Predisposing factors for nephrolithiasis and nephrocalcinosis in cystic fibrosis

Cystic fibrosis [CF] is characterized by chronic pulmonary disease, insufficient pancreatic and digestive function, and abnormal sweat concentration. There is controversy about predisposing factors of nephrolithiasis and nephrocalcinosis in patients with cystic fibrosis. We assessed the results of metabolic evaluation in patients with cystic fibrosis and its correlation with nephrocalcinosis. Forty five CF patients, mean age 47.1 months, were enrolled in the study. No one had past history of nephrolithiasis and/or nephrocalcinosis. The records were reviewed for clinical characteristics and all patients underwent metabolic evaluation including serum electrolyte measurements and spot urine analysis. Ultrasonography was performed in all patients to detect nephrocalcinosis and urolithiasis. Nephrocalcinosis was found in 5 [11%] patients. No patient had clinical symptoms of nephrolithiasis and/or micro/macroscopic hematuria. Metabolic evaluation of the CF patients versus normal reference values showed decreased serum uric acid in 48.8%, elevated serum phosphate in 24.4%, and urine oxalate excretion in 51%. Metabolic evaluation of the nephrocalcinosis positive patients versus nephrocalcinosis negative group showed no statistical difference in serum electrolytes. The mean value of urine calcium excretion was lower in patients with nephrocalcinosis [P=0.001]. Despite lack of any significant correlation, higher numerical hyperoxaluria was observed in patients with severe steatorrhea. There was no statistical correlation between steatorrhea and urine calcium as well as oxalate excretion. Hypocalciuria in the nephrocalcinotic CF patients may be seen. It can be hypothesized that hypocalciuria may be due to a primary defect in renal calcium metabolism in CF patients

Correlation between heat-shock protein 27 serum concentration and common carotid intima-media thickness in hemodialysis patients

Cardiovascular disease is a major factor in the deterioration of the health and the death of hemodialysis patients. Previous studies have mainly shown a decreased level of heat shock protein 27 [HSP27] in patients with cardiovascular disease. We conducted this study to investigate whether HSP27 correlates with common carotid intima-media thickness [CCIMT] and if it has a potential to be a biomarker for cardiovascular disease. In this cross-sectional study, the correlation between HSP27 serum concentration and CCIMT was investigated in 42 hemodialysis patients. An enzyme-linked immunosorbent assay method was used to measure HSP27 level in the plasma of the patients, and a high-resolution B-mode ultrasonography was applied to measure CCIMT. There was an inverse significant correlation between serum concentration of HSP27 and CCIMT only in patients that had hypertension as their only cardiovascular risk factor [r = 0.61, P = .02]. According to our results and the fact that HSP27 has been shown to be expressed in atherosclerotic plaques of both experimental animals and humans, we suggest that circulatory HSP27 concentration has a potential of being used as a marker for cardiovascular events

Cuboid fracture in a toddler discovered on the whole body bone scan: a case report

This report presents a 3.5-year-old boy who was hospitalized for limping. Medical history and physical exams were not suggestive for any definitive diagnosis. Laboratory and radiographic exams did not support any specific diagnosis either. Subsequently bone scan was performed and increased activity in the ankle due to cuboid fracture was incidentally observed

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

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