Siçanlarda oluşturulan deneysel piyelonefrit modelinde bilirübinin renal koruyucu etkisinin araştirilmasi

Amaç: Güçlü bir anti-oksidan olduğu bilinen bilirübinin, patogenezinde hem toksik hem de iskemi-reperfüzyon hasarının rol oynadığı piyelonefritte, renal hasar üzerine etkilerini araştırmak. Gereç ve Yöntem: Böbreklerine E.coli enjekte edilerek deneysel piyelonefrit oluşturulan Wistar türü 32 sıçan 4 gruba ayrıldı: Grup 1 (tedavisiz), Grup 2 (antibiyotik), Grup 3 (bilirubin), Grup 4 (antibiyotik + bilirubin). Antibiyotik tedavisi bakteri inokülasyonundan 3 gün sonra başlayıp 5 günæ bilirubin uygulaması ise bakteri inokülasyonu ile aynı gün başlayıp 8 gün sürdürüldü. Her gruptaki sıçanların yarısı 9. günde (erken dönem) sakrifiye edilerek, elde edilen böbrek dokuları histopatolojik parametreler, immunohistokimyasal renal fibrozis belirleyicileri (?? MMP-9, TIMP-1), apoptoz (TUNEL, kaspaz-3) ve oksidan/anti-oksidan sistem (MDA, SOD, GPX) aktiviteleri açısından değerlendirildi. Sıçanların geri kalan yarısı ise 6 hafta sonunda sakrifiye edilerek histopatolojik parametreler ve renal fibrozis belirleyicileri açısından incelendi. Elde edilen veriler 4 grup arasında karşılaştırıldı. Bulgular: İnflamatuar aktivite (akut bileşenæ PMNL yoğunluğu), erken ve geç dönemlerde Grup 4'te Grup 1'e göre anlamlı derecede düşük idi. Geç dönemde, inflamatuar hücre yoğunluğu (akut ve kronikæ tüm inflamatuar hücreler) Grup 3'te Grup 1 ve 4'e göre anlamlı derecede düşük, interstisyel fibrozis/tübüler atrofi Grup 4'te Grup 1 ve 2'ye göre, Grup 3'te Grup 2'ye göre anlamlı derecede düşük bulundu. Geç dönemdeki TIMP-1 ekspresyonu da benzer şekilde Grup 3'te Grup 2'ye göre anlamlı derecede düşük saptandı. TUNEL (+) hücre sayısı Grup 3 ve 4'te Grup 1'e göre anlamlı derecede düşük bulundu. MDA miktarı Grup 4'te Grup 1'e göre anlamlı derecede düşük, SOD aktivitesi ise Grup 4'e ek olarak Grup 2'de de Grup 1'e göre anlamlı derecede yüksek saptandı. Sonuç: Elde edilen veriler bir arada değerlendirildiğinde, bilirübinin antibiyotik ile birlikte uygulandığında piyelonefrit ilişkili inflamasyon, fibrozis ve apoptozis üzerine daha belirgin koruyucu etki sağladığı, tek başına kullanıldığında ise etkileri sadece geç dönemde inflamasyonun şiddetini ve apoptozu azaltmak ile sınırlı kaldığı gözlenmiştir. Aim: To investigate the effects of bilirubin in pyelonephritis associated renal damage in which both toxic and ischemia-reperfusion injury play role in pathogenesis. Materials and Methods: Experimental pyelonephritis was induced in 32 Wistar rats by inoculating E.coli into their kidneys and 4 groups were formed: Group 1 (no treatment), Group 2 (antibiotic), Group 3 (bilirubin), Group 4 (antibiotic + bilirubin). Antibiotic treatment was performed for 5 days starting 3 days after bacterial inoculation, while bilirubin was administered for 8 days starting from the day of bacterial inoculation. The half of the rats in each group were sacrificed on the 9th day (early period) and the rest of them were sacrificed at the end of the 6 weeks. Histopathological parameters, immunohistochemical renal fibrosis markers (?MMP-9, TIMP-1), apoptosis (TUNEL, caspase-3) and oxidant/anti-oxidant system (MDA, SOD, GPX) activities were evaluated. The rest of the rats were sacrificed at the end of the 6th week of the study and evaluated for histopathologic parameters and renal fibrosis markers. The data were compared between the 4 groups. Results: Inflammatory activity (acute componentæ intensity of PMNL infiltration) was significantly lower in Group 4 vs. Group 1 both in the early and late periods. In the late period, inflammatory cell intensity (acute and chronicæ all inflamatory cells) was lower in Group 3 vs. Groups 1 and 4, interstitial fibrosis/tubular atrophy was lower in Group 4 vs. Groups 1 and 2 and in Group 3 vs. Group 2. TIMP-1 expression in the late period was also lower in Group 3 vs. Group 2. TUNEL (+) cell counts were significantly lower in Group 3 and Group 4 vs. Group 1. MDA levels were significantly lower in Group 4 vs. Group 1 and SOD activity was significantly higher in Groups 2 and 4 vs. Group 1. Conclusion: Taken together, bilirubin is found to have protective effects on pyelonephritis associated inflammation in both early and late periods in addition to fibrosis and apoptosis when applied with antibiotics, although its effects are limited to prevention of inflammation in the late period and apoptosis when used alon

