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NEP/01(P) "DAY TIME WETTING IN CHILDREN"
Ravinder K. Gupta, Ritu Gupta
Child Care Clinic, 136, Nai Basti, Jammu Cantt (J&K) – 180003
[email protected]
Objective : To study clinical profile and socio-demographic factors associated with day time
wetting in children. Design : Prospective Study Setting Subjects and Methods : One hundred
children (5-16 years) with involuntary voiding of urine during daytime at least twice a week for 3
consecutive months were enrolled for the study at a pediatric clinic from June 2006 to May 2007.
The children were interviewed using pre-planned questionnaire for details regarding onset,
duration, family history, stress factors and previous treatment. The general physical and systemic
examination was done. Relevant routine investigations including urine, stool, RFT, blood sugar,
ultrasound and other specific investigations were performed. Results : Majority of the children
belonged to age group 5-10 years (86%). Female predominance was obvious (M: F = 1:1.5). The
daytime wetting was observed in firstborn (62%). About 43% had a positive history of enuresis in
one of their first degree relative. About 60% of children having such problem belonged to nuclear
family. Nocturnal enuresis was seen in 27% children. The students attending private English
medium schools were having more problem than government schools (61% vs 39%). Voluntary
holding of urine (43%) followed by UTI (17%), constipation (8%) and parasitosis (6%) were
common causes of daytime wetting. No apparent cause was observed in rest of children. Spina
bifida or other congenital anomalies were not seen. Urine specific gravity was less or equal to
1005 in 58% of such children. Conclusion : Daytime wetting is frequent in females, firstborn,
belonging to nuclear family, those attending private schools and have a definite family history.
Voluntary holding of urine and UTI are common causes of this problem… Specific gravity of
urine is low in children having problem of daytime wetting.
NEP/02(P) NEPHROTIC SYNDROME: A REVIEW FROM NEIGRIHMS, SHILLONG.
Ajit Chhetri, Rashna Dass, Niru Chhetri, Akash Handique, Vandana Raphael, Karalanglin
Tiewsoh
Asstt. Professor (Pediatrics), NEIGRIHMS, Mawdiangdiang, Shillong 793018.
[email protected]
Introduction: Nephrotic Syndrome is an important chronic disorder in children and there is limited
data from this region. Aims and objectives: To review clinical and renal biopsy findings in
children with Nephrotic Syndrome with atypical features. Material and Methods The data of nine
children admitted in Pediatric Ward of NEIGRIHMS, Shillong from January to July 2007 was
analyzed. Results: Between 6 to 15 yrs of age (Average 11 yrs), there were 6 male and 3 female
children (M: F ratio of 2:1). At presentation pedal edema was seen in all patients, facial puffiness
and hypertension in 7(78%) and ascites in 6 (67%).Microscopic hematuria was observed in all
cases. Heavy proteinuria, hypoproteinemia, hypercholesteremia and normal renal function tests
were found in all. Serum HBsAg and Anti HCV could be done in 8 patients and were negative.
ANA was negative in a child with associated polyarthralgia. In all the 9 patients, percutaneous
renal biopsy was done under ultrasonographic guidance after doing coagulation profile and blood
group testing. Children were monitored clinically during and after the procedure. There was no
complication. The specimens were examined by light microscopy. Histologic types were Minimal
change disease (44.4%), Mesangial Proliferative Glomerulonephritis (33.3%), Focal segmental
Glomerulosclerosis (11%) and Membrano Proliferative Glomerulonephritis (11%) Conclusion:
Minimal change disease was the most common histopathologic type. This was the first effort to
obtain data on Nephrotic Syndrome in children in Meghalaya. Though limited, it could form a
basis to guide us in planning academic researches related to Pediatric Nephrology.
NEP/03(P) PROGNOSTIC FACTORS AND CLINICAL PATTERN OF CHILDREN
WITH MESANGIOPROLIFERATIVE GLOMERULONEPHRITIS
Jolly Chandran, Indira Agarwal, Koshy C. George
Christian Medical College and Hospital, Vellore.
[email protected]
Aim: To assess the clinical pattern and prognostic indicators of proven Mesangioproliferative
Glomerulonephritis (MesPGN). Methodology: A 2 year retrospective analysis of 48 children
presenting to the pediatric nephrology unit was done. These children who had biopsy proven
MesPGN were analyzed for Clinical symptoms, laboratory data and response to treatment.
