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Introduction: Chronic kidney disease (CKD) is described by structural or functional defects staying for three months. End-stage kidney disease (ESKD) patients undergoing renal replacement therapy (RRT) face complications and increased susceptibility to infections due to their compromised immune system. In addition, malnutrition and chronic inflammatory conditions are prevalent in CKD patients. Selenium, an essential trace element, plays a crucial role as a cofactor in antioxidant enzymes like glutathione peroxidase (GPX), contributing to vascular endothelial function. Selenium deficiency in patients with ESKD may intensify oxidative stress, increase susceptibility to cardiovascular complications, and impact mortality rates. Despite the significance of selenium in this context, studies on its levels in children undergoing hemodialysis (HD) are limited. Objectives: This study assessed serum selenium levels in children undergoing HD, compared with healthy children. Furthermore, we sought to establish correlations between selenium levels and inflammatory profiles in the HD group. Patients and Methods: An observational cross-sectional study was conducted with 30 pediatric patients with ESKD undergoing HD (HD group) and 50 healthy children (control group) in Tehran, Iran. Blood samples were collected from both groups, and serum selenium levels along with inflammatory markers were analyzed. The inclusion criteria encompassed pediatric ESKD patients undergoing HD for at least six months without recent inflammation or infections. The exclusion criteria comprised active infections, immunodeficiency syndromes, and corticosteroid therapy. Statistical analyses were performed using SPSS statistics. Results: Significant differences were observed in serum selenium levels between the HD and control groups (P = 0.039). Correlation analysis disclosed a direct relationship among selenium levels and participant age (r = 0.235, P = 0.036), with no significant difference between genders. Notably, significant correlations were found between selenium levels and erythrocyte sedimentation rate (ESR) and platelet-to-lymphocyte ratio (PLR). In contrast, no significant correlation between selenium levels and other inflammatory profiles was established. Conclusion: This study underscores the importance of assessing serum selenium levels in pediatric ESKD patients undergoing HD. Understanding the interplay between selenium deficiency and inflammatory profiles can inform interventions aimed at improving outcomes and reducing complications in this vulnerable population. Further researches are necessary to explain these associations and to explore possible therapeutic interventions. [ABSTRACT FROM AUTHOR]

Objectives Shigellosis is one of the common causes of bacterial diarrhea in children. Seizures are common in shigellosis. It is essential to identify the risk factors of seizure in this disease. Materials & Methods This study was conducted on 224 children with shigellosis. The patients were divided into: With (case groups = 63 cases) and without seizures (control group = 161 cases). Groups were compared regarding different variables such as age, gender, clinical symptoms, and laboratory findings. Data analysis was done using statistical tests and SPSS software. Logistic regression analysis was used to determine the risk factors of seizures. Results Out of 224 cases of children with shigellosis, 107 (47.8%) were male and 117 (52.2%) female. Significant differences were observed between the two groups in terms of age, history of febrile convulsions, frequency of bloody diarrhea, frequency of fever, duration of diarrhea before hospitalization, abdominal pain, increase in BUN, hyponatremia, hypocalcemia, and red blood cell count in stool (P<0.05). Logistic regression analysis showed that a history of febrile seizure, fever, and hyponatremia are the risk factors for seizures in shigellosis. Conclusion This study concluded that a history of febrile seizure, fever, and hyponatremia are risk factors for seizure in childhood shigellosis, thus rapid diagnosis and treatment of childhood shigellosis with risk factors is very important. [ABSTRACT FROM AUTHOR]

Background: Carotid intima medial thickness (CIMT) is a reliable marker for assessing large and medium blood vessel atherosclerosis. This study aimed to investigate the carotid intima-media thickness in children with nephrotic syndrome admitted to Mofid Hospital during 2019-2021. Materials and Methods: This case-control study was conducted in Mofid Hospital for two years (2019-2021). The samples were selected in the case group from hospitalized children with nephrotic syndrome and the control group from hospitalized children without nephrotic syndrome. Results: The mean thickness of the right and left carotid intima-media thickness in the case group was 0.07 ± 0.43 and 0.43 ± 0.07 millimeters, respectively, and these two values were lower and equal to 0.42 ± 0.05 millimeters in the control group, respectively (P-value= 0.02, P-value = 0.016). There was a negative and significant relationship between the level of phosphate and CIMT on the left side, and with an increase of one unit in phosphate, the value of left CIMT decreased by 0.277 times. Also, there was a negative and significant relationship between right CIMT and the level of albumin at discharge time, so with an increase of one unit in albumin, the value of right CIMT decreased by 0.256 times. Conclusion: It is concluded that nephrotic syndrome causes an increase in CIMT and vascular damage in children. The increase of blood albumin and phosphate was associated with the decreased CIMT. [ABSTRACT FROM AUTHOR]

