فهرست مطالب masoumeh mohkam

 Carotid intima medial thickness (CIMT) is a reliable marker for assessing large and medium blood vessel atherosclerosis. This study aimed to investigate the carotid intima-media thickness in children with nephrotic syndrome admitted to Mofid Hospital during 2019-2021.

 This case-control study was conducted in Mofid Hospital for two years (2019-2021). The samples were selected in the case group from hospitalized children with nephrotic syndrome and the control group from hospitalized children without nephrotic syndrome.

 The mean thickness of the right and left carotid intima-media thickness in the case group was 0.07 ± 0.43 and 0.43 ± 0.07 millimeters, respectively, and these two values were lower and equal to 0.42 ± 0.05 millimeters in the control group, respectively (P-value= 0.02, P-value = 0.016). There was a negative and significant relationship between the level of phosphate and CIMT on the left side, and with an increase of one unit in phosphate, the value of left CIMT decreased by 0.277 times. Also, there was a negative and significant relationship between right CIMT and the level of albumin at discharge time, so with an increase of one unit in albumin, the value of right CIMT decreased by 0.256 times.

 It is concluded that nephrotic syndrome causes an increase in CIMT and vascular damage in children. The increase of blood albumin and phosphate was associated with the decreased CIMT.

It is now hypothesized that the Ambulatory Blood Pressure Measurement (ABPM) method in determining and controlling blood pressure and renal disease-related cardiac defects in children with renal impairment can be more applicable. We aimed to compare the mean blood pressure measured by the ABPM method with blood pressure measured by the auscultation method in determining cardiovascular complications by measuring left ventricular mass index (LVMI) in children with chronic kidney disease.
This cross-sectional study was performed on 40 children suffering from chronic kidney disease referred to Mofid Children Hospital in Tehran between 2019 and 2021. Each child was evaluated during the first 24 hours, every 20 minutes during the day, and every 30 minutes during the night, and blood pressure was assessed by the ABPM method and every 3 hours by the auscultation method. Patients also underwent echocardiography to determine LVMI.
Based on the assessment by auscultation method, 47.0% of children suffered from systolic hypertension, and 40.0% had diastolic hypertension. In total, 50% were hypertensive. According to ABPM blood pressure data, 23 patients (57%) had systolic hypertension and 24 patients (60%) had diastolic hypertension. In total, 16 patients (40%) had normal blood pressure and 24 patients (60%) had hypertension by the ABPM method. Also, according to ABPM measurement, 10 patients (25%) suffered from masked hypertension, and 6 patients (15%) from white-coat hypertension. There was a significant association between LVMI and the blood pressures assessed by the ABPM method.
Auscultation blood pressure measurement alone may not be sufficient to diagnose hypertension in patients with chronic kidney disease. It should be used in conjunction with the ABPM method.

Pediatric organ transplantation, specifically kidney transplant, has improved considerably in recent decades in Iran. Since infections are the most common cause of morbidity and mortality among transplanted children, pre-transplant vaccination is an effective preventive tool in this regard. In addition, administration of some vaccines is contraindicated in post- transplant period and the efficacy and immunogenicity of authorized vaccines may also be suboptimal in comparison to normal population. Therefore, pre-transplant period offers an outstanding chance to boost the immunization of this population. With regard to this population, it is imperative to establish a localized vaccination guideline, which can be used by nephrologists and other clinicians who are part of the transplant team, in Iran. Currently, such a local guideline for Iranian pediatric kidney transplant candidates is not available. The aim of this study is to provide a comprehensive overview of the existing vaccines recommended for these cases regarding the Expanded Program on Immunization (EPI) and available vaccines in Iran. In addition, general principles of vaccination, the use of specific vaccines as well as accelerated vaccination in this population are discussed in this article. This review could be a preliminary guide for preparing a comprehensive guideline for vaccination of this population in Iran.

