Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi

Background: Hematuria is an important and common sign of urinary system diseases in children. Careful assessment is needed for definitive diagnosis and appropriate management. In this study we aimed to investigate the demographic and clinical characteristics of patients who were admitted to our pediatric nephrology clinic with hematuria and to determine the features that will guide the diagnosis. Methods: Medical charts of 370 patients who were referred to our clinic in a period of four years with gross or microscopic hematuria were evaluated retrospectively. Demographical data, clinical and laboratory findings, imaging modalities and diagnosis of the patients were investigated. Findings: Of the patients 195 (52.7 %) were boys and 175 (47.3%) were girls and the majority of the patients were in the age group of 6-10 years. Major presenting feature was red colored urine (64.1 %). Non-glomerular causes were found to be significantly higher among patients with macroscopic hematuria (p=0.002). Acute poststreptococcal glomerulonephritis formed the majority of glomerular hematuria and urinary system infections formed the majority of non-glomerular hematuria causes respectively. Conclusions: This study suggests that a careful history, detailed physical examination and clinical evaluation may elucidate the etiology in the majority of the patients with hematuria. Advanced imaging modalities and renal biopsy are indicated only in selected cases.Amaç: Hematüri çocuklarda üriner sistem hastalıklarının önemli bir bulgusudur. Altta yatan ciddi hastalıkların belirtisi olabileceğinden ayırıcı tanı için dikkatli bir değerlendirme ve iyi bir klinik yaklaşım gerektirmektedir. Bu çalışmada pediatrik nefroloji kliniğimize hematüri nedeni ile başvuran hastaların demografik ve klinik özelliklerinin incelenmesi ve tanıya yol gösterecek özelliklerin belirlenmesi amaçlandı. Hastalar ve Yöntem: Bu çalışma, kliniğimizde makroskopik ve/veya mikroskopik hematüri nedeniyle izlenmiş olan 370 hastanın dosyası retrospektif olarak değerlendirilerek gerçekleştirildi. Hastaların demografik verileri,l aboratuar sonuçları ve klinik bulguları, görüntüleme tetkikleri ve nihai tanıları araştırıldı. Bulgular: Hastaların 195’i (%52.7) erkek, 175 (%47.7)’si kızdı ve çoğunluğu 6-10 yaş grubunda yer almaktaydı. Hastaların 234 ‘ü (%63.2) makroskopik hematüri ile başvururken , 44’ünde (%15.3) glomerüler hematüri saptandı. Makroskopik hematüri grubunda non-glomerular nedenler anlamlı olarak yüksek bulundu. Glomerüler hematüri nedenleri arasında ülkemizde halen yaygın olarak saptanan akut poststreptokokkal glomerülonefrit (APSGN), non glomerüler nedenlerden de üriner sistem enfeksiyonu en yüksek oranda görülen hastalıkları oluşturmaktaydı. Tartışma: Bu çalışma dikkatli bir öykü, ayrıntılı fizik muayene ve klinik değerlendirme ile hematüri ile başvuran hastaların büyük çoğunluğunda etiyolojinin aydınlatılabileceğini göstermektedir. İleri görüntüleme tetkikleri ve renal biyopsi sadece seçilmiş vakalarda endikedir

Effect of the timing of dialysis initiation on left ventricular hypertrophy and inflammation in pediatric patients

WOS: 000408418900015PubMed ID: 28396941Background The optimal time for dialysis initiation in adults and children with chronic kidney disease remains unclear. The aim of this study was to evaluate the impact of dialysis timing on different outcome parameters, in particular left ventricular (LV) morphology and inflammation, in pediatric patients receiving peritoneal dialysis and hemodialysis. Methods The medical records of pediatric dialysis patients who were followed-up in nine pediatric nephrology centers in Turkey between 2008 and 2013 were retrospectively reviewed. In addition to demographic data, we retrieved anthropometric measurements, data on dialysis treatment modalities, routine biochemical parameters, complete blood count, serum ferritin, parathormone, C-reactive protein (CRP), and albumin levels, as well as echocardiographic data and hospitalization records. The patients were divided into two groups based on their estimated glomerular filtration rate (eGFR) levels at dialysis initiation, namely, an early-start group, characterized by an eGFR of > 10 ml/min/1.73 m(2), and a late-start group, with an eGFR of 10 ml/min/1.73 m(2)) versus late-start dialysis (eGFR 0.05) nor in number of hospitalizations. Serum albumin levels were significantly higher in the earlydialysis group compared with the late-dialysis group (3.3 +/- 0.7 vs. 3.1 +/- 0.7 g/dl, respectively; p 0.05) and relatively lower CRP levels (3.64 +/- 2.00 vs. 4.37 +/- 3.28 mg/L, p > 0.05) than the late-start group, but these differences did not reach statistical significance. Conclusion Although early dialysis initiation did not have a significant effect on important clinical outcome parameters, including LVH, inflammatory state, and hospitalization, in our pediatric dialysis patients, this area of study deserves further attention

Renal Biopsy Prognostic Findings in Children With Atypical Hemolytic Uremic Syndrome

Backgroun

Effect of the timing of dialysis initiation on left ventricular hypertrophy and inflammation in pediatric patients

Background The optimal time for dialysis initiation in adults and children with chronic kidney disease remains unclear. The aim of this study was to evaluate the impact of dialysis timing on different outcome parameters, in particular left ventricular (LV) morphology and inflammation, in pediatric patients receiving peritoneal dialysis and hemodialysis

Effect of the timing of dialysis initiation on left ventricular hypertrophy and inflammation in pediatric patients

Background The optimal time for dialysis initiation in adults and children with chronic kidney disease remains unclear. The aim of this study was to evaluate the impact of dialysis timing on different outcome parameters, in particular left ventricular (LV) morphology and inflammation, in pediatric patients receiving peritoneal dialysis and hemodialysis