Introduction: Although some highlighted problems such as parental stress, child behavioural problems and financial instability occur after transplantation, much still remains unknown about the extent, nature, reasons and implications of family difficulties caused by renal transplantation in childhood. Objectives: To examine the psychosocial aspects, levels of parental stress and behavioural problems among children after renal transplantation and to study the predictors of psychosocial issues in the study sample. Design, setting and method: A cross sectional analytical study was conducted at the University Paediatric Unit of the Teaching Hospital, Peradeniya in September-October 2012. All patients who are being followed up at the post renal transplant clinic were recruited to the study. Data was collected using an intervieweradministered questionnaire and analyzed using SPSS 16.0. Results: Thirty-eight recipients of paediatric renal transplants were recruited. 67.5% were males. Feeling of happiness constantly or regularly was reported by 82.5% of children while irritability was a significant problem in 47.5%. Sleep disturbance was a recognized problem in 50% of children. At 2 years of transplantation 85 % of children had not attended school but at 5 years after transplantation school dropout was 10 %. This difference was ______________________________________
Background Distal (Type 1) renal tubular acidosis (dRTA) is characterized by inability to secrete hydrogen irons from the distal tubule. The aetiology of dRTA is diverse and can be either inherited or acquired. Common clinical presentations of dRTA in the paediatric age group include polyuria, nocturia, failure to thrive, constipation, abnormal breathing and nephrolithiasis. Though persistent hypokalemia is frequently seen in dRTA, hypokalemic muscular paralysis is uncommon and rarely described in children. Case presentation Three and a half years old girl was referred for evaluation of progressive loss of gross motor milestones over 6 months and acute episode of paralysis. Her other developmental domains were age appropriate. Notably, there was no history of polyuria, polydipsia, nocturia and abnormal breathing. Physical examination revealed proximal myopathy (waddling gait and positive Gower’s sign), diminished lower limb reflexes and muscle tone. Her serum potassium was low (2.1 meq/l) and she was subsequently investigated for hypokalemic paralysis. Diagnosis of distal renal tubular acidosis was made, based on hypokalemic hyperchloremic metabolic acidosis with normal anion gap, high urine pH, borderline hypercalciuria, medullary nephrocalcinosis and exclusion of other differential diagnosis. The child showed complete symptomatic recovery upon commencement of standard treatment for distal renal tubular acidosis. Conclusions This case report highlights the importance of considering hypokalemia and renal tubular acidosis in the differential diagnosis of acute flaccid paralysis and proximal myopathy. Early diagnosis will prevent costly investigations and enable rapid clinical recovery in the affected child.
Combined liver-kidney transplantation (CLKT) is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual (usually a cadaver) to the same recipient during a single surgical procedure. Most common indications for CLKT in children are autosomal recessive polycystic kidney disease and primary hyperoxaluria type 1. Atypical haemolytic uremic syndrome, methylmalonic academia, and conditions where liver and renal failure co-exists may be indications for CLKT. CLKT is often preferred over sequential liver-kidney transplantation due to immunoprotective effects of transplanted liver on renal allograft; however, liver survival has no significant impact. Since CLKT is a major surgical procedure which involves multiple and complex anastomosis surgeries, acute complications are not uncommon. Bleeding, thrombosis, haemodynamic instability, infections, acute cellular rejections, renal and liver dysfunction are acute complications. The long-term outlook is promising with over 80% 5-year survival rates among those children who survive the initial six-month postoperative period.
To the Editor: Levamisole has been used successfully in the management of nephrotic syndrome (NS) in childhood [1]. Due to its ability to act as a hapten, levamisole may cause increased formation of antibodies to various antigens [2].Our patient, a 10-y-old girl with frequently relapsing steroid sensitive NS presented with purpuric rash and nodules over lower and upper limbs. She has been on levamisole (2.5 mg/kg) alternate days for two and half years. The serum creatinine 3 mo before was 56 μmol/l. She was pale but there was no organomegaly. She had elevated blood pressure of 134/72 mmHg.Her urine albumin/creatinine ratio was 156 mmol/mg. Full blood count (FBC) showed pancytopenia and serum creatinine was 98 μmol/l. Anti-neutrophil cytoplasmic antibodies (ANCA) were positive with high titres. Antinuclear antibodies (ANA) and anti-double stranded DNA antibodies (DsDNA) were negative. The complement C3 and C4 were normal. The bone marrow biopsy was normal. The renal biopsy showed pauci immune focal necrotizing and crescentic glomerulonephritis.The levamisole was stopped immediately. The patient received methyl prednisolone 600 mg/m 2 and was followed up by intravenous cyclophosphamide; then started on daily dose of oral prednisolone 60 mg/m 2 for 4 wk. All three cell lines showed improvement after two weeks of stopping levamisole.At the three months follow-up, urine albumin/creatinine ratio was normal, renal functions revealed serum creatinine of 62 μmol/L and serum ANCA was negative.
received secondary education. Sixteen (40%) had delayed puberty, 17 (42.5%) had short stature and 11 (27.5%) had hypothyroidism. Restriction of sports, academic failure and restriction of leisure activities had the most impact as individual factors determining physical health in older children. The psychological health was adversely affected by altered physical appearance, delayed pubertal features and being labelled with a debilitating illness in both age groups of children with beta thalassemia. The families of these children had faced significant financial and transport difficulties and risk of lack of care to siblings. Most parents believed that services from social support group were required. Conclusions Factors underpinning the quality of life of patients with thalassemia above 12 years of age at professorial paediatric unit, Teaching hospital Peradeniya were diverse and included physical, psychological, social and family health related factors. The effect of most factors determining physical health increased with increased age of patients with thalassemia.Aims Home related unintentional injuries are a major threat to the health of children worldwide and are largely preventable. Accidental injuries were reported as the fourth leading cause of death among children in Sri Lanka. The aim of this study was to identify home related risk factors for accidental injuries in the paediatric age group. Method This hospital based cross sectional descriptive study was carried out at Lady Ridgeway hospital for children, Colombo over six months (2018 January-June). Care givers of 400 children were interviewed using a pretested, multistructured questionnaire regarding demographic, social and home related risk factors for five domains of child injuriesburns, electrocution, drowning, poisoning, and other accidental injuries.Results The majority of interviewees were mothers (385, 96.3%). Previous home accidents were reported in 91 (22.5%) children. The majority of mothers were housewives (290, 72.5%). Burns related risk factors wereunsafe kettles (121, 30.3%), free access to hot water (50, 12.5%), fire crackers (116, 29%), lighters (298, 74%), tea pots (300, 75%) and bike silences (118, 20.5%). Electrocution related risk factors wereeasy access to unsafe electric socket guards (179, 44.8%), and unprotected wires (15, 3.8%). Drowning related risk factors were -unprotected water sources (44, 11%), risk for flooding (53, 31.2%) and open water containers (14, 3.5%). Acute poisoning related risk factors wereunsafe storage of medicines (356, 89%) and household chemicals (373, 93.3%) and poisonous plants in home garden (13, 3.3%). Risk factors for other accidental injuries wereplay with small objects (297, 74.3%), pets (252, 63%), and access to sharp objects (321, 80.3%) and button batteries (103, 25.8%). ConclusionThe majority of risk factors for all domains of accidental injuries in children are preventable and effectiveness of interventions to avoid these risk factors should be evaluated.
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