Low protein alimentation normalizes renal haemodynamic response to acute protein ingestion in type 1 diabetic children.

The effect of an acute protein load (2 g kg-1 bodyweight [BW]) was studied in nine type 1 diabetic children. Patients were maintained on two different dietary regimens. In study one, patients were on a high protein diet providing from 2.7 to 1.8 g of protein/kg of BW per day. In study two, patients were reevaluated after three weeks of a diet providing from 1.0 to 1.2 g kg-1 of BW per day of protein. In study one (High Protein Diet), we failed to observe any rise in GFR and RPF following the protein meal (137 +/- 21 basal vs. 110 +/- 14 and 472 +/- 93 basal vs. 494 +/- 93 ml/1.73 m2 of SA min-1 at 60 min. This is in contrast with results from seven age matched controls consuming a free diet, which showed a significant rise in both GFR and RPF. In study two (low protein diet), basal GFR was significantly reduced. However after the protein load, both GFR (92 +/- 11 vs. 126 +/- 18 ml/1.73 m2 of SA min-1) and RPF (467 +/- 83 vs. 705 +/- 102 ml/1.73 m2 min-1) rose significantly (P less than 0.05 vs. basal). The data indicate that: 1. short term protein restriction reduces significantly GFR in type 1 diabetic children; 2. diabetic children maintained on an high protein intake show an altered haemodynamic response to protein ingestion; 3. a normal response to protein ingestion can be restored by short term dietary protein restriction.

Toxicity in uremia. 2. Correlation between PTH levels and impaired aspecific immunity.

The role of PTH in depressing polynuclear leucocyte (PMN) phagocytosis in uremia was investigated. The hydrophobicity and phagocytic activity of normal PMN was tested in presence of uremic patients' serum with low (Group A) or high (Group B) levels of plasma PTH. The PMN phagocytic index was lowered by serum of both groups, but more in presence of Group B serum (p A vs B less than 0.002). Similarly, the contact angle of cells was affected more in presence of serum of patients with high PTH levels (p B vs A less than 0.003; p B vs C less than 0.002).

Circadian rhythm with acrophase at night for urinary excretion of calcium and magnesium in childhood: population-based data of the cimitile study in southern Italy.

A population-based study on daily and overnight urine excretion of Ca and Mg was performed in 220 children aged 4-15 years living in Cimitile, Campania Region, Southern Italy. The Ca/creatinine and the Mg/creatinine ratio in overnight urine were significantly higher than in daily urine (p less than 0.01). This finding was also confirmed in hypercalciuric children. The Mg/Ca ratio in the general population was identical in daily and overnight urine while in the hypercalciuric group Mg/Ca in overnight urine was significantly higher (p less than 0.01) than in daily urine. The data point to the existence of a circadian rhythm with a peak at night for urine Ca and Mg excretion in children living in Cimitile and studied while attending to their everyday life.

IgA glomerulonephritis in Wiskott-Aldrich syndrome.

Renal morphology was evaluated in 2 siblings with Wiskott-Aldrich syndrome (WAS) aged 12 and 4 years. They gave a typical history of recurrent episodes of respiratory infection and presented with microhematuria of glomerular origin and proteinuria. The study disclosed a membranoproliferative glomerulonephritis with IgA mesangial deposition in the elder child, while immunofluorescence was negative in the younger. The data indicate that (1) a specific nephropathy does not exist in WAS and (2) the IgA nephropathy is the result of recurrent infections and of related formation of IgA immune complexes scarcely removed by a deficient reticuloendothelial system. This view is consistent with presenting features in WAS (microhematuria, episodes of macrohematuria, proteinuria, Henoch-Schönlein syndrome) and with the fact that it takes years to develop as indicated by the negativity of immunofluorescence in the younger patient.

Intraerythrocytic cation metabolism in children with uremia undergoing hemodialysis.

Erythrocytes from children with uremia who are undergoing hemodialysis show normal maximal velocity of NA+-Li+ countertransport and Na+/K+/Cl- cotransport and normal intracellular sodium content. These aspects of intracellular sodium metabolism are not affected by dialysis. The normality of intraerythrocytic cation metabolism in children with uremia is associated with anemia, increased systolic and diastolic blood pressure, reduced body mass index, retention of solutes (urea, creatinine, potassium), a low triiodothyronine and thyroxine syndrome, and high parathormone levels.

