ABSTRACT
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.
Subject(s)
Abdominal Pain/chemically induced , Abdominal Pain/drug therapy , Calcineurin Inhibitors , Drug Substitution , Immunosuppressive Agents/adverse effects , Kidney Transplantation/immunology , Sirolimus/therapeutic use , Tacrolimus/adverse effects , Abdominal Pain/diagnosis , Child , Female , Humans , Treatment Outcome , Vomiting/chemically induced , Vomiting/drug therapy , Weight Loss/drug effectsABSTRACT
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
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Nutritional Status , Kidney Failure, Chronic , Nutrition Disorders , Nutrition Assessment , Anthropometry , Cross-Sectional Studies , Statistics, Nonparametric , Nutrition DisordersABSTRACT
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
