Faik Tanman

The effects of vaccination with inactivated uropathogenic bacteria in recurrent urinary tract infections of children.

Secretory IgA (sIgA) is an important parameter in the predisposition to recurrent urinary tract infection (UTI). We investigated whether sIgA and frequency of UTI could be positively influenced by intramuscular vaccination with inactivated uropathogenic bacteria (Solco-Urovac). Ten otherwise healthy girls aged from 5 to 11 years (mean 9 1.7 years) with recurrent UTI were immunized with Solco-Urovac by i.m. injections three times at weekly intervals. A booster injection was given after 6 months. Urinary sIgA secretory component (SC) concentration was determined by radial immunodiffusion assay. Ten other age-matched girls with UTI were not immunized. Immunization therapy caused a significant reduction in the frequency of infection and an increase in urinary sIgA SC, while in the nonvaccinated group the values remained constant.

An Epidemiological Approach to Acute Renal Failure in Children

The records of 630 pediatric patients with acute renal failure were analysed. Of all patients admitted to the hospital during the same period, 5 per cent had acute renal failure. Newborns and infants constituted 79 per cent of the patients with ARF although this age group comprised only 44 per cent of the general pediatric patients. Acute gastroenteritis and septicaemia were the leading causes of ARF up to 8 years of age. Acute glomerulonephritis took the first place after 8 years of age. Mortality rate of our patients with acute renal failure was 28 per cent.

Pulse methylprednisolone therapy in children with membranoproliferative glomerulonephritis

The effects of pulse methylprednisolone (PM) therapy were studied in 15 patients (aged 3–14 years) with biopsy proven membranoproliferative glomerulonephritis (MPGN). Patients were treated with intravenous PM 30 mg/kg (max 1 g) given over 30 min every other day for a mean of 9.8 days (3–15 days). Oral prednisolone therapy was continued at a dose of 1 mg/kg/24 h for 1 month and subsequently tapered off the following month. Eight patients had hematuria and six had medically controlled hypertension. Serum C3 levels were low in 11 patients and all of the patients had proteinuria. Following PM therapy proteinuria was significantly reduced from 2602.9 ± 1852.5 mg/24 h to 1871.2 ± 2090.8 mg/24 h (P < 0.05) and at final evaluation, proteinuria was 774.33 ± 1225.67 mg/24 h which was significantly lower than pre‐ and post‐PM therapy values (P < 0.05). Serum creatinine levels were high in five patients before PM therapy and remained high in one of the patients who progressed to end‐stage renal failure. After PM therapy, high serum creatinine levels normalized in three patients and was reduced, but still above normal, in one. One patient, with initially normal serum creatinine, had elevated levels afterwards. Nine of the patients were considered responsive and six non‐responsive according to our tentatively defined criteria. Mean follow‐up period was 27.4 ± 24.1 months (6–84 months). Three patients were lost for follow‐up, and 12 were re‐evaluated. At final evaluation, all of the patients except one with end‐stage renal failure had normal creatinine levels. There was no correlation between the clinical and laboratory features at onset and the outcome of the disease in the responder or non‐responder patients. Results of our study show that PM therapy reduced proteinuria and may affect renal function positively in patients with MPGN. However, a prospective controlled study with repeat biopsies is required to draw a conclusion.

Megaloblastik Anemi ve Proteinüri Imerslund Grâsbeck Sendromu

Imerslund Grâsbeck sendromu nadir gorulen otosomal resesif gecisli megaloblastik anemi ve proteinuri ile karakterize bir hastaliktir B12 vitamini intrensek faktor kompleksinin terminal ileumda emilim kusuruna bagli bu hastalikta megaloblastik anemiye proteinuri bazen de steatore eslik etmektedir nbsp; 4 yasinda kiz hasta solukluk halsizlik sikayetleri ile basvurmus ve megaloblastik anemi tanisi konmustur Hastada idrarda proteinuri saptanmis ve yapilan bobrek biyopsisinde isik mikroskopisi ile normal histolojik bulgular gorulmustur Hastanin sekiz yillik izleme doneminde aylik B12 vitamin tedavisi ile anemisi kontrol altina alinmis ancak proteinurinin 300 2500 mg gun duzeyinde surdugu belirlenmistir Bu olgu nedeniyle Imerslund Grâsbeck sendromu tartisilmak istenmistir Anahtar kelimeler: Megaloblastik Anemi Proteinuri

