Evaluation of Children with Undescended Testes Referred to Children’s Medical Center in 5 years

Introduction: Cryptorchidism is the most common congenital anomaly in male genitalia in newborns with a frequency of 3% in term and 30% in preterm male newborns. Cryptorchidism is also known as undescended testis (UDT), which can be bilateral or unilateral. The aim of the study was to evaluate all cases with UDT referred to our center during 5 years.Materials and Method: All UDT cases that were referred to Children’s Medical Center during the last 5 years were included in our retrospective study. The data were collected from the patients’ records and one medical student entered the data in the questionnaire designed for the study.Results: A diagnosis of UDT was made at the time of birth in 122 (62.2%) of 196 cases, until one year of age in 153 (78.06%) cases, until two years of age in 161 (82.14%), until six years of age in 186 (94.89%) cases, and until 11 years of age in 196 (100%) cases. The age at surgery was under 1 year in 52 (26.53%) cases, between 1 and 2 years in 42 (21.24%) cases, between 2 and 6 years in 68 (34.69%) cases, and over 6 years in 34 (17.34%) cases.Conclusion: Age at diagnosis was significantly lower than the perfect age for operation in most cases and the age at surgery was higher than the perfect age for diagnosis in half of the cases. Therefore, collaboration between general practitioners and pediatric surgeons and pediatricians is necessary for perfect and timely management of UDT. Keywords: Undescended Testis; Cryptorchidism; Child; Newborn

Urodynamic Study in Children

A b s t r a c t:Urodynamic study (UDS) is a serial of clinical tests, like uroflowmetry, filling cystometry, pressure-flow studies and assessment of urethral closure pressure. These tests include urethral pressure profilometry and also measurement of the leak-point pressure of lower urinary system. UDS is one of the essential clinical studies in children complaining of voiding dysfunction, neurogenic bladder, urine incontinence, enuresis and another lower urinary tract symptom. The aim of proper bladder management in these patients is to maintain the lower urinary tract to have good capacity, low pressure, preventing infection and incontinence. Long term goal is preventing any undue damage to the upper urinary tracts and intact kidneys function. This review article of pediatric urodynamic study provides a classified diagnostic approach to bladder dysfunctions in children

A Rare case of HUS and ADEM

A 3-year-old girl was admitted with typical hemolytic uremic syndrome (HUS) and conservative treatments were initiated. During hospitalization, she had seizures, right hemiparesis, and loss of consciousness. Initial MR of the brain showed changes of acute disseminated encephalomyelitis (ADEM). She was treated with intravenous methylprednisolone and immunoglobulin. Upon improvement of her clinical condition, she was discharged with oral prednisolone which was tapered after two months. After one year fallow-up, the child now has a normal renal function and normal neurodevelopment

Prevalence of Microalbuminuria in Children with Asymptomatic Microscopic Hematuria

Introduction: A wide range of chronic and acute diseases begin with asymptomatic microscopic hematuria. Simultaneous presence of microalbuminuria and microscopic hematuria is suggestive of an important kidney disease. The purpose of this study was to determine the prevalence of microalbuminuria in children with asymptomatic microscopic hematuria.Materials and Methods: This cross-sectional study was done on 150 children aged 2-14 years with asymptomatic microscopic hematuria at Nephrology Clinic of Children’s Hospital Medical Center in 2013-2015. All patients had clinical and laboratory tests such as BUN, creatinine, electrolytes, urine albumin/ creatinine ratio, blood pressure, etc. The obtained data were recorded and analyzed with SPSS (ver. 18). All children with anatomical anomalies, hypertension, previous urinary tract surgery, or nephrolithiasis were excluded from the study.Results: The overall prevalence of microalbuminuria was 14.5 % and there was a significant relationship between microalbuminuria and the presence of dysmorphic red blood cells on urine analysis (p-value<0.05). The incidence of RBC cast was 54% (82 patients). Two children had upper-normal levels of blood pressure for age and sex that were followed closely and received special diets and medications. Twenty-nine patients (18.6%) had a positive family history of asymptomatic microscopic hematuria and the father of one of them had IgA nephropathy with ESRD. In children with microalbuminuria that received drugs for 3-28 months (mean, 6.3 months), microalbuminuria decreased significantly.Conclusions: Isolated asymptomatic microscopic hematuria is a benign disease but its association with proteinuria may indicate a serious problem with the risk of progressive renal disease. It is recommended to determine the microalbumin/creatinine ratio in cases with asymptomatic microscopic hematuria. Keywords: Asymptomatic Microscopic Hematuria; Microalbuminuria; Prevalence; Child

