Síndrome hemolítico urémico en Chile: presentación clínica, evolución y factores pronósticos / Hemolytic-uremic syndrome in Chile: clinical features, evolution and prognostic factors

Background: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. Aim: To describe the characteñstics ofpatients with the diagnosis ofHUS in Chile, and to identify the most reliable early predictors oímorbidity and moñality. Material and methods: The clinical records ofpatients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. Results: A cohort of 587 patients aged 2 to 8 years, 48 percent males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39 percent of the patients, hypertension in 45 percent and seizures in 17 percent. Forty two percent required renal replacement therapy (RRT) and perítoneal dialysis was used in the majoríty of cases (78 percent). The most frequently isolated etiological agentwas Escherichia coli. Mortality rate was 2.9 percent in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC) >20.000/mm³ and requirements of renal replacement therapy (p <0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC >20.000/mm³, seizures and hypertension. Conclusions: The present study emphasizes important clinical and epidemiological aspeets ofHUSin a Chilean pediatricpopulation.

Hipertensión endocraneana secundaria a trombosis de seno sagital en paciente con síndrome nefrótico / Intracranial hypertension due to saggital vein thrombosis in a patient with nephrotic syndrome

Entre las complicaciones posibles de observar en un paciente con un Síndrome nefrótico, deben considerarse los fenómenos trombóticos tanto venosos como arteriales, incluyendo la trombosis de senos venosos cerebrales. Objetivo:Presentar la evolución de un niño que desarrolló una trombosis de seno longitudinal superior asociada a un Síndrome nefrótico, comparando la evolución de nuestro paciente con los 32 casos descritos en la literatura. Caso clínico: Varón de 14 años que ingresó por síndrome nefrótico descompensado y cefalea moderada, asociado a papiledema bilateral, en el cual el scanner cerebral y la angioresonancia mostraron una trombosis de seno longitudinal superior en etapa aguda. El hallazgo más significativo fue un aumento de la presión intracraneana de hasta 44 cm. de agua. El aumento progresivo de los anticuerpos IgM anticardiolipinas determinó una terapia anticoagulante permanente. Discusión:En el síndrome nefrótico un estado de hipercoagubilidad y otros factores como deshidratación o traumatismos menores, pueden causar trombos en diferentes vasos, incluyendo los senos cerebrales. El seno más frecuentemente comprometido es el seno longitudinal superior. La sintomatología puede ser escasa a pesar de una marcada hipertensión endocraneana, motivo por el cual esta condición puede ser subdiagnosticada si no se realiza una búsqueda dirigida.

Hemodiálisis crónica en pediatría / Chronic hemodialysis in children

Background: The final objective of every children that is admitted to a program o hemodialysis or peritoneodialysis is to receive a renal graft. Aim: To report the experience in pediatric hemodialysis in two pediatric hospitals in Chile that are reference centers for renal transplantation. Patients and methods: Sixty patients, 55 percent female, aged 2 to 15 years old, admitted to the dialysis and transplant program since 1987, with a creatinine clearance of less than 20 ml/min/l.73 m2, were studied. Results: Twenty percent of children were less than 5 years old at the moment of admittance to the program and 3.3 percent weighed less than 10 kg. Etiologies of end stage renal disease were glomerulopathies in 33.4 percent, reflux nephropathy in 27.7 percent, obstructive uropathy in 13.3 percent, hypoplasia/dysplasia in 10 percent, hereditary problems in 8.3 percent and vascular disorders in 5 percent. Eighty six percent of patients were dialyzed less than 2 years and 5 percent more than 4 years. Fifty percent had received prior medical treatment, 5 percent bad been treated with intermittent peritoneal dialysis, 5 percent with chronic ambulatory peritoneal dialysis and 20 percent presented as a terminal renal failure. Sixty two percent received a renal graft, 25 percent is still on hemodialysis, 3.3 percent switched to chronic ambulatory peritoneal dialysis, 3.3 percent had a recovery of renal function and 6.7 percent died being on hemodialysis. Arterio-venous fistulae were the vascular accesses in 75 percent of patients, double lumen catheters in 50 percent and vein grafts in 5 percent. Malfunctioning or infections were the main complications of arterio-venous fistulae, accounting for 30 percent of hospital admissions. Conclusions: The availability of new vascular accesses and new hemodialysis machines specially designed for chndren, along with specially trained health care personnel, should reduce the mortality and complication rates of hemodialysis in this age group

Hemodiálisis crónica en pediatría / Chronic hemodialysis in children

La hemodiálisis crónica en pediatría comenzó a ser empleada en la década de los años de 1970 y en Chile en la siguiente. Desde entonces cada vez más pacientes con insuficiencia renal terminal utilizan este procedimiento de sustitución. En este artículo se revisan los fundamentos fisiopatológicos básicos de la hemodiálisis y su aplicación en forma de sugerencias y algunos aspectos técnicos del procedimiento, sin pretender una descripción exhaustiva de las técnicas y equipamientos actuales utilizados en el procedimiento