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This study aimed to assess the performance of waist-to-height ratio (WHtR) in the prediction of metabolic syndrome and to determine the appropriate cutoff value in Thai adolescents. Demographic data, blood pressure, fasting blood glucose, and lipid profile were obtained from the Thai National Health Examination Survey V database. The performances of WHtR, waist circumference, body mass index (BMI), and BMI z-score were analyzed by the receiver operating characteristics. Among 2644 adolescents, metabolic syndrome was identified in 4.27%. The areas under the receiver operating characteristic curves of WHtR, waist circumference, BMI, and BMI z-score were comparable (0.924-0.960). Performance of WHtR was more constant across age groups compared with other parameters. Using the cutoff value of WHtR at 0.5 resulted in the sensitivity and specificity of 98.5%/83.4% and 88.9%/86.0% in males and females, respectively. In conclusion, the cutoff value of WHtR at 0.5 provided good sensitivity and specificity for identifying metabolic syndrome in both genders. However, the other clinical risk factors or more definite scores should be considered when further assessment.

Background Presence of metabolic syndrome (MetS) in early life may influence cardiovascular outcome later in adulthood. There is limited data regarding MetS among Thai adolescents. This study aimed to estimate the prevalence of MetS and related factors in Thai adolescents. Methods Data on MetS components of 1934 Thai adolescents aged 10–16 years were obtained from the 5th National Health Examination Survey. Age at first screen time exposure, duration of screen time, frequency of food intake and physical activities were collected from interviews. MetS was defined according to 3 definitions: International Diabetes Federation (IDF), Cook’s, and de Ferranti’s. Results The prevalence of MetS was 4.1% by IDF, 8.0% by Cook’s, and 16.8% by de Ferranti’s definition. The overall prevalence was higher in male (19.0%) than female adolescents (15.3%). The most common MetS components composition among Thai adolescents was high waist circumference with high serum triglyceride and low HDL-cholesterol (40.0% for IDF, 22.6% for Cook’s and 43.5% for de Ferranti’s definition). Exposure to screen media during the first 2 years of life had a 1.3- fold increased odds of MetS by 1 out of 3 definitions (OR 1.30, 95% CI. 1.01–1.68). Duration of physical activity associated with decreased odds of MetS by Cook’s definition (OR 0.96, 95% CI. 0.92–0.99). Conclusions The prevalence of MetS among Thai adolescents was higher than previously reported by other studies. Screen media exposure during the first 2 years of life should be discouraged and measures to promote physical activity among children and adolescents should be strengthen.

Introduction Masked hypertension is defined as having a normal blood pressure (BP) in the office but elevated BP outside the office. This study aimed to determine the prevalence of masked hypertension in participants with obesity and to examine the correlation between body composition, dietary intake and ambulatory blood pressure parameters. Materials and methods The cross-sectional study of participants with obesity was conducted in the pediatric nutrition clinic of a University Hospital in Thailand. Demographic and anthropometric data, dietary intake, body composition analysis and ambulatory blood pressure monitoring were assessed in all participants. All parameters were compared between the group with masked hypertension and the normotensive group. Correlations between the parameters were analyzed. Results Among 49 children with obesity, 23 (47%, 95% confidence interval 34.7, 59.2%) had masked hypertension. Compared with the normotensive group, the group with masked hypertension had a greater mean BMI z-score (4.7 vs. 3.0, P = 0.003), a greater mean of body fat percentage (45 vs. 40, P = 0.012) and a greater total energy intake percentage of dietary reference intake (115 vs. 93, P = 0.034). Multivariate analysis showed that BMI z-score was significantly associated with masked hypertension. Interestingly, mean nighttime SBP positively correlated with BMI z-score and body fat percentage. Moreover, there were negative correlations between fruit intake portion per week and nighttime and 24-h SBP index. However, multivariate linear regression did not show significant correlation between these parameters. Conclusions Masked hypertension was frequent in participants with obesity. The greater BMI z-score and percentage of body fat mass correlated with higher nighttime SBP.

