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Introduction: Urinary tract infections (UTIs) are among the most important diseases of children. UTI timely diagnosis and treatment is essential to prevent renal failure. Objectives: This study aims to investigate the association of sacral dimples with recurrent UTIs and urodynamic findings in a group of pediatric patients. Patients and Methods: This case-control study was conducted on children aged one month to fifteen years old with recurrent UTIs. The association of sacral dimples with recurrent UTIs and urodynamic findings were studied. Results: In total, 229 patients with recurrent UTIs were recruited. One hundred thirty-one patients were in the case group (with sacral dimple), and 98 patients were in the control group (without sacral dimple). One-hundred and nine children (82.2%) in the case group and 56 children (57.1%) in the control group had abnormal voiding cystourethrography (VCUG) (PP=0.568). Twenty-two patients (16.8%) in the case group and 13 patients (13.3%) in the control group had renal scarring (P=0.578). Urodynamic findings were abnormal in 117 children (89.3%) in the case group and 70 children (71.4%) in the control group (P=0.001, OR=3.34, 95% CI: 1.65-6.78). Conclusion: In this study, abnormal uroflowmetry and bladder compliance were significantly more common in children with recurrent UTIs with sacral dimple in comparison to recurrent UTIs in patients without sacral dimple. It is recommended that in cases of sacral dimples, patients should undergo a urodynamic study to detect bladder dysfunction.

We model an optical switch with a variable gain based on the optical parametric amplification in a photonic crystal fibre (PCF). By solving the coupled amplitude equations, the switch gain as a fun...

In the time span between January 2018 and September 2020, 205 patients were enrolled in a prospective cohort study at Mofid Children's Hospital. Demographic information and clinical data on all the participating children were collected and rectal swabs were performed for the sampling method. All samples were analysed so as to identify the presence of Enterococcus and Candida colonization by the use of conventional biochemical tests. Resistance to vancomycin in Enterococcus isolates was phenotypically identified using an E-test kit and MIC value, interpreted according to the CLSI criteria. The presence of vanA and vanB genes, which encode the resistance to vancomycin, was screened by PCR assay. Candida species were detected in 21.5% of rectal swab samples. Candida glabrata (56.8%) and Candida albicans (43.2%) were the only Candida species detected. Enterococcus species were detected in 29.3% of rectal swab samples. Out of 60 Enterococcus isolates, 33 (55%) were resistant to vancomycin. Moreover, vanA was detected in 84.8% and vanB was detected in 3% of the 33 vancomycin-resistant Enterococcus isolates. Enterococcus and Candida species were frequently detected in the

Background: TNF-? is one of the most potent cytokines in proinflammatory reactions. Objectives: This article contributes to evaluate the correlation between urinary TNF-? and inflammatory response markers in children with acute pyelonephritis. Patients and Methods: This cross sectional study, was performed on children with acute pyelonephritis. Fresh random urine samples were obtained before treatment of pyelonephritis. Urine samples were tested for TNF-? and creatinine. We also evaluated our patients with routine biochemical studies. Results: One hundred and twenty children with acute pyelonephritis were evaluated. Urinary TNF-?/Cr was 0.0051 0.00083 Pg/g creatinine. The authors found out a significant difference in urinary TNF-?/Cr between patients who have normal and abnormal levels of urine leukocytes, urine protein, urine culture, erythrocyte sedimentation rate and C- reactive protein. This study revealed a significant correlation between urinary TNF-alpha and urine WBC (r = 0.36, P value = 0.02), ESR (r = 0.75, P value = 0.03) and CRP (r = 0.58, P value = 0.02). Conclusions: We concluded that urinary TNF-?/Cr might be a good indicator for inflammatory response in children with acute pyelonephritis.

Introduction: Constipation is one of the multiple factors that cause enuresis. The correlation between enuresis and constipation is well established. But there is limited research on the correlation of time of voiding and constipation. Aim: To find a correlation between time of enuresis and constipation. Material and methods: This cross sectional study was carried out in Mofid Children’s Hospital, from January 2010 to June 2011. All patients with constipation or enuresis were included in this study and evaluated for both conditions. We classified cases according to time of enuresis in 3 categories. Data were analyzed by SPSS and Epi-info with χ 2 and t-test. Value of p below 0.05 was considered significant. Results: In this study, 560 patients who visited a physician with constipation ( n = 400) or enuresis ( n = 160) were included. We investigated children with constipation for enuresis, and children with enuresis for constipation. Finally, constipation was pres ent in 480 cases and enuresis in 289 cases. Duration of constipation was 9.60 ±7.1 (1-42) weeks and duration of enuresis was 6.17 ±4.74 (1-25) weeks. Of 160 patients with enuresis, 80 (50%) had constipation. Of 400 patients with constipation, 129 had enuresis (32.25%). There was a significant correlation between duration of constipation and duration of enuresis ( p < 0.001, Pearson test). Of 318 constipated boys, 148 (61.46) had enuresis. Of 162 girls with constipation, 61 (37.65%) had enuresis. The rate of enuresis among constipated boys was significantly higher than girls ( p = 0.0001, χ 2 ). Of 560 patients, constipation and enuresis; only constipation; and only enuresis were found in 209 (37.32%), 271 (48.40%), and 80 (14.28%) cases respectively. Conclusions: Duration of constipation was correlated with duration of enuresis. The rate of enuresis in constipated boys was significantly higher than in constipated females. We strongly recommend careful inspection of both conditions in each patient who presents with one of them.

