Prevalence of nephrocalcinosis in children with congenital adrenal hyperplasia.

Background: We aimed to investigate the prevalence of nephrocalcinosis (NC) among children with diagnosed congenital adrenal hyperplasia (CAH). Our findings would be helpful for earlier diagnosis, management, and prevention of NC-related complications. Materials and Methods: In this cross-sectional study, children with CAH, aged <18 years old who were regularly referred for follow-up, were included. The information of the patients was extracted from their medical files, and they underwent renal ultrasonography for evaluation of the presence of NC. Results: From 120 studied patients with CAH, four patients (3.3%) had NC. The prevalence of NC was higher in males than females (P = 0.05). Mean age and age of CAH diagnosis had a trend to be lower in CAH patients with NC than those without. Regression analysis indicated significant association between NC and sex (P = 0.027, r = 2.24). Conclusion: The results of this study indicated a 3.3% prevalence rate of NC for children with CAH. NC had a trend to be more prevalent in male children with CAH. Though it was not significantly different but given that the mean age and age at diagnosis of CAH in children with CAH and NC was lower that CAH patients without NC, it is suggested that in patients with CAH and NC other factors such as genetic background or unknown disease related factors are associated with hypercalcemia and NC.

Electrolyte disturbances in children receiving omeprazole for gastroesophageal reflux disease.

BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the common gastrointestinal diseases with various side effects. Proton pump inhibitor (PPI) drugs are widely used for their treatment and long-term ingestion, which results in an electrolyte imbalance. This study investigates the changes in serum magnesium, calcium, sodium, and potassium after long-term use of omeprazole in children. MATERIALS AND METHODS: This cross-sectional study was conducted in 2016-2017 on 97 children and adolescents, aged 1-15 years, with GERD, in Isfahan, Iran. Enrolled were patients visiting a referral pediatric gastroenterology clinic (Imam Hossein and Amin Hospitals) examined by an academic pediatric gastroenterologist. Before and 4 weeks after omeprazole administration, clinical manifestations including lethargy, muscle spasm, dyspnea, nausea, vomiting, abnormal heartbeat and deep tendon reflexes, and Chvostek and Trousseau signs were recorded in a data-gathering form. In addition, fasting serum magnesium, calcium, sodium, and potassium were measured. RESULTS: The McNemar test results showed that omeprazole can reduce sodium, calcium, and magnesium levels statistically significantly (P < 0.05), but potassium levels do not have a meaningful reduction (P > 0.05). CONCLUSION: Consumption of omeprazole might cause asymptomatic hypomagnesemia, hypocalcemia, and hypernatremia in children. Such side effects should be considered in the follow-up of children under treatment with this medication.

BK virus excretion in acquired immunocompromised children: A comparison between kidney transplant recipients and steroid resistant nephrotic syndrome.

BACKGROUND: BK virus (BKV) is ubiquitous in human beings. Virus reactivation may occur in immunocompromised settings. The aim of this study was to compare BKV excretion in acquired immunocompromised children (kidney transplant recipients and steroid resistant nephrotic syndrome) with normal population. MATERIALS AND METHODS: One hundred and thirty one participants less than 20 years were recruited in the case-control study from June 2009 to December 2010. The participants consisted of 40 patients with steroid resistant nephrotic syndrome (subgroup 1), 39 kidney transplant recipients (subgroup 2) and 52 normal populations as control group. The first morning urine samples were analyzed in duplicate by conventional polymerase chain reaction (PCR) method for BKV. RESULTS: Nine participants out of 131 had positive results for BKV. Three patients in subgroup 1 (7.5%), two patients in subgroup 2 (5.1%) and six people (11.5%) in the control group had positive PCR results for urinary BKV. No significant difference was noted among groups, P = 0.53. The mean of glomerolar filtration rates in participants with positive and negative results for BKV were 125.5 ± 30.8 ml/min/m(2) and 132.2 ± 42.5 ml/min/m(2) respectively, P = 0.8. CONCLUSION: Acquired immunocompromised conditions did not increase the chance of urine BKV excretion in our study.

Is CKD Screening Program Necessary in Developing Countries?

