Assessment of Prognostic Factors in Children with Renal Tubular Acidosis Type IV Overwhelmed by Bilateral Obstructive Uropathy

Introduction: Hyperkalemia renal tubular acidosis (type IV) occurs secondary to impaired renal responsiveness to aldosterone. This can occur chronically in infants and children with a history of obstructive uropathy. The aim of this study was to assess of prognostic factors in children RTA type IV overwhelmed by bilateral obstructive uropathy.Materials and Methods: In this study, we recruited and observed 48 male patients with both bilateral obstructive uropathy at the urinary bladder outlet and RTA type IV for two years. In this period, we registered patients’ demographic data; also, children’s growth, sonographic data, renal function tests and serum electrolytes underwent serial assessment and in if clinically indicated, the patients were treated with drugs like citrate sodium and Kay oxalate.Results: Frequent urinary tract infection (p=0.0011), abnormal <20 weeks gestation sonography results like bilateral hydronephrosis (p=0.00001), birth weight below 2500 gr (LBW) (p=0.0014), preterm delivery (p=0.001), maternal age at birth below 20 years (p=0.0018), pregnancy more than 2 times (p=0.004), admission due to respiratory problems during infancy (p=0.003) and gestational diabetes (P=0.001) were significantly associated with a poor prognosis.Conclusions: Considering the results of this study, it seems logical to consider abortion in case of renal hydronephrosis and dysplasia in gestational age below 20 weeks.  Keywords: Hyperkalemia; Urologic Diseases; Renal Tubular Acidosi

The Evaluation of Serum Vitamin D Levels in Pediatric Patients With Vesicoureteral Reflux

Background and Aim: Vesicoureteral Reflux (VUR) refers to the pathological returnof urine from the bladder to the ureter and then to the kidney in some patients. Vitamin Ddeficiency is associated with some renal diseases. This study examines the relationshipbetween vitamin D deficiency and urinary reflux.Methods: In this cross-sectional study, 200 children referred to Amir Kabir Hospitalin Arak, Iran, were divided into 2 groups of patients with VUR (n=100) and anothergroup of pediatric participants considered healthy and had no findings of VUR (n=100).Confirmation of diagnosis was performed via voiding cystourethrogram. Serum vitaminD levels were evaluated by the Enzyme-Linked Immunosorbent Assay (ELISA) methodin all participants.Results: The results showed that the rate of vitamin D deficiency was 38% and 42%in the case and control groups, respectively. Therefore, no significant correlation wasobserved between the two study groups in terms of vitamin D deficiency. This findingwas regardless of VUR complications affecting vitamin D metabolism.Conclusion: We assume that VUR is a complicated condition with severalcomplications, and the relationship of each complication with vitamin D deficiency hasbeen determined to some extent in previous studies; however, this condition cannot beconsidered an independent factor leading to vitamin D deficiency

The Relationship Between Iron Deficiency Anemia and Reflux-Related Renal Injury in Infant and Children

Introduction: Anemia may be defined either quantitatively or physiologically. The diagnosis of anemia is determined by comparison of the patient's hemoglobin level with age-specific and sex-specific normal values. The easiest quantitative definition of anemia is any hemoglobin or hematocrit value that is 2 standard deviations (SDs) (95% confidence limits) below the mean for age and gender. The aim of this study was to evaluate the relationship between anemia and reflux nephropathy in patients with vesicoureteral reflux.  Material and Methods: This case-control study involved 260 children aged from 6 months to 2 years. They were divided into two groups of 130 children: the case group suffering from VUR with reflux nephropathy and the control group affected with VUR without reflux nephropathy .Results: Results of our study showed that the prevalence of anemia in the Reflux Nephropathy group was not considerably different than that of the control group.Conclusions: We concluded that there isn’t a direct correlation between anemia and reflux nephropathy in patients with vesicoureteral reflux.Keywords: Anemia, Iron-Deficiency; Vesico-Ureteral Reflux; Chil

Is Additional Fluid Therapy Effective in the Treatment of Children with Urinary Tract Infection?

