Journal of pediatric nephrology
Volume:10 Issue: 1, Winter 2022

Vascular access and Intravenous Fluid (IVF) administration are essential issues in children who are admitted to the emergency wards. Despite the common use of maintenance IVF, there are a lot of variations in fluid administration methods and no definite guidelines for IVF and electrolyte monitoring. Because hypotonic fluids cause hyponatremia in many children, isotonic fluids are indicated, according to recent studies, as an accepted method in pediatric IVF therapy to prevent hyponatremia. This narrative review aims to provide an evidence-based approach for selecting the most appropriate IVFs in patients aged 1 day to 18 years. Data showed that the basis of fluid therapy in children varies according to the type of disease and the underlying conditions of children. Depending on each case, the clinicians should decide on what and how fluid and electrolytes be used.

There is limited data on renal diseases in paediatric admissions in Cameroon. The aim was to describe the clinical spectrum and outcomes of renal diseases among admitted children in two regional hospitals in Cameroon.

we reviewed archived records of children admitted with renal disease from the 1st January 2017 to 31st December 2019 for renal diseases and outcomes.

In all, 148 (1.98%) of the 7457 admitted children had a renal disease. Their median age was 7.5 years (IQR 4-12) and 63.5% were females with 32.4% less than 5years. Urinary tract infection (51.4%), Acute kidney injury (21.6%), Nephrotic syndrome (12.2%), chronic kidney disease (12.2%) and renal mass (2.6%) were frequently described. Complicated UTI was observed in 9.2% of children with UTI whereas initiation of corticotherapy (83.3%) was the most common reason for admission in children with nephrotic syndrome. Malaria (40.6%) and sepsis (40.6%) were the most common aetiology of AKI whereas chronic GN was the most common aetiology of CKD. Out of the 32 children with AKI, 50% had an indication for dialysis with 87.5% having access to the therapy. Nine (75%) of the 12 children with non-dialysed CKD-5 needed dialysis with 55.5% (5/9) having access to it. Out of the 148 children, 07 (4.7%) died. Deaths were due to AKI and CKD; with specific death rates of 12.5% and 16.7% respectively.

Renal diseases are uncommon among admitted children. Overall in-hospital mortality was low.

Prenatal hydronephrosis is found in 1%-5% of pregnancies. Without well-timed diagnosis and treatment, it can lead to irreversible outcomes. Because little information is available on the indication of Vesicoureteral Reflux (VUR) regarding the antenatal diameter of the kidney pelvis, the current study aimed to determine the association between prenatal hydronephrosis and the VUR.

This cross-sectional study was conducted from 2011 to 2016 on 200 neonates with hydronephrosis detected in fetal life ultrasounds in the third trimester of pregnancy. We assessed the prenatal and postnatal kidney ultrasonography of 400 kidneys and Voiding Cystourethrogram (VCUG). We employed the Spearman correlation coefficient for determining the association between study variables. The obtained data were analyzed using SPSS 16.0 software at a significance level of less than 0.05.

Of 200 infants, 71.5% were males and 28.5% were females. No significant relationship was found between the degree of antenatal hydronephrosis and the VCUG severity (r=0.098, P=0.106). Despite antenatal hydronephrosis, the degree of postnatal hydronephrosis and the VCUG severity was correlated (r= 0.255, P=0.001).

There is no correlation between the severity of fetal hydronephrosis and VUR severity or the presence of a greater correlation between postnatal hydronephrosis and degree of VUR. Thus in cases of mild prenatal hydronephrosis, we suggest urinary tract ultrasonography three to seven days after birth and then cystography if postnatal sonography showed moderate or severe or progressive hydronephrosis.

Urinary tract infection is one of the most common infections in childhood. The disease should not be overlooked because it has long-term complications such as renal scarring and failure. We aimed to determine the relationships between radiological findings in children under five years with acute pyelonephritis and its long-term complications.

In this retrospective study, we reviewed the medical records of all children hospitalized with acute pyelonephritis in a two-year period. We studied, extracted, and analyzed the imaging and demographic data of the patients.

