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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 4 | Issue 1
Page Nos. 1-44

Online since Wednesday, June 30, 2021

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COMMENTARIES  

Judicious selection of oral cyclophosphamide in childhood nephrotic syndrome p. 1
Gurdeep Singh Dhooria
DOI:10.4103/ajpn.ajpn_17_21  
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Chronic kidney disease – End-stage kidney disease group p. 3
Ali Asghar Lanewala
DOI:10.4103/ajpn.ajpn_24_21  
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ORIGINAL ARTICLES Top

Vitamin d supplementation and bone health in children with nephrotic syndrome: A systematic review and meta-analysis p. 6
Rema G Caronan-Parallag, Tristan Marvin Z. Uy, Francisco E Anacleto, Eric Emmanuel T. Aragon, Lourdes Paula Real Resontoc
DOI:10.4103/ajpn.ajpn_35_20  
Background: While steroids have been the standard treatment in nephrotic syndrome (NS), they are known to deleteriously affect bone mineralization. Objectives: The objectives were to determine the efficacy and safety of vitamin D supplementation among children with NS on steroid therapy. Methods: We searched databases, scanned reference lists, and contacted trial investigators. Two reviewers collected and graded randomized controlled trials comparing oral vitamin D3 with placebo or no intervention in terms of bone mineral content/density (BMC/BMD), serum markers, and adverse events in pediatric NS. Results: We included 4 trials (164 subjects) with a collectively high risk of performance and/or detection bias. Although the vitamin D group had significantly more positive absolute change-from-baseline BMC than controls (mean difference 1.15; 95% CI 0.07-2-22;I 62%), the two trials were heterogeneous and included data. Moreover, in terms of other outcome measures, we did not find sufficient evidence of benefit from treatment. One study reported significantly improved parathyroid hormone levels but also a higher risk of hypercalciuria with vitamin D use. No nephrocalcinosis was reported. Subgroup analysis of first-episode NS revealed significantly more improved BMD with supplementation. Conclusion: Available evidence was low-quality and insufficient to recommend vitamin D supplementation in pediatric NS, although there may be benefit in first-episode NS. In contrast, vitamin D administration may be associated with hypercalciuria.
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Occurrence and outcome of acute kidney injury in very low birth weight neonates p. 14
Mohd Ashraf, Younus Ramzan Khan, Parvez Ahmed
DOI:10.4103/ajpn.ajpn_33_20  
Background: Neonatal acute kidney injury (AKI) carries significant morbidity and mortality, particularly among very low birth weight (VLBW) neonates. We aimed to evaluate the short-term outcomes and the risk factors of AKI in VLBW infants. Methods: All extramural VLBW neonates without AKI and congenital renal abnormalities were enrolled. Serum creatinine (SCr) was estimated on days 0, 4, and 10. Neonatal AKI was defined an increase in SCr by ≥0.3 mg/dL from the previous value within a period of 48 h or >1.5 time from baseline within 7 days. Results: Neonatal AKI developed in 26 (13.8%) out of 189 neonates studied. Among AKI group, 5 (19.2%) had stage 1, 9 (34.4%) neonates reached stage 2, and 12 (46.1%) neonates reached stage 3 AKI. Neonates with AKI had a significantly lower gestational age and birth weight (P < 0.001). Mortality in VLBW neonates with AKI was significantly higher as compared to those without AKI (crude hazard ratio 6.2; 95% confidence interval: 2.36–15.79, P <0.05). Conclusions: AKI is common in extramural VLBW neonates, is inversely correlated with gestational age and birth weight, and carries poor outcome.
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BRIEF REPORTS Top

