Clinical outcome of acute poststreptococcal glomerulonephritis [APSGN] in Iranian children

Recently, the prognosis of acute post-streptococcal glomerulonephritis [APSGN] has been reported as improved compared with the results of previous studies. In an attempt to clarify this in Iranian children, we analyzed the clinical course of patients with APSGN. In this retrospective study, a total of 53 children diagnosed as having APSGN according to the presence of hematuria and/or proteinuria, evidence of group A beta-hemolytic streptococcal infection, transient hypocomplementemia and absence of clinical or histological evidence of previous renal disease were studied in our department between March 1986 to September 2002. Fifty-three children, 19 females and 34 males, aged 3-13 years [mean 8.7 years] were enrolled in the study. All children had hematuria, proteinuria and decreased serum complement. There were no patients with renal dysfunction, but one case with nephritic syndrome. Forty-three [81%] had hypertension according to Second Task Force criteria. Blood pressure [BP] was normal in the remaining 10 [19%] patients. Eight children were lost for the follow-up examination. Two patients received renal biopsy. Both biopsies were abnormal showing mild changes with corresponding immunologic findings. Forty-five children were reassessed after an average of 5 months [range 1 month to 66 months]. At the last follow-up all of these children were in good physical health. The BP, serum creatinine, and complement levels were within normal limits. These findings indicated that the prognosis of APSGN during childhood is excellent, when adequately recognized and received supportive measures in the treatment, including control of high blood pressure and chemical imbalance in acute phase of disease. Additionally, according to our results, we could predict a favorable prognosis and reassure the family

[Incidence and severity of vesicoureteral reflux in siblings of children with known reflux]

The incidence of primary vesicoureteral reflux [VUR] is less than 1% in the general normal population, but it is high in siblings of children with VUR, with a reported incidence of 4.7-51%. VUR represents one of the most significant risk factors for acute pyelonephritis in children and caries long-term renal parenchymal damage. The purpose of this study was to detect the age-related incidence, and severity of reflux, in siblings of children with reflux.Out of 80 index patients with VUR, 95 siblings were evaluated with direct voiding cystography from 1994 to 2004. All siblings underwent renal ultrasonography [US] for size, shape, parenchymal echogenicity, corticomedullary differentiation, irregularity of the kidney outlining, and parenchymal reduction.Out of 95 siblings, 34 had VUR, representing an incidence of 35, 8%. The mean age at study entry of the 37 boys and 58 girls was 65 months [range 3 months to 13 years]. Reflux was unilateral in 22 siblings and bilateral in 12. Of the 34 refluxing siblings [46 refluxing ureters], 12 [35.3%] had history7 of symptomatic urinary tract infection [UTI]. Of the 46 refluxing units 22 were mild, 13 moderate, and 11 were severe.Reflux is low7in the majority of siblings. This study confirms a significant overall incidence of VUR [35.8%] in the siblings of patients with known reflux. Additionally, our review suggests that all siblings over 6 years should undergo a screening for VUR because of the high likelihood of identifying reflux in this population, even in the absence of urinary tract infection

Methylprednisolone pulse therapy in management of non responder nephrotic syndrome

Some patients with the diagnosis of childhood nephrotic syndrome are unresponsive to conventional treatment regimens. Recent studies of more aggressive therapies have provided strong evidence of the benefit of high dose methylprednisolone [MP] protocol with alternate day prcdnisone alone or with alternate - day prcdnisone plus an alkylating agent [I] in these patients. From May 1996 to May 1997 we have treated 14 patients with non-responder nephrotic syndrome with methylprednisolone protocol. Eight patients had histologic diagnosis of focal segmental glomerulosclerosis, 3 diffuse mesangial proliferation and 3 has minimal change disease. Cylosporin was added in two patients to methylprednisolone at the beginning of the second course of therapy. The patients were observed for an average of 8 months [range 4-12 months]. In the last follow up there were no patients in remission and all remained nephrotic. Seven patients had persistent massive proteinuria with normal creatinine clearance [CrCl] Two had decreased CrCl. Five progressed to end-stage renal disease. These observations suggest that "Pulse" methylprednisolone is not effective in patients with non responder nephrotic syndrome