ABSTRACT
Objetivos: Presentar nuestra experiencia sobre biopsias renales percutáneas guiadas ecográficamente en pacientes en edad pediátrica desde que se instauró dicha técnica en nuestro hospital, y valorar la correlación clínica/anatomopatológica y las complicaciones de la misma. Pacientes y métodos: Estudio retrospectivo de 180 biopsias renales percutáneas guiadas ecográficamente realizadas a un total de 164 pacientes (de 6 meses-18 años de edad) durante un periodo de 15 años. El protocolo de la biopsia incluye su realización en el quirófano mediante sedación y una ecografía a las 24 horas. Resultados: El motivo más frecuente de su realización fue la presencia de un síndrome nefrótico cortico dependiente/resistente (29,4%), seguido de la proteinuria de diverso rango con presencia de hematuria. El diagnóstico anatomopatológico más habitual fue la glomérulo nefritis mesangial por IgA (26,1%), seguido de cambios glomerulares mínimos, confirmándose en la mayoría de los casos la sospecha clínica. Únicamente se detectó una complicación grave (hematoma renal/hipotensión arterial)en un paciente de riesgo. Conclusiones: En nuestra experiencia, la biopsia renal percutánea es un método diagnóstico fiable y seguro, independientemente de la edad (AU)
Objectives: We present our experience on ultrasound guided percutaneous renal biopsies in pediatric patients from the beginning that this technique was established in our hospital, to value the clinical/anatomo pathologic correlation as well as the complications of the technique. Patients and methods: Retrospective study of 180 ultrasound guided percutaneous renal biopsies over a total of 164 patients (aged from 6 months to 18 years) in a period of 15 years. The protocol biopsy includes its carrying out in the operating room by means of sedation and also the realization of an ultrasound after 24 hours. Results: The most frequent reason for doing the biopsy was the presence of a corticoid dependent/resistant nephrotic syndrome (29.4%) followed by different levels of. The most frequent anatomopathological diagnostic was glomerulonephritis with Ig A mesangial deposits (26.1%) followed by minimal glomerular changes, confirming in the majority of the cases the initial clinical suspicion. Only in one case a severe complication was detected (renal hematoma/arterial hypotension) in a high-risk patient. Conclusions: In our experience, the percutaneous renal biopsies are a reliable and a safe diagnostic method regardless of age (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Biopsy/instrumentation , Biopsy/methods , Biopsy , Ultrasonography/instrumentation , Ultrasonography/methods , Ultrasonography , Kidney/anatomy & histology , Kidney/pathology , Nephrotic Syndrome/complications , Nephrotic Syndrome/diagnosis , Nephrotic Syndrome/pathology , Proteinuria/complications , Proteinuria/diagnosis , Glomerulonephritis, IGA/complications , Glomerulonephritis, IGA/diagnosisABSTRACT
OBJECTIVES: Our objectives were to determine epidemiology, clinical and laboratory characteristics of patients with haemolytic-uraemic syndrome (HUS) treated in our centre, to describe renal and extra-renal complications and the treatment required and to relate our findings with the existing bibliography. METHODS: We performed a 33-year retrospective review. We included all patients diagnosed with HUS and monitored in our hospital from January 1974 to August 2007. Clinical histories and imaging studies were reviewed. RESULTS: A total of 58 patients were included in our study, with a mean age of 2 years 11 months and most of them were admitted to hospital in summer. Familial hypocomplementaemia was present in one case. A total of 48 patients presented with typical HUS (with diarrhoea D+ HUS). Salmonella enteritidis and Escherichia coli O157:H7 were isolated from those patients. While 7 cases presented with atypical HUS (without diarrhoea, D- HUS), most of them associated with a respiratory tract infection due to Streptococcus. In one case platelet count was normal. Kidney biopsy was performed in 18 patients and 25 cases underwent peritoneal dialysis. As regards complications, one child with D+ HUS experienced renal cortical necrosis and required kidney transplant, while in the D-HUS group, the patient with familial hypocomplementaemia had severe hypertension. CONCLUSIONS: a) Incidence of HUS in our environment is low. b) HUS can be present even with a normal platelet count. c) We had one case of HUS in a patient with familial hypocomplementaemia who experienced severe hypertension. d) In our group of patients, the course of the disease was not influenced by the white blood cell counts, decreased diuresis or hypocomplementaemia.
