Sevgi Yavuz

Neutrophil gelatinase associated lipocalin as an indicator of acute kidney injury and inflammation in burned children

INTRODUCTION Neutrophil gelatinase associated lipocalin (NGAL) is a novel predictor of acute kidney injury (AKI), which increases with inflammation. We aimed to assess whether serum NGAL (SNGAL) and urine NGAL (UNGAL) can predict AKI in burned children. METHODS Patients were referred within the 12 h of burn to our center. Serum samples for SNGAL, C-reactive protein (CRP), procalcitonin (PCT) and urine for UNGAL, microalbumine (Umalb), creatinine (Ucr) were obtained at both admission and the 5th day after burn. Blood urea nitrogen (BUN) and serum creatinine (Scr) were examined daily. RESULTS Twenty-two subjects were enrolled and six (27.2%) of them developed AKI within the 48 h of injury. Burn size and abbreviated burn severity index (ABSI) were significantly increased in patients with AKI. CRP, PCT, SNGAL and UNGAL levels at admission and day 5 were significantly higher in patients with AKI than in those without AKI and controls. Scr was not significant between AKI and non-AKI groups at hospital days 1 and 5. A SNGAL level of 315 ng/ml and a UNGAL level of 100 ng/ml were determined as predictive cut-off values of AKI at admission (sensitivity and specificity: 71.4%, 83.3% and 93.3%, 93.7%, respectively). SNGAL and UNGAL were positively correlated with CRP, PCT, ABSI and Umalb/Ucr. CONCLUSION SNGAL and UNGAL are good early predictors of AKI in children with severe burn. NGAL might reflect the severity of burn insult and also could be used as an indicator of inflammation in burn children.

Apelin and nutritional status in children on dialysis

Abstract Background: We aimed to evaluate whether serum apelin could reflect the nutritional status of children on dialysis. Methods: Twelve patients on peritoneal dialysis (PD) and 20 patients on hemodialysis (HD) were enrolled. Patients received individualized diet for six months. Anthropometric and laboratory indices were measured at onset and the end of the study. Results: The anthropometric indices were all significantly lower in patients than in controls whereas similar in PD and HD patients. The protein catabolic rate (nPCR), height, mid-arm circumference (MAC), triceps skinfold thickness (TSF), arm muscle area (AMA) and arm fat area (AFA) z scores were significantly increased in dialysis patients after nutritional intervention. Weight z scores statistically increased in HD group whereas did not statistically change in PD group. Serum albumin levels were significantly improved in PD and HD patients. Apelin levels were similar in PD, HD and control groups. Post nutritional apelin values did not differ in each dialysis groups. On multivariate analysis, apelin was independently associated with age, weight, ESR and TG. Conclusions: Apelin seems to be not a useful indicator for monitoring the nutritional status in children on dialysis. However, the close link of apelin with inflammatory and lipid parameters suggested that apelin might be a novel target for slowing the atherogenic process in pediatric dialysis patients.

Assessment of cystatin C and cystatin C-based GFR formulas in reflux nephropathy

OBJECTIVE Early identification of reflux nephropathy (RN) could reduce the frequency of chronic kidney disease (CKD) caused by vesicoureteral reflux (VUR). We aimed to assess whether cystatin C has value for determining RN in children with VUR. MATERIALS AND METHODS Ninety-three children with VUR were classified into two groups according to the presence of renal parenchymal scarring (RS). Patients with RS were divided into three subgroups according to scar grade. Serum cystatin C, serum creatinine (Scr) and urine creatinine were measured. eGFR values of the patients were calculated with Scr-based, cystatin C-based and combined formulas. RESULTS Cystatin C was significantly higher in patients with RS than patients without RS and declined in parallel with grade of RS (p = 0.01). Scr was not significant in patients with and without RS. It was only significant between mild and severe scar subgroups (p < 0.05). All eGFR values were lower in RS (+) patients compared with RS (-) patients. All eGFR equations were negatively correlated with grade of RS (p < 0.05). CONCLUSION Cystatin C could be a useful marker for identifying the risk and severity of RN in patients with VUR. Renal functions could be more accurately determined with Scr-cystatin C combined eGFR equations.

Ambulatory blood pressure monitoring in children with vesicoureteral reflux.

OBJECTIVE To assess the value of ambulatory blood pressure monitoring (ABPM) for identifying the risk of hypertension (HT) in children with vesicoureteral reflux (VUR). METHODS Seventy-six children with primary VUR were enrolled. Patients were divided into 2 groups according to renal scarring (RS). Serum creatinine, urine protein, and urine creatinine were measured. All patients underwent ABPM and casual blood pressure (BP) examination. ABPM measurements were standardized to age, gender, and height by Lambda-Mu-Sigma method. RESULTS Urine protein and creatinine concentrations were statistically higher in RS (+) group than RS (-) group (P = .05). Casual systolic and diastolic BP standard deviation score (SDS) values were not statistically different between RS (+) and RS (-) groups. Day, night and 24-hour systolic BP SDS, day and 24-hour mean arterial blood pressure SDS values were significantly higher in RS (+) group than that of RS (-) group (P = .015, P = .031, P = .013, P = .07, and P = .021, respectively). All ABPM values significantly increased in patients with severe RS compared with ones with mild and moderate RS (P <.05). Casual and ambulatory BP SDS values did not significantly differ by grade of VUR (P >.05). CONCLUSION ABPM is more sensitive than casual BP measurements and might be used for early identification of HT in VUR patients. The severity of RS increases the risk of HT in children with VUR. Controlling HT with proteinuria would decrease the progression of renal damage in VUR.

