Biografía de una pediatra pionera en España: Nieves González Barrio (1884-1961) / Biography of a pioneering pediatrician in Spain: Nieves González Barrio (1884-1961)

Introducción: podemos encontrar mujeres pioneras en Pediatría y Puericultura en España, a principios del siglo XX, para rescatarlas del olvido y subrayar su papel dentro de la conquista del espacio público para la mujer. Nieves González Barrio (1884-1961) fue una de ellas. Objetivo: describir su vida profesional como pionera médica y pediatra-puericultora (biografía histórica), enmarcada en un contexto humanístico. Material y métodos: estudio histórico, hemerográfico (Biblioteca Nacional de España [BNE], BNF-Gallica [biblioteca de Francia], diario ABC, Memorias de la Junta de Ampliación de Estudios, la propia González Barrio en Blanco y Negro en 1935, y otros). Seleccionados: 22 artículos científicos, más 26 de prensa histórica y libros. Resultados: González Barrio presentó su tesis doctoral en 1915, sobre Kala-Azar. Fue médica pionera en los viajes formativos a EE. UU. Su actividad: la Medicina de Laboratorio y la Pediatría. Fue profesora (1926-1931) en la Escuela Nacional de Puericultura, encargada del laboratorio y de organizar el servicio de enfermeras visitadoras y niñeras. Fue una promotora de la especialización en enfermería. Perteneció a diversas instituciones médicas y educadoras, y de promoción de la mujer (el Lyceum Club femenino y otras). Comentarios: fue de las primeras médicas pediatras en España, doctoradas, y pionera en formación internacional, en investigación y docencia. Su vida profesional se vio truncada por los vaivenes de la política española y de la Sanidad, así como necesidades familiares. Su figura, su determinación personal, su legado, su gran capacidad polifacética y su labor como mujer científica y pediatra merecen ser tenidas en consideración y estudiadas en profundidad (AU)

Introduction. At the beginning of the 20th century, we can find and rescue from oblivion pioneer women in Pediatrics and Puericulture in Spain, to underline their role within the conquest of public space for women. María Nieves González Barrio (1884-1961) was one of them. Objective: to describe her professional life as a pioneering physician and pediatrician-pediatrician-puericulturist (historical biography), framed in a humanistic context.Material and methods. Historical and hemerographic study (BNE-National Library of Spain-, BNF-Gallica (library of France), ABC newspaper, Memoirs of the Junta de Ampliación de Estudios, González Barrio herself in Black and White in 1935, and others). Selected: 22 scientific articles and books, plus 26 historical press articles.Results. González Barrio presented her doctoral thesis in 1915, on Kala-Azar. She was a pioneer physician in formative trips to the USA. Her activity: Laboratory Medicine and Pediatrics. She was a professor at the National School of Puericulture, from 1926 to 1931, in charge of the laboratory and of organizing the service of visiting nurses and nannies. She was a promoter of nursing specialization. She belonged to several medical and educational institutions, and for the promotion of women, such as the Women's Lyceum Club and others.Comments. She was one of the first pediatric doctors in Spain, with a doctorate, and a pioneer in international training, research and teaching. Her professional life was truncated by the ups and downs of Spanish politics and healthcare, as well as family needs. Her figure, personal determination, legacy, her great multifaceted capacity and her work as a woman scientist and pediatrician deserve to be taken into consideration and studied in greater depth. (AU)

Usefulness of basic renal function tests in the management of hydronephrosis. / Utilidad de las pruebas básicas de función renal en el manejo de la hidronefrosis.

