Evaluation of fluid overload markers in pediatric hemodialysis patients

Assessment of hydration status in children undergoing hemodialysis (HD) is crucial. This study aimed to identify the techniques that can be utilized to assess fluid overload in children with end-stage renal disease (ESRD) undergoing HD. The study included 9 patients aged >5 years and < 18 years who underwent 27 HD sessions and were followed up for ≥1 month. The median age of the patients was 16 years (IQR: 5-17.8 years) and the female/male ratio was 1.25:1. Symptoms of volume overload were clinically observed based on 5 (18.5%) of the 27 measurements. There was a significant positive linear correlation between fluid overload by weight and pre- and post-HD bioimpedance spectroscopy (BIS) measurements (OH) (r=0.95 [P=0.000]). There was a significant difference in median IVC diameter between pre-HD and after HD (P=0.029). The median pre-HD IVC collapsing index was 13.8% (IRQ: 4%-46%), versus 17.1% (IRQ: 4.5%-45%) after HD; the difference was significant (P=0.000). BIS is the most widely used body composition monitor for estimating fluid status in children undergoing HD. The present study investigated the sensitivity of markers of volume load in children on a routine HD program. The parameters that best indicate volume load are the differences between pre-HD and post-HD BIS measurements, physical examination findings, and heart rate measurements. [Med-Science 2023; 12(2.000): 417-23

Clinical and histopathological prognostic factors affecting the renal outcomes in childhood ANCA-associated vasculitis

ObjectiveAntineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are very rare in childhood with an increased risk of morbidity and mortality. We aimed to evaluate renal prognostic factors in childhood AAV from the perspective of ANCA serotype, histopathological classification, and five-factor score (FFS).MethodsPediatric AAV patients from 11 referral centers in Turkey had been included to the study. The demographics, clinical findings, AAV subtypes, outcomes, and FFS were evaluated retrospectively. Kidney biopsies were classified histopathologically.ResultsTotally, 39 patients were enrolled in the study. Among all patients, 74.4% had renal involvement, 56.4% ear-throat-nose involvement, and 51.3% had musculoskeletal involvement. Proteinase 3 (PR3)-ANCA was positive in 48.7%, and myeloperoxidase (MPO)-ANCA was positive in 30.8%. 69.2% of patients had impaired renal function, and 28.2% had progressed to end-stage renal disease (ESRD) during the follow-up. At the time of diagnosis, FFS was 2 in 53.8%. The most common histopathologic classifications were as follows: crescentic type in 40.7% and sclerotic type in 25.9%. Gastrointestinal and renal involvement, MPO-ANCA positivity, serum creatinine levels, and impaired renal function during the follow-up were significantly higher in patients with FFS2, compared to patients with FFS <2. Patients with FFS2 had more common crescentic, mixed and sclerotic histopathologic findings in biopsies. By logistic regression analysis forward method, the strongest single-risk factor among all the parameters was the initial level of creatinine in patients with ESRD, compared to the other patients (p=0,007).ConclusionsEvaluation of the FFS, ANCA serology, and the creatinine levels may help to predict renal prognosis