Renal scar formation in children with recurrent urinary tract infections

Reports of renal scar formation in children even in the absence of vesicoureteral reflux necessitates studying other causes of this major complication. The present study mainly focuses on the role of recurrent urinary tract infections [UTI] in renal scar formation. The records of 53 patients with recurrent UTI and the data on their regular follow up visits were reviewed. Renal scar formation was confirmed by dimercapto-succinic acid [DMSA] scan. DMSA scan, done at a mean age of 8.31 years, revealed renal scar formation in 12 cases [22.44%]. Seventy-five percent of the patients with scar formation and 80.5% without scar were older than 3 years at the time of the first documented UTI. The etiologic organism was found to be Escherichia coli in 89.2% of the infections in the scar forming versus 78.8% in the non-scar forming group. In the presence of normal urinary tract anatomy, recurrent UTI can be a significant cause of renal scar formation in children

Cost benefit of the routine urinalysis

In the present health care environment, cost-benefit analysis is extremely important. In this screening program, the minimal cost of screening dipstick urinalysis in 1601 asymptomatic school children was determined. The process of screening was similar to all the studies. The minimal cost utilizing 3 general physicians was calculated. Costs were determined by using current charge for supplies ordered to perform tests, charges for tests performed by a commercial laboratory, and the cost of a final evaluation by a pediatric nephrologist. Initial abnormal urinalysis was found in 4.7% [76/1601] of patients. Upon retesting 1.37% [22/1601] of patients were calculated to have a persistent abnormality. The calculated cost was 1/530/000 Rials [164.5 $] to initially screen all 1601 patients with a dipstick urinalysis or 850 Rials [0.09 $] per patient. The calculated cost to evaluate the 22 patients with any persistent abnormality on repeat dipstick urinalysis was 246/840 Rials [26.5 $] or 11.220 Rials [1.2 $] per patient. This is the calculated cost for a single screening of 1601 asymptomatic pediatric patients. Multiple screening dipstick urinalysis in asymptomatic pediatric are costly and should be discontinued. We purpose that a single screening dipstick urinalysis be obtained at school entry age, between 6 and 7 years old, in all asymptomatic children

Bone mineral density in children with relapsing nephrotic syndrome

Given the high relapse rate of disease in children with steroid dependent nephrotic syndrome and the osteoporotic effect of long periods of steroid therapy, this survey was performed to find the bone mineral status of these patients. Bone mineral density and content [BMD and BMC] were measured using Dual energy X-ray absorptiometry in 37 nephrotic children, six girls and 31 boys aged from four to 21- yrs, as patient group and 37 age and sex-matched healthy individuals as control group. Historical data were collected by chart review. As compared to the control group, the patients were shorter in stature. The percentage of BMC of lumbar and BMD of femoral bones of the patients was significantly lower than control group. According to the Warner method, 12% of the patients were osteoporotic and the BMD of their femoral and lumbar bones was inversely correlated with cumulative steroid dose. Bone loss can occur in some steroid-dependent nephrotic patients, especially those with low age of onset and those with longer duration of the disease and higher cumulative dose of steroid. Therefore, measurements of BMD and BMC could be recommended, at least, for the selected patients

Urinary tract infection in infants and children with diarrhoea

To determine when children with acute diarrhoea should be investigated for urinary tract infection [UTI], we studied 120 patients and 120 healthy age- and sex- matched controls aged 4 weeks to 5 years. In those with positive or suspicious urine cultures, bacteriuria or pyuria, urine culture was repeated. We detected UTI in 8 patients [all < 2 years] and 1 boy in the control group. In those with UTI, invasive diarrhoea was observed in 1, fever in 7 and vomiting in 5 patients. In children with acute diarrhoea, investigation for UTI is only recommended for febrile, female infants aged 5- 15 months

Effect of betamethasone with or without gentamicin on renal scarring in rat model of pyelonephritis

To evaluate the effect of betamethasone in preventing renal scarring in rat model of pyelonephritis. Material and Sixty three female Sprague-Dawley rats were divided into seven equal groups [A-G]. After exposing the left kidney under general anesthesia, direct inoculation of colonies of mannose-sensitive E.coli was done in groups C-G and normal saline in group B. No injection was done in group A. After 48 hours of bacterial inoculation, intramuscular [IM] injections of gentamicin [3 mg/kg/ day for 10 days] was used in groups C, E and F. Betamethasone [0.3 mg/kg/day IM] was used after two days [group D and E] and 5 days [group F] of bacterial inoculation. Normal saline as daily IM injections for 10 days in group B and no IM injection in group G was done. After 8 weeks of bacterial inoculation, the rats were sacrificed and the volume of renal scar was determined using a point- counting technique. Changes in the weight and volume of the kidneys were not statistically significant. No scar was detected in group A, but all the other groups with intrarenal injections [including group B with no bacterial inoculation] had scarring. The volume density and absolute volume of the scar in groups C-G were significantly more than group B [p < 0.001], but no statistically significant difference was observed in groups C-G. Betamethasone with or without gentamicin, when used 48 hours or more after induced pyelonephiritis is not effective to prevent renal scar

Nephrotic syndrome in a girl with vesicoureteral reflux and situs inversus

In this case report a five year old girl is presented with steroid-responsive nephritic syndrome who had bilateral Vesicoureteral Reflux [VUR] and situs inversus. A combination of situs inversus, nephritic syndrome and VUR has been reported previously

