PREVENTION OF POST-CARDIAC SURGERY VITAMIN D DEFICIENCY IN CHILDREN WITH CONGENITAL HEART DISEASE: RESULTS OF A PILOT DOSE EVALUATION RANDOMIZED CONTROLLED TRIAL D. McNally1, K. O’Hearn2, J. Lougheed1, D. Fergusson3, G. Maharajh4, H. Weiler5, G. Jones6, A. Khamessan7, S. Redpath1, P. Geier1, L. McIntyre8, D.R. Doherty9, M. Lawson1, K. Menon1 1Children’s Hospital of Eastern Ontario, Pediatrics, Ottawa, Canada 2Children’s Hospital of Eastern Ontario Research Institute, Research, Ottawa, Canada 3Ottawa Hospital Research Institute, Clinical Epidemiology, Ottawa, Canada 4University of Ottawa, Division of Cardiovascular Surgery, Ottawa, Canada 5McGill University, School of Human Nutrition, Montreal, Canada 6Queen’s University, Biomedical and Molecular Sciences, Kingston, Canada 7Euro-Pharm International Canada Inc., Euro-Pharm International Canada Inc., Ottawa, Canada 8The Ottawa Hospital, Critical Care, Ottawa, Canada 9The Children’s University Hospital, Pediatric Intensive Care Unit, Dublin, Ireland

BACKGROUND There is lack of consensus on the necessity of renal biopsy in children with steroid-dependent nephrotic syndrome (SDNS) prior to cytotoxic therapy. OBJECTIVES To retrospectively evaluate: (a) the benefit of renal biopsy (RB) prior to cyclophosphamide therapy; (b) relationship between histopathologic results of RB samples and clinical course in children with SDNS. PATIENTS, MATERIALS AND METHODS RB was performed in 18 SDNS patients (11 boys and 7 girls). The mean age of the children at the time of nephrotic syndrome (NS) diagnosis was 6.4 +/- 3.9 years and 9.7 +/- 4.3 years at the time of RB. Following the RB, all children received prednisone and cyclophosphamide treatment for 12 weeks. Duration of remission and relapse rate was recorded. RESULTS The histologic evaluation revealed minimal change disease (MCD; n = 14) and IgM nephropathy (n = 4). These results didn't affect the ongoing therapy. MCD patients had longer remission compared to IgM nephropathy (3.2 +/- 1.5 vs 1.7 +/- 0.8 years; p = 0.05). Relapse rate did not differ significantly between MCD and IgM nephropathy (p = 0.22). The duration of remission was inversely correlated to relapse rate after the treatment (r = -0.66, p = 0.01). CONCLUSION We suggest that RB prior to cyclophosphamide therapy is not necessary in patients with SDNS (Tab. 2, Ref. 14). Full Text (Free, PDF) www.bmj.sk.

Purpose: The Society for Fetal Urology introduced a subjective grading system for classifying hydronephrosis that has important implications in patient diagnosis, treatment and outcome. The grading system is frequently used to standardize the severity of hydronephrosis, and compare results among patients and centers. Despite widespread use to our knowledge no groups have investigated the reliability of the grading system since its Introduction. We assessed the intrarater and interrater reliability of the Society for Fetal Urology grading system for hydronephrosis and examined levels of agreement by the degree of hydronephrosis (grades 0 to 4) and level of experience (staff vs trainee).Materials and Methods: A series of 50 pediatric renal ultrasound images from patients with a diagnosis of hydronephrosis were assessed by 4 staff individuals and 4 trainees using the Society for Fetal Urology grading system. Ultrasound images included the kidneys, ureters and bladder to be consistent with practice. After 7 to 14 days each rater repeated the assessment. The nonweighted Cohen K statistic was used to estimate intrarater and interrater reliability by Society for Fetal Urology grade and training level.Results: Staff and trainee raters independently assigned Society for Fetal Urology grades to 50 patients (99 renal units). The average number of images per ultrasound was 41, including the right and left kidneys. Overall interrater agreement for staff individuals was substantial for grade 0, moderate for grades 1, 2 and 4, and only slight to fair for grade 3. Intrarater agreement was substantial to almost perfect for staff agreement (range 69% to 94%, kappa 0.56 to 0.89) and trainees (range 63% to 90%, kappa 0.48 to 0.85).Conclusions: Our study suggests that the Society for Fetal Urology grading system has good intrarater but modest interrater reliability. Individual rater interpretations of the grading system may explain the modest interrater agreement. Proposed modifications to the Society for Fetal Urology classification system, such as distinguishing between diffuse and segmental cortical thinning, may improve reliability.

Background: Hypertension occurs in some patients with primary nephritic syndrome it may be mediated by changes in vasopressin activities or intravascular volume. Aim of study: is to find out how many patients with idiopathic nephritic syndrome hare hypertension. Subj. & Methods: The study included 50 children (29 males and 21 females) with age ranger between 1- 13 years. Sixteen patients (32%) were with initial attack of nephritic syndrome, while thirty four patients (68%) presented with relapse. Results: Nine (18%) patients had hypertension, eight (16%) patients were relapse cases, and one (2%>) patient was with initial attack. Hypertension was found in four (8%) patients with steroid resistant neurotic syndrome, three (6%) patients with steroid sensitive nephritic syndrome in relapse state and two (4%) patients with steroid dependent nephritic syndrome. Abnormal renal function was found in four patients (8%), two (4%) with hypertension and two (4%) without hypertension. It is concluded the necessity of the follow up and periodical measurement of blood pressure of nephritic patients to allow early recognition and management of hypertension. Conclusion: the necessity of the follow up & periodical measurement of blood pressure of nephroticpatients to allow early recognition & management of hypertension.