[Solitary kidney. Study of renal morphology and function in 95 children]. / Valoración de la morfología y función renal en una serie de 95 pacientes pediátricos con riñón unico.

UNLABELLED: The aim of the study was to evaluate renal growth and function of solitary kidney in paediatric patients. MATERIALS AND METHODS: A prospective study was performed in a fifteen years period between 1988 and 2003 in paediatric patients with a solitary kidney, in a Children's Hospital. All the following parameters were evaluated every year: age, sex, ethiology, elapsed time since the concept of solitary kidney was assessed (ET), blood pressure, renal function measured by GFR, urinary excretion of solutes, concentration ability and microalbuminuria (MA). DMSA was made at the beginning and every five years and renal ultrasonography was carried out every two years. Two groups were made depending of nephrourologic malformations in the remanent kidney and/or antecedents of pyelonephritis: Group I with antecedents of pyelonephritis and/or malformations; Group II, nor antecedents of pyelonephritis neither malformations. RESULTS: Ninety five patients were evaluated, 69% (n = 66) were males and 31% (n = 29) were females, with an age at diagnosis of 3.5 yr (ranged 0.1-17 yrs). ET was 9.2 yrs (range 1-20 yrs). The ethiology was: Nephrectomy of the contralateral kidney 39 patients (pts) (41%), renal agenesis (RA) 47 pts (49%) and nonfunctioning multicystic displastic kidney (MCDK) 9 pts (9.4%). Functional alterations were found in 18 pts (19%), such as MA in 12 pts (12.6%), decreased GRF in 5 pts (5.5%) and hypertension in 3 pts (3.2%). It was observed more significant functional alterations in the patients of the Group I (58%) versus Group II (9%) (p < 0.001). There was in Group II a significant correlation between kidney size and GFR (p < 0.01, r = 0.3), and between kidney size and ET (P < 0.05; r = 0.3). CONCLUSIONS: Any alteration in the renal function was observed in the 12.6% of the children. The most frequent affected parameter of renal damage was MA, followed by GFR reduction. Arterial hypertension was not a prominent finding. Alterations have been less frequently found in RA and MCDK of the Group II, so clinical reviews should be made with a lesser frequency.

Valoración de la morfología y función renal en una serie de 95 pacientes pediátricos con riñón único / Solitary kidney, Study of renal morphology and function in 95 children

El objetivo de nuestro trabajo es mostrar los resultados de la función así comola morfología renal en una población infantil, que tienen un solo riñón y consecuentementea los hallazgos encontrados, tratar de racionalizar y adecuar las revisionesmédicas.Material y métodos: Se trata de un estudio prospectivo de los pacientes monorrenosseguidos entre el año 1988 y 2003. Cada año se estudiaron los siguientesparámetros: variables demográficas (sexo, edad), clínicas (etiología, tiempo deriñón único, tensión arterial), función renal (Filtrado glomerular (FG), Excreciónfraccional (EF) de iones y Microalbuminuria (MA). El estudio de morfología renalse realizó mediante ecografía renal bianual y DMSA quinquenal. Se hicieron dosgrupos en función de los antecedentes de pielonefritis aguda y/o alteraciones nefrourológicas:Grupo I con antecedentes de pielonefritis Y/o alteraciones; GrupoII, sin antecedentes ni alteraciones.Resultados: Del total de 95 pacientes el 69% fueron varones (n = 66) y el 31%fueron mujeres (n = 29). La edad media al diagnóstico fue de 3,5 años (0,1-17años). El tiempo medio con riñón único fue 9,2 años (1-20 años). La etiologíafue: Nefrectomía contralateral (NF) en 39 (41%), Agenesia renal (AR) en 47(49%) y Displasia Multiquística (DM) con función renal anulada en 9 (9,4%). Seobjetivó una función renal alterada (microalbuminuria elevada y/o HTA y/o Insuficienciarenal) en 18 pacientes (19%). La MA fue la alteración funcional más frecuente(n = 12, 12,6%), seguido de descenso del FG (n = 5, 5,3%) e HTA (n =3, 3,2%). Se observó una prevalencia mayor de alteraciones funcionales en lospacientes del grupo I (58%) frente a los pacientes del grupo II (9%) (p < 0,001)En los pacientes del Grupo II encontramos correlación significativa entre el tamañorenal y el FG (p < 0,01, r = 0,3), así mismo entre el tamaño renal y eltiempo de RU (P < 0,05; r = 0,3).Conclusiones: El 12% de los pacientes mostraron alguna alteración de la funciónrenal, siendo la más frecuente la microalbuminuria, seguida de la reduccióndel filtrado glomerular. La HTA fue un hallazgo escaso. Éstas alteraciones fueron menos frecuentes en los pacientes con AR o DMQ que no tenían antecedentesde pielonefritis aguda ni alteraciones nefrourológicas asociadas, por lo que las revisionesen éste grupo deben ser menos frecuentes

