ABSTRACT
Introducción: El síndrome hemolítico urémico (SHU) se caracteriza por la presencia de anemia hemolítica microangiopática, trombocitopenia y afectación renal aguda. Es la principal causa de falla renal aguda en niños menores de 3 años. Un número variable de pacientes evoluciona con afectación renal a largo plazo con proteinuria, hipertensión arterial e insuficiencia renal crónica. Objetivo: Evaluar la afectación renal mediante el índice microalbuminuria/creatininuria en pacientes pediátricos con diagnóstico de SHU. Pacientes y Método: Estudio descriptivo de cohorte concurrente que analizó la presencia de microalbuminuria en pacientes diagnosticados de SHU entre enero de 2001 y marzo de 2012, que evolucionaron sin hipertensión y con función renal normal (clearance mayor de 90 ml/min medido por fórmula de Schwartz). Se evaluaron factores demográficos (edad, sexo), presentación clínica en el momento del diagnóstico, uso de antibióticos previo al ingreso y requerimiento de terapia de reemplazo renal. Resultados: Se estudiaron 24 pacientes, el 54% varones; la edad promedio en el momento del diagnóstico fue de 2 años; un 45% requirió diálisis peritoneal; un 33% evolucionó con microalbuminuria persistente; cuatro pacientes recibieron tratamiento antiproteinúrico con buena respuesta. El promedio de seguimiento fue de 6 años (rango: 6 meses a 11 años); todos los pacientes durante el seguimiento evolucionaron con creatinina plasmática normal. Conclusiones: En nuestro grupo, el porcentaje de microalbuminuria persistente en pacientes con diagnóstico previo de SHU fue similiar a lo descrito en la literatura; el tratamiento con antiproteinúricos podría retrasar el daño renal, pero es necesario realizar estudios prospectivos multicéntricos.
Introduction: Hemolytic uremic syndrome (HUS) is characterized by the presence of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney failure. It is the leading cause of acute kidney failure in children under 3 years of age. A variable number of patients develop proteinuria, hypertension, and chronic renal failure. Objective: To evaluate the renal involvement in pediatric patients diagnosed with HUS using the microalbumin/creatinine ratio. Patients and Methods: Descriptive concurrent cohort study that analyzed the presence of microalbuminuria in patients diagnosed with HUS between January 2001 and March 2012, who evolved without hypertension and normal renal function (clearance greater than 90 ml/min using Schwartz formula). Demographic factors (age, sex), clinical presentation at time of diagnosis, use of antibiotics prior to admission, and need for renal replacement therapy were evaluated. Results: Of the 24 patients studied, 54% were male. The mean age at diagnosis was two years. Peritoneal dialysis was required in 45%, and 33% developed persistent microalbuminuria. Antiproteinuric treatment was introduce in 4 patients, with good response. The mean follow-up was 6 years (range 6 months to 11 years). The serum creatinine returned to normal in all patients during follow up. Conclusions: The percentage of persistent microalbuminuria found in patients with a previous diagnosis of HUS was similar in our group to that described in the literature. Antiproteinuric treatment could delay kidney damage, but further multicenter prospective studies are necessary.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Peritoneal Dialysis/methods , Creatinine/blood , Albuminuria/epidemiology , Hemolytic-Uremic Syndrome/physiopathology , Retrospective Studies , Cohort Studies , Follow-Up Studies , Albuminuria/etiology , Hemolytic-Uremic Syndrome/complications , Hemolytic-Uremic Syndrome/therapyABSTRACT
Caracterizar la función tiroidea y la respuesta a test de TRH (thyroid releasing hormone), en niños con enfermedad renal crónica (ERC) leve (L), moderada (M), peritoneodiálisis (PD), hemodiálisis (HD) y trasplantados renales (TX).
