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Background: Vesico‐ureteral reflux (VUR) is considered to be a risk factor for recurrent febrile urinary tract infections and impaired renal transplant survival. Methods: An online survey supported by the European Society for Paediatric Nephrology was designed to evaluate current management strategies of VUR in native and transplanted kidneys of recipients aged <18 years. Results: Seventy‐three pediatric transplant centers from 32 countries contributed to the survey. All centers performed urological evaluation prior to pediatric kidney transplantation (KTx) with subsequent interdisciplinary discussion. Screening for VUR in native kidneys (30% in all, 70% in selected patients) led to surgical intervention in 78% (11% in all, 89% in selected patients) with a decided preference of endoscopic intervention over ureterocystoneostomy. Following KTx, continuous antibiotic prophylaxis was applied in 65% of the patients and screening for allograft VUR performed in 93% of selected patients. The main management strategies of symptomatic allograft VUR were continuous antibiotic prophylaxis (83%) and surgical treatment (74%) (endoscopic intervention 55%, redo ureterocystoneostomy 26%). Conclusions: This survey demonstrates the high variability in the management of VUR in pediatric KTx recipients, points to knowledge gaps, and might serve as a starting point for improving the care for patients with VUR in native and transplanted kidneys. [ABSTRACT FROM AUTHOR]

Introduction: Few data are available on the clinical utility of new red cell parameters for detecting anemia in children with inflammatory diseases. The aim was to investigate the utility of three new red cell parameters for distinguishing functional iron deficiency (FID) from absolute iron deficiency (AID) in children with familial Mediterranean fever (FMF). Methods: The study involved 198 children with genetically confirmed FMF and 18 healthy‐age and sex‐matched controls. Complete blood counts with the new red cell parameters of low hemoglobin (Hb) density (LHD), microcytic anemia factor (MAF), and red blood cell size factor (RSF) were measured in a Unicel® DxH800, along with conventional iron parameters. The FMF patients' medical records were retrospectively reviewed to assess inflammation status and genetic results. Results: The frequencies of FID and AID among the 198 FMF patients were 35% and 65%, respectively. Among patients with homozygous MEFV mutation, FID was more common than AID (P < 0.05). Mean LHD was significantly higher and mean Hb, MCV, MAF, and RSF were significantly lower among the FMF patients with FID compared to those with AID and controls (P < 0.05). Specificity for distinguishing FID from AID in children with FMF was greatest for MAF (92%; 95% confidence interval [CI] 85%‐96%), followed by LHD (85%; 95% CI 76%‐91%) and RSF (81%; 95% CI 72%‐88%). Conclusion: The new red cell parameters measured by the Unicel® DxH800 may be useful for guiding physicians in distinguishing FID from AID in children with FMF. [ABSTRACT FROM AUTHOR]

This study aims to evaluate BMD and bone biomarkers and to investigate the effects of immunosuppressives on bone disease after RTx. Thirty-three RTR aged 16.7 ± 3.7 yr and healthy controls (n = 32) were enrolled. There was no difference between pre- RTx BMD and BMD at the time of study (45.9 ± 30.9 months after RTx), while both values were lower than controls (p < 0.01 and p < 0.05, respectively). Worst BMD scores were obtained at sixth month after RTx (−0.2 ± 0.9) and best at fourth year (1.4 ± 1.3). 25-hydroxy-( OH) vitamin D and OPG were higher in RTR (p < 0.001). BMD z scores negatively correlated with OPG and cumulative CS doses at the time of study ( r = −0.344, p < 0.05 and r = −0.371, p < 0.05, respectively). Regression analysis revealed OPG as the only predictor of BMD (β −0.78, 95% CI −0.004 to −0.013, p < 0.001). The increase in OPG, a significant predictor of BMD, could either be secondary to graft dysfunction or for protection against bone loss. CS doses should be minimized to avoid their untoward effects on bone metabolism. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to perform a multicenter investigation in Turkish children on chronic peritoneal dialysis by examining the rates of peritonitis as well as causative organisms according to year. Methods: Twelve pediatric renal units participated in this study and data were obtained by review of the medical records. Results: One hundred and thirty-two patients were on continuous ambulatory peritoneal dialysis (CAPD), 21 were on automated peritoneal dialysis (APD) and 59 were on CAPD and APD at different times. Mean durations of CAPD and APD were 24.2 ± 21.1 months and 22.9 ± 12.8 months, respectively. Seventy-one (33%) out of 212 patients had no peritonitis episode. Overall peritonitis rate was one episode per 15.5 patient-months. The peritonitis rate was one episode per 15.4 patient-months for APD and one episode per 15.6 patient-months for CAPD. Coagulase-negative staphylococcus was the most common cause of peritonitis among patients with positive culture (20.6%). While the incidence of Gram-negative infection remained unchanged according to year in patients on CAPD ( P = 0.68), the rate of Gram-negative peritonitis in children on APD was significantly higher ( P = 0.03). Conclusions: Peritonitis rate was similar in CAPD and APD, but the risk of Gram-negative peritonitis in APD was higher than that of CAPD. [ABSTRACT FROM AUTHOR]