Multicystic dysplastic kidney (MCDK) is defined as a variant of renal dysplastic with multiple non-communicating cysts separated by dysplastic parenchyma. Contralateral vesicoureteral reflux (VUR) is the most frequent coincidence genitourinary anomaly in children with unilateral MCDK. Here, we described a case of unilateral MCDK (right side) with bilateral third-grade VUR who first, underwent conservative therapy because of electrolyte disturbance and metabolic acidosis.

Renal disorders have been reported as the underlying cause as well as complications of critical COVID-19 in pediatric patients. The purpose of this study was to investigate the pattern of kidney involvement, particularly acute kidney injury (AKI), among pediatric patients with COVID-19.

  In this prospective study, hospitalized pediatric patients with a clinical diagnosis of COVID-19 were enrolled. Demographic, clinical, and laboratory findings were collected and analyzed using a mixed method of qualitative and quantitative approaches and descriptive statistics.

  One hundred and eighty-seven patients, including 120 (64.2%) males and 67 (35.8%) females with COVID-19 with a median age (interquartile range) of 60 (24 to 114) months were enrolled in this study. Most patients (n = 108, 58.1%) had one or two underlying comorbidities, mainly malnutrition (77.4%), neurologic/learning disorders (21.4%), and malignancy (10.2%). According to the Kidney Disease Improving Global Outcomes (KDIGO) classification, AKI was detected in 38.5% of patients (stage 1: 55.6%, stage 2: 36.1%, and stage 3: 8.3%) at presentation or during hospitalization. Nine patients (4.8%) required hemodialysis and 16 (8.6%) eventually died. There was no significant association between AKI and admission to the pediatric intensive care unit (PICU) (P > .05), a multisystem inflammatory syndrome in children (MIS-C) (P > .05), comorbidities (P > .05), and mortality rate (P > .05).

Conclusion:

  Kidneys are among the major organs affected by COVID-19. Although kidney abnormalities resolve in the majority of pediatric COVID-19 infections, particular attention should be paid to serum creatinine and electrolyte levels in patients affected by COVID-19, particularly children with a history of malnutrition and kidney disorders.

Eculizumab is a humanized monoclonal antibody targeting the C5 (complement 5) member of complement proteins and inhibiting its cleavage to C5a and C5b. Eculizumab has been proven to be effective in a wide array of nephrologic, neurologic, and hematologic pediatric disorders. Kidney disorders, particularly those with immune-mediated pathomechanism, are the most common indications of eculizumab, including atypical hemolytic uremic syndrome (aHUS), hemolytic uremic syndrome (HUS), membranoproliferative glomerulonephritis (MPGN), immunoglobulin A (IgA) nephropathy, hematopoietic stem cell transplant-associated thrombotic microangiopathy, and less commonly post-infectious glomerulonephritis and diffuse proliferative lupus nephritis. In this review, we aimed to summarize the current evidence on approved and off-label applications of eculizumab and their specific considerations in pediatric kidney disorders.

Complications of nephrotic syndrome reduce quality of life in parents. Self-care education is associated with the possibility of reducing mortality and improving disease outcome. The aim of this study was to determine the effect of self-care education on quality of life of parents of children with nephrotic syndrome.

In this randomized clinical trial study, 60 children aged 7-18 years with nephrotic syndrome were randomly divided into two equal groups of test and control. Data collection tools were demographic information form and World Health Organization Quality of Life Questionnaire. The intervention group received 2 sessions of 60 minutes of self-care training based on Orem theory. The control group did not receive any training. The results of the intervention were analyzed after 4 weeks by SPSS 23 software.

The mean scores of quality of life in the experimental and control groups before the intervention were 74/3 ± 36/51  and52/4 ± 46/51 , respectively (P>0.05 ), No significant difference was observed between the two groups. One month after the intervention, it was  26/3 ± 90/99 in the experimental group and 27/9 ± 20/51 in the control group, which Significant difference  was observed between the two groups (P<0.05).

