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Background Kidney size evaluation is an essential examination in pediatric nephrology. While body length/height is the best predictor of kidney length, age-based and body surface area (BSA)-based normative values may be useful in clinical practice or research. This study aimed to establish ultrasound-based kidney length lambda-mu-sigma (LMS) percentiles by age and BSA in healthy children. Methods In 1758 Polish and Lithuanian children (868 boys, 49%) aged 0-19 years, kidney length was measured using ultrasonography. In all participants, anthropometric measurements were taken and kidney function was evaluated based on serum creatinine concentration. Participants with chronic or kidney diseases, abnormal kidney function, or pathologies in sonographic examination were excluded from the analysis. Results Kidney length (median kidney length) increased progressively from infancy to the age of 18 years, from 60.1 to 114.2 mm in males, and from 57.3 to 105.2 mm in females. A gradual increase of kidney length (50.sup.th percentile) in relation to BSA (from 46.1 mm in infants with a BSA of 0-1.2 m.sup.2 to 118.3 mm in adolescents with a BSA of 2.6-2.8 m.sup.2) was also observed. LMS percentiles by age (stratified by sex) and BSA were determined and presented as graphs and tables of percentiles and LMS parameters by 1-year age intervals and 0.2 m.sup.2 of BSA, respectively. Conclusions We present the first age- and BSA-based kidney length LMS normative values based on the largest pediatric cohort to date, which can be used in both clinical practice and research studies. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information, Author(s): Lukasz Obrycki [sup.1] , Jedrzej Sarnecki [sup.2] , Marianna Lichosik [sup.1] , Malgorzata Sopinska [sup.3] , Malgorzata Placzynska [sup.3] , Malgorzata Stanczyk [sup.4] , Julia Mirecka [sup.4] , Agnieszka [...]

Byline: Matthew E. Callister (1), Anne Burke-Gaffney (1), Gregory J. Quinlan (1), Helen Betts (2), Simon Nadel (2), Timothy W. Evans (1) Keywords: Meningococcal infection; Sepsis syndrome; Systemic inflammatory response syndrome; Thioredoxin; Oxidation-reduction; Cytokines Abstract: Objective To compare plasma levels of thioredoxin (Trx), TNF-[alpha] and IL-1[beta] in children during the acute phase of meningococcal septic shock (MSS) and in convalescence. Design and setting Retrospective, observational study in the paediatric intensive care unit of a postgraduate teaching hospital. Patients Thirty-five children requiring intensive care for meningococcal sepsis paired convalescent samples from 30 survivors (median interval between samples 62a-days) 25 healthy control children. Measurements and results Plasma Trx levels were significantly lower in the children with MSS, both during the acute illness (5.5a-ng/ml, IQR 1.4--11.4) and in convalescence (2.5a-ng/ml, IQR 0.4--6.9) than controls (18.8a-ng/ml, IQR 7.9--25.0). Levels of IL-1[beta] and TNF-[alpha] were higher in patients with acute MSS (30.3a-pg/ml, IQR 3.6--63.6, and 145.9a-pg/ml, IQR 31.8--278.1 respectively) than controls (3.7a-pg/ml, IQR 0--36.9, and 23.8a-pg/ml, IQR 0--124.3, respectively). Levels fell in convalescence (3.7a-pg/ml, IQR 0--25.5, 3.7a-pg/ml, IQR 0--304.8, respectively). Plasma Trx was higher in non-survivors, albeit a small group (na-=a-5), than in survivors (na-=a-30). Trx, IL-1[beta], and TNF-[alpha] levels were not correlated with predicted mortality as assessed by the paediatric risk of mortality (PRISM) score. Conclusions Children with MSS exhibit persistently low plasma levels of Trx during acute illness and in convalescence. Author Affiliation: (1) Unit of Critical Care, National Heart and Lung Institute Division, Imperial College Faculty of Medicine, Royal Brompton Hospital, SW3 6 lY, London, UK (2) Department of Paediatrics, St Mary's Hospital, Imperial College, London, UK Article History: Registration Date: 20/10/2006 Received Date: 17/05/2006 Accepted Date: 19/10/2006 Online Date: 18/11/2006

Abstract Glomerular filtration rate (GFR) in children can be estimated by the formula GFR=kxBH/Pcr (where BH is body height in centimetres and Pcr is the plasma creatinine concentration in micromoles [...]

