هادی سرخی

Considering the lack of knowledge and the difference in the prevalence of hyponatremia in non-bacterial meningitis and bacterial meningitis, this study was conducted with the aim of determining the relationship between hyponatremia and bacterial and non-bacterial meningitis and its complications.

This cross-sectional study was conducted on 183 children with meningitis referred to Shafizadeh Amirkola Children's Hospital in three age groups: 1 month to 2 years, 2-5 years, and 5-18 years. Based on cerebrospinal fluid analysis, cases of bacterial meningitis were considered to be WBC>100 with preference for PMN, glucose less than 40% of serum sugar and protein more than 1 g/L or positive culture or smear. Cases of non-bacterial meningitis were considered as WBC<100 with preference for lymphocyte, glucose more than 60% of serum sugar and protein less than 1 g/L or negative culture or smear. Gender of children, duration of hospitalization and occurrence of seizures in two groups of bacterial and non-bacterial meningitis with and without hyponatremia were investigated and compared.

In this study, the mean age of boys (68.26±47.10) with meningitis was higher than that of girls (42.56±32.50) (p<0.001). The mean age of meningitis patients with hyponatremia (51.87±47.56) was lower than that of patients without hyponatremia (72.54±45.03) (p=0.002). The frequency of hyponatremia in children with meningitis aged less than 2 years compared to other age groups (52 patients) (p=0.002), as well as infants who had seizure (37 patients) (p=0.001) has been significantly higher. In children who had hyponatremia, the duration of hospitalization was significantly longer (108 patients) (p=0.01).

Based on the results of the present study, it was found that younger children are at greater risk for hyponatremia, and the presence of hyponatremia at the beginning of diagnosis suggests a greater risk for seizures and increased length of hospitalization. However, the risk of hyponatremia in both types of bacterial and non-bacterial meningitis is almost the same.

Urinary tract anomalies are responsible for urinary tract infection (UTI) in more than 30% of children. The present study was carried out to determine the prevalence of urinary tract anomalies in children with pyelonephritis referred to Amirkola Children Hospital during 2010-2020.

In this cross-sectional study, all children with UTI admitted to Amirkola Children Hospital during 2010-2020 were enrolled. The inclusion criteria were children aged between 2 months and 18 years, positive signs and symptoms of UTI, and positive urine culture with reliable sampling. Children with a positive history of surgery on the urinary tract were excluded. Imaging studies included ultrasonography, DMSA, DTPA, VCUG, RNC, and IVP for the diagnosis of anomalies in the urinary tract.

Among 381 children with pyelonephritis, the mean age was 37.1+41.3 months, and 337 (88.5%) children were girls. One hundred forty-nine (39.1%) children had urinary anomalies. The most anomalies were VUR, ureterovesical junction obstruction, Ureterocele, and ureteral duplication in 112(75.16%), 11(7.38%), 9(6.04%), and 8(5.36%) of children, respectively. A significant difference was observed between age and anomaly prevalence (P=0.04), but there was no significant difference between sex and prevalence of anomaly (P=0.3).

The results of the study showed that about 39% of children with UTI had urological anomalies, the most common cause of which was VUR, and other urological anomalies (about a quarter) such as ureterovesical junction obstruction, Ureterocele. In addition to vesicoureteral reflux, paying attention to other urological anomalies in these children is recommended

Urinary reflux is the most common urological abnormality in children. About half of the children with urinary infection have urinary reflux at the same time. Considering the importance of urinary reflux in children and contradictory results reported regarding the relationship between different grades of vesicoureteral reflux and recurrent urinary tract infection, this study was conducted with the aim of comparing recurrent urinary tract infection in children with different grades of vesicoureteral reflux.

This cross-sectional study was conducted on 150 children with pyelonephritis and vesicoureteral reflux who refered to Amirkola Children's Hospital in 2011-2019. Reflux grades were determined by voiding cystourethrogram (VCUG) or direct radionuclide cystography (DRNC). Children were followed up for 2 years and in case of clinical symptoms with positive urine culture, they were considered as recurrent urinary tract infection.

