The aim of this prospective, multicenter study was to define the etiology and clinical features of acute kidney injury (AKI) in a pediatric patient cohort and to determine prognostic factors. Pediatric-modified RIFLE (pRIFLE) criteria were used to classify AKI. The patient cohort comprised 472 pediatric patients (264 males, 208 females), of whom 32.6% were newborns (median age 3 days, range 1-24 days), and 67.4% were children aged >1 month (median 2.99 years, range 1 month-18 years). The most common medical conditions were prematurity (42.2%) and congenital heart disease (CHD, 11.7%) in newborns, and malignancy (12.9%) and CHD (12.3%) in children aged >1 month. Hypoxic/ischemic injury and sepsis were the leading causes of AKI in both age groups. Dialysis was performed in 30.3% of newborns and 33.6% of children aged >1 month. Mortality was higher in the newborns (42.6 vs. 27.9%; p < 0.005). Stepwise multiple regression analysis revealed the major independent risk factors to be mechanical ventilation [relative risk (RR) 17.31, 95% confidence interval (95% CI) 4.88-61.42], hypervolemia (RR 12.90, 95% CI 1.97-84.37), CHD (RR 9.85, 95% CI 2.08-46.60), and metabolic acidosis (RR 7.64, 95% CI 2.90-20.15) in newborns and mechanical ventilation (RR 8.73, 95% CI 3.95-19.29), hypoxia (RR 5.35, 95% CI 2.26-12.67), and intrinsic AKI (RR 4.91, 95% CI 2.04-11.78) in children aged >1 month.

In this study we evaluated the indications, complications, and the spectrum of histopathological results of percutaneous renal needle biopsy (PRNB) performed in our clinic. Between June 1990 and December 2006, 679 PRNBs were performed on native kidneys of 614 children (304 boys, 310 girls) with a mean age of 10.4 years. Most frequent indications for PRNB were nephrotic syndrome (47%), hematuria, and/or proteinuria (15.9%), acute renal failure (14.6%) and complex renal manifestations (18.9%). The overall complication rate was 15.2%. The most common complications were perirenal hematoma (12.4%) and macroscopic hematuria (2.6%). The most frequent histopathological group of diseases were glomerulopathies; these were diagnosed in 376 patients (61.2%) and included membranoproliferative glomerulonephritis (11.1%), mesangial proliferation (10.7%), diffuse proliferative glomerulonephritis (7.7%), and focal segmental glomerulosclerosis (7.3%) as the most frequent. The second most frequent group of histopathology was manifestations secondary to systemic diseases; these were shown in 195 patients (31.8%). Amyloidosis (11.4%) and Henoch-Schönlein nephritis (9.9%) made the majority of this group. In conclusion, our study demonstrated that PRNB is a safe procedure with usually transient complications showing the most frequent renal diseases that cause diagnostic and therapeutic difficulties for pediatric nephrologists.

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SummaryPassive smoking, especially of maternal origin, is known to influence adversely the development of children's pulmonary function. In this study, the eVect of parental smoking on the pulmonary function of 360 primary school children aged 9-13 (mean 10.8±0.7) years was investigated. Information on parental smoking history was collected using a questionnaire, and spirometric measurements were performed on the children.All spirometric indices were lower in children who had been passively exposed to parental tobacco smoke than those not exposed. The percentage of households in which at least one parent smoked was 81.5%. This figure was significantly lower for mothers (27.5%) than for fathers (79%). Paternal smoking was associated with reduced levels of forced expiratory flow between 25-75% of vital capacity, peak expiratory flow, and flow rates after 50% and 75% of vital capacity expired (p<0.05). Maternal smoking did not have statistically significant adverse eVects on children's pulmonary function. This result might be due to the low occurrence of either pre-or post-natal smoking among mothers and confirms that, in our population, the main target group for antitobacco campaigns should be fathers.Keywords: passive smoking; pulmonary function; tobacco smoke Passive smoking is defined as the exposure of a nonsmoker to tobacco smoke in the environment. 1This condition is a major environmental health problem, especially for children, and is becoming increasingly important in Turkey, due to increasing cigarette consumption. In some local studies it has been reported that the percentage of families in which at least one parent smokes is 75%. It is widely known that smoking is the most common preventable cause of mortality and morbidity. Exposure to environmental tobacco smoke (ETS) has also been found to be a cause of preventable morbidity and mortality in nonsmokers, both children and adults. The adverse eVects of smoking may be due to one or more of the hundreds of diVerent chemicals in tobacco smoke, although our knowledge of these substances, apart from carbon monoxide and nicotine, is limited. 4 There is almost no organ system that is not aVected by smoking.The most commonly accepted eVect of smoking is lung cancer, 5 6 and there are many studies showing an association between passive smoking and wheezy bronchitis, asthma, bronchial hyper-reactivity, atopy predisposition and otitis media. 7 8 Recently, it has been shown that passive smoking increases the morbidity of asthma and usage of asthma medications in school-aged children, in whom pulmonary function is especially aVected by maternal smoking. 10We performed a cross-sectional study to evaluate the association of paternal and maternal smoking with their children's pulmonary function. Materials and methodsThis study was designed to examine the influence of passive smoking on pulmonary function tests of children in the 4th and 5th classes of two primary schools in the Altindag district of Ankara in April 1996.Information on the exposure of the children to ci...

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