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To review the most relevant clinical studies that evaluate kidney damage in children with primary vesico-ureteral reflux (VUR), we reviewed and compared randomized controlled trials and clinical trials from scientific literature. In these studies, vesico-ureteral reflux was diagnosed by voiding cystourethrogram and kidney damage was assessed by either DMSA scan or urography. Relative risk with 95% confidence intervals was calculated using Review Manager Software (The Cochrane Collaboration, 2000). The overall relative risk of kidney damage shown by DMSA scan and urography was statistically higher in children with vesico-ureteral reflux of various degrees than in controls (3.7 times and 2.8 times, respectively). However, in high-grade VUR, the relative risk of congenital kidney damage was 5.6 times that of controls. We conclude that severe VUR is frequently associated with early kidney damage, perhaps with prenatal onset. Progression of kidney damage may depend on the severity of VUR and untreated urinary tract infections. Prevention of congenital kidney damage from severe VUR is possible when there is early intervention, even during fetal growth.

Tautomerism of the nucleobase uracil is characterized in the gas phase through IR photodissociation spectroscopy of singly hydrated protonated uracil created with tandem mass spectrometric methods in a commercially available Fourier transform ion cyclotron resonance mass spectrometer. Protonated Uracil ions generated by electrospray ionization are re-solvated ill a low-pressure collision cell filled with a mixture of water vapor seeded in argon. Their structure is investigated by IR photodissociation spectroscopy in the NH and OH stretching region (2500-3800 cm(-1)) with a tabletop IR laser Source and in the 1000-2000 cm(-1) range with a free-electron laser. In both regions the IR photodissociation spectrum exhibits well-resolved spectral signatures that point to the presence of two different types of structure for monohydrated protonated uracil, which result from the two lowest-energy tautomers of uracil. Ab initio calculations confirm that no water-catalyzed tautomerization occurs during the re-solvation process, indicating that the two protonated forms of uracil directly originate from the electrospray process.

From the 1980s, the computer controlled Wilhe1my experiment has been the common method to measure contact ang1es. The typical samp1es have parallelepiped shapes and are relative1y flat and homogeneous, and the test liquids are not very viscous. Some results have been published for more complex and asymmetric shapes or for more complex experimental situations. However, one of the commonest difficulties in experiments using porous samples is the absorption of the liquid. In the case of porous stones, w o od or nonwoven fabrics the results can be doubtful because of significant absorption ofthe test liquid and swelling ofthe sample. In the present papera new procedure is presented for correctly using the Wilhemy experiments on porous samples. The method consists in simple modelling of the Washburn-like mechanism of absorption and i t produces consistent results. Some experiments are presented and analysed for calcareous stones, different kinds of woods and non-wo.ven fabrics. A companion paper explores the possible use ofthe Washburn equation in estimating the contact angles.

The control of the protective efficacy obtained on the stone by treatments with polymers is commonly performed though the measure of the static contact angle. The measurement of the true equilibrium angle obtained through a new technique called VEICA, and the measure of the receding contact angle give more coherent parameters which better correlate with the data of absorption of awter by capillarity. The equilibrium contact angle corresponds to an average description of the surface, the receding angle corresponds, by excess, to the condition of maximum penetration of the liquid by capillarity.

Actually, unilateral obstruction is not indicated for surgery, especially if renal function is unaffected. This retrospective study focused on the renal function after pyeloplasty for unilateral obstruction in children.Twenty-nine children were retrospectively reviewed. To compare the ultrasound readings in patients with different ages, the comparative-length-index (index) of each renal unit (RU) was calculated. MAG3 dynamic scintigraphy was applied to diagnose any obstructions.Children with left obstruction were younger than children with right obstruction, when surgery was performed. Scintigraphic scan of right RUs with obstruction operated later was a lower at diagnosis than jet of the normal contralateral. Normal scintigraphic scan at diagnosis of left RUs with obstruction operated early revealed that RU was slightly reduced after the operation. At both diagnosis and follow-up the index between obstructed RUs and normal contralateral was comparable, even if it was significantly higher in left obstructed RUs. At follow-up, however, the scintigraphic scan revealed that RUs were more reduced in patients who were treated late.Early pyeloplasty partially safeguard kidney function in children with unilateral obstruction, whose renal function was normal at birth. The reduced kidney function observed before surgery was not proportionally improved after surgery with respect to the contralateral that was not affected.

