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Objective: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are very rare in childhood with an increased risk of morbidity and mortality. We aimed to evaluate renal prognostic factors in childhood AAV from the perspective of ANCA serotype, histopathological classification, and five-factor score (FFS).Methods: Pediatric AAV patients from 11 referral centers in Turkey had been included to the study. The demographics, clinical findings, AAV subtypes, outcomes, and FFS were evaluated retrospectively. Kidney biopsies were classified histopathologically.Results: Totally, 39 patients were enrolled in the study. Among all patients, 74.4% had renal involvement, 56.4% ear-throat-nose involvement, and 51.3% had musculoskeletal involvement. Proteinase 3 (PR3)-ANCA was positive in 48.7%, and myeloperoxidase (MPO)-ANCA was positive in 30.8%. 69.2% of patients had impaired renal function, and 28.2% had progressed to end-stage renal disease (ESRD) during the follow-up. At the time of diagnosis, FFS was ≥ 2 in 53.8%. The most common histopathologic classifications were as follows: crescentic type in 40.7% and sclerotic type in 25.9%. Gastrointestinal and renal involvement, MPO-ANCA positivity, serum creatinine levels, and impaired renal function during the follow-up were significantly higher in patients with FFS ≥ 2, compared to patients with FFS < 2. Patients with FFS ≥ 2 had more common crescentic, mixed and sclerotic histopathologic findings in biopsies. By logistic regression analysis forward method, the strongest single-risk factor among all the parameters was the initial level of creatinine in patients with ESRD, compared to the other patients (p = 0,007).Conclusions: Evaluation of the FFS, ANCA serology, and the creatinine levels may help to predict renal prognosis. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to assess renal outcomes of delayed diagnosis of dilating primary vesicoureteral reflux (VUR) following recurrent febrile urinary tract infections (fUTIs) and its diagnostic imaging procedures. Material and methods: The medical records of patients who underwent ultrasonography (US), non-acute dimercaptosuccinic acid (Tc-99mDMSA) scintigraphy and voiding cystourethrography (VCUG), and who were older than 2 years at the time of VUR diagnosis were retrospectively reviewed. Results: A total of 32 children (female, n=27: 84.4%) with a mean age of 7.67±3.34 years at the time of diagnosis of VUR were included in the study. Grade III, IV, V VUR were found in 22%, 69%, and 9% of the patients, respectively. At the time of VUR diagnosis, abnormal US findings were detected in 75% of the cases. Tc-99mDMSA detected abnormalities in 83.9% (7 with a single scar, 7 with multiple lesions, 12 with reduced kidney function) of the patients. Estimated glomerular filtration rate of 3 patients with bilateral grade IV VUR was <75 mL/min/1.73 m². In 5 patients (16%), VUR could not be predicted by US+DMSA scintigraphy (Grade IV VUR in 3 and Grade III in 2 cases ). The sensitivity in predicting VUR was 75.00% (95% CI: 56.60-88.54) and 83.87% (95% CI: 66.27-94.55), respectively, for US alone and combined US+DMSA. Conclusion: VCUG should be performed routinely in addition to US and non-acute DMSA in all children referred with recurrent fUTIs. Awareness of childhood UTI in public and healthcare personnels should be increased in order to refer these patients at a early stage to pediatric urology and nephrology units. [ABSTRACT FROM AUTHOR]

The article provides answers to questions concerning proteinuria in a male adolescent with hearing loss.

Introduction: Micromethod erythrocyte sedimentation rate (MESR) correlates classic Westergren method in newborn. In literature, MESR or microsedimentation rate has been studied especially newborn infections. Some of them showed that this test is more valuable in the sepsis screening and predicting the presence of infection in neonates .To investigate diagnostic evaluation of MESR in infections as its fast, easy, economic method and the relation between other acute phase reactant parameters. Material and Methods: A total 31 patient and 24 healthy children were admitted in this study in Suleyman Demirel University Medical Faculty Department of Pediatric. The patient group had various infections included 14 lower respiratory tract infection, 8 upper respiratory tract infection, 6 urinary tract infection, 3 gastrointestinal infection. The control group had no acute or chronic infections, no history taken any drugs. We performed same tests (Westergren sedimentation and MESR, CRP, WBC, fibrinogen) into two groups. There is no statistical significant between two groups as age and sex. Results: There was no statistically significant difference of age (p=0.59) and sex (p=0.18). between two groups. Sedimentation was 11.75±5.87 mm/h (4-24) in control group, 59.48±26.42 mm/h (10-109) in patient group (p<0.01). MSER was 14.08±5.35 mm/h (4-24) in control group, 32±11.31 (12-60) mm/h in patient group (p<0.01). Mean of sedimentation rate, MESR, CRP, WBC, and fibrinogen were significantly higher in patient group(p<0.01). Conclusion: In several studies, the MESR values higher than the macromethod at values but this difference is not of sufficient magnitude at the clinical decision level . In our study, MESR was as sensitive and specific as erythrocyte sedimentation rate in the patient group than control group. Also, MESR is more practical as it is a simple and quick test which does not need venous sample. [ABSTRACT FROM AUTHOR]

The article discusess the treatment of nunchausen syndrome on an adolescent presenting with acquired acute renal damage. It mentions about the effectivness of laboratory and imaging findings in diagnosing the same; and impact of detailed medical history and systemic examinations in confirming the laboratory test results are also important.

A quiz is presented on an adolescent presenting with acquired acute renal damage.