Journal of pediatric nephrology
Volume:10 Issue: 2, Spring 2022

Different radiologic and radionuclide cystography studies have been suggested to detect and follow up vesicoureteral reflux (VUR) in children, with conflicting results. Conventional voiding cystourethrography seems the preferred method to evaluate urinary tract abnormality, voiding dysfunction, and accurate grading of VUR. However, radioisotopic cystography is a preferred method to evaluate VUR in women, patients without voiding dysfunction, and re-evaluate VUR.

COVID-19 pandemic originated in Wuhan City, China, in 2019. The disease spectrum ranges from asymptomatic to severe respiratory failure leading to death. Although in a lower percentage, pediatric patients also have complications, not only pulmonary but also systemic, affecting other organs. This article aims to study the renal involvement of pediatric patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

We designed a retrospective observational cohort study of patients hospitalized in the emergency department and intensive care unit of a tertiary medical facility hospital Infantil de México Federico Gomez in Mexico City, from March 1, 2020, to May 16, 2021. The inclusion criteria included patients younger than 18 years who had a positive Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test or a positive rapid antigen test of nasopharyngeal sample for SARS-CoV-2 at admission.

We included 165 patients, of whom 29(17.6%) patients developed renal complications during hospitalization. In these patients, 12(41.3%) patients developed proteinuria, 10(34.5%) developed any type of Acute Kidney Injury (AKI), i.e., Acute Kidney Injury Network (AKIN-1) in 26.6%, AKIN-2 in 40% and AKIN-3 in 33.3%. Also, 5(17.2%) patients had arterial hypertension, 2(6.9%) required renal replacement therapy, 4(13.8%) had hematuria. Only 1(3.4%) patient had developed rapidly progressive glomerulonephritis.

COVID-19 infection within its spectrum can cause kidney disease; the most common complications are proteinuria and AKI. Older age and admission to the intensive care unit are risk factors for kidney damage.

Peritoneal dialysis is an effective modality of renal replacement therapy in end-stage renal disease. The initial step in peritoneal dialysis management is securing the Peritoneal Dialysis Catheter (PDC). This study aims to compare the infective and mechanical complications of the surgical versus the percutaneous catheter insertion technique.

This retrospective analytical study was conducted on end-stage renal disease patients who attended the Department of Nephrology, ESIC Medical College, and Super Specialty Hospital. The study was conducted from January 2019 to June 2020. The records of 25 patients who underwent percutaneous PDC and 5 patients who underwent open surgical PDC technique were reviewed. The complications (mechanical and infective complications) at 3-, 6-, and 12-month intervals among the study groups were considered the primary outcome variables, and catheter and patient survival at 1-year interval were considered the secondary outcome variables. The student t test and the Chi-square test were used to compare the study groups. The data were analyzed via the coGuide software.

No significant differences in baseline parameters were observed among the groups (P>0.05). The infective complications, namely the peritonitis rate and the exit site infection were reported more in the surgical technique of PDC placement compared to percutaneous placement (20% vs 16% and 20% vs 0%, respectively); however, the difference was not statistically significant. Catheter migration was higher in surgical technique compared to the percutaneous technique (20% vs 4%) but it was not statistically significant.

Both the percutaneous and surgical techniques reported similar rates of complications, technique survival, and patient survival. Further randomized control trials or prospective cohort studies are needed to analyze the effectiveness and complications of these techniques.

Urinary stones are a common problem among children that causes pain, dysuria, and other complications, including urinary tract obstruction and infection. The prevalence of urinary stones in children has been increasing in recent decades. Since the causes of urolithiasis in children differ in various geographical regions, with diverse ethnic backgrounds and popular nutritional habits changing over time, we designed this study to update the identifiable etiologies of urinary stones in children younger than 14 years in Northwest Iran.

