Cardiac evaluation in children with problematic nephrotic syndrome

Hyperlipidemia, an important characteristic of nephrotic syndrome [NS] in children, is usually observed during the active phase of the disease and disappears with resolution of proteinuria. However, persistent lipid abnormalities have been reported and raised the question of development of atherosclerosis. This study was designed to elaborate the risk factors for developing atherosclerotic cardiovascular disease in patient with problematic NS. The study was conducted on 30 patients with primary NS from the nephrology clinic of Alexandria University Children's Hospital over one year duration. They were classified into 3 groups: group I included 20 patients with problematic NS [i.e. steroid resistant, steroid dependent or frequent relapsers], group II including 10 patients with minimal change NS in remission, and group Ill [control group] of 10 apparently healthy age and sex matched children. For all patients complete urine analysis, 24 hour urinary protein excretion, serum total proteins and albumin, serum urea and creatinine, creatinine clearance, complete lipid profile, plasma oxidized LDL [oxLDL] using ELISA technique, cardiac enzymes [creatine phosphokinase, myocardial isoenzyme, as partate amino transferase and lactate dehydrogenase], and serum complement 3 [C3] were quantified. Also detailed echocardiography, 12-lead ECG, and chest X-ray were done. Both systolic and diastolic blood pressures were significantly higher in group I when compared with group Ill [P= 0.02 and P =0.008 respectively]. Group I had significantly higher levels of triglycerides [TG], total cholesterol, low density lipoprotein [LDL] and very low density lipoprotein [VLDL] when compared with the other two groups [P=0.003, 0.001, 0.0002 and 0.02 respectively]. The mean value for oxLDL was significantly higher in group I when compared with group II and III. There was no significant difference in the level of high density lipoprotein [HDL] among the three groups. Also it was significantly higher in group II when compared with group III [P=0.002]. The mean value for the interventricular septal thickness in diastole [IVSd] and left ventricular posterior wall thickness in diastole [LVPWd] was higher in groups I and II in comparison with group Ill [P=0.02 and P=0.04 respectively]. In conclusion, Children with problematic nephrotic syndrome are at risk of developing atherosclerotic cardiovascular disease as result of systemic hypertension, increased LV mass, persistent significant elevation of levels of cholesterol, TG, LDL and ox-LDL with normal level of HDL

Effect of corticosteroid therapy on bone mineral density in corticosteroid responsive nephrotic children

Dual energy X-ray absorptiometry [DEXA] is the most widely employed technique for diagnostic and serial assessment of bone mass. It is helpful in the investigation and follow up of children with diseases impairing bone metabolism like nephrotic syndrome. The aim of this work was to study the effect of long term steroid therapy on bone mineral density in corticosteroid responsive nephrotic children using DEXA. The study was conducted on 26 corticosteroid responsive nephrotic children in the age group 5-14 years with criteria of MCNS. Nephrotic patients were divided into group A [16 children with first attack or infrequent relapsers] and group B [10 children with steroid dependent NS]. Also, 10 healthy children were included as control. There was no statistically significant decrease of BMD at the end of steroid protocol used in patients with group A. During one year period of follow up of these patients only two cases relapsed which represents a relapse rate of 12.5%. On the contrary, there was a significant decrease in BMD in steroid dependent cases [group compared to control group. Also, there was a negative correlation between the cumulative dose of steroids and BMD

Conclusion: DEXA is a safe method to measure bone density in children. It should be used for assessment of BMD in nephrotic children under steroid therapy for long periods for early diagnosis and management of osteoporosis

Sarcocystis of cattle in El-Minia, Upper Egypt and ultrastructure of sarcocystic hominis cysts

Skeletal muscle samples were obtained from 12 cattle, and all the examined samples were found infected with Sarcocystis cysts. Light microscopic [LM] examination of fresh isolated cysts showed three Sarcocystis species; S. cruzi with thin walled cyst of hairy protrusions and S. hirsuta and S. hominis with thick radially striated cyst wall. Cyst wall protrusion of S. hirsuta had a sloping pattern, while those of S. hominis were broadly seated on the cyst surface in upright pattern. Transmission electron microscope [TEM] examination of cysts of S. hominis showed villar protrusions, which arise with broad basis from the cyst surface, finger-like in outline and had microfilaments in the core. Leaflets of membrane-like structures were present between bradyzoites. The morphological criteria of this species and its medical importance were discussed and this is the first description of S. hominis from cattle in El-Minia, Upper Egypt

Passive smoking and lower respiratory tract illnesses in children

The relationship between household tobacco smoke exposure and wheezing and nonwheezing lower respiratory tract illnesses in young children was investigated using both a questionnaire and the urinary cotinine/creatinine ratio to assess passive smoking. A case-control study was conducted on 60 children [