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Aims: To evaluate the mortality, morbidity, and outcomes of young children undergoing complex revascularisation and/or autotransplantation procedures for severe bilateral renovascular hypertension in a tertiary and quaternary paediatric nephrology service [...]

The article discusses the study on the clinical indications, efficacy, and adverse events (AEs) for B-cell depleting agent and rituximab in children with systemic lupus erythematous (SLE). It states that rituximab improves the disease activity of children with lupus and serious infrequent AEs. The study suggest further studies.

A higher proportion of patients with juvenile-onset systemic lupus erythematosus (JSLE) will have renal involvement compared with adult-onset disease, some progressing to renal failure in adulthood. Histological examination is the gold standard for diagnosing lupus nephritis (LN), but its invasive nature limits routine use. Using cross-sectional cohort analysis, we aimed to determine whether urinary concentrations of monocyte chemoattractant protein-1 (MCP1), alpha-1-acid glycoprotein (AGP) and interferon-inducible protein 10 (IP10) are biomarkers of active LN. Sixty JSLE patients recruited to the UK JSLE Cohort Study were categorized according to the British Isles Lupus Assessment Group (BILAG) activity index. Patients with active renal JSLE (n = 8; renal BILAG score A, B) had significantly higher urinary MCP1 concentrations than patients with inactive renal disease (n = 52; renal BILAG score C, D, E; 582 pg/mg creatinine [Cr], 207 pg/mg Cr; p = 0.018) or healthy controls (n = 23; 117 pg/mg Cr; p = 0.005). Urinary AGP concentration was significantly elevated in patients with active renal disease compared with inactive renal disease (1517 ng/mg Cr, 485 ng/mg Cr; p = 0.027) or healthy controls (313 ng/mg Cr; p = 0.013). Urinary IP10 concentration was not significantly different between groups, but did strongly correlate with uMCP and uAGP levels (rho = 0.38, p = 0.009; rho = 0.33, p = 0.021). Urinary MCP1 and AGP are biomarkers of LN, providing insight into its pathophysiology. Longitudinal studies are warranted. [ABSTRACT FROM PUBLISHER]

Leptospirosis was diagnosed in a child presenting with acute kidney injury, anemia, and thrombocytopenia. Initial symptoms included abdominal pain and nonbloody diarrhea, followed by fever, vomiting, and skin rash. Leptospirosis was suspected and eventually confirmed. Although leptospirosis is uncommon in temperate climates, it is occurring in increasing numbers of participants in water sports, making it a consideration in the differential diagnosis of hemolytic uremic syndrome. Copyright © 2009 National Kidney Foundation, Inc. [ABSTRACT FROM AUTHOR]

Unlabelled: Chronic lung disease of prematurity (CLD) is associated with an inflammatory response in the preterm lung and increased levels of proinflammatory cytokines in tracheobronchial aspirate fluid (TAF). We investigated TAF levels of transforming growth factor-beta1 (TGF-beta1), interleukin-10 (IL-10), interleukin-4 (IL-4) and interleukin-12 (IL-12) cytokines possibly important in downregulating the proinflammatory response and/or inducing lung fibrosis in infants with developing and established CLD. Infants with CLD (n = 24) were compared with preterm infants with RDS that resolved (n = 22) and postoperative infants without lung disease (n = 23). TAF levels of TGF-beta1, IL-10, IL-4 and IL-12 were studied by quantitative enzyme immunoassay. Levels of TGF-beta1 were significantly higher during the first week of life in infants who developed CLD, remained high at 2 wk and past 4 wk of age. TAF levels of TGF-beta1 did not decrease significantly in six infants with CLD after treatment with steroids. TAF IL-10 was detected in 12/46 (26%) preterm infants. Infants with CLD or RDS were more likely to have measurable TAF levels of IL-10, compared with the postoperative infants without lung disease (p < 0.02 and 0.04, respectively). TAF levels of IL-4 or IL-12 were below the detection limits in all samples.Conclusions: We have demonstrated a sustained increase of TGF-beta1 levels in TAF from preterm infants who develop CLD, suggesting an important role for TGF-beta1 in the fibrotic response in the CLD lung. The elevated TGF-beta1 levels, combined with an absent or irregular secretion of IL-4, IL-10 and IL-12, can have importance for the increased tendency for the development of CLD in preterm infants. [ABSTRACT FROM AUTHOR]

