[One-year follow-up of radiologic and clinical findings in children with prenatal and neonatal hydronephrosis]

Hydronephrosis is a common problem in prenatal and newborn infants diagnosed by ultrasonography. Bladder to ureter reflux, the upper or lower urinary tract obstruction, and neurogenic bladder are the most common causes of hydronephrosis in newborns and infants. In this study, 100 neonates and infants with hydronephrosis were observed clinically and laboratorically for one year. Patients were allocated to two groups of fetal and newborn infants by the time of detection of hydronephrosis. Classification of the severity of hydronephrosis was based on the anteriorposterior diameter of renal pelvis including: mild hydronephrosis [5-9 mm], moderate [10-15 mm], and severe [more than 15 mm]. Fifty four patients were boy and 46 were girl. Mean age of patients in first visit of fetal and newborn infants hydronephrosis were respectively 2.5 [79% asymptomatic] and 5 month [100% symptomatic]. Causes of fetal hydronephrosis were: bladder to ureter reflux [45%], idiopathic hydronephrosis [41%], ureteropelvic junction obstruction [UPJO] [3.11%], physiological hydronephrosis [7.5%], and posterior urethral valve [8.3%]. Bladder to ureter reflux was the most common cause of hydronephrosis in all of the patients [57%]. The most common causes of mild and severe hydronephrosis were bladder to ureter reflux and ureteropelvic junction obstruction, respectively. In patients with fetal hydronephrosis, 100%, 30% and 6% of cases of severe, moderate, and mild hydronephrosis need surgery, respectively. Using ultrasonography in pregnancy led to the discovery of most asymptomatic fetal hydronephrosis more than infant hydronephrosis

[Clinical presentation of hyperuricosuria in children]

Hyperuricosuria [HU], defined as an increased uric acid excretion, has different symptoms in children and is responsible for the formation of kidney stone. This study was aimed to outline the clinical presentation and natural history of HU in children with hematuria, dysuria, discoloration of urine, and recurrent abdominal / flank pain. In this cross sectional study, from October 2002 to May 2006, 88 children with Hyperuricosuria at Dr Sheikh Hospital, Mashhad were evaluated. Urinalysis, urine culture, 24-hour urine collection for measurement of uric acid, Calcium and Creatinine, serum evaluation for BUN, Creatinine, uric acid, Calcium, Phosphorous and Hco3- and renal ultrasonugeraphy were carried out done for patients. All data were recorded and analyzed with descriptive statistical methods. From 88 evaluated patients, 51% were boys and 48.8% were girls. The mean age of children was 5.3 +/- 1.2 years. The mean Urine Uric Acid was 13.4 mg/kg/24h and mean Urine PH was 5.3. Hematuria was not among the presenting symptoms in 41 patients. Thirty three patients had normal urinalysis at the first examination, 28 of them had microcalculi [< 3 mm in diameter] at renal ultrasonography and 12 had stones [4-13 mm]. Dysuria and abdominal / flank pain were present in 22 and 17 patients, respectively. There was no microscopic hematuria in 24.3% of patients with microcalculi or stone. Family history of urolithiasis was positive in 63 of the children. Hyperuricosuria has to be suspected in children with dysuria, recurrent abdominal / flank pain, discoloration of urine, and familial history of urolithiasis. The lack of hematuria is not predictive of the absence of urolithiasis

Urinary tract infection in infants and children with diarrhoea

To determine when children with acute diarrhoea should be investigated for urinary tract infection [UTI], we studied 120 patients and 120 healthy age- and sex- matched controls aged 4 weeks to 5 years. In those with positive or suspicious urine cultures, bacteriuria or pyuria, urine culture was repeated. We detected UTI in 8 patients [all < 2 years] and 1 boy in the control group. In those with UTI, invasive diarrhoea was observed in 1, fever in 7 and vomiting in 5 patients. In children with acute diarrhoea, investigation for UTI is only recommended for febrile, female infants aged 5- 15 months

[ effect of oral Vitamin E on renal anemia in chronic hemodialysis children]

