ABSTRACT
Background: Nephrocalcinosis is rare in children. Its etiologies are multiple. The aim of this study was to analyze the etiology of nephrocalcinosis in Tunisian children
Methods: This retrospective study was conducted in the department of pediatrics in Charles Nicolle Hospital during a period of 10 years [2001-2010]
Results: There were 40 children. The mean age was 3.5 years. The most common signs and symptoms at presentation were growth retardation [42.5%] and hematuria [53.8%]. At presentation, renal failure was detected in 70% of patients. The diagnosis of nephrocalcinosis was performed by ultrasonography. The etiology of nephrocalcinosis included primary hyperoxaluria type 1 [65%] and distal renal tubular acidosis [20%]. A progression to renal insufficiency was observed in 18 cases
Conclusion: Primary oxaluria is the principal cause of nephrocalcinosis; early diagnosis and treatment are mandatory as they help limiting renal function deterioration
ABSTRACT
Background: Focal segmental glomerulosclerosis [FSGS] represents 20% of nephrotic syndrome in children. The clinical course and prognosis is heterogeneous in children. The aim of this study was to analyze treatment and outcome of children with FSGS
Methods: This retrospective study was conducted in the Department of Pediatrics in Charles Nicolle Hospital during a 15-year period [1996-2010]
Results: There were 30 children, 16 boys and 14 girls. The mean age was 7 +/- 4 years. Nephrotic syndrome was observed in 26 patients, hematuria was noticed in 2 patients and renal insufficiency was detected in 2 patients at presentation. FSGS, not otherwise specified, was the predominant variant. All patients with nephrotic syndrome were treated with steroids. Only three patients responded to it. Twenty one patients were treated with cisclosporin A and this resulted in a 57% complete remission and a 24% partial response. Cyclophosphamide was administered to 6 patients and engendered a 50% complete remission. Six patients were treated with mycophenolate mophetil and showed no response in all cases. Renal insufficiency has been developed in 12 children
Conclusion: Results from this study showed that the majority of children with FSGS achieve a high sustained remission rate with ciclosporine A
ABSTRACT
Introduction: Peritoneal dialysis [PD] is still the most common modality used in treatment for children with End Stage Renal Disease [ESRD]. The objective of this study was to identify the epidemiological, clinical, and microbiological factors affecting the outcome of PD
Methods: In this study, we retrospectively reviewed the records of 85 patients who were treated with DP for the last ten years [from January 2004 to December 2013] in the Department of Pediatrics in Charles Nicolle hospital, Tunis
Results: The mean duration of PD was 18.1 +/- 12 months [3.5-75 months]. The average age of PD onset was 9.3 +/- 5.7 years [29 days-23 years]. The sex ratio was 1.5. In a significant number of cases with ESRD, the primary cause is Congenital Anomalies of the Kidneys and Urinary Tract [CAKUT]. Seventy-four of our patients [87%] had been treated with Automated PD. The average time between catheter placement and PD commencement was 3.9 +/- 4.6 days. Catheter change was 1.62 [1-5]. Sixty-one patients [71.8%] had experienced at least one episode of peritonitis. The most frequently isolated organisms was the Gram-positive bacteria [61%]. Survival rates without peritonitis at 12th, 24th and 36th months were 40%, 32% and 18%, respectively. Transition to permanent hemodialysis was required in 66% of patients
Conclusion: Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention
ABSTRACT
Helicobacter pylori [Hp] infection is a common and universally distributed bacterial infection. It is predominantly acquired in childhood. To assess the relationship between endoscopic nodular gastritis and Hp infection. A retrospective study was conducted in children who underwent upper gastrointestinal endoscopy for chronic abdominal pain. All children who had five gastric biopsies for histologic analysis, urease test and Hp culture were included in the study. The Sensitivity and sensibility of nodular gastritis were determined and different parameters were studied according the presence or not of nodular gastritis[age, gender, Hp status, gastritis score and lymphoid follicles]. 49 children, mean age 6.9 +/- 3 years [range 1-12 years] were eligible for the analysis. Hp Infection was diagnosed in 35 out of the 49 children [71.5%]. Nodular gastritis was recorded in 16 out of 49 children and in 14 infected children and 2 out of 14 non infected children [p=0.07], 40% sensitivity, 85.7% specificity, 87.5% positive predictive value, and 36,4% negative predictive value. The parameters associated significantly to the presence of nodular gastritis were older age: [p=0.04], Hp infection: [p=0.01], chronic gastritis: [p=0.05], active gastritis: [p=0.02], follicular gastritis: [p=0.005], higher gastritis score: [p=0.005]. Completely normal gastric mucosal histology was never found in infected children with antral nodularity. Among all infected children, the gastritis score was significantly higher when there was a nodular gastritis and follicular gastritis was significantly associated to nodular gastritis. The endoscopic pattern of antral nodularity identifies children with Hp infection, and active chronic follicular gastritis
ABSTRACT
Premature rupture of membranes [PROM] is defined as rupture of membranes occurring before the onset of labor. It complicates 5 to 10% of pregnancies. It continues to be a major cause of morbidity and mortality in the newborn. To evaluate infectious risk associated with PROM in at term and asymptomatic new-born and to study this risk according to the duration of rupture. Retrospective study in neonatal unit of Charles Nicolle hospital of Tunis including all cases with isolated PROM in at term new-born during the year 2007. 299 cases were identified over 3749 live births that is an incidence of 8%, divided to: 21 cases [7%] between 6 and 12 hours, 86 cases [28.8%] between 12 and 18 hours, 61 cases [20.4%] between 18 and 24 hours and 131 cases [43.8%] more than 24 hours. Diagnosis of colonization was reported in 54% of cases when PROM occurred between 12 and 18 hours versus respectively 27.3%, 0% and 18% in respectively subset of 6 to 12 hours, 18 to 24 hours and more than 24 hours [p=0,03]. 62% of foeto-maternel infections were reported in subset of PROM more than 24 hours and 13.8% in the subset between 18 and 24 hours. Our study emphasizes the important risk of foetomaternel infection associated with isolated PROM. This risk is major when the rupture exceed 12 hours but the limit of 18 hours can unrecognized some cases of probable foeto-maternel infection
Subject(s)
Humans , Infant, Newborn , InfectionsABSTRACT
Vascular complications, especially those including the renal vein, remain a major cause of lost graft. To evaluate retrospectively the incidence and management of vascular complications after pediatric renal transplantation and to assess possible risk factors and their effects on patient and graft. A total of 82 consecutive renal transplants were performed in 79 patients at a single institution. The diagnosis of vascular complications was suspected in the presence of suggestive symptoms and confirmed by Doppler ultrasound and if necessary by a computed tomographic angiography. Urgent exploration was performed in all suspected cases. There were seven vascular complications [8,5%], including renal vein thrombosis in four patients, renal artery stenosis in one, and sural thrombophlebitis in two. The thrombosis of the graft vein which is the main complication occurred at mean 24 hours after renal transplantation. All these patients needed transplant nephrectomy after thrombosis event. In the remaining cases, the outcome was favorable even for the patient with transplant renal artery stenosis. Vascular complications are common and serious events affecting patient and graft survivals. A perfect surgical technique and rigorous radiological monitoring may result in decreased incidence and severity of these complications