Subject(s)
Immunoglobulins, Thyroid-Stimulating , Thyroid Function TestsABSTRACT
UNLABELLED: The aim of this study was to determine the frequency of renal abnormalities in HIV positive children hospitalized in one pediatric hospital in Chile. METHOD: a cross sectional study was performed during April 2007. RESULTS: A total of 18 patients were evaluated, ten male and eight female ranging in age from 4 to 19 years. The average age at the time of HIV diagnosis and nephrologic evaluations were 2,69 and 10,7 years respectively. All patients had acquired HIV infection by vertical transmission. Uriñe samples of two children had microalbuminuria; two had monosymptomatic hematuria, and ten had ¿squamous? cells. Hypercalciuria was detected in one patient, renal lithiasis in another and two patients had abnormal renal ultrasonography. All 19 patients had normal blood pressures. Overall 7 patients (39%) had a renal abnormality. CONCLUSIONS: The relatively high incidence of renal abnormalities in our series support the need for a nation-wide screening program to assess the incidence of renal impairment in pediatric HIV positive patients.
Subject(s)
AIDS-Associated Nephropathy/diagnosis , Adolescent , Child , Child, Preschool , Chile , Cross-Sectional Studies , Female , Hospitals, Pediatric/statistics & numerical data , Humans , Kidney Function Tests , Male , Young AdultABSTRACT
The aim of this study was to determine the frequency of renal abnormalities in HIV positive children hospitalized in one pediatric hospital in Chile. Method: a cross sectional study was performed during April 2007. Results: A total of 18 patients were evaluated, ten male and eight female ranging in age from 4 to 19 years. The average age at the time of HIV diagnosis and nephrologic evaluations were 2,69 and 10,7 years respectively. All patients had acquired HIV infection by vertical transmission. Uriñe samples of two children had microalbuminuria; two had monosymptomatic hematuria, and ten had ¿squamous? cells. Hypercalciuria was detected in one patient, renal lithiasis in another and two patients had abnormal renal ultrasonography. All 19 patients had normal blood pressures. Overall 7 patients (39 percent) had a renal abnormality. Conclusions: The relatively high incidence of renal abnormalities in our series support the need for a nation-wide screening program to assess the incidence of renal impairment in pediatric HIV positive patients.
El objetivo de este estudio fue evaluar la función renal de pacientes infectados con virus de inmuno-deficiencia humana (VIH) que se controlan en un hospital pediátrico chileno. Método: estudio de corte transversal. Resultados: Se evaluaron 18 pacientes, 10 varones y 8 mujeres; edad: entre 4 y 19 años, la edad promedio al diagnóstico de la infección por VIH y al momento de la evaluación fue 2,69 y 10,7 años, respectivamente. Todos nuestros pacientes adquirieron la infección vía vertical. Dos presentaron microalbuminuria y dos hematuria monosintomática. En 10 (55 por ciento) se encontraron células descamativas, en uno hiper-calciuria y en otro litiasis renal. Todos tuvieron presión arterial normal. La ecotomograña renal fue anormal en dos. Se han descrito varias anormalidades renales en pacientes con infección por VIH; en nuestro estudio, 7 pacientes (39 por ciento) tuvieron alteraciones en los exámenes de laboratorio. Conclusión: La alta frecuencia de afectación renal encontrada en pacientes pediátricos con infección por VIH hace necesario plantear un tamizaje nacional para determinar la incidencia de nefropatía asociada en nuestros pacientes.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Young Adult , AIDS-Associated Nephropathy/diagnosis , Chile , Cross-Sectional Studies , Hospitals, Pediatric/statistics & numerical data , Kidney Function Tests , Young AdultABSTRACT
Background: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. Aim: To describe the characteñstics ofpatients with the diagnosis ofHUS in Chile, and to identify the most reliable early predictors oímorbidity and moñality. Material and methods: The clinical records ofpatients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. Results: A cohort of 587 patients aged 2 to 8 years, 48 percent males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39 percent of the patients, hypertension in 45 percent and seizures in 17 percent. Forty two percent required renal replacement therapy (RRT) and perítoneal dialysis was used in the majoríty of cases (78 percent). The most frequently isolated etiological agentwas Escherichia coli. Mortality rate was 2.9 percent in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC) >20.000/mm³ and requirements of renal replacement therapy (p <0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC >20.000/mm³, seizures and hypertension. Conclusions: The present study emphasizes important clinical and epidemiological aspeets ofHUSin a Chilean pediatricpopulation.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Acute Kidney Injury , Anuria/etiology , Hemolytic-Uremic Syndrome/complications , Acute Kidney Injury , Anuria/epidemiology , Anuria/therapy , Child Health Services/statistics & numerical data , Chile/epidemiology , Follow-Up Studies , Hemolytic-Uremic Syndrome/mortality , Hemolytic-Uremic Syndrome/therapy , Hospitalization , Logistic Models , Prognosis , Renal Dialysis , Retrospective Studies , Risk FactorsABSTRACT