Background: Urinary tract infections (UTIs) are common in children. They can lead to hypertension and end stage renal disease (ESRD). Ghrelin is a regulatory hormone that maintains fat tissues and body composition. Ghrelin is mainly produced in the stomach and in smaller amounts in kidneys. It stimulates release of growth hormone (GH), increases food intake, and causes weight gain. Objectives: The aim of this study was to examine weather urinary Ghrelin concentration is involved in anorexia in patients with UTI and its urinary concentration changes with treatment. Patients and Methods: This study was performed on 40 hospitalized children with UTI at Mofid children’s hospital during years 2013 to 2014. Ghrelin and Creatinine were measured before and after treatment. statistical analyzes were performed using the SPSS software version 18 by student t test, Wilcoxon test and Spearman coefficient and differences were considered as significant if P < 0.05. Results: Mean age was 4.5 ± 3.8 years and 34 (85%) were females; 14 children (35%) had proteinuria, nine patients (29%) had Vesicoureteral Reflux (VUR), eight (20%) scare, five (12.5%) hydronephrosis and 33 (82.5%) anorexia. Mean urinary acylated Ghrelin before and after treatment were 138.4 ± 70.9 and 147.2 ± 72.6, respectively (P < 0.001). There was no significant difference between mean urinary Ghrelin before and after treatment in children with UTI with or without anorexia. Acylated Ghrelin had a direct correlation with the incidence of renal scarring (r = 0.37, P = 0.034). Conclusions: Urinary Ghrelin concentration was lower before treatment of UTI and significantly increased after cessation of inflammation. Further studies are required for more definite results.

Background: Urinary tract infection (UTI) is common in children. UTI with or without vesico-ureteral reflux (VUR) may result in renal scarring. Severe renal scarring impairs renal function and may result in hypertension, renal insufficiency, and end stage renal disease requiring dialyses or transplantation. Beta 2 micro-globulin (2MG) is a low molecular weight protein freely filtered by the glomeruli and then actively reabsorbed normally up to 99.9% in the proximal tubules; its urinary excretion is an indication of proximal tubular cell dysfunction. Objectives: The current study aimed to determine whether urinary 2MG excretion would be elevated in patients with various grades of renal scar, and also its relationship with renal outcome in long term follow-up. Materials and Methods: Urinary 2MG and Creatinine (Cr) were measured in 83 spot urine samples of patients that 53 of them did DMSA renal scan both at the time of admission to confirm pyelonephritis, and 6 month later to detect scars. 2MG was measured by radioimmunoassay method using 2MG 96-test kit (RADIM Company; Germany), and the creatinine was measurd by spectrophotometry and was recorded as microgram per mg creatinine. Twenty children had various grades of renal scars.Results were compared with the ratios of 19 children with low uptake scanning, 14 children with normal scanning after recovery from pyelonephritis, and 30 normal children served as controls. EXCEL and SPSS softwares were employed to compare the mean urinary 2MG in groups by student t-test, ANOVA, and Unpaired t-test at P,0.05 significance level. Subsequently patients were followed up for 6 years.\\r\\n Results: The mean urinary 2MG/Cr ratio was significantly higher in the scarring group (5.23 10.6) than in the normal group (0.19 0.2), and in low uptake group (0.49 0.86) (P < 0.05). When mean 2MG/Cr ratios were compared for each grade of scarring; patients with sever scar (grade III) had higher values (14.69 15.82) than grades I (0.36 0.35) and II (3.37 5.20) (P < 0.05). Patients without renal scar had a 2MG/Cr ratio below 0.46 microgram/mg Cr. The mean 2MG was also higher in the refluxing group (3.45 7.97) than nonrefluxing group (0.23 0.24) ug/mgCr (P = 0.01). Three patients who had the highest 2MG/Cr ratio values (33.3, 27, and 26.6 microgram/mg Cr) had sever scar that rapidly progressed to ESRD. They were transplanted 2 years later; after transplantation they still had recurrent UTIs. 2nd patient underwent native nephrectomy for renal abscess.\\r\\n Conclusions: Results of the current study revealed that mean 2MG/Cr ratio was higher in patients with renal scar and poor outcome. Measurement of Urinary 2MG may be useful in the early detection of tubular damage in refluxing patients and patients with renal scars and has prognostic significance.

Background: Renal scintigraphy with technetium 99m labeled dimercaptosuccinic acid (99mTc-DMSA) is a traditional imaging technique commonly used to detect renal scar in patients with probable vesicoureteral reflux (VUR) and/or urinary tract infection (UTIs). We determined whether normal results of DMSA renal scan obviate the need for voiding cystourethrography (VCUG) in evaluating children with UTIs. Materials and Methods: We observed medical records from June 2006 to April 2007 retrospectively of 208 children admitted with community acquired UTIs to Mofid children hospital (Tehran, IR/Iran) a teaching hospital in Tehran in which their age was between 2-120 months. The association between DMSA renal scan results and VCUG findings performed 48 hours and 1 month after the diagnosis was evaluated. To examine the accuracy of abnormal DMSA results in predicting VUR, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and negative and positive likelihood ratio (LRs) were calculated. Results: VUR was seen in 14.0% of renal units with normal results of DMSA and 17.3% of renal units with abnormal DMSA findings. High grade VUR (grade IIIV) was seen in 18 (7.1%) of the abnormal findings of DMSA group and in (2.8%) 1 of the normal DMSA results group (P = 0.56). In the group with previous UTI (n = 68), the sensitivity and NPV of abnormalities on DMSA renal scan for detecting the presence of VUR (grade IIIV) were 100%, and100%, respectively. In the group without evidence of previous UTI, the sensitivity and NPV of abnormalities on DMSA renal scan for detecting the presence of VUR (grade IIIV) were 93% and 97%, respectively. Totally the sensitivity and NPV of abnormalities on DMSA renal scan to detect the presence of VUR (grade IIIV) were 94% and 97%, respectively. Conclusions: As a screening test, DMSA renal scan is a high sensitive technique to assess VUR (grade IIIV) in children with UTI.