This study explored the relationship between BMI trajectories and the duration of obesity in Thai children diagnosed with hypertension. Demographic and blood pressure data from 536 children (270 boys, 50.3%) from a school in Bangkok, Thailand were collected. Hypertension was defined as blood pressure above the cutoff values specified in the 2017 American Academy of Pediatrics guidelines on 3 occasions. Records of BMI over the previous 3 years were reviewed. The prevalence of hypertension was 2.61% (14/536). Complete data on BMI trajectories were available in 421 non-hypertensive and 12 hypertensive children. The increase in BMI z-score over the previous 3 years was significantly greater in the hypertensive group than the non-hypertensive group, 1.45 (95% CI 0.42 to 1.88) versus 0.09 (95% CI: −0.35, 0.65), P = .008. In conclusion, children with a confirmed diagnosis of hypertension had a greater increase in BMI over the past 3 years than non-hypertensive children.

Supplemental material, sj-pdf-1-gph-10.1177_2333794X211012998 for Body Mass Index Trajectories and Duration of Obesity in Thai Children Diagnosed with Hypertension by Witchuri Paksi, Suthatip Sirijunpen, Pracha Nuntnarumit and Kwanchai Pirojsakul in Global Pediatric Health

Additional file 1: Supplementary Table S1. Patterns of combinations of metabolic syndrome components.

Introduction: There are limited data on the outcomes in children with Henoch-Schönlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) in limited-resource countries. This study was aimed to evaluate the outcome of HSPN and IgAN and to evaluate the pathological findings associated with unfavorable outcomes.Materials and methods: This was a retrospective study conducted in children (≤18 years) diagnosed with HSPN or IgAN, had estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 and underwent renal biopsy between year 2002 - 2018 at Ramathibodi Hospital, Bangkok, Thailand. Clinical outcomes were graded according to the outcome classification by Counahan, as follows: favorable [A, normal; B, minor urinary abnormalities (proteinuria < 1 g/1.73 m2/day)]; unfavorable [C, active renal disease (proteinuria > 1 g/1.73 m2/day and/or hypertension); D, renal insufficiency (eGFR < 60 mL/min/1.73 m2 or died)]. Pathologies were graded according to Oxford classification.Results: A total of 47 patients (28 HSPN and 19 IgAN) were included with means of age at 9.4 ± 2.8 vs 11.3 ± 4.3 years, respectively. After a median follow-up time of 50 months, proportions of favorable outcomes in the patients with HSPN and IgAN were 82.1% (23/28) and 89.5% (17/19), respectively (p-value = 0.685). In multivariate analysis, only endocapillary proliferation (E) was associated with unfavorable outcomes in both diseases with the odds ratio (95% CI) of 12.46 (1.36 - 114.51, p-value = 0.026).Conclusion: The clinical outcomes of most patients with HSPN and IgAN were favorable and comparable. Endocapillary proliferation (E) was the only factor associated with poor outcome in both diseases.

Masked hypertension defined as having normal office blood pressure (BP) but hypertension detected by continuous BP monitoring has been observed in children and adolescents with type 1 diabetes (T1D). However, no study has evaluated whether masked hypertension is associated with glycemic variability (GV) in these patients. We hypothesized that masked hypertension might be associated with high GV in patients with T1D.This cross-sectional study performed continuous glucose monitoring (CGM) in parallel with ambulatory blood pressure monitoring (ABPM) in T1D patients aged 6-21 years. Patients who had known hypertension were excluded. CGM data from the same day as ABPM was calculated for GV including standard deviation (SD), coefficient of variation (CV) of glucose levels, and unstable glycemia which was defined as having a CV of glucose levels ≥ 36%.Thirty-three patients had complete ABPM and CGM data. Mean (SD) age was 13.8 (3.8) years and mean (SD) duration of T1D was 5.4 (3.6) years. All patients had normal office BP, but ABPM showed masked hypertension in 9 patients (27%). In comparison with normotensive patients, patients with masked hypertension had longer duration of T1D (7.4 vs. 4.6 years, p = 0.049), higher insulin requirement (1.2 vs. 0.9 units/kg/day, p = 0.049), and higher SD of glucose (70.3 vs. 47.9 mg/dl, p = 0.038). Masked hypertension group had a greater number of patients (71% vs. 19%, p = 0.02) with unstable glycemia. Multivariate analysis revealed that unstable glycemia was associated with masked hypertension.The presence of unstable glycemia in children and adolescents with T1D is associated with masked hypertension. Graphical abstract.