Primary vesicoureteral reflux in children in southern Iran

Experience with vesicoureteral reflux [VUR] differs in different centers and there is plenty of controversies. To evaluate the outcome of primary VUR complications and the rate of recurrence of UTI. In a retrospective study, the medical charts of all infants and children with primary VUR who were followed up by one nephrologist were reviewed. During 16 years, 271 patients [226 females, 45 males] with 401 refluxing ureters were followed up as primary VUR. The patients' age at diagnosis was 4 days to 16 years [Mean: 4.4 years] and the mean duration of follow-up was 4.2 years. Urinary tract infection [UTI] was the presenting symptom in 97% and fever was recorded in 30% of cases. Frequencies of different grades of VUR at initial investigation were 6.5%, 52%, 23.4% and 18.1% for grades I to IV, respectively. The responsible microorganism in 90% of the first episodes of UTI was E. coli. Scarring or small size kidney was present in 63 patients. Recurrence of UTI in VUR of grades I to IV, were 68.7%, 51%, 60.1% and 46.8%, respectively. Follow-up voiding cystourethrogram revealed resolution of VUR in 52%, improvement in 31%, no change in 11%, and deterioration in 6%. Complications such as chronic renal failure, hypertension and renal tubular acidosis were observed in 11, 10 and 9 patients, respectively. Symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not related to the grade of VUR

Prevalence of urinary tract infection in preschool febrile children

Fever is a common presenting symptom, and the true prevalence of urinary tract infection [UTI] in pre-school febrile children with or without other symptoms is not known. To determine the prevalence of UTI in febrile children referring to the pediatric clinics or emergency rooms in Shiraz. During a 6-month period, 450 patients aged 3 to 6 years old, were divided into 3 equal groups. The first group had fever with no other symptoms or signs, the second group had symptoms that could be related to the urinary tract, and the third group had other symptoms. After obtaining a complete history and physical examination, urinalysis and urine culture were performed for each patient. In suspicious urine cultures [104- 105 colonies or mixed growth] or those with positive urine cultures [>105 colonies] but no urinary symptoms, the cultures were repeated. Twenty patients were labelled as having UTI [one girl in the first group, 3 boys and 13 girls in the second group, and 2 boys and one girl in the third group]. Male to female ratio was 1.36. Only one out of ten patients with a history of previous UTI had positive urine cultures. In 44 patients oral antibiotics had been started before this study, and all except 3 had negative urine cultures. In febrile children 3 to 6 years old with no history of previous UTI, infection of the urinary tract is not usual, unless a urinary symptom is present

Relapse Rate in Daily Single-Dose Prednisolone Therapy for Children with Primary Nephrotic Syndrome

Most current references recommend divided doses of prednisolone for the initial treatment of idiopathic minimal change nephrotic syndrome in children, with relapse occuring in the majority of them, but there is little experience concerning single-dose prednisolone therapy, especially considering the relapse rate. In this prospective study on 36 consecutive children with primary nephrotic syndrome, prednisolone [2 mg/kg/day] was used as a single daily dose in 17 patients [SD group], or divided into 3 doses in 19 cases [DD group] who were randomly selected, and relapse rates were compared. The mean age of the patients was 6 years [range 15 months-13 years] and there was no statistically significant difference between the two groups considering age, sex, clinical presentation, laboratory findings at the time of admission and prednisolone side effects. After 4 weeks of full dose prednisolone therapy, the drug was changed to 2 mg/ kg as a single dose every other day in both groups, irrespective of the response. During the third month of therapy, the drug was reduced to 1 mg/kg every other day and it was discontinued after 4 weeks. Relapse rate was compared in steroid responsive patients in both groups [14 in the SD and 11 in the DD group] who were matched for age, sex and paraclinical findings. During the first year of follow-up, in those who were initially steroid responsive, 2 patients in the SD and 6 in the DD group had no relapse. The number of total relapses/year in the SD and DD group were 19 for 12 patients and 8 for 5 patients respectively [p<0.02]. In conclusion, daily single-dose prednisolone therapy in childhood nephrotic syndrome can be effective for induction of remission and is tolerated well by patients but increases the relapse rate significantly

Vasopressin resistant diabetes insipidus in a patient with idiopathic hypercalciuria

An eleven year old boy with clinical presentation of diabetes insipidus [DI] was proved to have vasopressin resistant DI secondary to idiopathic hypercalciuria [IH]. He responded to treatment of hypercalciuria and eventually remained well, with normal urine calcium excretion. This case illustrates that IH must be considered in patients with vasopressin resistant DI

Analysis of prognostic features in children with the hemolytic uremic syndrome

The purpose of this study has been to evaluate various factors influencing prognosis in children with hemolytic-uremic syndrome [HUS]. Forty children with cfassical picture of HUS were seen in 1986-1991. Boys and girls were equally affected, aged from two months to ten years. In 35 patients [87.5%] there was a history of diarrhea which was bloody in 25. All were treated with peritoneal dialysis within the first 24 hours. Fresh frozen plasma [FFP] was transfused in the first two days for all except 11 patients for whom it was transfused in the third to fifth day of admission. Fifteen patients died [37.5%]; of these, 12[80%] had diarrhea for longer than 7 days, 11 [73%] had prominent neutrophilia, and 9 [60%] had significant neurological symptoms. Eleven of the fifteen patients had been transfused with FFP after the third day of hospitalization. Statistical analysis of data relating to mortality revealed the following regarding prognostic factors in HUS among children: mortality is higher in those with longer prodromal period [p<0.001]. in those with bloody diarrhea [p<0.025], in patients with prominent neutrophilia [p<0.001], and in those who had delayed treatment with FFP [p<0.001]. Prognosis was not affected by age, sex, or season of presentation