Background Currently used pediatric kidney length normative values are based on small single-center studies, do not include kidney function assessment, and focus mostly on newborns and infants. We aimed to develop ultrasound-based kidney length normative values derived from a large group of European Caucasian children with normal kidney function. Methods Out of 1,782 children aged 0–19 years, 1,758 individuals with no present or past kidney disease and normal estimated glomerular filtration rate had sonographic assessment of kidney length. The results were correlated with anthropometric parameters and estimated glomerular filtration rate. Kidney length was correlated with age, height, body surface area, and body mass index. Height-related kidney length curves and table were generated using the LMS method. Multivariate regression analysis with collinearity checks was used to evaluate kidney length predictors. Results There was no significant difference in kidney size in relation to height between boys and girls. We found significant (p < 0.001), but clinically unimportant (Cohen’s D effect size = 0.04 and 0.06) differences between prone vs. supine position (mean paired difference = 0.64 mm, 95% CI = 0.49–0.77) and left vs. right kidneys (mean paired difference = 1.03 mm, 95% CI = 0.83–1.21), respectively. For kidney length prediction, the highest coefficient correlation was observed with height (adjusted R2 = 0.87, p < 0.0001). Conclusions We present height-related LMS-percentile curves and tables of kidney length which may serve as normative values for kidney length in children from birth to 19 years of age. The most significant predictor of kidney length was statural height. Graphic Abstract

Urolithiasis is recurrent chronic disease and a complex nephro-urological problem. Currently it is diagnosed in very young children, even infants in the first quarter of life. Until recently the main method of treatment for stones, which for various reasons did not pass spontaneously, was open surgery. At present, the main method replacing open surgery is extracorporeal shock wave lithotripsy (ESWL). Usefulness of common known indicators of the renal function to assess the safety of ESWL procedure is evaluated and verified. The basic markers are serum creatinine, cystatin C, urea, glomerular filtration rate and albuminuria assessment. Unfortunately all these methods show little sensitivity in the case of acute injury processes. There are efforts to use new biomarkers of renal tubular activity, which include among others interleukin 18 (IL-18) and neutrophil gelatinase-associated lipocalin (NGAL). The aim of the study was to assess the safety of ESWL by means of albumin to creatinine ratio, serum cystatin C levels and concentration of two new markers: IL -18 and NGAL. Albumin to creatinine ratio (p = 0.28) and serum cystatin C (p = 0.63) collected before and 48 hours after ESWL did not show statistically significant differences. Similarly, both new markers (IL -18 and NGAL) showed no significant differences (urine IL -18 p = 0.31; serum NGAL p = 0.11; urine NGAL p = 0.29). In conclusion, serum cystatin C tests, urine albumin to creatinine ratio and new early markers of renal tubular injury confirmed the safety of the extracorporeal shock wave lithotripsy (ESWL) and show that the procedure does not cause any episode of acute renal injury.

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Pneumonia, which may be accompanied by the full spectrum of various clinical symptoms, with the most common including fever, chills, cough, chest pain, dyspnoea, tachypnoea, hypoxia, and auscultatory changes (crepitations, rales), is one of the most common lower respiratory infections. Chest radiography is a standard method used to confirm pneumonia. Transthoracic lung ultrasound has recently emerged as an alternative to radiology. The aim of this paper was to assess the utility of transthoracic lung ultrasound as an alternative to chest radiography in children with clinical manifestations of acute lower respiratory infection. A total of 63 patients aged between 1 month and 18 years, hospitalised in the Department of Paediatrics, Paediatric Nephrology and Allergology were qualified for the study. The study group included 44 children (mean age 4.3 ± 4.4 years), and the control group included 19 children (mean age 6.5 ± 3.8 years). Cough (42/44, 95%), dyspnoea (31/44, 70%), and fever (28/44, 64%) were the most common clinical symptoms in the study group. Auscultatory manifestations typical of pneumonia, i.e. crepitations, rales, reduced vesicular murmur, were observed in 30/44 (68%) patients; uncertain clinical symptoms of lower respiratory infection were observed in 14/44 (32%) patients. Lung ultrasound was performed within 48 hours of chest radiology. Both ultrasonographic and radiological lesions typical of pneumonia were found in 25/30 children presenting with clinical symptoms of pneumonia; no lesions in either of the modalities used were detected in 1/30 patients. Both ultrasonographic and radiological lesions typical of pneumonia were identified in 8/14 children with clinically uncertain pneumonia; no lesions were detected in diagnostic imaging in 1/14 children. Conclusions: Lung ultrasound is a useful tool for the assessment of lower respiratory inflammation in children. Ultrasonographic findings are comparable with those in radiology, which is considered a standard modality.

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