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Background In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics and predictors of long-term outcomes of patients < 15 kg on peritoneal dialysis (PD), hemodialysis (HD), and continuous kidney replacement therapy (CKRT). Methods Patients with history of paKST (CKRT, HD, PD) weighing < 15 kg and [greater than or equal to] 6 months of follow-up at Hacettepe University were included. Surviving patients were evaluated at last visit. Results 109 patients (57 females) were included. Median age at paKST was 10.1 months (IQR: 2-27 months). In total, 43 (39.4%) patients received HD, 37 (34%) PD, and 29 (26.6%) CKRT. 64 (58.7%) patients died a median 3 days (IQR: 2-9.5 days) after paKST. Percentages of patients using vasopressor agents, with sepsis, and undergoing mechanical ventilation were lower in those who survived. After mean follow-up of 2.9 ± 2.1 years, 34 patients were evaluated at mean age 4.7 ± 2.4 years. Median spot urine protein/creatinine was 0.19 (IQR: 0.13-0.37) and 12 patients (35.3%) had non-nephrotic proteinuria. Three patients had estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73m.sup.2 and 2 (6%) had hyperfiltration. In total 22 patients (64.7%) had [greater than or equal to] 1 kidney risk factor (elevated blood pressure/hypertension, hyperfiltration, eGFR < 90 ml/min/1.73m.sup.2, and/or proteinuria) at last visit. Among 28 patients on paKST < 32 months, 21 had [greater than or equal to] 1 risk factor (75%), whereas among 6 patients who had paKST [greater than or equal to] 32 months, one patient had [greater than or equal to] 1 risk factor (16.7%), (p = 0.014). Conclusions Patients on paKST who undergo mechanical ventilation and vasopressor treatment should be followed-up more closely. After surviving the acute period, patients on paKST need to be followed-up closely during the chronic stage. Graphical abstract, Author(s): Ömer Nazim Gülçek [sup.1] , Bora Gülhan [sup.2] , Selman Kesici [sup.3] , Eda Didem Kurt Sükür [sup.2] , Mutlu Hayran [sup.4] , Fatih Ozaltin [sup.2] [sup.5] [sup.6] , [...]

Background/Aims: Different optimization methods in brachytherapy treatment planning is used. The aim of this study is to evaluate dosimetric differences between manual optimization (MO) and inverse planning simulated annealing (IPSA) planning techniques commonly used in brachytherapy of cervical cancer. Methods: Fifteen cervical cancer patients were included in this study. Nucletron standard tandem-ovoid (TO) applicators were used for treatment. High-risk clinical tumor volume (HR-CTV), bladder, rectum, and sigmoid contouring were performed according to GEC-ESTRO recommendations. Two plans were created for each patient using IPSA and MO techniques. While a dose of 700 cGy was prescribed to the target volume during the planning phase, an effort was made to protect the organs at risk in the best way possible. IPSA and MO planning techniques were compared via dose volume histogram (DVH). Results: There was no significant difference between HR-CTV and CI values for MO and IPSA techniques. There was a significant difference between IPSA and MO techniques for the 2cm3 volume of the rectum (p= 0.002). It was observed that the bladder was better protected by the IPSA technique. There was a 6.26% dose difference between IPSA and MO for the bladder. A significant difference was found between IPSA and MO techniques for the 2cm3 volume of the sigmoid (p= 0.002). The IPSA technique was superior to the MO technique in terms of time. Conclusions: The IPSA technique was superior to the MO technique in terms of protecting organs at risk (OARs). IPSA provides a faster and higher quality plan in cervical brachytherapy.

BackgroundCongenital anomalies of the kidney and urinary tract (CAKUT) are defined as structural malformations of the kidney and/or urinary tract. Heat shock proteins (HSPs) are expressed in the kidney in response to cellular changes, such as thermal, hemodynamic, osmotic, inflammatory, and mechanical stresses. This study aimed to assess uHSP70 levels during acute urinary tract infections (UTI) and non-infection periods in patients with CAKUT, and to evaluate whether uHSP70 is elevated in CAKUT subtypes.MethodsAmong patients with CAKUT, 89 patients with UTI (CAKUT-A), 111 without UTI (CAKUT-B), and 74 healthy children were included in the study. uHSP70 levels were measured using enzyme-linked immunosorbent assay (ELISA).ResultsuHSP70 level was significantly higher in the CAKUT-A group than in the CAKUT-B and healthy control groups (p < 0.0001). Moreover, the level of uHSP70 was significantly higher in the CAKUT-B group than in the control group (p < 0.0001), but was not different between the CAKUT subtypes (p > 0.05).ConclusionUrine HSP70 can also be used to predict UTI in patients with CAKUT. Moreover, uHSP70 levels were higher in children with CAKUT during the non-infectious period than in healthy controls. This suggests that children with CAKUT are at risk of chronic non-infectious damage.