Background: The presence of vesicoureteral reflux (VUR) has been documented in 1.3% of the general population, 70% of infants with urinary tract infection (UTI), and 15–25% of children with UTI. Objectives: The main aims of this prospective cohort study were to compare the efficiency of different imaging techniques [renal ultrasonography, cortical scintigraphy with technetium-99m dimercaptosuccinic acid (99mTc DMSA)] in detecting VUR in patients with acute pyelonephritis. Patients and Methods: Between June 2003 and March 2010, we recruited a prospective cohort of patients aged 1 month to 14 years. Pediatric patients with documented urinary tract infections and imaging evidence of upper tract involvement were examined by DMSA scintigraphy, renal ultrasonography, and voiding cystourethrography (VCUG). The assessments included UTI profiling, kidney ultrasonography, and DMSA scans. Data were expressed as mean ± SD. Statistical tests were two-tailed and were considered significant when P ≤ 0.05. Results: A total of 1500 pediatric patients were eligible to receive treatment for pyelonephritis. DMSA scans were normal in 20.2% of the patients and abnormal in the remaining 79.8%, and the kidney ultrasonographies yielded normal results in 68.5% of the patients and abnormal results in the remaining 31.5%. There was a significant difference between the ultrasonography reports of patients with normal and abnormal DMSA scans. The VCUG results were normal in 74.1% of the patients and indicated VUR in the remaining 25.9% (VUR grade I in 10.7%, grade II in 7.3%, grade III in 4.7%, grade IV in 1.7%, and grade V in 1.5%). The refluxes were unilateral in 62.9% of the patients and bilateral in the remaining 37.1%. We found a significant correlation between the presence of VUR in VCUG and urological abnormality in ultrasonography (r = 0.14, P < 0.001). The incidence of VUR among patients showing severe abnormalities in DMSA scintigraphy, was significantly higher than that among patients with normal DMSA results or those showing mild to moderate changes in DMSA scintigraphy. Conclusions: We concluded that kidney ultrasonography and DMSA scans can be performed before VCUG in children with UTI. In addition, we recommend performing VCUG in cases of pyelonephritis only when the patients show abnormal kidney ultrasonography or DMSA scan results.

Otukesh H, Hoseini R, Rahimzadeh N, Fereshtehnejad S-M, Simfroosh N, Basiri A, Sharifian M, Hashemi GH, Falahzadeh H, Derakhshan A, Fazel M, Reiesee D, Sayedzadeh A, Vazirian S, Nikibakhsh AA, Moghadam AG, Mohamadzadeh H, Naderi A, Isfahani T, Larijani F, Shorkhi H, Pasha AA, Shahbazian H, Valavi E, Mortazavi F, Gheisari A. Outcome of renal transplantation in children: A multi-center national report from Iran. Pediatr Transplantation 2011: 15: 533–538. © 2011 John Wiley & Sons A/S. Abstract: The outcome of pediatric renal transplantation was previously reported by a single-center study at the year 2006. Therefore, we aimed to evaluate and report the characteristics and outcome of renal pediatric renal transplantation in a multi-center nationwide study. In this nationwide report, medical records of 907 children (≤18 yr) with renal transplantation in eight major pediatric transplant centers of Iran were recorded. These 907 patients received a total of 922 transplants. All children who failed to follow-up were excluded. Rather than baseline characteristics, graft and patient outcomes were considered for survival analysis. For further analysis, they were divided into two groups: patients who had graft survival time more than 10 yr (n = 91) and the ones with graft survival time of equal or less than 10 yr (n = 831). Of 922 recipients, 515 (55.8%) were boys and 407 (44.2%) were girls with the mean age of 13.10 (s.d. = 3.54) yr. DGF and AR were occurred in 10% and 39.5% of the transplanted children, respectively. Transplantation year, dialyzing status before transplantation, DGF, and AR were significant enough to predict graft survival in cox regression model (overall model: p

Cytokines play a major role in renal scar formation following febrile urinary tract infection (UTI). We investigated the role of dexamethasone combined with antibiotics in diminishing urinary interleukin-6 (UIL-6) and UIL-8 concentrations during the acute phase of pyelonephritis compared with standard antibiotic therapy. UIL-6 and UIL-8 concentrations were determined by enzyme immunoassay in 34 children with pyelonephritis who were treated with ceftriaxone plus dexamethasone (case group) and in 20 patients with the same diagnosis treated with ceftriaxone alone (control group). Urine samples were obtained at the time of presentation prior to drug administration and at follow-up 72 h after initiation of medication. Creatinine concentrations were also determined, and cytokine/creatinine ratios were calculated to standardize samples. Differences between cytokine/creatinine ratios in initial and follow-up urine samples were significant in the case group (P < 0.001) but not for controls. In addition, combined antibiotic and dexamethasone significantly decreased UIL-6 and UIL-8 concentrations compared with antibiotic alone (P < 0.05). We conclude that dexamethasone combined with antibiotics significantly decreases UIL-6 and UIL-8 levels in patients with acute pyelonephritis. This suggests that the clinical use of corticosteroids may prevent scar formation following febrile UTI.

