Salih Kavukçu

Herpes simplex virus (HSV) infection is common in solid organ transplant recipients due to viral reactivation under immunosuppression. We report a case of a 9-year-old renal transplant recipient who developed recurrent perioral HSV infection following discontinuation of antiviral prophylaxis. The patient presented with localized vesicular lesions without systemic symptoms, and each episode responded rapidly to oral antiviral therapy. However, recurrences occurred mainly during periods of increased immunosuppression, such as treatment for acute cellular rejection, or after cessation of prophylaxis, whereas no HSV-related episodes were observed during antiviral prophylaxis. Because of recurrent HSV episodes, long-term low-dose suppressive antiviral therapy was initiated. This case illustrates that HSV infection in pediatric renal transplant recipients may follow a recurrent course and underscores the importance of individualized management strategies given the uncertainty surrounding the optimal duration of prophylactic antiviral therapy.

Objectives: Clinical and radiological criteria for predicting surgical approach or spontaneous resolution have been evaluated mainly in primary non‐refluxing megaureters detected prenatally. We aimed to analyze these criteria in a retrospectively collected cohort of children with either prenatal or postnatal diagnosis of non‐obstructive non‐refluxing (NONR) megaureter. Methods: Hospital files of the children with NONR megaureter were evaluated retrospectively for age at diagnosis, presenting complaint, follow‐up period, accompanying urologic abnormalities, complications (renal scar and urinary tract infection), and final status. Results: There were 27 NONR megaureters in 25 patients (male/female: 19/6; prenatal/postnatal: 18/7). Two prenatal cases had bilateral involvement. Spontaneous resolution rate in renal units was lower in postnatal cases than in prenatal cases (2 out of 7 vs. 15 out of 20, OR 7.5). Spontaneous resolution rate was also higher when ureteral diameter was 10 mm (OR 19.2). Surgical intervention rate was higher in the presence of ureteral diameter ≥14 versus 99m Tc‐MAG3 scintigraphy compared to those without surgical intervention. Conclusions: Initial management of asymptomatic non‐refluxing megaureters should be observational monitoring. Majority of them resolve spontaneously if ureteral diameter is <11 mm with renal pelvis anteroposterior diameter ≤10 mm. However, children with ureteral diameter ≥14 mm are prone to develop febrile urinary tract infection, renal scar, and decreased renal function requiring surgical intervention.

Serum alkaline phosphatase concentration rises in some disease states. On the other hand, benign transient hyperphosphatasemia is most commonly recognized in infants and children younger than 2 years of age. It has also been described in adults. Benign transient hyperphosphatasemia is a self-limiting condition that is usually accompanied by some infectious and allergic disorders. Therefore it is important to keep this entity in mind to avoid unnecessary investigations. Here, we report two children who were diagnosed with benign transient hyperphosphatasemia following gastroenteritis.

Background: As voiding cystourethrography is invasive and exposes to radiation and urinary tract infection (UTI), identifying only high-grade reflux is important. We aimed to identify clinical, laboratory and imaging variables associated with high-grade primary reflux in children presenting with UTIs and/or urinary tract dilatation and develop a prediction model for severe reflux. Methods: Data of children who underwent voiding cystourethrography due to UTI and/or urinary tract dilatation were retrospectively analyzed for demographic, clinical and imaging findings. Patients with severe (grades 4–5) reflux were compared with the rest for these parameters and a prediction model was developed for severe reflux. Results: The study included 1044 patients (574 female). Severe reflux was present in 86 (8.2%) patients. Age < 2 years, male sex, non-E. coli uropathogens, UTD-P3 dilatation and multiple kidney scars on DMSA scintigraphy were associated with severe reflux. Using these variables a prediction model for severe reflux with a score ranging from 0–7 and accuracy rate of 93.4% was developed. A score ≥ 5 had sensitivity 44.2%, specificity 97.4%, PPV 60.3%, NPV 95.1% and OR 29.5 for severe reflux. Scores ≥ 5 and ≥ 4 catch 44% and 73% of severe reflux, while prevent invasive voiding cystourethrography in 94.0% and 83.6% of patients, respectively. Conclusion: Age < 2 years, male sex, non-E. coli uropathogen growth, presence of UTD-P3 dilatation on ultrasonography and multiple scars on DMSA scintigraphy are risk factors for severe reflux. A scoring system based on these variables appears to be effective in predicting the presence of severe reflux and eliminating unnecessary voiding cystourethrography. Graphical

