Routine delayed voiding cystourethography after initial successful endoscopic treatment with Dextranomer/Hialuronic Acid Copolimer (Dx/HA) of vesicoureteral reflux (VUR). Is it necessary? / ¿Es necesario realizar una cistouretrografía miccional seriada (CUMS) tardía tras el tratamiento endoscópico exitoso inicial con copolímero de dextranómreo/ácido hialurónico (Dx/HA) para el reflujo vesicoureteral (RVU)?

INTRODUCTION: Some guidelines recommend an early voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR), but there's no consensus if it's necessary a long-term follow-up in these patients. The aim of our study is analyze if it's necessary a delayed VCUG after initial successful treatment with Dx/HA. MATERIAL AND METHOD: We have reviewed all medical charts of patients that underwent Dx/HA treatment from 2006 to 2010. We have selected patients with initial successful treatment and more than 3 years of radiological and clinical follow-up. We have analyzed late clinical and radiological outcomes. RESULTS: One hundred and sixty children with 228 refluxing ureters underwent Dx/HA endoscopic treatment with a mean follow-up of 52.13 months. Early VCUG was performed in 215 ureters with an initial successful rate of 84.1%. The group of study was 94/215 ureters with more than 3 years of follow-up with a delayed VCUG. VUR was still resolved in 79,8% of the ureters. Clinical success rate was 91.7%. The incidence of febrile urinary tract infection in those patients with cured VUR and those with a relapsed VUR was 8 and 15%, respectively; but there were no significant differences. We have not found any variable related with relapsed VUR except those ureters that initially received 2 injections (P<.05). CONCLUSION: If our objective in the treatment of VUR is to reduce the incidence of febrile urinary tract infection it is not necessary to perform a delayed VCUG even though the long-term radiological outcomes is worse than clinical outcome.

Glomerulonefritis aguda asociada a neumonía: revisión de 6 casos / Pneumonia associated acute glomerulonephritis: a review of 6 cases

Introducción: Se ha descrito una asociación entre neumonía y glomerulonefritis aguda iniciándose ambos procesos de forma simultánea. Pacientes y métodos: Estudio retrospectivo de 6 pacientes ingresados en nuestro centro entre los años 2001 y 2010 con glomerulonefritis aguda asociada a neumonía concomitante, con frotis y cultivo amigdalar negativos y en ausencia de infección cutánea o episodio de neumonía anterior. Resultados: La media de edad de los pacientes al ingreso fue de 5,9 años sin diferencia de sexos. El diagnóstico de neumonía se realizó en el momento del ingreso, coincidiendo con la sintomatología nefrológica. Los síntomas más frecuentes fueron fiebre y hematuria macroscópica. Todos tuvieron un C3 (fracción C3 del complemento) bajo. En 5 de ellos se encontró una elevación significativa en la cifra de antiestreptolisinas (ASLO). En la mayoría de los casos la afectación renal fue leve a excepción de un caso de insuficiencia renal aguda con creatinina inicial de 2,77 mg/dl y filtrado glomerular de 27 ml/min/1,73m2 y 2 casos con proteinuria en rango nefrótico. Todos evolucionaron hacia la curación sin tratamiento o con mínimo tratamiento diurético o hipotensor, además de tratamiento antibiótico adecuado para su proceso neumónico, con resolución de la clínica entre 7—10 días y normalización del C3 en un período inferior a los 4 meses. Conclusiones: Aunque descrita con mucho menos frecuencia, existe asociación entre glomerulonefritis aguda y presencia concomitante de neumonía. Las ASLO, en nuestra serie, no son específicas de infección por Streptococcus pyogenes. El pronóstico respiratorio y renal fue favorable en todos los casos (AU)

Introduction: There is an association between pneumonia and acute glomerulonephritis. Both processes start simultaneously. Patients and methods: A retrospective study of 6 patients admitted to our centre between 2001 and 2010 with acute glomeruolonephritis associated with pneumonia. The result of the smear and tonsil culture was negative and there was an absence of cutaneous infection. Results: The average age of the patients on admission was 5.9 years with no differences in sex. The diagnosis for pneumonia was made at the time of admission, coinciding with the glomerular symptoms. The most frequent symptoms were fever and macrohaematuria. All had low levels of C3. A significant increase in ASLO was found in 5 cases. The majority of the cases had mild symptoms with the exception of one case of acute renal failure with an initial creatinine of 2.77 mg/dL and glomerular filtration rate of 27 ml/min/1.73m2, and two cases with proteinuria in the nephrotic range. All of them progressed satisfactorily without treatment or with minimum diuretic or hypotensive treatment in addition to the appropriate antibiotic treatment with clinical resolution in 7 to 10 days, and C3 returning to normal within a period of less than 4months. Conclusions: There is an association between acute glomerulonephritis and pneumonia, although it is very uncommon. The ASLOs in our series are not specific for Streptoccocus. Pyogenes infection. The respiratory and renal prognosis was favourable in all cases (AU)