Objective: To characterize the thyroid function in mild (L), moderate (M), hemodialysis (HD), peritoneal dialysis (PD), chronic renal failure (CRE) and post kidney transplant (TX). Method: 46 children between 9.3 +/- 3.7 years-old with CRF (10 mild (L), 10 moderate (M), 10 peritoneodialysis (PD), 6 hemodialysis (HD), 10 transplants (TX)) were evaluated. Basal total T4 and free T3, TRH test (TSH at 0-30-60 min), creatinine, BUN, creatinine clearance and anthropometric parameters were measured. The statistics analysis included Anova Test to compare group results and correlation coefficients for studied variables. Results: Basal thyroid hormone levéis were normal in all groups and no differences between groups (except higher TSH in L (p < 0.01)) were found. TRH test response was prolonged on L, M, PD and HD and deficient in TX, except 3 TX patients who had normal TRH response, all using Tacrolimus, Micofenolate and Prednisone on altérnate day treatment versus the remaining TX who where on Cyclosporine or Azathioprine, Micofenolate and continuous corticoid régimen. Prolonged TRH response correlates with creatinine (p < 0.001) and creatinine clearance (p < 0,01). Conclusions: Basal thyroid hormones were normal in all groups. TRH test response was predominantly prolonged in L, M, PD and HD, suggesting adaptative phenomena at tertiary level, and correlates with renal function. TX patients had deficient TRH response, suggesting hypofisial dysfunction.
Objetivo: Caracterizar la función tiroidea y la respuesta a test de TRH (thyroid releasing hormone), en niños con enfermedad renal crónica (ERC) leve (L), moderada (M), peritoneodiálisis (PD), hemodiálisis (HD) y trasplantados renales (TX). Pacientes y Método: Se estudiaron 46 pacientes con ERC (10 L, 10 M, 10PD,6HDy 10TX),9,3 +/- 3,7 años. Se midió t4t,t41,t3t, t31,TBGbasalytest de TRH(TSHa 0,30y60min). Se evaluó función renal, antropometría y se consignó tratamiento inmunosupresor (IS) en el grupo TX. Se utilizó anova para comparar los resultados entre los grupos y coeficiente de correlación para las variables estudiadas. Resultados: Los valores basales de hormonas tiroideas fueron normales en todos los grupos, sólo TSH fue significativamente mayor en L aunque dentro del rango normal (p < 0,01). La respuesta al test de TRH fue predominantemente prolongada en L, M, PD y HD y deficiente en TX; los 3 pacientes TX con tacrolimus, micofenolato y prednisona en días alternos tuvieron respuesta normal a diferencia del resto TX que recibían prednisona continua, ciclosporina y micofenolato. La prolongación de respuesta a TRH se correlacionó con creatininemia, BUN y clearance de creatinina (p < 0,01). Conclusiones: Los niveles de hormonas tiroideas basales se encuentran normales en todos los grupos de ERC. La respuesta a TRH fue predominantemente prolongada en L, M, PD y HD, demostrando un fenómeno adaptativo a nivel terciario del eje hipotálamo-hipofisis-tiroides. Los TX presentan una respuesta mayoritoriamente deficiente a TRH, sugerente de disfunción hipofisiaria, la que podría estar relacionada con el tipo de tratamiento inmunosupresor y al uso de corticoides en días continuos.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Thyroid Gland/physiopathology , Thyrotropin-Releasing Hormone/pharmacology , Renal Insufficiency, Chronic/physiopathology , Anthropometry , Dose-Response Relationship, Drug , Thyroid Gland , Thyroid Hormones/blood , Renal Insufficiency, Chronic/blood , Kidney Transplantation , Prospective Studies , Renal Dialysis , Thyroid Function TestsABSTRACT
BACKGROUND: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. AIM: To describe the characteristics of patients with the diagnosis of HUS in Chile, and to identify the most reliable early predictors of morbidity and mortality. MATERIAL AND METHODS: The clinical records of patients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. RESULTS: A cohort of 587 patients aged 2 to 8 years, 48% males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39% of the patients, hypertension in 45% and seizures in 17%. Forty two percent required renal replacement therapy (RRT) and peritoneal dialysis was used in the majority of cases (78%). The most frequently isolated etiological agent was Escherichia coli. Mortality rate was 2.9% in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC)>20.000/mm3 and requirements of renal replacement therapy (p<0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC>20.000/mm3, seizures and hypertension. CONCLUSIONS: The present study emphasizes important clinical and epidemiological aspects of HUS in a Chilean pediatric population.
