105,334 research outputs found
Cefepime-induced non-convulsive status epilepticus n a peritoneal dialysis patient
No full textNon-convulsive status epilepticus related to cefepime has not been reported in childhood dialysis patients, although several adult cases have been reported. We report a state of acute confusion in a 15-year-old boy on continuous ambulatory peritoneal dialysis (CAPD) receiving cefepime that was diagnosed as status epilepticus by electroencephalography (EEG). The EEG improved after anticonvulsive therapy. All clinical symptoms disappeared dramatically within 24 h of discontinuation of cefepime. The differential diagnosis of confusional states and the mechanisms of the convulsive effects of antimicrobials in chronic renal failure are discussed. The importance that the clinician is aware of the rare side effects of antimicrobials is emphasized. © IPNA 2004
Hypercalciuria and recurrent urinary tract infections: incidence and symptoms in children over 5 years of age
No full textHypercalciuria is an important and common risk factor in the formation of renal stones. In this study we evaluated the incidence and the clinical presentation of hypercalciuria in 75 children over 5 years of age with the diagnosis of recurrent urinary tract infection (UTI). We measured random urinary calcium/creatinine value (three times), 24-h urinary calcium excretion, serum calcium, phosphorus, electrolytes, blood gas, blood urea nitrogen and creatinine levels. Hypercalciuria was found in 32 patients (43%). The mean urinary calcium/creatinine ratio for hypercalciuric patients was 0.50 +/- 0.21 mg/mg (min: 0.24, max: 2.60). The mean urinary calcium/creatinine ratio for the rest of the study population-those without hypercalciuria-was 0.10 +/- 0.04 mg/mg (min: 0.01, max: 0.18). Presenting symptoms of the hypercalciuric patients and normocalciuric patients were similar. History of familial urolithiasis was positive in 19 patients (59%). Predisposing urinary tract abnormalities in recurrent UTI was shown in 12 of the hypercalciuric patients (12/32, 37.5%) and 8 of the normocalciuric patients (8/43, 19%) without a statistically significant difference between. We conclude that hypercalciuria is not a rare finding among recurrent UTI cases in Turkish children. Hypercalciuria does not modify the clinical presentation of UTI, and we suggest the investigation of urinary calcium excretion in children with recurrent UTI
Renal parenchymal scarring and reflux nephropathy [Renal parenkimal skar ve reflü nefropatisi]
No full textVesicoureteral reflux (VUR) is the abnormal flow of urine from the bladder into the upper urinary tract. In the majority of cases, it occurs as a result of a primary maturation abnormality of the vesicoureteral junction. When VUR is associated with bacteriuria, the possibility of pyelonephritis with subsequent renal scars increases, theoretically as a result of bacteria being more readily conveyed to the renal parenchyma. The ultimate evaluation for renal scars is done through a cortical renal scan using technetium-99 labeled dimercaptosuccinic acid. The long term complication of VUR is nephropathy. Reflux nephropathy (RN) is defined as the formation of renal parenchymal scarring and renal function impairment induced by VUR. Hypertension, proteinuria, chronic kidney disease and end stage renal failure are well-recognized sequelae of renal scars. In this review we tried to emphasize the importance of RN which is stil a significant cause of morbidity especially in developing countries
Transition of peritoneal dialysis patients from pediatric to adult nephrology unit
No full textDiyaliz tedavisi ve böbrek naklindeki gelişmeler sonucunda, son dönem böbrek yetmezliğinde olan daha fazla sayıda çocuk hasta erişkin döneme ulaşmaktadır. Böbrek nakli kısa dönemde mümkün değilse, periton diyaliz tedavisi genellikle hem sağlık personelinin hem de ailenin tercihi olmaktadır. Genç hastalar için aile merkezli ve koruyucu yaklaşıma sahip çocuk kliniklerinden kendi sorumluluğunu almasını bekleyen erişkin kliniklerine devir (transition) zor olabilir. Bu geçişin hastanın yaşına ve gelişimine uygun olması, tıbbi ve psikolojik gereksinimlerini karşılaması gerekir. Geçiş işlemi hasta dışında ailesini, çocuk doktorunu, erişkin doktorunu, hemşireleri ve sosyal bakım uzmanlarını da içermelidir. Bu işlem özel geçiş polikliniklerinde yapılmalı, bu polikliniklerde hasta izleyen çocuk nefroloji doktoru tarafından tıbbi özeti ile erişkin nefroloji doktoruna sunulmalı ve genç hasta erişkin doktoru ile tanıştırılmalıdır. Periton diyaliz tedavisi almakta olan adolesan hastalar için yapılan uygun ve başarılı devir işlemi, genç hastanın gelecekteki tedavisini ve hastalığının prognozunu olumlu etkileyecektir.Advances in renal transplantation and dialysis have dramatically improved the prognosis of children with end stage renal disease (ESRD) and have allowed most of them