[Pneumonia associated acute glomerulonephritis: a review of 6 cases]. / Glomerulonefritis aguda asociada a neumonía: revisión de 6 casos.

INTRODUCTION: There is an association between pneumonia and acute glomerulonephritis. Both processes start simultaneously. PATIENTS AND METHODS: A retrospective study of 6 patients admitted to our centre between 2001 and 2010 with acute glomeruolonephritis associated with pneumonia. The result of the smear and tonsil culture was negative and there was an absence of cutaneous infection. RESULTS: The average age of the patients on admission was 5.9 years with no differences in sex. The diagnosis for pneumonia was made at the time of admission, coinciding with the glomerular symptoms. The most frequent symptoms were fever and macrohaematuria. All had low levels of C3. A significant increase in ASLO was found in 5 cases. The majority of the cases had mild symptoms with the exception of one case of acute renal failure with an initial creatinine of 2.77mg/dL and glomerular filtration rate of 27ml/min/1.73m(2), and two cases with proteinuria in the nephrotic range. All of them progressed satisfactorily without treatment or with minimum diuretic or hypotensive treatment in addition to the appropriate antibiotic treatment with clinical resolution in 7 to 10 days, and C3 returning to normal within a period of less than 4 months. CONCLUSIONS: There is an association between acute glomerulonephritis and pneumonia, although it is very uncommon. The ASLOs in our series are not specific for Streptoccocus. pyogenes infection. The respiratory and renal prognosis was favourable in all cases.

Resultados de una serie de biopsias renales percutáneas guiadas ecográficamente en una población pediátrica: nuestra experiencia en 15 años / Results obtained from a series of ultrasound guided percutaneous renal biopsies in a pediatric population: our experience in 15 years

Objetivos: Presentar nuestra experiencia sobre biopsias renales percutáneas guiadas ecográficamente en pacientes en edad pediátrica desde que se instauró dicha técnica en nuestro hospital, y valorar la correlación clínica/anatomopatológica y las complicaciones de la misma. Pacientes y métodos: Estudio retrospectivo de 180 biopsias renales percutáneas guiadas ecográficamente realizadas a un total de 164 pacientes (de 6 meses-18 años de edad) durante un periodo de 15 años. El protocolo de la biopsia incluye su realización en el quirófano mediante sedación y una ecografía a las 24 horas. Resultados: El motivo más frecuente de su realización fue la presencia de un síndrome nefrótico cortico dependiente/resistente (29,4%), seguido de la proteinuria de diverso rango con presencia de hematuria. El diagnóstico anatomopatológico más habitual fue la glomérulo nefritis mesangial por IgA (26,1%), seguido de cambios glomerulares mínimos, confirmándose en la mayoría de los casos la sospecha clínica. Únicamente se detectó una complicación grave (hematoma renal/hipotensión arterial)en un paciente de riesgo. Conclusiones: En nuestra experiencia, la biopsia renal percutánea es un método diagnóstico fiable y seguro, independientemente de la edad (AU)

Objectives: We present our experience on ultrasound guided percutaneous renal biopsies in pediatric patients from the beginning that this technique was established in our hospital, to value the clinical/anatomo pathologic correlation as well as the complications of the technique. Patients and methods: Retrospective study of 180 ultrasound guided percutaneous renal biopsies over a total of 164 patients (aged from 6 months to 18 years) in a period of 15 years. The protocol biopsy includes its carrying out in the operating room by means of sedation and also the realization of an ultrasound after 24 hours. Results: The most frequent reason for doing the biopsy was the presence of a corticoid dependent/resistant nephrotic syndrome (29.4%) followed by different levels of. The most frequent anatomopathological diagnostic was glomerulonephritis with Ig A mesangial deposits (26.1%) followed by minimal glomerular changes, confirming in the majority of the cases the initial clinical suspicion. Only in one case a severe complication was detected (renal hematoma/arterial hypotension) in a high-risk patient. Conclusions: In our experience, the percutaneous renal biopsies are a reliable and a safe diagnostic method regardless of age (AU)