Of the 150 children studied, 126 (84%) were girls and 24 (16%) were boys with a mean age of 27.17±11.53 months. 95 people (63.3%) had once, 37 people (24.7%) twice, 8 people (5.3%) three times, and 10 people (6.7%) four times experience of recurrent urinary tract infection. The odds ratio of recurrent urinary tract infection was more than two times higher in children with grade 3 and 4 reflux involvement than in children with grade 1 and 2 reflux (OR=3.20, 95% CI=1.05-9.75, p=0.041). However, there was no significant difference in recurrent urinary tract infection in children based on age at diagnosis, gender, and whether the reflux was unilateral or bilateral.

The results of the study showed that children with moderate and severe involvement of vesicoureteral reflux experience higher recurrent urinary tract infection compared to mild involvement.

Ultrasound is easily available, cheap, non-invasive and radiation-free that could be considered as an alternative to Dimercaptosuccinic Acid (DMSA) in evaluation of kidney damage. The aim of this study was to determine the prediction of kidney damage in ultrasound compared with DMSA (standard method) in children with pyelonephritis and vesicoureteral reflux.

This cross-sectional study was performed in children aging one month to 18 years old with pyelonephritis and vesicoureteral reflux grade 2 and higher admitted in Amirkola Children's Hospital, 2011-2020. Renal ultrasound was done in all children at admission and DMSA was done after at least 4-6 months. Then, sensitivity, specificity, and positive and negative predictive values of ultrasound were studied. The kappa coefficient was determined for the percentage agreement between ultrasound and DMSA.

Out of 220 children with pyelonephritis and reflux, 153 were included in the study. In ultrasound, out of 306 kidneys, 262 (85.6%) and 44 (15.1%) were normal and abnormal, respectively, but DMSA showed 128 (41.8%) normal and 178 (58.2%) abnormal kidneys. The sensitivity and specificity of ultrasound in predicting kidney damage compared with DMSA were 19% (CI: 12-27%) and 86% (CI: 97-74%), respectively. The positive and negative predictive values of ultrasound compared with DMSA in predicting kidney damage were 82% (CI: 68-68%) and 24% (CI: 17-31%), respectively.

Based on current study, ultrasound alone is not able to predict kidney damage following pyelonephritis and vesicoureteral reflux and DMSA should be performed. If the ultrasound is normal, the chances of detecting kidney damage are much lower in DMSA.

 Urinary tract infections (UTIs) are among the most common bacterial and frequently recurring infection during childhood, especially in the ages of three months that can involve upper UTI (pyelonephritis) and lower UTI (cystitis). There are three forms of urinary tract infections include pyelonephritis, cystitis and bacteriuria without symptoms.  Approximately 10-30% of children experience a urinary tract infection in the early years of life. The prevalence of UTI has estimated 36.8% in some third world countries. Enterobacteriacea, especially Escherichia coli has been detected as the most common cause of UTI. The crucial criteria to diagnose of UTI are including: fever, pyuria, the growth of organism more than 105  colonies in culture medium. Nowadays, antibiotic resistance is a global concerning among pediatric patient with UTI. The other important issues are including, urine reflection and scar in the lining of the kidney tissue, failure in growth and function of kidney, chronic of kidney and eventually kidney graft and dialysis. So fast diagnostic and treatment of these patients to prevent of development is so important. Although DMSA scanning is a gold standard to detect of renal parenchymal tissue involvement but due to high cost, no accessible in all of the clinical centers and exposure to dangerous chemical substances of radioactive, it is used less. Some clinical symptoms, such as fever, stomachache, backache, nausea, anorexia and inflammatory markers such as white blood cell (WBC), Erythrocyte sedimentation rate (ESR),C_ Reactive Protein (CRP ) can be handy methods to detect of the site of urinary infectious, but it is not reliable method. So there is not a practical, fast and reliable method to separate of pyelonephritis and cystitis. Pyelonephritis can lead to scar and the next stages high blood pressure and kidney failure. The prevalence of kidney scars due to pyelonephritis had reported 26.5% to 49%.  Mean platelet volume (MPV) is an important index in detection of inflammatory. The aim of this study was to investigate the value of MPV in differentiation of pyelonephritis from cystitis in children with UTI.