Abstract Objective: The aim of this study is to report the survival and treatment results of patients with cervical esophageal cancer treated with definitive chemoradiotherapy, whose incidence is very low in the population and there is not enough information about treatment and toxicity results in the literature. Material and Method: Between 2013 and 2022, 10 patients (six males and four females) with cervical esophageal cancer treated with definitive chemoradiotherapy were included. Among these patients, seven had stage II disease, one stage III, and 2 stage IVA. All patients received radiotherapy at a median dose of 50.4 Gy and concurrent weekly chemotherapy. Results: The median follow-up period was 18 months. The two-year and 5-year overall survival rates were 42.2% and 21.1%, respectively. The two-year and 5-year disease-free survival rates were 45.7% and 22.9%, respectively. Disease progression was noted in 3 out of 10 patients (30%). Three patients were still alive during analyze. Percutaneous enteral gastrostomy was performed in 3 of 10 patients. These requirement occured in 1 due to local progression, and in the remaining 2 patients due to the side effect of RT. Conclusions: Overall survival rates were low, as similar findings appear in the literature. It was remarkable that the need for a percutaneous enteral gastrostomy was not observed in the IMRT group. All patients with complete remission were in stage 2.

Objective: This study aimed to determine the knowledge, attitudes and behaviors of students in a medical school about HPV, HPV vaccine and cervical cancer. Methods: The research was carried out in the students of Selcuk University Faculty of Medicine in April 2022. The universe of the study consisted of all medical school students and it was conducted with 125 volunteers who accepted the study. Participants were asked questions about HPV, HPV vaccine and cervical cancer. Results: One-hundred twenty five students participated in the study. The mean age was 20,89±2,339 (range 18-31). Of the 125 participants, 50,4% (n: 63) were female and 49,6% (n: 62) were male, and 74,4% (n: 93) were preclinical (1-2-3th year) students, and 25,6% (n = 32) were clinical (4-5-6th year) students. Majority of the respondents [ 86.4% (n=108)] reported that they did not have enough knowledge about HPV, HPV vaccine and diseases caused by HPV. Conclusion: As the result of the study, even medical school students were not fully informed about HPV, HPV vaccine, and cervical cancer. It is extremely important for more healty generation that medical students, who will be the pioneers of healthcare of the future and will educate the public on health and guide health policies, are given adequate training on HPV and HPV vaccine.

Background: The present dosimetric study aimed to evaluate the dosimetric benefits of using three-dimensional conformal radiotherapy (3D-CRT), dynamic intensity-modulated radiation therapy (D-IMRT), and Hybrid CRT/IMRT plans. Method: In this dosimetric research, 10 patients with locally advanced lung cancer (Stage-IIIB) were selected. The patients with centrally located tumors were particularly chosen to underline the complexity of the treatment plans. We performed 3D-CRT, D-IMRT, and Hybrid CRT/IMRT treatment plans using Varian with the Eclipse treatment planning system. The treatment plans were compared with respect to the doses received by the organs at risk, including total lungs, contralateral lung, ipsilateral lung, heart, spinal cord, esophagus, the dose homogeneity index, and conformity indexes. Paired samples t-test was performed for statistical analyses. Results: Hybrid method significantly advanced the target conformity index when compared with 3D-CRT and D-IMRT methods (P = 0.000). The total lung volume receiving 5 to 10 Gy was significantly lower in the 3D-CRT plans compared with that in D-IMRT and Hybrid plans (P = 0.025 and P = 0.003). V20 of the total lung was significantly lower in Hybrid plans (P =0.036). The average mean doses to heart in all the plans were similar with no significant differences. There was a statistically significant difference concerning the maximum doses for spinal cord, when D-IMRT plans were compared with 3D-CRT and Hybrid (P = 0.000). Conclusion: Hybrid technique could be highly conducive to the treatment, while 3D-CRT and D-IMRT techniques are not adequate alone for maintaining the spinal cord, heart, and esophagus in the treatment of LALC patients.

