Catheter-Obtained Urine Culture Contamination Among Young Infants: A Prospective Cohort Study

Objectives: A correct diagnosis of urinary tract infection in young infants requires an uncontaminated urine culture, commonly obtained by urethral catheterization. In the current study, we examined the rates and factors associated with contaminations of catheter-obtained urine cultures in very young infants.Methods: This prospective cohort study included 143 catheter-obtained urine cultures of infants ≤2 months of age admitted to the pediatric ward of a tertiary hospital in Israel from April 2019 to September 2020. Patient's and operator's study variables were documented at the time of catheter insertion. Positive urine cultures were reviewed by a pediatric nephrologist and a pediatric infectious disease specialist and designated as infection or contamination. The study variables were compared between those with or without contamination.Results: The contamination rate in our cohort was 29%. Females were more than twice as likely to have a contaminated urine culture (37 vs. 18%, respectively, P = 0.014). Circumcision status, official training about sterile catheterization, a sense of difficult catheterization, and the shift in which the culture was obtained did not influence the contamination rate.Conclusions: Catheter-obtained urine cultures have a high contamination rate among very young infants, especially among girls.

Clinical and echographic signs of acute kidney injury in premature babies born with very low and extremely low body weight

Introduction. One of the urgent issues in the first stage of nursing premature infants is acute kidney injury. The incidence of neonatal acute kidney injury in developing countries is 3.9/1000 live births, with 34.5/1000 among neonatal intensive care patients.The aim of the study was to establish echographic signs of acute kidney injury in deeply premature infants in the neonatal period.Materials and methods. 24 children with clinical and laboratory signs of acute kidney injury “AKI+” and 76 children without signs of acute kidney injury “AKI-“. All the children included in the study were born with a body weight of less than 1500 g and a gestation period of less than 32 weeks and were in the neonatal intensive care unit. To clarify the nature of the detected changes, a scientific analysis of the results of pathoanatomic studies of 55 deceased preterm infants was carried out.Results. In all children from the “AKI+” group, there was a pronounced diffuse-uneven increase in the echogenicity of the parenchyma, there was a depletion of the vascular pattern in the subcapsular zone and/or in the cortical layer of the parenchyma, in 25% of patients on the 5th-15th day of life, anechogenic formations without signs of blood flow, with a diameter of 1-3 mm in the cortical layer were noted. The changes had a bilateral nature of the lesion, with further observation they were gradually reduced and by 3 ± 2 months of life they were not determined during ultrasound of the kidneys.Discussion. Acute kidney injury is an urgent problem of preterm infants born with very low and extremely low body weight. The article presents the results of ultrasound examination of the kidneys in comparison with clinical and laboratory indicators and the results of pathomorphological studies. As a result of the study, the most characteristic ultrasound signs of acute kidney injury were identified, which are an uneven diffuse increase in the echogenicity of the renal parenchyma, small anechoic avascular inclusions (cysts) of the parenchyma, depletion of renal blood flow.Conclusions. Renal ultrasonography is an informative method, but echographic changes may be labile depending on the clinical course of the disease, and the absence of anechogenic masses in the parenchyma may be due to technical limitations of the ultrasonography method. It requires further monitoring and continued vigilance of the pediatrician and pediatric nephrologist.

Clinical and echographic signs of acute kidney injury in premature babies born with very low and extremely low body weight