Background Vesicoureteral reflux (VUR) is one of the most important risk factors for urinary tract infection (UTI). Diagnosis and treatment of VUR is important to prevent irreversible complications, such as renal scarring and chronic renal failure. This study was conducted to assess the value of direct radionuclide cystography (DRNC) in the detection of VUR in children with UTI and a normal voiding cystourethrography (VCUG). Methods DRNC was performed in 35 children with a normal VCUG after an episode of febrile UTI who had hydronephrosis or hydroureter, abnormal acute dimercaptosuccinic acid (DMSA) scan results and/or febrile UTI recurrence. This study was conducted in the nephrology department of Mofid Children's Hospital, Tehran (Iran). Results The results were statistically analyzed. Among the 70 ureters studied, 33 (49.1%) were observed to have VUR. Of these, 17 (51.5%) had mild, 14 (42.4%) moderate, and 2 (6.1%) severe reflux. A significant relationship was observed between DRNC results and DMSA renal scan findings (P < 0.05). Conclusions Based on our results, we suggest that DRNC may reveal VUR despite a normal VCUG in children with hydronephrosis, abnormal acute DMSA, and/or recurrent febrile UTI. Keywords Direct radionuclide cystography * Voiding cystourethrography * Vesicoureteral reflux * Children, Introduction Urinary tract infection (UTI) is a very common form of bacterial infection in children, with a prevalence ranging from 2 to 8%. It can present in three forms: acute [...]

Bartter syndrome is a rare genetic disease with 5 subtypes. In Bartter syndrome type 4, patients suffer from deafness and renal dysfunction since infancy. In this report, we introduced a 16-year-old girl with congenital deafness without any previous renal complaints referred to our center due to ankle pain. [ABSTRACT FROM AUTHOR]

Background: Newparameters called the pelvis-cortex (P/C) ratio, and percentage of pelvic improvement (PI) in the anteroposterior diameter (APD) are used for patients with ureteropelvic junction obstruction who have undergone pyeloplasty. Early improvement in these ultrasonic parameters can prevent isotope scanning for a successful repair. Methods: The data of pediatric patients (age range: 0 - 14 years) who underwent open pyeloplasty in Mofid Children Hospital pediatric surgery ward from 2017 to 2021 with follow-up longer than 12 months were analyzed retrospectively. This study encompassed only those children whose ultrasound and Technetium-99m diethylene triamine pentaacetic acid (DTPA) renal information were available before and after surgery. Results: A total of 67 patients meeting inclusion criteria were registered. The mean age at operation was 30 ± 37.44 months. The mean pelvic APD before surgery was 33.93 mm. The mean kidney cortex diameter before surgery was 5.26 ± 2.07 mm. The mean P/C ratio before surgery was 7.56 ± 4.38. The mean preoperative split renal function was documented at 42.23%. The mean follow-up duration was 32 months. The mean APD 3 months after surgery was 18.1 mm. The mean kidney cortex diameter 3 months after surgery was 6.72mm. The mean P/C ratio 3 months after surgery was 3.09. The PI in APD 3 months after surgery was 43.29%. The mean APD 6 months after surgery was 15.43mm. The mean kidney cortex diameter 6 months after surgery was 7.24mm. The mean P/C ratio 6 months after surgery was 2.8. The mean PI in APD 6 months after surgery was 50.83%. The mean postoperative tracer clearance halftime in diuretic renography was 20.77 minutes. In receiver operating characteristic curve analysis, it was observed that PI in APD > 12% in 3 months after surgery versus DTPA 6 months after surgery could predict successful pyeloplasty with sensitivity, specificity, and area under the curve (AUC) equal to 98.44%, 66.67%, and 0.87, respectively. The PI in APD > 26% 6 months after surgery versus DTPA 6 months after surgery could strongly predict successful pyeloplasty with sensitivity and specificity of 100% and AUC of 1. Conclusions: This study identified that PI in APD > 26% at 6 months after surgery can strongly predict successful pyeloplasty and is a strong predictor of surgical outcome. Unnecessary repeated nuclear scans 6 months after surgery can be avoided using the aforementioned parameter. [ABSTRACT FROM AUTHOR]

Background and aims: Contrast-induced renal impairment endangers the patients' health and imposes a financial burden on families and the health care system. Therefore, this study was conducted to examine the rate of nephropathy in patients admitted to Mofid Children's Hospital in 2018 and 2019. Methods: In this cross-sectional study serum creatinine was measured at baseline and 48-72 hours after CT-scan an increase of more than 25% in serum creatinine was considered CIN. Paired sample t-test was used to assess the change in the Cr. The research data were analyzed using SPSS-25 software and the significance level in all tests was set at P = 0.001. Results: In this study, 180 children underwent contrast-enhanced CT-scan with a mean age of 5.72 years, of whom 81 (45%) were girls and 99 (55%) were boys. The mean baseline creatinine was 0.633 ± 0.137 mg / dl, which increased significantly to 0.675± 0.164 mg / dl 48-72 hours after the first measurement. The chance of developing ARF in ciprofloxacin users was 4.86 times higher than patients who did not use this drug. Conclusion: In children underwent CT scan, the incidence of ARF is 17.2%. Ciprofloxacin increases the risk of acute kidney problems by 4.8 times. [ABSTRACT FROM AUTHOR]

