Child nephrology and urology最新文献

Neoplasms originating from the transitional epithelium of the urinary bladder are rare in children. This paper examines the clinical, epidemiological and histopathological characteristics of 3 such cases. The patients were males aged 4, 8 and 14 years at the time of diagnosis. Total painless hematuria was the presenting symptom in all of them. There was no history of previous exposure to dyes or other chemicals, but 1 patient was a systematic cigarette smoker. All tumors were solitary, noninfiltrating, grade 1 neoplasms. Following their local resection, no recurrences were noted 3-8 years postoperatively. This review supports the contention that transitional cell neoplasms of the bladder are less aggressive in children and, therefore, their local management constitutes an adequate therapeutic approach.

The optimal treatment, surgical or conservative, for multicystic dysplastic kidney (MDK) is still undetermined. We analyzed prospectively the evolution of 12 children with MDK who were managed conservatively. After a mean follow-up of 32 months, the only complication found was an episode of urinary tract infection in 3 patients. Complete involution of MDK was observed in 9 patients (75%), the mean period for sonographical disappearance being 16 months. Infants with MDK should be closely monitored and nephrectomy performed when MDK compresses neighbor organs or hypertension develops. There is no agreement on the best therapeutic approach in patients in whom MDK involution has not occurred after a prudential waiting time still not determined.

Renal involvement in desquamative interstitial pneumonitis (DIP) manifesting as chronic renal failure has been reported only once. An uncommon disorder in children, DIP has been associated with a variety of systemic disorders and has an immune-mediated pathogenesis. A 16-year-old Black male was diagnosed to have DIP on lung biopsy at the age of 10 months. He was first noted to have proteinuria at age 5 which progressed to nephrotic syndrome by age 13 when the laboratory tests showed elevated IgG, normal serum complement, increased circulating immune complexes and absent anti-GBM antibodies. A percutaneous renal biopsy specimen performed at age 13 revealed focal segmental glomerulosclerosis. Despite prednisone treatment of 2 mg/kg/day for 12 weeks, renal failure progressed requiring hemodialysis. Pulmonary functions, although reduced, remained stable.

A MEDLINE search of the English-language literature was conducted using the indexing terms 'immunology, calcitriol and vitamin D' to identify studies indicating a role for calcitriol as a primary immunomodulator. Sixty-six papers published between January 1956 and June 1991 were identified. Forty-five of these reports are cited in this review. The data strongly suggest an endocrine, autocrine and/or paracrine role for calcitriol in immune regulation. No unifying hypothesis has yet emerged explaining this collection of data. This paper provides a brief review of immune properties currently attributed to calcitriol.

Urinary urea was measured, under normal living conditions, in children aged 3-16 years, from Cimitile, a small town near Naples in Southern Italy. Urinary urea correlated with age, height, weight, body mass index and body surface area, and was independent from sex. Urinary urea also correlated with urinary creatinine, uric acid, oxalate, sodium and phosphate. Protein intake assessed from urea excretion was 2.66 +/- 0.66 g/kg at 3 years of age and 1.49 +/- 0.31 g/kg at 16 years, and exceeded Italian standards for recommended intake. Also, the height and weight of the children living in Cimitile, with few exceptions, were in excess of national reference standards.

Graves' disease was initially diagnosed in an 11-year-old Chinese boy in March 1989. After regular propylthiouracil (PTU) and thyroxine, he achieved a euthyroid state. Heavy proteinuria with class IV lupus glomerulonephritis, anemia, arthralgia, low serum complement and anti-dsDNA (+) appeared 15 months later. Thyrotoxicosis also relapsed at this time. His condition fitted the diagnostic criteria of systemic lupus erythematosus. His antimicrosomal antibody titer was 1:1,600 (+) thyroid-stimulating hormone receptor antibody level was strongly positive, and the titer of antiinsulin antibody was high as well. These clinical, laboratory and histological findings indicate that class IV lupus nephritis may be associated with Graves' disease.

A neonate with primary hyperparathyroidism was successfully managed by conservative medical treatment. This treatment consisted of intravenous saline load, followed by oral rehydration solutions containing between 60-90 mmol/l of sodium. The combined administration of sodium and diuretics maintained normal levels of serum calcium. Similar cases were previously treated by parathyroidectomy with or without autotransplantation. In selected patients, medical treatment should be considered as the initial approach in mild neonatal hyperparathyroidism. It poses no specific risks and offers an alternative to surgical intervention.