Background Distal Renal Tubular Acidosis is a disorder of acid-base regulation caused by functional failure of α-intercalated cells in the distal nephron. The recessive form of the disease (which is usually associated with sensorineural deafness) is attributable to mutations in ATP6V1B1 or ATP6V0A4, which encode the tissue-restricted B1 and a4 subunits of the renal apical H+-ATPase. ATP6V1B1 lies adjacent to the gene encoding the homeobox domain protein VAX2, at 2p13.3. To date, no human phenotype has been associated with VAX2 mutations. Case presentation The male Caucasian proband, born of a first cousin marriage, presented at 2 months with failure to thrive, vomiting and poor urine output. No anatomical problems were identified, but investigation revealed hyperchloremic metabolic acidosis with inappropriately alkaline urine and bilateral nephrocalcinosis. Distal Renal Tubular Acidosis was diagnosed and audiometry confirmed hearing loss at 2 years. ATP6V0A4 was excluded from genetic causation by intragenic SNP linkage analysis, but ATP6V1B1 completely failed to PCR-amplify in the patient, suggesting a genomic deletion. Successful amplification of DNA flanking ATP6V1B1 facilitated systematic chromosome walking to ascertain that the proband harbored a homozygous deletion at 2p13.3 encompassing all of ATP6V1B1 and part of VAX2; gene dosage was halved in the parents. This results in the complete deletion of ATP6V1B1 and disruption of the VAX2 open reading frame. Later ocular examinations revealed bilateral rod / cone photoreceptor dystrophy and mild optic atrophy. Similar changes were not detected in an adult harbouring a disruptive mutation in ATP6V1B1. Conclusions The genomic deletion reported here is firstly, the only reported example of a whole gene deletion to underlie Distal Renal Tubular Acidosis, where the clinical phenotype is indistinguishable from that of other patients with ATP6V1B1 mutations; secondly, this is the first reported example of a human VAX2 mutation and associated ocular phenotype, supporting speculation in the literature that VAX2 is important for correct retinal functioning.

This study was designed to investigate the effect of N-acetylcysteine (NAC), as a potent and safe antioxidant, on inflammatory biomarkers of acute pyelonephritis in pediatric patients.Children (15 years old) admitted with a diagnosis of pyelonephritis were recruited in a randomized placebo-controlled trial. They were randomly allocated to 2 groups and recieved placebo or NAC effervescent tablets with daily dose based on their weight, for 5 days. The children were evaluated for serum procalcitonin level, leukocyte count, C-reactive protein (CRP), serum creatinine, and clinical symptoms on the 1st and the 5th days.Seventy patients, 35 in each group, with a mean age of 5.54 ± 3.10 years completed the study. There was no significant difference between the two groups in the amount of changes in procalcitonin levels after 5 days (P = .90). Within-group analysis confirmed CRP reduction in both groups (P.001); however, between-group analysis did not show significant difference in CRP reductions, either (P = .65). No significant differences were found between the two groups in the day of resolving pyuria (P = .46), day of resolving bacteriuria (P = .81), or reductions in leukocyte count (P = .64) and neutrophil count (P = .49).A short period of NAC administration with the recommended doses could not lead to a significant decrease in inflammation biomarkers. Studies on higher doses and longer duration of NAC administration along with evaluation of the long-term effects of the intervention by tools such as renal scntigraphy are suggested.

Context: Urinary tract infections (UTIs) are among the most common infections in children that affect up to 3% of boys and 8% of girls. Delay in diagnosis and treatment causes renal injury and scars that can progress to end stage renal disease (ESRD) requiring dialysis and transplantation. Results: There are many pitfalls in diagnosis of UTIs both with urinalysis and culture methods and also in evaluating the risk factors and causes of UTIs. Conclusions: This paper reviews and discusses the common pitfalls in diagnosis and evaluation of UTIs in children.

Introduction Patients with end-stage renal disease and lower urinary tract abnormality are often considered high risk for renal transplantation. Methods and subjects To examine the degree of risk, we studied patients who received renal transplants between 1985 and 2003. Forty eight patients had congenital lower urinary tract anomalies and 168 patients comprised a control group without these anomalies. Results Mean age and distribution of sex were not significantly different between the case and the control group. Among patients with anomalies, 8% had delayed graft function; 75%, acute rejection; and 39.5%, chronic rejection. Among the controls 2.3% had delayed graft function; 59%, acute rejection; and 35%, chronic rejection. None of these differences was significant. Mean survival time was 6 years in affected patients and 7.3 years in the control group ( P = .7). Among patients with anomalies the rate of graft survival in the first year after transplantation was 90%; and those in the third, fifth, and seventh years, 76%, 65%, and 40%, respectively. For the controls, the graft survivals were 88% at 1 year; 73% at 3 years; 70% at 5 years; and 49% at 7 years after transplantation. Conclusion This study showed that a history of lower urinary tract anomalies had no effect on graft function. Graft survival was not different among these patients compared with patients free of these anomalies.

