The innate immune response during acute urinary tract infections; an overview

The components of immune system are specific (adaptive immunity) and non-specific (innate immunity). Regardless of antigenic properties, the non-specific components function either as eliminators or barriers of wide range of pathogens. A person is born with innate immunity as the natural resistances, which has three kinds; anatomic mechanical and biochemical factors. The resistances are provided by innate immunity via various chemical, cellular and physical approaches. The colonization, entry and spread of microorganisms can be prevented by innate immunity. Two main sub-divided types of adaptive immunity are humeral and cellular. Active immunity resulting from the development of antibodies in response to the presence of an antigen is a long-term and acquired immunity. This review article summarizes some important potential mechanisms in innate immune system. The host renal tract which has been investigated from many aspects of the pathogenesis of urinary tract infection (UTI) are still poorly defined and require a better understanding of the pathophysiology immune system

Pediatric vesicoureteral reflux approach and management

Vesicoureteral reflux (VUR), the retrograde flow of urine from the bladder toward the kidney, is congenital and often familial. VUR is common in childhood, but its precise prevalence is uncertain. It is about 10–20% in children with antenatal hydronephrosis, 30% in siblings of patient with VUR and 30–40% in children with a proved urinary tract infection (UTI). Ultrasonography is a useful initial revision but diagnosis of VUR requires a voiding cystourethrography (VCUG) or radionuclide cystogram (DRNC) and echo-enhanced voiding urosonography (VUS). Although for most, VUR will resolve spontaneously, the management of children with VUR remains controversial. We summarized the literature and paid attention to the studies whose quality is not adequate in the field of VUR management of children

Prevalence of Nephrolithiasis in 7-11 year-old Students: A Multicenter Study

Introduction: Renal diseases can be asymptomatic even in progressive disorders; therefore, detecting urine and ultrasound abnormalities may help facilitate early diagnosis and prevention of renal diseases. This study was conducted to investigate random urine parameters and urinary system ultrasonography findings in 7-11 year-old students.Materials and Methods: Healthy students from Tehran and Qom, Iran were enrolled in a prospective descriptive study and their sex, age, weight, height, and BMI were measured. Then, a fresh clean urine sample was collected and ultrasonography of the urinary tract was done. The urine specimen was tested for urine Ca/Cr, urine oxalate/Cr, and urine citrate/Cr.Results: Of 932 students, 47.9% were female and 52.1% were male. The age range of the students was 7-11 years with a mean age of9.08 years. A history of renal disease and UTI was positive in 1.1% and 9.9% of the students, respectively. Ultrasound was normal in78% and abnormal in 22% of the students. Abnormal findings included hydronephrosis in 1.1%, fullness of the urinary tract in 0.1%, urinary system duplication in 3%, urolithiases in 0.7%, decreased kidney size in 0.4%, increased bladder thickness in 8.9%, and other abnormal findings in 7.8% of the subjects. Abnormal urine findings included hypercalciuria, in 10.9%, urine hyperuricosuria in 5.4%, urine hyperoxaluria in 12.8%, and hypocitraturia in 96.9% of the students.Conclusions: According to the results, nephrolithiasis may be due to hyperoxaluria, hypercalciuria, and hyperuricosuria in a normal population. Genetics and nutrition are more important risk factors. Therefore, some nutritional interventions for decreasing urine oxalate, calcium, and uric acid may be beneficial. Keywords: Urinalysis; Ultrasonography; Hypercalciuria; Hyperuricosuria; Hyperoxaluria; Child

Epidemiological, Clinical and Laboratory characteristics of acute disseminated encephalomyelitis in children: a retrospective study

We aimed to study the precipitating factors, demographic data, clinical and radiological manifestations, electroencephalography and laboratory findings, as well as association with infections, immunization and incidence of relapse of acute disseminated encephalomyelitis (ADEM) in children admitted to Mofid Children Hospital, Tehran, Iran from Mar 2013 to Mar 2016.Materials & MethodsA 3-yr retrospective review of 29 children with definite final diagnosis of ADEM in Mofid Hospital in Tehran, Iran was performed. The diagnosis was based on specified criteria, including a presumed acute demyelinating process with no history of unexplained neurological symptoms and at least one demyelinating lesion shown on magnetic resonance imaging without evidence of previous destructive white matter lesions.ResultsOverall, 29 children diagnosed as ADEM were studied in terms of demographic characteristics, clinical manifestations and laboratory findings in two groups according to their recurrence. The mean age of the patients with recurrence was less than those without it were. It was more common in females but the difference was not statistically meaningful. There was no relationship between the season of the first episode of the disease and the recurrence incidence. Moreover, the relationship between viral infections and recurrence was statistically non-meaningful. No relationship between the recurrence of ADEM and clinical manifestations, radiological and laboratory findings was found.ConclusionThe reason for high rate of recurrence in our patients may be related to the younger age of children in our study.

