Background: Histopathological examination of renal biopsy has an important role in establishing glomerular disease in children. Objective: To describe and correlate the types of glomerular diseases reported in native kidney biopsy and their clinical presentations.
Hereditary hypophosphatemic rickets with Hypercalciuria (HHRH) is one of the four entities of hereditary hypophosphatemic rickets, characterized by vitamin D refractory rickets, Hyperphosphaturia, Hypercalciuria, hypophosphatemia, elevated serum 1, 25-dihydroxyvitamin D levels, normal serum Calcium, 25-hydroxyvitamin D and PTH levels. Clinically, it is difficult to differentiate the four entities without a genetic test. However, presence of Hypercalciuria by a simple bedside urine examination of spot calcium-creatinine ratio differentiates HHRH from other three entities of hereditary hypophosphatemic rickets. Correction of all the abnormalities, except for renal inorganic phosphate wasting can be achieved by simple prescription of oral phosphate supplementation. It is also the only type of refractory rickets in which Vitamin D supplementation is more hazardous than beneficial. In this study, we review the literature and describe a case of two year old female child who presented with vitamin D refractory rickets at our tertiary level pediatric centre in Cuttack, Odisha, India whose phenotypic characteristics corresponded with HHRH.
Background Severe malaria causes multi-organ involvement, Objective Methods of Paediatrics, Sardar Vallabh Bhai Patel Post Graduate Institute of Results Plasmodium falciparum and vivax infection kidney injury (AKI), disseminated intravascular coagulation difference of hypoglycemia, respiratory distress syndrome (RDS), Conclusion Malarial hepatopathy should be considered in patients presenting From the
To assess the factors, clinical presentations and complications associated with malarial nephropathy. Methods: This prospective study was conducted in the period from July 2009 to January 2013 and included malarial children with nephropathy, aged between 6 months to 14 years. Malaria was confirmed by microscopic examination of blood smear. Detailed clinical evaluation and investigations were carried out to find multi-organ afflictions with special emphasis on renal involvement. Acute Kidney Injury (AKI) staging was done as per Acute Kidney Injury Network Staging into three groups which is modified RIFLE (Risk, Injury, Failure, Loss, End stage renal disease) staging. Results: Out of 168 cases with malaria, 82 (48.8%) cases had nephropathy. One hundred and two (60.7%) were between 5-10 years age group. Renal involvement was seen with P. falciparum malaria in 58 (48.3%) patients. Oligo-anuria was present in 48 (58.5%) cases and generalized edema was present in 27 (32.9%) cases at the onset. Proteinuria was present in 66 (80.5%) cases. Hyponatremia was seen in 29 (35.3%) patients. Twenty (62.5%) cases presented in Stage III of AKI, 9 (28.1%) in stage II and remaining 3 (9.4%) cases in stage I. Fourteen cases (17.1%) were treated with peritoneal dialysis and six cases were shifted to hemodialysis unit requiring prolonged renal supportive care. Of them, thirteen cases had P. falciparum malaria. Sixteen patients out of 168 cases (9.5%) died. Nine children out of 16 (56.2%) who died were associated with malarial nephropathy of which seven cases (77.7%) had Stage III AKI among which 5 (71.4%) children had P. falciparum malaria and remaining cases had mixed infection.
Conclusion:The spectrum of malarial nephropathy in children is highly variable ranging from asymptomatic proteinuria to advanced stage of AKI. Renal involvement is more common and severe in P.falciparum. Children aged between 5-10 years along with oligo-anuria, symptomatic azotemia, electrolyte abnormalities and hepatopathy are more likely to develop advanced stage AKI and subsequently have an increased risk of mortality.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.