[Evaluation of response to treatment with polycitra-K in urolithiasis of children]

Development of stone depends on certain physicochemical factors. Several treatment methods including increased fluid intake and dietary modification, medical therapies such as potassium citrate and use of extracorporeal shock wave lithotripsy [ESWL] and finally surgery methods are used for treatment of urolithiasis. The aim of this study was to evaluate the level of response to medical therapy with polycitra-K in children with urolithiasis. The study population comprised all patients less than 14 years old with urolithiasis visited at Mofid and Labafi Nejad hospitals within the last five years. All patients with an initial ultrasonography showing stone in urinary tract. At the end of study, the complete resolution or passage or a decrease in the size of stone in later sonography was defined as response to treatment. From 109 patients, 91 cases continued medical therapy with polycitra-k and 51 patients [56%] responded to treatment. Hypercalciuria and hyperuricosuria were found to be the etiological factors in 25% and 19% of patients, respectively. The stone analysis revealed that 50% were composed of ca-oxalate. Stone disease was more common between the ages 1-3 years and the most common complaint was hematuria [20%]. Calcium Oxalate stones were the most frequent stones which responded to polycitra. The response rate in girls and boys was similar and in different age groups it was almost equal. Based on the response rate of medical therapy with polycitra-k is recommended for treatment of urolithiasis in children

[Hypercalciuria in urinary tract infection of children in Qods teaching hospital of Qazvin]

There are many underlying factors that increase the chance for occurrence of UTI and some reports indicate a role for hypercalciuria in UTI. The objective of this study was to assess the Ca/Cr status in urinary tract infection of children. This was a cross-sectional antegrade study conducted in Qods teaching hospital of Qazvin from 2006-2007, in which 50 children with urinary tract infection were studied for hypercalciuria. To determine hypercalciuria, the Ca/Cr ratio of a random urine sample was measured. Different variables such as age, gender, history of UTI and etc, were compared between hypercalciuric and normocalciuric groups. Results were analyzed with SPSS using t-test and chi square test. Of 50 patients, 27 cases [54%] were found to have hypercalciuria. There was a significant difference between hypercalciuric and normocalciuric groups regarding the abnormal sonographic findings [p<0.05]. Based on results of this study evaluation of hypercalciuria in UTI is recommended

Coexistence of vesicoureteral reflux and gasteroesophageal reflux in infants with urinary tract infection

vesicoureteral reflux [VUR] is a fairly common disorder in infants. Children with VUR frequently demonstrate various gastrointestinal symptoms such as nausea, vomiting, loss of appetite and weight loss. These symptoms similarly may present in gastrointestinal diseases like gastroesophageal reflux [GER]. It is thought that some children are prone to have both conditions. This study was done to investigate the coexistence of VUR and GER in infants with urinary tract infection. This cross sectional study was performed on all infants under 12 months old with urinary tract infection who were admitted to Tehran Mofid hospital during one year [Nov 2007-Nov 2008]. In all of these infants, we performed voiding cystoureterography [VCUG] to investigate VUR and gastric sonography to assess GER. We used questionnaires to assess our variables. Collected data were analized by SPSS ver 13 software and frequency tables and independent T test and Chi-square. Among 43 infants with urinary tract infection who performed VCUG and gastric sonography, the prevalence of VUR was 55.8% and the prevalence of GER was 48.8%. The coexistence of both conditions was found in 39.5%. No significant difference was found between coexistence of these disorders with presenting symptoms, sex, weight, type of microorganisms, type of feeding and grade of reflux. The coexistence of VUR and GER is common. Therefore in an infant with VUR who remains symptomatic in spite of treatment, the possibility of GER should be considered and evaluation for diagnosis and treatment of GER might be done

Urinary interleukin 6 and 8 concentrations in children with acute pyelonephritis, before and after treatment

