Role of Urinary Levels of Endothelin-1, Monocyte Chemotactic Peptide-1, and N-Acetyl Glucosaminidase in Predicting the Severity of Obstruction in Hydronephrotic Neonates

PURPOSE: Antenatal hydronephrosis (AH) is found in 0.5%-1% of neonates. The aim of the study was to assess the urinary concentrations of 3 biomarkers, endothelin-1 (ET-1), monocyte chemotactic peptide-1 (MCP-1), and N-acetyl-glucosaminidase (NAG) in severely hydronephrotic neonates. MATERIALS AND METHODS: Neonates with a history of prenatal hydronephrosis were enrolled in the prospective study in 2 groups. Group 1 included neonates with severe forms of obstruction requiring surgical intervention and group 2 included neonates with milder forms of obstruction without any functional impairment. Fresh voided urinary levels of ET-1, MCP-1, and NAG were measured and their ratios to urinary Cr were calculated. RESULTS: Fourty-two neonates were enrolled into the 2 groups: group 1, 24 patients (21 male, 3 female); group 2, 18 neonates (16 male, 2 female). There were no statistically significant differences between urinary ET-1, NAG, MCP-1 values, and ET-1/Cr and NAG/Cr ratios in groups 1 and 2. The urinary MCP-1/Cr ratio was significantly higher in group 1 than in group 2. For comparison of groups 1 and 2, the cut-off values were measured as 0.5709 ng/mg (sensitivity, 75%; specificity, 67%; positive predictive value [PPV], 71%; negative predictive value [NPV], 71%), 0.927 ng/mg (sensitivity, 77%; specificity, 72%; PPV, 77%; NPV, 72%), and 1.1913 IU/mg (sensitivity, 62%; specificity, 67%; PPV, 68%; NPV, 60%) for ET-1/Cr, MCP-1/Cr, and NAG/Cr ratios, respectively. CONCLUSIONS: The urinary MCP-1/Cr ratio is significantly elevated in neonates with severe obstruction requiring surgical intervention. Based upon these results, urinary MCP-1/Cr may be useful in identification of severe obstructive hydronephrosis in neonates.

Etiologic and epidemiologic pattern of urolithiasis in North Iran; review of 10-year findings

To determine epidemiologic and metabolic characteristics of renal stone in the northern Iran. We prospectively analyzed demographic, clinical and metabolic findings in children less than 16 years old with renal stone revealed by ultrasonography from September 2003 to May 2012. Evaluations included serum and urine measurement of main elements predisposing patients to stone formation. 271 children [160 males] aged 2 months to 16-years [mean 30 months] were evaluated. 91 [33.6%] had a positive family history, abdominal discomfort [18.8%], UTI [11.8%] and hematuria [11.4%] were main presenting features. 45 children were diagnosed accidentally without any specific compliant. Nearly all [99%] stones lay in kidney., 35.1% had metabolic, 10% infective and 4.1% obstructive trends, 110 children had no definable etiology. Hypercalciuria [25.5%] hyperoxaluria [18.4%] and hypocitraturia [18.1%] were more frequent than uricosuria [8.5%] and cystinuria [3.1%]. Metabolic derangement plays significant role in stone formation in our area. Patients should be carefully evaluated considering this point of view

Outcome of vesicoureteral reflux in infants: impact of prenatal diagnosis

Vesicoureteral reflux [VUR] is an important disorder that could be diagnosed in antenatal or postnatal period. The natural history of VUR seems to be different between prenatal or postnatal forms of the disease. We compared the natural history and outcome of vesicoureteral reflux in infants less than one year old diagnosed prenatally or postnatally. All infants less than 12 months old with VUR were enrolled in two groups. Group 1 composed of patients with antenatal hydronephrosis and group2, infants with diagnosis of VUR because of UTI or other postnatal problems. We followed patients for an average of 33 months. Outcome was assessed by several factors: somatic growth, need for surgery, resolution, occurrence of UTI and scar formation. We studied 236 renal units in 152 patients [70 boys, 82girls], 67 patients in group 1 and 85 patients in group2. Occurrence of recurrent UTI was 10.6% with no significant difference between two groups. Reflux resolved in postnatal group more significantly than in the other group [73% vs 49%]. Scar developed similarly in both groups [15% vs 25% of renal units]. Surgery performed in 7 [8.2%] of postnatal and 4 [6%] of prenatal group with no significant differences between the two groups. VUR diagnosed prenatally has similar importance and outcome as postnatal diagnosed one. We suggest performing the same imaging and treatment procedures for prenatally and postnatally diagnosed VUR

Imerslund-Gräsbeck Syndrome: report of two cases in a family

Imerslund-Gräsbeck Syndrome is an inherited disorder which present as a megaloblastic anemia followed by selective vitamine B12 deficiency and is associated with mild proteineuria. This rare disease is easily treatable if detected. In this paper two members of a family with Imerslund-Gräsbeck Syndrome are reported

Response of enuretic children with and without hypercalciuria to nasal desmopressin

Nocturnal enuresis is a common diagnosis in patients referred to pediatric and pediatric nephrology clinics. Nocturnal polyuria is an important patho-physiologic factor in enuresis. Hypercalciuria, with altering concentrating capacity of the kidneys, can affect children's response to desmopressin. This is a double blind clinical trial starting September 2007 to March 2008. One hundred and twenty four enuretic children, 76 [61.3%] males, 48 [38.7%] females, mean age 7.7 [ +/- 1.7], were evaluated by measuring random morning urinary calcium to creatinine ratio. Patients were divided into group 1 with a calcium to creatinine ratio equal to or more than 0.2 mg/mg, and group 2 with a ratio less than 0.2 [Hypercalciuric and non hypercalciuric respectively]. All patients received 10 to 40 mcg of nasal desmopressin at bed time. The response was defined as reduction in wet nights, a "full response" [greater than 90% reduction], "partial response" [50% to 90% reduction] and "no response" [less than 50% reduction]. Chi-square method was used to compare the responses and P<0.05 was considered statistically significant. Nineteen patients in group 1 [Hypercalciuric] and 105 patients in group 2 [Non hypercalciuric] were studied. Response to desmopressin was "full" in 47.4% in group 1 and 64.8% in group 2. 42.1% and 26.7% had "Partial response" in group1 and 2 respectively [P < 0.04]. Hypercalciuria can affect negatively the responsiveness to desmopressin therapy

Vesicoureteral reflux in neonates with hydronephrosis; role of imaging tools

Neonatal Hydronephrosis is a common abnormality diagnosed ante- or postnatally. The aim of this study was to determine the prevalence and severity of vesicoureteral reflux [VUR] in neonates with antenatal or postnatal hydronephrosis and the value of ultrasonography as a noninvasive tool for VUR prediction. In a prospective study, 202 infants with neonatal hydronephrosis were studied. Two successive renal ultrasound examinations were performed at 1 and 4-6 weeks after birth in neonates with antenatal hydronephrosis or immediately after presentation. Voiding cystourethrography [VCUG] was performed in all infants. The incidence of VUR was 29.7%, of which 17.8% had severe [grade IV-V] reflux. 27% of 133 neonates with unilateral and 34.8% of 69 cases with bilateral hydronephrosis had VUR. Although a significant association was observed between severity of hydronephrosis and VUR, 5.9% of normal appearing and 7.8% of grade 1 hydronephrotic neonates had high-grade reflux. VUR was observed significantly in hydronephrotic neonates. A normal or mildly hydronephrotic urinary tract on ultrasound scan cannot exclude presence of severe VUR. We recommend performing VCUG in all hydronephrotic newborns