This cross-sectional study was conducted on 144 children with urinary stones who were referred to Tabriz Children’s Hospital, Tabriz City, Iran, from March 2018 to September 2020. To determine the main causes of urolithiasis, such as metabolic disorders, urinary tract infections, and anatomical abnormalities, several variables, including age, sex, and results of ultrasound examination, urine analysis and biochemical tests, urine culture, and blood gas analysis, were collected, analyzed, and interpreted.

In this study, 90 boys and 54 girls with an average age of 11.75 (ranged: 1-160) months were included. The most common causes of urolithiasis were metabolic or biochemical disorders in 67 cases (46.5%), mainly hypercalciuria followed by hyperoxaluria, anatomical abnormalities in 10 children (7%), and urinary tract infections in 3 patients (2.1%). Dehydration leading to excessive urine concentration in 87 children (60.4%) was the most common condition associated with urolithiasis in the studied children.

Regarding the high prevalence of metabolic disorders, especially hypercalciuria in children with urolithiasis, these disorders should be considered for preventive, diagnostic, and therapeutic measures.

Urinary Tract Infection (UTI) is a common bacterial infection in children causing permanent renal damage. Differentiation between Acute Pyelonephritis (APN) and lower UTI is vital due to the involvement of renal parenchyma in APN. This study aimed to assess the efficiency of Procalcitonin (PCT) with C-Reactive Protein (CRP) to predict APN in children with UTI in a tertiary care hospital.

This analytical cross-sectional study was conducted in a tertiary care hospital between March 2013 and July 2014. Children aged 1 month to 16 years with febrile UTI were included in the study Sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic (ROC) curve were used to assess quantitative variables for diagnosing APN.

The Mean±SD age values in the APN group were 73.11±52.29 months, while it was 76.25±47.23 months in the lower UTI group. The Area Under the Curve (AUC) for fever, White Blood Cell (WBC), CRP, and PCT of the respondent showed that CRP was at the cut-off point of 5.0 mg/L, resulting in a sensitivity of 82.4% and a specificity of 80.0%, respectively. PCT was at the cut-off point of 1300 pg/mL, resulting in a sensitivity of 76.5% and a specificity of 100.0%, respectively. By comparing the Receiver Operating Characteristic (ROC) curve, PCT had a significantly higher Area Under the Curve (AUC) than CRP for differentiating APN and lower UTI.

Serum CRP and PCT are good markers for diagnosing APN in febrile UTI in children. However, the study showed that PCT is a better marker to differentiate APN and lower UTI compare to CRP.

Vesicoureteral Reflux (VUR) refers to the pathological return of urine from the bladder to the ureter and then to the kidney in some patients. Vitamin D deficiency is associated with some renal diseases. This study examines the relationship between vitamin D deficiency and urinary reflux.

In this cross-sectional study, 200 children referred to Amir Kabir Hospital in Arak, Iran, were divided into 2 groups of patients with VUR (n=100) and another group of pediatric participants considered healthy and had no findings of VUR (n=100). Confirmation of diagnosis was performed via voiding cystourethrogram. Serum vitamin D levels were evaluated by the Enzyme-Linked Immunosorbent Assay (ELISA) method in all participants.

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 was observed between the two study groups in terms of vitamin D deficiency. This finding was regardless of VUR complications affecting vitamin D metabolism.

We assume that VUR is a complicated condition with several complications, and the relationship of each complication with vitamin D deficiency has been determined to some extent in previous studies; however, this condition cannot be considered an independent factor leading to vitamin D deficiency.

Secondary hypertension is more common in children than adults, and renal disease is the most common cause. Several studies have shown a relationship between abnormalities in renal arterial vascularity and the onset of hypertension. We reported a case of hypertension in a 10-year-old girl with elevated plasma renin and normal aldosterone levels. Antihypertensive therapy was necessary to achieve blood pressure control, and the final diagnosis of hypertension was obtained from Computed Tomography (CT) angiography demonstrating unusual renal vascular abnormalities.