Clinical Course and Effective Factors of Primary Vesicoureteral Reflux.

Vesicoureteral reflux (VUR) is one of the most important causes of urinary tract infection and renal failure in children. It is a potentially self-limited disease. The aim of this study was to evaluate the clinical course and significant factors in children with primary VUR. The medical charts of 125 infants and children (27.2 % males, 72.8% females) with all grades of primary VUR were retrospectively reviewed. Mean age at diagnosis was 22.3 ± 22.9 months. 52% of patients had bilateral VUR. Mild reflux (Grade I, II) was the most common initial grade. 53.6% of patients achieved spontaneous resolution. 30.1% of patients had decreased renal function on initial DMSA renal scan, significantly in males and severe VUR. Reflux nephropathy occurred in 17.6% of patients, especially in renal damage and male sex. No significant association was observed between recurrent urinary tract infection with the severity of VUR, and the presence of renal damage at admission. Age at diagnosis, gender, grade, laterality, the absence of recurrent urinary tract infection and renal damage had a significant correlation between spontaneous VUR resolution. Spontaneous resolution of primary VUR occurred significantly in female patients, age ≤ 30 months at diagnosis, mild-to-moderate VUR, unilateral reflux, the absence of recurrent urinary tract infection, and renal damage.

Trends in steroid response among children with idiopathic nephrotic syndrome.

INTRODUCTION: Idiopathic nephrotic syndrome (INS) is a common chronic illness in childhood and is initially treated with corticosteroids. Recent reports indicate that the incidence of steroid resistance and focal segmental glomerulosclerosis is on the rise. However, these reports involved different ethnic populations. The purpose of this study was to compare the characteristics of INS in Iranian children in different periods. MATERIALS AND METHODS: A retrospective chart review of children admitted with the diagnosis of new-onset INS was performed. Patients were divided into two groups based on date of presentation periods of 1991 to 2002 and 2005 to 2012. Steroid resistance was defined as persistent proteinuria (2+ and more) within 8 weeks of oral corticosteroid treatment. RESULTS: A total of 238 children included in this study (119 in each group). There was an insignificant decrease in the frequency of steroid resistance, along with an insignificant change in histopathology towards focal segmental glomerulosclerosis. CONCLUSIONS: These findings indicate that in contrast to other reports of INS from various ethnic compositions, a tendency to steroid resistance is still arguable in the population of Iranian children.

Changing trends in characteristics of infantile hydronephrosis.

BACKGROUND: Hydronephrosis (HN) or calycial dilatation is the most common prenatal urologic abnormality. The aim of this study was to identify the possible changes in demographic and clinical manifestations of infantile HN in previously and recently diagnosed patients. METHODS: 193 children with infantile HN admitted to Ali-asghar Children's Hospital in two different periods (group 1; 1997-2003, and group 2; 2005-2011) were evaluated in this cross-sectional study. Variables such as time at diagnosis, gender, clinical manifestations, etiology, laterality, grade, and associated anomalies were also evaluated. RESULTS: The mean age at diagnosis was 32.3± 42.6 (group 1) and 21.4± 36.4 (group 2), respectively. 69.8% of patients were males. 75% of prenatally diagnosed patients were asymptomatic. Urinary tract infection was the most common symptom, followed by pain, hematuria, and decreased renal function. Obstruction in ureteropelvic junction was the most common etiology, accounting for 39.6% of all patients. Neurogenic bladder, vesicoureteral reflux, nephrolithiasis, and ureterovesical junction obstruction were the other common etiologies. 55.5% of all patients had unilateral HN, which was more common on the left side. No significant difference documented between two groups of patients, except for mild HN (23.7% vs. 39%), which was more common in newly diagnosed patients (p= 0.001). CONCLUSION: There was no changing trend in demographic and clinical manifestations of infantile HN. However, the severity of infantile HN has been decreased significantly in recently diagnosed patients.