Context: Patients with chronic kidney disease (CKD) are mostly immunocompromised and more prone to infections. Risk of acquisition of infections is increased during dialysis. Hepatitis B virus (HBV) infection remains a major issue among hemodialysis patients and long-term complications of HBV infection in children are more. Following a regular vaccination schedule and maintenance of adequate antibody titer are the important ways to prevent HB infection in the hemodialysis population. Aims: The aim of this study was to compare the seroconversion rate of hepatitis B vaccine in children with CKD between maintenance dialysis and nondialysis group. Materials and Methods: This interventional study was carried out in the Department of Pediatric Nephrology, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, from July 2018 to December 2019. Total 36 previously diagnosed advanced stages of patients with CKD were enrolled in the study. Patients were divided into two groups: Group A: maintenance hemodialysis (MHD) patients and Group B: nondialytic patients. Baseline antiHBs titer was done in both groups. In each group, 18 patients were enrolled. Patients who had mean baseline antiHBs >10 mIU/mL (seroconversion) were considered as primary response and patients who had mean antiHBs titer <10 mIU/mL were considered as nonseroconversion. Patients of both groups who had mean antiHBs titer 0.00 mIU/mL were given secondary vaccination by three doses of recombinant hepatitis B vaccine (20 μg) intramuscularly in a 0, 1, and 2 months of schedule. Patients who had mean antiHBs titer > 0.00 but <10 mIU/mL were vaccinated by a single booster dose (20 μg). Four weeks after completion of the vaccination, seroconversion (antiHBs titer >10–100 mIU/mL) and seroprotection (antiHBs titer >100 mIU/mL) rates were measured by immunometric technique in both groups and compared between the groups. Statistical analysis used: Statistical analysis was performed by the Statistical Package for the Social Sciences (SPSS) software program, version 20.0 for Windows (SPSS, Chicago, Illinois). The quantitative observations were indicated by frequencies and percentages. Fisher’s exact test was used to determine the association between categorical variables; Kruskal–Wallis test and unpaired t test were used to determine the association between continuous variables. Results: In this study, all enrolled patients (100%) had developed seroconversion (>10 mIU/mL). In Group A only 1 patient (9%) had seroprotection level and total 11 patients had mean antiHBs titer 46.66 ± 10.90 mIU/mL, whereas in Group B 6 patients (54%) had seroprotection level with mean antiHBs titer 326.15 ± 123.27 mIU/mL. Therefore, more seroprotection level was observed in Group B and the difference between Groups A and B was statistically significant (P = 0.0176). Conclusion: It may be concluded from the study that the immune response of the hepatitis B vaccine was significantly lower in MHD than nondialysis group patients, so it was realized that hemodialysis had effects on reduction of antiHBs titer.

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Background: Non-compliance to medications and health advice significantly impact care of patients as well as impose financial burden in nephrotic syndrome (NS) patients. Aim: The aim of this article is to determine the cause and consequence of non-compliance in NS patients. Materials and Methods: This prospective study was conducted between March 2020 and February 2021 in the department of Pediatric Nephrology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Seventy-seven NS patients were recruited randomly. In-person interviews were conducted with attendents of patients, along with patients if possible. Clinical and laboratory data were collected from medical records. Residence, financial constraints, educational status, health advices (daily bed side urine test), relapses of disease, different types of immunosuppressive medications, etc. were provided for the cause of non-compliance. Consequences of non-compliance were observed through the experience of relapses, asthma attack or infection, and drug toxicity. Data were analyzed using SPSS software version 20. Results: A total of 77 patients were analyzed and among them 74.02% were non-compliant and 25.98% were compliant. Among the non-compliant patients, non-compliance to asthma medication, prednisolone, second-line immunosuppressive drugs, and third-line immunosuppressive drugs were 43.87%, 31.57%, 14.03%, and 10.53%, respectively. About 56.14% of the patients did not do bed side urine for albumin (BSUA). Remote location (63.15%), financial constraints (36.84%), low parental education (35.09%), ignorance (17.54%), and undetermined cause (17.50%) were observed as main contributing factors for non-compliance. Among study populations, 77.19% experienced more relapses in comparison to compliance (10%). Non-compliant patients experienced more asthma attack (70.17%, 40/57), pneumonia (63.2%), and steroid toxicity (36.8%) in comparison to the compliance group (45%, 36.8%, and 10%, respectively). About 31.57% of the non-compliant group had spent 30,000–70,000 taka in comparison to 5% in the compliance group and it was statistically significant (P = 0.031). Conclusion: Poor compliance to medications and health-related advices have diverse effects including frequent relapse, drug toxicity, higher rates of complications and hence increased healthcare cost. Remote location, ignorance, and idiopathic causes were major contributing factors behind non-compliance issue. Appropriate counseling might change this prevailing non-compliance scenario in future.

