Mustafa Soran

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.

Severe osteoporosis and high level TSH in a child before the diagnosis of acute lymphoblastic leukemia.

Osteoporosis in children is rare and mostly secondary to such conditions as prolonged immobilization, malabsorption syndromes, corticosteroid excess, osteogenesis imperfecta, celiac disease, Turner syndrome, and malignancy. Idiopathic juvenile osteoporosis (IJO) is a very rare condition of primary bone demineralization that presents in childhood. IJO, a disease of unknown etiology, manifests typically by pain, bone deformities, and fractures. Diagnosis of IJO was made by excluding other common causes of osteoporosis in this age. Bisphosphonates, calcitriol, fluoride, and calcitonin have been administered therapeutically, but the results were equivocal. Usually the disease remits by itself. Patient that has serious osteoporosis and high thyroid stimulating hormone level was diagnosed as IJO by eliminating secondary reasons. We report this case, whose symptoms were disappeared after parenteral pamidronat treatment, and he was reexamined owing to anemia and trombositopenia, and diagnosed as B-cell acute lymphoblastic leukemia, just to emphasis the importance of close follow-ups of IJO patients.

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.

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).

Serum levels of carnitine, apolipoprotein A I, and apolipoprotein B in children with nephrotic proteinuria

To our knowledge, the affect of hyperlipidemia on serum carnitine levels in nephrotic patients has not been evaluated. We report preliminary results of serum carnitine levels and their correlation with some apolipoproteins in nephrotic children. Sixteen children (13 boys, 3 girls) with nephrotic proteinuria and 10 age-matched normal healthy children (5 boys, 5 girls) were evaluated at the Department of Pediatrics Dicle University Hospital, Diyarbakir, Turkey. The underlying renal diseases were minimal change nephrotic syndrome in 13 patients (clinical diagnosis), focal segmental glomerulosclerosis in 1 patient (biopsy proven), and mesangiocapillary glomerulonephritis in 2 patients (biopsy proven). Venous blood samples were collected after an overnight fast before treatment was begun. Routine biochemical analyses were carried out and a 24-h urine collection was performed for assessment of proteinuria. Serum apolipoprotein (Apo) A I and B were measured by immunoprecipitation and serum camitine by the carnitine acetyltransferase enzymatic method. Data were analyzed by Mann-Whitney U test and Pearsons correlation. The results are shown in Table 1. Carnitine levels were lower in nephrotic patients than controls (P <0.05). Correlations between the parameters are shown in Table 2. Serum triglycerides are significantly reduced in patients with type IV hyperlipoproteinemia after carnitine administration [1]. Oral carnitine has been reported to have a lipid-lowering effect, with a concomitant increase in highdensity lipoprotein cholesterol [2]. When L-carnitine was given to rats fed a cholesterol-rich diet serum lipid levels were reduced and the apolipoprotein pattern returned to normal. Since serum levels of Apo B and E fall by 30% and 8% respectively after camitine treatment, it is likely that the marked decrease in total serum lipids is associated with a significant decrease in the level of these apolipoproteins [3]. The serum Apo A I concentration was unaltered during parenteral nutrition in infants, Apo A II underwent a transient increase, Apo B increased, and serum free carnitine Table 2: Pearsons correlation between parameters

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.