ABSTRACT
INTRODUCTION: Between 1991 and 2006, the Latin American Dialysis and Renal Transplantation Registry collected data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay). Access to RRT was universal in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay, all countries belonging to the medium-high or high income group. METHODS: Data about patients on renal replacement therapy (RRT) were supplied by national affiliates or the Registry's Coordination Committee. Transplant data were gathered and shared with the Latin American and Caribbean Society of Transplantation. RESULTS: RRT prevalence increased from 162 patients per million population (pmp) in 1991 to 478 pmp in 2005 and 473 pmp in 2006 (59.2% hemodialysis, 20.4% peritoneal dialysis and 20.4% with a functioning kidney allograft). Countries with the highest prevalence were Puerto Rico (1,148.9 pmp), Uruguay (924.5 pmp) and Chile (907.6 pmp). Latin America's (LA) incidence increased from 27.8 pmp in 1992 to 188 pmp in 2006. The LA Kidney transplant rate increased from 3.7 pmp in 1987 to 15,4 pmp in 2006, and 166 combined transplants - kidney and another organ, mainly pancreas - were performed. In the medium-high income group 2006, (Argentina, Brazil, Chile, Costa Rica, Cuba, Mexico, Panama, Uruguay, Venezuela) the prevalence rate was 534.8 pmp vs. 289.5 pmp in the middle-low income group. The transplant rate was 18.4 pmp in the medium-high income group vs. 7 pmp in the middle-low group (p < 0.01). CONCLUSIONS: RRT incidence and prevalence continue to grow steadily. Access to RRT is universal only in some countries included in the medium-high or high income group. It is imperative to accomplish the goal of making RRT available to all who need it.
Subject(s)
Kidney Transplantation/statistics & numerical data , Renal Dialysis/statistics & numerical data , Humans , Kidney Transplantation/trends , Latin America , Registries , Renal Dialysis/trendsABSTRACT
PIP: The incidence of urinary tract infection (UTI) varies depending on the age of the child. In 1984 a review of 1000 school children in the city of Santo Domingo found an incidence of 0.4%. In a prospective study 109 patients were investigated who presented at the outpatient consulting ward of nephrology of the Robert Reid Cabral Hospital, Santo Domingo, Dominican Republic, with fever and/or clinical symptoms suggestive of UTI. Uroculture was taken by means of suprapubic punction in all those cases which had not received antimicrobial therapy at least 72 hours before taking the specimens. The signs of UTI in the 109 patients were dysuria, urinary incontinence, and enuresis. 41 patients had urocultures positive for UTI bacteria, while the remaining 68 children's urocultures did not show bacterial growth, therefore they were judged not to have UTI. In the 41 patients with UTI the etiologic agents were Escherichia coli in 20 (48.78%), Enterobacter in 14 (34.15%), Klebsiella in 4 (9.76%), Staphylococcus in 4 (9.76%), Pseudomonas in 4 (9.76%), and Salmonella in 3 (7.32%). In all cases of positive uroculture more than 10 leukocytes were observed in the urinary sediment. Only 15 of the 41 patients with positive uroculture had leukocytosis. Fever as a clinical symptom was found in 7 of the 109 cases, and in 3 of these bacteria were grown in the uroculture. In 40 patients out of 109 the fever was associated with clinical signs of UTI, finding positive uroculture in 20 of these patients.^ieng
Subject(s)
Child , Clinical Laboratory Techniques , Infections , Prospective Studies , Signs and Symptoms , Urogenital System , Adolescent , Age Factors , Americas , Biology , Caribbean Region , Demography , Developing Countries , Diagnosis , Disease , Dominican Republic , Latin America , North America , Physiology , Population , Population Characteristics , ResearchABSTRACT
The serum lipid levels of 25 children with SNI of LGM were quantified. All cases showed total cholesterol and triglyceride levels above the 95% percentile for both their age and sex (417 +/- 119 mg/dL and 448 +/- 313 mg/dL respectively). Ninety-two percent of the children showed LBD above the 95 percentile for their and sex (307 +/- 108 mg/dL) and 72% showed LAD in the normal lower limit, under the fifth percentile for their age and sex (26.9 +/- 13.7 mg/dL). A important percentage of the patients showed elevated LMBD (90.8 +/- 61.0 mg/dL). A direct proportional relationship occurred between total cholesterol and LBD (r = + 0.854), yet, an inverted relationship was not seen between total cholesterol and LAD (r = -0.315) nor between total cholesterol and serum albumin (r = -0.248).
