Pericardial effusion in childhood nephrotic syndrome.

BACKGROUND: Nephrotic syndrome (NS) is one of the most common renal diseases in children, which is defined as idiopathic NS and secondary NS. Current data on adult showed that pericardial effusion was related only to SLE, but not to non-SLE nephrotic patients. Until now there were no studies about children. OBJECTIVE: To compare the frequency and clinical manifestations of pericardial effusion in childhood NS with SLE and non-SLE patients. MATERIAL AND METHOD: Consecutive cases of NS at Queen Sirikit National Institute of Child Health (QSNICH) from June 2004 to May 2005 were prospectively studied. Information concerning the following: gender, age, clinical manifestations, laboratory investigation and echocardiogram in each patient were obtained. RESULTS: A total of 37 cases were included, 13 with SLE and 24 with idiopathic cause. Pericardial effusion was found without any symptoms and signs of pericardial disease in both groups; 9 cases (69.2%) of SLE and 2 cases (8.3%) of non-SLE patients. Statistically significant differences were demonstrated between two groups (p = 0.001). CONCLUSION: Pericardial effusion in childhood NS was more frequent in SLE than non-SLE nephrotic patients statistically significant. This result was different from previous study in adult which revealed no pericardial effusion in non-SLE group.

Assessment of the different methods to predict equilibrated Kt/V in pediatric hemodialysis.

OBJECTIVES: To determine the degree of urea rebound in children on hemodialysis and compare the different calculation models for Kt/V. MATERIAL AND METHOD: The present study was performed in 50 hemodialysis sessions of 5 pediatric patients, 2 males and 3 females, aged 5-18 years, who had received hemodialysis for 7-48 months. Blood urea samples were obtained at the beginning, 70 minutes intradialysis, the end and every 10 minutes for 1 hour post- dialysis. The compared 6 different models of Kt/V were single pool, Daugirdas, equilibrated, rate equation, Maduell and Smye method. RESULTS: Urea rebound was found to be completed at least 60 minutes post- dialysis and mean percentage value was 30.68 +/- 9.663. Mean value of equilibrated Kt/V was 1.442 +/- 0.259 while that of single-pool Kt/V calculated by InC1/C2 was 1.705 +/- 0.252 leading to overestimation of Kt/V by 0.265 +/- 0.075. Mean value calculated by Daugirdas method was 2.083 +/- 0.336. Mean values obtained by rate equation, Maduell and Smye methods were 1.485 +/- 0.209, 1.442 +/- 0.209 and 1.379 +/- 0.343 which differed from equilibrated Kt/V by 0.086 +/- 0.058 (p = 0.002), 0.069 +/- 0.063 (p = 0.967) and 0.132 +/- 0.132 (p = 0.015), respectively. CONCLUSION: Urea rebound in pediatric patients is completed at least 60 minutes after cessasion of hemodialysis. Kt/V calculated from single-pool is not suitable for children. The Maduell model gives the best correlation to equilibrated Kt/V when compared to rate equation and Smye models.

Out-patient antibiotics switch therapy in pediatric urinary tract infection.

OBJECTIVE: To compare the outcomes of out-patient antibiotics switch therapy with the treatment provided in the hospital among pediatric urinary tract infection (UTI) cases. MATERIAL AND METHOD: A comparative study was carried out using the febrile UTI patients of age 1 month-15 years in the observation room (OPD), Queen Sirikit National Institute of Child Health, Bangkok, Thailand, from 1st January 2000 to 31st December 2000 and the admitted pediatric UTI cases during the same period. The treatment at the OPD was started with parenteral antibiotics, then switched to oral form when the patients were clinically improved and defervesence occurred. RESULTS: There were 95 cases of pediatric UTI of which 29 cases were treated in the observation room as out-patient, 66 cases were treated as in patients after admitting them. The success rate of treatment was the same in both groups. The patients in the observation room were fit enough to be discharged but continued oral treatment within 1.93 +/- 0.65 days, compared with 6.24 +/- 2.72 days of the admitted group. Gentamicin and ceftriazone were the two most common parenteral antibiotics and norfloxacin was the most commonly prescribed oral antibiotics in both group. Mean age of the OPD group (6.24 +/- 2.72 years) was higher than the admitted group (0.97 +/- 1.7 year). Escherichia coli (E. coli) was the most commonly found organism in the urine culture and the sensitivity pattern was the same in both groups. CONCLUSION: The study revealed that some pediatric UTI patients can be treated as out-patients using antibiotics switch therapy in the observation room instead of being admitted.

Intussusception associated with a relapsing nephrotic patient: a case report.

BACKGROUND: Gastrointestinal disturbances are encountered frequently in the course of the nephrotic syndrome but intussusception is a rare association. It may be the result of incoordinate motility and bowel wall edema. OBJECTIVE: To report a case of intussusception associated with relapsing nephrotic syndrome. CASE REPORT: The authors reviewed the case of a 5-year-old boy who had been diagnosed as having nephrotic syndrome at Queen Sirikit National Institute of Child Health for 1 year, who later presented with nephrotic symptoms and an acute abdomen. Abdominal ultrasonography and barium enema were performed which diagnosed ileo-colic intussusception. Resection of the ileum and appendectomy were performed while the relapsing nephrotic syndrome was treated by prednisolone. The patient's recovery was excellent. Percutaneous renal biopsy was done because of the frequent relapsing condition and showed mesangial proliferative glomerulonephritis consistent with IgM nephropathy. Intussusception should be included in the differential diagnosis of relapsing nephrotic syndrome presenting with acute abdominal pain. Abdominal ultrasonography is helpful in confirming this condition.