Subject(s)
Acute Kidney Injury/etiology , Anuria/etiology , Hemolytic-Uremic Syndrome/complications , Acute Kidney Injury/mortality , Acute Kidney Injury/therapy , Anuria/epidemiology , Anuria/therapy , Child , Child Health Services/statistics & numerical data , Child, Preschool , Chile/epidemiology , Female , Follow-Up Studies , Hemolytic-Uremic Syndrome/mortality , Hemolytic-Uremic Syndrome/therapy , Hospitalization , Humans , Infant , Logistic Models , Male , Prognosis , Renal Dialysis , Retrospective Studies , Risk FactorsABSTRACT
Introducción: El Síndrome Hemolítico Urémico (SHU) se caracteriza por falla renal aguda, anemia hemolítica microangiopática y trombocitopenia; es la causa más frecuente de insuficiencia renal aguda en la infancia. Objetivo: a) Describir las características actuales del cuadro inicial de SHU en nuestro medio y comparar con lo descrito anteriormente; b) Describir la evolución a 1 año plazo y evaluar posibles factores pronósticos de función renal. Sujetos y Métodos: Se estudiaron variables demográficas, presentación clínica, exámenes bioquímicos y hematológicos, en 374 pacientes con SHU diagnosticados entre Enero 1990 a Diciempe 2002 en 9 hospitales de la Región Metropolitana; se evaluó además función renal al año de seguimiento en una muestra de 213 pacientes y se identificaron factores pronósticos de insuficiencia renal crónica y mortalidad utilizando el análisis de regresión logística. Resultados: Se analizaron 374 pacientes, 50,5 por ciento mujeres, 65,5 por ciento de la Región Metropolitana, edad promedio 1,5 ± 1,4 años (0,2 a 8); 91 por ciento presentó diarrea, 31 por ciento ocurrió en verano, al ingreso 57 por ciento presentó anuria, 43,3 por ciento hipertensión arterial y convulsiones 23 por ciento. Al alta 28 por ciento persistía hipertenso. Las terapias de sustitución renal utilizadas fueron: diálisis peritoneal (50 por ciento), hemodiafiltración (6 por ciento) y hemodiálisis (3 por ciento); recibió plasmaféresis 1 por ciento. Se aisló agente etiológico en 17 por ciento, siendo en 69 por ciento E. coli enterohemorrágica. La mortalidad fue de 2,7 por ciento, siendo la causa principal la falla orgánica múltiple. En el seguimiento al año: 80 por ciento mantuvo función renal normal, 14 por ciento presento deterioro de la función renal, 6 por ciento proteinuria y 4 por ciento hipertensión. Se encontró significativo como factor pronóstico de daño renal: hipertensión arterial (p < 0,0001), necesidad de peritoneodiálisis y hemodiálisis (p: 0,001, p: 0,0015 respectivamente), anuria (p: 0,005) y convulsiones (p: 0,01). Se correlacionó con mortalidad en la etapa aguda: convulsiones, requerimiento de hemodiafiltración y plasmaféresis, (p < 0,0001, p: 0,0001 y p < 0,0001 respectivamente).