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Background: This prospective observational study was conducted to see the prevalence, etiology, clinical profile, and immediate outcome of community-acquired acute kidney injury (AKI) in a pediatric critical care nephrology setup in Bangladesh. Materials and Methods: The prevalence, etiology, outcome, and fatality predictors of critically ill children with AKI, aged 5 days to 17 years from January 2016 to June 2018 were studied at Dhaka Shishu (Children) Hospital, Bangladesh. AKIN criteria were used to screen AKI. They were given supportive care and dialysis. Results: The prevalence of AKI among 725 patients was 61%. All the AKI cases were at AKIN stage III. Pre-renal cause accounted for 63%, renal 19% and post-renal 18%. The most common etiology of pre-renal AKI was post-diarrheal hypovolemia (50%), renal cause of AKI includes glomerulonephritis (45%) and among post-renal cause posterior urethral valves was 78%. Hypovolemia and shock were found in 12% of cases. Congestive cardiac failure (10%), hypertensive crisis (7%), severe hypernatremia (24%), severe metabolic acidosis (11%), and dialysis requirement (76%) were found to be associated with the worst outcome. Fifty-one percent improved with normal renal function. Of 441 AKI cases, 201 (46%) improved and among them 102 (51%) regained with normal renal functions. Approximately 99 (49%) with partial renal recovery and most (41) of them were due to renal cause of AKI. The overall worst outcome was observed in 54% and mortality in 40%. The highest mortality was found among neonates (60%) and infants (41%). Glasgow coma scale was <3 in 16% cases. Need for mechanical ventilation (11%) and longer hospital stay >30 days (9%) were the important predictors of fatality in AKI. Conclusion: Higher prevalence of severe AKI was associated with high mortality in neonates and infants in critical-care setup. Longer hospital stay and need for dialysis and mechanical ventilator predicted worst outcome.

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Background: Urinary tract infection (UTI) is the third most common medical problem in the pediatric population, especially in infants. Vesicoureteral reflux (VUR) is common in children with UTI. Objective: The aim of this article is to assess the relationship between VUR-associated UTI and renal scar in children. Materials and Methods: A cross-sectional study was conducted among children who were admitted in the Pediatric Nephrology Department of BSMMU with UTI during the period of March 2013 to July 2014. A total of 30 UTI patients aged 1–5 years were included in the study. Children with neurogenic bladder or structural abnormality of urinary tract other than VUR were excluded from this study. History of the patients was taken and physical examination was done and recorded. Several investigations such as urinary routine and microscopic examination, culture and sensitivity with colony count, ultrasonogram of kidney, ureter, and bladder with post-void residual urine, micturating cystourethrogram, and dimercaptosuccinic acid (DMSA) renal scan were done. The collected data were analyzed by using SPSS version 12. Results: Mean age of the patients was 2.50 ± 1.18 years within the range of 1–5 years. Boys (80.0%) were predominant than girls (20.0%). Among the right kidneys 10 (33.3%) and among the left kidneys 11 (36.7%) had renal scar. There was a significant relation between increased VUR grading and increased number of renal scars on right and left kidneys (P = 0.013 and P = 0.020, respectively). There was no significant relation between increased number of UTI episodes and increased number of renal scars on right and left kidneys (P = 0.057 and P = 0.951, respectively). There was a positive correlation between VUR grade and renal scar [r = + 0.741 (P < 0.001)]. There was a positive correlation between VUR grade and renal scar [r = + 0.917 (P < 0.001)]. Conclusion: It can be concluded that severity of VUR had a significant correlation with renal scarring on DMSA scintigraphy.