OBJECTIVE: Nowadays, the algorithms for the study of hydronephrosis in children include voiding cystourethrogram (VCUG) and diuretic renogram (DR) in all patients. Both are invasive, distressing, and associated with radiation risk. However, basic renal function tests (bRFTs) are not included. This study was designed to determine whether bRFTs may help avoid VCUG and/or DR in some children. METHODS: Retrospective review of hydronephrosis (≥20 mm renal pelvis) patient records over one year (n = 38) (pyeloureteral stenosis (PUS) n = 12; high-grade vesicoureteral reflux (VUR) n = 8; non-obstructive hydronephrosis (NOH) n = 18. Data from the three protocolized bRFTs (maximum urine osmolality after DDAVP (UOsm), albumin/creatinine ratio (Alb/Cr), and NAG/creatinine ratio (NAG/Cr), together with VCUG and DR, were analyzed. RESULTS: 38 hydronephrosis patients (pyeloureteral stenosis (PUS) n = 12; high grade vesicoureteral reflux (VUR) n = 8; non-obstructive hydronephrosis (NOH) n = 18. UOsm was decreased in 100% of VUR patients, 75% of PUS patients, and 16.7% of NOH patients. Alb/Cr ratio was increased in 62.5% of VUR patients, 8.3% of PUS patients, and 11.1% of NOH patients. NAG/Cr ratio was increased in 42.8% of VUR patients, 25% of PUS patients, and 6.7% of NOH patients. UOsm was decreased in most patients who required surgery (100% of VUR patients and 74% of PUS patients), but only in 11.1% of patients who did not (NOH group). CONCLUSIONS: These results suggest that bRFTs may be useful in delaying or avoiding VCUG in some hydronephrosis cases. UOsm is the most sensitive test. No child with (high grade) VUR had a normal UOsm. VCUG could have been avoided in 43% of our patients -with a normal UOsm- without missing any high grade VUR.

OBJETIVO: Actualmente, los algoritmos para estudiar hidronefrosis en niños, incluyen realizar cistografía miccional (CUMS) y renograma diurético (RD) a todos. Ambos son invasivos, molestos, y con riesgo de radiación. Contrariamente, las pruebas básicas de función renal (PFRb), no están incluidas. Este estudio se realizó para saber si las PFRb, pueden ayudarnos a evitar alguna CUMS y/o RD. METODOS: Análisis retrospectivo de todas las historias de niños con hidronefrosis (pelvis renal ≥20 mm) atendidos durante un año (n=38), [estenosis pieloureteral (EPU) n = 12; reflujo vesicoureteral (RVU) de alto grado n = 8; hidronefrosis no obstructiva (HNO) n = 18]. Analizamos las tres PFRb protocolizadas [osmolalidad urinaria máxima tras DDAVP (UOsm), albúmina/creatinina (Alb/Cr) y NAG/creatinina (NAG/Cr)], junto con CUMS y RD. RESULTADOS: UOsm estaba disminuida en 100% RVU, 75% EPU, 16,7% HNO. Alb/Cr estaba aumentado en 62,5% RVU, 8,3% EPU, 11,1% HNO. NAG/Cr estaba aumentado en 42,8% RVU, 25% EPU, 6,7% HNO. En relación a la necesidad de cirugía, UOsm estaba disminuida en la mayoría de pacientes intervenidos (100% con RVU y 74% con EPU), mientras solo en el 11% de pacientes sin cirugía (HNO). CONCLUSION: Estos resultados sugieren que las PFRb pueden ser útiles para retrasar o evitar CUMS en algunos niños con hidronefrosis. La UOsm es la PFRb más sensible. Ningún niño con RVU (de alto grado) mostró una UOsm normal. Se podrían haber evitado CUMS en el 43% de nuestros pacientes, con UOsm normal, sin haber perdido ningún diagnóstico de VUR (de alto grado).

Urinary Clara Cell Protein in Kidney Transplant Patients: A Preliminary Study.

