4 research outputs found
Diagnostic Accuracy of Presepsin, sMR, and Established Inflammatory Biomarkers in Critically Ill Children with Sepsis or Systemic Inflammatory Response Syndrome
No full textBackground: Pediatric sepsis is a life-threatening emergency and remains complex to diagnose promptly due to the absence of universally reliable biomarkers. C-reactive protein (CRP) and procalcitonin (PCT) are widely used but have limited effectiveness. We evaluated the diagnostic reliability of presepsin and soluble mannose receptor (sMR) and identified optimal biomarker combinations for distinguishing sepsis from non-infectious systemic inflammatory response syndrome (SIRS) in children. Methods: A total of 80 children were enrolled in this prospective study, including 53 consecutive admissions to the pediatric intensive care unit (PICU) (sepsis, n = 42; non-infectious SIRS, n = 11) and 27 healthy controls. The serum levels of new biomarkers presepsin and soluble mannose receptor (sMR) levels were quantified by ELISA methods and their diagnostic reliability (both individually and combined with CRP and PCT) was assessed using receiver operating characteristic (ROC) curves and multivariate logistic regression. Results: Significantly higher concentrations of all measured markers were found both in septic and other critically ill patients than in healthy controls (p < 0.05). No single biomarker reliably differentiated sepsis from non-infectious SIRS. The sMR + CRP + PCT combination demonstrated the highest diagnostic accuracy (AUC = 0.78, p = 0.0007), surpassing the CRP + PCT model (AUC = 0.71, p = 0.0087). Conclusions: The addition of sMR to the established markers CRP and PCT improves the diagnostic effectiveness in pediatric sepsis. Larger multicenter studies are warranted to confirm clinical utility
Congenital anomalies of the kidney and the urinary tract - leading cause for chronic kidney disease in children - a case report
No full textIntroduction: The spectrum of congenital anomalies of the kidneys and the urinary tract is extremely broad and ranges from mild, asymptomatic malformations to severe, life-threatening ones. In young children congenital anomalies are the leading cause for kidney failure and for kidney transplantation or dialysis. Prenatal sonography has facilitated the detection of urological abnormalities presenting with hydronephrosis. The goal of management is preservation of renal function through mitigation of the risk for recurrent urinary tract infections (UTI) and/or obstruction.Material and methods: A case report of a 14-year-old male patient is discussed. He is diagnosed at the age of two months with congenital bilateral grade 2 hydronephrosis and megaureters, caused by obstructive uropathy - Marion`s disease (congenital bladder neck sclerosis).Results: The diagnosis is confirmed via abdominal ultrasound, intravenous urography and computed tomography (CT). At four months the patient is consulted with a pediatric urologist in University Hospital for Emergency Medicine `N.I. Pirogov`, where corrective surgery is performed. He is admitted multiple times at the Pediatric urology department in Sofia and at the Pediatric department in University Hospital `St. Marina` in Varna due to UTIs and an exacerbation of his kidney disease. The patient underwent five surgeries after the diagnosis in accordance with the severity of his anomaly. The imaging studies demonstrated grade 1 hydronephrosis with improvement of urinary tract drainage. During the periodical follow-ups his renal laboratory test results indicated chronic kidney disease stage 2.Conclusion: Congenital anomalies of the kidney and urinary tract are the main cause for chronic kidney disease in pediatric patients. Advances in prenatal diagnostics are essential for early detection and diagnosis, requiring a multidisciplinary approach in management and prevention of this condition
Hemolytic-uremic syndrome - case report
No full textIntroduction: Hemolytic-uremic syndrome (HUS) is a common cause of community-acquired acute kidney injury in young children. It is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency. The syndrome predominantly occurs in infants and children after prodromal diarrhea. HUS is classified into two main categories, depending on whether it is associated with Shiga-like toxin (Stx) or not and has clinical features in common with thrombotic thrombocytopenic purpura (TTP), rendering the differential diagnosis difficult.Materials and Methods: A case report of a 2-year-old child is discussed. Two days prior to hospitalization the patient had diarrhea, vomiting and a sudden onset of weakness and lethargy. The physical examination revealed generalized edema, lack of rashes and no neurological deficit.Results: The laboratory tests showed normocytic normochromic anemia (hemoglobin 59 g/l), thrombocytopenia (27Ñ…10^9), elevations in serum blood, urea, nitrogen and creatinine. The results from the peripheral blood smear came back with anisocytosis, poikilocytosis and schistocytosis. Urinalysis showed proteinuria, leukocyturia and hematuria. Abdominal ultrasonography detected bilateral hyperechoic renal parenchyma, as well as the presence of free fluid in the pelvis,. Immediate antibiotic treatment, infusion therapy and hemotransfusion were initiated. An infusion of furosemide was administered.Conclusion: With early recognition and intensive supportive care, the mortality for diarrhea-associated HUS is <5%. Although most of the patients recover renal function completely, there are risks of chronification of the disease. HUS is the most common cause of acute kidney injury in children. Knowing clinical symptomatology and course of action allows for a timely diagnosis and accurate treatment
Acute necrotizing encephalopathy with fatal outcome in a patient with fulminant influenza A (H1N1) infection
Full text linkInfluenza is a viral infection that spreads annually as an epidemic, and every few years as a pandemic. In most cases, the infection occurs with mild symptoms. However, severe illness with serious complications is possible, as certain subtypes of the virus, such as H1N1, are associated with a higher risk of more severe course of the infection. Neurological involvement, although rarely observed during acute influenza infection, is one of the serious complications with a risk of permanent damage or death. Children belong to the risk groups for whom vaccination after 6 months of age is of particular importance, both for limiting the spread of the infection and for preventing complications. We present a clinical case of a 6-year-old child with a fulminant course of infection with influenza A, subtype H1N1, with severe neurological involvement and fatal outcome
