Outcomes of Maintenance Peritoneal Dialysis in Children: A State Hospital Experience from Southeastern Turkey

This study aimed to evaluate the clinical features, laboratory features, and outcomes of pediatric patients on peritoneal dialysis (PD) and compare the factors affecting mortality. The demographic, clinical, and laboratory data of 50 patients on maintenance PD followed up for more than 3 months were retrospectively analyzed for non-survivors and survivors to evaluate all factors affecting mortality. The patients (26 boys and 24 girls) had a mean age of 85.4 ± 58.7 months (range: 1-194 months) at the initiation of PD. The mean duration of dialysis at follow-up was 27.8 ± 21.7 months (range: 3-115 months). The rate of peritonitis was one episode per 27.27 patient months. PD was discontinued because of transplantation in eight patients, death in eight patients, and shifting to hemodialysis in three patients. In the Kaplan-Meier analysis, the 1-year patient survival rate at 1 year, 2 years, and 5 years was 81.8%, 51.7%, and 12.3%, respectively. Non-survivors were significantly younger at the start of kidney replacement therapy, had a final younger age at dialysis, and had lower albumin levels than survivors. We excluded four patients with a follow-up period of <6 months. Cox regression analysis revealed a low albumin status (P = 0.014, hazard ratio: 0.230) and a high level of ferritin (P = 0.002, hazard ratio: 1.002) to be risk factors for mortality. This study showed a high mortality rate. Hypoalbuminemia, a younger age at the start of kidney replacement therapy, and a younger final age at dialysis had a significant association with mortality.

Additional VCUG-related parameters for predicting the success of endoscopic injection in children with primary vesicoureteral reflux

INTRODUCTION AND OBJECTIVE

Prediction of vesicoureteral reflux (VUR) prognosis and decision for treatment are usually made according to the reflux grading classification. But the management of VUR is still controversial since there are difficulties in distinguishing reflux grade due to inter- and intra-observer variations. Previous studies have demonstrated that the distal ureteral diameter ratio (UDR) on voiding cystourethrography (VCUG) may be more predictive for clinical prognosis than reflux grade. We aimed to predict the success of endoscopic injection in primary VUR by creating new models that include other additional parameters (timing of reflux, delayed post-voiding contrast drainage of the upper urinary tract) as well as UDR.

STUDY DESIGN

A total of 200 patients aged 2-15 years with primary VUR undergoing endoscopic injection were retrospectively evaluated. Demographic and clinical data for a total of 248 renal units were recorded. Besides reflux grade and laterality, distal ureteral diameter, UDR, timing of reflux [early filling, late filling or voiding] and presence of contrast delay in upper tract drainage were also assessed on VCUG. According to the complete resolution of VUR on the control VCUG at the postoperative 3rd month, the renal units were divided into two main groups: successful (n = 171, 68.9%) and unresolved (n = 77, 31.1%) RESULTS: The failure rate of endoscopic injection was found to be 4.068 times greater with early filling reflux on VCUG, 3.076 times greater with UDR>0.24, 2.745 times greater with delayed contrast drainage of the upper urinary tract, 2.666 times greater with the presence of scar in DMSA, 2.493 times greater with bladder-bowel dysfunction and 2.341 times greater with febrile urinary tract infection. We also observed that a model in which all VCUG-related parameters were combined provided a better estimation of endoscopic injection outcomes compared to only the reflux grade (AUC: 0.903 vs. 0.604, respectively).

DISCUSSION

Distal ureteral dilatation is considered to be a more decisive factor for clinical outcomes of primary VUR rather than upper urinary tract dilatation since ureterovesical junction anatomy plays a more important role in primary VUR pathophysiology. Studies investigating new prediction models on this topic have recently become more popular. However, a consensus has not yet been achieved.

CONCLUSION

We consider that UDR level, the timing of reflux and delayed upper tract drainage on VCUG may be more predictive parameters of endoscopic injection success compared with reflux grade, and could facilitate selecting the best candidates for surgery.

Evaluation of the children with C3 glomerulopathy

C3 glomerulopathy (C3G) is a clinical spectrum that presents with a variety of symptoms, ranging from a mild disease with asymptomatic microhematuria and/or proteinuria to severe disease with nephritic or nephrotic syndrome and renal impairment. Herein, we aim to document the clinical and laboratory findings, response to immunosuppressive and supportive treatment and prognosis of the children with C3G. We retrospectively reviewed the medical records of patients diagnosed with membranoproliferative glomerulonephritis (MPGN). Kidney biopsy materials were reexamined for the diagnosis of C3G. The inclusion criteria for C3G are the dominant C3 staining with or without scanty immunoglobulins (Ig) deposition on immuno- fluorescence (IF) and MPGN patterns on light microscope. Twelve of 69 patients with MPGN were included in the study based on the definition criteria of C3G. Ten of them had only C3 staining and the rest of the patients had both C3 staining and a small amount of IgG/M staining on IF microscopy. One patient was on remission with only ACEI. The rest of the patients used immunosuppressive treatment and two of them needed eculizumab therapy. One of them did not respond to the treatment of eculizumab and progressed to end-stage renal failure. C3G is a disease characterized by a heterogeneous clinical presentation and outcome. Because of this broad spectrum of disease, treatment may vary widely. We think that complement-targeting therapy with eculizumab should be an alternative option for refractory cases, especially in the early stage of disease, if they did not respond to immunosuppressive treatment.

Treatment and long-term outcome in primary nephrogenic diabetes insipidus

BACKGROUND

Primary nephrogenic diabetes insipidus (NDI) is a rare disorder and little is known about treatment practices and long-term outcome.

METHODS

Paediatric and adult nephrologists contacted through European professional organizations entered data in an online form.

RESULTS

Data were collected on 315 patients (22 countries, male 84%, adults 35%). Mutation testing had been performed in 270 (86%); pathogenic variants were identified in 258 (96%). The median (range) age at diagnosis was 0.6 (0.0-60) years and at last follow-up 14.0 (0.1-70) years. In adults, height was normal with a mean (standard deviation) score of -0.39 (±1.0), yet there was increased prevalence of obesity (body mass index >30 kg/m2; 41% versus 16% European average; P < 0.001). There was also increased prevalence of chronic kidney disease (CKD) Stage ≥2 in children (32%) and adults (48%). Evidence of flow uropathy was present in 38%. A higher proportion of children than adults (85% versus 54%; P < 0.001) received medications to reduce urine output. Patients ≥25 years were less likely to have a university degree than the European average (21% versus 35%; P = 0.003) but full-time employment was similar. Mental health problems, predominantly attention-deficit hyperactivity disorder (16%), were reported in 36% of patients.

CONCLUSION

This large NDI cohort shows an overall favourable outcome with normal adult height and only mild to moderate CKD in most. Yet, while full-time employment was similar to the European average, educational achievement was lower, and more than half had urological and/or mental health problems.