Child nephrology and urology最新文献

The long-term effect of hydrochlorothiazide (HCT) was studied in 30 children (17 boys and 13 girls), aged 4-13 years (mean 7.6 +/- 3.4), with renal hypercalciuria (HCU) for a period of 2.5 +/- 0.95 years. The purpose of the study was to evaluate the effect of HCT mainly on renal calcium excretion, but also on serum K+, Ca, P, Mg, cPTH, nephrogenic cAMP (ncAMP) and bone mineral content (BMC). In addition to the above-mentioned parameters, oxalate, uric acid, citrate and cystine levels in 24-hour urine collections were also measured, and UCa/UCr, UP/UCr, UMg/UCr in 3-hour urine collections were assayed. The results of the study showed that 1 mg/kg/day of HCT caused a rapid and long-lasting correction of HCU, a decrease in serum cPTH and ncAMP, a significant increase in BMC and prevention of the formation of new urinary stones or of the increase in size of stones already present. No side effects were observed.

We report 9 female patients with labial fusion and concomitant urinary tract infection. The mean age at presentation was 47 months. All except 1 patient had labial fusion extending at least 50% of the length of the labia minora. All had symptoms of urinary tract infection and a positive urine culture. We recommend that a urine culture be performed in children with labial fusion and that all girls with urinary tract infection should be checked for labial fusion.

Digital subtraction radiography (DSR) was used to evaluate the anatomy and function of the bladder and urethra in 20 children with clinical urinary disturbances deriving from recurrent urinary tract infections. Following image subtraction, a complete study of bladder and urethra morphology and activity before and during voiding was obtained. Furthermore, DSR permitted a reduction in exposure doses given to children compared to conventional film-screen examinations. Results indicate the applicability of this technique for use on a wider scale and suggest its use as an alternative to other diagnostical techniques for the study of this subject.

In 9 children with idiopathic hypercalciuria, an oral calcium-loading test was performed. After this calcium excretion, vitamin D levels, parathyroid hormone levels and phosphate excretion were measured during a period of calcium restriction, a period of high calcium intake and a period of low calcium intake and phosphate supplementation. In our patients, there was no correlation between calcium excretion following acute and long-term calcium loading. Phosphate excretion was normal during the periods of low and high calcium intake and there were no signs of renal phosphate leakage. Elevated levels of 1,25-dihydroxyvitamin D were found with no significant change after altering phosphate or calcium intake (95% confidence intervals for the difference in 1,25-dihydroxyvitamin D levels were -2.2-15.4 pg/ml in the period with low and high calcium intake; -19.8-28.2 pg/ml in the period with low calcium intake and extra phosphate, and -24.2-19.6 pg/ml in the period with high calcium intake and extra phosphate). These data support the hypothesis of an autonomously elevated 1,25-dihydroxyvitamin D level as pathogenetic mechanism for idiopathic hypercalciuria.

To evaluate the development of renal function in fetal malnutrition conditions, we tested glomerular filtration rate and fractional sodium excretion (FENa) of premature twins at birth (less than or equal to 35 weeks gestational age) with birthweight discordance, divided according to birthweight (less than or equal to 10% group A; higher birthweight group B). Groups A and B of twins are comparable in fluid intake, biochemical serum tests (glucose, sodium, potassium, albumin, total protein, osmolality and hematocrit) and also in percent weight decrease at 24 h of life. Moreover, both creatinine clearance (CrCl) and FENa result respectively correlated directly (r = +0.63) and indirectly (r = -0.46) with gestational age of twins. Consequently, CrCl (8.3 +/- 4.3 vs 8.3 +/- 4.5 ml/min/1.73 m2) and FENa (3 +/- 2.8 vs. 2.7 +/- 2.8%) do not result different in relation to birthweight discordance of premature twins. In conclusion, at birth, gestational age is the main determinant of kidney function in premature twins with birthweight discordance.

The present review summarizes the characteristics of renal bone disease in pediatric patients treated with maintenance peritoneal dialysis. Fifty-eight patients underwent iliac crest bone biopsy after double tetracycline labeling, measurements of aluminum in bone and various serum biochemical determinations including serum PTH, alkaline phosphatase, calcium, phosphorus and aluminum. Evidence of osteitis fibrosa was present in 45% of patients and mild lesions of secondary hyperparathyroidism were found in an additional 25%. Thus, secondary hyperparathyroidism remains the predominant bone lesion despite the use of oral calcitriol. Evidence of aluminum accumulation was substantially less prevalent, findings not surprising due to the widespread use of calcium carbonate as the main phosphate binder agent. However, aplastic bone lesion without aluminum staining was present in the majority of patients with low-turnover lesions of the bone without osteomalacic findings. The long-term evolution of such lesions remains to be evaluated. The potential value of alternative modes of calcitriol administration for the control of secondary hyperparathyroidism is discussed as well as the differences in the bioavailability of sterol according to the different routes for calcitriol administration.

Hemolytic uremic syndrome has been associated with insulin-dependent diabetes mellitus eight times in the past, while the hemolytic uremic syndrome and rhabdomyolysis association has been described once. The occurrence of both conditions in a patient with the hemolytic uremic syndrome has not been reported. In this report, we described a 28-month-old girl who presented with severe hemolytic uremic syndrome muscle weakness and elevated muscle enzymes. Later, she developed hyperglycemia and ketosis requiring initiation of insulin therapy. The current literature was reviewed, and a hypothesis for the mechanism of injury and the multisystemic nature of this syndrome is presented. In patients with the hemolytic uremic syndrome, identification of potential extrarenal involvement is important as it may determine the final outcome of this disease.