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Author(s): Sevgin Taner [sup.1] , Elif Afat Turgut [sup.2] , Elif Akkaya [sup.3] , Metin Cil [sup.4] , Umit Celik [sup.2] Author Affiliations: (1) Department of Pediatric Nephrology, Adana City [...]

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]

Kahramanmaraş was hit by two major earthquakes nine hours apart on February 6th, 2023, with magnitudes of 7.8 and 7.5 on the Richter scale, respectively. Ten other cities were also devastatingly affected by these earthquakes. More than 50 thousand people died in Turkey. The occurrence of two severe earthquakes on the same day in such a wide geographical area caused significant challenges. This disaster, with its devastating effects, focused attention on the significance of establishing a national and comprehensive emergency disaster plan prior to any disaster. Additionally, it highlighted the necessity of preparing a well-organized healthcare team capable of providing prompt and appropriate fluid replacement for pediatric patients in the early stages of a disaster. This is a crucial issue which must be addressed prior to major disasters. Another very important issue in this tragic disaster was the condition of chronically ill pediatric patients. Indeed, an emergency response is important not only for disaster victims, but also for those patients with chronic diseases in need of uninterrupted medical care. It is vital that individuals of all ages, as well as personnel from all sectors, receive the appropriate education, awareness, and knowledge on what actions to take, where to go, and where to gather in such situations. [ABSTRACT FROM AUTHOR]

Aim: Celiac disease is associated with an increased risk of cardiovascular disease due to inflammation and autoimmunity involved in its pathophysiology. We aimed to evaluate vascular involvement in children with celiac disease based on their augmentation index, carotid pulse wave velocity, carotid intima-media thickness, echocardiographic findings, and blood pressure. Materials and Methods: This cross-sectional and controlled study was performed at a single center between 2018 and 2019. The study population consisted of 44 patients with celiac disease who had been on a gluten-free diet for at least one year. Results: We compared celiac patients with a healthy group. While the celiac patients had significantly higher carotid intima media thickness and carotid pulse wave velocity values, there was no difference in the augmentation index values. There was no significant difference in carotid artery intimal medial thickness, augmentation index and carotid pulse wave velocity values between the diet-compliant and non-compliant groups. Conclusion: Although hypertension was not detected, arterial stiffness and carotid intima media thickness measurements were higher in the celiac disease patients compared to the healthy controls. This showed that these parameters can be used in early vascular damage assessment. These measurements, which are non-invasive and repeatable, can be a guide for the monitoring of the development of preclinical atherosclerosis in the follow-up of the pediatric patients diagnosed with celiac disease. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to evaluate children with ''neurogenic bladder'' diagnosis in terms of anxiety and depression. Material and Methods: Thirty-three pediatric patients with neurogenic bladder followed in Adana City Training and Research Hospital Pediatric Urology and Nephrology outpatient clinics from May 2023 to July 2023 and 20 healthy controls who were age and sex-matched, from public schools located in the same geographic area were included in the study. All participants were requested to complete the Hospital Anxiety and Depression Scale, Conners' Parent Rating Scale and Turgay DSM-IV Disruptive Behavior Disorders Rating Scale. Results: Global score of the CPRS reported by parents, was higher in patients than controls (p=0.012). CPRS Hyperactivity/Impulsivity and Anxiety subscale scores of the patients were significantly higher than controls. Global score of the CPRS reported by parents, was higher in patients with CKD than without (p=0.033). CPRS- Learning problems subscale of the patients with CKD was also higher than the patients without (p=0.023). DSM-IV Total score and the DSM-IV inattention score was higher in patients with CKD than without. Hospital Anxiety and Depression Scale-anxiety subscale reported by children was higher in patients without wheelchair dependence than the patients with (p=0.002). CPRS-conduct disorder and CPRS-Hyperactivity/ Impulsivity subscale scores of the patients without wheelchair dependence was higher than the patient with (p=0.016, p=0.009). DSM-IV hyperactive/impulsive subscale score of the patients without wheelchair dependence was higher than the patients with (p=0.043). Conclusion: Children with NB are at risk for physical, neurocognitive, psychosocial, and family challenges. Anxiety and depression symptoms should not be underestimated. For long-term appropriate management of such vulnerable patients psychological support is required. [ABSTRACT FROM AUTHOR]

