Evaluation of the effects of magnesium supplement in primary and secondary preventions of nephrolithiasis: a systematic review

Introduction: The role of magnesium supplement to prevent primary and/or secondary kidney stones has not been fully determined. The aim of this study is to evaluate the effects of magnesium supplement in modifying urinary risk factors of recurrent kidney stones

Method: We searched MEDLINE, Scopus, and Google Scholar databases on December 7, 2014 and reference lists of systematic reviews and randomized, controlled trials. Among the initial 282 articles found by our search strategy and hand searching, we found eight English-language studies were eligible for our study

Result: Magnesium supplementation could be beneficial in nephrolithiasis prevention through increasing urinary magnesium, citrate, and calcium while declining urinary oxalate. In pediatric patients, the results were more prominent and could decline urinary oxalate up to 90% of the baseline

Conclusions: Magnesium supplementation could be beneficial, especially with potassium-citrate combination. However, due to the low number of well-designed randomized controlled trials, especially in pediatrics, the conclusions of this study need further confirmation

Urine alpha-1-microglobulin reliability in the diagnosis of pyelonephritis: a systematic review

Introduction:Pyelonephritis is known as kidney inflammation due to bacterial infection which should be diagnosed and treated promptly. In this article, we decided to systematically review the diagnostic value and reliability of evaluating urine excretion low molecular weight protein alpha-1-microglobulin [A1M]

Methods: PubMed and Scopus were searched for the relevant articles about the efficacy of urine alpha-1-micriglobulin assays in the diagnosis of pyelonephritis in children. The search strategy was microglobulin AND pyelonephritis. No language and date limitations were included in this review

Results: A total of 16 articles were retrieved from PubMed and 23 articles from Scopus. After studying the abstracts, only 5 articles were selected, which specifically studied the efficacy of alpha-1-micrglobulin in the diagnosis of pyelonephritis in children

Discussion: A1M is not an acute phase protein but its concentration alters in several clinical conditions

Conclusion: Evaluating the urine concentration of A1M is a noninvasive and cost effective strategy with the diagnostic capability for urinary tract disorders such as early recognition of tubular damages during pyelonephritis

Association of nocturnal enuresis with vesicoureteral reflux and renal cortical damage

The prevalence of Vesicoureteral reflux [VUR] is higher in enuretic children than in non-enuretic children. Recent studies have reported VUR in 6-23% of children with enuresis. To clarify the association of nocturnal enuresis with Vesicoureteral reflux [VUR] and to identify children who are at risk for VUR. During 2007-2009, neurologically normal children who were referred with a chief complaint of nocturnal enuresis and had abnormal renal ultrasonography [US] results, daytime incontinence, abnormal results in urodynamic studies, urinary tract infection, or a history of VUR in their siblings were prospectively evaluated for VUR by voiding cystourethrography [VCUG]. A total of 60 children [26 boys and 34 girls] aged 5-17 [mean +/- SD: 8.46 +/- 2.45] years met the inclusion criteria and were enrolled in the study. Twenty-eight [46.7%] patients had mono-symptomatic nocturnal enuresis [MNE], and 32 [53.3%] had non-mono symptomatic nocturnal enuresis [NMNE]. VUR was reported in 10 [16.7%] patients and posterior urethral valve [PUV] was found in l [1.7%] patient. The prevalence of VUR was significantly higher in patients with daytime incontinence and in girls [P = 0.016 and 0.003 respectively]. We did not find any significant correlations between VUR and the form of enuresis [primary versus secondary], urinary tract infection, or any diurnal urinary symptoms other than daytime incontinence [P> 0.05 for all]. Of 10 renal scintigrams, 5 [50%] showed renal cortical defects. VUR is uncommon in children with MNE and in those with NMNE who do not wet themselves during the day; however, it is a relatively common finding in enuretic children who have daytime incontinence. We recommend VCUG in all enuretic children who have daytime incontinence

Monosymptomatic and non-monosymptomatic nocturnal enuresis: a clinical evaluation

