Journal of pediatric nephrology
Volume:11 Issue: 1, Winter 2023

Nocturnal enuresis is defined as a wetting episode at nighttime in children over 5 years of age and it is divided into primary and secondary types. Primary nocturnal enuresis refers to cases who had never had a dry bed with a prevalence from 1.6% to 15% and it may continue to adolescence. Ignoring the problem has some psychological consequences and a significant impact on the quality of life. Conservative therapy and active intervention have been proposed as the modality of treatment. This review address on the assessment of nocturnal enuresis, sleep disorder, psychological impact, and the management of enuresis by considering the causes of resistance to treatment.

This study aims to evaluate the clinical and histopathological profile in children with crescentic glomerulonephritis (CGN) and determine the predictors of renal outcome.

In this retrospective study, we reviewed all native kidney biopsies performed in patients <18 years over 9 years (2011-2019). Individuals with ≥20% crescents with follow-up for at least 1 year were enrolled.

This study included 34 patients. The most common variety was immune-complex glomerulonephritis (GN) (type II CGN) (n=21; 62%), including patients with Henoch-Schonlein purpura (n=6), lupus nephritis (n=6), post-infectious GN (n=3), C3GN (n=3), and dense deposit disease (n=3). The second most common was pauci-immune GN (type III CGN; n=12; 35%) followed by anti-glomerular basement membrane disease (type I CGN; n=1; 3%). Hypertension (88%), hematuria (84.2%), and oliguria (64%) were the most common presenting features. The outcome predictors for poor renal survival were the presence of oliguria (HR-5.11, P=0.035), severe hypertension (HR-11.51, P=0.019), estimated glomerular filtration rate <15 mL/min/1.73 m2 at presentation (HR-5.05, P=0.007), percentage of crescents (HR-10.66, P=0.001), presence of fibrous crescents (HR-6.34, P=0.001), and interstitial fibrosis and tubular atrophy (HR-8.88, P=0.0046). The overall outcome of the study revealed complete recovery (n=12), partial recovery (n=6), chronic kidney disease (n=3), and end-stage renal disease (n=13). The renal survival in patients with ≥50% crescents was poor (P=0.037) as compared to subjects with <50% crescents.

Renal survival can be predicted by the severity of presenting features and histopathological markers. Two-thirds of patients had type II CGN with renal survival outcomes similar to type III CGN. The percentage of crescents is the most important predictor of renal survival.

Hypertension (HTN) has become more prevalent among youngsters. It is frequently under-recognized due to a lack of routine blood pressure measurement in many health centers, partly owing to a shortage of devices and possibly because of the notion that it is not the foremost disease in children. In Bangladesh, there is a scarcity of data on how doctors view childhood HTN and their practice of measuring blood pressure in children. We aimed to conduct this survey among pediatricians and healthcare providers to determine the perception and knowledge about childhood HTN and their practice of measuring blood pressure in children, which can be served as a baseline for future reference.

This cross-sectional mailed-based survey was done on pediatricians and approved by the institutional review board of Dr. Khan Shishu Hospital & the Institute of Child Health from June to December 2021. We obtained the email addresses of all pediatricians from the Bangladesh Pediatric Association. The survey instrument/questionnaire was developed based on the 2017 clinical practice guideline. The data were analyzed and expressed as frequency and percentage.

Of the 536 pediatricians in the mailing sample, 257 cases responded and the response rate was 47.9%. The majority of respondents (62.4%) were general pediatricians and only 12.2% were pediatric nephrologists. This survey revealed that 77.2% of pediatricians did not measure blood pressure routinely among children 3-18 years of age, whereas 66% reported measuring blood pressure if children had risk factors. The majority of pediatricians (92.8%) had blood pressure machines at their clinic and only 60% had blood pressure cuffs available for children. Most of the pediatricians (68.7%) did not use a blood pressure chart for labeling blood pressure and only 35.7% reported that they repeated auscultatory blood pressure measurements three times to diagnose HTN.

The findings of our study point to a knowledge and practice gap among pediatricians, who are primary health care providers, when diagnosing hypertension in children. For children aged 3 to 18 years, most pediatricians reported no regular assessment of blood pressure. Most pediatricians did not repeat blood pressure measurements for diagnosis, nor did they often use blood pressure cuffs or charts for children. These issues need to be addressed for better diagnosis and treatment of childhood HTN.

