Prediction of vesicoureteral reflux in children with first urinary tract infection by dimercaptosuccinic acid and ultrasonography

Urinary tract infection [UTI] is one of the most common causes of febrile pediatric diseases. Also, vesicoureteral reflux [VUR] is a significant risk factor for UTI. Voiding cystourethrography [VCUG] is the method of choice for evaluation of VUR. This study was done to predict VUR by DMSA scan [technetium 99 m-labeled dimercaptosuccinic acid] and ultrasonography [US]. In a prospective study, all children with first time acute pyelonephritis were selected and evaluated by DMSA scan and US. Then VCUG was done with negative urine culture. All children with final diagnosis of obstructive congenital anomaly were excluded. The sensitivity, specifity, positive predictive values, negative predictive values, Confidence Interval of DMSA scan and US were calculated for prediction or exclusion of VUR. Among 100 children with UTI diagnosis, VUR was detected in 39 children and 63 [31.5%] kidneys. DMSA scan was abnormal in 103 [51.5%] units, 45 units had VUR [PPV=44%], 79 units with normal DMSA scan had no VUR [NPV=81%]. Of kidney units that were abnormal by DMSA or US, 51 units had VUR. PPV and NPV were 44% and 56%, respectively. DMSA scan alone or with US cannot predict VUR [especially low grade VUR]. But according to NPV, it seems that absence of VUR can be predicted. So, more studies are needed to determine the usefulness of DMSA scan and US instead of VCUG for detection of VUR

Rubinstein-Taybi Syndrome; a case report

Rubinstein-Taybi Syndrome is a rare genetic disorder with characteristic features including downward slanting palpebral fissures, broad thumbs and halluces, and mental retardation. Systemic features may involve cardiac, auditory, ophthalmic, endocrine, nervous, renal and respiratory systems. This syndromeis sporadic in nature and has been linked to microdeletion at 16p 13.3 encoding CREB-binding protein gene [CREBBP]. We report a 15-years-old girl, a known case of chronic renal failure, with downward slanting palpebral fissures towardthe ears, hypertelorism, short stature, beaked nose, micrognathia, strabismus, dental anomalies, large toes, broad thumbs, and mental retardation

Randomized clinical trial of sedation with oral midazolam for voiding cystourethrography in children

Voiding Cystourethrography [VCUG] is a distressing procedure for children. Conscious sedation with any drug that its dose would not influences the procedure is preferred. The aim of this study was to assess the effectiveness of conscious sedation using oral midazolam in children undergoing VCUG. From November 2008 to October 2009 period, 93 Patients [68 girls and 25 boys], age ranging from 24 months to 11 years old [mean, 5.8 years] were double blindly randomized to receive a placebo [water] or oral midazolam before the examination. The primary outcome measures were patients' cooperation, facility of the procedure, 48 hours post procedure memory of children, bladder urine residue and detection of Vesocoureteral reflex. The data were analysed by SPSS and categorical variables compared using t-test and continuous variables compared using Chi. Square and Fisher's exact tests. 93 children were randomizly divided in two groups. In midazolam group, 44[93.6%] patients had good cooperation but in the control group 26[56.5%] had bad cooperation and 19 patients [41.3%] very bad cooperation [P=0.000]. In midazolam group, 36 children [76.6%] had easy separation from their parents but in control group 20 children [43.5%] had moderate resistant and 21[45.7%] severe resistant. [P=0.000]. Eighteen [38%] patients of the study group and twenty patients [43%] of control group had VUR respectively [P=0.65]. According to this study, midazolam is a useful sedation in children undergoing VCUG

Sonographic measurement of bladder wall thickness in healthy children

The aim of this study was to determine the ultrasonographic [US] bladder wall thickness [BWT] in normal children. In 106 children [54 boys and 52 girls, aged 8 months to 15 years] without any history and laboratory findings of bladder dysfunction or infection, US measurement of bladder points was performed with bladder filled to at least 50% of its expected capacity. The mean thickness of four bladder wall points was 1.79 +/- 0.28 mm. The mean anterior wall thickness was 1.5 +/- 0.31 mm [range 0.9-2.2 mm], posterior 2 +/- 0.36 mm [range 1.2-3.1 mm], right lateral 1.8 +/- 0.34 mm [ranges 0.8-3mm] and left lateral 1.8 +/- 0.36mm [range 1-3mm]. There was a significant difference between bladder sites [P<0.05] except between lateral sites. We recommend after measurement of four points, to compare these values with normal +/- 2SD curves according to age

Renal scaring and vesicoureteral reflux in children with urinary tract infection [UTI]

To determine the extent of renal scarring in children with vesico-ureteral reflux [VUR] and upper urinary tract infection and to evaluate the relationship between different degrees of VUR and the renal scar. Forty two patients [age ranging from one month to 14 years] with VUR were studied consecutively. VUR was diagnosed by voiding cystourethrography [VCUG] and dimercaptosuccinic acid [DMSA] scan was done at least 4-6 months after the last episode of pyelonephritis. Eighty-four kidney units were examined. VUR was positive in 64 units. Twenty two subjects had bilateral VUR and 20 patients had unilateral VUR. Forty units [62.5%] had scarring. Kidney units with VUR in boys had more scarring than girls [90% Vs 62.5%] 64% kidney units with children less than five years of age had renal scarring. High grade reflux was associated with more severe reflux. Renal scarring is more common in younger children, boys and those with high grade reflux