comparison of ultrasound and non-contrast helical computerized tomography for children nephrolithiasis detection

Nephrolithiasis is less common in children than adults, but its diagnosis and management in children may be more perplexing. In this article, we compare two imaging ultrasound [US] and non-contrast helical computerized tomography [CT] for diagnosis of nephrolithiasis. A total of 20 children who diagnosed as nephrolithiasis by US were imaged simultaneously by non-contrast helical CT. Their history like as family history in first and second degree relatives and urine analysis for hematuria and urine randomly calcium to creatinine ratio was obtained. All data analyzed by chi[2] and Mann-Whitney U-test in SPSS 16 and P < 0.05 was considered to be significant. Out of 20 cases, only 5 cases diagnosed as nephrlithiasis by US were confirmed by CT method 2 out of 20 cases had another extrarenal origin for their complaint who diagnosed wrongly as nephrolithiasis by US. Stone size based of US that was confirmed by CT method was larger 4.6 +/- 1.5 [minimum 3 max 6 mm] than non-confirmed ones 2.3 +/- 0.7 mm [P 0.002]. Hematuria occurred more in correct diagnosed compared with misdiagnosed [P 0.005]. Positive family history and urine calcium ratio was not differed between two groups. Non contrast helical CT is essential to confirm of nephrolithiasis and other extrarenal origin of complaints, which diagnosed wrongly as nephrolithiasis in children. Stone size and presence of hematuria are two major factors for right diagnosis of nephrolithiasis as US method but Urine calcium excretion ratio or positive family history cannot be predictive as this study

efficacy of hydration with normal saline versus hydration with sodium bicarbonate in the prevention of contrast-induced nephropathy

Contrast-induced acute kidney injury [contrast-induced nephropathy [CIN]] is one of the major causes of hospital-acquired acute renal failure. Volume supplementation is the most effective strategy to prevent acute renal failure caused by contrast; but the effects of sodium bicarbonate regimens are unknown in CIN prevention. The aim of this survey is to compare the efficacy of hydration with normal saline versus hydration with sodium bicarbonate in the prevention of the CIN in patients undergoing coronary angiography. In a clinical trial, 350 patients undergoing coronary interventions were randomized into two groups: One group received normal saline and another group received sodium bicarbonate before and after infusion of the contrast. Patients in both the groups had received N-acetylcysteine. CIN was defined as relative increase in serum creatinine equal to or more than 25% of baseline or increase to 0.5 mg/dl in 48 h after the injection of the contrast. CIN was seen in 46 patients [13.1%] after coronary interventions. Incidence of CIN in patients receiving normal saline [19.4%] was more than in patients receiving sodium bicarbonate [6.9%] [P = 0.001]. Hemodialysis was needed only in one patient who received saline normal. Relative risk to induce CIN in both groups was as 2.8 and was in the range of 1.50-5.25 with confidence interval of 95% and P = 0.001. Thus, the probability of CIN was significantly more in the usage of normal saline. This survey showed that hydration with sodium bicarbonate is superior to hydration with normal saline and has better protection effects

Xanthogranulomatous pyelonephritis presenting with thrombocytopenia and renal mass

Xanthogranulomatous pyelonephritis [XGP] is a rare event in children without any predisposing factor like calculi, obstruction or vesicoureteral reflux. In this case we report a four-year-old girl who presented with a renal mass, hematuria, flank pain, anemia and thrombocytopenia-these signs and symptoms misled us to Wilms tumor. Thrombocytopenia which is a strange event in XGP resolved after nephrectomy. Normal contra lateral kidney was infected four months after right nephrectomy. This suggests that these patients should be under strict surveillance and antibiotic prophylaxis as they are a high-risk group for urinary tract infection, and thrombocytopenia should be considered as a laboratory test finding in XGP

Correlation between pediatric open heart surgery outcomes and arterial-mixed venous oxygen saturation differences

Low Cardiac Output Syndrome [LCOS] contributes to postoperative morbidity and mortality. This article tries to find a predictive factor to interpret outcome after cardiac operation. In a cross-sectional study, 100 children with congenital heart disease undergoing cardiovascular surgery with cardiopulmonary bypass [CPB] without significant left-to-right shunt were selected. Arterial and central venous oxygen saturation values were measured via blood samples simultaneously obtained in 6-hr intervals for a total of 24-hr during postoperative period at hours 0, 6, 12, 18, and 24. Postoperative ventilation support [intubation period] and cardiovascular support were also obtained from the hospital records. Statistical analysis was later performed comparing the arterial-mixed venous oxygen saturation differences and durations of required ventilatory and cardiovascular support, both for the complicated and non-complicated patient groups. The data was processed with correlation Pearson and Mann-Whitney U tests in SPSS 15 software, P less than 0.05 was significant. Mortality following cardiac operation is 6% and complications may happen in 45% of the cases. The highest Arterial-mixed venous oxygen saturation difference occurred immediately post operation [up to 57%]. These measures were high up to 18 hours in complicated and non-complicated groups [36% vs. 31% ; P< 0.05]. This factor cannot predict prolongation of intubation period in patients [P > 0.05]. Arterial-mixed venous oxygen saturation difference may be high as much as 57% or as low as 23%.These different measures, being higher up to 18 hours in complicated to non-complicated groups after 18 hours, can be related to tissue ischemia during surgery and cannot be discriminative.

effect of cyanosis on active clotting time during diagnostic catheterization

Cardiac catheterization is a common procedure which needs a careful coagulation monitoring. In our study, we aimed to find factors influencing active clotting time [ACT] following heparin therapy. ACT of 71 patients who were scheduled to undergo transcutaneous diagnostic catheterization and angiography were measured at baseline, 2 and 60 minutes after 50 IU/kg heparin loading. ACT in two groups of patients [cyanotic and non-cyanotic] was compared. All data were analyzed with Wilcoxon, Mann-Whitney test and Pearson in SPSS 16, P value less than 0.05 was considered significant. ACT following heparin at 2nd and 60th minutes was not significantly different in cyanotic and non-cyanotic groups. At 60th minute following heparin administration, ACT decreased more dramatically in older children. Cyanosis does not affect ACT measures following heparin treatment. Moreover, after 60 minutes, heparin efficacy [ACT values] decreased more with increase in patients' age.

