The occurrence of primary nocturnal enuresis and associated factors in 5-year-old outpatients in Slovenia.

AIM: To determine the occurrence of primary nocturnal enuresis in 5-year-old outpatients in Slovenia and the possible correlations with different factors. METHODS: The epidemiological study was conducted in Slovenia between 2005 and 2007. A special questionnaire was distributed randomly among the parents of 1846 5-year olds in children's outpatient clinics in all regions of Slovenia. RESULTS: The response rate was on average 71.0%, which means that 7% of all Slovenian 5-year olds were included in the study. The occurrence of primary nocturnal enuresis was 8.7% and was higher in families with many siblings (chi(2) test, p < 0.01). The boy:girl ratio was 1.4 (Student t-test, p = 0.024). Parents were found to be more disturbed by the problem than their children (chi(2) test, p < 0.01). The maternal and paternal education levels of children with primary nocturnal enuresis did not differ from the Slovenian adult population (chi(2) test, p > 0,05). CONCLUSION: The occurrence of primary nocturnal enuresis in 5-year-old outpatients in Slovenia is comparable with data from other countries. Primary nocturnal enuresis is more frequent in boys than in girls, with higher occurrence in families with more siblings, and parents are more disturbed by the problem than their children.

Cyclic voiding urosonography for detecting vesicoureteric reflux in renal transplant recipients.

BACKGROUND: The clinical significance of vesicoureteric reflux (VUR) in renal transplant recipients remains controversial. Voiding urosonography (VUS), a new modality for detecting VUR, can be used in these patients. The sensitivity of X-ray and radionuclide cystography for detecting VUR may be improved with cyclic procedures. The aim of our study was to evaluate whether cyclic VUS is superior to the single-cycle procedure. METHODS: Cyclic VUS was performed in 27 renal transplant recipients. Eight were children or adolescents and the remaining 19 recipients were adults. VUS was performed according to accepted guidelines. After the first micturition, the catheter was left in place and the entire procedure was repeated under the same conditions. RESULTS: Both initial cycle and cyclic VUS detected 17 out of 27 (63%) VURs in the same patients. The sensitivity was not improved by cyclic VUS. However, there were differences between the initial cycle and cyclic VUS (P=0.028) when comparing the number of negative results and the grades of VURs detected. This difference was even more pronounced when analysing only positive results. In the initial cycle, five out of 17 (29%) VURs were grade III, compared with 10 out of 17 (59%) grade III VURs in the same patients using the cyclic procedure (P=0.008). CONCLUSIONS: Cyclic VUS did not improve the detection sensitivity for VUR in our study. However, given that VUR grade may be important for the management of renal transplant recipients, the use of cyclic VUS may provide a useful diagnostic tool for these patients.

Real-time ultrasound-guided renal biopsy with a biopsy gun in children: safety and efficacy.

UNLABELLED: Real-time ultrasound-guided renal biopsy (RB) with a biopsy gun has become a standard procedure in the treatment of children. The purpose of the study was to establish the complication rate after real-time ultrasound-guided RB with a biopsy gun, the adequacy of renal tissue samples for pathohistological tests, the rate of concurrence between clinical and pathohistological diagnoses, and the benefits of the procedure. From January 1994 to October 1999, 88 renal biopsies were performed on 82 children, 81 of whom (35M, 46F, aged 3-20 y) were included in this retrospective study. The nephrotic syndrome (in infants, older children, those with evidence of nephritis or failing corticosteroid therapy) was the most frequent indication of RB. Other indications were non-nephrotic proteinuria, nephritic syndrome, glomerular haematuria, renal allograft dysfunction, unexplained acute or chronic renal failure, and kidney disease progression monitoring. No serious complications were noted. The adequacy rate of renal tissue samples ranged from 93.1 to 96.6%, depending on which definition of the adequacy of renal tissue samples was used. Clinical and pathohistological diagnoses matched in 81.4% of the cases. Data obtained by RB were very beneficial to patients in terms of establishing, confirming or altering the diagnosis and, consequently, the treatment. CONCLUSION: The results confirm that real-time ultrasound-guided RB with a biopsy gun is a safe procedure and provides information that is very beneficial to patients.