Results: Of the 163 children who underwent renal biopsy, 48 children (29.4%) had MesPGN.
Their mean age was 9.8 years (range 1-17 yrs). Male: Female ratio was 1.8 :1. Mean duration of
onset of illness was 16 months. Their presenting symptoms included edema (56%),gross
hematuria (23%), hypertension (9%) and renal failure (4%). Persistent microhematuria(27%) was
the most frequent indication for biopsy. Immunofluorescence showed C3 deposits in 22%, IgA
deposits in 10 % and full house immune complexes in 8%.All children received steroids, 11
received IV cyclophosphamide and 7 oral cyclophosphamide. Fifty six percent achieved complete
remission, 27% partial remission and 10% remained non responsive. The mean number of
cyclophosphamide doses required in the responders was 3. Amongst the nonresponders (partial or
no response) 71% (5/7) had high S.Creatinine (>1.0 gm%), persistent proteinuria was seen in 57%
(12/21) , low S.Complement in 70 % (7/10) and 58 % (10/17) had hypertension.
Hypoalbuminemia at presentation did not alter the outcome. Conclusion: Mesangioproliferative
glomerulonephritis is a common renal condition in children.. Hypertension, high serum creatinine,
low complement and persistent proteinuria at presentation are associated with poorer prognosis.
NEP/04(O) A STUDY OF BACTERIOLOGICAL INVESTIGATION OF COMMUNITY
ACQUIRED URINARY TRACT INFECTION IN CHILDREN ATTENDING A
TERTIARY CARE HOSPITAL.
N.Choudhuri, T.K.Chatterjee, K.Nayek, T.N.Ghosh,.M.S.Akhtar.
Dept of Pediatrics & Microbiology, Burdwan Medical College
[email protected]
INTRODUCTION: Urinary tract infection is a common problem in pediatric patient.This study
shows drug sensitivity and emergence of resistance among urinary pathogens.
AIMS AND OBJECTIVES:1) To know the magnitude of community acquired UTI in pediatric
age
group attending tertiary care hospital. 2) To assess the resistance pattern of urinary isolates.
3) To formulate a guideline for the empirical thertapy of such infection. MATERIALS AND
METHODS: The study was conducted among 248 pediatric OPD patient of age group one month
to12 yrs of both sexes during the period from 01.09.04 to 01.08.05 with symptoms suggestive of
UTI (fever,vomiting,abdominal pain,frequency of micturation,dysuria etc). Urinary samples were
processed according to standard laboratory protocols including Kirby Bauer technique.Common
urinary antibiotics were used viz. ampicilin,amikacin, Co-trimoxazole etc RESULTS: In 248
patient, 53.6% were males; 46.45% were females which showed identical sex ratio ( p > 0.1 ).
Majority 89.9% pt were below 8 yrs Incidence of the disease increased from infantile age group to
6 yrs of age.Sharp fall was observed after 8 yrs age. Male patient of 5 to 6 yrs & female pt of 4 to
6 yrs age were most vulnerable. Among the total no. of cases the most important pathogen was
E.coli (48.4%). 4.8% belonged to klebsiella sp. and staphylococcus and pseudomonas were
responsible for .8% each. Among culture positive cases E.coli was responsible for 88.2% cases.
This study shows a generalised decrease in bacterial susceptibility to common oral antibiotics.
Commonly used oral antibiotics like cotrimoxazole and ampicillin resistant (87-100%) in most of
the cases . A moderate resistance (40-70%) pattern has been observed in different generation of
cephalosporin. Moreover fluroquinolones, which rarely used in pediatric population are also
resistant in 50-60% cases with the exception of Nitrofurantoin .The only drug which is 100%
sensitive to all types of pathogen isolated is Amikacin, the drug which is available only in
parenteral form. CONCLUSION: This study shows a generlised decrease in bacterial
susceptibility of common oral antibiotics. Empirical initial treatment with commonly used
antibiotics like Cotrimoxazole and Ampicillin might have total failure.An alarming resistance
pattern has been observed in different generation of Cephalosporins and Quinolones hich are used
in most of cases of UTI. The only drug for which there is 100% susceptibility is Amikacin.
