Vesicoureteric reflux in children: a 13-years experience

We review our thirteen year's experience [1997 and 2009] with surgical treatment of vesicoureteric reflux [VUR] at King Hussein medical center, pediatric surgery section. All files of patients who underwent intravesical cross-trigonal uretric reimplantation for VUR, between January 1997 and December2009 in our hospital were reviewed. Demographic details, reflux grade, bilaterality, radiological investigations, surgical approach and outcome were analyzed. 334 patients with VUR [grade II to V] underwent uretric reimplantation during the study period. 47.6% of the patients were males and 52.4% were female. The patients were between two and a half months to fourteen years of age. 11.7% were less than one year of age and 61% < 5years. 294 [88%] of the patients were classified as primary VUR and 40[12%] as secondary. The duration of follow up was from 8 months to 13 years. Persistent VUR requiring re-do ureteral reimplantation in 18 [5.4%] cases, and nephrectomy due to end- stage renal disease [ESRD] were performed in 33 [9.8%] patients. Successful rate was achieved in 90.2% of cases. The most frequent clinical abnormality leading to the diagnosis of VUR is UTI; the ultimate objective of treatment of VUR is to prevent infection, to allow normal growth and to prevent permanent renal parenchyma damage

changing spectrum of end stage renal disease at Queen Rania Al-Abdullah two Hospital of Paediatrics

End stage Renal Disease is a rare condition in children. It is usually the result of slowly progressive irreversible kidney damage. The aim of this study is to determine the causes, outcome and describe the demographic features of all children with end stage renal disease on regular dialysis at Queen Rania Al-Abdullah two Hospital of Paediatrics. This is the referral centre for all pediatric subspecialties in Jordan. A retrospective review of all computerized data for all children with end stage renal disease who were on regular dialysis at Queen Rania Hospital during the period January 2006 to April 2011 were done. The data was reviewed regarding gender, age at the initiation of dialysis, mode of dialysis and primary disease. The outcome of these children was also followed and reviewed. Out of 98 children who were on regular dialysis at Queen Rania Hospital, 90 [92%] were on hemodialysis and eight [8%] were on peritoneal dialysis, 53 [54%] were female, 45 [46%] were male. The mean age at the initiation of dialysis was 8.2 +/- 2.3 years; the commonest cause of end stage renal disease was congenital anomalies of the kidney and urinary tract which occurred in 34 [34.5%] children. However unknown causes were found in four cases [4%]. Thirty-nine children [39.5%] were transplanted and 25 [25.5%] children died while they were on dialysis. The most common cause of end stage renal disease at our center was congenital anomalies of the kidney and urinary tract, which is a preventable cause when detected early. The increased percentage of renal transplants observed among patients with end stage renal disease on regular dialysis at our center is promising as it offers the best choice of renal replacement therapy

Dual-time [99m] TC-MAG3 diuretic renography and new criteria in the assessment of obstructive uropathy

Obstructive pattern within hydronephrotic non-obstructed kidney is frequently encountered during [99m] TCMAG3 diuretic renography. The aim of this study was to assess the value of applying new protocol and criteria on dual-time imaging in ruling out obstruction. We included 53 children [56 kidneys] in this study [28 boys and 25 girls with age range three weeks to 12 years]. All had hydronephrosis, which was bilateral in three children. Eighteen children had pyeloplasty, while 35 children had no previous surgical interventions. All children were referred for assessment of renal outflow obstruction and kidney function. All children underwent routine diuretic [99m]Tc MAG3 renal renography. All had obstructive patterns during diuretic [99m] TcMAG3 renography and underwent a second dynamic study 30 minutes later for 10 minutes. Non obstructive criteria were set as down sloping second time renogram with drop of kidney counts by 50% of peaked activity in first time renogram. Obstructive criteria on dual-time imaging were set as progressive rising second time renogram or flat second time renogram with drop of kidney counts by less than 30% compared to first time study. Equivocal criteria were set as flat renograms with drop of kidney activity by 3 0-50% or down sloping renogram with drop of kidney counts by<30% over 10 minutes. Non obstructive patterns were noticed in 16 kidneys 15 [patients], with down sloping curves during second time renograms in seven kidneys and flat second time renogram with drop of activity by> 50% in 9 kidneys. Obstructive patterns on dual time point [99m] TcMAG3 renography were noticed in 31 kidneys [29 patients]. Eleven kidneys [six patients] were false positive, since three patients had neurogenic bladder with no obstruction, two patients had long standing severe hydronephrosis with no obstruction and one patient had glomerulonephritis. Equivocal patterns were noticed in nine patients, four of them were turned to have significant obstruction, while five had no obstruction. Dual-time [99m] Tc-MAG3 diuretic renography can increase the efficiency in differentiating between obstructed and non-obstructed hydronephrosis compared to routine single time study

