Histopathological spectrum of childhood idiopathic steroid-resistant nephrotic syndrome in Tunisia

In children, renal biopsy is routinely required in the management of idiopathic steroid-resistant nephrotic syndrome particularly prior to starting nephrotoxic immunosuppressive agents. To investigate the correlations between the results of initial renal biopsy in Tunisian children with idiopathic steroid-resistant nephrotic syndrome and the subsequent response to cyclosporine-prednisolone combination. We conducted a retrospective study of children with idiopathic steroid-resistant nephrotic syndrome over the period 2002- 2009. Data on clinico-biological features, histological diagnosis and response to cyclosporine-prednisolone were collected. Thirty patients were enrolled, of whom 16 had focal segmental glomerulosclerosis, eight had minimal change disease and six had diffuse mesangial proliferation. Complete Remission was achieved in 15 patients [50%]. Nine patients [30%] went into partial remission. Only six patients presented no response [20%]. No statistically significant relationship between the different pathological types and the response to CsA-prednisone was found. In our study, two important facts were noted: 1] the predominant histopathological subtype was the focal segmental glomerulosclerosis; 2] a high remission rate was achieved in our patients using a combined cyclosporine-prednisolone treatment regimen. This response is not dependent on the histological type

[Urinary tract infections in children following renal transplantation: a single-center experience]

Urinary tract infection [UTI] is the most common complication after kidney transplantation and represents a potential life-threatening risk for the immuocompromised child. The aim of this report is to determinate incidence, risk factors, microbilogic features and evaluate the impact of this complication on graft outcome and patient mortality. We performed a retrospective cohort study reviewing the medical records of 17 children from 38 who received a renal transplant in our center between January 1992 and June 2008 and who present an urinary tract infection. All patients received Lich-Gregoire implantation and insertion of double-J stunt. Antibioprophylaxis was not systematic. After a mean period of 6 years, 9 children [5 boys+4 girl] developed early UTI [during the first month after transplantation] and 5 [3boys + 2 girl] had late UTI. Three patients [2boys+1girl] with an indeterminate nephropathy developed early and late UTI. Causal agents are: E.Coli, Klebsiella Pneumoniae and Candida albicans. The further voiding cystourethrography showed a vesico-ureteral reflux on graft in 5 cases. Among the 17 patients, 4 lost their graft and are actually on haemodialysis. The urinary tract infection represents the major complication after renal transplantation. Diagnosis ant treatment must be made early to avoid the loss of the graft