First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults.

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.

Prevalence of Vesicoureteral Reflux in Children with Urinary Tract Infection.

Vesicoureteral reflux (VUR) is reported in 30%-50% of children affected by urinary tract infection (UTI). We aimed to investigate the frequency of VUR in children presenting with UTI and the changes in its prevalence from birth up to 18 years. This research was an observational retrospective study in the nephrology clinic of an academic tertiary hospital during 2003-2016. Patients with UTI subjected to direct cystourethrography were enrolled (908 patients, 86.23% of girls and 13.77% of boys). They were aged from 3 days to 214 months (33 ± 33.2 months). VUR was observed in 419 of 908 (46.14%) cases. High-grade VUR (VUR Grades IV-V) and VUR were significantly more prevalent in boys (P = 0.001 for both). Only 9.2% of the VUR subjects were diagnosed after 5 years of age. The patients with VUR developed UTI at a significantly younger age compared with those without VUR (P = 0.0001). Abnormal kidney ultrasound results were significantly more common in patients with VUR than in those without VUR (P = 0.0001). The prevalence of VUR in the 1st, 2nd, 3rd, 4th, and 5th years of life was estimated to be 56.64%, 48.2%, 49.46%, 35.8%, and 45.07%, respectively. The highest and lowest VUR prevalence was 56.64% (1st year of life) and 0% (13-18 years). In addition, severe VUR was not an uncommon finding, and affected 10.7% of the total population. The results indicated a decrease in the prevalence of VUR with increased age when considering the five main age subgroups of childhood.

Impact of Chronic Functional Constipation on Lower Urinary Tract System: A Cases - Control Study.

INTRODUCTION: Association of constipation with incomplete bladder emptying, functional bladder outlet un-coordination, urinary tract infection (UTI), and upper urinary tract dilatation has been reported. We designed a study to determine the impact of chronic functional constipation on kidney and bladder ultrasound parameters, the results of the uroflowmetry test, and its association with UTI. METHODS: The study group consisted of 24 cases and 48 controls, who were children between 5 to 18 years-old, from June 2017 to June 2018. The case group included children with chronic functional constipation. The healthy children with urinary continence and regular bowel habits without any history of UTI were considered as the control group. The variables were bladder volume, postvoiding urinary residual volume, full and empty bladder wall thicknesses, uroflowmetry parameters and, UTI prevalence. RESULTS: There were no significant differences in the prevalence of UTI, upper urinary tract dilatation on kidney ultrasound, uroflowmetry and, bladder ultrasound parameters between the case and control groups (P > .05 for all). We found abnormal uroflowmetry curves in 58.3% and 35.4% of the case and control groups, respectively (P > .05) and a higher rate of staccato curves in constipated compared to healthy children. CONCLUSION: the prevalence of UTI and upper urinary tract dilatation on kidney ultrasonography are not significantly different between constipated and healthy children. Moreover, it seems that chronic constipation has no significant impact on the storage and emptying functions of the bladder. The higher frequency of staccato curves in constipated compared to healthy children can indicate that fecal mass causes detrusor sphincter dyssynergia.  DOI: 10.52547/ijkd.6568.

Ectopic Intrathoracic Kidney Associated with Ipsilateral Ectopic Spleen and Diaphragmatic Hernia in a Pediatric Patient: A Case Report.

Background: Intrathoracic kidney is the rarest form of an ectopic kidney that is usually accompanied by left congenital diaphragmatic hernia (CDH) (Bochdalek hernia), the association of which with other anomalies is rare. Case Presentation: Herein, we describe a case with a diagnosis of an intrathoracic kidney associated with the ectopic spleen and diaphragmatic hernia diagnosed during imaging studies for urinary tract infections (UTIs). This study reports an 11-month-old male case with a history of CDH and several episodes of UTIs. A kidney ultrasound revealed that the left kidney and spleen were located in the thoracic cavity. Despite intrathoracic lying of the left kidney, there was no vesicoureteral reflux. Technetium-99m dimercaptosuccinic acid scan reported a highly positioned left kidney . Conclusion: With the consideration of a pediatric literature review among patients with intrathoracic ectopic kidney, our case was special and notable since it was the first neonate who had an association of intrathoracic spleen and kidney in the same side with a delayed diagnosis. The main point of this case was that radiologists should consider thoracic kidney a differential diagnosis of unilateral renal agenesis when there is a history of diaphragmatic hernia.

