Background/aim: In nonmonosymptomatic nocturnal enuresis (NMNE), the incidence of organic abnormality and urodynamic disorder is more frequent than the general population. The aim of this study is to identify urodynamic disorders and renal scarring in children with NMNE. Materials and methods:This study evaluated the urodynamic disorders and renal scarring of a total of 30 patients who were diagnosed with NMNE. A video-urodynamic test and Tc-99m dimercaptosuccinic acid renal scintigraphy were applied.Results: Records of 605 patients who had been diagnosed with enuresis were analyzed, and 215 (33.5%) of them had been diagnosed with NMNE. Thirty patients older than 6 years old with NMNE were included in the study. Detrusor overactivity was identified in 10 patients. Bladder capacity was low in 5 patients and bladder compliance was low in 2 patients. Renal scarring was identified in 1 patient. Unilateral vesicoureteral reflux was found in 4 patients. Conclusion:Bladder function disorder is also a significant risk factor for the development of renal scarring, besides other risk factors. Organic abnormalities are seen more often in patients with NMNE than patients with monosymptomatic nocturnal enuresis, so urodynamic studies should be remembered for patients with NMNE.
Henoch-Schönlein purpura (HSP) is the most common form of systemic small vessel vasculitis involving the skin, joints, kidneys, and gastrointestinal tract in childhood.1 Because of its systemic nature, involvement of other organ systems such as genitourinary, cardiopulmonary, and nervous systems may be observed.2-4 Although headache and behavioral changes have been described in a significant proportion of children with HSP, severe neurological complications have been reported as rarely as 2% during the acute phase of the disease. [4][5][6] In this article, we report a severe neurologic involvement in a four-year-old boy with HSP who was treated with intravenous pulse methylprednisolone and pulse cyclophosphamide, and followed-up for four years without any sequel. CASE REPORTA four-year-old boy presented with complaints of sudden onset of purpuric rash on his extensor surfaces of the lower extremities and arthralgia of the ankles for three days which had developed following a mild upper respiratory tract infection three days prior to admission. His medical and family histories were unremarkable. Physical examination showed a temperature of 36.6 °C, respiratory rate of 28/minute, pulse rate of 88/minute, and blood pressure of 110/80 mmHg. Physical examination revealed symmetric palpable rash on his lower extremities. Both ankles were tender and swollen. Abdominal palpation and digital rectal examination were normal. Neurologic examination was also normal. Laboratory examination disclosed the following results: hemoglobin, 12.6 g/dL; hematocrit, 35%; white blood cell count, 9,300/mm 3 ; platelet count, 387,000/mm 3 ; erythrocyte sedimentation rate, 17 mm/hour; C-reactive protein, 18.3 mg/dL; while blood chemistry analysis was normal. Antistreptolysin O titer was 250 Todd units. Coagulation parameters, serum complements, and immunoglobulin levels were normal. Hepatitis markers, antinuclear antibody, ABSTRACTHenoch-Schönlein purpura is a common form of systemic small vessel vasculitis in childhood. Although headache and behavioral changes have been described in a significant proportion of children with Henoch-Schönlein purpura, severe neurological complications are rare. In this article, we report a case of central vasculitis in a four-year-old boy who presented with hemiplegia and aphasia. The treatment options for cerebral vasculitis of Henoch-Schönlein purpura are numerous but controversial in pediatric patients. Our patient was successfully treated by pulse methylprednisolone and pulse cyclophosphamide. The patient was followed-up for four years without any sequel.
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