Burcu Yazıcıoğlu

Background: Limited data exist on rehospitalization in paediatric dialysis patients. The objective of this study was to identify indications, rates and risk factors for 30-day readmissions in this population. Methods: We used a prospective multinational, multicentre cohort study of haemodialysis (HD) and peritoneal dialysis (PD) patients discharged between July 2017 and July 2018. Readmission was identified as repeat hospitalization within 30 days of a prior (index) admission. Potentially preventable readmissions were clinically related to the initial admission. Early readmissions were those occurring within 7 days of discharge. The primary outcome was 30-day readmission. Secondary outcomes included potentially avoidable and early readmissions. Results: A total of 54 (31%) of 176 patients (102 PD, 74 HD) had at least one readmission; 84 (18%) discharges were followed by readmission. PD and HD patients had similar readmission rates {30.4% versus 31.1%; hazard ratio [HR] 1.06 [95% confidence interval (CI) 0.61–1.81]}. Compared with PD, HD patients had a significantly shorter time to readmission (8 versus 14 days; P = .019), higher early readmission rates (46% versus 18%; P = .010) and risk [odds ratio (OR) 3.87 (95% CI 1.35–11.11)]. Main readmission causes were dialysis access–related non-infectious complications (31%) and access infections (22.7%); 47% of readmissions were potentially avoidable. Lower haemoglobin levels were linked to readmission [HR 0.78 (95% CI 0.64–0.95)]. Bicarbonate use was associated with a 51% lower readmission risk [HR 0.49 (95% CI 0.24–0.99)]. Neurological comorbidity [OR 7.00 (95% CI 1.04–47.22)] and partial recovery [OR 56.45 (95% CI 3.02–1053.10)] were risk factors for avoidable readmission. Risk of avoidable and early readmission decreased with age [OR 0.98 (95% CI 0.97–0.99) and OR 0.99(95%CI 0.98–0.99), respectively]. Conclusions: Readmissions are common in paediatric dialysis patients, with a substantial proportion being potentially preventable. To reduce rehospitalizations, interventions should target modifiable factors such as access complications, anaemia and incomplete recovery at discharge, while recognizing non-modifiable risks like HD and younger age to identify high-risk patients.

Objective: Vesicoureteral reflux (VUR) is a prevalent congenital anomaly in children, with a higher incidence in those with febrile urinary tract infections. Early detection and management of VUR are crucial to prevent reflux nephropathy and its associated complications. This retrospective observational study aimed to evaluate the accuracy and advantages of ultrasonography (USG) in diagnosing VUR grade compared to voiding cystourethrography (VCUG), the gold standard. Material and Methods: The study included 147 children aged 0-5 years who underwent VCUG for urinary tract infections, as well as antenatal and postnatal hydronephrosis. Patients were categorized into two age groups: 0-24 months (Group 1) and 25-60 months (Group 2). USG findings, including parenchymal thickness, renal pelvis anteroposterior diameter, renal parenchymal echogenicity, and distal ureteral dilatation, were compared between low-grade and high-grade VUR in both groups. Results: Binary logistic regression analysis revealed that renal pelvis anteroposterior diameter and distal ureteral dilatation were independently associated with high-grade VUR in Group 1. The optimal cut-off value of renal pelvis anteroposterior diameter for predicting high-grade VUR was 5 mm, with 78.0% sensitivity and 76.0% specificity. However, no USG findings were independently associated with high-grade VUR in Group 2. Conclusion: USG examinations performed by experienced radiologists can effectively decrease radiation exposure in children, especially those with high-grade VUR under two years of age, and may prevent unnecessary radiation exposure in some pediatric patients

Background and hypothesis: Hospital admissions in pediatric dialysis patients need to be better studied, and most existing studies are retrospective and based on registry data. This study aimed to analyse and compare hospital admission rates, causes, length of stay (LOS), and outcomes in children treated with peritoneal dialysis (PD) and hemodialysis (HD). Methods: Data from 236 maintenance PD and 138 HD patients across 16 European dialysis centers were collected between 1 July 2017 and 30 June 2018. A total of 178 hospitalized patients (103 PD, 75 HD) were included for further analyses. Results: There were 465 hospitalization events (268 PD, 197 HD) with a rate of 0.39 admissions per 100 patient-days at risk (PDAR) and 2.4 hospital days per 100 PDAR. The admission rates were not significantly different between HD and PD patients. The most common causes of hospitalization were access-related infections (ARI) (17%), non-infectious complications of access (NIAC) (14%), and infections unrelated to access (12%). ARI was the leading cause in PD patients (24%), while NIAC was more common in HD patients (19%). PD patients had more ARIs, diagnostic procedures, and treatment adjustments (P < .05), while HD patients had more NIACs, infections unrelated to access, access placement procedures, and interventional/surgical procedures (P < .001). LOS was longer with acute admissions than non-acute admissions (P < .001). Overall LOS and LOS in the intensive care unit were similar between HD and PD patients. High serum uric acid and low albumin levels were significant predictors of longer LOS (P = .022 and P = .045, respectively). Young age, more significant height deficit, and older age at the start of dialysis were predictors of longer cumulative hospital days (P = .002, P = .001, and P = .031, respectively). Conclusion: Access-related complications are the main drivers of hospitalization in pediatric dialysis patients, and growth and nutrition parameters are significant predictors of more extended hospital stays.