Objectives: Nephrotic syndrome is a glomerular disease characterised by a loss of albumin and high-molecular-weight proteins such as thyroxine-binding globulin and thyroid hormones, potentially resulting in subclinical or even overt hypothyroidism. This study aimed to compare thyroid hormone levels between nephrotic children and healthy controls as well as between nephrotic children in the active phase of the disease and those in remission. Methods: This case-control study was conducted between March 2016 and 2018 at a paediatric hospital in Qazvin, Iran. A total of 73 nephrotic children comprised the case group--including 49 with active disease and 24 in remission--while the control group included 74 healthy children. Thyroid function was assessed according to levels of thyroid-stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine (T4), total T4, total T3 and anti-thyroid peroxidase. Results: All of the controls had normal total T4 levels. Elevated TSH levels were more frequent in nephrotic children compared to controls (34.2% versus 10.8%; P = 0.001). A significantly lower number of patients with active disease were euthyroid compared to those in remission (51% versus 95.8%; P = 0.001). Moreover, 7 (9.5%) of patients in the active and no patient in remission phase had abnormal total T4 levels (P <0.001), while 14.3% and 0% had highly elevated TSH levels (P = 0.002). Conclusion: Due to the prevalence of subclinical and even overt hypothyroidism, thyroid screening tests may be required for nephrotic children. However, further research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background and Aim: Urinary tract infection (UTI) is one of the most common and important childhood diseases that may lead to complications such as acute pyelonephritis, renal scaring, and renal failure if not diagnosed and treated properly. The antibiotic resistance rate has increased recently because of unnecessary antibiotic consumption. In order to prescribe an appropriate drug as empirical therapy, it is necessary to know the prevalence of pathogens causing UTI and their antibiotic resistance rate in the community. Therefore, this study was conducted to present an appropriate guideline for UTI empirical therapy through evaluating the rate of antibiotic resistance in a sample of hospitalized patients suffering from UTI. Methods: This retrospective descriptive analytical study was conducted in 130 children with UTI whose medical records included antibiogram results in hospitals affiliated with Shahid Beheshti University during 2016-2017. Results: Of 130 patients, 73.07% were girls and 26.92% were boys. About 50% of the patients were under one-year-old, 33.07% were 1-3 years old, and 16.15% were over 3 years old. The detected pathogens were E. coli in 63.07%, Enterococcus in 14.61%, Klebsiella in 13.07%, Pseudomonas aeruginosa in 5.38%, and Enterobacter in 3.84%. Conclusion: Based on the data of the present study, ampicillin, co-trimoxazole and first-generation cephalosporins are not appropriate for UTI empirical therapy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We aimed to determine the relationship between serum glutathione peroxidase and febrile seizure. MATERIALS & METHODS: In this case-control study, 43 children with simple febrile seizure (case group) were compared with 43 febrile children without seizure (control group) in terms of serum glutathione peroxidase level, measured by ELISA method. This study was conducted in Qazvin Children Hospital, Qazvin University of Medical Sciences in Qazvin, Iran in 2012-2013. The results were analyzed and compared in two groups . RESULTS: From 43 children 24 (53%) were male and 19 (47%) were female in children with simple febrile seizure, and 26 (60%) were male and 17 (40%) were female in febrile children without seizure (control group) (P=0.827). Serum glutathione peroxidase level was 166 U/ml (SD=107) in the case group and 141 U/ml (SD=90.5) in the control group of no significant difference. CONCLUSION: There was no significant relationship between serum glutathione peroxidase and simple febrile seizure. Thus, it seems that glutathione peroxidase, an essential component of antioxidant system, does not play any role in the pathogenesis of simple febrile seizure. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Renal diseases are one of the most common causes of referrals and admissions of children, hence it is important to know their neurological presentations. This study aimed to determine neurological presentations of renal diseases in children. MATERIAL & METHODS: A total of 634 children with renal diseases, admitted to Qazvin Pediatric Hospital, Qazvin, central Iran from 2011 to 2013 were studied. Neurological presentations of patients were established and the results were analyzed using statistical tests. RESULTS: Neurological presentations were found in 18 (2.8%) out of 634 patients, of whom 15 had febrile seizures, two thromboembolism, and one encephalopathy. Among patients with urinary tract infection (UTI), 2.6% had febrile seizures, 11.1% of those with glomerulonephritis had encephalopathy, and 3.7% of those with nephrotic syndrome had cerebral thromboembolism. CONCLUSION: Results showed neurological presentations in 2.8% of children with renal diseases, and febrile seizure as the most common presentation. [ABSTRACT FROM AUTHOR]

This is a report of a 44-month-old baby girl diagnosed as a case of atypical hemolytic uremic syndrome (aHUS) presenting with hematuria, periorbital edema, anemia, thrombocytopenia, and hypertension lacking any history of previous bloody diarrhea. She was treated with plasma infusion followed by plasmapheresis and peritoneal dialysis. After two months, she was discharged in remission undergoing periodic plasmapheresis. Four months later, she was visited for fatigue, tachypnea, and palpitation. Cardiac evaluation revealed dilated cardiomyopathy with an ejection fraction of 15- 20%. She was hospitalized and treated with inotropes and diuretics; one week later, she was discharged in a favorable condition. After six months follow-up, she showed an acceptable renal and cardiac state. It seems that cardiomyopathy can occur as a late and rare complication of HUS. We recommend cardiac evaluation for all patients with HUS at its presentation and in later follow-ups. [ABSTRACT FROM AUTHOR]

We report a six-year-old female child who presented with continued incontinence and a normal physical examination. Urodynamic study was normal and uroflowmetry showed a prolonged low peak flow rate (PFR) in voiding. VCUG revealed left grade ? VUR. Her symptom continued in spite of medical treatment. Finally, MRU showed a single system ectopic ureter with a dysplastic kidney on the right side and a refluxing duplex kidney on the contralateral side. She underwent surgical correction and recovered. [ABSTRACT FROM AUTHOR]