Introduction: Urinary tract infection can result in many complications such as abscess, hypertension, renal failure, renal scar, reflux, etc. Since there is no general agreement on the administration of additional fluid (1.5 times maintenance) for the early treatment of UTI, this study was conducted to evaluate the effect of additional fluid therapy.Materials and Methods: In This clinical trial study, 206 children with UTI who were admitted at Amir Kabir Hospital (Arak, Iran) from March 2012 to March 2013 were divided into two groups of 103. One group received the usual amount of maintenance fluid while the other group received 1.5 times more than usual maintenance. The course of the resolution of dysuria, frequency, malodorous urine, abdominal pain, and fever was compared between the two groups. Urine culture was performed for all patients 2, 7-10, and 90 days after admission. The patients were age and sex matched. The data was analyzed using descriptive statistics and the X2 method based on independent sample t-test.Results: Additional fluid had a significant effect on malodorous urine dysuria. However, it had an inverse effect on the treatment of fever and urinary frequency as it made them last longer. There was no difference in other parameters like abdominal pain and urine culture in 3 stages.Conclusions: Based on our study, the intake of excessive amounts of water has no significant effects on the results of the UTI treatment. However, due to lack of adequate evidence, further studies should be conducted in this field.Keywords: Urinary Tract Infection; Child; Fluid Therapy

Comparison of Relation between Attention Deficit Hyperactivity Disorder in Children with and without Simple Febrile Seizure Admitted in Arak Central Iran

How to Cite This Article: Salehi B, Yousefichaijan P, Safi Arian S, Ebrahimi S, Naziri M. Comparison of Relation between ADHD in Children with And without Simple Febrile Seizure Admitted in Arak Amir-Kabir Hospital on 2010-2011. Iran J Child Neurol. Autumn 2016; 10(3):56-61.AbstractObjectiveFebrile seizure is one of the most prevalent childhood convulsions with the most common age of onset at 14-18 mo old. Fever decreases the brain threshold for seizure. Attention Deficit Hyperactivity Disorder (ADHD) is also a neurologic-behavioral problem defined by attention deficit and hyperactivity according to DSM-IV criteria in which the child must have these signs in two different environments. There is controversy on the possible relation between febrile seizure and ADHD; while some studies approve a strong relation, some exclude any relation and some attribute ADHD to the side effects of other reasons. Materials & MethodsThis descriptive-analytic study enrolled all children of 3-12 yr old with febrile seizure (according to Nelson Pediatrics Textbook diagnosed by the pediatrician in charge) referring to Amir Kabir Hospital, Arak, central Iran in 2010-2011.Overall, 103 of them with no corporeal or psychological disorder (like depression, anxiety, schizophrenia and other CNS maternal disease) were compared to 103 children of the same age and gender admitted due to disease other than febrile seizure utilizing DSM IV criteria for ADHD. Data were analyzed using SPSS version 18. ResultsThe hyperactivity disorder in the control and case group was 34.3% and 16.7%, respectively, denoted a significant relation between simple febrile seizure and hyperactivity. ConclusionHyperactivity has a significant relation with febrile seizure in male gender, making further investigation in these children prudent for early diagnosis and management. References1. Cunningham NR, Jensen P. ADHD. In: Kliegman RM, Stanton BF, Geme III JW, Schor NF, Behrman RE, eds. Nelson Textbook of pediatrics. 19th ed. Philadelphia: WB Saunders; 2011. p. 108-12.2. Greenhill LL, Hechtman LI. Attention- Deficit Disorders. In: Sadock BJ, Sadock VA, Ruiz P, Kaplan HI, editors. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins; 2009.p.1223-1231.3. Biederman J, Faraone SV, Keenak K, Steinjard R, Tsuang M. Familial association between ADHD and anxiety disorders. APA 1991; 48: 633–642.4. Austin JK, Perkins SM, Johnson CS, Fastenau PS. Behavior problems in children at time of first recognized seizure and changes over the following years. Epilepsy Behave 2011;21(4):373-81.5. Baum KT, Byars AW, deGrauw TJ, Dunn DW. The effect of temperament and neuropsychological functioning on behavior problems in children with new onset seizures. Epilepsy Behave 2010; 17(4):467-73.6. Fastenau PS, Johnson CS, Perkins SM, Byars AW. Neuropsychological status at seizure onset in children: risk factors for early cognitive deficits. Neurology 2009;73(7):526-347. Anna W, Kelly B, Cynthia S, Ton J. The relationship between sleep problems and neuropsychological functioning in children with first recognized seizures Epilepsy Behave 2008; 13(4):607-13.8. Ying C, Nai W, Chao C, Shan T, Jing J. Neurocognitive Attention and Behavior Outcome of School-Age Children with a History of Febrile Convulsions: A Population Study. Epilepsies 2000; 41(4):412-20.9. Chang YC, Guo NW, Wang ST, Huang CC. Working memory of school- aged children with a history of febrile convulsions: a population study. Neurology 2001; 57(1):37-42.10. Hesdorffer DC, Ludvigsson P, Olafsson E, Gudmundsson G. ADHD as a Risk Factor for Incident Unprovoked Seizures and Epilepsy in Children. Arch Gen Psychiat 2004; 61(7):731-6.11. Dunn D, Harezlak J, Ambrosius W, Austin J. Teacher assessment of behavior in children with new – onset seizures. Seizure 2002; 11(3):169-75.12. Tsai JJ, Wang ST. Assessing the behavioral and cognitive effects of seizures on the developing brain. Prog Brain Res 2002; 135: 377-90.13. Austin J, Harezlak J, Dunn D, Huster G. Behavior Problems in children before first recognized seizures. Pediatrics 2001; 115-122.14. Yousefichaijan P, Eghbali A, Rafiei M, Sharafkhah M, Zol M, Firouzifar M. The Relationship between iron deficiency anemia and simple febrile convulsion in children. J Pediatr Neurosci 2014; 9: 110-114.15. Yousefichaijan P, Salehi B, Firouzifar M, Sheikholslami H. The correlation between ADHD and enuresis in children with nocturnal enuresis. I.U.M.S, 2nd week, 2012. 184(30): 8-14

