Cyclosporine in Pediatric Nephrology

Cyclosporine began to be used as one of the immunosuppressive agents in transplantation in the beginning of the 1980s, and in the treatment of nephrotic syndrome in the pediatric nephrology. Therapeutic area of cyclosporine is narrow and its side effects limit its usage. Preference for cyclosporine and tacrolimus as a calcineurin inhibitor is left for the choice of the department. There are still countries with preferred-cyclosporine use because of economic reasons. Cyclosporine is currently being used in the treatment of nephrotic syndrome, but due to its high relapse rates in a short-term use, and nephrotoxicity in long-term use, search for new drugs with fewer side effects keeps continuing. As long as its use is indispensable, it will be necessary to keep track of kidney function and blood level of this medication closely to protect the patients from toxicity

Characteristics of infant urolithiasis: A single center experience in western Turkey

Introductio

Antireflux surgery does not change ongoing renal functional deterioration

Aim Treatment modalities of vesicoureteral reflux (VUR) consist of antimicrobial prophylaxis and antireflux surgery. In this study, we aimed to determine if antireflux surgery changes the course of renal functional deterioration in children with VUR and urinary tract infections (UTI). Methods Medical files of patients with VUR diagnosed during evaluation for UTI were evaluated retrospectively for gender, age, follow-up period, and renal ultrasonography (US) and serial 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy findings. Estimated glomerular filtration rate and urinary protein levels were determined at the initial and last visits, and before the operation in children who had antireflux surgery. The patients were divided into two groups as solely medically treated (Group 1) and both medically and surgically treated (Group 2). Group 2 was further divided as those with stable renal function (Group 2a) and with progressive renal injury (Group 2b). Results There were 140 patients (77 female; mean age 51.6 +/- 51.9 months). Group 1 and Group 2 included 82 and 58 patients, respectively. In Group 2, the number of patients with the abnormal US, DMSA scintigraphy, and renal function was higher than in Group 1. Recurrent UTI rate was similar, but progressive scarring was more prominent in the antireflux surgery group. In Group 2, 31 patients had a stable renal function (Group 2a) while 27 had progressive deterioration of renal functions (Group 2b). These subgroups were not different with respect to the rate of high-grade VUR, the presence of a renal scar in DMSA, and UTI recurrence. However, the bilateral renal scar was more common in Group 2b. Conclusion Antireflux surgery does not change the course of ongoing renal injury and renal functional deterioration