Prevalencia de compromiso renal en pacientes pediátricos internados con enfermedad por coronavirus 2019: estudio multicéntrico / Prevalence of renal involvement among pediatric patients hospitalized due to coronavirus disease 2019: A multicenter study

Introducción. El compromiso renal (CR) en niñosinternados con enfermedad por coronavirus2019 (COVID-19, por su sigla en inglés) varía entre el 1,2 % y el 44 %. Dado que existe limitada información local, el objetivo primario de este estudio fue estimar la prevalencia de CR en nuestro medio. Población y métodos. Estudio transversalrealizado en 13 centros de Argentina entre marzo y diciembre de 2020. Se incluyeron pacientes internados con COVID-19, de 1 mes a 18 años y que tuvieran al menos una determinación de creatinina sérica y/o de orina completa.Se excluyeron aquellos con enfermedad renal conocida. Se consideró CR la presencia de lesión renal aguda (LRA), proteinuria, hematuria, leucocituria y/o hipertensión arterial (HTA). Resultados. De 528 historias clínicas elegibles, seincluyeron las de 423 pacientes (el 55,0 % de sexo masculino, mediana de edad 5,3 años). El cuadro clínico fue asintomático en el 31 %, leve en el 39,7 %, moderado en el 23,9 %, grave en el 1,2 %, crítico en el 0,7 %, y el 3,5 % presentó síndrome inflamatorio multisistémico pediátrico (SIMP). Dos pacientes (0,47 %) fallecieron. La prevalencia de CR fue del 10,8 % (intervalo de confianza 95% 8,2-14,2), expresada por leucocituria (16,9 %), proteinuria (16,0 %), hematuria (13,2 %), HTA (3,7 %) y LRA (2,3 %). Ninguno requirió diálisis. Presentar CR se asoció (p <0,0001) con formas graves de enfermedad. Conclusión. La prevalencia de CR en pacientes pediátricos internados con COVID-19 en 13 centros de nuestro país fue del 10,8 % y predominó en las formas clínicas graves.

Introduction. Renal involvement among pediatric patients with coronavirus disease 2019 (COVID-19) ranges between 1.2% and 44%. Given the limited information available locally, the primary objective of this study was to estimate the prevalence of renal involvement in our setting. Population and methods. Cross-sectional study conducted in 13 Argentine sites between March and December 2020. Patients aged 1 month to 18 years hospitalized due to COVID-19 and with at least one measurement of serum creatinine and/or a urinalysis were included. Those with a known kidney disease were excluded. Renal involvement was defined as the presence of acute kidney injury (AKI), proteinuria, hematuria, leukocyturia and/or arterial hypertension (HTN). Results. Among 528 eligible medical records, 423 patients were included (55.0% were males; median age: 5.3 years). The clinical presentation was asymptomatic in 31%; mild, in 39.7%; moderate, in 23.9%; severe, in 1.2%; critical, in 0.7%; and 3.5% had multisystem inflammatory syndrome in children (MIS-C). Two patients (0.47%) died. The prevalence of renal involvement was 10.8% (95% confidence interval: 8.2­14.2); it was described as leukocyturia (16.9%), proteinuria (16.0%), hematuria (13.2%), HTN (3.7%), and AKI (2.3%). No patient required dialysis. Renal involvement was associated with severe forms of disease (p < 0.0001). Conclusion. The prevalence of renal involvement among pediatric patients hospitalized due to COVID-19 in 13 Argentine sites was 10.8%; severe forms of disease prevailed.