Urinary tract infections [UTI] are common cause of morbidity and mortality especially in young children around the world. Pyelonephritis can lead to scar formation, and subsequent hypertension and renal failure. Interleukins play a major role in renal scar formation following febrile pyelonephritis. The aim of this study was to investigate the level of urinary interleukin-6 [UIL-6] and UIL-8 concentrations during the acute phase of pyelonephritis and after two kinds of treatment. UIL-6 and UIL-8 concentrations were determined by enzyme immunoassay in 34 children with acute pyelonephritis who were treated with Ceftriaxone plus steroids [case group] and in 20 patients treated with antibiotic alone [control group]. Cases and controls were age and sex matched. Urine samples were obtained at the time of presentation prior to drug administration and at follow-up 72 hours after initiation of medication. Creatinine concentrations were also determined, and cytokine/creatinine ratios were calculated. The differences between the cytokine/creatinine ratios in the initial urine samples and the follow-up samples were significant in the case group [p < 0.001], but not for the controls. In addition, combined antibiotic and steroids significantly decreased UIL-6 and UIL-8 concentrations compared with antibiotic alone [p < 0.05]. We conclude that steroids combined with antibiothics significantly decrease UIL-6 and UIL-8 levels in patients with acute pyelonephritis. This result can suggest that the clinical use of corticosteroids may prevent scar formation following pyelonephritis

[Renal transplantation in children with cystinosis]

Cystinosis is an inherited metabolic disease in which transfer of cystine out of lysosome is impaired. This phenomenon leads to accumulation of cystine in different organs and causes organ dysfunction. Growth retardation is seen in these patients and later they go on to develop renal failure needing dialysis or renal transplantation. The aim of this study was to evaluate the outcome and complications of renal transplantation in patients with cystinosis. In this case series study in years 1996-2006 all patients with renal failure due to cystinosis who received renal transplantation, were followed for 43 +/- 1/1 months, Before operation, all patients were examined to determine if they are appropriate candidate for renal transplantation and after operation DPTA scan was performed to evaluate graft function and in later follow up necessary lab tests were done. All patients received triple immunosuppressive therapy including cyclosporine, prednisolone and Mycophenolate Mofetil. In the presence of rejection symptoms such as fever and a rise in creatinine, graft rejection was confirmed by DPTA scan and sonography of transplanted kidney. Patient survival was 100% and 4 years graft survival was 86.7%. Mean creatinine level before operation was 5.44 +/- 2.58 and post operation was 0.86 +/- 1.03 and at the last follow-up was 1.51 +/- 1.45 mg/dl, mean GFR at the last follow-up was 54.1 +/- 31.2 ml/min/1.73m2. Six [40%] patients were on dialysis before operation, 5 [33%] had acute rejection and 5 [33%] suffered from UTI after the operation. Growth retardation was seen in all of patients. Thirteen patients [86%] were affected by CMV infection and 6 [40%] by CMV disease; that were treated successfully by Ganciclovir for 2 weeks. One patient was affected by vessel thrombosis in post operation period and one patient had graft loss due to kink of vessel after operation. Renal transplantation in patients with cystinosis has favorable outcome. It is the treatment of choice for patients with cystinosis and End Stage Renal Failure [ESRF]

[Prevalence of proteinuria among school children of Qazvin [2002]]

A total number of 659 school children [6-12 years-old] selected primarily in cluster and later by stratified random samplings were studied for proteinuria in Qazvin during 2002. Initially, the morning urine samples were qualitatively analyzed using dipstick test followed by sulfosalicylic acid method, quantitatively. After 6 months, the positive cases were followed up for urine proteine/creatinine ratio. The prevalence of proteinuria was found to be 1.8% among the population study with boys twice as common as in females. Symptomatic renal disease was shown to have a prevalence of 1.5 per 1000 children

[Diagnostic value of urinary N-Acetyl Glucose Aminidase in pyelonephritic patients]

Urinary tract infection [UTI] is one of the most common bacterial infections among children and its prevalence is between 5-7% in females and 1-1.6% in males.Urosepsis, febrile seizure, renal insufficiency and hypertension are common complications of acute pyelonephritis in children. The aim of this study was to evaluate the diagnostic value of urinary NAG in pyelonephritic patients. This is a Quasi Experimental study conducted between April 2005 and May 2006 on 72 children admitted in Mofid Hospital due to pyelonephritis. The first sample [fresh random urine] was obtained and its levels NAG and Creatinin were measured. The second one was obtained on 48th hour of after-treatment period. We examined pyelonephritic children [75% female] with mean age of 43 +/- 39 months. Post-treatment urinary NAG lavel was significantly higher than pre-treatment. Urinary NAG revealed to have a sensitivity of 78% and specificity of 72% in diagnosis of pyelonephritis. There was no significant correlation between urinary NAG level and CBC, ESR, CRP, Urinary WBC, Ultrasonography, DMSA scan and VCUG. We concluded that Urinary NAG is a sensitive and specific test in diagnosis of pyelonephritis