Association of neutrophil gelatinase associated lipocalin and cystatin c with kidney function in children with nephrotic syndrome

Nephrotic syndrome [NS] is a major clinical concern in human health, especially in children. Despite of the etiology, the prediction of remission in different treatment regimens based on suitable biomarkers is under development. The goal of this evaluation was the demonstration of correlation between serum level of Neutrophil gelatinase associated lipocalin [NGAL] and cystatin C with kidney function in patients with NS. During the period between September 2008 and December 2011, 52 patients admitted to St. Al Zahra University Hospital were selected for evaluation. The measured parameters consisted of NGAL, cystatin C, creatinine, albumin, blood urea nitrogen, urine protein, glomerular filtration rate. Demographic data were collected and considered in comparisons. Comparison between variables and their correlations were examined. Means of serum NGAL and cystatin C were significantly higher in case than the control group, P < 0.05. The mean of serum NGAL in patients without remission and who achieved remission were 23.09 [standard deviation [SD] +/- 10.11] and 36.26 [SD +/- 20.10] ng/ml respectively; P < 0.05. Serum NGAL levels had a correlation with the following factors: Systolic blood pressure, diastolic blood pressure [DBP], cystatin C, remission. Linear regression analysis showed a significant correlation between cystatin C and systolic and DBP. Based on the results, serum NGAL can be used as a prognostic marker for remission. In addition, NGAL and cystatin C are biomarkers of kidney injury in NS

Chronic kidney disease stages 3-5 in Iranian children: need for a school-based screening strategy: the CASPIAN-III study

There is scarce epidemiological data on early and asymptomatic stages of chronic kidney disease [CKD] in children, especially from developing countries. In this study, we investigated the frequency of CKD stages 3-5 among general students of Isfahan [a large province of Iran], and compared the findings with those derived from the main pediatric nephrology referral center of province. This study was performed among 712 Isfahani school students [377 boys] aged 7-18 years, as part of the baseline survey of a national surveillance system. Blood samples were analyzed for blood urea nitrogen, creatinine, and cystatin C. Glomerular filtration rate [GFR] was calculated based on two 2009 Schwartz equations [the "updated" and the "new" equations]. CKD was defined as GFR <60 ml/min/1.73 m2. Additionally, a retrospective analysis of clinical records of children with stages 3-5 CKD referred to main referral center of province from November 2001 to December 2011 was made. The mean age of students was 12.2 +/- 2.4 years. In students' screening, the frequency of CKD was 1.3% and 1.7% based on the updated Schwartz and the new Schwartz equation, respectively. The referral center survey revealed an annual incidence of 14.5 per million age-related population [pmarp], and a prevalence of 118.8 pmarp in our province. The prevalence of asymptomatic and undetected low GFR in Iranian children is higher than what is reflected from the reports of referral centers. Simple screening programs like annual urinalysis among high-risk school students should be considered

Protective status of end stage renal disease children against tetanus and diphtheria vaccination

Vaccination against fatal viral and bacterial diseases is still the best protective way to lower morbidity and mortality rate in end-stage renal disease [ESRD] patients. It has been reported that there is high incidence of low protective levels of IgG after vaccination in ESRD adult patients. The aim of this study was to evaluate the protective status of vaccination against diphtheria and tetanus in ESRD children after completing routine vaccination. This cross-sectional study was carried on 83 participants less than 18 years including 27 patients on hemodialysis or peritoneal dialysis and 56 normal populations from February 2008 until December 2008 at St. Alzahra hospital, Isfahan, Iran. To determine anti-tetanus and anti-diphtheria antibodies level, Tetanus IgG ELISA kit [IBL International, Germany, RE56901] and Diphtheria IgG ELISA kit [IBL International, Germany, RE56191] were used. The participants must not received immunoglobulin, blood products or immunosuppressive medication in the current 6 months. The mean age of case and control group were 12.5 +/- 2.7 years and 11.7 +/- 3.3 years, respectively, P > 0.05. According to IgG levels, 93% of hemodialysis patients and approximately 87% of peritoneal dialysis children needed booster doses of diphtheria vaccination. The results for IgG titer against tetanus revealed that in 91% of hemodialysis patients and 83% of peritoneal dialysis children booster doses of tetanus were recommended. Booster doses of vaccines may be required in ESRD children. Measuring serum IgG levels against vaccines to define protective levels are recommended

Evaluating the effectiveness of adding magnesium chloride to conventional protocol of citrate alkali therapy in children with urolithiasis

