Spot Urinary Citrate Normograms in Children.

Citrate in the urine inhibits nephrolithiasis, and oral citrate solutions are used to prevent stones forming. The present study aimed to estimate the normograms of the urinary levels of citrate, creatinine, and their ratio in spot urine samples collected from 237 healthy children, aged from 1 month to 14 years. The findings showed the mean, standard deviation, median, and 5th and 95th percentiles of the values and compared them among age groups and between the sexes by using analysis of variance and independent t-tests. Our findings indicate that the ratio of spot urinary citrate to creatinine was higher for children younger than 18 months of age, possibly related to the consumption of dairy protein as their main meal. The 5th percentiles (lower cut off) for spot urinary citrate-to-creatinine ratio, were 915 mg/g for children aged under 18 months, 109 mg/g and 126 mg/g for older boys and girls.

Hypercalciuria following ceftriaxone a fact or myth.

INTRODUCTION: Nephrolithiasis is a common worldwide problem both in children and adults. Ceftriaxone as a widely used antibiotic can contribute to the formation of renal stones and hypercalciuria. OBJECTIVES: To find the effect of ceftriaxone, a widely used antibiotic, on urinary calcium excretion rate in children. PATIENTS AND METHODS: 84 infants and children over 3 months admitted to hospital for non-renal problems. They were all previously healthy children affected with a condition mandating hospitalisation. They were randomly divided into 2 groups; those who received ceftriaxone according to their physician decision as the case group and those who did not receive antibiotics as the control group. The patients urinary calcium excretion was determined as calcium to creatinine ratio in a random urine sample in the first and third day of their admission. All data was expressed by mean ± SD and analysed by t independent and chi-square tests by SPSS 16. P P value less than 0.05 was significant. RESULTS: Eighty-four cases were analysed. Calcium excretion in received and non-received ceftriaxone groups was 0.13 ± 0.06 and 0.14 ± 0.02 respectively at first day of admission ( P = 0.1). After 3 days, the urine calcium to creatinine ratio increased to 0.27 ± 0.2 and 0.26 ± 0.08 in received and non- received ceftriaxone groups ( P = 0.8). CONCLUSION: In children, urinary calcium excretion increases 2 times in average in a short time after admission because of gastroenteritis, and ceftriaxone is not different to other antibiotics for increase urinary calcium excretion in 3 days after admission.

The comparison of ultrasound and non-contrast helical computerized tomography for children nephrolithiasis detection.

AIMS: Nephrolithiasis is less common in children than adults, but its diagnosis and management in children may be more perplexing. In this article, we compare two imaging ultrasound (US) and non-contrast helical computerized tomography (CT) for diagnosis of nephrolithiasis. SUBJECTS AND METHODS: A total of 20 children who diagnosed as nephrolithiasis by US were imaged simultaneously by non-contrast helical CT. Their history like as family history in first and second degree relatives and urine analysis for hematuria and urine randomly calcium to creatinine ratio was obtained. All data analyzed by χ(2) and Mann-Whitney U-test in SPSS 16 and P < 0.05 was considered to be significant. RESULTS: Out of 20 cases, only 5 cases diagnosed as nephrlithiasis by US were confirmed by CT method 2 out of 20 cases had another extrarenal origin for their complaint who diagnosed wrongly as nephrolithiasis by US. Stone size based of US that was confirmed by CT method was larger 4.6 ± 1.5 (minimum 3 max 6 mm) than non-confirmed ones 2.3 ± 0.7 mm (P 0.002). Hematuria occurred more in correct diagnosed compared with misdiagnosed (P 0.005). Positive family history and urine calcium ratio was not differed between two groups. CONCLUSIONS: Non contrast helical CT is essential to confirm of nephrolithiasis and other extrarenal origin of complaints, which diagnosed wrongly as nephrolithiasis in children. Stone size and presence of hematuria are two major factors for right diagnosis of nephrolithiasis as US method but Urine calcium excretion ratio or positive family history cannot be predictive as this study.

The Efficacy of Hydration with Normal Saline Versus Hydration with Sodium Bicarbonate in the Prevention of Contrast-induced Nephropathy.