Inferior vena cava index in edematous patients

To find a relation between extracellular over fluid and inferior vena cava index as a noninvasive, cost effective and accessible method. In a cross sectional study 54 cases [no edema 30, mild and moderate 13 and significant edema 11 cases] entered to study. Inferior vena cava index [IVCi] measured by difference of inspiration to expiration divided to maximum size multiply by 100, we also find delta ratio as difference of maximum to minimum size of inferior vena cava. All data expressed by rate and ratio, relation of edema severity to IVCi or delta ratio performed by mann whitney and regression test, P less than 0.05 was significant. IVCi in 30 cases with no edema, 13 cases with mild to moderate and 11 cases with significant edema were%46 +/- 16,%42 +/- 16,%38 +/- 17, there is a reverse relation of IVCi and edema severity but these relations were not significant [P>0.05]. Averaged Delta ratio [millimeter] decreased in severe edema but it was not significant[3.7mm +/- 2 vs. 2.8mm +/- 1.6]. In edematous conditions IVCi and delta ratio decrease but these changes are not significant for edema severity estimation.

Infant boy with microcephaly gastroesophageal reflux and nephrotic syndrome [galloway-mowat syndrome]: a case report

In this case report, we present the first diagnosed case of Galloway-Mowat syndrome in Iran. A 7 month old infant boy with microcephaly that had prominently stunted head growth after birth, gastroesophageal reflux, multiple craniofascial characters, hypothyroidism and nephrotic syndrome diagnosed at 5 months of age associated with rapid decline in renal function and heavy proteinuria in 2 months

Cardiac findings in congenital nephrotic syndrome

Congenital nephrotic syndrome is a severe debilitating problem associated with extra renal manifestation such as diverse cardiac findings. During four years 6 cases diagnosed as congenital nephritic syndrome in base of definitive criteria their documents reviewed and echocardiographic evaluation has been done for all with or without cardiac sign or symptoms, results gathered and expressed as incidence. All cases have some grades of structural or functional defects from simple form like as tricus-pid regurgitation to complex defects. It may be run in consecutively in siblings of a family from non consanguine parents. Pulmonary stenosis may occur in all parts subvalvualr, valvular and peripheral parts of pulmonary artery, left ventricular hypertrophy and mitral regurgitation observed in some, moderate tricuspid regurgitation observed in half of cases due to pulmonary hypertension or right ventricular hypertrophy due to pulmonary stenosis

Right atrial pressure significance in renal function indices

With attention to association of right atrial pressure to renal venous hypertension, we try to review renal function indices changing due to congenital heart disease as base of right atrial pressure and cyanosis condition. Forty five children without preexisting renal disease, diagnosed as pulmonary hypertension due to congenital heart disease with or without cyanosis entered to this study their renal function indices besides to their right atrial pressure measured by angiographic documents .The effects of right atrial pressure and cyanosis on renal function indices evaluated by appropriate statistical methods. Right atrial pressure is not a common problem but it is more frequent in cyanotic than acyanotic patients. In addition significant proteinuria occurs in cyanotic patients with high right atrial pressure [above 5 mmHg]. There is not any difference between renal function as glomerular filtration rate or creatinine in either groups of cyantic or acyanotic with a high or normal right atrial pressure. In cyanotic congenital heart disease patients who have pulmonary hypertension measuring of right atrial pressure seems essential; in high risk group including those with high right atrial pressure and cyanosis, significant proteinuria may happen in up to 30% of cases independent of age or gender

Association of proteinurai in children with acyanotic congenital heart disease and pulmonary hypertension in a Tertiary University Hospital in Northwest Iran

This study was performed to detect the severity of proteinuria in children with cyanotic pulmonaryhypertension. Twenty children suffering from pulmonary hypertension due to acyanotic heart disease evaluated for proteinuria. They were divided into two groups of equal less than two amd more than two years old, because of the difference in proteinuria ratio in these two groups. Association of proteinuria with age, hematocrit, mean pulmonary arterial pressure and tricuspid regurgitation were evaluated. Although there was not any case of proteinuria in nephrotic range but significant roteinuria was observed in 2 out of 11 children aged below 2 years of age, and 3 out of 9 in children above 2 years old. However there was no relationship between ages, mean pulmonary. Arterial pressure, hemoglobin, hematocrit, tricuspid regurgitation and proteinuria. There was not any relationship between proteinuria and the severity of pulmonary artery pressure, tricuspid 1-egurgitation, age and hematocrit in this group of children Significant proteinuria in children with acyanotic congential heart disease was present in 25% of cases [5 out of 20]. Nephrotic syndrome is uncommon in children with acyanotic pulmonary hypertension congenital heart disease