NEP/05(O) PREVALENCE OF URINARY TRACT INFECTION IN PRESCHOOL
FEBRILE CHILDREN IN DAVANGERE
Pradeep N, S.S.Prakash, M.L.Kulkarni
Department of pediatrics,.J.M.Medical college,Davangere
[email protected]
Background and objectives: Urinary tract infection is a common problem in the pediatric age
group and is a significant risk factor for long term sequelae. The present study was undertaken to
know the prevalence of urinary tract infection in 500 preschool febrile children. Methods: This is a
cross-sectional study in which 500 preschool febrile children aged 3-6 years were selected.
Detailed history was taken and clinical examination was done in all the cases to findout the cause
of fever. Necessary investigations were done and all the data were recorded in a specially designed
proforma for this study Results: Prevalence of UTI in febrile preschool children in the age group
of 3-6 years was 4%. Above 50% of cases belonged to grade V socioeconomic status. Next to
fever (100%), dysuria (45%) and vomiting (35%) were the common symptoms.The most common
organism isolated was E.coli. 75% of microorganisms were sensitive to ceftriaxone.
Ultrasonographic features suggestive of acute pyelonephritis was found in 20% of cases with UTI.
MCU showed VUR in 2 cases. Interpretation and conclusion: UTI should be considered as a
potential cause of fever in children below 6 yrs of age. As the febrile children with UTI usually
present with nonspecific signs and symptoms, urine culture should be considered as a part of
diagnostic evaluation. Parents should be educated about the importance of UTI and its long term
complications so that they bring the children voluntarily for regular follow up.
NEP/06(O) USEFULNESS OF IMAGING & EARLY DETECTION OF CONGENITAL
MALFORMATIONS OF KIDNEY IN UTI
Archana Prasad, Premalatha
Bangalore Medical College & Research Institute, Bangalore
[email protected]
A total of 56 cases of UTI admitted in Vani Vilas Children's Hospital attached to BMC&RI were
studied & evaluated according to IAP protocol. Of them, 19 cases[33.9%] had 1st episode of UTI
between 1-<5 years & 18 cases [32.14%] had onset between 5-<10 years. Only 9 cases had onset
below 1 year of age & 10 cases after 10 years of age. Of them 18 cases [32.14%] were dignosed
between 1-<5 years & 17 cases [30.35%] were dignosed between 5-<10 tears. Cause for delayed
diagnosis was found to be late referral. 36 cases [64.28%] were found to have associated
congenital malformations of kidney & outflow tract.VUR was found in 8 cases, Puv in 2 cases,
Phimosis in 3, 4cases were Multicystic dysplastic kidnys, 2 cases of unilateral renal agenesis, 1
case of APCKD, 1 with fused ectopia, 1 with pelvic kidey & HIV, 1 with hypoplatic kidney, 5
with PUJ obstruction , 6 with calculus, 1 with renal cyst. GFR wss reduced in 13 cases &
hypertension was seen in 4 cases. All cases of congenital malformatiomns were started on
antibiotic prophylaxis & only 1 case had break through UTI.After treatment GFR normalised in 10
cases
&
improved
in
3
cases.
It was concluded that early referral of a case with congenital renal malformation, Imaging studies
according to IAP protocol & early initiation of antibiotic prophylaxis can decrease the renal
damage.
NEP/07(P) CALCIUM STATUS IN CHILDREN WITH STEROID RESPONSIVE
NEPHROTIC SYNDROME
Sanjiv Nanda, Vikas Dua
11/8 FM, Medical Enclave, Rohtak.