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Background: Membranoproliferative glomerulonephritis (MPGN) is a progressive disease with poor prognosis. An emerging consensus on classification based on immunofluorescence findings separates MPGN into two groups: immune complex-mediated MPGN and complement-mediated MPGN. This study was undertaken to investigate the clinical, biochemical, and histopathological parameters in-between these two groups histologically diagnosed as MPGN previously. Materials and Methods: We conduct a retrospective cross-sectional study carried out at the Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period from June 2016 to December 2017. A total of 67 histologically diagnosed MPGN cases were enrolled in the study. Immunofluorescence evaluations were performed and correlated with retrospective clinical and biochemical data. Results: Immune complex-mediated MPGN and complement-mediated MPGN cannot be differentiated by histopathology. There were no significant differences between clinical (age, sex, clinical presentation) and biochemical (serum creatinine, C3 level, C4 level) parameters between immune complex-mediated MPGN and complement-mediated MPGN. Conclusion: Clinical and biochemical and histopathological parameters in-between these two groups of MPGN show no significant difference.

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Introduction: This cross sectional study was carried out with an aim to evaluate the accuracy of ultrasonography (USG) in the evaluation of hydronephrosis (HDN) in pediatric age group. Methodology: The study was carried out from January 2017 to November 2017 in the Department of Radiology and Imaging, Sir Salimullah Medical Collage and Mitford Hospital, Dhaka. Eighty two patients aged from 1-18 years, admitted as suspected HDN were included as study subject. Result: In this study, the mean age of the patients was 6.31 (±3.34) years and 46.3% belonged to 5 years age group. Male and female ratio was approximately 2:1, 55 (67.1%) were male. Regarding the presenting complains, loin pain was most common (81.7%) feature. Recurrent urinary tract infection (URI) was observed in 52.4%, hematuria in 29.3%, flank mass in 18.3%, vomiting in 2.4% of the study patients. In every patient, with proper clinical evaluation, renal function test was done. After admission, in every patient USG and IVU was done in every patient. In IVU, it was found that 25.6% of cases had left sided HDN , 24.4% right sided HDN and 31.7% both sided HDN. In USG, out of 93 HDN cases in IVU, 85 were correctly diagnosed. The sensitivity was 91.4%. Out of 71 non-obstructed kidneys on USG, 68 were correctly assigned as non HDN, the specificity was 95.8%. Conclusion: This study findings showed USG to be a sensitive screening technique for excluding urinary tract obstruction.

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This article reports two cases of prolonged cholestatic type hepatitis A, a rare clinical manifestation of hepatitis A virus infection in children. Acute hepatitis A virus infection typically resolves spontaneously in 90% of the cases. In children, complete recovery usually occurs in most of the cases within two months. Occasionally, the cholestatic variety may persist for several months, characterized by intense pruritus and prolonged conjugated hyperbilirubinemia. The diagnosis is based on the presence of IgM anti-HAV, symptoms longer than 8 weeks, bilirubin concentration >10 g/dL in the absence of substantial hepatocellular and biliary damage. Use of only ursodeoxycholicacid (UDCA) rather than the combined use of UDCA and corticosteroid is sufficient.

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Background: Genitourinary (GU) disorders may be congenital or acquired. Congenital cases are most often undiagnosed. This study was carried out to find the types of congenital, acquired GU cases and redo surgery from neonate to early adult life and the age of diagnosis of congenital anomalies. Materials and Methods: This retrospective study was carried out from January’2016 to December’2018 in the inpatients of the Paediatric Surgery Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All admitted patients having congenital or acquired GU cases and postoperative complications of these systems required redo surgery were included. The data were reviewed for patient demographics, frequency, and distribution pattern of admitted GU cases and types of redo surgery. Result: A total of 1329 patients were operated in the Paediatric Surgery Department of BSMMU, Dhaka, Bangladesh over a 3 years’ period. Among them, 508 patients (38.2%) were GU cases. The age ranged from 2 days to 18 years (mean age: 5.68 ± 3.77) at diagnosis. The male: female ratio was 5.7:1. Out of the total 508 patients, 432(85%) were boys while only 75 (15%) were girls. Among the 508 GU cases, 355 (69.9%) were congenital cases, 56(11%) were acquired cases, and redo cases were 97(19.1%). In this study, 43.7% of children who had congenital GU anomalies were >5 to 12 years old, and the neonatal age group was in 2.3% of cases. Among the congenital GU anomalies, hypospadias was more common in 141(27.8%) cases. 41(8.1%) had urogenital tumors. Wilm’s tumor was in 18 (3.5%) of children, 9 (1.8%) patients had urethral stricture, 6(1.2%) patients had urolithiasis. In case of redo surgery, urethrocutaneous fistula was found in 42(8.3%) patients. Conclusion: GU cases are more common than the other systemic cases in pediatric surgical patients. Among the GU cases, congenital anomalies are more than the acquired cases in our institution. But most of the congenital anomalies were diagnosed at a later age.

