Acute Kidney Injury in Children with Acute Gastroenteritis

Introduction: This study was done in Children’s Medical Center Hospital affiliated with Tehran University of medical science, Tehran, Iran.Materials and Methods: The patients were 140 children who were admitted for gastroenteritis and we detected acute kidney injury in them. All of the patients were admitted and managed in the Emergency Department, and were evaluated for symptoms of AKI including dehydration, renal function tests, electrolytes, and urine output.Results: The median age of the children with gastroenteritis and AKI was 2.5 years (ranging from 2 months to 12 years) and 78.6% of them were male. Acute kidney injury (AKI) was present in 116 (82.9%) patients at admission with 53 (37.8%) patients in the “failure” category (RIFLE). Twelve children had anuria and 54 patients had oliguria. At presentation, 24 patients (15%) had serum BUN levels between 30-75 and creatinine levels in the range of 0.9-2.1mg/dl. One patient had HUS that was excluded from this study. Seventy-six children had symptoms of severe dehydration and metabolic acidosis. After adequate fluid therapy, 30 children had polyuria of 6.4 (range 4-9) cc/kg/min. Twenty-three patients (16.4%) had hyponatremia and 41 patients (29.2%) had hypernatremia. Nine children (6.4%) suffered from hypokalemia. Some children had received ORS at home. All of them were managed in the emergency ward and discharged with normal GFR without any electrolyte abnormalities. The patients were fallowed for 3-6 months and all of them had normal renal function at the end of the study.Conclusions: Early diagnosis and urgent management of gastroenteritis and dehydration can prevent AKI.Keywords: Acute Kidney Injury; Child; Gastroenteritis

Hyperammonemic Induced Coma by Bacterial Overgrowth in a Child With Hirschsprung’s Disease

Cases with Hirschsprung’s disease show the functional intestinal obstruction. Obstruction in these patients may lead to bacterial overgrowth with stasis and inflammation of the colon. Bacterial overgrowth can cause hyperammonemia that makes lethargy and loss of conscious and finally admitting in ICU. The purpose of this case report is to present a case that had Hirschsprung’s disease and referred to Children’s Medical Center with serum hyper-ammonium caused by bacterial overgrowth that induced coma and altered level of consciousness then made her to admit to PICU. A 15-year-old female referred to Children’s Medical Center with lethargy and low grade diarrhea. She had hypocalcemia and hypoalbuminemia with high PT and INR. Because of loss of conscious, she admitted at PICU. Laboratory findings showed hyperammonemia in this case, but other criteria were normal. Administration of antibiotic and lactulose therapy was started that lead to a reduction in serum ammonium level and discharging of the case. Thirteen days later she referred again with mentioned symptoms, and clinical evaluations showed high serum ammonium level. This time because of loss of conscious she had to admit at PICU and used NG tube. Administration of lactulose syrup and sodium benzoate make her in a better condition. Narrowing rectum toward the sigmoid and highly enlarged intestinal lopes was on behalf of Hirschsprung’s disease. Finally, the patient with the acceptable situation and oral periodic metronidazole discharged. It is essential to check serum ammonium level in the cases with loss of conscious. The choice for controlling hyperammonemia is lactulose therapy

Features of Childhood Acute Myeloid Leukemia in Iran: a Report from Double Center Study

Acute Myeloblastic Leukemia is one of the important malignancies in children. For better managing the prognosis of this disease, there should be enough information about common features of this malignancy. The aim of this study was to evaluate these common features in children with Acute Myeloblastic Leukemia. A total of 104 eligible children less than 15-year-old have been referred from 2007-2011 to two referral centers for childhood malignancies. Basic epidemiological information recorded in checklists for each individual. Analyzes have been done by SPSS version 22. Out of patients, 57 cases were males (54.8%). The male/female ratio was 1.2. The mean age of patients was 6.5 ± 4.3 years. The majority subtypes of patients were M3, M4, non-M3, and M2, respectively. The common molecular abnormalities were t (15;17) and inv (16). Of patients, 19.2% had an early relapse. The mean age of relapse in patients was 6.7 ± 3.9 years. Sixty patients (57.7%) were alive, and 44 cases (42.3%) died during or after therapy. The three years overall survival rate of patients was 42% in this study. According to our data, AML has the same frequency as compared with data from developing countries. But different epidemiological characteristic was a lower rate of three years overall survival in patients. These data may serve the health authorities for more effective environmental and preventive measurements, purposeful allocation of resources for facilitating up-to-date diagnostic and treatment modalities, psychological support programs for respective family members and educational purposes