Pain syndrome induced by calcineurin inhibitor and resolved by conversion to sirolimus in a child after kidney transplantation: a case report.

Pain induced by calcineurin inhibitors is a rare complication of unknown pathogenesis. We have reported herein a 7-year-old child who presented with abdominal pain, vomiting, and weight loss showing no significant findings after an extensive laboratory and imaging workup. After conversion from tacrolimus to sirolimus, there was complete resolution of the gastrointestinal symptoms and pain; the patient displays excellent renal function. Calcineurin inhibitor-induced pain syndrome is diagnosis of exclusion but must be considered because the withdrawal of this immunosuppressive agent is associated with improvement in symptoms and quality of life.

[Nutritional status of children and teenagers with chronic renal failure]. / Avaliação do estado nutricional de crianças e adolescentes com insuficiência renal crônica.

BACKGROUND: the purpose of this study is to evaluate the nutritional status of children and teenagers with chronic renal (CRF) failure using anthropometric measurements. MATERIAL AND METHODS: 41 children and adolescents with (CRF) (creatinine "clearance" < 50 ml/min/1,73m(2)) followed at the Pediatric Nephrology Unit (HC-UNICAMP), between January 1995 and November 1996, were evaluated by the assessment of anthropometric measurements, mid upper arm circunference (MUAC) and triceps skinfold (TSF). With these measurements, mid arm fat area (MUAFA) and arm muscle area (AMA) were calculated and its z-scores. These measurements were performed twice at least, ranging from 0.21 to 1.3 years (0.88 +/- 0.04). RESULTS: all the z-scores (MUAC, TSF, MUAFA and AMA) were very low, and only the AMA z-score was statistically significant (p= 0,03 Wilcoxon test). The patients were divided in to groups, according to their treatment, and the MAC z-score for the renal transplantation group was statistically significant (p= 0,02 Wilcoxon test). CONCLUSIONS: these data demonstrate a compromised nutritional status from both muscle and fat stores, with an improvement in muscle stores.

Avaliaçäo do estado nutricional de crianças e adolescentes com insuficiência renal crônica / Nutritional status of children and teenagers with chronic renal failure

A desnutriçäo está freqüentemente relacionada com doenças crônicas. O diagnóstico precoce realizado por técnicas práticas e simples favorece o tratamento, minimizando as complicaçöes. OBJETIVO: avaliar a situaçäo nutricional de crianças e adolescentes com insuficiência renal crônica (IRC) utilizando parâmetros antropométricos. MÉTODOS: Foram avaliadas 41 crianças e adolescentes com IRC ("clearance" de creatinina abaixo de 50 ml/min/1,73m2) acompanhadas no Ambulatório de Nefrologia Pediátrica do HC-Unicamp, de janeiro de 1995 a novembro de 1996, pelas medidas do perímetro braquial (PB) e da prega cutânea tricipital (PCT), com as quais calculou-se a área de gordura braquial (AGB) e área muscular braquial (AMB) e os respectivos escores z. Estas medidas foram realizadas pelo menos duas vezes, com intervalo de 0,21 a 1,3 anos (0,88 ± 0,04). RESULTADOS: Os escores z obtidos tanto para PB, como para PCT, AGB e AMB apresentaram valores muito baixos, sendo que, na evoluçäo, apenas o escore z de AMB apresentou melhora estatisticamente significativa (p= 0,03 teste de Wilcoxon). Quando selecionados quanto ao tratamento de substituiçäo renal, apenas os transplantados renais apresentaram melhora estatisticamente significativa para o escore z de PB (p= 0,02 teste de Wilcoxon). CONCLUSÄO: Estes dados mostram uma situaçäo nutricional comprometida tanto em relaçäo à reserva de gordura, quanto de músculo, com melhora no acompanhamento apenas em relaçäo à área muscular

Inherited risk factors for thrombophilia in children with nephrotic syndrome.

UNLABELLED: A hereditary tendency to venous thrombosis rarely results in a spontaneous thrombotic episode before puberty. The acquired hypercoagulability associated with nephrotic syndrome (NS) could, however, coincide with underlying inherited thrombophilia, thereby resulting in a thrombotic event. In order to determine the contribution of inherited prothrombotic conditions to thrombosis in children with NS, we analysed DNA from a cohort of patients with NS for the common genetic risk factors of vascular disease. We evaluated 53 children with NS and 41 paediatric controls for prevalence of the factor V mutation Arg506-->Gln (factor V Leiden), the prothrombin variant (20210G-->A), and homozygosity for Ala677-->Val in the methylenetetrahydrofolate reductase gene (MTHFR). Eight thrombo-embolic events were identified in 6 out of 53 (11%) children. Three thrombotic events occurred during NS activity and were associated with systemic infections in two and an arterial puncture in one. An inherited risk factor was identified in seven children, all without thrombosis (two heterozygous for the prothrombin variant and five homozygous for the MTHFR-T). None of the studied inherited risk factors were identified among those with thrombosis. CONCLUSIONS: These data suggest that inherited thrombophilia is not a strong risk factor for the development of non recurrent thrombosis in children with NS.