Subject(s)
Lipids/blood , Nephrosis, Lipoid/blood , Adolescent , Child , Child, Preschool , Cholesterol/blood , Female , Humans , Infant , Lipoproteins/blood , MaleABSTRACT
PIP: In recent years, health indicators in developing countries including most of Latin America have deteriorated as a consequence of low economic growth rates, inflation, and reduced spending on health, education, and social assistance for the absolutely impoverished. It will be difficult to determine the extent to which the long crisis has hampered achievement of reduced infant and child mortality rates and low weight births, or of increased primary school attendance and per capita calorie consumption. The difficulty of analysis stems from the inadequacy of most national statistical series, which are susceptible to bias. Available information suggests that the crisis has been disastrous for the most vulnerable sectors. The level of absolute poverty has increased to 50% of the population, which in itself demonstrates the limitations that will be faced by programs to improve health indicators.^ieng
Subject(s)
Economics , Evaluation Studies as Topic , Health Status Indicators , Developing Countries , Health , Latin AmericaABSTRACT
PIP: In developing countries infectious diseases continue to be the primary cause of morbidity in children and they are also responsible for an increasing number of untimely deaths. Viral, bacterial, mycotic, and parasitic agents are responsible for various pathological conditions that are present in the most vulnerable groups of the population. Poverty, crowding, lack of access to potable water, low level of education, and inadequate disposition of excreta provide an ideal environment for infectious agents. During human history viruses have represented an important group of disease-producing agents, both in mothers and children. The teratogenic, immunogenic, and oncogenic capabilities of many viruses has been established, and every so often new activities and characteristics of these agents are identified in relation to epidemiology, physiology, and pathogenics. An interesting work concerning parvovirus B19 by Drs. Mateo and Polanco was published in the Archivos Dominicanos de Pediatria. This virus appears to be responsible for infectious erythema and particularly for the medullar aplasia crisis observed in many chronic hemolytic anemias. For the Dominican Republic this discovery is of interest because of the relatively high prevalence of falciform anemia; this disease most often occurs as hereditary anemia, and the medullar aplasia crisis is one of the forms of expression of this disease.^ieng
Subject(s)
Blood , Evaluation Studies as Topic , Genetic Diseases, Inborn , Maternal-Child Health Centers , Morbidity , Socioeconomic Factors , Virus Diseases , Americas , Biology , Caribbean Region , Delivery of Health Care , Developing Countries , Disease , Dominican Republic , Economics , Health , Health Services , Latin America , North America , Physiology , Primary Health CareABSTRACT
Se realizo determinacion serica de magnesio (Mg++) en 79 ninos; 17 casos eran desnutridos con kwashiorkor y 22 eran marasmaticos. Cuarenta ninos eutroficos que sirvieron de control. El valor promedio de Mg++ serico en ninos desnutridos con kwashiorkor fue de 1.08 +/- 0.05 mEq/l mientras que en los marasmaticos fue de 1.83 +/- 0.08 mEq/l. En los eutroficos el valor promedio de Mg++ fue de 1.7 +/- 0.06 mEq/l El valor promedio de Mg++ en los ninos con kwashiorkor fue significativamente menor que en los desnutridos marasmaticos y los ninos eurotroficos, p < 0.01. No se encontro diferencia entre los desnutridos mararasmaticos y el grupo control. Se analizan las posibles hipotesis que explicarian estas diferencias
Subject(s)
Infant, Newborn , Infant , Child, Preschool , Humans , Male , Female , Kwashiorkor , Magnesium , Magnesium Deficiency , Protein-Energy MalnutritionABSTRACT
Se analiza la velocidad de filtracion glomerular (VFG) en 45 recien nacidos a termino (RNT) sanos empleando una formula empirica donde: VFG (ml/min/1.73m2 S.C.) = 0.55 x Talla/Crp. En esta ecuacion la talla se expresa en centimetros y Crp es creatinina plasmatica. La VFG se determino al momento del nacimiento tomando sangre del cordon para medir Crp, a los 8 y 30 dias de edad. El primer dia de nacido la VFG fue en promedio de 50.2 ml/min/1.73m2 S.C., a los 8 dias de edad no se observo un aumento significativo y el valor promedio fue de 53.1 +/- 30 ml/min/1.73 m2 S.C.A los 30 dias de edad la VFG experimento un incremento significativo, 65.1 +/- 24 ml/min/1.73m2 S.C., en relacion con el primer y el octavo dia de edad, p < 0.02.Nuestras observaciones senalan que la VFG es baja en RNT aun a los 30 dias de edad.Se analizan los factores que podrian condicionar esta disminucion
Subject(s)
Humans , Male , Female , Glomerular Filtration Rate , Infant, NewbornABSTRACT
Se pesquisaron 1000 escolares femeninos, entre 7 y 16 anos de edad en busca de bacteriuria. Cuatro de ellas resultaron sospechosa al analisis de la orina con la cinta Screen-Rapignost. El urocultivo fue positivo en las 4. Los estudios radiologicos mostraron anormalidades de vias urinarias en 2 de ellas. Se analizan las consecuencias de las bacteriurias en ninas y la necesidad de que el pediatra y el medico general no la pasen por alto al detectarla
Subject(s)
Child , Adolescent , Humans , Female , Bacteriuria , Urinary Tract InfectionsABSTRACT
Se estudia un paciente con la llamada glomerulonefritis crescentica aguda acompanada de insuficiencia renal progresiva y la cual fue tratada con metilprednisolona con respuesta satisfactoria, comentandose sobre la enfermedad y sus caracteristicas
Subject(s)
Child , Humans , Female , Acute Kidney Injury , Glomerulonephritis , MethylprednisoloneABSTRACT
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.
Subject(s)
Peritoneal Dialysis , Uremia/therapy , Child , Humans , Hypertonic Solutions , Peritoneal Dialysis/adverse effects , Peritoneal Dialysis/instrumentation , Peritonitis/etiologyABSTRACT
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.
Subject(s)
Anemia/etiology , Kidney Failure, Chronic/complications , Anemia/therapy , Blood Transfusion , Child , Erythropoiesis , Folic Acid Deficiency/etiology , Hemolysis , Histidine/deficiency , Humans , Iron Deficiencies , Kidney Failure, Chronic/physiopathology , Renal DialysisABSTRACT
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
Subject(s)
Anemia , Erythropoiesis , Renal Insufficiency, ChronicABSTRACT
Se comunican dos casos de sindrome hemolitico uremico (SHU) en dos ninos de 10 meses y 2 anos de edad. Ambos pacientes presentaron insuficiencia renal aguda (IRA), cuya severidad amerito manejo con dialisis peritoneal respondiendo satisfactoriamente. Por otra parte los autores discuten los aspectos relacionados con la fisiopatologia de la trombocitopenia y de la anemia hemolitica microangiopatica. Finalmente se analiza la terapeutica del sindrome
Subject(s)
Hemolytic-Uremic Syndrome , Acute Kidney Injury , Peritoneal DialysisABSTRACT
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.
