Acute kidney injury in a critically ill influenza: a H1N1 infected child

Influenza H1N1 infection is a globally recognized epidemic and is known for several extra-pulmonary complications. Here, for the first time we report a case of a six-year old male child with severe H1N1 infection with acute kidney injury. The child was referred to our center with fever, chills, cough and cold for 2 days. Investigations revealed H1N1 infection with deranged LFT and RFT with anuria. Child was subjected to mechanical ventilation and received higher antibiotics in addition to oseltamivir. The child underwent 13 cycles of hemodialysis and renal profile normalized after a period of 35 days. Our case highlights the importance of recognizing extra-pulmonary complications of H1N1 infection in the pediatric population and the preparation required by healthcare practitioners to reduce the associated mortality.

Efficacy of Levamisole in Children with Frequently Relapsing and Steroid-dependent Nephrotic Syndrome.

Objectives: To assess the efficacy of levamisole in frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome. Study Design: Retrospective analysis of hospital case records. Setting: Pediatric nephrology department of a tertiary referral pediatric hospital. Participants: 62 children with frequently relapsing nephrotic syndrome and 35 children with steroid-dependent nephrotic syndrome. Methods: Case records of children who were diagnosed as steroid-dependant or frequently-relapsing nephrotic syndrome from June 2004 to June 2011, were reviewed. Levamisole was given daily (2 mg/kg/d) along with tapering doses of alternate day steroids after remission on daily steroids. Results: Levamisole was effective in 77.3% children with a better (80.6%) efficacy in frequently relapsing nephrotic syndrome. A total of 34 children completed 1 year follow-up post levamisole therapy. The cumulative mean (SD) steroid dose 1-year before therapy was 4109(1154) mg/m2 and 1-year post therapy was 661 (11) mg/m2 (P<0.001). The relapses were also less during the period of post-levamisole therapy. Conclusion: Levamisole is an effective alternative therapy in frequently relapsing and steroid-dependent nephrotic syndrome.