Esra Baskin

Renal artery stenosis is a rare but important cause of renovascular hypertension in children that may lead to malignant hypertension and renal failure. A 13-year-old girl presented with malignant hypertension and acute kidney injury, and imaging demonstrated occlusion of both renal arteries. Endovascular recanalization was unsuccessful because of complete, heavily fibrotic occlusions involving a long segment of the right renal artery extending to the hilum, leaving no suitable distal artery for reconstruction, and a 7.3-mm segment of the left renal artery at its aortic origin. To preserve renal function, surgical revascularization was performed by in situ reimplantation of the left renal artery into the aorta, without autotransplantation. Postoperatively, renal function recovered, the proteinuria present at admission regressed, and the patient became normotensive without antihypertensive medication.

Background: The urinary calcium-to-citrate (Ca/Cit) ratio has emerged as a useful indicator of lithogenic risk in older children; however, no reference data exist for infants and toddlers. This study aimed to evaluate whether the spot Ca/Cit ratio can distinguish stone-forming from non–stone-forming children under 24 months of age and to assess its diagnostic performance compared with conventional urinary markers. Methods: This retrospective single-center study included 181 children aged 1–24 months who underwent metabolic evaluation and ultrasonography at their first presentation to a tertiary pediatric nephrology clinic between 2012 and 2024. Based on urinary calcium excretion and ultrasonographic findings, participants were categorized as normocalciuric stone-free controls ( n = 57), hypercalciuric stone-formers ( n = 29), or non-hypercalciuric stone-formers ( n = 95). Spot urine calcium, citrate, and related biochemical ratios were analyzed. The diagnostic accuracy of the Ca/Cit ratio for predicting stones was assessed using receiver operating characteristic (ROC) analysis. Results: The Ca/Cit ratio differed significantly across groups, with the highest levels observed in hypercalciuric stone-formers (0.46 mg/mg) compared with controls (0.17 mg/mg; p < 0.001) and non-hypercalciuric stone-formers (0.31 mg/mg; p < 0.001). A Ca/Cit threshold > 0.23 mg/mg (≈ 1.10 mmol/mmol) demonstrated moderate diagnostic ability for stone detection (AUC 0.695; 95% CI 0.613–0.785), yielding 66.1% sensitivity and 63.2% specificity. Age showed no meaningful correlation with Ca/Cit values. Normocalciuric stone-free children provided an age-appropriate reference distribution for Ca/Cit ratios. Conclusions: In infants and toddlers evaluated for suspected urinary stone disease, the Ca/Cit ratio offers moderate discriminatory power and may serve as a practical adjunctive marker of stone risk. A ratio > 0.23 mg/mg (≈ 1.10 mmol/mmol) appears to indicate increased lithogenic potential. Larger prospective studies are needed to validate reference intervals and refine clinically applicable cut-off values for this young age group.

Objective: Kawasaki disease (KD) is an acute systemic vasculitis of childhood that may lead to coronary artery involvement (CAI) if not promptly treated. Early identification of laboratory predictors for coronary complications is essential. This study aimed to identify early laboratory predictors of coronary complications in KD, to help clinicians assess risk during the acute phase. Material and Methods: We retrospectively analyzed 38 pediatric KD patients. Clinical and laboratory data—including hemoglobin (Hb), hematocrit (Htc), white blood cell count (WBC), platelet counts (PLT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), liver enzymes, and Harada scores—were collected and compared between patients with and without CAI. Receiver operating characteristic (ROC) and logistic regression analyses were performed. Results: The mean age was 35.0±32.6 months, with 65.8% male. CAI was observed in 16 of 38 patients (42.1%). No statistically significant differences were found in the laboratory values at diagnosis between patients with and without CAI. Conclusion: Routine hematological and inflammatory markers at admission were not predictive of CAI in KD. These findings highlight the need for high clinical suspicion in incomplete cases and suggest that incorporating clinical features and risk scores may improve early risk stratification.

Objective: Urinary stone disease (USD) is characterized by stone formation in the urinary system with an approximate prevalence of 5%-10% in children. In thisr study, the authors investigated the metabolic abnormalities that play a role in stone formation in pediatric patients with USD admitted to the authors’ pediatric nephrology clinic during the last 10 years, the demographic characteristics of the patients, and the presenting symptoms. Materials and Methods: A total of 325 pediatric patients, 166 boys (51.1%) and 159 girls (48.9%), who presented to the Pediatric Nephrology outpatient clinic of the authors’ center with a prediagnosis of USD were retrospectively analyzed. Results: Of 325 patients, 159 (48.9%) were female and 166 (51.1%) were male. The median age at diagnosis was 29 (0-229) months. 188 (57.9%) of the patients had a positive family history of USD and 22 (6.8%) had parental consanguinity. Hypocitraturia was found in 26.2% and hypercalciuria in 17.5% of patients. Stones were detected in 198 patients (60.9%) in the initial ultrasonography (USG) evaluation. Stones were most commonly located in the renal pelvis (75.8%) followed by the ureter (10.1%) and both renal pelvis and ureter (3%). About 40.4% of the stones were located in the left side, bilaterally in 37.8%, and 21.2% in the right side. Conclusion: Urinary stone disease is common in children. Unlike adult patients, patients with a positive family history of USD and parental consanguinity necessitate further metabolic evaluation and should be investigated for underlying urinary tract infection. Identifying stone disease early in childhood can help us detect urinary tract and metabolic abnormalities earlier. Cite this article as: Dönger U, İncekaş C, Gülleroğlu SK, Baskın E. Pediatric urinary stone disease: A 10-year single-center experience from Türkiye. Turk Arch Pediatr. 2025;60(1):29-33.