Out of 210 available cases, 54 children with acute culture-positive pyelonephritis were included. All the included cases had undergone ultrasound, Radionuclide Cystogram (RNC), Voiding Cystourethrography (VCUG) (for urinary reflux), and late DMSA (Dimercaptosuccinic Acid) scintigraphy. We found that 46.2% had Vesicoureteral Reflux (VUR), and 57.4% had an abnormal ultrasound, with hydronephrosis being the most common finding (74.1%). We also found a significant correlation between ultrasound and VUR (P=0.002). About 37% also had abnormal DMSA scintigraphy. However, in those with normal ultrasound results, 20% suffered from VUR, with one being severe. Seven cases also had abnormal DMSA scintigraphy.

We demonstrated that a normal urinary ultrasound does not rule out the possibility of VUR or the risk of progression to renal parenchymal dysfunction and scarring. Therefore, we suggest further utilizing the available radiologic techniques to diagnose and minimize subsequent renal complications in the disease promptly.

Electrolyte disorders in hospitalized children have several causes. One of the most important and common causes is using inappropriate maintenance intravenous fluids. This study aimed to investigate the effect and type of maintenance of intravenous fluids on the incidence of electrolyte disturbance in hospitalized children.

This research is a prospective cohort study. Non-surgical hospitalized children were divided into two groups based on the type of intravenous fluid received (normal saline [0.9% NaCl] or half saline [0.45% NaCl]). After matching two groups in terms of age and gender, the incidence of electrolyte disturbances (sodium and potassium) was evaluated in the two groups on the second and third days of the study.

A total of 163 patients were included in this study. About 55.5% of the children were boys, and 44.5% were girls. The Mean±SD age of the children was 48.42±36.35 months, and their mean weight was 19.49±10.88 kg. Also, 50.6% of patients were in the half saline group and 49.4% in the normal saline group. Initially, serum sodium and potassium levels were normal in both groups. On the second and third days of the study, the incidence of serum sodium and potassium disorders was higher in patients who received half saline fluid, but this higher incidence was not statistically significant (P>0.05).

There is no significant difference between normal saline and half saline in terms of electrolyte disturbance if the patient’s clinical condition is judged correctly and an appropriate volume of fluids is prescribed.

Nephrotic syndrome, especially the steroid-resistant form, is often complicated by hypertension in childhood. The syndrome is common in black children. However, the histopathological finding of membranous nephropathy in children with nephrotic syndrome is rare. Liddle’s syndrome is a rare genetic abnormality that presents with salt-sensitive hypertension caused by constitutive activation of the amiloride-sensitive epithelial sodium channel. The epithelial sodium channel comprises homologous α, β, and γ subunits that share similar structures. Gene mutations associated with Liddle’s syndrome occur in either the β or γ subunits and disturb or truncate a conserved proline-rich sequence (i.e., PY motif), leading to constitutive activation of the epithelial sodium channel. The association of nephrotic syndrome with Liddle’s syndrome has only been described in an adult patient. We present here the first case of these two syndromes (nephrotic syndrome and Liddle’s-like syndrome) co-existing in a child with membranous nephropathy in his histopathological finding on kidney biopsy.

Ethanol is a chemical that is easily absorbed in all parts of the gastrointestinal tract. This feature increases the risk of poisoning by ingesting this chemical at any amount; the signs and symptoms depend on the poisoned individual. Common symptoms of ethanol poisoning include sedation, poor coordination, vomiting, slurred speech, ataxia, respiratory depression, coma, and death. A rare manifestation of alcohol consumption is the raccoon eye. This article presents a 5-year-old girl who gradually showed a unilateral raccoon eye following ethanol consumption.

A 12-year-old girl was admitted with tea-colored urine for 24 hours. She had normal blood pressure and no edema with a rapid and progressive increase in blood urea nitrogen and serum creatinine, so one session of hemodialysis was done. The condition got worse by a thrombus formation in the heart. C4 was normal, but C3 was low, while serologic tests for lupus and Anti-Neutrophil Cytoplasmic Antibody (ANCA) were negative. Urinalysis showed proteinuria and hematuria. The kidney biopsy revealed crescentic glomerulonephritis. Treatment with 3 pulses of methylprednisolone and cyclophosphamide, and antithrombotic drugs were given with rapid recovery to normal serum creatinine and decrease in proteinuria. C3 was normalized after 2 months, and the clot disappeared, while hematuria and proteinuria continued as 1+ after 5 months. Due to the continuous proteinuria, Myfortic was continued for one year. Then, after stopping Myfortic, proteinuria did not return, and only microscopic hematuria continued. In conclusion, severe crescentic glomerulonephritis may have minimal symptoms and be complicated by heart thrombosis but with excellent response to medical therapy.