OBJECTIVE: The aim of this exploratory study was to analyze the urinary excretion of Clara cell protein (CC16), a new marker of proximal tubular dysfunction (PTD), in kidney transplantation (KT). MATERIALS AND METHODS: Urinary concentrations of CC16, ß2-microglobulin (ß2m), and N-acetyl-glucosaminidase (NAG) were measured in 50 KT patients (72% men; mean age 50.4 ± 12.4 years; diabetes in 24%; duration of KT 4.3 ± 3.1 years) and 10 healthy controls (6 men; mean age 33.6 ± 13.4 years). RESULTS: Urinary levels of ß2m, NAG, and CC16 were significantly higher in KT patients than in controls: ß2m: 0.77 (interquartile range [IQ] 0.22 to 4.62) g/g vs 0.069 (IQ 0.05 to 0.10) g/g; NAG: 3.16 (IQ 2.09 to 5.33) U/g vs 1.73 (IQ 1.25 to 2.07) U/g; CC16: 26.01 (IQ 8.62 to 123.3) g/g vs 2.51 (IQ 0.83 to 7.18) g/g (P < .001). Elevated levels of ß2m, NAG, and CC16 were found in 81%, 28%, and 71% of KT patients, respectively. Urinary levels of ß2m, NAG, and CC16 significantly increase as glomerular filtration rate (GFR) decreases. Interestingly, in patients with GFR >60 mL/min, we still found high levels of ß2m, NAG, and CC16 in 77%, 13%, and 52%, respectively. Diabetic subjects had significant higher levels of the 3 markers compared with nondiabetic subjects, without differences in albumin excretion or GFR. CC16 showed a positive correlation with urinary albumin (r = 0.42, P < .001), NAG (r = 0.352, P < .05), and ß2m (r = 0.75, P < .001). CONCLUSION: PTD is highly prevalent in KT patients. This is the first study that analyzes CC16 in KT patients, showing that the urinary excretion of this protein is significantly increased in this population. Further studies are needed to examine the clinical value of CC16 in KT patients.

El ocaso del artículo / The decline of the article

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Discípulos y maestros. Lo que aprendimos de Juan Rodríguez Soriano / Disciples and teachers. What we learn from Juan Rodríguez Soriano

Juan Rodríguez Soriano (1933-2010) fue un eminente nefrólogo pediátrico español, formador de varias generaciones de pediatras y nefrólogos pediátricos. Estaba considerado internacionalmente como uno de los pioneros de la nefrología pediátrica y, referente, en el de las tubolopatías. Su prestigio en esa especialidad fue unánimemente reconocido. Realizó sus estudios de Medicina en la Universidad de Barcelona. En 1959, obtuvo, una beca para ampliar su formación en el Hópital des Enfants Malades de Paris. En 1963 fue admitido en el Albert Einstein College of Medicine de Nueva York, en el que identificó la acidosis tubular proximal renal como una entidad fisopatológica independiente. En 1970, se hizo cargo del Departamento de Pediatría del Hospital Universitario de Cruces, cerca de Bilbao. Alklí, junto a Alfredo Vallo, siguió investigando y publicando sobre muchos temas pediátricos pero, especialmente sobre diversos aspectos de sus dos grandes temas de interés, las pruebas de función renal y las grandes temas de interés, las pruebas de función renal y la tubulopatías. A lo largo de 30 años, ambos desarrollaron las bases para la creación de una auténtica “escuela científica” nefrológica pediátrica (AU)

Juan Rodríguez Soriano (1933-2010) was an eminent Spanish nephrologist, forming several generations of paediatricians and paediatric nephrologist. He was internationally regarded as one of the pioneers of paediatric nephrology, and reference in tubolopathies. His reputation in that field was unanimously recognized. He studied medicine at the University of Barcelona. In 1959, he won a scholarship to further their training in the Hospital des Enfants Malades in Paris. In 1963 he was admitted to the Albert Einstein College of Medicine in New York where identified the proximal renal tubular acidosis as an independent physiopathological entity. In 1970, he took charge of the Department of Pediatrics, University Hospital of Cruces, Bilbao. There, nex to to Alfredo Vallo, continued its research and publications on many paediatric topics, but especially on various aspects of its two main topics of interest: renal function test and tubulopathies. Over 30 years, both developed the basis for creating a true “scientific school” of the paediatric nephrology (AU)

[Posterior urethral valves, unilateral vesicoureteral reflux and renal dysplasia (VURD syndrome). Long-term follow-up of kidney function]. / Válvulas de uretra posterior, reflujo vesicoureteral unilateral y displasia renal (síndrome VURD). Seguimiento de la función renal a largo plazo.

Posterior urethral valves, unilateral vesicoureteral reflux and renal dysplasia (VURD syndrome) is an infrequent entity in childhood that has provoked multiple controversies. The shortage of studies that evaluate the long-term outcome in these children prompted up to write the present article. Three patients that met strict criteria for a diagnosis of VURD syndrome were retrospectively reviewed, with special emphasis on several indicators of renal function in these patients at diagnosis and in adulthood. The three patients currently have normal renal function, unlike a large percentage of patients diagnosed with posterior urethral valves with vesicoureteral bilateral reflux. Although the sample is small, our results support the hypothesis of good long-term renal function in affected children.