A Case of Recurrent Urinary Tract Infections With Neurogenic Bladder Due to Spinal Tumors.

Neuroblastic tumors are the most common extracranial solid tumors in children. They are manifested by different clinical presentations ranging from cord compression symptoms to asymptomatic cases. A 2.5-year girl with a history of vaginal delivery at 39 gestational weeks and low Apgar score presented by repeated episodes of urinary tract infections and progressive paraplegia started at the age of 8 months. Brain MRI and EEG were normal. Voiding cystourethrography revealed grade II vesicoureteral reflux in the left kidney. Lumbar MRI with and without contrast showed a dumbbell shape mass, the hyper signal in T2 -weighted image and low signal in T1 -weighted image, extramedullary, and intramural with mass effect on the cord. Microscopic examination of tissue obtained by surgery reported ganglioneuroma. Our case was interesting because of her presentation, neurogenic bladder associated with repeated episodes of urinary tract infections, and secondary paraplegia. Neurogenic bladder dysfunction is rarely reported in cases with ganglioneuroma.

Diagnostic Values of Kidney Ultrasonography for Vesicoureteral Reflux (VUR) and High Grade VUR.

INTRODUCTION: Vesicoureteral reflux (VUR) is a well-known risk factor for urinary tract infection (UTI). We aim to define diagnostic values of kidney ultrasonography (US) as a predictor of VUR and high grades VUR in children presented by UTI. METHODS: This retrospective study was conducted during October 2003 to 2016. Children aged ≤ 18 years with history of UTI who had underwent kidney US and direct cystography [voiding cystourethrography (VCUG) or radionuclide cystography (RNC)] enrolled in the study. Diagnostic values of hydronephrosis, hydro ureter, renal scaring, hydroureteronephrosis, decreased kidney size and abnormal kidney US for diagnosis of VUR and high grades VUR (grades IV-V) were evaluated. RESULTS: Hydro-ureter, renal scaring, and hydroureteronephrosis were significantly more prevalent in VUR+ versus VUR- cases, also in higher grades compared with lower grades (grades I-III) VUR (P < .05 for all). Additionally, hydronephrosis was more common in VUR+ compared with VUR- patients (P < .0001). As a predictor of VUR and higher grades of VUR, abnormal kidney US had the highest sensitivity (24.87% and 40.84%, respectively), abnormal kidney US and hydro ureter reached the highest NPV (70.42% and 81.27%, respectively), hydroureteronephrosis and hydro ureter showed the highest accuracy (68.51% and 82.21%, respectively) . CONCLUSION: Kidney US is a valuable screening test, abnormal renal US significantly increases the probability of VUR and high grades VUR , but if used as the only screening test , about 2/3 and 1/3 and 20% of VUR , high grades VUR and grade V VURs will be missed. DOI: 10.52547/ijkd.5966.

Five cases of severe vesico-ureteric reflux in a family with an X-linked compatible trait.

Vesico-ureteric reflux (VUR) is one the most common inherited disorder in humans. Even though this defect is common among siblings and parents of index patients (27-40%), the mode of inheritance is not well defined. Parents and siblings (three female and two male) of a 13-year-old girl with end-stage renal failure (ESRF) due to reflux nephropathy were screened for VUR although they had not presented episodes of urinary tract infection. VUR was identified in the father (44 years old) and in all the three sisters (aged 15 years, 16 years and 18 years) while the two brothers (aged 5 years and 8 years) had normal renal ultrasonograms and cystograms. A technetium-99m di-mercapto-succinic acid ((99m)Tc-DMSA) scan demonstrated renal scars in the father and in two of the sisters with VUR. No episodes of urinary infection had been documented for any relatives. Haplotype analysis on the X-chromosome confirmed paternity. This is the first description of VUR compatible with an X-dominant trait. This mode of inheritance must be added to what is already known on familial VUR, and future studies should also consider this possibility.

