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Background and Aim: The aim of this study was to explore the spectrum of histopathology in children who underwent a renal biopsy for difficult NS in a tertiary care pediatric nephrology center. Methods: This prospective observational study was conducted in the Pediatric Nephrology Department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2011 to July 2018. Patients who presented with difficult patterns of nephrotic syndrome and underwent a renal biopsy were enrolled in this study. Results: A total of 140 patients were recruited in this study. The patients with steroid resistance nephrotic syndrome (SRNS) and nephrotic syndrome with atypical presentation underwent a renal biopsy; a good number of atypical NS cases were steroid dependent nephrotic syndrome (SDNS). They were grouped into Group A (SRNS), Group B (SDNS) and Group C (nephrotic syndrome with atypical presentation). In patients with SDNS, minimal change disease (MCD) (51.3%) was the most common histological pattern followed by mesangioproliferative glomerulonephritis (MesPGN) (33.3%); whereas MesPGN was the commonest histological pattern in SRNS (56.8%) and nephrotic syndrome with atypical presentation (54.7%) followed by MCD and focal segmental glomerulosclerosis (FSGS). Most of the patients responded to immunosuppressive therapy. In SRNS, a partial response was achieved in 18.9% and chronic kidney diseases (CKD) occurred in 16.2% of the cases. In comparison, 10.9% of the patients with nephrotic syndrome with atypical presentation achieved partial response and 7.8% developed CKD, which were not statistically significant. In addition, 5.4% of the patients with SRNS died. Conclusion: Mesangioproliferative glomerulonephritis was the most common histopathological diagnosis in patients with SRNS and nephrotic syndrome atypical presentation in our population. MCD was predominant in SDNS cases. [ABSTRACT FROM AUTHOR]

Introduction: This study was conducted to determine the etiology and outcomes of AKI in 4 tertiary centers of Dhaka, Bangladesh irrespective of RRT requirement and the hospital setting in which they were treated. Materials and Methods: This retrospective study was carried out in 4 tertiary care centers (Bangabandhu Sheikh Mujib Medical University, National Institute of Kidney Disease and Urology, Dhaka Shishu Hospital, and Dhaka Medical College Hospital) and 3 NICUs (Bangabandhu Sheikh Mujib Medical University, Dhaka Shishu Hospital and Dhaka Medical College Hospital of Dhaka) from January 2013 to December 2014. For the purpose of this study, AKI was defined according to the pediatric RIFLE (risk, injury, failure, loss, and end stage) criteria. All children admitted to the Pediatric Nephrology Inpatient Department and NICU of these hospitals were enrolled in the study. Data were collected from the registry of the hospitals. Ethics approval was obtained from the Institutional Review Board. Results: A total of 2285 patients in the Nephrology Ward and 3764 patients in the NICU were included in the study. About 8.1% (185) of the patients had AKI, and the death rate was 18.5%. Out of 3764 children in the NICU, 530 had AKI and 17.2% of the patients died. Conclusions: The renal cause of AKI was the most predominant causes in our setting in hospitalized patients and perinatal asphyxia was a predominant cause of AKI in neonates. The overall mortality rate was 13-26%, which is comparable to other South Asian countries. [ABSTRACT FROM AUTHOR]

Introduction: This study was conducted to determine the etiology and outcomes of AKI in 4 tertiary centers of Dhaka, Bangladesh irrespective of RRT requirement and the hospital setting in which they were treated. Materials and Methods: This retrospective study was carried out in 4 tertiary care centers (Bangabandhu Sheikh Mujib Medical University, National Institute of Kidney Disease and Urology, Dhaka Shishu Hospital, and Dhaka Medical College Hospital) and 3 NICUs (Bangabandhu Sheikh Mujib Medical University, Dhaka Shishu Hospital and Dhaka Medical College Hospital of Dhaka) from January 2013 to December 2014. For the purpose of this study, AKI was defined according to the pediatric RIFLE (risk, injury, failure, loss, and end stage) criteria. All children admitted to the Pediatric Nephrology Inpatient Department and NICU of these hospitals were enrolled in the study. Data were collected from the registry of the hospitals. Ethics approval was obtained from the Institutional Review Board. Results: A total of 2285 patients in the Nephrology Ward and 3764 patients in the NICU were included in the study. About 8.1% (185) of the patients had AKI, and the death rate was 18.5%. Out of 3764 children in the NICU, 530 had AKI and 17.2% of the patients died. Conclusions: The renal cause of AKI was the most predominant causes in our setting in hospitalized patients and perinatal asphyxia was a predominant cause of AKI in neonates. The overall mortality rate was 13-26%, which is comparable to other South Asian countries. [ABSTRACT FROM AUTHOR]

