Abstract Background and objective: The present research aims to determine efficacy of potassium citrate solution in the treatment of renal microlithiasis in children one month to 15 years old in Shahrekord Pediatric Nephrology Clinic. Methodology: In this clinical trial study, 60 children aged 1 month to 15 years referred to Shahrekord Pediatric Nephrology Clinic who had one or two (microlithiasis) less than 3 mm in ultrasound; They were included in the study by available sampling. Children were randomly divided into 2 groups receiving placebo (water) and receiving potassium citrate solution. After 3 months, the number and size of stones and the consequences of stones were recorded in both groups and analyzed using SPSS software and relevant statistical tests. Results: Out of 60 children studied, 34 were male (56.7%) and 26 were females (43.3%) with a mean age of 61.62 47 47.54 months. After 3 months of intervention, the mean number and size of stones in each group had a significant decrease (P <0.001) and this amount was lower in the group receiving potassium citrate than the group receiving placebo, but this difference was not statistically significant (<0.05). P). Also, the consequences of kidney stones in both groups were similar and there was no significant difference (P <0.05). Conclusion: The results of this study showed that potassium citrate solution has no effect on the treatment of one or two microlithiasis in children and in these patients the use of supportive therapy is still sufficient. Keywords: Kidney stones, Microlithiasis, Children, Potassium citrate

Abstract Background and Aim: Acute Kidney Injury (AKI) is an important complication of Nephrotic Syndrome (NS) associated with adverse outcome. The frequency of AKI has increased to almost double in the last decade. To determine the incidence of AKI, risk factors and its association with outcome in hospitalized children with NS. Methods – All children aged 1-18 years with diagnosis of NS from 01 November 2018 to 31 May 2020 were enrolled for the study. AKI was diagnosed using the KIDIGO 2012 guidelines and classified according to pediatric RIFLE definition. Results –The mean age of children in this cohort was 4.7± 2.8 years. Complications were observed in 67% cases only. Among all complications the most frequent complication was anemia (25%). The incidence of AKI in hospitalized children with NS was 18.6%. According to pRIFLE criteria of AKI; 11.6% of children met Stage 1 (risk) criteria, 4.6% met Stage 2 (injury) criteria and 2.3% met Stage 3 (failure) respectively. Among all NS children, 53% received nephrotoxic drugs during the hospital stay. On applying multivariate logistic regression analysis, only male gender, associated anemia and Vancomycin use in NS patients came out to be significant independent risk factor for acute kidney injury. Conclusions: AKI is more frequent in first episode of NS rather than in any type of relapses. Although, nephrotoxic drug and male gender are known independent risk factors for development of AKI, associated anemia is till yet not considered as independent risk factor for AKI in children with NS.

Bladder tumour resulting in voiding difficulty in a child is rarely encountered in clinical practice. There are various investigations that help in preoperative diagnosis of bladder tumour and systematic approach is needed to arrive at an early diagnosis. We are reporting a case of botryoid variant of rhabdomyosarcoma of bladder in an infant who presented with complaints of lower abdominal mass, poor urinary stream and hematuria for 3 months.

Introduction This case-series describes a short term follow-up of Renal Transplantation (RT) in three children at the Zenith Medical and Kidney Centre (ZMKC), Abuja, Nigeria. Methods The immediate allograft function (IAF) and recipients’ survival at 6-24 months of follow-up from January 2018 to January 2020 were described. RT involved the use of basiliximab and thymoglobulin for induction therapy and oral prednisolone, tacrolimus and mycophenolate mofetil for maintenance immunosuppressive therapy. Results Recipients were 9 years to 17 years (average age of 12 years) of age. Primary steroid-resistant focal segmental glomerulosclerosis nephrotic syndrome, congenital posterior urethral stricture and lupus nephritis were the causes of the end-stage kidney diseases. The IAF was excellent in all the cases. All the 3 children are alive with good allograft functions at 6-24 months of the follow-up period. Conclusion This case series shows that a successful paediatric RT programme is feasible in a resource-constrained setting like Nigeria

Background: Urinary tract infection (UTI) in neonates might be associated with bacteremia and congenital anomalies of the kidney and urinary tract (CAKUT), that in complicated situations can lead to renal parenchymal scarring and chronic kidney disease. Aim: To determine occurrence of UTI in neonatal sepsis. Methods: This cross sectional study was conducted on 500 term, extramural hospitalized neonates, suspected to have infection underwent, a detailed history, physical examination and a comprehensive sepsis workup. The diagnosis of neonatal UTI was based, on positive urine culture, obtained by suprapubic aspiration (SPA). Results: Out of 500 neonates included in our study (324 boys and 176 girls), blood culture was positive in 84 (36.5%) neonates in early-onset sepsis group (n=230), while in late-onset sepsis group (n=270) blood culture was positive in130 (48.1%), p-value < 0.05. In both early-onset sepsis (EOS) and late-onset sepsis (LOS) groups, blood culture was found to be positive in a greater proportion of male (41.3%) than female (29.3%) patients, p-value <0.05. The most common organism isolated from blood and urine culture was Klebsiella, followed by E-coli. Urine culture was positive in 34 (6.8%) patients, among whom 29 (85%) culture-positive cases were from the LOS group, a p-value of <0.05. Conclusions: UTI is not uncommon among the hospitalized neonates, and UTI evaluation among septic neonates can prove beneficial for the prevention of long-term sequelae of neonatal UTI.

