Evidence Based Practice in Pediatric Urolithiasis

Nephrolithiasis is an increasing problem in children. Due to the different presentations and etiology of this disease in children compared with adults, we decided to perform an extensive search to find trials and arrange an evidence based study in this regard.Keywords: Urolithiasis; Child; Evidence-Based Practic

The Role of Ischemia Reperfusion Damage on Renal Transplant, what are the new treatments?

How to Cite This Article: Otukesh H, Hoseini R, Rahimzadeh N, Hosseini S, Ahmadpoor P, Javadi Larijani F. The role of Ischemia reperfusion damage on renal transplant, what are the new treatments? J Ped. Nephrology 2013 July;1(1):1-7.Ischemia reperfusion damage usually occurs after renal transplantation. These injuries can stimulate the innate immune system, trigger an inflammatory response and ultimately activate the adaptive immune system. These events may result in rejection, graft fibrosis and chronic allograft nephropathy. Different mechanisms contribute to innate immune system activation following ischemia reperfusion injury in renal transplants. Some of these mechanisms are known and described by investigators while the remaining are still unknown. To clarify the precise mechanisms underlying the innate immune system activation and rejection progression helps us to plan therapeutic protocols to reduce immunologic responses to ischemic events and to improve the graft function and outcome. In this review, we will discuss how innate and adaptive immune systems are activated during an ischemic insult and thereafter discuss related therapeutic interventions to block the activating pathways. Keywords: Ischemia; Renal transplantation; Reperfusion

Clinical Features and Outcome in Children With Primary Hyperoxaluria; Single Center Experience

No abstrac

Bladder Volume Wall Index In Children With Urinary Tract Infections

How to Cite This Article: Hooman N, Hallaji F, Mostafavi SH, Sharif MR, Tatarpoor P, Otukesh H. Bladder Volume Wall Index in Children with Urinary Tract Infections. J Ped. Nephrology 2013 July;1(1):18-22.Introduction: Few studies have focused on the correlation between bladder ultrasound and urinary tract infection. The aim of this study was to evaluate the bladder volume wall index in children with single or recurrent urinary tract infection.Materials & Methods: This case-control study was conducted between March 2008 and December 2009. The study was performed on one hundred children (8 boys, 92 girls) aged 4-15 years with a history of urinary tract infection and thirty-nine (20 males, 19 females) age- matched healthy children who had negative urine culture one month before investigation. The kidneys, ureters, and bladder sonography were performed in all children. Bladder volume wall index was calculated for each child and the result of 70-130 was presumed normal. Student T-test, chi-square, likelihood ratio, and risk ratio were used. P-value <0.05 was considered significant.Results: The mean bladder volume was 262.5 (±82) in recurrent urinary tract infection, 235 (±54) in single urinary tract infection, and 278 (±80) in controls (P<0.05). The bladder was thick (<70) in 37 (28 cases, 9 controls) and thin (>130) in 38 children (28 cases, 10 controls) (P>0.05). The median residual volume was not different between the two groups. The abnormal BVWI in children with vesicoureteral (VU) reflux was 75% as compared to 51% in those without VU reflux (P>0.05). There was no correlation between BVWI and age, gender, groups, vesicoureteral reflux status, or residual volume (P>0.05).Conclusions: According to our findings, the bladder volume wall index is not sensitive enough to discriminate children who are prone to urinary tract infection. Keywords: Urography; Urinary Tract Infections; Ultrasonography; Urinary Bladde

Učestalost hipertenzije i kardiovaskularnih rizika u djece s ožiljcima na bubrežnom tkivu nakon mokraćne infekcije