Self care education based on Orem's theory is effective in increasing the quality of life of parents of children with nephrotic syndrome which can be used as a complementary and effective method to improve that in parents of this group of patients.

Introduction. Hydronephrosis, a condition that is mostly congenital, is considered as the most common type of pediatric urinary tract disorder. The aim of this study was the evaluation of the prognosis and outcomes of hydronephrosis in cases of congenital hydronephrosis. Methods. In a cross-sectional study, run in a tertiary clinic of pediatric nephrology, from 2015 to 2020, patients with fetal hydronephrosis were selected. Ultrasonography, urinalysis and kidney function tests were ordered for all patients and in the presence of hydronephrosis, repeated ultrasonography, voiding cystourethrography and dimercaptosuccinic acid scan were performed. In cases with evidence of obstruction, a diethylenetriamine pentaacetic acid scan and relative surgical procedures were performed. Results. Among 141 cases, mean age was 8 ± 1.4 years and 80.9% were male. Partial or complete obstruction in the right and left kidney was found in 16.3 and 24.8% of patients, respectively. The degree of hydronephrosis was mild in 46.1%, moderate in 39%, and severe in 9.2% of the patients. At the last follow-up period, hydronephrosis recovered in 46% of the patients, while 54% experienced persistence or exacerbation of the disease. Meanwhile, 7.1% of patients showed neurogenic bladder, 19.1% urinary tract infection and 22.7% urinary stones. Conclusion. Our study revealed that fetal hydronephrosis ends in complete recovery following birth in 46% of the cases. However, in cases experiencing persistent or exacerbating hydronephrosis, optimized treatment and/or surgical intervention are required.

Nephrotic syndrome (NS) is the most common pediatric chronic kidney disease characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Corticosteroids, as the mainstay of treatment, resolve symptoms in most patients. However, some patients experience a relapsing-remitting course. Currently, there is no specific biomarker for the prediction of steroid response in patients with NS. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are inexpensive, readily accessible parameters that are proved to be related to the inflammatory state in many disorders.

We evaluated NLR and PLR ratios before and after steroid therapy in 50 pediatric patients with NS in a single pediatric referral center. Data analysis was carried out using SPSS software and the significance level was considered as 0.05.

Medical response to steroid was compatible with steroid-dependent (SD) nephrotic syndrome (NS) in 30% (n=15), steroid-resistant (SR) NS in 12% (n=6), steroid-sensitive (SS) NS in 36% (n=18), and frequently relapsing (FR) NS in 22% (n=11). Fourteen patients (29.2%) did not experience recurrence. Before and after steroid therapy, the mean PLRs were 10.9 and 11.7 and the mean NLRs were 1.9 and 2.2, respectively, which were not statistically different (P>0.05).

We do not recommend NLR and PLR as predictors of steroid response in pediatric patients with NS.

Nocturnal enuresis is one of the most common chronic problems of childhood. It has a significant effect on health and quality of life of children and their families. Despite pharmacological treatments, enuresis in most children relapses after the medication is discontinued. Also available drugs have many side effects that limited their uses. So, we compared the effect of topical use of Saussurea costus (Falc.) Lipsch. (Qost) oil as a Persian Medicine product on pediatric nocturnal enuresis in a parallel randomized double blinded study. Eighty-two patients aged 5 to 15 years who were diagnosed as monosymptomatic nocturnal enuresis were allocated to receive costus oil or sesame oil topically below the navel twice a day for 4 weeks. Patients were evaluated prior to and following end of the study in terms of frequency of enuresis and any observed adverse events. The results were evaluated with valid PLUTSS questionnaire. For evaluation, Chi-square and Fisher's exact tests, Mann-Whitney and Wilcoxon tests were used. Significant p value was < 0.05. A significant decrease in mean scores of the questionnaires was noted in both groups. The results before and after the intervention were significantly different in both groups, but there was no statistically significant difference between the intervention and control groups. At the end of the 4th week, the frequency and volume of enuresis showed a 46.2 percent reduction in costus oil group and a 25.5 percent reduction in sesame oil group. According to this study, the response rate based on PLUTSS questionnaire in costus oil group is 74.5%; while in the sesame oil group is 69%. No drug side effect was noticed in this study. Based on the results of this study, costus oil is effective in children with monosymptomatic nocturnal enuresis; however, there is no significant difference between costus oil and sesame oil.

