La vuelta a la vida normal después del trasplante / Return to normal life after the transplant

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Renal transplantation in children with nephrotic syndrome in the first year of life.

OBJECTIVE: The aim of this work was to analyze the evolution of the 1st renal transplantation in children with nephrotic syndrome in the 1st year of life (NSFL). METHODS: In this retrospective study of 15 patients (8 women and 7 men) with NSFL receiving transplants from 1989 to 2013, 9 had NS of Finnish type, 4 diffuse mesangial sclerosis, 1 minimal changes, and 1 collapsing glomerulopathy. We analyzed the clinical and analytic situation at 4 time points: before dialysis, before transplantation, 3 months after transplantation, and long-term evolution. RESULTS: Mean follow-up was 72.8 months (range, 1 month to 16.9 years); mean age at diagnosis was 2.21 months (range, 0-8.2 months); mean age at onset of replacement therapy was 22.9 ± 16.4 months (range, 3.8-55.4 months); and mean time on dialysis was 14.9 months (range, 2-44 months). Age at transplantation was 3.1 years (range, 1.8 to 7.7 years), with 6 living-donor transplantations (LDTs) and 9 cadaveric (CDTs). Ten patients required nephrectomy before transplantation (9 bilateral) to control proteinuria after 3.1 ± 3.8 months on dialysis, 1 during transplantation, and 3 after transplantation (2 persistent proteinuria, 1 hypertension). Mean time on dialysis for LDTs was 5.4 ± 2.7 months versus 13.2 ± 6.9 months for CDTs (P < .005). Mean age of cadaveric donors was 6.2 ± 2.4 years and that of living donors 35.5 ± 7.9 years. As complications, there was 1 bleeding from venous anastomosis and 1 urinary leakage after surgery. After 6 ± 5.2 years of evolution, actuarial survival at both 1 and 7 years was 92.9%. One graft was lost owing to acute rejection 1 month after transplantation and 2 others owing to chronic rejection >9 years after transplantation. None had disease recurrence. CONCLUSIONS: Short-term complications did not differ from the rest of population if transplantation occurred with standard albumin levels, for which most required pre-transplantation nephrectomy because dialysis failed to reduce proteinuria.

BK virus infection in pediatric renal transplantation.

BACKGROUND: Polyomavirus BK (BKV) is a common complication after renal transplantation and an important cause of graft loss. The purpose of this study was to determine the incidence of BKV infection (viremia) in our population and to describe clinical features, global outcomes, and potential correlations with clinical or epidemiologic factors. METHODS: This retrospective single-center study included 84 pediatric recipients of kidney transplantation from January 2006 to September 2012. BKV infection screening consisted of periodic determination of decoy cells in urine samples, confirmed by means of quantitative polymerase chain reaction test in blood. RESULTS: Twenty-two patients (26%) developed BKV viremia. BKV replication appeared early after renal transplantation (median, 2 months). One-third of patients remained asymptomatic, and 27% presented elevated serum creatinine. Immunosuppression was reduced in 90% of patients, and 83% achieved clearance of viremia within 6 months. There was only 1 case of histologically confirmed BKV nephropathy, which evolved to graft loss despite leflunomide, intravenous immunoglobulins, and mycophenolate discontinuation. Risk of BKV viremia was associated with younger age at transplantation (5.9 y vs 10.9 years; P = .001) and cadaveric donor (relative risk, 3.2; P < .05). BKV infection did not affect short-term renal function and graft survival. CONCLUSIONS: BKV viremia is very common in the pediatric renal transplant population, especially in younger children and in those receiving a kidney from cadaveric donors. It develops in the 1st months after transplantation. Reduction of immunosuppression seems to be a good therapeutic option, with high rates of clearance of the infection, although the only patient with confirmed BKV nephropathy had poor outcome.

Usefulness of bone turnover markers as predictors of mortality risk, disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study.

BACKGROUND: Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA). METHODS: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4 mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (ß-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded. RESULTS: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with ß-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression. CONCLUSION: In patients with PCa and bone metastases treated with ZA, ß-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially important.

Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study.

BACKGROUND: Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL). METHODS: This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxy-terminal telopeptide of type I collagen (ß-CTX) were analysed. RESULTS: Patients with RCC who died or progressed had higher baseline ß-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline ß-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that ß-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC. CONCLUSION: Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOL.

Contextualizacion de la mutilación genital femenina desde enfermería. Análisis videográfico / Contextualization of female genital mutilation since nursing. Analysis videographic

El objetivo del presente trabajo se centra en analizar los documentos audiovisuales referentes al ritual que envuelve a la mutilación genital femenina. Material y método: búsqueda y revisión en la red del material videográfico que aporte información de la mutilación genital femenina en su contexto y que sea fuente primaria de información. Resultados: El análisis de los documentos videográficos obtenidos permite identificar un gran número de datos necesarios para estudiar la mutilación genital femenina en su contexto. Para analizar la información recogida se han establecido 10 categorías diferentes. Conclusión: Los documentos visuales constituyen una fuente de investigación fundamental para el análisis de los elementos presentes en el ritual de la mutilación genital femenina; son una herramienta a tener en cuenta en la formación de profesionales de la salud sobre esta práctica, que afecta en gran medida a la salud de mujeres y niñas inmigrantes. El conocimiento obtenido a raíz de esta revisión puede ser utilizado para abordar de forma cultural la mutilación genital femenina (AU)

The purpose of this paper is to analize the audiovisual documents relating to the ritual of the female genital mutilation. Material and method: pursuit and review of the video footage that give us information about the female genital mutilation in context, and be a primary source of information Results: The anlysis of the video footage obtained allows us to identify a large amount of data in order to study the female genital mutilation in context. To analyze the collected information 10 categories have been stablished. Conclusion: The visual documents are a essential source of research for the analysis of the female genital mutilation ritual; they are a tool to consider in the training of health professionals in this area, which affects health of women and immigrant children. The knowledge obtained due to this review can be used in order to approach in a cultural way the female genital mutilation (AU)

Anti-HLA antibodies posttransplantation in children: do we know what it means?

OBJECTIVE: Anti-HLA antibodies posttransplantation are associated with the appearance of acute and chronic rejection. The goal of this study was to determine the association between the presence of anti-HLA antibodies posttransplantation in children and the clinical outcome. PATIENTS AND METHODS: We studied the presence and the level of class I and II anti-HLA antibodies by microbead technology (Luminex) in 32 children after kidney transplantation; 87% underwent a first transplantation. Their mean age was 13.9 +/- 2.52 years. When anti-HLA was positive, 60% of children showed an increase in creatinine within the previous 3 months. The statistical analysis was performed with the SPSS 9.0 program. RESULTS: Only 4/32 children displayed class I anti-HLA antibodies at low levels (5-7.2) and 43% class II anti-HLA antibodies (level: 5-308). We did not observe an association between the presence of antibodies and age, sex, type of donor, immunosuppression, hypertension, proteinuria, time from transplantation, or reason to evaluate antibodies; 37.5% showed good graft function. The presence of anti-HLA antibodies posttransplantation was associated with retransplantations and with the percentage of antibodies by panel-reactive antibodies. There was trend towards an association with a previous acute rejection episode (P = .072); 62.5% of children with C4d-positive biopsies displayed anti-HLA antibodies vs 20% of those who were C4d-negative (P = .088). Graft survival was 100%. CONCLUSIONS: The presence of anti-HLA antibodies posttransplantation was influenced by pretransplantation factors-previous level of anti-HLA antibodies, retransplantation, DR matching- and also by posttransplantation factors, such as the occurrence of an acute rejection episode.

Double renal transplantation--a strategy with donors under 3 years old.