Hipertensión arterial por esfuerzo: posible predictor de riesgo cardiovascular / Exercise-induced arterial hypertension: possible predictor of cardiovascular risk

Introducción: Durante el ejercicio se produce una elevación fisiológica de la presión arterial. Algunos sujetos previamente normotensos presentan grandes incrementos con el ejercicio, lo que podría ser un factor pronóstico adverso.Casos clínicos: Dos varones de 15 y 16 años, sin antecedentes personales de interés, remitidos por pérdida de conciencia de minutos de duración, en el primer caso, con recuperación espontánea mientras entrenaba al baloncesto y, en el segundo, con cefalea importante desencadenada durante un partido de fútbol. Se constataron cifras de presión > P99 en ambos. La exploración física era normal. Se realizaron determinaciones en condiciones de reposo, que mostraron intervalos de normalidad. Los hallazgos analíticos, función renal, metabólica y hormonal fueron normales. No se encontraron anomalías en la eco-Doppler. Se descartó afección de órganos diana. La monitorización ambulatoria de la presión arterial mostró máximos de presión > P99 coincidiendo con la realización de ejercicio; las demás lecturas estaban dentro de la normalidad. Se suprimió el ejercicio físico intenso sin requerir otro tipo de medidas.Conclusiones: Valorar la aparición de hipertensión arterial en adolescentes que practican deporte, introducir la monitorización ambulatoria de la presión arterial como cribado en revisiones médico-deportivas y suprimir el esfuerzo como única medida terapéutica(AU)

Introduction: Exercise produces a physiological increase of the blood pressure. Some previously normotensive subjects have significant increases with exercise, which could be an adverse prognostic factor.Clinical cases: Two male subjects, 15 and 16 years old, with no personal background of interest, were referred. The first one was due to loss of consciousness for several minutes with spontaneous recovery while practicing basketball. The second case was for a strong headache that occurred while playing soccer. Blood pressure values for both were > P99 and their physical examinations were normal. Tests performed at rest showed normal ranges. The laboratory findings, renal and metabolic function and hormones were normal. There were no abnormalities on the echo-Doppler. Involvement of target organs was ruled out. Ambulatory blood pressure monitoring showed tension peaks > P99, coinciding with exercise, the remaining readings being within normality. Intense physical exercise was discontinued, without requiring any other type of actions.Conclusions: Introducing ambulatory blood pressure monitoring as screening in medicalsports check-ups and suppression of exercise as the only therapeutic measures should be evaluated when faced with arterial hypertension in adolescents who practice sports(AU)

[Hemolytic-uraemic syndrome. A review of 58 cases]. / Síndrome hemolítico-urémico. Revisión de 58 casos.

OBJECTIVES: Our objectives were to determine epidemiology, clinical and laboratory characteristics of patients with haemolytic-uraemic syndrome (HUS) treated in our centre, to describe renal and extra-renal complications and the treatment required and to relate our findings with the existing bibliography. METHODS: We performed a 33-year retrospective review. We included all patients diagnosed with HUS and monitored in our hospital from January 1974 to August 2007. Clinical histories and imaging studies were reviewed. RESULTS: A total of 58 patients were included in our study, with a mean age of 2 years 11 months and most of them were admitted to hospital in summer. Familial hypocomplementaemia was present in one case. A total of 48 patients presented with typical HUS (with diarrhoea D+ HUS). Salmonella enteritidis and Escherichia coli O157:H7 were isolated from those patients. While 7 cases presented with atypical HUS (without diarrhoea, D- HUS), most of them associated with a respiratory tract infection due to Streptococcus. In one case platelet count was normal. Kidney biopsy was performed in 18 patients and 25 cases underwent peritoneal dialysis. As regards complications, one child with D+ HUS experienced renal cortical necrosis and required kidney transplant, while in the D-HUS group, the patient with familial hypocomplementaemia had severe hypertension. CONCLUSIONS: a) Incidence of HUS in our environment is low. b) HUS can be present even with a normal platelet count. c) We had one case of HUS in a patient with familial hypocomplementaemia who experienced severe hypertension. d) In our group of patients, the course of the disease was not influenced by the white blood cell counts, decreased diuresis or hypocomplementaemia.