The outcome of Iranian children on continuous ambulatory peritoneal dialysis: the first report of Iranian National Registry.

BACKGROUND: Continuous ambulatory peritoneal dialysis is not a very common modality to treat Iranian children with end-stage renal disease; however, there is sometimes no choice but to offer this therapy to salvage the patient. Obviously, promotion in each program needs re-evaluation to find the pitfalls. Therefore, a nation-wide survey on pediatric continuous ambulatory peritoneal dialysis was conducted to find the cause of death or termination of dialysis. METHODS: All children, younger than 14 years old, treated by continuous ambulatory peritoneal dialysis in nine main pediatric nephrology wards in Iran between 1993 and 2006 were included in this historical cohort study. Patient and technique survival rates were determined. Kaplan-Mayer and Cox-regression analysis were used to compare the survival. 2 x 2 table was used to calculate the risk ratio. A P<0.05 was considered significant. RESULTS: One hundred twenty children with a mean age of 47.6 months were on continuous ambulatory peritoneal dialysis. The most frequent cause of renal failure was hereditary-metabolic-cystic disease. One hundred eighty-two peritoneal dialysis catheters were inserted surgically. The median first catheter exchange was 0.74 year (95%CI: 0.5 - 0.98). The most frequent cause of catheter replacement was catheter outflow failure due to displacement, adhesion, and infection (persistent peritonitis or tunnel infection). The mean patient survival was 1.22 years (95%CI: 0.91 - 1.53). The mortality rate was 55% before 1997, and 60% between 1998 and 2001, which declined to 23% after 2002 (P<0.05). Young age (<24 months) was the only independent factor that predicted mortality (P<0.05). The outcome of children was as follows: recovery of renal function (6.7%), renal transplantation (8.3%), switch to hemodialysis (16.7%), still on continuous ambulatory peritoneal dialysis (23.3%), death (43.3%), and lost to follow-up (1.7%). CONCLUSION: The mortality is still high among Iranian children on peritoneal dialysis. Young age is the most important factor influencing on survival and mortality.

p53-independent Noxa induction by cisplatin is regulated by ATF3/ATF4 in head and neck squamous cell carcinoma cells.

The platinum-based DNA damaging agent cisplatin is used as a standard therapy for locally advanced head and neck squamous cell carcinoma (HNSCC). However, the mechanisms underpinning the cytotoxic effects of this compound are not entirely elucidated. Cisplatin produces anticancer effects primarily via activation of the DNA damage response, followed by inducing BCL-2 family dependent mitochondrial apoptosis. We have previously demonstrated that cisplatin induces the expression of proapoptotic BCL-2 family protein, Noxa, that can bind to the prosurvival BCL-2 family protein, MCL-1, to inactivate its function and induce cell death. Here, we show that the upregulation of Noxa is critical for cisplatin-induced apoptosis in p53-null HNSCC cells. This induction is regulated at the transcriptional level. With a series of Noxa promoter-luciferase reporter assays, we find that the CRE (cAMP response element) in the promoter is critical for the Noxa induction by cisplatin treatment. Among the CREB/ATF transcription factors, ATF3 and ATF4 are induced by cisplatin, and downregulation of ATF3 or ATF4 reduced cisplatin-induced Noxa. ATF3 and ATF4 bind to and cooperatively activate the Noxa promoter. Furthermore, ERK1 is involved in cisplatin-induced ATF4 and Noxa induction. In conclusion, ATF3 and ATF4 are important regulators that induce Noxa by cisplatin treatment in a p53-independent manner.

