STUDY OF ANTIBIOTIC SENSITIVITY PATTERN IN CHILDREN WITH NEPHROTIC SYNDROME PRESENTING WITH UTI

BACKGROUND:Nephrotic syndrome (NS) results in proteinuria of more than 3.5 g protein per day and is characterized by edema,hyperlipidemia,hypoproteinemia and other metabolic disorders.Prevalence of UTI in nephrotic syndrome is high.It precipitates relapse and delays remission. AIMS AND OBJECTIVES:The aim of this retrospective study is to analyze the incidence of UTI,its Predisposing factors along with its bacterial and fungal etiologies in patients with NS and antibiotic sensitivity pattern in nephrotic children with UTI. METHODS: This retrospective study was carried out in a tertiary care, CIVIL HOSPITAL,AHMEDABAD between July 2018 and July 2019 among the admitted cases of nephrotic children under 12 years of age. Examinations for microscopy and cultures of urine, sputum, throat swab, blood and fluid were also carried out in the children,along with routine examination,if found necessary. Urinary specimens were collected by clean catch method following careful preparation of urethral orifices. The specimens were immediately inoculated on culture media. Identification of organisms and antibiotic sensitivity 1 susceptibility testing was performed according to CLSI guidelines 2010 by Kirby –Bauer disc diffusion method. RESULTS: Total 41 nephrotic children were enrolled.Incidence of UTI was fairly high in nephrotic syndrome,especially in frequent relapse (48.48%). Kleibsella pneumonia (45.5%) was the most common organism, followed by E.coli (24.24%),responsible for UTI in both first episode and frequent relapse of nephrotic syndrome in the following study. CONCLUSION: As per the study, common isolates of UTI in nephrotic syndrome have developed resistance to commonly used oral or parenteral drugs.In my study,it is observed that colistin was the most sensitive parenteral drug for all isolates followed by Meropenem and aminoglycoside.

Molecular factors predicting steroid resistance in pediatric nephrotic syndrome

Objectives: the objective of this paper was to study the levels of cellular hypoxia, apoptosis controlling factors in children with steroid-sensitive and steroid-resistant nephrotic syndrome. Background: patients with steroid-resistant nephrotic syndrome (SRNS) represent a challenging subset of patients with nephrotic syndrome who often fail standard immunosuppression and have a higher likelihood of progressing to end-stage renal disease. The search of the biochemical markers undergoing the steroid-resistance is under urgent need. Methods: an examination of kidney biopsies and blood of 56 patients (aged 10 to 15 years) with nephrotic syndrome was done. Conventional clinical investigations, immunohistochemistry, immunoblotting were used in this study. Results: patients with steroid-resistant nephrotic syndrome show an increased level of HIF-1 alfa (a marker of cellular hypoxia) as compared to the control group and children with steroid-sensitive nephrotic syndrome. Patients with steroid-resistant nephrotic syndrome show a down-regulation of anti-apoptotic marker BcL-xL as compared to the control group and children with steroid-sensitive nephrotic syndrome. Conclusion: hypoxia-induces disorders and apoptosis activation markers are considered to be included in the complex scheme predicting steroid-resistance in nephrotic children.

Thyroid Dysfunction in Children with Idiopathic Nephrotic Syndrome Attending a Paediatric Hospital in Qazvin, Iran

Objectives: Nephrotic syndrome is a glomerular disease characterised by a loss of albumin and high-molecular-weight proteins such as thyroxine-binding globulin and thyroid hormones, potentially resulting in subclinical or even overt hypothyroidism. This study aimed to compare thyroid hormone levels between nephrotic children and healthy controls as well as between nephrotic children in the active phase of the disease and those in remission. Methods: This case-control study was conducted between March 2016 and 2018 at a paediatric hospital in Qazvin, Iran. A total of 73 nephrotic children comprised the case group—including 49 with active disease and 24 in remission—while the control group included 74 healthy children. Thyroid function was assessed according to levels of thyroid-stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine (T4), total T4, total T3 and anti-thyroid peroxidase. Results: All of the controls had normal total T4 levels. Elevated TSH levels were more frequent in nephrotic children compared to controls (34.2% versus 10.8%; P = 0.001). A significantly lower number of patients with active disease were euthyroid compared to those in remission (51% versus 95.8%; P = 0.001). Moreover, 7 (9.5%) of patients in the active and no patient in remission phase had abnormal total T4 levels (P <0.001), while 14.3% and 0% had highly elevated TSH levels (P = 0.002). Conclusion: Due to the prevalence of subclinical and even overt hypothyroidism, thyroid screening tests may be required for nephrotic children. However, further research is needed to confirm these findings. Keywords: Nephrotic Syndrome; Children; Albuminuria; Proteinuria; Hypothyroidism; Iran.