In this analytical cross- sectional and diagnostic study which was approved by the Ethics Committee of Babol University of Medical Sciences, Babol, Iran, with the ethics code IR. MUBABOL1724132572, a total of 141 children (1 month to 18 years) with urinary tract infections hospitalized in pediatric Hospital of Amirkola, Babol were enrolled from 2015 to 2020. Inclusion criteria including positive urine culture and exclusion criteria including negative urine culture, lack of diagnosis of pyelonephritis and cystitis, lack of cooperative of patients and the history of blood disorder associated with abnormal platelets (Bernard-Soulier syndrome, gene mutation myh9, ITP).
Considering the inclusion and exclusion criteria, diagnosis of pyelonephritis and the result of positive culture, patients enrolled to this study. And then, whole blood specimens from patients were collected to detect of MPV, CRP, and ESR. According to traditional guidelines, chocolate/ blood agar (non selective medium) used for routine urine cultures.
MPV was investigated and compared between patients with pyelonephritis and cystitis. Diagnostic value of MPV by statistical indicators specificity, sensitivity and AUC were calculated and finally statistical analysis of data was carried out using the SPSS (v 16.0) software package.The statistical tests, such as chi- square test, independent t- test, Mann withney, Spearman rank correlation, ROC and Kolmogorov-Smirnov were used in this study. P-Value less than 0.05 were assumed as statistical significance. MPV was evaluated in patients with pyelonephritis and cystitis by independent t- test. Correlation analytical was used to detect of relationship between MPV, ESR, CRP and leucocytes among two groups of pyelonephritis and cystitis. ROC (Receiver Operating Characteristics Curve) was used to evaluate and comparison of sensitivity, specificity and the area under the curve for the MPV in patients with pyelonephritis and cystitis.

Among 141 patients with UTI, 63.8% with pyelonephritis and 36.2% with cystitis enrolled in this study. MPV in patients with reflux was detected 8.67± 0.95 fl and in patients without reflux was detected 8.66± 0.99 fl. This finding was no statistically significant difference between MPV and reflux (P= 0.96). In this study, according to two groups of patients with pyelonephritis and cystitis the frequency of bacteria was investigated. The most common pathogen among both groups of patients was detected Escherichia coli. There was no statistically significant between type of pathogen among two groups ( P= 0.167).  The result of laboratory variables investigation in both groups of pyelonephritis and cystitis were detected 8.7 fl and 8.5 fl, respectively. There was no statistically significant difference between two groups (P= 0.329). Although there was no statistically significant difference in platelet count (P= 0.374), leucocyte (P= 0.115) and lymphocyte (P= 0.073), but we found statistically significant differences in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) between two groups, (P= 0.001). MPV comparison results between two groups (pyelonephritis and cystitis) showed there was no statistically significant difference between two groups.  There was no statistically significant between MPV and ESR, CRP and leucocyte, (P> 0.05).

According to the result of our study, the role of MPV in differentiating pyelonephritis from acute cystitis was detected. The evidence of this study showed MPV has low diagnostic value in differentiating pyelonephritis from acute cystitis in children with UTI.  So, detection of Mean platelet volume is not an appropriate method and it needs to more studies to find Para clinical factor in diagnostic is worth wealthy.

Intussusception is one of the most common causes of intestinal obstruction in children 5 months to 3 years, which is the most common cause of acute abdominal pain and its prevalence increases as a result of viral infection. In this report, were present a case of intussusception in a 17-years-old boy following COVID-19.

 A 17-year-old adolescent boy with a known case of steroid-dependent nephrotic syndrome from the age of two has been referred to the emergency department with severe abdominal pain and vomiting. On ultrasound, renal mass and free fluids were shown. Ileocecal intussusception was observed and was repaired without any complications.

Based on the results of this study, intussusception should be considered in every patient with nephrotic syndrome with COVID-19 infection.

 Urinary tract infection (UTI) is one of the most common infections in children. Arbitrary use of antibiotics has increased the resistant strains and transmits these resistant factors to other pathogens. Therefore, this study was designed to follow the resistance trend in 9-years in children with urinary tract infections referred to the Amirkola Children's hospital (Northern Iran).

