Acute tubulointerstitial nephritis in children and chronic kidney disease.

BACKGROUND: Acute tubulointerstitial nephritis (ATIN) is a rare condition in children. The etiology, treatment, and outcome of childhood ATIN remain poorly understood. The long-term prognosis seems to be favorable; however, chronic kidney disease has been reported. This article describes clinical outcomes in a series of children with biopsy-proven ATIN. METHODS: All medical records with biopsy-proven ATIN between January 2006 and 2016 were retrospectively analyzed. The incidence, clinical features, etiology, treatment, and outcome were recorded for each patient. RESULTS: Over 10 years, ATIN was diagnosed in 25 cases (8%) based on 306 renal needle biopsies. The most frequent clinical signs were abdominal pain, asthenia/weight loss, and fever. A median glomerular filtration rate estimated at 30.1mL/min/1.73 m2 (16.5; 45.5). Drug-induced toxicity was the main etiology (eight patients). Other causes were TINU syndrome (tubulointerstitial nephritis and uveitis) (seven patients), infection (two patients), and toxic agents other than medication (one patient). No etiology was found in seven patients (idiopathic cases). Eighteen patients (72%) were treated with steroids. At the end of follow-up, eight patients presented chronic kidney disease, three hypertension, and three tubular dysfunction. Overall, renal function was highest in the idiopathic ATIN group and in children treated without delay. CONCLUSIONS: In a single-center 10-year series of biopsy-confirmed ATIN in children, drugs and TINU syndrome were the main etiologies of ATIN. This study suggests that children with idiopathic ATIN and prompt treatment have a better prognosis. In this series, occurrence of chronic kidney disease justified long-term follow-up.

[Clustered cases of intrafamily invasive Streptococcus pyogenes infection (or group A streptococcus)]. / Cas groupés intrafamiliaux d'infection invasive communautaire àStreptococcus pyogenes (ou streptocoque du groupe A).

Streptococcus pyogenes or group A streptococcus (GAS) is responsible for serious invasive infections with a risk of secondary infection in patients with more contact than in the general population. Regardless of clustering, few intrafamilial invasive infections have been reported despite a recent increase in the incidence of invasive GAS disease. We report the cases of two brothers, one a boy of 8.5 years with toxic shock syndrome with no bacteria identified and the second, 1 week later, his 14.5-year-old brother in hospital for sepsis due to GAS. The occurrence of a confirmed case of invasive GAS and a probable case within such a short period met the definition of clustered cases. Both brothers showed no risk factors for invasive disease and no gateway including skin was found. Antibiotic therapy was initiated in the family as recommended by the French Higher Council of Public Hygiene.

[Streptococcal toxic shock syndrome or Kawasaki disease? Two case studies of children with group A streptococcal pneumonia empyema]. / Syndrome de choc toxinique streptococcique ou syndrome de Kawasaki ? À propos de 2 cas cliniques d'enfants présentant une pleuropneumopathie à streptocoque bêta hémolytique du groupe A.

We report 2 cases of children with group A streptococcus pyogenes pleuropneumonia, in one child associated with Kawasaki disease and in the other with streptococcal toxic shock syndrome. These 2 features, with theoretically well-defined clinical and biological criteria, are difficult to differentiate in clinical practice, however, likely due to their pathophysiological links. In case of clinical doubt, an echocardiography needs to be performed to search for coronary involvement and treatment including intravenous immunoglobulins, and an antibiotic with an anti-toxin effect such as clindamycin has to be started early.

[Amanita proxima poisoning in a child]. / Un cas pédiatrique d'intoxication par Amanita proxima.

Mushroom intoxication due to Amanita proxima poisoning is characterized by moderate gastrointestinal symptoms, followed by severe acute renal failure and sometimes by hepatic cytolysis. This syndrome was described in the 1990s in the southeast of France; we report here the first pediatric case, requiring dialysis but achieving complete recovery. The mother of this 11-year-old boy, who had eaten the same mushrooms but in smaller quantities, had only biological renal and hepatic involvement.

[Kawasaki disease in older children and young adults: 10 years of experience in Marseille, France]. / Maladie de Kawasaki chez le grand enfant et l'adulte jeune : expérience marseillaise sur 10 ans.

Kawasaki disease is a well-known disease in young children. However, it can also affect older children. The aim of this study was to determine the different characteristics of Kawasaki disease in older children and young adults. This is a descriptive, retrospective, and multicenter study including all cases of Kawasaki disease occurring in children over 8 years and adults hospitalized at children's or adult Hospitals, in Marseille, France, between 1999 and 2009. The clinical, biological, prognostic, and therapeutic data were reviewed for each case. Over a 10-year period, 98 patients were hospitalized for Kawasaki disease. Six cases were aged between 8 years and 1 month and 21 years and 7 months. All patients showed a classic form of the disease with associated organ damage in 5 patients. A cardiac problem was present in 5 cases with 2 patients needing intensive care. The median time to diagnosis and treatment was 11.2 days, with all patients initially diagnosed erroneously. Current treatment guidelines were applied in 2 patients. Kawasaki disease in children over 8 years and adults under 30 years has a worse prognosis than in young children even though clinical features are atypical. It is rarely seen by clinicians in this age group, causing a delay in diagnosis, the main factor of the poor prognosis. The diagnosis of Kawasaki disease must be raised when predisposing factors are present in this group.

[BCG and infants with a high risk of tuberculosis: a study of the vaccination rate in Marseille after suspension of the BCG requirement]. / BCG et nourrissons à risque de tuberculose : étude de couverture vaccinale à Marseille après la levée d'obligation.

OBJECTIVES: The obligation for BCG vaccination, suspended in July 2007, was replaced by a vaccination targeting children with a high risk of tuberculosis. The purpose of this study was to assess the vaccination rate of infants living Marseilles and its suburbs who had criteria for BCG vaccination. MATERIAL AND METHODS: This observational study consisted in interviewing the parents of children born after the suspension of the obligatory BCG vaccination and admitted for a medical visit at the Pediatric Emergency Department of the Timone-Enfants University Hospital between 1 December 2008 and 31 March 2009. For each child, we noted the demographic data, the criteria for BCG eligibility, the vaccination status, and, when the child was not vaccinated but at risk for tuberculosis, the information received by the family on the vaccination. RESULTS: A total of 224 out of 271 eligible children were included (82.6%; mean age, 7.1 ± 4.9 months). One hundred and fifty-seven infants had at least one criterion for BCG vaccination; 116 of them were vaccinated (73.9%). The number of criteria for the vaccination did not influence the vaccine rate. Families of non-vaccinated high-risk children (n=41) had been informed about BCG in 39% of the cases. BCG was planned in 11 of these 41 infants. CONCLUSION: Eighteen months after suspension of the obligation for BCG vaccination, our results are encouraging but underline the need for improving information to families concerned by this new vaccination policy.

Anakinra is safe and effective in controlling hyperimmunoglobulinaemia D syndrome-associated febrile crisis.

Hyper-IgD and periodic fever syndrome (HIDS) is a hereditary autoinflammatory syndrome, characterized by recurrent inflammatory attacks. Treatment of HIDS is difficult. Recently, the IL-1ra analogue anakinra was reported to be successful in aborting the IgD inflammatory attacks in a vaccination model. We report a clinical case of spectacular reduction of febrile attacks in a severe HIDS patient.