Amikacin-induced Nephrotoxicity in a Child with Idiopathic Nephrotic Syndrome in Iran: A Case Report

We report an unusual case of Amikacin-induced nephrotoxicity in a child. The patient was a seven and a half year old girl with nephrotic syndrome and cushingoid facial features who was referred to Tehran Children's Medical Center for renal biopsy so as to start cyclosporine therapy for the diagnosis of disease recurrence. Before coming to our center she was admitted to another hospital with complaints of severe abdominal pain and vomiting. In the course of hospitalization in our center, the patient gradually became oliguric and her serum creatinine increased from 0.3 mg/dl to 3.5 mg/dl. During her previous hospitalization about 2 weeks ago, use of amikacin and ceftriaxone was found. There were several reasons for kidney failure in the child, one of which was possibility of amikacin-induced nephrotoxicity. A renal biopsy showed diffuse mesangial proliferative and tubular lesions, which were in favor of amikacin toxicity. It seems that Amikacin can lead to nephrotoxicity if the patient is dehydrated and experiencing reduction of effective vascular volume. Regarding logical use of amikacin,renal function should be monitored regularly. Keywords: Acute Tubular Necrosis; Acute Renal Failure; Acute Tubulointerstitial Nephritis; Nephrotic Syndrome; Amikacin; Iran

A Rare case of Aphallia

.Aphallia (total absence of penis) is an extremely rare abnormality that can be part of the urorectal septum malformation sequence.We are reporting a 40-day-old boy who was referred to our nephrology clinic due to the absence of the penis and urinating through the rectum. He was born to a 17-year-old mother and a 24-year-old father, and was delivered term via normal vaginal delivery.The pregnancy was uncomplicated with no maternal toxin or medication exposure. Both parents were healthy and there was no family history of congenital abnormality. The parents were also unrelated.  Physical examination revealed agenesis of the penis, a normal scrotum, and bilateral normally positioned testises. Moreover, the heart, lungs, abdomen, head and neck, and spinal column were all normal on examination. The karyotype was 46XY and the gender was male. Initial ultrasonography one week after birth revealed moderate bilateral hydronephrosis but the last ultrasonography 45 days later revealed only mild fullness of both kidneys.Keywords: Aphallia; Gender; penile agenesis

A Rare Case of Wolfram Syndrome

A 15-year-old boy was referred because of bilateral hydroureteronephrosis. He had poorly controlled diabetes mellitus since he was 4 years old. He had polyuria and polydipsia. On water deprivation test, he developed hypernatremia along with increased levels of BUN and creatinine. He also had hypertension that was effectively managed with losartan. Bilateral optic atrophy was detected on ophthalmoscopic examination. It seems that this boy is a rare case of Wolfram syndrome.Keywords: Diabetes Insipidus; Diabetes Mellitus; Wolfram Syndrome; DIDMOAD; Deafness; Optic Atrophy

Comparison of the Incidence of Postoperative Hyponatremia after Infusion of Hypotonic Versus Isotonic Intravenous Solutions in Children