Urinary tract infection (UTI) among children is sometimes associated with anorexia and sometimes failure to thrive. Appetite-regulating hormones may be a causative factor. Leptin regulates appetite, food intake, and body weight via hypothalamic melanocortin-4 receptor. Leptin is also a potential cytokine for inflammation. The aim of this study was to evaluate serum and urine leptin before and after treatment of children with UTI.In this before-after study, serum and urine leptin were measured in 40 patients with UTI at admission and 5 days after treatment. Pyelonephritis was suggested by signs and symptoms and confirmed with positive urine culture and dimercaptosuccinic acid renal scintigraphy. Other measurements included urinalysis, urine culture, urine creatinine level, complete blood count, erythrocyte sedimentation rate, C-reactive protein level and serum levels of urea, creatinine, glucose, cholesterol, and triglyceride.The mean serum leptin level was 6.85 ± 18.90 ng/mL before the treatment and 8.29 ± 18.30 ng/mL after the treatment, the difference of which was not significant (P = .64). There were significant correlations between serum leptin and age, weight, and C-reactive protein. Urine leptin levels were reduced significantly from 0.75 ± 0.82 ng/mL to 0.46 ± 0.27 ng/mL after the treatment (P = .03). A significant correlation was observed between urine leptin level with age and weight.Serum leptin level did not change significantly after treatment of UTI, but urine leptin significantly decreased. Serum leptin level was higher in patients with anorexia in comparison with children with normal appetite; however, the difference was not significant.

Background: Monoclonal antibodies block interleukin-2 receptors on alloantigen-reactive T-Lymphocytes and induce selective immunosuppression. It is postulated that induction therapy with these agents in pediatric transplantation may decrease acute rejection and improve graft survival with no significant side effect or increase in the incidence of viral infections. Objectives: The aim of this study was to examine the effects of interleukin 2 receptor blockers on patient and graft survival in renal-transplanted children. Patients and Methods: One hundred and eighty six children aged 7-13 years who received renal transplantation in university-affiliated hospital between 2003 and 2012 were enrolled in the study. All patients received prednisolone, cyclosporine and mycophenolate mofetil or azathioprine as basic immunosuppressive therapy. Patients were divided into two groups according to receiving induction therapy with IL2-receptor blockers. We investigated for acute rejection episodes, Cytomegalovirus (CMV) and BK virus infection and one and three year’s survival of the patients and the grafts Results: From 186 renal-transplanted children included in this study, 36 patients were in treated group (group 1) and 150 patients in control group (group 2). The mean age of the patients was 10.4 ± 2 years and 55.6% were males. In first six months of transplantation, eight patients in group one had one episode of acute rejection and no one had two episodes. Early acute rejection rate was 8.36 (22%). In the control group, 37 patients had one episode and three patients had two episodes of acute rejection (rejection rate 28.6%). Therefore, early acute rejection rates were lower in group one. Late acute rejection rates did not show any difference in group 1 and group 2 (27.7% vs. 27.3% respectively). There was lower prevalence of steroid-resistance rejection in group 1 patients (5.5%) compared with 6.6% in group 2, but it did not reach statistical significance. None of the patients in IL2-R blocker group died at one year follow-up (patient survival 100%). However, in control group, four (2.6%) patients died toward the end of first year (patient survival 97.4%). When patients in group 1 and group 2 were age and sex matched with equal number the difference was significant (P < 0.05). Conclusions: Induction therapy with IL2-R blockers reduced the rate of early acute rejection, but had no effect on late acute rejections. Patient and graft survival were better in treated group, but did not reach statistical significance. A longer period of follow-up may be required to discern a clear advantage for induction therapy with these agents.

Vesicoureteral reflux (VUR) is one of the most important risk factors for urinary tract infection (UTI). Diagnosis and treatment of VUR is important to prevent irreversible complications, such as renal scarring and chronic renal failure. This study was conducted to assess the value of direct radionuclide cystography (DRNC) in the detection of VUR in children with UTI and a normal voiding cystourethrography (VCUG). DRNC was performed in 35 children with a normal VCUG after an episode of febrile UTI who had hydronephrosis or hydroureter, abnormal acute dimercaptosuccinic acid (DMSA) scan results and/or febrile UTI recurrence. This study was conducted in the nephrology department of Mofid Children’s Hospital, Tehran (Iran). The results were statistically analyzed. Among the 70 ureters studied, 33 (49.1 %) were observed to have VUR. Of these, 17 (51.5 %) had mild, 14 (42.4 %) moderate, and 2 (6.1 %) severe reflux. A significant relationship was observed between DRNC results and DMSA renal scan findings (P

Hydronephrosis is a common finding in patients with urinary tract infection (UTI). Endothellin-1 (ET-1) is a potent vasoactive peptide that has vasoconstrictive effects. It has been shown that urinary ET-1 increases in urinary obstructions. In this study, we measured the urinary ET-1 level in patients with UTI and hydronephrosis of various causes. In this case-control study, we evaluated the urinary ET-1 level in 45 patients who had UTI and hydronephrosis, serving as a case group, and 45 patients who had UTI without hydronephrosis, serving as a control group. Urinary ET-1 was quantified using enzyme-linked immunosorbent assay and urinary creatinine (Cr) by Jaffe method. To rule out the effect of urinary flow rate, the urinary ET-1 to Cr correlation was considered for analysis of the results. The mean age of the patients in the case and control groups was 36.5 ± 27.2 and 26.2 ± 15.5 months, respectively (P >0.01). The mean urinary ET-1 was 89.6 ± 41.7 pg/dL in the case group and 29.3 ± 26 pg/dL in the control group, P

The widespread use of prenatal ultrasonography results in increased recognition of congenital hydronephrosis, a therapeutic and diagnostic challenge. This study was conducted to investigate the natural course of prenatal hydronephrosis and the accuracy of postnatal APD in determining the outcome.All newborns with prenatal hydronephrosis were followed up by ultrasonography after birth. Voiding cystoureterography, diethylene triaamine pentaacetic acid renal scintigraphy, and dimercaptosuccinic acid renal scintigraphy were done if indicated. The receiver operating characteristic curve was plotted to determine the best cutoff for the anterior-posterior pelvic diameter (APD) to distinguish surgical from spontaneously resolving group.Of 178 neonates, 42 (23%) required surgery. The area under the curve for APD to predict the need for surgery was 0.925 with an APD cutoff of 15 mm. The diagnostic value of APD for determining the need for surgery was determined by sensitivity and specificity of 95.2% and 73.5%, respectively.Postnatal APD on ultrasonography has a valuable diagnostic accuracy for requiring surgery and provides a useful guide for parental counseling.

