Fingernail creatinine as a predictor of prior renal function in children

It is often difficult to distinguish acute renal failure clinically from chronic renal failure, especially in children who do not have records of their medical history. The objective of this study was undertaken to re-examine the history the association between fingernail creatinine [NCr] and serum creatinine [SCr] in children with renal diseases as nephrotic syndrome, acute renal failure and chronic renal failure and the possibility of clinical use of this association. In this study, clipped fingernail specimen from 10 normal control children [mean age 9.5 +/- 2.57 years 6 males and 4 females], 8 children with nephrotic syndrome [mean age 9.93 +/- 2.2 years 5 males and 3 females], 7 children with acute renal failure [mean age 9.57 +/- 3.06 years 4 males and 3 females] and 10 children with chronic renal failure [mean age 10.15 +/- 2.44 years 6 males and 4 females] under regular hemodialyis were analysed for creatinine by autoanalyser using Jaffe's reaction. The results show that Ncr level of nephrotic syndrome [23.4 +/- 4.02 mg/100 mg nail] and Ncr of children with acute renal failure [22.05 +/- 4.27 mg/100 mg nail] were similar to that of NCr of normal control group [23.99 +/- 4.46 mg/100 mg nail] and significantly lower than NCr of the children with chronic renal failure [61.88 +/- 6.3 mg/100 gm nail]. Also, there were a strong positive correlations between NCr of children with chronic renal failure and SCr[r = 0.401] and duration of renal failure [r = 0.410]. This study confirms that the NCr measurement is of valid clinical value in differentiating acute from chronic renal failure

Urinary iron children with nephrotic syndrome

Urinary transferrin loss is a typical feature in relapse of the idiopathic nephrotic syndrome [I.N.S.], also, there is increased urinary iron in animals and humans with nephrotic syndrome. Urinary N-acetyl-beta-D- gluosaminidase [NAG] is indicator for renal damage. To estimate the urinary iron and urinary NAG in children with idiopathic nephrotic syndrome, and the possible role of iron in the different histopathological types of the disease. Our study was performed on 2 groups of patients, minimal change nephrotic syndrome [MC NS] group 10 children [6 boys and 4 girls] mean age 9.75 +/- 2.2 years, focal segmental glomerulosclerosis. [FSGS] group 8 children [5 boys and 3 girls] mean age 9.63 +/- 1.9 years with 12 children [7 boys and 5 girls] of matched ages as a control group. Laboratory parameters hemoglobin concentration [HB], serum albumin, serum iron, serum ferritin, serum transferrin, serum creatinine, BUN, urinary protein per 24 H, urinary transferrin, urinary iron and urinary NAG were evaluated. The results proved decrease in HB in both group of N.S., decrease serum albumin, serum iron, serum ferritin and serum transferrin in both groups of N.S. especially FSGS and significant increase in urinary protein per 24H, urinary transferrin, urinary iron and urinary NAG in both groups of N.S especially FSGS group. There was an increased urinary transferrin and this is accompanied by corresponding increase in a reactive iron species and this could incite tubulo-interstitial injury and renal damage. Measuring urinary iron and urinary NAG could be a respectable method for follow up and prediction of the prognosis in children with idiopathic nephrotic syndrome

Effect of steroids on some hemostatic parameters in children with nephrotic syndrome

Disturbances in hemostatic parameters have been investigated in 20 children with minimal change nephrotic syndrome [15 boys and 5 girls], all were steroid sensitive. Studies were performed before remission with steroid [prednisone] treatment and after complete remission. Our aim is to determine the effect of steroids on these hemostatic parameters. Increased platelet count, platelet aggregation, serum fibrinogen and factors VIII and IX. While no changes in prothrombin time and partial thromboplastin time were noted before remission and after remission with steroid therapy. But after remission platelet count, platelet aggregation, serum fibrinogen and factors VIII and IX were significantly decreased. So, the hemostatic parameters showed a tendency toward normality on steroid [prednisone] therapy, The correction of hemostatic parameters by steroid [prednisone] appeared to be indirect one by correction of proteinuria, hypoalbuminemia, hypercholestrolemia and the hemoconcentration through effect of steroids [prednisone] on the affected glomeruli. We advise to give antiplatelet [as aspirin] to decrease platelet aggregation specially in cases with severe hypoalbuminaemia and haemoconcentration to avoid thrombo-embolic complications