Venetoclax Is Effective in Small-Cell Lung Cancers with High BCL-2 Expression.

Purpose: Small-cell lung cancer (SCLC) is an often-fatal neuroendocrine carcinoma usually presenting as extensive disease, carrying a 3% 5-year survival. Despite notable advances in SCLC genomics, new therapies remain elusive, largely due to a lack of druggable targets.Experimental Design: We used a high-throughput drug screen to identify a venetoclax-sensitive SCLC subpopulation and validated the findings with multiple patient-derived xenografts of SCLC.Results: Our drug screen consisting of a very large collection of cell lines demonstrated that venetoclax, an FDA-approved BCL-2 inhibitor, was found to be active in a substantial fraction of SCLC cell lines. Venetoclax induced BIM-dependent apoptosis in vitro and blocked tumor growth and induced tumor regressions in mice bearing high BCL-2-expressing SCLC tumors in vivo BCL-2 expression was a predictive biomarker for sensitivity in SCLC cell lines and was highly expressed in a subset of SCLC cell lines and tumors, suggesting that a substantial fraction of patients with SCLC could benefit from venetoclax. Mechanistically, we uncover a novel role for gene methylation that helped discriminate high BCL-2-expressing SCLCs.Conclusions: Altogether, our findings identify venetoclax as a promising new therapy for high BCL-2-expressing SCLCs. Clin Cancer Res; 24(2); 360-9. ©2017 AACR.

Cross-fused renal ectopia associated with vesicoureteral reflux; a case report.

Crossed renal ectopia is a rare urinary system anomaly which mostly is asymptomatic and is diagnosed incidentally. Urinary obstruction, infection, and neoplasia of the urinary system and nephrolithiasis are main complications of this anomaly. A 6-year-old boy admitted to the hospital with colicky abdominal pain and nausea. Abdominal examination revealed tenderness in right lower quadrant. Urine analysis and culture were normal. Kidney ultrasonography showed right kidney in pelvis cavity with no kidney tissue in left side. TC 99-DMSA scan demonstrated no radiotracer accumulation in the normal renal area. Radiotracer accumulation was seen in the pelvis area with a deviation to the left. Voiding cystoureterogram revealed right sided grade II vesicoureteral reflux. Severe urological anomalies in children may be asymptomatic or have nonspecific symptoms such as abdominal pain.

High doses of oral folate and sublingual vitamin B12 in dialysis patients with hyperhomocysteinemia.

INTRODUCTION: Folic acid and vitamin B12, alone or in combination have been used to reduce homocysteine (Hcy) levels in dialysis patients. OBJECTIVES: We aimed to assess the efficacy of high doses of oral folate and vitamin B12 in reducing plasma Hcy levels after a 12-week treatment. PATIENTS AND METHODS: Thirty-two dialysis patients aged 10-324 months screened for hyperhomocysteinuria. Then cases with hyperhomocysteinemia received oral folate 10 mg/day with sublingual methylcobalamin 1 mg/day for 12 weeks. In pre- and post-intervention phases plasma Hcy concentration, serum folate, and vitamin B12 levels were measured. Changes in plasma Hcy, serum folate, and vitamin B12 concentrations were analyzed by paired t tests, and P values < 0.05 were considered significant. RESULTS: Eighteen (56.2%) patients had hyperhomocysteinuria. Vitamin B12 and folate levels were normal or high in all cases. Two patients were lost due to transplant or irregular drugs consumption. Plasma Hcy levels were reduced in all, and reached normal values in 50%. A statistically significant differences between first Hcy levels with levels after intervention was found (95% CI, 5.1-8.9, P = 0.0001). CONCLUSION: Oral folate 10 mg/day in combination with sublingual vitamin B12, 1 mg/day can be considered as a favorable treatment for hyperhomocysteinemia in dialysis patients.

Absolute and Relative Carnitine Deficiency in Patients on Hemodialysis and Peritoneal Dialysis.

