperfusion damage on renal transplant, what are the new treatments? J Ped. Nephrology 2013 July;1(1):1-7.

Ischemia reperfusion damage usually occurs after renal transplantation. These injuries can stimulate the innate immune system, trigger an inflammatory response and ultimately activate the adaptive immune system. These events may result in rejection, graft fibrosis and chronic allograft nephropathy.

Different mechanisms contribute to innate immune system activation following ischemia reperfusion injury in renal transplants. Some of these mechanisms are known and described by investigators while the remaining are still unknown.

To clarify the precise mechanisms underlying the innate immune system activation and rejection progression helps us to plan therapeutic protocols to reduce immunologic responses to ischemic events and to improve the graft function and outcome. In this review, we will discuss how innate and adaptive immune systems are activated during an ischemic insult and thereafter discuss related therapeutic interventions to block the activating pathways.

Keywords: Ischemia; Renal transplantation; Reperfusion.

Original Research Papers

Bladder Volume Wall Index In Children With Urinary Tract Infections

Nakysa Hooman, Farideh Hallaji, Seyed- Hassan Mostafavi, Mohammad- Reza Sharif, Parvin Tatarpoor, Hasan Otukesh

Journal of Pediatric Nephrology, Vol. 1 No. 1 (2013), 24 July 2013, Page 18-22

How to Cite This Article: Hooman N, Hallaji F, Mostafavi SH, Sharif MR, Tatarpoor P, Otukesh H. Bladder Volume Wall Index in Children with Urinary Tract Infections. J Ped. Nephrology 2013 July;1(1):18-22.

Introduction: Few studies have focused on the correlation between bladder ultrasound and urinary tract infection. The aim of this study was to evaluate the bladder volume wall index in children with single or recurrent urinary tract infection.

Materials & Methods: This case-control study was conducted between March 2008 and December 2009. The study was performed on one hundred children (8 boys, 92 girls) aged 4-15 years with a history of urinary tract infection and thirty-nine (20 males, 19 females) age- matched healthy children who had negative urine culture one month before investigation. The kidneys, ureters, and bladder sonography were performed in all children. Bladder volume wall index was calculated for each child and the result of 70-130 was presumed normal. Student T-test, chi-square, likelihood ratio, and risk ratio were used. P-value <0.05 was considered significant.

Results: The mean bladder volume was 262.5 (±82) in recurrent urinary tract infection, 235 (±54) in single urinary tract infection, and 278 (±80) in controls (P<0.05). The bladder was thick (<70) in 37 (28 cases, 9 controls) and thin (>130) in 38 children (28 cases, 10 controls) (P>0.05). The median residual volume was not different between the two groups. The abnormal BVWI in children with vesicoureteral (VU) reflux was 75% as compared to 51% in those without VU reflux (P>0.05). There was no correlation between BVWI and age, gender, groups, vesicoureteral reflux status, or residual volume (P>0.05).

Conclusions: According to our findings, the bladder volume wall index is not sensitive enough to discriminate children who are prone to urinary tract infection.

Keywords: Urography; Urinary Tract Infections; Ultrasonography; Urinary Bladder

Frequency of Hyponatremia in Gastroentric Patients Treated with Intravenous Hypotonic Fluid

Hamidreza Badeli, Kioomars Golshekan, Moslem Shahrdami, Mohammadreza Azizi Asl, Afagh Hassanzadeh Rad

Journal of Pediatric Nephrology, Vol. 1 No. 1 (2013), 24 July 2013, Page 23-27

How to Cite This Article: Badeli HR, Golshekan K, Shahrdami M, Azizi Asl MR, Hassanzadeh Rad A. Frequency of Hyponatremia in Gastroentric Patients Treated with Intravenous Hypotonic Fluid. J Ped.  Nephrology 2013 July;1(1):23-27.

