ABSTRACT
Acute tubulointerstitial nephritis (TIN) is responsible for nearly 10% of acute renal failure (ARF) cases in children. It is mostly drug-induced, but in a few cases viruses are involved, probably by an indirect mechanism. An immune-competent 13-month-old boy was admitted to the intensive care unit for severe ARF with anuria in a context of fever, cough, and rhinorrhea lasting 1 week. The kidney biopsy performed early brought out tubulointerstitial damage with mild infiltrate of lymphocytes, without any signs of necrosis. There were no virus inclusion bodies, no interstitial hemorrhage, and no glomerular or vascular damage. Other causes of TIN were excluded: there was no biological argument for an immunological, immune, or drug-induced cause. Adenovirus (ADV) and respiratory syncytial virus (RSV) were positive in respiratory multiplex polymerase chain reaction (PCR) in nasal aspirate but not in blood, urine, and renal tissue. The patient underwent dialysis for 10 days but the response to corticosteroid therapy was quickly observed within 48 h. The mechanism of TIN associated with virus infection is unknown. However, it may be immune-mediated to be able to link severe renal dysfunction and ADV and/or RSV invasion of the respiratory tract.
Subject(s)
Adenovirus Infections, Human/diagnosis , Nephritis, Interstitial/diagnosis , Respiratory Syncytial Virus Infections/diagnosis , Adenovirus Infections, Human/pathology , Adenoviruses, Human/genetics , Adenoviruses, Human/isolation & purification , Adrenal Cortex Hormones/therapeutic use , Biopsy, Needle , Diagnosis, Differential , Humans , Infant , Kidney/pathology , Male , Multiplex Polymerase Chain Reaction , Nephritis, Interstitial/pathology , Respiratory Syncytial Virus Infections/pathology , Respiratory Syncytial Virus, Human/genetics , Respiratory Syncytial Virus, Human/isolation & purificationABSTRACT
Uveitis in children is a rare disease, often going undiagnosed. Vogt-Koyanagi-Harada syndrome, a uveomeningeal disease from an autoimmune process, rarely affects children, but an early diagnosis is essential in order to begin systemic corticosteroid therapy within the shortest delay possible for a better visual prognosis. We report a case of a 10-year-old boy, already treated with corticosteroids for the last 3 years for a nephrotic syndrome, referred for a sudden decrease in visual acuity affecting both eyes, associated with typical cutaneous manifestations of the disease.
Subject(s)
Uveomeningoencephalitic Syndrome , Child , Emergencies , Humans , Male , Severity of Illness Index , Uveomeningoencephalitic Syndrome/diagnosis , Uveomeningoencephalitic Syndrome/drug therapyABSTRACT
BACKGROUND: Hypertension may be associated with intussusception. CASE REPORT: An 8-month-old infant showed the following symptoms: lethargy, vomiting and hypertension. Abdominal ultrasound suggested the diagnosis of intussusception, which was confirmed by barium enema. The hypertension resolved after the intussusception was reduced. CONCLUSION: Intussusception should be considered a diagnostic possibility in infants who show a history of vomiting and in whom lethargy and systematic hypertension are noted. This case re-affirms the diagnostic usefulness of abdominal ultrasonography.
Subject(s)
Hypertension/etiology , Intussusception/diagnosis , Acute Disease , Barium Sulfate , Calcium Channel Blockers/therapeutic use , Enema , Humans , Hypertension/drug therapy , Infant , Intussusception/therapy , Male , Nifedipine/therapeutic use , Sleep Stages , VomitingABSTRACT
Jeune syndrome (asphyxiating thoracic dystrophy) is a rare inherited disease which is fatal in early childhood in 70% of cases. Severe renal involvement may occur and lead to chronic renal insufficiency in patients who survive respiratory failure. Therefore the opportunity to perform kidney transplantation is quite rare. We report a successful cadaver renal transplantation in a 10-year-old boy with Jeune syndrome type 2.
Subject(s)
Asphyxia Neonatorum/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Osteochondrodysplasias/complications , Thorax/abnormalities , Cadaver , Child, Preschool , Humans , Infant, Newborn , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/therapy , Male , Renal Dialysis , SyndromeABSTRACT
In 2 boys, aged 3 and 13 years, suffering from severe growth failure, endocrine evaluation showed growth hormone deficiency and central hypothyroidism without diabetes insipidus. Magnetic resonance imaging demonstrated a transection of the pituitary stalk, and the presence of an ectopic neurohypophyseal nodule.
Subject(s)
Growth Hormone/deficiency , Magnetic Resonance Imaging , Pituitary Diseases/diagnosis , Pituitary Gland, Posterior/surgery , Adolescent , Child, Preschool , Growth Disorders/metabolism , Humans , Hypothyroidism/complications , Male , Pituitary Diseases/pathologyABSTRACT
Pharmacokinetic studies of 13 children treated with cyclosporine A (CyA) were retrospectively analysed (9 renal transplants, 1 combined liver-kidney transplant, 1 heart transplant; 2 were treated for a nephrotic syndrome). The patients were separated into 2 groups: patients 0-15 years (group 1), patients 15-18 years (group 2). In comparison with adults (group 3), children of the 2 groups required higher CyA doses, related either to body weight or to body surface area. CyA dosage was performed by high performance liquid chromatography on whole blood samples. Despite higher doses, trough CyA levels were lower in groups 1 and 2 compared with group 3. Nephrotoxicity occurred in the only 2 children treated with CyA doses higher than 10 mg/kg/d.