Adrenomedullin (AM) is a 52-amino acid peptide that causes vasodilatation by increased synthesis of nitric oxide. Its production by different cells such as cardiac myocytes, smooth muscle, endothelial, and oncogenic cells is stimulated by inflammatory processes. It has been shown that in the presence of inflammation in the urinary system, concentration of AM increases. In this study, we measured urinary AM in children with acute pyelonephritis before and after treatment and compared its level with that in healthy children.In a case-control study, 31 children with clinical and paraclinical documentation of pyelonephritis (case group) and 30 healthy children without pyelonephritis or other infections (control group) were studied. Urinary AM were measured on spot urine samples by high-performance liquid chromatography, and creatinine was measured by spectrophotometry to report the AM-creatinine ratio.Urinary AM-creatinine ratios were 61.3 +/- 119.4 pg/mg and 4.26 +/- 11.4 pg/mg, respectively, in the case and control groups (P = .01). After treatment of pyelonephritis in the patients of the case group, this ratio decreased to 13.1 +/- 21.9 (P = .048). The coefficient correlation between urinary AM and leukocytes count was 0.252 (P = .17). Urinary AM levels were 1896 +/- 1748 pg/dL and 391 +/- 477 pg/dL in the patients with 4+ versus negative C-reactive protein levels, respectively (P = .008).Urinary AM increases in the course of pyelonephritis and decreases significantly after treatment.

The outcome of pediatric renal transplantation was previously reported by a single-center study at the year 2006. Therefore, we aimed to evaluate and report the characteristics and outcome of renal pediatric renal transplantation in a multi-center nationwide study. In this nationwide report, medical records of 907 children (≤18yr) with renal transplantation in eight major pediatric transplant centers of Iran were recorded. These 907 patients received a total of 922 transplants. All children who failed to follow-up were excluded. Rather than baseline characteristics, graft and patient outcomes were considered for survival analysis. For further analysis, they were divided into two groups: patients who had graft survival time more than 10yr (n=91) and the ones with graft survival time of equal or less than 10yr (n=831). Of 922 recipients, 515 (55.8%) were boys and 407 (44.2%) were girls with the mean age of 13.10 (s.d.=3.54) yr. DGF and AR were occurred in 10% and 39.5% of the transplanted children, respectively. Transplantation year, dialyzing status before transplantation, DGF, and AR were significant enough to predict graft survival in cox regression model (overall model: p0.001). Nowadays, there is a successful live donor pediatric renal transplantation in Iran. Graft survival has improved in our recipients and now the graft survival rates are near to international standards.

This study was conducted to evaluate preventive effect of a combination of heparin and aspirin on vascular thrombosis and kidney transplant outcomes of pediatric kidney transplant recipients.Twenty-four pediatric kidney transplant recipients received heparin, 50 U/kg, every 8 hours for 7 postoperative days, and aspirin, 5 mg/kg, thrice a week from day 3 of transplantation for 3 months. These patients were compared with a matched group of pediatric kidney allograft recipients in terms of development of thrombosis and serum creatinine level at 1 year postoperation.The mean age of patients was 9.4 ± 3.2 years. No vascular thrombosis was developed among the 24 patients with anticoagulant therapy, while in the control group, 5 grafts (7.9%) developed thrombosis (P = .19). Serum creatinine levels at 1 year were lower in the children with anticoagulant therapy as compared with the controls (P = .02).Our study revealed a reduction in kidney allograft thrombosis incidence in children who received heparin and aspirin after transplantation, which was clinically important although the difference was not statistically significant. Lower serum creatinine levels as compared with a historical cohort group were seen 1 year after transplant surgery. These findings are required to be confirmed by further studies.

The role of vitamin A in re-epithelialization of the damaged mucosal surfaces has been documented. The aim of this study was to evaluate the role of vitamin A in preventing renal scaring after acute pyelonephritis in children.This clinical trial study was conducted in children with acute pyelonephritis in Mofid Children Hospital (Tehran, Iran). Patients were randomly divided into two groups to receive ceftriaxone and vitamin A or ceftriaxone only. Dimercaptosuccinic acid (DMSA) renal scintigraphy was performed before the start of the treatment and 6 months later. Results were compared for renal scaring between the two groups.Seventy-six patients (11 boys and 65 girls) were enrolled. The mean age was 25 ± 24 months and 54 patients (71.1%) were under 2 years old. The average vitamin A level was 71 ± 24 microg/dL in the treatment group and it was 62 ± 18 µg/dL in the control group. Baseline DMSA scans were comparable between the two groups in terms of scarring (P = .53), but the second DMSA scans showed a significant change in progression of the renal injury and scaring in the control group compared to those treated with vitamin A as well as antibiotic (P.001).We found administration of the vitamin A was useful in decreasing the amount of the injury and scarring following the pyelonephritis. Based on our study, vitamin A can be used in conjunction with other treatments in the management of acute pyelonephritis in children.