Introduction: Acute gastroenteritis (AGE) is one of the most common infectious illnesses of childhood. While no treatment is needed for self-limited virus-induced AGE, dehydration caused by diarrhea and emesis is of great concern and should be treated vigorously. However, there is no consensus on the most appropriate electrolyte composition of intravenous fluids; therefore, according to basic protocols in our hospital which suggest hypotonic fluid therapy for AGE, investigators aimed to assess the frequency of hyponatremia in gastroenteritis patients treated with intravenous hypotonic fluid therapy.

Materials and Methods: This descriptive observational study was conducted at 17 Shahrivar Pediatrics Hospital between September 2008 and January 2011. The patients’ medical records were assessed and children aged between 1 month and 14 years with a diagnosis of gastroenteritis and dehydration were enrolled in the study. According to sodium concentration at T0, patients were divided into three groups: hyponatremic, hypernatrmic and isonatremic. The blood samples were analyzed for the sodium concentration at T0 and during 24 hours. Statistical analyses were performed by T test and chi-square using SPSS18 and statistical significance was defined as a p-value less than 0.05.

Results: The mean age of the participants was 16.43±11.1 months; 58 patients were male (67.4%) and 28 were female (32.6%). At T0, 35 patients (40.7%) were hyponatremic, 2 patients (2.3%) were hypernatremic and 49 patients were isonatremic. Sodium concentration in the hyponatremic and isonatrmic group were 137.25±1.9 and 138.29±2.04 mEq/L respectively which showed a significant difference (p=0.028).

Conclusions: Our study showed that increased sodium intake could decrease acquired hyponatremia. It seems that hyponatremia could be prevented by administering high sodium concentration fluids.


Keywords: Hyponatremia; Gastroenteritis; Hypotonic Solution; Intravenous Infusion

The sensitivity of ultrasonography in detecting renal cortical defects in pyelonephritic patients with or without vesicoureteral reflux

Masoumeh Mohkam, Chehreh Mahdavi, Banafsheh Arad, Hamid-Reza Moien, Nasim Pooralizadeh, Farshid Kompani

Journal of Pediatric Nephrology, Vol. 1 No. 1 (2013), 24 July 2013, Page 28-31

How to Cite This Article: Mohkam M, Mahdavi C, Arad B, et al. The sensitivity of ultrasonography in detecting renal cortical defects in pyelonephritic patients with or without vesicoureteral reflux. J Ped. Nephrology 2013 July;1(1):28-31.

Introduction: The presence of renal scarring has been documented in 5% to 15% of febrile urinary tract infections. The main aim of this study was to compare the value of renal ultrasonography and cortical scintigraphy with technetium-99m dimercaptosuccinic acid (DMSA) in detecting renal cortical defects in acute pyelonephritis.


Materials and Methods: Between June 2003 and February 2012 a prospectivecohort study of patients aged 1 month to 14 years of age was conducted. Pediatric patients with documented urinary tract infections were evaluated with renal ultrasonography, voiding cystoureterography (VCUG) and DMSA scintigraphy. Statistical test was two-tailed and was considered significant when P≤ 0.05.

Results: The results of DMSA scans showed 70.2% of cases as being abnormal. Renal ultrasonographies were reported to be normal in 72.45 and showed mild hydronephrosis in 37.7% of cases, moderate to severe hydronephrosis in 40.62%, stone formation in 13.66% and scar formation or decreased cortical thickness in 8.2%. There was a significant difference in ultrasonography reports between patients with normal and abnormal DMSA scans (P< 0.012) but there was no significant difference in detection of scar formation between DMSA scan results and those of ultrasonography in our patients. Among patients with severe abnormalities on DMSA scintigraphy the percent of cases with vesicoureteral reflux was significantly higher than those with normal scans or mild to moderate changes on DMSA scintigraphy. (46.3% vs 26.9%).

Conclusions: We concluded that ultrasonography is a sensitive method for detection of renal cortical defects and ultrasonography can also predict the presence of vesicoureteral reflux in pyelonephritic patients.