Nocturnal enuresis is divided into monosymptomatic nocturnal enuresis [MNE] and non-monosymptomatic nocturnal enuresis [NMNE]. This study reviews clinical and ultrasonography [US] findings in enuretic children, and compares the organic and functional pathologies of the lower urinary tract [[UT] in children with MNE to those who have NMNE. We enrolled 111 neurologically normal children with chief complaints of enuresis in this study. Participants included 60 boys and 51 girls, aged 5-17 years. There were 43 [38.8%] patients diagnosed with MINE and 68 [61.2%] with NMNE. Urine analysis, urine culture and kidney-bladder US were performed for patients. Some patients underwent a voiding cystoureterography [VCUG], urodynamic study [UDS], or both. Patients were divided into three groups: i] MNE, ii] NMNE without daytime incontinence [NMNE - daytime incontinence], and iii] NMNE plus daytime incontinence [NMNE + daytime incontinence]. Constipation [P= 0.011], encopresis [P= 0.003] and urge incontinence [P = 0.001] were significantly more frequent in patients with NMNE + daytime incontinence. Bladder wall thickness [BWT] was the most common US finding. One patient with MNE and 9 with NMNE + daytime incontinence had vesicoureteral reflux [VUR; P 0.016]. Posterior urethral valve [PUV] was reported in one patient with NMNE. Evidence of bladder dysfunction was noted in about half of the patients who underwent UDS, with a higher prevalence in cases that had NMNE + daytime incontinence [P = 0.297]. Bowel symptoms and VUR were significantly more prevalent in cases with NMNE + daytime incontinence. We recommend VCUG in enuretic children who have daytime incontinence. In addition our study has revealed that symptoms suggestive of an overactive bladder [OAB] are not good indicators for bladder dysfunction

Role of high-dose hydrochlorothiazide in idiopathic hypercalciuric urolithiasis of childhood

The aim of this study was to evaluate the role of hydrochlorothiazide in pediatric calculus formers with hypercalciuria and define possible factors affecting response to treatment. Nineteen pediatric calculus formers, 12 girls and 7 boys, aged 15 days to 60 months, with idiopathic hypercalciuria received high-dose hydrochlorothiazide [1 mg/ kg/d to 2 mg/kg/d] and citric acid-potassium citrate [1 mEq/ kg/d] and were evaluated in a 2-year period. Avoiding high-salt diets was recommended throughout the study and increasing fluid intake was encouraged. The patients received hydrochlorothiazide for 2.5 to 15 months [mean, 6 +/- 3 months], and 10 of them [52.6%] reached normacalciuria. Resolution of hypercalciuria was associated with decreased calculi sizes in 1 [5.3%] and stone-free condition in 4 [21.1%]. No significant differences were found between responders and nonresponders with regard to age at presentation, gender, family history of calculus, and size and number of calculi. Our study showed that a combination of diet modification and hydrochlorothiazide has reasonable hypocalciuric effects; however, it is not very efficient in stopping calculus formation process. In addition, clinical and radiological data were not helpful to predict patients with better response to treatment

Metabolic factors associated with urinary calculi in children

We aimed to identify metabolic and anatomical abnormalities present in children with urinary calculi. Metabolic evaluation was done in 142 pediatric calculus formers. Evaluation included serum biochemistry; measurement of daily excretion of urinary calcium, uric acid, oxalate, citrate, and magnesium [in older children]; and measurement of calcium, uric acid, oxalate, and creatinine in random urine samples in nontoilet-trained patients. Urinary tests for cystinuria were also performed. All of the patients underwent renal ultrasonography. Sixty-one patients [42.7%] had metabolic abnormalities. Anatomical abnormalities were found in 12 patients [8.4%]. Three children [2.1%] had infectious calculi, and 3[2.1%] had a combination of metabolic and anatomic abnormalities. In 66 children [46.2%] we did not find any reasons for calculus formation [idiopathic]. Urinalysis revealed hypercalciuria in 25 [17.6%], hyperuricosuria in 23 [16.1%], hyperoxaluria in 17 [11.9%], cystinuria in 9 [6.3%], hypocitraturia in 3 [2.1%], and low urinary magnesium level in 1 [0.7%] patients. Sixteen patients [11.2%] had mixed metabolic abnormalities. Metabolic abnormalities are common in pediatric patients with urinary calculi. In our study, calcium and uric acid abnormalities were the most common, and vesicoureteral reflux seemed to be the most common urological abnormality which led to urinary stasis and calculus formation

Alterations of peripheral leukocyte count, erythrocyte sedimentation rate, and C-reactive protein in febrile urinary tract infection

