‘Children Kidney Care Centers’: Rationale, requirements and recommendations for best facilities and better future

Specialized centers are needed for nephrology and urology care of children. The justifications are the specialized nature of care needed and the growing incidence and prevalence. Children with chronic kidney disease (CKD) are at risk of morbidity, mortality, and decreased quality of life. Current pediatric practice structures are apparently poorly suited for the increasing demands of chronic disease in children. Kidney diseases account for around 8%-10% of total outpatients and 12% of admissions to the pediatric ward in hospitals. The major causes of pediatric CKD in registries are congenital anomalies of the kidney and urinary tract (around 50%), followed by inherited nephropathies and glomerulonephritis. The nephrologist’s role is important for specialized investigations and treatment. Urologist’s services are essential for the wide variety of conditions from birth to early adult age for complete cure and complementing medical management. Children have a right to treatments and to resources that are as sophisticated and advanced as those available to adults. Simple and sophisticated care for all children with ailments of the kidneys and related structures is important for ensuring ‘health for all’. The availability of ‘Child Kidney Care Centers’ will go a long way in improving the lives of affected children.

Allele frequency of nonsense mutation responsible for hereditary nephropathy in English cocker spaniel dogs

Hereditary nephropathy is a primary progressive glomerular disease in dogs associated with the c.115A>T mutation in the COL4A4 gene in English cocker spaniel (ECS) dogs. The disease is inherited in an autosomal recessive manner. Hereditary nephropathy has been described in this breed since the late 1940s. To date, there are no data on the prevalence of this disease in Brazil, so the aim of this study was to evaluate the allelic frequency of this mutation in ECS dogs in this country. The DNA samples were purified from blood samples or buccal swabs from 221 ECS dogs. Fragments of the DNA containing the mutation were amplified by PCR and submitted to direct gene sequencing. The allele frequency of the mutation was 0.9%. The presence of the mutation in the ECS dog population in Brazil reveals the importance of performing the genotyping tests in these dogs as a method of diagnosing the disease and identifying heterozygous animals, aiming to reduce clinical cases of disease through mating.

Neonatal stroke and haematuria: Questions

This is a report of an infant born near term with neonatal stroke and haematuria. Changes were noted on foetal magnetic resonance images, and these persisted postnatally. A routine renal ultrasound scan during follow-up detected haematuria with no associated proteinuria. A likely pathogenic genetic mutation was identified. This case highlights a relatively newly discovered cause for hereditary nephropathy affecting the basement membrane, initially affecting the glomerular but later the renal tubular basement membranes. The renal phenotype, pathogenic genotype and pathological findings on renal biopsy are discussed.

Neonatal stroke and haematuria: Answers

BACKGROUND

This is a report of an infant born near term with neonatal stroke and haematuria. The renal phenotype, pathogenic genotype and pathological findings on renal biopsy are discussed.

CASE-DIAGNOSIS

Prenatal magnetic resonance imaging revealed anomalies which persisted postnatally. Haematuria was detected during follow-up. The posttnatal renal ultrasound scan was normal, and there was no associated proteinuria. A likely pathogenic genetic mutation was detected.

CONCLUSIONS

This case highlights a relatively newly discovered cause of hereditary nephropathy in which the basement membrane is affected, with initial effects on the glomerular membranes and subsequent effects on the renal tubular basement membranes.