Introduction: The role of urinary Tumor Necrosis Factor Alpha (TNF-a) in the diagnosis and treatment of different disorders has been evaluated recently. This study was conducted to evaluate the correlation of urinary TNF-α with urological abnormalities in pediatric pyelonephritis. Materials and Methods: This prospective study was conducted on children with acute pyelonephritis. Urine samples were tested for TNF-a (ELISA colorimetric, SANQUINE, USA) and creatinine in study group. Renal ultrasonography and voiding cystoureterography were performed in all patients, as well. Results: One hundred pyelonephritic patients were enrolled in the study. Urinary TNF-a/Cr was in an abnormal range in 91.9% of the patients. This query revealed a significant correlation between urinary TNF-alpha and kidney ultrasound results (r=0.59) and grading of reflux in voiding cystoureterography (r=0.128). Furthermore, our study showed a significant difference between the level of urinary TNF-a/Cr in patients with and without abnormality on kidney ultrasonography (p value < 0.000). Conclusions: The results of this study indicate the efficacy of urinary TNF- α in detection of inflammatory disorders such as pyelonephritis and pediatric urological abnormalities. [ABSTRACT FROM AUTHOR]

Objective: A neurogenic bladder is one which functions abnormally due to disorders of sacral nerves that control the bladder's ability to fill, store and empty urine. Abnormal bladder function can cause the bladder to be underactive or overactive. This study was planned to evaluate the treatment outcome of our patients with neurogenic bladder dysfunction (NGBD). Methods: Thirty three patients who have been treated for NGBD were evaluated. Diagnosis was confirmed by voiding-cysto-urethrography (VCUG) and urodynamic study. The patients were treated medically and all had clean intermittent catheterization (CIC). Data regarding age, sex, clinical and paraclinical findings, sonography, imagings, renal scan, associated anomalies, treatment and outcomes were collected and entered in SPSS software version18 and analyzed by descriptive statistical. Findings: Totally 33 patients aged three days to four years (mean 6.8 months) were included in this study. There were 20 (61%) males and 13 (39%) females. Mean follow-up period was 3.4±1.2 years (1.5 months to 5 years). Eighty two precent cases had bilatral and 18% unilatral hydronephrosis and bilatral vesicouretral reflux (VUR) existed in 67% and unilatral in 33% of the patients. Treatment consisted of antibiotherapy and CIC in all patients, which was only in 33% of the cases succesful. The most common associated anomaly was meningomyelocle in 8 patients. Vesicostomy was performed in 22 (67%) cases. Kidney scan showed scar in 10 patients at follow-up study. Complete continence on follow-up was achieved in 24 (71% ) patients, and it was improved in 6 (18% ) cases. Mortality rate was 9% (3 cases). Cure rate was 85% in urinary tract infection, 82.7% in hydronephrosis, 80% in VUR and 86.5% in kidney function. Conclusion: Anticholinergic medications was not effective in all our patients. We believe that permanent vesicostomy is an effective and acceptable surgical intervention for protection of upper urinary tract decompression, especially in those who do not respond to medical treatment and have high risk position. [ABSTRACT FROM AUTHOR]

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood which can contribute to high blood pressure and renal failure later in life. There are diffident methods for evaluation of a child with UTI for differentiation of cystitis from acute pyelonephritis. One of which is measuring protein in urine. The aim of this study is to investigate the role of UTI in provoking proteinuria. Material and Methods: This is Quasi- experimental study, before and after, in patients with acute pyelonephritis in Mofid Children's Hospital during 2004- 2006. All pyelonephritic patients were treated by intravenous ceftriaxone for at least for 10 days. Random urine samples were taken from all patients at the onset of admission before starting the antibiotic and at the ninth day of treatment for the evaluation of urine protein and creatinine. Results: 152 children between 1 to 2 years of age entered the study. The prevalence of proteinuria in the acute phase of pyelonephritis was 94.8%. According to our study the prevalence of proteinuria during pyelonephritis is higher in children less than 2 years old (97.3%) and 20% of patients showed nephrotic range of proteinuria. In all cases random urine samples were normal after completion of treatment (p<0.005). Conclusions: the results of this study illustrate that proteinuria has a high frequency during UTI and acute pyelonephritis. Proteinuria during pyelonephritis may be massive and in the nephrotic range but should not be the cause of concern because in the majority of cases it disappears following treatment. [ABSTRACT FROM AUTHOR]