INTRODUCTION: The prevalence of congenital anomaly of kidney and urinary tract (CAKUT) and related chronic kidney disease (CKD) may be increased in countries with higher rate of consanguineous marriage. Therefore, we evaluated the prevalence of CKD by biochemical and kidney ultrasound measurements in the firstgrade pupils. METHODS: This cross -sectional study was carried on children aged 6 to 7 years. Urine analysis, serum creatinine, urine microalbumin to creatinine ratio and kidney ultrasound have been evaluated for participants. RESULTS: 653 children were recruited to the study. Stage 1 and stage 2 systolic hypertension have been found in 6.5 and 1%, respectively. The percentage of stage 1 and stage 2 diastolic hypertension were 1.3 and 0.3%, respectively. Both weight Z-score and waist Z-score had positive correlation with systolic and diastolic blood pressure. Microalbuminuria (in 2.5%) did not have any correlation with the following factors: hypertension, body mass index, microscopic hematuria, glomerular filtration rate, kidney sonographic abnormalities or kidney parenchymal thickness and family history of kidney transplantation. GFR less than 90 mL/ min /1.73 m2 has been detected in 1.8% of the students. Only 1.7% had urine RBC more than 5 in each high-power field (hpf). Approximately 1.5% had anatomical abnormality of kidney and urinary tract (hydronephrosis or hydroureter). CONCLUSION: Considering the higher prevalence of elevated blood pressure and microalbuminuria in Iranian children, a CKD screening program based on evaluating microalbuminuria and blood pressure measurement is needed. However, irrespective of high prevalence of consanguineous marriage in Iran, using kidney ultrasound as a screening tool has not been recommended.  DOI: 10.52547/ijkd.7306.

Prevalence of Nonalcoholic Fatty Liver Disease in Children with Renal Failure Underwent Treatment with Dialysis.

Background: In this study, we aimed to investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) in children with renal failure under treatment with dialysis and its association with biochemical measurements. Methods: In this cross-sectional study, children aged less than 18 years with chronic kidney disease (CKD) who were under treatment with dialysis at least 3 months ago were enrolled. To evaluate fatty liver in those patients who had no recent liver ultrasonography (last 6 months), liver ultrasonography was performed. The characteristics of patients with renal failure with and without NAFLD based on the ultrasonographic evaluation were compared. The association between NAFLD and the studied variables was evaluated. Results: In this study, 39 children (31 males and 8 females) with renal failure who underwent treatment with dialysis were included. From the studied population, six (19.4%) had NAFLD based on ultrasonographic evaluation. There were no differences between renal failure patients with and without NAFLD regarding the biochemical and anthropometric characteristics (P > 0.0). Conclusions: The prevalence of NAFLD in our studied children with renal failure who underwent treatment with dialysis was like the general population and it was not associated with the biochemical and anthropometric characteristics of the patients. Given the importance of NAFLD in renal failure patients as well as its subtle nature, it is recommended to screen patients with CKD for NAFLD.

Neurodevelopmental Outcomes of Infants with Benign Enlargement of the Subarachnoid Space.

Objective: Benign enlargement of the subarachnoid space (BESS) is the most common cause of macrocephaly in infants. This study aimed to evaluate the neurodevelopmental outcomes in infants with BESS. Materials & Methods: In this follow-up study, all records of infants diagnosed with BESS in 2012-2016 were assessed. A clinical follow-up examination was carried out at 6, 12, 18, and 24 months of age to assess the macrocephaly outcomes. Denver Developmental Screening Test-II (DDST-II) was used for evaluating the psychomotor development of infants at 24 months of age. All data were entered in SPSS Version 13, and descriptive statistics were measured. Results: Out of 32 infants included in this study, 28 (87.5%) were boys. Five cases of prematurity history (15.6%), and 23 cases of macrocephaly in the family (71.9%) were recorded. The mean age of BESS diagnosis was 6.8 months (SD=3.2). subdural hematoma was reported in one infant (3.1%). Also, 28 infants showed macrocephaly at 18 months of age (83.3%). Seven patients had developmental delay, according to DDST-II (22%). The mean head circumference at birth and six months of age was significantly greater in infants with developmental delay compared to those with normal development. There was a significant difference between the mean head circumference at birth (P=0.05) and the mean head circumference at six months of age (P=0.02). Conclusion: Developmental delay is frequent in BESS infants, especially those with macrocephaly at birth and six months of age, and requires medical attention.

