Aim
Febrile urinary tract infection is a common bacterial infection in childhood. The kidney damage after acute pyelonephritis (APN) could be related to the stimulation of the proinflammatory ...response. We aimed to investigate the role of inflammatory cytokines and the effect of dexamethasone after a first episode of APN.
Methods
Subanalysis of the DEXCAR RCT in which children with confirmed APN (1 month–14 years) were randomly assigned to receive a 3 days course of either intravenous dexamethasone or placebo. Urinary cytokine levels at diagnosis and after 72 h of treatment were measured.
Results
Ninety‐two patients were recruited. Younger patients, males and those with abnormalities in the ultrasound study or vesicoureteral reflux showed higher values of urinary cytokines. Patients with severe APN had higher Tumour Necrosis Factor (TNF)α levels (81.0 ± 75.8 vs. 33.6 ± 48.5 pg/mg creatinine, p = 0.015). Both intervention groups showed similar basal clinical characteristics, including urinary cytokine levels. Treatment reduced urinary cytokine levels irrespective of dexamethasone administration. Neither the intervention group nor the urinary cytokine levels modulated the development of kidney scars.
Conclusion
Basal urinary cytokines were associated with age, abnormal ultrasound and vesicoureteral reflux. Patients with severe APN had higher TNFa urinary levels. Administration of dexamethasone in children with APN does not improve the control of the proinflammatory cytokine cascade.
Hypertension is a public health issue that can have its origin in the early phases of development. Maternal smoking during pregnancy (MSDP) could play a role in offspring's cardio-metabolic ...programming. To assess the relationship between MSDP and later blood pressure (BP) in children we conducted a secondary analysis of a randomized dietary intervention trial (EU-Childhood Obesity Project). Healthy term infants with normal birth weight were recruited during the first 8 weeks of life in 5 European countries and followed until 11 years of age. Data on MSDP was collected at recruitment. BP and anthropometry were assessed at 11 years of age. Children were classified according to AAP guidelines as normal BP: BP < 90th percentile; high BP: ≥ 90th percentile with the subset of children having BP > 95th percentile categorized as hypertensive. Out of 572 children, 20% were exposed to MSDP. At 11 years, 26.8% had BP over the 90th centile. MSDP beyond 12 weeks of gestation was associated with higher systolic BP percentile (adjusted B 6.935; 95% CI 0.454, 13.429; p = 0.036) and over twofold increase likelihood of hypertension (OR 2.195; 95% CI 1.089, 4.423; p = 0.028) in children at 11 years. MSDP was significantly associated with later BP in children.
High protein intake has been associated with kidney hypertrophy, which is usually reversible; however, when it occurs early in life, it could lead to cell programming with a long-lasting effect. This ...study aimed to assess whether higher protein ingestion early in life has a persistent effect on kidney volume at 11 years of age, as well as its influence on blood pressure. This is a secondary analysis of a randomized control trial that compared the growth of infants fed with a higher-protein formula versus those fed with a lower-protein formula, with a control group of breastfed infants. Renal ultrasound and anthropometric measurements were assessed at 6 months and 11 years of age. At 11 years, urinary protein, albumin and creatinine, and blood pressure were measured in 232 children. Feeding with a higher-protein formula was associated with a larger kidney volume (β = 8.71, 95%CI 0.09-17.33,
= 0.048) and higher systolic blood pressure (β = 3.43, 95%CI 0.78-6.08,
= 0.011) at 11 years of age. Microalbuminuria was detected in 7% of the patients, with no differences among groups (
= 0.56). The effect of increased protein ingestion early in life may condition kidney volume and blood pressure in later childhood.
Background
Urinary tract infection (UTI) is one of the most common bacterial infections in childhood and is associated with long-term complications. We aimed to assess the effect of adjuvant ...dexamethasone treatment on reducing kidney scarring after acute pyelonephritis (APN) in children.
Methods
Multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial (RCT) where children from 1 month to 14 years of age with proven APN were randomly assigned to receive a 3-day course of either an intravenous corticosteroid (dexamethasone 0.30 mg per kg/day) twice daily or placebo. The late technetium 99 m-dimercaptosuric acid scintigraphy (> 6 months after acute episode) was performed to assess kidney scar persistence. Kidney scarring risk factors (vesicoureteral reflux, kidney congenital anomalies, or urinary tract dilatation) were also assessed.