Objective Febrile seizures are the most common cause of seizure in children. Identification of risk factors is very important. This study was conducted to determine the association between the serum copper level and simple febrile seizure in children. Materials & Methods In this study, 30 children with simple febrile seizures (case group) were compared with 30 children with febrile illness without seizures (control group) regarding serum copper level. This study was conducted in Qazvin children's hospital (Qazvin, Iran). Results The mean serum copper levels in the case and control groups were 141.41±30.90 and 129.43±18.97 mcg/dl, respectively. This difference was not significant statistically. Conclusion This study revealed that there is no association between serum copper levels and febrile seizures. It seems that copper deficiency is not a risk factor for febrile seizures in children. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate serum thyroid hormone levels in epileptic children receiving anticonvulsive drugs. Materials & Methods: In this case- control study, 30 epileptic children who were receiving anticonvulsive drugs (case group) were compared with 30 healthy children (control group). This study was carried out in the Qazvin Children's Hospital (Qazvin, Iran) from October to December 2007. Both groups were matched for age and sex. Thyroid hormone levels were measured using a radioimmunoassay and immunoradiometric assay. Data were analyzed using Chi-square and Student's t-tests. Results: The mean serum T3 and T4 levels in the case group were 2.36 ± 0.73 nmol/L and 95.96 ± 27.01 nmol/L, respectively, and the corresponding values in the control group were 1.88 ± 0.93 nmol/L and 147.46 ± 35.77 nmol/L, respectively. The mean serum thyroid-stimulating hormone (TSH) levels in the case and control groups were 2.73±0.73 mIU/mL and 2.49 ± 2.17mIU/mL, respectively. Conclusions: This study revealed that long-term consumption of anticonvulsive drugs resulted in a decline in serum T4 levels and an increase in serum T3 levels, but had no effect on TSH levels. [ABSTRACT FROM AUTHOR]

Introduction. The role of vitamin A in re-epithelialization of the damaged mucosal surfaces has been documented. The aim of this study was to evaluate the role of vitamin A in preventing renal scaring after acute pyelonephritis in children. Materials and Methods. This clinical trial study was conducted in children with acute pyelonephritis in Mofid Children Hospital (Tehran, Iran). Patients were randomly divided into two groups to receive ceftriaxone and vitamin A or ceftriaxone only. Dimercaptosuccinic acid (DMSA) renal scintigraphy was performed before the start of the treatment and 6 months later. Results were compared for renal scaring between the two groups. Results. Seventy-six patients (11 boys and 65 girls) were enrolled. The mean age was 25 ± 24 months and 54 patients (71.1%) were under 2 years old. The average vitamin A level was 71 ± 24 μg/ dL in the treatment group and it was 62 ± 18 μg/dL in the control group. Baseline DMSA scans were comparable between the two groups in terms of scarring (P = .53), but the second DMSA scans showed a significant change in progression of the renal injury and scaring in the control group compared to those treated with vitamin A as well as antibiotic (P < .001). Conclusions. We found administration of the vitamin A was useful in decreasing the amount of the injury and scarring following the pyelonephritis. Based on our study, vitamin A can be used in conjunction with other treatments in the management of acute pyelonephritis in children. [ABSTRACT FROM AUTHOR]

Objective: Urinary tract is one of the most common sources of infection in children under the age of two years. Many known and unknown risk factors predispose to this important disease in children. This study was conducted to determine whether using a specific type of diaper plays a role in urinary tract infection (UTI) in girls under the age of 2 years. Methods: This case control study was performed in hospitalized children; girls with their first urinary tract infection were selected as cases, and those admitted for other reasons comprised the control group. Two groups were matched for age (±1 month), and other known risk factors for UTI. Type of diapers (superabsorbent, standard disposable and washable cotton), used for these children during six months, from October 2007 to March 2008, were compared in both groups. Findings: Fifty-nine matched pair infant girls less than 2 years were selected. It was revealed that in cases with UTI superabsorbent diapers were used more frequently than in controls (Odds ratio =3.29, P-value=0.005) There were no significant differences in other factors like number of diapers used per day, the time between defecation and diaper change, mothers' educational level, level of family income and mother's occupation. Conclusion: The use of superabsorbent diapers could be a risk factor for urinary tract infection in infant girls. [ABSTRACT FROM AUTHOR]

Journal of Pediatric Nephrology | Volume 8| Number 4| 2020 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. VCUG of the patient A 12-year-old Boy with Urinary Incontinence Dalirani R et al Journal of Pediatric Nephrology | Volume 8| Number 4| 2020 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. 1 Photo Quiz http://journals.sbmu.ac.ir/jpn DOI: https://doi.org/10.22037/jpn.v8i1.32442 A 12-year-old Boy with Urinary Incontinence A 12-year-old boy who was referred with incontinency and recurrent urinary tract infections. [Extracted from the article]

Introduction. Renal disorders have been reported as the underlying cause as well as complications of critical COVID-19 in pediatric patients. The purpose of this study was to investigate the pattern of kidney involvement, particularly acute kidney injury (AKI), among pediatric patients with COVID-19. Methods. In this prospective study, hospitalized pediatric patients with a clinical diagnosis of COVID-19 were enrolled. Demographic, clinical, and laboratory findings were collected and analyzed using a mixed method of qualitative and quantitative approaches and descriptive statistics. Results. One hundred and eighty-seven patients, including 120 (64.2%) males and 67 (35.8%) females with COVID-19 with a median age (interquartile range) of 60 (24 to 114) months were enrolled in this study. Most patients (n = 108, 58.1%) had one or two underlying comorbidities, mainly malnutrition (77.4%), neurologic/learning disorders (21.4%), and malignancy (10.2%). According to the Kidney Disease Improving Global Outcomes (KDIGO) classification, AKI was detected in 38.5% of patients (stage 1: 55.6%, stage 2: 36.1%, and stage 3: 8.3%) at presentation or during hospitalization. Nine patients (4.8%) required hemodialysis and 16 (8.6%) eventually died. There was no significant association between AKI and admission to the pediatric intensive care unit (PICU) (P > .05), a multisystem inflammatory syndrome in children (MIS-C) (P > .05), comorbidities (P > .05), and mortality rate (P > .05). Conclusion. Kidneys are among the major organs affected by COVID-19. Although kidney abnormalities resolve in the majority of pediatric COVID-19 infections, particular attention should be paid to serum creatinine and electrolyte levels in patients affected by COVID-19, particularly children with a history of malnutrition and kidney disorders. [ABSTRACT FROM AUTHOR]

