Acute Renal Failure In Children Research Articles

The Role of the Complement System in the Pathogenesis of Infectious Forms of Hemolytic Uremic Syndrome.

Hemolytic uremic syndrome (HUS) is an acute disease and the most common cause of childhood acute renal failure. HUS is characterized by a triad of symptoms: microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. In most of the cases, HUS occurs as a result of infection caused by Shiga toxin-producing microbes: hemorrhagic Escherichia coli and Shigella dysenteriae type 1. They account for up to 90% of all cases of HUS. The remaining 10% of cases grouped under the general term atypical HUS represent a heterogeneous group of diseases with similar clinical signs. Emerging evidence suggests that in addition to E. coli and S. dysenteriae type 1, a variety of bacterial and viral infections can cause the development of HUS. In particular, infectious diseases act as the main cause of aHUS recurrence. The pathogenesis of most cases of atypical HUS is based on congenital or acquired defects of complement system. This review presents summarized data from recent studies, suggesting that complement dysregulation is a key pathogenetic factor in various types of infection-induced HUS. Separate links in the complement system are considered, the damage of which during bacterial and viral infections can lead to complement hyperactivation following by microvascular endothelial injury and development of acute renal failure.

Consumer Protection Against the Production and Sale of Syrup Drugs Suspected of Being Contaminated with Hazardous Materials

Recently, the Indonesian health world has been shocked by the alleged production and sale of syrup drugs suspected to be contaminated with Ethylene Glycol (EG)/Diethylene Glycol (DEG) which exceeds the safe threshold and triggers acute renal failure in children. This is very worrying because it is feared that the impact will be even wider. Based on the information cited by the author from the news article that the Food and Drug Supervisory Agency of the Republic of Indonesia (BPOM RI) released an updated list of ethylene glycol (EG)/Diethylene Glycol (DEG) tainted syrup drugs that exceed the safe threshold. The contamination is suspected of triggering acute renal failure in children. The method which was used in this Scholar Paper was the Qualitative Research Method, a kind of Normative Legal Writing which was based on prescriptive library research concerning the study of positive law. For the Primary Legal Materials, Scholar used references such as Act Number 8 Year 1999 regarding to Consumer Protection, etc. And for Secondary Legal Material, Scholar uses books, journals, papers, newspapers, and report of legal writing. Then, for Tertiary Legal Materials, Scholar used references such as legal dictionary, dictionary Indonesian-English dictionary and vice versa, etc. Consumer has rights that must be protected from legal perspectives. Law Number 8 of 1999 concerning Consumer Protection Article 1 point (2) states that consumers are every user of goods and or services available in society, whether for the benefit of themselves, family, others, or other living beings and not for trading. It is crystal clear as regulated by our legislation, Consumer Protection must have a guarantee of legal certainty given to consumers. In this case Consumer Protection must have a guarantee of legal certainty provided to consumers in this case is a guarantee of the safety of syrup drugs on the market so that they are safe for consumption by their buyers. Plus buyers who take the syrup medicine are in an unwell state. Of course they want what is called healing, instead of getting worse, conditions such as kidney failure or even death.

Pediatric Acute Renal Failure in Chad: Epidemiological, Clinical and Evolutionary Aspects

