D-dimer Versus Procalcitonin for the Diagnosis of Pediatric UTI and Prediction of Renal Parenchymal Involvement.

INTRODUCTION: Previous studies have investigated the applicability of different serum biomarkers for the diagnosis of urinary tract infection (UTI) and differentiation between acute pyelonephritis (APN) and cystitis. We aimed to compare serum D-dimer with procalcitonin (PCT) for the diagnosis of UTI and prediction of APN in a pediatric population. METHODS: This cross-sectional study included children aged 1 month to 14 years with their first UTI episode confirmed by positive urine culture. Serum PCT and D-dimer were measured in all participants before the initiation of antibiotic therapy. Dimercaptosuccinic acid (DMSA) scan was performed in all children within 2 months of UTI resolution to determine renal parenchymal involvement. RESULTS: From the 43 children included in this study, 69.8% were female. D-dimer level was significantly higher in boys (823.26 ± 298.19 vs. 582.96 ± 359.96 ng/mL; P < .05). PCT level was comparable in boys and girls (P > .05). Logistic regression revealed that regardless of gender, children aged 2 to 6 years had significantly higher chance of at least one positive marker compared to those 6 to 14 years (OR = 6.12, 95% CI: 1.09 to 34.47, P < .05). The area under the curve value from the receiver operating characteristic curve of D-dimer ≥ 513 ng/mL for prediction of APN was 0.873, with a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 84.8, 90, 96.6, 64.3, and 86%; respectively. CONCLUSIONS: According to the results of the current study, 81.4% of children aged 1 month to 14 years with their first UTI episode, were either PCT or D-dimer positive. D-dimer appears to have the highest diagnostic performance for the detection of APN. DOI: 10.52547/ijkd.6089.

Chronic Kidney Disease in Iran: First Report of the National Registry in Children and Adolescences.

PURPOSE: Knowing the epidemiological aspects of chronic kidney disease (CKD) in children is crucial for early recognition, identification of reversible causes, and prognosis. Here, we report the epidemiological characteristics of childhood CKD in Iran. MATERIALS AND METHODS: This cross-sectional study was conducted during 1991 - 2009. The data were collected using the information in the Iranian Pediatric Registry of Chronic Kidney Disease (IPRCKD) core dataset. RESULTS: A total of 1247 children were registered. The mean age of the children at registration was 0.69 ± 4.72 years (range, 0.25 -18 years), 7.79 ± 3.18 years for hemodialysis (HD), 4.24 ± 1.86 years for continuous ambulatory peritoneal dialysis (CAPD), and 3.4±1.95 years for the children who underwent the renal transplantation (RT) (P < .001). The mean year of follow-up was 7.19 ± 4.65 years. The mean annual incidence of CKD 2-5 stages was 3.34 per million age-related population (pmarp). The mean prevalence of CKD 2-5 stages was 21.95 (pmarp). The cumulative 1-, 5-, and 10-year patients' survival rates were 98.3%, 90.7%, and 84.8%, respectively. The etiology of the CKD included the congenital anomalies of the kidney and urinary tract (CAKUT) (40.01%), glomerulopathy (19.00%), unknown cause (18.28%), and cystic/hereditary/congenital disease (11.14%). CONCLUSION: The incidence and prevalence rate of pediatric CKD in Iran is relatively lower than those reported in Europe and other similar studies. CAKUT was the main cause of the CKD. Appropriate management of CAKUT including early urological intervention is required to preserve the renal function. Herein, the long-term survival rate was higher among the children with CKD than the literature.

Prevalence of idiopathic hypercalciuria in children with urinary system related symptoms attending a pediatric hospital in Bandar Abbas in 2014.