Comparison of childhood hypertension guidelines

Hipertansiyon (HT) çocukluk çağlarında giderek artan sıklıkta görülmektedir. Bu hastaların daha iyi değerlendirilmesi için çeşitli kılavuzlar yayınlanmıştır. Bunlar içinde en sık kullanılanlar; ABD Ulusal Kalp, Akciğer ve Kan Enstitüsü (NHLBI)’nün Ulusal Yüksek Kan Basıncı Eğitim Programı (NHBPEP) tarafından güncellenerek hazırlanan ve 2004’te yayınlanan 4. Rapor (4. Rapor-2004), 2016 yılında Avrupa Hipertansiyon Derneği tarafından hazırlanan kılavuz (ESH-2016), ve en sonuncusu 2017’de Amerikan Pediatri Akademisi tarafından hazırlanan kılavuzdur (AAP-2017). Bu kılavuzlar benzer olsa da aralarında ciddi farklar bulunmaktadır. 4. Rapor-2004 ve ESH-2016 kılavuzları, daha önce Amerikalı çocuklarda saptanan, yaşa ve boya göre oluşturulan kan basıncı (KB) persentil tablolarını kullanır. Daha sonra obez çocukların ölçümleri çıkarılarak yeni tablolar oluşturulmuş ve AAP-2017’de bu tablolar kullanılmıştır. ESH-2016’da 16 yaş, AAP-2017’de ise 13 yaşından itibaren KB değerlendirmelerinin erişkin kılavuzlarına göre yapılması önerilir. Hipertansif hastanın değerlendirilmesi, Yaşam İçi Kan Basıncı İzlemi (YİKBİ) kriterleri, laboratuvar testlerinin zamanlaması ve tedavi kılavuzlara göre farklılık göstermektedir. Sonuç olarak; henüz tüm dünya çocuklarını kapsayan evrensel KB tabloları oluşturulamamış olduğundan, ofis KB ve YİKBİ’nin değerlendirilmesinde hangi kılavuza göre hareket edileceği noktasında yaş, etnik ve coğrafi koşulların göz önünde bulundurulması gerekmektedir. Güncel olarak yayınlanan kılavuzların takip edilmesi ile ileride gelişebilecek kardiyovasküler olayların azaltılması mümkün olabilecektir.Hypertension (HT) is seen with increasing frequency in childhood. Various guidelines have been published to better evaluate these patients. The most frequently used of these are; The 4th Report (The 4th Report-2004) updated and published by the National Heart Lung and Blood Institute (NHLBI) National High Blood Pressure Education Program (NHBPEP) Working Group in 2004, a guideline prepared by the European Society of Hypertension in 2016 (ESH-2016), the last one is the guideline prepared by the American Academy of Pediatrics in 2017 (AAP-2017). Although these guidelines have some similarities, there are serious differences between them. The 4 th Report-2004 and ESH-2016 guidelines use blood pressure (BP) percentile tables based on age and height previously determined in American children. Then, new tables were created by extracting the measurements of obese children and these tables were used in AAP-2017. From the age of 16 in ESH-2016 and 13 in AAP-2017, it is recommended that BP evaluations should be made according to adult guidelines. Evaluation of the hypertensive patient, Ambulatory Blood Pressure Monitoring (ABPM) criteria, the timing of laboratory tests and treatment differ according to guidelines. As a result; since universal BP tables covering all children around the world have not yet been created; age, ethnic and geographical conditions should be taken into account when evaluating which guidelines the office BP and ABPM should follow. By following the currently published guidelines, it will be possible to reduce future cardiovascular events

