Juvenile idiopathic arthritis (JIA), one of the most common chronic inflammatory diseases in childhood, may affect cardiovascular health. We aimed to compare non-invasive markers of arterial stiffness (AS) in children with JIA and healthy children. This was a cross-sectional study of patients with non-systemic JIA with a disease duration of 6 months or longer at the time of enrollment, along with healthy children. Peripheral and central blood pressure (BP), pulse wave velocity (PWV), and augmentation index (AIx) were obtained with an ambulatory BP device. Left ventricular function was evaluated with echocardiography. A total of 46 patients with JIA and 65 healthy children were included. The age, gender, SDSs of height, body weight, and body mass index were similar between groups. Peripheral systolic and diastolic BPs, mean arterial pressure, central systolic and diastolic BPs, and central pulse pressure measurements were significantly higher in the patient group (p < 0.05). While the AIx was comparable, the PWV was significantly higher in the patients. There were no differences between left ventricular functions. The patient and physician assessments on visual analogue scales were not correlated with any of the cardiovascular indices. Neither disease activity nor corticosteroid treatment was associated with PWA measurements in the patient group. Higher PWV was independently associated with age and SBP, and not with other variables included in the model. Conclusion: We found that children with non-systemic JIA exhibit higher PWV and peripheral and central BPs, which may be associated with an increased risk of future structural changes. Further research with larger cohorts is needed to confirm cardiovascular implications in JIA patients..

OBJECTIVES:Headache is a common complaint in children and may indicate early hypertension (HT), an emerging concern in pediatrics. Children with primary headache (PH) may exhibit elevated blood pressure (BP) load or impaired nocturnal dipping despite normal office BP. This study aimed to evaluate the utility of ambulatory blood pressure monitoring (ABPM) in children with PH. METHODS:A case-control study was conducted including 37 children aged 8-17 years diagnosed with PH according to the International Classification of Headache Disorders (ICHD-3) criteria, all with office BP below the 95th percentile. Thirty-seven age- and sex-matched healthy subjects served as controls. Demographic, office BP, and ABPM parameters were compared between groups. RESULTS:Of the PH group, 81% (n = 30) had migraines and 19% (n = 7) had tension-type headache. No significant differences were found between groups regarding age, BMI SDS, or office systolic BP SDS. However, ABPM revealed significantly higher total, daytime, and nocturnal systolic BP, and increased nocturnal systolic and diastolic BP loads in the PH group (all p < 0.05). No differences were noted between headache subtypes. CONCLUSION:Children with PH may exhibit increased BP loads and disrupted BP patterns despite normal office measurements. ABPM appears to be a useful tool for accurately detecting subtle BP alterations in this population.

BACKGROUND:Immunoglobulin M nephropathy (IgMN) is a pathological term defining glomerulonephritis with IgM deposition. The clinical significance is still a matter of debate. The aim was to evaluate children with IgM nephropathy (IgMN) in terms of clinical and pathological features, along with treatment responses and outcomes. MATERIALS AND METHODS:The children with idiopathic nephrotic syndrome (INS) who underwent kidney biopsy at our center (n=41) were evaluated retrospectively. Twenty-one children with IgMN were included. RESULTS:The female to male ratio was 0.9, the median age was 3.5 years in the study group. The mean disease duration and follow-up periods were 11.8 and 11.3years, respectively. At admission, 14% of the patients had hypertension, and 19% had microscopic hematuria. Steroid-dependent nephrotic syndrome (SDNS) was observed in 62% of the patients at admission and 81% at last visit. The patients with IgM (≥2+) depositions had more SDNS than those with IgM (1+). The most common light microscopic diagnosis was mesangial proliferative glomerulonephritis (MesPGN) (47.6%). Focal segmental glomerulosclerosis (FSGS) elevated significantly from 14% at initial biopsy to 57% at follow-up biopsies. Patients who progressed to FSGS mostly had C3 co-deposition, high IgM intensity (≥2+), diagnosis of MesPGN, and SDNS clinic. The most frequently used adjuvant agent was cyclosporine-A (n=19) with mean duration of 68 months. It provided lower relapse rates. Rituximab (n=4) showed 75% remission rate. None of the patients had needed renal replacement treatment. Two patients who were steroid-resistant at admission had FSGS in their first biopsies, acted as multi-drug resistance at follow-up, and ended up in Stage-2 chronic kidney disease (CKD). CONCLUSION:This study shows IgMN is mainly presented with SDNS clinic and MesPGN pathology. Evolution to FSGS may be related to steroid resistance, MesPGN, high IgM intensity, and C3 co-deposition.