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Very early-onset inflammatory bowel disease (VEO-IBD) is a genetically and phenotypically unique entity from adult-onset or older pediatric IBD and a growing subset of IBD. In most cases, a child with VEO-IBD presents with similar manifestations like an older patient with IBD, but some may present with a highly aggressive course and some cases may present with features of immunodeficiency. It differs from adult-onset IBD in many aspects such as disease behavior, location of the disease, and disease type and mostly occurs due to genetic causes. Next-generation genome sequencing could be an important tool for diagnosing genetic defects, especially in children with VEO-IBD disease. Most of the children with VEO-IBD do not comply with conventional therapy, and they ultimately need early immunosuppressive therapy that may grossly affect the child growth and development and also may possess long-term risks of cancer and opportunistic infections.

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Gastric teratomas (GTs) are very rare tumors in children. They usually present with a palpable mass in the upper abdomen. We report a case of GT in a 4-month-old male infant who was presented with a palpable central abdominal mass. Ultrasound and computed tomography (CT) scan revealed a huge mass with heterogenous consistency and scattered calcification within the mass, extending from epigastric to hypogastric region. His biochemical marker of alpha-fetoprotein (AFP) was raised (1277 ng/mL). The preoperative clinical diagnosis was suspected teratoma but not specifically gastric one. On laparotomy, the mass was found to be attached with the greater curvature of the stomach and it was excised completely with all layers of the attached part of the greater curvature of the stomach wall. Histopathology confirmed it was a grade-I immature GT. The rarity of the origin of teratoma in addition to its immature variety prompted us to report the case.

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Objectives: This study aimed to discuss demographic profile, variation in clinical feature, laboratory analysis, clinical severity, and consequences of treatment in dengue fever. Materials and Methods: This was a prospective observational study. All patients included in the study were admitted with fever and diagnosed with dengue fever either by serological test or antigen test. Results: The majority (92.85%) of children came from urban areas. Male children were predominately (59.52%) affected. Common clinical features were fever (100%), vomiting (65.8%), abdominal pain (31.7%), rashes (41.6%), loose motion (34.1%), and bleeding manifestation (30.50%). Tourniquet test was positive in 34.12% of cases. Pleural effusion was present in 15.87% and ascites were present in 13.49% of cases. Peritonitis developed in 2.38% of patients. Approximately 7.93% of the patients had central nervous system involvement and 1.5% of cases came with active convulsion. Regarding investigations, leukopenia (42.85%), thrombocytopenia (69.84%), increased hematocrit (35.7%), and elevated serum glutamic-pyruvic transaminase (SGPT) (42.06%) were present. Approximately 43.65% of children came with dengue fever, 30.95% of children came with dengue hemorrhagic fever and 25.39% of children came with DSS. In DSS 100% of patients came with hypotension and tachycardia and 78.12% of patients came with compensated shock. Leukopenia (55.55%) and raised hematocrit (60%), elevated SGPT (45.28%), and decreased albumin level (60%) were prominent in DSS. There was no case fatality. Conclusion: Dengue fever’s severity and clinical variation increase day by day. As there is no vaccine against dengue in our country, we will try to improve our public awareness for prevention and continuous serological surveillance will be needed to achieve the goal.