Correlation between Stable Hyperglycemia and Mortality in Children Admitted to the Pediatric Intensive Care Unit of Imam Hossein Hospital.

BACKGROUND: Stress-induced hyperglycemia is an important issue among pediatrics admitted in the pediatric intensive care unit (PICU). Former studies have declared that hyperglycemia has a high prevalence rate and could increase the risks of mortality among pediatrics. Here, we aimed to investigate the prevalence rate of hyperglycemia and its effects on mortality among pediatrics in the PICU of the hospital. MATERIALS AND METHODS: This cross-sectional study was performed in 2018-2019 on 88 patients admitted in PICU. Data regarding blood sugar (BS) and other clinical and laboratory parameters were collected. Hyperglycemia was accounted for as BS of >126 mg/dl. Hyperglycemia was divided into: mild (126 200). The pediatric risk of mortality (PRISM) score was also calculated for each patient during the first 24 h. RESULTS: Thirty patients (34.1%) had persistent hyperglycemia and 58 patients (65.9%) had normal glycemic indexes. Eleven patients (12.5%) had mild, 9 patients (10.2%) had moderate, and 10 patients (11.4%) had severe hyperglycemia. The prevalence of mortality was 5.7% among hyperglycemic patients and 6.8% among normal glycemic pediatrics. There were no statistically significant differences regarding mortality rate (P = 0.499). The mean PRISM score for normal glycemic patients was 7.03 ± 5.18 and for patients with hyperglycemia was 7.36 ± 6.37. CONCLUSION: Hyperglycemia has no significant effects on mortality and PRISM score of pediatrics in PICU, despite of the previous studies. The frequency of hyperglycemia was also 5.7% among the patients admitted in PICU.

Pruritus Features in Children with End-Stage Renal Disease Underwent Dialysis: A Cross-Sectional Study.

OBJECTIVE: Evaluation of the pruritus features in children with end-stage renal disease (ESRD) who underwent dialysis at an academic tertiary pediatric dialysis center. METHODS: This cross-sectional study was conducted at an academic tertiary pediatric dialysis center, Isfahan, Iran. The reviewed medical records of the children included their characteristics, dialysis properties, and laboratory parameters. The 4-item itch questionnaire was utilized to assess distribution, severity, frequency, and associated sleeping disorders. RESULTS: Thirty ESRD patients with pruritus, including 23 males (76.7%) with a mean age of 11.7 ± 3.64 years, were recruited. The most common cause of CKD was nephronophthisis (23.3%). The median total score of pruritus was 5 (range: 3-15). The distribution score of pruritus was directly correlated with the age (Spearman's rho = 0.42, P = 0.02) and serum level of parathyroid hormone (PTH) (Spearman's rho = 0.42, P = 0.04). In the reduced multiple logistic regression model, the increasing level of serum calcium was associated with increased odds of having total pruritus score ≥ 5 (OR (odds ratio): 4.5; 95% CI 1.12 to 18.05). In addition, an increase in age for one year was found to be associated with 50% higher odds of having total pruritus score ≥ 5 (OR: 1.5; 95% CI 1.03 to 2.18). CONCLUSION: Increased level of serum Ca and higher age were associated with increased odds of having more severe pruritus score in children.

Comparison of the effect of antibiotic-lock and ethanol-lock methods on infection rate in children with hemodialysis catheter.

