Averting the Legacy of Kidney Disease--Focus on Childhood

Julie R Ingelfinger, Kamyar Kalantar-Zadeh, Franz Schaefer

Journal of Pediatric Nephrology, Vol. 4 No. 1 (2016), 13 February 2016, Page 1-7

World Kidney Day 2016 focuses on kidney disease in childhood and the antecedents of adult kidney disease that can begin in earliest childhood.  Chronic kidney disease (CKD) in childhood differs from that in adults, as the largest diagnostic group among children includes congenital anomalies and inherited disorders, with glomerulopathies and kidney disease in the setting of diabetes being relatively uncommon.  In addition, many children with acute kidney injury will ultimately develop sequelae that may lead to hypertension and CKD in later childhood or in adult life. Children born early or who are small-for date newborns have relatively increased risk for the development of CKD later in life.  Persons with a high-risk birth and early childhood history should be watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or treatment.  Successful therapy is feasible for advanced CKD in childhood; there is evidence that children fare better than adults, if they receive kidney replacement therapy including dialysis and transplantation, while only a minority of children may require this ultimate intervention Because there are disparities in access to care, effort is needed so that those children with kidney disease, wherever they live, may be treated effectively, irrespective of their geographic or economic circumstances.  Our hope is that World Kidney Day will inform the general public, policy makers and caregivers about the needs and possibilities surrounding kidney disease in childhood.


IgA vasculitis in Henoch-Schönleinpurpura

Mehrnoush Hassas Yeganeh, Reza Shiari, Khosro Rahmani

Journal of Pediatric Nephrology, Vol. 4 No. 1 (2016), 13 February 2016, Page 8-13

Henoch-Schönleinpurpura (HSP), also termed IgA vasculitis(IgAV), is a systemic vasculitis with anoutstanding cutaneous involvement.Henoch-Schönleinpurpura (HSP) is a small-vessel vasculitisfeatured by palpable purpura on the lower extremities and IgA-dominant immune complex deposition within the wall and lumen of dermal vessels in the lesions. This disorder is associated with joint, gastrointestinal and renal involvement, although the level and severity of involvement is variable.The histologic findings in the kidney are identical to those in IgAnephropathy. Additionally,high circulating levels of galactose-deficient IgA1 are found in patients with both IgAnephropathy and HSP (IgAV). Both of these two findingsadvocate that the two disorders may have a common pathogenesis.

Cardiorenal syndrome or renocardial syndrome:A review

Hasan Otukesh, Semira Mehralizadeh

Journal of Pediatric Nephrology, Vol. 4 No. 1 (2016), 13 February 2016, Page 14-24

Cardirenal syndrome,as a complex pathophysiological disorder of the heart and kidneys,whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other, has been under focus of interest for a long time.In this review we intend to define the interaction between the kidneys and the heart  and different circulating components to characterize the pathophysiological course of the syndrome and discuss the new approaches for the management of this entity.

Original Research Papers

Is Additional Fluid Therapy Effective in the Treatment of Children with Urinary Tract Infection?

Parsa Yousefichaijan, Mojtaba Sharafkhah, Ali Cyrus, Fatemeh Dorreh, Ali Arjmand

Journal of Pediatric Nephrology, Vol. 4 No. 1 (2016), 13 February 2016, Page 25-29

Introduction: Urinary tract infection can result in many complications such as abscess, hypertension, renal failure, renal scar, reflux, etc. Since there is no general agreement on the administration of additional fluid (1.5 times maintenance) for the early treatment of UTI, this study was conducted to evaluate the effect of additional fluid therapy.

Materials and Methods: In This clinical trial study, 206 children with UTI who were admitted at Amir Kabir Hospital (Arak, Iran) from March 2012 to March 2013 were divided into two groups of 103. One group received the usual amount of maintenance fluid while the other group received 1.5 times more than usual maintenance. The course of the resolution of dysuria, frequency, malodorous urine, abdominal pain, and fever was compared between the two groups. Urine culture was performed for all patients 2, 7-10, and 90 days after admission. The patients were age and sex matched. The data was analyzed using descriptive statistics and the X2 method based on independent sample t-test.

