Renal functional reserve in insulin dependent diabetic children.

BACKGROUND: Microalbuminuria has been shown to be predictive for clinical diabetic nephropathy. Renal functional reserve (RFR), as a response to protein loading in a short period of time, is a parameter to assess the ability of kidneys to increase the glomerular filtration rate (GFR). The aim of this study was to predict the early phase of diabetic nephropathy by measuring urinary albumin level and RFR capacity in patients with insulin-dependent diabetes mellitus (IDDM). METHODS: Twenty-two patients with IDDM were studied: 11 with a disease duration of less than 5 years (group 1) and 11 with a disease duration of more than 5 years (group 2). As the control group, 15 healthy children (group 3) were included in the study. At the beginning of the study, glucose was measured and the urinary albumin/creatinine ratio was calculated. Average glycosylated hemoglobin (HbA1c) over 1 year was determined. After protein loading (red meat containing 2 g/kg of protein), the creatinine clearance was calculated at each hour for a duration of 4 h. The RFR was accepted as the peak percentage increase in GFR over the baseline value. RESULTS: Although metabolic control in group 2 was better, the RFR in group 2 was significantly lower than in group 1 (P < 0.05). Urinary microalbumin levels between the groups did not differ (P > 0.05). In two patients in whom microalbuminuria was detected, the RFR was much lower. CONCLUSIONS: Detecting lower RFR levels in patients with normal urinary albumin excretion, as well as in patients with microalbuminuria, may support the idea that the RFR capacity is more sensitive than microalbuminuria in assessing the early phase of diabetic nephropathy.

Central diabetes insipitus in a patient with congenital toxoplasmosis.

A 33-day-old male infant who developed central diabetes insipitus as a complication of congenital toxoplasmosis is presented. He had polyuria and hypernatremia on admission and responded to Intranasal desmopressin acetate with the normalization of above mentioned findings. Computed tomographic (CT) scan of the brain showed obstructive hydrocephaly with periventricular and right basal ganglion calcification. CT scan of the pituitary gland, thyroid function tests, and serum cortisol levels were all normal. This is the first report of isolated diabetes insipitus with congenital toxoplasmosis in literature and central diabetes insipitus should be remembered if polyuria and hypernatremia develops in a patient with congenital toxoplasmosis.

Effect of intraperitoneal immunoglobulin infusion on neutrophil function in CAPD children with and without peritonitis.

The present study was designed to assess the effect of intraperitoneal infusion of immunoglobulin (Ig) on neutrophil functions in uninfected and infected patients treated by continuous ambulatory peritoneal dialysis (CAPD). Fourteen children were included in the study. Healthy laboratory and medical personnel (n = 10) served as controls. Blood and peritoneal dialysate effluent (PDE) samples were obtained before and after Ig infusion. In all patients, chemotactic response of peripheral blood neutrophils (PBN) was significantly lower than in healthy controls. Peripheral blood neutrophils obtained from patients during peritonitis episodes (n = 10) showed significantly higher values compared to the values obtained from patients without peritonitis (n = 12). After the intraperitoneal infusion of Ig (100 mg/kg), chemotaxis of PBNs increased significantly in both patient groups. Chemiluminescence measures of PBN of the uninfected (n = 12) and infected patients (n = 7) were similar. They increased significantly in both groups after the Ig infusion, although they remained within the lower limits of the controls. The peritoneal neutrophils (PNs) showed significantly lower chemotactic activity in uninfected patients (n = 11) than in the infected ones (n = 10). The response of PNs to the Ig infusion was also more prominent in infected patients. Immunoglobulin infusion did not increase the chemiluminescence of PNs in infected patients (n = 7); the chemoluminescence of PNs did increase after Ig infusion in uninfected patients (n = 12). These data suggest the of administration intraperitoneal Ig for prophylaxis and/or treatment of peritonitis in CAPD patients.

Cyclosporin-induced remission in an infant with alkylating agents-resistant nephrotic syndrome. A case report.

The efficacy of cyclosporin-A, a potent immunosuppressive agent, has not been clearly proven in the management of childhood nephrotic syndrome. The occurrence of early relapse as the dose of cyclosporin is tapered or as soon as the drug is stopped and the potential nephrotoxic effects of prolonged treatment have caused it to be used in limited cases. We report an eighteen-month-old boy with steroid toxicity and alkylating agents-resistant nephrotic syndrome, who subsequently went very quickly into remission lasting at least one year after receiving cyclosporin-A for only three months.

Hemoglobinopathies in the district of Antalya, Turkey.

A screening program was conducted to ascertain the incidence of hemoglobinopathies in the district of Antalya, Turkey. The survey sample was selected from the household registration forms of health centers by systematic random sampling. Heparinized blood samples were collected from 1,616 subjects from 884 families. The prevalence of beta thalassemia traits with increased Hb A2 was 10.2%. This is higher than that found in previous studies performed in Antalya. The prevalence of abnormal hemoglobins (Hbs) was found to be 0.8%. Four subjects had Hb AS; five had Hb D-Los Angeles (B 121 [GH4] Glu-Gln); one had Hb Ube-2 (68 [E1] Ans-Asp), one had Hb P-Nilotic (fusion between B 22 and) and two had Hb D-like variants.

Growth and sexual maturation in children with thalassemia major.

BACKGROUND AND METHODS. Growth and endocrine disturbances are still important problems for patients with thalassemia major, which is a major health problem in southern part of Turkey. In the present study 71 thalassemia major patients over 3 years of age were evaluated for physical and sexual maturation status. RESULTS AND CONCLUSION. Twenty-three patients (32.4%) were below the third centile for height. Growth retardation was more pronounced in patients 10 years of age and up according to height and weight standard deviation scores (SDS). Delay in bone age SDS was found in almost all patients, and 74.5% of our patients over 12 years of age had not yet entered puberty. These results show that growth and endocrine disturbances have significant negative effects in the quality of life of thalassemic patients. More detailed studies will help to solve these problems.