Children with Mineral Bone Disorder Due to Chronic Kidney Disease

Objective: Mineral bone disorders due to chronic kidney disease (CKD-MBD) in children occur as a result of decreased glomerular filtration rate and abnormalities in phosphorus, calcium, parathyroid hormone, and vitamin D metabolism rates. Increased parathormone synthesis may result in the development of adenomas in the parathyroid gland. The aim of this study was to evaluate parathyroid lesions in children with CKD-MBD using ultrasound (US) elastography.Materials and Methods: Fifteen patients with a diagnosis of CKD-MBD (average age, 15.5 +/- 2.4 years; seven girls) and 15 healthy children (average age, 13.8 +/- 2.5 years; six girls) were included in the study. The patients were evaluated clinically and in terms of laboratory findings (calcium, phosphorus, alkaline phosphatase, vitamin D, and parathormone levels), and all patients were evaluated using strain US elastography. The parathyroid strain ratio indices of the study group were compared with the thyroid strain ratio indices of the control group.Results: Among 11 patients with stage 5 CKD who underwent parathyroid US, nodules were observed in 8 patients, whereas parathyroid nodules were not observed in 3 patients with stage 3-4 CKD. The parathyroid lesions average strain ratio index (1.1 +/- 0.5) was significantly higher than that of the control group (0.46 +/- 0.16).Conclusion: The stiffness of parathyroid lesions in children with US elastography was evaluated for the first time in this study to the best of our knowledge, and it is believed that a high strain ratio index could be a useful indicator of the presence of adenomas. We propose that the findings be supported by future larger studies.C1 [Girisgen, Ilknur; Yuksel, Selcuk] Pamukkale Univ, Div Pediat Nephrol, Sch Nursing, Denizli, Turkey.[Gungor, Gulay] Pamukkale Univ, Dept Radiol, Sch Med, Denizli, Turkey

observed differently

Aim: We aimed to evaluate the efficacy of rituximab therapy in children with nephrotic syndromes and to share our experiences.Material and Methods: Twelve children with nephrotic syndrome (four with steroid-dependent, eight with steroid-resistant nephrotic syndrome) who were treated with rituximab were retrospectively evaluated in terms of clinical and laboratory data and CD19-20 levels. All patients received rituximab (375 mg/m(2)) once weekly for 4 weeks. A proteinuria-free period under steroid therapy was not sought prior to initiating rituximab therapy.Results: The overall remission rates in patients with steroid-dependent and steroid-resistant nephrotic syndrome were 100% and 27%. Focal segmental glomerulosclerosis was diagnosed in six patients and the remission rate was 33% in this population. CD19 cell depletion was observed in 10 of the 12 children. Seven of the 10 patients with CD19 depletion achieved remission, whereas the other three had persistent nephrotic proteinuria despite CD19 depletion. Two patients without CD19 depletion never achieved remission. Relapse occurred in three of the seven patients associated with increased CD19.Conclusion: We observed that rituximab could be given without waiting for a proteinuria-free period under steroid therapy. Our result suggest that administering four weekly doses of rituximab increases the like-lihood of remission, considering the amount of drug lost in the urine of children with nephrotic proteinuria. However, our findings must be confirmed with dose-comparison studies conducted with larger populations and an evaluation of long-term adverse effects. Some patients did not achieve remission despite B cell depletion, which suggests that B cell depletion is necessary but insufficient for remission in nephrotic syndromes.C1 [Girisgen, Ilknur; Yuksel, Selcuk] Pamukkale Univ, Dept Pediat, Div Pediat Nephrol, Fac Med, Denizli, Turkey.[Pekal, Yucel] Pamukkale Univ, Dept Pediat, Fac Med, Denizli, Turkey

the Inner Western Anatolian Region in Turkey

Objective: Pediatric urolithiasis is a globally growing problem. The composition and frequency of urinary tract stones vary not only among different countries, but across various regions in a country. Hence, we aimed to identify the types and frequencies of urinary tract stones in children from our region (Inner Western Anatolian part of Turkey), and to compare our findings with the results from other regions in our country.Material and methods: In this retrospective analysis of 53 pediatric urolithiasis cases that were treated in our hospital between 2009 and 2019, the demographic data, clinical course, radiological and metabolic findings, the recurrence rate, and the composition of the stones were evaluated.Results: The mean age of the patients was 5.9 +/- 46 (0.5-18) years, and there were 30 (56.6%) girls and 23 (43.4%) boys. An analysis of the composition of the stones revealed that the majority (85%) consisted of calcium oxalate. The highest risk of recurrence and the need for multiple shockwave lithotripsy (SWL) sessions or surgical intervention appeared to be related with the presence of whewellite stones, which are the most challenging stones in childhood.Conclusion: According the study results, the urinary stone types vary across different regions in our country, and the frequency of uric acid stones decreased going westward, while the frequency of oxalate stones increased. We conclude that this difference in the frequency of the type of urinary stones might reflect the regional dietary habits. Regional frequency and etiology studies for the types of urolithiasis may facilitate the approach to the treatment of urolithiasis.C1 [Girisgen, Ilknur; Becerir, Tulay] Pamukkale Univ, Dept Pediat Nephrol, Sch Med, Denizli, Turkey.[Yuksel, Selcuk] Pamukkale Univ, Dept Pediat Nephrol Rheumatol, Sch Med, Denizli, Turkey.[Karcili, Kadriye] Pamukkale Univ, Dept Pediat, Sch Med, Denizli, Turkey