BACKGROUND: Contrast-induced acute kidney injury [contrast-induced nephropathy (CIN)] is one of the major causes of hospital-acquired acute renal failure. Volume supplementation is the most effective strategy to prevent acute renal failure caused by contrast; but the effects of sodium bicarbonate regimens are unknown in CIN prevention. The aim of this survey is to compare the efficacy of hydration with normal saline versus hydration with sodium bicarbonate in the prevention of the CIN in patients undergoing coronary angiography. MATERIALS AND METHODS: In a clinical trial, 350 patients undergoing coronary interventions were randomized into two groups: One group received normal saline and another group received sodium bicarbonate before and after infusion of the contrast. Patients in both the groups had received N-acetylcysteine. CIN was defined as relative increase in serum creatinine equal to or more than 25% of baseline or increase to 0.5 mg/dl in 48 h after the injection of the contrast. RESULTS: CIN was seen in 46 patients (13.1%) after coronary interventions. Incidence of CIN in patients receiving normal saline (19.4%) was more than in patients receiving sodium bicarbonate (6.9%) (P = 0.001). Hemodialysis was needed only in one patient who received saline normal. Relative risk to induce CIN in both groups was as 2.8 and was in the range of 1.50-5.25 with confidence interval of 95% and P = 0.001. Thus, the probability of CIN was significantly more in the usage of normal saline. CONCLUSION: This survey showed that hydration with sodium bicarbonate is superior to hydration with normal saline and has better protection effects.

Piperazine side-effects in a patient with pre-existing renal insufficiency.

Piperazine as an antihelminth has many adverse effects, especially on patients with renal insufficiency. We report the use of piperazine in a girl with a moderately severe kidney disease due to Biedl Bardet syndrome. She developed coma and acute kidney injury due to acute interstitial nephritis (AIN), anemia and thrombocytopenia. The presence of fever, proteinuria, acidosis, anemia, sterile pyuria and non-oliguric renal failure strongly suggested AIN. Her problems abated mostly by discontinuing of piperazine and supportive therapy, except anemia and thrombocytopenia.

Effect of peripheral edema on oscillometric blood pressure measurement.

INTRODUCTION: Blood pressure (BP) measurement is essential for epidemiological studies and clinical decisions. It seems that tissue characteristics can affect BP results and we try to find edema effect on BP results taken by different methods. METHODS: BP of 55 children before open heart surgery were measured and compared according to three methods: Arterial as standard and reference, oscillometric and auscultatory methods. Peripheral edema as a tissue characteristic was defined in higher than +2 as marked edema and in equal or lower than +2 as no edema. STATISTICAL ANALYSES: data was expressed as Mean and 95% of confidence interval (CI 95%). Comparison of two groups was performed by T independent test and of more than two groups by ANOVA test. Mann-Whitney U and paired T-test were used for serially comparisons of changes. P less than 0.05 was considered significant. RESULTS: Fifty five children aged 29.4±3.9 months were divided into two groups: 10 children with peripheral edema beyond +2 and 45 cases without edema. Oscillometric method overestimated systolic BP and the Mean (CI 95%) difference of oscillometric to arterial was 4.8 (8/-1, P=0.02) in edematous and 4.2 (7/1, p=0.004) in non edematous. Oscillometric method underestimated diastolic BP as -9 (-1.8/-16.5, P=0.03) in edematous group and 2.6 (-0.7/+5, P= 0.2) in non edematous compared to arterial method. CONCLUSION: Oscillometric device standards cannot cover all specific clinical conditions. It underestimates diastolic BP significantly in edematous children, which was 9.2 mmHg in average beyond the acceptable standards.

Association of Brucella meningoencephalitis with cerebrospinal fluid shunt in a child: a case report.

OBJECTIVE: Brucellosis is an endemic zoonosis in Iran. It is a systemic infection that can involve any organs or systems of the body and have variable presentations. Ventriculoperitoneal (VP) shunt infections due to brucellosis have been rarely reported in the literatures. This is the history of a four years old boy who developed Brucella meningoencephalitis at the age of 42 months, whilst he had a VP shunt in situ for hydrocephalus treatment. Also, he presented brucellosis as acute abdomen. This patient was treated with trimethoprim-sulfamethoxazole, gentamicin and rifampicin. The shunt was extracted and all clinical and laboratory test abnormalities subsided through this management. We propose that in a patient with Brucella meningoencephalitis, the cerebrospinal fluid shunt system can be extracted and treatment with appropriate combination of antibiotics could be successful. Moreover, it shows that brucellosis should be considered in the differential diagnosis for acute abdomen and ascites in endemic regions.