Background COVID-19 is less frequent in children than in adults and affects the former less severely; despite the fact that respiratory symptoms are the most frequent, in some cases unusual manifestations can be seen. Case-diagnosis We present a 15-year-old boy who tested positive for SARS-COV-2 infection and onset of nephrotic syndrome, without antecedent of kidney disease and who had normal urine tests shortly before being affected by COVID-19. Conclusions The patient described in this report, who was admitted due to nephrotic syndrome and respiratory syndrome, tested positive for COVID-19. He, based on the data review by the researchers, is the first reported case of COVID-19 with simultaneous onset of complete picture of nephrotic syndrome. The presence of both diagnoses could be a coincidence or an unusual form of presentation of COVID-19.

Introduction: Lupus nephritis (LN) is a common complication of Systemic Lupus in children and adolescents; in these age groups, kidney damage is more aggress...

Aim: Latin-America Pediatric Renal Transplant Registry began in 2003. The objective is to analyze and share the results of pediatric kidney transplantation performed in Latin America. Methods: Data of pediatric renal transplants performed on patients from 43 centers in 14 countries: Argentina, Brasil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Guatemala, Honduras, México, Nicaragua, Paraguay, Perú y Venezuela between January 1st, 2004 and December 31st, 2012 was collected. Results: Data on 2944 renal transplants were obtained. Mean age was 11.4+3.6 years, 57% male. Main etiology were congenital uropathy/vesicoureteral reflux (28%), followed by glomerulopathy (23%), including 326(11%) FSGS, hereditary diseases(14.7%), vascular diseases(3.1%), unknown in 17%. Sixty percent of transplants were performed with deceased donors and initial immunosuppression consisted mainly of tacrolimus (77%), mycophenolic acid(71%), steroids(96%) and induction therapy with anti- IL-2R antibodies (72%)One year graft survival was 97% and 87% (p<0,05), respectively for living donors (LD) and deceased donors (DD). Graft loss incidence was 16%, most frequently caused by (in descending order) acute and chronic rejection, arterial or venous thrombosis, death with functioning kidney and recurrent renal disease. Patient survival at 1 and 3 years was 96% and 95%, respectively. Mortality rate was 4% mainly due to infection and cardiovascular disease. Conclusion: The results are comparable to that of other international centers. Efforts are being made to provide on-line data entry, in order to facilitate reporting, and to supply an exchange of information, among the participating centers, as with other centers in the world.

Urinary tract infection (UTI) is a clinical entity induced by invasion, colonization and multiplication of bacteria in the urinary tract which overpass de host defensive mechanisms, and could be the expression of functional or morphological disorders. UTI is a frequent cause of morbidity and affects 5 - 11% of pediatric patients and it is the first documented cause of pediatric nephrological consultation in Venezuela. The frequency of recurrence is 15-20% in children under 1 year of age after the first episode of UTI, and the risk is higher with previous episodes. Pathogenesis of UTI includes 3 related factors: the pathogenic germ, host and environment factors. Early detection of UTI and adequate study of the patient are important clues for the prevention of renal damage and prevention of progression to chronic renal disease. Important factors for the development of renal damage are: febrile UTI, anatomical or functional obstructive uropathy, vesicoureteral reflux with dilatation of the urinary tract, delay in the initiation of antibiotic treatment and presence of E. Coli. The diagnosis of UTI is based on clinical manifestations which vary with age and gender, and the presence or not of urological and/or neurological disorders. Alterations in the urine analysis could suggest UTI, but the definitive test for the diagnosis is de urine culture, which should be performed previously to antibiotic therapy; etiological diagnosis is made by the presence of significative growth of bacteria in the urine. The less invasive method to collect the urine sample is the clean catch with previous perineal asepsis. The number of colonies/ml required to consider a urine culture as positive vary according with the sample collection method.

Rapidly progressive glomerulonephritis (RPGN) is a rare entity; early diagnosis is important for adequate and prompt treatment. The objective of this paper i...

The Latin American Pediatric Nephrology Association (ALANEPE) reports the first regional kidney transplant registry in Latin America. A mean range of 75%, 30% to 100% renal transplant recipients under 21 yr old were included. Out of 20 countries invited to participate, 14 performed renal transplant, 11 had universal financial support from their governments. The centers included: Brazil (9), Argentina (4), Chile (4), Venezuela (3), Mexico (2), and one in: Cuba, Colombia, Costa Rica, Nicaragua, Guatemala, Ecuador, Honduras, Paraguay and Peru. The registry included 1458 patients, average of 291 per year, 55% male. Mean follow-up 23.4 +/- 17 months; mean age was 11.7 +/- 4.3 yr (1-21), 11% under five yr of age. Etiology: uropathy/ reflux nephropathy 27%, glomerulopathies 24% (included 12% FSGS), hypo/dysplasia (11%), vascular (6%), congenital/hereditary (5%), unknown (19%). Induction therapy: 71% anti-IL2RAb, 13% ATG/TIMO, 14% non-induction. Maintenance therapy: Tacrolimus 64%, Cyclosporine 32%, MMF 54%, MPS 20%, noTORi 96%, steroids 90%, withdrawal or steroid avoidance 10%. Loss of graft 155/1458 (11%), death with functioning graft (3.4%), vascular thrombosis (2.8%), acute rejection (2.8%), recurrence of disease (1%). Forty-eight patients died (3.3%); infection was the main cause 23 (2.1%). Global patient survival rate at one, three, and five yr was 97%, 96%, and 96%. Graft survival rate at one, three, and five yr LRD was 96%, 93% and 89%; for DD 92%, 86% and 76% respectively. Both survival rates were higher in LRD (p < 0.008 and p < 0.001). A pediatric renal transplant study has started, making information available to be shared between the centers and the world.

