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Originals

Pneumonia-associated acute glomerulonephritis

T. Srivastava, B.A. Warady and U.S. Alon

Volume 57 (2002) p. 175 - 182

Abstract

T. Srivastava, B.A. Warady and U.S. Alon

Section of Nephrology, The Children?s Mercy Hospital, University of Missouri at Kansas City, Kansas City, USA
Objective: Post-infectious glomerulonephritis typically occurs 7 – 14 days after an infection. However, in
several children we observed acute glomerulonephritis (AGN) to develop concurrently with pneumonia. The objective of the study was to delineate the clinical course and outcome of pneumonia-associated AGN. Study design: The hospital database was searched from 1984 – 1999 for c+hildren admitted with both acute pneumonia and AGN, each diagnosis having been made within 72 hours of each other. Results: 11 boys, age 3.8 –12.7 years, were identified. Ten children had lobar pneumonia and 1 had an interstitial infiltrate. All responded to antibiotic therapy with resolution of fever and respiratory symptoms. Only 1 child developed an empyema. The mean ± SD hospital stay was 5.9 ± 3.9 days. All patients had an abnormal urinalysis with hematuria (gross hematuria in 5), proteinuria and cellular casts. At presentation, 7 children had a serum creatinine > 1.0 mg/dl and creatinine clearance £ 80 ml/min/1.73 m²; in all, serum creatinine returned to normal and the creatinine clearance was > 80 ml/ min/1.73 m² on follow-up. Nine of the 11 children had a low serum complement C3, 3 of whom also had low complement C4. Anti-streptolysin-O (ASO) titers were elevated in all 10 children tested.Six children developed hypertension and received anti-hypertensive medications. Only 1
child was severely oliguric requiring peritoneal dialysis for 4 days. He underwent a
kidney biopsy, which showed acute proliferative glomerulonephritis without crescents.Neither a biopsy nor dialysis was performed in the other children. At follow-up, blood pressure, urinalysis and serum complements had normalized in the 9 children in whom follow-up was available. Conclusion: Children with pneumonia who are found to have abnormal urinalysis, hypertension, azotemia or oliguria should be evaluated for concomitant glomerulonephritis. In most children, pneumonia-associated AGN runs a benign course and has a good prognosis, however, in some short-term medical intervention may be necessary.

Original

Dietary modifications alone do not improve bone mineral density in children with idiopathic hypercalciuria

A.L. Schwaderer, T. Srivastava, L. Schueller, R. Cronin, J.D. Mahan and D. Hains

Volume 76 (2011) p. 341 - 347

Abstract

Dietary modifications alone do not improve bone mineral density in children with idiopathic hypercalciuria

A.L. Schwaderer¹, T. Srivastava², L. Schueller³, R. Cronin⁴, J.D. Mahan¹ and D. Hains¹

¹The Ohio State University College of Medicine/Nationwide Children’s Hospital, Department of Pediatrics, Division of Pediatric Nephrology, Columbus, OH, ²Bone and Mineral Disorder Clinic, The Children’s Mercy Hospital and Clinics, University of Missouri, Kansas City, MO, ³The Research Institute at Nationwide Children’s Hospital, and ⁴The Ohio State University College of Medicine, Columbus, OH, USA
Prior cross-sectional studies have demonstrated an association between hypercalciuria and low bone mineral density (BMD) in children and adults. However, the natural history of BMD in children with hypercalciuria and its response to therapy has not been evaluated. The objective of this retrospective study was to determine the change over time in lumbar (L1 – L4) BMD Z-score measured on sequential DXA scans in 19 children with hypercalciuria treated with dietary recommendations without (n = 12, Group A) and with citrate (n = 7, Group B). The mean lumbar bone density Z-score/year decreased in Group A (–0.11 ±/0.41) indicating that children with hypercalciuria lose L1 – L4 BMD over time. In contrast, the L1 – L4 BMD Zscore/ year increased in Group B (0.19 ± 0.38) suggesting that pharmacologic therapy may reverse this trend. Similarly 75% of patients in Group A, but only 29% patients in Group B had a decrease in L1 – L4 BMD. There was a definite, although not significant, trend towards improved mean bone mineral density Z-score per year and a lower percentage of patients with a decreased Z-score in hypercalciuric children treated with potassium citrate. Our findings suggest the possibility that dietary recommendations alone is not adequate as the bone mineral density of children with hypercalciuria will decrease over time, potentially increasing the risk for osteoporosis as an adult.Correspondence to:
Dr. A.L. Schwaderer
700 Children’s Drive
Columbus, OH 43205, USA
Email: [email protected]

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