[Evaluation of N-acetyl-beta glucosaminidase in upper and lower urinary tract infections in childhood. Clinical study of 168 children]. / Valutazione della N-acetyl-beta-glucosaminidasi (NAG) nelle infezioni delle alte e delle basse vie urinarie in età pediatrica. Studio clinico su 168 bambini.

BACKGROUND: Urinary N-acetyl-beta-glucosaminidase (NAG) is a renal tubular enzyme that may be used as a marker of tubular damage. METHODS: We studied 96 patients 1 to 8 years old and considered NAG excretion to distinguish cystitis from pyelonephritis. Whenever urinary NAG values were expressed in relation to urinary creatinine concentration and compared with urinary NAG values in 72 normal controls 1 to 14 years old grouped by age. RESULTS: Our results demonstrate that urinary NAG levels are elevated in children with pyelonephritis in the presence or absence of urinary tract abnormality. CONCLUSIONS: Therefore, we conclude that NAG may be considered as a further criteria in the diagnosis of upper urinary tract infection and interstitial tubular damage.

[Crossed renal ectopy with fusion. Report of a case]. / Ectopia renale crociata con fusione. Descrizione di un caso clinico.

Crossed renal ectopia is a rare urinary tract anomaly, often associated with malformations involving various organs and systems. We report a case of crossed renal ectopy with fusion, without associated abnormalities. Recurrent abdominal pain, sometimes with microhematuria, were the clinical features, never accompanied by alteration of the renal function.

[Peroxidation of erythrocyte lipids and levels of vitamin E in red blood cells in children with chronic renal insufficiency]. / Perossidazione dei lipidi eritrocitari e livelli di vitamina E nei globuli rossi dei bambini con insufficienza renale cronica.

The tocopherol and malonyldialdeyde levels in the erythrocytes of 15 children affected by chronic renal failure, free of therapy, have been studied. Decreased levels of the former and increased of the latter were found. These data indicate red blood cell lipids peroxidation, responsible, at least in part, of the reduced red blood cell survival and of chronic anemia.

[Long-term therapy with amoxicillin and clavulanic acid in recurrent urinary tract infections in childhood]. / Terapia a lungo termine con amoxicillina ed acido clavulanico nelle infezioni recidivanti delle vie urinarie in età pediatrica.

Experiments have been carried out with an association of amoxicillin and clavulanic acid for the long-term treatment of recurrent urinary tract infections. 20 children whose antibiogram showed that the microbe in question was insensitive to amoxicillin alone were selected for treatment; five suffered from urinary tract malformations. Urine sterilisation was obtained by administering a dose of 40 mg/kg/die for five days. Treatment continued with a single evening dose of 20 mg/kg for six months. A positive result was obtained in 18 subjects (90%). One case of E. coli proved resistant to the antibiotic. In another case, treatment had to be suspended for vomiting. At the end of treatment, haematological controls proved normal.

Amoxycillin and clavulanic acid in the treatment of urinary tract infections in children.

The efficacy of amoxycillin-clavulanic acid combination in the treatment of urinary tract infections resistant, in vitro, to amoxycillin was studied in 42 children. Of the 24 children with urinary tract infection for the first time, combination therapy, dosing twice daily for 5 days (40 mg/kg.day), cleared the infection in 23 (96%) cases. Relapse occurred in four (17%) cases within 30 days. Of the 18 children who presented with recurrent urinary tract infections therapy, as above, cleared the infection in 16 (89%) cases. In these cases, long-term therapy was performed at a dosage of 20 mg/kg once daily. Tolerance was good; gastro-intestinal disorders in five (12%) cases which regressed by dosing at 8 h rather than 12 h intervals. In conclusion, amoxycillin-clavulanic acid can be considered a first choice treatment of urinary tract infections in children.

[Long-term prognosis in monosymptomatic microscopic hematuria]. / Prognosi a lungo termine della ematuria microscopica monosintomatica.

