Collaborative Brazilian Pediatric Renal Transplant Registry (CoBrazPed-RTx): A Report From 2004 to 2013.

BACKGROUND: The Collaborative Brazilian Pediatric Renal Transplant Registry started in 2004 as a multicenter initiative aiming to analyze, report, and share the results of pediatric kidney transplantation in Brazil. Data from all pediatric kidney transplants performed between January 2004 and December 2013 were recorded electronically and periodically updated. All patients under 18 years old from the participating centers were enrolled. Demographic data, etiology of chronic kidney disease, and patient and graft survival were analyzed. From a total of 2443 pediatric kidney transplants performed in Brazil during the study period, we report data from 1751 pediatric renal transplants performed in 13 centers enrolled in the collaborative study. Median age at transplantation was 12.4 years, and most of recipients were male (56%). The most common underlying renal etiologies were obstructive uropathy (31%) and glomerulopathy (26%). METHODS: According to donor source, 1155 (66%) of transplants were performed with deceased donors (DD). Initial immunosuppression consisted mainly of tacrolimus, mycophenolate, steroids, and induction therapy with anti-IL-2R antibodies. RESULTS: One-year graft survival (death-censored) was 93% and 90% (log rank test, P < .01), respectively, for living donor (LD) and DD. Graft losses (15%) were most frequently caused by vascular thrombosis, chronic allograft nephropathy, death with functioning kidney, acute rejection, and recurrent renal disease. Recipients of DD had 2.02 (95% confidence interval: 1.14-3.59) times the hazard of graft loss compared with those of LD (P = .015). Patient survival rates at 1 and 5 years were 98% and 97% for LD and 97% and 93% for DD, respectively. The mortality rate was 3.8%, mainly as the result of infection and cardiovascular disease. CONCLUSIONS: The results of this collaborative pediatric transplant study are comparable to international registries. Our effort has been able to maintain an exchange of information, both among the participating centers and with other international registries.

[Retinol-binding protein urinary levels in a pediatric population: evolution according to age] / Níveis urinários da proteína transportadora do retinol em uma população pediátrica: evolução em função da idade.

OBJECTIVE: The kidney of the child, mainly the newborn, is specially susceptible to ischemic and/or toxic injuries, which can affect the renal tubular function. Therefore, reliable and precocious markers of tubular dysfunction would be useful in Pediatrics. The urinary levels of retinol binding-protein (RBPu) has been used in this way. Our goal was to evaluate the RBPu behavior in childhood to establish a reference interval and verify possible differences according to the age. METHODS: We studied healthy children aged 1 month to 8 years and healthy term and preterm babies; in the last group we only included babies without hemodynamic repercussion. We collected isolated urine samples once for children above 1 month and periodically for those below this age. In this urine, besides the dipsticks test (Combur 9(R), Boehringer), RBPu and creatinine were measured. RESULTS: We observed that the RBPu levels in childhood do not have a normal distribution; after logarithm data transformation we were able to establish an interval of reference for children above one month of age: 3 to 269 micro g/L, mean of 27 micro g/ L. In newborns, we found a large variation of RBPu excretion. However, we noticed that the excretion decreases significantly, reaching the healthy adult levels at the end of the 1st month, for term as well as for preterm newborns. CONCLUSIONS: We suggest that RBPu can be used as a marker of proximal tubular dysfunction, since we could establish an interval of reference, and it can be repeated whenever necessary in the follow-up of this kind of injury, because it is not an invasive exam. Moreover, this study contributes to the knowledge of the tubular function development for showing that at the end of the 1st month of life the newborn's kidney is able to reabsorb RBPu as the healthy adult kidney is.

[Hematuria in children: retrospective study of 128 pediatric patients] / Hematúria na criança: estudo retrospectivo de 128 casos.

OBJECTIVE: To evaluate the diagnostic frequency of the various diseases associated with the development of hematuria in children, in a pediatric nephrology unit pertaining to a university hospital. METHODS: The clinical records of 128 children (70 male, 50 female) who presented intermittent/persistent macroscopic hematuria or persistent microscopic hematuria as the chief clinical complaint/finding, in the period of 1978-1995, were retrospectively analyzed. This evaluation was performed with special attention to the patientacute;s clinical history, physical examination, personal and family morbid history information. Patients whose investigation was not complete were not considered for analysis. The mean age on presentation was 8.2 years (5 months - 16 years) and the mean period of observation was 3.2 years (1 month-15 years). RESULTS: Macroscopic hematuria occurred in 104 patients and persistent microscopic hematuria was present in 24 patients. Urinary metabolic disturbances and urinary lithiasis, alone or in association, were diagnosed in the majority of the patients (65.5%). Hypercalciuria was the urinary metabolic disturbance (90.1%) mostly detected, either alone (73.2%) or in association with hyperuricosuria (16.9%). A positive family history of lithiasis was reported in 32.1% of the patients in which the diagnosis of lithiasis/urinary metabolic disturbance was confirmed. Glomerulopathies were diagnosed in 25% of the patients, with the predominance of post-infectious acute glomerulonephritis (11 patients, 34%). In 6 children, the etiology of hematuria was not elucidated, despite extensive investigation, including renal biopsy.CONCLUSION: The authors present an algorithm for the diagnosis of hematuria in children and suggest that in cases of isolated hematuria, presenting without clinical clues to the possible etiology, laboratory investigation should be started with the evaluation of urinary metabolic disturbances / lithiasis.