Prevalence of Obsessive-Compulsive Disorder in Pediatric and adolescent Patients with Chronic Kidney Disease

Introduction: Chronic Kidney Disease (CKD) is defined as renal injury and/or a glomerular filtration rate below 60mL/min/1.73m2 for more than 3 months. Neurologic symptoms in CKD include fatigue, poor concentration, headache, drowsiness, memory loss, seizures, and peripheral neuropathy. Obsessive-Compulsive Disorder (OCD) is a chronic disabling illness characterized by repetitive, ritualistic behaviors over which the patients have little or no control. Common obsessions include contamination and thoughts of harming loved ones or oneself. Washing and cleaning compulsions are common in children, as is checking. The purpose of this study was to investigate the relationship between OCD and CKD.Materials and Methods: In this case-control study, we evaluated 186 children aged 6-17 years old who were visited in the pediatric clinics of Amir-Kabir Hospital, Arak, Iran. The control group consisted of 93 healthy children and the case group included 93 age and sex matched children with stage 1 to 3 CKD. Then, the children’s behavioral status was evaluated using the Children’s Yale-Brown Obsessive-Compulsive Scale (C-YBOCS). The C-YBOCS is helpful in identifying children with OCD. The data was analyzed using descriptive and analytical statistics in SPSS-16.Results: Compulsion was detected in 31 cases (33.3%) with CKD and 7 controls (7.5%), and obsession was found in 3 cases (3.2%) with CKD and 4 controls (4.3%). The difference in compulsion was significant (P-value=0.021) while the difference in obsession was not significant between the 2 groups (p-value=0.3). The most common symptom in CKD children with compulsion was silent repetition of words.Conclusions: Compulsion is more common in CKD versus non-CKD children. The observed correlation between compulsion and CKD makes psychological counseling mandatory in children with CKD. Keywords: Chronic Kidney Diseases; Obsessive-compulsive disorder; Child

Bone Mineral Density in Children with Nephrotic Syndrome Treated under GC for More than 2 Years

Background: Nephrotic Syndrome (NS), common in the pediatric population is typically treated with high-dose glucocorticoid (GC). Long-term GC treatment in refractory cases results in osteoporosis susceptibility. Immunosuppressants adjuvant to GC, used to induce remission in steroid-resistant NS, have shown controversial effects on bone density. This study aims to evaluate and compare bone density in children with NS undergoing GC therapy for ≥2 years with or without immunosuppression using DEXA.Methods: Twenty-three NS patients were enrolled in the study and underwent DXA scan. Demographic data and years of disease, and electrolytes including calcium, phosphorus, and vitamin D levels, as well as creatinine, Glomerular Filtration Rate (GFR), and albumin were documented.Results: DEXA scan showed low bone density in 4 out of 23 participants (17.4%), two of whom had scores lower than -2, which is indicative of osteoporosis, 2 of whom received cyclosporine and one received tacrolimus adjuvant therapy. Disease chronicity was significantly higher in children with lower whole-body Z-scores. Lower than normal vitamin D levels were detected in 68% of cases.Conclusion: Our observations revealed a 2:1 ratio of cyclosporine to tacrolimus use in patients in Z-score <-1. We suggest that pediatric patients undergoing ≥2 years of GC therapy, especially in high doses or adjuvant to immunosuppressants, be screened for bone loss using DEXA scan for timely diagnosis and management. Furthermore, clinicians should be aware of the beneficial effects of vitamin D supplements in long-term GC therapy and evaluate their patients for vitamin D and calcium deficiency

