Renal transplantation in Thai children.

Renal transplantation in children has been performed for over 25 years in developed countries but has never been reported in Thai children. We report an 8 year-old girl with end-stage renal disease due to chronic glomerulonephritis who had been transplanted at Siriraj Hospital. She was treated with continuous peritoneal dialysis for 9 months and developed several episodes of bacterial peritonitis and hypertension. She was transplanted using her father’s kidney and her serum creatinine level was normal within 7 postoperative days. The patient developed severe hypertension which was controlled with 4 antihypertensive agents. Five weeks postoperation her new ureter leaked. Although surgery was performed with internal stent placed, the patient continued to have urinary leakage and ureteric reconstruction using bladder flap or her own ureter will be done later. The patient’s renal function was normal on follow up.

IgA nephropathy in Thai children.

We retrospectively studied 11 patients with IgA nephropathy admitted into the Department of Pediatrics, Siriraj Hospital from 1983 to 1993. These patients represented 2 percent of 552 patients with glomerular disease admitted at the same duration. Female to male ratio was 1.75 : 1. Average age of onset was 98.5 months (range 46-144 months). Common manifestations included macroscopic hematuria (72.7 percent), microscopic hematuria 1 patient (9.1 percent), edema (27.3 percent) and nephritic syndrome (18.2 percent). Proteinuria was found in 4 patients (36.2 percent) and 3 patients (27.2 percent) had increased serum creatinine concentration at the time of diagnosis. Serum immunoglobulin A was increased in 1 of 5 patients studied (20 percent). Percutaneous renal biopsy was performed in all cases. Nine patients had diffuse proliferative glomerulonephritis, the rest had focal segmental glomerulonephritis. Both patients with nephritic syndrome were given oral prednisolone and 1 patient with proteinuria and severe renal pathology was given the combination of prednisolone and cyclophosphamide, all responded well. Seven patients had been followed up for 1 to 9 years. Three patients (42.8 percent) had increased serum creatinine. We suggest that urine protein and renal function should be measured in all patients with IgA nephropathy at diagnosis and followed up periodically. We also recommend the use of prednisolone in patients with IgA nephropathy who presented with nephritic syndrome.

Electrical injury in Thai children: Its epidemiology and prevention.

Electrical current can affect every organ system in the body as a result of heating eletrogenic changes. The clinical features following electric injury are described as local and general lesions. Electrical burns were common local electrical injury and mostly involved the hand. Fourty nine percent of electrical shock or loss or consciousness were found in this series which were general lesion; one of them was presented with brain lesion and recovered after 6 month-follow up. The incidence and causes of injury in various age-groups were as the following: the children under 3 years old placed their finger in the wall sockets; 4-6 years old put in or pulled cord plug; the 7-12 years old handled the faulty electrical equipment; the children over 12 years mostly began labour life that got electrical injury during working in an unsafe place and with carelessness. Electrical burns caused deformity, most common with the upper extremities. A proper, safe electrical equipment should necessarily be developed by the government, especially the cord plug and wall socket.