Health-related quality of life of pediatric renal transplant recipients and their parents: the role of associated factors and clinical counseling

Background/aim: This study evaluates the health-related quality of life (HRQoL) of pediatric renal transplant recipients and their parents and investigates the effects of clinical, socioeconomic, and psychological factors as well as continuous counseling on the HRQoL. Materials and methods: Patients aged 8-17 years (mean: 14.9 +/- 2.9) were enrolled. Clinical and demographic data were noted. The Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES), and Turkish version of the Kinder Lebensqualitat Fragebogen (KINDL) questionnaire for children and the BDI, RSES, parent-proxy version of KINDL, and Short-Form 36 (SF-36) for parents were applied (step 1). Following a 1-year counseling program, the tests were repeated (step 2). Results: Child-self and parent-proxy KINDL scores were optimal with no difference between periods (for child-self and parent-proxy scores, P > 0.05). Parent SF-36 scores indicated optimal results. Parent RSES scores decreased in step 2 (P < 0.05). The BDI scores were higher in parents than children in both periods (P < 0.05 for step 1 and P < 0.01 for step 2). Higher creatinine levels, lower monthly income, and urological comorbidities modified the HRQoL negatively in step 1. Conclusion: Continuous education with psychosocial counseling carries importance in improving HRQoL in the posttransplant period

Changing trends in pediatric renal biopsies: analysis of pediatric renal biopsies in national nephrology registry data

Renal biopsy is the gold standard method for determining the diagnosis, treatment, and prognosis in children with renal disease. This study aims to evaluate the histopathological features of pediatric renal biopsies obtained from the national nephrology registry in the last two decades. Data recorded in the Turkish Society of Nephrology Registry System (TSNRS) in 1991 as well as in between 2001 and 2010 were analyzed. A total of 3892 biopsies were recorded; with the least number in 1991 (total 103 biopsies from 17 centers) and the highest number in 2008 (total 654 biopsies from 23 centers). Glomerular diseases constituted the main group in the registry (62.64\%), followed by systemic diseases (20.06\%). Focal and segmental glomerulosclerosis (FSGS) and Henoch-Schonlein purpura (HSP) nephritis (IgA vasculitis) were the most common glomerular and systemic diseases, respectively. Overall prevalence of renal amyloidosis and membranous nephropathy (MN) was quite low (1.87\% and 1.56\%, respectively) in all periods. Compared to 1991, there was an increasing trend in the frequencies of certain disorders including hemolytic uremic syndrome (HUS), IgA nephropathy, and HSP nephritis; and there was a decrease in acute proliferative glomerulonephritis (GN) in 2008. As well as demonstrating the etiologies of renal diseases which can only be identified by renal biopsies, this study provides important information regarding the changing patterns of histopathological findings due to better management of pediatric renal diseases over the years in Turkey

Evaluation of growth in children and adolescents after renal transplantation

Despite the advances in the last decades, it is well-known that optimal growth is usually not achieved in children with chronic kidney disease (CKD) even after successful renal transplantation (RTx). In this study, our aim was to evaluate growth patterns and factors affecting growth in pediatric and adolescent renal transplant recipients (RTR). Thirty-seven prevalent RTR with mean age of 17.0 +/- 2.9 years and mean post-RTx duration of 4.2 +/- 2.0 years were evaluated. Growth parameters, height velocities and factors affecting growth at the time of RTx (baseline) and in the post-RTx follow-up were also retrospectively assessed. Cumulative corticosteroid ( CS) doses were calculated. Mean height and weight standard deviation score (SDS) values were negative (-1.4 +/- 1.1 and -1.2 +/- 1.5, respectively), whereas height SDS was positive in 16\% of the patients. Mean weight, height, and BMI (body mass index) SDS of the RTR were significantly higher than the values at transplantation (p<0.001 for weight and height SDS; p<0.05 for BMI SDS). Height SDS was <-2.0 in 19\% of the patients while 60\% at the baseline. Main factors associated with post-RTx height SDS were pre-RTx height SDS (B: 0.448, p<0.01) and CKD duration (B: -0.01, p<0.05). Although it was much better than the pre-RTx period, the present study reveals that postRTx growth was less than anticipated. As well as minimizing post-RTx CS doses and preserving graft function in the post-RTx follow-up, performing early transplantation and all efforts for minimizing pre-RTx growth deficit are crucial for an optimal post-RTx growth

Successful treatment of a childhood synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome with subcutaneous methotrexate: A case report

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is defined as a syndrome that is related to various osteoarticular manifestations and chronic dermatological conditions especially severe acne. SAPHO syndrome is a rare and unusual clinical entity in childhood and treatment choices are variable. We report an 11-year-old girl who suffered from SAPHO syndrome and successfully treated with subcutaneous methotrexate. We report our case in order to take attention to this rare clinical condition in evaluating patients and also to point out that treatment options beyond biologic agents should be the first line treatment in childhood

Results of native and transplant kidney biopsies of children in a single center over a 15 years period