Çocuklarda idrar çıkışının azalması (oligüri ve anüri), akut böbrek hasarının erken teşhisinde kreatinin seviyelerinden daha hızlı sonuç veren kritik bir göstergedir. Bu durum prerenal (dehidratasyon, hipovolemi), renal (parankim hasarı) veya postrenal (obstrüksiyon) nedenlerden kaynaklanabilir ve tanıda pRIFLE ile KDIGO gibi standart evreleme kriterleri kullanılır. Tedavi sürecinde sıvı dengesinin sağlanması, elektrolit bozukluklarının giderilmesi ve altta yatan etiyolojinin hızlıca belirlenmesi hayati önem taşır. Reduced urine output in children (oliguria and anuria) is a critical indicator for early diagnosis of acute kidney injury, providing more immediate results than creatinine levels. This condition can stem from prerenal (dehydration, hypovolemia), renal (parenchymal damage), or postrenal (obstruction) causes, and diagnosis relies on standardized staging criteria such as pRIFLE and KDIGO. In the treatment process, maintaining fluid balance, addressing electrolyte imbalances, and rapidly identifying the underlying etiology are of vital importance.

Çocuklarda Döküntülü Hastalıklara Yaklaşım Eda GÜL ŞAHİN Bebeklerde ve Çocuklarda Uzamış Ateş Metin YİĞİT Çocukluk Çağında Epistaksis Handan ATSIZ SEZİK Öksürük Yasemin KORKUT KURTOĞLU Hırıltılı, Hışıltılı Solunum Merve KOŞUCU Çocuk ve Adölesanlarda Göğüs Ağrısı Fatma HAYVACI CANBEYLİ Çarpıntı Münevver YILMAZ Bulantı ve Kusma Önder SEZER Çocukluk Çağı Karın Ağrılarına Yaklaşım Gökçe İŞCAN Çocukluk Çağı İshalleri Zeynep AŞIK Çocuklarda Konstipasyon Emel PEKER Serkan ÇALIŞ İdrarda Renk Değişiklikleri Burcu ŞİRİN Poliüri Özlem AYNAOĞLU HAKVERDİ Oligüriler, Anüriler Burcu YAZICIOĞLU Çocukluk Çağında İdrar Kaçırma: Enürezis Başak KORKMAZER Enkoprezis Meltem GÜMÜŞ Gastrointestinal Sistem Kanamalarına Yaklaşım Serap ÖKSÜZ Kulak Ağrısı Müjgan KAYA TUNA Ödem Deniz DÖNMEZ EVİNÇ Lenfadenopati Seda ARAS Perianal Yakınmalar Alparslan KAPISIZ Cem KAYA Zafer TÜRKYILMAZ Ramazan KARABULUT Kaan SÖNMEZ Kırmızı Göz Esin Tunca KIRIKKAYA Skrotal Yakınmalar Cem KAYA Alparslan KAPISIZ Zafer TÜRKYILMAZ Ramazan KARABULUT Kaan SÖNMEZ Baş Ağrısı Melek ÖZARSLAN Boğaz Ağrısı Sibel BAKTIR ALTUNTAŞ Ekstremite Ağrıları Aksanur GÖKÇE Febril Konvülziyon Özlem ÖZSOY Senkop Şenay AKBAY Erken Ergenlik Setenay Dilara ÖZDEMİR Geç Puberte Aybüke DEMİR ALSANCAK Çocukluk Çağında Düşmeler Savaş SEZİK Yanık Kerem YILMAZ İştahsız Çocuk Halime Seda KÜÇÜKERDEM Laden JAFERİ

Background Coronavirus disease-2019 (COVID-19) has been challenging for patients and medical staff. Radical changes have been needed to prevent disruptions in patient care and medical education. Methods A web-based survey was sent to European Society for Pediatric Nephrology (ESPN) members via the ESPN mailing list to evaluate the effects of the COVID-19 pandemic on delivery of pediatric nephrology (PN) care and educational activities. There were ten questions with subheadings. Results Seventy-six centers from 24 countries completed the survey. The time period was between the beginning of the pandemic and May 30, 2020. The number of patients admitted in PN wards and outpatient clinics were significantly decreased (2.2 and 4.5 times, respectively). Telemedicine tools, electronic prescriptions, online applications for off-label drugs, and remote access to laboratory/imaging results were used in almost half of the centers. Despite staff training and protective measures, 33% of centers reported COVID-19 infected staff, and 29% infected patients. Difficulties in receiving pharmaceuticals were reported in 25% of centers. Sixty percent of centers suspended living-related kidney transplantation, and one-third deceased-donor kidney transplantation. Hands-on education was suspended in 91% of medical schools, and face-to-face teaching was replaced by online systems in 85%. Multidisciplinary training in PN was affected in 54% of the centers. Conclusions This survey showed a sharp decline in patient admissions and a significant decrease in kidney transplantation. Telemedicine and online teaching became essential tools, requiring integration into the current system. The prolonged and fluctuating course of the pandemic may pose additional challenges necessitating urgent and rational solutions. Graphical abstract