Accuracy of cystosonography in the diagnosis of vesicourethral reflux in children.

Vesicoureteric reflux (VUR) is found in 1% of all children and in 30%-50% of those with urinary tract infection. Furthermore, VUR in childhood is the main reason for pyelonephritis, hypertension and chronic kidney disease. Recently, a variety of procedures with low radiation have been recommended for diagnosis of VUR. Therefore, in this study, voiding urosonography (VUS) or cystosonography was performed for evaluation of VUR and for comparing it with radio nucleotide cystography (RNC). We studied 25 children admitted with initial diagnosis of VUR in our center in the year 2007. Simultaneously, RNC and VUS were performed for all the patients. VUR was detected in eight patients with the VUS procedure and in nine children with RNC. Another patient was diagnosed only by RNC, and two other patients by only VUS. The two methods were concordant in detection and exclusion of urinary reflux in 87% (P: 0.000, r: 0.728). Furthermore, the diagnosis of various grades of reflux by these two schemes were comparable (P: 0.0000, r: 0.724). Sensitivity and specifity of VUS was determined as 87% and 88%, respectively, with a 94% positive predictive value and a 77% negative predictive value. We conclude that VUS is a highly accurate, safe and inexpensive tool for the screening, diagnosis and follow-up of VUR.

Pruritus in hemodialysis patients.

BACKGROUND: Pruritus is one of the most bothersome symptoms in patients on maintenance hemodialysis (HD), however little progress is seen in our understanding of its pathogenesis. The aim of this study was to evaluate the frequency of pruritus in HD patients in Tehran, Iran, and to correlate its presence and intensity with relevant clinical and laboratory parameters. METHODS: One hundred sixty-seven patients on maintenance HD at three out-patient HD units were enrolled in the study. Itch intensity was scored as mild, moderate and severe. Some relevant clinical and laboratory parameters (age, sex, xerosis, presence of neuropathy, duration of dialysis, history of atopy and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone [PTH] and alkaline phosphatase) were evaluated. RESULTS: Pruritus was found in 41.9% of patients. The intensity of itching was mild, moderate and severe, in 51.4%, 11.4% and 37.7% of patients, respectively. In 22 patients (31.4%) pruritus intensified during and after dialysis. There was no significant difference in the serum levels of creatinine, blood urea nitrogen, calcium, phosphorus, alkaline phosphatase, PTH and hematocrit between patients with and without pruritus. Age, sex, xerosis, underlying renal disease, history of atopy and duration of haemodialysis were not significantly different between the two groups. However, neuropathy was significantly more common in the pruritic group (63.8% versus 42.1%) (pv = 0.006). CONCLUSION: Clinical neuropathy was the only significant finding in the pruritic group in our study. This finding justifies further research on nerve function and neurotransmitters in hemodialysis patients and the introduction of new drugs targeting neuropathy.