Background: The earthquake on February 6, 2023, significantly impacted Türkiye, affecting 13.5 million individuals and resulting in substantial damage and loss of life, including among children. Due to the high number of cases, earthquake-affected children who received initial medical intervention were transferred to various hospitals for further treatment. In our study, we aimed to evaluate the socio-demographic and clinical characteristics of earthquake-affected children who received treatment in our hospital. Materials and Methods: The study included children admitted to our hospital either through referral or outpatient assessment. Socio-demographic data on age, gender, place of residence, reason for admission, duration of entrapment, rescue method, loss of first-degree relatives, presence of a companion, and discharge status were collected. Descriptive statistical methods were used for analysis. Results: Between February 9 and March 2, 2023, 42 pediatric patients were hospitalized at a tertiary care center in İzmir. The mean age was 8.3±4 years, with 23 (54.8%) being male. The average duration under the wreckage was 28.60±26.87 hours (range: 1-105 hours). Among 33 children trapped, 17 (51.5%) were rescued by official teams, while 16 (48.5%) were extricated by civilians or relatives. Seventeen children (40.4%) who had no accompanying relatives were cared for by hospital staff. First-degree relative loss was reported in 24 (29.16%) cases. Fasciotomy was required in 14 (42.4%) children, and six (18%) underwent amputation. No significant correlation was found between entrapment duration and the need for amputation, fasciotomy, or dialysis. The mean hospitalization period was 33 days (range: 6-84). Following discharge, 29 (70.7%) children were unable to return home. Conclusion: Although the study represents a limited sample, the displacement of many children highlights significant social challenges. Beyond medical treatment, long-term housing solutions and psychological support remain critical components of post-disaster care for pediatric patients.

Objective: Since with chronic kidney disease (CKD) is an inflammatory process, and disorders of uremia, calcium, and phosphorus metabolism are associated with cardiovascular disease (CVD), patients CKD are at high risk for developing CVDs. This study aims to evaluate epicardial adipose tissue (EAT) parameters which play an active role in the development of CVD and atherosclerosis in patients with CKD. Method: Twenty-seven CKD patients aged 0-18 and their age -matched 15 control patients were compared. Physical examination and laboratory findings of the patient group were recorded. Both groups evaluated EAT with M-mode echocardiographic measurements. Results: There was no difference between the 2 groups in terms of age, gender, and body mass index. EAT1, and EAT2 values were higher in the patient group, and these two measurements increased correlatedly as the CKD stage increased. Additionally, the correlation of EAT with blood phosphorus level and parathyroid hormone was evaluated. Conclusion: Cardiovascular morbidity and mortality are high in CKD. Therefore, early diagnosis is important. Evaluations of EAT and follow-ups at certain intervals can give us information in this sense as a non-invasive parameter.

INTRODUCTION:The incidence of infantile urolithiasis (IU) has been rising, attributed to factors such as climate change, the widespread use of ultrasonography, dehydration, and alterations in nutritional practices. Studies investigating the influence of infant feeding practices on stone formation remain limited. OBJECTIVES:This study aims to identify the risk factors associated with stone formation in infants and to evaluate whether formula feeding influence the development of IU. STUDY DESIGN:Infants aged 1-12 months who were diagnosed with IU and followed up at pediatric nephrology clinics in 19 centers across Türkiye between January 2022 and January 2024 were included in the patient group. Healthy infants served as the control group. A structured questionnaire assessing nutritional, demographic, and clinical characteristics was administered to both groups. A comparative analysis was conducted between the patient and control groups. RESULTS:Among the 1.094 infants included in the study, 45.7 % (n = 500) comprised the patient group, while 54.3 % (n = 594) were in the control group. A history of urinary tract infection, family history of urolithiasis and stone surgery, and vitamin D supplementation were significantly more common in the patient group compared to the control group (p = 0.006, <0.001, <0.001, and <0.001, respectively). Urine densities ranging from 1010 to 1020, as well as those greater than 1020, were more frequently observed in the patient group than in the control group (30.3 % vs. 20.1 % and 5.9 % vs. 0.4 %, respectively. Exclusively formula feeding (OR = 1.96 [1.094-3.521], p = 0.024), vitamin D consumption (OR = 3.994 [2.348-6.793], p < 0.001), and a family history of stone surgery (OR = 2.423 [1.457-4.027], p = 0.001), were identified as independent risk factors for stone formation. DISCUSSION:Türkiye is an endemic region for urolithiasis due to factors such as a high animal-based diet and a hot climate. Urolithiasis is reported to affect 10-20 % of children, with infantile urolithiasis accounting for 9-23 % of this incidence. This study represents the largest case series on infantile urolithiasis, investigating the impact of nutrition on its development. CONCLUSIONS:Exclusive breastfeeding should be encouraged, as it serves as a protective factor against stone formation in infants. Preventing dehydration is also essential. Infants receiving vitamin D supplementation, as well as those with a family history of urolithiasis or stone surgery, should be closely monitored for the potential development of urinary stones.