Introduction. Urinary tract infection (UTI) among children is sometimes associated with anorexia and sometimes failure to thrive. Appetite-regulating hormones may be a causative factor. Leptin regulates appetite, food intake, and body weight via hypothalamic melanocortin-4 receptor. Leptin is also a potential cytokine for inflammation. The aim of this study was to evaluate serum and urine leptin before and after treatment of children with UTI. Materials and Methods. In this before-after study, serum and urine leptin were measured in 40 patients with UTI at admission and 5 days after treatment. Pyelonephritis was suggested by signs and symptoms and confirmed with positive urine culture and dimercaptosuccinic acid renal scintigraphy. Other measurements included urinalysis, urine culture, urine creatinine level, complete blood count, erythrocyte sedimentation rate, C-reactive protein level and serum levels of urea, creatinine, glucose, cholesterol, and triglyceride. Results. The mean serum leptin level was 6.85 ± 18.90 ng/mL before the treatment and 8.29 ± 18.30 ng/mL after the treatment, the difference of which was not significant (P = .64). There were significant correlations between serum leptin and age, weight, and C-reactive protein. Urine leptin levels were reduced significantly from 0.75 ± 0.82 ng/mL to 0.46 ± 0.27 ng/mL after the treatment (P = .03). A significant correlation was observed between urine leptin level with age and weight. Conclusions. Serum leptin level did not change significantly after treatment of UTI, but urine leptin significantly decreased. Serum leptin level was higher in patients with anorexia in comparison with children with normal appetite; however, the difference was not significant. [ABSTRACT FROM AUTHOR]

Introductions: The widespread use of prenatal ultrasonography results in increased recognition of congenital hydronephrosis, a therapeutic and diagnostic challenge. This study was conducted to investigate the natural course of prenatal hydronephrosis and the accuracy of postnatal APD in determining the outcome. Materials and Methods: All newborns with prenatal hydronephrosis were followed up by ultrasonography after birth. Voiding cystoureterography, diethylene triaamine pentaacetic acid renal scintigraphy, and dimercaptosuccinic acid renal scintigraphy were done if indicated. The receiver operating characteristic curve was plotted to determine the best cutoff for the anterior-posterior pelvic diameter (APD) to distinguish surgical from spontaneously resolving group. Results: Of 178 neonates, 42 (23%) required surgery. The area under the curve for APD to predict the need for surgery was 0.925 with an APD cutoff of 15 mm. The diagnostic value of APD for determining the need for surgery was determined by sensitivity and specificity of 95.2% and 73.5%, respectively. Conclusions: Postnatal APD on ultrasonography has a valuable diagnostic accuracy for requiring surgery and provides a useful guide for parental counseling. [ABSTRACT FROM AUTHOR]

Introduction. Adrenomedullin (AM) is a 52-amino acid peptide that causes vasodilatation by increased synthesis of nitric oxide. Its production by different cells such as cardiac myocytes, smooth muscle, endothelial, and oncogenic cells is stimulated by inflammatory processes. It has been shown that in the presence of inflammation in the urinary system, concentration of AM increases. In this study, we measured urinary AM in children with acute pyelonephritis before and after treatment and compared its level with that in healthy children. Materials and Methods. In a case-control study, 31 children with clinical and paraclinical documentation of pyelonephritis (case group) and 30 healthy children without pyelonephritis or other infections (control group) were studied. Urinary AM were measured on spot urine samples by high-performance liquid chromatography, and creatinine was measured by spectrophotometry to report the AM-creatinine ratio. Results. Urinary AM-creatinine ratios were 61.3 +/- 119.4 pg/mg and 4.26 +/- 11.4 pg/mg, respectively, in the case and control groups (P = .01). After treatment of pyelonephritis in the patients of the case group, this ratio decreased to 13.1 +/- 21.9 (P = .048). The coefficient correlation between urinary AM and leukocytes count was 0.252 (P = .17). Urinary AM levels were 1896 +/- 1748 pg/dL and 391 +/- 477 pg/dL in the patients with 4+ versus negative C-reactive protein levels, respectively (P = .008). Conclusions. Urinary AM increases in the course of pyelonephritis and decreases significantly after treatment. [ABSTRACT FROM AUTHOR]

