Download annexure – ii

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE – II
Proforma for Registration of Subjects for Dissertation
1.
NAME OF THE
:
DR. GIRISH.G.
CANDIDATE AND
POST GRADUATE IN PEDIATRICS
ADDRESS
No. 319, 1st FLOOR, KHB COLONY,
17th ‘D’ MAIN, 5th CROSS, 5th BLOCK,
KORAMANGALA,
BANGALORE-560 095.
2.
NAME OF THE
:
INSTITUTION
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE,
BANGALORE.
3.
COURSE OF STUDY
:
M.D. IN PEDIATRICS.
:
31-05-2008
:
KIDNEY SIZE AND INCIDENCE OF
AND SUBJECT
4.
DATE OF ADMISSION
TO THE COURSE
5.
TITLE OF THE TOPIC
URINARY TRACT INFECTION IN
MALNOURISHED CHILDREN.
6. BRIEF RESUME OF THE INTENDED WORK:
6.1
NEED FOR THE STUDY:
Malnutrition is one of the most common health problems, involving hundreds of
millions of children in the world.1
It is well-known that growth of visceral organs in affected by various factors.
Nutrition is one of the most important factors that determine the growth and size of
the human body in childhood.1
The kidney has been found to form a significantly higher percentage of the body
weight in the older children having the greatest degree of weight deficit. 1
Kidney size is an important parameter in the evaluation of renal growth in
children. Measuring the renal dimensions gives an opportunity to evaluate whether
growth of kidneys is adequate or not according to age and anthropometric measurements
of the child.1
Malnutrition and infection is a vicious cycle.2 Urinary tract infection is a major
cause of morbidity in children and is an important occult infection in malnourished
children.3
There is increasing understanding of the importance of organ growth and
differentiation early in life as a possible predictors of disease in adulthood.4 Malnutrition
produces certain changes such as decreased multiplication of cells and decreased cell size
(mostly due to the depletion in the enzyme granules and cellular organelles). Electrolyte
abnormalities in malnutrition produces hydropic degenerative changes in the kidney cells,
particularly of the proximal tubule, which result in the decreased functioning of the
already present glomeruli.5
Malnourished children with smaller kidney size have some long term
consequences in the form of increased risk of developing hypertension or tendency to
develop chronic kidney disease1 and if there is associated urinary tract infection the risk
of future renal morbidity increases further and hence there is a need for the present study.
6.2
REVIEW OF LITERATURE:
Aydin Ece, Ayfer Gozu, Yaser Bukte, Murat Tutanc, Halil Kocanaz had
undertaken a study at Dicle University enrolling 74 severe malnourished non-edematous
children and 47 age matched well nourished children and concluded that malnourished
children had smaller kidneys than their healthy controls and the strongest correlation was
found between height and kidney size in malnourished children.1
Schimdt IM, Molgaard C, Main KM, Michelsen KF had undertaken a prospective
cohort study at Copenhagen University enrolling 102 10-year-old children and concluded
that boys have larger kidneys than girls, reflecting a difference in lean body mass, lean
body mass being a stronger predictor of kidney volume than height, weight and body
surface area in healthy 10 year old children.4
Christophe C, Cantraine F, Bogaert C, Conseemut C, Henquirat S et al. from the
University of Brussels had studied the kidney size in 170 children aged 0-15 years found
a linear relationship between renal length and height. Additionally, they found that the
longitudinal dimension of the kidneys versus body surface area yielded the most accurate
correlation.6
In 1985, Dinkel E, Ertal M, Dittrich M, Peters H, Berres M, Schulte-Wissermann
H. from the Dept. of Pediatric University Mainz Mainz,FRG had studied the sonography
of 325 children without any kidney pathology and stated that renal length showed a high
correlation with body height. These researchers found that renal volume showed the best
correlation with body surface area and showed almost the same correlation with body
weight. 6
Gurmeet R. Singh, and Wendy E. Hoy, had undertaken a study at the University
of Queensland involving 210 children and showed that kidney length and kidney volume
correlated significantly and positively with weight, height, body mass index(BMI), and
body surface area, correlation with body surface area were among the strongest.7
Bertram L. Kasike and Andrew J. Umen, from the University of Minnesota
demonstrated that kidney weight correlated best with descriptive models of body build
that incorporated combined functions of height and weight and no model correlated with
kidney weight better than body surface area.8
Banapurmath CR and Jayamony S. had undertaken a study involving 88 severely
malnourished children from the pediatric wards of Chigateri General Hospital and
detected urinary tract infection in 8 (10.7%) children.3
6.3
OBJECTIVES OF THE STUDY:

To study the effect of malnutrition on kidney size and correlate it with the
anthropometric measurements.

