Peritonitis as a risk factor of acute renal failure in nephrotic children.

Idiopathic acute renal failure (IARF) is an uncommon but severe complication in children with relapsing nephrotic syndrome and may require long-term dialytic support until recovery of renal function takes place. Due to limited understanding of the pathophysiology of IARF, specific guidelines for its prevention and therapy have not been developed. Among triggering factors, peritonitis was present in half of all pediatric patients with this complication described in the English literature over the past 15 years. We report an additional nephrotic child who developed IARF following spontaneous bacterial peritonitis. The renal biopsy showed tubular epithelial changes consistent with acute tubular necrosis. A discussion of related literature and possible pathogenesis of this association is presented.

[Role of pediatricians in the prevention of adult hypertension]. / Rol del pediatra en la prevención de la hipertensión arterial esencial del adulto.

Physiopathological events that cause cardiovascular disease in adults, start at early stages of life, even before birth. Thus, their prevention should start at childhood. High blood pressure is an important cardiovascular risk factor and pediatricians should not only detect those children whose blood pressure is above normal values for age and sex but also take special care of normotensive children with risk factors for hypertension. Active and passive preventive measures should be applied to modify factors such as obesity, high salt intake, potassium and calcium intake, birth and placental weight disparity and sedentariness. Pediatricians should be mainstay in the implementation of these preventive strategies.

[Anemia associated with acute post streptococcal glomerulonephritis]. / La anemia de la glomerulonefritis aguda post-estreptocócica.

Thirty-three children with post-streptococcal acute glomerulonephritis, age mean: 8.3 years (range: 6 - 12) were studied prospectively. Mean initial hematocrit (Hct) was 31.6% with 90% showing Hct under the normal lower limit for this age group. Reticulocyte index (RI) was < 0.5 in half of the cases. Serum iron concentration, total iron binding capacity (TIBC) and percentage of transferrin saturation were normal for this age group although 75% of the children had increased serum ferritin levels. At the time of discharge, Hct increased to 35.1% but 44% still had anemia. Hct increased spontaneously for 105 days stabilizing at 38%. Based on Hct changes, 3 groups were defined: Group I (3 individuals): normal upon discharge; Group II (19): partial recovery at discharge, slow recovery stabilizing after 105 days; Group III (11): lower Hct, slower recovery but with RI significantly higher than group II (0.96 vs 0.45 p < 0.01). Our data suggest that although hemodilution is present in all, it may be considered the solely factor only in 3 cases (Group I). In group II, evidence of bone marrow depression was indicated by the low RI. On the other hand, the intense anemia that could not be justified only by hemodilution and marrow depression in group III, suggests other pathogenic factors.

[Chronic hemorrhagic cystitis induced by cyclophosphamide in dermatomyositis refractory to corticosteroid treatment]. / Cistitis crónica hemorrágica por ciclofosfamida en dermatomiositis refractaria a tratamiento esteroidal.

Dermatomyositis was diagnosed at age 7 years to a fourteen year old female. The disease was unresponsive to high doses of prednisone, so she was treated with oral cyclophosphamide 0.8 mg.kg.day (25 mg.m2) but treatment was withheld after sixteen weeks because of hemorrhagic cystitis and changed to azathioprine for two years, which resulted in complete remission of dermatomyositis. Nevertheless silent microscopic hematuria persisted and chronic cystitis was demonstrated by cystoscopy and vesical biopsy at age 13 years. In this case chronic cystitis developed earlier and at lower doses of cyclophosphamide than in other previously reported cases.

[Blood pressure measurement with Doppler in normal newborn infants and infants]. / Medición de presión arterial con Doppler en recién nacidos y lactantes normales.

Systolic blood pressure (SBP) was measured by Doppler method in an aleatory sample of 251 healthy children from south-east Santiago Chile (131 females and 120 males) which were divided by age in five groups: 0 to 28 days (n = 5) 1 to 5 months (n = 48), 6 to 11 months (n = 48), 12 to 17 months (n = 46) and 18 to 24 months (n = 45). Great dispersion of SBP values occurred among newborn infants (range 85 to 125) in comparison with groups 1 to 5 months (105 to 130), 6 to 11 months (118 to 130). Fifty and 95 percentiles were, respectively, 107 to 125; 116 to 130; 121 to 130; 118 to 130 and 120 to 130. These values were greater than those obtained by sphygmomanometry in a similar matched group of children.

Glomerulonefritis aguda post-estreptococica: descripcion epidemiologica. / Acute post-streptococcal glomerulonephritis: epidemiological report

Se presentan las caracteristicas epidemiologicas, bacteriologicas y serologicas de 84 pacientes de glomerulonefritis aguda ocurridos en el Servicio de Salud Metropolitano Sur Oriente, entre Enero de 1980 y Diciembre de 1981 con especial enfasis en la localizacion de la infeccion estreptococica que los origino y su vinculacion con dichas caracteristicas. Existen claras diferencias en cuanto a edad y estacion del ano de las GNA segun derivan de una infeccion cutanea o faringea, asi como en la tasa de aislamiento del estreptococo B hemolitico A y sus serotipos. Igualmente la respuesta inmunitaria medida con anticuerpos antiestreptococicos es diferente segun la localizacion y prueba usada. Lo anotado confirma lo hallado por autores extranjeros en el sentido de que la localizacion determina caracteristicas epidemiologicas diferentes. Se estudiaron ademas, los contactos intrafamiliares de los casos y en ellos se observo una actividad estreptococica significativamente superior a la de la poblacion general, medida por aislamientos y titulos de anticuerpos antiestreptococicos