Bedside diagnosis of outpatient childhood urinary tract infection using three-media dipslide culture test

To determine the accuracy of a three-media dipslide test, the Uricult Trio, for the diagnosis of childhood urinary tract infections (UTIs), we collected urine specimens from children at the outpatient department. Two hundred consecutive patients presenting with symptoms of UTI were examined. Randomly voided, midstream, clean-catch and catheterized samples were used. Each was tested by routine laboratory culture and the dipslide test. The subjects’ ages ranged from 4 months to 7 years, with a median age of 5 years. There were 112 (56%) boys and 86 (43%) girls. Of the subjects, 98 (49%) showed urine culture results indicating significant bacteriuria. There was complete agreement in 70 cases (35%). The sensitivity and specificity of the dipslide were 68% and 82%, respectively. The positive and negative predictive values were 81% and 71%, respectively. The likelihood ratio for a positive test was 3.7, while for a negative test it was 0.39. The specificity, using Escherichia coli special agar, increased to 85% and the negative predictive value to 93%. The Uricult Trio dipslide method was technically simple and could be applied in the outpatient setting. Further studies are required, however, before it can be recommended as a routine diagnostic tool.     

Renal vascular thrombosis in the newborn

Neonatal renal vascular thrombosis is rare but has devastating sequelae. The renal vein is more commonly affected than the renal artery. Most neonates with renal vein thrombosis present with at least one of the three cardinal signs, namely, abdominal mass, macroscopic hematuria and thrombocytopenia, while unilateral renal artery thrombosis presents with transient hypertension. Contrast angiography is the gold standard for diagnosis but because of exposure to radiation and contrast agents, Doppler ultrasound scan is widely used instead. Baseline laboratory tests for platelet count, prothrombin time, activated partial thromboplastin time and fibrinogen concentration are essential before therapy is initiated. Maternal blood is tested for lupus anticoagulant and anticardiolipin antibody. Evaluation for prothrombotic disorders is warranted when thrombosis is clinically significant, recurrent or spontaneous. Management should involve a multidisciplinary team that includes neonatologists, radiologists, pediatric hematologists and nephrologists. In addition to supportive therapy, recent guidelines recommend at least prophylactic heparin therapy in the majority of cases to prevent thrombus extension. Thrombolytic therapy is reserved for bilateral thrombosis compromising kidney function. Long-term sequelae, such as kidney atrophy, systemic hypertension and chronic kidney disease, are common, and follow-up by pediatric nephrologists is recommended for monitoring of kidney function, early detection and management of hypertension and chronic kidney disease.     

Investigation of the current situation regarding diagnosis and treatment of Alport syndrome in Asian countries: results of survey of the Asian Paediatric Nephrology association (AsPNA) tubular and inherited working group

Background

Alport syndrome is one of the most common inherited kidney diseases worldwide. A genetic test or kidney biopsy is necessary for a definite diagnosis of this disease, and an accurate diagnosis system for this disease is highly desired in each country. However, the current situation in Asian countries is not clear. Therefore, the tubular and inherited disease working group of the Asian Pediatric Nephrology Association (AsPNA) aimed to assess the current situation of diagnosis and treatment for Alport syndrome in Asia.

Methods

The group conducted an online survey among the members of AsPNA in 2021–2022. Collected data included the number of patients for each inheritance mode, availability of gene tests or kidney biopsy, and treatment strategies for Alport syndrome.

Results

A total of 165 pediatric nephrologists from 22 countries in Asia participated. Gene test was available in 129 institutes (78%), but the cost was still expensive in most countries. Kidney biopsy was available in 87 institutes (53%); however, only 70 can access electron microscopy, and 42 can conduct type IV collagen α5 chain staining. Regarding treatment, 140 centers use renin-angiotensin system (RAS) inhibitors (85%) for Alport syndrome patients.

Conclusions

This study result might suggest that the system is underdeveloped enough to diagnose all Alport syndrome patients in most Asian countries. However, once diagnosed with Alport syndrome, most of them were treated with RAS inhibitors. These survey results can be used to address knowledge, diagnostic system, and treatment strategy gaps and improve the Alport patients’ outcomes in Asian countries.