Results: Additional fluid had a significant effect on malodorous urine dysuria. However, it had an inverse effect on the treatment of fever and urinary frequency as it made them last longer. There was no difference in other parameters like abdominal pain and urine culture in 3 stages.

Conclusions: Based on our study, the intake of excessive amounts of water has no significant effects on the results of the UTI treatment. However, due to lack of adequate evidence, further studies should be conducted in this field.

Keywords: Urinary Tract Infection; Child; Fluid Therapy.

The Prevalence of Acute Kidney Injury in Neonates with Asphyxia

Maryam Saboute, Behnaz Parvini, Nasrin Khalessi, Zohreh Kalbassi, Majid Kalani, Nastran khosravi

Journal of Pediatric Nephrology, Vol. 4 No. 1 (2016), 13 February 2016, Page 30-32

Introduction: Asphyxia is a common cause of mortality and morbidity among neonates. Following severe asphyxia and ischemia, reperfusion occurs which damages vital organs like the kidneys. This study was conducted to determine the prevalence of AKI based on the definition of a serum creatinine level higher than 1.5 mg/dL, in neonates with asphyxia.

Materials and Methods: This retrospective study was performed in Ali-Asghar and Shahid-Akbar-Abadi Hospitals, Tehran, Iran in a period of one year. The medical documents of all newborns diagnosed with asphyxia were studied. The asphyxia grade was determined according to the asphyxia Sarnat criteria. The kidney function was evaluated based on the serum creatinine level.

Results: Thirty-eight cases met the inclusion criteria. There were 13 Sarnat grade-1 cases (34.2%), 19 grade 2 cases (50%), and 6 grade 3 patients (17.6%).  Three (7.8%) patients (2 patients in grade 3 and one patient in grade 2 of the Sarnat grading scale) developed AKI. AKI was detected in 33% of the patients in grade 3 and 5.2% of the patients in grade 2 of the Sarnat grading scale. Nine patients (23%) died, of whom 83% were in grade 3 and 16.9% in grade 2 of asphyxia.

Conclusions: AKI developed in 7.8% of the cases, of whom 33% were in grade 3 and 5.2% were in grade 2 of the Sarnat grading scale. The low rate of AKI development in our study might be duo to the small sample size and patient mortality in the first 3 days of life.

Keywords: Acute kidney injury; Neonates; Asphyxia.

Assessment of Blood Pressure in Primary Monosymptomatic Nocturnal Enuresis

Parsa Yousefichaijan, Ali Khosrobeigi, Hassan Taherahmadi, Manoochehr Soltani, Yazdan Ghandi, Fakhreddin Shariatmadari, Somaye Bayat, Saeed Alinejad, Mojtaba Hashemi, Ali Arjmand

Journal of Pediatric Nephrology, Vol. 4 No. 1 (2016), 13 February 2016, Page 33-36

Introduction: Enuresis is defined as the repeated voiding of urine into bed at least twice a week for at least 3 consecutive months in a child who is at least 5 years of age. Primary enuresis occurs in children who have never been consistently dry through the night.  Monosymptomatic enuresis has no associated daytime symptoms. Increased nocturnal urine production in primary nocturnal enuretic patients could possibly be associated with autonomic nervous system dysfunction. The aim of this study was to investigate autonomic nervous system function in enuretic children.

Materials and Methods: In this study, children with monosymptomatic primary nocturnal enuresis (MPNE) and healthy children without MPNE were enrolled and their blood pressure was measured twice a day (in the morning and afternoon). Urinalysis, urine electrolyte levels, urinary culture, and urinary system ultrasound were performed in all the children. They were also requested to have a diary about daily fluid intake and the volume of daily urine.

