@article {10751, title = {Adolescent with intermittent haematuria.}, journal = {Arch Dis Child Educ Pract Ed}, year = {2018}, month = {2018 May 10}, issn = {1743-0593}, doi = {10.1136/archdischild-2018-315049}, author = {Pillon, Roberto and Pennesi, Marco and Rabach, Ingrid and Barbi, Egidio} } @article {10760, title = {Boy with fish-mouth meatus.}, journal = {Arch Dis Child}, year = {2018}, month = {2018 Jun 14}, issn = {1468-2044}, doi = {10.1136/archdischild-2018-315360}, author = {Cortellazzo Wiel, Luisa and Pederiva, Federica and Castagnetti, Marco and Barbi, Egidio and Pennesi, Marco} } @article {10479, title = {Antibiotic Prophylaxis for Urinary Tract Infection-Related Renal Scarring: A Systematic Review.}, journal = {Pediatrics}, volume = {139}, year = {2017}, month = {2017 May}, abstract = {

CONTEXT: Acute pyelonephritis may result in renal scarring. Recent prospective studies have shown a small benefit of antibiotic prophylaxis in preventing symptomatic and febrile urinary tract infections (UTIs), while being underpowered to detect any influence in prevention of renal damage.

OBJECTIVES: Review of the literature and a meta-analysis to evaluate the effect of antibiotic prophylaxis on UTI-related renal scarring.

DATA SOURCES: Medline, Embase, and Cochrane Controlled Trials Register electronic databases were searched for studies published in any language and bibliographies of identified prospective randomized controlled trials (RCTs) performed and published between 1946 and August 2016.

STUDY SELECTION: Subjects 18 years of age or younger with symptomatic or febrile UTIs, enrolled in prospective RCTs of antibiotic prophylaxis where Tc dimercaptosuccinic acid scans were performed at entry into the study and at late follow-up to detect new scar formation.

DATA EXTRACTION: The literature search, study characteristics, inclusion and exclusion criteria, and risk of bias assessment were independently evaluated by 2 authors.

RESULTS: Seven RCTs (1427 subjects) were included in the meta-analysis. Our results show no influence of antibiotic prophylaxis in preventing renal scarring (pooled risk ratio, 0.83; 95\% confidence interval, 0.55-1.26) as did a subanalysis restricted to those subjects with vesicoureteral reflux (pooled risk ratio, 0.79; 95\% confidence interval, 0.51-1.24).

LIMITATIONS: Limitations include the small number of studies, short duration of follow-up, and insufficient children with high-grade dilating reflux and/or renal dysplasia enrolled in the studies.

CONCLUSIONS: Antibiotic prophylaxis is not indicated for the prevention of renal scarring after a first or second symptomatic or febrile UTI in otherwise healthy children.

}, keywords = {Acute Disease, Antibiotic Prophylaxis, Child, Cicatrix, Humans, Kidney, Pyelonephritis, Urinary Tract Infections}, issn = {1098-4275}, doi = {10.1542/peds.2016-3145}, author = {Hewitt, Ian K and Pennesi, Marco and Morello, William and Ronfani, Luca and Montini, Giovanni} } @article {10483, title = {The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I - Diagnosis and treatment of the first episode and the first relapse.}, journal = {Ital J Pediatr}, volume = {43}, year = {2017}, month = {2017 Apr 21}, pages = {41}, abstract = {