Background/aimCongenital anomalies of the kidney and urinary tract (CAKUT) are characterized by renal developmental disorders in the embryonic period. STAT3 is a member of the STAT protein family. The members of this protein family play roles in various cellular mechanisms, such as the early stages of embryonic development, kidney development, and renal diseases. This study aims to determine the frequency of STAT3 rs1053004, rs744166, rs3816769, and rs4796793 polymorphisms in individuals with CAKUT disease.Materials and methodsTwo of the four polymorphisms, rs744166 (c.-1-13666T>C, NM_001369512.1) and rs4796793 ( c.-1915C>G, NM_001369512.1), were analyzed by a polymerase chain reaction and restriction fragment length polymorphism method (PCR-RFLP). Two other polymorphisms, rs1053004 (c.*1671C>T, NM_001369512.1) and rs3816769 (c.273+314A>G, NM_001369512.1), were analyzed by real-time PCR-melting curve analysis.ResultsOur research indicates that individuals with the TT allele for rs1053004 SNP have a 1.23 times greater risk of disease than those with the CC allele, and the CC allele for rs3816769 has a 1.41 times greater risk of disease than those with the TT allele. These findings suggest a potential genetic predisposition to CAKUT. Furthermore, our research has identified significant connections between rare haplotypes and CAKUT (p=0.041). The CCTC haplotype for rs744166, rs4796793, rs1053004, and rs3816769 polymorphism was exclusively present in the CAKUT group, while the CGTT haplotype for the same polymorphisms was solely detected in the control group.ConclusionThe presence of rare haplotypes for the rs1053004, rs3816769, rs4796793, and rs744166 polymorphisms may significantly affect the onset or prevention of CAKUT. These findings could potentially have important clinical implications, providing a deeper understanding of the genetic basis of CAKUT and potentially influencing future diagnostic and treatment strategies.

The reliability of blood-gas measurements compared with automated laboratory tests in providing rapid results for pediatric patients is currently under investigation. The compatibility between fast-response blood-gas tests and standard automatic laboratory tests remains a subject of debate. In this retrospective single-center study, our objective was to compare the measurements of hemoglobin and electrolytes obtained through blood-gas analysis with the corresponding values obtained from standard laboratory tests in pediatric renal transplantation, specifically focusing on the immediate pretransplant period. We retrospectively investigated 26 pediatric kidney transplant patients in the pretransplant period. We reviewed their medical records and compared and simultaneous measurements of hemoglobin, sodium, and potassium from a blood-gas analyzer versus a laboratory automatic analyzer. We assessed the agreement between the 2 analyses with BlandAltman analysis and Cohen kappa statistic. Among the 26 pediatric kidney transplant recipients, mean age was 10.1 ± 4.9 years and 60.0% were male patients. The mean differences between blood-gas and the venous laboratory analyzer (95% CI) were as follows: 0.11 g/dL for hemoglobin (-0.27 to 0.05 g/dL; P > .05), 0.39 mEq/L for sodium (-0.58 to 1.35 mEq/L; P > .05), and 0.00 mEq/L for potassium (-0.25 to 0.25 mEq/L; P > .05). Cohen kappa test showed the highest agreement for sodium, with no significant difference in mean values. Our study demonstrated strong agreement between hemoglobin, sodium, and potassium values obtained through blood-gas measurements and venous blood samples in pediatric kidney transplant recipients. Demonstrating the concordance between rapid blood-gas analysis and automated laboratory tests can offer valuable guidance to clinicians.

