Zinc supplement in reduction of relapses in children with steroid sensitive nephrotic syndrome

To determine whether Zinc supplementation could reduce relapse rate in children with nephrotic syndrome. Randomized-controlled trial. National Institute of Child-Health and The Kidney Centre, Karachi, from January 2008 to June 2009. Sixty nephrotic children aged 2 - 15 years were selected. Baseline data including age, number of infections and relapses during pre and post study one year were recorded. Randomization was done to divide into Zinc group [Zg] to receive Zinc versus placebo [Pg] for 6 months. Relapses and infections were treated with standard therapy. T-test and chi-square tests were used to compare the mean values and proportions respectively with significance at p < 0.05. Among 60 children, 54 completed trial [Zg = 25, Pg = 29]. Forty [74%] were males and 14 [26%] females. Mean age, pre study relapses and Zinc level in the two groups were similar. Overall, infections and relapses were observed in 43 [79.62%] and 17 cases [31.48%] respectively. There was no significant difference in frequency of infections and mean infection rate in Zg [20, 80% and 1.92 +/- 1.47] compared to Pg [23, 79.3% and 2 +/- 1.53, p = 0.950]. Relapses occurred in 7 [28%] in Zg compared to 10 [34%] in Pg which was not significant [p = 0.609]. Mean infection and relapse rate per patient per year [PPPY] in Zg was 1.92 +/- 1.47and 1.14 +/- 0.37 compared to 2 +/- 1.53 and1.3 +/- 0.48 in Pg respectively [p=0.846, 0.464]. Pre study relapses in two groups were similar [Zg vs. Pg = 96 vs. 96.6%] whereas post study relapses in Zg were lower [7, 28%] compared to Pg [10, 34.5%]. Post study mean relapse rate in Zg was 1.14 +/- 0.37 PPPY compared to 2.71 +/- 1.11 in pre study [p = 0.005]. In Pg, post study mean relapse rate PPPY was 1.30 +/- 0.48 compared to 1.70 +/- 0.48 in pre study period [p = 0.037]. Relapse rate reduction was 43% after Zinc supplementation compared to 27% reduction in placebo. Metallic taste was observed in 10% of cases. Zinc supplementation was helpful in reducing relapses in nephrotic syndrome

Urinary citrate level in urinary stone formers versus controls

To determine the urinary citrate [UC] level in stone formers [SF] versus controls. Case control study. Department of Pediatric Nephrology, National Institute of Child Health [NICH], Karachi from January- July 2008. Eighty six children of 1-13 years, 43 in each group, stone former [SF] and controls were studied. In both groups, 24-hours UC was measured by citrate lyase method. Hypocitraturia was defined as 24- hours UC-level < 5mg/kg for children under 9 years and <7mg/kg for 9 years and above. Data including age, sex, weight, 24-hours urine volume [UV] and UClevel were analyzed using descriptive statistics on SPSS version 15. Of the 86 children, 59 [68.6%] were males and 27 [31.4%] females. Overall mean age was 5.65 + 3.05 years, while that of SF and controls was 5.61+ 3.1 and 5.70 + 3.04 years respectively. Mean 24-hours UV and UC-level in total of 86 samples was 385.10+130 ml and 88.10 + 62.11mg respectively. Mean + SD 24-hours UC-level [mg] in SF and controls was 69.4 + 53.55 [95%CI 53.39-85.41] and 106.8 + 65 [95%CI 87.37-126.23] respectively. Overall hypocitraturia was found in 42[48.8%] children. Frequency of hypocitraturia was high in SF [n 30, 69.8%] compared to controls [n 12, 27.9%] with a significant difference between the two groups [p<0.001]. Overall hypocitraturia was found in 48.8% of cases. Though hypocitraturia was prevalent in both groups, but was significantly high [69.8%] in SF compared to controls [27.9%]. Hypocitraturia may be an important metabolic risk factor and urinary citrate level should be included in the metabolic evaluation in all stone formers

Histopathological pattern in childhood glomerulonephritis

To determine the histopathological pattern in childhood glomerulonephritis [CGN]. This retrospective analysis of renal biopsies of 118 children with various clinical syndromes of CGN was carried out at the National Institute of Child Health [NICH] and The Kidney Center [TKC], Karachi, from July 2005 to December 2009. The age ranged from 6 months to 16 years. All biopsies were studied under light microscopy [LM] and immunoflourescence [IMF] Histopathological lesions [HPL] were classified as primary and secondary glomerular diseases. Demographic data, indications and HPL were retrieved and analyzed using descriptive statistics. Out of 118 patients, 62 [52.54%] were males and 56[47.45%] females. Mean age was 8.2 +/- 3.9 years. Major indications for biopsy were primary nephrotic syndrome [PNS 86, 72.88%]. secondary GN [SGN, 17, 14.4%] and nephritic-nephrotic syndrome [NNS 13, 11%]. Overall, primary glomerular diseases [PGD] accounted for 84.74% of all biopsies. Minimal change disease [MCD 38, 32.2%] and focal segmental glomerulosclerosis [FSGS 35, 29.66%] were the two most common lesions and accounted for 43% and 33.72% respectively in PNS. Other important lesions were membranous GN [MGN 10, 8.47%], membranoproliferative [MPGN 9, 7.16%], post-infective [PIGN 4, 3.38%] and IgM nephropathy [IgMN 3, 2.54%]. Among secondary glomerular diseases [SGD], lupus nephritis [LN 11, 9.32%] was the most common lesion followed by Henoch-Schonlein nephritis [HSN] and haemolytic uraemic syndrome [HUS] each in 3 [2.52%]. Overall, MCD and FSGS were the two most common HPL in PGD and both dominated in PNS. Lupus nephritis was the leading lesion in SGD. These histopathological pattern of CGN in our study is in conformity with the existing literature from Pakistan

Outcome of pediatric renal biopsy with monopty gun technique

To determine the outcome of percutaneous renal biopsy [PRB] using Monopty-gun technique [MGT] and to compare the results of sedation with general anesthesia [GA] used for the procedure. Descriptive Study. Department of Pediatrics at National Institute of Child Health [NICH] and the Kidney Center Postgraduate Training Institute [KPTI], Karachi from June 2005 to February 2010. Renal biopsies were performed either under sedation /GA at NICH and KPTI respectively using MGT under ultrasound guidance [USG] after routine tests. A resident/ nurse monitored the procedure. Data including age, sex, indication, vitals monitored, number of attempts per patient, glomeruli per biopsy and complications were recorded. Using statistical-Package-Scientific-Software [SPSS] version- 15, descriptive statistics were applied. Paired test was used to compare pre-and- post procedure vitals. P<0.0 was considered significant. A total of 147 biopsies in 145 children were performed. Boys were 79 [54.58%] and girls 66 [45.51%]. Mean age was 7.31 +/- 4.23 years. Most of the procedures were performed under sedation [n 105, 71.42%]. Indication were nephritic syndrome [NS] in 96[65.3%], secondary glomerulonephritis [SGN] in 17 [11.6%], nephritic-nephrotic syndrome [NNS] in 16 [10.9%], congenital nephritic syndrome [NS] in 15[10.2%] and others 3[2.06%]. The success and adequacy rate was 95.91% and 95.23% respectively. Failure occurred in 5[3.4%] cases. Overall, 26[17.68%] complications were observed in 21[14.28%] patients with 6[4%] being major. Technique related complications [20, 76.92%] were more than sedation/GA related [SGRC-n 6.23%]. The complications were more in sedation but the outcome was better in GA. MGT is a safe for PRB in children. The success, adequacy and complication rates in our study are in uniformity with the current standards