Journal of pediatric nephrology
Volume:9 Issue: 2, Spring 2021

In the evaluation of patients presenting with chronic hyperkalemia hyponatremia and normal anion gap acidosis, pseudohypoaldosteronism types I and II are within the spectrum of differential diagnosis. Recognition of these patients is important to prevent inappropriate mineralocorticoid therapy. Using clinical scenarios we aim to illustrate clinical mimics and dissimilarities to differentiate theses disorders.

Contrast-induced renal impairment endangers patients' health and imposes a financial burden on families and the health care system. Therefore, this study examines the rate of nephropathy in patients admitted to the Mofid Children's Hospital in 2018 and 2019.

This study was a retrospective cross-sectional study in a useful pediatric hospital on 180 children in which contrast-enhanced CT-scans were performed. Baseline serum creatinine and then serum creatinine were determined 48-72 hours after CT-scan and in case of more than 25% increase in serum creatinine, it was considered CIN. Shapiro-Wilk test was used to check the normality of quantitative data distribution. Independent t-test, Mann-Whitney and Chi-square (if necessary Fisher's exact test) were used to compare the characteristics between the two groups of patients. The research data were analyzed using SPSS-25 software and the significance level in all tests was considered to be P <0.05.

In this study, 180 children who underwent contrast-enhanced CT-scan with a mean age of 5.72 years, of which 81 (45 ٪) were girls and 99 (55 ٪) were boys. The mean baseline creatinine of patients was 0.633 ± 0.137 mg / dl and the mean creatinine of patients two weeks after the first measurement was 0.675. 0.164 mg / dl. Patients' creatinine levels increased statistically significantly after two weeks.

In children on CT scan with an increase in contrast, the incidence of ARF is 17.2%. Ciprofloxacin increases the risk of acute kidney problems by 4.8 times.

Rituximab is a novel therapy that can help patients with steroid-dependent or resistant nephrotic syndrome. The aim of this study was to evaluate the efficacy of rituximab in children with corticosteroid-dependent and resistant nephrotic syndrome and to determine the factors associated with its efficacy.

In this study, 40 children with corticosteroid-dependent or resistant nephrotic syndrome who were treated with rituximab in Dr. Sheikh Hospital, Mashhad, between 2014 and 2018 were enrolled. Patients with a history of hematuria, severe urinary tract infection, or secondary nephrotic syndrome were excluded.

The mean age of patients was 11.9 ± 5.04 years, and 55% were female. The most common underlying pathology of nephrotic syndrome was focal segmental glomerulonephritis(FSGS)(42.5%) followed by membranoproliferative glomerulonephritis(MPGN)and minimal change disease(MCD). Most of the participants (62.5%) were steroid-dependent and the rest (27.5%) were steroid resistant. Only 10% of the patients showed complications following rituximab administration and 57.5% went into complete remission. A negative family history and steroid-dependent nephrotic syndrome were significantly associated with a better treatment response. Moreover, patients with steroid-resistant nephrotic syndrome were more likely to have a positive family history, while factors associatedwith steroid response included underlying pathology, gender, and family history.

Rituximab can cause remission in more than half of the patients with steroid-resistant or dependent nephrotic syndrome. Moreover, the only factors that reduce response to rituximab are a history of corticosteroid resistance and a positive family history of nephrotic syndrome.

Henoch-Schönlein purpura (HSP) is the most common childhood vasculitis characterized by leukocytoclastic vasculitis. This study was done to describe the presentation and immediate outcome of children admitted to HSP at our Institute.

This retrospective study was conducted on children with HSP admitted to our department over a period of 7 years (January 2010 until December 2016).

Twenty-three children with a diagnosis of HSP were identified during the study period. The mean age was 9.4 years (4 years to 16 years). There were 15 girls and 8 boys with a male: female ratio of 1:1.9. The youngest child was 4 years old and most of the children (73.9%) were in the age group 5-12 years. Forty percent of the children presented between January and March. Major manifestations were rash (100%), joint pain (52%), renal involvement (52%), and abdominal pain (47.8%). Three (13.0%) children presented with systemic manifestations before the appearance of the rash. One child had MPGN 2 years before the onset of rash. There was no mortality. Most of the children recovered well; six (26%) had persistent hypertension and three (13%) had persistent proteinuria. Hypertensive emergency was seen in two children. One child had intussusception that resolved spontaneously.

