Pediatric Nephrology最新文献

An underlying medical condition as a cause for elevated blood pressure is suspected when hypertension occurs in younger children or those with markedly high readings (hypertensive urgency or emergency). We highlight a unique presentation and underlying medical condition, polycythemia vera (PV), as the cause of secondary hypertension in an asymptomatic 5-year-old child presenting for a routine physical examination and found to have hypertensive urgency. Laboratory evaluations revealed leukocytosis, polycythemia, thrombocytosis, and low erythropoietin level. JAK2-V617F mutational analysis confirmed the diagnosis of PV. She was managed with antihypertensive medications, therapeutic phlebotomy, and cytoreductive therapy with notable improvement in hypertension over time. She continues regular follow-up with nephrology and hematology/oncology. She has not had any further serious complications or evolution of her PV. This case demonstrates the importance of a broad differential diagnosis in the setting of very early onset hypertension, including myeloproliferative disorders.

Background: The urinary calcium-to-citrate (Ca/Cit) ratio has emerged as a useful indicator of lithogenic risk in older children; however, no reference data exist for infants and toddlers. This study aimed to evaluate whether the spot Ca/Cit ratio can distinguish stone-forming from non-stone-forming children under 24 months of age and to assess its diagnostic performance compared with conventional urinary markers.

Methods: This retrospective single-center study included 181 children aged 1-24 months who underwent metabolic evaluation and ultrasonography at their first presentation to a tertiary pediatric nephrology clinic between 2012 and 2024. Based on urinary calcium excretion and ultrasonographic findings, participants were categorized as normocalciuric stone-free controls (n = 57), hypercalciuric stone-formers (n = 29), or non-hypercalciuric stone-formers (n = 95). Spot urine calcium, citrate, and related biochemical ratios were analyzed. The diagnostic accuracy of the Ca/Cit ratio for predicting stones was assessed using receiver operating characteristic (ROC) analysis.

Results: The Ca/Cit ratio differed significantly across groups, with the highest levels observed in hypercalciuric stone-formers (0.46 mg/mg) compared with controls (0.17 mg/mg; p < 0.001) and non-hypercalciuric stone-formers (0.31 mg/mg; p < 0.001). A Ca/Cit threshold > 0.23 mg/mg (≈ 1.10 mmol/mmol) demonstrated moderate diagnostic ability for stone detection (AUC 0.695; 95% CI 0.613-0.785), yielding 66.1% sensitivity and 63.2% specificity. Age showed no meaningful correlation with Ca/Cit values. Normocalciuric stone-free children provided an age-appropriate reference distribution for Ca/Cit ratios.

Conclusions: In infants and toddlers evaluated for suspected urinary stone disease, the Ca/Cit ratio offers moderate discriminatory power and may serve as a practical adjunctive marker of stone risk. A ratio > 0.23 mg/mg (≈ 1.10 mmol/mmol) appears to indicate increased lithogenic potential. Larger prospective studies are needed to validate reference intervals and refine clinically applicable cut-off values for this young age group.

Background: Acute kidney injury (AKI) is common in critically ill children, frequently necessitating continuous kidney replacement therapy (CKRT). Procalcitonin (PCT) is widely used as an infection biomarker, yet its interpretation during CKRT remains unclear. Adult data regarding extracorporeal clearance of PCT are inconsistent, while pediatric evidence is limited.

Methods: In this prospective observational study (May 2021-October 2023), 40 critically ill children receiving CKRT in a tertiary PICU were enrolled. Serum PCT was measured at CKRT initiation (T0), 12 h (T12), and 24 h (T24). CKRT modalities (CVVH, CVVHD, CVVHDF), effluent doses, and membrane types (PS, PAES, AN69-ST) were recorded. PCT kinetics were analyzed using non-parametric tests, with correlation assessed by Spearman's rank.

Results: Median baseline PCT was 3.6 ng/mL (IQR 0.5-27.2), rising to 7.4 (0.6-29.5) at T12 and stabilizing at 7.7 (0.6-30.5) at T24. Differences across time points were not statistically significant (p = 0.68). PCT trajectories were unaffected by CKRT modality, effluent dose, or membrane type, and no correlation was found between effluent dose and PCT changes. Stratification by high versus low effluent dosing revealed no significant differences. CKRT-related complications occurred in 17.5%, mainly filter clotting, without influencing PCT. PICU mortality was 35%, reflecting illness severity rather than CKRT.

Conclusions: In pediatric CKRT, short-term PCT dynamics are driven by the underlying septic or inflammatory process rather than CKRT parameters. PCT typically peaks within 12 h of CKRT initiation and then stabilizes, supporting its reliability for infection monitoring and antibiotic stewardship during early CKRT. Larger studies are warranted to define long-term PCT behavior and prognostic utility.