Potassium citrate [K-Cit] is one of the medications widely used in patients with urolithiasis. However, in some cases with calcium oxalate [CaOx] urolithiasis, the significant response to alkaline therapy with K-Cit alone does not occur. There is scarce published data on the effect of magnesium chloride [Mg-Cl2] on urolithiasis in pediatric patients. This study aimed to evaluate the effect of a combination of K-Cit - MgCl[2] as oral supplements on urinary parameters in children with CaOx urolithiasis. This study was conducted on 24 children with CaOx urolithiasis supplements included potassium citrate [K-Cit] and magnesium chloride [Mg-Cl2]. The serum and urinary electrolytes were measured before [phase 0] and after prescribing K-Cit alone [phase 1] and a combination of K-Cit and Mg-Cl[2] [phase 2]. Each phase of therapy lasted for 4 weeks. The mean age of patients was 6.46 +/- 2.7 years. Hyperoxaluria and hypercalciuria were seen in 66% and 41% of patients, respectively. Serum magnesium increased significantly during phase 2 comparing with phase 0. Urinary citrate level was significantly higher in phase 1 and 2 in comparison with phase 0, P < 0.05. In addition, urinary oxalate excretion was significantly diminished in phase 2 comparing with phase 0 and 1, P < 0.05. Soft stool was reported by 4 patients, but not severe enough to discontinue medications. These results suggested that a combination of K-Cit and Mg-Cl2 chloride is more effective on decreasing urinary oxalate excretion than K-Cit alone. The Iranian Clinical Trial registration number IRCT138707091282N1

Urinary BK virus excretionÿin children newly diagnosed with acute lymphoblastic leukemia

Determining the risk factors in developing or increasing the relapses of acute lymphoblastic leukemia [ALL] may help health and preventive systems to launch new programs. Up to 90% of normal population changes to seropositive for BK virus by the age of 10 years. Whether this oncogenic virus is responsible for evolving ALL is unclear. In this study, we evaluated the excretion of urinary BK virus in newly diagnosed children with ALL compared with normal population. This case-control study was carried out on 62 participants [32 ALL patients and 32 normal subjects], aged 1-18 years, in Saint Al-Zahra and Sayyed-Al-Shohada University Hospitals, Isfahan, Iran. A polymerase chain reaction [PCR] method was used to detect the BK virus in specimens. PCR amplification was performed using specific primers of PEP-1 [5?-AGTCTTTAGGGTCTTCTACC-3?] and PEP-2 [5?-GGTGCCAACCTATGGAACAG-3?]. Thirty-five out of 62 participants [54.8%] were males and the remaining were females. The mean duration of disease was 9.6 +/- 9.69 months. Central nervous system [CNS] relapse was seen in 29% of the patients. Positive PCR for urine BK virus was seen in three children with ALL [9.7%]. No positive result for urine BKV was achieved in the control group. However, Fisher's exact test did not show any significant difference between the two groups [P > 0.05]. In addition, there was no significant correlation between BKV positivity and frequency of relapses. To demonstrate the role of BK virus in inducing ALL or increasing the number of relapses, prospective studies on larger scale of population and evaluating both serum and urine for BK virus are recommended

effects of blockingÿangiotensinÿreceptorsÿonÿearlyÿstagesÿofÿdiabeticÿnephropathy

This study aimed to investigate the beneficial effects of angiotensin receptor blockers [ARBs] on markers of endothelial function in patients with early stage of diabetic nephropathy [DN]. This cross-sectional study was conducted on 32 participants with IDDM from January 2010 until May 2011 in Isfahan, Iran. The participants were candidate for receiving ARBs or angiotensin-converting enzyme inhibitors [ACEIs] to decrease microalbuminuria. The inclusion criteria were as follows: the age of onset of insulin-dependent diabetes mellitus [IDDM] less than 15 years; normal glomerular filtration rate [GFR]; normal blood pressure; normal cardiovascular examination; negative urine culture, receiving no medications except insulin. Microalbuminuria was measured in two fasting urine samples with a sampling interval of at least 1-2 months by ELISA method. Patients with two abnormal results were included. Microalbumin to creatinin ratio equal to or more than 30 mg/gm was considered abnormal. The fasting blood samples to determine serum nitric oxide [NO] and vascular cell adhesion molecule [VCAM] were obtained at the time 0 [before starting the study], and after 2 months of receiving ARBmedication. Valsartan tablet [Diovan, Novartis Company] with a dose of 1 mg/kg/day up to 80 mg/day in a single dose was administered. Urine microalbumin to creatinin ratio after valsartan consumption was lower than microalbumin level before the medication, P < 0.05. After valsartan consumption, serum VCAM-1 level reduced and NO level increased significantly, P < 0.05. Angiotensin receptor blockers may reduce VCAM-1 and microalbuminuria and may increase NO levels in early stages of DN. Thus administration of ARBs might be considered even in early stages of DN

Validation of Persian version of pedsQL[TM] 4.0[TM] generic core scales in toddlers and children

