Zinc supplement in reduction of relapses in children with steroid sensitive nephrotic syndrome

To determine whether Zinc supplementation could reduce relapse rate in children with nephrotic syndrome. Randomized-controlled trial. National Institute of Child-Health and The Kidney Centre, Karachi, from January 2008 to June 2009. Sixty nephrotic children aged 2 - 15 years were selected. Baseline data including age, number of infections and relapses during pre and post study one year were recorded. Randomization was done to divide into Zinc group [Zg] to receive Zinc versus placebo [Pg] for 6 months. Relapses and infections were treated with standard therapy. T-test and chi-square tests were used to compare the mean values and proportions respectively with significance at p < 0.05. Among 60 children, 54 completed trial [Zg = 25, Pg = 29]. Forty [74%] were males and 14 [26%] females. Mean age, pre study relapses and Zinc level in the two groups were similar. Overall, infections and relapses were observed in 43 [79.62%] and 17 cases [31.48%] respectively. There was no significant difference in frequency of infections and mean infection rate in Zg [20, 80% and 1.92 +/- 1.47] compared to Pg [23, 79.3% and 2 +/- 1.53, p = 0.950]. Relapses occurred in 7 [28%] in Zg compared to 10 [34%] in Pg which was not significant [p = 0.609]. Mean infection and relapse rate per patient per year [PPPY] in Zg was 1.92 +/- 1.47and 1.14 +/- 0.37 compared to 2 +/- 1.53 and1.3 +/- 0.48 in Pg respectively [p=0.846, 0.464]. Pre study relapses in two groups were similar [Zg vs. Pg = 96 vs. 96.6%] whereas post study relapses in Zg were lower [7, 28%] compared to Pg [10, 34.5%]. Post study mean relapse rate in Zg was 1.14 +/- 0.37 PPPY compared to 2.71 +/- 1.11 in pre study [p = 0.005]. In Pg, post study mean relapse rate PPPY was 1.30 +/- 0.48 compared to 1.70 +/- 0.48 in pre study period [p = 0.037]. Relapse rate reduction was 43% after Zinc supplementation compared to 27% reduction in placebo. Metallic taste was observed in 10% of cases. Zinc supplementation was helpful in reducing relapses in nephrotic syndrome

Outcome of pediatric renal biopsy with monopty gun technique

To determine the outcome of percutaneous renal biopsy [PRB] using Monopty-gun technique [MGT] and to compare the results of sedation with general anesthesia [GA] used for the procedure. Descriptive Study. Department of Pediatrics at National Institute of Child Health [NICH] and the Kidney Center Postgraduate Training Institute [KPTI], Karachi from June 2005 to February 2010. Renal biopsies were performed either under sedation /GA at NICH and KPTI respectively using MGT under ultrasound guidance [USG] after routine tests. A resident/ nurse monitored the procedure. Data including age, sex, indication, vitals monitored, number of attempts per patient, glomeruli per biopsy and complications were recorded. Using statistical-Package-Scientific-Software [SPSS] version- 15, descriptive statistics were applied. Paired test was used to compare pre-and- post procedure vitals. P<0.0 was considered significant. A total of 147 biopsies in 145 children were performed. Boys were 79 [54.58%] and girls 66 [45.51%]. Mean age was 7.31 +/- 4.23 years. Most of the procedures were performed under sedation [n 105, 71.42%]. Indication were nephritic syndrome [NS] in 96[65.3%], secondary glomerulonephritis [SGN] in 17 [11.6%], nephritic-nephrotic syndrome [NNS] in 16 [10.9%], congenital nephritic syndrome [NS] in 15[10.2%] and others 3[2.06%]. The success and adequacy rate was 95.91% and 95.23% respectively. Failure occurred in 5[3.4%] cases. Overall, 26[17.68%] complications were observed in 21[14.28%] patients with 6[4%] being major. Technique related complications [20, 76.92%] were more than sedation/GA related [SGRC-n 6.23%]. The complications were more in sedation but the outcome was better in GA. MGT is a safe for PRB in children. The success, adequacy and complication rates in our study are in uniformity with the current standards