Pediatric kidney care experience after the 2023 Turkey/Syria earthquake.

BACKGROUND/AIMS: Two earthquakes on February 6th, 2023 destroyed ten cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. METHOD: A web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were asked. RESULTS: 903 injured children (median age: 11.62 years) were evaluated. Mean TUR was 13 h (Interquartile range-IQR: 32.5), max 240 h). 31 of 32 patients with a TUR of >120 h survived. The patient who rescued after ten days survived.Two-thirds of the patients were given 50 mEq/L sodium-bicarbonate in 0.45% sodium-chloride solution on admission day. 58% of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% of 3000-4000 mL/m2 BSA, and only 2% of >4000 mL/m2 BSA. 425 patients had surgeries, 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively.Crush-AKI developed in 314 patients (36% of all patients). 189 patients were dialyzed. Age > 15 years, creatine phosphokinase (CK)≥20 950 U/L, TUR≥10 h, and the first-day IVF volume < 3000-4000 mL/m2 BSA were associated with Crush-AKI development. 22 deaths were recorded, 20 of 22 occurred in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. CONCLUSIONS: This is the most extensive pediatric kidney disaster data after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also asscoiated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.

Bedside sonographic assessments for predicting predialysis fluid overload in children with end-stage kidney disease.

Although the number of studies evaluating methods to predict fluid overload is increasing, the assessment of fluid status in children on dialysis is still fraught with inaccuracies. We aimed to evaluate the predictive capability of lung ultrasounds and the inferior vena cava collapsibility index (cIVC) in predialysis overhydration in children with end-stage kidney disease. Ten children with end-stage kidney disease who were on an intermittent hemodialysis program were included. The hydration status of the patients was clinically evaluated. Moreover, 30 predialysis and 30 postdialysis lung ultrasound, cIVC, and bioimpedance spectroscopy (BIS) measurements were performed. The median age of the participants was 14 (IQR, 13-15) years, and two (20%) were male. There was a strong positive correlation between the predialysis total number of B-lines and predialysis fluid overload (r=0.764, p<0.001). Additionally, there was a moderate negative correlation between predialysis cIVC and predialysis fluid overload (r=-0.599, p=0.002). Although the moderate correlation was determined between the postdialysis fluid overload and total number of B-lines, no correlation was determined using cIVC. Receiver operating characteristic curves demonstrated that the total number of B-lines and cIVC could successfully predict the predialysis fluid overload (relative hydration >7% derived from the BIS; AUROC 0.82 and 0.80, respectively). When both evaluations were combined, if either the total number of B-lines or the cIVC was outside the corresponding cutoff range (>10.5 and ≤23.5, respectively), it was detected in 16 out of 17 sessions (sensitivity 94%). If either one was outside the corresponding cutoff range (total number of B-lines >10.5 and cIVC ≤18.2), the severe predialysis fluid overload was predicted successfully in all eight (100%) sessions. Conclusion: Randomized controlled studies are needed to prove the reliability of the combined use of lung ultrasounds and cIVC in the assessment of predialysis fluid overload. What is Known: • The association of chronic fluid overload with increased morbidity and mortality raises the need for optimal determination of fluid overload in pediatric patients who are dialysis-dependent at a young age. • The linear correlation between the total number of B-lines on lung ultrasound images and fluid overload by weight has been shown. What is New: • This study evaluates the lung ultrasound and inferior vena cava collapsibility index combined in predicting fluid overload in dialytic children. • If either the total number of B-lines or the cIVC was outside the corresponding cutoff range (>10.5 and cIVC ≤18.2, respectively), the severe predialysis fluid overload was predicted successfully in all eight (100%) sessions.

A comparative study of the pancreas in pediatric patients with cystic fibrosis and healthy children using two-dimensional shear wave elastography.

PURPOSE: To compare sonographic parameters of the pancreas between healthy children and pediatric cystic fibrosis (CF) patients with pancreatic involvement using shear wave elastography (SWE) and to investigate the efficacy of SWE in the diagnosis of pancreatic involvement in pediatric CF patients. METHODS: The pancreas was evaluated in 38 patients with CF and 38 healthy children using conventional B-mode ultrasonography (US) and two-dimensional (2D)-SWE. RESULTS: The pancreatic 2D-SWE values of the CF group were significantly lower than those of the healthy control group (1.01 ± 0.16 vs. 1.31 ± 0.01 m/s for the head, 1.03 ± 0.05 vs. 1.28 ± 0.08 m/s for the pancreatic body, and 1.02 ± 0.05 vs. 1.30 ± 0.10 m/s for the tail; p < 0.005 for all the comparisons). When the threshold values were obtained for the pancreatic head, body, and tail segments for the differentiation of the CF patients and healthy controls, the sensitivity of the test was determined as 81.5%, 76.3%, and 73.3%, respectively, and the specificity as 97.3%, 100%, and 100%, respectively. When the patients were divided into two groups based on the presence of B-mode US characteristics (homogeneity, sharp demarcation, and hyperechoic pancreas), there was a significant difference in the 2D-SWE values of the pancreatic head between the patients with and the patients without these characteristics (p = 0.048 for homogeneity, p = 0.021 for sharp demarcation, and p = 0.006 for hyperechoic pancreas). CONCLUSION: The measurement of 2D-SWE values was found to be an easily applicable non-invasive test with high sensitivity and specificity for the demonstration of changes in the pancreas of pediatric CF patients.