Relationship between microalbuminuria and creatinine clearance and the kidney scars in children with vesicoureteral reflux

Background and Objectives: Vesicoureteral Reflux [VUR] is one of the common urinary tract anomalies that may cause renal parenchymal damages. Recent studies show that microalbuminuria may be helpful in diagnosis of glomerular damage at early stages. The aim of this study was to evaluate the correlation between microalbuminuria and creatinine clearance, kidney scar, in grading of reflux

Methods and Materials: In this cross sectional study 87 children with VUR were studied from 2012 to 2013 in Children's Hospital of Tabriz/Iran. Three months after treatment of UTI, serum creatinine and urine microalbumin was measured and renal DMSA scan was done in all cases

Results: Mean age of patients was 4.49+/-2.64 years and 82.8% of them were female. Severity of reflux was mild in 23%, moderate in 33.3% and severe in 43.7% of patients. DMSA scan was abnormal in 58 patients [66.6%]. With increase in grading of reflux the amount of albuminuria increased and creatinine clearance decreased but these change were not statistically significant [P=0.12]. Urinary albumin in patients with scar [33.32+/-28.69 ing/24 hr] was significantly higher than patients without scar [10.82+/-8.83 mg/24 hr] [JMX006]. Frequency of scared kidney in mild, moderate and severe grades of reflux was 50%, 62.1%, and 78.9% respectively [P=0.07]. Frequency of microalbuminuria was 31% in patients with scar while only 3.4% of patients without scar had micro albuminuria [FMX003]

Conclusion: We did not find any significant correlation between micro albuminuria, creatinine clearance and abnormality in DMSA scan with reflux grading. However there was a significant con-elation between micro albuminuria and scarred kidney. So micro albuminuria may be helpful in diagnosis of renal parenchymal damage. But, further investigations are needed to confirm this finding

[Rare MEFV mutations in patients with henoch schonlein purpura from north west of country]

Background and Objectives: coexistence of Familial Mediterranean Fever [FMF] with various systemic vasculitides, such as Henoch Schonlein Purpura [HSP] and other inflammatory disorders has been reported and MEFV gene has been suggested to play a significant role in the pathogenesis of this association. In This study, the rare MEFV mutations in patients with HSP from north west of country and its association with clinical symptoms of disease were evaluated

Material and Methods: Forty unrelated patients were referred by specialists to the Molecular Medical Genetic Center of Tabriz. Clinical diagnosis of HSP was made according to published criteria. The control group consists of 200 ethnically matched persons apparently healthy without any king of inflammatory diseases. screening for the 3 mutations; R761H, P396S and R408Q were performed by using amplification refractory mutation system polymerase chain reaction [ARMS-PCR[and polymerase chain reaction restriction fragment length polymorphism [PCR-RFLP]. Chi[2] test and Fisher's exact test were used to statistical analysis

Results: Of 40 patients studied, 37 [92.5%] showed without mutation, while 3 [7.5%] had MEFV mutation that three of them were compound heterozygous for the P396S/R408Q mutations. There was a statistically significant difference between the patient group and healthy individuals regarding P396S and R408Q mutations [p= 0.0043]. findings suggest that P396 and R408Q mutations always together occurred and not only contribute to the susceptibility to HSP, also associated with clinical symptom of fever

Conclusion: Our results suggest that some MEFV mutations could be a contributory genetic factor to HSP in the north west of the country

Changing patterns in sensitivity of bacterial uropathogens to antibiotics in children

To determine the sensitivity/resistance of bacterial uropathogens to antibiotics in children and evaluate the changing pattern of their sensitivity over a six years period. Medical records of children between two moths to 14 years of age who admitted with symptomatic urinary tract infection were studied in two periods: First from 2006 to 2007 and the second from 2000 to 2001 in Children's Hospital of Tabriz/Iran. The sensitivity patterns of uropathogens were compared between two periods of study. The most frequently isolated germs were E.Coli, klebsiella, enterobacter, pseudomonas aeroginosa and proteus in a descending order. In study of 2006-2007: Among the oral agents, nitrofurantoin and ciprofloxacin, and among the parenteral agents, amikacin and gentamicin had the highest activity against E.coli. The highest sensitivity of klebsiella was to ciprofloxacin, nalidixic acid, cefixime, and amikacin in a descending order. The activity of ceftriaxone, ceftizoxime, nalidixic acid and cephalexin against E.coli has decreased significantly over six years [P<0.05]. Also the activity of ceftriaxone, ceftizoxime, gentamicin, amikacin and nalidixic acid against klebsiella has decreased in comparison with results of six years ago [P<0.05]. There was not any significant difference in sensitivity of enterobacter and pseudomonas with results of six years ago. Increasing resistance of uropathogens to third generation cephalosporines and aminoglycosides raises an alarm for widespread use of these life saving drugs. The guidelines for empiric treatment of UTI should be revaluated periodically based on local studies