ADPN, a recently discovered adipocytokine, has attracted great attention because of its anti-atherogenic properties. It was suggested as a protective factor for the cardiovascular system because of its close correlation with several risk factors. Our aim was to investigate serum ADPN levels in pediatric RTR and to document possible relationships between ADPN and arteriosclerotic risk factors. Twenty-one RTR, aged 16.3 ± 4.0 yr, and 23 healthy age and sex-matched control subjects were enrolled in this study. Serum lipid/lipoprotein fractions, homocysteine and ADPN levels as well as intima-media thickness of the cIMT were determined in both groups. Significantly higher serum ADPN (p < 0.001) and homocysteine (p < 0.05) levels as well as higher cIMT (p < 0.001) were found in RTR compared with the control subjects, whereas apolipoprotein B and lipoprotein (a) levels were not significantly different. HDL cholesterol was positively correlated with log ADPN ( r = 0.585, p < 0.01). There were inverse correlations between log time post-transplantation and log ADPN as well as HDL cholesterol ( r = −0.438, p < 0.05 and r = −0.578, p < 0.05, respectively). There were no correlation between log ADPN, log homocysteine, log apolipoprotein B, lipoprotein (a), creatinine clearance and cumulative steroid dose. Despite reasonable lipid profiles and remarkably elevated ADPN levels, our pediatric RTR with stable graft function displayed a risk for arteriosclerosis because of increased cIMT and mild hyperhomocysteinemia. Regarding the close positive correlation between ADPN and HDL cholesterol, it could be speculated that ADPN is a novel negative surrogate marker of arteriosclerosis. To our knowledge, this is the only report investigating levels and diverse correlates of ADPN in a pediatric RTR group. Further studies in larger groups of recipients are needed to clarify the interaction between arteriosclerotic risk factors and ADPN. [ABSTRACT FROM AUTHOR]

Abstract Background : Cardiovascular complications are the most frequent cause of death in patients with end-stage renal failure (ESRF). We aimed to investigate systolic and diastolic functions in children with ESRF. Methods : Thirty-nine children with ESRF (17 on continuous ambulatory peritoneal dialysis (CAPD), eight on hemodialysis and 14 on predialysis) were examined to assess systolic and diastolic functions by echocardiography and ultrasound Doppler. Left ventricular systolic and diastolic functions were measured both in patients and age-matched healthy controls (n = 20) and the indices of cardiac performance were compared. Results : Increased left ventricular mass index (LVMI) and decreased volume/mass ratio with normal systolic left ventricular function was found in patients, as compared with controls. Left ventricular diastolic dysfunction was observed in dialysis patients. In most of these patients, left ventricular isovolumic relaxation time was prolonged, except in CAPD patients. The peak of late diastolic flow (A) velocities were increased with a reduction of the early diastolic flow velovity (E) – the E/A ratio. The E velocities were unchanged in all patients as compared with controls. Our data indicated an abnormality of myocardial relaxation in patients with ESRF. We found no relationship between E/A ratio and LVMI. Among three groups of patients, the LVMI and diastolic abnormalities were highest in the hemodialysis group indicative of poor control of hypervolemia and hypertension. Conclusions : The technique of CAPD has some advantages as a renal replacement therapy for preserving cardiac functions as compared with hemodialysis. However, it must be remembered that patients with hemodialysis have features that effects cardiac status, such as higher volume load and higher afterload (hypertension). [ABSTRACT FROM AUTHOR]

Abstract: Measles is a rare communicable disease which may be fatal in renal transplant patients. Herein we present a patient with renal transplantation who had measles and who subsequently developed subacute measles encephalitis 4 months later. We recommend all children with chronic renal failure be vaccinated against measles before transplantation. [ABSTRACT FROM AUTHOR]

Presents a case study on the treatment of fungi balls in infancy. Background on the case report; Discussion on the case study.