OBJECTIVE: To evaluate the transplantation of both kidneys from donors under 3 years old to older pediatric recipients, in order to provide adequate renal mass and improve graft survival. PATIENTS AND METHODS: Seven patients received a double kidney transplant from a donor under 3 years old (mean age 2.7 years). The primary renal disease was obstructive uropathy in two patients, and hemolytic uraemic syndrome, tuberous sclerosis, nephronoptisis, reflux nephropathy and nephrotic syndrome (one patient each). Recipients were 14-18 years old and had a mean height of 165.2 cm. Five were in dialysis and it was the second transplantation for two. Both kidneys were sequentially placed in the same iliac fossa; the first was placed the most cranially with the second placed caudal to the first. The surgical technique was similar to that used to place a single graft. Immunosuppression induction employed monoclonal antibodies followed by a triple therapeutic regime (mofetyl micofenolate/steroids/tacrolimus). RESULTS: Diuresis was started immediately with all the grafts and there was no thrombosis in any patient. One patient lost both grafts due to recurrence of her primary disease. Another patient developed lymphocele 1 year post transplant and required laparoscopic drainage. The grafts in six patients are doing well after a follow up of 1 to 7 years. CONCLUSION: Double transplant of both kidneys from a donor under 3 years old can provide sufficient renal mass for adequate renal function and does not present a higher risk of complications.

[Neonatal pelvic ectasia: long-term outcome and association with ureterovesical anomalies]. / Ectasia piélica neonatal: evolución a largo plazo y asociación a anomalías vesicoureterales.

OBJECTIVE: To analyze the outcome of neonatal pelvic ectasia (PE) and the association between this entity and vesicoureteral reflux and/or other urinary tract abnormalities. PATIENTS AND METHODS: We performed a retrospective study of 255 children (205 boys, 50 girls) with an ultrasonographic diagnosis of PE in the first month of life. The initial ultrasonographic examination was indicated by urinary tract infection in 30 neonates, abnormalities in the prenatal ultrasonographic examination in 150 and by other reasons in 75. Pelvic ectasia was classified in four stages according to anteroposterior pelvic diameter: I < 1 cm, II 1-1.5 cm, III 1.6-2 cm, and IV > 2 cm. RESULTS: Pelvic ectasia was bilateral in 153 children (60 %) and unilateral in 102 (left side in 81.4 % and right side in 18.6 %). Stage I was found in 75.49 %, stage II in 20.34 %, stage III in 3.9 % and stage IV in 0.24 %. The mean follow-up was 32.6 +/- 25.2 months. At the end of the first year, the results of renal ultrasound were normal in 70.2 % of left-sided PE and in 55.9 % of right-sided PE, but 46 patients (18 %) showed worsening of PE between the first and second ultrasound scans. Voiding cystourethrography was performed in 79.6 % of the children and some abnormalities were found in 50 (24.6 %): urethral dilatations in two patients and vesicoureteral reflux in 48. No correlation was found between vesicoureteral reflux and the degree of ectasia (74 % had an anteroposterior diameter of < or = 1 cm). Urinary tract infection was present in 24.3 % of the children and 13 required surgery (eight pyeloplasties, four urethral reimplantations and two resections of type III urethral valves). CONCLUSIONS: Neonatal PE was more prevalent in boys (4:1) and was more frequently located on the left side in both sexes. Associated vesicourethral reflux was found in 23.64 % with no correlation between the degree of dilation and the presence or degree of reflux. Consequently, cystourethrography should be performed in any child with pelvic ectasia, regardless of stage, side or sex.

Ectasia piélica neonatal: evolución a largo plazo y asociación a anomalías vesicoureterales / Neonatal pelvic ectasia: long-term outcome and association with ureterovesical anomalies

