Journal of pediatric nephrology
Volume:10 Issue: 3, Summer 2022

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.

This study aims to investigate how to benefit from clinical and laboratory methods for further selection in the decision-making process to perform a cystogram and assess the severity of vesicoureteral reflux (VUR).

We retrospectively reviewed the voiding cystourethrography (VCUG), ultrasound (US), and medical records of pediatric patients with VUR. The exclusion criteria included having neurological lesions, a posterior urethral valve, and a lack of documentation of a renal ultrasound or voiding cystourethrography (VCUG). At the time of data entry, we retrieved demographic findings and laboratory test results, including routine biochemical parameters, complete blood count, and calculated blood sodium/potassium ratio

Sixty-three pediatric patients with VUR were enrolled in this study. The mean (SD) age of the patients (female/male=37/26) at the time of diagnosis was 62.0±6.5 months (range 1-195 months). Seventeen patients (26.9%) had high-grade VUR, and 46 patients (73.1%) had low-to-moderate-grade VUR. The mean potassium level of the mean serum sodium to potassium (Na/K) ratio was significantly lower in the high-grade VUR group (4.7±0.5 vs. 4.3±0.4 mEq/L, P=0.022, 29±3 vs. 32±3, P=0.029, respectively). The proportion of patients with severe anterior-posterior (AP) diameter dilation was significantly higher in the lowgrade VUR group than in the high-grade VUR group (4 [23.5%] vs. 35 [76.5%], P=0.005).

We conclude that the low serum sodium to potassium (Na/K) ratio allows us to predict the VUR grade. The effect of VUR on the renin-angiotensin-aldosterone system can be demonstrated by prospective controlled studies.

This study aimed to investigate the strength of the relationship between renal resistive index with left ventricular mass index, microalbuminuria, and retinopathy to find a predictive value of the renal resistive index in early detection of end-organ damage.

Pediatric patients diagnosed with hypertension were included in this study between January 2020 and January 2022.

A total of 41 consecutive patients who were never treated for essential hypertension were included in this study. Microalbuminuria was detected in 10 patients (24%). Retinopathy was detected in only 2 patients (4.9%). Echocardiographic data were available in 25 patients. The mean left ventricular mass index was 30±10 (17-53 g/m2.7). Three male patients (12%) had left ventricular hypertrophy but none of the females had left ventricular hypertrophy. We categorized the patients into two groups according to the presence of microalbuminuria and compared the two groups. The value of the renal resistive index in the microalbuminuric group was significantly higher than in the nonalbuminuric group (0.8±0.2 vs. 0.6±0.2, P=0.047). We found a positive correlation between renal resistive index and urine microalbumin (r=0.636, P=0.014). In regression analysis, higher resistive index values were independently associated with microalbuminuria but not left ventricular hypertrophy. (OR=-0.633, 95% CI 24.4-187.2, P=0.015)

To our knowledge, this is the first study to analyze the correlation of RI with microalbuminuria in hypertensive children. We found a significantly higher resistive index in patients with microalbuminuria; we also found a correlation between these variables. This shows that this finding and an abnormal resistive index can be used as early signs of hypertension.

Urinary Tract Infection (UTI) is common in children. This study aims to evaluate demographic characteristics, etiologies, and clinical presentations of UTI in childhood.

A cross-sectional retrospective study was conducted to investigate the available data of the children with UTI referred to the nephrology clinic of a tertiary academic children’s hospital from September 2002- 2016. Patients aged 0-18 years were included in the study.

A total of 1245 cases, including 1084 girls (87.06%) and 161 boys (12.94%) were included in the study. The age of patients at the first presentation was 35.43±34.94 months. Fever was the most common manifestation (60.1%). The most and least cases of UTI were reported in children aged 2-24 months (49.7%) and over 10 years old (2.9%), respectively. The most common pathogens were E. coli, Klebsiella, Staphylococcus, Enterobacter, Proteus, and Enterococcus species, respectively. The frequency of infection with E. coli in girls was significantly higher than in boys (P=0001), while infection with Staphylococcus and Proteus species was higher in boys (P=0.0001 and 0.002, respectively). The incidence of pyelonephritis decreased with age. Furthermore, febrile UTIs were as common in boys as in girls (P=0.42).

The prevalence of UTI is significantly higher in girls, and the frequency of UTI varies according to age, reaching its peak in the first year of life, and the lowest frequency in children over 10 years of age. Moreover, pyelonephritis is more common in younger children (infants 2-24 months). Gender is a crucial factor in terms of pathogens.

Fetal hydronephrosis (HY) is a frequent congenital condition that may be detected by prenatal ultrasound studies. The main underlying abnormalities found in these cases after birth are ureteropelvic junction stenosis, primary vesicoureteral reflux, megaureter, duplex kidneys, and posterior urethral valves, with uretero-pelvic junction stenosis and primary vesicoureteral reflux accounting for most cases.

Neonates with a prenatal diagnosis of congenital HY born between 2017 and 2020 were referred to our center for the appropriate management and follow-up and were included in this cross-sectional study. Ultrasonographic studies were performed in all these neonates in the first week of birth. Prenatal HY was categorized as mild, moderate, severe, and highly severe when the antero-posterior diameter of the renal pelvis was less than 5 mm, between 5 mm and 10 mm, between 10 mm and 15 mm, and more than 15 mm, respectively.

A total of 164 children with prenatal HY were included in this study. 84 patients (51.2%) had unilateral HY and 80 patients (48.8%) had bilateral HY. Twelve patients had posterior ureteral valves and 64 patients (39%) had vesical-urethral reflux (VUR). no significant relationship was observed between unilateral or bilateral reflux and outcome (P value 0.645).

Prenatal screening of HY is vit

Neonatal hematuria is a very rare occurrence and is mostly due to secondary pathology. This case report describes a rare case of a near-term male neonate with gross Hematuria seen immediately after birth. Urine microscopy confirmed hematuria without growth in urine or blood cultures. A full blood count and coagulation profile showed no obvious cause for the Hematuria, and a renal tract ultrasound showed a mobile haematoma in the bladder but no other structural abnormalities. The newborn received an additional dose of intravenous vitamin K and was managed conservatively. The Hematuria resolved on the second day of life without recurrence on his 12-month follow-up, with no clear cause for the presentation. We discuss a rare case of neonatal gross Hematuria, its differential diagnoses, and clinical approach.

Kawasaki disease is a form of vasculitis, mainly in small and medium-sized arteries of unknown origin, and often occurs in childhood. It is the leading form of heart disease acquired in childhood in developed countries. Pyelonephritis is not usually associated with Kawasaki, but hereby we represent a case of Kawasaki disease associated with pyelonephritis; however, we can’t say whether pyelonephritis had a role in stating Kawasaki and it could be a proper and valuable topic for research.