Introduction: Renal diseases in children can be congenital or acquired. In Bangladesh, pediatric nephrology care is available for last 2 decades, but there was no epidemiological study to see the pattern of renal diseases in children of the country. So, this study was carried out to observe the pattern of renal diseases in children of pediatric nephrology centers of Dhaka city. Materials and Methods: The children aged 1 day to 18 years with renal problems attended at selected four pediatric nephrology centers of Dhaka city (BSMMU, DMCH, DSH and NIKDU). Results: Among 6453 patients, 1123 were admitted in IPD and 5330 were visited at OPD. Mean age was 5.8±3.5 years in IPD patients and 6.90±1.37 years in OPD patients. In IPD among 1123 patients, 720 (64.1%) were male and 403 (35.8%) were female and in OPD among 5330 patients 3336 (62.59%) were male and 1994 (37.4%) were female. Nephrotic Syndrome (76% in IPD and 74% in OPD) was the most common disease followed by chronic kidney disease (CKD 6%) in IPD and urinary tract infections (UTI 9.4%)in OPD were the next common disease. Common presentations were proteinuria (27.6%), oliguria or anuria (26.2%) and edema (25.7%). Conclusions: The current pattern of renal diseases shows, that the most common renal diseases are NS followed by CKD and UTI. In the study male patients are more common than female [ABSTRACT FROM AUTHOR]

Diabetes insipidus is a clinical condition, characterized by polyuria and polydipsia, that results from either insufficient production or end organ resistance to antidiuretic hormone (ADH). Diabetes insipidus is of two types: central diabetes insipidus (CDI) and nephrogenic diabetes insipidus (NDI). Children with diabetes insipidus may present with polyuria, polydipsia, frequent dehydration, constipation, and failure to thrive. Acquired NDI may results from various drugs and conditions but NDI due to obstructive uropathy is very rare. There are very few case reports of NDI due to obstructive uropathy. We report a 2-year-old child who presented with diabetes insipidus as a consequence of obstructive uropathy. [ABSTRACT FROM AUTHOR]

Introduction: The clinical outcome of patients with Frequent Relapse Nephrotic Syndrome (FRNS) or Steroid Dependent Nephrotic Syndrome (SDNS) treated with cyclophosphamide or cyclosporine (CsA) is yet to be established. This study was carried out to compare the efficacy of CsA with cyclophosphamide in patients with FRNS or SDNS. Materials and Methods: A total of 54 FRNS or SDNS children were randomly enrolled in this prospective study from August 2013 to July 2014. All the study subjects were treated with prednisolone 60 mg/m2 /day until the patients were in remission for three consecutive days. The patients were then randomly divided into two groups (Group-A & Group-B). Group-A was treated with cyclophosphamide at a dose of 2.5 mg/kg/day for 60 days, along with tapering dose prednisolone for 8 weeks. The Group-B study population was treated with cyclosporine at a dose of 3 mg/kg/day for 6 months or longer along with tapering dose of alternate day prednisolone for the initial 8 weeks. Four patients in Group-B and one patient in Group-A did not continue the treatment. So, we followed-up 49 children during this period. Results: The efficacy of both drugs was good after 6 months of treatment. Remission was observed in 80% of the cases in Group- A and 79% of the cases in Group-B. Even after 6 months of treatment 6.7% and 10.5% of the patients with SDNS in Group-A and Group-B needed to continue corticosteroid therapy, respectively. The side effects of immunosuppressive therapy were more frequently observed in Group-B patients. On the other hand, the mean serum creatinine level after 6 months therapy was 0.55±0.21mg/dl in Group-A and 0.84±0.43 mg/dl in Group-B. The difference between the two groups was statistically significant (p<0.05). Conclusions: This study showed that both drugs were effective in FRNS and SDNS. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess different grades of VUR and renal scar in children presented with single or recurrent episodes of UTI. Material and Methods: Thirty-six children aged one month to 16 years with single or recurrent episodes of UTI were enrolled in this prospective descriptive study performed from July 2012 to June 2013. Grading of vesico-ureteric reflux, renal cortical scar and their co-relation in children presented with UTI were the outcome variables. Results: Of 36 patients, 33 (91.6%) were male and 3 (8.4%) female. Patients were divided into three groups based on their age (<12 months, 12-60 months and older than 60 months). VUR was detected in 37 (51.39%) renal units among all the group of patients evaluated for UTI. Mild reflex (grades I and II) was found in 2 (2.78%), moderate in 9 (12.5%) and severe in 26 (36.11%) patients. Of 72 kidney units, 37 kidney units had different grades of cortical scar. Grades I & II renal scar found in 12 (33.33%) patients in the right kidney and 14 (38.88%) in the left kidney. Higher grades of scar (grades III & IV) were found in the right kidney and the left kidney in 5 (13.88%) and 6 (16.66%) patients, respectively. A positive co-relation was observed between grades of reflux and grades of renal scars (for the right kidney r= +0.670, p<0.01; the left kidney r= +0.700, p<0.01). Conclusions: Higher grades of renal scar were directly related in children with male sex, younger age and having higher grades of VUR. [ABSTRACT FROM AUTHOR]