Objetivo: Analizar la evolución de la ectasia piélica neonatal y su asociación con reflujo vesicoureteral u otras anomalías del tracto urinario. Pacientes y métodos: Análisis retrospectivo de 255 niños (205 varones y 50 mujeres), con ectasia piélica diagnosticada por ecografía en el primer mes de la vida. Indicación de la primera ecografía: alteración ecográfica prenatal, 150; infección urinaria, 30, y otras, 75. Clasificación en cuatro grados atendiendo al diámetro anteroposterior de la pelvis: grado I, 2 cm. Resultados: En 153 (60 por ciento) la dilatación fue bilateral; de las unilaterales, izquierda 81,4 por ciento, y derecha, 18,6 por ciento. Grado I, 75,49 por ciento; II, 20,34 por ciento; III, 3,93 por ciento y IV, 0,24 por ciento. El tiempo medio de evolución es 32,6 25,2 meses con normalización al año del 70,2 por ciento de las derechas y del 55,9 por ciento de las izquierdas, empeorando 46 (18 por ciento) entre la primera y la segunda ecografía. Se practicó cistouretrografía miccional en 203 (79,6 por ciento), y se encontraron anomalías en 50 (24,6 por ciento): 2 dilataciones uretrales y 48 reflujos vesicoureterales, sin correlación entre reflujo y grado de la ectasia (74 por ciento con diámetro anteroposterior [DAP] <= 1 cm). El 24,3 por ciento han presentado infección urinaria. Intervenciones quirúrgicas: ocho pieloplastias, cuatro reimplantaciones ureterales y dos resecciones de válvulas uretrales tipo III. Conclusiones: La ectasia piélica neonatal predomina en varones (4:1) y en el riñón izquierdo en ambos sexos. Se asocia a reflujo vesicoureteral en el 23,64 por ciento sin correlación entre grado de dilatación y presencia y/o grado de reflujo, por lo que parece aconsejable practicar cistouretrografía miccional independientemente del grado, la lateralidad y el sexo (AU)

Preemptive treatment with oral ganciclovir for pediatric renal transplantation.

This prospective study examines 42 children in the first year after renal transplantation. They all received intravenous ganciclovir prophylaxis for cytomegalovirus in the immediate post-transplant period. Quantitative antigenemia (pp68) determinations and blood, urine and throat cultures were done on a scheduled basis to detect cytomegalovirus. Infection was detected in 22 children (52.4%) within an average 44.31 +/- 27.38 days; 5/22 were symptomatic. The antigenemia was positive (+) in all the infected patients, and so were blood culture in 68.2%, urine culture in 59.1% and throat culture in 31.8%. A positive antigenemia was the earliest finding in all cases but 1. The 5 children with clinical symptoms received intravenous ganciclovir. Asymptomatic infected children received oral ganciclovir at an average dose of 47.64 +/- 8.10 mg/kg/day (median 46.58 (range 33-58.7) mg/kg/day) for an average of 58.47 +/- 27.76 days (median 58 (range 26-211) days). No patient developed disease or ganciclovir resistance during the treatment. No patient presented acute graft rejection or renal dysfunction and their glomerular filtrate rate at 1 year was similar to that of noninfected children (90.38 +/- 26.51 vs. 93.93 +/- 36.24 ml/min/1.73 m2). We conclude that preemptive treatment with oral ganciclovir is useful and safe in children with renal transplantation and that monitoring blood antigenemia is a sensitive and early method to detect and control CMV infection.

Immunoprophylaxis with Simulect (basiliximab) in pediatric kidney transplant recipients: results from routine clinical practice at 5 kidney transplant units.

BACKGROUND: Simulect (basiliximab) was introduced in Spain in February 1999, being the first anti-interleukin-2 receptor monoclonal antibody used in our country for the prevention of acute rejection in kidney transplantation. The objective of this study was to assess the efficacy and safety of Simulect (basiliximab) in routine clinical practice in pediatric Spanish kidney transplantation units. METHODS: In this prospective, observational study, we collected data related to demographics, parameters of efficacy, immunosuppressive therapy, and safety on kidney transplant patients treated with Simulect (basiliximab) using an on-line collection system. RESULTS: Fifty pediatric patients at 5 kidney transplant units with 12 months follow-up included recipient mean age of 10.00 years (DS 5.40). Twenty-nine (58.00%) were boys and 21 (42.00%) were girls. Cold ischemia time was 15 hours and 50 minutes (DS 9.70 h). No patient presented with a PRA >50%. For prophylactic immunosuppression, 85.70% of patients received triple therapy with CNI (cyclosporine 48.97% or tacrolimus 36.73%), MMF (87.76%) or AZA (12.24%), and steroids. Acute rejection incidence at 12 months was 22%, including 3 steroid-resistant episodes (6%). One patient lost the graft (2%), 7 adverse events (AE) were reported (1 mild, 4 moderate, and 1 severe AE), of which none were attributed to the study drug. CONCLUSIONS: Simulect (basiliximab) treatment of pediatric patients who underwent kidney transplantations performed in routine clinical practice showed good prophylaxis against acute rejection with excellent safety.

