Background: Infections of urinary tract were considered as the most common hospital-acquired infections in hospitalized patients. Area-specific monitoring studies aimed to assess the prevalence of causative organisms of urinary tract infections (UTIs) and their responsiveness to different available antimicrobials in a sample of Arab children, which may help the clinician to choose the correct empirical treatment. We aimed to study the type of urinary pathogens isolated from hospitalized patients with first-episode UTI in our locality and its antibiotic susceptibility pattern. Materials and Methods: Urine samples were collected from 320 clinically suspected cases of UTI from inpatient wards and outpatient clinic of Pediatric Department of Tanta University Hospital during the period from June 2016 to June 2017. The samples were tested microbiologically by standard procedures. Antibiotic susceptibility of the isolated pathogens was tested for commonly used antibiotics by disc diffusion method according to hospital policy. Results: Significant bacteriuria was present in 75% of the samples, 16.25% were sterile, and 8.75% showed insignificant bacteriuria. The most common pathogens were Escherichia coli (55%), Klebsiella spp. (26.6%), and Proteus mirabilis (14.2%). The mean susceptibility was high for amikacin (85%), ceftriaxone (82%), cefotaxime (80%), nitrofurantoin (80%), and nalidixic acid (78%) but low for ampicillin (21%), cephalexin (30%), and sulfamethoxazole + trimethoprim (37%). Conclusions: The antibiotics which are commonely used in UTIs such as trimethoprim/sulphamethoxazole,ampicillin and cephalexin are not appropriate for embrical treatment of common UTIs.This may be attributed to high rate of bacterial resistance .Regular monitering of these patients is recommended to establish reliable information about patterns of urinary pathogens aiming optimal embrical therapy for children with UTI.

Background and Objectives: Nephrotic syndrome (NS) is a well-known risk factor for arterial or venous thromboembolism (TE). There is a higher risk of TE in steroid-resistant nephrotic syndrome (SRNS) than in steroid-sensitive NS (SSNS). The aim of this study was to investigate serum level of von Willebrand factor-cleaving protease activity which is known as vWF-CP in children with idiopathic NS (INS) and its correlation with clinical and laboratory parameters. Patients and Methods: This study was conducted on 120 children with INS, including 40 SSNS, 40 SRNS, and 40 healthy controls. All subjects are investigated by complete blood count, 24 h collected urine analysis for urine volume, urinary proteins, total serum protein and serum albumin, total serum cholesterol, prothrombin time, partial thromboblastin time (PTT), and serum vWF-CP activity. Results: There was a highly significant decrease in serum vWF-CP activity in SSNS and SRNS groups when compared to control group while there was no significant difference in serum vWF-CP activity between SSNS and SRNS groups. Conclusions: Serum vWF-CP activity is a biomarker for endothelial dysfunction and hypercoagulable state. The decreased vWF-CP activity in different extent of nephrotic patients (SSNS and SRNS) may be one of the pathogenesis of thrombosis as a common complication of NS. Regular follow-up of nephrotic patients and estimation of serum vWF-CP level as its decreased level is a risk factor of thrombosis.

Background and Objectives: It is important to distinguish steroid sensitive nephrotic syndrome (SSNS) from steroid resistant nephrotic syndrome (SRNS) to avoid initial full dose steroid therapy in the latter. Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of acute kidney injury (AKI) even on top of chronic kidney disease (CKD). The aim is to determine urinary NGAL level in children with idiopathic nephrotic syndrome (INS) as a prognostic factor for INS, it can predict steroid resistance early in the course of INS. Subjects and Methods: The present study was carried out on ninety children with INS who were admitted in Pediatric Nephrology Unit of Tanta University Hospital. Thirty healthy children of the same age and sex served as control group. The subjects were subdivided into three groups: Group 1 (SSNS), Group 2 (SRNS), and Group 3 (controls). Patients and controls were subjected to clinical evaluation, laboratory investigations which included 24 h urinary collection for urinary volume and protein, complete blood count, serum cholesterol, serum albumin, blood urea, serum creatinine, and urinary NGAL measurement by enzyme-linked immunosorbent assay. Results: There was a significant increase in uNGAL levels in SRNS when compared with SSNS or controls. There was no significant difference in uNGAL levels between Group 1 and Group 3. ROC curve of uNGAL to predict SRNS had cutoff value >315 at the area under the curve 0.9, sensitivity 86.7%, and specificity 93.3%. There was a significant positive correlation between urinary NGAL level and age of patients and disease duration and serum creatinine level. Conclusions: Urinary NGAL can predict SRNS in INS in children.