Amaç: Varisella, özellikle küçük çocuklarda potansiyel olarak ciddi komplikasyonları olan oldukça bulaşıcı bir hastalıktır. Türkiye’de su çiçeği aşısı, 2013 yılında 12 aylık bebekleri hedef alan Ulusal Suçiçeği Aşısı programına entegre edildi. Resmi olarak rapor edilen su çiçeği vakaları son yirmi yılda önemli ölçüde azalmış olsa da, eksik raporlama hala bir sorun olmaya devam ediyor. Bu çalışmada üçüncü basamak bir merkezde suçiçeği seropozitifliğinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Kalitatif bir immünolojik test olan enzim bağlantılı immünosorbent testi (ELISA), anti-varisella antikorlarını tespit etmek için kullanılmıştır. Türkiye’de ikamet eden 4-18 yaş arası bireylerden serum örnekleri toplandı. Aşı kayıtları, su çiçeği geçmişi ve hastalık bildirimine ilişkin bilgiler de toplanmıştır.Bulgular: Toplam 90 çocuğun su çiçeği IgG antikoru kayıtlarına erişildi. Çalışma popülasyonunda pozitif su çiçeği antikorlarının genel prevalansı %58.0 (n=47)’di. Seropozitiflik oranları 4-6 yaş grubunda %67.2, 7-12 yaş grubunda ise %30 olarak belirlendi. Özellikle 4-6 yaş grubu seropozitiflik ile yaş arasında anlamlı bir ilişki gösterdi [p=0.005; OR=4.85; 95%CI (1.614-14.569)].Sonuç: Suçiçeği için %58’lik seropozitiflik oranı endişe vericidir. Bunun ışığında daha kapsamlı çalışmaların yapılması değerli bir yol gösterici olacaktır. 4-6 yaş aralığında ek doz su çiçeği aşısı yapılması düşünülebilir. Böyle bir aşılama stratejisinin uygulanmasının potansiyel faydalarını ve fizibilitesini değerlendirmek için daha fazla araştırma yapılması gerekmektedir.

Objectives: Solid- organ transplant recipients are at an increased risk of severe infections due to their immunosuppressed state. Despite the recommendation of routine screening and vaccination before transplant to mitigate this danger, vaccination rates in these patients are still below desirable levels. We aimed to investigate the prevalence of positive antibody rates for measles, mumps, rubella, and varicella among children who are candidates for renal transplant. Materials and Methods: This retrospective study was conducted at a single center and included 144 pediatric kidney transplant patients for the past 7 years. We reviewed the medical records of all participants to evaluate their serologic status for measles, mumps, rubella, and varicella viruses before kidney transplant. Results: In this study, 144 pediatric kidney transplant candidates (mean age 11.5 years, 56.9% male) were enrolled, and the most frequent causes of the chronic renal disease were congenital anomalies of the kidney and urinary tract and glomerular diseases (32.6%). Seropositivity rates for measles, mumps, rubella, and varicella were 59.0%, 31.9%, 46.5%, and 43.6%, respectively, and all patients who tested negative for antibodies were vaccinated before transplant. Younger age at transplant (OR = 0.909, 95% CI = 0.840-0.923; P =.017) and congenital anomalies of the kidney and urinary tract (OR = 3.46, 95% CI = 1.1548-7.735; P =.002) were significantly associated with increased measles seropositivity, although no significant associations were observed for the other viruses. Conclusions: We observed lower seropositivity rates for measles, mumps, rubella, and varicella in pediatric kidney transplant patients versus healthy children and other previous studies. It is essential to address these suboptimal rates to protect the health of these vulnerable patients. Future research should focus on targeted interventions to improve vaccination rates and outcomes in this population.

Background: Literature supports the protective role of mineralocorticoid antagonist (MRA) against the renal injury induced by aldosterone in kidney transplant recipients. However, there is limited data available regarding the safety and efficacy of MRAs in pediatric renal transplant patients. Therefore, we aimed to investigate the effect of long‐term eplerenone administration in children with chronic allograft nephropathy (CAN).Methods: Twenty‐six renal transplant children with biopsy‐proven CAN, an estimated glomerular filtration rate (eGFR ) > 40 mL/min per 1.73 m² and with a significant proteinuria were included. Selected patients were randomly divided into two groups as follows; Group 1 (n = 10) patients received 25 mg/day eplerenone and Group 2 (n = 16) patients did not receive eplerenone for 36 months. Patients were examined in the renal transplant outpatient clinic biweekly for the first month and once a month thereafter. The primary outcome of the patients was compared.Results: Mean eGFR stayed stable in group 1 patients, but significantly decreased in group 2 at 36 months (57.53 ± 7.53 vs. 44.94 ± 8.04 mL/min per 1.73 m², p = .001). Similarly, spot protein–creatinine ratio was significantly lower in group 1 compared to group 2 patients at 36 months (1.02 ± 7.53 vs. 3.61 ± 0.53, p < .001). Eplerenone associated hyperkalemia was not observed in group 1 patients (4.6 ± 0.2 vs. 4.56 ± 0.3, p = .713).Conclusion: The long‐term eplerenone administration blunted the chronic allograft nephropathy by maintaining a stable eGFR levels and decreasing urine protein–creatinine ratio. Eplerenone associated hyperkalemia was not observed in our study.