SUMMARY INTRODUCTION: The majority of children with idiopathic nephrotic syndrome respond to steroid therapy; however, approximately 15% of cases are steroid...

El virus del dengue es un miembro de la familiaFlaviviridae. Las infecciones por dengue pueden serasintomaticas, o bien, provocar fiebre no diferenciada, fiebrehemorragica por dengue (DHF) y sindrome shock por dengue(DSS). Se cree que una funcion inmune intacta es necesariapara que tanto DHF como DSS, se presenten a traves de unmecanismo dependiente de anticuerpos. De aqui, que los pacientestrasplantados, deberian mostrar un menor riesgo dedesarrollar formas severas de la enfermedad debido a su relativainmunosupresion.Caso Clinico: Paciente varon de 15 anos, trasplantado renaldonante cadaver dos anos previos que se presenta con fiebrede cinco dias de evolucion asociada a debilidad, mialgias, cefaleay trombocitopenia. Examen fisico: hipotension (TA:80/50 mmHg), palidez cutaneo mucosa e hipoactividad. Al inicio,las pruebas serologicas para dengue, citomegalovirus yEpstein Barr fueron negativas. Al septimo dia, la serologiaviral para dengue fue positiva para IgG, IgM y PCR. Presentoepistaxis y melena ameritando recibir concentrado plaquetario,plasma fresco congelado y crioprecipitado. Se detectopoliserositis: derrame pleural derecho, ascitis. Los niveles deplaquetas iniciaron su ascenso al decimo dia en el que se registraron90.000/mm3. El GFR fue de 80 ml/min/1.73m2 y laproteinuria llego a 7 mg/m2/hora. Ecografia doppler del injertonormal.Comentarios: El dengue en trasplantados tiene una evolucionbenigna por la relativa inmunosupresion que reduce elriesgo de complicaciones debidas a la respuesta inmuneantigeno-anticuerpo incrementada. No obstante, esa no fue laevolucion de nuestro paciente. Precisa evaluacion y control por el probable deterioro de la funcion renal posteriormente.

-Diagnosticos en rinones trasplantados: rechazo agudo 50%, necrosis tubular aguda 25%, rechazo cronico 20%, enfermedad recurrente en trasplante 5%. Complicaciones: Hematuria transitoria: 21 casos (5%), hematoma perirenal: 3(<1%), perforacion intestinal: 2 (<0.5%), hemorragia importante: 2 (<0.5%), nefrectomia: 1(0.2%). Conclusiones: La presente es una de las primeras casuisticas de biopsias renales reportadas en Latinoamerica y una de las mas grandes en el mundo y, de acuerdo a nuestros resultados, es un procedimiento seguro con gran utilidad diagnostica, pocas complicaciones, sin mortalidad. SUMMARY Introduction: Evaluation and analysis of the results of renal biopsy are important for diagnostic, therapeutic and prognostic matters. Objective: to evaluate a series of renal biopsies performed during the period 1978-2007 in the Hospital de Ninos de Valencia, Venezuela. All patients had history of either primary or secondary nephropathies. Methods: 421 biopsies were done in 377 patients, ages 2 months-20 years; 57% boys. 26 patients were re-biopsed. Percutaneous needle biopsy (PNB) was performed in all the patients, except in one who underwent open biopsy because of a solitary kidney. Renal tissue was processed for optical, inmunofluorescence and electronic microscopy in 98% of cases. The biopsy technique, clinical syndromes at presentation, hystopathological pattern, effectiveness and complications are described. Results: Adequate sample was obtained in 392 cases (93%) (more than 10 glomeruli) and inadequate or failed biopsy in 29 (7%). Clinical syndromes at presentation were: nephrotic syndrome: 199 cases (50%), atypical acute nephritic syndrome: 53 (13%), others: hematuria and proteinuria, isolated proteinuria, kidney transplant biopsy or systemic diseases: 143 (37%). The hystopathological pattern obtained was as follows: A.- Primary glomerulonephritis (PG): 302 cases, 77%, B.- Secondary nephropathies: 68 cases, 17% , C.- Kidney transplant biopsies: 28 cases, 5 %. Primary Glomerulonephritis diagnosis: minimal change disease: 140 cases, 46%, Focal Segmental Glomerulosclerosis: 79 (26%), diffuse proliferative glomerulonephritis / mesangial: 67 (22%), membranous glomerulonephritis: 16 (5%). Secondary nephropathies: lupus nephritis: 20 cases (32.25%), IgA Nephropathy: 22 cases (35.50%), others: 20 cases (32.25%). Transplant biopsies: rejection 50%, acute tubular necrosis 25%, chronic rejection 20%, and recurrent disease 5%. Complications: transient hematuria: 21 (5%), perirenal hematoma: 3 (<1%), gut perforation (<0.2%), bleeding which required blood transfusion: 2 (<0.5%) and nephrectomy because of incontrollable bleeding 1 (0.2%). Conclusions: this series of renal biopsies is one of the first reported in Latin-America and one of the largest in the world. According to our results, renal biopsy is a reliable and safe procedure in pediatric nephrology. Our casuistic shows that it is useful for the diagnosis, prognosis and follow up of patients with various nephropathies, excellent effectiveness and low number of complications, with no mortality.