 In this cross-sectional study, all children who had Urinary tract infections between 1994 to1998 and 2013 to 2018 with one month to 18 years old were included. Data (covering 9 years), such as age, sex, antibiotic resistance profile, urine culture results, and history of UTI, were collected retrospectively from patients' records. Cases were selected based on clinical and microbiological criteria. Antimicrobial susceptibility was determined by the Kirby–Bauer disk diffusion method.

 Escherichia coli was the most predominant organism isolated from urine samples. The highest drug resistance was related to cefazolin (83.3%). Resistance to nitrofurantoin was higher in children older than 5 years (P≤0.001). Moreover, the resistance pattern to gentamicin, amikacin, ceftriaxone, cephalexin, and imipenem differed in females and males (P>0.05).

 A 9-year study showed that 91.4% of the strains are still sensitive against amikacin which is a suitable treatment option in the studied strains. The establishment of antimicrobial stewardship programs and regular monitoring of antimicrobial resistance could help to reduce inappropriate prescribing for UTIs.

Kawasaki disease is an acute vasculitis of childhood and can be associated with complications such as hyponatremia. The present study was conducted to evaluate the serum sodium levels and its association with cardiac complications in children with Kawasaki disease.

In this cross-sectional study, all Kawasaki patients (according to AHA criteria) referred to Amirkola Children's Hospital in Babol in 2017-2018 were evaluated. Patients underwent serum sodium assessment and echocardiography and the relationship between serum sodium levels and cardiac complications including ectasia and coronary aneurysm, myocarditis, pericarditis and coronary artery occlusion was investigated.

Of the 60 patients with Kawasaki disease, 27 (45%) were male and 33 (55%) were female. Their mean age was 32±8 months. 28 patients (47%) had serum sodium levels lower than 135 mEq/L while normal serum sodium level (135-150 mEq/L1) was reported in 53% of patients. Cardiac complications including coronary ectasia and myocarditis were reported in 16 and 32 patients, respectively. There was no significant difference between serum sodium levels and cardiac complications. There was no difference in the incidence of cardiac complications and hyponatremia in males and females.

According to the results of the present study, serum sodium levels cannot be a good criterion for cardiac prognosis.

Due to bacterial resistance to antibiotics, new antibacterial agents is essential. In Persian medicine Fennel (Fuenoculum vulgare Mill.) and Ajwain (Carum copticum (L.) Benth. & Hook.f.) are recommended for the treatment of some infections. In this research, bacteriostatic and bactericidal effects of aqueous and hydroalcoholic extracts of fennel and Ajwain on E. coli were investigated. In an in-vitro study 30 clinical isolates of urine culture of children with urinary tract infection from Amirkola Pediatric Hospital in Babol and a standard sample were used. Antibacterial effects of 4 grouos including aqueous and hydroalcoholic extracts of fennel and Ajwain by measuring the diameter of the inhibition zone using disc diffusion (concentrations 16, 32, 64, 128, 256 and 512 mg/disc) and determination of Minimum Inhibitory Concentrations (MIC) and Minimum Bactericidal Concentration (MBC) with Microdilution method was compared with Gentamicin (30mg/disc) as a positive control
FINDINGS: There was no significant difference in inhibition zone with Gentamicin at concentrations of 64, 128, 256, and 512 mg/disc in standard and clinical samples. At concentrations of 16 and 32, Gentamicin was significantly better. The extract of 512 mg/disc (12.93±2.66) of hydroalcoholic extract of Carum copticum was significantly better than 256 mg/disc (9.53±1) (p=0.002). The MIC and MBC for standard samples were 4 and 8, respectively, and for clinical samples 3.83±2.36 and 5.8 mg / ml, respectively. Other extracts were not able to inhibit the growth of Escherichia coli.
The results showed that the Hydroalcoholic extract of Carum copticum has bacteriostatic and bactericidal effects on standard and clinical isolates of Escherichia coli.