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Nephropathic infantile cystinosis is a rare congenital metabolic disorder with an autosomal recessive penetrance in the family, which causes the accumulation of cystine in the lysosomes of different organs of the body. The nephropathic infantile type presents in early infancy in the form of proximal renal tubular acidosis and carries a poor prognosis including renal failure requiring renal replacement therapy and blindness if left untreated. Here we report a case of nephropathic cystinosis in an 8-year-old girl who presented in her early infancy at 8 months of age and was diagnosed as distal renal tubular acidosis and started on alkali therapy. Her symptoms initially improved but she had delayed milestones of motor development, persistent polyuria, and weakness. At the presentation of 8 years, she was found to have features of rickets in both upper and lower limb and hypertensive. Her blood reports revealed a nonanion gap metabolic acidosis with hypokalemia and hypophosphatemia. She also had proteinuria and glycosuria but no hypercalciuria. Considering her clinical and biochemical features, she was sent for eye evaluation, which revealed the presence of cystine crystal in the conjunctiva, stroma of the cornea, and peripheral retina. Clinical diagnosis of cystinosis is often challenging as some cases may mimic features of distal renal tubular acidosis, so careful evaluation is necessary. Parents were counseled about the disease and genetic test and her treatment was continued with phosphate supplement along with alkali supplements. Though the genetic test is confirmatory for diagnosing nephropathic cystinosis, a complete initial evaluation including blood, urine analysis, and an ophthalmological evaluation can guide us toward early diagnosis and management.

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Renovascular hypertension is an important cause of secondary hypertension in the pediatric age group. Reflux nephropathy has also been regarded as one of the most common disorders leading to secondary hypertension in children. Secondary hypertension must be appropriately diagnosed and treated. Here we report the presentation, diagnosis, and management of a case of secondary hypertension in a 9-year-old boy due to unilateral diffuse narrowing of the left renal artery along with ipsilateral grade 4 primary vesicoureteral reflux.

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Urinary tract infection (UTI) is the most common and serious bacterial infection in the pediatric age group. It is more prevalent in girls than in boys, except in early infancy. Escherichia coli is responsible for 80–90% of cases of pediatric UTI. The occurrence and severity of this illness are largely mediated by bacterial virulence factors and host defense mechanism. The clinical manifestations of UTI in children are highly heterogeneous, and non-specific collection of urine sample to diagnose the condition accurately is quiet challenging for young pre-continent children. Till date, urine culture is the gold standard for diagnosing UTI. Selection of appropriate antibiotic for the treatment of UTI must be guided by the local guideline and current sensitivity pattern. Ideal imaging protocol and use of antibiotic prophylaxis are still a matter of debate. Current trend is less use of antibiotic prophylaxis due to increasing antibiotic resistance. Prophylaxis cannot alter the long-term consequences, like renal scarring in selected patients. The debate on the indication and duration of antibiotic prophylaxis is still ongoing. So, this review aimed to provide a contemporary overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, complications, and preventive measures of UTI including chemoprophylaxis in pediatric population. It also highlights the conflicting recommendations of international guidelines, which reveal the necessity of further research to establish the tailored approach of pediatric UTI.

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Background: There is a scarcity of published data regarding the clinical and pathological pattern of idiopathic nephrotic syndrome in adolescents in our country. Materials and methods: A retrospective analytical study was undertaken on 550 children with idiopathic nephrotic syndrome admitted to Bangabandhu Sheikh Mujib Medical University from January 2019 to July 2021. Data regarding clinical and laboratory parameters, current clinical status of the patients and their steroid responsiveness, complications, types of histopathological lesions, and treatment profile were retrieved from departmental automation. These parameters of the patients whose disease onset between 1 and <10 years of age (Group A) were compared to the same parameters of those with onset of disease between 10 and 18 years (Group B). Results: We found that hypertension, hematuria, and azotemia were more prevalent in childhood group than adolescent group. IFRNS was the most common disease course in Group B (56.2%) and more of them were currently on remission (80%). SRNS was more common in Group A (16.7%) and more of them were on relapse (76.16%) currently during the last follow-up. Precipitating factors such as infection and asthma were more in younger children. The rate of complication was more in childhood group in comparison to adolescent group. On renal biopsy specimen, minimal change disease (MCD) was the most common histological lesion in adolescent group (24.86%) compared to childhood group (16.16%). Adolescents (Group B) required less amount of second- and third-line immunosuppressive drugs than younger children (Group A). Conclusions: The overall clinical and histological condition was more favorable in adolescent group in comparison to childhood group in our setup. These findings necessitate larger prospective study in the future for further validation of this observation.