The Mean Platelet Volume in children with Pyelonephritis

Introduction: The mean platelet volume (MPV) is a determinant of inflammation. The aim of the present study was to investigate the MPV levels in children with pyelonephritis and to evaluate the possible relationship between MPV and febrile UTI.Materials and Methods: In this prospective observational study, 82 patients with Pyelonephritis (group A) and 82 patients with viral gastroenteritis (group B) were enrolled from 20 Jun 2013 through 15 Jan 2014. The patients were divided into two groups according to the presence of pyelonephritis and viral gastroenteritis. The pyelonephritis group (A) included 82 patients and the acute gastroenteritis group (B) included 82 patients. Complete blood count (CBC) parameters were measured at admission. Routine biochemical tests were performed. Groups were compared according to different parameters.Results: A total of 164 patients were included from inpatients of Amir-Kabir Hospital. The mean platelet volume was lower in group (A) and it was associated with acute pyelonephritis (P =0 .003). The MPV (6.03 ± 0.26 fl vs. 9.06 ± 0.73 fl) was significantly lower in group (A), the platelet count (219.88-± 52.31vs. 184.09 ± 52.21) was significantly higher in group (A), and the WBC count (13.01± 3.43 vs. 8.30 ± 1.13) was significantly higher in group (A).Conclusions: MPV levels were significantly lower in children with pyelonephritis compared with controls. MPV can be used as a negative acute phase reactant in children with febrile UTI.Keywords: Child; Pyelonephritis; Mean Platelet Volume; Urinary tract infection

Prenatal Risk Factors for Infantile Reflux Nephropathy

Introduction: Vesicoureteral reflux (VUR) refers to the retrograde flow of the urine from the bladder to the ureter and kidney. In children with a febrile urinary tract infection (UTI), those with reflux are 3 times more likely to develop renal injury compared to those without reflux. Reflux nephropathy was once accounted for as much as 15-20% of end-stage renal disease in children and young adults. With greater attention to the management of UTIs and a better understanding of reflux, end-stage renal disease secondary to reflux nephropathy is uncommon. Reflux nephropathy remains one of the most common causes of hypertension in children. Reflux in the absence of infection or elevated bladder pressure does not cause renal injury. We sought to determine the association of infantile reflux nephropathy (IRN) with prenatal risk factors. Materials and Methods: In this study, 96 infants with reflux-related renal injury and 96 infants with VUR without reflux nephropathy were evaluated. Maternal information was assessed. Data was analyzed using SPSS version 18.Results: The results of this study showed that age more than 35 years, pre-gestational hypertension, preeclampsia and eclampsia, preterm delivery, very low birth weight (VLBW), pre gestational diabetes mellitus, and maternal BMI&lt;18.5kg/m2 (underweight) were prenatal risk factors for infantile reflux nephropathy.Conclusions: The data suggests that prenatal factors may affect the risk of IRN. Adequate prenatal care and good maternal support can be effective in the prevention of reflux-related renal injury. Keywords: Vesico-Ureteral Reflux; Risk Factors; Prenatal; Infant

The Association Between Hyponatremia and Reflux-Related Renal Injury in Acute Pyelonephritis

Introduction: The kidney regulates sodium balance and is the principal site of sodium excretion. Sodium is unique among electrolytes because water balance, not sodium balance, usually determines its concentration. Although water balance is usually regulated by osmolality, volume depletion stimulates thirst, renal protection of water and ADH secretion. Volume reduction has priority over osmolality; volume depletion stimulates ADH secretion, even if a patient has hyponatremia. The aim of this study was to consider scar nephropathy in children with UTI and hyponatremia and compare it with children without hyponatremia.Material and Methods: 200 children with pyelonephritis were included in this case–control study as case and control groups, respectively. Subjects were selected from children referred to the pediatric clinic of our hospital in Arak, Iran. Case group included children with hyponatremia and UTI (with VUR) and control group included children with UTI (With VUR) and normal serum sodium. Data was analyzed using SPSS ver.18Results: Among 200 (100%) children in both groups, 5 children (5%) had normal sodium and reflux nephropathy and 23 children had hyponatremia and reflux nephropathy.Conclusions: Hyponatremia in children with reflux nephropathy was significantly more common than children without reflux nephropathy. The observed correlation between reflux-related injury and hyponatremia necessitates evaluation of electrolytes in children with pyelonephritis.Keywords: Pyelonephritis; Child; Hyponatremia; Vesico-Ureteral Reflux