To evaluate the reliability, validity and feasibility of the Persian version of the Pediatric Quality of Life inventory PedsQL[TM] 4.0 [TM] 4.0 Generic Core Scales in Iranian healthy students ages 7-15 and chronically ill children ages 2-18. We followed the translation methodology proposed by developer to validate Persian version of PedsQL[TM] 4.0TM 4.0 Generic Core Scales for children. Six hundred and sixty children and adolescents and their parents were enrolled. Sample of 160 healthy students were chosen by random cluster method between 4 regions of Isfahan education offices and 60 chronically ill children were recruited from St. Alzahra hospital private clinics. The questionnaires were fulfilled by the participants. The Persian version of PedsQL[TM] 4.0TM 4.0 Generic Core Scales discriminated between healthy and chronically ill children [healthy students mean score was 12.3 better than chronically ill children, P<0.001]. Cronbachs' alpha internal consistency values exceeded 0.7 for children self reports and proxy reports of children 5-7 years old and 13-18 years old. Reliability of proxy reports for 2-4 years old was much lower than 0.7. Although, proxy reports for chronically ill children 8-12 years old was more than 0.7, these reports for healthy children with same age group was slightly lower than 0.7. Constructive, criterion face and content validity were acceptable. In addition, the Persian version of PedsQL[TM] 4.0TM 4.0 Generic Core Scales was feasible and easy to complete. Results showed that Persian version of PedsQL[TM] 4.0[TM] 4.0 Generic Core Scales is valid and acceptable for pediatric health researches. It is necessary to alternate scoring for 2-4 years old questionnaire and to find a way to increase reliability for healthy children aged 8-12 years especially, according to Iranian culture

Hypercalciuria, a promoting factor to urinary tract infection in children

Urinary tract infection [UTI] is one of the most common diseases of urogenital tract in children. Detecting predisposing factors for UTI takes an important place in managing patients with UTI. Recently, a few studies emphasized on idiopathic hypercalciuria [IH] as a predisposing factor for UTI and dysfunctional voiding. Therefore, we carried out a survey to find out whether non-calculus IH is a contributing factor in children with the first attack of pyelonephritis. This is a case-control study carried out on 60 children aged 2-11 years admitted at St Al-Zahra hospital, Isfahan, Iran, with the first episode of upper UTI and 200 age- and gender-matched normal healthy children between September 2003 and February 2005. We used second fasting spot urine sample to measure calcium and creatinine. Two urine samples were obtained one week apart to increase the accuracy of measurement. All samples were collected after at least 6 weeks of completing the treatment course of pyelonephritis. Ultrasound examination and VCUG were performed in all patients before entering the survey as case group to rule out obstruction and VUR. Mean age of case and control group were 4.86 +/- 3.08 years and 4.22 +/- 2.9 years, respectively. The mean calcium to creatinine ratio [Ca/Cr] in case and control group were 0.308 +/- 0.21 and 0.208 +/- 0.12 mg/ mg, respectively, P < 0.001. The difference between the mean values of these two groups was significant only in age group <6 years, P < 0.0001 and odds ratio was 2.1 [95% CI 1.03-7.8]. After determining the mean values of urine Ca/Cr ration according to both age groups and gender, it was cleared that only significant difference was related to male <6 years. The likelihood of hypercalciuria should be assessed especially in male children with UTI and without any urinary tract obstruction

New treatment protocol for primary nocturnal enuresis in children according to ultrasound bladder measurements

To evaluate the response rate of various modalities of therapy in primary nocturnal enuretic children according to the ultrasound bladder volume and wall thickness index [BVWI] measurements. From February 2006 to November 2007, a total of 31 children, aged 6-12 years old were enrolled in a clinical trial. Based on BVWI they were divided into 3 groups as follows: Group 1 [BVWI <70%] was treated with oral desmopressin and oxybutynin; Group 2 [BVWI 70% to <130%] was treated with oral desmopressin. Group 3 [BVWI >130%] was treated with oral desmopressin accompanied by double-voiding technique and scheduled voiding. All of them were treated for 3 months. Significant reductions in mean bed-wetting frequency before and after first treatment cycle were observed in all groups [p<0.05]. The complete response rate was 70% in Group 1, 25% in Group 2, and 20% in Group 3. Overall, the complete and partial response rate was 9/10 [90%] children in Group 1, 13/16 [81%] in Group 2, and 3/5 [60%] in Group 3. Bedwetting frequency significantly decreased at the first and second treatment cycles in Group 2 [p<0.05] for each pair wise comparison. The proposed treatment representation according to ultrasound BVWI measurements achieves favorable response rates in children with PNE. We suggest that this treatment should be used to develop the management of enuresis in children

Fungal peritonitis in Iranian children on continuous ambulatory peritoneal dialysis

Fungal peritonitis [FP], causing catheter obstruction, dialysis failure, and peritoneal dysfunction, is a rare but serious complication of peritoneal dialysis. In this study, the frequency and risk factors of FP are evaluated in children who underwent peritoneal dialysis. A retrospective multicenter study was performed at the 5 pediatric peritoneal dialysis centers in Iran from 1971 to 2006, and FP episodes among 93 children were reviewed. Risk ratios were calculated for the clinical and demographic variables to determine the risk factors of FP. Ninety-three children aged 39 months on average were included in study. Sixteen out of 155 episodes of peritonitis were fungi infections, all by Candida albicans. The risk of FP was higher in those with relapsing bacterial peritonitis [P = .009]. Also, all of the patients had received antibiotics within the 1 month prior to the development of FP. Catheters were removed in all patients after 1 to 7 days of developing FP. Six out of 12 patients had catheter obstruction and peritoneal loss after the treatment and 5 died due to infection. Fungal peritonitis, accompanied by high morbidity and mortality in children should be reduced by prevention of bacterial peritonitis. Early removal of catheter after recognition of FP should be considered