Clinical and biochemical factors associated with biliary atresia.

AIM: To determine the clinical and biochemical factors associated with biliary atresia. METHODS: This retrospective study was carried at the Pediatric Hepatobiliary Clinic, of a tertiary care referral center, from May 2005 to April 2006. Thirty-three infants with neonatal cholestasis were enrolled. All patients were evaluated by detailed history and clinical examination. Patients diagnosed with biliary atresia on intra-operative cholangiogram and liver biopsy underwent the Kasai operation. Clinical and biochemical factors predictive of biliary atresia were determined. RESULTS: Seventeen infants (51.5%) had neonatal hepatitis, (42.4%) biliary atresia and two (6.1%) neonatal sepsis. Clay colored stools was the only clinical feature suggestive of biliary atresia which was seen in 11 biliary atresia children (79%) and was statistically significant (p = 0.05). No other biochemical markers were suggestive of biliary atresia, such as alkaline phosphatase (p = 0.10) or gamma glutamyl transferase (GGTP) (p = 0.64). On follow-up 6 patients (43%) with biliary atresia developed chronic liver disease and two patients (14%) died of their disease, whereas 41% patients with neonatal hepatitis made successful recovery. (p = 0.02) CONCLUSION: Presence of clay colored stools is a predictive marker for biliary atresia and should be used as one of the markers for urgent cholangiogram, since most of the children with biliary atresia go on to develop chronic liver disease.

Renal manifestations of HIV infected highly active antiretroviral therapy naive children in India.

BACKGROUND: There are several studies on renal manifestations in human immunodeficiency virus (HIV) infected children from American and African regions, but similar studies from India are lacking. A cross-sectional study was carried out in 28 HIV infected antiretroviral therapy (ART) naïve children coming to the pediatric HIV clinic. METHODS: Demographic data of the children, clinical presentations including blood pressure, detailed laboratory investigations (serum creatinine, glomerular filtration rate), urine analysis (urine morphology, urine albumin, pus cells, and red blood cells), and CD4 counts were collected. RESULTS: Of the 28 children, 15 (53.6%) had renal manifestations with a male to female ratio of 1:1.5. The most common renal manifestation in our study was abnormal glomerular filtration rate (GFR) in 11 (44.0%) of 25 children. This was followed by pus cells in urine in 6 (21.4%) of the 28 children while 3 (10.7%) of them had proteinuria. The mean age of children with renal manifestations was 5.04±2.75 years as compared to those without renal manifestations who had a mean age of 7.38±2.95 years (P=0.0390). CDC class and sex were not associated with renal manifestations. CONCLUSIONS: Our study suggests that reduced GFR is the common renal manifestation, particularly in younger children. Other renal manifestations are related to proteinuria. The lack of correlation of CDC classification with renal manifestations mandates screening of children with HIV for renal disease. A more detailed study of renal manifestations in HIV-infected children is needed.

Clinical and biochemical factors associated with biliary atresia.

Aim: To determine the clinical and biochemical factors associated with biliary atresia. Methods: This retrospective study was carried at the Pediatric Hepatobiliary Clinic, of a tertiary care referral center, from May 2005 to April 2006. Thirty-three infants with neonatal cholestasis were enrolled. All patients were evaluated by detailed history and clinical examination. Patients diagnosed with biliary atresia on intra-operative cholangiogram and liver biopsy underwent the Kasai operation. Clinical and biochemical factors predictive of biliary atresia were determined. Results: Seventeen infants (51.5%) had neonatal hepatitis, (42.4%) biliary atresia and two (6.1%) neonatal sepsis. Clay colored stools was the only clinical feature suggestive of biliary atresia which was seen in 11 biliary atresia children (79%) and was statistically significant (p=0.05). No other biochemical markers were suggestive of biliary atresia, such as alkaline phosphatase (p=0.10) or gamma glutamyl transferase (GGTP) (p=0.64). On follow-up 6 patients (43%) with biliary atresia developed chronic liver disease and two patients (14%) died of their disease, whereas 41% patients with neonatal hepatitis made successful recovery. (p=0.02) Conclusion: Presence of clay colored stools is a predictive marker for biliary atresia and should be used as one of the markers for urgent cholangiogram, since most of the children with biliary atresia go on to develop chronic liver disease.