Introduction: Hyponatremia is the most common electrolyte disorder in patients following surgical interventions (19-50%). Hospital acquired hyponatremia is often due to using hypotonic solution s and can be lethal.Materials and Methods:Between January and December 2014, 190 children (1 month to 12 years) who were admitted in the urology department of Children’s Hospital Medical Center for elective surgical procedures were enrolled in the study. The patients were randomly divided into two groups: group I received 50 mEq/L sodium and 20 mEq/L potassium in D/W 5% and group II received 154 mEq/l sodium and 20 mEq/L potassium in D/W 5% at the maintenance dose for a period of 6 hours following the operation. The patients did not have any oral fluid intake 6 hours postoperatively. The incidence of hyponatremia before and after maintenance IV fluid therapy was analyzed. Other characteristics of the patients such as age, gender, duration of hospitalization, other concomitant electrolyte disturbances, and symptoms of hypervolemia were also evaluated. The incidence of fluid-IV therapy-induced hyponatremia was investigated and analyzed in different categories of patients.  Results: One hundred and ninety patients were enrolled. The mean age was 3.75 years (ranging from 1 month to 12years).  One hundred and thirty-three patients (70%) were boys. The incidence of hyponatremia before and after maintenance IV fluid therapy was 9.5% and 36%, respectively. After the therapy, the incidence of hyponatremia was 54% and 17% in hypotonic and isotonic groups, respectively. Final multivariate logistic analysis showed that hyponatremia was common in patients that received hypotonic solution after surgery.Conclusions: Hyponatremia was markedly induced in patients receiving hypotonic solution after surgery. It seems isotonic fluid therapy after surgery protects the patients from hyponatremia.Keywords: Hyponatremia; Isotonic solutions; Hypotonic solutions; Child

The Association between Neonatal Icterus or Neonatal Phototherapy and the Likelihood of Childhood Asthma among Iranian Children

Background: There might be a close link between neonatal icterus and/or neonatal phototherapy and childhood asthma. The present study aimed to assess the relationship between neonatal icterus and/or phototherapy and the likelihood of childhood asthma among Iranian population. Materials and Methods The present case-control study was performed on 102 consecutive asthmatic children hospitalized at Children’s Medical Center, Tehran, Iran. Asthma was diagnosed by a pediatric asthma and allergy specialist based on clinical manifestations and/or spirometry results for children older than 5 years. A total of 113 sex and age-matched children without asthma who were admitted to other wards during the same period of time were selected as the control group. Data were collected by a researcher-made checklist including data regarding participants’ age, gender, and gestational age, history of neonatal icterus and history and duration of phototherapy, filled by participants’ parents/guardians. Results: There was a significant difference between cases and controls with respect to preterm birth, history of phototherapy and duration of phototherapy. History of icterus was not associated with childhood asthma. In the multivariable logistic regression model, both history of phototherapy (P=0.029), and duration of phototherapy (P=0.03) were considered as determinants for occurrence of childhood asthma. Conclusion According to the results, history of neonatal icterus was not associated with childhood asthma, but history and duration of phototherapy were both determinants of childhood asthma

Is D-penicillamine Safe in Management of Little Children with Kidney Cystine Stones? A Case Series

Nephrolithiasis is quite common in children. It sometimes has a genetic basis and can lead to serious complications like urinary obstruction, multiple surgical interventions, or even renal insufficiency if left treated. Cystinic stones and cystinuria account for approximately 8% of the cases of nephrolithiasis in children. We studied seven pediatric patients, 1 to 3 years old (mean age: 20.5 months), with cystinic urinary stones receiving D-penicillamine plus other drugs to dissolve the stone. All of them tolerated the treatment very well and did not show any serious complication. All of our cases were managed with D-penicillamine that was initiated at a low dose and then increased progressively. We used low dose D-penicillamine, maximim15 mg/kg/day, which was beneficial without any specific side effects. D-penicillamine can be used safely in little children. Gradual induction and close observation with CBC, urine analysis, BUN, creatinine, and liver function tests may be required. D-penicillamine can prevent new stone formation and resolve the present cystinic calculi. Low dose D-penicillamine may be sufficient in treating cystinic calculi in children. We suggest more evaluations on the advantage of low dose D-penicillamine in cystinuria.Keywords: D-Penicillamine; Cystinuria; Nephrolithiasis; Complications