Objective: Aim of the study is to evaluate congenital genitourinary tract anomaly prevalence in Syrian refugee children population and detect difficulties in management of this population. Material and Methods: Syrian refugee patients who applied to Adana City Training and Research Hospital Pediatric Urology and Pediatric Nephrology outpatient clinics between February 2020 and June 2022 were retrospectively analyzed. Patients aged between 1 month and 18 years with the diagnosis of congenital genitourinary disease were included in the study. Age, gender, application dates, follow-up periods, surgical needs, and hospitalization needs of the patients were recorded from the electronic patient files. Results: A total of 288 Syrian refugee children (183 male/105 female) with the diagnosis of congenital genitourinary disease were included in the study. Among 288 Syrian refugee children, congenital anomalies of the kidney and urinary tract (CAKUT) was the leading congenital urogenital disease with 175 patients (60.8%). This was followed by nonspecific hydronephrosis in 61 patients (21.2%), urogenital anomaly in 47 patients (16.3%), and cystic kidney disease in 5 patients (1.7%). Conclusion: As a conclusion, we think that close cooperation between health personnel, social workers, and interpreters will not only protect patients from long-term complications and provide a better quality of life, but also protect the health system from additional financial burden. Interdisciplinary training on cultural sensitivity and special problems of refugees should be established in treatment centers. We believe that special education programs for patients and their families can improve understanding of the disease and its treatment. [ABSTRACT FROM AUTHOR]

Aim: Nephrotic syndrome (NS) is the most common childhood glomerular disease manifested by proteinuria, edema and hypoalbuminemia. The aim of this study was to examine children with primary NS in terms of their clinical laboratory and histopathological features, and to evaluate their treatment responses. Materials and Methods: Thirty-eight (21 boys/17 girls) patients followed up with primary NS were included in this study. Results: The mean age at diagnosis was 6.4 years. The histopathological diagnoses were focal segmental glomerulosclerosis (FSGS) in 17 patients, minimal change disease (MCD) in 8, membranoproliferative glomerulonephritis (MPGN) in 3, and membranous glomerulonephritis in 1 patient. Those patients with MPGN were older than those with MCD and FSGS (p=0.035). Twenty-four patients were steroid sensitive. Steroid response rates were 88% in those patients with MCD, 41% in patients with FSGS and 33% in those with MPGN. At their last visit, three patients (7.9%) were diagnosed with chronic kidney disease. Conclusion: NS is the most common glomerular disease of childhood. Early diagnosis and the histopathological features of this disease have an important place in its prognosis. Knowing the demographic, clinical and pathological features of the disease is helpful in monitoring its progress and its prognosis. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare the acute kidney injury (AKI) incidence in pediatric septic shock patients according to the three different classifications. Methods: We analyzed retrospectively 52 patients with severe sepsis between January 2019 and December 2019. Results: While 21 patients have been diagnosed with SA‐AKI according to the pRIFLE criteria, 20 children have been diagnosed according to the AKIN criteria, and 21 children have been diagnosed according to the KDIGO criteria. Older age, lower platelet count were determined as independently risk factor for SA‐AKI. Older age and higher PRISM score were associated with mortality. According to Canonical correlation coefficients, pRIFLE is the most successful classification to distinguish AKI state. The canonical correlation coefficients for pRIFLE, KDIGO, and AKIN were 0.817, 0.648, and 0.615, respectively. Conclusion: Although AKI incidence was similar between the three classifications, pRIFLE was the most successful classification to distinguish AKI state. [ABSTRACT FROM AUTHOR]

Background/aim: There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. Materials and methods: This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. Results: Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10-15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. Conclusion: COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients' susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage. [ABSTRACT FROM AUTHOR]

Emphysematous pyelonephritis (EPN) is severe necrotising inflammation of renal parenchyma. Because of the devastating consequences of the pathology aggressive treatment can prevent permanent renal damage. Fifteen-year-old-girl patient without medical follow-up applied to emergency room with fever and vomiting. Computed Tomography (CT) revealed EPN. After diagnostic procedure minimal invasive procedures like double J catheter and nephrostomy tube insertion failed. While taking into account family's treatment and medical follow-up compliance, also severe dilatation in both ureters made bilateral ureterocutaneostomy (UC) to be considered as a feasible option. UC creation can be thought as a safe and effective alternative surgical procedure. Pediatric neurogenic bladder (NB) population incompatible to treatment and follow-up are candidates for EPN development. We also believe that UC can be beneficial in terms of acute and long-term management of EPN in NB patients who the clinician thinks will not be compatible with complex surgical intervention, follow-up and treatment. [ABSTRACT FROM AUTHOR]