Journal of pediatric nephrology
Volume:9 Issue: 4, Autumn 2021

Kidney transplantation is the preferred treatment modality for end - stage renal disease (ESRD) in children. Despite its benefits and advances that have been accomplished, pediatric kidney transplantation remains a challenge in terms of achieving a satisfactory outcome. We sought to evaluate the outcome of pediatric kidney transplantation in Mashhad.

Dat a were acquired retrospectively from children below 18 years old who underwent kidney transplantation in three main hospitals of Mashhad from 2000 to 2014. After obtaining written informed consent from parents, data were collected using a questionnaire and analyzed with the SPSS software.

Of 52 children, 51.9% were boys and 48.1% were girls with a mean age of 13.3 ± 4.3 years. Among them, 8 (15.4%) children received transplants from relative live donors, 16 (30.8%) from non - relative live donors, and 28 (53.8%) from deceased donors. The most common etiology leading to ESRD in these children was reflux nephropathy in 18 (34.6%) patients. After a 5 - year follow - up period, the graft survival rate was 69.2% with infection being the most common cause of transplant rejection. Moreover, 13.5% of children died, mostly due to surgical complications.

We found that to increase the survival rate of pediatric kidney transplantation in Mashhad, first the surgical methods should be enhanced as they wer e recognized as the most common cause of death. In addition, infection control in children, as the most common cause of transplant rejection, should be improved.

Acute Kidney Injury (AKI) is an important complication of Nephrotic Syndrome (NS) associated with adverse outcome. The frequency of AKI has increased to almost double in the last decade. To determine the incidence of AKI, risk factors and its association with outcome in hospitalized children with NS.

All children aged 1-18 years with diagnosis of NS from 01 November 2018 to 31 May 2020 were enrolled for the study. AKI was diagnosed using the KIDIGO 2012 guidelines and classified according to pediatric RIFLE definition.

The mean age of children in this cohort was 4.7± 2.8 years. Complications were observed in 67% cases only. Among all complications the most frequent complication was anemia (25%). The incidence of AKI in hospitalized children with NS was 18.6%. According to pRIFLE criteria of AKI; 11.6% of children met Stage 1 (risk) criteria, 4.6% met Stage 2 (injury) criteria and 2.3% met Stage 3 (failure) respectively. Among all NS children, 53% received nephrotoxic drugs during the hospital stay. On applying multivariate logistic regression analysis, only male gender, associated anemia and Vancomycin use in NS patients came out to be significant independent risk factor for acute kidney injury.

AKI is more frequent in first episode of NS rather than in any type of relapses. Although, nephrotoxic drug and male gender are known independent risk factors for development of AKI, associated anemia is till yet not considered as independent risk factor for AKI in children with NS.

Urinary tract infection (UTI) in neonates might be associated with bacteremia and congenital anomalies of the kidney and urinary tract (CAKUT), that in complicated situations can lead to renal parenchymal scarring and chronic kidney disease.

To determine occurrence of UTI in neonatal sepsis.

This cross sectional study was conducted on 500 term, extramural hospitalized neonates, suspected to have infection underwent, a detailed history, physical examination and a comprehensive sepsis workup. The diagnosis of neonatal UTI was based, on positive urine culture, obtained by suprapubic aspiration (SPA).

Out of 500 neonates included in our study (324 boys and 176 girls), blood culture was positive in 84 (36.5%) neonates in early-onset sepsis group (n=230), while in late-onset sepsis group (n=270) blood culture was positive in130 (48.1%), p-value < 0.05. In both early-onset sepsis (EOS) and late-onset sepsis (LOS) groups, blood culture was found to be positive in a greater proportion of male (41.3%) than female (29.3%) patients, p-value <0.05. The most common organism isolated from blood and urine culture was Klebsiella, followed by E-coli. Urine culture was positive in 34 (6.8%) patients, among whom 29 (85%) culture-positive cases were from the LOS group, a p-value of <0.05.

UTI is not uncommon among the hospitalized neonates, and UTI evaluation among septic neonates can prove beneficial for the prevention of long-term sequelae of neonatal UTI.

Bladder tumors resulting in voiding difficulty in a child are rarely encountered in clinical practice. There are various investigations that help with preoperative diagnosis of bladder tumors and a systematic approach is needed to draw an early diagnosis. We report a case of the botryoid variant of rhabdomyosarcoma of the bladder in an infant that presented with complaints of a lower abdominal mass, poor urinary stream for three months and hematuria for one month.