Amaç: Bu çalışmada, Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi’ndeki hekim ve hastalara uygulanan anketler ile hekim-hasta ilişkileri üzerinden hekimlik mesleğinin yıllar içindeki değer algısının değişip değişmediğini sorgulamak amaçlanmıştır. Yöntem: Tanımlayıcı ve kesitsel tipte planlanmış çalışmanın kapsamını 2022 Mayıs-Haziran aylarında üniversite hastanesinde çalışan 100 hekim ve hastaneye başvuran 100 hasta oluşturmaktadır. Hekim ve hastalara farklı sorular içeren memnuniyet anketleri uygulanmıştır. Hekimlere 13 soru yöneltilmiş olup genel memnuniyetleri ve yaşadığı olumsuzluklar sorulmuştur. Hastalara 17 soru yönetilmiş olup sağlık hizmetinin kalitesi ve hekimi ile ilgili düşünceleri sorulmuştur. Bulgular: Hekimlerin %93’ü, toplumun hekimliğe eskisi gibi saygılı bir tutum sergilemediği görüşündedir. Mevcut şartlarda hekimlik yapmak istemeyenlerin oranının %60 olduğu görülmüş olup şartların hekimlerin yurt dışında çalışma düşüncesinde de bir artışa yol açtığı saptanmıştır. %91’i maaşlarından memnun olmadığını, %68’i tatil sürelerini yeterli bulmadığını aktarmıştır. Hasta anketindeki sonuçlara bakıldığında hastaların, kendi hekimleri hakkındaki düşüncelerinin çok büyük bir kısmının oldukça olumlu olduğu görülmüştür. 19 yaş altındaki hastaların yaklaşık yarısının kendisini muayene eden doktorun yerinde kendisini görmek istediği görülmüştür. Doktorların sosyo-ekonomik durumları, çalışma koşulları bu duruma sebebiyet veren noktalar olarak gösterilmiştir. Sonuç: Hekimlerin yaşadığı sosyoekonomik sıkıntılar, şiddet olayları gibi unsurlar ve hastaların hastanedeki işleyiş kaynaklı yaşadığı problemler hekimlik mesleğinin ve hekimlerin değerinin toplum gözünde önceki yıllara göre olumsuz yönde bir değişime uğradığını göstermektedir.

Amaç: Böbrek ve idrar yollarının konjenital anomalileri (BİYKA) yenidoğanlarda en sık görülen doğum defektlerindendir. Bu çalışma ile çocukluk çağında önemli bir morbidite nedeni olan ve ilerleyen dönemde kronik böbrek hastalığına yol açabileceği düşünülen BİYKA tanısı için ebeveyn yaşının etkisi araştırıldı. Gereç- Yöntem: Bu retrospektif vaka kontrol çalışması Mart 2013-Şubat 2018 tarihleri arasında Dokuz Eylül Üniversitesi Tıp Fakültesi Çocuk Nefroloji Kliniği ile Sağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi Çocuk Kliniği’ne başvuran antenatal böbrek ve idrar yollarının konjenital anomalileri tanısı almış 714 hastanın bilgisayar tabanlı medikal kayıtları incelenerek yapılmıştır. Böbrek ve idrar yollarının konjenital anomalileri tipi (hidronefroz, ektopi, agenezi, multikistik displastik böbrek, çift toplayıcı sistem, üreteropelvik darlık, hipoplazi) ile doğum esnasındaki anne ve baba yaşları kaydedilmiştir. Kontrol grubunu ise aynı tarih aralığında doğan ve herhangi bir anomalisi olmayan sağlıklı infantlar oluşturmaktadır. Bulgular: Çalışmaya dahil edilen toplam 2178 olgunun 714’ü böbrek ve idrar yollarının konjenital anomalileri tanısı alan 1464’ü ise sağlıklı infantlardan oluşmaktaydı. Böbrek ve idrar yollarının konjenital anomalileri tanısı alan infantların anne ve baba yaş ortalamaları kontrol grubuna göre daha düşük saptandı. En sık tanı alan böbrek ve idrar yollarının konjenital anomalileri tipi hidronefrozdu (627 hasta, %87,8). Anne yaşı ile herhangi bir böbrek ve idrar yollarının konjenital anomalileri tipi arasında ilişki saptanmazken, hidronefroz ile baba yaşı arasında pozitif yönlü çok düşük düzeyde istatistiksel olarak önemli bir ilişki saptanmıştır (rho=0,08; p=0,032). Sonuç: Paternal yaş ve hidronefroz arasında düşük düzeyde istatistiksel anlamlılık saptanmıştır.

