Compensatory hypertrophy and progressive renal damage in children nephrectomized for Wilms' Tumor.

Clinical, biochemical, and sonographic evaluation of the remaining kidney function and size was performed in 34 patients, 12 males and 22 females, ages 2.1-19.6 years, nephrectomized (NP) for Wilms' tumor (WT) at least 2 years before (mean 8.6). All patients had normal blood pressure and serum bicarbonates. Two of them had microhematuria, four proteinuria 4 mg/m2/hr, and 11 microalbuminuria (MA) > 20 mg/24 hr. Only one patient had reduced creatinine clearance and maximum bipolar length (MBL) as well as kidney volume (KV) < 100% of expected. In the other patients, average MBL was 128 +/- 11% (P = 0.0001). MBL, but not KV, was inversely correlated (P = 0.04) to age at NP. KV, but not MBL, was directly correlated (P = 0.009) to MA. Average MA was 48 +/- 94 mg/24 hr and was correlated to the time from NP (P = 0.026). The remaining kidney increases in volume much more than in length. The increase in KV is related to the degree of MA, whereas the increase in MBL is higher in subjects younger at NP. The high prevalence of significant MA, which is in turn related to the time from NP and to the KV, raises some concerns about the long-term renal prognosis of children NP for WT.

Advanced RUS and normal carpal bone age in childhood obesity.

METHODS: Skeletal maturation was evaluated in 60 prepubertal children aged 7.7 +/- 0.27 years (range 2.7-12.6). The radius, ulna and short bones (RUS) and the carpal (CARP) bone age were assessed. Height corresponded to 1 +/- 0.1 Z scores. RESULTS: RUS bone age was 1.04 +/- 0.2 years more advanced than chronological age (P = 0.0001). CARP bone age was only 0.2 +/- 0.2 years more advanced than chronological age and the difference was not significant. However, the degree of advancement of CARP bone age in respect of chronological age was significantly (P = 0.0001) correlated with height Z scores. CONCLUSIONS: CARP bone age is less sensitive than RUS bone age to the factors promoting the early skeletal maturation in obese children. Nevertheless, the degree of CARP bone age advancement, although minimal, is correlated with overheight.

Bone mineral content in nephrotic children on long-term, alternate-day prednisone therapy.

Bone mineral content (BMC) was measured by single-photon absorptiometry in 24 children with steroid-dependent, minimal-lesion nephrotic syndrome after 1 to 6.3 years of alternate-day prednisone therapy and in a sex- and age-matched control group. Bone mineral content was -0.002 +/- 1.2 standard deviation scores in patients and 0.3 +/- 1.4 in controls (t = 1.17; P = 0.25). No significant relation was found between BMC in patients and the amount of prednisone taken or the duration of therapy. Alternate-day prednisone therapy at doses usually needed to keep children with steroid-dependent nephrotic syndrome under control does not significantly affect BMC.

Alternate-day steroids affect carpal maturation more than radius, ulna and short bones.

Radius, ulna, short bones (RUS) and carpal (CARP) bone age were assessed in 26 steroid-dependent nephrotic boys after at least 1 year of alternate-day prednisone therapy, and in 26 age- and sex-matched control subjects. No significant difference in RUS bone age was found between patients and controls. CARP bone age of patients was significantly (P = 0.01) more retarded than in controls. In patients, CARP bone age delay was related to their relative height at the time of study (P = 0.01). We conclude that CARP bones are more prone to effects of steroids than are RUS bones. Therefore, CARP bone age may be a more sensitive tool in monitoring the effects of steroids on skeletal growth and maturation.