Comparing the effects of 8 weeks and 12 weeks of corticosteroid therapy on serum 25-hydroxyvitamin D levels in children with nephrotic syndrome in the recovery phase

Background: Nephrotic syndrome is a relatively common problem in childhood that can be caused by various diseases. These patients are susceptible to osteoporosis due to the nature of the disease and the complication of steroid therapy. Therefore, the aim of this study was to compare serum 25-hydroxyvitamin D levels in children with nephrotic syndrome in the recovery phase and under the two different treatment regimens. Materials and Methods: This clinical trial study was performed on 68 children with primary nephrotic syndrome referred to the Nephrology Clinic of Besat Hospital in Hamedan in 2014. Thirty-four patients were treated for 8 weeks and 34 patients were treated for 12 weeks. The two groups were matched for age and sex. At the end of the treatment, serum 25-hydroxyvitamin D levels were measured and compared in the two groups and the rate of relapse was also assessed. Results: There was no significant difference between the two groups in age and sex. The mean of vitamin D levels in the 8-week treatment group was significantly higher than the other group (21.61±11.39 and 16.18±9.79, respectively), and this difference was statistically significant (P=0.039). Absence of relapse was 47.1 in the 8-week treatment group and 73.5 in the 12-week treatment group, this difference was also statistically significant (P= 0.026). Conclusion: The recurrence rate was significantly lower in the 12-week treatment compared to the 8-week treatment. However, vitamin D levels significantly decreased in this treatment group compared to the other group

Awareness of Academic Staff Physicians with Principles of Evidence-Based Medicine and its Application in Daily Practice

Introduction: The purpose of this study was to evaluate familiarity of academic staff physicians with EBM and its application in daily practice. Methods: This cross-sectional study was conducted in 2022 with the participation of academic staff physicians of Hamadan University of Medical Sciences in Iran. Data were collected using CEBM questionnaire and were analyzed with SPSS 20 software, using T-test and Spearman correlation statistical tests. Results: Out of 156 academic physicians, 97 (62.2%) completed the questionnaire, 62 (63.9%) were male, and 33 (34%) had participated in EBM workshops. Mean score of knowledge and attitude questions were 14.7± 3.9 and 3.8± 0.5 respectively. There was no significant difference between males and females in knowledge and attitudes (P >0.05). Physicians who participated in EBM workshops had higher scores in knowledge (P <0.05) but not in attitude (P= 0.06). Positive and significant correlation between age (r = 0.32, P = 0.001) and teaching experience (r = 0.28, P = 0.005) was observed with knowledge and attitude about EBM. 69.1% of participants used very little or not at all EBM in their daily practice. The most important obstacles were lack of time (49.5%) and specific information (22.7%). More than 65% of physicians tended to use EBM in their daily practice. Conclusion: The academic staff physicians of Hamadan, Iran had a positive attitude towards evidence-based medicine, but did not have enough information in this regard. Accordingly, its application in daily clinical work was relatively low. Holding EBM workshops is essential to increase awareness about EBM

Prevalence of reflux nephropathy in Iranian children with solitary kidney: results of a multi-center study

Abstract Background: Given the importance of the function of the remnant kidney in children with unilateral renal agen‑ esis and the significance of timely diagnosis and treatment of reflux nephropathy to prevent further damage to the remaining kidney, we aimed to determine the prevalence of reflux nephropathy in this subgroup of pediatric patients. Methods: In general, 274 children referred to pediatric nephrologists in different parts of Iran were evaluated, of whom 199 had solitary kidney and were included in this cross‑sectional study. The reasons for referral included urinary tract infection (UTI), abnormal renal ultrasonography, being symptomatic, and incidental screening. Demographic characteristics, including age and gender were recorded. History of UTI and presence of vesicoureteral reflux (VUR) were evaluated. Results: Of the 274 children evaluated in this study with the mean age (SD) of 4.71 (4.24) years, 199 (72.6%) had solitary kidney. Among these, 118 (59.3%) were male and 81 (60.7%) were female, 21.1% had a history of UTI, and VUR was present in 23.1%. The most common cause of referral was abnormal renal ultrasonography (40.2%), followed by incidental screening (21.1%), being symptomatic (14.1%), and UTI (5.5%). In 116 children (58.3%), the right kidneys and in 83 (41.7%) the left kidneys were absent. Besides, 14.6% of the participants had consanguineous parents and 3% had a family history of solitary kidney. Upon DMSA scan, the single kidney was scarred in 13.1%, of which only 7.5% were associated with VUR. In addition, proteinuria and hematuria were observed in 6.5% and 1.5% of children, respectively. Conclusions: The prevalence of reflux nephropathy was 7.5% in children with solitary kidney with a male predomi‑ nance. Given the relatively high prevalence of reflux nephropathy in these children, screening for VUR in the remnant kidney appears to be essential in this population. Keywords: Vesicoureteral reflux, Nephropathy, Children, Solitary kidney, Renal agenesi

