Validity of the Adrogué-Madias Formula for the Management of Acute Dysnatremias in Critically Ill Children: A Prospective Multicenter Analysis.

OBJECTIVE: Current conventional formulas do not predict the expected changes in serum sodium after administration of various fluids to correct serum sodium abnormalities. The Adrogué-Madias formula is currently the preferred and widely used fluid prescription for adult patients with dysnatremias, but its therapeutic efficacy has not been validated in pediatric patients. METHODS: In this prospective study, we used the Adrogué-Madias formula for calculating the appropriate rate of various fluids administration to correct serum sodium abnormalities in 7 critically ill children with acute dysnatremias. RESULTS: After administration of various intravenous fluids using the Adrogué-Madias formula, the anticipated as well as the achieved sodium concentrations were almost similar. CONCLUSIONS: This study demonstrates that the use of the Adrogué-Madias quantitative formula allows to calculate the appropriate rate of administration of various fluids. The calculated fluid administration resulted in the subsequent actual laboratory values and clinical changes.

Assessment of Urinary Level of Neutrophil Gelatinaseassociated Lipocalin (NAGL) in Children with Renal Scar Due to Vesicoureteral Reflux.

INTRODUCTION: Renal scarring is a serious complications of urinary tract infection and vesicoureteral reflux (VUR). The dimercaptosuccinic acid (DMSA) scan is the gold standard method for diagnosing renal scars but is an expensive procedure that risks ionizing materials and is not available to everyone. Neutrophil gelatinase-associated lipocalin (NGAL) increases following inflammation, infection, and acute kidney injury in the urine. The aim of this study was to evaluate the urinary level of NGAL and determine its diagnostic value in renal scarring. METHODS: Patients aged 3 to 60 months with pyelonephritis were included in this study. Voiding cystourethrography (VCUG) was performed in the presence of hydronephrosis on ultrasonography. Children with VUR underwent DMSA scans six months after successful treatment of pyelonephritis., Patients were divided into two groups based on the result of DMSA scan: those with and those without renal scars. Levels of urinary NGAL were measured in both groups. RESULTS: Ninety-two children with VUR (grades 2 to 5) were studied, of whom 40 had renal scars and 52 did not. The urinary level of NGAL at the cutoff point of 284 ng/dL had 70% sensitivity and 100% specificity for the detection of renal scars and was higher in patients with renal scars. (P < .05). CONCLUSION: The urinary level of NGAL is considerably higher in children with renal scarring. It is not a good test for screening and early diagnosis due to its low sensitivity, although it can identify renal scars caused by VUR with high specificity.  DOI: 10.52547/ijkd.6951.

Revisiting the Management of Pediatric Kidney Transplants, A Multicenter Analysis

The newest Kidney Disease Improving Global Outcomes (KDIGO) guideline recommendations were investigated mainly for the care of adult kidney transplant recipients, but no guideline exists for the management of pediatric transplant recipients. This review provides update recommendations in the management of pediatric kidney transplantation. Four electronic databases, PubMed, EMBASE, Google Scholar, and Web of Science were searched systematically for the last two decades, using Mesh terms in English language. The Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach was used for grading the quality of the overall evidence and the strength of recommendations for each outcome across the studies. The overall quality of evidence categorized as high (A), moderate (B), low (C), or poor (D). The strength of a recommendation was determined as level 1 (recommended) or level 2 (suggested). The ungraded statements were determined on the basis of common sense to provide general advice. Of the 317 citations which were screened for the evidence review, 62 were included in data extraction. The included studies were randomized controlled trials, prospective cohorts and cross-sectional, descriptive, and review studies. Of the 115 statements, 56 (48.6%) were graded 1 (we recommend), 34 (29.5%) were graded 2 (we suggest), and 25 (21.7%) were ungraded statements. Altogether, only 22 (19.1%) of recommendations reached the "A" or "B" levels of quality of evidence. The pediatric kidney transplant recipients are different from adult recipients regarding the primary kidney diseases, surgical techniques, drug metabolism, adherence to medications, growth and neurocognitive development and immunization needs prior to transplantation.  DOI: 10.52547/ijkd.7179.

Assessment of Serum Level of Vitamin D in Infants with Nephrolithiasis.

INTRODUCTION: Detection of nephrolithiasis is readily possible in infants with the advent of new imaging technology. Vitamin D is routinely given to newborn infants shortly after birth during infancy. Vitamin D is known to increase urinary calcium excretion which may be responsible for the increased incidence of nephrolithiasis during infancy. To test this hypothesis we studied the serum level of vitamin D and renal handling of calcium in infants with nephrolithiasis . METHODS: In this prospective case-controlled study, we measured serum levels of vitamin D and calcium accompanied by urinary calcium level in infants between 1 to 12 months with nephrolithiasis who fed with breast milk and vitamin D supplement and compared these parameters with healthy infants without nephrolithiasis after matching for sex and postnatal age as the control group. All infants with nephrolithiasis were evaluated for metabolic disorders and other risk factors and positive cases were excluded from the study. RESULTS: Fifty infants between 1 to 12 months with mean postnatal age 6.96 ± 2.29 months with nephrolithiasis and 50 control infants with mean postnatal age 6.94 ± 2.55 months were enrolled in the study. Mean serum level of vitamin D in the case and control groups was 41.49 ± 11.69 and 35.67 ± 6.76 ng/mL, respectively. Mean serum level of calcium in case group was 9.63 ± 0.32 vs. 8.59 ± 1.21 mg/dL in the control group. Mean urinary calcium- creatinine ratio (Ca/Cr) in the study and control groups was 0.15 ± 0.16 and 0.08 ± 0.02, respectively, Differences were statistically significant in all three variables (P < .05). CONCLUSION: Routine consumption of vitamin D increases urinary level of calcium and in presence of other predisposing factors could accelerate the genesis of nephrolithiasis in infants.

Validity of glucose measurements in the blood by a glucometer reagent strip in critically ill infants.

INTRODUCTION: Hypoglycemia in critically ill infants is a frequent metabolic disorder which is often due to defective glucose homeostasis. If not recognized annotated early, it can result in severe neurological damage with high mortality and morbidity. Today, glucometer is recommended for fast measuring blood glucose. The aim of this study was to evaluate the accuracy of glucometer for early diagnosis of hypoglycemia in the acutely ill infant. MATERIALS AND METHODS: This study evaluates 130 critically ill infants less than 1year of age who were admitted to Besat hospital - Sanandaj - IRAN. Blood sugar was measured by standard serum method (glucose oxidase) and glucometer reagent strip. RESULTS: The overall means of blood sugar were 115.6 ±â€¯1.75 with serum method and 119.1 ±â€¯1.56 with glucometer method. The rates of sensitivity, specificity, positive predictive value and negative predictive value with glucometer method and with serum glucose method were 72%, 53%, 62%, and 77% respectively. The correlation between the two methods was significant (p < 0.001). Kappa statistics for the two methods was 42%. CONCLUSIONS: The results showed that in general, glucometer may be appropriate for rapid screening in emergency situations and when frequent blood glucose monitoring is needed but it cannot be regarded as a very suitable and reliable tool for diagnosis of hypoglycemia in critically ill infants.