Results
Ninety-one participants completed the follow-up and were finally included (dexamethasone
n
= 49 and placebo
n
= 42). Both groups had similar baseline characteristics. Twenty participants showed persistent kidney scarring after > 6 months of follow-up without differences in incidence between groups (22% and 21% in the dexamethasone and placebo groups,
p
= 0.907). Renal damage severity in the early DMSA (β = 0.648,
p
= 0.023) and procalcitonin values (β = 0.065
p
= 0.027) significantly modulated scar development. Vesicoureteral reflux grade showed a trend towards significance (β = 0.545,
p
= 0.054), but dexamethasone treatment showed no effect.
Conclusion
Dexamethasone showed no effect on reducing the risk of scar formation in children with APN. Hence, there is no evidence for an adjuvant corticosteroid treatment recommendation in children with APN. However, the study was limited by not achieving the predicted sample size and the expected scar formation.
Trial registration
Clinicaltrials.gov, NCT02034851. Registered in January 14, 2014.
Graphical abstract
“A higher resolution version of the Graphical abstract is available as Supplementary information.”
The aim of this study is to determine whether during the year 2020, coinciding with the COVID-19 pandemic, there has been an increase in the incidence of diabetes mellitus in children compared to the ...previous 2 years. It is also to find out if lockdowns and the difficulty providing face-to-face care in the health system have led to children showing more severe symptoms at the time of diagnosis.
Retrospective observational multicenter study of the province of Tarragona where data is collected from new diagnoses of type 1 diabetes mellitus in patients under the age of 15 during the year 2020 and compared with years 2018 and 2019.
The number of new diagnoses of type 1 diabetes during 2020 was 37 cases compared to 2019 and 2018 which was 23 and 29 respectively. The median age at onset was 9 years, 54% males. There was an increase in new diagnoses in the range of 10 to14-year-olds, with a decrease in the range of 0–4 year-olds. In 2020, the incidence in the group of patients with families from the Maghreb area rose from 52.2 cases per 100,000 population/year (c/105 p-y) in 2019 to 135.8 in 2020. Compared to the previous year, 2020 showed a significant decrease of ketoacidosis at the onset. None of the patients was diagnosed with COVID-19 during admission.
During the year 2020 concurring with the COVID-19 pandemic, there was an increase in the number of new diagnoses of type 1 diabetes mellitus in pediatrics. Contrary to expectations, the presentation did not worsen by decreasing the proportions of ketoacidosis at onset. This data would suggest that, although attendance in the different health facilities dropped drastically during the year 2020 at the expense of virtual consultations, health systems and families were able to detect the symptoms of the disease early.
El objetivo de este estudio es determinar si durante el año 2020 coincidiendo con la pandemia COVID-19 ha habido un incremento en la incidencia de diabetes mellitus en la infancia respecto a los últimos 2 años. Debido al confinamiento domiciliario y la dificultad en la asistencia presencial en los centros de salud se analiza si han debutado con síntomas más graves.
Estudio retrospectivo observacional multicéntrico de la provincia de Tarragona donde se recogen los datos de los nuevos diagnósticos de diabetes mellitus tipo 1 en pacientes menores de 15 años durante el año 2020 y se comparan con los años 2018 y 2019.
El número de nuevos diagnósticos de diabetes mellitus tipo 1 durante el año 2020 fue de 37 casos en comparación con los años 2019 y 2018 que fueron de 23 y 29 respectivamente. La mediana de edad al debut fue de 9 años, 54% varones. Hubo un incremento de debuts en la franja de 10 a 14 años con una disminución en el rango de 0 a 4 años. En el año 2020 hubo un aumento de la incidencia en el grupo de pacientes con familias procedentes de la zona del Magreb, desde 52,2 en 2019 a 135,8 casos/100,000 habitantes y año (c/105 h-a) en 2020, especialmente en el subgrupo de 10 a 14 años. Respecto al año anterior, en 2020 se evidenció una disminución importante de niños al debut con cetoacidosis. Ninguno de los pacientes fue diagnosticado de COVID-19 durante el ingreso.
Durante el año 2020 coincidiendo con la pandemia COVID-19 hubo un incremento en el número de nuevos diagnósticos de diabetes mellitus tipo 1 en pediatría. Al contrario de lo esperado, la forma de presentación no empeoró, disminuyendo las presentaciones en forma de cetoacidosis. Este dato sugeriría que, aunque la presencialidad en los diferentes centros de salud bajó de manera drástica durante el año 2020 a expensas de las consultas virtuales, los sistemas de salud y las familias supieron detectar de manera precoz los síntomas de la enfermedad.
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