Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) Misdiagnosed as Recurrent Urinary Tract Infection

Recurrent fever is common in children and specific infections account for the fever in most cases. PFAPA is not an uncommon cause of periodic fever during childhood. On the other hand, in patients with vesicoureteral reflux (VUR), urinary tract infection usually presents with fever.Here, we report two PFAPA cases in patients with VUR in whom recurrent episodes of fever were misdiagnosed as UTI. Keywords: PFAPA Syndrome; Periodic Fever Syndrome; Vesico-Ureteral Reflux; Urinary Tract Infections; Child

Comparison of Two Diagnostic Methods of Vesicoureteral Reflux in Children with Urinary Tract Infection

 Introduction: Urinary tract infection is common in children and vesicoureteral reflux is one of its predisposing factors. Contrast cystography and radionuclide cystography are two common methods for the diagnosis of vesicoureteral reflux. This study compared two methods, indirect radionuclide cystography (IRC) with voiding cycling method and voiding cystoureterography with contrast (VCUG).Materials & Methods: This analytical study was conducted on 55 children with urinary tract infection who were referred to our nephrology clinic in six months. In order to diagnose urinary reflux, 109 ureters (one child had a single kidney) were evaluated using IRC and VCUG methods with a one-month interval. Kappa coefficient was used to determine the agreement rate, and the McNemar’s test was employed to compare the ability of two methods in the diagnosis of VUR.Results: The mean age of the children was 5.4 years (range: 6 months to 13 years). A total of 38 children (69%) were female and 17 (30.9%) were male. Seventy percent of the children older than three years old had urinary control. From 109 ureters, 29 (26.4%) with urinary reflux were detected by the IRC method, whereas only 15 (13.6%) were diagnosed using VCUG. Statistically, the two methods did not have agreement in the diagnosis of VUR (Kappa: 0.556, p< 0.001) and the IRC method had more power to diagnose VUR in comparison with VCUG.Conclusions: Although we observed a significant difference in the diagnostic value of two methods, the choice of diagnostic method depends on specific technical conditions. However, in ideal conditions, the IRC method is suggested to be performed since it is more powerful in the diagnosis of urinary reflux.Keywords: Vesico-Ureteral reflux; Urinary Tract Infections; Pediatrics; Diagnostic Imaging

Values of Urinary Mineral Excretion in Healthy Iranian Children

Introduction: Normal values of urinary mineral excretion differ in different geographic parts. The aim of this study was to determine age-related reference intervals for urinary minerals in healthy children in the south-west of Iran. Materials and Methods: Midstream non-fasting urine samples were collected and the amount of calcium, oxalate, uric acid, phosphate, magnesium, citrate, and creatinine was measured in all urine samples. The urinary mineral concentrations were reported as mineral to creatinine ratios (mg/mg). Data were analyzed by SPSS software version 16 and independent t-test and T-Hoteling test was used.Results: The study involved 232 children aged 7 to 10 years. The 5th and 95th percentile values of urinary minerals to creatinine ratios were determined. The mean urinary Ca/Cr ratio was 0.14± 0.18 with a 95th percentile value of 0.295. For oxalate to creatinine ratio, the mean value was 0.068± 0.09 mg/mg with a 95th percentile value of 0.23. The mean uric acid to creatinine ratio was 0.358±0.211 mg/mg with an upper 95th percentile value of 0.69 and the mean Ph/Cr ratio was 0.439 and the 95th percentile was 1.01 mg/mg. Conclusions: We found out that the normal values of random urinary mineral to creatinine ratio differ in our region from the other countries and even from the other regions in Iran. We concluded that child's age and ethnicity should be taken into consideration when assessing the urinary mineral to creatinine ratio.Keywords: Urine Specimen Collection; Urine minerals; Child; Iran; Calcium; Oxalate; Citrate; Uric Acid; Phosphate

Is Urinary Interleukin-8 a Marker of Vesicoureteral Reflux in Children?

Introduction: Developing non-invasive but accurate methods to diagnose vesicoureteral reflux (VUR) is in progress. Cytokines, such as interleukin-8 (IL-8), are important mediators in inflammatory responses and are demonstrated to change during UTI and pyelonephritis, as well. Therefore, we attempted to evaluate the differences of IL-8 in children with UTI compared to children with and without VUR to assess if it can be hypothesized to be an appropriate diagnostic marker in children with VUR.Materials and Methods: We evaluated urine levels of IL-8 in 41 children aged 1 to 60 months who recovered from UTI for a minimum duration of 2-3 weeks. They were divided into 2groups: A and B (with and without VUR, respectively). Additionally, a group of normal children was considered as the control group (group C). Urine IL-8 levels were measured for the three groups and corrected for urine creatinine (Cr) (IL-8/Cr). Afterwards, they were compared using One-Way ANOVA test.Results: The mean IL-8/Cr level was 81.7 ± 90.1 in group A, 289.8±640.2 in group B, and 9.6 ± 12.2 in group C with no significant difference (p=0.056).Conclusions: Our finding suggests there is no significant difference in urine IL-8/Cr levels between patients with and without VUR and therefore, we cannot propose IL-8 as a diagnostic marker for VUR. Keywords: Interleukin-8; Pediatrics; Pyelonephritis; Urinary Tract Infections; Vesico-Ureteral Reflux