Byline: Zvi Zadik (1), Dario Price (2), Gary Diamond (3) Keywords: Bone mass; Quantitative speed of sound Abstract: More than 85% of peak skeletal mass is accrued by the age of 18 years, making bone growth during childhood and adolescence a critical process. The purpose of this study is to establish pediatric reference curves for bone Speed of Sound (SOS) as measured by multi-site quantitative ultrasound. Analysis was performed on a total of 1085 healthy subjects ages 0--18 years (595 females, 490 males). Demographic and anthropometric parameters (height and weight), as well as data on calcium intake and physical activity, were collected. Ultrasound bone measurements were performed at the mid-shaft tibia and the distal third of the radius (Sunlight Omnisense(r) 7000P). An age-related speed of sound (SOS) curve that describes SOS changes at the tibia and radius in both genders was demonstrated. SOS showed a steep increase during the first 5 years of life in both genders at the tibia and radius. The period between the ages of 6--11 years is characterized with a very shallow increase in SOS at both sites. Thereafter, during the pubertal period, there is a second growth burst in SOS, starting at age 11 for girls and age 14 for boys. No significant meaningful correlation was found between the anthropometric parameters (height, weight and BMI) and the SOS measurements after the age parameter was controlled. Subjects who reported low physical activity levels were found to have lower Z-scores than their counterparts (P&lt 0.05). The SOS of pre-menarche girls was significantly lower than that of post-menarche girls at the radius and tibia (P&lt 0.05). The level of calcium intake did not correlate with bone SOS. Intra-operator precision measurements were 0.36% (0.25--0.47%) at radius and 0.30% (0.20--0.40%) at the tibia. To date, there is no widely accepted classification or clinical working guidelines for children's bone health assessment or prediction of fracture risk based on bone strength measurements in children. This study establishes a pediatric reference curve for the Omnisense, and therefore supports the feasibility of using Sunlight Omnisense(r) 7000P, a multi-site bone sonometer, for the assessment of pediatric bone properties. Further studies mainly in different diseased children groups should further support the use of such a basic tool for clinical evaluation, assisting the physician to work towards healthy bones for his patients. Author Affiliation: (1) Pediatric Endocrinology Unit, Kaplan Medical Center, PO Box 1, 76100, Rehovot, Israel (2) Pediatric Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel (3) Child Development Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel Article History: Received Date: 26/11/2002 Accepted Date: 23/06/2003 Online Date: 12/08/2003

Byline: Marcia C. Willing (1,6), James C. Torner (2), Trudy L. Burns (3), Kathleen F. Janz (4), Teresa Marshall (5), Julie Gilmore (5), Sachi P. Deschenes (1,5), John J. Warren (5), Steven M. Levy (5) Keywords: Bone; Bone mineral density; Children; COL1A2; Genetic polymorphisms; Osteocalcin Abstract: We examined the association of candidate gene polymorphisms with bone mineral density (BMD) and bone mineral content (BMC) in a cohort of 428 healthy non-Hispanic white children participating in the Iowa Bone Development Study, a longitudinal study of determinants of bone accrual in childhood. BMD and BMC measurements of the hip, spine and whole body were made using a Hologic 2000 Plus densitometer in 228 girls and 200 boys ages 4.5--6.5 years. Genotypes at 14 loci representing eight candidate genes [type I collagen genes (COL1A1 and COL1A2), osteocalcin, osteonectin, osteopontin, vitamin D receptor (VDR), estrogen receptor (ER), androgen receptor (AR)] were determined. Gender-specific and gender-combined prediction models for bone measures that included age, weight, height (and gender) were developed using multiple linear regression analysis. COL1A2 and osteocalcin genotypes were identified as having the strongest and most consistent association with BMD/BMC measures. Osteonectin, osteopontin and VDR translation initiation site polymorphisms were associated with some individual bone measures, but none of the associations was as consistent as those identified for the COL1A2 and osteocalcin genes. No association was identified with COL1A1 (RsaI and Sp1), VDR (BsmI) and ER polymorphisms (PvuII, XbaI, TA) and BMD/BMC. However, we identified significant gene-by-gene interaction effects involving the ER and both VDR and osteocalcin, which were associated with BMD/BMC. Our data suggest that genetic variation at multiple genetic loci is important in bone accrual in children. Moreover, the combination of genotypes as several loci may be as important as a single genotype for determining BMD and BMC. Author Affiliation: (1) Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA (2) Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, 52242, USA (3) Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, 52242, USA (4) Department of Health, Leisure and Sports Studies, College of Liberal Arts, University of Iowa, Iowa City, IA, 52242, USA (5) Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, 52242, USA (6) Department of Pediatrics, 2609 JCP, Division of Medical Genetics, University of Iowa, Iowa City, IA, 52242, USA Article History: Received Date: 02/09/2002 Accepted Date: 20/03/2003 Online Date: 22/07/2003