[email protected]
AIMS: The study was directed to make comparative evaluation of the calcium status in patients of
nephrotic syndrome, which relapse frequently or were steroid dependent versus children suffering
from nephrotic syndrome which relapse infrequently or were in remission. MATERIAL &
METHOD: Study was undertaken in thirty patients of nephrotic syndrome, ten of these were in
first attack or infrequent relapsers (Group I), ten were frequent relapsers or steroid dependent
(Group II) and rest of the ten patients were in remission. Investigations done were-serum calcium,
serum ionic calcium, serum phosphorus, serum parathormone, 24 hours urinary calcium and
phosphorus, glomerular filtration rate and serum proteins. RESULTS: There was evidence of
decreased serum calcium, ionic calcium, 24 hours urinary calcium during active disease. There
was further decrease in serum calcium, ionic calcium, 24 hours urinary calcium in frequent
relapsers. These parameters normalized at the time of remission. Serum parathormone levels were
increased in active disease, which further increased in frequent relapsers and normalized at the
time of remission. Serum phosphorous and 24 hours urinary phosphorous values were normal
during first attack, relapse and remission. Five frequent relapsers and steroid dependent patients
had radiological features of osteoporosis. DISCUSSION: Patients with longstanding nephrotic
syndrome are prone to metabolic bone disease. To confirm this more elaborated research with
large population of patients is required. Thus children with protracted nephoritc syndrome
especially those who are frequently relapsers or steroid dependent should undergo regular bone
mass evaluation. Appropriate intervention should be planned in them to prevent osteoporosis.
NEP/08(P) PROTECTIVE EFFECT OF BREAST FEEDING AGAINST URINARY
TRACT INFECTION
Parveen Mittal, Mohinder Singh, Parveen Mittal, Pradeep Bhatia, Neha Garg
37,KHALSA COLLEGE COLONY,PATIALA – 147001
[email protected]
INTRODUCTION : Many well-designed studies have demonstrated that breast-feeding protects
from several forms of infection. A longer duration of breast-feeding gives lower risk of infection
indicating long-term protective effects of breast-feeding. Present study was aimed to find the
protective effect of breast-feeding against urinary tract infection and also to find the effect of
duration of breast-feeding on the incidence of UTI. AIMS AND OBJECTIVES: To study the
protective effect of breast-feeding against urinary tract infections. To study the effect of duration
of breast-feeding on incidence of urinary tract infection. MATERIALS AND METHODS: 50
children aged 3 months to 2 years in which UTI was diagnosed by urine culture formed the study
group while 50 children of matching age and sex without urinary tract infection were taken as
control group. Type of feeding was defined as the type that child was receiving at the time of
interview. Children who were given both breast-feeding and artificial feeding were included in the
breast-feeding group RESULT:Mean age in study group was 12.16 ± 5.95 while in control group
it was 11.73 ± 5.85 and the difference was statistically not significant. There was no difference in
gender distribution in two groups. The number of children who were breast-fed were 26 (52%) in
UTI cases. Whereas 37 (74%) children in control group were breast-fed, showing thereby that a
child receiving artificial feeding was 2.62 times more likely to have UTI in comparison to the one
who were receiving breast-feeding. Mean duration of breast-feeding in study group (UTI cases)
was 8.10 ± 4.76 in comparison to 10.52 ± 5.80 in control subjects and the difference was
statistically significant.CONCLUSION:The prevalence of urinary tract infection is low in breastfed children.Longer duration of breast-feeding is associated with lower risk of urinary tract
infection.
NEP/09(P) BONE MINERAL DENSITY IN CHILDREN WITH STEROID-SENSITIVE
NEPHROTIC SYNDROME
OP Mishra, S K Meena, S K Singh, R N Mishra, R Prasad
12 GF, Kabir Colony, P.O.-B.H.U., Varanasi-221005
[email protected]
Background. Patients of nephrotic syndrome are treated with Prednisolone therapy. The drug has
several side effects including disturbances in bone metabolism. The cumulative dose may affect
bone mineral content and density in these patients.Patients and Methods. Forty children of with
steroid sensitive idiopathic nephrotic syndrome were studied. They were classified into 3 different
sub-groups: 18 were first attack nephrotic syndrome (group A), 14 infrequent relapsing nephrotic
syndrome (group B) and 8 belonged to frequent relapsing nephrotic syndrome (group C) according
to their status at the time of presentation. Duel energy x-ray absorptiometry (DXA) evaluation of
lumbar spine was performed at completion of treatment in first episode and infrequent relapsers
and in frequent relapsers on alternate day therapy during remission.Results. Patients of group B
and C received significantly higher total cumulative doses of prednisolone (275.9±93 and 558.5
±147.8 mg/kg, respectively) as compared to group A (133.7 ±21.4 mg/kg). The mean values of
bone mineral content (BMC) and bone mineral density (BMD) did not differ significantly among
different groups, except in group C patients who had significantly higher mean values of these
parameters as compared to group A. The BMC was found to have significant positive correlations
with age, weight, height, spine area and total cumulative dose of prednisolone; with significant
correlation to spine area when other parameters were adjusted. The BMD had significant positive
correlations with age, weight, height, spine area and total cumulative dose of prednisolone. But
after adjusting other co-variates, it had no correlation with cumulative dose of Prednisolone. Out
of 40 patients, only 2 had significantly low BMD Z-scores (one had osteopenia and another had
osteoporosis).Conclusion: The BMC and BMD are unaffected by prednisolone therapy in patients
with steroid sensitive idiopathic nephrotic syndrome.