BACKGROUND: Idiopathic hypercalciuria is a group of diseases which can be manifested with urinary symptoms. Its importance is due to high prevalence, recurrent infections, and stone formations which are often asymptomatic. OBJECTIVE: The objective of this study was to determine the prevalence of idiopathic hypercalciuria in children with urinary system related symptoms in Bandar Abbas in 2014. METHODS: This descriptive cross-sectional study was done in 2014 in a children's hospital in Bandar Abbas (southern Iran) on 321 children who were between 2 months to 14 years old. Random morning urine sample was obtained from all the patients, and calcium to creatinine ratio was assessed for all the patients for two times. Hypercalciuria is defined as urinary calcium excretion rate that is greater than 4 mg/kg per 24 hours in a child older than two years of age. Data was analyzed using IBM SPSS statistics 23.0 software and Chi-square and independent-samples t-test. RESULTS: Among the 321 children assessed, 153 (47.7%) had idiopathic hypercalciuria. The mean age of the children with idiopathic hypercalciuria was 55.20±43.71. Prevalence of idiopathic hypercalciuria was 48.3% in children with urinary tract infection, 54.9% and 53.6% in children with microscopic and macroscopic hematuria respectively, In children with dysuria, there were 52.1%, and 51.8% in children with frequency, 49.1% in children with kidney stone which was confirmed with sonography, 28.6% and 37.5% in children with nocturnal and daily urinary incontinency respectively. Results of this study showed no significant relationship between urinary system symptoms and idiopathic hypercalciuria (p>0.05). CONCLUSION: Hypercalciuria can be presented with different symptoms associated with urinary symptoms. Therefore, it is recommended to check the urinary calcium level in children with urinary symptoms with no definite etiology.

Predictive Accuracy of Urinary neutrophil gelatinase associated lipocalin (NGAL) for renal parenchymal involvement in Children with Acute Pyelonephritis.

INTRODUCTION: Urinary tract infections (UTIs) are among the most prevalent infections in children and infants. Early and accurate detection of renal parenchymal involvement in UTI is necessary for decision making and determining treatment strategies. The aim of this study was to determine the predictive accuracy of urinary neutrophil gelatinase-associated lipocalin (NGAL) for renal parenchymal involvement in children with acute pyelonephritis. METHODS: This descriptive, cross-sectional study was conducted in 2014 on children who had been diagnosed with UTI. Children who were admitted to Koodakan Hospital in Bandar Abbas, Hormozgan Province, Iran, and whose ages ranged from two months to 14 years were enrolled in the study. Urine samples were taken to conduct urinary NGAL tests, urine cultures, and urinalyses. In addition, some blood samples were collected for the purpose of determining leukocyte count and C-reactive protein (CRP) and to conduct erythrocyte sedimentation rate (ESR) tests. All patients underwent a dimercaptosuccinic acid (DMSA) scan. SPSS software was used to analyze the data. RESULTS: Among the participants in the study, 29 were male (32%), and 60 were female (68%). The mean age of the children who participated in the study was 2.99 ± 2.94 years. The results of the Kruskal-Wallis test showed a significant increase in the urinary NGAL level, an increase in the CRP level, and higher DMSA scan grades (p < 0.001). The cutoff point amounted to > 5 mg/l, having the negative predictive value (NPV) of 76.3%, the specificity of 97.83%, the positive predictive value (PPV) of 96.7%, and the sensitivity of 67.4%. CONCLUSION: Urinary NGAL is not sensitive enough for the prediction of renal parenchymal involvement, but it is a specific marker.

Desmopressin versus Oxybutynin for Nocturnal Enuresis in Children in Bandar Abbas: A Randomized Clinical Trial.

BACKGROUND: Nocturnal enuresis is among the most common disorders in children. Several pharmacological and non-pharmacological treatments are available for nocturnal enuresis. Studies for reaching the best pharmacological treatment for this disorder are continuing. OBJECTIVE: To compare the effectiveness and safety of Desmopressin and oxybutynin for treatment of nocturnal enuresis in children from Bandar Abbas in 2014. METHODS: This randomized controlled trial was conducted in 2014 and participants included 66 children with nocturnal enuresis who were more than 5 years old. Patients were randomly assigned into two groups. The first group received 120 microgram Desmopressin daily for 2 months, then 60 microgram daily for 2 months, then 60 microgram every 2 days. The second group received 5 mg oxybutynin twice a day for 6 months. The patients were followed after 1, 3, and 6 months to track treatment response. The study outcomes were frequency of nocturnal enuresis, urinary incontinency, urgency, and frequency. Data were analyzed using SPSS software. RESULTS: There were no significant differences between the two groups with respects to sex, age, place of residence, and parents' education (p<0.05). Nocturnal enuresis, incontinency, urgency, and frequency of nocturnal enuresis was significantly lower with Desmopressin treatment in comparison to the oxybutynin treated group after 1 and 3 months (p<0.05). In addition, constipation and xerostomia were more frequent among the oxybutynin group after 1, 3, and 6 months (p<0.01). Blurred vision was also more frequent among oxybutynin group after 3 months (p<0.01). After 6 months the frequency of nocturnal enuresis and its frequency was higher in oxybutynin group in comparison to the Desmopressin group (p<0.05). CONCLUSION: Desmopressin is more effective and has lower rate of side effects in comparison to oxybutynin for treatment of nocturnal enuresis. We recommend using Desmopressin for treatment of nocturnal enuresis in children. More studies are needed to achieve the best pharmacological treatment option for treatment of nocturnal enuresis. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov with a ClinicalTrials.gov Identifier: NCT02538302. FUNDING: The funder of this research is Hormozgan University of Medical Sciences.

