Pediatric Nephrology最新文献

Background: Acute kidney injury (AKI) is an important complication in neonates with hypoxic ischemic encephalopathy (HIE). The aim was to assess the association between early lactate elimination trend and development of AKI in neonates with HIE receiving therapeutic hypothermia.

Methods: Medical records of 257 neonates with moderate-severe HIE were retrospectively analyzed for development of AKI based on neonatal Kidney Disease Improving Global Outcomes (KDIGO) criteria. Blood lactate values over time for the first 5 days were recorded. The percentage decrease in lactate values was calculated during the first 12 h and on a daily basis and reported as lactate elimination trend. Logistic regression analysis and receiver operating characteristics curve (ROC) analysis were conducted.

Results: AKI developed in 70 neonates (27.2%). Median initial and 12-h lactate values were significantly higher in the AKI group. Lactate elimination trend at 12-h was significantly lower in the AKI group compared to neonates with no AKI (43.6% vs 61.4%, p < 0.001). Lower 12-h lactate elimination trend was associated with development of AKI (OR: 21.27, 95%CI: 6.73-67.17, p < 0.001). ROC curve analysis demonstrated a 47.5% decrease in lactate values at 12-h as critical cut-off value of lactate elimination trend with 90% specificity and 64% sensitivity to predict AKI. Area under curve was found to be 0.813 (95% CI: 0.76-0.86, p < 0.001).

Conclusions: Lactate elimination trend in the first 12 h can be used as an early marker for AKI in neonates with HIE receiving therapeutic hypothermia. The presence of decreased lactate elimination trend will allow for careful fluid management and early medical interventions in this highly vulnerable patient population.

Background: Albuminuria is a sensitive marker of early kidney injury and serves as a key indicator for the diagnosis of chronic kidney disease. Excessive screen time has been associated with various adverse health issues in pediatric populations. However, the relationship between screen time and albuminuria remains unclear.

Methods: Data from 6277 adolescents were obtained from five provinces in the 2016-2017 China Nutrition and Health Surveillance of Children and Lactating Women. A total of 4524 participants were included in the main analysis. Screen time of various electronic devices was self‑reported using a structured questionnaire, and the total screen time was further categorized as < 1 h/day, 1-2 h/day, and > 2 h/day. Albuminuria was assessed through laboratory measurements and defined by the urine albumin-creatinine ratio. The association between screen time and albuminuria was examined using logistic regression models.

Results: After adjusting for all covariates, screen time showed a significant association with the odds of albuminuria ([Model 3] 1-2 h/day: OR = 1.68, 95% CI 1.28-2.20, p < 0.001; > 2 h/day: OR = 1.34, 95% CI 1.01-1.80, p < 0.05). This association remained robust in sensitivity analyses. A stronger association was observed among participants with insufficient sleep (p for interaction < 0.05).

Conclusions: This study found that screen time was linked to albuminuria in the general adolescent population, which suggests that excessive screen time may have implications for early kidney damage. Further longitudinal cohort studies are essential to clarify the causality.

The energy requirement of renal proximal tubular cells depends on mitochondrial fatty acid β-oxidation. Enoyl-CoA hydratase-l-3-hydroxyacyl-CoA dehydrogenase (EHHADH) is a crucial enzyme in mitochondrial fatty acid oxidation, and mutations in EHHADH reportedly cause Fanconi syndrome. Here, we report the case of a 28-year-old Japanese woman with a long-term history of low-molecular-weight proteinuria (LMWP) who exhibited a missense mutation in the EHHADH gene. She was diagnosed with LMWP at 4 years of age. The search for the CLCN5 gene was unremarkable, and kidney biopsy revealed no significant tubulointerstitial changes. The LMWP persisted, and glucosuria gradually developed thereafter. Unexpectedly, next-generation sequencing identified a heterozygous missense mutation in the EHHADH gene. Her father, who harbored LMWP, also had the same mutation. Furthermore, immunostaining of the stored kidney specimens showed decreased immunoreactivity for cytochrome c oxidase subunit 4 in the proximal tubules, suggesting an underlying mitochondrial impairment.

Background: Immunosuppressive drugs are required for childhood frequent-relapse nephrotic syndrome (FRNS), steroid-dependent NS (SDNS), or steroid-resistant NS (SRNS). However, the benefits of immunosuppressants need to be balanced with their known side effects. This study aimed to compare remission rates of FRNS, SDNS, and SRNS in children treated with cyclophosphamide versus cyclosporin A (Cy A).

Methods: We retrospectively reviewed the medical records of children diagnosed with NS at Prince of Songkla University Hospital, Thailand. Remission rates and complications in patients with FRNS/SDNS and SRNS were compared among those treated with oral cyclophosphamide, Cy A, or cyclophosphamide followed by Cy A.

Results: Among 148 children (102 boys, 68.9%), the median age was 4.6 years (IQR 2.5-8.4). FRNS, SDNS, and SRNS were diagnosed in 37 (25.0%), 50 (33.8%), and 61 (41.2%) children, respectively. Among 87 FRNS/SDNS patients, 67 were treated with cyclophosphamide, 2 with Cy A, and 18 with cyclophosphamide followed by Cy A. There were no statistically significant differences in remission rates or complications among the treatment groups. Among 61 SRNS patients, 27 were treated with cyclophosphamide, 11 with Cy A, and 23 with cyclophosphamide followed by Cy A. The remission rates were 29.6%, 72.7%, and 43.5%, respectively. Acute kidney injury (AKI) was reported in 14.8%, 18.2%, and 52.2% of patients, respectively.

Conclusions: In FRNS/SDNS patients, remission rates were comparable between cyclophosphamide and Cy A treatments. In SRNS patients, Cy A treatment resulted in a higher remission rate than cyclophosphamide but was associated with a greater incidence of AKI.

Background: BK virus is a polyoma virus which has been associated with impaired graft function in kidney transplant recipients. After primary infection, the virus becomes latent in the renal/urinary epithelium. In immunocompetent hosts, there are usually no pathological sequelae.

Case: An 11-year-old female on chronic immunosuppression for a severe auto-immune/inflammatory condition was referred to Paediatric Nephrology due to a persistently elevated serum creatinine. Extensive investigation yielded BK viruria and viraemia. Kidney biopsy showed multifocal lymphocytic tubulitis, with cytonuclear changes. Immunohistochemical staining for SV40 was positive, and a diagnosis of native kidney BK virus nephropathy was made.

Conclusion: We present the first non-malignancy/transplant-associated paediatric case of BK virus nephropathy in a native kidney. In an era of increasing use of immunosuppressive medicines for a variety of indications, clinicians should include BK virus infection in their differential diagnosis for nephropathy in patients on chronic, high-dose immunosuppression.