Bircan Z

Two cases of nephrotic syndrome and tertian malaria in south-eastern Anatolia

Abstract.Tertian malaria is endemic in south-eastern Anatolia. As in Europe and America, in south-eastern Anatolia, an etiological agent is seldom identified in nephrotic syndrome. Two patients with Plasmodium vivax and nephrotic syndrome are described here. The possible relationship between Plasmodium vivax and nephrotic syndrome should be explored in children in endemic malarial regions.

The effect of alternate-day low dose prednisolone on bone age in children with steroid dependent nephrotic syndrome.

Radius, ulna, short bones (RUS), carpal (CARP) bone age (BA), tibial corticodiaphyseal (C/D) ratio and trabecular aspect were assessed in 19 children with steroid dependent nephrotic syndrome and 15 age matched healthy children. Both RUS and CARP BA were significantly lower than in the controls. Trabecular aspect and tibial C/D ratio did not show any statistical significance. There was a positive correlation between HSDS and RUS BA delay (r=−0.476, p<0.05); CARP BA delay and RUS BA delay (r=0.563, p<0.01) and RUS BA and CARP BA (r=0.891, p<0.001). In conclusion, RUS and CARP BA are both retarded and positively correlated in steroid dependent nephrotic children.

Sialic acid in childhood renal diseases: Correlation with clinical and laboratory indices

There are many kinds of glycoproteins that have sialic acid residues and it has been reported that these are elevated in some renal diseases and their significance in the pathogenesis of several renal diseases has been investigated. In the present study the serum and urine levels of sialic acid were measured in healthy controls and in children with either poststreptococcal acute glomerulonephritis (PSAGN) or minimal change nephrotic syndrome (MCNS) to test if there is any correlation with clinical and laboratory indices. In PSAGN and MCNS patients the serum and urine sialic acid concentrations at onset and relapse were significantly different from healthy controls (Mann‐Whitney U‐test P < 0.005). There was not a significant correlation between the clinical severity, serum creatinine and complement C3 levels and serum sialic acid concentrations in PSAGN patients. Also there was not a significant correlation between edema, serum albumin, IgG, transferrin, α‐1‐antitrypsin and serum sialic acid concentrations in MCNS patients. Although high serum and urine sialic acid levels were found in both PSAGN and MCNS patients, it does not have any clinical significance nor is it important as a diagnostic or prognostic marker.

Chronic renal failure in south eastern anatolia

The presence of an indwelling central venous line (CVL) predisposes pediatric patients to thrombosis [1], especially those on long-term total parenteral nutrition [2], cancer patients, and those undergoing hemodialysis [3]. Oral anticoagulants such as warfarin are often used to prevent or treat CVL-related thrombosis. Because of the unpredictability of the anticoagulation effects of warfarin, especially in the presence of other medications, careful and frequent monitoring of coagulation is essential. The heparin used to flush CVLs, even if present in a minute amount, can cause a significant prolongation of coagulation screening tests. We describe a simple way of obtaining blood specimens, consistently free of heparin contamination, through a CVL on patients undergoing hemodialysis. All the procedures are performed on a sterile field set up around the patients CVL with the nurse masked and wearing sterile gloves. The initial 3 ml of blood from the CVL is discarded; 10 ml of non-heparinized normal saline is flushed in through the CVL; 30 ml of blood is drawn through the CVL into a clean sterile syringe without the addition of heparin. Specimens of blood are then collected through the CVL for coagulation tests. The 30 ml of blood in the syringe is then re-infused back through the CVL. The maximum duration that the non-heparinized blood is left in the syringe is seldom more than 30 s. We never had problems with blood clotting or infections with this method. The additional steps of flushing the CVL with non-heparinized normal saline and the subsequent withdrawal of 30 ml of blood before blood sampling almost eliminate any problem with heparin contamination. The reinfusion of the withdrawn blood under aseptic conditions significantly decreases the blood loss in these patients. With this technique, there was no heparin contamination in 27 of 30 blood samples and minor contamination in 3 (activated partial thromboplastin time less than twice normal). We describe here a simple yet consistent way of obtaining blood specimens from CVL without heparin contamination from patients undergoing hemodialysis. With the increased realization of the risk of CVL-related thrombosis in hemodialysis patients, more patients are anticipated to be on oral anticoagulants. Our method of blood sampling would greatly facilitate this procedure and enhances the reliability of the samples obtained.

The first micturition times of the newborns whose mothers were treated with magnesium sulfate

Background: The aim of this study was to determine whether magnesium sulfate used for the treatment of severe pre-eclampsia or eclampsia had an effect on the first micturition time of the newborn. Methods: The first group included 20 newborns all of whose mothers had severe pre-eclampsia or eclampsia, and all mothers had been treated with magnesium sulfate according to the Parkland Memorial Hospital eclampsia regimen. The second group included 20 newborns all of whose mothers were normal pregnants, and did not receive any drug that had an effect on the contractility of smooth muscles. The first micturition times of all newborns in two groups were determined following delivery and were compared statistically. Results: All newborns urinated in the first 24 hours. There were no statistically significant differences in the micturition times between the two groups (p > 0.05). There was no residual urine after the first micturition, and none of them had any urinary tract abnormality and neurological pathology. Conclusions: From the results, it was concluded that magnesium sulfate had no effect on the first micturition time of the newborns, when applied according to the Parkland Memorial Hospital eclampsia regimen in severe pre-eclamptic or eclamptic pregnants.

The effect of metabolic acidosis on serum apolipoprotein A I and apolipoprotein B levels in children with chronic renal failure

In this report serum apolipoprotein A I (Apo A I) and apolipoprotein B (Apo B) levels were determined in children with chronic renal disease (CRD) during metabolic acidosis, after the correction of metabolic acidosis and in healthy children to look for the effect of metabolic acidosis on Apo A I and B levels. It was found that Apo A I levels were significantly decreased during metabolic acidosis (p<0.05) but Apo A I/Apo B ratios were not affected before and after the correction of acidosis in the CRD group (p>0.05) although it was significantly different from those in the controls (p<0.01).

The effect of alternate-day low-dose prednisolone on bone age in children with steroid-dependent nephrotic syndrome.

Radius, ulna, short bones (RUS), carpal (CARP) bone age (BA), tibial cortico-diaphyseal (C/D) ratio and trabecular aspect were assessed in 19 children with steroid dependent nephrotic syndrome and 15 age matched healthy children. Both RUS and CARP BA were significantly lower than in the controls. Trabecular aspect and tibial C/D ratio did not show any statistical significance. There was a positive correlation between HSDS and RUS BA delay (r = -0.476, p < 0.05); CARP BA delay and RUS BA delay (r = 0.563, p < 0.01) and RUS BA and CARP BA (r = 0.891, p < 0.001). In conclusion, RUS and CARP BA are both retarded and positively correlated in steroid dependent nephrotic children.