In autosomal recessive distal renal tubular acidosis (DRTA), a substantial fraction of the patients have progressive bilateral sensorineural hearing loss. This coexistence is due to the mutations of a gene expressed both in the kidney and in the cochlea. The aim of this study was to assess the correlation between hearing loss and DRTA.In this study, 51 children diagnosed with renal tubular acidosis were evaluated. Diagnosis of DRTA was based on clinical manifestations and detection of normal anion gap metabolic acidosis, urine pH higher than 5.5, and positive urinary anion gap. Audiometry was performed in children with DRTA and sequencing of the ATP6V1B1 gene was done for those with sensorineural hearing loss.Twenty-seven patients (52.9%) had DRTA, of whom 51.9% were younger than 1 year old, 55.6% were boys, and 44.4% were girls. Eleven patients (40.7%) had bilateral sensorineural hearing loss, consisting of 5 of 15 boys (33.3%) and 6 of 12 girls (50.0%). There was no correlation between hearing loss and gender. Three patients with hearing loss had mutation in the ATP6V1B1 gene (11.1% of patients with DRTA and 27.3% of patients with DRTA and hearing loss).This study indicated that a significant percentage of the children with DRTA had sensorineural hearing loss and mutation in ATP6V1B1 gene. It is recommended to investigate hearing impairment in all children with DRTA.

INTRODUCTION. Urinary tract infection is the most common serious bacterial infection in children. The aim of this study was to compare the value of different laboratory and imaging techniques in detecting renal involvement in acute pyelonephritis. MATERIALS AND METHODS. In a cross-sectional study of patients 1 month to 14 years of age diagnosed with urinary tract infection were examined with systemic inflammatory markers, renal ultrasonography, voiding cystourethrography (VCUG), and technetium Tc 99m dimercaptosuccinic acid ((99m)Tc-DMSA) renal scintigraphy. A total of 1467 pediatric patients were eligible for treatment of pyelonephritis. Evaluations included a complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), urinalysis, urine culture, and measurement of serum blood urea nitrogen and creatinine levels. RESULTS. The results of (99m)Tc-DMSA scans were normal in 20.2%, mild decreased cortical uptake in 45.0%, moderate decreased cortical uptake in 12.3%, severe decreased cortical uptake in 12.0%, and decreased cortical function plus irregularity or scar formation in 10.5%. Voiding cystourethrography showed vesicoureteral reflux in 25.9%. The sensitivity of (99m)Tc-DMSA for prediction of vesicoureteral reflux was 84.1% with a negative predictive value of 80.6%. Significant differences were found in the level of blood leukocyte count (P = .03), urine leukocyte count (P = .003), ESR (P = .008), and age (P = .04) between patients with normal and abnormal (99m)Tc-DMSA scan results. CONCLUSIONS. We found that in patient with clinical signs of pyelonephritis, (99m)Tc-DMSA renal scintigraphy can detect pyelonephritis more accurately than the other inflammatory and imaging tests.

Tumor necrosis factor-alpha (TNF-alpha) is an important mediator of the inflammatory response in serious bacterial infections. The aim of this study was to evaluate the potential of urinary TNF-alpha for diagnosis of acute pyelonephritis in children.This study was conducted from March 2006 to December 2007 on children with confirmed diagnosis of acute pyelonephritis. They all had positive renal scintigraphy scans for pyelonephritis and leukocyturia. The ratios of urinary TNF-alpha to urine creatinine level were determined and compared in patients before and after antibiotic therapy.Eighty-two children (13 boys and 69 girls) with acute pyelonephritis were evaluated. The mean pretreatment ratio of urinary TNF-alpha to urinary creatinine level was higher than that 3 days after starting on empirical treatment (P = .03). The sensitivity of this parameter was 91% for diagnosis of acute pyelonephritis when compared with demercaptosuccinic acid renal scintigraphy as gold standard.Based on our findings in children, the level of urinary TNF-alpha-creatinine ratio is acute increased in pyelonephritis and it decreases after appropriate therapy with a high sensitivity for early diagnosis of the disease. Further research is warranted for shedding light on the potential diagnostic role of urinary TNF-alpha in pyelonephritis in children.

The aim of this study was to assess urinary interleukin-8 (IL-8) levels in pyelonephritis and its relation with the clinical course of the infection and of inflammatory changes detected by renal scintigraphy.In this quasi-experimental before-after study, we evaluated 91 children aged 1 to 144 months (mean 34.4 +/- 35.2 months) with pyelonephritis. Inflammatory markers including erythrocyte sedimentation rate, C-reactive protein, leukocyte count, and urinary IL-8, together with the results of ultrasonography, voiding cystourethrography, and dimercaptosuccinic acid renal scintigraphy were evaluated in these children. The ratios of urinary IL-8 to creatinine (IL-8/C) before and after the treatment were compared with each other.Urinary IL-8/C levels were significantly higher after the empirical treatment in comparison with those before the treatment (0.19 +/- 0.21 versus 0.51 +/- 0.53, P.001). No correlation was found between the urinary IL-8 levels and leukocyturia, urine culture results, other inflammatory markers, or findings of imaging examinations.We found high urinary IL-8 levels in children with pyelonephritis. We also documented its increasing after the treatment. We conclude that evaluation of urinary IL-8 can be a noninvasive test for diagnosis of upper urinary tract infection and its response to treatment.