Multiple inflammatory syndrome in children (MIS-C) is a multisystem inflammatory disease following COVID-19 in children. This disease occurs a few weeks after COVID-19. A child with this condition develops a cytokine release cascade that results in organ damage. The involved organs include the heart, lungs, brain, gastrointestinal tract, and central nervous system. Fever is present in all patients and Kawasaki-like symptoms are one of the common features in these children. In this article, we introduce a child with MIS-C who has skin, gastrointestinal, neurological, and renal symptoms and has been hospitalized in the PICU.

Food protein-induced enterocolitis syndrome (FPIES), is a non-IgE mediated food allergy presenting in infants younger than 12 months. Diagnostic delay may occur due to overlapping clinical symptoms with several conditions. Here, we present two cases of FPIES, mistakenly diagnosed and treated as Bartter syndrome. This study aims to emphasize the several features of this syndrome that may mimic other diagnoses and sometimes leading to near-death events due to delay in the diagnosis and improper treatment. The first patient was a 30-month-old boy with multiple episodes of profuse vomiting and diarrhea within 1 hour after breastfeeding, beginning from the first month of life progressing to hypokalemia and metabolic alkalosis at the age of 5 months leading to the diagnosis of Bartter syndrome. The second patient had a history of unremitting diarrhea which had been started soon after his first breastfeeding followed by biliary vomiting on the 7th day of life. He was treated in another hospital for neonatal sepsis, however, without an appropriate response to treatment. To conclude, despite the current belief on the rarity of FPIES, it is a more prevalent disease than expected with various non-specific manifestations imitating other conditions which may result in diagnostic delay and sometimes fatalities. To shed light on the importance of the physicians’ awareness of this syndrome, these two cases are presented here as examples of FPIES imitating other disorders.

Information about renal involvement in pediatric patients with COVID-19 is limited, and there is not enough data about renal and urinary tract involvement in children infected with this novel virus.

This study aimed to determine the spectrum of kidney diseases in pediatric patients with COVID-19, admitted to a tertiary children’s hospital.

This cross-sectional study was conducted on 71 pediatric patients with COVID-19 infection. Diagnosis of COVID-19 was established based on the guidelines by the IranianMinistry of Health. The patients’ demographic characteristics, clinical symptoms, laboratory results, and renal ultrasonography findings were extracted from the hospital medical records.

On admission, 10% of patients had oliguria, 7.7% had edema, and 3% had hypertension. The first urinalysis indicated proteinuria, leukocyturia, and hematuria in 46%, 24%, and 23% of the patients, respectively. Overall, 40.7% of the patients showed some degree of renal involvement. During hospitalization, acute kidney injury (AKI) occurred in 34.5% of the patients. Based on the pediatric risk, injury, failure, loss of kidney function, and end-stage kidney disease (pRIFLE) classification, stage I (risk group) was found in 20% of patients, stage II (injury group) in 25% of patients, and stage III (failure group) in 55% of patients with AKI. The total mortality rate was estimated at 12.67%, and the incidence of in-hospital death was 30% in pediatric patients with severe COVID-19 infection associated with AKI.

The prevalence of AKI was high in patients with COVID-19 infection hospitalized in our tertiary hospital. We also found that a decrease in renal function was associated with a higher risk of mortality. Overall, early detection of AKI and effective treatment may help reduce mortality in patients with COVID-19.

