Isotonic versus hypotonic saline solution for maintenance intravenous fluid therapy in children: a systematic review.

BACKGROUND: The administration of hypotonic saline solution for maintenance intravenous fluid (IVF) therapy has been the standard of care, but recent evidence has shown this treatment to be associated with hyponatremia-related complications. The aim of this systematic review was to determine which IVF, i.e., a hypotonic or an isotonic saline solution, poses less risk for the development of hyponatremia among hospitalized children who require maintenance IVF therapy. METHODS: Medline, Cochrane Library, LILACS, Current Controlled Trials, reference lists, and abstract proceedings were searched for randomized controlled trials (RCTs) comparing hypotonic and isotonic saline solutions for maintenance IVF therapy in hospitalized children. Two reviewers independently assessed all potentially relevant studies and subsequently extracted data and evaluated the methodological quality of the RCTs. Studies were then combined and analyzed using a random effects model. RESULTS: Eleven RCTs met the inclusion criteria. Our analysis of these 11 RCTs showed that among hospitalized children receiving maintenance IVF therapy, isotonic solutions significantly decreased the risk of developing hyponatremia [relative risk (RR) 0.50, 95% confidence interval (CI) 0.40-0.62] without significantly increasing the risk for hypernatremia (RR 0.83, 95% CI 0.41-1.67). CONCLUSIONS: Current evidence does not support the standard practice of prescribing a hypotonic saline solution as maintenance IVF therapy to hospitalized children. Although there is no single IVF composition ideal for all children, an isotonic saline solution does appear to be the safer choice when maintenance IVF therapy is used in the general pediatric population.

Profile of acute kidney injury in pediatric leptospirosis.

BACKGROUND/AIM: Leptospirosis is an emerging public health zoonotic disease driven by climate and environment. Reports on leptospirosis-induced acute kidney injury (AKI) in children are scant and lacking in detail. The main objective is to provide an accurate and comprehensive description of AKI in pediatric leptospirosis. METHODS: We reviewed records of children ≤ 18 years old referred to the Section of Pediatric Nephrology in a tertiary-level government hospital from January 2004 to December 2012. They presented with clinical manifestations of leptospirosis and a microscopic agglutination test (MAT) ≥ 1:400. Patients were stratified as oliguric and non-oliguric with the former having a urine output of <0.5 mL/kg/h. RESULTS: A total of 86 cases were included with 53 children (62%) presenting with oliguria during their confinement. Blood urea nitrogen (BUN) (p=0.04) and serum creatinine (p=0.01) levels were significantly more elevated in the oliguric subjects than the non-oliguric children upon hospital admission with a median estimated GFR (eGFR) of 9 and 11 mL/min per 1.73 m(2), respectively. Peritoneal dialysis (PD) was initiated in 19 (36%) patients in the oliguric group. Death occurred in 2 (4%) subjects with oliguric AKI. The most common pathologic serovars isolated were L. manilae (13%) and L. poi (13%). CONCLUSION: Anicteric oliguric AKI due to leptospirosis is more frequent and severe than non-oliguric kidney failure in the pediatric population.

Distal renal tubular acidosis in Filipino children, caused by mutations of the anion-exchanger SLC4A1 (AE1, Band 3) gene.

AIM: To describe the clinical features and genetic basis of distal renal tubular acidosis (dRTA) in Filipino children. METHODS: Clinical description and gene analysis of affected members of 7 families. RESULTS: In all affected children, the disease was associated with mutations of the SLC4A1 gene that codes for the bicarbonate/chloride anion-exchanger 1 (AE1, band 3) protein situated in the red cell membrane and the alpha-intercalated (proton-secreting) cell of the renal collecting duct. In 2 families, affected children were homozygous for a substitution of aspartic acid for glycine in residue 701 of the AE1 protein (G701D); in the other 5 families, affected children were compound heterozygotes of this mutation with the AE1 mutation (Delta400-408) that causes Southeast Asian ovalocytosis (SAO). All affected children had morphological red cell changes that closely resembled SAO, including the children who were homozygous for G701D and did not have the SAO mutation. Homozygous G701D thus produces morphological red cell changes that are not readily distinguishable from SAO. The parents of all 7 families were originally domiciled in the islands of the Visayas group in the central part of the Philippine archipelago. CONCLUSION: Recessive renal tubular acidosis in Filipinos is usually caused by SLC4A1 mutations, commonly G701D.

Teaching Renal Physiology to the Millennial Student: the University of the Philippines Manila Experience.

OBJECTIVES: To compare the conventional style from a multi-modal approach in the teaching of renal physiology among University of the Philippines-College of Medicine (UPCM) first-year medical students in terms of their attitudes and rating scale. METHODS: We conducted an exploratory sequential mixed methods design using an online survey employing a likert scale followed by a focus group discussion of medical students taking the excretory module from 2016 to 2019. Abbreviated plenary live lectures, online videos embedded in a learning management system, patient contact experience ward work, role-playing, and quiz shows are used to integrate the lessons being taught. RESULTS: One-hundred sixty-one respondents out of 185 medical students answered the online survey. We identified that the 67.8% of students found web-facilitated videos extremely effective in understanding renal physiology. Among the online videos, voice-over powerpoint format was proven to be most helpful. Students disclosed that the overall scheme was generally positive and it proved to be enjoyable and provided great learning experiences. CONCLUSION: Applied to a class of millennial students, the pilot flight of the redesigned program attempted to engage the audience in such a way that they would not only memorize the topics by rote, they would be able to understand the topics so they could then correlate them to a real-world, clinical, or a laboratory setting following a multi-modal representation.

Bedside diagnosis of outpatient childhood urinary tract infection using three-media dipslide culture test.

To determine the accuracy of a three-media dipslide test, the Uricult Trio, for the diagnosis of childhood urinary tract infections (UTIs), we collected urine specimens from children at the outpatient department. Two hundred consecutive patients presenting with symptoms of UTI were examined. Randomly voided, midstream, clean-catch and catheterized samples were used. Each was tested by routine laboratory culture and the dipslide test. The subjects' ages ranged from 4 months to 7 years, with a median age of 5 years. There were 112 (56%) boys and 86 (43%) girls. Of the subjects, 98 (49%) showed urine culture results indicating significant bacteriuria. There was complete agreement in 70 cases (35%). The sensitivity and specificity of the dipslide were 68% and 82%, respectively. The positive and negative predictive values were 81% and 71%, respectively. The likelihood ratio for a positive test was 3.7, while for a negative test it was 0.39. The specificity, using Escherichia coli special agar, increased to 85% and the negative predictive value to 93%. The Uricult Trio dipslide method was technically simple and could be applied in the outpatient setting. Further studies are required, however, before it can be recommended as a routine diagnostic tool.

Postpartum hemolytic uremic syndrome in a 17-year-old Filipina primigravid.

A 17-year-old Filipina primigravid developed acute renal failure secondary to hemolytic uremic syndrome (HUS) after undergoing emergency cesarean section for severe pre-eclampsia and abruptio placenta. She underwent hemodialysis with concurrent infusions of fresh-frozen plasma and packed red cells for 5 weeks. Renal biopsy revealed findings consistent with HUS with glomerular crescents. She received three doses of pulse methylprednisolone followed by oral prednisone. Renal function improved 5 weeks after the onset of HUS. The pathogenesis, differential diagnosis, and treatment options of postpartum HUS are discussed.