Introduction. Urinary tract infection is the most common serious bacterial infection in children. The aim of this study was to compare the value of different laboratory and imaging techniques in detecting renal involvement in acute pyelonephritis. Materials and Methods. In a cross-sectional study of patients 1 month to 14 years of age diagnosed with urinary tract infection were examined with systemic inflammatory markers, renal ultrasonography, voiding cystourethrography (VCUG), and technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA) renal scintigraphy. A total of 1467 pediatric patients were eligible for treatment of pyelonephritis. Evaluations included a complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), urinalysis, urine culture, and measurement of serum blood urea nitrogen and creatinine levels. Results. The results of 99mTc-DMSA scans were normal in 20.2%, mild decreased cortical uptake in 45.0%, moderate decreased cortical uptake in 12.3%, severe decreased cortical uptake in 12.0%, and decreased cortical function plus irregularity or scar formation in 10.5%. Voiding cystourethrography showed vesicoureteral reflux in 25.9%. The sensitivity of 99mTc-DMSA for prediction of vesicoureteral reflux was 84.1% with a negative predictive value of 80.6%. Significant differences were found in the level of blood leukocyte count (P = .03), urine leukocyte count (P = .003), ESR (P = .008), and age (P = .04) between patients with normal and abnormal 99mTc-DMSA scan results. Conclusions. We found that in patient with clinical signs of pyelonephritis, 99mTc-DMSA renal scintigraphy can detect pyelonephritis more accurately than the other inflammatory and imaging tests. [ABSTRACT FROM AUTHOR]

Introduction: In autosomal recessive distal renal tubular acidosis (DRTA), a substantial fraction of the patients have progressive bilateral sensorineural hearing loss. This coexistence is due to the mutations of a gene expressed both in the kidney and in the cochlea. The aim of this study was to assess the correlation between hearing loss and DRTA.Materials and Methods: In this study, 51 children diagnosed with renal tubular acidosis were evaluated. Diagnosis of DRTA was based on clinical manifestations and detection of normal anion gap metabolic acidosis, urine pH higher than 5.5, and positive urinary anion gap. Audiometry was performed in children with DRTA and sequencing of the ATP6V1B1 gene was done for those with sensorineural hearing loss.Results: Twenty-seven patients (52.9%) had DRTA, of whom 51.9% were younger than 1 year old, 55.6% were boys, and 44.4% were girls. Eleven patients (40.7%) had bilateral sensorineural hearing loss, consisting of 5 of 15 boys (33.3%) and 6 of 12 girls (50.0%). There was no correlation between hearing loss and gender. Three patients with hearing loss had mutation in the ATP6V1B1 gene (11.1% of patients with DRTA and 27.3% of patients with DRTA and hearing loss).Conclusions: This study indicated that a significant percentage of the children with DRTA had sensorineural hearing loss and mutation in ATP6V1B1 gene. It is recommended to investigate hearing impairment in all children with DRTA. [ABSTRACT FROM AUTHOR]

Introduction. Tumor necrosis factor-alpha (TNF-α) is an important mediator of the inflammatory response in serious bacterial infections. The aim of this study was to evaluate the potential of urinary TNF-α for diagnosis of acute pyelonephritis in children. Materials and Methods. This study was conducted from March 2006 to December 2007 on children with confirmed diagnosis of acute pyelonephritis. They all had positive renal scintigraphy scans for pyelonephritis and leukocyturia. The ratios of urinary TNF-α to urine creatinine level were determined and compared in patients before and after antibiotic therapy. Results. Eighty-two children (13 boys and 69 girls) with acute pyelonephritis were evaluated. The mean pretreatment ratio of urinary TNF-a to urinary creatinine level was higher than that 3 days after starting on empirical treatment (P = .03). The sensitivity of this parameter was 91% for diagnosis of acute pyelonephritis when compared with demercaptosuccinic acid renal scintigraphy as gold standard. Conclusions. Based on our findings in children, the level of urinary TNF-α-creatinine ratio is acute increased in pyelonephritis and it decreases after appropriate therapy with a high sensitivity for early diagnosis of the disease. Further research is warranted for shedding light on the potential diagnostic role of urinary TNF-α in pyelonephritis in children. [ABSTRACT FROM AUTHOR]

Background: Honey has been used in medicine since ancient times. Limited reports are available to indicate its antibacterial, antiviral, and antidiarrheal properties. This study aimed to determine the effect of honey on acute diarrhea in children., Methods: This randomized clinical trial included 80 children with acute diarrhea. Forty children received honey and zinc gluconate (trial group) and 40 received only zinc gluconate (control group). After treatment, vomiting/diarrhea duration, the recovery time, and the duration of hospitalization were compared between the groups., Results: Among the 40 children in the trial group, 19 were male and 21 were female. In the control group, 25 children were male and 15 female (P=0.26). After initiating treatment, the duration of diarrhea, recovery time, and the duration of hospitalization was significantly shorter in the trial group than in the control group (P<0.05)., Conclusion: This study showed that honey with zinc gluconate reduces the duration of diarrhea, accelerates the recovery time, and shortens the duration of hospitalization.

