Asunto(s)
Fallo Renal Crónico/etiología , Síndrome Nefrótico/complicaciones , Prednisona/uso terapéutico , Adulto , Femenino , Glomeruloesclerosis Focal y Segmentaria/complicaciones , Glomeruloesclerosis Focal y Segmentaria/patología , Humanos , Síndrome Nefrótico/tratamiento farmacológico , Síndrome Nefrótico/patología , Pronóstico , RecurrenciaAsunto(s)
Fallo Renal Crónico/sangre , Glomérulos Renales , Fosfatos/sangre , Adolescente , AMP Cíclico/orina , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Fallo Renal Crónico/orina , Masculino , Hormona Paratiroidea/administración & dosificación , Hormona Paratiroidea/sangre , Talasemia/sangreRESUMEN
Lactic acidosis accompanied by acute renal failure in the newborn period was studied in two infants with circulatory insufficiency and hypoxia. Peritoneal dialysis was necessitated by anuria and serum potassium concentrations of 12.0 and 8.9 mEq/1. Plasma lactate concentration was 35 and 50 mM/1 and blood pH 7.23 and 7.18, respectively, at the time dialysis was instituted. Because of the uncontrollable anaerobic metabolism in these two patients, and the attendant inability to metabolize lactate, the use of commercial lactate-containing dialysates as a source of base was shown to be ineffective in correcting the acidosis and hypothesized to cause a worsening of metabolic acidosis due to a loss of bicarbonate from extracellular fluid into dialysate. Stabilization or improvement in the metabolic acidosis occurred with the utilization of a dilaysate containing bicarbonate with a gradient favoring movement of bicarbonate into, and lactate out of, extracellular fluid.
Asunto(s)
Acidosis/terapia , Lesión Renal Aguda/terapia , Enfermedades del Recién Nacido/terapia , Lactatos/metabolismo , Diálisis Peritoneal , Acidosis/diagnóstico , Bicarbonatos/uso terapéutico , Femenino , Humanos , Recién Nacido , Lactatos/sangre , MasculinoRESUMEN
To establish the relationship between the type of focal sclerotic lesion of glomeruli and the development of progressive renal disease, the clinical courses of 20 children with focal segmental and 7 with focal global sclerosis were analyzed. Only five patients, all of them with focal segmental sclerosis, did not have the nephrotic syndrome, although all had proteinuria. Results suggest that patients with focal global sclerosis have a course identical to that of children with the minimal lesion form of nephrotic syndrome: onset in early childhood, response to steroid therapy, and a relapsing, nonprogressive course. Focal segmental sclerosis, in constrast, is characterized by older age at onset, high incidence of nephritic symptoms, lack of response to steroid therapy, and a progressive course with histologic and functional deterioration. Since most published reports have not distinguished between these two entities, a more favorable prognosis in focal segmental sclerosis may be inferred than is actually the case.