The Link - November 2024

While vesicoureteral reflux (VUR), in and of itself, is not harmful to the kidney, its presence predisposes patients to acute pyelonephritis by transporting bacteria from the bladder to the kidney, which can lead to renal scarring, hypertension, and, ultimately, chronic kidney disease (CKD). Reflux nephropathy (RN) is estimated to be responsible for up to 20% of all children with chronic renal failure.¹ Reflux nephropathy is also the second leading cause of chronic tubulointerstitial disease and the fourth most common cause of end-stage renal disease (ESRD) in children behind focal segmental glomerulosclerosis (FSGS), renal aplasia, dysplasia and obstructive uropathy.^2,3 RN is responsible for ESRD in 7% to 17% of children worldwide; thus, it is important for all pediatric practitioners to understand its etiology, diagnosis and management strategies.

Until recently, United States Department of Health and Human Services (DHHS) recommended that women living with HIV (WLWH) avoid breastfeeding). However, in January 2023, the DHHS guidelines for perinatal HIV infection were updated to say, “People with HIV should receive evidence-based, patient-centered counseling to support shared decision-making about infant feeding.” Where did this change in recommended practices come from and what exactly is being recommended?

Winter sports, including hockey, wrestling, basketball, skiing and snowboarding, are high risk for head injuries. A 10-year study on pediatric skiing and snowboarding found that the most injured body part was the head.⁶ This finding is concerning given that many ski resorts do not require, but only recommend, wearing helmets. Another study concludes that the most common injury for youth ice hockey players is concussion.⁴ With winter just around the corner, high clinical concern for concussions is essential for appropriate diagnosis and management.

Providing vaccines is a daily occurrence in pediatric health care. Knowing when to withhold or delay vaccines is important and sometimes complicated. In the case of routine illness, since there is no evidence that acute illness reduces vaccine effectiveness or safety, they can be administered. As a precaution, however, it is recommended that vaccines should be delayed in the case of moderate or severe acute illness until the illness has abated. Mild illnesses with or without fever (such as otitis media, upper respiratory tract infection or gastroenteritis) and antibiotic use are not contraindications to routine vaccination.