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Background: Hearing impairment (HI) is an important disability hampering the overall development, particularly cognitive domain in children. Coexistence of HI with intellectual disability (ID) affects adversely the overall prognosis of a child. To highlight this underdetermined issue, this study has been done to determine the proportion of ID in children of HI. Materials and Methods: This cross-sectional study is held in children with HI of 0–42 months. In the study subjects, psychological assessment was done by Baily Scale of Infant Development III (BSID III). Detailed history was taken; physical examination was done in each patient after taking informed written consent. Hearing assessment was done by an audiologist and was leveled as mild, moderate, severe, and profound. Results: The study subject was 203, and mean age was 27.2 ± 8.7 (3–42) months. There was a slight male predominance. Majority of children mode of birth was lower uterine segment cesarean section. Neonatal seizure was significantly associated with intellectual impairment in the study subject (P <0.001). No significant association of the HI was found in different levels of intellectual status of the children; however, 35% of the study subject had borderline intellectual status and most of them belonged to the profound HI. Conclusion: A significant proportion of the study subjects had borderline intellectual status, although very limited numbers had ID. Moreover, children with profound hearing loss were most affected.

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Kartagener’s syndrome or primary ciliary dyskinesia (PCD) is a very rare congenital malformation comprising of a classic triad of sinusitis, situs inversus, and bronchiectasis. PCD is a genetic disorder with manifestations present from early life, and this distinguishes it from acquired mucociliary disorders. Approximately one half of patients with PCD have situs inversus. We present a case of 12-year-old girl with sinusitis, situs inversus, and bronchiectasis. The correct diagnosis of this rare congenital autosomal recessive disorder in early life is important for the overall prognosis of the syndrome, as many of the complications can be prevented if timely management is instituted.

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Diffuse mesangial sclerosis (DMS) is a histopathological finding of a few percentages of children presented with nephrotic syndrome (NS) in the first or second decade of life. It can be an isolated finding or can be associated with some syndrome. Here we report one case of DMS presenting in the first year of life who had a fatal outcome. Early detection of this disease is necessary to draft a management plan and counseling regarding prognosis.

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Introduction: Patients with urinary tract infection (UTI) associated with vesicoureteric reflux (VUR) are prone to develop hypercalciuria and hyperuricosuria compared with UTI patients without VUR, which may lead to the formation of stones due to stasis, infection, and inflamed urinary mucosa. Objective: To assess calcium and uric acid excretion in children with VUR and without VUR having a history of treatment for UTI. Materials and Methods: This cross-sectional and analytical study was conducted in the Department of Paediatric Nephrology and Urology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Sixty-one children of both sex from 2 months to 12 years were treated for UTI 4 weeks prior to enrollment for the study and evaluated by micturating cystourethrogram taking all precautionary measures to detect VUR. Patients were grouped into Group A (30 patients with VUR) and Group B (31 patients without VUR). Fasting urine was analyzed for calcium/creatinine (Ca/Cr) and uric acid/creatinine (UA/Cr) ratios. Urinary calcium and urinary uric acid levels were determined by the colorimetric test, and urinary creatinine was measured by the clinical risk and error analysis method by using the Dimension RxL Max System (SIEMENS) of both groups of patients in the Department of Biochemistry, BSMMU. Results: Median (min–max) of Ca/Cr ratio was 0.207 (0.034–0.646) and 0.150 (0.090–0.500) in Group A and Group B, respectively, and the difference between these two groups was statistically significant (P < 0.050). Median (min–max) of UA/Cr ratio was 0.972 (0.307–1.951) and 0.616 (0.500–1.390) in Group A and Group B, respectively, and the difference between these two groups was also statistically significant (P < 0.050). Hypercalciuria was significantly higher in Group A (20.0%) than in Group B (3.2%; P < 0.050). Similarly, hyperuricosuria was significantly higher in Group A (33.3%) than in Group B (6.5%; P < 0.05). Conclusion: Children with VUR having UTI may have a higher level of hypercalciuria and hyperuricosuria than those without VUR.