Thyroid Function in Children with Idiopathic Nephrotic Syndrome

Background: The underlying abnormality in nephrotic syndrome is an increase inpermeability of the glomerular membrane. Urinary loses of binding proteins such asThyroxine Binding Globulin (TBG) albumin results in a reduction in serumthyroxine(T4) and sometimes in total T3 levels. The study was done to assess thyroidhormone status of idiopathic nephrotic syndrome patients at diagnosis, comparethe thyroid function after treatment with steroid, correlate with serum albumin andcompare the thyroid function with control group. Materials and methods: It was an analytic type of cross sectional study, done inPaediatric ward, Chittagong Medical College Hospital, Chattogram from 01.05.11 to30.11.11. Total 58 patients in two groups were included. In group A 32 cases ofidiopathic nephrotic syndrome patients and in group B 26 control cases of same ageand sex were taken. In group A thyroid function was done at initial diagnosis and inhypothyroid patients in this group again thyroid function was done after treatmentwith steroid. Data was collected through interviewing with pre-designedquestionnaire, physical examination and investigation techniques. Results: Thyroid hormone level of nephrotic children were significantly lower thanthat of control group. Nephrotic children with thyroid hypofunction were foundeuthyroid after initial treatment with steroid that was statistically significant andthere was positive correlation between serum albumin and thyroid hormone level. Conclusion: Children suffering from nephrotic syndrome had significant thyroidhypofunction because of low serum albumin level and after treatment with steroidthey became euthyroid. Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 51-54

P1826ASSESSMENT OF GROWTH PARAMETERS OF CHILDREN IN LONG TERM FOLLOW UP WITH DIFFERENT RELAPSING COURSE OF NEPHROTIC SYNDROME

Background and Aims Childhood Nephrotic syndrome has its peak onset in the age group 2-4 years, and that is also a period of significant height growth. Corticosteroids and chronic diseases are known to have long term effects on growth parameters of these children. Hence we assessed and compared the growth of children with Infrequent relapsing (IFRNS) and remission (R) as group 1, Frequent -relapsing (FR), and steroid - dependent (SD) as group 2 and steroid -resistant (SR) as group 3. Method This retrospective single center study collected data from medical records of children presented in a pediatric nephrology clinic in a tertiary care center in New Delhi. Nephrotic children, aged 1-18 years with regular follow up in the period of 2014 to 2019 were included. Basic demographic details including age at onset and age at last follow up in clinic, sex, anthropometry details at last follow up were recorded. We traced initial height at nephrotic syndrome onset to assess growth velocity but were unavailable at the moment so excluded from analysis. Also, children completed less than 1 year follow up, and compliance issues were excluded. Z scores (standard deviation score) for weight, height and BMI were calculated. Initial comparison of three groups as FR/SDNS, IFRNS/R and SRNS was done. But in the second comparison, we combined FR/SD and SR children in one group as Difficult nephrotic syndrome (DNS) group. Anova Kruskal-Wallis test was used to find significance in three groups in table 1. Subsequent analysis was done by the non-parametric statistic method Mann-Whitney Test to assess significance in subgroups of boys and girls. Results: 27 IFR/R nephrotic children, 36 FR/SD, and 15 SRNS were compared as in Table1. D-NS and IFRNS-R for boys and girls ratio (11; 16) & (18; 32) followed for a median period of 18 (max 46; 12), 24.6 (57.6; 12), and 32 (50;12) months respectively. Conclusion Linear growth (height) is the most affected parameters in children in SRNS and FR/SD nephrotic syndrome. Effect is more significant in girls then in boys as they showed improvement in . No difference in weight and BMI is seen on applied statistics in two groups.

Steroid sensitive nephrotic syndrome in children: Frequency of relapse during the first twelve months after completion of six months steroid therapy.

Objectives: Nephrotic syndrome (NS) is described as the existence of nephrotic-range proteinuria along with edema, hyperlipidemia and hypoalbuminemia. NS is estimated to be 15 time more frequent in children as compared to adults. Relapse is a major problem while managing nephrotic children. This study was aimed to find out the frequency of relapse in children with first episode of steroid sensitive nephrotic syndrome (SSNS) during the first 12 months, after completion of 6 months steroid therapy. Study Design: Descriptive case series study. Setting: Department of Paediatric Nephrology, The Children’s Hospital & the Institute of Child Health, Multan. Period: From February 27, 2018 to February 27, 2019. Material and Methods: A total of 55 children, aged 1 to 10 years, diagnosed with SSNS, 1st presentation of NS (based on history) and who successfully completed 6 months steroid therapy, were enrolled. They were taught to check proteinuria at home by dipstick method and enter daily results on the follow up card provided from the Nephrology department of the hospital. The outcome variable, that is relapse, was noted on the Proforma. Results: Amongst 55 children, gender distribution showed 38 (69.1%) male and 17 (30.9%) females. Children with body weight <20 kg were 33 (60%) and those having ≥20kg were 22 (40%). Patients with age <6 years were 54.5% and patients with age ≥6 years were 45.5%. Mean age was 5.93± 3.36 years. Frequency of relapse was noted to be 78.2% and patients who did not relapse within 1 year of completion of treatment were 21.8%. Conclusion: Nephrotic syndrome is a common presentation of childhood renal problems and is major cause of morbidity in our set up. Relapses are frequently associated with SSNS and most of the patients relapse within 1 year of completion of treatment. Relapses are more common in male children as compared to female children.