Tubular disorders form a significant proportion of pediatric kidney diseases and are an important differential diagnosis of failure to thrive (FTT) in children. Data regarding their outcome is scarce from India. We evaluated the clinical profile of these children and studied the outcome in terms of their growth and renal failure. This is a retrospective longitudinal study of all children with renal tubular disorders attending a tertiary care pediatric nephrology center from 2005 to 2010. Growth and renal outcomes were assessed by Z scores and estimated glomerular filtration rate at diagnosis and. The common disorders encountered were distal renal tubular acidosis (d-RTA) (44%), Bartter-like (Bartter's and Gitelman) syndromes (22%) followed by hereditary Fanconi syndrome (cystinosis and idiopathic Fanconi syndrome) (13%) and few cases of nephrogenic diabetes insipidus, hypophosphatemic rickets and idiopathic hypercalciuria. Male: female ratio was 1.22. The median age at diagnosis was 1.5 (range 0.13-11) years. Growth failure was the presenting feature in 86% of children followed by polyuria (60%) and bone deformities (47%). In 60% of children with hereditary Fanconi syndrome, nephropathic cystinosis was diagnosed, all of whom progressed to stage III chronic kidney disease (CKD) within 3.41 ± 1.42 years. With appropriate therapy, catch-up growth was noted in d-RTA and Bartter syndrome. Renal tubular disorders usually present with FTT. d-RTA is the most common etiology followed by Bartter-like syndrome. Renal function is preserved in all these disorders except for nephropathic cystinosis, who ultimately progressed to CKD. With appropriate and inexpensive therapy, these children do grow well.

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Pyuria is defined as more than 5WBCs/mm 3 of urine and if this definition is taken into consideration it correlates in 90% cases of UTI. However, pyuria may be masked in significant infections due to Proteus, Klebsiella and Pseudomonas due to disintegration of White Blood Cells caused by alkaline condition produced by these urease positive organisms. Children were subjected to physical examination, blood pressure recording and urine was collected and further analyzed. All children were advised to collect mid stream clean catch urine sample under strict aseptic precautions. The collected urine samples were tested for protein, blood and bacteria by dipstick method and microscopy rapid screening test like griess nitrate test was done. 95% of the children had no RBCs in urine. 2.8% showed 1-5 RBCs/ HPF. Significant hematuria (> 5 RBCs/ HPF) was seen in 2.2% of children.