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Background Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related–acute kidney injury (Crush-AKI) and death. Method Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded. Results A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of >120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000–3000 mL/m2 body surface area (BSA), 40% at 3000–4000 mL/m2 BSA and only 2% at >4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age >15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume <3000–4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. Conclusions These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000–4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days. [ABSTRACT FROM AUTHOR]

Aim: The main objective of this study was to predict upper urinary tract damage utilizing novel approaches, such as machine learning models, by incorporating simple predictors alongside established radiological and clinical factors. Materials and Methods: In this retrospective study, a total of 191 patients who underwent blood tests, urine analysis, imaging, and urodynamic studies (UDS) in order to assess their nephrological and urological status were included. Basic statistical analyses were conducted using IBM SPSS Version 25. A significance level of p<0.05 was employed to establish statistical significance. The machine learning analyses were performed on Ddsv4-series Azure Virtual Machines, equipped with 32 vCPUs with a memory capacity of 128 GiB. Results: In the model where clinical and imaging data were jointly assessed, the k-nearest neighbor (KNN) model demonstrated the highest performance, achieving values of 0.813 area under the curve and 0.854 accuracy. For the KNN Model, the best predictors for kidney function loss were as follows: neutrophil/lymphocyte (1.0577), abnormal bladder in ultrasound (1.054), vesicoureteral reflux (0.901), ferritin (0.898), neutrophil/albumin (0.678), platelet/lymphocyte (0.619), increased detrusor leakage pressure (0.435), age (0.3505), decreased bladder capacity in urodynamics (0.3009), and white blood cell (0.266). Conclusion: Based on our findings, initial patient evaluation through basic blood and urine tests, ultrasonography, UDS, and voiding cystourethrography is crucial for identifying risk factors and preventing renal damage. Complete blood count-derived inflammatory biomarkers offer cost-effective and accessible alternatives to other radiological tools in primary care settings. These machine learning models may hold clinical relevance in pre-clinical or resource-limited hospitals, by guiding clinicians in implementing preventative measures. [ABSTRACT FROM AUTHOR]

Xanthogranulomatous pyelonephritis (XGP) is a chronic, destructive, granulomatous inflammation of the renal parenchyma leading non-functioning kidney. Contrast-enhanced computed tomography (CT) is the most useful diagnostic method. A 6-year-old female patient admitted to us with complaints of abdominal pain, fever, fatigue, weakness. Recurrent urinary tract infection was present in her history. The patient's urine specimen revealed leukocyturia, hematuria, positive for nitrite and bacteria, white blood cell: 12.7x10³ /microl, hemoglobin: 6.2 g/dl and C-reactive protein (CRP): 101 mg/ dl. In the urinary system Ultrasound (US) imaging, the contours of the left kidney were irregular and lobulated, and medullary punctate echogenicity and calcifications were present. Contrast-enhanced abdominal CT showed increased left kidney size and opacities suggestive of stone in the collecting system; pararenal area was heterogeneous. Although the patient's gentamicin treatment was completed in 7 days and meropenem treatment in 14 days, acute phase reactants did not regress. No activity uptake was observed in the left kidney lodge in renal cortical scintigraphy. Left total nephrectomy was performed with the diagnosis of non-functioning left kidney and chronic pyelonephritis. Kidney biopsy material were reported as XGP. XGP is a rare and aggressive cause of chronic pyelonephritis with serious consequences such as nephrectomy requirement. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance has been studied in adult patients with early and end-stage chronic kidney disease (CKD). However, there are limited publications on the pediatric patient population. This paper evaluated the association between sleep disturbances and quality of life (QoL) in pediatric patients with CKD., Methods:  The study included 22 patients and 22 healthy controls from the pediatric nephrology outpatient clinic. All participants completed the Turkish Generic Health-Related Quality of Life Questionnaire for Children and Adolescents (HRQoLQ) and the Child Sleep Habits Questionnaire (CSHQ). Patients diagnosed with CKD were compared in terms of HRQoLQ and CSHQ scores within themselves as kidney replacement therapy (KRT) recipients and non-recipients and with the control group., Results: The mean HRQoLQ total score of the patients was 89.0 ± 12.4 and the mean CSHQ total score was 46.7 ± 5.6; there was no correlation between the total scores (p=0.599). CSHQ total and subgroup scores were similar in patients with and without KRT. The CSHQ total and subgroup median scores were not different in the patient and control groups. According to the HRQoL scale, the total QoL score and the physical and emotional well-being subscale scores were lower in patients receiving KRT than in those not receiving KRT., Conclusion: Sleep problems and HRQoL should not be underestimated in the pediatric CKD population, especially in patients receiving KRT. Large-scale studies with long-term outcomes are needed to understand better and improve QoL., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Local Ethics Committee of Adana City Training and Research Hospital issued approval with approval number 2756 on 03/08/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Taner et al.)