Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study

BACKGROUND

Myelomeningocele (MMC) is highly prevalent in developing countries, and MMC-related neurogenic bladder is an important cause of childhood chronic kidney disease (CKD). This nationwide study aimed to evaluate demographic and clinical features of pediatric patients with MMC in Turkey and risk factors associated with CKD stage 5.

METHODS

Data from children aged 0-19 years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1 year of age without pre-existing kidney abnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15 ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group.

RESULTS

A total of 911 (57.8% female) patients were enrolled, most of whom were expectantly managed. Stages 1-4 CKD were found in 34.3%, 4.2%, 4.1%, and 2.4%, respectively. CKD stage 5 was observed in 5.3% of patients at median 13 years old (range 2-18 years). Current age, age at first abnormal DMSA scan, moderate-to-severe trabeculated bladder on US and/or VCUG, and VUR history were independent risk factors for development of CKD stage 5 (OR 0.752; 95%; CI 0.658-0.859; p < 0.001; OR 1.187; 95% CI 1.031-1.367; p = 0.017; OR 10.031; 95% CI 2.210-45.544; p = 0.003; OR 2.722; 95% CI 1.215-6.102; p = 0.015, respectively). Only eight CKD stage 5 patients underwent surgery related to a hostile bladder between 1 and 15 years old.

CONCLUSION

MMC-related CKD is common in childhood in Turkey. A proactive approach to neurogenic bladder management and early protective surgery in selected cases where conservative treatment has failed should be implemented to prevent progressive kidney failure in the pediatric MMC population in our country.

Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: A multicenter study

INTRODUCTION

Neuropsychiatric (NP) involvement is a restricted area in juvenile-onset systemic lupus erythematosus (jSLE).

AIM

To investigate the prevalence, demographic and clinical features, and outcomes of the neurological involvement in the Turkish jSLE population.

METHODS

This study was based upon 24 referral centers' SLE cohorts, multicenter and multidisciplinary network in Turkey. Patient data were collected by a case report form which was standardized for NP definitions according to American Collage of Rheumatology (ACR). Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) neuropsychiatric part was used to determine NP damage. Variables were evaluated Ward's hierarchical clustering analyses, univariate, and multivariate logistic regression analyses.

RESULTS

A hundred forty-nine of 1107 jSLE patients had NP involvement (13.5%). The most common NPSLE findings were headache (50.3%), seizure (38.3%), and acute confusional state (33.6%). Five clusters were identified with all clinical and laboratory findings. The first two clusters involved neuropathies, demyelinating diseases, aseptic meningitis, and movement disorder. Cluster 3 involved headache, activity markers and other SLE involvements. Idiopathic intracranial hypertension, cerebrovascular disease, cognitive dysfunction, psychiatric disorders and SLE antibodies were in the fourth, and acute confusional state was in the fifth cluster. In multivariate analysis, APA positivity; OR: 2.820, (%95CI: 1.002-7.939), P: 0,050, plasmapheresis; OR: 13.804 (%95CI: 2.785-68.432), P: 0,001, SLEDAI scores; OR: 1.115 (%95CI: (1.049-1.186), P: 0,001 were associated with increased risk for neurologic sequelae.

CONCLUSION

We detected the prevalence of juvenile NPSLE manifestations in Turkey. We have identified five clusters that may shed light pathogenesis, treatment and prognosis of NP involvements. We also determined risk factors of neurological sequelae. Our study showed that new definitions NP involvements and sequelae for childhood period are needed.

A rare entity in a pediatric patient: coexistence of emphysematous cystitis and emphysematous pyelonephritis

BACKGROUND

Emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) are rare urinary tract infections. They have a wide spectrum of clinical manifestations; ranging from asymptomatic to septic shock at presentation. In children, EC and EPN are rare complications of urinary tract infections (UTIs). Their diagnosis is based on clinical manifestations, laboratory results and characteristic radiological findings of gas within the collecting system, renal parenchyma and/or perinephric tissue. Computed tomography is the best radiological option in the diagnosis of EC and EPN. Despite the availability of various treatment modalities including medical and/or surgical treatment alternatives, these life-threatening conditions have high mortality rates reaching up to 70 percent.

CASE

Urinary tract infection was detected in the examinations of an 11-year-old female patient suffering from lower abdominal pain, vomiting and dysuria for two days. Air was detected in the bladder wall on X-ray. EC was detected in the abdominal ultrasonography. Air formations in the bladder lumen and calyces of both kidneys in abdominal computed tomography confirmed the presence of EPN.

CONCLUSIONS

Individualized treatment should be instituted according to the severity of EC and EPN, and the overall health condition of the patient.

The Effect of Iron Deficiency Anemia and Different Treatment Methods on DNA Damage: 8-hydroxy-2-deoxyguanosine Level

Ionic iron causes damages at the cellular level by forming free radicals. Reactive oxygen species lead to the formation of oxidative base damages in DNA. Among these forms the most common one and the one which has the best known mutagenity is 8-hydroxy-2′-deoxyguanosine (8-OHdG). We aimed to determine iron deficiency anemia (IDA) and its different forms of treatments; probable oxidative damage on DNA by looking at the level of 8-OHdG. The patients were divided into 4 subgroups: Oral treatment (p.o.) group; Intramuscular treatment (i.m.) group; Intravenous treatment (i.v.) group; Healthy control group. Blood and urine samples were taken from all patients totally 4 times. 8-OHdG levels detected in blood and urine samples were compared with the control group. IDA and the treatment of it affect the level of 8-OHdG. p.o. therapy should be the top priority on children.