Journal of pediatric nephrology
Volume:3 Issue: 1, Winter 2015

Many clinical studies have confirmed Procalcitonin (PCT) as a specific inflammatory marker in sepsis and bacterial infections. It is believed that PCT level is increased in various noninfectious conditions such as acute pancreatitis, major surgery, trauma and active autoimmune disease. In recent studies increased levels of serum PCT was distinguished in several kidney diseases like pyelonephritis, vesicoureteral reflux, kidney transplantation and hemodialysis. The aim of this review is to describe usefulness of PCT and practical aspect of this biomarker in nephrology field.

Kidney transplantation is recognized as the optimal therapy for children with ESRD. We performed this study to compare the children’s behavioral problems and their parents’ function in pediatric patients with Kidney transplantation in Arak Amir Kabir Hospital. To perform this case-control study, we recruited 29 children with renal transplantation and compared them with 29 healthy children aged 5-14 years old. The Child Behavior Checklist (CBCL4/18) was used for the assessment of the children’s behavioral problems and Global Assessment of functioning (GAF) was employed for the evaluation of their parents’ behaviors. Among 29 patients with RTR, anxiety/depression, somatic complaints, social problems, and attention problem were demonstrated in 65.5%, 55.1%, 51.7%, and 76%, respectively. We found a significant difference between cases and controls. Delinquent and aggressive behavior was not seen in two groups. As a significant difference, the parents’ mean stress and behavior score in case and control groups was 22.4% and 63.1%, respectively. The higher prevalence of behavioral problems in the renal transplant recipients and their parent’s functional impairment highlights the importance of early parental intervention for early prevention of future behavioral problems in their siblings.

Diagnosis of neonatal acute kidney injury (AKI) is a difficult dilemma and there is no consensus in this regard. Based on RIFLE criteria the definition of ARF is changed lately in adult and pediatric groups. Studies to evaluate the RIFLE criteria in the definition of neonatal ARF have not been performed. The aim of this study was to determine prevalence of AKI based on old definition of ARF and RIFLE criteria separately. This descriptive study was conducted on 904 critically ill neonates. The authors determined the RIFLE criteria for each neonate based on serum creatinine and urine output at the second day of admission. The RIFLE acronym stands for risk, injury, failure, loss of kidney function and end stage renal disease. Prevalence of AKI was determined based on old definition of ARF and RIFLE criteria separately. Based on RIFLE criteria, 22.5% of study group had normal renal function and 77.5% had AKI at the second day of admission. Among patients with AKI 43% met the risk, 51% the injury and about 6% the failure criterion. Based on old definition of ARF in neonates, the prevalence of ARF in our study group was 3.2%. There was a significant difference between AKI prevalence by RIFLE criteria and the former definition (P<0.001). The RIFLE criterion is a simple tool for the detection and classification of AKI in NICUs.

All children sometimes misbehave and some may have temporary behavioral problems due to stress. For example, the birth of a sibling, a divorce, or a death in the family may cause a child to act out. Behavior disorders are more serious. They involve a pattern of hostile, aggressive, or disruptive behaviors for more than 6 months. The behavior is also not appropriate for the child''s age. Nocturnal enuresis (NE) is one of the most frequent pediatric pathologies. The prevalence of primary nocturnal enuresis (PNE) is around 9% in children aged 5-10 years and about 40% of them have one or more episodes per week. in this study, we recruited 146 children with MPNE and 146 healthy children without MPNE aged 6-18 years old. The children behavioral checklist for children behavioral assessment was completed by the parents. Data was analyzed using ANOVA and chi- square tests. Among 292 children in both groups, somatic complaints, thought problems, delinquent problems, social problems, and ADHD were not significantly different between cases and controls while internalization, externalization, anxiety-depression, aggressive behaviors, isolation-depression, and affective-behavioral problems were significantly different. Considering the results of this study, the higher prevalence of behavioral problems in children with MPNE highlights the importance of early intervention for better treatment and prevention of behavioral problem in children.

Normal values of urinary mineral excretion differ in different geographic parts. The aim of this study was to determine age-related reference intervals for urinary minerals in healthy children in the south-west of Iran. Midstream non-fasting urine samples were collected and the amount of calcium, oxalate, uric acid, phosphate, magnesium, citrate, and creatinine was measured in all urine samples. The urinary mineral concentrations were reported as mineral to creatinine ratios (mg/mg). Data were analyzed by SPSS software version 16 and independent t-test and T-Hoteling test was used. The study involved 232 children aged 7 to 10 years. The 5th and 95th percentile values of urinary minerals to creatinine ratios were determined. The mean urinary Ca/Cr ratio was 0.14± 0.18 with a 95th percentile value of 0.295. For oxalate to creatinine ratio, the mean value was 0.068± 0.09 mg/mg with a 95th percentile value of 0.23. The mean uric acid to creatinine ratio was 0.358±0.211 mg/mg with an upper 95th percentile value of 0.69 and the mean Ph/Cr ratio was 0.439 and the 95th percentile was 1.01 mg/mg. We found out that the normal values of random urinary mineral to creatinine ratio differ in our region from the other countries and even from the other regions in Iran. We concluded that child''s age and ethnicity should be taken into consideration when assessing the urinary mineral to creatinine ratio.

We report an unusual case of Amikacin-induced nephrotoxicity in a child. The patient was a seven and a half year old girl with nephrotic syndrome and cushingoid facial features who was referred to Tehran Children''s Medical Center for renal biopsy so as to start cyclosporine therapy for the diagnosis of disease recurrence. Before coming to our center she was admitted to another hospital with complaints of severe abdominal pain and vomiting. In the course of hospitalization in our center, the patient gradually became oliguric and her serum creatinine increased from 0.3 mg/dl to 3.5 mg/dl. During her previous hospitalization about 2 weeks ago, use of amikacin and ceftriaxone was found. There were several reasons for kidney failure in the child, one of which was possibility of amikacin-induced nephrotoxicity. A renal biopsy showed diffuse mesangial proliferative and tubular lesions, which were in favor of amikacin toxicity. It seems that Amikacin can lead to nephrotoxicity if the patient is dehydrated and experiencing reduction of effective vascular volume. Regarding logical use of amikacin,renal function should be monitored regularly.

A 15-year-old boy was referred because of bilateral hydroureteronephrosis. He had poorly controlled diabetes mellitus since he was 4 years old. He had polyuria and polydipsia. On water deprivation test, he developed hypernatremia along with increased levels of BUN and creatinine. He also had hypertension that was effectively managed with losartan. Bilateral optic atrophy was detected on ophthalmoscopic examination. It seems that this boy is a rare case of Wolfram syndrome.