Vesicoureteral reflux (VUR) followed by urinary tract infection (UTI) is a major contributing factor to kidney failure, especially during early childhood. This study aimed to evaluate the possibility of spontaneous high-grade VUR resolution in infants aged less than one year.
This cross-sectional study was conducted at Amirkola Children’s Hospital of Babol, Iran on all the infants aged less than one year with high-grade VUR (III-V). Infants were followed-up in terms of at least one kidney per age, reflux grade, and kidney failure for two years. Evaluation of reflux resolution was performed using voiding cystourethrography (VCUG) and radionuclide cystography (RNC) each year. In addition, presence of kidney failure was assessed via dimercaptosuccinic acid (DMSA) scan within at least 4-6 months after the last UTI diagnosis. Data analysis was performed in SPSS V.22 using Chi-square and Kaplan-Meier survival analysis, and P value of less than 0.05 was considered statistically significant.
FINDINGS: In total, 97 kidneys in 49 infants were evaluated (one infant had only one kidney). Among the studied patients, 29 infants (59.2%) were female, and mean age of the study population was 5.9±3.66 months. Out of 49 infants with VUR, complete recovery was observed in 33 cases (67.3%), while partial resolution (reduced grade of reflux) was reported in 13 cases (26.5%), and lack of resolution was observed in 3 cases (6.1%).
According to the results of this study, spontaneous resolution of high-grade VUR could occur in a high percentage of infants aged less than one year. Therefore, it is recommended that early surgical operation be reconsidered for this patient population

Congenital anomalies are amongst the main challenges for the families. The aim of this study was to determine the prevalence rate of neonates congenital anomalies. This descriptive-cross-sectional study was done in Mehregan Hospital in Babol from 2007 to 2009. Neonates were examined by two pediatricians. Sex, gestational age, type of anomalies and neonates` discharge status was recorded in a questionnaire. One thousand sixty hundred eighty four neonates were examined, 884(52.6%) were males and 798(47.4%) were females. The mean gestational age was 38.61.1 weeks. Total prevalence of congenital anomalies was 5.1% (CI 95%: 5.09-5.11). Musculoskeletal anomalies prevalence was 2.4%.In each group of female and male, the prevalence of congenital anomalies were 5.7% and 5.4% respectively (p>0.05). According to our findings the prevalence of congenital anomalies especially the musculoskeletal anomalies is high. Thus, more medical attention to diagnosis and treatment them on early stages is needed. Furthermore, more studies for understanding and preventing of congenital anomalies are necessary.

In beta-thalassemia major patients، iron overload can cause dysfunction in many organs. The aim of this study was to determine the correlation between renal tubular dysfunction with iron overload in beta-thalassemic patients referring to our thalassemia center. In this descriptive-analytic study، beta-thalassemia major patients aged more than ten years were selected. Magnetic Resonance Imaging T2*done for patients. Iron overload of liver designed by MRIT2*. It was considered as two levels; severe and mild to moderate levels. Forty five patients were severe iron overload (case) and forty five patients were mild to moderate levels (control). They were matched for age and gender. Random morning urine samples were collected and the electrolytes، uric acid، creatinine and urinary B2M (beta2-microglobulin) levels were examined. Blood samples for levels of BUN، Cr، Na، K، FBS and Ferritin were taken too. Then، Ca/Cr ratio in urine، Pr/Cr ratio in urine، fractional excretion (FE) Na، FE K and FE uric acid were calculated. Abnormal excretion of these biochemical factors considered as a renal tubular dysfunction. The data was analyzed and p<0. 05 was considered significant. Mean age of patients in case and control groups were 27±6. 106 and 27. 64±7. 834 years، respectively. Serum ferritin level (case; 2300. 46±146. 32، control; 1488. 09±1051. 46، p=0. 002)، the urinary Ca/Cr ratio (case; 0. 11، control; 0. 12، p=0. 01)، and urinary β2M/Cr ratio (case; 502. 18±1053. 21، control; 513. 48±936. 86; p=0. 024) were significant. The results of study showed that iron overload can affect the renal tubular function.