This study is the first study of Henoch Schonlein purpura from northeast India documenting certain peculiarities in the presentation. The results indicate a wide spectrum of presentations in HSP

Kidney disease occurs frequently in human immunodeficiency virus (HIV) infected individuals and is a leading contributor to morbidity and mortality in patients with HIV. Early detection of kidney damage will aid in instituting interventional measures that could slow down or halt the progression of kidney disease. The aim of this study was to determine the prevalence and risk factors of microalbuminuria in HIV infected children in Jos, Nigeria and compare them with those of HIV negative children.

A total of 135 HIV infected and 135 HIV uninfected children aged 1-18 years were screened for microalbuminuria using microalbumin 2-1 combo test strips. Logistic regression analysis was used for determination of the association between microalbuminuria and various predicted risk factors.

Thirty (22.2%) HIV infected and 13 (9.6%) uninfected children had microalbuminuria (p = 0.001). Logistic regression analysis showed that an increase in the WHO clinical stage was significantly associated with the presence of microalbuminuria in HIV infected children (p = 0.004).

The prevalence of microalbuminuria is higher in HIV infected children, as such the detection of microalbuminuria as early as possible in the course of the disease and prompt initiation of therapy are very important in our resource poor environment.

The recent recommendations are to use isotonic fluids as maintenance intravenous fluids (mIVF) in children and most commonly prescribed fluid is 0.9%NS(Normal Saline) but there are concerns of hypernatremia, fluid overload and hyperchloremic metabolic acidosis leading to increased morbidity and even mortality mainly by its adverse effects on kidneys. Most of available literature is in adult population. There is still not enough evidence to approve or disapprove 0.9% NS as safe mIVF in children. This study was done to assess the clinical and biochemical effects of 0.9% Sodium chloride as isotonic mIVF in general pediatric non-critically ill patients.

Descriptive cohort study in admitted children requiring mIVF for minimum 24 hours. Change in blood pressure(BP) and biochemical parameters like serum sodium(S Na), serum chloride(S Cl) and bicarbonate and to observe incidence of hypo/hypernatremia, hyperchloremia and metabolic acidosis at 24 and 48 hours from baseline.

Out of 250 children analyzed, mean age was 3.79±3.2 years with majority (43.6%) in the age group of 2 months- 1years. There was no significant change in BP at any time point. Mean serum chloride level at baseline, 24hours and 48hours to be 103.81±4.717,104.5±4.581 and 105.28±4.545 respectively with a significant rise at 48 hours of mIVF(p-value< 0.001) and among 3 points of time(p-value<0.01]. There was significant decrease in bicarbonate level at 48 hours from baseline(p<0.05).

0.9% NS as mIVF in non-critically ill paediatric patients leads to significant increase in serum chloride levels leading to hyperchloremia and metabolic acidosis.

To provide basic renal data in the pediatric age group in a poorly resourced hilly state of India which may be utilized by researchers and health planners.

Retrospective analysis of case records of children reporting to pediatric nephrology clinic from April 2016 to March 2017 was performed. Case records were analyzed and broadly categorized into various groups and subgroups based on clinical presentations and investigation findings.

205 children presented with renal diseases at the pediatric nephrology clinic over a period of 1 year. Registered kids presenting to pediatric nephrology clinic were broadly categorized into 10 groups. Nephrotic syndrome (NS) was the commonest renal disease observed contributing 45.6% of registered cases. It was followed by congenital anomalies of kidney and urinary tract (CAKUT( which accounted for 26.8% cases. Edema was the commonest presenting symptom and proteinuria was the common urinary finding detected. Focal segmental glomerulosclerosis was the commonest histopathological finding reported on renal histopathology and peritoneal dialysis was found to be the most frequently used modality for renal replacement therapy.

Our data reflects geographical variations of patterns of renal diseases in a resource poor hilly state of northern India. Improvement of pediatric renal services and training of health workers would help in early detection and treatment of these conditions leading to reduction in their morbidity and mortality.

urinary tract infection is a prevalent disease in children. Determining the location of the bacterial invasion has a great impact on the treatment, follow-up, and complications. For this purpose, different laboratory and imaging methods are used, which are often invasive or unavailable. One of the non-invasive methods is to measure biomarkers such as interlukin-8 (IL-8) in the urine. The aim of this study was to evaluate the urinary level of interleukin-8 in acute pyelonephritis.