Ocurrence enzootic hematuria in buffaloes in Brazil: epidemiological, clinical, and pathological aspects / Ocorrência de hematúria enzoótica em búfalos no Brasil: aspectos epidemiológicos, clínicos e patológicos

It is reported the occurrence of enzootic hematuria (EH) in buffaloes in Brazil after performing an epidemiological survey and clinicopathological analises. To date, EH caused by ingestion of Pteridium esculentum subsp. arachnoideum, a radiomimetic plant popularly known as "bracken fern", has not been described in this species in Brazil. Bovine EH is responsible for high economic losses in Brazil's Southeast Region not only because of the deaths it causes, but also owing to its negative effect on productivity. In São José do Barreiro County, São Paulo, some farmers in areas with a high incidence of bovine EH have been replacing cattle with buffaloes, based on the premise that the latter would be more resistant to poisoning by ingestion of Pteridium spp. However, even though initial observations indicated that buffaloes are indeed less sensitive than cattle to the toxic principle of Pteridium spp., cases of hematuria in this species have been reported. According to preliminary date, EH only occurs in buffaloes over six years of age. Macroscopic examination revealed a thickened urinary vesicle mucosa, along with multiple foci of ulcerated, exophytic, verrucous, and pedunculated lesions. In one of the buffaloes studied, the bladder wall was ruptured and exhibited marked secondary inflammation. Histologically, neoplastic and non-neoplastic changes similar to those described in cattle poisoned by Pteridium spp. were observed. The neoplasms found included papilloma, carcinoma in situ, urothelial carcinoma (low and high grade), inverted, microcystic, and trabecular variants, urothelial carcinoma with divergent differentiation (squamous and glandular), squamous cell carcinoma, lymphangioma, hemangioma, and hemangiosarcoma. There was also coexistence of epithelial and mesenchymal neoplasms. Bovine papillomavirus particles were not detected by polymerase chain reaction in the bladder samples analyzed.

Descreve-se, através de levantamento epidemiológico e avaliação clínico-patológica, a ocorrência de hematúria enzoótica (HE) em búfalos no Brasil. Essa condição, causada pela ingestão da planta radiomimética Pteridium esculentum subsp. arachnoideum, conhecida popularmente como "samambaia" ou "samambaia do campo", até então não havia sido descrita nessa espécie no Brasil. Na Região Sudeste, a HE bovina é responsável por elevadas perdas econômicas, devidas não apenas aos óbitos, mas também em função da queda de produtividade. No município de São José do Barreiro/SP, alguns produtores de áreas com alta incidência de HE bovina, vêm substituindo os bovinos por búfalos, com base na premissa de que estes seriam mais resistentes à intoxicação. Embora, de acordo com observações iniciais, os búfalos realmente sejam menos sensíveis que os bovinos ao princípio tóxico de Pteridium spp., ainda assim, tem-se verificado a ocorrência de casos de hematúria nessa espécie. De acordo com o levantamento inicial, a HE só ocorre em búfalos com idade a partir de seis anos. Ao exame macroscópico, verificou-se a mucosa da bexiga espessa, com múltiplos focos de lesões ulceradas, exofíticas, papiliformes, verrucosas, pedunculadas. Histologicamente, foram observadas alterações neoplásicas e não neoplásicas semelhantes às descritas nos bovinos com HE. Entre as neoplasias foram encontrados papiloma, carcinoma in situ, carcinoma urotelial (baixo e alto grau), variantes invertida, microcística e trabecular, carcinoma urotelial com diferenciação divergente (escamosa e glandular), carcinoma de células escamosas, linfangioma, hemangioma e hemangiossarcoma. Ocorreu também coexistência entre neoplasias epiteliais e mesenquimais. Não foram detectadas partículas de papilomavírus bovino pelo teste PCR nas amostras de bexiga analisadas.