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis is a type of systemic autoimmune disease with blood vessels swelling and inflammation. Wegener's Granulomatosis (WG) is closely associated with antineutrophil cytoplasmic autoantibodies, particularly those directed to proteinase 3 (PR3). An 18-year-old boy with granulomatosis with polyangiitis (GPA) who was diagnosed 6 months back with scleritis and sinusitis at the onset of the disease. During his initial visits to Ear Nose Throat and ophthalmology departments lab tests was not performed on time due to lack of typical symptoms of kidney involvement. Half a year later, lab tests showed PR3-ANCA (Proteinase 3) positive and advanced renal dysfunction, and was finally diagnosed as sclerotic renal failure with fibrotic crescents based on renal biopsy. Scleritis may be the earliest manifestation in systemic vasculitis and is sometimes hard to diagnose at the onset. Delayed diagnosis and treatment will lead to irreversible renal dysfunction.

Nephromegaly in childhood can result from a wide variety of causes, yet iron - deficiency anemia has not been previously described. We report a child with severe iron - deficiency anemia associated with transient bilateral nephromegaly. We hypothesize that inc reased renal production of erythropoietin as well as greater cardiac output with subsequent glomerular hyperfiltration secondary to critical anemia explained the observed nephromegaly. The normalization of kidney size following resolution of anemia support s this hypothesis. Our case report suggests an additional etiology of bilateral nephromegaly in the pediatric population and thus merits attention among physicians.

Introduction This case-series describes a short term follow-up of Renal Transplantation (RT) in three children at the Zenith Medical and Kidney Centre (ZMKC), Abuja, Nigeria. Methods The immediate allograft function (IAF) and recipients’ survival at 6-24 months of follow-up from January 2018 to January 2020 were described. RT involved the use of basiliximab and thymoglobulin for induction therapy and oral prednisolone, tacrolimus and mycophenolate mofetil for maintenance immunosuppressive therapy. Results Recipients were 9 years to 17 years (average age of 12 years) of age. Primary steroid-resistant focal segmental glomerulosclerosis nephrotic syndrome, congenital posterior urethral stricture and lupus nephritis were the causes of the end-stage kidney diseases. The IAF was excellent in all the cases. All the 3 children are alive with good allograft functions at 6-24 months of the follow-up period. Conclusion This case series shows that a successful paediatric RT programme is feasible in a resource-constrained setting like Nigeria

 Research into the association between anemia and urinary tract infections (UTIs) is not adequate and only a few studies are available in this regard. Therefore, the aim of this study was to investigate the relationship between iron deficiency anemia and urinary tract infections in children presenting to Hazrat Masoumeh Hospital, Qom, Iran.

 The medical records of pediatric patients with and without UTI hospitalized in Qom Hazrat Masoumeh Hospital were evaluated.  Then, the anemia profile was evaluated in the two groups (e.g. hemoglobin, ferritin, transferrin, etc.)

 There were 32 patients (64%) in the urinary tract infection group and 26 patients (52%) in the non-urinary tract infection group. Twenty-eight patients (56%) in the urinary tract infection group and 20 patients (40%) in the non-urinary tract infection group had iron deficiency anemia, but no significant relationship was found between the two groups (P value = 0.08). The mean hemoglobin concentration was 11.19 ± 1.73 in patients with urinary tract infection and 11.56 ± 1.89 in the non-infected group. Regarding anemia profile variables, no significant relationship was found between the two groups (P values: Hb = 0.15 SI = 0.21 TIBC = 0.90 Ferritin = 0.05 Transferrin sat = 0.132).

 No statistically significant difference was found in anemia between the two groups of children with and without urinary tract infections. However, the indicators of anemia were lower in children with urinary tract infections compared to the control group and these children are prone to anemia.

Spasms or seizures during the first month of life are the most common clinical manifestations of central nervous system failure in infants and occur due to overactivity of a group of nerve cells in the brain and excessive electrical stimulation of neurons. The purpose of the present study was to evaluate the prevalence of renal complications of levetiracetam in neonates with seizures.

A retrospective descriptive-analytical study was conducted to evaluate the levels of creatinine and blood urea as well as t duration of levetiracetam use in all neonates. Renal ultrasound was only performed for cases with elevated creatinine levels. Finally, the obtained data were analyzed.

No significant differences were foundbetween neonatal subgroups, especially in infants on levetiracetam, except a transient increase in creatinine and urea levels. During the 6-month follow-up, only three cases had increased creatinine levels above 1.4. These three cases had normal genitourinary ultrasound. In addition, of neonates diagnosed with choroid cyst on ultrasound, the creatinine level was above 1.4 in one case and below 1.4 in other cases.

According to the results of the present study, no serious renal complication was observed with levetiracetam and its use can be recommended for patients.