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Introduction: Nephrotic syndrome (NS) is characterized by swelling, proteinuria, hypoalbuminemia, or hyperlipidemia. The incidence of NS depends on the country and ethnicity and is highest in Asia than in Europe. Nephrotic syndrome can cause complications such as arterial thromboembolism (ATE) due to a hypercoagulable state. Case Presentation: We encountered a 9-year-old boy with NS and infarct stroke, which was treated with corticosteroid and low molecular weight of heparin with clinical improvement. Conclusions: We recommend that all NS children with high platelet levels perform thromboelastography (TEG) examination and use prophylactic anticoagulation with monitoring of bleeding risk during therapy.

BACKGROUND: Kidney manifestations are life-threatening conditions, such as end-stage kidney disease, notably when caused by viral infections. The severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), is an emerging global health problem, potentially affecting all organs, including the kidney. Most reports on kidney manifestations were focused on the adult and elderly population but limited on children. AIM: This study aims to analyze the association between kidney function and the severity of the disease of pediatric patients suffering from COVID-19. METHODS: From March 2020 to March 2021, an observational analytic study was conducted in Hasan Sadikin General Hospital, Bandung, Indonesia. The demographic data, clinical signs, laboratory results, and notable kidney function were analyzed, and based on its clinical appearance the disease was classified as severe and non-severe. Subsequently, the Mann–Whitney test for nonparametric was used to analyze the collected data. RESULTS: In this study, 40 COVID-19 children were selected as the subjects, and the median estimated glomerular filtration rate (eGFR) value in the severe group was discovered to be lower (88.2 mL/min/1.73 m2) compared to the non-severe (124.4 mL/min/1.73 m2), it was statistically significant (p = 0.041). There was no difference in hemoglobin and leukocyte values between the two groups (p > 0.05). Furthermore, the CRP and NLR results showed no difference between the groups (p > 0.05). CONCLUSION: A severe SARS-CoV-2 infection correlates with kidney function, which was manifested by a lower median eGFR value in the severe compared to the non-severe group.

Background Nephrotic syndrome causes loss of medium-sized plasma proteins and binding proteins, resulting in thyroid hormone deficiency. Objective To assess for potential correlations between subclinical hypothyroidism in pediatric nephrotic syndrome with albumin, globulin, and proteinuria. Methods This cross-sectional study was conducted in the Department of Pediatrics, Hasan Sadikin General Hospital, Bandung, West Java. All types of nephrotic syndrome patients aged 1 month to < 18 years were included. Blood and urine specimens were collected from the patients for albumin, globulin, thyroid function (T3, fT4 and TSH), and proteinuria tests and analyzed with standard techniques. Results There were 26 subjects, 20 males and 6 females. Ten subjects developed subclinical hypothyroidism, with mean albumin and thyroid-stimulating hormone (TSH) levels of 0.92 g/dL and 6.9 mIU/L, respectively. There was a negative correlation between albumin level and subclinical hypothyroidism (rpb=-0.702; P

Dany Hilmanto,1 Fitriana Mawardi,2 Ayuningtyas S Lestari,3 Ahmedz Widiasta1 1Division of Nephrology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Community and Family Medicine Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Yogyakarta, Indonesia; 3Nursing Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Yogyakarta, IndonesiaCorrespondence: Dany Hilmanto, Division of Nephrology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, 38 Jalan Professor Eyckman, Pasteur, Sukajadi, Bandung, West Java, Indonesia, Email danyhilmanto@yahoo.comIntroduction: Nephrotic syndrome (NS) is one of the most common childhood kidney diseases. During the active phase, the disease pathogenesis affects various biological functions linked to loss of proteins negatively, which can result in systemic complications. Complications of childhood NS are divided into two categories: disease-associated complications and drug-associated complications. However, complications in pediatric patients with NS, especially disease-associated complications are still limited. Although reported in the literature, information is not comprehensive and needs to be updated. This study aimed to systematically assess systemic complications in children with NS, especially disease-associated complications, to better understand how they impact outcomes.Methods: We conducted a systematic search of several databases: BioMed Central Pediatrics, PubMed, Google Scholar, the National Library of Medicine, Cochrane Library, CINAHL/EBSCO, British Medical Journal, Science Direct, Scopus, and Elsevier’s ClinicalKey. We followed the PRISMA guidelines to plan, conduct, and report this review. We used the Joanna Briggs Institute’s critical appraisal tools for assuring the quality of the journal articles that were chosen.Results: Eleven articles concerning complications in childhood NS were analyzed. Systemic disease-associated complications in covered were cardiovascular complications, infections, thyroid-hormone complication, kidney complications, and oral health complications.Conclusion: NS is marked by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia, which can result in systemic disease-associated complications. Cardiovascular complications, infections, thyroid-hormone complications, kidney complications, and oral health complications are the main systemic complications in childhood NS. It is essential that health-care providers prevent these complications for proper maintenance of patients’ health.Keywords: disease complications, nephrotic syndrome, pediatric, systemic complications