Many ventilator‐dependent children have comorbid conditions including urinary tract disorders. We aimed to present a focused review of the literature describing the causes and management of urinary system problems in children with long‐term home mechanical ventilation. We performed a literature search in PubMed/MEDLINE, Scopus, and Web of Science with keywords “children,” “home mechanical ventilation,” “urinary system,” “urinary tract,” “neurogenic bladder,” “clean intermittent catheterization,” “urinary tract infection,” “urolithiasis,” and “acute kidney injury.” We included original articles, reviews, guidelines, and case reports published in English. Ventilator‐dependent children may have neurogenic bladder/bowel dysfunction which renders them prone to urinary tract infection, high bladder pressure, vesicoureteral reflux, hydronephrosis, and renal dysfunction. These children require bladder catheterization, medications affecting parasympathetic/sympathetic nervous systems, or surgical procedures to prevent urinary infections, and to maintain continence and renal functions. However, bladder catheterization or surgical procedures like augmentation cystoplasty may also be complicated with urinary infections, urolithiasis, or urethral strictures. Urolithiasis frequency is also increased due to immobilization‐related hypercalciuria, hypocitraturia caused by antiepileptic drugs, urinary stasis, and urinary infections. On the other hand, mechanical ventilation can impair renal function by reduction of cardiac output, redistribution of intrarenal blood flow and stimulation of sympathetic and hormonal pathways. Children requiring long‐term invasive home mechanical ventilation may have other comorbid conditions, including urinary system diseases, which become manifest as these patients are being kept alive due to the advances in ventilation strategies. These children must be carefully observed for urological complications and managed accordingly to prevent kidney injury.

Objective: We aimed to evaluate MEFV mutation frequency and the effects of MEFV mutations on the clinical course including renal involvement in children with Henoch-Schonlein Purpura (HSP). Methods: Children with a diagnosis of HSP who were evaluated for the presence of MEFV mutations were enrolled in this study. Patients were primarily assigned into two groups based on the presence of MEFV mutations as Group 1 including patients without mutations and Group 2 including patients with mutations in at least one allele (heterozygous, homozygous, or compound heterozygous). We also investigated specifically the effects of M694V mutation on the course of HSP by comparing patients with M694V mutation in at least one allele with patients not carrying M694V mutation. Results: Forty-seven patients (23 female) were enrolled. MEFV mutation rate (53%) was 3.5 times the rate in general population. M694V was the most common mutation (48%). Patients with MEFV mutations, especially those with M694V mutation, had lower incidence of preceding infection, but increased inflammatory markers, scalp edema and relapse rate. Renal involvement and long-term prognosis were not affected by the presence of MEFV mutations. Conclusions: MEFV mutations cause susceptibility to develop HSP and are associated with increased inflammation and altered clinical course. However, renal involvement and long-term prognosis were not affected by the presence of MEFV mutations.