ABSTRACT
The objective of this study was to measure the frequency and severity of the behavioral effects of high-dose oral steroid therapy in children with nephrotic syndrome. We conducted a prospective assessment of the behavior of 12 children using a standardized psychological questionnaire at the time of diagnosis and again after 4 weeks of steroid therapy. A group of control children was also assessed. There was a significant increase in the total behavior score ( P=0.03) and specifically in aggressive and poor attention behavior items in the group of nephrotic children compared with the control group. Four of the children with nephrotic syndrome developed abnormal behavior in the clinical range compared with none of the controls. In conclusion, children with nephrotic syndrome treated with high-dose oral steroids are at risk of developing clinically relevant behavioral changes.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Child Behavior Disorders/chemically induced , Child Behavior Disorders/psychology , Nephrotic Syndrome/complications , Nephrotic Syndrome/psychology , Adrenal Cortex Hormones/therapeutic use , Aggression/psychology , Attention , Child , Child, Preschool , Female , Humans , Male , Nephrotic Syndrome/drug therapy , Psychiatric Status Rating Scales , United Kingdom/epidemiologyABSTRACT
Abnormalities of sodium-lithium countertransport have been extensively implicated in adult primary hypertension and a relationship between sodium-lithium countertransport and family history of hypertension in children has been previously found. More recently it has been suggested that increased sodium-lithium countertransport may play a part in the pathogenesis of nephropathy in insulin dependent diabetes mellitus (IDDM). Children and adolescents with IDDM and their family members were studied. In those with IDDM (n = 36, median age 14.6 years, range 9.5-19.2 years) there was no relationship between sodium-lithium countertransport (range 0.098-0.585 mmol/l red blood cells/hour) and age, blood pressure as expressed by systolic or diastolic SD scores, glycated haemoglobin, serum lipids, or intracellular sodium concentration. A positive relationship (rs = 0.44) was found between sodium-lithium countertransport and early morning urinary albumin to urinary creatinine ratio (UA/UC), expressed as the logarithm of the geometric mean of two consecutive samples, for each individual (range 0.4-22 mg/mmol). Sodium-lithium countertransport was increased in those with IDDM compared with their non-diabetic siblings, in a paired analysis (n = 26). There was no relationship between UA/UC in the children with diabetes and sodium-lithium countertransport in their parents. These studies in this population of diabetic children indicate that increased sodium-lithium countertransport may play a part in the early stages of the development of nephropathy in IDDM.
Subject(s)
Albuminuria/blood , Antiporters/blood , Diabetes Mellitus, Type 1/blood , Diabetic Nephropathies/blood , Adolescent , Adult , Child , Child, Preschool , Diabetes Mellitus, Type 1/genetics , Family , Female , Humans , Male , Middle Aged , ParentsABSTRACT
We have studied the relationship between sodium-lithium countertransport, determined in childhood, and family history of hypertension. Countertransport was measured in healthy children and those with secondary hypertension. There was no significant difference in countertransport between these two groups. In the normal children (n = 52, median age 6.8 years), there was a positive relationship between body mass index and countertransport (rs = 0.34, p < 0.02). A positive relationship between family history of hypertension using a ranked scoring system, and countertransport, not related to age, body mass or blood pressure (n = 34, rs = 0.63, p < 0.001) was also found. There was no significant relationship between intracellular sodium concentration and countertransport. These data confirm that countertransport in normal children is related to body mass index and indicate that a genetic predisposition to primary hypertension marked by sodium-lithium countertransport is identifiable in childhood.
Subject(s)
Hypertension/genetics , Lithium/blood , Sodium/blood , Adolescent , Adult , Blood Pressure , Body Mass Index , Child , Child, Preschool , Erythrocytes/metabolism , Humans , Hypertension/blood , Severity of Illness IndexSubject(s)
Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Adrenergic alpha-Antagonists/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Child , Diuretics/therapeutic use , Humans , Hypertension/therapy , Vasodilator Agents/therapeutic useABSTRACT
The relevance of providing a rapid anticonvulsant monitoring service was assessed over a five year period at a paediatric epilepsy outpatient clinic. Altogether 481 drug assays were performed on 144 patients when considered clinically indicated. Drugs most frequently assayed were carbamazepine and sodium valproate, singly or in combination; sodium valproate, single or in combination; 90% of assays performed for phenytoin were from patients who were also taking another anticonvulsant. There were only six assays for ethosuximide and 10 for phenobarbitone. Physician's choice of drug dosage was recorded on a questionnaire before and after each assay result was known. Comprehensive patient details were analysed by a paediatric clinical pharmacologist, whose decision as to total daily anticonvulsant dosage was affected by knowledge of the drug concentration significantly less often than that of the clinicians for all the more commonly assayed drugs. There were a large number of drug assays that had no discernable clinical application. A more discriminating use of assays may both improve patient management and reduce considerably the number of anticonvulsant assays required.