Predictive accuracy of urinary ß2-microglobulin for kidney injury in children with acute pyelonephritis.

INTRODUCTION: Leukocyte count, erythrocyte sediment rate and C-reactive protein are available laboratory markers which may be helpful in prediction of technetium Tc 99m dimercaptosuccinic acid (DMSA) renal scintigraphy results. None of these, however, have enough accuracy for prediction of renal injury and scar. This study was aimed to evaluate the diagnostic accuracy of urinary ß2-microglobulin in detection of renal injury in children with acute pyelonephritis. MATERIALS AND METHODS: Eighty-nine children between 2 months and 14 years old with the diagnosis of acute pyelonephritis that had no past history of infection in the urinary tract system were enrolled in the study. A standard urine sample according to patients' age was obtained for urine culture, urinalysis, and urinary ß2-microglobulin tests. Blood sample was obtained for leukocyte count, creatinine, blood urea nitrogen, C-reactive protein, erythrocyte sediment rate, and electrolytes tests. All patients underwent DMSA scan. RESULTS: The cutoff point for urinary ß2-microglubulin for prediction of positive DMSA scan was 0.8 mg with a sensitivity of 40.9% (95% CI, 26.3% to 56.8%) and a specificity of 84.1% (95% CI, 69.9% to 93.4%), a positive predictive value of 72.0% (95% CI, 50.6% to 87.9%) and an negative predictive value of 58.7% (95% CI, 45.6% to 71.0%). CONCLUSIONS: Urinary ß2-microglobulin is not enough sensitive and specific to be used as a diagnostic marker for prediction of renal injury. Other common markers such as erythrocyte sediment rate, leukocyte count, and C-reactive protein can be used in combination to predict kidney injury in children with acute pyelonephritis.

Comparison of urinary sodium and potassium in children older than two with idiopathic hypercalciuria and a healthy control group in Bandar-Abbas, Iran, in 2013.

BACKGROUND: Idiopathic hypercalciuria is an important cause of symptoms related to the urinary system. The urinary excretion of high sodium and low potassium is a risk factor for hypercalciuria and urolithiasis. The aim of this study was to compare the urinary excretion of sodium and potassium by children older than two with idiopathic hypercalciuria and healthy control children in Bandar-Abbas, Iran. METHODS: This case control study was conducted during 2012 and 2013 in Bandar-Abbas, a city in southern Iran. The urinary excretion of sodium and potassium by 50 children with idiopathic hypercalciuria who were older than two was compared with that of 62 healthy children. IBM SPSS Statistics 21 software was used to analyze the data, and P < 0.05 was considered to be significant. RESULTS: Fifty children with idiopathic hypercalciuria (21 males and 29 females) were compared with 62 healthy children (19 males and 43 females). The results of the study indicated that there were no significant differences in the mean sodium and potassium levels in the urine of the two groups of children (P = 0.401 and P = 0.479, respectively.). CONCLUSION: The study showed no significant differences in the excretion of sodium and potassium in the urine of children with idiopathic hypercalciuria and that of healthy children in Bandar-Abbas. This finding was inconsistent with the results of similar studies conducted earlier. Therefore, more studies are needed on populations in different areas with various climates and difference races.