Medical records consist of documents evidencing a patient's health status at a moment of life. There is a close relationship between disease progress and daily physician orders issued in medical records. Each order in fact reflects the patient's medical status and his/her disease progress. In this study, while keeping the previous progress page in the records, a column of brief disease progress was included in physician order sheets to increase the quality of records and promote the education of learners. In this cross-sectional controlled interventional study, medical records of all patients admitted to super specialty wards of Amirkola Children Hospital during the first quarters of 2009 and 2010 were included. From a total of 3462 records, 150 records were studied each year. Each indicator of disease progress, which was recorded based on subjective, objective, assessment, and plan (SOAP) note, was given a score. Finally, if only three indicators were mentioned in the record, it was considered as poor. Scores 4-5 represented moderate and scores 6-7 were considered as good. The scores of the records were then compared using statistical tests including t-test, paired t-test, Pearson's correlation coefficient, chi-square test, Fisher's exact test, and Kappa coefficient. P values less than 0.05 were considered as significant. The mean number of physician orders in records during the first quarters of 2009 and 2010 were respectively 9.15 ± 10.8 and 8.45 ± 6.80 cases. Good scores had the highest frequency in the new brief disease progress form. The highest average of results in the studied groups was observed in brief disease progress notes of 2010. Comparison of mean scores revealed statistically significant differences (P < 0.05). Adding a new column named "brief disease progressive note" in physician order sheets significantly promoted the recording of disease progress and reasons for medical orders based on SOAP note. Therefore, it is recommended to include this column in physician order sheets.

Vesicoureteral reflex is the most important factor in urinary tract infection. For prevention of urinary tract infection (UTI) in children with vesicoureteral reflux (VUR), prophylactic antibiotics are used, but maybe accompany with uncompliance of the parents and also it must use for long time. So, this study aimed at comporison of evaluation of discontinuation of antibacterial prophylaxis in children with VUR. This semi experimental study was done in 54 children with low grade VUR (1, 2) and higher than 5 years old. None of them have had any episode of UTI since last year. They were divided in two groups, continue and discontinue of prophylactic drugs and were followed for at least one year. Then the risk and episode of recurrent UTI were compared in 2 groups. The data were analyzed by SPSS and P<0.05 was determined as significant. mean age of patients were 7.8±2.5 years. Forty two (77.8%) children were girls and others (22.2%) were boys. Five episode of UTI were diagnosed in first group and 7 episodes for second group (P>0.05). Also the risk of recurrent UTI was 1.5 time in girls. According to this study, discontinuing of prophylactic drug in children with grade І and grade П of VUR and after 5 years old is safe and there isn’t increased risk of recurrent UTI.

Kidney transplantation is a choice treatment for most patients with end-stage renal disease and transplantation outcome is different in kidney transplant centers. This study was done to analyze the results of kidney transplantation in kidney transplant center of Shahid Beheshti hospital in Babol, Iran. This survival analysis study was performed on the results of the first 200 renal transplantations during 5 consecutive years. Data including age, sex, 1, 2 and 3 years graft and patient survival, kidney transplant recipients, nephrologic and urologic complications, and creatinine distribution at end of 1, 2 and 3 years after transplantation were gathered and evaluated. The mean age of patients was 39.34±15.1 years, and 116 (58%) of patients were male. 1, 2 and 3 year graft survival was 98.86%, 97.3% and 97.3%, respectively and 1, 2 and 3 year patient survival was 96.63%, 96.63% and 93.12%, respectively. Treatment of clinical acute rejection without pathological diagnosis was performed on 19 patients (9.5%) and 16 patients responded to treatment. Acute tubular necrosis and gradual decrease in creatinine was seen in 13%. The surgical complication was seen in 3.5%.of patients who respond to treatment. At the end of first year, 0.5% of patients had creatinine more than 2. The results of this study showed that the short term graft survival in kidney transplant recipients was considerable.