Spot Urinary Citrate Normograms in Children

Citrate in the urine inhibits nephrolithiasis, and oral citrate solutions are used to prevent stones forming. The present study aimed to estimate the normograms of the urinary levels of citrate, creatinine, and their ratio in spot urine samples collected from 237 healthy children, aged from 1 month to 14 years. The findings showed the mean, standard deviation, median, and 5th and 95th percentiles of the values and compared them among age groups and between the sexes by using analysis of variance and independent t-tests. Our findings indicate that the ratio of spot urinary citrate to creatinine was higher for children younger than 18 months of age, possibly related to the consumption of dairy protein as their main meal. The 5th percentiles (lower cut off) for spot urinary citrate-to-creatinine ratio, were 915 mg/g for children aged under 18 months, 109 mg/g and 126 mg/g for older boys and girls

Urinary Level of Interleukin-8 in Acute Pyelonephritis

Backgroundand Aim: urinary tract infection is a prevalent disease in children. Determining the location of the bacterial invasion has a great impact on the treatment, follow-up, and complications. For this purpose, different laboratory and imaging methods are used, which are often invasive or unavailable. One of the non-invasive methods is to measure biomarkers such as interlukin-8 (IL-8) in the urine.The aim of this study was to evaluate the urinary level of interleukin-8 in acutepyelonephritis. Methods: This cross- sectional study was carried out on 50 children aged 3-60 months. The children were divided into two groups. The first group included children with acute pyelonephritis and the second group included healthy children who were randomly selected as controls. Then, the urine levels of IL-8 and creatinine were measured. Results: The mean age of the subjects in case and control groups was 17.5 ± 22 and 22.5 ± 18.2 months, respectively (P = 0.92). The mean urinary ratio of IL- 8/Cr in the patient and control groups was 161.7 ± 90.1 and 12.2 ± 19.6 Pgr/mgr respectively, indicating a significant difference (P = 0.03). The results showed that a urinary IL-8/Cr ratio of 32 pg/mg was diagnostic according to the Receiver Operating Curve (ROC). Conclusion: Urinary IL-8/Cr ratio can be used for early diagnosis of acute pyelonephritis &nbsp

Relationship between Blood Pressure and Passive Smoking in Elementary School Children

Objective: Many diseases form their basis during childhood. One example is the changes in vascular structure and function, leading to atherosclerosis. In this study, we have assessed the impact of exposure to cigarette smoke on blood pressure of elementary school children in Kermanshah. Methods: 80 elementary school children exposed to cigarette smoke and 80 not exposed to smoke were studied in fall 2010. Information regarding the smoking status of parents and the children’s health were obtained through questionnaires completed by parents. After physical examination and exclusion of those children with acute and chronic diseases as well as those consuming medicine, we measured and compared blood pressure in the exposure and non-exposure groups. Data were analyzed using the ANOVA statistical test. Values are expresses as Mean±SD. Findings: The mean systolic and diastolic blood pressures of the exposure group were higher than those of the non-exposure group (109.3±9.97/64.92±7.36 vs105.47±8.98/62.5±7.01, respectively; CI: 0.95, P<0.05). Meanwhile, difference between two groups according to sex was not statistically significant. Conclusion: Our study indicates that systolic and diastolic blood pressures are higher in those elementary school children exposed to cigarette smoke compared to those who are not

Investigating the Disseminated Varicella Zoster Virus Infection After Rituximab Use in Nephrotic Syndrome: A Case Report: Disseminated Varicella Zoster

The infection with varicella-zoster virus in immune-deficient patients is an importantand complex challenge in treating patients and requires decisions on an individual basis.Rituximab is an anti-CD20 positive B cells monoclonal antibody. Nowadays, it is frequentlyused in patients with idiopathic nephrotic syndrome and makes them susceptible to variousinfections. In this study, we report a 16-year-old male subject with steroid-resistant nephroticsyndrome who developed a severe and generalized form of chicken pox following rituximabadministration

Normal Values for Random Urinary Calcium to Creatinine Ratio in Iranian Children

Objective: Due to worldwide variations, reference values of urinary calcium to creatinine ratio in pediatric population are not yet well established. To determine normal values for urinary calcium to creatinine ratio and its relation to urinary sodium or potassium, a descriptive (correlation type) study was conducted in 7 to 12 years old healthy children in Urmia, Iran. Methods: Primary school children were divided into two sectors and 7 clusters (4 cluster school boys and 3 school girls). The subjects were randomly selected. Random, non–fasting morning urine samples were obtained from 364 healthy children aged 7 to 12 years during fall 2005 and immediately sent to laboratory to determine urine calcium (Uca), creatinine(Cr), sodium (Na) and potassium (K). For data analysis, mean and 95th percentile of UCa/Cr and UNa/K were used. Pearson test was used to determine any relationship between UCa/Cr and UNa/K values. For comparison of UCa/Cr and UNa/K values between males and females, Mann-Withny test was used. Findings: A total number of 364 children were enrolled in the study. There were 208 (57.1%) males and 156 (42.9%) females. The mean and 95th Percentile for UCa/Cr was 0.11 ( 0.10 and 0.24 respectively. The mean and 95th percentile for UNa/K were 2.30 ( 1.42 and 5.21 respectively. There was no significant difference in UCa/Cr and UNa/K between two sexes (P>0.05). We found a weak relationship between UCa/Cr and UNa/K (P<0.01). Conclusion: UCa/Cr value may differ according to geographic location. For screening purposes, reference values should be determined in each geographic location