La escala pediátrica de evaluación del fallo multiorgánico secuencial (pSOFA): una nueva escala de predicción de la mortalidad en la unidad de cuidados intensivos pediátricos / Paediatric sequential organ failure assessment (pSOFA) score: A new mortality prediction score in the paediatric intensive care unit

OBJETIVOS: Analizar el rendimiento de la escala Sequential Organ Failure Assessme (SOFA) adaptada por edad en niños ingresados en la unidad de cuidados intensivos pediátricos (UCIP) y establecer si la escala SOFA puede competir con el síndrome de respuesta inflamatoria sistémica (SRIS) para el diagnóstico de sepsis, de acuerdo con las recomendaciones del consenso Sepsis-3. MÉTODOS: Estudio prospectivo observacional en 2 centros con 281 niños ingresados en la UCIP. Se calcularon las puntuaciones de las escalas SOFA, Pediatric Risk of Mortality (PRISM) y Pediatric Index of Mortality-2 (PIM2) y se evaluó la presencia de SRIS al ingreso. La variable primaria fue la mortalidad a los 30 días. RESULTADOS: La puntuación SOFA fue más alta en los no supervivientes (p < 0,001) y la mortalidad se incrementó progresivamente de los subgrupos con las puntuaciones SOFA más bajas a aquellos con las puntuaciones más altas. El análisis de las curvas de las características operativas del receptor (ROC) mostró que el área bajo la curva (AUC) para la predicción de la mortalidad a 30 días con la puntuación SOFA fue de 0,89, comparado con 0,84 y 0,79 con las escalas PRISM y PIM2, respectivamente. La AUC de la puntuación SOFA para la predicción de estancia prolongada en la UCIP fue de 0,67. La escala SOFA se correlacionó con las escalas PRISM (coeficiente de correlación de Spearman rs = 0,59) y PIM2 (rs = 0,51). En niños con infección, la AUC de la escala SOFA para la predicción de la mortalidad fue de 0,87, mientras que la AUC del SRIS fue de 0,60. El diagnóstico de sepsis definido como una puntuación SOFA de 3 o más predijo la mortalidad mejor que el SRIS y que la escala SOFA con el punto de corte de 2 puntos recomendada en el consenso Sepsis-3. CONCLUSIONES: La puntuación SOFA al ingreso es útil como predictor de la evolución en la población general de la UCIP y es más apropiada que el SRIS para definir la sepsis pediátrica

OBJECTIVES: To assess performance of the age-adapted SOFA score in children admitted into Paediatric Intensive Care Units (PICUs) and whether the SOFA score can compete with the systemic inflammatory response syndrome (SIRS) in diagnosing sepsis, as recommended in the Sepsis-3 consensus definitions. METHODS: Two-centre prospective observational study in 281 children admitted to the PICU. We calculated the SOFA, Pediatric Risk of Mortality (PRISM), and Pediatric Index of Mortality-2 (PIM2) scores and assessed for the presence of SIRS at admission. The primary outcome was 30-day mortality. RESULTS: The SOFA score was higher in nonsurvivors (P<.001) and mortality increased progressively across patient subgroups from lower to higher SOFA scores. The receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the SOFA score for predicting 30-day mortality was 0.89, compared to AUCs of 0.84 and 0.79 for the PRISM and PIM2 scores, respectively. The AUC of the SOFA score for predicting a prolonged stay in the PICU was 0.67. The SOFA score was correlated to the PRISM score (rs = 0.59) and the PIM2 score (rs = 0.51). In children with infection, the AUC of the SOFA score for predicting mortality was 0.87 compared to an AUC of 0.60 using SIRS. The diagnosis of sepsis applying a SOFA cutoff of 3 points predicted mortality better than both the SIRS and the SOFA cutoff of 2 points recommended by the Sepsis-3 consensus. Conclusions; The SOFA score at admission is useful for predicting outcomes in the general PICU population and is more accurate than SIRS for definition of paediatric sepsis

Immunoglobulin G and M levels in childhood nephrotic syndrome: two centers Egyptian study.

