Acute and chronic renal impairment can be developed in patients who undergo HSCT even though the pre-transplant renal function is in normal limits and the conditioning regimen does not include TBI. Both glomerular and tubular renal function evaluation should be part of a long-term follow-up in children following HSCT.

Primary peritonitis is a well-described infectious complication of nephrotic syndrome. Current data on the true incidence of peritonitis and efficacy of preventive pneumococcal vaccination are not clear in this group of children. In this nationwide study, among a total of 268 patients with an initial diagnosis of steroid sensitive nephrotic syndrome, eight episodes of primary peritonitis were detected in seven patients during 5 years. All eight attacks of peritonitis occurred in the relapse period. Seven of these peritonitis episodes occurred in the first 2 years of nephrotic syndrome, three of them during the first attack. One patient had two attacks with a 6-month interval. Only two of the patients were steroid sensitive, while four of them were steroid dependent, and one was steroid resistant at the diagnosis of peritonitis. The causing microorganism was identified in three patients (Streptococcus hemolyticus, Streptococcus pneumoniae, and alpha-hemolytic Streptococcus). Incidence of peritonitis (2.6%) in our series was not high when compared with previous reports. None of the patients had been immunized against pneumococcus before or after the peritonitis attack. It raises the question if the vaccine is necessary for every child with steroid sensitive nephrotic syndrome. However, we suggest that immunization against pneumococcus is not indicated in children with steroid-responsive nephrotic syndrome (NS) and should be reserved for the small number of children who have steroid-dependent or steroid-resistant NS.

The serum procalcitonin test, like other commonly used laboratory parameters, e.g. serum C-reactive protein and white blood cell count, was inadequate in distinguishing renal parenchymal involvement in acute febrile urinary tract infections.

The methodologies to diagnose hypercalciuria have not yet been standardized. The aims of this study were to assess the correlation between urinary calcium/creatinine ratio (UCa/Cr) > or = 0.21 (mg/mg) and 24 h urinary calcium excretions and to determine the reference values of the UCa/Cr ratio among a large population of schoolchildren in southern Turkey. Non-fasting, second morning urine samples were collected from 2,143 children aged 7-14 years. In children with suspected hypercalciuria [UCa/Cr > or = 0.21 (mg/mg)], 24 h urine samples were collected. The 95th percentile values of the UCa/Cr ratio for each age were calculated and showed a decrease in value with advancing age. In all, 269 (12.5%) of the children had UCa/Cr > or = 0.21 (mg/mg), of whom 66 (24.5%) had daily urinary calcium excretion > or =4 mg/kg per day. A weak correlation was found between spot UCa/Cr ratios and daily urinary calcium excretions in children with UCa/Cr > or = 0.21 (r = 0.27). We conclude that a spot UCa/Cr ratio of 0.21 (mg/mg) as the upper limit of normal cannot be used universally to define hypercalciuria. Age-specific reference values for UCa/Cr should be established for each population, to be used as a screening test for hypercalciuria, and the definite diagnosis should be established with 24 h urinary calcium excretion whenever possible.

Chronic peritoneal dialysis (CPD) has been utilized in the treatment of children since 1989 in Turkey. The aims of this study were to summarize our experience with CPD in children and to establish a pediatric registry data system in Turkey. Standard questionnaires were sent to all pediatric CPD centers. 514 patients treated between 1989 and 2002 in 12 pediatric centers were enrolled in the study. Reflux nephropathy was the most common (18.1%) cause of renal failure. Mean age at dialysis initiation was 10.1+/-4.6 years. Mean duration of dialysis was 24.1+/-20.5 months. Continuous ambulatory peritoneal dialysis (CAPD) was the first CPD modality for 476 (92.6%) patients, 142 of whom switched to automated peritoneal dialysis (APD) during follow-up. Currently, 47.3% of the patients are still on CPD, 15.4% were transplanted, 13.2% switched to hemodialysis, 16.7% died. The patient and technique survivals were 90% and 95% at one year and 70% and 69% at five years, respectively. The survival was significantly shorter in the youngest age group (0-24 months) compared to those in older age groups (p=0.000). We herein report the first results of the TUPEPD study providing information on demographic data and survival of pediatric CPD patients. As opposed to clear recommendations in favor of APD, there is a clear preponderance of CAPD in our pediatric CPD population. That vesicoureteral reflux (VUR) is still the leading cause of renal failure is a distressing finding. Remarkably lower survival rates and transplantation ratios are as striking and distressing as the high incidence of VUR among the causes of ESRD. We conclude that we must make a great effort to achieve better results and to change these undesirable events.