Background and Aim: Kidney transplantation is the preferred treatment modality for end-stage renal disease (ESRD) in children. Despite its benefits and advances that have been accomplished, pediatric kidney transplantation remains a challenge in terms of achieving a satisfactory outcome. We sought to evaluate the outcome of pediatric kidney transplantation in Mashhad. Methods: Data were acquired retrospectively from children below 18 years old who underwent kidney transplantation in three main hospitals of Mashhad from 2000 to 2014. After obtaining written informed consent from parents, data were collected using a questionnaire and analyzed with the SPSS software. Results: Of 52 children, 51.9% were boys and 48.1% were girls with a mean age of 13.3 ± 4.3 years. Among them, 8 (15.4%) children received transplants from relative live donors, 16 (30.8%) from non-relative live donors, and 28 (53.8%) from deceased donors. The most common etiology leading to ESRD in these children was reflux nephropathy in 18 (34.6%) patients. After a 5-year follow-up period, the graft survival rate was 69.2% with infection being the most common cause of transplant rejection. Moreover, 13.5% of children died, mostly due to surgical complications. Conclusion: We found that to increase the survival rate of pediatric kidney transplantation in Mashhad, first the surgical methods should be enhanced as they were recognized as the most common cause of death. In addition, infection control in children, as the most common cause of transplant rejection, should be improved.

Nephromegaly in childhood can result from a wide variety of causes, yet iron-deficiency anemia has not been previously described. We report a child with severe iron-deficiency anemia associated with transient bilateral nephromegaly. We hypothesize that increased renal production of erythropoietin as well as greater cardiac output with subsequent glomerular hyperfiltration secondary to critical anemia explained the observed nephromegaly. The normalization of kidney size following resolution of anemia supports this hypothesis. Our case report suggests an additional etiology of bilateral nephromegaly in the pediatric population and thus merits attention among physicians.

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis is a type of systemic autoimmune disease with blood vessels swelling and inflammation. Wegener's Granulomatosis (WG) is closely associated with antineutrophil cytoplasmic autoantibodies, particularly those directed to proteinase 3 (PR3). An 18-year-old boy with granulomatosis with polyangiitis (GPA) who was diagnosed 6 months back with scleritis and sinusitis at the onset of the disease. During his initial visits to Ear Nose Throat and ophthalmology departments lab tests was not performed on time due to lack of typical symptoms of kidney involvement. Half a year later, lab tests showed PR3-ANCA (Proteinase 3) positive and advanced renal dysfunction, and was finally diagnosed as sclerotic renal failure with fibrotic crescents based on renal biopsy. Scleritis may be the earliest manifestation in systemic vasculitis and is sometimes hard to diagnose at the onset. Delayed diagnosis and treatment will lead to irreversible renal dysfunction.

Background and Aim: Urinary tract infection is one of the most common childhood diseases. The results of studies investigating discontinuation or continuation of antibiotics in children with recurrent urinary tract infections and urinary reflux are controversial. Therefore, this study was conducted to compare prophylactic antibiotic treatment twice a week versus every night in the recurrence of urinary tract infections in children. Methods: This clinical trial was conducted using non-random simple sampling. Group A was given a single daily dose of cephalexin 10 mg/kg and group B was given cotrimoxazole at a dose of 5 mg/kg. Both groups were followed for ten months. Recurrences of urinary tract infections were compared between the two groups. Results: The mean age of the participants was 3.53±2.04 years. Most of the subjects were female (n=37, 61.7%). Urinary reflux was unilateral in 65% of the cases (n=39) and bilateral in the rest. There was no significant difference in age distribution, sex, and type of reflux between groups A and B. The frequency of recurrent urinary tract infection was 8.3% in group A and 6.7% in group B indicating no significant difference (p = 0.500). Conclusion: The results of this study showed that the frequency of recurrence of urinary tract infections in children who received prophylactic antibiotic treatment twice a week was not significantly different compared to the group of children who received continuous antibiotic prophylaxis.

Cerebral salt wasting syndrome (CSWS) is an important cause of persistent hyponatremia in children admitted to the intensive care unit. It needs to be promptly differentiated from the syndrome of inappropriate antidiuretic hormone (SIADH) secretion as a cause of hyponatremia in pediatric neurological patients. These two entities often have similar presenting symptoms however the treatment of both can be drastically different, which makes the distinction critical. We present a 6-month-old male child with hydrocephalus secondary to aqueductal stenosis, a blocked VP shunt, meningitis, and hyponatremia. A diagnosis of CSWS was considered and fludrocortisone was started. The patient improved gradually with a reduction in urine output and a gradual increase in serum sodium levels. A diagnosis of CSWS should be strongly considered in hyponatremic pediatric patients with significant natriuresis and suitable treatment should be initiated promptly to prevent long-term neurologic sequelae.