RESUMO
Malnutrition is closely linked to chronic kidney disease [CKD] in adult patients with poor outcome. But data on pediatric patients is inadequate. The aim of this study was to describe the prevalence of growth failure and malnutrition in pediatric CKD patients and explore the relationship of these parameters to each other and to other clinical parameters. This study included 42 patients and 29 healthy children matched for age and gender. Patients were classified firstly in age group and secondly in therapy modalities. Nutritional evaluations were performed according to the Kidney Disease Outcomes Quality Initiative guidelines, and we performed adjustments using values from children with the same chronological age as reference. In pubertal group, the mean height SDS was lower than in pre-pubertal period while it was higher than in early childhood [P=0.4 and P=0.03 respectively]. In all groups, 45% of patients had malnutrition: 20 patients on predialysis, 22 patients with end stage renal disease [14 on hemodialysis, and 8 on peritoneal dialysis]. The mean weight SDS was lower in end stage renal disease groups [P<0.001]. The height SDS was lower in end stage renal disease groups [P<0.001]. Growth failure and malnutrition remain a significant clinical problem as age and therapy modalities are dependent in children with CKD
RESUMO
To evaluate the frequency of urinary tract infections [UTIs] and degree of renal parenchymal damage as well as the parameters of growth, development and nutritional status in antenatal hydronephrosis cases with vesicoureteral reflux [VUR]. Infants, whose antenatal ultrasonography [US] showed a fetal renal pelvic parameter of 5mm or greater were investigated. Of the 277 infants with antenatal HN, 36 [56 renal units [RUs]] were diagnosed with VUR. All cases with VUR were evaluated in terms of the frequency of UTIs, scars appearing on [99m] Technetium-dimercaptosuccinic acid scan [DMSA], growth and development [height and weight standard deviation scores [HSDS and WSDS]], and nutritional status [relative weight [RW]]. Statistical evaluation was performed using the Chi-squared test. Of these 36 patients with VUR, 25 [69.4%] were males and 11 [30.6%] females. Of the 56 RUs, 48 [85.7%] had severe VUR [>/= Grade III]. The mean duration of postnatal follow-up was 38.8 +/- 24.50 months. The annual UTI frequency was found to be 1.25 +/- 0.83 episodes/year. Of these 36 infants, 32 [88.8%] recovered from VUR following either medical [17 patients, 47.2%] or surgical [15 patients, 41.6%] treatment. The initial DMSA showed parenchymal defects in 16 [44.4%] RUs, and 4 RUs showed revcovery in the final DMSA. Although statistically insignificant [P>0.05], initial growth and development [HSDS: -0.17 +/- 0.86; WSDS: 0.00 +/- 0.14] and nutritional status [RW: 98.19 +/- 8.81] values gradually improved [0.05 +/- 1.06, 0.06 +/- 1.071 and 101.97 +/- 14.85, respectively]. Postnatal early diagnosis and appropriate management of VUR in infants with antenatal hydronephrosis can prevent the occurrence of frequent UTIs, renal scarring and malnutrition, enabling normal growth and development