Background: In chronic kidney disease, systemic inflammation may contribute to the endothelial dysfunction and accelerated thrombosis. Vascular access thromboembolism is the most common cardiovascular complication of children with end-stage renal disease (ESRD). Recently, a disintegrate-like and metalloproteinase with thrombospondin type 1 repeats 13 (ADAMTS13) is suspected to be involved as a specific von Willebrand factor cleaving protease. Objectives: To evaluate serum ADAMTS13 level in children with ESRD on regular hemodialysis (HD) and its correlation to thrombotic episode in HD patients. Materials and Methods: The present study was carried out on forty children with ESRD on regular HD in Pediatric Department of Tanta and Aswan University hospitals and forty healthy age- and sex-matched children were serving as controls. All patients and controls were subjected to thorough history taking, especially history concerning vascular access thrombosis, clinical examination including anthropometric measurements, and routine laboratory assessment measuring complete blood count (CBC), blood urea, serum creatinine, parathormone, prothrombin time, partial thromboplastin time, bleeding time, clotting time, blood electrolytes, and urine analysis. Laboratory investigations also included serum ADAMTS 13 level in this study. Results: There was a positive history of thrombi formation in patients more than controls, especially in the vascular access, and there was a significant decrease in ADAMTS13 level in patients when compared to controls. Conclusions: Diminished serum ADAMTS13 level is an early biomarker for hypercoagulability and thrombotic tendency. Children with ESRD under regular HD have lower levels of serum ADAMTS 13 than controls which increases the risk for thrombosis.

Objectives: To explore possible link between intradialytic hypotension (IDH) with serum fibroblast growth factor 23 (FGF23) and serum soluble klotho (sKl) in maintenance hemodialysis (MHD) patients in a single dialysis center. Materials and Methods: Cross-sectional data were collected from MHD patients. Intradialytic blood pressure was recorded continuously in a 1-month period. According to the dialysis records, MHD patients were divided into IDH group and non-IDH group. Fast sera of the MHD patients were obtained for FGF23 and sKl assay at the end of IDH record month, and other routing laboratory results were analyzed statistically for comparison between the two groups. Results: A total of eighty MHD patients with complete laboratory data were enrolled into the study. The occurrence rate of IDH was 77.5%. The significant differences in serum ferritin (P = 0.046), serum triglyceride (P = 0.045), parathyroid hormone (P = 0.042), calcium-phosphorus product (P = 0.047), and serum FGF23 (P < 0.001) were found between the two groups, but the difference in sKl between the two groups was marginal (P = 0.747). Furthermore, the serum FGF23 was positively correlated with the occurrence of IDH (r = 0.807, P< 0.001). Conclusions: The present study indicated a positive correlation between serum FGF23 and IDH in MHD patients, which suggested the FGF23 could be a potential biomarker for incidence of IDH in the hemodialysis population.

Purpose: The aim of the study was to identify correlation between DNA damage marker 8-hydroxy 2-deoxy guanosine (8-OHdG) and other prognostic factors such as Gleason's score, serum prostate-specific antigen (PSA), and stage in carcinoma prostate and to assess a probability-correlation between DNA damage and benign prostatic hyperplasia (BPH) and control. Materials and Methods: A study has been carried out prospectively. Forty patients of carcinoma prostate, 34 BPH, and 14 healthy controls were included in the study between the period of July 2010 to July 2012. Serum 8-OHdG level was measured in all subjects as a marker of DNA damage. Results: Serum 8-OHdG level was significantly raised in patient with prostate cancer (313.39 ± 69.48 ng/mL) as compared with BPH patients (204.42 ± 40.97 ng/mL) and control group (198.94 ± 15.74 ng/mL) with P< 0.001. Serum 8-OHdG level in BPH patients was higher than the controls, but the mean difference was statistically insignificant (P = 1.000). The patients with serum PSA >20 ng/mL, Gleason's score >6 had higher mean 8-OHdG levels as compared to serum PSA ≤20 and Gleason score ≤6, as P< 0.05. There was also direct association found between prostate volume and stage of the tumor though it was not significant. Conclusions: These findings suggest that oxidative stress level was significantly raised in prostate cancer patients. It was also observed that a significant direct association exists between oxidative stress and certain clinicopathologic factors, including serum PSA, Gleason score, and metastasis which show that with progression of disease, there was increase in oxidative stress level.

