Hypertension is a common complication after renal transplantation and is associated with increased risk of cardiovascular disease. The aim of the current study was to investigate the diurnal blood pressure pattern and its relation to structural and functional cardiac changes in renal transplant recipients. Sixty-six stable renal transplant patients (34 female, 32 male), aged 7 to 25 years (mean 17.4±4.3 years) were enrolled in this study. Cardiac function assessed by tissue Doppler echocardiography and blood pressure measurement performed using both the ambulatory and the casual method. Hypertension was demonstrated in 57% of recipients by the casual method and in 75.7% by ambulatory blood pressure monitoring (ABPM). The efficacy of BP control among patients on antihypertensive drugs was 60%. The prevalence of non-dipping was 73%. There was significant inverse correlation between systolic or diastolic day-time or night-time BP index and post-transplant duration (p<0.001, r=-0.386), but no correlation between ABP parameters and BMI, gender, and eGFR. There was a significant relationship between all ABP parameters and left ventricular mass index (LVMI) (p=0.025-0.007, r=0.28-0.38). LVMI was significantly higher in hypertensive than in normotensive cases (p=0.034). There was no difference in diastolic function between hypertensive and normotensive patients or between patients with and without left ventricular hypertrophy (LVH). In conclusion, our study showed the advantage of ABPM over the casual method of diagnosis of hypertension. LVH is common in transplant patients and is likely associated with arterial hypertension. Hypertension and LVH cannot differentiate transplant patients with diastolic malfunction.

IntroductionUrinary tract infections (UTIs) are among the most prevalent infections in children and infants. Early and accurate detection of renal parenchymal involvement in UTI is necessary for decision making and determining treatment strategies. The aim of this study was to determine the predictive accuracy of urinary neutrophil gelatinase-associated lipocalin (NGAL) for renal parenchymal involvement in children with acute pyelonephritis.MethodsThis descriptive, cross-sectional study was conducted in 2014 on children who had been diagnosed with UTI. Children who were admitted to Koodakan Hospital in Bandar Abbas, Hormozgan Province, Iran, and whose ages ranged from two months to 14 years were enrolled in the study. Urine samples were taken to conduct urinary NGAL tests, urine cultures, and urinalyses. In addition, some blood samples were collected for the purpose of determining leukocyte count and C-reactive protein (CRP) and to conduct erythrocyte sedimentation rate (ESR) tests. All patients underwent a dimercaptosuccinic acid (DMSA) scan. SPSS software was used to analyze the data.ResultsAmong the participants in the study, 29 were male (32%), and 60 were female (68%). The mean age of the children who participated in the study was 2.99 ± 2.94 years. The results of the Kruskal-Wallis test showed a significant increase in the urinary NGAL level, an increase in the CRP level, and higher DMSA scan grades (p < 0.001). The cutoff point amounted to > 5 mg/l, having the negative predictive value (NPV) of 76.3%, the specificity of 97.83%, the positive predictive value (PPV) of 96.7%, and the sensitivity of 67.4%.ConclusionUrinary NGAL is not sensitive enough for the prediction of renal parenchymal involvement, but it is a specific marker.

BackgroundIdiopathic hypercalciuria is a group of diseases which can be manifested with urinary symptoms. Its importance is due to high prevalence, recurrent infections, and stone formations which are often asymptomatic.ObjectiveThe objective of this study was to determine the prevalence of idiopathic hypercalciuria in children with urinary system related symptoms in Bandar Abbas in 2014.MethodsThis descriptive cross-sectional study was done in 2014 in a children’s hospital in Bandar Abbas (southern Iran) on 321 children who were between 2 months to 14 years old. Random morning urine sample was obtained from all the patients, and calcium to creatinine ratio was assessed for all the patients for two times. Hypercalciuria is defined as urinary calcium excretion rate that is greater than 4 mg/kg per 24 hours in a child older than two years of age. Data was analyzed using IBM SPSS statistics 23.0 software and Chi-square and independent-samples t-test.ResultsAmong the 321 children assessed, 153 (47.7%) had idiopathic hypercalciuria. The mean age of the children with idiopathic hypercalciuria was 55.20±43.71. Prevalence of idiopathic hypercalciuria was 48.3% in children with urinary tract infection, 54.9% and 53.6% in children with microscopic and macroscopic hematuria respectively, In children with dysuria, there were 52.1%, and 51.8% in children with frequency, 49.1% in children with kidney stone which was confirmed with sonography, 28.6% and 37.5% in children with nocturnal and daily urinary incontinency respectively. Results of this study showed no significant relationship between urinary system symptoms and idiopathic hypercalciuria (p>0.05).ConclusionHypercalciuria can be presented with different symptoms associated with urinary symptoms. Therefore, it is recommended to check the urinary calcium level in children with urinary symptoms with no definite etiology.