Displasia renal multiquística unilateral y megacaliosis contralateral. Una asociación inusual / Unilateral multicystic dysplastic kidney and contralateral megacalycosis. An unusual association

La dilatación de vías urinarias no siempre es sinónimo de obstrucción. Es conocido que existen malformaciones con aparente hidronefrosis en las que el flujo de la orina no está interrumpido. Por otra parte, con cierta frecuencia, se observa que en un mismo paciente pueden coexistir dos o más malformaciones distintas de vías urinarias. Se presenta un caso clínico en el que coexistían una displasia renal multiquística unilateral y una megacaliosis contralateral, asociada a un megauréter segmentario distal ipsolateral. Esta asociación es inusual en la literatura médica. A pesar de ello, la función glomerular renal es normal y existe, únicamente, un ligero defecto de la capacidad de concentración renal (AU)

[Unilateral multicystic dysplastic kidney and contralateral megacalycosis. An unusual association]. / Displasia renal multiquística unilateral y megacaliosis contralateral. Una asociación inusual.

Dilation of the genitourinary tract is not always synonymous with obstruction. It is well known that malformations with apparent hydronephrosis and normal urinary flow can exist. In addition, two or more distinct malformations of the genitourinary tract can coexist in the same patient. We present a case of coexistence of a unilateral multicystic dysplastic kidney and contralateral megacalycosis associated with ipsilateral distal segmental megaureter. This association is unusual in the literature. Glomerular renal function was normal, with only a slight defect of renal concentration capacity.

Study of renal metabolic disturbances related to renal lithiasis at school age in very-low-birth-weight children.

We studied 34 asymptomatic children who were born with a very-low-birth-weight (VLBW) and had no perinatal history of acute renal failure nor treatment with furosemide. The study was done at preschool or school age, looking for echographic changes and renal tubular disturbances which are known to predispose to renal lithiasis. The results were compared with those of a control group of 18 children who had been born at term with a body weight >2,500 g. One or more renal tubular disturbances were found in 64.70% of the VLBW children. Most frequently found were decreased ammonium excretion in response to furosemide (38.23%), enhanced N-acetylglucosaminidase excretion (35.29%), hypercalciuria (26.47%), and hypocitraturia (23.53%). Echography revealed renal cortical hyperechogenicity (17.65%) and renal lithiasis (8.82 %) in some of the VLBW children. We found a significant positive correlation (r = 0.7) between the perinatal level of plasma phosphate and the total amount of H+ excreted in response to furosemide at preschool or school age. Because these renal tubular anomalies may be precursors of future lithiasis, and the renal function and echography tests are not invasive, we suggest that renal tubular function be measured and followed up in every VLBW child, particularly when perinatal hypophosphatemia has occurred.

[Urinary excretion of N-acetyl-beta-D-glucosaminidase and microglobulin 2 in type I diabetes mellitus]. / Estudio de la eliminación urinaria de N-acetil-beta-D-glucosaminidasa y beta 2 microglobulina en la diabetes mellitus tipo I.

We studied the urinary elimination of two indicators of renal proximal tubular function. N-Acetyl-Gluosaminidase (NAG) and beta 2 microglobulin (beta 2m) in 23 healthy and 67 diabetic children aged 2-15 years and with disease evolution times between 1 month and 12 years. In order to obviate the variations of glomerular filtration present in the diabetes, both proteins were evaluated in the form of indices of excretion (IE). It was found that the diabetic children as a whole presented higher values of NAGIE than the controls (p less than 0.001), and that this increased as the degree of metabolic control worsened, the latter being judged by either fructosamin or HbA C (r = 0.59 for both). The increase in the urinary elimination of NAG had a directly proportional relation with the evolution time of the diabetes. With respect to the beta 2mIE, no significant differences were found on dividing the children according to the degree of metabolic control, although the values did increase with longer evolution times. Thus it may be concluded that NAGIE was shown to be a more useful parameter than beta 2m for evaluating the renal proximal tubular function in infant and juvenile diabetes.