Renal biopsy is an important diagnostic procedure in pediatric nephrology. This study retrospectively investigates the indications, results and complications in a single tertiary children's hospital in Turkey. We evaluated the native and transplant kidney biopsies in Gazi University Pediatric Nephrology Department between 2001 and 2015. A total of 196 biopsies (144 natives and 52 transplants) were included into the study. The mean age of the patients was respectively 10.8 +/- 3.5, 13.9 +/- 1.5years. The main indication for a biopsy was non-nephrotic proteinuria with or without hematuria (n=35), followed by steroid-resistance nephrotic syndrome (SRNS) (n=34) and Henoch-Schonlein purpura (HSP)-related proteinuria (n=20) for native kidneys. We found that focal segmental glomerulosclerosis (FSGS) (11.7\%) was the most common histopathologic diagnosis for native kidneys, but acute cellular rejection (7.6\%) was the most common histopathologic diagnosis for transplant kidneys. The complication rate in our study was founded 6.6\% totally. Different complication rates were found in other studies; however, we think that this difference comes from the inspecting methodology of the complications. Hence, we wanted to share our own experience in the context of other studies in the literature

Cerebral Vasculitis in Henoch-Schonlein Purpura: A Case Report

Henoch-Schonlein purpura is a common form of systemic small vessel vasculitis in childhood. Although headache and behavioral changes have been described in a significant proportion of children with Henoch-Schonlein purpura, severe neurological complications are rare. In this article, we report a case of central vasculitis in a four-year-old boy who presented with hemiplegia and aphasia. The treatment options for cerebral vasculitis of Henoch-Schonlein purpura are numerous but controversial in pediatric patients. Our patient was successfully treated by pulse methylprednisolone and pulse cyclophosphamide. The patient was followed-up for four years without any sequel

Evaluation of non-infectious complications of peritoneal dialysis in children: a multicenter study

Background Peritoneal dialysis (PD) is the most common kidney replacement therapy in children. Complications associated with PD affect treatment success and sustainability. The aim of this study was to investigate the frequency of PD-related non-infectious complications and the predisposing factors. Methods Retrospective data from 11 centers in Turkey between 1998 and 2018 was collected. Non-infectious complications of peritoneal dialysis (NICPD), except metabolic ones, in pediatric patients with regular follow-up of at least 3 months were evaluated. Results A total of 275 patients were included. The median age at onset of PD and median duration of PD were 9.1 (IQR, 2.5-13.2) and 7.6 (IQR, 2.8-11.9) years, respectively. A total of 159 (57.8%) patients encountered 302 NICPD within the observation period of 862 patient-years. The most common NIPCD was catheter dysfunction (n = 71, 23.5%). At least one catheter revision was performed in 77 patients (28.0%). Longer PD duration and presence of swan neck tunnel were associated with the development of NICPD (OR 1.191; 95% CI 1.079-1.315,p = 0.001 and OR 1.580; 95% CI 0.660-0.883,p = 0.048, respectively). Peritoneal dialysis was discontinued in 145 patients; 46 of whom (16.7%) switched to hemodialysis. The frequency of patients who were transferred to hemodialysis due to NICPD was 15.2%. Conclusions Peritoneal dialysis-related non-infectious complications may lead to discontinuation of therapy. Presence of swan neck tunnel and long duration of PD increased the rate of NICPD. Careful monitoring of patients is necessary to ensure that PD treatment can be maintained safely

Urine soluble TLR4 levels may contribute to predict urinary tract infection in children: the UTILISE Study.

Background: One of the most common bacterial infections in childhood is urinary tract infection (UTI). Toll-like receptors (TLRs) contribute to immune response against UTI recognizing specific pathogenic agents. Our aim was to determine whether soluble TLR4 (sTLR4), soluble TLR5 (sTLR5) and interleukin 8 (IL-8) can be used as biomarkers to diagnose UTI. We also aimed to reveal the relationship between urine Heat Shock Protein 70 (uHSP70) and those biomarkers investigated in this study. Methods: A total of 802 children from 37 centers participated in the study. The participants (n = 282) who did not meet the inclusion criteria were excluded from the study. The remaining 520 children, including 191 patients with UTI, 178 patients with non-UTI infections, 50 children with contaminated urine samples, 26 participants with asymptomatic bacteriuria and 75 healthy controls were included in the study. Urine and serum levels of sTLR4, sTLR5 and IL-8 were measured at presentation in all patients and after antibiotic treatment in patients with UTI. Results: Urine sTLR4 was higher in the UTI group than in the other groups. UTI may be predicted using 1.28 ng/mL as cut-off for urine sTLR4 with 68% sensitivity and 65% specificity (AUC = 0.682). In the UTI group, urine sTLR4 levels were significantly higher in pyelonephritis than in cystitis (p < 0.0001). Post-treatment urine sTLR4 levels in the UTI group were significantly lower than pre-treatment values (p < 0.0001). Conclusions: Urine sTLR4 may be used as a useful biomarker in predicting UTI and subsequent pyelonephritis in children with UTI. Graphical abstract: [Figure not available: see fulltext.