BackgroundNocturnal enuresis is among the most common disorders in children. Several pharmacological and non-pharmacological treatments are available for nocturnal enuresis. Studies for reaching the best pharmacological treatment for this disorder are continuing.ObjectiveTo compare the effectiveness and safety of Desmopressin and oxybutynin for treatment of nocturnal enuresis in children from Bandar Abbas in 2014.MethodsThis randomized controlled trial was conducted in 2014 and participants included 66 children with nocturnal enuresis who were more than 5 years old. Patients were randomly assigned into two groups. The first group received 120 microgram Desmopressin daily for 2 months, then 60 microgram daily for 2 months, then 60 microgram every 2 days. The second group received 5 mg oxybutynin twice a day for 6 months. The patients were followed after 1, 3, and 6 months to track treatment response. The study outcomes were frequency of nocturnal enuresis, urinary incontinency, urgency, and frequency. Data were analyzed using SPSS software.ResultsThere were no significant differences between the two groups with respects to sex, age, place of residence, and parents’ education (p<0.05). Nocturnal enuresis, incontinency, urgency, and frequency of nocturnal enuresis was significantly lower with Desmopressin treatment in comparison to the oxybutynin treated group after 1 and 3 months (p<0.05). In addition, constipation and xerostomia were more frequent among the oxybutynin group after 1, 3, and 6 months (p<0.01). Blurred vision was also more frequent among oxybutynin group after 3 months (p<0.01). After 6 months the frequency of nocturnal enuresis and its frequency was higher in oxybutynin group in comparison to the Desmopressin group (p<0.05).ConclusionDesmopressin is more effective and has lower rate of side effects in comparison to oxybutynin for treatment of nocturnal enuresis. We recommend using Desmopressin for treatment of nocturnal enuresis in children. More studies are needed to achieve the best pharmacological treatment option for treatment of nocturnal enuresis.Trial registrationThe trial is registered at ClinicalTrials.gov with a ClinicalTrials.gov Identifier: NCT02538302FundingThe funder of this research is Hormozgan University of Medical Sciences.

Background: Urinary tract infections (UTIs) are very common in children. Several biomarkers have been used for the diagnosis of UTI and prediction of renal parenchymal involvement. Objectives: This study aimed to evaluate plasma D-dimer as a diagnostic marker of UTI in children. Methods: This cross-sectional study included 41 children aged 1 month to 14 years with their first febrile UTI confirmed by positive urine culture referred to Bandar Abbas Children’s Hospital, Iran, from October 1, 2017, to April 1, 2018. Participants’ demographic features, including age and gender were recorded. White blood cell (WBC) count, percentage of neutrophils, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum D-dimer were measured in random blood samples for all the patients. Results: Out of 41 children (mean age: 5.50 ± 4.01 years) evaluated in this study, 6 (14.6%) were male, and 35 (85.4%) were female. The mean plasma D-dimer level was 1496.49 ± 2787.55 µg/L. A significant positive correlation was found between D-dimer with ESR (r = 0.647, P = 0.026) and CRP (r = 0.525, P = 0.001). Plasma D-dimer was not associated with age; however, age was inversely correlated with WBC count (r = -0.327, P = 0.037). No significant relationship was found between plasma D-dimer, ESR, CRP, WBC count, and neutrophil percentage with gender (P > 0.05). Conclusions: According to our results, in children aged 1 month to 14 years with culture-confirmed UTI, plasma D-dimer is positively correlated with ESR and CRP. Nevertheless, D-dimer appears not to be influenced by age or gender. Further studies are required to confirm the utility of D-dimer as a diagnostic marker of UTI in children.

