Primary vesicoureteral reflux in children in southern Iran

Experience with vesicoureteral reflux [VUR] differs in different centers and there is plenty of controversies. To evaluate the outcome of primary VUR complications and the rate of recurrence of UTI. In a retrospective study, the medical charts of all infants and children with primary VUR who were followed up by one nephrologist were reviewed. During 16 years, 271 patients [226 females, 45 males] with 401 refluxing ureters were followed up as primary VUR. The patients' age at diagnosis was 4 days to 16 years [Mean: 4.4 years] and the mean duration of follow-up was 4.2 years. Urinary tract infection [UTI] was the presenting symptom in 97% and fever was recorded in 30% of cases. Frequencies of different grades of VUR at initial investigation were 6.5%, 52%, 23.4% and 18.1% for grades I to IV, respectively. The responsible microorganism in 90% of the first episodes of UTI was E. coli. Scarring or small size kidney was present in 63 patients. Recurrence of UTI in VUR of grades I to IV, were 68.7%, 51%, 60.1% and 46.8%, respectively. Follow-up voiding cystourethrogram revealed resolution of VUR in 52%, improvement in 31%, no change in 11%, and deterioration in 6%. Complications such as chronic renal failure, hypertension and renal tubular acidosis were observed in 11, 10 and 9 patients, respectively. Symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not related to the grade of VUR

Relapse Rate in Daily Single-Dose Prednisolone Therapy for Children with Primary Nephrotic Syndrome

Most current references recommend divided doses of prednisolone for the initial treatment of idiopathic minimal change nephrotic syndrome in children, with relapse occuring in the majority of them, but there is little experience concerning single-dose prednisolone therapy, especially considering the relapse rate. In this prospective study on 36 consecutive children with primary nephrotic syndrome, prednisolone [2 mg/kg/day] was used as a single daily dose in 17 patients [SD group], or divided into 3 doses in 19 cases [DD group] who were randomly selected, and relapse rates were compared. The mean age of the patients was 6 years [range 15 months-13 years] and there was no statistically significant difference between the two groups considering age, sex, clinical presentation, laboratory findings at the time of admission and prednisolone side effects. After 4 weeks of full dose prednisolone therapy, the drug was changed to 2 mg/ kg as a single dose every other day in both groups, irrespective of the response. During the third month of therapy, the drug was reduced to 1 mg/kg every other day and it was discontinued after 4 weeks. Relapse rate was compared in steroid responsive patients in both groups [14 in the SD and 11 in the DD group] who were matched for age, sex and paraclinical findings. During the first year of follow-up, in those who were initially steroid responsive, 2 patients in the SD and 6 in the DD group had no relapse. The number of total relapses/year in the SD and DD group were 19 for 12 patients and 8 for 5 patients respectively [p<0.02]. In conclusion, daily single-dose prednisolone therapy in childhood nephrotic syndrome can be effective for induction of remission and is tolerated well by patients but increases the relapse rate significantly

Kidney transplantation in children and adolescents of southern Iran

In this first report on the experience with renal transplantation in children and adolescents in southern Iran during the past five years, thirty-two patients [aged 5-19 years old; 18 males, 14 females] received renal allografts. Pretransplantation pathologic diagnoses by kidney biopsy were; membranoproliferative glomerulonephritis [MPGN], rapidly progressive glomerulonephritis [RPGN], chronic glomerulonephritis, chronic pyelonephritis, reflux nephropathy, obstructive uropathy and renal tubular acidosis [RTA]. The cause of ESRD was unknown in eleven cases. Overall one year graft survival was 89%, 71% at two years, and 50% at four years. The overall patient survival at one year was 93% and at two years, 86%. Well-being and remarkable improvement of physical, emotional, biochemical and endocrinological impairment were noticeable in 74% of the patients. No recurrence of primary disease was detected during the study period

Analysis of prognostic features in children with the hemolytic uremic syndrome

The purpose of this study has been to evaluate various factors influencing prognosis in children with hemolytic-uremic syndrome [HUS]. Forty children with cfassical picture of HUS were seen in 1986-1991. Boys and girls were equally affected, aged from two months to ten years. In 35 patients [87.5%] there was a history of diarrhea which was bloody in 25. All were treated with peritoneal dialysis within the first 24 hours. Fresh frozen plasma [FFP] was transfused in the first two days for all except 11 patients for whom it was transfused in the third to fifth day of admission. Fifteen patients died [37.5%]; of these, 12[80%] had diarrhea for longer than 7 days, 11 [73%] had prominent neutrophilia, and 9 [60%] had significant neurological symptoms. Eleven of the fifteen patients had been transfused with FFP after the third day of hospitalization. Statistical analysis of data relating to mortality revealed the following regarding prognostic factors in HUS among children: mortality is higher in those with longer prodromal period [p<0.001]. in those with bloody diarrhea [p<0.025], in patients with prominent neutrophilia [p<0.001], and in those who had delayed treatment with FFP [p<0.001]. Prognosis was not affected by age, sex, or season of presentation