Objective: In post-transplant period, glucose metabolism is altered mostly due to immunsupressive agents and fast weight gain. Insulin resistance, impaired glucose tolerance test results and new onset diabetes after transplantation are detected pathologies. Moreover, this altered glucose metabolism could be a cause of cardiovascular complications, deterioration of graft problems and morbidities. Early detection and appropriate treatment plan have importance to reduce risk and complication rate. In this study, we aimed to assess glucose metabolism changes in children between pre-and post-transplantation period. Methods: We conducted a retrospective study with the clinical and laboratory findings of 36 pediatric kidney transplant patients in our clinic. Last laboratory assesment before transplantation and also, clinical and laboratory parameters in post-transplant period were taken from evaluation records according to our annually assessment protocol. Results: In 9 (25%) patients have altered glucose metabolism (new onset diabetes mellitus after transplantation in 2 patients, insulin resistance in 3 patients, glucose intolerance in 4 patients). There was a positive corelation between age, being on chronic periton dialysis programme, the need for insulin treatment in perioperative and first 24 hours in post-transplant period, low glomerular filtration rate, high body mass index, begining of puberty and new onset diabetes mellitus after transplantation, insulin resistance and glucose intolerance (p<0.05). Conclusion: In conclusion, altered glucose metabolism in pediatric kidney transplant patients is an important co-morbidity. We believe that risk assessment for glucose metabolism disorders should be start before transplantation and continued annually after transplantation.

BACKGROUND:The two strongest earthquakes in Turkey for eight decades hit Kahramanmaraş province on February 6, 2023. This study aimed to determine psychiatric complaints, acute stress symptoms, anxiety, depression, and sleep characteristics in children who were treated in a tertiary inpatient pediatric unit after the earthquakes. They were evaluated in the fourth week after the earthquake. METHODS:Trauma experiences and acute stress disorders were evaluated by child and adolescent psychiatrists, sleep characteristics were examined by the Child Sleep Habits Questionnaire (CSHQ), and the anxiety and depressive symptoms were investigated using the Revised Child Anxiety and Depression Scale (RCADS). Forty-two patients aged 1-17 were included. RESULTS:Trauma experiences and acute stress disorder symptoms were similar for all age groups examined. There were no significant differences in RCADS or CSHQ scores based on age or gender groups. There were significant differences in RCADS scores when the children were grouped as having parental loss or not and, similarly, there were significant differences in sleep anxiety and resistance to bedtime in CSHQ between these children. CONCLUSION:This research offered baseline findings about psychological outcomes after these earthquakes in child survivors, and it may provide a further basis to assess the effect of psychological interventions after earthquakes. These results may offer a foundation for suitable psychological interventions for children in developing countries.

ABSTRACT Background Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related–acute kidney injury (Crush-AKI) and death. Method Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded. Results A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of >120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000–3000 mL/m2 body surface area (BSA), 40% at 3000–4000 mL/m2 BSA and only 2% at >4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age >15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume <3000–4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. Conclusions These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000–4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.