Results: The MPNE group comprised 100 children (M/F: 58/42) and the control group included 100 healthy children (M/F: 51/49). The mean age of the children was 8.1±2.3 and (8.9±2.53 years in MPNE and control groups, respectively. The mean diastolic blood pressure (DBP) during the nighttime and daytime did not differ between the groups (p-value>0.05); however, the mean systolic blood pressure (SBP) was significantly higher in the nighttime in the MPNE group (p-value<0.05) but did not differ between the groups during the daytime (p-value>0.05).

Conclusions: Nighttime SBP was significantly higher in children with MPNE. These subtle abnormalities of the circadian blood pressure regulation may reflect autonomic nervous system dysfunction and contribute to the pathogenesis of MPNE.

Keywords: Child; Enuresis; Blood pressure; Autonomic dysfunction

Non-localizing Fever as Urinary Tract Infection in Children

Javaid Ahmed Bhat Ashraf, Mohd Ashraf, Khurshid Ahmed Wani, Mohsin Rashid, Junaid Manzoor, Lubna Shaheen

Journal of Pediatric Nephrology, Vol. 4 No. 1 (2016), 13 February 2016, Page 37-40

Introduction: Urinary tract infection (UTI) is one of the commonly diagnosed bacterial infections of childhood. However, fever without a localizing point often remains the diagnostic dilemma and not diagnosing UTI could have devastating result for an otherwise easily manageable entity.

Materials and Methods: All febrile children aged 2 months to 10 years without an apparent cause of fever were enrolled and evaluated for possible UTI.

Results: A total of 304 children were recruited; 140 were males and 164 females. Of 304 who had fever without any apparent signs, 40 had UTI. The prevalence of UTI was 13.2% in the study group.

Conclusions: Urinary tract infection presenting as fever without any focus was present in 13.2% of hospitalized patients favouring urine examination to rule out UTI in all febrile children without definite source of fever.

Keywords: Child; E Coli; Fever; Urinary tract infections.

Case Reports

Duplex Moiety Kidney With Ureteral Ectopia; A Case Series

Vikrant V Kumbhar, Charu Tiwari, Hemanshi S Shah

Journal of Pediatric Nephrology, Vol. 4 No. 1 (2016), 13 February 2016, Page 41-44

Ureteral ectopia is a common condition presenting as incontinence in females and incidentally detected in males. The diagnosis requires thorough radiological investigations to delineate the anatomy and formulate the treatment. The prognosis is generally excellent. We presented a series of three cases of ureteral ectopia and discussion regarding their management.

Keywords: Female; Urinary Incontinence; Ectopic Ureter; Duplex Moiety Kidney.

Dilated Cardiomyopathy Several Months after Hemolytic Uremic Syndrome

Nasrin Esfandiar, Fariba Alaei, Mostafa Sharifian, Mastaneh Alaei, Reza Dalirani, Mohammad Reza Khalilian

Journal of Pediatric Nephrology, Vol. 4 No. 1 (2016), 13 February 2016, Page 45-48

This is a report of a 44-month-old baby girl diagnosed as a case of atypical hemolytic uremic syndrome (aHUS) presenting with hematuria, periorbital edema, anemia, thrombocytopenia, and hypertension lacking any history of previous bloody diarrhea. She was treated with plasma infusion followed by plasmapheresis and peritoneal dialysis. After two months, she was discharged in remission undergoing periodic plasmapheresis. Four months later, she was visited for fatigue, tachypnea, and palpitation. Cardiac evaluation revealed dilated cardiomyopathy with an ejection fraction of 15-20%.  She was hospitalized and treated with inotropes and diuretics; one week later, she was discharged in a favorable condition. After six months follow-up, she showed an acceptable renal and cardiac state. It seems that cardiomyopathy can occur as a late and rare complication of HUS. We recommend cardiac evaluation for all patients with HUS at its presentation and in later follow-ups.  

Keywords: Cardiomyopathy; Hemolytic Uremic Syndrome; Child.

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