Persistence of serum lipid abnormalities in children with idiopathic nephrotic syndrome.

We investigated the severity and duration of hyperlipidemia in 59 nephrotic children during relapse and remission. Serum total cholesterol and triglyceride values were greater than or equal to 95th percentile for age and sex in all patients with minimal change nephrotic syndrome in relapse and in patients with non-MCNS and persistent proteinuria. Most of these patients also had a significant elevation of low- and very-low-density lipoproteins. A significant number of children with MCNS during prolonged remission had elevated serum concentrations of total cholesterol (46%), triglycerides (42%), LDL (29%), and VLDL (40%). Persistence and severity of lipid changes correlated well with duration of disease and frequency of relapses. Significantly decreased HDL and HDL/LDL were found in patients with non-MCNS and persistent proteinuria. Our results suggest that nephrotic children may have prolonged periods of hyperlipidemia even after clinical remission. In addition, some of these children with significantly decreased HDL/LDL may be at increased risk of developing premature atherosclerosis.

Funcion renal en el feto y en el recien nacido. / Kidney function in the fetus and in the newborn infant

Se presenta una revision de los diversos estados de desarrollo morfologico, fisiologico, metabolico y endocrinologico del rinon. Durante el desarrollo del embrion y en el periodo fetal temprano, las funciones excretoras, asi como de homeostasis hidrica y electrolitica, son manejadas principalmente por las membranas placentarias, actuando el amnios como reservorio de los productos de desecho. Despues que se establece la circulacion fetal se inician, tanto el flujo sanguineo renal, como la filtracion glomerular, los cuales se incrementan a medida que avanza el embarazo; los glomerulos que se desarrollan en primer termino son los de la zona yuxtamedular. El desarrollo de la funcion tubular es mas tardio que la glomerular. Este desequilibrio glomerulotubular persiste hasta el periodo de neonatal temprano. La capacidad limitada del neonato para concentrar, pero adecuada para diluir la orina, se correlaciona bastante bien con la composicion organica del neonato: expansion del volumen extracelular y relativa hipotonicidad intracelular. Se concluye que en el individuo normal, las necesidades homeostaticas del organismo se correlacionan adecuadamente con la funcion renal presente en las diversas etapas del desarrollo

Chronic renal failure in children: analysis of main causes and deterioration rate in 81 children.

Cause of chronic renal failure (CRF), age at clinical onset, and deterioration rate were studied in 81 unselected children 2 months to 18 years old who were referred to UM-JMH during a six-year period. Obstructive uropathies caused 42%, glomerulopathies 27%, renal hypoplasias 15%, and hereditary and vascular nephropathies 8%. Age at clinical onset of CRF was significantly lower in patients with obstructive uropathies (2.8 years) and renal hypoplasias (2.4 years) than in glomerulopathies (10.7 years). Deterioration rate correlated with cause of CRF; it was more rapid in primary glomerulopathies (4.1 years) and renal hypoplasias (4.2 years) than in obstructive uropathies (6.7 years). Within the six-year period, half the patients studied reached end-stage renal disease (ESRD). Final outcome did not seem to be modified significantly by corrective procedures. These findings suggest that major efforts should be directed toward identification of the etiopathogenesis of congenital nephropathies to prevent occurrence of CRF.

Prolonged nitroprusside and intermittent hemodialysis as therapy for intractable hypertension.

Nitroprusside was used with intermittent hemodialysis over a 26-day period in a 6-year-old boy with intractable hypertension. Hemodialysis effectively removed thiocyanate from the blood, thus preventing its accumulation and subsequent toxic manifestations. Prolonged nitroprusside infusion maintained arterial blood pressure at acceptable levels until the patient became responsive to other antihypertensive therapy.