Nephro-Urology Monthly
Volume:12 Issue: 4, Nov 2020

 Nephrotic syndrome is the most common glomerular disease affecting children, characterized by heavy proteinuria, edema, hypoalbuminemia, and hyperlipidemia. The mainstay treatment is with prednisolone, whose response is of prognostic significance. Steroid response rates vary across geographical regions, which may be due to the role of genetic and environmental risk factors among different ethnic groups. There is a paucity of data on response to treatment with prednisolone in pediatric patients with nephrotic syndrome in the Tigray region, Northern Ethiopia.

 To assess the pattern of response to prednisolone in pediatric patients treated for nephrotic syndrome at Ayder Comprehensive Specialized Hospital from 2014 to 2019.

 A record-based retrospective study was conducted at Ayder Comprehensive Specialized Hospital Mekelle City, Ethiopia. Data was collected and recorded on a predesigned form. Sixty-three patients fulfilled the inclusion criteria, whose data was entered, coded, and analyzed using the statistical software package (SPSS) version 20. Variables of interest included age, gender, blood pressure, presence of hematuria, acute kidney injury, biopsy, secondary causes of nephrotic syndrome, and response to steroid therapy. Data was presented in tables and graphs.

 The age of the patients ranged from 1 - 17 years, with a median age of 3 years. Fifty-one patients (81%) were males, with a male to female ratio of 4.2:1. Hematuria was present in 66.7%, whereas hypertension was seen in 49.2% of the patients. Thirty-nine patients (61.9%) were responsive to prednisolone, 24 cases (38.1%) were resistant, 8 (20.5%) were steroid-dependent and 19 (48.7%) had relapses. Younger age (AOR 16.671, 95% CI: 1.645 - 168.904 P = 0.017) and high cholesterol values (AOR 1.013, 95% CI: 1.005 - 1.021 P = 0.01) were independent factors associated with steroid responsiveness.

 The steroid response rate in this study is similar to that in Asian and some African countries. Most patients in our hospital had atypical features of nephrotic syndrome. Younger age and high cholesterol levels were independent factors affecting steroid response.

 Detection of anti-HLA antibodies (HLAabs) in organ transplantation recipients is vital to determine whether the recipient has specific HLAabs against the donor’s HLA molecules (donor-specific anti-HLA antibodies [DSA]).

 This preliminary study involved seven subjects: five without prior HLA sensitization and two with a history of possible HLA sensitization (kidney transplantation and pregnancy). Two of the subjects were siblings, two of the subjects were mother and son, and two of them were first cousins once removed. All the subjects underwent HLA typing, and four of the subjects underwent HLAabs assays using the sequence-specific oligonucleotide probes (SSOP) method.

 There were 10/16 HLA matches between subjects who were siblings and between subjects who were mother and son, and 6/16 HLA matches were found between subjects who were first cousins once removed. Subjects with previous kidney transplantation developed 59 HLA-Abs toward class I and class II HLA (the mean fluorescence intensity (MFI) value range: 1,003.36 to 12,404.77). HLAabs were also found among subjects without prior HLA sensitization, albeit with relatively lower MFI values.

 HLA typing and HLAabs detection for donor-recipient compatibility assessment using the SSOP method offers more detailed, semi-quantitative results. Further research involving larger subjects in cohort settings will be useful for profiling MFI cut-off values for HLAabs.

Delayed graft function (DGF) and acute rejection (AR) are common complications in kidney transplant patients.

The study evaluated DGF and AR in highly sensitized patients and their effects on kidney function for six months post-transplantation.

We enrolled 95 patients with kidney transplants from living donors who were divided into two groups. Group 1 included 47 highly sensitized patients with panel reactive antibody (PRA) < 20.0% and negative donor-specific antigen, and group 2 included 48 patients with negative PRA. All patients were followed for the state of DGF, AR, and kidney function for six months.

Group 1 showed a significantly higher proportion of DGF and AR than group 2 (27.7% versus 2.1%, P < 0.001 and 14.9% versus 2.1%, P = 0.031, respectively). The rates of positive PRA in DGF and AR patients were significantly higher than those in non-DGF and non-AR patients (92.9% versus 42.0%, P < 0.001 and 87.5% versus 46.0%, P = 0.031, respectively). Transplanted kidney function was significantly worse in patients with PRA and DGF and/or AR than in patients with negative PRA and non-DGF and non-AR only in the seventh-day post-transplantation.

Kidney transplant in highly sensitized patients with positive PRA was related to the increased ratio of DGF and AR.

 Liver diseases, mainly hepatitis B and C, commonly occur in patients with end-stage renal diseases (ESRD). Alanine and aspartate aminotransferase are important for the diagnosis and monitoring of liver diseases. Several studies demonstrated that patients with chronic kidney disease (CKD) have lower levels of serum aminotransferases than the normal population. The present study was designed to compare these enzymes in different types of dialysis in ESRD patients and the general population in Iran.