Keywords: Ultrasonography; Pyelonephritis; Pediatrics; Vesico-ureteral Reflux; Technetium Tc 99m dimercaptosuccinic acid; Radionuclide imaging

Prognostic Factors and Mortality Rate in Neonates with Acute Renal Injury in NICU

Nasrin Esfandiar, Masoumeh Mohkam, Abolfazl Afjeii, Farshid Kompani, Ilnaz Shahrazad, Mandana Naderi, Babak Otoukesh, Hamid Raiati

Journal of Pediatric Nephrology, Vol. 1 No. 1 (2013), 24 July 2013, Page 32-36

How to Cite This Article: Esfandiar N, MohkamM, Afjeii A, et al. Prognostic Factors and Mortality Rate in Neonates with Acute Renal Injury in NICU. J Ped. Nephrology 2013 July;1(1):32-36.

Introduction: Acute Renal Injury (AKI) is a frequent clinical condition in the Neonatal Intensive Care Units (NICUs). Most AKI causes are preventable; performing rapid preventive, diagnostic, and therapeutic measures could prevent the potential complications. The present study was conducted to define the risk factors and mortality rates of neonates with and without AKI admitted in the NICU of a tertiary care hospital.

Materials and Methods: Demographic and biochemical data of NICU of Mahdieh Hospital were collected and analyzed. More than twofold increase in normal serum creatinine level or >0.8 mg/dl (for infants > 4 days age) was defined as AKI. All newborns were divided into two groups: with and without AKI. Risk factors and mortality rates were compared in the 2 groups.

Results: The mortality rate of newborns with AKI was 4.5%. The other risk factors for mortality in neonates with AKI were as follows: Hyaline Membrane Disease (HMD) (P <0.03), using mechanical ventilation (P <0.041), using surfactant (P <0.04), first minute Apgar score <5, PCO2 >60 mmHg (P <0.035), birth weight < 2500 g (P <0.003) and serum creatinine (SCr) level >1 mg/dl (P <0.003). ROC Curve revealed that low birth weight was the most significant risk factor for mortality of neonates with AKI admitted in the NICU.

Conclusions: Mortality related to AKI was associated with HMD, using mechanical ventilation, the need to surfactant use, low Apgar score, high blood PCO2, high serum creatinine level, and low birth weight.

Keywords: Acute Kidney Injury; Prognosis; Hospital mortality; Intensive Care Units; Neonate.

Case Reports

Hemorrhagic Cystitis Following Cephalexin Overdose in a Child.

Zahra Pournasir, Fariba Farnaghi, Fereshteh Mehregan, SedighehTahareh Tehranchi

Journal of Pediatric Nephrology, Vol. 1 No. 1 (2013), 24 July 2013, Page 37-38

How to Cite This Article: Pournasiri Z, Farnaghi F, Mehregan F, Tehranchi ST. Hemorrhagic Cystitis Following Cephalexin Overdose
in a Child. J Ped. Nephrology 2013 July;1(1):37-38


Hemorrhagic Cystitis (HC) is an infectious or noninfectious process that leads to gross hematuria originating from the urinary bladder mucosa. A previously healthy 2.5-year-old boy was referred to our center five hours after ingestion of 120 ml (6 g) of cephalexin suspension with abdominal pain, diarrhea, vomiting, and gross hematuria. The results of the general physical examination were unremarkable except for mild suprapubic tenderness. He was admitted to the hospital and hydrated.

Laboratory tests on admission showed normal CBC & electrolytes, normal PT&PTT, negative coombs test, many RBCs per high-power field (HPF) in the urine, and normal urinary tract sonography. Within 24 hours, the urine cleared, showing only 1 to 2 red blood cells per high power field with no changes in the CBC, electrolytes, or kidney function tests. His urine culture was negative. Although there are reports of antibiotic- induced HC, the rarity of cephalosporins and cephalexin induced hemorrhagic cystitis encouraged us to report this observation.

Keywords: Cystitis; Hematuria; Cephalexin; Poisoning; Child.

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