BACKGROUND: Hemodialysis catheter-related infection has a high incidence and complications. Antibiotic-lock or ethanol-lock can be used to prevent such infections. The aim of this study was to compare the effectiveness of antibiotic-lock and ethanol-lock methods in children undergoing hemodialysis and to evaluate the optimality of these methods. METHODS: In this cohort clinical study, 25 children with chronic renal failure with hemodialysis catheter referring to Imam-Hossein Hospital in Isfahan, Iran, in 2016-2017 were studied. During two 6-month course, their catheter was locked first with antibiotics for 6 months, and then with ethanol for 6 months. Side effects, para-clinical findings and infectious species were also studied and data were analyzed. RESULTS: In the first 6 months, 44% of the subjects and in the second 6 months, 12% of the subjects had catheter infections. The rate of infection, redness and catheter site sensitivity at the second 6-month course was significantly lower compared to the first 6-month course (P<0.05). CONCLUSION: Both Antibiotic-lock and ethanol-lock are useful and practical methods for controlling infection. However, according to the results of this study, the ethanol-lock method seems to be more effective than antibiotic-lock in controlling the infection in children with hemodialysis catheter.

Importance of Mean Platelet Volume in Predicting Cardiac Mechanics Parameters and Carotid-Intima Media Thickness in Children With End-Stage Renal Disease and Comparison With Healthy Children.

Cardiovascular disease (CVD) is the major cause of death in children with ESRD. Echocardiography and Doppler ultrasound are useful devices for diagnosing cardiovascular abnormalities in such patients. However, they are expensive, difficult to perform as a routine, and not available in many centers. Therefore, finding a more accessible and inexpensive method for CVD evaluation biomarkers is needed. The aim of this study was to evaluate the relationship between mean platelet volume (MPV) as a routine hematological parameter with cardiac mechanics characteristics in children with ESRD. Forty-two children under dialysis and 60 age- and sex-matched healthy subjects as control group were enrolled in the study. Carotid-intima media thickness (CIMT) and echocardiographic parameters were measured in both groups. In addition, hematological and biochemical variables were evaluated in blood samples of participants. MPV was significantly higher in patients than in controls. CIMT, left ventricular mass index (LVMI), end diastolic diameter, strain rate, and global longitudinal strain were significantly different between the two groups. MPV was positively correlated with LVMI and inversely with ejection fraction. In receiver operating characteristic (ROC) curve analysis, the area under the ROC curve (AUC) values for MPV in predicting left ventricular hypertrophy (LVH) and abnormal CIMT were 0.65 (P = 0.07) and 0.53 (P = 0.74), respectively. MPV was correlated with some cardiac abnormalities in children with ESRD. However, it could not show appropriate predictive values in diagnosing LVH and subclinical atherosclerosis. Further studies with prospective design could shed more light in this topic.

Bullous Systemic Lupus Erythematosus and Lupus Nephritis in a Young Girl.

Bullous systemic lupus erythematosus (BSLE) is an autoimmune blistering disease occurring in patients with systemic lupus erythematosus (SLE). It is a rare disease, especially in children. A 14-year-old girl initially presented with fatigue, generalized vesiculobullous skin lesions, and ulcers over the hard palate and oral mucosa. Clinical investigations revealed hematuria and proteinuria, a high erythrocyte sedimentation rate and titer of antinuclear antibody, and anti-double-stranded DNA. Skin biopsy findings were suggestive of BSLE. A renal biopsy confirmed the features of class V lupus nephritis. Based on the clinical features and investigations, a diagnosis of BSLE with nephritis was made. She received methylprednisolone pulse therapy and hydroxychloroquine; however, it did not alleviate the vesiculobullous eruption, so treatment with dapsone started and resulted in the dramatic disappearance of the lesions. Interruption of dapsone due to hemolysis did not aggravate the bullous disease. During follow-up, she had multiple flare-ups of disease and nephritis without rebound of bullous lesions. BSLE is a rare presentation of SLE in children. Differentiating it from other skin bullous diseases and SLE with blister is important for the correct management. The unusual presentation of this disease may delay the diagnosis and therefore requires a high index of clinical suspicion.

Gene mutation analysis in Iranian children with nephronophthisis: a two-center study.