INTRODUCTION: Carnitine deficiency is commonly seen in dialysis patients. This study assessed the association dialysis and pediatric patients' characteristics with plasma carnitines levels. MATERIALS AND METHODS: Plasma carnitine concentrations were measured by tandem mass spectrometry in 46 children on hemodialysis or peritoneal dialysis. The total carnitine, free carnitine (FC), and L-acyl carnitine (AC) levels of 40 µmol/L and less, less than 7 µmol/L, and less than 15 µmol/L were defined low, respectively. An FC less than 20 µmol/L and an AC/FC ratio greater than 0.4 were considered as absolute and relative carnitine deficiencies. The correlation between carnitines levels and AC/FC ratio and age, duration of dialysis, characteristics of dialysis, and blood urea nitrogen and serum albumin concentrations were assessed. RESULTS: Absolute carnitine deficiency, low total carnitine, and low AC concentrations were found in 66.7%, 82.6%, and 51% of the patients, respectively. All of the patients had relative carnitine deficiency. Carnitine measurements were not significantly different between the hemodialysis and peritoneal dialysis groups. More severe relative carnitine deficiency was found in those with lower blood urea nitrogen levels and those on peritoneal dialysis. No linear correlation was found between carnitine levels and age, duration of dialysis, characteristics of dialysis, serum albumin level, or blood urea nitrogen level. CONCLUSIONS: Absolute and relative carnitine deficiencies are common among children on dialysis. Patients with lower blood urea nitrogen levels and peritoneal dialysis patients are more prone to severe relative carnitine deficiency.

Urolithiasis in the First 2 Months of Life.

INTRODUCTION: There is limited data about urolithiasis in young infants. We reviewed clinical, imaging, and biochemical data of urolithiasis in the first 2 months of life. MATERIALS AND METHODS: In an 11-year period, 77 of the 1172 children diagnosed with urolithiasis (6.8%) were 60 days old and younger (64.9% boys and 35.1% girls). Routine diagnostic assessments included urinalysis and urine culture; measurement of calcium, uric acid, oxalate, and creatinine in nonfasting random urine; measurement of blood urea nitrogen and serum creatinine, sodium, potassium, calcium, and phosphorus levels; and venous blood gasometry. Urinary calculi were diagnosed using tridimensional ultrasonography with 5-MHz, 7.5-Mhz, and 10-MHz probes. RESULTS: The most common symptom was irritability (37.6%). A family history of urinary calculi was documented in 49.4% of the patients. The calculi were 0.5 mm to 6 mm in length. Eight infants (10.4%) had urinary tract infection. Hypercalciuria was found in 21 of 62 patients (33.8%). There were no cases of hyperuricosuria, hyperoxaluria, or struvite calculus. Vesicoureteral reflux was reported in 9 of 20 patients who underwent voiding cystourethrography. Two-thirds of asymptomatic and 85% of symptomatic infants were diagnosed during summer and autumn, and the peaks of calculus visits were in September, October, and November. Of 43 infants (55.8%) who were followed up (Mean, 16.2 ± 15.2 months), none needed calculus removal interventions. CONCLUSIONS: Hypercalciuria is the most common urinary metabolic abnormality in young infants with urinary calculus. Infection was not an important factor for our cohort in the pathogenesis of the disease.

Comparison of combined treatment with desmopressin plus oxybutynin and desmopressin plus tolterodine in treatment of children with primary nocturnal enuresis.