Introduction: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden and potentially reversible reduction in kidney function, as measured by glomerular filtration rate (GFR) affecting the exocrine functions of the kidney. It engages the short-term vital prognosis and the long-term renal function prognosis. It is an important cause of morbidity and mortality in sub-Saharan Africa. Our objective was to study the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of acute renal failure in children at the Renaissance University Hospital Center and Mother and Child University Hospital in N’Djamena, Chad. Methodology: This was a descriptive and analytical cross-sectional study for six months from March to August 2020. All children aged 1 year to 15 years that were hospitalized in the emergency room of the Mother and Child University Hospital and went for follow-up consultations in the Nephrology and Dialysis Department of the Renaissance University Hospital Center with acute renal failure defined by the KDIGO 2012 criteria were included in the study. The data were analyzed by Excel 2019 and SPSS 18.0 with significance (p<0.05). Results: Thirty children were included in the study with a hospital prevalence of 0.56%. The mean age was 8.33 years with a sex ratio of 3.28. The average consultation time was 10.1 days. Vomiting was the main reason for consultation (46.7%). About 27% of patients had oligoanuria. There were 86% of the cases that were anemic, half of which were severe. Mean serum creatinine was 434.02 µmol/l and the mean urea level was 26.86 mmol/l. Severe malaria was the main cause of AKI (33.3%). All patients suffering from malaria received antimalarials based on artemisinin derivatives. Intermittent hemodialysis was indicated in 22 patients (73.4%). The evolution was marked by a total recovery of renal function in 20 patients, 8 deaths and 2 transitions to chronic kidney disease. Deaths were statistically related to AKI severity, age range 1-5 years, femoral catheters and infections (p<0.0000). Conclusion: Acute kidney injury is an uncommon pathology in pediatrics and in Chad. It is often linked to severe malaria and has a high mortality rate.

Characterization of enterohemorrhagic Escherichia coli from diarrhoeic patients with particular reference to production of Shiga-like toxin

Enterohemorrhagic Escherichia coli (EHEC) is a subtype of pathogenic E. coli that causes diarrhea or hemorrhagic colitis in humans, which can progresses to hemolytic uremic syndrome (HUS), a leading cause of acute renal failure in children, and morbidity and mortality in adults. Stool samples (n = 273) of patients (1 day-40 years old) suffered from bloody diarrhea and abdominal cramps, were examined bacteriologically and molecularly for the presence and pathogenicity of EHEC with phylogenetic analysis of the obtained stx1, stx2, and eaeA virulence genes’ sequences. Overall, 71 (26.01%) E. coli isolates were identified as EHEC with the following serogroupes: O1:H11 (3), O128:H2 (9), O26:H11 (6), O157:H7 (3), O25:H2 (7), O145:H328 (2), O125:H6 (9), O86:H8 (5), O18:H15 (11) and untypable (16). The highest isolation rate were in samples belonged to infants below two years old (42.25%). Antimicrobial susceptibility testing showed that all isolates were highly sensitive to ciprofloxacin, nitrofurantoin, gentamycin, imipenem and vancomycin (100% each), however, they were resistant to ampicillin, cephalexin, penicillin and tetracycline (100% each). In-vitro pathogenicity testing of the isolates revealed that 67 (94.37%) isolates were positive for Congo red test, 47 (66.20%) isolates possessed P fimbriae (MRHA) and 17 (23.94%) possessed type 1 fimbriae (MSHA). Moreover, 46 (64.79%) isolates exhibited hemolysis and 42 (59.15%) isolates showed distinct cytopathic effect to Vero cells. Molecular detection of enterohemorrhagic E. coli (EHEC) pathotype virulence genes, confirmed the presence of stx1 gene in O157:H7 (MA2), O26:H11, O145:H328 and O125:H6 serogroups; stx2 gene in (O157:H7 (MA1), O128:H2 and O25:H2; while all serogroups except (O125:H6) carried the eaeA intimin virulence gene. A phylogenetic tree, based on the nucleotide sequences of toxin-encoding genes, demonstrates that Shiga toxin E. coli (STEC) isolates have considerable genetic variation and belong to various phylogenetic groupings.

Острое повреждение почек как осложнение кишечных инфекций у детей (обзор литературы)

The article discusses one of the main complications in acute intestinal infections in children — acute kidney injury (AKI), which is often a life-threatening condition that occurs due to acute loss of kidney function. In the future, these patients may develop chronic kidney disease. The main pathogenetic aspects of this complication in children and the mechanisms of its development are analyzed; the frequency of occurrence is shown according to the data of different authors. Transient renal dysfunction occurs in 21.9–41.6% of children with acute intestinal infections. Hemolytic uremic syndrome is the leading cause of acute renal failure in children under 3 years of age. Aspects of the AKI diagnosis at the present stage are presented, including endogenous markers for assessing the glomerular filtration rate (GFR). The importance of early diagnosis of AKI is shown, and the need to introduce new standardized criteria for calculating GFR is substantiated.