INTRODUCTION: Nephronophthisis is of the most commonly inherited ciliopathies that leads to end-stage renal disease in children. The NPHP1 gene is the first identified gene responsible for nephronophthisis and related diseases. This study assessed mutations of the NPHP1 gene in 16 Iranian families with at least one member presenting features of nephronophthisis. MATERIALS AND METHODS: Fifty-seven patients diagnosed with chronic kidney disease or end-stage renal disease were referred to Imam Hossein Children Hospital, in Isfahan, Iran. The gene analysis study was carried on 16 patients and their first-degree relatives (40 DNA samples) suspicious of having nephronophthisis. The NPHP1 deletion analysis was performed for exons 5, 7, and 20 of the NPHP1 gene. RESULTS: The patients' median age was 15 years. The mean and median age of the first presentation was 10.06 ± 2.59 years and 10.5 years, respectively. A homozygous deletion was identified in the NPHP1 gene spanning at least from exon 5 to exon 20 in two families. High-throughput mutation analysis identified a homozygous truncating mutation (c.1504C>T, p.R502*) in the NPHP5 in 5 families. CONCLUSIONS: By combining NPHP1 deletion analysis with multiplex-polymerase-chain-reaction-based high-throughput mutation analysis we could identify the molecular disease-cause in 7 of 15 families from Iran. In 8 families, the molecular disease cause remained unknown.

Association of neutrophil gelatinase associated lipocalin and cystatin-C with kidney function in children with nephrotic syndrome.

BACKGROUND: Nephrotic syndrome (NS) is a major clinical concern in human health, especially in children. Despite of the etiology, the prediction of remission in different treatment regimens based on suitable biomarkers is under development. The goal of this evaluation was the demonstration of correlation between serum level of Neutrophil gelatinase associated lipocalin (NGAL) and cystatin-C with kidney function in patients with NS. METHODS: During the period between September 2008 and December 2011, 52 patients admitted to St. Al Zahra University Hospital were selected for evaluation. The measured parameters consisted of NGAL, cystatin-C, creatinine, albumin, blood urea nitrogen, urine protein, glomerular filtration rate. Demographic data were collected and considered in comparisons. Comparison between variables and their correlations were examined. RESULTS: Means of serum NGAL and cystatin-C were significantly higher in case than the control group, P < 0.05. The mean of serum NGAL in patients without remission and who achieved remission were 23.09 (standard deviation [SD] ±10.11) and 36.26 (SD ± 20.10) ng/ml respectively; P < 0.05. Serum NGAL levels had a correlation with the following factors: Systolic blood pressure, diastolic blood pressure (DBP), cystatin-C, remission. Linear regression analysis showed a significant correlation between cystatin-C and systolic and DBP. CONCLUSIONS: Based on the results, serum NGAL can be used as a prognostic marker for remission. In addition, NGAL and cystatin-C are biomarkers of kidney injury in NS.

Association of proteinuria with various clinical findings and morphologic variables of oxford classification in immunoglobulin a nephropathy patients.

BACKGROUND: Immunoglobulin A nephropathy (IgAN) with nephrotic syndrome is an uncommon form of IgAN. Clinical and morphological characteristics of proteinuria in IgAN, especially when is in nephrotic range have not yet been fully examined. This study was aimed to correlate morphologic variables of the Oxford classification, and various clinical data with proteinuria in IgAN patients. We also aimed to demonstrate the significance of prevention of proteinuria as one of the important factors in progression of this disease. METHODS: In an observational study conducted on IgAN patients, total of 114 biopsies were entered in the study. IgAN was diagnosed by light and immunofluorescence study. RESULTS: Of 114 patients 70.2% were male. Mean age of patients was 37.7 ± 13.6 years. The mean of proteinuria was 1742 ± 1324 mg/day. Also mean of serum creatinine (Cr) was 1.6 ± 1.5 mg/dL. Of 114 patients, 11(9.6%) had nephrotic range proteinuria. In this study, there was a positive correlation between proteinuria and serum Cr, peri-glomerular fibrosis or interstitial fibrosis. There was a positive association between proteinuria and totally sclerotic glomeruli too. There was also a positive association between the amount of fibrous crescents and the level of proteinuria. Nephrotic proteinuria could just be seen in male patients. Also, nephrotic syndrome had a positive association with the number of crescents. CONCLUSIONS: Our findings firstly support the prognostic value of crescent due to its association with proteinuria and secondly imply the importance of treatment of proteinuria to prevent progression of IgAN.

Efficacy of Co-administration of Garlic Extract and Metformin for Prevention of Gentamicin-Renal Toxicity in Wistar Rats: A Biochemical Study.