Bedwetting or enuresis is not uncommon in children, although its prevalence varies by age. Spontaneous remission of enuresis may occur at a rate of approximately 15% per year, but treatment protocols should be carried out because of its significant impact on a child’s family, emotional state, self-esteem, and totally on the quality of life (QoL). Today, non-pharmacological therapy is an initial treatment for enuresis, in which both the parents and children are motivated to take the behavioral management approach. This study was done to determine the effectiveness of non-pharmacological therapy in pediatrics with enuresis.

This prospective observational research was carried out in pediatrics aged 5 to 15 years with bedwetting who visited the outpatient department of Asgar Ali Hospital from January 2021 to December 2021. They were categorized into two groups, primary and secondary (monosymptomatic and non-monosymptomatic) enuresis according to the definition of the international children’s continence society (ICCS). Also, our patients were divided into different age groups: Group A: 5-7 years, group B: 8-10 years, and group C: >10 years, and the response was classified as no response: <50%, partial response: 50-99%, and complete response: 100% reduction in baseline symptom frequency.

Among the 74 patients, 28 cases (38%) were male and 46 cases (62%) were female, with most of them having primary enuresis 72(97%), and only two patients had secondary enuresis. Most patients were monosymptomatic 62(83.7%), and only 12 cases (16%) were non-monosymptomatic. Among 32 patients (43%) of group A, 87.5% had complete response within three months of follow-up, in group B, of a total of 20 patients (27%), 40% had complete and 40% had partial response, and in group C, among 22 patients (30%), only 9% had complete and 46% had partial response.

Non-pharmacological therapy in enuretic patients showed encouraging recovery.

Studies on the prevalence of kidney stones in Iranian children are limited. Children with nephrolithiasis have a high risk of recurrent stones; therefore, a thorough evaluation is warranted. Due to the paucity of data on Iranian children, this study aims to investigate the prevalence of kidney stones in this population.

This cross-sectional study examined the prevalence of kidney stones among outpatients and inpatients at various university centers in Iran from March to December 2019. Twenty-six pediatric nephrologists from 13 centers participated and completed a questionnaire on the total number of inpatients and outpatients and the number of patients with kidney stones. The diagnosis was based on radiological results.

A total of 97 912 patients were included, with 20327 hospitalized and 77585 outpatients. Of all patients, 2.86% had kidney stones, the prevalence of which was 1.5% in inpatients and 3.2% in outpatients. This figure is about 1% more than Iran’s past reports. Inpatient stones in Kerman City, Iran (3.65%) and outpatients in Zahedan City, Iran (16.4%)

The incidence rate of nephrotic syndrome (NS) is 2-7 children per 100,000 children. Children with NS usually have some calcium homeostasis problems leading to abnormal bone histology, hypocalcemia, reduced serum vitamin D metabolites, and impaired intestinal absorption of calcium during their disease or following treatment.

This is a prospective study on patients with NS on their first visit before any initial treatment. One hundred and three children aged 2-12 years referring to our nephrology department from March 2018 to June 2019 were enrolled in this study. Serum concentrations of calcium, phosphorus, albumin, 25(OH)2 vitamin D3, and creatinine were measured in all patients. The correlation of 25(OH) vitamin D3 with the type of nephrotic syndrome, gender, and age of the patients was evaluated.

Sixty-two patients were male (60.2%) and 41 cases were female (39.8%). Vitamin D deficiency (<20 ng/dL) was observed in 87 out of 103 patients (96.7%). Also, 24 patients underwent kidney biopsy: ten patients were found with minimal change disease (41.7%), seven patients (29.2%) showed focal segmental glomerulosclerosis, and seven cases had diffuse mesangial proliferation. Mean serum levels of calcium, phosphorous, albumin, and cholesterol were 7.512, 4.756, 1.932, and 450.68 mg/dL, respectively, and there was no correlation between vitamin D levels and these parameters except albumin.

Because of the high prevalence of vitamin D deficiency and its serious consequences in NS patients, it is recommended to measure the levels of this vitamin at the first visit and treat this deficiency, if necessary, along with other specific treatments.

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.

The infection with varicella-zoster virus in immune-deficient patients is an important and complex challenge in treating patients and requires decisions on an individual basis. Rituximab is an anti-CD20 positive B cells monoclonal antibody. Nowadays, it is frequently used in patients with idiopathic nephrotic syndrome and makes them susceptible to various infections. In this study, we report a 16-year-old male subject with steroid-resistant nephrotic syndrome who developed a severe and generalized form of chicken pox following rituximab administration.