to survive to adulthood. If renal transplantation is not possible in the near future, peritoneal dialysis (PD) is the treatment modality of choice for most children with ESRD. It is difficult for young patients to transfer from child-centered and family focussed pediatric services to adult-orientated healthcare units with expectations on patient in terms of responsibility about their illness. The transition process should include patients, families, pediatricians, adult healthcare providers, nurses and social workers and it should not only be appropriate to age, developmental stage but also intellectual ability, psychological and medical needs of the patient. To promote the successful transition of young people, it should be through a transition clinic where the young patient is seen by pediatric and adult specialists before being transferred. An appropriate and successful transition of adolescents performing PD will have a positive effect on the future treatment and prognosis of the illness
Downregulation of the expression of bone morphogenetic protein 7 in experimental pyelonephritis
No full textBone morphogenetic protein 7 (BMP 7) is a member of the transforming growth factor (TGF) beta superfamily and is involved in regeneration, repair, and development of specific tissues, for example kidney, gut, lens, and skeleton. BMP 7 has emerged as a renotrophic factor and experimental studies have shown its protective role against fibrotic processes. Tubulointerstitial changes are present in the pyelonephritic kidney which progresses to fibrosis. Renal fibrosis may lead to significant morbidity in the form of hypertension, proteinuria, and loss of renal function. The objective of this study was to investigate BMP 7 expression in experimental acute and chronic pyelonephritis models. Eighteen Wistar rats were injected with 0.1 mL solution containing E. coli ATCC 25922 10(10) cfu mL(-1) into left renal medullae. Six rats were used as a sham group and were given 0.1 mL 0.9% NaCl. Pyelonephritic rats were sacrificed 24 h (group I, n=6), 1 week (group II, n=6), and 6 weeks (group III, n=6) after E. coli injection. Serum creatinine levels were analyzed. Renal tissues were studied histopathologically by use of hematoxylin and eosin and scored for diagnosis of pyelonephritis. BMP 7 expression was studied semiquantitatively by immunohistochemical staining. Acute (group I) and chronic (group II and group III) pyelonephritic histopathological changes were observed in experimental pyelonephritic groups. A gradual decrease in BMP 7 expression was observed in the tubulointerstitial and tubular area of the pyelonephritic kidneys, mildest in the acute pyelonephritic group and most severe in the chronic pyelonephritic 6th week group. A statistically significant difference was observed between tubulointerstitial BMP 7 expression by groups I and III (P=0.017) and by groups III and IV (P=0.000). Tubular BMP 7 expression was statistically significantly different between groups II and IV (P=0.009) and between groups III and IV (P=0.002). The data imply that BMP 7 has a major role in chronic pyelonephritis. Tubulointerstitial and tubular BMP 7 expression also had a significant negative correlation with fibrosis, tubular, atrophy, and vascular changes. Serum creatinine levels of the study group were all normal. We conclude that the decrease in renal BMP 7 expression in experimental chronic pyelonephritis is one of the factors responsible for fibrotic changes in persistent renal damage
Periton diyalizi yapılan çocuk hastalarda serum copeptin düzeyleri ile peritoneal transport parametreleri ve biyoempedans belirteçleri arasındaki ilişki
No full textVaricella vaccination in children with steroid-sensitive nephrotic syndrome
No full textWe have studied serological and clinical response to live, attenuated varicella zoster virus (VZV) vaccine (Varilrix, SmithKline Beecham) in 20 patients with steroid-sensitive nephrotic syndrome (SSNS) in remission and 22 normal controls who had no history of varicella and no detectable antibody to VZV Nephrotic patients included 15 boys and 5 girls, with a mean age of 4.7 years (range 2-11.4 years). The controls were healthy age-matched children (13 girls and 9 boys). Seventeen patients with SSNS (85%) and 19 healthy controls (86%) seroconverted 8 weeks after vaccination. One patient with SSNS had a relapse 20 days after vaccination, and 1 child in the control group had a rash. Two years after vaccination, antibodies to VZV were detected in 12 of 17 responders, 2 of 3 non-responders, and 13 of 22 controls. Within 2 years of vaccination, 3 of the vaccine responder children with SSNS had a mild varicella infection. Two responder and 1 non-responder nephrotic children and 9 controls were lost to long-term follow-up. Our results show that immunization with a single dose of VZV vaccine is safe and effective in children with SSNS in remission
- …
