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: 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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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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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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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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Hepatitis C virus (HCV) infection is an emerging problem for children and adolescents. The estimated 3.5–5 million children have chronic HCV infection globally. Early detection of HCV infection and early administration of appropriate treatment in childhood are necessary to prevent decompensated liver disease and hepatocellular carcinoma as in adults. Perinatal transmission is the most common route of HCV infection in children. An antibody-based test (anti-HCV) should be done in children at or after 18 months of age to detect HCV infection. Children who are anti-HCV-positive after 18 months of age should be further confirmed with an HCV-RNA assay after age 3 to recognize chronic hepatitis C infection. These patients should be further tested to determine the genotype. Children who are anti-HCV- and HCV-RNA-positive need to be treated with direct-acting antiviral. The purpose of the article is to discuss epidemiology, natural history, diagnosis, and management of HCV infection in children and adolescents.

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