INTRODUCTION: Nocturnal enuresis (enuresis) is one of the most common developmental problems of childhood, which has often a familial basis, causes mental and psychological damage to the child and disrupts family solace. OBJECTIVES: In this study, we compared therapeutic effects of combination therapy of desmopressin plus oxybutynin with desmopressin plus tolterodine, in the treatment of children with primary nocturnal enuresis. PATIENTS AND METHODS: The present study is a clinical trial study, where 59 patients with primary nocturnal enuresis in the age range of 5 to 14 years old were selected from the visitors of nephrology clinic of Dr. Sheikh pediatrics hospital (Mashhad, Iran). Patients were divided into 2 treatment groups where the first group received combined therapy with desmopressin and oxybutynin, and the second group received combined therapy with desmopressin and tolterodine. Data was analyzed using SPSS 16 software and descriptive and analytical statistics (chi-square test). RESULTS: The mean of age of patients in total was 2.55 ± 7.90 years. In the treatment group with desmopressin and oxybutynin, 26 of 30 patients (86.7%) achieved a complete remission and 4 patients (13.3%) still suffered from enuresis during a 3-month evaluation. The comparison of 2 groups, in terms of the outcome of the 3-month treatment, showed significant differences between the remission and recovery of 2 groups, where the recovery in the group with desmopressin plus tolterodine was higher than the group with desmopressin plus oxybutynin (P = 0.001). CONCLUSION: The results showed that combined treatment with desmopressin plus tolterodine performs better than desmopressin plus oxybutynin .

Lower Urinary Tract Urological Abnormalities and Urodynamic Findings of Physiological Urinary Incontinence Versus Non-mono Symptomatic Nocturnal Enuresis in Children.

BACKGROUND: Although 98% of children attain daytime bladder control by three years of age, urinary incontinence is regarded physiological up to the fifth year of life. OBJECTIVES: This study aimed to assess whether lower urinary tract urological abnormalities and abnormal urodynamic findings are infrequent in children with physiological urinary incontinence in contrast to those with non-monosymptomatic nocturnal enuresis (NMNE). PATIENTS AND METHODS: During a three-year period (2007-2009), 66 neurologically normal children including 51 children (34 girls, 17 boys) older than five years of age with NMNE and intermittent daytime incontinence, and 15 children with physiological urinary incontinence (eight girls and seven boys) aged four to five years of age without any known urological abnormalities were enrolled in the study. Patients with neurologic deficits or known urological anomalies were excluded from the study. Kidney-bladder ultrasonography, voiding cystourethrography (VCUG), and urodynamic studies were performed to evaluate the anatomy of urinary tract and bladder function. RESULTS: Urinary tract infection was found in 23 (34.8%) children, 17 (33.3%) and 6 (40%) patients with NMNE and physiological urinary incontinence, respectively. Out of 48 patients who underwent VCUG, vesicoureteral reflux (VUR) was found in seven and eight children younger and older than five years of age, respectively. Abnormal urodynamic findings were reported in 5 (62.5%) of eight children younger than five-year-old, and 14 (63.6%) of 22 patients older than 5-year-old. CONCLUSIONS: VUR might be more frequent in children with physiological urinary incontinence than the normal population, and might be as common as NMNE with intermittent daytime incontinence.

Pneumococcal sepsis, peritonitis, and cellulitis at the first episode of nephrotic syndrome.

Bacterial infections are common in patients with nephrotic syndrome, including peritonitis, sepsis, meningitis, urinary tract infection, and cellulitis. An 8-year-old boy presented with colicky abdominal pain, vomiting, swollen and painful erythematous lesions around the umbilicus and in anterior surface of left thigh (cellulitis), mild generalized edema, and ascites. The microorganism isolated from peritoneal fluid and blood cultures was Pneumococcus. Association of pneumococcal sepsis, peritonitis, and cellulitis has been rarely reported in nephrotic syndrome.

Association of nocturnal enuresis with vesicoureteral reflux and renal cortical damage.