Increased sympathetic nervous system activity has been proposed as a potential mechanism for the blood pressure (BP) elevation seen in individuals born small for gestational age (SGA). This study was carried out to detect the changes in BP and heart rate (HR) in children born SGA during exposure to stress and to assess for changes in urinary catecholamine excretion. Nineteen children aged 6–14 years born SGA and 17 age- and gender-matched healthy controls were included in the study. The stress test included a mathematical test and venipuncture. BP and HR were monitored during the test. Spot urine samples were collected at baseline and after the stress test to determine dopamine, epinephrine and norepinephrine levels. At baseline, there was no difference in BP and HR between the SGA and control groups, but mean urinary norepinephrine levels were slightly higher in the SGA group (55.7 ± 16.1 vs. 43.4 ± 3.8 mcg/gCr; P = 0.10). Compared to the control group, mean maximal HR increase was higher in the SGA group (31.3 ± 3.1 vs. 19.2 ± 3.8%; P = 0.008), and mean duration of maximal HR to baseline HR was longer (186 ± 23 vs. 97 ± 13 s, respectively; P = 0.003). There was a significant negative correlation between birth weight and maximal HR increase (r = −0.497, P = 0.003). Children born SGA showed significantly greater increases in HR and significantly longer periods of tachycardia during exposure to stress than did healthy controls. The rise in HR was inversely correlated with birth weight. These findings suggest that children born SGA have a greater increase in sympathetic response when exposed to stress than do healthy individuals.

Background Sleep disturbance is common among chronic haemodialysis patients, which leads to poor quality of life, in addition to increased instances of morbidity and mortality. Hypervolemia has been linked to sleep problems observed in chronic haemodialysis patients, which suggests that optimising one’s fluid status could improve the sleep quality of this patient group. In our study, we subjectively examined and objectively measured sleep parameters, using actigraphy recordings, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and Epworth Sleepiness Scale (ESS), in order to compare bioelectrical impedance analysis (BIA)-guided and standard clinical-guided dry weight adjustment. Methods We randomly selected 19 chronic haemodialysis patients with subclinical hypervolemia, defined as a clinically euvolemic status, despite the ratio of extracellular water to total body water being more than 0.4 in BIA. Furthermore, these patients, who were poor sleepers (PSQI > 5), were assigned to either a BIA-guided dry weight group (BIA group) or a standard clinical-guided one (clinical group). The primary outcome was changes in sleep actigraphy parameters between the groups at 1, 3, and 6 months. Changes observed in the PSQI and ESS score between the two groups over the same period of time were the secondary endpoints. Results The mean age of the participants was 63.53 ± 11.12 years, and 42% of them were male. All sleep parameters measured by means of actigraphy were not significantly different between the two groups. Interestingly, at 3 and 6 months, the subjective sleep quality significantly improved in the BIA group, as reflected by a greater decline in the PSQI score, in comparison with the clinical group (3 months: mean difference − 1.82 [− 3.13 to − 0.51], P = 0.006; 6 months: mean difference − 3.16 [− 4.49 to − 1.83], P

