Thirty-seven children with end-stage renal disease were evaluated for gastroduodenal lesions by upper gastrointestinal endoscopy between January 1993 and January 1998. The mean (+/-SD) age of the patients was 14.3+/-2.4 years (range 9-17 years). Endoscopic examination was abnormal in 17 patients (46%). The lesions were antral gastritis plus bulbitis (n=6), nodular bulbitis (n=4), antral gastritis (n=4), and duodenal ulcer (n=3). Fifteen patients had symptoms related to gastroduodenal disease, whereas 22 patients were asymptomatic at the time of endoscopic examination; 80% of the symptomatic and 23% of the asymptomatic patients had gastroduodenal lesions on endoscopy. Antral mucosal biopsy was taken from 26 of 37 children for the detection of Helicobacter pylori by the urease test. H. pylori was detected in 10 of 16 patients with gastroduodenal lesions (8 symptomatic, 2 asymptomatic). None of the patients with normal endoscopic examination were positive for H. pylori. Thus, we have demonstrated a significant number of gastroduodenal lesions and their frequent association with H. pylori in our pediatric renal transplant candidates. Our results emphasize the importance of gastrointestinal evaluation in these patients. Endoscopic examination should be considered in symptomatic patients and in areas where H. pylori is endemic.

In order to assess certain aspects of pediatric kidney transplantation (Tx) in Turkey, we retrospectively analyzed the results of 56 of these pediatric procedures performed at our center. From January 1986 to January 1998, 56 pediatric renal Tx (29 males, 27 females; 0-17 yr of age) were carried out at Başkent University Hospital. All were first-time Tx. Fifty-one (91%) patients were on hemodialysis and four (7.3%) were on peritoneal dialysis prior to Tx. Pre-emptive Tx was performed for only one patient. Living-related donors (LRD) provided 47 (84%) of the transplanted organs and cadaver sources were utilized for nine (16%) patients. The mean cold ischemia time (CIT) for cadaveric donors (CD) was 38.6 h (range 23-56 h). Among living-related graft (LRG) recipients, the average waiting time for Tx was 4 months for Tx performed after 1990 and 8 months for those prior to 1990 (p < 0.05). Median length of hospital stay for Tx was 17 +/- 1.1 and 18 +/- 1.4 days for LRG and cadaveric graft (CG) recipients, respectively. Fifteen of 47 (33%) LRG recipients and six of nine (67%) CG recipients received anti-rejection treatment within 30 days following the Tx surgery. Graft failure developed in 16 (12 LRG, four CG) recipients. Two patients developed Kaposi's sarcoma, 17 and 3 months after Tx. There were total of six deaths (four with functioning grafts). The 1-, 3-, and 5-yr graft survival rates were 93%, 75%, and 63%, respectively, and corresponding patient survival rates were 96%, 92%, and 77%. The social and educational status of 27 patients with functioning grafts were also evaluated. Our results showed that 56% of patients ended their education before high school and only three patients have been married. The high rate of school drop-out and unemployment among pediatric renal transplant recipients in our population underline the need for a more intensive rehabilitation program.

Schimke immuno-osseous dysplasia is a rare autosomal recessive multi-system disorder, with clinical features of growth retardation, spondylo-epiphyseal dysplasia, nephrotic syndrome and immunodeficiency beginning in childhood. Here, we report a new case, in a 10-year-old boy with characteristic symptoms of Schimke immuno-osseous dysplasia. The patient presented with short stature and, later, developed nephrotic syndrome and peritonitis. In addition, he had perinuclear anti-neutrophilic cytoplasmic antibody (p-ANCA)-positive arthritis. Renal pathology of the patients with this disease usually show focal segmental glomerulonephritis, whereas our patient had membranous nephropathy, which has not previously been reported.

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