Reliability and Validity of a Chinese Version of Urinary Tract Infection Symptom Assessment Questionnaire

ABSTRACTObjectives:Our study evaluates the reliability and validity of a Chinese version of the Urinary Tract Infection Symptom Assessment questionnaire (UTISA).Material and Methods:Our study enrolled women who were diagnosed with uncomplicated urinary tract infection (uUTI) at clinics. The Chinese version of UTISA was completed upon first visit to the clinic for uUTI and at 1-week follow-up. We enrolled 124 age-matched women without uUTI from the community as the control group. The UTISA consists of 14 items (seven symptom items and seven related to quality of life), with each item scoring 0 to 3. The internal consistency was assessed with Chronbach's alpha test. Factor analysis was used to classify symptoms into latent factors. The predictive validity was analyzed by using logistic regression and Receiver Operating Characteristic (ROC) curve analysis.Results:Mean total symptom scores of the UTISA in the 169 cases and 124 controls were 8.9±4.6 and 1.4±2.4, respectively (p<0.01). The alpha coefficient was 0.77, showing a homogeneous composition of symptoms. At a cut-off value of greater than 3, the UTISA symptom score had good predictive value for uUTI (sensitivity of 87.0%, and specificity of 93.1%). Factor analysis revealed two latent variables: 1) lower urinary tract symptoms and 2) physical symptoms. Among the seven items, we found that urinary frequency (OR=2.6), dysuria (OR=5.0), sense of incomplete emptying (OR=2.0), and hematuria (OR=7.6) were significant predictors for uUTI.Conclusions:The Chinese version of UTISA is reliable to predict uncomplicated UTI in women with an optimal cut-off point at >3.

Symptomatic complications of ureteric stents

To calculate the frequencies of symptomatic complications of pigtail ureteral stents and to determine the effect of stent duration on symptomatic complications. All s tented adult patients [PTFE Coated Cook_ 6 Fr Double J Stent] presenting at the Institute of Kidney Diseases Hayatabad Peshawar were evaluated by history, examination, urine analysis and cultures, X-ray KUB and ultrasound KUB. SPSS version 11.0 was used for the data entry and analysis. Results are presented in the form of tables. Out of 100 patients, 68% were males and 32% females. Stent indications included stone surgery in 14% of cases, prior to extracorporeal shockwave lithotripsy [ESWL] in 36%, ureteric obstruction in 36%, pyeloplasty in 10%, and anuria in 4% of cases. Complications at 2 and 4 weeks were hematuria in 52% and 40% of cases, flank pain in 48% and 58%, frequency of micturation in 66% and 78%, dysuria in 72% and 80%, urgency in 60% and 72% and suprapubic pain in 42% and 50% of cases respectively. Ureteric s tenting is a life saving procedure but associated with significant morbidity. It's unnecessary and prolonged use should be avoided

Raising awareness of chronic kidney disease in a Brazilian urban population

The incidence and prevalence of chronic kidney disease have been increasing in recent years in developing countries. The aim of this study was to report the results of a general chronic kidney disease awareness program applied to an urban population in a large Brazilian city. From January 2002 to January 2005 a total of 8883 individuals in the city of Curitiba (PR, Brazil) were screened for hypertension, body mass index, hematuria, and proteinuria. A family history and previous medical diagnosis of hypertension and diabetes mellitus (DM) were also recorded. Of the 8883 individuals assessed, 56% were women, subject median age was 47 years (range: 17-93 years) and more than 90% were Caucasian. Thirty percent had signs of hematuria, 6% had proteinuria, and 3% had hematuria and proteinuria. The median of mean arterial pressure values was 93 mmHg (range: 71- 135 mmHg) and 16% of the population screened had a history of hypertension. A significant positive family history of both hypertension or DM was present in 42% (P < 0.0001; chi-square = 83.18) and 7% (P < 0.0001; chi-square = 161.31) of thehypertensive group, respectively. Finally, the prevalence of hypertension and DM was significantly higher in older individuals with proteinuria. In the present study, a higher prevalence of hematuria and proteinuria was found in older individuals with hypertension and diabetes compared to the general population. These data confirm the need for public awareness of renal disease in high-risk individuals.