Balanced Reciprocal Translocation t(X;1) in a Girl with Tall Stature and Primary Amenorrhea

Chromosomal translocations constitute one of the most important, yet uncommon, causes of primary amenorrhea and gonadal dysgenesis. Although X-autosome translocations are frequently associated with streak gonads and clinical features of the Turner syndrome, the majority of X-autosome carriers may present with a variable phenotype, developmental delay, and recognizable X-linked syndrome due to nonrandom X-inactivation. In this article, we describe a healthy 15.5-year-old girl with primary amenorrhea, gonadal dysgenesis, and tall stature without other manifestations of the Turner syndrome. Relevant clinical, biochemical, endocrinological, and cytogenetical evaluations were performed. Initial investigations revealed hypergonadotropic hypogonadism (FSH=134 mIU/mL [normal=10–15 mIU/mL], LH=47.5 [normal=10–15 mIU/mL], and estradiol=24.3 pmol/L). On ultrasound examination of the pelvis, streak ovaries with a hypoplastic uterus were noted. Chromosome study, performed according to routine procedures, revealed an apparently balanced reciprocal translocation involving the short arm of chromosome 1(p2) and the long arm of the X chromosome (q2) in all the cells with the following karyotype: 46,X,t(1;X)(p13;q22). She was placed on hormone replacement therapy. In our patient, X-autosome translocation was associated with gonadal dysgenesis and tall stature. We conclude that t(X;1) may be associated with gonadal dysgenesis without other congenital abnormalities. To our knowledge, normal phenotype with gonadal dysgenesis and tall stature in association with t(X;1) translocation has not been previously reported

Pathologic findings of renal biopsies in children; an 11-year experience from a single center in West of Iran

Background: Renal biopsy is an important diagnostic procedure in pediatric nephrology. Although considered as an invasive method, numerous renal diseases cannot be definitively diagnosed and treated without it. Objectives: The aim of this study was histopathological study of renal biopsy results in children of 6 months to 18 years old. Patients and Methods: In this retrospective cross-sectional study, the available data from children who had undergone kidney biopsy between 2007 and the end of 2017 were evaluated. Demographic data, indications of biopsy, the outcome of patients, biopsy complications and histopathologic findings were collected using a checklist. Finally, data were presented as frequency and percentages. Results: The most common cause of biopsy in children was nephrotic syndrome (43.7%). Focal segmental glomerulosclerosis (FSGS) with 39 cases (32.7%) had the highest frequency in examined biopsies. In the long-term follow-up, 71 children (59.7%) cured, 7 (5.9%) died, 25 (21.0%) continued treatment, 6 (5.0%) underwent a kidney transplant surgery, and the outcome of 10 children (8.8%) was unknown. While 6.7% of patients were diagnosed with complications of biopsy, the most frequent of them was hematuria. There was no case of death or nephrectomy and only one patient needed packed RBC transfusion. Conclusion: Nephrotic syndrome was the most common indication for kidney biopsy. FSGS had the highest frequency in examined biopsies

Frequency of Microalbuminuria in Type 1 Diabetic Children

Objective: Diabetic nephropathy is a serious complication of type 1 diabetes which involves one third of the patients. The aim of this study was to estimate the frequency of microalbuminuria in type 1 diabetic patients visited in Pediatric Endocrine Clinic in Hamedan, west province of Iran, in 2007. Methods: Diabetic patients visited in Pediatric Diabetes Clinic were enrolled in the study. Variable data such as age, sex, duration of the disease, stage of puberty, dose of insulin/kg/day, and blood pressure of the patients were obtained according to history and physical examination. 24h urine samples were collected for protein, creatinine, and microalbumin. Data analysis was assessed using independent t-test and chi-square test. Findings: One-hundred five patients (56 females and 49 males) with a mean age of 13.3±5.5 years, were evaluated. Fifteen (14.3%) cases had microalbuminuria. Mean age in microalbuminuric group was 16.2±2.8, and in non-microalbuminuric group was 12.7±5.6 years (P=0.024). Mean duration of diabetes was 9.1±3.2 yr in microalbuminuric and 4.5± 3.9 in non-microalbuminuric group. There was a significant correlation between duration of diabetes and microalbuminuria (P<0.001). Blood pressure was normal in 95.5% of the patients while in patients with microalbuminuria 73.3% had hypertension (P<0.001). Frequency of micro­albuminuria was higher in patients taking lower doses of insulin corrected to their body weight (P=0.008). Conclusion: Frequency of microalbuminuria was significant, so regular screening is highly recommended for early detection and timely treatment of diabetic nephropathy in order to prevent progression to end stage renal disease