Steroid-resistant nephrotic syndrome (SRNS) is a burden in the country due to the progressive severity of chronic kidney disease (CKD). Calcineurin inhibitors (CNIs) or monoclonal antibodies are currently recommended for the treatment of this disease. In developing countries, steroid and cyclophosphamide (CPA) are available drugs used during the treatment. This study aims to provide a non-invasive modality that can be used to predict the response of SRNS children to CPA therapy. Subsequently, the proteinuria duration was shortened to reduce the risk of glomerular damage. The present study aims to determine whether there is a correlation between baseline serum TGFB and proteinuria in SRNS children six months after receiving CPA treatment. The author hypothesized that there would be a negative correlation between those variables.A prospective-cohort-study was conducted at Hasan Sadikin General Hospital Bandung, Indonesia. A total of 88 SRNS children, aged 1 to 18 were accessed for serum TGF-β level before receiving CPA therapy for six months, and clinical signs were observed. Furthermore, after six months of CPA treatment, the subjects were divided into CPA responder and non-responder based on the presence of proteinuria, then the data were analyzed using multiple logistic regression to adjust age and gender.There was a statistically significant relationship between TGF-β and the risk of non-response to CPA therapy, after accounting for age, gender, baseline GFR, baseline ureum, and baseline urinary protein, the adjusted-OR was 1.051 (95% CI 1.007, 1.097, p = 0.022).The high level of serum TGF-β obtained prior to CPA administration are reliable data for estimating adverse results on CPA therapy. Based on these results, a high baseline TGF-β level correlates with the poor response of CPA therapy.

Persistent proteinuria in children is a silent killer as it potentially of being progressive severity of chronic kidney disease (CKD). Monoclonal antibodies are currently recommended for the treatment of this disease. In some developing and low socioeconomic countries, the aforementioned agents are nearly impossible to be given. Also, the COVID-19 disease has a huge impact in all countries in the world, including in nephrology and other immunocompromized patients in children. The problems caused by this disease are also exacerbated by the economic conditions of poor and developing countries. It is challenging for clinicians in poor and developing countries to take advantage of alternative modalities for the management of the disease. Therapeutic plasma exchange (TPE) is a very useful modality for the management of diseases that require clearance of proteins with a certain molecular weight. Diseases that require TPE in pediatric nephrology field is glomerular disease either related to autoimmune diseases or not. Evidence about the success of COVID-19 treatment with TPE has also been widely reported by researchers in various parts of the world. This article aims to analyze in detail the benefits of TPE in overcoming this pandemic, as well as knowing the very appropriate timing for plasmapheresis in this disease.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for coronavirus disease (COVID-19), potentially have severe kidney adverse effects. This organ expressed angiotensin-converting enzyme 2 (ACE2), the transmembrane protein which facilitate the entering of the virus into the cell. Therefore, early detection of the kidney manifestations of COVID-19 is crucial. Previous studies showed ACE2 role in various indications of this disease, especially in kidney effects. The MicroRNAs (miRNAs) in this organ affected ACE2 expression. Therefore, this review aims at summarizing the literature of a novel miRNA-based therapy and its potential applications in COVID-19-associated nephropathy. Furthermore, previous studies were analyzed for the kidney manifestations of COVID-19 and the miRNAs role that were published on the online databases, namely MEDLINE (PubMed) and Scopus. Several miRNAs, particularly miR-18 (which was upregulated in nephropathy), played a crucial role in ACE2 expression. Therefore, the antimiR-18 roles were summarized in various primate models that aided in developing the therapy for ACE2 related diseases.

BackgroundKidney manifestations are life-threatening conditions, such as end-stage renal disease (ESRD), especially when attributed to viral infections. The severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), is an emerging health problem worldwide, potentially affecting all organs, including the kidney. Most reports on kidney manifestations were conducted mostly on the adult and elderly population, and limited on children. Therefore, this study aims to analyse the correlation between kidney manifestations with the renal function of pediatric patients suffering from COVID-19.MethodsAn observational analytic study was conducted in Hasan Sadikin General Hospital, Bandung, Indonesia, from March to August 2020. The demographic data, clinical signs, laboratory results, and notable kidney function were analysed, while the disease was classified as severe and nonsevere based on its clinical appearance. The Mann-Whitney test for nonparametric was used to analyze the collected data. Results. In this study, 16 COVID-19 children were selected as the research subjects, the median eGFR value in the severe group was lower (49.59 ml / minute / 1.73m2) compared to the nonsevere (113 ml / minute / 1.73m2), however, not statistically significant (p = 0.521). Significant high CRP and low thrombocyte levels were found in severe SARS-CoV-2 infection (pConclusion. A severe SARS-CoV-2 infection tends to affect the kidney, which is manifested as decreased glomerular filtration rate (GFR).

Urinary tract tuberculosis (TB) is a rare extrapulmonary manifestation of TB in children. The disease is potentially underdiagnosed because it clinically resembles other urinary tract infections. A 13-year-old adolescent girl presented with pain, difficulty in micturition, and gross hematuria for almost two years before admission, and she had left flank pain since one year ago and significant loss of body weight during the illness. The close TB contact was her grandmother who was on TB treatment. Acid-fast bacilli yielded positive result, Mantoux test was positive (17 mm), urine GeneXpert MTB/Rif was positive; tuberculoma was identified on kidney histopathology, and a diuretic renogram revealed an uncorrected glomerular filtration rate (GFR) of the right and left kidney to be 32.5 mL/min/1.73 m2and 5 mL/min/1.73 m2, respectively. During the treatment, oral anti-TB drug-induced hepatotoxicity (ADIH) occurred to the patient. This problem was solved with management according to the British Thoracic Society (BTS) guidelines. Screening TB in children is very important for a better outcome. If children complain of some complicated urinary tract infection, TB should be suspected. Optimaly treating children with urinary tract TB exagerrated with ADIH and CKD is very challenging.

Background Diabetic Ketoacidoasis (DKA) is associated with significant morbidity and mortality and probably could be prevented by earlier diagnosis of diabetes mellitus (DM) and intervention. The level alertness of primary care doctors and knowledge on DM play a role to prevent severe complication of DKA. Objective