Background Autosomal dominant neurohypophyseal diabetes insipidus (adNDI) is caused by arginine vasopressin (AVP) deficiency resulting from mutations in the AVP-NPII gene encoding the AVP preprohormone. Aim To describe the clinical and molecular features of Italian unrelated families with central diabetes insipidus. Patients and methods We analyzed AVP-NPII gene in 13 families in whom diabetes insipidus appeared to be segregating. Results Twenty-two patients were found to carry a pathogenic AVP-NPII gene mutation. Two novel c.173 G>C (p.Cys58Ser) and c.215 C>A (p.Ala72Glu) missense mutations and additional eight different mutations previously described were identified; nine were missense and one non-sense mutation. Most mutations (eight out of ten) occurred in the region encoding for the NPII moiety; two mutations were detected in exon 1. No mutations were found in exon 3. Median age of onset was 32.5 months with a variability within the same mutation (3 to 360 months). No clear genotype–phenotype correlation has been observed, except for the c.55 G>A (p.Ala19Thr) mutation, which led to a later onset of disease (median age 120 months). Brain magnetic resonance imaging (MRI) revealed the absence of posterior pituitary hyperintensity in 8 out of 15 subjects, hypointense signal in 4 and normal signal in 2. Follow-up MRI showed the disappearance of the posterior pituitary hyperintensity after 6 years in one case. Conclusion adNDI is a progressive disease with a variable age of onset. Molecular diagnosis and counseling should be provided to avoid unnecessary investigations and to ensure an early and adequate treatment.

Aim Our aim was to update the recommendations for the diagnosis, treatment and follow‐up of the first febrile urinary tract infection in young children, which were endorsed in 2012 by the Italian Society of Pediatric Nephrology. Methods The Italian recommendations were revised on the basis of a review of the literature published from 2012 to October 2018. We also carried out an ad hoc evaluation of the risk factors to identify children with high‐grade vesicoureteral reflux or renal scarring, which were published in the previous recommendations. When evidence was not available, the working group held extensive discussions, during various meetings and through email exchanges. Results Four major modifications have been introduced. The method for collecting urine for culture and its interpretation has been re‐evaluated. We have reformulated the algorithm that guides clinical decisions to proceed with voiding cystourethrography. The suggested antibiotics have been revised, and we have recommended further restrictions of the use of antibiotic prophylaxis. Conclusion These updated recommendations have now been endorsed by the Italian Society of Pediatric Nephrology and the Italian Society for Pediatric Infectivology. They can also be used to compare other recommendations that are available, as a worldwide consensus in this area is still lacking.

We report the case of an infant boy with polyuria and a familial history of central diabetes insipidus. Laboratory blood tests disclosed hypokalemia, metabolic alkalosis, hyperreninemia, and hyperaldosteronism. Plasma magnesium concentration was slightly low. Urine analysis showed hypercalciuria, hyposthenuria, and high excretion of potassium. Such findings oriented toward type III Bartter syndrome (BSIII). Direct sequencing of the CLCNKB gene revealed no disease-causing mutations. The water deprivation test was positive. Magnetic resonance imaging showed a lack of posterior pituitary hyperintensity. Finally, direct sequencing of the AVP-NPII gene showed a point mutation (c.1884G>A) in a heterozygous state, confirming an autosomal dominant familial neurohypophyseal diabetes insipidus (adFNDI). This condition did not explain the patient’s phenotype; thus, we investigated for Gitelman syndrome (GS). A direct sequencing of the SLC12A3 gene showed c.269A>C and c.1205C>A new mutations. In conclusion, the patient had a genetic combination of GS and adFNDI with a BSIII-like phenotype.