An 11-Year-Old Child with Autosomal Dominant Polycystic Kidney Disease Who Presented with Nephrolithiasis

Patients with autosomal dominant polycystic kidney disease become symptomatic and are diagnosed usually at adulthood. The rate of nephrolithiasis in these patients is 5–10 times the rate in the general population, and both anatomic and metabolic abnormalities play role in the formation of renal stones. However, nephrolithiasis is rare in childhood age group. In this paper, an 11-year-old child with autosomal dominant polycystic kidney disease presenting with nephrolithiasis is discussed

Protracted Febrile Myalgia Associated with Fever of Unknown Origin

Fever of unknown origin (FUO) is considered in children as fever >38.3°C (101°F) at least once a day for 8 days and more without any apparent diagnosis. There are lots of underlying factors for fever of unknown origin and the three most common etiologic categories in children are infectious diseases, connective tissue diseases, and neoplasms. In this article, we have presented a 15-year-old girl admitted with normal physical, and biochemical examination findings except fever and an elevated acute phase reactant. She was diagnosed with protracted febrile myalgia syndrome (PFMS) when severe myalgia was added to her complaints although she denied previously experienced periodic fever, abdominal pain, arthralgia or chest pain. We presented our case to emphasize that protracted febrile myalgia syndrome, one of the atypical clinical manifestations of Familial Mediterranean fever, may be the presenting symptom of Familial Mediterranean fever as well as an underlying cause of fever of unknown origin

The 6th of february earthquake and the Turkish society of pediatric nephrology-organizational aspects of pediatric kidney care

The 6 February 2023 earthquake that struck southern and central Turkey and northern and western Syria had unique drawbacks, such as the occurrence of two strong, destructive earthquakes nine hours apart in multiple and densely populated geographical areas, exposure to unforgiving winter conditions, and increased anxiety and fear due to multiple aftershocks [1, 2]. As of 26 March 2023, >50 000 people have been killed and many more have been injured in Turkey [3]. One recent editorial and a letter emphasized the vital importance of increased awareness of disaster preparedness and rapid action on organizational issues [4, 5]. Nongovernmental organizations including academic medical societies should take responsibility during disasters [6] and work together with other stakeholders. Since an earthquake should be considered a “kidney disaster” because of crush injuries and resultant acute kidney injury [7], the Turkish Society of Pediatric Nephrology (TSPN) took primary responsibility during the immediate and early phases of earthquake

COVID-19 in pediatric nephrology centers in Turkey

Background/aim: There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. Materials and methods: This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. Results: Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10–15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. Conclusion: COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients’ susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage

Concurrent protracted febrile myalgia syndrome in a child with diabetic ketoacidosis

Familial Mediterranean Fever (FMF), characterized by recurrent attacks of inflammation in predominantly serosal and synovial membranes, is caused by MEFV gene mutations resulting in abnormal pyrin. Protracted febrile myalgia syndrome (PFMS), a kind of vasculitis requiring corticosteroid treatment, is associated with M694V mutation of MEFV gene. Here, we report a case where the patient developed PFMS leading to the diagnosis of FMF concurrently at the time of treatment for diabetic ketoacidosis (DKA) of new-onset type 1 diabetes mellitus and discuss the possible mechanisms of simultaneous DKA and FMF-associated PFMS. DKA-associated cytokine release may be a predisposing factor or trigger for FMF-associated PFMS