Clinical and laboratory indices of severe renal lesions in children with febrile urinary tract infection.

AIM: To evaluate the predictive value of various clinical and laboratory parameters on the identification of acute extensive and/or multifocal renal involvement in children with febrile urinary tract infections (UTI). METHODS: The medical records of 148 children (median age: 2.4 months, range: 11 days-24 months), who were admitted during a 3-year period with a first episode of febrile UTI, were analysed. Acute dimercaptosuccinic acid scintigraphy (DMSA), clinical and laboratory parameters were evaluated. RESULTS: Seventy six children (51%) had abnormal findings on the acute DMSA. Of them, 20 had DMSA grade 2, while 56 had grade 3 and 4. Patients with a DMSA grade 3 and 4 were more likely to have shivering (OR 3.4), white blood count (WBC) ≥ 18 000/µL (OR 2.4), absolute neutrophil count (ANC) ≥ 9300/µL (OR 4.4), C-reactive protein (CRP) ≥ 50 mg/L (OR 2.7) and procalcitonin (PCT) ≥ 1.64 ng/mL (OR diagnostic). There was a significant difference of WBC (p = 0.004), ANC, CRP and PCT levels (p < 0.001) between children with normal and grade 2 aDMSA versus those with aDMSA grade 3 and 4. CONCLUSIONS: Shivering and elevated inflammatory markers increase the risk of acute extensive and/or multifocal kidney involvement in children with febrile UTI. Procalcitonin seems to be an excellent marker of the severity of acute parenchymal involvement.

Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines.

Childhood renal osteodystrophy (ROD) is the consequence of disturbances of the calcium-regulating hormones vitamin D and parathyroid hormone (PTH) as well as of the somatotroph hormone axis associated with local modulation of bone and growth cartilage function. The resulting growth retardation and the potentially rapid onset of ROD in children are different from ROD in adults. The biochemical changes of ROD as well as its prevention and treatment affect calcium and phosphorus homeostasis and are directly associated with the development of cardiovascular disease in pediatric renal patients. The aims of the clinical and biochemical surveillance of pediatric patients with CRF or on dialysis are prevention of hyperphosphatemia, avoidance of hypercalcemia and keeping the calcium phosphorus product below 5 mmol(2)/l(2). The PTH levels should be within the normal range in chronic renal failure (CRF) and up to 2-3 times the upper limit of normal levels in dialysed children. Prevention of ROD is expected to result in improved growth and less vascular calcification.

Progress of ossification and epithelialization of wounds after simple or surgical extractions of teeth in rats with chronic renal failure: an experimental study.

Our aim was to investigate the progress of wound healing after simple and surgical removal of the first two molars of the right and left maxillary segments, respectively, in Wistar rats with experimentally induced moderate chronic renal failure (CRF). Sixty Wistar rats were divided into two groups of 30 rats each: experimental and control. CRF was induced in the experimental group by an intraperitoneal injection of cisplatin, 5 mg/kg body weight (BW) initially and then with two maintenance doses of 2.5 mg/kg BW at intervals of one month. The teeth were extracted one month after the last dose of cisplatin. The sockets and the kidneys of all the rats of both groups were evaluated. The mandibles of the 15 rats in the experimental group that developed moderate CRF, together with those of two controls, were evaluated for abnormalities that suggested renal osteodystrophy. The histopathological examination showed: (a) that there were no significant differences in the pattern of wound healing no matter how the tooth was extracted; (b) there were no specific abnormalities in the mandible to indicate of secondary hyperparathyroidism or renal osteodystrophy; and (c) the kidneys of the rats of the experimental group underwent histopathological changes that were significantly different from those in the controls (P < 0.001). Our results indicate that moderate CRF does not have any appreciable or significant modifying effect on wound healing after tooth extraction in Wistar rats.

Is rhGH anabolic in patients undergoing peritoneal dialysis?

The effect of rhGH treatment on protein metabolism was studied in nine prepubertal patients on CAPD. An improvement in nitrogen balance as evidenced by a falling of blood urea nitrogen and urea nitrogen appearance with a constant protein intake was noticed. The significant increase in serum creatinine and creatinine excretion with a constant weekly creatinine clearance and the increase in mid-arm muscle circumference were all indications of an improvement in lean body mass. In addition, there was an improvement in the pattern of plasma amino acids and an increase in serum albumin, possibly as a result of the improvement of protein metabolism.

Diabetes mellitus after therapy with recombinant human growth hormone (rhGH).

An eight-year-old boy developed diabetes mellitus (DM) after kidney transplantation. This boy had previously been treated with recombinant human growth hormone (rhGH) for short stature due to chronic renal failure. An impaired glucose tolerance was documented after one year of rhGH treatment. An oral glucose tolerance test returned to normal six months after the discontinuation of rhGH. The boy was treated again with rhGH for seven months until his transplantation. A high fever with an enlargement of the parotid gland was noted and signs of acute rejection appeared two weeks post-transplantation. Two months after transplantation, overt DM had developed, and he was treated with insulin. The insulin dose was progressively decreased and was discontinued eight months after transplantation.

Effect of the correction of anemia with recombinant human erythropoietin on growth of children treated with CAPD.

UNLABELLED: Anemia correction with recombinant human erythropoietin (EPO) has been suggested to have a positive effect on nutritional status by improving appetite and protein metabolism. To assess this effect growth velocity and various parameters of nutritional status of 10 children on continuous ambulatory peritoneal dialysis (CAPD) were estimated at the start and one year after the correction of anemia. There was no significant improvement of growth velocity after EPO administration. Energy and protein intake, standard deviation scores of anthropometric measurements, BUN, serum creatinine, albumin, potassium, phosphorous and protein catabolic rate did not differ significantly before and after EPO administration. There was a significant correlation of protein intake and protein catabolic rate. CONCLUSION: There was no significant improvement of nutritional status and growth of children on CAPD treated with EPO, possibly because there was no evidence of malnutrition in most patients.

The effect of the correction of metabolic acidosis on nitrogen and potassium balance of patients with chronic renal failure.

Nitrogen and potassium balance studies were conducted in six nondialyzed uremic patients. Each patient was investigated before and after supplementation with sodium bicarbonate and sodium chloride. Every period of the study lasted longer than 1 wk. Each patient had the same calorie and protein intake during the whole study. Urea nitrogen appearance was correlated with protein intake for the assessment of the compliance of patients with their diets. There was a significant decrease of blood urea nitrogen (p = 0.014) of 36% during bicarbonate supplementation and both metabolic balance studies improved significantly (p = 0.0005 and 0.0096). However, there was no significant improvement during sodium chloride administration indicating that the effect of bicarbonate was the result of the correction of metabolic acidosis and not of the expansion of the extracellular volume.

Growth in children receiving continuous ambulatory peritoneal dialysis.

Linear growth of 17 children receiving CAPD was compared with growth in 18 patients receiving hemodialysis and 20 who had undergone transplantation, as well as with the previous growth in 11 of the 17 patients. Growth was normal in 10 receiving CAPD, fair in six others, and poor in only one. Growth velocity indexes in those receiving CAPD were significantly better than those of the group receiving hemodialysis (P less than 0.01) but did not differ significantly from those of children who had undergone kidney transplant. All patients grew significantly better after beginning CAPD than before (P less than 0.01). Appropriate management of renal osteodystrophy combined with adequate energy and protein intake were important factors in the growth of patients receiving CAPD.