Comparison of frequency of heamaturia with rapid and slow decompression of urinary bladder in the management of chronic urinary retention

The objective of this study was to compare frequency of haematuria after slow decompression and rapid decompression of urinary bladder in the management of chronic urinary retention. Quasi experimental study. This study was carried out in Combined Military Hospital Quetta from May 2007 to Nov 2007. Sixty patients fulfilling the inclusion criteria were randomly assigned to two equal groups. Group A was subjected to intermittent clamping of Foley catheter and group B was subjected to no clamping of Foley catheter. On insertion of Foley catheter sample of urine was taken in a test tube and saved. A second sample was also taken in another test tube after one hour of complete decompression of either group and compared with original sample for occurrence of haematuria. Frequency of haematuria was calculated after both the procedures and recorded. confounding variables were traumatic catheterization and patients who were taking anticoagulants or having bleeding disorders. These were controlled by including only those cases where catheter was passed atraumatically by registrar surgery. The frequency of haematuria was found to be equal in both groups. Rapid decompression of the urinary bladder in cases of chronic urinary retention is a safe and convenient method of decompressing the urinary bladder in patients of chronic urinary retention, without any increase in frequency of haematuria

workup of microscopic and gross hematuria

Based on the American Urological Association best practice policy statement, the presence of gross hematuria is always an indication for prompt full investigation

Hematuria: estudio desde el punto de vista urológico / Haematuria: study from a urological viewpoint

La hematuria verdadera se caracteriza por la presencia de más de 5 glóbulos rojos por campo microscópico corriente o por más de 3 por campos microscópicos de alto poder. Frente a la sospecha clínica de hematuria, lo primero es descartar la existencia de una pseudo-hematuria (hemoglobinuria, mioglobinuria, así como algunos alimentos y medicamentos). Las hematurias verdaderas se dividen en micro y macroscópicas así como en fisiológicas y patológicas, las que pueden ser continuas o intermitentes. En relación con su origen se reconocen hematurias renales sean glomerulares o post-glomerulares o extrarrenales (existencia o no de proteinuria y de dismorfia). Toda hematuria exige un completo estudio diagnóstico urológico y nefrológico (examen de sedimento urinario, tests de función renal; imágenes pielo, eco y topográficas y exploración endoscópica). Así y todo, no se logra precisar la etiología del 5 a 10 por ciento de las hematurias microscópicas.

Hematuria en niños: análisis de la casuística en un centro de referencia nacional, Valencia, Venezuela / Haematuria in children: analysis of the etiology and characteristics in a national reference center, Valencia, Venezuela

Hematuria es una manifestación frecuentemente encontrada en la práctica clínica pediátrica. El objetivo central del presente trabajo es reportar las características clínico-epidemiológicas de 362 niños con hematuria atendidos durante el periodo junio 1998 a mayo 1999 en nuestra institución; esta cifra correspondió al 1,1 por ciento de todas las consultas y admisiones pediátricas y al 8.4 por ciento de las correspondientes a nefrología pediátrica para el período estudiado. El promedio de edad fue de 7,7 ñ 6,1 años, rango 0-17 años, 56 por ciento varones y 44 por ciento hembras. 62 por ciento presentaba hematuria microscópica y 38 por ciento macro y microscópica. La etiología de la hematuria para el grupo total fue: hipercalciuria idiopática y otras alteraciones metabólicas 23,5 por ciento, nefritis aguda 19,3 por ciento. infección documentada de vía urinarias 19 por ciento, urolitiasis 16 por ciento, malformaciones congénitas del tracto urinario 8,3 por ciento "hematuria primaria" 4,4 por ciento síndrome nefrótico 2,2 por ciento, hipoxia neonatal 1,6 por ciento, traumatismos del tracto urinario 1,4 por ciento, nefropatía por IgA 1,4 por ciento y otras 2,9 por ciento. El grupo etario más afectado fue el de los preescolares (34,3 por ciento), seguido por los escolares (27,3 por ciento), luego lactantes, preadolescentes y adolescentes y recién nacidos. Se especifican las causas de hematuria para cada grupo etario y las probables causas que expliquen la frecuencia de determinadas patologías en nuestra área geográfica. La presente casuística, eminentemente descriptiva, muestra la frecuencia, etiología y otras características de la hematuria en clínica nefrológica pediátrica en un centro de referencia y abre la posibilidad de estudios comparativos

Non-diabetic renal disease in patients with type 2 diabetes mellitus.