Byline: W. Pluskiewicz (1), P. Adamczyk (2), B. Drozdzowska (3), K. Szprynger (2), M. SzczepaAska (2), Z. Halaba (4), D. Karasek (5) Keywords: Adolescents; Bone mineral density; Chronic renal failure; Dialysis; Predialyis; Quantitative ultrasound Abstract: Bone status was assessed in 15 children and adolescents with predialysis chronic renal failure (CRF) and in 25 subjects with end-stage renal failure (ESRF). The mean age in the whole group was 14.6+-3.2 years and CRF had been recognized 5.8+-4.0 years earlier. The mean age, body size, duration of the disease and Tanner stages did not differ significantly between patients with predialysis CRF and ESRF. The control group consisted of 890 healthy subjects matched with patients for age. Bone mineral density (BMD) was measured by DPX-L (Lunar, Madison, WI) at the spine (s-BMD) and total body (TB-BMD) quantitative ultrasound (QUS) was performed by DBM 1200 (IGEA, Italy) at the hand phalanges (Ad-SoS). Laboratory investigations included the evaluation of intact parathyroid hormone (i-PTH), total and ionized serum calcium, and serum phosphate. In the whole group of patients the following mean values were obtained: Ad-SoS 1952+-79 m/s (significantly lower than in controls, who had Ad-SoS 2022+-85 m/s, p&lt 0.05 the difference remained significant after adjusting for body mass index), s-BMD 0.87+-0.22 g/cm.sup.2 (Z-score --1.6), TB-BMD 0.92+-0.12 g/cm.sup.2 (Z-score --1.44), i-PTH 276+-300 pg/ml, total calcium 2.46+-0.19 mmol/l, ionized calcium 1.14+-0.08 mmol/l, phosphate 1.68+-0.61 mmol/l. Skeletal measurements correlated significantly with age, body size and Tanner stages (also after adjusting for age), while significant correlations of these parameters with the duration of CRF and laboratory investigations (except of correlations of i-PTH with Ad-SoS and with TB-BMD in predialysis patients) were not observed. None of the studied variables differed significantly between predialysis and dialysis patients. In conclusion, both predialysis and dialysis children and adolescents showed a decrease in BMD and quantitative ultrasound measurements. The severity of skeletal alterations was similar in the early phase (predialysis patients) and end stage (dialysis patients) of the disease and did not show a tendency to progress with CRF duration. Author Affiliation: (1) Department and Clinic of Internal Diseases, Diabetology and Nephrology, Metabolic Bone Diseases Unit , Silesian School of Medicine in Katowice, 3 Maja 13/15 Street, 41-800, Zabrze, Poland (2) Department and Clinic of Nephrology, Endocrinology and Metabolic Disorders of Childhood, Silesian School of Medicine in Katowice, Zabrze, Poland (3) Department and Chair of Pathomorphology, Silesian School of Medicine in Katowice, Zabrze, Poland (4) Outpatient Medical Care, Zabrze, Poland (5) Department and Clinic of Internal Diseases, Diabetology and Nephrology, Silesian School of Medicine in Katowice, Zabrze, Poland Article History: Received Date: 28/02/2002 Accepted Date: 04/10/2002 Online Date: 16/04/2003