BACKGROUND: The prevalence of vesicoureteral reflux (VUR) is higher in enuretic children than in non-enuretic children. Recent studies have reported VUR in 6-23% of children with enuresis. OBJECTIVES: To clarify the association of nocturnal enuresis with vesicoureteral reflux (VUR) and to identify children who are at risk for VUR. PATIENTS AND METHODS: During 2007-2009, neurologically normal children who were referred with a chief complaint of nocturnal enuresis and had abnormal renal ultrasonography (US) results, daytime incontinence, abnormal results in urodynamic studies, urinary tract infection, or a history of VUR in their siblings were prospectively evaluated for VUR by voiding cystourethrography (VCUG). RESULTS: A total of 60 children (26 boys and 34 girls) aged 5-17 (mean ± SD: 8.46 ± 2.45) years met the inclusion criteria and were enrolled in the study. Twenty-eight (46.7%) patients had mono-symptomatic nocturnal enuresis (MNE), and 32 (53.3%) had non-mono symptomatic nocturnal enuresis (NMNE). VUR was reported in 10 (16.7%) patients and posterior urethral valve (PUV) was found in 1 (1.7%) patient. The prevalence of VUR was significantly higher in patients with daytime incontinence and in girls (P = 0.016 and 0.003 respectively). We did not find any significant correlations between VUR and the form of enuresis (primary versus secondary), urinary tract infection, or any diurnal urinary symptoms other than daytime incontinence (P > 0.05 for all). of 10 renal scintigrams, 5 (50%) showed renal cortical defects. CONCLUSIONS: VUR is uncommon in children with MNE and in those with NMNE who do not wet themselves during the day; however, it is a relatively common finding in enuretic children who have daytime incontinence. We recommend VCUG in all enuretic children who have daytime incontinence.

Monosymptomatic and non-monosymptomatic nocturnal enuresis: a clinical evaluation.

BACKGROUND: Nocturnal enuresis is divided into monosymptomatic nocturnal enuresis (MNE) and non-monosymptomatic nocturnal enuresis (NMNE). This study reviews clinical and ultrasonography (US) findings in enuretic children, and compares the organic and functional pathologies of the lower urinary tract (LUT) in children with MNE to those who have NMNE. METHODS: We enrolled 111 neurologically normal children with chief complaints of enuresis in this study. Participants included 60 boys and 51 girls, aged 5 - 17 years. There were 43 (38.8%) patients diagnosed with MNE and 68(61.2)% with NMNE. Urine analysis, urine culture and kidney-bladder US were performed for patients. Some patients underwent a voiding cystoureterography (VCUG), urodynamic study (UDS), or both.  RESULTS: Patients were divided into three groups: i) MNE, ii) NMNE without daytime incontinence (NMNE - daytime incontinence), and iii) NMNE plus daytime incontinence (NMNE + daytime incontinence). Constipation (P = 0.011), encopresis (P = 0.003) and urge incontinence (P = 0.001) were significantly more frequent in patients with NMNE +daytime incontinence. Bladder wall thickness (BWT) was the most common US finding. One patient with MNE and 9 with NMNE+ daytime incontinence had vesicoureteral reflux (VUR; P = 0.016). Posterior urethral valve (PUV) was reported in one patient with NMNE.  Evidence of bladder dysfunction was noted in about half of the patients who underwent UDS, with a higher prevalence in cases that had NMNE +daytime incontinence (P = 0.297). Bowel symptoms and VUR were significantly more prevalent in cases with NMNE + daytime incontinence.  CONCLUSION: We recommend VCUG in enuretic children who have daytime incontinence. In addition our study has revealed that symptoms suggestive of an overactive bladder (OAB) are not good indicators for bladder dysfunction.

Abnormal urodynamic findings in children with nocturnal enuresis.

Reduced nocturnal bladder capacity has been suggested in the pathogenesis of nocturnal enuresis. This study was conducted to define frequency of bladder dysfunction in enuretic children and determine parameters which might predict bladder dysfunction. 60 children were enrolled. Full urodynamic study (UDS) was done in case of abnormal uroflowmetry, abnormal bladder ultrasound, daytime incontinence and age 10 years. Of 60 patients ultrasound 48 underwent complete UDS. In 11, results of UDS were unreliable. The results were normal in 10 (20.8%) and 27 (56.2%) had abnormal UDS .The study revealed that abnormal UDS is common in enuretic children and overactive bladder is the most common findings. No clinical feature were found, which could identify children requiring UDS.