Abstract Background Among the possible causes of hypertension in adolescence, electrolyte imbalances and environmental pollutants are drawing increasing attention. We aimed to examine the relationship between bisphenol A (BPA), phthalate metabolites, and serum electrolytes and blood pressure. Methods Eighty-six participants aged 12–15 years were included in the study. Body mass index (BMI), office blood pressure and 24-h ambulatory blood pressure measurements (ABPM), and carotid intima-media thickness were determined. Blood samples were taken for hemogram, renal function tests, and serum electrolytes. Free- and total-BPA and phthalate metabolites were analyzed from urine samples. Results Of the participants, 34 were evaluated as normal blood pressure profile, 33 as white-coat hypertension (WCHT), and 19 as ABPM-hypertension. Adolescents in ABPM- hypertension groups had higher BMI-standard deviation score (SDS), leucocyte, platelet count; but lower serum chloride, compared to the normal blood pressure profile group. The percentage of adolescents with detectable urinary mono-benzyl phthalate (MBzP) was higher in ABPM-hypertension (42.1%) and WCHT groups (33.3%), compared to the normal blood pressure profile group (5.9%, p = 0.004). Associations between MBzP and ABPM- hypertension and WCHT were remained after confounding factor adjustment. Adolescents with detectable MBzP levels had also higher “albumin-corrected calcium” and lower serum phosphate and “albumin-corrected calcium x phosphate product” compared to others. Adolescents with detectable urinary MBzP levels had higher blood pressure profiles in some 24-h (mean arterial pressure-SDS, systolic blood pressure-SDS), daytime (systolic blood pressure-SDS), and night-time (mean arterial pressure-SDS, systolic blood pressure-SDS, and diastolic blood pressure-SDS) measurements, compared to others. WCHT was found to be associated negatively with monomethyl phthalate and the sum of dibutyl phthalate metabolites and ABPM-HT with MCPP. There was no significant association between blood pressure profiles and free- and total-BPA status. Conclusion MBzP was associated with adverse blood pressure profiles in adolescence. Additive follow-up studies are necessary for cause-effect relations.

Abstract Background Data on the long-term effects of neonatal acute kidney injury (AKI) are limited. Methods We invited 302 children who had neonatal AKI and survived to hospital discharge; out of 95 patients who agreed to participate in the study, 23 cases were excluded due to primary kidney, cardiac, or metabolic diseases. KDIGO definition was used to define AKI. When a newborn had no previous serum creatinine, AKI was defined as serum creatinine above the mean plus two standard deviations (SD) (or above 97.5th percentile) according to gestational age, weight, and postnatal age. Clinical and laboratory features in the neonatal AKI period were recorded for 72 cases; at long-term evaluation (2–12 years), kidney function tests with glomerular filtration rate (eGFR) by the Schwartz formula, microalbuminuria, office and 24-h ambulatory blood pressure monitoring (ABPM), and kidney ultrasonography were performed. Results Forty-two patients (58%) had stage I AKI during the neonatal period. Mean age at long-term evaluation was 6.8 ± 2.9 years (range: 2.3–12.0); mean eGFR was 152.3 ± 26.5 ml/min/1.73 m2. Office hypertension (systolic and/or diastolic BP ≥ 95th percentile), microalbuminuria (> 30 mg/g creatinine), and hyperfiltration (> 187 ml/min/1.73 m2) were present in 13.0%, 12.7%, and 9.7% of patients, respectively. ABPM was performed on 27 patients, 18.5% had hypertension, and 40.7% were non-dippers; 48.1% had abnormal findings. Female sex was associated with microalbuminuria; low birth weight (