Renal anemia is one of the most frequently observed complications in patients undergoing chronic hemodialysis [HD]. Reduced red blood cell survival due to oxidative damage is one of causes of anemia in these patients. Vitamin E [alpha - tocopherol] is a natural biological antioxidant, which protects red cells from these effects of reactive oxygen metabolites and could be useful as a collateral therapy for anemia in HD patients. The aim of the present study was to investigate the potential beneficial effect of anti oxidant vitamin E supplementation [oral] on renal anemia and to find out whether this improvement mechanism is attributable to the enhanced hematopoietic function or to prolonged RBC life. This clinical trial study included [8 cases with mean age 14 +/- 2.9 years and 7 controls with mean age 14 +/- 2.7 years] stable children on chronic hemodialysis, at hemodialysis center in Sheikh Children Hospital - Mashhad. At the time of entry, there was no evidence of iron deficiency or history of blood transfusion. All of children [case and control] received subcutaneous erythropoietin [EPO] 120 +/- 80 u/kg/BW/week, Folic acid 1 mg/day and Iron 1-2 mg/kg/day. Oral vitamin E 200 u/day for 3 months was prescribed to cases only. Laboratory parameters determined at the beginning of the study were: Iron, Ferritin, Transferrin, Total Iron binding capacity, Hemoglobin [Hb], Hematocrit, Reticulocyte count and peripheral blood smear. Hb and HCT were checked every month during the study and the results were compared to those obtained earlier. Prescription of oral vitamin E for 3 months resulted in significantly higher levels of Hb and Hct in cases compared to those in controls [11.4 +/- 1.7 vs. 10.1 +/- 1.9 Hb and 35.3 +/- 5 vs. 31.3 +/- 6 Htc, P< 0.05]. Antioxidant vitamin E supplementation improves renal anemia by decrease of oxidative stress and RBC life span in hemodialysis patients

[Labial fusion and urinary tract symptoms]

Labial fusion is a common benign prepubertal gynecologic condition that is defined as partial or complete adherence of the labia minora. Most cases are mild and/or asymptomatic, but in some cases may be presented with urinary symptoms. Clinical course and management of 87 cases with labial fusion and urinary tract symptoms, presented between 1372 and 1382, was reviewed retrospectively. Patients age was between 8 months to 6 years [mean= 2y and 8 mo]. 56 cases had been visited by physicians but without genital examination. None of mothers were informed of normal genital condition. 36 cases [41%] had UTI without urologic abnormalities. Topical conjugated estrogen was effective in all patients with minor side effects. Recurrence was noted in 23 cases [26%] which responded to estrogen re-treatment. All of girls with any complaints especially urinary symptoms and UTI must be examined with high index of suspicion for labial fusion

Nephrotic syndrome in a girl with vesicoureteral reflux and situs inversus

In this case report a five year old girl is presented with steroid-responsive nephritic syndrome who had bilateral Vesicoureteral Reflux [VUR] and situs inversus. A combination of situs inversus, nephritic syndrome and VUR has been reported previously

Primary vesicoureteral reflux in children in southern Iran

Experience with vesicoureteral reflux [VUR] differs in different centers and there is plenty of controversies. To evaluate the outcome of primary VUR complications and the rate of recurrence of UTI. In a retrospective study, the medical charts of all infants and children with primary VUR who were followed up by one nephrologist were reviewed. During 16 years, 271 patients [226 females, 45 males] with 401 refluxing ureters were followed up as primary VUR. The patients' age at diagnosis was 4 days to 16 years [Mean: 4.4 years] and the mean duration of follow-up was 4.2 years. Urinary tract infection [UTI] was the presenting symptom in 97% and fever was recorded in 30% of cases. Frequencies of different grades of VUR at initial investigation were 6.5%, 52%, 23.4% and 18.1% for grades I to IV, respectively. The responsible microorganism in 90% of the first episodes of UTI was E. coli. Scarring or small size kidney was present in 63 patients. Recurrence of UTI in VUR of grades I to IV, were 68.7%, 51%, 60.1% and 46.8%, respectively. Follow-up voiding cystourethrogram revealed resolution of VUR in 52%, improvement in 31%, no change in 11%, and deterioration in 6%. Complications such as chronic renal failure, hypertension and renal tubular acidosis were observed in 11, 10 and 9 patients, respectively. Symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not related to the grade of VUR