Comparison of diagnosis of VUR nephropathy by urinary level of ceruloplasmin with DMSA-Scan in children

Background: Children with vesicoureteral reflux (VUR) are at risk of recurrent pyelonephritis, kidney scars, hypertension, and renal failure. Currently, VUR complications can be diagnosed by different imaging methods such as sonography, intravenous pyelography and dimercaptosuccinic acid (DMSA) scan, having certain limitations. Urinary level of ceruloplasmin (Cp) might be an effective non-radiological method. The aim of this study was to compare the urinary level of Cp with DMSA scan in the diagnosis of VUR complications. Methods: The present cross-sectional study was conducted in Pediatric Research Center of Qom University of Medical Sciences and Health Services, Iran. Subjects consisted of 61 children with VUR, diagnosed by voiding cystoureterography (VCUG) and undergone either DMSA scan or urine Cp measurement. VUR stages and complications of the cases were evaluated using serum and urinary renal parameters. Data were analyzed using SPSS 22. Results: Among them, 80.3% were girls with a mean age of 7.2±3.8 years. Mean Cp urine level was statistically different between VUR sides in DMSA scan (unilateral: 269.56 vs. bilateral: 450.42 µg/dL) (P=0.034, r =0.273), but was not statistically different among various VUR degrees (P=0.102, r=0.211), different ages and genders (P>0.05). Conclusions: Urinary level of Cp was not statistically different among VUR degrees, but was higher in bilateral VUR cases, indicating Cp can be used as a safe, non-invasive, and cheap measurement tool for screening test. Further studies are required to confirm Cp as an effective method

Prevalence of reflux nephropathy in Iranian children with solitary kidney: results of a multi-center study

Abstract Background: Given the importance of the function of the remnant kidney in children with unilateral renal agen‑ esis and the significance of timely diagnosis and treatment of reflux nephropathy to prevent further damage to the remaining kidney, we aimed to determine the prevalence of reflux nephropathy in this subgroup of pediatric patients. Methods: In general, 274 children referred to pediatric nephrologists in different parts of Iran were evaluated, of whom 199 had solitary kidney and were included in this cross‑sectional study. The reasons for referral included urinary tract infection (UTI), abnormal renal ultrasonography, being symptomatic, and incidental screening. Demographic characteristics, including age and gender were recorded. History of UTI and presence of vesicoureteral reflux (VUR) were evaluated. Results: Of the 274 children evaluated in this study with the mean age (SD) of 4.71 (4.24) years, 199 (72.6%) had solitary kidney. Among these, 118 (59.3%) were male and 81 (60.7%) were female, 21.1% had a history of UTI, and VUR was present in 23.1%. The most common cause of referral was abnormal renal ultrasonography (40.2%), followed by incidental screening (21.1%), being symptomatic (14.1%), and UTI (5.5%). In 116 children (58.3%), the right kidneys and in 83 (41.7%) the left kidneys were absent. Besides, 14.6% of the participants had consanguineous parents and 3% had a family history of solitary kidney. Upon DMSA scan, the single kidney was scarred in 13.1%, of which only 7.5% were associated with VUR. In addition, proteinuria and hematuria were observed in 6.5% and 1.5% of children, respectively. Conclusions: The prevalence of reflux nephropathy was 7.5% in children with solitary kidney with a male predomi‑ nance. Given the relatively high prevalence of reflux nephropathy in these children, screening for VUR in the remnant kidney appears to be essential in this population. Keywords: Vesicoureteral reflux, Nephropathy, Children, Solitary kidney, Renal agenesi

New Attention to Vesicoureteral Reflux In Children: A Review Article : VUR in Children

Background and Aim: Vesicoureteral reflux (VUR) as a known cause of urinary tractinfection (UTI), renal scarring, and nephropathy, is congenital and often familial. Theprevalence of VUR is unclear, although most cases of VUR resolves spontaneously, themanagement of children with VUR is controversial. The purpose of this review was toevaluate VUR in order to provide an update on management to improve its prognosis.Methods: The articles from several sources, including PubMed, Scopus, Embase, GoogleScholar, Web of Science, and the Directory of Open Access Journals, were included.Conclusion: Due to various complications, VUR is very scary for patients or families, andspecial attention is needed. A challenge for pediatric nephrologists is the early diagnosisof VUR and the progressive complications of kidney disease. There is no internationallyaccepted, uniform, evidence-based algorithm for the assessment of reflux anywhere

Etiology of Hematuria in Children: A Review Article: Etiology of Hematuria in Children

Background and Aim: The etiology of hematuria in children is different. Hematuria isa known risk factor for developing chronic kidney disease (CKD). This narrative reviewaimed to evaluate the etiology of hematuria in children, mainly new hematuria research, toprovide an update on the management, and complications that can improve the prognosis ofhematuria.Methods: For this narrative review, articles from several sources, including Scopus, GoogleScholar, Embase, Web of Science, PubMed, and the Directory of Open Access Journals were used.Results: Kidney and urinary tract infection (UTI) is the most common cause of hematuriain children. Renal structural abnormalities, hypercalciuria, urinary stones, and extrarenalabnormalities associated with hematuria.Conclusion: Hematuria is a symptom and very dangerous, but due to various causes in thesepatients, it is needed in all patients.The challenge for pediatric nephrologists is the early diagnosis of children with progressiveforms of kidney disease from other causes. This manuscript reviews the multiple potentialcauses of microscopic hematuria and provides a framework for the initial assessment andmonitoring of such patients. No internationally accepted, uniform, evidence-based algorithmexists for its diagnostic evaluation anywhere. It is recommended that extensive publicattention be paid to the etiology and management of hematuria

Non-Nephrotic Proteinuria in Children: A Review

Proteinuria is defined as an increased abnormal urinary excretion of proteins. In normal conditions, few proteins are lost through the urine. Proteinuria is a problem and dilemma in pediatric practice. Non- nephrotic proteinuria is described and its follow-up is discussed in the following. Keywords: Proteinuria; Non-nephrotic proteinuria; Nephrotic syndrome; Child