Low-flux versus high-flux synthetic dialysis membrane in acute renal failure: prospective randomized study.

The influence of dialyzer membrane on the morbidity and mortality of patients with acute renal failure remains a matter of debate. The aim of the prospective randomized clinical study was to assess the influence of the flux of a synthetic dialyzer membrane on patients' survival rate, restitution of renal function, and duration of hemodialysis treatment of patients with acute renal failure as a part of multiorgan failure. Seventy-two patients treated in intensive care units of the University Medical Center Ljubljana were randomized according to the dialyzer used throughout the duration of hemodialysis treatment. There were 38 patients in the low-flux group (dialyzer F6, low-flux polysuphone, Fresenius, Bad Homburg, Germany) and 34 patients in the high-flux group (dialyzer Filtral 12, sulphonated high-flux polyacrylonitrile, Hospal, Industrie Meyzieu, France). Both groups were balanced in terms of sex, age, APACHE II score, oliguria before dialysis, cause of acute renal failure, inotropic support, mechanical ventilation, and the number of failing organs. The patients' survival rate was 18.7% in the low-flux group and 20.6% in the high-flux group. Ten patients (26.3%) recovered their renal function in the low-flux group and 8 (23.5%) in the high-flux group. Hemodialysis treatment lasted 11.2 days in the low-flux and 10.7 days in the high-flux group. An analysis of subgroups with a lower mortality rate (subgroup of patients without oliguria and subgroup of patients with less than 4 failed organ systems) did not show significant differences between the low-flux and high-flux groups in terms of survival rate, recovery of renal function, and duration of hemodialysis treatment. In conclusion, no significant differences were found in the results of low-flux versus high-flux synthetic membrane dialyzer treatment in patients with acute renal failure as a part of multiorgan failure in terms of survival rate, recovery of renal function, incidence of oliguria during hemodialysis, and duration of hemodialysis treatment. The number of failing organs seems to be the most important single factor determining the survival of patients with acute renal failure as a part of multiorgan failure.

Echo-enhanced ultrasound voiding cystography in children: a new approach.

The development of echo-enhancing agents has significantly improved the detection of the movement of fluid within the urinary tract by ultrasonography (US). The purpose of our study was to compare ultrasound voiding cystography (USVC) for the detection of vesicoureteric reflux (VUR) in children with direct radionuclide voiding cystography (DRVC). Ninety-nine children, aged 1.1-12.3 years, with 198 potentially refluxing units, were investigated simultaneously by DRVC and USVC. The indications for cystography were urinary tract infection, follow-up of a previously detected VUR, and screening of siblings of children with VUR. During the investigation an echo-enhancing agent (Levovist) was administered intravesically through a catheter already in place for the DRVC. The movement of both agents, radiotracer and Levovist, was registered simultaneously by a computerized gamma camera and US, respectively. The results were analyzed with DRVC representing the reference diagnostic test. The overall sensitivity and specificity of USVC for the detection of VUR were 79% and 92%, respectively. USVC may represent a reliable diagnostic tool for the detection and follow-up of VUR in children.

Unfavorable course of minimal change nephrotic syndrome in children with intrauterine growth retardation.

BACKGROUND: Intrauterine growth retardation (IUGR) is associated with higher morbidity and mortality not only in perinatal life but also in later life. The purpose of our study was to determine whether IUGR has any effect on the course of minimal change nephrotic syndrome (MCNS) in children. METHODS: Forty children who were between 1 and 16 years old at the onset of MCNS, who have been followed for at least three years and for whom we were able to obtain birth weights and gestational ages, were included. The diagnosis of MCNS was predicted on the basis of clinical and laboratory features, and in 11 children (27.5%) the diagnosis was confirmed by renal biopsy. IUGR was defined as birth weight below the tenth percentile for gestational age. RESULTS: Five children (12.5%) had signs of IUGR at birth. In children with IUGR, we observed a higher mean number of relapses (10.4 vs. 3.3, P < 0.001) and a higher incidence of steroid dependency (80% vs. 21%, P < 0.02) than in children without IUGR. Other differences between children with and those without IUGR included more frequent treatment with cytotoxic agents and cyclosporine, and a higher incidence of renal biopsy in children with IUGR. CONCLUSION: Our study demonstrated an unfavorable course of MCNS in children with IUGR. IUGR could therefore enable early identification of those children who are at risk of becoming frequent relapsers and of developing steroid dependency. This, however, should be confirmed in a larger number of patients.