Introduction. One of the urgent issues in the first stage of nursing premature infants is acute kidney injury. The incidence of neonatal acute kidney injury in developing countries is 3.9/1000 live births, with 34.5/1000 among neonatal intensive care patients.The aim of the study was to establish echographic signs of acute kidney injury in deeply premature infants in the neonatal period.Materials and methods. 24 children with clinical and laboratory signs of acute kidney injury “AKI+” and 76 children without signs of acute kidney injury “AKI-“. All the children included in the study were born with a body weight of less than 1500 g and a gestation period of less than 32 weeks and were in the neonatal intensive care unit. To clarify the nature of the detected changes, a scientific analysis of the results of pathoanatomic studies of 55 deceased preterm infants was carried out.Results. In all children from the “AKI+” group, there was a pronounced diffuse-uneven increase in the echogenicity of the parenchyma, there was a depletion of the vascular pattern in the subcapsular zone and/or in the cortical layer of the parenchyma, in 25% of patients on the 5th-15th day of life, anechogenic formations without signs of blood flow, with a diameter of 1-3 mm in the cortical layer were noted. The changes had a bilateral nature of the lesion, with further observation they were gradually reduced and by 3 ± 2 months of life they were not determined during ultrasound of the kidneys.Discussion. Acute kidney injury is an urgent problem of preterm infants born with very low and extremely low body weight. The article presents the results of ultrasound examination of the kidneys in comparison with clinical and laboratory indicators and the results of pathomorphological studies. As a result of the study, the most characteristic ultrasound signs of acute kidney injury were identified, which are an uneven diffuse increase in the echogenicity of the renal parenchyma, small anechoic avascular inclusions (cysts) of the parenchyma, depletion of renal blood flow.Conclusions. Renal ultrasonography is an informative method, but echographic changes may be labile depending on the clinical course of the disease, and the absence of anechogenic masses in the parenchyma may be due to technical limitations of the ultrasonography method. It requires further monitoring and continued vigilance of the pediatrician and pediatric nephrologist.

Diagnostic accuracy of an interdisciplinary tertiary center evaluation in children referred for suspected congenital anomalies of the kidney and urinary tract on fetal ultrasound - a retrospective outcome analysis

Background Fetal ultrasound organ screening has become a standard of care in most high-income countries. This has resulted in increased detection of congenital abnormalities, which may lead to major uncertainty and anxiety in expectant parents, even though many of them are of minor relevance. In order to optimize prenatal counselling, we introduced an interdisciplinary approach for all pregnant women referred to our center by private obstetricians for a co-assessment of suspected relevant fetal abnormalities of the kidney or urinary tract, involving both experienced prenatal ultrasound specialists and a pediatric nephrologist or urologist. Methods In a retrospective analysis, we evaluated reports of intrauterine evaluation and postnatal follow-up in order to assess accuracy of explicit intrauterine diagnoses and outcome of hydronephroses according to their severity in this setting. Results A total of 175 fetuses were examined between 2012 and 2019 and followed postnatally at our Pediatric Nephrology or Urology Department. There was a high concordance (85.9%) between explicit intrauterine and final diagnoses. Resolution rate of hydronephrosis was higher in patients with intrauterine low-grade than high-grade hydronephrosis (61.8% versus 11.9%). An etiological diagnosis was found in 62.5%, 52.0%, and 11.1% of patients with intrauterine bilateral high-grade, unilateral high-grade, and unilateral high-grade with contralateral low-grade hydronephrosis, respectively, but in none of the patients with intrauterine low-grade hydronephrosis. Conclusions The results of our study demonstrate that, through interdisciplinary teamwork, intrauterine assessment of the fetal kidneys and urinary tract is highly accurate and allows a good discrimination between relevant and transient/physiological hydronephroses. Graphical abstract

For Whom the Bell Tolls: Acute Kidney Injury and Electronic Alerts for the Pediatric Nephrologist

With the advent of the electronic medical record, automated alerts have allowed for improved recognition of patients with acute kidney injury (AKI). Pediatric patients have the opportunity to benefit from such alerts, as those with a diagnosis of AKI are at risk of developing long-term consequences including reduced renal function and hypertension. Despite extensive studies on the implementation of electronic alerts, their overall impact on clinical outcomes have been unclear. Understanding the results of these studies have helped define best practices in developing electronic alerts with the aim of improving their impact on patient care. As electronic alerts for AKI are applied to pediatric patients, identifying their strengths and limitations will allow for continued improvement in its use and efficacy.