To study the incidence of urinary tract infection, hypertension and proteinuria
in malnourished children.
7
MATERIALS AND METHODS:
Study Design :- Hospital based prospective study.
7.1
SOURCE OF DATA:- A minimum of 50 children with Grade II, Grade III
and Grade IV malnutrition(according to classification by Indian Academy of
Pediatrics) admitted and 50 apparently normal healthy children attending the OPD
in Vani Vilas Children’s Hospital and Bowring and Lady Curzon Hospitals during
the study period Nov 2008 to Dec 2009.
7.2
METHOD OF COLLECTION OF DATA: -
Definition of Study Subjects- A minimum of 50 cases of malnourished children who
fulfill the following inclusion criteria will be selected.
Definition of Controls- A minimum of 50 apparently healthy children attending the OPD
will be selected.
INCLUSION CRITERIA: Malnourished children who were born out of a term gestation and were
appropriate for gestational age aged between six months and five years of age
belonging to GradeII, Grade III and Grade IV malnutrition i.e less than 70% of
the expected weight for age (according to the classification of malnutrition by the
Indian Academy of Pediatrics)
EXCLUSION CRITERIA: Children less than six months and more than five years of age.
 Children who were born either premature or postmature and/or were small for
gestational age or large for gestational age.
 Children greater than 70% of the expected weight for age.
 Children having congenital anomalies of the kidney and urinary tract (CAKUT)
and anatomical abnormalities that could influence the renal size including
hydronephrosis, vesicoureteric reflux, nephrolithiasis.
 Children with chronic diseases such as AIDS and Tuberculosis.
After getting written informed consent from parents all malnourished children who
fulfilled the inclusion criteria were subjected to investigations like ultrasound
abdomen, routine examination of urine, urine culture and sensitivity.
Diminished renal size was defined when the renal length was less than the 5th
percentile for that particular age based on normograms.6 Urinary Tract Infection was
defined in the presence of more than 5 pus cells per high power field in a centrifuged
urine sample and/or positive urine culture.9
Statistical analysis used for the analysis of the data collected includes Student’s t test,
paired t test, Pearson’s correlation analysis and Multiple linear regression.
7.3
Does the study require any investigation or interventions to be
conducted on patients or other human beings or animals ? If so
please describe briefly? YES
Present study includes investigation on patients only and it includes1. Ultrasound Abdomen.
2. Routine Examination of Urine.
3. Urine Culture and Sensitivity.
7.4
Has the ethical committee clearance has obtained for this study
from your Institution ? YES
8.
LIST OF REFERENCES:
1. Ece Aydin, Gozu Ayfer, Bukte Yaser, Tutanc Munat, Kocamaz Halil. The
effect of malnutrition on kidney size in children. Pediatric Nephrology 2007; 22:
857-863.
2. Bhaskaran P. The vicious cycle of malnutrition and infection. Indian Pediatrics
1992; 29: 805-814.
3. Banapurmath CR, Jayamony S. Prevalence of urinary tract infection in severely
malnourished preschool children. Indian Pediatrics 1994; 31: 679-682.
4. Schimdt IM, Molgaard C, Main KM, Michelsen KF. Effect of gender and lean
body mass on kidney size in healthy 10-year-old children. Pediatric Nephrology
2001; 16: 366-370.
5. Hay RW, Stanfield JP. The pathology of protein-energy malnutrition.Chapter 3 in
: Alleyne GAO, Hay RW, Picous DI, Stanfield JP, Whitehead RG. Protein-energy
Malnutrition. 1st edition. New-Delhi: Jaypee Brothers Medical Publishers; 1989,
pp 26-37.
6. Konus OL, Ozdemir A, Akkaya A, Erbas G, Calik H, Isik S. Normal Liver,
spleen, and kidney dimensions in neonates, infants, and children: evaluation with
sonography. American Journal of Roentgenology 1998; 171: 1693-1698.
7. Singh GR, Hoy WE. Kidney volume, blood pressure, and albuminuria: findings in
an Australian Aboriginal community. American Journal Kidney Disease 2004; 43:
254-259.
8. Kasike BC, Umen AJ. The influence of age, sex, race, and body habitus on kidney
weight in humans. Archives Pathology Laboratory Medicine 1986; 110: 55-60.
9. Bagga Aravind, Srivatsava RN. Urinary Tract Infection. Chapter 15 in: Bagga
Aravind, Srivatsava RN. Pediatric Nephrology. 4th edition. New Delhi: Jaypee
Brothers Medical Publishers; 2005, pp 240-241.
9.
SIGNATURE OF THE
:
CANDIDATE
DR. GIRISH.G
10.
REMARKS OF THE
GUIDE
11.
NAME & DESIGNATION
OF GUIDE
11.1 GUIDE
: Malnutrition is a common co-morbid
condition in pediatrics and its effect on
kidney has not been studied. Hence
there is a need for the study.
:
DR. PREMALATHA. R.,
PROFESSOR, DEPARTMENT OF
PEDIATRICS,
BANGALORE MEDICAL COLLEGE &
RESEARCH INSTITUTE BANGALORE.
11.2 SIGNATURE
:
11.3 CO-GUIDE
:
Dr. H. SATISHCHANDRA
PROF. & HOD
DEPARTMENT OF
RADIODIAGNOSIS & IMAGING
BANGALORE MEDICAL COLLEGE &
RESEARCH INSTITUTE, BANGALORE.
11.4 SIGNATURE
:
11.5 HEAD OF THE
DEPARTMENT
:
DR. GANGADHAR B. BELAVADI,
PROF. AND HOD,
DEPARTMENT OF PEDIATRICS,
VANIVILAS HOSPITAL,
BANGALORE MEDICAL COLLEGE &
RESEARCH INSTITUTE, BANGALORE.
11.6 SIGNATURE
:
12.1 REMARKS OF THE
CHAIRMAN & DEAN
:
12.2 SIGNATURE