This consensus document is aimed at providing an updated, multidisciplinary overview on the diagnosis and treatment of pediatric nephrotic syndrome (NS) at first presentation. It is the first consensus document of its kind to be produced by all the pediatric nephrology centres in Italy, in line with what is already present in other countries such as France, Germany and the USA. It is based on the current knowledge surrounding the symptomatic and steroid treatment of NS, with a view to providing the basis for a separate consensus document on the treatment of relapses. NS is one of the most common pediatric glomerular diseases, with an incidence of around 2-7 cases per 100000 children per year. Corticosteroids are the mainstay of treatment, but the optimal therapeutic regimen for managing childhood idiopathic NS is still under debate. In Italy, shared treatment guidelines were lacking and, consequently, the choice of steroid regimen was based on the clinical expertise of each individual unit. On the basis of the 2015 Cochrane systematic review, KDIGO Guidelines and more recent data from the literature, this working group, with the contribution of all the pediatric nephrology centres in Italy and on the behalf of the Italian Society of Pediatric Nephrology, has produced a shared steroid protocol that will be useful for National Health System hospitals and pediatricians. Investigations at initial presentation and the principal causes of NS to be screened are suggested. In the early phase of the disease, symptomatic treatment is also important as many severe complications can occur which are either directly related to the pathophysiology of the underlying NS or to the steroid treatment itself. To date, very few studies have been published on the prophylaxis and treatment of these early complications, while recommendations are either lacking or conflicting. This consensus provides indications for the prevention, early recognition and treatment of these complications (management of edema and hypovolemia, therapy and prophylaxis of infections and thromboembolic events). Finally, recommendations about the clinical definition of steroid resistance and its initial diagnostic management, as well as indications for renal biopsy are provided.

}, keywords = {Adrenal Cortex Hormones, Child, Child, Preschool, Consensus, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Humans, Italy, Male, Nephrotic Syndrome, Practice Guidelines as Topic, Prognosis, Recurrence, Retreatment, Societies, Medical, Survival Rate, Treatment Outcome}, issn = {1824-7288}, doi = {10.1186/s13052-017-0356-x}, author = {Pasini, Andrea and Benetti, Elisa and Conti, Giovanni and Ghio, Luciana and Lepore, Marta and Massella, Laura and Molino, Daniela and Peruzzi, Licia and Emma, Francesco and Fede, Carmelo and Trivelli, Antonella and Maringhini, Silvio and Materassi, Marco and Messina, Giovanni and Montini, Giovanni and Murer, Luisa and Pecoraro, Carmine and Pennesi, Marco} } @article {10563, title = {Outcome of childhood-onset full-house nephropathy.}, journal = {Nephrol Dial Transplant}, volume = {32}, year = {2017}, month = {2017 Jul 01}, pages = {1194-1204}, abstract = {

Background: Patients with full-house nephropathy (FHN) present renal lesions that are indistinguishable from those of lupus nephritis (LN) but lack the systemic features necessary to meet diagnostic criteria for systemic lupus erithematosus (SLE). Some have been reported to develop a delayed SLE with time. The clinical outcome of children having FHN without SLE has never been reported.

Methods: Children with biopsy-proven FHN were selected after excluding SLE cases by the absence of America College of Rheumatology criteria. The proportion of patients with complete (proteinuria <0.5 g/day) or partial remission (proteinuria <=50\% from baseline), relapse (estimated glomerular filtration rate <25\% and/or proteinuria >=50\% from baseline) and progression to Stage III chronic kidney disease (CKD) was described according to age and gender groups with the Kaplan-Meier curve and compared with the Log-rank test. Entity of treatment was summarized by a score at induction (0-6 months) and maintenance (6-18 months). Cox-regression model was performed to test predictors of remission, relapse and progression to CKD.

Results: Among 42 patients (28 pre-pubertal) who met the inclusion criteria, 39 (92.9\%) achieved partial and 32 (76.2\%) complete remission of nephropathy over 2.78 and 7.51 months of follow-up. At 10 years, the probability of progressing to CKD was 4.8\%. Of those achieving remission, 18\% had a renal flare mainly within 4 years after remission. Pre-pubertal males achieved complete remission more frequently than other patients but often relapsed; pre-pubertal females were treated more aggressively. Cox-regression analysis did not find independent predictors of remission or relapse.

Conclusions: The outcome of the patients with FHN we investigated was encouraging. Recurrences are limited to the first 4 years following diagnosis, allowing progressive withdrawal of immunosuppression in patients achieving remission. Evaluation of risk factors for adverse outcome is necessary especially in pre-pubertal children.