Gastric emptying of liquids in rats with acute renal insufficiency.

The gastric emptying of watery meals was studied in 112 male Wistar rats. The meals utilized were saline and glucose-saline solutions whose emptying was assessed 10 and 30 minutes after administration. A liquid 5% glucose meal and a 0.25 M sodium bicarbonate meal were assessed after 30 minutes and a commercial meal was assessed after 60 minutes. For each study time eight control animals and eight animals bilaterally nephrectomized 48 hours before the gastric emptying tests were used. The meals were labeled with red phenol and the gastric residue was determined by standard methodology. A blood sample to determine serum creatine and blood gases analysis was obtained from 22 animals of the control group and the same number of nephrectomized animals. At the time of the gastric emptying tests, the nephrectomized animals had significantly higher levels of creatinine and moderate metabolic acidosis. Results for the saline meal showed that at 10 minutes there was a significant delay in emptying in animals with renal insufficiency. Results for the glucose-saline meal were similar to the saline alone group, except that they did not differ significantly between the control group and the nephrectomized groups. There was a significant delay in the emptying of all the other meals in the animals with renal insufficiency. These data suggest that uremia does not lead to serious disturbances in gastric motility, but that it does interfere with the mechanisms controlling gastric emptying.

[Brain abscess in childhren: A ten cases report] / Abscesso cerebral na infância: relato de 10 casos.

OBJECTIVES: Considering that the brain abscess is rare in infants, with a high mortality rate, the objective of this paper is to report the clinical evolution of ten children with the diagnosis of brain abscess in the Pediatric Nursery of the Hospital das Clínicas of the Medical School of the Campinas State University (UNICAMP).METHODS: The data of the patients with diagnosis of brain abscess recorded between January 1986 and July 1995 were reviewed. The following data were analyzed: age, sex, clinical manifestations, physical examination, radiological data, etiological agent, treatment, complications and clinical evolution of the patients.RESULTS: The age of the patients varied from 2 to 13 years (median 3 years); 6 of them were female. The neurological manifestations predominated, and 2 patients had history of prior otorhinolaryngological infection (chronic otitis media and sinusitis). Two patients had congenital cyanogenic cardiopathy (Fallot tetralogy and Pulmonary Stenosis with Interventricular Communication). The diagnosis and follow-up were made with computed tomography of the brain. In six cases there were one sole abscess located more frequently in the frontal lobe. The treatment in majority of the cases was broad-spectrum antibiotic association and surgical drainage. Five patients had neurological sequelae (seizure, hydrocephalus and paresis); one death occurred.CONCLUSIONS: Although rare, the brain abscess has to be remembered in patients that have neurological alterations associated to risk factors, as otorhinolaryngological infections and congenital cyanotic cardiopathy, being mandatory the realization of computed tomography of the brain to confirm the diagnosis.

[Liver abscess in childhood: report of 8 cases]. / Abscesso hepático na infância: relato de oito casos.

The authors present eight cases of children with liver abscess diagnosed in the Pediatric Nursery of the "Hospital das Clínicas", State University of Campinas, SP, Brazil, during eight years. Five children were younger than five years. They were four boys and four girls. The symptomatology was inespecific. Staphylococcus aureus was the more frequent etiologic agent and in two cases it was seen Ascaris lumbricoides worm inside the abscess. The findings of ultrasound and computadorized tomography were similar. In most cases, were employed the association of broad spectrum antibiotics and percutaneous draining, and a good clinical outcome was observed in all patients.

[Gastric emptying and metabolic acidosis. II. Study, in an experimental model in rats, of gastric retention of a sodium bicarbonate solution]. / Esvaziamento gástrico e acidose metabólica. II--Estudo, num modelo experimental em ratos, da retenção gástrica de uma solução de bicarbonato de sódio.