 Asymptomatic microscopic hematuria (AMH) in children has been known as a troublesome clinical condition which demands a patient to visit a physician. This study aimed to investigate the role of a specific diet on the amelioration of AMH in children.

 The current analysis was carried out in children ranging from 6 months to 14 years. This before and after research study was performed to evaluate the effects of certain diet on the treatment of pediatric AMH. Renal function tests, kidney ultrasonography and urinary assessments were performed and patients with AMH were enrolled in this query. Study group was ordered to consume a specific hypoallergenic diet. The number of urinary red blood cells was compared before and after diet. Data were analyzed using SPSS. A value of P < 0.05 was considered significant.

 Our special diet was effective in the treatment of stable microscopic hematuria in 72% of study group. Statistically, after a special diet, there was a significant decrease in the number of red blood cells in urine test (P <0.001).

 Specific hypoallergenic diet was effective in treatment of AMH in children. Reducing urinary red blood cell counts has been linked to the effectiveness of diet in the management of stable microscopic hematuria.

COVID-19, a disorder caused by a novel coronavirus, is a major global human threat. Patients with end stage renal disease and those undergoing dialysis constitute a susceptible population because of their less efficient immune system. Hemodialysis wards are considered as a high-risk area in the outbreak of a COVID-19 epidemic, therefore prevention plays a key role which is essential in the mitigation and containment of the COVID-19 outbreak in hemodialysis centers. We try to classify prevention guidelines concisely in this article for easier implementation. Keywords: COVID-19; Nephropathy; Dialysis; Prevention.

Urinary tract infection (UTI) is common among pediatric population. Pyelonephritis, especially in young infants, is associated with a significant morbidity. Usually, clinical manifestations, laboratory findings, and imaging are used to differentiate between lower and upper UTI. Lack of specific clinical findings and commonly used nonspecific blood indices are important hamper differentiation between lower and upper UTI in early stages. Imaging techniques are neither cost benefit nor safe for detection of UTI. Recent efforts have focused on characterization of novel serum and urinary biomarkers for early detection of acute pyelonephritis in children. It seems that urinary NGAL, NAG, TNF-α and IL-8 may be used as novel markers for early diagnosis of acute pyelonephritis in children.

Pearson syndrome is a rare mitochondrial disorder confirmed by mt-DNA deletion which typically occurs in the first two years of life. That is to say children are at high fatal risk, most infants are marked with some common features especially anemia and pancreatitis, which results in death in early childhood. A 6-month-old Iranian female infant was presented with macrocytic anemia, required packed red blood cell transfusions. She also was affected by exocrine pancreatic dysfunction, in which she underwent Creon treatment.By first year of age she had experienced some severe metabolic crises intermittently. After hospitalized for some months she was expired unfortunately. In conclusion, Pearson syndrome, as a rare disease affects many organs, such as liver, kidney, pancreas, bone marrow, which led to anemia, failure to thrive, and multi organ failure. In such cases, a physician must consider and evaluate all possible damages, especially anemia and pancreatitis. We present a case of Pearson syndrome with anemiaKeywords: Mitochondrial disorders; Pearson syndrome; Pancreatitis; Acidosis; Infants.

