Journal of pediatric nephrology
Volume:7 Issue: 4, Autumn 2019

Hydrothorax is a rare but serious complication of peritoneal dialysis. We report a recurrent pleural effusion in a case of ESRD (end stage renal disease) treated by pleurodesis using tetracycline.

Routine clinical and laboratory assessments facilitate diagnosis of erythropoietin (EPO) resistant anemia by allowing early identification of patients with nonadherence. Resistance to erythropoietin (EPO) rarely happen in Chronic Kidney Disease (CKD) children and can be affected by many factors such as poor compliance, hyperparathyroidism, malnutrition, inadequate dosages and medication. We studied the frequency and the cause of EPO resistant in CKD children.

This observational retrospective study was performed in 2008 in Aliasghar pediatric hospital. Children who were treated by EPO and had still Hemoglobin (Hb) less than 10mg/dl considered as resistant anemic cases. Therefore, their related data consisting of demographic data, EPO dosage, medications, underlying disease, the mode of dialysis and lab tests were reviewed.

among 20 cases reviewed, 8(40%) had Hb<8.male to female ratio was 1.66. The median range of age was 7.9 y/o. the median Hb was 6.25 mg/dl. 3 cases (37.5%) was true resistant in EPO agent (2 patient had bone marrow fibroses due to hyperparathyroidism and 1 had EPO Ab) and 5 cases (62.5%) had inadequate dosage of EPO (incompliance)

EPO unresponsiveness is frequent and because of its heterogeneous causes need full investigation including complete history to find the underlying reason.

An 8-year-old boy presented with primary nocturnal enuresis as the first clinical sign of ureterocele in the absence of dysuria, urinary incontinence or urinary tract infections. A prolonged history of bedwetting prompted subsequent clinical and laboratory evaluations, leading to the correct diagnosis of ureterocele.  Primary and persistent nocturnal enuresis as an initial manifestation of ureterocele has not been reported previously. The present patient showed a feature not previously described in children with ureterocele. Although rare, ureterocele should be considered in the differential diagnosis of children presenting with primary nocturnal enuresis. 

Antenatal hydronephrosis refers to the dilation of renal pelvic during fetal development. This condition, is commonly diagnosed during intrauterine ultrasonography. According to available statistics, fetal anomalies are seen in about 0.5 to 2.5% of intrauterine ultra-sonographies. The most common of these anomalies is hydronephrosis. The severity of renal pelvic dilatation in the first sonography after birth may help to diagnose the underlying cause of antenatal  hydronephrosis.

AbstractSickle cell disease (SCD) is a common hemoglobinopathy in the world with progressive multi organ failure. Many organs have been affected in this disease, but sickle cell nephropathy (SCN) is a major complication which affects the quality of life in these patients. SCN has a wide range of renal manifestations such as asymptomatic microalbuminuria, hyposthenuria, hematuria, frank proteinuria, nephrotic syndrome and end stage renal disease (ESRD). Nowadays novel biomarkers such as N-acetyl-beta-D-glucosaminidase (NAG), kidney injury molecule-1 (KIM-1) and transforming growth factor β (TGF-β) has allowed the early detection of the kidney involvement in sickle cell disease. The angiotensin converting enzyme (ACE) inhibitor drugs such as captopril or enalapril and also ACE receptor blockers (losartan) have beneficial effects in albuminuria or proteinuria. Also endothelin-1 (ET-1) receptor antagonists have a promising role in glomerular injury in SCD. In sickle patients who develop ESRD, renal replacement therapy can be life- saving. In recent years, kidney transplantation is the only curative treatment for advanced chronic kidney disease in these patients. 

To determine the spectrum of congenital anomalies of kidney and urinary tract (CAKUT) in Indian children, and to evaluate its clinico-epidemiological characteristics.

A tertiary-care, hospital-based cross-sectional study conducted (November 2016-October 2018) at SCBMCH & SVPPGIP Hospital included children aged ≤14 years with a diagnosis of CAKUT. Incidence of individual congenital anomalies and clinico-epidemiological characteristics of each anomaly thus considered were evaluated.

In 140 children, 9 types of congenital anomalies were reported; posterior urethral valve was most common (37.85%) followed by pelvi-ureteric junction obstruction (32.14%) and vesico-ureteric reflux (14.28%). Hypospadiasis (5%), renal agenesis (2.86%), multicystic kidney disease (2.86%), duplication of pelvi-calyceal system (2.14%), horseshoe kidney (1.42%) and ureterocele (1.42%) were other CAKUTs. A total of 68.57% were boys (girls=31.43%). The CAKUTs were observed more in children with: age 1-5 years (32.14%), unilateral disease (45%), and term delivery (67.86%), and in children of mother aged >30 years (58.57%). Diabetes was present in mothers of 4 children (gestational: 2, pre-gestational: 2), hypertension in 3, tobacco use in 5, oligohydramnios in 7 and polyhydramnios in 3 mothers. Majority of the children had asymptomatic (37.86%) manifestation followed by burning micturition (31.43%). Non-renal congenital anomalies were present in 15.71% children (gastrointestinal malformations: 5.71% were most common). Positive family history for CAKUT was seen in 7.8% cases.

The most frequent CAKUTs were posterior urethral valve and pelvi-ureteric junction obstruction in our study. The study also provided the clinico-epidemiological characteristics of CAKUT. These data can be helpful for prenatal counseling and management of CAKUTs.

Urinary tract infection (UTI) is one of the most common and important diseases in childhood, and if it not be diagnosed and treated properly, it may lead to some complications such as acute pyelonephritis, renal scaring and renal failure. Nowadays, the antibiotic resistance rate has been increased because of unnecessary antibiotic consumption. In order to prescribe an appropriate drug as empirical therapy, it is necessary to know about prevalence rate of pathogenes causing UTI and their antibiotic resistance rate in the community. So we attempted to present an appropriate guideline for UTI empirical therapy by evaluating the rate of antibiotic resistance in hospitalized patient’s samples, suffering from UTI.

Materials & methods:

This was a retrospective descriptive analytical study on 130 children with UTI during 2016-2017 in Shahid Beheshti University hospitals who had antibiogram in their medical records and the relative information was recorded and analyzed.

In these 130 patient’s sample, 73/07% were girls and 26/92% were boys. About 50 % of patients were under1 year old, 33/07 % were 1-3 years old and 16/15% were over 3 years old. The detected pathogens were: E.coli 63/07%, Enterococcus14/61%, Klebsiella 13/07%, Pseudomonas aeruginosa 5/38%, Entrobacter 3/84%.

Based on the data of the present study, prescribing Ampicillin, Co-trimoxazole and First generation Cefalosporins are not appropriate enough in UTI empirical therapy.