Objectives: The objective of this study was to assess the clinical presentations of perianal warts in boys and to evaluate the possible relationship between the presence of perianal warts and the sexual abuse as mode of transmission. Materials and Methods: In a prospective clinical study, it conducted on 16 boys with clinically evident perianal warts at the Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Upper Egypt, between September 2012 and March 2016. A detailed history from the child and his family was taken. All boys underwent full clinical general and local examinations including (1) site, number, size, and the shape of warts in perianal region, (2) physical signs of sexual abuse, (3) warts in other body areas, and (4) signs of other sexually transmitted diseases. Results: The age of boys ranged from 4 to 10 years, with a mean ± standard deviation of 6.4 ± 1.9 years. Fourteen boys (87.5%) presented with multiple moist papules. Eleven boys (68.75%) had a progressive course. Fourteen boys (87.5%) had no symptoms (incidentally discovered) and 2 boys (12.5%) had perianal itching and pain. Thirteen boys (81.25%) had confirmed history of sexual abuse. Fourteen boys (87.5%) had no physical signs of sexual abuse and 2 boys (12.5%) had perianal fissures. Conclusion: Our results suggested that sexual abuse should be considered in every case of boys with perianal warts.

Introduction: Success of renal transplantation, besides other factors, depends on the total number of nephrons in the transplanted kidney. The aim of our study was to investigate the effect of ratio of donor kidney weight (DKW) to recipient body weight (RBW) on renal allograft function. Materials and Methods: We conducted a retrospective study at our hospital on 245 patients who underwent live-related kidney transplant. Patients were divided into three groups depending on the ratio of DKW in grams to RBW in kilograms. Results: Mean age of the recipients was 40.19 ± 11.86 years (15–68 years) and donor was 46.18 ± 10.98 years (22–75 years). Male:female ratio for recipients and donors was 205:40 and 163:82, respectively. The decrease in mean creatinine level was more rapid in Group 3 patients as compared with Group 2 and Group 1 patients at 7 days and the trend continued till 3 years. Conclusion: The higher DKW/RBW ratio is an important factor for early function and late function of grafts. Extreme mismatch between the DKW and RBW should be kept in mind, and the DKW/RBW ratio can help us prognosticate patients' renal allograft function.

Background and Objectives: The prevalence of nondiabetic renal disease (NDRD) in those with type 2 diabetes mellitus (T2DM) is common worldwide; however, data from India are limited. Materials and Methods: This study included participants with T2DM who underwent renal biopsy with suspicion of NDRD from September 2009 to August 2016. Results: Seventy-one participants (males: 47 [66.2%] and females: 24 [33.8%]) of T2DM with mean age and standard deviation of 52.93 ± 12.56 years were included in the study. The indications for renal biopsy included acute on chronic renal failure in 35.2% (25), nephrotic syndrome in 31% (22), acute renal failure in 14.1% (10), nephritic syndrome in 14.1% (10), and others in 5.6% (4) of participants. The prevalence rates of NDRD, diabetic nephropathy (DN), and DN with NDRD were 50.71% (36), 28.16% (20), and 21.13% (15), respectively. Among the participants with NDRD, 69.44% (25) had primary glomerular diseases (PGDs), 16.67% (6) had tubulointerstitial diseases (TIDs), and 13.89% (5) had secondary glomerular diseases (SGDs). IgA nephropathy was the most common of PGDs affecting 28% (7), followed by postinfective glomerulonephritis (PIGN) in 20% (5), membranous nephropathy in 16% (4), focal segmental glomerulosclerosis in 12% (3), and miscellaneous lesions in 24% (10). Acute interstitial nephritis and primary amyloidosis were the most common of TIDs and SGDs, respectively. Among the patients with combination of DN with NDRD, 53.33% (8) were TIDs and 46.67% (7) had glomerular diseases. Acute tubular injury/necrosis and PIGN were the most common of TIDs and glomerular disease, respectively. The figures in brackets representing number of patients. Conclusions: The majority of the participants with T2DM had NDRD either alone or in combination with DN in the study, underlining the utility of renal biopsy for their diagnoses in those with appropriate indication. Wide spectrum of PGDs, TIDs, and SGDs was found in the study.