Effect of intrauterine growth retardation on the clinical course and prognosis of IgA glomerulonephritis in children.

Intrauterine growth retardation (IUGR) resulting in a reduced number of nephrons is one of the nonimmune mechanisms that have been recently proposed as contributing to the progression of renal diseases. The purpose of our study was to determine whether IUGR has any effect on the clinical course and prognosis of IgA glomerulonephritis (IgA GN) in children. Fifty children with biopsy-proven IgA GN, who were followed for at least 3 years, were included. Six of the 50 children (12%) had signs of IUGR at birth, defined as birth weight below the 10th percentile for gestational age. There were no significant differences in initial clinical presentation between children with IUGR and those without IUGR. However, in kidney biopsy specimens, we found a significantly higher mean percentage of sclerotic glomeruli in children with IUGR than in those without IUGR (33 vs. 13%, p < 0.015). At the end of the follow-up period, we observed a significantly higher incidence of arterial hypertension in children with IUGR than in those without IUGR (50 vs. 11 %, p < 0.05). Other differences between the two groups of children were not statistically significant. In conclusion, our study demonstrated an increased risk of the development of arterial hypertension and glomerulosclerosis in children with IgA GN who had suffered from IUGR with a birth weight below the 10th percentile for gestational age. IUGR may therefore help to identify early in the course of IgA GN those children who are at higher risk of an unfavorable course.

A follow-up study of vesico-ureteric reflux and renal scars in asymptomatic siblings of children with reflux.

The objectives of this study were to follow up children with vesico-ureteric reflux (VUR) and renal scars, to evaluate kidney growth and to determine the incidence of urinary tract infection (UTI) and elevated blood pressure in 40 asymptomatic siblings of children with VUR, in whom VUR had been detected at an early age, and to gather additional data which could help to evaluate the need for screening for VUR in asymptomatic siblings. During the follow-up period of 3-7 years, two children (5%) had UTI; 66% of VUR grade 1 and 2 disappeared. The progression of scars was only detected in two of nine children with renal scars on the initial study, both of whom had high-grade VUR. Renal ultrasound was normal in all siblings and none developed hypertension. The results indicate that low-grade sterile VUR may not play a major role in renal scarring, but this may not be the case with high-grade sterile VUR. Considering the correlations among VUR, UTI and reflux nephropathy, routine screening for VUR at an early age in asymptomatic siblings of children with VUR seems to be justified to identify those at the greatest risk of subsequent renal damage.

Chronic single needle predilutional haemofiltration in a pre-school child.

Peritoneal dialysis is the preferred dialysis mode for children with end stage renal disease (1). It avoids problems with vascular access and enables near normal life style. Haemodialysis is the only mode of treatment for a child waiting for renal transplantation when peritoneal dialysis is not possible. Haemofiltration, as a mode of renal replacement therapy, was introduced in 1967 by Lee Henderson (2).

Ultrasound screening of older asymptomatic siblings of children with vesicoureteral reflux: is it beneficial?

The purpose of this prospective study was to determine the prevalence of renal abnormalities in 88 older asymptomatic siblings of the children with vesicoureteral reflux (VUR), using ultrasound (US) as a diagnostic method. The age of the siblings ranged from 5 to 15 years, the median age being 8.33 years. A midstream urine sample was taken for standard urinalysis and urine culture, and blood pressure was measured in all children. US examination did not reveal chronic inflammatory changes of the kidneys such as a small shrunken kidney, noticeable parenchymal thinning or parenchymal echogenicity changes; nor did it reveal a small kidney due to growth retardation or any dilatation of the renal tract to indicate reflux. No hypertension was found. The study failed to prove the benefit of US screening of older asymptomatic siblings. The results of the present study are discussed in relation to other techniques and investigations/screening for VUR.