INTRODUCTION: Idiopathic nephrotic syndrome (INS) is the most common glomerular disease in children. Immune cell subsets may play a role in pathogenesis of INS. We aimed to assess immunoglobulin G (IgG) and immunoglobulin M (IgM) levels in children with nephrotic syndrome (NS) to predict prognosis of the disease and response to treatment. METHODS: This prospective case control study was done in Pediatric Nephrology Units at Minoufia and Benha University Hospitals, during the period from 1st March 2014 to 30th June 2015. Seventy-five children in the active stage of INS and 75 apparently healthy children of matched age and sex were included in this study. Statistical evaluation was performed by SPSS version 18.0 using independent-samples t-test, Chi-square, and Pearson's correlation coefficient (r). RESULTS: Compared with healthy children, IgM level was high, IgG level and IgG/IgM ratio were low (p≤0.05). The IgG level and IgG/IgM ratio decreased more in FRNS than in IFRNS group, and was the lowest in SRNS group. The IgM level increased more in FRNS than in IFRNS group, and was the highest in SRNS group (p<0.05, respectively). CONCLUSIONS: Our findings support the idea that IgG level has a prognostic value in NS in children.

Biochemical alteration in children with idiopathic nephrotic syndrome associated with an increased risk of sensorineural hearing loss; additional insights in cochlear renal relationship.

OBJECTIVES: Children with Idiopathic Nephrotic Syndrome (INS) are at risk of hearing loss due to the adverse impact of medications and related immunological and genetic factors on both cochlea and kidney. So this work was planned to evaluate hearing status in children with INS and to clarify the possible associated risk factors by interpreting the clinical and laboratory profiles of those children. METHODS: Ninety children with INS aged 5-14 years [30 patients with steroid-sensitive nephrotic syndrome (SSNS), 30 patients with steroid dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS), and 30 patients with steroid-resistant nephrotic syndrome (SRNS)], and 90 age and sex matched normal controls were enrolled into this study. Laboratory measurements of serum calcium, creatinine, cholesterol, blood urea and other relevant investigations were done. Pure tone audiometry was done with the sensory-neural hearing loss (SNHL) diagnosed when the level bone conduction was >20 dB and the difference in air to the bone gap was <15 dB. RESULTS: 40% children with INS had SNHL, mostly of mild degree HL and primarily occurred at the lower frequencies. A highly significant statistical difference between controls and various types of nephrotic syndrome regarding pure tone audiometry measurements at frequencies 250, 500, 1000 Hz, whereas insignificant difference interpreting pure tone audiometry measurements in 2000, 4000 and 8000 Hz. CONCLUSIONS: Children with different phenotypes of nephrotic syndrome are at risk of sensorineural hearing impairment. The hazards associated with this impairment were higher blood pressure, hypercholesterolemia, hypoalbuminemia, and hypocalcemia.

Bone mineral density in children with idiopathic nephrotic syndrome / Densidade mineral óssea em crianças com síndrome nefrótica idiopática

Abstract Objectives: To assess bone mineral density (BMD) in children with idiopathic nephrotic syndrome (NS) and normal glomerular filtration rate (GFR). Methods: Cross-sectional case-control study carried out on 50 children: 25 cases of NS (16 steroid-sensitive [SSNS] and nine steroid-resistant [SRNS] under follow up in the pediatric nephrology unit of Menoufia University Hospital, which is tertiary care center, were compared to 25 healthy controls with matched age and sex. All of the participants were subjected to complete history taking, thorough clinical examination, laboratory investigations (serum creatinine, blood urea nitrogen [BUN], phosphorus [P], total and ionized calcium [Ca], parathyroid hormone [PTH], and alkaline phosphatase [ALP]). Bone mineral density was measured at the lumbar spinal region (L2-L4) in patients group using dual-energy X-ray absorptiometry (DXA). Results: Total and ionized Ca were significantly lower while, serum P, ALP, and PTH were higher in SSNS and SRNS cases than the controls. Osteopenia was documented by DXA scan in 11 patients (44%) and osteoporosis in two patients (8%). Fracture risk was mild in six (24%), moderate in two (8%), and marked in three (12%) of patients. Conclusion: Bone mineralization was negatively affected by steroid treatment in children with NS.