OBJECTIVES: A wide spectrum of non-diabetic renal diseases (NDRD) are reported to occur in patients with type 2 diabetes mellitus. However, the prevalence and nature of NDRD in type 2 diabetics is not widely documented in our country. Therefore, the objectives of this study were to analyse prevalence and spectrum of non-diabetic renal disease in type 2 diabetic patients. METHODS: Two hundred sixty type 2 diabetic with clinical renal diseases were screened for evidence of NDRD, between April 1997 to March 1999. Renal disease other than diabetic nephropathy was found in 32 (12.3%) patients. Their (male 23; female 9) age ranged between 35-72 (mean 54.15+/-10.3) years. The duration of diabetes was < 5 years in 14 (43.7%), between 5-9 years in 8 (25%) and > 10 years in 10 (31.2%) patients. RESULTS: The presenting clinical syndromes were : chronic renal failure 15 (47%), acute nephritic syndrome 6 (18.7%), nephrotic syndrome 5 (15.6%), acute renal failure 4 (12.5%) and rapidly progressive glomerulonephritis (RPGN) in 2 (6.2%) cases. Overall, incidence of glomerular (46.8%) and tubulo-interstitial lesions (53.2%) were almost equal in type 2 diabetes patients. The spectrum of non-diabetic renal diseases includes : primary isolated glomerulopathy 12 (37.5%); mesangioproliferative GN superimposed on diabetic glomerulosclerosis (DGS) in 3 (9.3%); acute tubulo-interstitial nephropathy (TIN) 4 (12.5%); chronic TIN 10 (31.25%) and three patients had chronic pyelonephritis. Diabetic retinopathy was absent in 22 (69%) cases where 10 (31%) patients had background diabetic retinopathy. None of the patients with non-diabetic glomerular disease had diabetic retinopathy, except two who had DGS in addition to mesangioproliferative GN on renal biopsy. The background diabetic retinopathy was seen in 47% of patients with TIN without clinical evidence of diabetic nephropathy. The recovery of renal function or clinical improvement was observed in 47% of patients with NDRD with institution of appropriate treatment. CONCLUSION: The prevalence of NDRD was 12.3% in our type 2 diabetic patients. Both non-diabetic glomerulopathy (47%) and tubulo-interstitial nephropathy (53%) can occur with nearly equal frequency in such patients. It is also gratifying to diagnose and treat NDRD in type 2 diabetics in selected cases.

Hematuria / Hematuria

Os autores abordam os aspectos clinicos da hematuria e a contribuiçäo da propedeutica subsidiaria na investigaçäo de sua etiologia, caracterizando a natureza inespecífica deste sinal micro ou macroscopico. Tal análise é fundamental para orientar a instituiçäo do tratamento adequado para as diferentes afecçöes primárias

Prostatectomía laser: un año de seguimiento / Laser prostatectomy: 1 year follow up