Primary vesicoureteral reflux (VUR) is a hereditary disease and the risk of scar increased with VUR. In a few years ago, probability of renal scar formation before delivery and urinary tract infection is suggested. So, this study was done to evaluate this theory and detection of renal scar in neonates with prenatal hydronephrosis and VUR. This cross sectional study was performed on 59 neonates with history of prenatal hydronephrosis. The hydronephrosis were proved after delivery and VCUG (voiding cystourethrography) was done with negative urine cultures. For detection of scar (decrease radioisotope absorption), DMSA (Dimercaptosuccinic Acid) was done in all neonates with VUR. Scar in grade I-V was assessed. This study was done in 59 neonates with history of prenatal hydronephrosis and VUR. Thirty nine (66.1%) neonates were boy and others were girl. Among 116 kidney units, 95 units had VUR and 51 (53.7%) units had scar. Thirsty nine (62%) units with VUR in boys and 12 (37.5%) units in girls had scar (p<0.05). Also, none of units with grade I had scar. Scar in grade II-V was 37.5%, 42.1%, 48.1% and 88.5%, respectively (p<0.05). The existence of high rate scar in these neonates, especially in males and with high grade VUR indicated that early diagnosis and also prevention of UTI and new scare formation is very important.

Diagnosis and treatment of renal stone are very important especially according to non-special symptoms and risk of complication in children. According to invasive surgical methods for treatment of these patients, this study was done to evaluate oral potassium citrate solution efficacy in children with urolithiasis. This quasi experimental study was done on 150 children who referred to nephrology department or clinic with renal stone and without urinary obstruction (2002-2010). All children were treated with potassium citrate solution initially 1 ml/kg/day and then it was increased till urine PH reached to above 6.5-7. Urinary ultrasonography was done every 3 months and response to treatment was evaluated according to the stone size, age and duration of treatment. The age of children was 25 days to 15 years (Mean 36.7±37.4 month). Eighty five cases (56.6%) were male and 65 (43.4%) were female. The rate of complete response to drug (absence of stone) was 78.7% during one year. Mean of follow up was 15.9± 14.6 months and the risk of relapse (recurrence of stone) was 12.4%. There weren’t significant difference between response to treatment and stone size, age and children sex. Potassium citrate has been found to be significantly effective in treatment of renal stone, so we suggest using this drug for treatment of renal stone in all children without urinary obstruction.

In spite of recent developments in treatment of urinary tract infection (UTI) in children, renal damage and scar can be associated with UTI and vesicoureteral reflux (VUR). The risk of renal damage is more in children with younger age, especially in children under one year. This study was done to evaluate the risk of renal scar presentation in infants with UIT and VUR. This study was done on 71 children less than one year old with VUR and UIT that were referred to Amirkola Children Hospital (2007-2008). VUR was diagnosed by Voiding cystourethrography (VCUG) grade I-V and scar (grade I-IV) by DMSA (Dimercaptosuccinic acid) 4-6 months later. Then the results were surveyed. Among 71 children, 49 (69%) patients were female.142 kidney units were evaluated and 114 (80.3%) units had VUR and the grades II (47.4%) was the most common grade of VUR. Among 142 renal units, 48 (38.8%) units had scar. The most common grade of scar was grade I (31 units, 64.6%). The most common grade of scar was seen in grade II of reflux (18 units, 37.5%). According to this study, more than one-third of children less than one year old with UIT and VUR had scar. So, more attention and good follow up are needed for UTI in this age group. Also the potential of scar formation before delivery must be mentioned.

Background and Regarding the importance of diagnosis and proper time of treatment in patients with urinary tract infection (UTI) and vesicoureteral reflux as risk factors for scar, this study was performed to detect the probability of scars appearance in children. This study was performed on 42 children with urinary tract infection and vesicoureteral reflux (detected by VCUG), referred to pediatric nephrology units (clinic and ward) of Amirkola children hospital and evaluation of scar was done by DMSA at least 4-6 month after the last UTI. Of 42 patients, 29 (69%) were female and 13 (31%) were male. Among 84 checked renal units, 64 had reflux and 20 had no reflux with 62.5% and 15% of the cases with scars. In males 21 units and in females 43 units had reflux. 2.8 of renal units with reflex grade I, 13.24 with grade II, 17.23 with grade III, both renal units with grade IV and 6.7 with grade V had scar (P=0.001). The results of this study showed that males and age group of 1 month to 2 years have higher risk for VUR and scar. In spite no correlation was found between age of children and scar. However, prompt evaluation and proper time of treatment are very important.