Resumo Objetivos: Avaliar a densidade mineral óssea (DMO) em crianças com síndrome nefrótica idiopática (SNI) e com taxa de filtração glomerular (TFG) normal. Métodos: O estudo transversal de caso-controle foi feito com 50 crianças: 25 casos de SNI [16 sensíveis a esteroides (SNSE) e nove resistentes a esteroides (SNRE) com acompanhamento na unidade de nefrologia pediátrica do hospital da Menoufia University, centro de cuidados terciário] foram comparados com 25 controles saudáveis do grupo de controle com idade e sexo equivalentes. Todos os participantes foram submetidos a anamnese completa, exame clínico completo, exames laboratoriais [creatinina sérica, nitrogênio ureico no sangue (BUN), fósforo (P), cálcio (Ca) total e ionizado, paratormônio (PTH) e fosfatase alcalina (ALP)]. A densidade mineral óssea foi mensurada na região da coluna lombar (L2-L4) no grupo de pacientes com a absorciometria por raios X de dupla energia (DXA). Resultados: Os níveis de cálcio total e ionizado eram significativamente menores, ao passo que o fósforo sérico, a FA e o PTH eram maiores em casos de SNSE e SNRE do que nos controles. A osteopenia foi documentada pelo exame DXA em 11 pacientes (44%) e a osteoporose em dois (8%). O risco de fratura era leve em seis (24%), moderado em dois (8%) e acentuado em três (12%). Conclusão: A mineralização dos ossos foi afetada negativamente pelo tratamento com esteroides em crianças com SNI.

Bone mineral density in children with idiopathic nephrotic syndrome.

OBJECTIVES: To assess bone mineral density (BMD) in children with idiopathic nephrotic syndrome (NS) and normal glomerular filtration rate (GFR). METHODS: Cross-sectional case-control study carried out on 50 children: 25 cases of NS (16 steroid-sensitive [SSNS] and nine steroid-resistant [SRNS] under follow up in the pediatric nephrology unit of Menoufia University Hospital, which is tertiary care center, were compared to 25 healthy controls with matched age and sex. All of the participants were subjected to complete history taking, thorough clinical examination, laboratory investigations (serum creatinine, blood urea nitrogen [BUN], phosphorus [P], total and ionized calcium [Ca], parathyroid hormone [PTH], and alkaline phosphatase [ALP]). Bone mineral density was measured at the lumbar spinal region (L2-L4) in patients group using dual-energy X-ray absorptiometry (DXA). RESULTS: Total and ionized Ca were significantly lower while, serum P, ALP, and PTH were higher in SSNS and SRNS cases than the controls. Osteopenia was documented by DXA scan in 11 patients (44%) and osteoporosis in two patients (8%). Fracture risk was mild in six (24%), moderate in two (8%), and marked in three (12%) of patients. CONCLUSION: Bone mineralization was negatively affected by steroid treatment in children with NS.

Effect of vitamin C supplementation on lipid profile, serum uric acid, and ascorbic acid in children on hemodialysis.

Children with end-stage renal disease (ESRD) suffer from dyslipidemia and hyperuricemia that might play a causal role in the progression of cardiovascular disease (CVD). The aim of the study is to assess the effects of Vitamin C supplementation on uric acid, ascorbic acid, and serum lipid levels among children on hemodialysis (HD). This prospective study was conducted in the pediatric nephrology unit at Menoufia University Hospital. The study included a total of 60 children with ESRD on maintenance HD therapy. They were divided into two groups: Group I (supplemented group, n = 30) received intravenous Vitamin C supplementation and Group II (control, n = 30) received placebo (intravenous saline) for three months. The results are shown as a mean ± standard deviation. Statistical evaluation was performed by SPSS software (version 11.5) using paired t-test. After supplementation with Vitamin C, the serum Vitamin C and high-density lipoprotein levels increased significantly with a significant reduction in the levels of serum uric acid, cholesterol, low-density lipoproteins, and triglyceride at the end of the study period. No significant changes were observed in the control group. Vitamin C can serve as a useful urate lowering medicine in HD patients to avoid complications of hyperuricemia. Furthermore, it had favorable effects on the lipid profile. This improvement can be considered as a preventive strategy in the progression of CVD in HD patients. Vitamin C supplementation improves ascorbic acid deficiency in these patients.