Spectrum of biopsy-proven renal disease in the pediatric age group at King Hussein Medical Center

This is a retrospective analysis of kidney biopsies done for children with glomerular diseases in the pediatric age group. The medical records of all children who underwent kidney biopsy between January 1999 and June 2003 were studied. Demographic data including age and gender, as well as the indication for biopsy, the result, the diagnostic value, and complications of the procedure were recorded. All biopsies were done under ultrasound guidance. A total number of 65 biopsies were done. Four were in previously diagnosed patients to rule out cyclosporine toxicity and therefore excluded from the study The biopsy was inadequate in three cases [46%] All of the remaining 58 biopsies were included in the study and analyzed. The mean age at biopsy was 7.56 +/- 4.22 years. Renal disease was more common in males [62.1%]. The most common indication for biopsy was steroid resistant nephrotic syndrome accounting for 32.7% of the cases. The most common primary glomerular disease at renal biopsy was focal segmental glomerulosclerosis occurring in 19% of patients followed by mesangiocapillary glomerulo-nephritis and then minimal change disease. The most common secondary renal disease was Henoch-Schoenlein purpura representing 6.9% of cases followed by systemic lupus erytheniatosus in 3.4% of eases. The kidney biopsy was normal in 5.2% of patients. When patients with difficult nepbrotic syndrome were analyzed the most common lesion was local segmental glomerulosclerosis in 39.1%. Mesangiocapillary glomerulonephritis was present in 26.1%, minimal change disease in 17.4%, diffuse mesangial nephritis in 13% and congenital nephrotic syndrome in 4.3%. Gross hematuria was noticed in eight [13.8%] patients' however blood transfusion was only needed in two [3.4%] patients. One patient [1.7%] required radiological intervention for AV fistula post biopsy. The distribution of renal disease in the pediatric age group at King Hussein Medical Center is similar to that described in other countries with some differences. The kidney biopsy is safe and the diagnostic yield is excellent. Taking into account the lack of reliable data in Jordan this study illustrates die importance of having a regional registry for renal disease in children

Vesicoureteric reflux of the contralateral kidney in children with unilateral multicystic renal dysplasia

This is a prospective study conducted at King Hussein Medical Center between 1994-1996 to find the incidence of vesicoureteric reflux of the contralateral kidney in patients with unilateral multicystic renal dysplasia. Patients and A total of 12 patients diagnosed as having unilateral multicystic renal dysplasia were prospectively studied, the diagnosis was suggested by ultrasound and confirmed by nuclear scan, all patients underwent micturating cystourethrography. Four patients out of 12 were found to have vesicoureteric reflux of the contralateral kidney. Vesicoureteric reflux put the contralateral kidney at risk of pyelonephritic scarring, therefore micturating cystourethrography should be part of the initial evaluation of all infants with unilateral multicystic renal dysplasia

Nephrotic syndrome in children at king hussien medical center

To document the clinical profile, including the response to steroid therapy, of patients with primary nephrotic syndrome and the histopathological findings in steroid non-responders. Patients and A retrospective review of 125 children diagnosed as having primary nephrotic syndrome at King Hussien Medical Center between 1982-1994. Documentation included response to steroid, relapse rate, and histopathological diagnosis of resistant cases. 85 males and 40 females aged 1.5-12 years with a median age of four years were reviewed, 96 patients [76.8%] went into remission and 29 were steroid-resistant [23.2%]. Among those who were steroid-resistant, eight had minimal change nephropathy [MCNS], 14 had membranoproliferative glomerulonephritis and seven had focal segmental sclerosis [FSGS]. 64.5% of steroid-sensitive patients had further relapses, and 10.5% became steroid resistant. The demographic features of our patients, response to steroid therapy, and subsequent course are similar to those reported by others