Eculizumab Use in a Temporarily Dialysis-Dependent Patient With Shiga Toxin-Producing Escherichia Coli Hemolytic Uremic Syndrome With Neurological Complications.

Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is the most common cause of acute renal failure in children, and it is associated with thrombocytopenia and hemolytic anemia. Although this disease primarily affects the kidney, it can also contribute to cellular damage in other organ systems, such as the CNS. Eculizumab is a monoclonal antibody that binds to complement proteins to prevent complement-mediated intravascular hemolysis in atypical HUS. In STEC-HUS, complement activation also occurs by Shiga toxin, and previous cases of eculizumab use in the setting of neurological involvement have been shown to be successful. We report the successful use of eculizumab in the setting of typical STEC-HUS-induced neurological symptoms including seizure, altered mental status, and left arm weakness. The patient also experienced concomitant renal failure requiring dose adjustment for hemodialysis. Following 2 doses of eculizumab, our patient was discharged to an inpatient rehabilitation facility with resolution of her renal injury, seizures, and altered mentation without adverse effects from eculizumab throughout the admission. Based on our case study, it appears that eculizumab may be given during or between hemodialysis without dose adjustment.

Prevalence of acute renal failure in pediatrics admitted to the emergency department

Introduction: Causes of acute renal failure in children vary in developed and developing countries. Prevention plays an important role in reducing the complications of acute renal failure (ARF), while changes in fluid therapy management and infection control can reduce the incidence and severity of renal failure. Objectives: The aim of this study was to investigate the prevalence and causes of ARF in children. Patients and Methods: A prospective descriptive-analytical study was conducted in Ali-Ibn-Abitaleb hospital in Zahedan during a period of one year from April to March 2017 in patients aged one month to 15 years who were admitted to the pediatric emergency department. Results: Among 201 patients with acute kidney injury (AKI), the highest number was 112 patients (28.3%) between one month and one year, followed by 80 patients (7.9%), one year to five years, and 9 patients (3.1%) above 5 years. Gender did not play a significant role in the development of acute kidney disease. The most common causes of AKI were sepsis (87.2%), underlying renal disease (64.9%), heart disease (37.5%), and gastrointestinal disease (19.5%), respectively. The most common laboratory findings in patients with AKI were hypokalemia (56.7%) and hypernatremia (57.1%). Conclusion: ARF is one of the most problems in medical system, but its exact cause is not well established. Knowing ARF epidemiology by standard definitions can help to measure high-risk pediatrics, as the first step for treatment and improving outcomes. A future study may benefit from better identification of risk factors and early detection of AKI using novel biomarkers to prevent the progression of AKI.

Eliglustat prevents Shiga toxin 2 cytotoxic effects in human renal tubular epithelial cells.

Shiga toxin-producing Escherichia coli is responsible for post-diarrheal (D+) hemolytic uremic syndrome (HUS), which is a cause of acute renal failure in children. The glycolipid globotriaosylceramide (Gb3) is the main receptor for Shiga toxin (Stx) in kidney target cells. Eliglustat (EG) is a specific and potent inhibitor of glucosylceramide synthase, first step of glycosphingolipid biosynthesis, actually used for the treatment of Gaucher's disease. The aim of the present work was to evaluate the efficiency of EG in preventing the damage caused by Stx2 in human renal epithelial cells. Human renal tubular epithelial cell (HRTEC) primary cultures were pre-treated with different dilutions of EG followed by co-incubation with EG and Stx2 at different times, and cell viability, proliferation, apoptosis, tubulogenesis, and Gb3 expression were assessed. In HRTEC, pre-treatments with 50 nmol/L EG for 24 h, or 500 nmol/L EG for 6 h, reduced Gb3 expression and totally prevented the effects of Stx2 on cell viability, proliferation, and apoptosis. EG treatment also allowed the development of tubulogenesis in 3D-HRTEC exposed to Stx2. EG could be a potential therapeutic drug for the prevention of acute kidney injury caused by Stx2. For the first time, we have demonstrated that Eliglustat prevents Shiga toxin 2 cytotoxic effects on human renal epithelia, by reducing the expression of the toxin receptor globotriaosylceramide. The present work also shows that Eliglustat prevents Shiga toxin 2 effects on tubulogenesis of renal epithelial cells. Eliglustat, actually used for the treatment of patients with Gaucher's disease, could be a therapeutic strategy to prevent the renal damage caused by Shiga toxin.