The gastric emptying of a 0.25 M sodium bicarbonate solution was studied in rats with metabolic acidosis induced by a previous (6 hours) orogastric infusion of a 0.5 M ammonium chloride solution. Two control groups were used: one previously infused with 0.5 M sodium chloride and the other with water, in the same volume that further solutions. Every animal was fed with 2 ml/100 g of its weight of these solutions. The test meal (bicarbonate solution) was utilized containing 6 mg% red fenol as a marker. The gastric retentions were determined 6 hours after those first meals at 5, 10, 20 and 30 minutes. The results demonstrated that the gastric retentions of the bicarbonate solution were significantly lower in the acidotic group than that one of water group (at 20 minutes) and that one of the sodium chloride (at 10, 20 and 30 minutes). The data here presented suggest that metabolic acidosis accelerates the gastric emptying of a sodium bicarbonate solution.

[Gastric emptying and metabolic acidosis. I. Study of an experimental model in rats, using an ammonium chloride solution administered through the orogastric route]. / Esvaziamento gástrico e acidose metabólica. I. Estudo de um modelo experimental em ratos, empregando uma solução de cloreto de amônio por via orogástrica.

The goal of the study was get an experimental model of metabolic acidosis which was appropriated in future gastric emptying studies. For this proposal were utilized 141 female Wistar rats in three stages: in the first (n = 27) was defined the installation, manutention and spontaneous recuperation of the metabolic acidosis produced by the orogastric infusion of a two ml by 100 g of an 0.5 M ammonium chloride solution; in the second (n = 60), it was studied the gastric emptying of the same solution utilized in the first stage and in the last stage (n = 54) it was determined the gastric emptying of the water, for excluding the possibility that the acidificant solution had caused any lesion in the gastric mucosa. As control group were utilized animals fed as a sodium chloride solution in the same concentration and volume that the acidificant solution. The results showed that 6 hours after the infusion, the gastric emptying of two above mentioned meals was complete and there was still a moderate metabolic acidosis in the group with infusion of ammonium chloride solution. Further more, the metabolic acidosis persisted in moderate values until 8 hours after the infusion. Based on these data the interval between 6 and 8 hours after the infusion of the these solutions was considered the best to the further studies about metabolic acidosis and gastric emptying. Finally, the gastric emptying of water, studied in rats with acidosis and controls demonstrated no differences between them. This was interpreted as a clue that the ammonium chloride solution did not modificate the integrity of the gastric mucosa.

Gastric emptying of maltose, sucrose, lactose and lactulose in rats with ontogenic lactase deficiency.

The gastric emptying of maltose, sucrose, lactose and lactulose was compared in young adult rats with ontogenic lactase deficiency. Eight animals were employed for each sugar meal at each time of study (total number of animals = 192). Each animal received a test meal consisting of a solution of the sugar (100 mg/ml) and phenol red as marker and gastric retention was measured at 5, 10, 20, 30, 45 and 60 min after orogastric infusion of the test meal. Gastric retention was determined by measuring the concentration of the marker in the residual test meal recovered from the stomach after killing the animal. There was no difference between the gastric emptying of lactose and lactulose. The gastric emptying of maltose was significantly slower during the initial 30 min and the emptying of sucrose was identical to that of maltose only at 5 min and could not be distinguished from that of lactose and lactulose at later times. These data support the observation, made in human subjects, that, under conditions of ontogenic lactase deficiency, the modulation of gastric emptying of lactose is ineffective. It is possible that the rapid emptying of sucrose is due to the saturation of sucrase because of substrate overload which impairs the intestinal inhibitory control of gastric emptying.

Gastric emptying of maltose, sucrose, lactose and lactulose in rats with ontogenic lactase deficiency

The gastric emptying of maltose, sucrose, lactose and lactulose was compared in young adult ratswith ontogenic lactase deficiency. Eight animalswere employed for each sugar meal at each time od study (total number of animals = 192). Each animal received a test meal consisting of a solution of the sugar (100 mg/ml) and phenol red as marker and gastric retention was measured at 5,10,20,30,45 and 60 min after orogastric infusion of the test meal. Gastric retention was determined by measuring the concentration of the marker in the residual test meal recovered from the stomach after killing the animal. There was no difference between the gastric emptying of lactose and lactulose. The gastric emptying of maltose was significantly slower during the initial 30 min and the emptying of sucrose was identical to that of maltose only at 5 min and could not be distinguished from that oflactose and lactulose at later times. These data support the observation, made in human subjects, that under conditions of ontogenic lactase deficiency, the modulation of gastric emptying of lactose is ineffective. It is possible that the rapid emptying of sucrose is due to the saturation of sucrase because of substrate overload which impairs the intestinal inhibitory control of gastric emptying