Objectives Increased sympathetic activity is proposed to be a mechanism of high blood pressure in children born small for gestational age. Ambulatory blood pressure monitoring is a form of blood pressure measurement that can detect high blood pressure outside the hospital in patients with normal office blood pressure. This condition is called masked hypertension. There are limited data on association between ambulatory blood pressure and urinary catecholamines during exposure to stress in children born small for gestational age. Methods Nineteen children born small for gestational age and 17 healthy controls ages 6-14 years old were included. Demographic data and office blood pressure were collected. Urinary catecholamines were collected before and after exposure to stress including mathematical test and venipuncture. Afterwards, ambulatory blood pressure monitoring was performed to obtain 24-hour blood pressure profiles. Results All children had normal office blood pressure but ambulatory blood pressure monitoring revealed masked hypertension in six children born small for gestational age (32%) and two controls (11.7%). After stress, median percentage of increase in urine norepinephrine levels was greater in children born small for gestational age with masked hypertension than that of children born small for gestational age without masked hypertension (9.2 vs. -13.2 μg/g creatinine, P = 0.05). There was no increase in urine norepinephrine levels in controls with masked hypertension. Among children born small for gestational age, awake SBP z-scores had significant positive correlations with pre- and post-stress urinary dopamine levels (r = 0.530, P = 0.02 and r = 0.597, P = 0.007, respectively). Conclusion Masked hypertension is not uncommon in children born small for gestational age. After stress, urinary norepinephrine levels were increased in children born small for gestational age with masked hypertension.

Background: In 2017, the American Academy of Pediatrics (AAP) launched a new clinical practice guideline for diagnosis of hypertension in children and adolescents. The new cut-off values were 2–3 m...

BEDTIME study LMM analysis. (DOC 40 kb)

This is the case of a 5-year-old girl diagnosed with end-stage renal disease due to bilateral renal hypoplasia who developed anemia of unknown cause.

This is the case of a 5-year-old girl diagnosed with end-stage renal disease due to bilateral renal hypoplasia who developed anemia of unknown cause.

Data on renal allograft outcome in sensitized children are scarce. We report the clinical courses of four children who received desensitization therapy prior to renal transplantation in our institution. Between 2009 and 2011, four pediatric patients with stage 5 chronic kidney disease received desensitization therapy due to: (1) positive donor-specific antibodies (DSA) and/or crossmatches with potential living donors, (2) more than three positive crossmatches with deceased donors or (3) high calculated panel-reactive antibody of >80 %. Desensitization with rituximab, intravenous immunoglobulin and bortezomib was performed in all patients. Induction therapy included combinations of plasmapheresis and/or alemtuzumab or anti-thymocyte globulin. Standard post-transplant medications included tacrolimus, mycophenolate mofetil and prednisolone. Post-transplant screening revealed DSA in three patients. Biopsy showed no evidence of rejection at 1 month in two patients, one of whom developed chronic active antibody-mediated rejection 4.5 years later. One patient developed borderline acute cellular rejection at 1 month, but the serum creatinine level was stable and DSA disappeared without treatment 1 month later, with stable long-term allograft function at 3 years. Estimated or measured glomerular filtration rate of the patients ranged between 30 and 75 ml/min/1.73 m2 after 1 to 4.5 years. The four sensitized patients reported here who received desensitization therapy had successful renal transplants with a low risk of immediate post-transplant rejection. Overall, long-term allograft functions and complications from immunosuppression were encouraging.

Ornithine transcabamylase (OTC) deficiency is the most common and severe form of abnormal urea synthesis. It can result in hyperammonemia, severe neurologic manifestation, brain edema, and early death. Rapid removal of ammonia by hemodialysis can decrease mortality and morbidity in the patients with severe increase of ammonia levels. However hemodialysis (HD) in infants and young children are technically difficult to perform. Continuous venovenous hemofiltration (CVVH) is increasingly used as an alternative for HD, but performing CVVH in a neonate can be problematic due to small body size and difficult vascular access. The authors reported a successful CVVH using umbilical vein as a vascular access site for ammonia removal in a neonate with OTC deficiency with progressive elevation of plasma ammonia. Technical problems, pitfalls in performing the CVVH, and how the authors overcame the problems are discussed.