RETRACTED: Internet of things medical image detection and pediatric renal failure dialysis complicated with respiratory tract infection

Acute Renal Failure in children in need of dialysis, peritoneal dialysis, hemodialysis, including intermittent and continuous blood filtration, or blood dialysis, can be managed in various ways. Selection of dialysis in the management of a particular patient, the goal of dialysis use of each model and institutional resources are determined by several factors, including the unique strengths and weaknesses. To provide practical guidance for physicians involved in managing acute renal failure in children, this review considers these aspects of acute renal failure management. Respiratory tract infections (genital tract infection) is a common reason people seek medical care services. Reproductive tract infection is associated with high short-term mortality. Inconsistent evidence exists concerning the risk of death of the patient's existence and reproductive tract infections of the kidney disease. Besides, the Company, together with respiratory infections, the main features of each type, is a complex common type of dialysis in children with renal failure. Finally, are open to detecting dialysis respiratory infections in children with renal failure, which is expected to facilitate future studies of the complex medical network of smart medicine and Internet issues when pointed out the application of deep reinforcement learning.

Acute renal failure in children. Multicenter prospective cohort study in medium-complexity intensive care units from the Colombian southeast.

Acute kidney injury is frequent in critically ill children; however, it varies in causality and epidemiology according to the level of patient care complexity. A multicenter prospective cohort study was conducted in four medium-complexity pediatric intensive care units from the Colombian southeast aimed to estimate the clinical prognosis of patients with diagnosis of acute kidney injury. We included children >28 days and <18 years of age, who were admitted with diagnosis of acute kidney injury classified by Kidney Disease Improving Global Outcomes (KDIGO), during the period from January to December 2017. Severe acute kidney injury was defined as stage 2 and stage 3 classifications. Maximum KDIGO was evaluated during the hospital stay and follow up. Length of hospital stay, use of mechanical ventilation and vasoactive drugs, use of renal replacement therapy, and mortality were assessed until discharge. Prevalence at admission of acute kidney injury was 5.2% (95%CI 4.3% to 6.2%). It was found that 71% of the patients had their maximum KDIGO on day one; an increment in the maximum stage of acute kidney injury increased the pediatric intensive care unit stay. Patients with maximum KDIGO 3 were associated with greater use of mechanical ventilation (47%), compared with maximum KDIGO 2 (37%) and maximum KDIGO 1 (16%). Eight patients with maximum KDIGO 2 and 14 with maximum KDIGO 3 required renal replacement therapy. Mortality was at 11.8% (95%CI 6.4% to 19.4%). Acute kidney injury, established and classified according to KDIGO as severe and its maximum stage, was associated with worse clinical outcomes; early therapeutic efforts should focus on preventing the progression to severe stages.

Particulate Shiga Toxin 2 in Blood is Associated to the Development of Hemolytic Uremic Syndrome in Children.

Hemolytic uremic syndrome (HUS), the leading cause of acute renal failure in children (< 3 years), is mainly related to Shiga toxins (Stx)-producing Escherichia coli (STEC) infections. STEC are confined to the gut resulting in hemorrhagic colitis, whereas Stx are delivered in blood to target kidney and brain, with unclear mechanisms, triggering HUS in 5 to 15% of infected children. Stx were found on circulating cells, free in sera (soluble Stx) or in blood cell-derived microvesicles (particulate Stx), whereby the relationship between these forms of circulating toxins is unclear. Here, we have examined 2,846 children with bloody diarrhea and found evidence of STEC infection in 5%. Twenty patients were enrolled to study the natural course of STEC infections before the onset of HUS. In patients, Stx were found to be associated to circulating cells and/or free and functionally active in sera. In most children, Stx were bound to neutrophils when high amounts of toxins were found in feces. Time-course analysis showed that Stx increased transiently in patients' sera while the decrease of toxin amount on leukocytes was observed. Notably, patients who recovered (85%) displayed different settings than those who developed HUS (15%). The distinctive feature of the latter group was the presence in blood of particulate Stx2 (Stx2 sedimented at g-forces corresponding to 1 μm microvesicles) the day before diagnosis of HUS, during the release phase of toxins from circulating cells. This observation strongly suggests the involvement of blood cell-derived particulate Stx2 in the transition from hemorrhagic colitis to HUS.