Urinary tract infections in children presenting with acute gastroenteritis p. 19
Fatemeh Saeedi, Iran Malekzadeh, Mastaneh Moghtaderi
DOI:10.4103/ajpn.ajpn_38_20  
Management of acute gastroenteritis (AGE) includes treatment of underlying infections as well, since AGE may be an atypical presentation of urinary tract infection (UTI). The present study was planned to study the prevalence of UTI in children presenting with AGE. Two hundred consecutive patients presenting with AGE at 2 months to 4 years of age to one center's emergency department over 1 year were evaluated for UTI. Of 200 patients, 103 were male and 97 were female. One patient had infectious diarrhea. One hundred and forty-one (70.5%) patients were febrile, 63 (31.5%) patients had mild dehydration, 107 (53.5%) patients had moderate dehydration and 30 (15%) patients had severe dehydration. Twenty-five (12.5%) patients had pyuria. Fifteen (7.5%) patients had positive urine cultures. One of these (6.7%) patients had a history of UTI in the mother and 5 (33.3%) patients reported a history of UTI in their siblings. Of 15 patients with UTI, 13 (86.6%) were girls; 5 (38.4%) had labial adhesions. Escherichia coli and Klebsiella were isolated in 4 and one cases in urine culture, respectively. UTI underlies 7.5% of children presenting with AGE.
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Catheter-related blood stream infections among children on hemodialysis over 7 years: A single-center experience p. 22
Gurinder Kumar
DOI:10.4103/ajpn.ajpn_31_20  
Patients with end-stage kidney disease frequently require hemodialysis (HD) through central venous catheters (CVCs) as a bridge to renal transplantation. However, longevity of CVCs is affected by the occurrence of CVC-related bloodstream infections (CVC-RBI). This retrospective study evaluated the outcomes of CVCs inserted for HD, with specific attention to rates and etiology of CVC-RBI. Over 7 years between January 2010 and December 2016, 39 patients, aged 2–15 years, were admitted for HD for ESRD in the Department of Pediatric Nephrology, Sheikh Khalifa Medical City, Abu Dhabi, UAE. The most etiology for ESRD was renal dysplasia (28.2%). Tunneled cuffed CVC was inserted most commonly in the right internal jugular vein (40.2%). The most common reason for change of CVC was CVC-RBI (28.9%). The estimated rate of CVC-RBIs was 1.72/000 CVC days. Staphylococcus aureus was the most common (28.6%) etiology. CVC longevity was significantly influenced by the occurrence of CVC-RBI (P < 0.001), and the rates of CVC-RBI were significantly different between patients with less or more than 200 CVC days (P = 0.002). Most patients either continued on HD (48.7%) or underwent kidney transplantation (28.2%). This study highlights that rates of CVC-RBI were low but were associated with prolonged CVC use.
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Heterogenous phenotypes of congenital nephrotic syndrome related to NPHS1 mutation p. 26
Sze Wa Wong, Eugene Yu Hin Chan, Alison Lap Tak Ma, Liz Yuet Ping Yuen, Wai Ming Lai
DOI:10.4103/AJPN.AJPN_18_20  
We report the heterogeneous outcomes in congenital nephrotic syndrome (CNS) secondary to variants in NPHS1 gene. We retrospectively reviewed the records of all patients with genetically confirmed NPHS1-related CNS who presented to one center between 2000 and 2018. Four patients from three families were identified. Three progressed to kidney failure at 2–10 years and required kidney replacement therapy. Two patients with Arg1160Ter NPHS1 variant had slow disease progression, with one reaching only stage 2 chronic kidney disease in early adulthood. This report shows the phenotypic heterogeneity in CNS with NPSH1 variants indicating that genotype/phenotype correlations in NPHS1-related CNS are poor.
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Late effect of chemotherapy for osteosarcoma on kidney function p. 30
Takuji Enya, Tomoki Miyazawa, Kohei Miyazaki, Naoki Sakata, Keisuke Sugimoto
DOI:10.4103/AJPN.AJPN_29_20  
With improvement in the outcomes of chemotherapy, the management of late effects of chemotherapy is an increasingly important concern in patients with osteosarcoma. However, the risk factors for late effects on kidney function are not clear. We report seven cases of osteosarcoma, including three patients with severe or recurrent drug-induced acute kidney injury, who were diagnosed with tubulointerstitial nephritis after the treatment of osteosarcoma. Although late renal effects are considered to be dose-dependent, they are not invariable with the same protocol. The severity and frequency of acute kidney injury following chemotherapy might have influenced the occurrence of renal late effects.
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CASE REPORTS Top

Delayed presentation with henoch–schönlein purpura in a patient with immunoglobulin a nephropathy p. 33
WA Lasanthi Kumari Weerasooriya, Neelakanthi V I. Ratnatunga, Dinesh Rangana, Shenal Thalgahagoda
DOI:10.4103/ajpn.ajpn_36_20  
Henoch–Schönlein purpura (HSP) nephritis (HSPN) and immunoglobulin A (IgA) nephropathy (IgAN) are related conditions that may be encountered sequentially in the same patient, are described in twins, and have common biological and pathological basis. The clinical features as well as the spectrum of severity at presentation vary significantly among patients. Here, we report a girl who first presented with acute glomerulonephritis and biopsy evidence of acute diffuse proliferative IgA nephritis with crescents, and 5 years later, she developed HSP and proteinuria. Such delayed appearance of cutaneous manifestations after initial renal involvement is unusual, though reported previously. This presentation stresses the importance of long-term follow-up of patients with HSPN and primary IgAN.
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Exercise-induced gross hematuria due to concurrent nutcracker syndrome and immunoglobulin a nephropathy p. 36
Eugene Yu-hin Chan, Kevin Kin-Fen Fung, Tsz Wai Ho, Elaine Yee-ling Kan, Alison Lap-tak Ma
DOI:10.4103/ajpn.ajpn_32_20  
We describe a patient presenting with loin pain and recurrent exercise-induced hematuria who concurrently had immunoglobulin A (IgA) nephropathy and nutcracker syndrome. While the diagnosis of IgA nephropathy did not fully explain the clinical symptoms, initial computed tomography was unrevealing. Renal venography eventually confirmed the presence of nutcracker syndrome.
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CORRESPONDENCE Top

Singleton newborn with bilateral renal and ureteric agenesis, without features of potter sequence p. 40
WA Lasanthi Kumari Weerasooriya, Shenal Thalgahagoda, Dinesh Rangana, Mathula Hettiarachci
DOI:10.4103/AJPN.AJPN_30_20  
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JOURNAL SCAN Top

Journal scan p. 42
Priyanka Khandelwal
DOI:10.4103/ajpn.ajpn_26_21  
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