Predictive value of fractional excretion of filtered sodium for hypertension in acute post-streptococcal glomerulonephritis.

The course of acute post-streptococcal glomerulonephritis was followed in 81 children, 66 of whom were hypertensive on admission. Sixty-one hypertensive patients were available for follow-up; in seven (11.5%), hypertension recurred 1 to 9 days after initial blood pressure elevation had returned to normal. Thirteen initially normotensive patients were available for follow-up; six (46%) developed hypertension 1 to 9 days after admission. Initial FENa was less than or equal to 0.5 in all 13 patients with recurrence of initial hypertension or who developed initial hypertension while under observation, and in another 25 patients who did not have this course. On the other hand, FENa was greater than 0.5 in 36 patients, none of whom had recurrence of initial hypertension or developed hypertension while under observation. Therefore, an admission FENa less than or equal to 0.5 seems to be an accurate predictor for development of hypertensive episodes.

[Chronic peritoneal dialysis in childhood]. / Diálisis peritoneal crónica en la infancia.

Peritoneal dialysis, used initially (1923) for the management of acute renal failure, became obsolete very soon, because of its infectious complications. Due to this and because of the successful advent of hemodialysis with the artificial kidney in the 40's, peritoneal catheter of indefinite tolerance came into use. This circumstance allowed the use of peritoneal dialysis in the management of chronic uremia. At the onset, it was used intermittently within the hospital and the dialysant solutions were changed by the medical staff. Subsequently, a continuous ambulatory scheme developed, where 4 to 5 changes are dialy made outdoors by the patient or his relatives which cuts down costs and allows more freedom of action and better feeding. Peritonitis still remains as a disadvantage; however, its incidence has dropped because of technical improvements of the equipment. It is concluded that peritoneal dialysis, but specially with the ambulatory scheme, offers a great rehabilitation potentiality for the uremic child.

[Arteriovenous fistula and thrombosis of the renal vein: complication of a surgical renal biopsy]. / Fístula arteriovenosa y trombosis de vena renal: complicación de una biopsia renal quirúrgica.

Hematuria is the most common complication of renal biopsy. Other complications are less frequent, but some of them may be life threatening. Herein, we present a case or recurrent hematuria. Within one year, two renal biopsies were surgically performed in this patient. The histological diagnosis reported minimal change glomerular lesions. Complications arose after the second biopsy, with development of an abdominal mass in the left side with severe pain. IVP showed absence of dye excretion from the left kidney. Renal arteriogram showed an arteriovenous fistula in the lower pole and absence of venous circulation in the same side. This data was consistent with renal vein thrombosis. The fistula was a complication of the renal biopsy, and most likely, the renal vein thrombosis developed from the fistula. Both complications disappeared spontaneously, the patient is asymptomatic and the IVP is normal. We conclude that the renal biopsy is not a harmless surgical procedure and it is necessary to carry out a through evaluation in order to justify the necessity to perform it.

[Anemia in chronic renal insufficiency]. / La anemia en la insuficiencia renal crónica.

Anemia is the most common hematologic disturbance of patients with chronic renal failure. It is usually normocytic, normochromic and the bone marrow does not show erythroblastic compensatory changes. The anemia is the resultant of different factors; inadequate erythropoiesis, hemolysis and bleeding, being the former the most important mechanism. The important role of the erythropoietin and its mechanism of production are discussed. Patients in intermittent peritoneal dialysis program show higher hemoglobin concentration than patients in chronic hemodialysis. The authors mention the therapeutic approach used to minimize the anemia emphasizing the need of reducing the number of blood transfusions (unless absolutely necessary), since they inhibit erythropoiesis.

La anemia en la insuficiencia renal cronica. / Anemia in chronic renal failure

La anemia constituye la alteracion hematologica mas comunmente observada en pacientes con insuficiencia renal cronica. Habitualmente, es de tipo normocromico normocitico y la medula osea no muestra cambios compensatorios en el numero de eritroblastos. La anemia representa el resultado de la interrelacion de diversos factores: eritropoyesis inadecuada, hemolisis y hemorragias, siendo el primer factor el mas importante. Se discute el papel que desempena la eritropoyetina, asi como el sistema que regula su produccion. Los pacientes mantenidos en dialisis peritoneal intermitente muestran niveles de hemoglobina superiores a los de pacientes en hemodialisis cronica, lo que se pudo demostrar en estudio prospectivo realizado en el Departamento de Nefrologia del Hospital Infantil de Mexico, donde se estudiaron 18 ninos con insuficiencia renal terminal. Los autores discuten las medidas terapeuticas utilizadas para reducir el grado de anemia haciendo enfasis en evitar transfusiones sanguineas frecuentes que inhiben la eritropoyesis, a menos que exista indicacion precisa

[Treatment of arterial hypertension in children]. / Tratamiento de la hipertensión arterial en niños.

The blood pressure is the resultant of the relationship of three different factors: cardiac output, peripheral vascular resistance and blood volume. The etiology of hypertension in children is variable; however increased peripheral vascular resistance (renin dependent) and increased blood volume (sodium dependent), play a role in a variable degree in most cases of hypertension. Increased blood volume is the predominant factor in some cases of (acute glomerulonephritis), whereas vasoconstriction is the most important mechanism in others (renal segmental hypoplasia). Therefore, it becomes important to evaluate each individual case in order to approach therapy. Diuretics are indicated in patients with hypertension secondary to hypervolemia, while antihypertensives are more useful in cases with vasoconstriction. The scheme of treatment for acute hypertensive crises followed in the Department of Nephrology of the Hospital Infantil de Mexico is presented by the authors. A review of the most commonly antihypertensives used in Pediatrics is made, regarding mainly mechanisms of action, indications, recommended doses and side effects.

Post-mortem aeroportography.

The authors suggest a new methodology for the study of the intrahepatic portal system, using atmospheric air as a contrast medium. They used 48 livers of normal and pathological corpses, obtaining post-mortem cholangiographies and vinyl molds. Comparing the images obtained with literature data and with the vinyl molds, the authors conclude that the method is accurate, presenting furthermore many advantages with regard to contrasts generally used, such as low cost, easy performance, possibility repeating the radiographs as many times as necessary, and the possibility of simultaneous obtaining contrasts of other intra-hepatic systems by use of other radio-opaque contrast media in another system, as for example the biliary or the arterial system.

The intra-hepatic biliary system in cirrhósis.

The authors study 14 cirrhotic livers by means of post-mortem cholangiography and vinyl casts. They analyze the radiographs according to thorough criterions, described in the text, and come to the conclusion that intrahepatic biliary ducts in cirrhotic livers present serious alterations, represented by distorted ducts with focal stenoses, nodular impressions, wall irregularities, increase of the number of obtuse angles and poor peripheral filling, which confer a disharmonic aspect to the intra-hepatic biliary ducts of these organs. Furthermore, they show that livers with post-necrotic cirrhosis present bile ducts much more seriously damaged than those with Laennec's cirrhosis. The paper was submitted to statistical analysis and allows objective conclusions.