Objective Patients with Behçet's disease (BD) may experience long-term morbidity caused by various forms of cardiovascular disease. This study aimed to assess the risk for cardiovascular comorbidity in paediatric BD patients with and without vascular involvement, independent of the contribution of traditional risk factors. Methods Paediatric patients classified as having BD according to the 2015 Peadiatric BD (PEDBD) criteria were included in the study. Twenty-four-hour ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography, and carotid intima-media thickness (cIMT) measurements were performed. Patients with an active disease or those who have other known risk factors for cardiovascular disease were not included in the study. Results Thirty-one children and adolescents with paediatric BD (16 female, 51.6%; F/M: 1.06) were enrolled in the study. Among the BD patients, 10 patients (34.4%) had abnormal ABPM. Carotid IMT values, mean arterial pressure, systolic and diastolic blood pressure by ABPM and the prevalence of abnormal ABPM, non-dipping, and ambulatory hypertension were similar between patients with and without vascular involvement. The echocardiography measurements showed that BD patients with vascular involvement had a significantly higher velocity and velocity time integral of the left ventricle outflow tract, which may indicate increased stiffness of the aorta. Conclusion Paediatric BD patients with vascular involvement may tend to have more cardiovascular risk factors. However, cardiovascular assessment should be considered in all BD patients, regardless of the involved systems. We suggest that ABPM may accurately define hypertension and cardiovascular risk in BD. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines (CPGs) are systematically developed statements backed by scientific evidence to assist practitioners in management in clinical practice. An international cross-sectional survey was conducted by the IPNA to examine the perceptions of pediatric nephrologists on guidelines and their usage and to identify important diseases for future clinical practice guidelines (CPGs). The survey found that the majority of pediatric nephrologists find CPGs useful in clinical practice and admitted to using them most of the time. Developing CPGs is challenging and there are standards available to develop trustworthy guidelines. While evidence-based global guidelines are ideal, pediatric nephrologists expressed the desire that they address regional differences. Most respondents (89.2%) to the survey agreed that adult guidelines did not cover the pediatric perspective adequately and 71.4% opined that consensus-based pediatric guidelines can be developed when evidence for the pediatric population is lacking. The development of high-quality practice guidelines requires substantial resources and may not be feasible in resource-poor countries. Adaptation of an existing guideline has been suggested as an alternative and the ADAPTE collaboration provides a systematic approach to adapting guidelines. Several diseases where pediatric guidelines are needed as a priority including IgA and C3 glomerulopathy were identified in the survey. Implementation of guideline-based care is challenging and the survey found that lack of availability of guidelines (43%) and resources (22.8%) are important reasons for poor implementation in lower-middle and low-income countries. Perceived complexity of guidelines, physician attitudes, and lack of training also contribute to non-adherence to guidelines., Author(s): Pankaj Hari [sup.1] , Khalid Alhasan [sup.2] , Arvind Bagga [sup.1] , Melvin Bonilla-Felix [sup.3] , Paula Alejandra Coccia [sup.4] , Ali Duzova [sup.5] , Ill-So Ha [sup.6] , [...]

Abstract Autosomal recessive polycystic kidney disease (ARPKD) is characterized by bilateral fibrocystic changes resulting in pronounced kidney enlargement. Impairment of kidney function is highly variable and widely available prognostic markers are urgently needed as a base for clinical decision-making and future clinical trials. In this observational study we analyzed the longitudinal development of sonographic kidney measurements in a cohort of 456 ARPKD patients from the international registry study ARegPKD. We furthermore evaluated correlations of sonomorphometric findings and functional kidney disease with the aim to describe the natural disease course and to identify potential prognostic markers. Kidney pole-to-pole (PTP) length and estimated total kidney volume (eTKV) increase with growth throughout childhood and adolescence despite individual variability. Height-adjusted PTP length decreases over time, but such a trend cannot be seen for height-adjusted eTKV (haeTKV) where we even observed a slight mean linear increase of 4.5 ml/m per year during childhood and adolescence for the overall cohort. Patients with two null PKHD1 variants had larger first documented haeTKV values than children with missense variants (median (IQR) haeTKV 793 (450–1098) ml/m in Null/null, 403 (260–538) ml/m in Null/mis, 230 (169–357) ml/m in Mis/mis). In the overall cohort, estimated glomerular filtration rate decreases with increasing haeTKV (median (IQR) haeTKV 210 (150–267) ml/m in CKD stage 1, 472 (266–880) ml/m in stage 5 without kidney replacement therapy). Strikingly, there is a clear correlation between haeTKV in the first eighteen months of life and kidney survival in childhood and adolescence with ten-year kidney survival rates ranging from 20% in patients of the highest to 94% in the lowest quartile. Early childhood haeTKV may become an easily obtainable prognostic marker of kidney disease in ARPKD, e.g. for the identification of patients for clinical studies.

