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Background For the purpose of a better understanding of enteric hyperoxaluria in Crohn's disease (CD) in children and adolescents, we investigated the occurrence and risk factors for development of hyperoxaluria in those patients. Methods Forty-five children with CD and another 45 controls were involved in this cross-sectional study. Urine samples were collected for measurement of spot urine calcium/creatinine (Ur Ca/Cr), oxalate/creatinine (Ur Ox/Cr), and citrate/creatinine (Ur Citr/Cr) ratios. Fecal samples were also collected to detect the oxalyl-CoA decarboxylase of Oxalobacter formigenes by PCR. Patients were classified into 2 groups: group A (with hyperoxaluria) and group B (with normal urine oxalate excretion). The disease extent was assessed, and the activity index was calculated. Results According to the activity index, 30 patients (66.7%) had mild disease and 13 patients (28.9%) had moderate disease. There was no significant difference in Ur Ox/Cr ratio regarding the disease activity index. O. formigenes was not detected in 91% of patients in group A while it was detected in all patients in group B (p < 0.001). By using logistic regression analysis, the overall model was statistically significant when compared to the null model, ([chi].sup.2 (7) = 52.19, p < 0.001), steatorrhea (p = 0.004), frequent stools (p = 0.009), and O. formigenes (p < 0.001). Conclusion Lack of intestinal colonization with O. formigenes, steatorrhea, and frequent stools are the main risk factors for development of enteric hyperoxaluria in CD patients. Identifying risk factors facilitates proper disease management in future studies. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information, Author(s): Amr Salem [sup.1] , Happy Sawires [sup.1] , Ayman Eskander [sup.2] , Radwa Marwan [sup.3] , Engy Boshra [sup.2] Author Affiliations: (1) grid.7776.1, 0000 0004 0639 9286, Pediatric Nephrology [...]

Aim Methods Results Conclusion Stricture formation is the most common remote complication of caustic ingestion. The aim of this study was evaluation of the efficacy of early topical endoscopic application of mitomycin C (MMC) in prevention of stricture formation after corrosive ingestion in children.We enrolled 78 children with a history of caustic ingestion within 48 h in a prospective, randomised‐controlled study. Only 61 children completed the study and were classified into two groups: group A and B. After initial stabilisation, patients in group A (n = 30) received topical application of MMC within the initial 48 h while patients in group B (n = 31) only received conventional management. Follow‐up endoscopic dilatation was done every 2 weeks to patients in either group until no need for further dilatation.The barium study, which was done on the third week, revealed that all the patients (100%) on conservative management (group B) had strictures while only nine patients (30%) in group A had strictures (P < 0.001). The median number of dilatations required for patients in group B was 26 (min. = 23 and max. = 32) while in group A, it was 0 (min. = 0 and max. = 7) (P < 0.001). The success of early MMC application was complete response in 26 patients (86.7%), partial response in 3 patients (10%) and no response in 1 patient (3.3%). On the other side, conventional therapy with endoscopic dilatation achieved complete response in 11 patients (35.5%).Early topical MMC application proved its efficacy and safety in prevention of scar and stricture formation in children following caustic ingestion. [ABSTRACT FROM AUTHOR]

Background The rationale for the prescription of vitamin D analogues in patients with chronic kidney disease (CKD) is still a matter of debate. We aimed to compare native vs. active forms of vitamin D on pre-dialysis children with CKD and evaluate effects on calcium (Ca), phosphorus (P), and parathyroid hormone (PTH). Methods Thirty children with pre-dialysis CKD were enrolled in a prospective cross-over study. Patients were randomly classified into two groups. Group A received native cholecalciferol while group B received alfacalcidol for 3 months. After 1 month (washout period), patients were switched to receive the opposite form for another 3 months. Serum Ca, P, alkaline phosphatase (ALP), PTH, and 25(OH)D.sub.3 were measured at study start (BL-1), end of first period (FU-1), before second period (BL-2), and after second period (FU-2). Results There was significant increase in levels of 25(OH)D.sub.3 after administration of either native or active vitamin D in the first period in both groups (p < 0.001 and < 0.001, respectively) and also in the second period for both groups (p = 0.02 and < 0.001, respectively). There was no significant difference between both groups regarding changes in serum Ca (1st period; p = 0.770 and 2nd period; p = 0.412), serum P (1st period; p = 0.835, 2nd period; p = 0.052), and serum PTH (1st period; p = 0.250, 2nd period; p = 0.539). Conclusion Alfacalcidol and native vitamin D3 were equally effective in decreasing PTH levels and increasing serum 25(OH)D.sub.3 in pre-dialysis CKD patients. There was no significant difference between the two forms regarding changes in serum Ca or P., Author(s): Happy Sawires [sup.1] , Fatina Fadel [sup.1] , Ahmed Hussein [sup.1] , Rasha Helmy [sup.1] Author Affiliations: (1) grid.7776.1, 0000 0004 0639 9286, Pediatric Nephrology Department, Cairo University, , [...]