A group of 210 children, aged one to twelve years (86 males and 124 females) were sent to our Clinic with the diagnosis of microscopic hematuria. Twelve children in which microhematuria wasn't confirmed were immediately excluded; thirty children were excluded because they showed pathologic findings. The remaining 168 children were put under diagnostic examination (hematologic exams, urinoculture, abdomen radiographic, family screening). The cause of microhematuria was identified in 52 of them. The group was selected down to 116 who were then monitored for a period ranging from 1 to 9 years with periodical clinical and biohumoral controls and with diagnostic exams. Biopsies were performed only in 16 cases in which a nephropathy was suspected. Nine cases presented significant histological lesions. Seventy five children were subjected to observation for a period of over one year. After few years hematuria gradually disappeared in twenty six children. After nine years microhematuria had disappeared spontaneously in 39.9% of cases. It remained in core of 33.6% of case, for which no cause could be found. With reference to the full group of 168 children, the following pathologies have been found responsible of microhematuria: a) urinary way infections: 25 cases (14.8%) b) nephropathies: 16 cases (9.5%) c) familiar hematurias: 14 cases (8.3%) d) lithiasis: 9 cases (5.3%) e) alteration of the coagulation system: 3 cases (1.8%) f) renal hypercalciuria without lithiasis: 3 cases (1.8%) Based on these observation, we believe that careful waiting is the best tactic in the cases of monosymptomatic microhematuria.(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemical and clinical effects of vitamin E administration in homozygous beta-thalassemia.

In beta-thalassemic homozygotes, low plasma levels of tocopherols may induce a red blood cell (RBC) lipid peroxidation and consequent hemolysis. This is an indication to treat these patients with vitamin E. In this study 26 beta-thalassemic homozygotes aged 2-14 years, were given vitamin E, 10 orally and 16 parenterally, 300 mg per day for 15 days. Prior to administration and blood transfusion, as compared to normal subjects of the same age, plasma and RBC tocopherols were significantly lower, whereas RBC malonyldialdehyde (MDA) was significantly increased. In both groups, after tocopherol administration, an increase in plasma and RBC tocopherols and a decrease in RBC MDA were found. The significance of these variations was greater in the parenterally treated group than in orally treated group. The treatment with vitamin E, appears to be effective to reduce the RBC oxidative damage in homozygous beta-thalassemia, principally when administered parenterally perhaps because of its poor intestinal absorption in these subjects.

[Microscopic hematuria in children]. / L'ematuria microscopica nel bambino.

The AA. studied ninety children affected by microscopic hematuria whose origin was not clear. Periodic controls have been effectuated during a period from one to five years. The hematuria is spontaneously disappeared in the 46,7% of the cases. In sixteen children (17,7%) the hematuria was also present in some relatives, nine children were affected by urinary tract malformations. Only twenty subjects were affected by a significant renal pathology.

Evidence of red blood cell membrane lipid peroxidation in haemodialysis patients.

Some metabolic alterations of the pentose-phosphate shunt can increase susceptibility to red blood cell (RBC) lipid peroxidation in uraemic patients on maintenance haemodialysis. We investigated this phenomenon in 19 uraemic patients undergoing chronic haemodialysis by determining RBC malonyldialdehyde (MDA), a secondary product of lipid peroxidation and plasma and RBC tocopherols, which are powerful antioxidants. Evidence of RBC membrane lipid peroxidation was demonstrated by an increase of RBC MDA. RBC tocopherols were significantly decreased because of enhanced antioxidant activity. No significant variations of these parameters were found before and after dialysis.

[Results of 3 or 10 days' treatment with nitrofurantoin or cotrimoxazole in urinary infections in children]. / Risultati della terapia per tre o dieci giorni con nitrofurantoina o cotrimoxazolo nelle infezioni urinarie del bambino.

110 children, affected by UTI, were included in this study; 52 of them were treated for 10 days and the remaining 58 for 3 days. Both groups were treated with cotrimoxazole or nitrofurantoin. Urine cultures were repeated soon after the end of therapy and repeated subsequently for a period of 6 months or of 1 year. There is not a great difference between the results obtained with the 10 days treatment and those of the 3 days treatment. An high percentage of relapses occurred in UTI caused by Proteus and Klebsiella.

[Reye's syndrome: pathogenetic problems (author's transl)]. / La sindrome di Reye: problemi patogenetici.

The authors describe six subjects with Reye's syndrome. All subjects died nevertheless the treatment (exchange-transfusions infusions of citrulline and ornithine). The autoptical studies showed cerebral oedema and fatty degeneration of the liver. Hepatic and seric OTC activity was measured in three patients: enzyme activity was virtually absent in one patient and normal in the other two. Instead in one patient was found partial CPS deficiency. However, Reye's syndrome is not only correlated with enzymatic deficiency of urea's cycle but sometimes also with toxic and metabolic causes.