Validación del peso y la talla autodeclarados en población adolescente / Validation of self-reported weight and height in an adolescent population

Fundamento: Examinar la relación entre el peso y la talla autodeclarados y las medidas antropométricas objetivas en la población adolescente, con objeto de evaluar su validez para poder estimar la prevalencia del índice de masa corporal (IMC) bajo (percentil 15) y elevado (percentil 85) en la población estudiada. Sujetos y método: La información del peso y la talla autodeclarados y objetivos se ha obtenido en una muestra representativa de 3.244 adolescentes entre 15 y 18 años escolarizados en centros de enseñanza secundaria de la Comunidad de Madrid. Se estima el error relativo medio, la correlación entre parámetros subjetivos y objetivos, así como la sensibilidad, la especificidad y el valor predictivo positivo de un IMC bajo y elevado. Resultados: El error relativo medio del peso es de un +0,07 por ciento en los varones y de un -0,79 por ciento en las mujeres. La estatura tiene un error medio de +0,51 y +0,98 por ciento en varones y mujeres respectivamente, y el del IMC de -0,88 y -2,63 por ciento. La correlación entre el IMC autodeclarado y objetivo es de 0,87 en los varones y de 0,90 en las mujeres. La prevalencia del IMC elevado se subestima un 34,1 por ciento en los hombres y un 34,4 por ciento en las mujeres. Por el contrario, la prevalencia del IMC bajo se sobrestima un 10,7 y un 14,8 por ciento en varones y mujeres, respectivamente. Conclusión: El análisis del IMC como variable continua, a partir de los datos de las medidas del peso y la talla autodeclarados, tiene poco margen de error. Su utilización como variable categórica conlleva una subestimación importante de la prevalencia de IMC elevado, y una sobrestimación de menor magnitud del IMC bajo (AU)

Dismenorrea funcional en la Comunidad Autónoma de Madrid: estudio de la prevalencia en función de la edad / Functional dysmenorrhea in the Autonomous Community of Madrid: study of prevalence according to age

Objetivos: Se trata de hallar datos epidemiológicos fiables y válidos sobre la incidencia de la dismenorrea funcional en la Comunidad Autónoma de Madrid. Material y método: Se utilizó un cuestionario de dolor menstrual elaborado para este estudio. El valor discriminativo de los elementos del cuestionario se puso a prueba mediante una prueba de Crombach y mediante la diferencia de medias de las puntuaciones en los ítems, encontrándose que todos los elementos (ítems) relevantes eran capaces de diferenciarente personas con o sin trastorno (i.e. dismenorrea) a un nivel de confianza del 99 por ciento. Dos mil mujeres pro c e d e n t e s de distintos ámbitos de la Comunidad Autónoma de Madrid, completaron el cuestionario. La muestra final fue de 1.387 mujeres. El rango de edad oscilaba entre los 13 y los 52 años. La muestra incluye todos los estratos socioculturales. La muestra total fue dividida en 4 submuestras, en función de la edad de los sujetos: adolescentes, jóvenes, adultas y mayores. Las variables consideradas en este estudio fueron: prevalencia del trastorno, frecuencia del dolor menstrual, Intensidad y localización. Para las variables continuas se realizaron análisis de varianza. Para controlar el posible efecto del nivel de estudios y del número de hijos de las mujeres de la muestra, se realizaron además análisis de covarianza introduciendo estas variables como covariadas. Cuando los análisis iniciales indicaron la presencia de diferencias significativas, se re a l i z a ro n pruebas post - hoc (Scheffé). Cuando el factor a analizar tenía carácter nominal se optó por la utilización de pruebas Chicuadrado. Resultados: Los resultados indican que el 61,9 por ciento de las mujeres sufren dolor menstrual, disminuyendo el porcentaje a medida que aumenta la edad de las mujeres. También el número de hijos influye significativamente en la incidencia del trastorno. El 78,4 por ciento de la muestra sufre dolor menstrual en, al menos, 3 menstruaciones al año y el 15,6 por ciento lo sufre en todas las menstruaciones. La intensidad media del dolor en la escala numérica (de 0 a 10) fue 4,56. La intensidad de dolor depende de la edad, así como del número de hijos de las mujeres. La correlación entre intensidad del dolor y frecuencia del mismo fue elevada y significativa. Respecto a la localización del dolor, el 80,7 por ciento de las mujeres de la muestra manifestaban sufrir dolor en la zona abdominal, un 45 por ciento en la zona lumbar, un 38,9 por ciento en las mamas, y sólo un 7,5 por ciento en los muslos. Conclusiones: Como conclusión más relevante de los resultados hallados en el estudio habría que señalar la elevada incidencia de la dismenorrea funcional entre la población femenina de la Comunidad Autónoma de Madrid; incidencia que es elevada para cualquiera de los grupos de edad estudiados y que va, en un porcentaje importante de los casos, acompañada de una intensidad de dolor menstrual de carácter severa o incapacitante. Estos resultados ponen de manifiesto la relevancia del problema y la necesidad de que se dediquen más recursos y profesionales a su estudio, mejorando así calidad de vida y la salud de una parte importante de la población (AU)