BACKGROUND: Gentamicin (GM) nephrotoxicity has been related to oxidative stress. Garlic and metformin (MF) have anti-oxadant activity and therefore, this study was aimed to evaluate the preventive and curative effects of garlic, MF and their combination on GM indeced tubular toxicity in Wistar rats. METHODS: In a pre-clinical study, 70 male Wistar rats were randomly designated into 7 groups of 10 and treated as follows: Group 1: Received saline for 20 days. Group 2: Were injected 100 mg/kg/d of GM intraperitoneally (ip), for 10 days and saline for 10 more days. Group 3: Received GM for 10 days then 20 mg/kg garlic ip for the next 10 days. Group 4: Received GM for 10 days and MF (100 mg/kg) orally for the next 10 days. Group 5: Received GM for 10 days and a combination of MF and garlic for the next 10 days (100 and 20 mg/kg, respectively). Group 6: The same as group 5but with half-doses of MF and Garlic. Group 7: Received GM for 10 days together with a combination ofMF and garlic. On 20(th) day of the experiment the serum blood urea nitrogen (BUN) and creatinine (Cr) were measured and compared in different groups. RESULTS: GM injection significantly increased the serum BUN and Cr (P < 0.05). Administration of MF, garlic or their combination with or after injection of GM (high doses) could atenuate BUN and Cr. CONCLUSIONS: The results indicate that MF and garlic or their combination have curative and protective activity against GM nephrotoxicity.

Correlation of immunostaining findings with demographic data and variables of Oxford classification in IgA nephropathy.

BACKGROUND: Oxford classification for IgA nephropathy (IgAN) did not include pattern of immunostaining in the analysis. OBJECTIVE: The aim of this study is to determine the potential correlation between the immunostaining data and morphologic variables of Oxford classification (MEST) and various clinical and demographic data of patients with IgAN. PATIENTS AND METHODS: The pathologic diagnosis of IgAN requires the demonstration of IgA-dominant mesangial or mesangio-capillary immune deposits through immunofluorescence (IF) microscopy. The immune deposits were semiquantitatively assessed as 0 to 3+ positive bright. These were correlated with various clinical, demographic and histological variables of Oxford classification. RESULTS: A total of 114 biopsies were enrolled to the study (70.2% were male).  Mean age of the patients was 37.7 ± 13.6 years. This study showed that, only C3 deposits had a significant correlation with serum creatinine. Other antibodies (IgA, IgM and IgG) had no significant association with serum creatinine. This study also showed that IgA deposition score had significant positive association with endocapillary proliferation (E) and segmental glomerulosclerosis (S) variables of Oxford classification. Moreover, IgM deposition score had positive association with S variable. There was no significant association of IgG deposition score with four morphologic variables of Oxford classification. There was significant association of C3 deposition score with S and E variables too. CONCLUSIONS: The significant relationships of IgA and C3 deposits with some of the Oxford variables need more attention. We propose to further investigate this aspect of IgAN disease.

Acute kidney injury: A pediatric experience over 10 years at a tertiary care center.

BACKGROUND: The etiology of acute kidney injury (AKI) varies in different countries. In addition, the etiology of AKI in hospitalized children is multifactorial. The importance of diagnosing AKI is not only because of short-term high morbidity and mortality rate, but also for its effect on developing chronic kidney disease. OBJECTIVES: we studied retrospectively AKIs of children who were hospitalized over 10 years in a University hospital. MATERIALS AND METHODS: A retrospective analysis of the medical recorded data of 180 children less than 18 years treated for AKI in Alzahra Hospital, Isfahan, Iran, were performed during the period of March 2001 to February 2011. For each patient, demographic and anthropometric data, laboratory data, electrocardiographic findings, ultrasound results, etiology of AKI and short-term outcomes were recorded. RESULTS: The male to female ratio was 1.57 to 1. Mean age was 5.28 ± 6.3 (SD) years and the median was 1.8 years. The more frequent age group was children less than 2 years. The mortality rate was 22.2% (40 patients). The mortality was not correlated with age (p= 0.74). Renal replacement therapy was recommended for 62 patients (34.4%). Mean of the first and last glomerular filtration rate (GFR) were 18.33± 1.12 ml/min/1.73 m² and 52.53 ± 2.98 ml/min/1.73 m², respectively. The most common urinary sediment finding in approximately 70% of the patients was either renal epithelial cell or renal cell cast. Increased kidney echogenicity was the most common ultrasound finding (48%). Using ANOVA regression analysis, the etiology of disease was the only predictor of mortality (p=0.0001). CONCLUSIONS: We concluded that the mortality is still high in AKI. Furthermore, the poor outcome (defined as low GFR) are higher among patients with low levels of first GFR and higher RIFLE score.