Screening haemodialysis patients for infection with human immune deficiency virus (HIV).

A group of 484 patients having regular haemodialysis was tested for the presence of antibodies to the human immunodeficiency virus (HIV). With a commercial enzyme-linked immunoassay kit, the serum of 17 appeared positive. When these 17 samples were retested by a different method, however, none was found to contain antibodies to the virus. Furthermore, evaluation of the clinical state of these 17 patients for the presence of any prodromal symptoms associated with the acquired immune deficiency syndrome was negative. It is therefore suggested that patients having regular haemodialysis are presently at low risk of contracting infection by HIV. By contrast, 81% of these patients had antibodies to cytomegalovirus.

Phase contrast microscopy of the urine sediment for the diagnosis of glomerular and nonglomerular bleeding-data in children and adults with normal creatinine clearance.

In a pediatric and in an adult group of patients with hematuria and normal creatinine clearance overnight urine examination was carried out on 2 nonconsecutive days by means of phase contrast microscopy by two independent observers working in two different institutions. In this way it was possible to distinguish between patients on the basis of dysmorphic (glomerular) and isomorphic (nonglomerular) red cells in urine and to correlate the findings with the final diagnosis. A clear-cut indication (more than 80% of isomorphic and/or dysmorphic red cells) was obtained in 163 patients (102 of pediatric age) and final diagnosis of hematuria correlated with red-cell microscopy findings in 96.4% of glomerular diseases and in all cases of nonglomerular origin. Mixed hematuria (50-75% of dysmorphic red cells) was found in 2 cases of renal tuberculosis, 2 cases of polycystic kidney disease and in 1 child with viral meningoencephalitis with a bladder stone. The data indicate that the method is safe and accurate but further experience must be gathered for the many etiologies of glomerular and nonglomerular diseases hitherto not studied.

Population based data on age related excretion of creatinine sodium and potassium in children of Southern Italy--the Cimitile study.

This is a population based study on urinary excretion of sodium, potassium and creatinine in children from Southern Italy aged 3-16 years. Mean urinary creatinine excretion was 33 +/- 10 mg/kg. Mean sodium excretion was of 3.91 +/- 1.52 mM/kg. Urinary sodium, potassium and creatinine correlated with age, body weight, body mass index (BMI) and height and no difference was found in the comparison among sexes. The data point to an excessive sodium intake in these children and additionally claim for a reconsideration of urinary creatinine excretion in this age group.

Intracellular ion metabolism in erythrocytes and uraemia: the effect of different dialysis treatments.

The present report focuses on some aspects of the intra-erythrocytic cation metabolism (e.g. the maximal velocity of the Na+-Li+ countertransport and Na+/K+/Cl- cotransport) in uraemic patients on different dialysis treatments. Patients undergoing dialysis treatment [continuous ambulatory peritoneal dialysis (CAPD) or haemodialysis (HD)] overall showed higher Na+-Li+ countertransport than controls. With regard to Na+/K+/Cl- cotransport, CAPD patients and controls did not differ and both showed, on average, higher values than HD patients. A subgroup of HD patients was studied before and after dialysis. No significant overall changes were detected as a result of the dialysis process with regard to Na+/K+/Cl- cotransport. Na+-Li+ countertransport was significantly reduced by dialysis and a distinctly different response to dialysis was evident according to predialysis values. Patients with high values of Na+-Li+ countertransport showed a significant reduction in this parameter while patients with normal values showed no effect. No distinct association was detected between alteration in either Na+-Li+ countertransport or Na+/K+/Cl- cotransport and the clinical characteristics of the patients. It is concluded that uraemia and/or dialysis influences the maximal velocity of the parameters under investigation. The effect on Na+-Li+ countertransport seems to be similar for both CAPD and HD, while Na+/K+/Cl- cotransport is not altered in CAPD patients.

Acute renal failure due to cisplatin.