Síndrome hemolítico-urémico. Revisión de 58 casos / Hemolytic-uraemic syndrome. A review of 58 cases

Objetivos: Nuestros objetivos han sido determinar aspectos epidemiológicos, formas clínicas y analíticas de los pacientes con síndrome hemolítico-urémico (SHU) tratados en nuestros centros, así como describir las complicaciones renales y extrarrenales, el tipo de tratamiento requerido y relacionar nuestros casos con la bibliografía actual. Métodos: Efectuamos una revisión retrospectiva de la historia clínica, analítica y estudios de diagnóstico por imagen de los pacientes con diagnóstico de SHU, atendidos desde enero de 1974 hasta agosto de 2007, es decir, durante los últimos 33 años. Resultados: Un total de 58 pacientes fueron incluidos en nuestro estudio, con una edad media de 2 años y 11 meses; de ellos, estaban ingresados en verano 34 niños. Destaca la presencia de hipocomplementemia familiar en un caso. Con SHU típico (diarrea positivo [D+]) aparecieron 48 casos en los que se aislaron Salmonella enteritidis y Escherichia coli 0157:H7. Con SHU atípico (diarrea negativo [D-]) se contabilizaron 7 casos, y entre las causas destacaban procesos respiratorios de etiología estreptocócica. El recuento plaquetario fue normal en un caso. De los procedimientos empleados cabe destacar que se realizó biopsia renal en 18 pacientes y diálisis peritoneal en 25 casos. Entre las complicaciones se encontraron: en el grupo D+, un caso de necrosis cortical que requirió trasplante renal y en el grupo D-, un paciente con SHU familiar, hipocomplementemia e hipertensión arterial maligna. Conclusiones: Hemos llegado a las siguientes conclusiones: a) la enfermedad presenta una baja incidencia en nuestro medio; b) se ha detectado un caso con plaquetas normales; c) un paciente presentó SHU familiar recurrente con hipocomplementemia e hipertensión arterial grave, y d) indicadores como la leucocitosis, la oligoanuria o la hipocomplementemia no influyeron en el curso de la enfermedad (AU)

Objectives: Our objectives were to determine epidemiology, clinical and laboratory characteristics of patients with haemolytic-uraemic syndrome (HUS) treated in our centre, to describe renal and extra-renal complications and the treatment required and to relate our findings with the existing bibliography. Methods: We performed a 33-year retrospective review. We included all patients diagnosed with HUS and monitored in our hospital from January 1974 to August 2007. Clinical histories and imaging studies were reviewed. Results: A total of 58 patients were included in our study, with a mean age of 2 years 11 months and most of them were admitted to hospital in summer. Familial hypocomplementaemia was present in one case. A total of 48 patients presented with typical HUS (with diarrhoea D+ HUS). Salmonella enteritidis and Escherichia coli O157:H7 were isolated from those patients. While 7 cases presented with atypical HUS (without diarrhoea, D- HUS), most of them associated with a respiratory tract infection due to Streptococcus. In one case platelet count was normal. Kidney biopsy was performed in 18 patients and 25 cases underwent peritoneal dialysis. As regards complications, one child with D+ HUS experienced renal cortical necrosis and required kidney transplant, while in the D-HUS group, the patient with familial hypocomplementaemia had severe hypertension. Conclusions: a) Incidence of HUS in our environment is low. b) HUS can be present even with a normal platelet count. c) We had one case of HUS in a patient with familial hypocomplementaemia who experienced severe hypertension. d) In our group of patients, the course of the disease was not influenced by the white blood cell counts, decreased diuresis or hypocomplementaemia (AU)

Ureterohidronefrosis bilateral secundaria a hidromucocolpos de diagnóstico prenatal / Bilateral ureteral hydronephrosis secondary to prenatally diagnosed hydromucocolpos

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[Nephropathy in Schönlein-Henoch purpura: a retrospective study of the last 25 years]. / Nefropatía en la púrpura de Schönlein-Henoch: estudio retrospectivo de los últimos 25 años.