Vesicoureteric reflux and renal scars in asymptomatic siblings of children with reflux.

The purpose of the study was to determine the incidence of vesicoureteric reflux (VUR), renal scars and hypertension in asymptomatic siblings of children with VUR. The study comprised 105 siblings of patients with VUR. Their age ranged from 4 months to 6.3 years. All had a direct radionuclide voiding cystography (DRVC) performed, and VUR was detected in 47 of 105 (45%). High grade VUR in the first year of life had an incidence of 50% compared with a 9% incidence in siblings older than 2 years, while only one of the 27 siblings with a low VUR grade was younger than 1 year. In 43 of 47 siblings with VUR, a technetium-99m dimercaptosuccinic acid (99mTc-DMSA) scan was performed and renal scars were found in 10, which presents 23% of siblings with VUR who were scanned and 10% of all siblings studied. One child had hypertension. Identifying VUR among asymptomatic siblings could possibly prevent renal damage and its consequences. Thus, the predictive value of positive family history alone in identifying VUR was 45% while 23% of siblings had renal scars. This incidence justifies the routine investigation of asymptomatic siblings, by using DRVC at an early stage.

Cyclic direct radionuclide voiding cystography: increasing reliability in detecting vesicoureteral reflux in children.

The purpose of this study was to establish the sensitivity of cyclic direct radionuclide cystography (RVC) in detecting vesicoureteral reflux (VUR) in infants and small children, and to compare it to the conventional (one cycle only) RVC. 428 patients (856 renal units) were admitted to the study from January 1991 through March 1992 and all had a cyclic RVC. The age of the patients ranged from 4 months to 7 years. The overall agreement of both cycles in detecting VUR in this study was 45%, the lowest being in detecting VUR I (36%), and the highest in detecting VUR III (86%). If we had used a conventional RVC (the first cycle only), 17 (29%) VUR I, 50 (36%) VUR II and 3 (9%) VUR III, which were detected in the second cycle only, would have been missed. We conclude that cyclic RVC detected 43% more VURs than the conventional (first cycle only) RVC, and would therefore recommend its use as a standard procedure instead of the conventional RVC.

Detecting vesico-ureteral reflux in asymptomatic siblings of children with reflux by direct radionuclide cystography.

The incidence of vesicoureteral reflux (VUR) among asymptomatic siblings of children with VUR is much higher than the estimated incidence in the general population. It might be expected that identifying them and keeping them under close observation and/or either surgical or conservative treatment, might reduce the risk of renal scarring. Fifty-three asymptomatic children, all under 6 years of age and all siblings of children with proven VUR, were studied and direct radionuclide voiding cystography (DRVC). There were 31 (58%) boys, and 22 (42%) girls. Nine children (17%) were younger than 1 year, 13 (25%) were between 1 and 2 years of age, while 31 (58%) were older than 2 years. VUR was detected in 22 (42%) of the 53 siblings. The incidence of VUR varied considerably according to the age, and sex of the child, the highest being in boys younger than 1 year. Most of the severe reflux was seen in children under 2 years of age. Out of 11 patients with VUR, grade 2 and 3, there were 10 younger than 2 years, whereas, only 2 of the 11 siblings with VUR, grade 1 were younger than 2 years of age. The mean age of children with VUR grades 2 and 3 was 19 months, compared to the mean age of 50 months for those with VUR grade 1. DRVC, a highly sensitive method, exposes the patient to much less radiation than X-ray voiding cystography. We believe that the benefit of detecting VUR in asymptomatic siblings with DRVC outweights the invasiveness of the procedure. The predictive value of positive family history alone in identifying VUR in our study was 42%.(ABSTRACT TRUNCATED AT 250 WORDS)

A urine collector for separating the initial, midstream and final portions of voided urine in infancy and early childhood.

The object of this study was to design a simple and non-invasive method for the collection of uncontaminated urine samples in children aged up to 4 years. We developed a disposable plastic midstream urine collector for use in combination with a specially designed chair which was simple to use and cost effective. In this study we compared the initial portion, midstream and final portion during a single voiding in 40 children and found significant differences between initial and other fractions of the urine sample.