سال:1398 | دوره: | شماره: |تعداد مقالات:8

Tuberculosis (TB) is a serious and important infectious disease worldwide. Children commonly develop renal tuberculosis (TB) as a complication of primary pulmonary infection with Mycobacterium tuberculosis characterized by hilar lymphadenopathy often with lung opacity. Renal TB accounts for up to 27% of extra-pulmonary cases. The disease is more prevalent in children with immunodeficiency syndromes and the recipients of organ transplantations. The signs and symptoms of renal TB are non-specific and challenging. Most patients present with persistent non-glomerular microscopic hematuria without abdominal or flank pain. Some may have signs and symptoms of the lower urinary tract such as voiding dysfunction. A diagnosis of renal TB is suspected upon detecting pyuria in the absence of common bacterial infections and is confirmed by isolation of acid-fast lactobacillus in the urine or tissue biopsy. Anti-tuberculosis drugs most frequently used in the pediatric age group are a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol.

Proteinuria is defined as an increased abnormal urinary excretion of proteins. In normal conditions, few proteins are lost through the urine. Proteinuria is a problem and dilemma in pediatric practice. Non-nephrotic proteinuria is described and its follow-up is discussed in the following.

A 14-year-old boy with end-stage renal disease secondary to focal segmental glomerulosclerosis complicated with heavy proteinuria received a non-related living kidney transplantation. Postoperatively he continued to excrete higher level of proteinuria. Allograft biopsy showed mild mesangial expansion and hypercellularity. Urine sample was collected from allograft renal pelvis under local anesthesia and ultrasound guidance. Based on the importance of heavy proteinuria and lack of definite method of differentiating its source during the early weeks after kidney transplantation, it seems that percutaneous renal pelvis urine sampling may be noted as a preferred method of detecting the source of proteinuria.

Meningitis retention syndrome (MRS) is an underreported clinical syndrome in children that presents with meningitis and acute retention of urine. It is usually associated with aseptic meningitis, but there are case reports of MRS associated with viral and other kind of meningitis. There is no imaging abnormalities in the brain and spine associated with acute urinary retention. Here we report a case of an 11-year-old boy who presented with signs of meningism and acute urinary retention. Further evaluation revealed features of meningitis in cerebrospinal fluid analysis and normal imaging of the brain and spine. He completely recovered from urinary retention after meningitis treatment.

Background and Aim: Obesity causes a decrease kidney function and an increase in kidney volume. The aim of this study was to understand the relationship among kidney volume, obesity and blood pressure in Mexican-American children in South Texas. Methods: To study those effects, data was collected from 454 ultrasound done on 289 girls and 762 ultrasound done on 382 boys visiting a pediatric clinic in South Texas from 2003 to 2018. The relationship between kidney volume and obesity was analyzed. IBM SPSS is used for data analysis. Results: Children with fatty livers have a higher kidney volume when compared to children with non-fatty livers. When comparing children classified as BMI percentile (0, 50%), BMI percentile [50%, 85%), BMI percentile [85%, 95%), and BMI percentile above 95%, the kidney volume is increasing as BMI percentile increases. We also found that there is a positive relationship between the kidney volume and systolic blood pressure. Children with high systolic blood pressure (above 119 mmHg) have a larger volume when compared to children with low blood pressure (above 110 but less than or equal 119 mmHg), 110 and below mmHg. Conclusion: Obesity causes inflammation, and lipid accumulation. These effects can cause an increase in kidney volume. Kidney volume increases can be caused by hypertension. This is even severe for Mexican-American children in south Texas.

Q1: What is the most probable diagnosis for him? A1: Based on the American College of Rheumatology and European League Against Rheumatism (EuLAR) and Pediatric Rheumatology Society (PReS) criteria, he is diagnosed with Henoch-Schonlein purpura. Q2: What is the best treatment for him? A2: IV fluid, High-dose pulse IV steroid. Symptomatic treatment is usually enough for symptoms such as rash and arthritis. Acetaminophen and NSAIDs can be used. Aspirin must be avoided in children....

Background and Aim: The aim of this study was to explore the spectrum of histopathology in children who underwent a renal biopsy for difficult NS in a tertiary care pediatric nephrology center. Methods: This prospective observational study was conducted in the Pediatric Nephrology Department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2011 to July 2018. Patients who presented with difficult patterns of nephrotic syndrome and underwent a renal biopsy were enrolled in this study. Results: A total of 140 patients were recruited in this study. The patients with steroid resistance nephrotic syndrome (SRNS) and nephrotic syndrome with atypical presentation underwent a renal biopsy; a good number of atypical NS cases were steroid dependent nephrotic syndrome (SDNS). They were grouped into Group A (SRNS), Group B (SDNS) and Group C (nephrotic syndrome with atypical presentation). In patients with SDNS, minimal change disease (MCD) (51. 3%) was the most common histological pattern followed by mesangioproliferative glomerulonephritis (MesPGN) (33. 3%); whereas MesPGN was the commonest histological pattern in SRNS (56. 8%) and nephrotic syndrome with atypical presentation (54. 7%) followed by MCD and focal segmental glomerulosclerosis (FSGS). Most of the patients responded to immunosuppressive therapy. In SRNS, a partial response was achieved in 18. 9% and chronic kidney diseases (CKD) occurred in 16. 2% of the cases. In comparison, 10. 9% of the patients with nephrotic syndrome with atypical presentation achieved partial response and 7. 8% developed CKD, which were not statistically significant. In addition, 5. 4% of the patients with SRNS died. Conclusion: Mesangioproliferative glomerulonephritis was the most common histopathological diagnosis in patients with SRNS and nephrotic syndrome atypical presentation in our population. MCD was predominant in SDNS cases.

Background and Aim: Rapidly progressive glomerulonephritis (RPGN) is characterized by a rapid decline in the renal function and urinary abnormalities. There is limited information on epidemiological factors and clinical and histopathological patterns of RPGN from developing countries. Therefore, the objective of this study was to identify the etiology, clinical features, histopathological patterns, and treatment outcomes of patients with clinically suspected RPGN. Methods: This retrospective study was conducted in the Pediatric Nephrology Department of Bangabandhu Sheikh Mujib Medical University from January 2014 to January 2019. Patients with clinically suspected RPGN that underwent renal biopsy were enrolled in this study. Results: Thirty-five patients were recruited in this study. Macroscopic hematuria, edema, hypertension, uremia, and oliguria were common clinical presentations. Diffuse proliferative GN (28. 5%) and crescentic GN (22. 8%) were the most common histological diagnoses in this study. Immune mediated GN (62%) followed by idiopathic GN (25%) were found to be the most frequent cause of crescentic GN. Renal replacement therapy was required in 45% of the cases and 11. 4% of the patients developed end-stage renal disease. Conclusion: Renal histology is an integral part of the investigation of patients with suspected RPGN for both diagnostic and prognostic purposes. Diffuse proliferative GN was the most common histopathological diagnosis in patients with clinical RPGN in our population. Preservation of renal function depends on early intervention and detection of RPGN in pediatric patients.