Macrophage activation syndrome (MAS) is a fatal complication in rheumatic diseases. It is characterized by prolonged fever, pancytopenia, and hepatosplenomegaly, which are consequences of uncontrolled macrophage activation. MAS in children is most commonly associated with systemic juvenile idiopathic arthritis. Its association with systemic lupus erythematosus (SLE) is relatively rare, so we report a Thai boy who initially presented with MAS and eventually was diagnosed as having SLE. He also had recurrent MAS during the course of therapy. Hyperferritinemia is one of the abnormal laboratory findings in MAS and it has been used as an inflammatory marker. However, its correlation with disease activity remains unclear. Therefore, a review of literature regarding MAS-associated SLE in children and ferritin level in this disease was carried out.

Evaluate the outcomes of pediatric patients with Henoch-Sch6nlein purpura nephritis andfind the parameters correlated with outcomes of treatment.Review of medical records was performed in twenty patients diagnosed with Henoch-Schinlein purpura nephritis. Demographic data, clinical parameters and records of treatment at diagnosis and the last visit were collected and analyzed.Median age at diagnosis was 8-year-old and median follow-up time was 39 months. All patients had urine protein to creatinine ratio (UPCR) of more than 1.0 g/g while ten patients had hypoalbuminemia. Renal pathology results were class I, II, and III in 2, 14, and 4 patients respectively. Prednisolone was prescribed in all patients and cyclophosphamide was given in 13 patients. All patients had first resolution of proteinuria at median time of six months (range 2-47 months). At the last visit, 13 patients (65%) had remission of proteinuria (remission group), while seven patients (35%) became proteinuric relapse (relapse group) with UPCR0.2 g/g. Interestingly, the remission group had median time to first resolution of proteinuria shorter than the relapse group (6 months and 19 months, p0.001). Moreover, estimated glomerular filtration rate at diagnosis correlated negatively with UPCR at the last visit (r = -0.773, p = 0.001).Pediatric patients with Henoch-Schönlein purpura nephritis who presented with heavy proteinuria had favorable outcome after treatment. The patients who had early resolution ofproteinuria remained in remission more than those who had late resolution.

To evaluate the clinical course of children with primary distal renal tubular acidosis and to determine parameters correlated with the outcomes.A retrospective review of medical records was carried out. The parameters at initial diagnosis and the last visit were collected including height standard deviation score (SDS), weight SDS, ultrasonography of kidneys, serum electrolytes, urine electrolytes, urine calcium to urine creatinine ratio (urine Ca/Cr), serum creatinine, bicarbonate dosage and glomerular filtration rate estimated by Schwartz's formula (eGFR).Fifteen patients were included with median follow-up time of 12 years (range 4.5 to 19 years). Median age at diagnosis was 3 years (range 0.25 to 9 years). At the last visit, median height SDS increased significantly from -3.1 to -0.8 (p = 0.04). Height SDS at the last visit correlated with age at diagnosis (r = -0.54, p = 0.038) and serum bicarbonate at the last visit (r = 0.68, p = 0.008). Moreover, at the last visit, eGFR correlated with urine Ca/Cr (r = -0.84, p = 0.001).After treatment, growth of patients improved satisfactorily. The outcomes were associated with age at diagnosis, compliance of bicarbonate therapy and urine Ca/Cr at the last visit.

The incidence of end stage of renal disease (ESRD) in US children age 0-19 years is 12.9 per million/year (2012). The economic and social burden of diagnosing, treating and preventing chronic kidney disease (CKD) in children and adults remains substantial. Advances in identifying factors that predict development of CKD and its progression, as well as advances in the management of co-morbid conditions including anemia, cardiovascular disease, growth, mineral and bone disorder, and neurocognitive function are discussed. Despite recent reports from retrospective registry data analysis and multi-center prospective studies which have significantly advanced our knowledge of CKD, and despite advances in the understanding of the pathogenesis, diagnosis and treatment of CKD much work remains to be done to improve the long term outcome of this disease.