Development and Validation of Shiga Toxin-Producing Escherichia coli Immunodiagnostic Assay.

Shiga toxin (Stx)–producing Escherichia coli (STEC) and its subgroup enterohemorrhagic E. coli are important pathogens involved in diarrhea, which may be complicated by hemorrhagic colitis and hemolytic uremic syndrome, the leading cause of acute renal failure in children. Early diagnosis is essential for clinical management, as an antibiotic treatment in STEC infections is not recommended. Previously obtained antibodies against Stx1 and Stx2 toxins were employed to evaluate the sensitivity and specificity of the latex Agglutination test (LAT), lateral flow assay (LFA), and capture ELISA (cEIA) for STEC detection. The LAT (mAb Stx1 plus mAb stx2) showed 99% sensitivity and 97% specificity. Individually, Stx1 antibodies showed 95.5% and 94% sensitivity and a specificity of 97% and 99% in the cEIA and LFA assay, respectively. Stx2 antibodies showed a sensitivity of 92% in both assays and a specificity of 100% and 98% in the cEIA and LFA assay, respectively. These results allow us to conclude that we have robust tools for the diagnosis of STEC infections.

Acute Renal Failure in Children at the University Hospital of Brazzaville

Introduction: Acute renal failure (ARF) is a medical emergency that does not spare children. Its interest lies in the search for etiologies and management made difficult by the poor quality of hospital technical platform in Africa. Objectives: To improve the management of ARF in children, determine its prevalence, and identify the causes and factors associated with mortality. Patients and Methods: We reviewed the records of children from one month to 17 years hospitalized between January 2016 and December 2018 in every pediatric department at the University Hospital of Brazzaville and included those whose discharge diagnosis included the item “ARF”. Study variables were age, sex, source, (para)clinical signs, stage and type of ARF, etiology and evolutionary profile. Results: Included were 18952 hospitalized children out of whose 253 had ARF 1.3%. There were 145 (57.3%) boys and 108 (42.7%) girls with an average age of 71.5 months. The mean time to consultation was 8.1 days. ARF was at failure stage in 147 cases (58.1%). It was functional in 210 cases (83.0%), out of which 95.1% resulted from severe dehydration. No extra-renal treatment was performed. Lethality was 34.4%. Hypovolemic shock (56.3%), severe sepsis (18.4%) and severe malaria (14.9%) were the main causes. Young age, provenance of the child, severe dehydration, deep coma, oligoanuria, stage of failure, hyperkalemia, absence of an extra-renal purification center were factors associated with mortality (p Conclusion: The high prevalence of ARF and its lethality requires public health actions including proper management of dehydration and malaria but also the creation of an extra-renal purification center.

