Lower Urinary Tract Obstruction in Newborns

Lower urinary tract obstruction (LUTO) is a rare birth defect with a prevalence between 1 in 5,000 and 1 in 25,000 pregnancies. LUTO is one of the most common causes of congenital abnormalities of the renal tract. Several genetic conditions have been associated with LUTO. Most common causes of LUTO are posterior urethral valves and urethral atresia. Despite available prenatal and postnatal treatments, LUTO is a significant cause of morbidity and mortality in newborns causing significant end stage renal disease and pulmonary hypoplasia.

Pediatric Chronic Kidney Disease

Chronic kidney disease (CKD) in children has a significant impact on morbidity, mortality, and quality of life. The degree of renal dysfunction should be calculated using pediatric-specific formulas and the degree of CKD staged; this allows for appropriate dosing of medications based on renal function and monitoring for progression and comorbid conditions including metabolic acidosis, bone disease, anemia, cardiovascular complications, malnutrition and electrolyte abnormalities, growth failure, and psychosocial issues. Treatment strategies include treating the underlying disease and using general renal protective measures. Effective management of these complex issues requires a specialized multidisciplinary team approach.

Anemia, cough, and acute renal failure in a teenager: case presentation and review

Anemia and cough are common problems with adolescent females. We present a case where these common symptoms led to the discovery of an uncommon entity, Goodpasture's Syndrome. The purpose of this report is to review the clinical manifestations, treatment and pathology of Goodpasture's Syndrome.

Aortic dissection in young patients with chronic hypertension

We describe four patients aged 14 to 21 years who developed acute aortic dissection. In three of the four patients, the course was fatal, despite aggressive medical and surgical intervention. All four patients had sustained systemic hypertension related to chronic renal insufficiency. The patients had no other identifiable risk factors for aortic dissection, including congenital cardiovascular disease, advanced atherosclerosis, vasculitis, trauma, pregnancy, or family history of aortic dissection. Although aortic dissection is rare in individuals younger than 40 years of age, young patients with sustained systemic hypertension are at increased risk for this serious and often fatal condition. Physicians must be aware of this rare complication of hypertension and consider aortic dissection in the differential diagnosis of unusual chest, abdominal, and back pain in hypertensive children, adolescents, and young adults.

Autoimmune hemolytic anemia after Kawasaki disease in a child

A 2-year-old male presented with upper respiratory tract infection symptoms, continuous high fever, extensive truncal rash with desquamation, lymphadenopathy, subconjunctival hemorrhage, and oral stomatitis. He was diagnosed with Kawasaki disease and did well on aspirin. Approximately 8 weeks after initial presentation he had evidence of severe immune hemolysis. At that time a direct antiglobulin test was microscopically positive; it became strongly positive (3 + IgG, w + C3) 2 weeks later. The serology was unusual in that a warm IgG autoantibody and a low titer high thermal range cold antibody of unusual specificity (anti-Ena or anti-Pr) were present. We were uncertain as to which antibody caused the hemolysis, or whether they worked synergistically. The hemolysis resolved following treatment with high dose prednisone.

New onset childhood seizures. Emergency department experience

Fifty-six cases of new onset seizures evaluated in a pediatric emergency department (ED) during a one-year period were assessed retrospectively for efficiency of diagnosis and workup. The majority of patients (69%) were less than two years of age. Based on etiology, the most common seizure type was febrile (71%) followed by idiopathic (21%) and symptomatic (7%). Significant laboratory abnormalities were found in four (7%) patients; two had hyponatremia, one carbamazepine overdose and one bacterial meningitis. Screening laboratory tests including brain CT scans were generally not helpful. A thorough history including specific details regarding the seizure and a complete physical examination should eliminate the need for major laboratory and radiologic workup in the emergency department.