Byline: C. M. Neu (1), F. Rauch (1), F. Manz (2), E. SchAnau (2) Keywords: Key words:Children -- Cortical bone -- Modeling -- Quantitative computed tomography -- Radius -- Reference data Abstract: It is becoming increasingly accepted that bone size is an important determinant of bone mass. Studies on the development of bone size may therefore promote a better understanding of the basis of diseases which are due to low bone mass. Here, we characterize the temporal changes in cross-sectional bone size, geometry and mass at the radial diaphysis in healthy subjects from 6 to 40 years of age (n= 469 273 females). Peripheral quantitative computed tomography was used to measure total and cortical cross-sectional area, bone mineral content (BMC) and volumetric bone mineral density (BMD) at the site of the forearm whose distance from the ulnar styloid process corresponded to 65% of forearm length. Over the age range of the study, total cross-sectional area increased by 39 mm.sup.2 (50%) in females and by 85 mm.sup.2 (116%) in males. Cortical area increased to a similar extent in both sexes. Between 6--7 years and adulthood, BMC increased by 52 mg/mm (111%) in females and by 73 mg/mm (140%) in males and was significantly higher in males after the age of 15 years. Volumetric BMD increased by 246 mg/cm.sup.3 (48%) in females but by only 132 mg/cm.sup.3 (23%) in males and was significantly higher in women than in men. In summary, these data show that BMC in men is higher than in women, because periosteal modeling continues longer in boys than in girls. Volumetric BMD is higher in women, partly because the size of the marrow cavity does not increase in girls as it does in boys. Author Affiliation: (1) Children's Hospital, University of Cologne, Cologne, Germany , DE (2) Research Institute of Child Nutrition, Dortmund, Germany, DE Article note: Received: 11 May 2000 / Accepted: 11 January 2001

Byline: Gilles Orliaguet (1), Philippe Meyer (1), Stephane Blanot (1), Emmanuelle Schmautz (1), Brigitte Charron (1), Bruno Riou (2), Pierre Carli (1) Keywords: Children Trauma Outcome TRISS Abstract: Objective: Using a weighted combination of the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the type of injury (blunt or penetrating) and patient age, the TRISS method is used to calculate the probability of survival (ps) in trauma patients. The goal of this study was to compare the ability of the American Major Trauma Outcome Study (MTOS) norm for adult blunt trauma patients (ADULT) and the specific norm for paediatric patients (PED) to estimate the ps of injured children using TRISS methodology. Design: Retrospective analysis using a paediatric trauma patient database. Setting: a French level 1 paediatric trauma centre. Patients: Four hundred seven consecutive paediatric blunt trauma patients, treated over a 3-year period. Measurements: The observed and expected survivals were compared, using the M, W and Z scores, with both ADULT and PED. The W score is the number of survivors more or less than expected from the MTOS predictions for 100 patients. A Z score, which measures the significance of W, between --1.96 and +1.96, indicates no significant difference between observed and expected survivors. A value of M less than 0.88 indicates a disparity in the severity match between the study group and the MTOS group. We calculated the standardised W score (Ws), which represents the W score that would have been observed if the case mix of severity was identical to that of the MTOS group. Accordingly, a standardised Z score (Zs) was also calculated. In addition, we calculated the area under the receiver operating curve (aROC) using both norms, while calibration was also assessed by calculation of the Hosmer-Lemeshow goodness-of-fit tests. Results: Using PED, the number of actual survivors (n=364) was not significantly different from the MTOS (n=358). The value of M, 0.65, indicated a disparity in the severity match between the study group and the MTOS group, due to a higher proportion of patients with lower ps (TRISS Author Affiliation: (1) Department of Paediatric Anaesthesiology and Critical Care, Hopital des Enfants Malades, 149 rue de Sevres, 75743 Paris Cedex 15, France (2) Department of Anaesthesiology and Critical Care and Emergency Department, Groupe Hospitalier Pitie Salpetriere, 47 boulevard de l'hopital, 75651 Paris Cedex 13, France Article History: Received Date: 02/08/2000 Accepted Date: 15/01/2001 Article note: Final revision received: 10 January 2001 Electronic Publication