 In this cross-sectional study, ESRD patients who were candidates for organ transplants in Montaserieh Hospital in Mashhad (Iran) from 2007 to 2014 were enrolled. The data of 1116 patients were collected by reviewing their medical records. Patients were divided into two groups of hemodialysis (n = 1034) and peritoneal dialysis (n = 82); their liver enzymes were compared with 510 healthy individuals from the MASHAD study.

 There was a significant difference between hemodialysis and peritoneal dialysis patients and the control group regarding the age (P < 0.0001) and gender (P = 0.005).

 The reduction in serum aminotransferase levels in ESRD cases compared to the control group suggested that renal failure influences liver enzymes that were mildly increased in peritoneal dialysis versus hemodialysis patients in samples provided before the dialysis session.

 Urinary tract infections (UTIs) with non-Escherichia coli (E. coli) species are associate with urological abnormalities.

 To compare the prevalence of non-E. coli infections in patients with urological anomalies, neurogenic bladder dysfunction, and those with apparently normal urinary systems.

 Pediatric nephrology clinic at a tertiary-care center in east of Iran. Children affected by UTI enrolled from 2003 to 2016. The results of urine culture were noted at enrolment. Cases with nephrolithiasis who had normal voiding cystourethrogram were excluded. After the implementation of imaging and urodynamic examinations, 832 patients enrolled according to the following inclusion criteria: cases with vesicoureteral reflux, urinary obstruction, neurogenic bladder, and patients with apparently normal urinary tract. The prevalence of infections with E. coli vs. non-E. coli pathogens were compared between different groups of enrolled cases.

 In this study, 62.26% of the subjects had a normal urinary system, while 33.77%, 3.97%, and 2.4% of whom had vesicoureteral reflux, neurogenic bladder, and obstruction, respectively. Non-E. coli pathogens were responsible for infections in 17.29%, 19.39%, 33.74%, and 17.15% of these cases, respectively. Infections with non-E. coli pathogens were significantly more prevalent in cases with neurogenic bladder (P = 0.003). Pseudomonas species were responsible for 4/125, 5/118, 5/28, and 0/6 episodes of non-E. coli infections in cases with apparently normal urinary system, patients with vesicoureteral reflux, cases with neurogenic bladder, and those with urinary obstruction, respectively (P = 0.004).

 Infections with non-E. coli and also Pseudomonas species are significantly more prevalent in patients with neurogenic bladder dysfunction rather than those with urological abnormalities and/or cases with apparently normal urinary system.

 Vesicourethral reflux (VUR) is a common urinary tract disorder in children, which may be associated with urolithiasis.

 The current study aimed to investigate vesicoureteral reflux in children with and without urolithiasis.

 In this case-control study, 130 children younger than 10 years, with a confirmed diagnosis of urinary tract infection (UTI) are investigated. The demographic information and clinical status of all participants were recorded. Ultrasonography was performed for all children, and they were divided into two groups of 65 subjects based on the

group 1, children with UTI+stone; and group 2, children with UTI+ non-stone. All children received Voiding Cystourethrogram to evaluate Vesicourethral reflux.

 The mean age of participants was 7.48 ± 3.2 years, and 68 (52.7%) of them were male. Also, VUR was observed in 33 (25.38%) cases. The frequency of reflux in the UTI + stone group was 21 (32.3%), which was significantly higher than the other group (12 cases, or 18.46%) (P = 0.011). However, the association between UTI and stone (P = 0.3, CC = -0.01) was not significant.

 This study demonstrated a significant correlation between urinary tract stones and VUR in children with urinary tract infections. It is recommended to investigate the presence of stone or VUR in children suffering from any of the described disorders.

Congenital nephrotic syndrome (CNS) is a rare genetic kidney disorder. Different associations between CNS and other organ anomalies have been reported previously. However, urologic abnormalities are not common. This case report can show the association of CNS as a genetic disorder with other abnormalities with a genetic basis. However, the association with urinary abnormalities is rare. We have reported a 25-day-old male newborn, who was referred to our hospital with generalized edema. During the initial evaluation, CNS was diagnosed. The baby, then four months old, was admitted to the hospital with high fever and poor feeding, and a diagnosis of febrile urinary tract infection was made. A voiding cystouretrography was performed that revealed bilateral high-grade vesicoureteral reflux. According to our findings in this case and the genetic basis of CNS and urinary tract anomalies, we recommend the investigation of the urinary tract in CNS patients if indicated.

Children with immunological diseases like SLE are vulnerable to any type of infection, and their management is considered an important issue in the COVID-19 pandemic. Here, we describe an 11-year-old female, previously known to have lupus nephritis, complaining of tachypnea, persistent fever, low oxygen saturation (SaO2), and generalized edema with confirmed COVID-19 using sputum PCR testing on the first day of admission.

Here we reported a one-year-old infant with tissue damage in the scrotum area, in which a small button cell battery had been found in his diaper. Evidence suggested that the lesion was caused by contact with the leaky battery with the scrotal skin. The treatment procedure was prescribed by a dermatologist. The healing process was tracked over the examination times. After two months, the site of the lesion showed complete remission. The findings suggested that in such cases, after removing the chemical agent, blisters, and necrotic tissues, therapeutic measures should be performed similarly to the thermal burns.