Renal diseases can be asymptomatic even in progressive disorders; therefore, detecting urine and ultrasound abnormalities may help facilitate early diagnosis and prevention of renal diseases. This study was conducted to investigate random urine parameters and urinary system ultrasonography findings in 7-11 year-old students. Healthy students from Tehran and Qom, Iran were enrolled in a prospective descriptive study and their sex, age, weight, height, and BMI were measured. Then, a fresh clean urine sample was collected and ultrasonography of the urinary tract was done. The urine specimen was tested for urine Ca/Cr, urine oxalate/Cr, and urine citrate/Cr. Of 932 students, 47.9% were female and 52.1% were male. The age range of the students was 7-11 years with a mean age of9.08 years. A history of renal disease and UTI was positive in 1.1% and 9.9% of the students, respectively. Ultrasound was normal in78% and abnormal in 22% of the students. Abnormal findings included hydronephrosis in 1.1%, fullness of the urinary tract in 0.1%, urinary system duplication in 3%, urolithiases in 0.7%, decreased kidney size in 0.4%, increased bladder thickness in 8.9%, and other abnormal findings in 7.8% of the subjects. Abnormal urine findings included hypercalciuria, in 10.9%, urine hyperuricosuria in 5.4%, urine hyperoxaluria in 12.8%, and hypocitraturia in 96.9% of the students. According to the results, nephrolithiasis may be due to hyperoxaluria, hypercalciuria, and hyperuricosuria in a normal population. Genetics and nutrition are more important risk factors. Therefore, some nutritional interventions for decreasing urine oxalate, calcium, and uric acid may be beneficial. Keywords: Urinalysis; Ultrasonography; Hypercalciuria; Hyperuricosuria; Hyperoxaluria; Child.

Imaging modalities such as voiding cystourethrography (VCUG), direct radionuclide cystography (DRNC), and renal cortical scintigraphy (RCS) with technetium-99m dimercaptosuccinic acid (Tc-99mDMSA), are helpful in detecting possible abnormalities of urinary tract such as vesicoureteral reflux (VUR). However, there are confounding data regarding the preference of these modalities. In the present study, we aimed to assess the role of Tc-99mDMSA scan in prediction of possible VUR and the subsequent need for VCUG or DRNC.
Three hundred fifty seven children under 14 years old with first-time febrile urinary tract infection (UTI) who were admitted between April 2004 and February 2017 were enrolled. Data regarding to VCUG or DRNC in order to evaluate the presence of possible VUR were recorded. Finally, accuracy of Tc-99mDMSA scans in prediction of VUR were assessed.
Analyses showed a sensitivity and specificity of 95.65% and 14.72%, respectively for Tc-99mDMSA scan in detection of VUR. Patients with mild renal involvement in Tc-99mDMSA scans had a 3.5-fold greater risk of having VUR than those with a normal scans (odds ratio=3.5; 95% confidence interval [CI]: 1.4-8.58; p=0.007). In addition, the risk of VUR is up to 7.0-fold greater in children with moderate renal involvement (odds ratio=7.0; 95% CI: 2.6-13.2; p According to the results, Tc-99mDMSA scan can be used as a screening test in prediction of VUR in infants and children with first- time febrile UTI.

Urinary tract infection (UTI) among children is sometimes associated with anorexia and sometimes failure to thrive. Appetite-regulating hormones may be a causative factor. Leptin regulates appetite, food intake, and body weight via hypothalamic melanocortin-4 receptor. Leptin is also a potential cytokine for inflammation. The aim of this study was to evaluate serum and urine leptin before and after treatment of children with UTI. In this before-after study, serum and urine leptin were measured in 40 patients with UTI at admission and 5 days after treatment. Pyelonephritis was suggested by signs and symptoms and confirmed with positive urine culture and dimercaptosuccinic acid renal scintigraphy. Other measurements included urinalysis, urine culture, urine creatinine level, complete blood count, erythrocyte sedimentation rate, C-reactive protein level and serum levels of urea, creatinine, glucose, cholesterol, and triglyceride. The mean serum leptin level was 6.85 ± 18.90 ng/mL before the treatment and 8.29 ± 18.30 ng/mL after the treatment, the difference of which was not significant (P =. 64). There were significant correlations between serum leptin and age, weight, and C-reactive protein. Urine leptin levels were reduced significantly from 0.75 ± 0.82 ng/mL to 0.46 ± 0.27 ng/mL after the treatment (P =. 03). A significant correlation was observed between urine leptin level with age and weight. Serum leptin level did not change significantly after treatment of UTI, but urine leptin significantly decreased. Serum leptin level was higher in patients with anorexia in comparison with children with normal appetite; however, the difference was not significant.