Schönlein-Henoch purpura is a systemic vasculitis due to IgA-mediated hypersensitivity, almost exclusively affecting the pediatric age group. Long-term prognosis is mainly conditioned by renal involvement, which can appear at onset or during the course of the disease. To evaluate renal involvement, 764 patients with Schönlein-Henoch purpura were retrospectively reviewed. Of these, 153 (20 %) had renal involvement, the most frequent form of presentation being non-nephrotic hematuria/proteinuria (67 patients) followed by isolated hematuria (41 patients). Renal biopsy was performed in 39 patients, and the most frequent pathological findings were diffuse mesangial proliferation with IgA deposits and less than 50 % of crescentic glomeruli. Treatment was not curative. Three patients (2 %) progressed to end-stage renal failure and required renal transplantation. One patient died. Notably, two of the patients who underwent renal transplantation had disease recurrence. We stress that nephropathy is usually benign and that it requires long-term follow-up.

Nefropatía en la púrpura de Schönlein-Henoch: estudio retrospectivo de los últimos 25 años / Nephropathy in Schönlein-Henoch purpura: a retrospective study of the last 25 years

La púrpura de Schönlein-Henoch es una vasculitis sistémica por hipersensibilidad mediada por inmunoglobulina A (IgA) que afecta casi exclusivamente a la edad pediátrica. La afectación renal que puede presentarse desde su inició o bien posteriormente es la que condiciona la mayoría de las veces el pronóstico a largo plazo. Con el objetivo de evaluar la afectación renal se procedió al estudio retrospectivo de 764 pacientes afectados de púrpura de Schönlein-Henoch. De ellos, 153 (20 %) presentaron afectación renal siendo la forma de presentación más frecuente la hematuria/proteinuria no nefrótica (67 pacientes) seguida de la hematuria aislada (41 pacientes). Se efectuó biopsia renal en un total de 39 pacientes siendo el hallazgo anatomopatológico más frecuente la proliferación mesangial difusa con depósitos de IgA y menos de un 50 % de semilunas. Los tratamientos efectuados no fueron determinantes por lo que respecta a la evolución final. Tres pacientes (2 %) evolucionaron a insuficiencia renal terminal precisando trasplante renal. Un paciente falleció. Hay que destacar la reaparición de la enfermedad en dos de los pacientes trasplantados. Se remarca la evolución generalmente benigna de la nefropatía y la necesidad de un seguimiento a largo plazo de la misma

Schönlein-Henoch purpura is a systemic vasculitis due to IgA-mediated hypersensitivity, almost exclusively affecting the pediatric age group. Long-term prognosis is mainly conditioned by renal involvement, which can appear at onset or during the course of the disease. To evaluate renal involvement, 764 patients with Schönlein-Henoch purpura were retrospectively reviewed. Of these, 153 (20 %) had renal involvement, the most frequent form of presentation being non-nephrotic hematuria/proteinuria (67 patients) followed by isolated hematuria (41 patients). Renal biopsy was performed in 39 patients, and the most frequent pathological findings were diffuse mesangial proliferation with IgA deposits and less than 50 % of crescentic glomeruli. Treatment was not curative. Three patients (2 %) progressed to end-stage renal failure and required renal transplantation. One patient died. Notably, two of the patients who underwent renal transplantation had disease recurrence. We stress that nephropathy is usually benign and that it requires long-term follow-up

Una curiosa asociación: síndrome nefrótico y enfermedad celíaca / A curious association: nephorotic syndrome and celiac disease

No hemos encontrado ningún caso descrito en la literatura de síndrome nefrótico y enfermedad celíaca. Presentamos 5 pacientes diagnosticados de síndrome nefrótico durante los últimos cinco años a 4 de los cuales se les había diagnosticado previamente una enfermedad celíaca, siendo el último de ellos diagnosticado al solicitarse los marcadores de celiaquía en el momento del debut del síndrome nefrótico. La enfermedad celíaca no influyó en el pronóstico ni en la evolución del síndrome nefrótico. No hemos encontrado explicación para el aumento de la asociación de las dos enfermedades en nuestra serie Destacamos la necesidad de incluir los marcadores de celiaquía en el estudio de los pacientes afectos de síndrome nefrótico (AU)

Estudios multicéntricos y ensayos clínicos en poblaciones especiales / Multicenter studies and clinical trials in special populations

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[Long-term effect of angiotensin-converting inhibitors in children with proteinuria]. / Efecto a largo plazo de los inhibidores de la enzima conversora de la angiotensina en niños con proteinuria.