Subject(s)
Hemolytic-Uremic Syndrome , Adolescent , Child , Child, Preschool , Female , Hemolytic-Uremic Syndrome/diagnosis , Hemolytic-Uremic Syndrome/epidemiology , Hemolytic-Uremic Syndrome/therapy , Humans , Infant , Longitudinal Studies , Male , Retrospective StudiesABSTRACT
Objetivos: Nuestros objetivos han sido determinar aspectos epidemiológicos, formas clínicas y analíticas de los pacientes con síndrome hemolítico-urémico (SHU) tratados en nuestros centros, así como describir las complicaciones renales y extrarrenales, el tipo de tratamiento requerido y relacionar nuestros casos con la bibliografía actual. Métodos: Efectuamos una revisión retrospectiva de la historia clínica, analítica y estudios de diagnóstico por imagen de los pacientes con diagnóstico de SHU, atendidos desde enero de 1974 hasta agosto de 2007, es decir, durante los últimos 33 años. Resultados: Un total de 58 pacientes fueron incluidos en nuestro estudio, con una edad media de 2 años y 11 meses; de ellos, estaban ingresados en verano 34 niños. Destaca la presencia de hipocomplementemia familiar en un caso. Con SHU típico (diarrea positivo [D+]) aparecieron 48 casos en los que se aislaron Salmonella enteritidis y Escherichia coli 0157:H7. Con SHU atípico (diarrea negativo [D-]) se contabilizaron 7 casos, y entre las causas destacaban procesos respiratorios de etiología estreptocócica. El recuento plaquetario fue normal en un caso. De los procedimientos empleados cabe destacar que se realizó biopsia renal en 18 pacientes y diálisis peritoneal en 25 casos. Entre las complicaciones se encontraron: en el grupo D+, un caso de necrosis cortical que requirió trasplante renal y en el grupo D-, un paciente con SHU familiar, hipocomplementemia e hipertensión arterial maligna. Conclusiones: Hemos llegado a las siguientes conclusiones: a) la enfermedad presenta una baja incidencia en nuestro medio; b) se ha detectado un caso con plaquetas normales; c) un paciente presentó SHU familiar recurrente con hipocomplementemia e hipertensión arterial grave, y d) indicadores como la leucocitosis, la oligoanuria o la hipocomplementemia no influyeron en el curso de la enfermedad (AU)
Objectives: Our objectives were to determine epidemiology, clinical and laboratory characteristics of patients with haemolytic-uraemic syndrome (HUS) treated in our centre, to describe renal and extra-renal complications and the treatment required and to relate our findings with the existing bibliography. Methods: We performed a 33-year retrospective review. We included all patients diagnosed with HUS and monitored in our hospital from January 1974 to August 2007. Clinical histories and imaging studies were reviewed. Results: A total of 58 patients were included in our study, with a mean age of 2 years 11 months and most of them were admitted to hospital in summer. Familial hypocomplementaemia was present in one case. A total of 48 patients presented with typical HUS (with diarrhoea D+ HUS). Salmonella enteritidis and Escherichia coli O157:H7 were isolated from those patients. While 7 cases presented with atypical HUS (without diarrhoea, D- HUS), most of them associated with a respiratory tract infection due to Streptococcus. In one case platelet count was normal. Kidney biopsy was performed in 18 patients and 25 cases underwent peritoneal dialysis. As regards complications, one child with D+ HUS experienced renal cortical necrosis and required kidney transplant, while in the D-HUS group, the patient with familial hypocomplementaemia had severe hypertension. Conclusions: a) Incidence of HUS in our environment is low. b) HUS can be present even with a normal platelet count. c) We had one case of HUS in a patient with familial hypocomplementaemia who experienced severe hypertension. d) In our group of patients, the course of the disease was not influenced by the white blood cell counts, decreased diuresis or hypocomplementaemia (AU)