}, keywords = {Adolescent, Age of Onset, Child, Disease Progression, Female, Glomerular Filtration Rate, Glomerulonephritis, Humans, Kidney Diseases, Lupus Erythematosus, Systemic, Lupus Nephritis, Male, Proteinuria, Recurrence, Remission Induction, Retrospective Studies, Risk Factors, Survival Rate}, issn = {1460-2385}, doi = {10.1093/ndt/gfw230}, author = {Ruggiero, Barbara and Vivarelli, Marina and Gianviti, Alessandra and Pecoraro, Carmine and Peruzzi, Licia and Benetti, Elisa and Ventura, Giovanna and Pennesi, Marco and Murer, Luisa and Coppo, Rosanna and Emma, Francesco} } @article {3497, title = {Rituximab in steroid-dependent or frequently relapsing idiopathic nephrotic syndrome.}, journal = {J Am Soc Nephrol}, volume = {25}, year = {2014}, month = {2014 Apr}, pages = {850-63}, abstract = {

The outcome of steroid-dependent or frequently relapsing nephrotic syndrome of minimal change disease (MCD), mesangial proliferative GN (MesGN), or FSGS may be poor and with major treatment toxicity. This academic, multicenter, off-on trial (ClinicalTrials.gov $\#$NCT00981838) primarily evaluated the effects of rituximab therapy followed by immunosuppression withdrawal on disease recurrence in 10 children and 20 adults with MCD/MesGN (n=22) or FSGS who had suffered >=2 recurrences over the previous year and were in steroid-induced remission for >=1 month. Participants received one dose (n=28) or two doses of rituximab (375 mg/m(2) intravenously). At 1 year, all patients were in remission: 18 were treatment-free and 15 never relapsed. Compared with the year before rituximab treatment, total relapses decreased from 88 to 22 and the per-patient median number of relapses decreased from 2.5 (interquartile range [IQR], 2-4) to 0.5 (IQR, 0-1; P<0.001) during 1 year of follow-up. Reduction was significant across subgroups (children, adults, MCD/MesGN, and FSGS; P<0.01). After rituximab, the per-patient steroid maintenance median dose decreased from 0.27 mg/kg (IQR, 0.19-0.60) to 0 mg/kg (IQR, 0-0.23) (P<0.001), and the median cumulative dose to achieve relapse remission decreased from 19.5 mg/kg (IQR, 13.0-29.2) to 0.5 mg/kg (IQR, 0-9.4) (P<0.001). Furthermore, the mean estimated GFR increased from 111.3{\textpm}25.7 to 121.8{\textpm}29.2 ml/min per 1.73 m(2) (P=0.01), with the largest increases in children and in FSGS subgroups. The mean height z score slope stabilized in children (P<0.01). Treatment was well tolerated. Rituximab effectively and safely prevented recurrences and reduced the need for immunosuppression in steroid-dependent or frequently relapsing nephrotic syndrome, and halted disease-associated growth deficit in children.

}, keywords = {Adolescent, Adrenal Cortex Hormones, Adult, Antibodies, Monoclonal, Murine-Derived, Child, Female, Glomerulonephritis, Membranoproliferative, Glomerulosclerosis, Focal Segmental, Humans, Male, Middle Aged, Nephrosis, Lipoid, Nephrotic Syndrome, Recurrence, Rituximab}, issn = {1533-3450}, doi = {10.1681/ASN.2013030251}, author = {Ruggenenti, Piero and Ruggiero, Barbara and Cravedi, Paolo and Vivarelli, Marina and Massella, Laura and Maras{\`a}, Maddalena and Chianca, Antonietta and Rubis, Nadia and Ene-Iordache, Bogdan and Rudnicki, Michael and Pollastro, Rosa Maria and Capasso, Giovambattista and Pisani, Antonio and Pennesi, Marco and Emma, Francesco and Remuzzi, Giuseppe} } @article {1944, title = {Endoscopic treatment of primary vesicoureteral reflux.}, journal = {N Engl J Med}, volume = {367}, year = {2012}, month = {2012 Jul 5}, pages = {88; author reply 89}, keywords = {Female, Humans, Ureteroscopy, Vesico-Ureteral Reflux}, issn = {1533-4406}, doi = {10.1056/NEJMc1204964$\#$SA1}, author = {Pennesi, Marco and L{\textquoteright}erario, Ines and Barbi, Egidio} } @article {1823, title = {Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up.}, journal = {Acta Paediatr}, volume = {101}, year = {2012}, month = {2012 May}, pages = {451-7}, abstract = {