BACKGROUND: Prolonged proteinuria is a risk factor for renal damage. Angiotensin-converting enzyme (ACE) inhibitors can reduce proteinuria in adults with different types of nephropathy. PATIENTS AND METHODS: We evaluated treatment with low doses of ACE inhibitors (captopril and enalapril) in nine children with proteinuria due to chronic glomerular nephropathy. The patients' diagnoses were Henoch-Schönlein nephropathy, Berger's disease, Alport's disease, and chronic glomerulonephritis (GN) (membranous GN, focal and segmental GN, and membranoproliferative GN). None of the patients were receiving concomitant treatment. Those who had received corticoids, immunosuppressive or hypotensive drugs during the previous 3 months were excluded. The medication was administered over a prolonged period (mean 26.6 6.36 months). RESULTS: Proteinuria was initially in the nephrotic range (M = 55.34 10.44 mg/m2/h). In all patients concentrations fell significantly after 6 months and at the end of the treatment(p = 0.01 and p = 0.05). No adverse reactions to the medication were observed. The decrease in glomerular filtration rate was not significant. No significant changes in arterial pressure were found during treatment. CONCLUSIONS: ACE inhibitors could be an effective alternative for reducing proteinuria in children with prolonged nephropathy. These inhibitors do not produce the adverse effects associated with other drugs and can therefore be used for long periods.

Efecto a largo plazo de los inhibidores de la enzima conversora de la angiotensina en niños con proteinuria / Long-term effect of angiotensin-converting enzyme inhibitors in children with proteinuria

Antecedentes: La proteinuria por sí misma representa un riesgo de lesión renal cuando se mantiene elevada de forma persistente a lo largo del tiempo. Los inhibidores de la enzima conversora de la angiotensina (IECA) pueden reducir la proteinuria en adultos con diversas nefropatías. Pacientes y métodos: Se ha evaluado el efecto del tratamiento con dosis bajas de IECA (captopril y enalapril) en 9 niños con proteinuria afectados de nefropatía glomerular crónica. Los diagnósticos de los pacientes eran: nefropatía de Schönlein-Henoch, enfermedad de Berger, enfermedad de Alport y glomerulonefritis crónica (membranosa, focal y segmentaria y mesangiocapilar). En ningún caso debían recibir tratamiento concomitante, y se excluyeron aquellos que hubieran recibido corticoides, inmunosupresores o hipotensores en los últimos 3 meses. La medicación se administró durante un período de tiempo prolongado (tiempo medio 26,6 6,36 meses). Resultados: La proteinuria que era inicialmente de rango nefrótico (mujeres 55,34 10,44 mg/m2/h) descendió en todos los casos de forma significativa a los 6 meses y al final del tratamiento (p < 0,01 y p < 0,05). No se han observado reacciones adversas a la medicación. El descenso en las cifras de filtrado glomerular no fue significativo. Tampoco se modificó de forma significativa la presión arterial durante el tratamiento. Conclusiones: Los IECA pueden ser una alternativa eficaz en la reducción de la proteinuria en niños con nefropatías de larga evolución, sin los efectos secundarios de otros fármacos, por lo que pueden utilizarse durante tiempo prolongado (AU)

[Indications for renal biopsy in idiopathic nephrotic syndrome in children. Results of a national survey]. / Indicaciones de la biopsia renal en el síndrome nefrótico idiopático infantil. Resultados de una encuesta nacional.

BACKGROUND: The role of the renal biopsy in children with nephrotic syndrome is controversial, especially in patients with frequent relapses or corticosteroid-dependent nephrotic syndrome. METHODS: We have sent a survey about the nephrotic syndrome to all the Spanish pediatric nephrologists who are members of the Spanish Association of Pediatric Nephrology. The survey is based in 7 questions about biopsy utility in the different circumstances of the illness. RESULTS: The survey reveals a scarce participation, 50%. The 85% of the inquired people uses the same diagnostical criterion. Referring the indication of renal biopsy in this disease, the 85% considers that it would be necessary to do it in case of corticosteroid resistance. The 57.7% of pediatric nephrologists would recommend a biopsy in children with frequently relapsing or corticosteroid-dependent nephrotic syndrome prior to cytotoxic therapy. The 33% doesn't practice biopsy before cytostatic administration, only when alterations in the renal function appear during the treatment. The 50% of the inquired considers that less than a year of age is an indication of biopsy in the nephrotic syndrome, and the 24.4% thinks that the age should never be an indication. CONCLUSIONS: The surveys aren't much used in our country as a resource of information. We think that the participation of expert people in the surveys gives validity to the obtained results. There are different opinions among pediatric nephrologists concerning the biopsy in children with frequently relapsing and corticosteroid-dependent nephrotic syndrome.