ackground and aims: Congenital heart disease (CHD) is described as an abnormality in the heart structure or intra-thoracic great vessels that leads to functional problems. Since most of these disorders require medical and surgical interventions identifying concomitant disorders such as renal and urinary tract abnormalities is of great importance in the management of these patients. The present study aimed to investigate the relative frequency of abnormal kidney and urinary tract findings in abdominal cineangiography during cardiac catheterization of patients with CHD in Shahid Modarres Cardiovascular Medical and Research Center., Methods: The present study was performed prospectively on 545 patients aged < 18 years with CHD who underwent cardiac catheterization and concurrent abdominal cineangiography in Shahid Modarres Cardiovascular, Medical and Research Center, Tehran, Iran during a three-year period. The required data were extracted using a researcher-made questionnaire from patients' electronic medical files., Results: Of a total of 545 patients in this study, 26 had both CHD and renal or urinary tract malformation. Patent ductus arteriosus was the most common CHD in patients with renal or urinary tract malformations (odds ratio: 1.2, 95%, CI: 2.25-11.63). In this study, the most common renal and urinary malformations among CHD patients was partial duplication of the kidney followed by Ureteropelvic Junction Obstruction., Conclusion: Since the prevalence of renal and urinary tract malformations is higher in CHD patients, performance of concurrent abdominal cineangiography during cardiac catheterization may lead to early diagnosis and treatment as well as better pre- and post-operative management of patients., (© 2021 Khalilian, Mollatayefeh, Tahouri, Mahdavi, Dalirani, licensee HBKU Press.)

Purpose: The present study aimed to determine the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and Urinary tract infections (UTIs) in children., Methods: In this case-control study, 70 children with UTI (case group) were compared with 70 healthy children (control group) in terms of serum 25(OH)D levels. The children were between 1 month and 12 years of age. Serum 25(OH)D levels were measured using enzyme-linked immunosorbent assay (ELISA). The results were analyzed and compared between both groups., Results: Among 70 children with UTI (case group), 5 children (7.2%) were male and 65 (92.8%) were female. Among the healthy children (control group), 9 (12.8%) and 61 children (87.2%) were male and female, respectively ( P =0.39). The mean±standard deviation of age in the case and control groups were 53.2±35.6 and 36.1±60.2 months, respectively ( P =0.24). The mean level of serum 25(OH)D in the case group was significantly higher than that of the control group (20.4±8.6 ng/mL vs. 16.9±7.4 ng/mL, P =0.01)., Conclusion: This study showed that there was a relationship between serum 25(OH)D levels and UTI in children. It seems that 25(OH)D plays a role in the pathogenesis of UTI., Competing Interests: Conflicts of interest: No potential conflict of interest relevant to this article was reported.

Objective: A neurogenic bladder is one which functions abnormally due to disorders of sacral nerves that control the bladder's ability to fill, store and empty urine. Abnormal bladder function can cause the bladder to be underactive or overactive. This study was planned to evaluate the treatment outcome of our patients with neurogenic bladder dysfunction (NGBD)., Methods: Thirty three patients who have been treated for NGBD were evaluated. Diagnosis was confirmed by voiding-cysto-urethrography (VCUG) and urodynamic study. The patients were treated medically and all had clean intermittent catheterization (CIC). Data regarding age, sex, clinical and paraclinical findings, sonography, imagings, renal scan, associated anomalies, treatment and outcomes were collected and entered in SPSS software version18 and analyzed by descriptive statistical. Findings : Totally 33 patients aged three days to four years (mean 6.8 months) were included in this study. There were 20 (61%) males and 13 (39%) females. Mean follow-up period was 3.4±1.2 years (1.5 months to 5 years). Eighty two precent cases had bilatral and 18% unilatral hydronephrosis and bilatral vesicouretral reflux (VUR) existed in 67% and unilatral in 33% of the patients. Treatment consisted of antibiotherapy and CIC in all patients, which was only in 33% of the cases succesful. The most common associated anomaly was meningomyelocle in 8 patients. Vesicostomy was performed in 22 (67%) cases. Kidney scan showed scar in 10 patients at follow-up study. Complete continence on follow-up was achieved in 24 (71% ) patients, and it was improved in 6 (18% ) cases. Mortality rate was 9% (3 cases). Cure rate was 85% in urinary tract infection, 82.7% in hydronephrosis, 80% in VUR and 86.5% in kidney function., Conclusion: Anticholinergic medications was not effective in all our patients. We believe that permanent vesicostomy is an effective and acceptable surgical intervention for protection of upper urinary tract decompression, especially in those who do not respond to medical treatment and have high risk position.

Introduction: The aim of this study was to assess urinary interleukin-8 (IL-8) levels in pyelonephritis and its relation with the clinical course of the infection and of inflammatory changes detected by renal scintigraphy., Materials and Methods: In this quasi-experimental before-after study, we evaluated 91 children aged 1 to 144 months (mean 34.4 +/- 35.2 months) with pyelonephritis. Inflammatory markers including erythrocyte sedimentation rate, C-reactive protein, leukocyte count, and urinary IL-8, together with the results of ultrasonography, voiding cystourethrography, and dimercaptosuccinic acid renal scintigraphy were evaluated in these children. The ratios of urinary IL-8 to creatinine (IL-8/C) before and after the treatment were compared with each other., Results: Urinary IL-8/C levels were significantly higher after the empirical treatment in comparison with those before the treatment (0.19 +/- 0.21 versus 0.51 +/- 0.53, P < .001). No correlation was found between the urinary IL-8 levels and leukocyturia, urine culture results, other inflammatory markers, or findings of imaging examinations., Conclusions: We found high urinary IL-8 levels in children with pyelonephritis. We also documented its increasing after the treatment. We conclude that evaluation of urinary IL-8 can be a noninvasive test for diagnosis of upper urinary tract infection and its response to treatment.