ПОРАЖЕНИЕ ПОЧЕК У ДЕТЕЙ С ТЯЖЕЛЫМИ ФОРМАМИ ОСТРЫХ КИШЕЧНЫХ ИНФЕКЦИЙ

Introduction. Acute intestinal infections and diarrhea-associated hemolytic-uremic syndrome (HUS) are the main cause of acute renal failure in children. Objective: to establish the frequency of development of acute renal failure in children hospitalized in the intensive care unit of an infectious hospital with severe forms of acute intestinal infections. Material and methods. A retrospective comparative statistical analysis of 123 case histories of children with acute intestinal infections who were undergoing treatment in the intensive care unit of the Grodno Regional Infectious Disease Clinical Hospital was conducted. Patients were divided into 3 groups: 1 group (n = 84) - children with acute intestinal infections and lack of clinical and laboratory signs of impaired renal function; 2 group (n = 27) - children with acute intestinal infections and prerenal acute renal failure (reduced diuresis, increased urea and / or serum creatinine, normalized against the background of ongoing rehydration therapy during the day); 3 group (n = 12) - children with acute intestinal infections and renal acute renal failure. Results. The age of the children was 1.0 (0.2, 2.2) year. Children prevailed up to a year – 49,6%, from one to five years – 42,3%, over 8 years – 8,1%. Oligouria was recorded in 28.5% of children, anuria in 3.3%. A statistically significant difference in levels of urea and creatinine in groups (p˂0,05) was established. The highest rates were observed in patients of the 3 group. In 9 of them (75%), a typical HUS associated with infectious diarrhea was diagnosed. Conclusion. In 21,9% of children with acute intestinal infections, prerenal acute renal failure was diagnosed, in 9,8% - renal. The main cause of renal acute renal failure in children with severe forms of acute intestinal infections is a typical HUS associated with the infectious etiology of diarrhea.

Outcome of acute renal failure in children in Chennai, India

Background: Acute Renal Failure (ARF) is one of the common causes of morbidity and mortality in children. With the availability of increasing knowledge and awareness, dialysis facilities and excellent supportive treatment, the overall outcome is changing. This study is undertaken to find out the outcome of ARF in children.Methods: This prospective cross-sectional study was done in Institute of Child Health and Hospital for Children, (ICH and HC) Egmore, Chennai from February 2014 to January 2016. Children with elevated blood urea (&gt;40 mgs/dl) and serum creatinine (&gt;1 mg/dl) were included and evaluated for etiology, treatment modality and outcome and other co-morbid features. Data was analysed on SPSS 20.0. P value of &lt;0.05 was considered significant.Results: A total of 105 children (65 boys, 40 girls) from newborn period to 12 years were examined. The common age of presentation of ARF is 1-4 years with a male preponderance and acute glomerulonephritis were found to be commonest cause. There was no statistically significant difference in mortality in relation to age group (P 0.98). There was a statistically significant difference in mortality in relation to duration of oliguria (P 0.02), Serum creatinine levels (P 0.03). The role of other biochemical values like serum potassium (P 0.14), serum bicarbonate (P 0.59) were not found statistically significant. Peritoneal dialysis in general improves survival, but it is not statistically significant (P 0.33). Systemic complications associated with ARF increases mortality and it is statistically significant (Chi- square value = 9.13, P = 0.003).Conclusions: ARF in children is due to transient disorders and early referral to major centres even with 1-2 days oliguria and early treatment will improve the prognosis. Peritoneal dialysis in severe ARF with associated complications really helped the children.

Ouabain Protects Human Renal Cells against the Cytotoxic Effects of Shiga Toxin Type 2 and Subtilase Cytotoxin

Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in children. The majority of cases are associated with Shiga toxin (Stx)-producing Escherichia coli (STEC). In Argentina, HUS is endemic and presents the highest incidence rate in the world. STEC strains expressing Stx type 2 (Stx2) are responsible for the most severe cases of this pathology. Subtilase cytotoxin (SubAB) is another STEC virulence factor that may contribute to HUS pathogenesis. To date, neither a licensed vaccine nor effective therapy for HUS is available for humans. Considering that Ouabain (OUA) may prevent the apoptosis process, in this study we evaluated if OUA is able to avoid the damage caused by Stx2 and SubAB on human glomerular endothelial cells (HGEC) and the human proximal tubule epithelial cell (HK-2) line. HGEC and HK-2 were pretreated with OUA and then incubated with the toxins. OUA protected the HGEC viability from Stx2 and SubAB cytotoxic effects, and also prevented the HK-2 viability from Stx2 effects. The protective action of OUA on HGEC and HK-2 was associated with a decrease in apoptosis and an increase in cell proliferation. Our data provide evidence that OUA could be considered as a therapeutic strategy to avoid the renal damage that precedes HUS.

A Retrospective Study of Acute Renal Failure in Children: Its Incidence, Etiology, Complications and Prognosis.