Se revisa en forma retrospectiva la experiencia clínica en el tratamiento de la Hiperplasia Benigna de la Próstata con el uso de láser de Nd:YAG y técnica por contacto. Se trataron 59 pacientes durante 14 meses, con un seguimiento del 90 por ciento, que en promedio fue de 13 meses. El cáteter uretral se mantuvo en el postoperatorio por un promedio del 6.4 días. El 18 por ciento de los enfermos necesitó reinserción del catéter uretral. Hubo hematuria significativa intraoperatoria en 8 pacientes, todos con adenoma mayor de 50 grs. Disuria significativa se presentó en 10 pacientes (20.8 por ciento). El score de síntomas (AUA) promedio, se redujo desde 19.8 puntos en el preoperatorio a 2.6 al año de evolución con un 86 por ciento de mejoría. La flujometría se incrementó en un 75.8 por ciento: desde un promedio de 11.6 ml/seg en el preoperatorio a 20.4 ml/seg en el largo plazo. No hubo impotencia en esta serie y la eyaculación se conservó en el 71 por ciento. Cuatro enfermos fueron reoperados por adenoma residual significativo (6.7 por ciento). Se concluye que se trata de una excelente técnica con indicación en adenoma de volumen menor a 35 grs

Screening proteinuria and hematuria in Malaysian children.

Screening for proteinuria and hematuria is important in the prevention of chronic renal disease. In Malaysia to date no such attempt has been made to establish the prevalence of proteinuria and hematuria. A total of 45,149 primary school children from three districts in Kelantan were screened for proteinuria and hematuria. They were 23,289 boys and 21,860 girls. The prevalence of abnormal urinary sediments after third screening was 0.17% ie 0.07% were in boys and 0.10% were in girls. The commonest abnormality was proteinuria (0.12%), followed by hematuria (0.03%) and combination of proteinuria and hematuria (0.02%). Hematuria was more commonly seen in girls compared to boys while proteinuria was seen in almost equal proportion in boys and girls. Despite screening large number of children the prevalence of asymptomatic proteinuria and hematuria was far lower than in an earlier reported study. Furthermore the majority had mild abnormalities.

A histomorphologic and ultrastructural study of the malignant tumours of the renal pelvis.

The study was carried at two different centres. Only 9 cases of primary malignant tumours of the renal pelvis could be collected during the period of 7 years (1984-1990). Renal pelvis malignancies constituted 0.21% of all the malignancies and 12.16% of all the malignant growths of the kidney (9 out of 74 cases). The age of these patients ranged from 24 to 70 years; the mean being 41.7 years. Male/female ratio was 8:1. Common triad of complaints (pain, haematuria and lump) was noticed in 22.2% of patients. Individually they were noticed in 77.8%, 66.7% and 44.4% of patients respectively. Transitional cell carcinoma was the commonest, seen in 7 patients (77.8%) whereas squamous cell carcinoma and adenocarcinoma were noticed in one patient (11.1%) each. Hydronephrosis, chronic pyelonephritis and nephrolithiasis were noticed in 66.7%, 44.4% and 22.2% of patients respectively. Ultrastructural study of urothelial tumours revealed tumour cells in various stages of differentiation with loss of intercellular junctions and dense collection of rough endopasmic reticulum fibrils around the nucleus.

Frequency and glomerular or post-glomerular origin of hematuria in brazilian patients with scickle cell syndromes

A ocorrência de hematuria foi investigada prospectiva e retrospectivamente em uma amostra de 50 pacientes adultos, portadores de anemia falciforme, hemoglobinopatia SC ou S/beta-talassemia. A origem glomerular ou pós-glomerular da hematuria foi determinada pela investigaçäo do dimorfismo eritrocitário. Durante um ano de seguimento, constatou-se a ocorrência de um ou mais episódios de hematuria em 11/50 (22%) dos pacientes, sendo a origem glomerular dessa manifestaçäo reconhecida em 2/10 (20%) dos casos. Os pacientes com lesäo glomerular manifestaram hematuria contínua, enquanto que aqueles com lesäo pós-glomerular manifestaram hematuria episódica. A frequência de hematuria näo diferiu significativamente entre os pacientes SS e SC, nem entre os falcêmicos e os pacientes de uma amostra geral controle do mesmo hospital. Episódios antecedentes de hematuria confirmada laboratorialmente foram vewrificados em 18/50 (36%) dos casos, variando. no entanto, com o tempo de seguimento ambulatorial