Background and Objectives: Tubular ectasia is a rare, pathologically benign condition which initially may present as tiny cyst. Knowledge of typical ultrasound features of this condition helps to differentiate it from other malignant lesions of testis. This study was conducted to find out ultrasound spectrum of tubular ectasia of rete testis and epididymis. Methods: Patients undergoing scrotal ultrasound and doppler for various indications including scrotal pain, infertility, postvasectomy and prior to recanalisation of vas were studied. The history, clinical examination, semen analysis and ultrasound features were analyzed. Our emphasis was on early detection of this rare but benign entity involving testis and epididymis. Results: Scrotal ultrasound with colour doppler in these patients revealed the abnormalities ranging from early changes like specked appearance and tiny cysts to more severe forms involving rete testis and epididymis. Associated abnormalities like epididymal cyst, hydrocele and spermatocele were also found in addition to tubular ectasia in some cases. Conclusion: Tubular ectasia is a pathologically benign condition which can be reliably diagnosed on ultrasound and colour doppler. Familiarity with the ultrasound and doppler features of tubular ectasia will definitely help in early diagnosis which in turn will help in reducing patients' anxiety and prevent unnecessary interventions.

Objectives: The objective of this study was to explore the values of prostate-specific antigen (PSA) before and after transurethral prostatic resection (TURP) surgery and the corresponding correlation with the resection extent through short and long-term changes of benign prostatic hyperplasia (BPH) of patient's serum PSA after TURP. Materials and Methods: Data were abstracted from a retrospective sampling study of 209 cases of BPH patients. The values of serum PSA level were measured preoperatively and at specified periods after TURP surgery; 5 days, 1 month, 3 months, and 6 months. These periods were correlated with the resection extent. Results: Quantitative PSA values were collected before and after the surgical procedure at the time periods. The decrease of PSA value was observed 5 days after surgery when compared with preoperative PSA value, which is about 4.42 ± 8.78 ng/mL while 35% decrease was reported following a month after surgery. Moreover, PSA levels in these five periods were significantly different (P < 0.01), and the value of PSA >4 ng/mL group is still higher than the group of PSA ≤4 ng/mL after the decrease. Resection extent of TURP: The mean differences between real removal quality and the quality, according to the prostate ultrasonography, should be removed, which is expressed in ± standard deviations. The value of the total sample is −0.941 ± 9.56 ng/mL. Values in the group of PSA ≤4 ng/mL and PSA >4 ng/mL are 0.13 ± 10.53 and −3.83 ± 5.41, respectively. There appears to be a positive correlation between the variations of PSA and the resection extent (P < 0.01, R = 0.91). In addition, a positive correlation was confirmed between the variations of PSA and the resection extent in the group of PSA ≤4 ng/mL and PSA >4 ng/mL (P < 0.01, R 1 = 0.986, R 2 = 0.924). Conclusion: A downward trend is demonstrated here in PSA after TURP. The PSA value lowered to a normal level in about 1 month. The interesting point is that there is an inverse relationship between the larger size of the resection and the decrease in PSA values. Thus, missed and misdiagnoses of prostate cancer could be reduced with the long-term follow-up of BPH patients' postoperative levels of serum after TURP. In regards to patients whose preoperative PSA >4 ng/mL, monitoring standards should be taken according to their postoperative PSA baseline when measuring their results of prostate needle biopsies and the diagnosis of prostatic cancer.