Two hundred and thirty-two strains of Escherichia coli isolated from children with non-obstructive acute pyelonephritis (n=65), women with non-obstructive acute pyelonephritis (n=63) and the faecal flora of healthy children (n=33) and adults (n=71) were examined for cytotoxic necrotizing factor production, haemolysin synthesis, verocytotoxin production and expression of mannose-resistant haemagglutination of human erythrocytes. Forty-eight per cent of the pyelonephritogenic Escherichia coli strains produced cytotoxic necrotizing factor and 61 % produced haemolysin compared to 25 % and 27 % of faecal control strains (p<0.001 and p<0.001 respectively). Cytotoxic necrotizing factor production did not occur among the non-haemolytic Escherichia coli strains which confirms the close association between these two toxic factors. The bacterial phenotypes producing both haemolysin and cytotoxic necrotizing factor, and the phenotype expressing both these toxic factors and mannose-resistant haemagglutination occurred significantly more often in pyelonephritogenic strains than in faecal isolates (p<0.001). Haemolytic strains without the ability to produce cytotoxic necrotizing factor were more common in faecal isolates than in uropathogenic strains (p=0.05). Strains lacking the ability to synthesize both these toxins were also over-represented in faecal isolates (p<0.01). [ABSTRACT FROM AUTHOR]

The faecal colonization with Clostridium difficile was investigated among 343 infants during their first 18 months of life. Rectal swabs were taken at the ages of 6 days, 6 weeks, 6 months, 11 months and 18 months. About 25 % of the children were colonized with Clostridium difficile between 6 days and 6 months of age. The colonization rate decreased to 3 % at 18 months of age. The rate of strains producing cytotoxin was low in infants less than 6 months of age, but at that age about half of the strains isolated were toxin-producing. Breast-fed children were significantly less often colonized with Clostridium difficile than were bottle-fed infants, both at 6 weeks of age (21 % versus 47 %, p<0.05) and at 6 months of age (19 % versus 39 %, p<0.001). Colonization with Clostridium difficile at 6 months of age was associated with a greater frequency of diarrhoeal disease between 6 and 11 months of age (27 % versus 16 %, p<0.05). This association was even more pronounced when the bacteria persisted at 11 months of age (54 %, p<0.01). Antibiotic therapy could not be demonstrated to influence colonization with Clostridium difficile at any age. [ABSTRACT FROM AUTHOR]

A total of 323 Escherichia coli strains from children with primary acute non-obstructive pyelonephritis (n=144) or cystitis (n=56) and from adults with acute non-obstructive pyelonephritis (n=66) or cystitis (n=57) were examined for presence of the aerobactin-mediated iron uptake system and expression of P-fimbriae. Overall, pyelonephritogenic Escherichia coli strains were significantly more often aerobactin-positive (72 %) than cystitis strains (42 %) (p<0.001). Seventy-three percent of the isolates from children with acute pyelonephritis were aerobactin-positive compared to 54 % of the cystitis strains (p<0.05). Pyelonephritogenic Escherichia coli strains from adults were also significantly more often aerobactin-positive (70 %) than cystitis strains (30 %) (p<0.001). The cystitis strains from children were more often aerobactin-positive than cystitis strains from adult patients (p<0.05). There was a significant correlation between presence of the aerobactin-mediated iron uptake system and expression of P-fimbriae in all strains (p<0.001). [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the properties of fecal P-fimbriated Escherichia coli strains in neonates and to relate these characteristics to the later development of acute pyelonephritis. In a 2 1/2 year prospective study of the children admitted to a particular neonatal ward, 113 children were found to be fecally colonized with a P-fimbriated Escherichia coli strain. However, only one of these children developed pyelonephritis from this strain during the first year of life. The combined results of serotyping, biochemical phenotyping and determination of outer membrane protein pattern as clonal characterization suggested that only 26 of the P-fimbriated strains belonged to a pyelonephritogenic Escherichia coli clone. It is concluded that the risk of a child colonized with an Escherichia coli strain belonging to such a clone of developing pyelonephritis, as calculated in this study, is about 4 %. [ABSTRACT FROM AUTHOR]