Background/Objectives: The Tc-99m dimercaptosuccinic acid (DMSA) renal scan clearly images the renal cortex, highlighting functional tissue areas and indicating regions of renal scarring, infection, malformations, or other types of renal damage. To enhance the management of paediatric cases involving renal malformations and to reduce the incidence of chronic and progressive kidney diseases in “future adults”, our study aims to identify and categorise various renal anomalies. Methods: This has been achieved by analysing the Tc-99m DMSA renal scans of a large cohort of 931 children diagnosed with different renal pathologies. After interpreting the scans, we categorised the renal malformations and cortical modifications into four groups: kidney number anomalies, positional anomalies, structural anomalies, and shape anomalies. Results: There has been a notable increase in the demand for renal scintigraphy in recent years, rising from 82 cases in 2019 to 183 cases in 2024. Structural anomalies were the most common type of malformations (73% from all patients), featuring a significant variety of cortical modifications. In total, 98 cases (93% from kidney number anomalies and 10.5% from all children) were diagnosed with renal agenesis. Additionally, 30 children (3.2% from all patients) had positional anomalies, primarily ectopic kidneys, and 54 patients (5.8% from all cases) had shape malformations, especially fused kidneys. Conclusions: Combining the Tc-99m DMSA renal scan with ultrasound provides a more reliable diagnosis of paediatric renal progressive diseases. A more accurate diagnosis allows for quicker treatment and prevention of potential complications, ultimately improving the quality of life and decreasing hospital costs of paediatric patients becoming adults.

Viper bites are medical emergencies that can develop into serious clinical complications and can endanger the life of the paediatric patient. This observational retrospective study analyses 24 cases of viper bites involving paediatric patients (<18 years) encountered over 10 years (2016–2025) in the emergency department of Saint Mary Emergency Hospital of Iasi, Romania, with a focus on those requiring specialised surgical monitoring. Sociodemographic factors, toxicity, and surgical management of snakebites were analysed. In 83.33% cases, viper bites were found on the lower limb. The retrospective study was completed through an in-depth analysis of two representative cases, with a particular focus on the evolution up to compartment syndrome. Of the 24 cases presented in the Emergency Department, one was a rare and severe case, which evolved into compartment syndrome and required fasciotomy to save the limb in the Plastic Surgical Department. Another one, with the bite localised at the upper limb, had perilesional oedema, without skin colour changes or secretions, preservation of joint contours, and normal nail colouration. Both were analysed and described in detail with all available data (images, investigations, etc.) to highlight pathophysiological and therapeutic aspects. Appropriate, multidisciplinary treatment considerably improves the functional prognosis of patients with viper bites; administration of antivenom and selective fasciotomy contribute to successful outcomes. The study emphasises that viper bites in children remain a public health problem in Romania and require prompt and multidisciplinary treatment.

Background: Idiopathic nephrotic syndrome (NS) in children is characterized by urinary protein loss and potential disruptions in trace element homeostasis. The dynamic changes in zinc, copper, and magnesium levels in relation to disease activity remain incompletely defined. Objective: This study aimed to evaluate serum zinc, copper, and magnesium and urinary copper and magnesium alterations in homeostasis in pediatric nephrotic syndrome and to examine their associations with disease stage, proteinuria, disease duration, renal function, and corticosteroid response. Materials and Methods: This is a prospective cohort study involving 108 participants, including 74 pediatric patients with idiopathic nephrotic syndrome and 34 healthy controls, comprising 164 clinical and biological assessments. Serum and urinary concentrations of Zn, Cu, and Mg were analyzed, alongside clearance parameters and the fractional excretion of magnesium. Statistical analysis included non-parametric tests, Spearman correlations, ROC analysis, and multivariable logistic regression. Results: Serum zinc levels were significantly lower during active disease phases and normalized during remission (p < 0.001); however, these differences in serum zinc concentration with stages of the NS disappeared after adjustment for serum protein levels (p = 0.424), suggesting a transport deficit secondary to hypoproteinemia. Although serum zinc concentrations were also significantly reduced in patients with concomitant infection, adjustment for serum protein levels attenuated this association, and the zinc-to-protein ratio did not differ significantly according to infection status (p = 0.08). Urinary copper levels and clearance were elevated during active disease and positively correlated with proteinuria (rho = 0.35–0.38; p < 0.001); the Cu/Zn ratio varied significantly across disease stages (p < 0.001) and was associated with both disease activity and a tendency toward corticosteroid resistance. Magnesium demonstrated a pattern of tubular conservation during active phases, with elevated fractional excretion values during remission (p < 0.001) and inverse correlations with proteinuria. Disease duration, but not relapse burden, was positively correlated with serum zinc and fractional magnesium excretion and inversely correlated with serum magnesium. In the multivariable analysis, serum proteins emerged as the sole independent predictor of disease activity, while age and the Cu/Zn ratio were associated with corticosteroid resistance. Conclusions: Pediatric nephrotic syndrome induces significant alterations in zinc, copper, and magnesium homeostasis, dependent on glomerular permeability and plasma protein status. Zinc changes with stages of NS likely reflect a secondary transport defect. In contrast, zinc changes with infection likely occurred because of a shift of zinc to the intracellular compartment. Urinary copper serves as a marker of glomerular permeability and magnesium highlights tubular adaptation. The Cu/Zn ratio and magnesium handling parameters may prove clinically useful in monitoring disease activity and treatment response.

Background: Pediatric idiopathic nephrotic syndrome (INS) is classified primarily by corticosteroid response, delaying identification of steroid-resistant disease and exposing children to unnecessary treatment toxicity. Novel biomarkers could enable earlier biological stratification and treatment guidance. Objectives: The study aimed to map available evidence on candidate biomarkers in pediatric INS published since 2020, with emphasis on anti-nephrin autoantibodies and their potential for clinical translation. Data Sources: PubMed/MEDLINE and Web of Science Core Collection (January 2020–October 2025), with a supplementary verification search in Scopus and Embase and manual reference screening. Eligibility Criteria: Original studies reporting circulating, urinary, or tissue-based biomarkers in children aged 0–18 years with idiopathic NS, with outcomes related to diagnosis, treatment response, relapse prediction, or monitoring. Studies in adults only, secondary NS, or animal models were excluded. Results: After screening, 34 studies met the eligibility criteria and were included, grouped into five categories: autoantibodies, urinary markers, immune cell signatures, cytokines/chemokines, and exploratory markers (metabolomics, extracellular vesicles, lipid profiles, microRNAs). Anti-nephrin IgG emerged as the most mechanistically informative marker, with seroprevalence declining across phenotypes (SSNS 68%, SDNS 28%, non-genetic SRNS 14%, genetic SRNS 2%) and positivity predicting response to intensified immunosuppression. Of the candidates reviewed, urinary NGAL and peripheral B-cell subset monitoring are the most readily implementable with existing laboratory infrastructure. Conclusions: Pediatric INS encompasses a spectrum of immune-mediated podocytopathies that may soon be distinguishable by emerging biomarker profiles. Anti-nephrin autoantibodies provide the strongest mechanistic evidence for an autoimmune podocytopathy.