Hypertension is a late outcome of refl ux nephropathy and renal parenchymal scar secondary to urinary tract infection (UTI). We presumed that it might be detected much earlier after episodes of UTI and the associated cardiovascular risk factors assessed. Between 2009 and 2011, 85 (67 female and 18 male) children aged 5-15 years with a history of febrile UTI, followed-up for at least one year from the fi rst episode of febrile UTI, were enrolled in the study. The variables included 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, carotid sonography, renal 99mcTc-DMSA, glomerular fi ltration rate, and microalbuminuria. Masked hypertension was detected in 18.8%, hypertension in 7.1% and white coat hypertension in 9.4% of cases. Prehypertension was seen in 20% of children. Out of 85 cases, 43.5% were non-dippers. Out of 56 children with hypertensive and prehypertensive parameters on ABPM, 9.1% showed left ventricular mass index >51g/m2.7 (p>0.05). Signifi cant correlation was only recorded between abnormal blood pressure and the severity of renal parenchymal scar (p<0.05). In conclusion, ABPM is suggested for early detection of masked hypertension and abnormal blood pressure pattern in all normotensive children with a history of recurrent UTI.Hipertenzija je kasni ishod refl uksne nefropatije i ožiljaka na bubrežnom parenhimu koji nastaju nakon mokraćne infekcije. Pretpostavili smo da bi se to moglo otkriti znatno ranije nakon epizoda mokraćne infekcije te procijeniti pridružene kardiovaskularne čimbenike rizika. Od 2009. do 2011. godine, u ispitivanje je uključeno 85 (67 Ž, 18 M) djece u dobi od pet do 15 godina s anamnezom febrilne mokraćne infekcije koja su bila praćena najmanje jednu godinu od prve epizode febrilne mokraćne infekcije. Praćene su sljedeće varijable: 24-satno ambulatorno praćenje krvnog tlaka (ambulatory blood pressure monitoring, ABPM), ehokardiografi ja, karotidni ultrazvuk, 99mcTc-DMSA bubrega, glomerularna stopa fi ltracije i mikroalbuminurija. Maskirana hipertenzija otkrivena je u 18,8%, hipertenzija u 7,1% i hipertenzija “bijele kute” u 9,4% slučajeva. Prehipertenzija je zabilježena u 20% djece. Od 85 slučajeva 43,5% ih nije pokazalo odgovarajući pad krvnog tlaka tijekom noći (non-dipper). Od 56 djece s hipertenzivnim i prehipertenzivnim parametrima na ABPM 9,1% ih je imalo indeks lijeve ventrikularne mase veći od 51g/m2.7 (p>0,05). Značajna korelacija zabilježena je između nenormalnog krvnog tlaka i težine ožiljka na bubrežnom parenhimu (p<0,05). U zaključku, ABPM se može preporučiti za rano otkrivanje maskirane hipertenzije i nenormalnog kretanja krvnog tlaka kod sve normotenzivne djece s anamnezom opetovane mokraćne infekcij

Cardiorenal syndrome or renocardial syndrome:A review

Cardirenal syndrome,as a complex pathophysiological disorder of the heart and kidneys,whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other, has been under focus of interest for a long time.In this review we intend to define the interaction between the kidneys and the heart  and different circulating components to characterize the pathophysiological course of the syndrome and discuss the new approaches for the management of this entity

Surgical complications of hemolytic uremic syndrome: Single center experiences

Purpose: To determine the prevalence, outcome and prognostic factors in children with hemolytic uremic syndrome (HUS) who underwent laparotomy. Materials and Methods: The medical records of 104 patients with HUS who presented to our center between 1986 and 2003 were reviewed retrospectively. Data were analyzed using Student&#x2032;s t test for comparing means, Fisher&#x2032;s exact test for frequencies and Pearson&#x2032;s correlation for finding the correlations. Results: 78&#x0025; of cases presented with vomiting and diarrhea. Seven out of 104 needed surgical exploration. The indications of surgery were acute abdomen, severe abdominal distention and the sign of peritonitis. The findings at laparotomy were intussusceptions, perforation (colon, ileum), gangrene of entire colon, rectosigmoidal tearing, duodenal obstruction and toxic megacolon. Pathological findings were transmural infarction in two cases in which staged surgical management was performed (cecostomy, resection, later anastomosis). Four out of seven patients died because of pulmonary failure, coma and multiple organ failure ( P&#60; 0.05) compared to those who did not need laparotomy. The patients requiring surgery were young (&#60; 3 years), had high leukocyte count (>20000 mm 3 ) and low albumin level (&#60; 3g/dl) ( P&#60; 0.05). Conclusion: Surgical complications of HUS are rare but are assorted with high mortality due to respiratory failure and multiple organ failure. Early decision of laparotomy associated with intensive care, including mechanical ventilation, adequate dialysis and ultrafiltration, are recommended

Association between Amylase Excretion Fraction and Acute Renal Transplant Rejection in Pediatrics

Background and Objectives: Serum amylase increases and its excretion fraction decreases in patients with renal failure. Excretion fraction can be used as a diagnostic way in individuals with acute renal transplant rejection. In this study, the association between amylase excretion fraction and acute renal transplant rejection, was investigated in pediatrics.   Methods: in this case - control study, serum and urine amylase and serum and urine creatinine, were measured in children without (30 cases) and with (30 cases) acute renal transplant rejection, and their amylase excretion fraction was determined. Sonography of kidney and urinary tract, was used to rule out the obstruction due to surgical manipulation. To rule out cyclosporine intoxication and urinary tract infection (differential diagnostic factors of acute renal transplant rejection), serum cyclosporine and urine CRP were assessed, respectively. Data analysis was performed using t-test and logistic regression test.   Results: In children with acute renal transplant rejection, variables of urine creatinine (20.1±5.5 vs 15.9±4.7, p=0.002), urine amylase (744.9±376.6 vs 584.8±218.3, p=0.049), and amylase fraction excretion (238.7±118.4 vs 96.112±2.5, p<0.001), were significantly higher, as compared to the group without acute renal transplant rejection. Based on the multiple logistic regression analysis, among the measurable variables, only amylase fraction excretion, urine amylase and urine creatinine, only amylase fraction excretion and urine creatinine could independently predict acute renal transplant rejection.   Conclusion: The findings of the current study showed that accurate assessment of the urine creatinine and amylase fraction excretion, can predict the probability of acute renal transplant rejection in children