Background Azithromycin (AZM) is a macrolide antibiotic with anti-inflammatory and immunomodulatory effects. Our aim was to compare the immunomodulatory effects of AZM combined with steroid therapy with that of steroid therapy alone in children with steroid-dependent nephrotic syndrome (SDNS). Methods We enrolled 57 patients with SDNS in a multicenter randomized control trial. Patients were classified into two groups: group A (intervention group, N = 29) and group B (control group, N = 28). After achievement of remission with full-dose daily prednisone, patients in group A received AZM in conjunction with steroids which was tapered gradually, while patients in group B received steroids alone. Urine protein creatinine ratio (uPCR) and TNF-[alpha] were measured at different points of follow-up throughout the study period (5 months after achieving remission). Results After achievement of remission by full-dose steroids, there were significant differences of TNF-[alpha] between the two groups after 1-, 3- and 5-month follow-up (p < 0.001, 0.003, and 0.001, respectively). Also, there was significant difference of TNF-[alpha] in both intervention and control groups after exclusion of the relapsed cases at 3- and 5-month follow-up (, p = 0.031 and p = 0.003, respectively). There was significant difference between both groups after 5-month follow-up as regards the number of relapsed patients (group A = 4, group B = 11, p = 0.015). Conclusion AZM was capable of reducing serum TNF-[alpha] which is one of the inflammatory cytokines implicated in the pathogenesis of NS., Author(s): Happy Sawires [sup.1] [sup.2] , Hanan Abdelaziz [sup.1] , Heba Mostafa Ahmed [sup.3] , Osama Botrous [sup.3] , Michael Agban [sup.4] Author Affiliations: (Aff1) 0000 0004 0639 9286, grid.7776.1, [...]

Objective: Although many methods for pain assessment in newborns are available, none of them are widely accepted. Our aim was to answer the question: do newborns respond similarly to different painful procedures? Methods: Sixty term newborns were involved in non-randomized prospective study. They were classified into 2 groups: Group A (n=30) who needed intubation and Group B (n=30) who necessitated umbilical vein catheterization. Close observation prior to and 10 minutes after the painful procedures was performed for recording of physiological and behavioral indicators. Plasma renin activity (PRA) was measured before and 10 minutes after the painful procedures. Findings: There was statistically significant difference between the 2 groups as regards physiological and hormonal responses to pain (P<0.05). Apart from palmar sweating and crying, there was no significant difference in behavioral response (P>0.05). The median pre- and post-intubation levels of PRA were 3.04 and 12.05 ng/ml/hour, respectively. There was significant (P<0.001) increase of PRA after intubation. On the other hand, the median pre- and post-catheterization levels of PRA were 5.21 and 9.19 ng/ml/hour, respectively. There was significant (P<0.001) increase of PRA after umbilical vein catheterization. We found that PRA was the only indicator of pain in group A (P=0.047). On the other hand, we did not find any indicator of pain in group B. Conclusion: We concluded that full-term newborns vary in their physiological and hormonal responses to different painful procedures but their behavioral response is the same. [ABSTRACT FROM AUTHOR]

Introduction. During hemodialysis, the expression of different adhesion molecules changes, thus serving as markers of biocompatibility of dialysis membranes. Our aim was to investigate whether low-flux and high-flux dialysis membranes have different effects on the concentration of adhesion molecules and their association with leukocytes and pro-inflammatory cytokines. Materials and Methods. We enrolled 80 pediatric patients on hemodialysis. Baseline levels of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were measured. The patients were classified into 2 groups to use either low-flux filters or high-flux filters for 3 months. At the end of the 3 months, predialysis samples were obtained for measurement of ICAM-1, VCAM-1, TNF-α and interleukin-1. Post-dialysis samples were collected for measurement of CBC, ICAM-1, VCAM-1, TNF-α, and interleukin-1. Forty volunteers were involved as a control group. Results. Both TNF- α and IL-1 were higher in the patients compared to the control group (P < .001). Compared to the control group, there was a significant increase in ICAM-1 and VCAM-1 (P < .001) in both groups predialysis and postdialysis. The postdialysis increments of ICAM-1 with the high-flux membranes were significantly less compared to the low-flux membranes (P < .001). Serum ICAM-1 and VCAM-1 significantly correlated with TNF-α and interleukin-1 in all groups. Conclusions. The postdialysis increments of the adhesion molecules are due to the effect of dialysis membranes, which is less with the use of high-flux filters. [ABSTRACT FROM AUTHOR]

Introduction. Hyperparathyroidism is a common finding in patients with renal insufficiency and parathyroid hormone (PTH) is considered a uremic toxin responsible for many of the abnormalities of the uremic state and bone disease. The aim of this study was to investigate the influence of permeability of low-flux versus high-flux dialysis membranes on intact PTH during hemodialysis in children. Materials and Methods. Forty-four children aged between 4 and 13 years old on regular hemodialysis were enrolled in a prospective study. Low-flux polysulfone membranes were used for at least 6 months and then the patients were switched to use high-flux polysulfone membranes for 3 months. Serum electrolytes and intact PTH before and after dialysis were compared before and after changes in dialysis membrane. Results. At the end of the 3-month use of high-flux filters, predialysis intact PTH level (49.40 ± 19.64 ng/dL) showed a highly significant decline (P < .001) compared to the predialysis intact PTH (21.67 ± 4.85 ng/dL) with low-flux membranes at the start of the study. Intact PTH level correlated negatively with serum ionized calcium and positively with serum phosphorus levels only in the predialysis samples with the use of low-flux but not high-flux filters. Conclusions. In children, high-flux dialysis membranes are more efficient in removal of intact PTH, one of the middle-sized uremic toxins, than low-flux membranes. [ABSTRACT FROM AUTHOR]