[Validation of self-reported weight and height in an adolescent population]. / Validación del peso y la talla autodeclarados en población adolescente.

INTRODUCTION: The aim of this study was to examine the relationship between self-reported population in order to evaluate the validity of self-reported measures for the purpose of estimating the prevalence of low (less-than-or-equal 15th percentile) and high (greater-than-or-equal 85th percentile) body mass index (BMI) in the study population. SUBJECTS AND METHOD: Information on self-reported and objective weight and height was obtained from a representative sample of 3,244 adolescents, aged 15-18 years, in secondary education schools in the Autonomous Community of Madrid. We calculated the mean relative error; the correlation between subjective and objective parameters, sensitivity, specificity and predictive value positive of low and high BMIs. RESULTS: The mean relative errors were as follows: weight: +0.07% for males versus and 0.79% for females; height, +0.51% for males versus +0.98% for females; BMI: 0.88% for males versus 2.63% for females. The correlation between self-reported and objective BMI was 0.87 for males and 0.90 for females. The prevalence of high BMI was underestimated by 34.1% and 34.4% of females white that of low BMI was overestimated by 10.7% of males and 14.8% of females. CONCLUSION: Analysis of BMI as a continuous variable, based on self-reported weight and height measurement data, entails a small margin of error. However, its use as a categorical variable involves a considerable underestimate of the prevalence of high BMI, and an smaller overestimate of the prevalence of low BMI.

Does treatment of bladder dysfunction prior to renal transplant improve outcome in patients with posterior urethral valves?

Fourteen patients with posterior urethral valves and end-stage renal failure were urodynamically evaluated in order to identify and correct any bladder dysfunction before renal transplant. Of the 14 patients, during filling, six had normal bladder function, two had an over-distended bladder (one with instability), one had instability, four had poor compliance, and one had a very reduced bladder capacity. During the voiding phase, one had a myogenic failure and another had detrusor-sphincteric dyssynergia. Four patients underwent bladder augmentation. Three were managed with anticholinergic therapy and two required clean intermittent catheterization owing to post-voiding residual urine. A renal transplant was performed in all of these patients at a mean age of 8.2 years. We compared outcome in these 14 patients with bladder dysfunction treated before transplantation with outcome in a matched control group of 14 transplant patients. Graft function and survival were similar in both groups. We believe that urodynamic studies must be included in the pretransplant evaluation of patients with posterior urethral valves in order to diagnose any bladder dysfunction and commence appropriate treatment to avoid any negative influence on graft function.