Bir Mezoblastik Nefroma Olgusu

Mezoblastik nefroma; fetal renal hamartoma yenidoganin mezankimal hamartomasi leiomyomatoz hamartoma gibi degisik adlar ile de anilan bir bobrek tumorudur Yenidogan ve erken sut cocuklugu doneminde fizik muayenede batinda palpe edilen bir kitle seklinde saptanir Ek bulgu olarak hematuri hipertansiyon kusma ve sarilik gozlenebilir nbsp; Bu hastalarin tanisinda; IVP ultrasonografi ve bilgisayarli tomografiden yararlanilir Tumorun cerrahi olarak cikartilmasi ile sagilim saglanir Yenidogan doneminde mezoblastik nefroma tanisi konulan bir olgu sunularak yenidogan donemi bobrek tumorleri gozden gecirilmistir Anahtar kelimeler: Renal Tumor Yenidogan Mesablostik Nefroma

Atnalı Böbrek Anomalisi ile Birlikte Rastlanan Diğer Bulgular

Horseshoe kidney is the most common fusion anomaly of the kidney and can be associated with certain syndromes While 2 3 of the cases may be asymptomatic throughout life 1 3 of may be merged with hydronephrosis calculus formation recurrent urinary tract infection or hypertension at different stages of life Out of 11 horseshoe kidney cases followed by the Istanbul University Faculty of Medicine Pediatric Nephrology Department 27 were Turner syndrome 27 had lumbar meningomyelocele 18 showed severe growth retardation and 9 had congenital heart disease VSD aorta insufficiency Forty five percent also had recurrent urinary tract infection 18 had hydronephrosis 18 had vesicoureteral reflux and 9 nephrolithiasis These results show the importance of genetics nephrourologic evaluation and follow up of children with horseshoe kidney Key words: Urinary Tract Abnormalities Hydronephrosis Nephrolithiasis Hypertension

D Hipervitaminozuna Bağlı Olarak Gelişen Hiperkalsemi ve Nefrokalsinoz

D vitamini alimina bagli hiperkalsemi hiperkalsiuri nefrokalsinoz gelisen yaslari 5 9 ay arasinda ucu erkek ikisi kiz bes hasta sunuldu Uc olguda normal tedavi dozunda 2 olguda asiri yuksek doz D vitamini ile bu tablo gelismisti D vitamini entoksikasyonu aksidental nedenle yuksek doz D vitamini alinmasiyla olusabilecegi gibi bazen asiri duyarlilik sonucu normal dozlar ile de ortaya cikabilmektedir Anahtar kelimeler: D Vitamini Entoksikasyon Meduller Nefrokalsinoz Hiperkalsemi Hiperkalsiuri

Efficacy of captopril treatment in children with steroid‐resistant nephrotic syndrome

We studied the efficacy of captopril, an angiotensin‐converting enzyme inhibitor in treating persistent moderate or severe proteinuria in children with various glomerular diseases other than minimal‐change nephrotic syndrome. Captopril was administered for 3 months to 15 normotensive and nonazotemic or mildly azotemic patients (12 boys, 3 girls) in whom corticosteroid and cytotoxic treatment had failed to induce remission. Urinary protein excretion decreased from 2873.14±1937.50 (mean ± s.e.m.) to 1684.71 ± 1463.13 mg/day (P < 0.05). The reduction in proteinuria was not related to a significant fall in systemic blood pressure or a change in renal function. Serum albumin did not rise and side effects due to captopril were not observed. We concluded that, in the short term, captopril can be used safely and effectively for decreasing the proteinuria of nephrotic children unresponsive to conventional therapy.