Chronic kidney disease (CKD) is a common non-communicable disease in children, and kidney dysfunction is the leading metabolic risk factor for death. Despite this, awareness of the CKD burden remains limited, and significant inequities exist in access to diagnosis and care worldwide. Kidney disease risk in children begins in utero and is dependent on the mother's health and wellbeing. This is further impacted each day by poverty, nutrition, education, infection, and safety. Greater community awareness is needed, especially in lower resource settings, where children present late and may have no access to care. Early diagnosis, possibly supported by screening at schools, can have important public and individual health consequences. Catastrophic health expenditure is common if families attempt to pay out of pocket for kidney replacement therapy. Health systems require strengthening from the antenatal clinic through tertiary care to ensure children with kidney disease are identified and treated early, appropriately, affordably, and well. Local non-governmental organizations have had some success in mitigating inequities. Governments must step up, measure, and acknowledge the burden of kidney disease in children, ensure appropriate public health measures to reduce risk, strengthen primary care to improve the quality of diagnosis and care, and progressively scale up equitable access to all forms of kidney care. Kidney disease risk is strongly linked with social and structural determinants of health. A holistic approach to supporting child wellbeing-outlined by the Sustainable Development Goals and a One Health Approach-will positively impact child kidney health and promote equity among all children.

Background: Acute kidney injury (AKI) is a significant complication for preterm infants, impacting both short- and long-term outcomes. This study aimed at identifying perinatal risk factors associated with early AKI and evaluating AKI's impact on long-term outcomes.

Methods: This retrospective cohort included 339 infants (born < 32 weeks gestational age or < 1500 g birth weight) admitted to a Level IV NICU between 2013 and 2017. AKI was defined either by serum creatinine (SCr) or urine output (UO) criteria. We examined gestational age, birth weight, perinatal factors, and medications (non-steroidal anti-inflammatory drugs [NSAIDs], inotropes) as predictors. Outcomes included early AKI, length of stay, growth at discharge, and neurodevelopment at 12 and 24 months corrected age. Univariate and multivariate logistic regression identified AKI risk factors, while linear regression assessed AKI's impact on neurodevelopment.

Results: AKI incidence varied by definition: AKI-SCr 42%, AKI-UO 7%. For AKI-SCr, extremely low birth weight (ELBW, OR 2.96, p = 0.002), NSAIDs (OR 2.14, p = 0.037), and inotropes (OR 2.26, p = 0.026) increased risk. Maternal hypertension (OR 0.51, p = 0.038) and female sex (OR 0.56, p = 0.037) were protective. For AKI-UO, ELBW (OR 6.52, p = 0.006) and inotropes (OR 3.60, p = 0.04) were the only risk factors. AKI-UO was linked to lower growth Z-scores and longer hospitalization. The relationship between AKI and poorer neurodevelopment disappeared after adjusting for neonatal comorbidities.

Conclusions: Neonatal early AKI incidence and risk factors depend on diagnostic criteria. Low gestational age, birth weight, and drug exposure are key risk factors. Refining AKI definitions and conducting longitudinal outcome studies are essential.

Introduction: Despite major advances in antiretroviral therapy, HIV infection remains a significant global public health challenge. HIV can directly affect the kidneys, leading to HIV-associated nephropathy in children, a condition characterized by proteinuria, elevated serum creatinine, and kidney enlargement. HIV-associated nephropathy is a serious complication that may progress to kidney failure and death.

Objective: To estimate the prevalence of HIV-associated nephropathy in children.

Methods: We searched PubMed, Embase, LILACS, SciELO, and Web of Science for relevant studies. Searches used the terms "AIDS-associated nephropathy" AND "child."

Results: A total of 1,181 records were identified, of which 10 studies (n = 1,136 children living with HIV) met inclusion criteria. Most included studies were conducted before widespread ART availability and used proteinuria as a proxy for HIV-associated nephropathy. The pooled prevalence of HIV-associated nephropathy was 17% (95% CI, 8%-31%; I² = 93%, p < 0.01). Subgroup analysis showed marked geographic variation, with a prevalence of 29% (95% CI, 22%-38%) in Africa and 8% (95% CI, 3%-20%) in North America. By sex, 59% (95% CI, 49%-69%) of male children developed HIV-associated nephropathy compared with 41% (95% CI, 31%-51%) of female children. Boys were significantly more likely to develop HIV-associated nephropathy (p = 0.02). The mortality rate among affected children was 53% (95% CI, 40%-56%). Key risk factors included lack of antiretroviral therapy and the presence of AIDS.

Conclusion: HIV-associated nephropathy was historically a common and life-threatening complication among children living with HIV. However, the available evidence is largely based on studies conducted more than a decade ago and often relied on proteinuria rather than biopsy-confirmed diagnosis.