UNLABELLED: We report the recommendations for the diagnosis, treatment, imaging evaluation and use of antibiotic prophylaxis in children with the first febrile urinary tract infection, aged 2 months to 3 years. They were prepared by a working group of the Italian Society of Pediatric Nephrology after careful review of the available literature and a consensus decision, when clear evidence was not available.

CONCLUSION: These recommendations are endorsed by the Italian Society of Pediatric Nephrology. They can also be a tool of comparison with other existing guidelines in issues in which much controversy still exists.

}, keywords = {Anti-Bacterial Agents, Child, Preschool, Female, Fever, Follow-Up Studies, Humans, Infant, Male, Urinary Tract Infections}, issn = {1651-2227}, doi = {10.1111/j.1651-2227.2011.02549.x}, author = {Ammenti, Anita and Cataldi, Luigi and Chimenz, Roberto and Fanos, Vassilios and La Manna, Angela and Marra, Giuseppina and Materassi, Marco and Pecile, Paolo and Pennesi, Marco and Pisanello, Lorena and Sica, Felice and Toffolo, Antonella and Montini, Giovanni} } @article {1912, title = {Importance of bladder bowel dysfunction in patients with urinary tract infection.}, journal = {J Pediatr}, volume = {161}, year = {2012}, month = {2012 Aug}, pages = {370; author reply 370}, keywords = {Cystoscopy, Female, Fever, Humans, Male, Ureteroscopy, Urinary Tract Infections, Vesico-Ureteral Reflux}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2012.04.014}, author = {Giurici, Nagua and Pennesi, Marco} } @article {1853, title = {Managing children under 36 months of age with febrile urinary tract infection: a new approach.}, journal = {Pediatr Nephrol}, volume = {27}, year = {2012}, month = {2012 Apr}, pages = {611-5}, abstract = {

BACKGROUND: Recent guidelines on urinary tract infection (UTI) agree on reducing the number of invasive procedures. None of these has been validated by a long-term study. We describe our 11-years experience in the application of a diagnostic protocol that uses a reduced number of invasive procedures.

METHODS: We reviewed retrospectively the records of 406 children aged between 1 and 36 months at their first UTI. All patients underwent renal ultrasound (RUS). Children with abnormal RUS and those with UTI recurrences underwent voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) renal scans.

RESULTS: RUS after the first UTI was pathological in 7.4\% children; 4.4 \% had a second UTI. We performed 48 VCUG: 14 patients (29\%) had vesicoureteral reflux (VUR), 12 of which showed an abnormal RUS while 2 had recurrent UTI. After DMSA renal scan renal damage appeared in only 6 of them (12.5\%); all these children showed grade IV VUR.

CONCLUSIONS: The application of our guidelines leads to a decrease in invasive examinations without missing any useful diagnoses or compromising the child{\textquoteright}s health.

}, keywords = {Anti-Bacterial Agents, Child, Preschool, Female, Humans, Infant, Male, Pediatrics, Recurrence, Retrospective Studies, Urinary Tract Infections}, issn = {1432-198X}, doi = {10.1007/s00467-011-2087-3}, author = {Pennesi, Marco and L{\textquoteright}erario, Ines and Travan, Laura and Ventura, Alessandro} }