The aim of this study was to assess the usefulness of peripheral leukocyte count, differential leukocyte count, erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP] level in febrile urinary tract infection [UTI] for defining the UTI level. A total of 61 children aged between 1 and 10 years with documented febrile UTI [axillary temperature >/= 38°C] were studied. They had a urine culture positive for infection. Laboratory investigations including peripheral total and differential leukocyte counts, ESR, and CRP were assessed in relation to the inflammatory responses. Leukocyte count results were available in all of the patients, ESR in 41, and CRP in 36. Leukocyte count was normal in 6 patients [9.8%]. Lymphocytic leukocytosis was seen in 1 patients [1.6%], neutrophilic leukocytosis in 25 [41.0%], and relative neutrophilia in 29 [47.5%]. Thirty patients [73.2%] had a high ESR and 23 [63.9%] had a positive CRP. In children with a high ESR, 12 [29.3%] had neutrophilic leukocytosis and 14 [34.1%] had relative neutrophilia. Relative neutrophilia and neutrophilic leukocytosis with positive CRP both were found in 11 patients [30.6%]. Negative CRP with absence of neutrophilic leukocytosis was found in a significantly higher proportion of patients. There were no direct correlations between the severity of systemic inflammatory responses and urinary tract inflammatory response. Findings of this study showed that ESR and differential leukocyte count are two valuable tests in febrile UTI and may be useful for localization of UTI level, but the total leukocyte count and CRP level as in qualitative methods are not useful, and many patients with febrile UTI do not have leukocytosis

ANCA-negative pulmonary-renal syndrome with pathologic findings suggesting thrombotic thrombocytopenic purpura

Background: Thrombotic thrombocytopenic purpura [TTP] is a rare disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurologic abnormalities, fever and renal dysfunction. The disease classically spares the lung tissue, but recently some cases were reported that presented with respiratory involvement [adult respiratory distress syndrome or pulmonary-renal syndrome]. Presentation with pulmonary-renal syndrome has rarely been reported. Case Presentation: We report a 14-yaers-old boy admitted to the hospital because of a biochemical evidence of renal failure. Two days after admission he developed a high fever, hemoptysis and respiratory distress. Open kidney biopsy was performed and confirmed the diagnosis and finally the patient expired due to neurologic involvement. This case is presented to discuss the need to update the criteria for TTP diagnosis and considering TTP in the differential diagnosis of pulmonary renal syndromes

10-year-old boy with pulmonary-renal syndrome and positive C-ANCA

The term pulmonary-renal syndrome has been frequently used to describe the clinical manifestations of a great number of diseases in which pulmonary hemorrhage and glomerulonephritis coexist. Antineutrophil Cryoplasmic Autoantibody [ANCA] associated vasculitides include Wegener?s Granulomatosis [WG], microscopic polyangiitis [MPA], renal limited pauci-immune glomerulonephritis and Churg-Strauss syndrome. Causes of pulmonary-renal syndrome which are more frequently associated with antineutrophil cytoplasmic autoantibodies are included MPA and WG. These diseases involve kidney as pauci-immune rapidly progressive glomerulonephritis. For MPA the estimated prevalence is 3-37 cases per million; and for WG It is approximately 3 per 100.000 persons that only 0.1 percent of patients are younger than 19 years. Pathologically, the major finding in renal biopsy is necrotizing glomerulonephritis accompanied by crescent formation in MPA and WG. A 10-year-old boy admitted to our hospital because of respiratory distress, hemoptysis, evidence of renal failure and glomerulonephritis [pulmonary- renal syndrome]. Laboratory findings revealed biochemical evidence of renal failure and positive cytosolic anti-neutrophil cytoplasmic antibody [C-ANCA]. Chest x-ray showed multiple round opacities with well defined margins in the right lung. Open renal biopsy showed necrotizing vasculitis with involvement of small and medium sized vessels

Urinary tract infection and predisposing factors in children

This study was designed to determine the predisposing factors in children with symptomatic urinary tract infection [UTI] according to age and gender. We reviewed prospectively 183 pediatric patients with symptomatic UTI admitted to emergency department or referred to nephrology clinic from November 2002 through July 2005. All patients underwent renal ultrasonography and voiding-cystouretherography or radionuclide cystography. Diuretic renal scan or intravenous pyelography [IVP] was performed in those with urinary system dilatation. Urodynamic studies were done in patients with normal radiologic findings and recurrent infections or urinary-intestinal symptoms. Of 183 patients, 130 cases [71%] were female and 53 patients [29%] male. Most of the patients [61.9%] were between 2-24 months old [P=0/001]. Vesicoureteral reflux [VUR] was the most common predisposing factor in both genders [46.9% in girls and 48.9% in boys]. Voiding dysfunction in girls and urinary obstruction in boys were found with a significant difference [P=0/03 for both]. In all age groups, except patients