Evaluation of serum Resistin in children with chronic renal failure undergoing hemodialysis.

INTRODUCTION: High serum resistin levels are associated with the incidence of chronic kidney disease (CKD). The objectives of this study were to determine the serum concentrations of resistin in children that present with chronic renal failure (CRF) and end stage renal disease (ESRD), in order to examine the impact of hemodialysis (HD) on serum resistin levels, and to determine if a correlation exists between resistin and growth retardation in patients with CRF. METHODS: This case control study was undertaken in the pediatric hemodialysis unit of the Benha and Menoufia University hospitals from April 2014 to March 2015. The case group consisted of 50 patients with CRF aged from 6-18 years (25 of them under HD and 25 of them under conservative treatment) and 30 healthy children who constituted the control group. Urea, creatinine, and serum resistin were measured before and after the HD session for patients with CRF who are already under HD. RESULTS: A highly significant difference was found between the resistin levels in the two groups with mean level of 20.2 ± 7.58 ng/ml in the patient case group as compared to 4.9 ± 1.72 ng/ml in the control group. This highly significant difference found in the resistin level differed according to the Chronic Kidney Disease (CKD) stage of progression as patients on regular HD had resistin levels with a mean of 24.6 ± 7.28 ng/ml while the CKD patients under conservative treatment have resistin level mean of 15.6 ± 4.72 ng/ml. there was a highly significant difference in resistin levels before HD (mean = 24.6 ± 7.28) and after hemodialysis (mean = 14.7 ± 5.2). CONCLUSION: Patients with CRF experienced higher than normal resistin levels as compared to the case control group and it was found that patients on HD had more elevated levels of resistin than did those patients who were on conservative treatment. HD treatments were found to be capable of lowering a patient's resistin levels. A highly significant negative correlation was found between serum resistin levels and the two contributing factors of total body weight and body mass index (BMI) as well as demonstrating a significant negative correlation between serum resistin levels and height percentiles.

Effect of zinc supplementation on body mass index and serum levels of zinc and leptin in pediatric hemodialysis patients.

INTRODUCTION: Zinc is an essential trace element for human nutrition, and its deficiency is associated with anorexia, poor food efficiency, growth retardation, and impaired neurological and immune systems. The zinc-deficiency rate is particularly high in many disease states, such as with end-stage renal disease patients undertaking hemodialysis. The aim of this study was to determine the effect of zinc supplementation on body mass index (BMI) and serum levels of zinc and leptin in pediatric hemodialysis patients. PATIENTS AND METHODS: This was a prospective clinical trial study in which 60 hemodialysis patients were randomly divided into two groups: group I received 50-100 mg zinc sulfate (equivalent to 11-22 mg elemental zinc) according to age, sex, and nutritional status of the child; and group II received placebo (cornstarch) twice daily for 90 days. Anthropometric measurements were taken, and serum zinc and leptin levels were determined by colorimetric test with 5-Br-3'-phosphoadenosine-5'-phosphosulfate and enzyme-linked immunosorbent assay, respectively, at days 0 and 90 of the study. RESULTS: Zinc supplementation resulted in a significant increase in mean serum zinc level and BMI. Serum leptin decreased significantly after supplementation in children under hemodialysis. A significant negative correlation was observed between serum zinc and leptin levels as a result of zinc supplementation. CONCLUSION: There was an increase in serum zinc level and BMI and decreased serum leptin after zinc supplementation in children under hemodialysis.