NEP/10(P) ANTENATAL DIAGNOSIS OF RENAL PELVIC DILATATION - FOLLOW
UP AND MANAGEMENT IN NEWBORNS.
Mugilan Anandarajan, Sanjeev Bali
Paediatric Nephrology, Royal Belfast Hospital for Sick children, United Kingdom
[email protected]
Background: Advancements in Radiology have increased the pick up rate for Antenatal diagnosis
of Renal Pelvic Dilatation. Protocol for Evaluation of these newborns and follow up and
management in post natal period with radiological investigations varies in different centers.
Objectives: To evaluate the efficacy of current guideline for follow up of newborns diagnosed
antenatally to have renal pelvic dilatation and evaluate extent of problems and the follow up
process. Methods: Retrospective study with Data collected from Radiology department – Renal
Ultrasound scans carried out at less that 45 days of age Over the Time period (April 2005 – April
2006) and Data on Indication and follow up collected from Child’s medical files.Results: 36
children satisfied criteria with Abnormal ( > 9 mm) or equivocal scans ( 6 – 9 mm) of Renal
Pelvic Diameter measurement. Post natal Renal USS was Normal in 16 newborns and Abnormal
in 20 and these children had required follow up with Micturating Cysto urethrogram and DMSA
scans along with prophylactic antibiotics.Conclusions: Antenatal Diagnosis of Renal Pelvic
Dilatation requires close monitoring postnatally to prevent children from developing scars or
reduced renal function. It also aids in early identification of Pelvi Ureteric Junction Obstruction.
NEP/11(O) EVALUATION OF STEROID EFFECTS USING TWO DIFFERENT
REGIMES IN CHILDREN WITH NEPHROTIC SYNDROME
I Agarwal, S Kiruthiga, L. Mathew, V Moses.
Departments of Child Health and Radiology, Christian Medical College, Vellore
[email protected]
AIMS: To compare the effect of alternate day long-term steroid therapy with daily short-term
steroid therapy in children with nephrotic syndrome. METHODOLOGY: Twenty five children
receiving alternate day prolonged therapy (Soyka regime) (Group I) were compared with 25
children on short course steroid therapy (ISKDC regime) (Group II). Children were examined for
steroid side effects and underwent blood tests, ophthalmologic evaluation and radiological
examination. RESULTS: Though remission was achieved in < 4 weeks by 84 % in group II
against 60% in group I, total dose received (25 – 50 mg/kg) was lower in group I (44% vs 20%).
Forty six % had 1-2 relapses, 44% had 3-6 relapses and 6% had 6-10 relapses. Proportion having >
2 relapses was much higher in group II (60% versus 40%). Mean relapse / patient / year was 1.6
in Group I against 3.1 in Group II. Delayed bone age (44 %), radiological evidence of osteoporosis
(42%). cushingoid facies (28%), posterior subcapsular cataract (16%), decreased growth velocity
(14%) and hypertension (12%) were the side effects almost equally distributed in the two groups.
More patients from Group II received a higher cumulative dose/ kg /year of >150 mg (76%versus
56% in group I) and these had higher risk for hypertension, delayed bone age and osteoporosis.
CONCLUSION: Alternate day, prolonged therapy (Soyka regime) compared to short course, daily
therapy (ISKDC) resulted in lower cumulative dose to the patient. Acute side effects and severity
of infections were less. Mean relapse/patient /year were lower. Group II patients receiving higher
cumulative dose had osteoporosis and delayed bone age.