Journal of pediatric nephrology
Volume:11 Issue: 2, Spring 2023

Vesicoureteral reflux (VUR) as a known cause of urinary tract infection (UTI), renal scarring, and nephropathy, is congenital and often familial. The prevalence of VUR is unclear, although most cases of VUR resolves spontaneously, the management of children with VUR is controversial. The purpose of this review was to evaluate VUR in order to provide an update on management to improve its prognosis.

The articles from several sources, including PubMed, Scopus, Embase, Google Scholar, Web of Science, and the Directory of Open Access Journals, were included.

Due to various complications, VUR is very scary for patients or families, and special attention is needed. A challenge for pediatric nephrologists is the early diagnosis of VUR and the progressive complications of kidney disease. There is no internationally accepted, uniform, evidence-based algorithm for the assessment of reflux anywhere

Nephrotic syndrome (NS) is the most common pediatric renal disease. Immune dysregulation, prolonged immunosuppressive treatment, and recurrent prolonged proteinuria in NS cause alterations in serum immunoglobulins, especially hypogammaglobulinemia. Thus, anti-HBs titer may be reduced in NS patients. We assessed anti-HBs titer among hepatitis B-vaccinated children with NS.

This case-control study was conducted at the Department of Paediatrics of the Institute of Child & Mother Health, Dhaka, from July 2020 to June 2021. Sixty-one children with primary and recurrent NS previously vaccinated according to the expanded programme on immunization program were evaluated for anti-HBs titer and compared with 61 age- and sex-matched healthy children.

Protective anti-HBs titer was found in 29(47.5%) and 40(65.6%) cases in the case and control groups, respectively. The mean anti-HBs titer was 37.2±35.5 IU/L in the case group and 55.7±28.3 IU/L in the control group, which showed a significant difference between the groups. The mean anti-HBs titer was 52.9±35.5 IU/L in the first attack, 33.9±36.8 IU/L in the infrequent relapse nephrotic syndrome (IFRNS), and 22.2±27.41 IU/L in the frequent relapse nephrotic syndrome (FRNS), respectively. The difference was also significant statistically. The mean anti-HBs titer was lower in the FRNS and IFRNS and significant in the FRNS compared to the first attack. The mean anti-HBs titer was significantly (P<0.05) lower in the IFRNS and FRNS compared to the controls.

Anti-HBs titer was found significantly lower than the protective level in the first attack and relapse cases of NS.

There is a concern regarding the relationship between biodemographic parameters at different ages and the size of inferior vena cava (IVC) and the collapsibility index (CI). Due to the lack of normative data on these parameters in children, we aimed to use ultrasound to determine the mean sizes of IVC in healthy children and calculate the CI.

In this analytical cross-sectional study, we measured the IVC diameter in euvolemic children aged four weeks to 12 years. The maximum IVC diameter was recorded during the exhalation phase of the respiratory cycle, while the minimum diameter was recorded during the inhalation phase using M-mode. Additionally, we calculated the CI by dividing the difference between the maximum and minimum IVC diameters by the maximum diameter.

In this study, 534 euvolemic healthy children with a mean age of 6.77±3.22 years were assessed. The mean diameter of the maximum IVC during exhalation was 5.26±4.70 and the mean diameter of the minimum IVC during inspiration was 2.96±2.89 mm. The mean CI in the present study was 0.5±0.13. Ultrasound measurements of IVC diameter during exhalation, unlike IVC diameter during inhalation, were positively correlated with age, weight, and height. The mean IVC and CI had a direct and significant correlation with biodemographic parameters, such as age, height, weight, and body mass index.

Evaluating intravascular volume status holds significant clinical relevance, particularly in pediatric patients. Utilizing ultrasound to assess the IVC allows for swift and noninvasive analysis of an individual’s hemodynamics, impacting clinical decision-making positively. Establishing normative IVC measurements in healthy and euvolemic children can serve as valuable reference data for clinicians and help them accurately assess fluid status in unwell pediatric patients.

The spike glycoprotein is a prime focal point for vaccine development due to its possession of numerous T-cell and B-cell epitopes. In this study, we investigated the effects of some important mutations (K444T, N460K, F490S, L452R, and T478R) on the immunogenicity of the spike protein in the Omicron variant. Additionally, we forecasted the effects of these mutations on the spike protein’s solubility, allergenicity, and immunogenicity.

In this research, we obtained 100 SARS-CoV-2 spike sequences from two databases, namely the Global Initiative on Sharing All Influenza Data (GISAID) EpiCoV and NCBI. We conducted a comparative analysis between the wild-type spike protein (Wuhan accession number: NC_045512.2) and the mutated spike proteins. The analysis focused on solubility, allergenicity, and immunogenicity. It was carried out using various bioinformatics servers, such as Dynamut, toxin pred, soluprot, Allertop, IEDB, and Vaxigen, as well as tools, like Mega XI and Pymol II.V.II visualizer.

According to the prediction of the IEDB server, the K444T mutation is likely to decrease the humoral immune response. In addition, spike proteins in wild types and mutants do not have allergenic properties, and these proteins are soluble and can be expressed in Escherichia coli.

Vaccines formulated using spike protein design are effective. These findings indicate the potential for developing pan-coronavirus vaccines that offer protection not only against SARS-CoV-2 but also against a range of other coronaviruses in the future.

Glomerulocystic kidney disease (GCKD) is characterized by cystic dilatation of the Bowman’s capsule and adjacent tubules. It is a rare form of cystic kidney disease and can occur at any age. Sometimes GCKD may not be differentiated from other cystic kidney diseases. It usually presents with renal failure. Here, we reported a case of a four-year-old girl presented with end-stage renal disease who had glomerulocystic kidney disease in renal histopathology.

Alport syndrome is an inherited glomerular disease characterized by hematuria, proteinuria, hypertension, progressive kidney failure, hearing loss, and ocular pathologies. It is caused by a mutation in COL4A3, COL4A4, or COL4A5 genes. A lamellar or uniformly thinned glomerular basement membrane is a pathognomonic histologic appearance for Alport syndrome. Light microscopy shows nonspecific findings, including mesangial matrix expansion and hypercellularity. Renal tubules are other main components of the kidney and the major sites in response to injuries. They are vulnerable to various conditions, such as hypoxia, proteinuria, and nephrotoxic substances, including heavy metals, like lead and mercury. We demonstrated that a patient with asymptomatic Alport syndrome may have accelerated worsening of kidney functions due to occupational exposure to lead and mercury. Regarding the initial diagnosis with current clinical and laboratory findings in patients, it is noteworthy that there is always the possibility of another pathology, and additional investigations may be needed. Besides, when considering public health issues and the financial burden due to occupational diseases, we desired to draw attention to the importance and need to create safer work environments and make frequent inspections.

There has been a history of various bacterial infections and glomerular injuries, which are now pooled under the terminology of infection-related glomerulonephritis (IRGN). IRGN is an immune complex-mediated glomerulonephritis (GN) preceded by infection with subsequent recovery of renal function after the resolution of the infection. Pediatric IgA-dominant infection associated with GN is rare and generally has a favorable prognosis compared to adults with severe comorbidities, like diabetic nephropathy. We reported a 13-year-old girl presented with acute kidney injury with nephritic features with no history of concurrent illness.