Acute kidney failure in neonatal period

Acute kidney failure [AKF] is a common clinical problem in neonatal intensive care units and is usually associated with a contributing condition such as sepsis, asphyxia, and heart failure. The aim of this study was to determine the types, frequency of associated contributing conditions, and short-term outcome of neonatal AKF. Medical records of neonates with a diagnosis of AKF from March 2003 to September 2006 were studied in a tertiary care children's hospital in Tabriz, Iran. Of 6042 hospitalized neonates, 151 with documented AKF [100 boys and 51 girls] were reviewed in the study. Ninety-one patients [60.3%] had been referred from other cities. Fifty-seven patients [37.7%] developed AKF following a surgery. Causes of AKF were intrinsic kidney failure in 52.3%, prerenal in 42.4%, and postrenal in 5.3%. Oliguria was observed in 72.2% of the patients. Perinatal asphyxia was present in 29.8% of the neonates, sepsis in 28.5%, respiratory distress syndrome in 25.2%, dehydration in 24.2%, and heart failure in 21.2%. Most patients [85.4%] had more than 1 associated contributing condition. Mortality rate was 20.5%. Most patients [76.2%] were discharged with normal kidney function and 3.3% with diminished kidney function. Initial admission to NICU, female sex, septicemia, and the need for mechanical ventilation were associated with a higher mortality rate. The frequency of associated contributing conditions and short-term outcome of neonatal AKF in our institution is comparable with other studies; however, intrinsic kidney failure comprises the most common form of AKF in our patients

Acute renal failure due to copper sulfate poisoning; a case report

Copper sulfate is a blue and odorless salt with various industrial, chemical, agricultural and medicinal applications. Copper sulfate poisoning is rare in children. A 23-month old boy accidentally ingested a solution of copper sulfate, used as a disinfectant agent in animal husbandry. He was referred to Children's Hospital of Tabriz because of frequent vomiting and lethargy. The major systemic complications were intravascular hemolysis, anemia and acute renal failure. The patient was successfully treated with multiple packed cell transfusions, dimercaprol, penicillamine and peritoneal dialysis. Plasma copper level 15 days after ingestion was 216 micro g/dl. Copper sulfate is a highly toxic agent that, when ingested, can cause local and systemic damage including coma, shock, severe intravascular hemolysis, hepatotoxicity and acute renal failure with high mortality

Evaluation of hemostatic factors in children with nephrotic syndrome

Thromboembolism [TE] is one of the serious complications of nephrotic syndrome [NS]. The aim of this study was to evaluate the haemostatic factors in children with nephrotic syndrome. Plasma Level of protein C, Protein S, fibirinogen and antithrombin III [AT III] were evaluated in thirty nephrotic children at relapse and remission period and the results were compared with those of 30 healthy children. The mean age of patients was 5.38 +/- 3.07 years. Plasma Level of protein S and AT III during relapse were significantly lower than their level in remission period and in control group. The mean fibrinogen level during relapse was significantly higher than its level in remission period and in control group. There was no significant difference in protein C levels at relapse with remission period and with control group. Serum albumin levels during relapse were positively correlated with AT III levels. There was no correlation between urinary protein excretion and the haemostatic factors. Despite reduced levels of AT III and protein S and increased levels of fibrinogen, none of our patients revealed thromboembolism. It seems that coexistence of several factors is necessary to induce TE

Clinical features and risk factors of pediatric urolithiasis

Urolithiasis in children although occurring less often than adults, causes considerable morbidity. The main aim of this study is to evaluate clinical features and risk factors of pediatric urolithiasis. All children with documented urolithiasis who were referred to department of pediatric nephrology between 1999 and 2005, were evaluated from the point of demographic features, family history, clinical symptoms, imaging results and laboratory findings. We investigated 184 patients [100 females and 84 males] with urolithiasis between 2 months and 14 years of age [mean age 3.66 +/- 3.49 years]. The stones' diameter was 3-27 mm [mean 8.20 +/- 5.36]. In 85.8% of cases the stone was located only in kidneys and in 3.3% only in bladder. The most common causes of presentation were urinary tract infection [UTI], restlessness and gross hematuria. Positive family history was detected in 41%, UTI in 40.8%, anatomic abnormality in 13% and sterile pyuria in 18.5% of patients. Metabolic evaluation, which was carried out in 162 patients, revealed that 104 [64%] of them had a metabolic risk factor including normocalcemic hypercalciuria [42%], Hyperuricosuria [10.5%], Cystinuria [7.4%], and Hyperoxaluria [4.3%]. All children with urolithiasis should be completely evaluated, as most of them have an anatomic, infectious or metabolic risk factor

Urogenital anomalies associated with anorectal malformations

Urogenital anomalies are frequently associated with anorectal malformations which are a common source of significant morbidity. The aim of this study was to evaluate the incidence and nature of associated urogenital anomalies in patients with Anorectal Malformations [ARM]. Documents of 104 patients with ARM were studied from 2003 to 2005. All patients underwent sonography of urinary tract and lumbosacral radiography. Other imaging studies were done in selected cases and voiding cystourethrography [VCUG] performed in 62 patients. Urologic malformations were found in 44 patients [42.3%] without sexual preponderance [p>0.05]. Genital anomalies were detected in 16 cases [15.5%] with a significantly high frequency in males [p<0.05]. The incidence of associated urogenital anomalies was significantly higher in "high" form of anomaly than those with "low" form [p<0.05]. Vesicoureteral reflux [VUR], hydronephrosis, and renal agenesis were the most common urologic anomalies respectively. Cryptorchidism and hypospadiasis were the most frequent genital anomalies. Sacrospinal anomalies were detected in 22% of patients. The high incidence of associated urogenital anomalies necessitates a careful investigation of all patients with ARM. VCUG is essential even with normal sonographic findings