Clinical Characteristics and Metabolic Abnormalities in Pediatric Urolithiasis in South East Iran

Introduction: To investigate clinical presentation, metabolic risk factors and urinary tract abnormalities in paediatric urolithiasis. Materials and Methods: Between 2011 and 2012, 100 children (53 boys and 47 girls) were treated for urolithiasis. Clinical presentation, calculus localisation, urinary tract infection status, presence of anatomic abnormalities and urinary metabolic risk factors were retrospectively evaluated.Results: The most common clinical features on admission were restlessness/irritability (62%), flank pain (33%) and gross hematuria (4%). Twenty-one percent of patients were detected incidentally during evaluation for other conditions. Urine random tests revealed metabolic abnormalities, including hypercalciuria (56%) and hypocitraturia (64%) in most cases. Anatomic malformation (32%) and urinary tract infections (UTI)(9%) were other presentations.Conclusions: We concluded that most patients were symptomatic and hypocitraturia was the most common risk factor.Keywords: Urolithiasis; Urinary Tract; Pediatrics, Demographic Factor; Hypercalciuria

Clinical Course of 250 Pediatric Cases of Vesicoureteral Reflux in Zahedan, Southeast of Iran

introduction: Although the incidence of primary reflux is 0.1-1.3% in the general population, it is much higher (29-50%) in children with urinary tract infection (UTI). This study aimed to evaluate the epidemiologic characteristics and outcome of vesicoureteral reflux (VUR) in Iranian children in Zahedan, southeast of Iran.Materials and Methods: In this historical cohort study, we reviewed all records of 250 patients diagnosed with VUR who were referred to a Pediatric Nephrology Clinic in Zahedan, Iran between April 2008 and September 2009 and were followed until June 2011. The diagnosis of VUR was made by convectional voiding cystourethgraphy (VCUG). Following the diagnosis, patients received prophylactic low-dose oral antibiotic and were followed by radionuclide cystography (RNC) for 18 months.Results: Of 250 patients with VUR, 153 (61.2%) were female with a mean age of 2.7 ±2.0 years at presentation. One hundred and thirty patients (52%) had unilateral VUR and 120 patients (48%) had bilateral VUR. In 54.4% of the patients, VUR was detected during the investigation for UTI and 13.2% had prenatal hydronephrosis. Voiding dysfunction was the most important condition with VUR (15.2%). Kidney ultrasound confirmed abnormal results in 73.2% of the patients.  Renal scaring secondary to VUR was detected in 85 (34%) patients at the time of VUR diagnosis.Conclusions: Our data showed that VUR was significantly higher in female children and the frequency of abnormal renal scan was significantly higher in children with high–grade VUR. Further studies may be needed to determine the risk factors and apply effective interventions to minimize the progression of renal damage.Keywords: Vesicoureteral reflux; Child; Zahedan

Clinical Signs and Causes of Chronic Kidney Disease in Pediatrics

Background: Chronic kidney disease (CKD) is a worldwide medical condition with increasing frequency that impairs the quality of life of children. This study aimed to assess the clinical signs and causes of CKD in children in Zahedan, Iran. Methods: This cross-sectional study was run on 489 children up to 20 years with stages of 3 to 5 CKDs, in Zahedan during 2010-2019. Informed written consent was obtained from the patients’ parents. Data analysis was performed by SPSS 20 considering 0.05 as significant level. Results: Amongst the clinical manifestations, edema (16.4%), (FTT) (13.5%), urinary symptoms (12.3%) and vomiting (11.5%) were more common and congenital structural anomalies (41.7%) were the most common cause of hospital admission. From among the studied children with CKD, 65.8% had stage 5, about 44.4% had conservative treatment and in total, 19.00% died. Most of the laboratory parameters were different in death and survival cases, for instance, Systolic and diastolic BP were higher in deaths when platelet blood was lower. Main causes of CKD (congenital structural anomalies, cystic/hereditary/congenital disease, glomerular diseases, Renal Tubular Disease, unknown origin and stone) had a significant association with gender (X2=13.42, p=0.02), treatments (X2=70.77, p<0.001), stage of CKD (X2=40.31, p<0.001) and survival (X2=11.59, p=0.041). Stages of CKD had a significant relation with treatment (X2=118.18, p<0.001), and survival (X2=26.5, p<0.001). Conclusion: The causes of CKD were significantly associated with treatments, stage of CKD, and survival. Stages of CKD had significant associations with treatment and survival. Therefore, more attention to children with these signs is essential for early diagnosis and proper treatment

Evaluation of Antibiotic Sensitivity of Urinary Tract Pathogens among Children in Zahedan, South East of Iran

Background Urinary tract infection (UTI), are the most frequent and serious infection in childhood around the world. The present study aimed to evaluate antibiotic sensitivity of urinary tract pathogens among children in Zahedan, South East Iran. Materials and Methods This cross-sectional study analyzed 396 patients aged 1-18 years with positive urine and suspected UTI. Gender and age of children, kind of isolated bacteria in urine culture, susceptibility and resistance of these bacteria to current antibiotics were studied. Bacterial growth for more than 105 CFU/ml was considered as positive. Data analyzed by SPSS version 21.0. Results The most common age of urinary tract infection were < 1 year and 1-7 years for boys and girls, respectively, and the variation of sex distribution was significant in different age groups (P = 0.003). The most prevalent cause of UTI was Escherichia coli(E.coli) (77%), in total ages and both gender, afterward was Enterobacter (8.1%) and Klebsiella (7.1%). E.coli sepsis was highly sensitive to nitrofurantoin (74.7%), ciprofloxacin (72.5%), and amikacin (64.6%), both highly resistant to trimethoprim and sulfametoxazole (74.8%), ampicillin (66.9%), and nalidixic acid(51.1%); and its resistance to ceftriaxone was increasing. Conclusion  In this study resulted that E. coli was the first responsible pathogen in proven culture of UTI in children, which was increased in resistance to popular antibiotics like Ampicillin, Sulfamethoxazole-trimethoprimand Nalidixic acid. In several countries, emphasize the need for local population specific surveillance for guiding empirical therapy for UTI in children