Adolescent Organ Transplants: A Lifetime Commitment to Medication

Purpose: Medication non-adherence is the most prevalent issue within the adolescent population, where often times adolescent patients will face barriers to achieve adherence. This article sought out to present a narrative review of medication adherence barriers identified and reported in adolescent organ transplant patients, whilst providing potential adherence intervention methods. Method: A literature review was conducted using the databases PubMed, MasterFILE Premier*, Elsevier, and Google Scholar. The articles were chosen based on their relativity to the topic of medication adherence barriers and interventions in adolescent organ transplant patients. Also, a total of 11 different medical practitioners were contacted for an interview. Results: Twenty-six studies were chosen to be a part of this review, and based on the content of the studies, five barrier types were developed: “treatment-related barriers”, “psychosocial barriers”, “transition readiness barriers”, and “relationship barriers”. The literature review also identified various intervention methods for medication adherence in regards to education, behavior, relationships, and mental health interventions. One interview was conducted with a pediatric nephrologist. Conclusion: Based on these results it is important to acknowledge that there is not one common barrier among every patient, as each patient develops a unique set of barriers. The review recognized the importance of awareness on the vast possibilities of barriers rather than a generalized approach to adherence.

Dispensary observation of children with urinary tract infection in the practice of a pediatrician and pediatric nephrologist

The review examines the issues of dispensary observation, which is the most critical stage in care for patients with urinary tract infection (UTI). It includes periodic examination and preventive treatment of children after acute, recurrent and chronic UTI. The purpose of dispensary observation is the timely detection and/or prevention of complications and exacerbations of diseases, their prevention, effective rehabilitation of the urinary system after a previous infection at the outpatient stage. The schemes of antibacterial prophylaxis from the standpoint of Russian and foreign clinical guidelines are presented. The issues of primary and secondary prevention of UTI are discussed. The article considers the practical issues of dispensary observation of children with a previous UTI at the outpatient stage. The schemes of antibacterial prophylaxis from the standpoint of Russian and foreign clinical recommendations are presented. The issues of primary and secondary prevention of UTI are discussed.

Complications of Ultrasound Guided Renal Biopsy in 100 Children: Experience at a Tertiary Care Hospital

Background: Use of automated device with ultrasound guidance in renal biopsy has improved the adequacy and reduced the complication. Chittagong Medical College Hospital (CMCH) is a tertiary teaching hospital where Pediatric Nephrology Department started its journey on 11th December 2013. Since then renal biopsy is going on. Aim of the study is to see the rate of adequacy and complication of renal biopsy along the course of years. Materials and methods: This is a retrospective study carried on 100 consecutive ultrasonography guided percutaneous renal biopsy from lower pole of left native kidney performed by the pediatric nephrologist. All hospitalized children aged up to 12 years admitted since 2014 were included. Spring loaded automated biopsy needle was used in 88% cases and Trucut biopsy needle in 12% cases. Results: Most of the patients were aged between 1 to 10 years with male female ratio 0.9:1. Midazolam was used for sedation in all patients except one who needed general anesthesia. Light microscopy and Direct Immunofluorescence (DIF) report was made but no facility for electron microscopy. Gross hematuria was experienced in 5% cases and one case needed blood transfusion. There was one case with blood clot in urinary bladder causing dysuria but no urinary retention was observed. Post biopsy perinephric hematomas developed in 4 cases. Number of needle passes to obtain adequate biopsy material in native kidney was £3 in 78% cases. Adequate specimen was found in 95% cases. Conclusion: Percutaneous renal biopsy can be done adequately and safely in resource poor setup if pediatric nephrologist and radiologists are available. Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 9-12

Approach to Persistent Microscopic Hematuria in Children

Persistent isolated microscopic hematuria is relatively common in pediatric practice, affecting around 0.25% of children. Isolated microscopic hematuria can be caused by a myriad of potentially benign or serious causes, including urologic issues; kidney stones; glomerular diseases, including disorders of the glomerular basement membrane; hematologic abnormalities; and others. The challenge for the pediatrician or pediatric nephrologist is to distinguish children with potentially progressive forms of kidney disease versus other causes while minimizing cost and inconvenience for the child and family. This manuscript will review the multiple potential causes of microscopic hematuria and provide a framework for the initial evaluation and monitoring of such patients.