treatment algorithm for children with lupus nephritis to prevent developing renal failure

Chronic kidney disease is one of the most common complication of systemic lupus erythematosus, which if untreated can lead to the end-stage renal disease [ESRD]. Early diagnosis and adequate treatment of lupus nephritis [LN] is critical to prevent the chronic kidney disease incidence and to reduce the development of ESRD. The treatment of LN has changed significantly over the past decade. In patients with active proliferative LN [Classes III and IV] intravenous methylprednisolone 1 g/m[2]/day for 1-3 days then prednisone 0.5-1.0 mg/kg/day, tapered to <0.5 mg/kg/day after 10-12 weeks of treatment plus mycophenolate mofetile [MMF] 1.2 g/m[2]/day for 6 months followed by maintenance lower doses of MMF 1-2 g/day or azathioprine [AZA] 2 mg/kg/day for 3 years have proven to be efficacy and less toxic than cyclophosphamide [CYC] therapy. Patients with membranous LN [Class V] plus diffuse or local proliferative LN [Class III and Class IV] should receive either the standard 6 monthly pulses of CYC [0.5-1 g/m[2]/month] then every 3[rd] month or to a shorter treatment course consisting of 0.5 g/m[2] IV CYC every 2 weeks for six doses [total dose 3 g] followed by maintenance therapy with daily AZA [2mg/kg/day] or MMF [0.6 g/m[2]/day] for 3 years. Combination of MMF plus rituximab or MMF plus calcineurin inhibitors may be an effective co-therapy for those refractory to induction or maintenance therapies. This report introduces a new treatment algorithm to prevent the development of ESRD in children with LN

Weight, height and body mass index nomograms; early adiposity rebound in a sample of children in Tehran, Iran

Assessing growth is a useful tool for defining health and nutritional status of children. The objective of this study was to construct growth reference curves of Iranian infants and children [0-6 years old] and compare them with previous and international references. Weight, height or length of 2107 Iranian infants and children aged 0-6 years old were measured using a cross-sectional survey in Tehran in 2010. Standard smooth reference curves for Iranian population were constructed and compared to multinational World Health Organization 2006 reference standards as well as a previous study from two decades ago. Growth index references for Iranian girls are increased in compare to data from two decades ago and are approximately close to the international references. In boys; however, the increment was considerably large as it passed the international references. Not only the values for indexes was changed during two decades, but also the age at adiposity rebound came near the age of 3, which is an important risk factor for later obesity. During two decades, growth indexes of Iranian children raised noticeable. Risk factors for later obesity are now apparent and demand immediate policy formulations. In addition, reference curves presented in this paper can be used as a diagnostic tool for monitoring growth of Iranian children

Fungal peritonitis in Iranian children on continuous ambulatory peritoneal dialysis

Fungal peritonitis [FP], causing catheter obstruction, dialysis failure, and peritoneal dysfunction, is a rare but serious complication of peritoneal dialysis. In this study, the frequency and risk factors of FP are evaluated in children who underwent peritoneal dialysis. A retrospective multicenter study was performed at the 5 pediatric peritoneal dialysis centers in Iran from 1971 to 2006, and FP episodes among 93 children were reviewed. Risk ratios were calculated for the clinical and demographic variables to determine the risk factors of FP. Ninety-three children aged 39 months on average were included in study. Sixteen out of 155 episodes of peritonitis were fungi infections, all by Candida albicans. The risk of FP was higher in those with relapsing bacterial peritonitis [P = .009]. Also, all of the patients had received antibiotics within the 1 month prior to the development of FP. Catheters were removed in all patients after 1 to 7 days of developing FP. Six out of 12 patients had catheter obstruction and peritoneal loss after the treatment and 5 died due to infection. Fungal peritonitis, accompanied by high morbidity and mortality in children should be reduced by prevention of bacterial peritonitis. Early removal of catheter after recognition of FP should be considered

[Prevalence of hypertension in junior and senior high school children in Iran]

To determine the prevalence of high blood pressure in a representative sample of children and adolescents from Tehran, Iran, and also to compare our results with those reported by the Second Task Force. This cross-sectional study was carried out from March 2004 to September 2005. Individuals between 13 and 18 years of age were selected randomly from the list of schools [grade 6 through 12] in various locations throughout Tehran. All measurements were performed at public and high schools. The size of the sample was defined based on the expected prevalence of hypertension for the age group. After randomization, data were collected through a questionnaire. Blood pressure was measured twice. Weight and height were also measured. High blood pressure was defined as systolic and/or diastolic blood pressure over the 95th percentile in both measures. The final sample included 6038 [3280 boys 2758 girls] apparently healthy students. In all students who had a systolic or diastolic blood pressure equal or more than the 95th percentile, blood pressure was measured after 1 and 2 weeks [second and third rescreening]. Blood pressure was elevated in 287 students in the initial screening [4.7%], with a decrease to 1.0% and 0.8% when this group was screened a second and third time respectively. According to the 1987 Task Force Report in United States, systolic hypertension was found in 2.8% and diastolic hypertension in 3.4% in screening. In rescreening, both systolic and diastolic hypertension had fallen to 0.7%. In the third screening systolic hypertension had fallen to 0.6% and diastolic hypertension to 0.5%. The prevalence of elevated blood pressure was 0.8% in the present study. No statistically significant difference was noted between the prevalence of elevated blood pressure between genders. Additionally, these results confirm the importance of the Task Force recommendation that multiple BP measurements should be obtained before making a diagnosis of hypertension