@article {10780, title = {First urinary tract infections in children: the role of the risk factors proposed by the Italian recommendations.}, journal = {Acta Paediatr}, volume = {108}, year = {2019}, month = {2019 Mar}, pages = {544-550}, abstract = {

AIM: In 2009, the Italian society for paediatric nephrology suggested the need for cystography, following a first febrile urinary tract infection (UTI), only in children at high risk for dilating vesicoureteral reflux or in the event of a second infection. The aim of this study was to evaluate the adequacy of the risk factors proposed by the Italian guidelines.

METHODS: Children aged 2-36~months, managed by 10 Italian hospitals between 2009 and 2013, with a first febrile UTI were retrospectively evaluated.

RESULTS: Four hundred and fourteen children were included: 51\% female, mean age eight months. Escherichia coli was responsible of 84\% UTIs. 269 children (65\%) presented at least one risk factor, thus were further investigated: 44\% had a reflux. The presence of a pathogen other than E.~coli significantly predicted high-grade reflux, both in the univariate (Odd Ratio 2.52, 95\% Confidence Interval 1.32-4.81, p~<~0.005) and multivariate analysis (OR 2.74, 95\% CI: 1.39-5.41, p: 0.003). 26/145 children (18\%) with no risk factors experienced a second UTI, which prompted the execution of cystography, showing a dilating reflux in 11.

CONCLUSION: Among the risk factors proposed by the Italian guidelines, only the presence of a pathogen other than E.~coli significantly predicted reflux. Cystography can be postponed in children with no risk factors.

}, issn = {1651-2227}, doi = {10.1111/apa.14506}, author = {Alberici, I and La Manna, A and Pennesi, M and Starc, M and Scozzola, F and Nicolini, G and Toffolo, A and Marra, G and Chimenz, R and Sica, F and Maringhini, S and Monasta, L and Montini, G} } @article {8328, title = {In vitro sensitivity to methyl-prednisolone is associated with clinical response in pediatric idiopathic nephrotic syndrome.}, journal = {Clin Pharmacol Ther}, volume = {100}, year = {2016}, month = {2016 Sep}, pages = {268-74}, abstract = {

The aim of this study was to evaluate the in vitro steroid sensitivity as a predictor of clinical response to glucocorticoids in childhood idiopathic nephrotic syndrome (INS). Seventy-four patients (median age 4.33, interquartile range [IQR] 2.82-7.23; 63.5\% male) were enrolled in a prospective multicenter study: in vitro steroid inhibition of patients{\textquoteright} peripheral blood mononuclear cell proliferation was evaluated by [methyl-(3) H] thymidine incorporation assay at disease onset (T0) and after 4 weeks (T4) of treatment. Steroid dependence was associated with increased in vitro sensitivity at T4 assessed both as drug concentration inducing 50\% of inhibition (IC50 ; odds ratio [OR] = 0.48, 95\% confidence interval [CI] = 0.24-0.85; P = 0.0094) and maximum inhibition at the highest drug concentration (Imax ; OR = 1.13, 95\% CI = 1.02-1.31; P = 0.017). IC50 > 4.4 nM and Imax < 92\% at T4 were good predictors for optimal clinical response. These results suggest that this test may be useful for predicting the response to glucocorticoid therapy in pediatric INS.

}, issn = {1532-6535}, doi = {10.1002/cpt.372}, author = {Cuzzoni, E and De Iudicibus, S and Stocco, G and Favretto, D and Pelin, M and Messina, G and Ghio, L and Monti, E and Pasini, A and Montini, G and Decorti, G} }