Objective: We aimed to evaluate the clinical significance of the "unclassified" blood pressure phenotypes on left ventricular hypertrophy in children. Materials and Methods: All children evaluated with ambulatory blood pressure monitoring in the pediatric nephrology department between October 2018 and January 2021 were included in the study. Prehypertension, normotensive, white coat hypertension, masked hypertension, ambulatory hypertension groups and 2 other groups including increased blood pressure load, normal ambulatory blood pressure measurements, but normal (unclassified group 1) or high (unclassified group 2) office blood pressure measurements were defined according to the American Heart Association 2014 statement. Left ventricular mass index, left ventricular mass index/95 percentile values, and left ventricular hypertrophy ratios were compared between the groups separately to establish the influence of the unclassified cases. Results: A total of 497 children were included. There were 52 cases in normotensive, 47 cases in unclassified group 1, 50 cases in masked hypertension, 79 cases in white coat hypertension, 104 cases in unclassified group 2, and 165 cases in the ambulatory hypertension group. Left ventricular mass index/95 percentile and left ventricular hypertrophy in masked hypertension were significantly higher than normotensive but similar between normotensive and unclassified group 1 groups. Left ventricular hypertrophy was significantly higher in the ambulatory hypertension group compared to white coat hypertension, and similar between white coat hypertension and unclassified group 2 groups. Conclusion: Independent of age, we have found that interpretation of blood pressure load not only has a limited predictable effect on left ventricular hypertrophy but also causes a large group of patients to be unclassified.

Objective: We retrospectively examined the nephrological conditions of the victims who applied to the Pediatric Nephrology Clinic in our hospital in İzmir after the February 6, 2023 Kahramanmaraş earthquake. Method: Age, gender, time spent under debris, number of crushed extremities, presence of acute kidney injury (AKI), creatine kinase (CK) levels and prognosis of all patients were evaluated. 5% dextrose-0.45% NaCl solution was given as 1500 cc/m2/day if the CK levels of the children were between 1000-3000 U/L, and as 3000 cc/m2/day for those >3000 U/L. If the bicarbonate value is <25, alkalinization was achieved by applying NaHCO3 treatment to 50 mEq/L. If CK values fell below 3000 U/L, the amount of fluid was reduced by half, and if it was below 1000 U/L, it was discontinued. If blood gas pH is >7.50 and/or bicarbonate ≥30, alkalinization treatment is discontinued; if 25-30 it is halved. Results: Of the total 33 pediatric patients, 48.5% were girls and 51.5% were boys. The children had a mean age of 9.0±3.9 years. The mean stay under the rubble was 17.00 (4.25-48.00) hours. The CK values of 23 patients were >1000 U/L at the time of admission. Six patients had acute kidney injuries at admission. Four patients received hemodialysis and/or hemodiafiltration treatment. The CK values returned to normal in 5.0 (3.0-8.0) days in the patients who received fluid and alkalinization treatments. The serum creatinine values of all patients normalized. Conclusion: Even in the case of concomitant AKI in crush syndrome developing after an earthquake, full recovery can be achieved with aggressive fluid and alkalinization treatment.

OBJECTIVES:Renal transplant recipients are at risk for ventricular arrhythmia and sudden death. To assess that risk, we compared the ventricular repolarization markers of pediatric renal transplant recipients with those of healthy children.MATERIALS AND METHODS:We included 30 children and adolescents who were followed for at least 6 months after renal transplant; 30 age- and sex-matched children were included for the control group. Demographic features, medications, and laboratory findings were recorded. Blood pressure measurements, ventricular repolarization indexes including QT dispersion, corrected QT dispersion, T-wave peak-to-end interval dispersion, the T-wave peak-to-end interval∕QT ratio, the T-wave peak-to-end interval∕corrected QT ratio, left ventricular mass index, and relative wall thickness were compared between groups. In addition, the correlations of ventricular repolarization indexes with other variables were evaluated.RESULTS:Blood pressure standard deviation scores, the mean heart rate, QT dispersion, corrected QT dispersion, the T-wave peak-to-end interval∕QT ratio, the T-wave peak-to-end interval/corrected QT ratio, left ventricular mass index, and relative wall thickness values were significantly higher in renal transplant patients, whereas T-wave peak-to-end interval dispersion, ejection fraction, and fractional shortening were similar between groups. Although ventricular repolarization indexes were similar in patients with and without left ventricular hypertrophy, only corrected QT dispersion was significantly higher in patients with hypertension (P = .006). The only variable that significantly predicted prolonged corrected QT dispersion was the systolic blood pressure standard deviation score (P = .005, β = .403).CONCLUSIONS:Ventricular repolarization anomalies, hypertension, left ventricular hypertrophy, and cardiac geometry irregularity may be observed after renal transplant in pediatric recipients despite acceptable allograft functions and normal serum electrolyte levels. Control of systolic blood pressure would decrease the risk of ventricular repolarization abnormalities, namely, the corrected QT dispersion. Follow-up of cardiovascular risks with noninvasive methods is recommended in all pediatric renal transplant recipients.