This cross-sectional study was carried out on 50 children aged 3-60 months. The children were divided into two groups. The first group included children with acute pyelonephritis and the second group included healthy children who were randomly selected as controls. Then, the urine levels of IL-8 and creatinine were measured.

The mean age of the subjects in case and control groups was 17.5 ± 22 and 22.5 ± 18.2 months, respectively (P = 0.92).The mean urinary ratio of IL-8/Cr in the patient and control groups was 161.7 ± 90.1 and 12.2 ± 19.6 Pgr/mgr respectively, indicating a significant difference (P = 0.03).The results showed that a urinary IL-8/Cr ratio of 32 pg/mg was diagnostic according to the Receiver Operating Curve (ROC).

Urinary IL-8/Cr ratio can be used for early diagnosis of acute pyelonephritis

Methemoglobinemia is a rare disease characterized by the elevated levels of methemoglobin in the blood. It may be congenital or acquired. Co-trimoxazole is an antibiotic that belongs to the sulfone group. Sulfone group drugs may produce drug-induced acquired methemoglobinemia. Methemoglobin is an oxidized form of hemoglobin that has an increased affinity to oxygen and a reduced ability to release oxygen to tissues. High levels of methemoglobin in red blood cells cause tissue hypoxia. This disorder may present with several symptoms such as cyanosis, fatigue, dyspnea, and headache. Because it is a rare cause of cyanosis and hypoxemia, the diagnosis of methemoglobinemia is often delayed. We herein discuss a five-year-old boy with steroid-resistant nephrotic syndrome who presented with exertional dyspnea and cyanosis and was later diagnosed as a case of co-trimoxazole-induced methemoglobinemia.

A 3-year-old boy presented with abdominal pain and distension, lower extremities and facial edema, and anuria for several days that was associated with ureteropelvic junction obstruction (UPJO). Initial ultrasonography showed the presence of a massive bilateral hydronephrosis with UPJO and a computerized tomography (CT) scan without contrast revealed a massive hydronephrosis and hydroureter (grade 3). A follow-up study, after relief of ureteral obstruction, showed the reversal of this pattern. Blood biochemical tests revealed a severe acidosis, hyperkalemia, and a BUN/Cr ratio of more than 20. The patient underwent emergency nephrostomy. The general condition of the patient improved. Abdominal distention reduced, levels of urea and creatinine decreased, and acidosis resolved. A CT scan revealed an almost complete disappearance of the hydronephrosis and a normal ureter. Ureteropelvic junction obstruction (UPJO) was established as the cause of giant hydronephrosis.

The spleen is the mostly common injured solid organ in blunt abdominal trauma and contributes to mortality and morbidity. Epidermoid splenic cysts are sample of primary congenital cysts that contain an epithelial lining, unlike secondary cysts, which are collected of fibrous tissues.

An 18-year-old male presented with acute left upper abdominal pain, feeling of fullness and dyspepsia from 10 days ago. His past history was renal transplantation from deceased doner, 5 year prior to presentation. Physical examination revealed normal findings except a palpable soft mass with size of 15x20 cm in the left upper quadrant (LUQ).

Severe gastrointestinal manifestations and rashes of Henoch Schonlein Purpura (HSP) may not always respond to prednisolone or other immunosuppressive agent. Though reduced factor XIII may play a role in gastrointestinal manifestations but its role in management of skin rashes is uncertain. Here, we reported a case treated with different immunosuppressive agents but didn`t respond.  Thereafter, despite having the normal factor XIII assay, the unremitting GI symptoms and skin rashes, has improved after prescribing colchicines & infusion of Cryoprecipitate containing factor XIII.

Paraquat is a widely used synthetic herbicide in agriculture based country. Ingestion of toxic dose of paraquat can be fatal with life threatening effects on kidney, lungs, gastrointestinal tract (GIT), liver, heart and other organs. Till date no specific antidote or efficacious life saving treatment is established in case of paraquat poisoning and prognosis is uniformly very poor worldwide. Here we reported a case who presented with acute renal failure, shock, GIT bleeding with oral mucosal ulceration and pulmonary complication due to accidental paraquat poisoning and delayed hospitalization after poison ingestion. In spite of partial improvement the patient expired after 2 weeks of admission. So any paraquat poisoning case must be hospitalized and if needed patient should be referred to equipped center as early as possible after ingestion of poison to save life.