Background Hypertension is prevalent in children on dialysis and associated with cardiovascular disease. We studied the blood pressure (BP) trends and the evolution of BP over 1 year in children on conventional hemodialysis (HD) vs. hemodiafiltration (HDF). Methods This is a post hoc analysis of the '3H - HDF-Hearts-Height' dataset, a multicenter, parallel-arm observational study. Seventy-eight children on HD and 55 on HDF who had three 24-h ambulatory BP monitoring (ABPM) measures over 1 year were included. Mean arterial pressure (MAP) was calculated and hypertension defined as 24-h MAP standard deviation score (SDS) [greater than or equal to]95th percentile. Results Poor agreement between pre-dialysis systolic BP-SDS and 24-h MAP was found (mean difference - 0.6; 95% limits of agreement -4.9-3.8). At baseline, 82% on HD and 44% on HDF were hypertensive, with uncontrolled hypertension in 88% vs. 25% respectively; p < 0.001. At 12 months, children on HDF had consistently lower MAP-SDS compared to those on HD (p < 0.001). Over 1-year follow-up, the HD group had mean MAP-SDS increase of +0.98 (95%CI 0.77-1.20; p < 0.0001), whereas the HDF group had a non-significant increase of +0.15 (95%CI -0.10-0.40; p = 0.23). Significant predictors of MAP-SDS were dialysis modality ([beta] = +0.83 [95%CI +0.51 - +1.15] HD vs. HDF, p < 0.0001) and higher inter-dialytic-weight-gain (IDWG)% ([beta] = 0.13 [95%CI 0.06-0.19]; p = 0.0003). Conclusions Children on HD had a significant and sustained increase in BP over 1 year compared to a stable BP in those on HDF, despite an equivalent dialysis dose. Higher IDWG% was associated with higher 24-h MAP-SDS in both groups., Author(s): Francesca De Zan [sup.1] , Colette Smith [sup.2] , Ali Duzova [sup.3] , Aysun Bayazit [sup.4] , Constantinos J Stefanidis [sup.5] , Varvara Askiti [sup.5] , Karolis Azukaitis [sup.6] [...]

Background: Posterior urethral valves (PUVs) and ureteropelvic junction obstruction (UPJO) are congenital obstructive uropathies that may impair kidney development. Objective: To identify genetic variants associated with kidney injury in patients with obstructive uropathy. Design, setting, and participants: We included 487 patients born in 1981 or later who underwent pyeloplasty or valve resection before 18 yr of age in the discovery phase, 102 PUV patients in a first replication phase, and 102 in a second replication phase. Outcome measurements and statistical analysis: Signs of kidney injury were defined as dialysis, nephrectomy, kidney transplantation, estimated glomerular filtration rate (eGFR) 600 000 single-nucleotide polymorphisms (SNPs) in the discovery sample comparing patients with and without signs of kidney injury within 5 yr after surgery. We performed stratified analyses for PUV and UPJO and Kaplan-Meier and Cox regression analyses in the discovery and two replication samples for the associated SNPs, and RNA and protein expression analyses for the associated gene in fetal tissues. Results and limitations: Despite the small and nonhomogeneous sample, we observed suggestive associations for six SNPs in three loci, of which rs6874819 in the CDH12 gene was the most clear (p = 7.5 × 10–7). This SNP also seemed to be associated with time to kidney injury in the PUV discovery and replication samples. RNA expression analyses showed clear CDH12 expression in fetal kidneys, which was confirmed by protein immunolocalization. Conclusions: This study identified CDH12 as a candidate gene for kidney injury in PUV. Patient summary: We found that variants of the CDH12 gene increase the risk of kidney injury in patients with extra flaps of tissue in the urethra (posterior urethral valves). This is the first report on this gene in this context. Our study provides interesting new information about the pathways involved and important leads for further research for this condition.

Background High prevalence of arterial hypertension is known in pediatric renal transplant patients, but how blood pressure (BP) distribution and control differ between age groups and whether sex and age interact and potentially impact BP after transplantation have not been investigated. Methods This retrospective analysis included 336 pediatric renal transplant recipients (62% males) from the Cooperative European Pediatric Renal Transplant Initiative Registry (CERTAIN) with complete BP measurement at discharge and 1, 2 and 3 years post-transplant. Results At discharge and 3 years post-transplant, arterial hypertension was highly prevalent (84% and 77%); antihypertensive drugs were used in 73% and 68% of the patients. 27% suffered from uncontrolled and 9% from untreated hypertension at 3 years post-transplant. Children transplanted at age < 5 years showed sustained high systolic BP z-score and received consistently less antihypertensive treatment over time. Younger age, shorter time since transplantation, male sex, higher body mass index (BMI), high cyclosporine A (CSA) trough levels, and a primary renal disease other than congenital anomalies of the kidney and urinary tract (CAKUT) were significantly associated with higher systolic BP z-score. Sex-stratified analysis revealed a significant association between high CSA and higher systolic BP in older girls that likely had started puberty already. An association between BP and estimated glomerular filtration rate was not detected. Conclusions BP control during the first 3 years was poor in this large European cohort. The description of age- and sex-specific risk profiles identified certain recipient groups that may benefit from more frequent BP monitoring (i.e. young children) or different choices of immunosuppression (i.e. older girls)., Author(s): Rizky I. Sugianto [sup.1] , Bernhard M. W. Schmidt [sup.2] , Nima Memaran [sup.1] , Ali Duzova [sup.3] , Rezan Topaloglu [sup.3] , Tomas Seeman [sup.4] , Sabine König [...]