The aim of the study was to evaluate renal growth and function of solitary kidneyin paediatric patients.Materials and methods: A prospective study was performed in a fifteen yearsperiod between 1988 and 2003 in paediatric patients with a solitary kidney, in aChildren’s Hospital. All the following parameters were evaluated every year: age,sex, ethiology, elapsed time since the concept of solitary kidney was assessed (ET),blood pressure, renal function measured by GFR, urinary excretion of solutes, concentrationability and microalbuminuria (MA). DMSA was made at the beginningand every five years and renal ultrasonography was carried out every two years.Two groups were made depending of nephrourologic malformations in the remanentkidney and/or antecedents of pyelonephritis: Group I with antecedents ofpyelonephritis and/or malformations; Group II, nor antecedents of pyelonephritisneither malformations.Results: Ninety five patients were evaluated, 69% (n = 66) were males and31% (n = 29) were females, with an age at diagnosis of 3.5 yrs (ranged 0.1-17yrs). ET was 9.2 yrs (range 1-20 yrs). The ethiology was: Nephrectomy of the contralateralkidney 39 patients (pts) (41%), renal agenesis (RA) 47 pts (49%) andnonfunctioning multicystic displastic kidney (MCDK) 9 pts (9.4%). Functional alterationswere found in 18 pts (19%), such as MA in 12 pts (12.6%), decreasedGRF in 5 pts (5.5%) and hypertension in 3 pts (3.2%). It was observed more significantfunctional alterations in the patients of the Group I (58%) versus GroupII (9%) (p < 0.001).There was in Group II a significant correlation between kidneysize and GFR (p < 0.01, r = 0.3), and between kidney size and ET (P < 0.05;r = 0,3).Conclusions: Any alteration in the renal function was observed in the 12.6% ofthe children. The most frequent affected parameter of renal damage was MA, followedby GFR reduction. Arterial hypertension was not a prominent finding. Alterationshave been less frequently found in RA and MCDK of the Group II, soclinical reviews should be made with a lesser frequency

[Recurrent infection of the urinary tract in girls]. / Infección recurrente del tracto urinario en niñas.

A group of 18 girls, studied in a period between 1979 and 1985 with recurrent urinary tract infections (RUTI), with at least three culture documented episodes of bacteriuria in the previous year and without radiologic evidence of urinary tract abnormality is described. Incidence was 6.1% amount a selected group of 295 girls with urinary tract infection. The period of follow-up was between 2 and 6 years (X 3.33). Symptomatology was light. No predominance of urinary symptoms were found. E. coli was the most frequent germ isolated. The number of recurrences/year/girl were significantly lower with prophylactic treatment and with years of evolution. Renal damage was not found. Vesicoureteral reflux appeared in two girls only. They had a benign course and a good prognosis. Reduction of aggressive investigation in this group of patients is proposed.

Incidence of glomerulonephritis in congenital syphilis.

We present 5 patients with abnormal urinalysis from a series of 11 infants with congenital syphilis. Three of these 5 patients had a biopsy that demonstrated a membranous glomerulonephritis, and in two cases treponemal antigens were identified in the capillaries of the glomeruli. We suggest that glomerulonephritis with few clinical manifestations is a frequent complication of congenital syphilis and that every patient with congenital syphilis must be studied in order to detect alterations in glomerular function.

Familial C1q deficiency associated with renal and cutaneous disease.

A familial C1q deficiency of complement in three siblings has been established. The patients were two brothers and a sister (12, 11 and 9 years old) with clinical and pathological features of Rothmund-Thomson syndrome (Poikiloderma congenital) and mesangial proliferative glomerulonephritis with diffuse IgM deposits. Abnormality has been defined as a total lack of CH50 haemolytic activity, undetectable C1q, failure to correct the defect with functionally pure C2 to C9 complement components, normal values for C2, C3, C4 and C5 and restoration of CH50 haemolytic activity when purified human C1q was added to the assay.

[Natural history of urinary tract infection in children]. / Historia natural de las infecciones del tracto urinario en niños

Urinary tract infection was studied in 61 children whose ages ranged between 6 months and 9 years. History, symptoms, urine cultures and renal function are compared between those with normal radiology and those with pyelonephritis and/or reflux and obstructive lesions. Prognosis was analized in these two groups.

[Urinary tract infection in early infancy, study of 15 cases]. / Infección urinaria sintomática en el lactante pequeño. Anánisis de 15 casos

Urinary tract infection in the newborn shows peculiar characteristics not found in older children. 15 cases of urinary tract infection in infants aged 7 days to 2 months are presented. There is higher incidence in males (11 m./4 f.). Severe clinical picture diverse and undefined clinical course, incidence of jaundice radiological findings and posterior evolution are specially noted. Early diagnosis and effective management lined in base to evolution and prognosis. Hospital stay varied between 2 and 12 weeks. No deaths were registered.