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Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. The most common cause of NS is idiopathic NS (INS). Minimal change NS (MCMS) is more than 80% in patients with favorable outcomes. However, a few children have focal segmental glomerulosclerosis along with secondary causes, which are at risk for complications. Complications may be disease-associated or may be drug-related complications. Disease-related complications include infections (e.g., peritonitis, sepsis, cellulitis, chicken pox), thrombo-embolism, hypovolemic crisis, hypercholesterolemia, acute kidney injury (AKI), anemia and other AKIs, hypothyroidism, hypocalcemia, and bone disease. The majority of children with MCNS respond to corticosteroids or cytotoxic agents, alkylating agents, cyclosporine A, and mycophenolate mofetil. Early detection and management of these complications will improve outcome for these patients with NS. This article provides an update of current available therapeutics strategies and case-based management of common complications of NS.

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Hypertension in children and adolescents is a major health condition that clinicians frequently overlook. Children should have their blood pressure checked annually beginning at the age of 3, or at each visit if risk factors are present. Secondary etiologies of hypertension are more common in children than adults, with renal parenchymal and renovascular disease being the most common. In youngsters, overweight and obesity are highly associated with primary hypertension. All children newly diagnosed with hypertension should have a history and physical examination to rule out any underlying medical conditions. Other risk factors for cardiovascular disease, such as diabetes mellitus and hyperlipidemia, should be examined in children with hypertension, and a retinal examination and echocardiography should be performed to assess for target organ damage. In children with hypertension, lifestyle adjustments such as weight loss if they are overweight or obese, a nutritious diet, and regular exercise are initially used to address the condition. Children with stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease, or persistent hypertension despite a trial of lifestyle modifications are more likely to require antihypertensive medications. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide diuretics (thiazide diuretics) are all efficacious, safe, and well tolerated in children.

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Background: Children with chronic kidney disease (CKD) are immunocompromised and they are more prone to develop hepatitis B and hepatitis C virus infections. Objective: The aim of this study was to evaluate the status of hepatitis B and hepatitis C in children with CKD. Study Design: This was a cross-sectional study. Study Setting and Period: This study was conducted at the Department of Pediatrics Nephrology, Dhaka Shishu (Children) Hospital, from February 2019 to July 2019. Study Population: Children aged 6 months–18 years with the diagnosis of CKD participated in the study. Materials and Methods: A total of 35 purposively selected patients with CKD were enrolled. Thorough history, physical examination, and necessary investigations were done. CKD staging was done by using the revised Schwartz formula. All 35 patients were in CKD stages 3–5. They were divided into three groups: CKD stage 3–4; CKD stage 5 pre-hemodialysis (pre-HD); and CKD stage 5 maintenance HD. Then hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (anti-HCV), and hepatitis B surface antibody (anti-HBs) titer were assessed in all patients and compared between the groups. Analysis was done by the analysis of variance (ANOVA) and t test. A value of P < 0.05 was considered statistically significant. Results: The study revealed that all 35 patients were negative for HBsAg and anti-HCV. Anti-HBs antibody titer in 25.7% patients were 00 mIU/mL, in 40% patients <10 mIU/mL, in 20% patients 10–100 mIU/mL, and in 14.3% patients >100 mIU/mL. Majority (65.7%) of the patients had no protection (titer 0–<10 mIU/mL) against hepatitis B virus (HBV) infection and seen declining of anti-HBs antibody titer with increase of age in the study population. No significant difference of antibody titer was found in between gender, cause of CKD, different stages of CKD, and duration of the disease. Conclusion: In this study, all patients with CKD were negative for HBsAg and anti-HCV. Patients were negative for HBsAg. However, majority (65.7%) of patients show no protection against HBV infection.

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Neonatal hypernatremic dehydration is not so uncommon and causes high morbidity and mortality if associated with acute kidney injury (AKI). We herein discuss a neonate who presented with serum sodium of 193 mmol/L with AKI, and we successfully treated this neonate with peritoneal dialysis.

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