Prompt diagnosis and localization of pyelonephritis are of great importance in children. The urinary excretion of enzymes, and in particular N-acetyl-beta-D-glucosaminidase (NAG), is considered a simple noninvasive marker for detection of renal tubular dysfunction due to pyelonephritis. This study was performed to determine the diagnostic value of urinary NAG in acute pyelonephritis.In a quasi-experimental study conducted on 72 children with confirmed pyelonephritis, we measured urinary NAG, creatinine, and NAG-creatinine ratio before and after the treatment. Diagnostic values of these parameters were evaluated by considering the patients before and after the treatment as disease-positive and disease-negative groups, respectively.The patients were 18 boys (25.0%) and 54 girls (75.0%) with a mean age of 43.0 +/- 39.0 months. The mean levels of urinary NAG were 12.20 +/- 6.14 U/L and 5.46 +/- 7.98 U/L before and after the treatment, respectively (P.001). The sensitivity and specificity of urinary NAG-creatinine ratio for diagnosis of pyelonephritis were 73.6% and 77.3%, respectively, with a cutoff point of 10.16 U/g (area under the curve = 0.76, 95% confidence interval, 0.67 to 0.76). Significantly higher levels of urinary NAG were found in those who had a negative urine culture at diagnosis (8.8 +/- 10.4 U/L) compared to those with a positive urine culture (4.5 +/- 8.7 U/L).We concluded that urinary NAG is elevated in children with pyelonephritis and it can be considered as a further criterion in the diagnosis of upper urinary tract infection.

Bardet-Biedl syndrome is an autosomal recessive disorder characterized by obesity, polydactyly of hands and feet, retinitis pigmentosa, hypogenitalism, various degrees of intellectual impairment and renal anomalies. Other clinical features include speech disorder, brachydactyly, developmental delay, polyuria/polydipsia, ataxia, poor coordination/clumsiness, diabetes mellitus, left ventricular hypertrophy, hepatic fibrosis, and renal hypoplasia/dysplasia. If spasticity and mental retardation present, it fulfills the criteria for Laurence-Moon-Bardet-Biedl syndrome.Between July 1985 and January 2005, 2,282 kidney transplantations were performed at Labbafinejad Medical Center, of whom 262 were children under 15 years of age (61% males). Among children, five (four females) had Bardet-Biedl syndrome who were transplanted preemptively. Kidneys were taken from living unrelated donors.All five patients had retinitis pigmentosa and obesity with body mass index up to 39.33 kg/m(2). The cause of end-stage renal failure was reflux nephropathy in one, neurogenic bladder in one, and renal hypoplasia/dysplasia in three patients. The mean age at transplantation was 11 years (range: 6-17 years). Immunosuppressives administered were prednisolone, cyclosporine, and mycophenolate mofetil. All of them suffered at least one episode of acute rejection shortly after transplantation but reversed with methylprednisolone pulses; in the last follow-up, the mean creatinine was 1.2 (range: 0.6 - 2.3 mg/dL). The mean glomerular filtration rate before transplantation was 10 mL/min/1.73 m(2); in the last follow-up it was 79 (range: 38-137).Renal transplantation is a safe and successful procedure and renal replacement therapy of choice in patients with Bardet-Biedl syndrome and end-stage renal failure, but special attention should be paid to body mass index and steroid-free immunosuppression if other suitable drugs, such as sirolimus and basiliximab are affordable.

Urinary tract infection is one of the most common diseases in children. Early diagnosis and comprehensive treatment can significantly decrease late serious complications. Knowledge of the sensitivity and resistance pattern of uropathogens in specific geographical locations is an important factor for choosing suitable antibacterial treatment. This study was conducted in order to evaluate the antibacterial resistance of urinary pathogens at Mofid Children's Hospital between March 2000 and August 2001. Positive urine cultures from 1,177 children aged less than 12 years (mean age, 31.7 months; female to male ratio, 2:1) were studied. Cultures were performed on urine samples obtained by sterile urine bags in infants and midstream urine in older children; if samples were contaminated then a suprapubic sample was taken in infants. Sensitivity was measured by the disc diffusion method using the NCCLS protocol. The most prevalent urinary pathogen was Escherichia coli (666 cases, 56.6%). Overall, the lowest resistance rate of microorganisms was that against ciprofloxacin (6.7%) and the highest resistance rate was that against penicillin (83%). A comparison of these data with those of other countries shows that there is considerable geographic variation in bacterial patterns of sensitivity and resistance properties. Therefore, the selection of antibiotics for empiric therapy should be based on the sensitivity and resistance pattern of uropathogens in the respective city.

Introduction. Since kidney transplantation is the therapy of choice for children with end-stage renal disease (ESRD), we investigated the effects of mycophenolate mofetil (MMF) in pediatric renal transplantation. Methods and subjects. Two hundred sixteen children received renal transplants between 1985 and 2003: 100 patients received MMF with cyclosporine and prednisolone (cases), and 116 patients, azathioprine with cyclosporine and prednisolone (controls). Results. The MMF group (100 patients) showed better graft survival and function than the AZA group (116 patients). Patients who received MMF immediately after transplantation experienced less graft loss and acute rejection episodes in the first 3 months after transplantation (P

KIDNEY transplantation is the treatment of choice for end-stage renal disease. A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis. Renal transplantation has a background of more than 35 years in Iran. More than 12,000 renal transplantations have been performed in this country. We conducted this study to present a brief report of a large number of living donor renal transplants in the two main transplantation centers in Tehran with more than 15 years follow up.

In this paper, we first study the effects of the varying gravitational constant G as well as the bulk viscosity on the evolution of the Universe field with pressureless dark matter and ghost dark energy (GDE). Then, we establish a correspondence between viscous GDE and scalar field models of dark energy including quintessence, tachyon, K-essence and dilaton energy density in a flat FRW universe. This correspondence allows us to reconstruct the potential and dynamics of the scalar fields according to the evolution of interacting viscous GDE with varying G.