BackgroundAcute renal failure (ARF) developed due to various causes and may lead to significant morbidity and mortality among pediatric patients.ObjectivesThe study was conducted to determine the incidence, etiology, outcome of treatment and clinical presentation of ARF in pediatric patients in Somalia.MethodsComprehensive case history of 39 pediatric patients below 12 years of age, admitted with renal diseases in four tertiary care hospitals in Hargeisa and Borama cities in Somalia during December 2015 to November 2016. They were subjected to clinical investigation and laboratory test analysis based on the inclusion criteria of renal insufficiency characterized by serum creatinine level more than 1.5 mg/dl.ResultsARF was most commonly found in five to 12 years age group (53.8%) compared to infant (zero to one year) and pre-school (one to five years) children (23.08%). Mean age of presentation was 6.14 years. Male female ratio in this study was 1.2: 1. Most common presenting clinical feature in our study was oliguria (97.43%), swelling (69.2%), fever (84.1%), abdomen pain and nausea-vomiting (41.02%). Common clinical signs were edema (66.66%), altered sensorium (51.28%), hematuria (48.71%) and hypertension (38.46%). Snake bite and acute post streptococcal glomerulonephritis were the two most common causes of ARF in children in our study. Common complications were hypertension (38.46%), anemia (35.89%), hyperkalemia (25.64%) and infection (20.51%), all of which were within the previously reported range. The factors which correlated positively with increased mortality and morbidity were females with age below one year , etiology like septicemia and systemic lupus erythematosus (SLE), high peak serum creatinine concentration and complicated by disseminated intravascular coagulation (DIC).ConclusionMany causes of ARF are preventable and it should be possible to reduce mortality and morbidity due to ARF through purposive preventive measure and availability of the better medical facility.

Clinical characteristics of children with hemolytic uremic syndrome in Hangzhou, China.

Hemolytic uremic syndrome (HUS) is a main cause of acute renal failure in children. This study aimed to analyze the clinical characteristics of HUS. A retrospective analysis was performed in 46 children with sporadic HUS. Of the 46 HUS patients, 20 (43.5%) were diarrhea-related HUS, and 26 (56.5%) were atypical HUS. Anemia, edema, oliguria, hemoglobinuria and hypertension were the most common manifestations. Thrombocytopenia, hyponatremia, hypocalcemia, hyperkalemia, metabolic acidosis, increased fibrinogen and hypocomplementemia were found in most patients. The age of onset (younger than 2 years or not, P=0.009), the duration of oliguria or anuria (more than one week or not, P=0.005), accompanied with extrarenal complications or not (P=0.005), dialysis and plasma exchange (P=0.04) were associated with the mortality rate. The age of onset younger than 2 years, oliguria/anuria more than 1 week, and associated with extrarenal complications were predictive factors of poor prognosis.

Unusual severe case of hemolytic uremic syndrome due to Shiga toxin 2d-producing E. coli O80:H2

BackgroundHemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in children, with the majority of cases caused by an infection with Shiga toxin-producing Escherichia coli (STEC). Whereas O157 is still the predominant STEC serotype, non-O157 serotypes are increasingly associated with STEC-HUS. However, little is known about this emerging and highly diverse group of non-O157 serotypes. With supportive therapy, STEC-HUS is often self-limiting, with occurrence of chronic sequelae in just a small proportion of patients.Case diagnosis/treatmentIn this case report, we describe a 16-month-old boy with a highly severe and atypical presentation of STEC-HUS. Despite the presentation with multi-organ failure and extensive involvement of central nervous system due to extensive thrombotic microangiopathy (suggestive of atypical HUS), fecal diagnostics revealed an infection with the rare serotype: shiga toxin 2d-producing STEC O80:H2.ConclusionsThis report underlines the importance of STEC diagnostic tests in all children with HUS, including those with an atypical presentation, and emphasizes the importance of molecular and serotyping assays to estimate the virulence of an STEC strain.

Acute Renal Failure in children with Diabetic ketoacidosis

Acute Renal Failure in children with Diabetic ketoacidosis