Chronic kidney disease in children: A report from a tertiary care center over 11 years.

BACKGROUND: Chronic kidney disease (CKD) is an overwhelming illness in children. Considering the importance of CKD in pediatric age group, in addition to the racial and ethnic differences in prevalence and etiology of CKD, epidemiologic studies are recommended. The majority of the results regarding the incidence of CKD have been achieved from studies on hospitalized children. OBJECTIVES: This study evaluates the incidence and etiology of chronic renal failure (CRF) in children in a tertiary care center in Isfahan, the second large province of Iran. PATIENTS AND METHODS: A retrospective analysis of medical record data of children less than 19 years old, hospitalized for CKD at St Alzahra hospital, Isfahan, Iran, during the period of November 2001 until December 2011 was made. A total of 268 eligible cases were recruited. Patients were categorized into 5 groups according to glomerular filtration rate (GFR) and KDOQI guideline. RESULTS: Out of 268 patients, 144 patients were male (54%). The mean and median of age was 11.01± 0.39(SD) years and 12.5 years, respectively. Approximately 55% of patients had either systolic and/or diastolic hypertension. The most frequent etiology of CKD was glomerular diseases (34%) followed by reflux nephropathy (16.7%). Most patients (74.8%) had GFR less than 15 ml/min/m², when diagnosed. Anemia was the most prevalent laboratory abnormality (85%). Small-size kidneys were seen in 65.8% of patients. Kidney replacement therapy (either hemo- or peritoneal dialysis) was applied for 72.3% of the patients. The transplantation rate average was 7.2 per million children population. The annual incidences of CKD (mostly advanced stages) were 5.52 per million population (PMP) and 16.8 per million children population, respectively. The all cause of mortality rate was 18.4%. Younger age was the only independent predictor of mortality (p=0.005). CONCLUSIONS: We concluded that glomerular diseases are the leading cause of CKD in our patients. In addition, the annual incidence of CKD is considerably high.

Oxford-MEST classification in IgA nephropathy patients: A report from Iran.

BACKGROUND: There is a limited knowledge about the morphological features of IgA nephropathy (IgAN)in the middle east region. OBJECTIVES: The objective of this study was to evaluate the spectrum of histopathological findings in IgAN patients at our laboratory. PATIENTS AND METHODS: At this work, an observational study reported which was conducted on IgAN patients using the Oxford-MEST classification system. RESULTS: In this survey, of 102 patients 71.6 % were male. The mean age of the patients was 37.7 ± 13.6 years. Morphologic variables of MEST classification was as follows; M1: 90.2 %, E: 32 %, S: 67 % also,T in grads I and II were in 30% and 19% respectively, while 51% were in grade zero. A significant difference was observed in segmental glomerulosclerosis (P=0.003) and interstitial fibrosis/tubular atrophy frequency distribution (P= 0.045), between males and females . Furthermore, it was found that mesangial hypercellularity was more prevalent in yonger patients. Moreover, there was a significant correlation between serum creatinine and crescents (P<0.001). There was also significant correlation of serum creatinine with segmental glomerulosclerosis (P<0.001). CONCLUSIONS: Higher prevalence of segmental glomerulosclerosis and interstitial fibrosis/ tubular atrophy, as the two of, four variables of Oxford-MEST classification of IgAN in male patients further attests that male gender is a risk factor in this disease.In this study the significant correlation between serum creatinine and crescent was in an agreement with previous studies and suggests for the probable accomodation of extracapillary proliferation as a new variable in MEST system.