Karyomegalic-like nephropathy, Ewing's sarcoma and ifosfamide therapy.

Karyomegalic interstitial nephropathy has been reported as a rare interstitial nephritis in adult patients. Histology shows atypical epithelial cells and large abnormal hyperchromatic nuclei with irregular outlines. We report 3 adolescent patients who all recovered from their initial treatment for Ewing's sarcoma but developed a tubulopathy attributed to ifosfamide therapy. Renal impairment resulted in biopsy, which showed features of karyomegalic nephropathy in all 3. One patient has progressed to haemodialysis. Recognition of the pathology may be important in similar patients. It is surmised that the unusual histological findings in these patients stem from a common pathogenesis which may be related to chemotherapeutic agent related nuclear damage. At present there is no specific treatment to prevent progressive renal impairment.

Cutaneous warts in children before and after renal transplantation.

Cutaneous warts occur in 3.9-4.9% of children in the UK. The incidence is increased in organ transplant recipients and may be increased in patients with chronic kidney disease (CKD), since uraemia reduces the immune system's function. We surveyed the records from our CKD and renal transplant clinic to ensure patients with warts were identified and appropriately treated. Data were collected by questionnaire. The presence of warts, location, treatment, levels of pain and emotional upset were recorded. Nine of 49 (18.4%) pre-transplantation patients (33 male, median age 12.1 years) were currently suffering from warts compared with 17 of 60 (28.3%) post-transplantation patients (34 male, median age 13.9 years). A further 14 pre-transplantation and 16 post-transplantation patients had previously suffered from warts which had resolved. Forty-one patients had sought treatment for warts, mainly from primary care. Five patients, all having received transplants, were seen by a dermatologist. Self-rated levels of pain and emotional upset were generally low, apart from those of four adolescent patients who expressed significant emotional upset. We concluded that cutaneous warts are more common among CKD patients. Appropriate information and treatment are required before and after transplantation. The majority of warts can be treated in primary care, but selected patients with extensive warts that cause distress need early referral for dermatology opinion.

Automated microscopy, dipsticks and the diagnosis of urinary tract infection.

OBJECTIVES: Automated microscopy is increasingly used to screen urine samples for suspected urinary tract infection (UTI). A 98.8% negative predictive value has been reported in adult studies. The aim of our study was to validate this method in a paediatric population. METHODS: Urine samples were collected from children with known or suspected nephrourological disease attending nephrology and urology clinics over a 6-week period. Samples were tested with dipstick, the UF-100 flow cytometer (automated microscopy) and culture. A gold standard of a positive culture of morethan 10(5) colony forming units per ml (cfu/ml) with a pathogenic organism was used and the sensitivity, specificity and likelihood ratios were calculated. RESULTS: 280 urine samples were collected from 263 patients (143 male, median age 10.2 years, range 0.1-19.75 years). 221 (79%) were midstream or clean-catch samples. Automated microscopy identified 42 of 186 samples as requiring culture and 17 of 19 samples which had a pure growth of more than 10(5) cfu/ml. Two patients were not identified by automated microscopy: one was treated for vulvovaginitis, and one commenced prophylactic antibiotics prior to the culture result being obtained. The sensitivity, specificity, positive and negative likelihood ratios were 0.89, 0.85, 5.98 and 0.17, respectively. This compared to 0.95, 0.72, 3.34 and 0.29, respectively, with urine dipstick. CONCLUSION: Automated microscopy performed comparably to urine dipstick in the diagnosis of UTI with improved specificity and likelihood ratios with slightly reduced sensitivity. The data support the use of automated microscopy for screening urine samples for culture in children, but different automated microscopy methods and algorithms require local evaluation.