A case of acute renal failure associated with cisplatin therapy for a stage IV neuroepitelioma of the chest wall is described. This case was associated with a normal magnesium concentration and with presence of fibrinogen in the Tubular Basement Membrane and of IgG in the interstitial infiltrates. Immunological activation was evidentiated by fine needle aspiration biopsy (FNAB) at the time of renal biopsy.

Cyclosporin A in nephrotic syndrome of childhood--a 14 month experience.

Cyclosporin A (CsA) in combination with 6-methylprednisolone was administered over a six-month period to 10 children with nephrotic syndrome (6 frequently relapsing and 4 steroid resistant) at a dose providing blood CsA concentrations of 200-400 ng/ml. In frequent relapsers 6-methylprednisolone was given initially at a dose of 60 mg/m2/day and subsequently at a dose of 35 mg/m2/48 h. In steroid resistant cases the steroid was given at an initial dose of 1 mg/kg tapering to 0.35 mg/kg by the end of the first month and to 0.22 mg/kg by the fourth month being also administered at the same dosage during the fifth and the sixth month. Among the frequent relapsers there were 30 relapsers in 116 months before CsA and 1 relapse during 70 months after CsA (in 5 patients urine was protein free and 1 relapsed after 7 months. Two of the steroid resistant cases healed. There was a modest incidence of CsA toxicity as evidenced by the usual clinical monitoring and by evaluation of creatinine clearance, plasma potassium and evolution of renal parenchymal cells as studied in the course of sequential fine needle aspiration biopsies.

Tumor markers in uremia: carcinoembryonic antigen, neuron-specific enolase, carbohydrate antigen CA-50 and alpha-fetoprotein.

The incidence of the tumor markers was studied in 140 patients aged between 18 and 84 years who had been on dialysis for 4-188 months. Neuron-specific enolase increased in 81 cases, CA-50 carbohydrate antigen in 44, while alpha-fetoprotein was within the normal range. Carcinoembryonic antigen (CEA) with 2 monoclonal assays was increased in 7 cases. When polyclonal assays were used, CEA was found to be elevated in 12 cases with one set and in 72 cases with another kit set. The data point to the potential usefulness of these markers for the detection of malignancy and possibly neuropathy in uremia; to the importance of renal tubules in the metabolism of proteins, glycoprotein and peptides, and to the activation/inhibition in various enzyme systems in the uremic state.

Sequential fine needle aspiration biopsy in glomerulonephritis.

Cellular immune mechanisms have been shown to play a prominent role in glomerulonephritis. Cellular mediators of inflammation cause both acute and progressive glomerular and tubular injury. Understanding the mediation pathways offers the opportunity for therapeutic manipulation. In addition to polymorphonuclear leucocytes, monocytes/macrophages, B-cells and T-cells subsets are being enumerated in normal and diseased renal tissues. The correlation between immunological findings in peripheral blood and infiltrate composition in renal tissue, by using weekly Fine Needle Aspiration Biopsy (FNAB), for assessing the clinical status and monitoring the immunosuppressive therapy was the aim of this study. When determining the intensity of inflammation the numerical values of the Total Corrected Increment (T.C.I.) were defined as follows: less than 1.5 no inflammation; from 1.5 to 2.0 inflammation possible; greater than 2.0 inflammation. The ratio between OKT4 and OKT8 was used as the index: greater than 2.0 immunologic activation; greater than 2.0 no immunologic activation. When the T.C.I. was greater than 1.5 and the OKT4/OKT8 less than 2.0, or the T.C.I. less than 1.5 and the OKT4/OKT8 greater than 2.0 we used only a standard treatment. When both activation indexes were in the normal range we have not treated the patients. When the T.C.I. was greater than 1.5 and the OKT4/OKT8 was greater than 2.0 we treated the patients with standard treatment plus methylprednisolone pulses every time the activation indexes monitored by FNAB, showed an increase. A spontaneous improvement was obtained in untreated patients. The patients treated by standard therapy alone showed a different outcome. All patients treated with standard therapy plus methyl-prednisolone pulses showed a progressive clinical improvement.(ABSTRACT TRUNCATED AT 250 WORDS)