Background Given the importance of the function of the remnant kidney in children with unilateral renal agenesis and the significance of timely diagnosis and treatment of reflux nephropathy to prevent further damage to the remaining kidney, we aimed to determine the prevalence of reflux nephropathy in this subgroup of pediatric patients. Methods In general, 274 children referred to pediatric nephrologists in different parts of Iran were evaluated, of whom 199 had solitary kidney and were included in this cross-sectional study. The reasons for referral included urinary tract infection (UTI), abnormal renal ultrasonography, being symptomatic, and incidental screening. Demographic characteristics, including age and gender were recorded. History of UTI and presence of vesicoureteral reflux (VUR) were evaluated. Results Of the 274 children evaluated in this study with the mean age (SD) of 4.71 (4.24) years, 199 (72.6%) had solitary kidney. Among these, 118 (59.3%) were male and 81 (60.7%) were female, 21.1% had a history of UTI, and VUR was present in 23.1%. The most common cause of referral was abnormal renal ultrasonography (40.2%), followed by incidental screening (21.1%), being symptomatic (14.1%), and UTI (5.5%). In 116 children (58.3%), the right kidneys and in 83 (41.7%) the left kidneys were absent. Besides, 14.6% of the participants had consanguineous parents and 3% had a family history of solitary kidney. Upon DMSA scan, the single kidney was scarred in 13.1%, of which only 7.5% were associated with VUR. In addition, proteinuria and hematuria were observed in 6.5% and 1.5% of children, respectively. Conclusions The prevalence of reflux nephropathy was 7.5% in children with solitary kidney with a male predominance. Given the relatively high prevalence of reflux nephropathy in these children, screening for VUR in the remnant kidney appears to be essential in this population.

Original Article AbstractIntroduction: Ureteropelvic junction obstruction (UPJO) is associated with inadequate urine drainage from renal pelvis into ureter. UPJO results from incomplete recanalization of proximal ureter during fetal period which finally leads to hydrostatic distention of renal pelvis and calyces. Diagnosis is based on clinical symptoms, ultrasound, and diuretic isotopic renogram. Various surgical methods are used for treatment including dismembered pyeloplasty which is associated with better outcomes.

Background: To date, limited studies have evaluated the role of vitamin A in acute pyelonephritis (APN). Accordingly, we aimed to investigate the effect of this vitamin on the prevention of renal damage in children with APN. Methods: This assessor-blind randomized controlled trial included 108 children with APN, aged 3 months to 14 years, who were admitted to Bandar Abbas Children’s Hospital, Bandar Abbas, Iran, in 2020. Patients were randomly allocated to two equal groups. Children in the vitamin A group received vitamin A in addition to antibiotics (ceftriaxone), while those in the control group only received antibiotics. Then, children in both groups underwent dimercaptosuccinic acid (DMSA) scanning once at baseline and four months after treatment. Photopenic areas in the DMSA scan were regarded as damaged areas. Further, serum vitamin A levels, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) were measured in all participants before the initiation of treatment. Finally, the demographic features of the participants were noted, including age and gender. Results: Patients in both groups were comparable regarding age and sex. Serum vitamin A levels, CRP, and ESR did not differ significantly between groups before treatment. The mean number of photopenic areas in the baseline DMSA scan was similar in both groups (P=0.481); however, the mean number of photopenic areas in the DMSA scan after four months was significantly lower in the vitamin A group compared to controls (P=0.004). Conclusion: Therefore, the use of vitamin A, along with antibiotics can significantly decrease renal damage in children with APN.