Interleukin-18, CRP and procalcitonin levels in vesicoureteral reflux and reflux nephropathy

Abstract Background: Some patients with vesicoureteral reflux (VUR) develop reflux nephropathy (RN) and a number of them progress to chronic kidney disease (CKD). However, it is unclear to predict which patient will develop RN and/or CKD. The aim of this study is to evaluate the role of Interleukin-18 (IL-18), C-reactive protein (CRP) and procalcitonin (PCT) as an indicator of RN in VUR. Methods: Ninety-three children aged 3.5–16 years with primary VUR were enrolled. Patients were divided into two groups according to the presence of renal scarring (RS). CRP, PCT, blood urea nitrogen (BUN), serum creatinine (Scr), urinary protein (Up), creatinine (Ucr) and microalbumin (Umalb), serum and urine IL-18 levels were determined during urinary tract infection (UTI) free episode. Results: BUN, Scr, Up/Ucr and Umalb/Ucr concentrations were higher whereas calculated creatinine clearance (Ccr) values were lower in RS (+) group compared to RS (−) group. CRP, PCT, serum and urine IL-18 levels and mean urine IL-18/Cr concentrations were similar in both groups. Serum and urine IL-18 levels did not differ according to the grade of VUR. No significant correlation was found between CRP, PCT and IL-18. Conclusions: Proteinuria and microalbuminuria are valuable hallmarks of RN. CRP and PCT seem not to be reliable indicators of RN in VUR patients. Moreover, serum and urine IL-18 might not predict RN.

The Assessment of Urinary Metabolites in Children with Urinary Tract Infection

1 Ercan Nain1, Sevgi Yavuz2, Aysel Kiyak2, Oguzhan Durmaz2, Gonul Aydogan1, Orhan Korkmaz3 1Cocuk Sagligi ve Hastaliklari Klinigi, 2Cocuk Nefrolojisi Klinigi, 3Radyoloji Klinigi, Kanuni Sultan Suleyman Egitim ve Arastirma Hastanesi, Istanbul, Turkiye Idrar Yolu Enfeksiyonunda Uriner Metabolitler / Urinary Metabolites in Urinary Tract Infection The Assessment of Urinary Metabolites in Children with Urinary Tract Infection

Medullary nephrocalcinosis in Schimke immuno‐osseous dysplasia

Schimke immuno‐osseous dysplasia (SIOD) is a rare hereditary disease characterized by skeletal dysplasia, immune deficiency and progressive renal disease. Kidney involvement mainly determines the prognosis. The most common renal pathology is focal segmental glomerulosclerosis (FSGS). Medullary nephrocalcinosis refers to the diffuse deposition of calcium salts in renal medulla and has not previously been identified in SIOD. Here we report the first case of a pediatric patient having typical features of SIOD with medullary nephrocalcinosis.

Membranous nephropathy presenting with nephrotic syndrome in a child with thalassemia major

Few data on the renal effects of thalassemia syndrome are available in the literature. Recent clinical studies identified proximal tubular damage and glomerular filtration abnormalities in thalassemia. Iron‐chelating agents might be nephrotoxic as well, but proven glomerular injury, either due to anemia or chelating therapy, has not previously been demonstrated in thalassemia patients. Here, we report the first thalassemia patient presenting with nephrotic syndrome to be diagnosed with membranous nephropathy in the literature.

Renal ektopili çocukların ürolojik ve nefrolojik analizi

Objective: To assess the morphological and clinical features of children with renal ectopia (RE) and assess whether the lateralization of ectopia determines the prognosis. Methods: The clinical, laboratory and radiological data of 61 patients diagnosed as RE in our center between the years of 2004 and 2014 were retrospectively reviewed. Results: There were 32 girls (52.5%) and 48 boys (47.5%). The median age was 48 (2-204) months and follow-up time was 60 (2-120) months. RE was right-sided in 33 (54%) and left-sided in 26 (46%) patients. 52 patients (85.2%) had simple RE whereas 9 (14.8%) had crossed RE. 27 children (44.3%) had additional urinary abnormality, 15 (24.6%) had extra-renal disease. The most common urinary tract malformation was vesicoureteral reflux (VUR) (21%). Renal scarring (RS) was detected in 17 patients (27.9%) on DMSA scan. 32 patients (52.5%) experienced urinary tract infection (UTI), 5 (8.2%) had hypertension, 11 (11%) had proteinuria, 5 (8%) had chronic renal disease (CKD). No significant difference was found between ectopia sides for development of additional urinary or systemic disease, UTI, proteinuria, hypertension and CKD (p> 0.05). Conclusion: The children with RE should be carefully examined for additional urinary or systemic abnormalities. Voiding cystourethrogram might be recommended in those patients for the increased risk of VUR. The patients with RE should be closely followed-up for avoiding long term complications including proteinuria, hypertension and CKD because of susceptibility to UTI and RS. The lateralization of ectopia might not affect the incidence of additional abnormality or late complications.