Subclinical rhythmic EEG discharge of adults: SREDA in two children.

Subclinical rhythmic electroencephalogram (EEG) discharge is an uncommon rhythmic EEG pattern that has been reported to occur in adults. It is thought to be a nonspecific finding with little clinical significance. This article reports this EEG pattern in two children and suggests it be called subclinical rhythmic EEG discharge of adults and children.

The use of urinary red cell morphology to determine the source of hematuria in children.

Urinary red cell morphology has been used to indicate the source of renal tract bleeding. A double blind study was undertaken to evaluate the reliability of urinary red cell morphology in predicting the source of hematuria in a pediatric population. Two independent observers used phase-contrast microscopy, one also using Nomarski differential interference microscopy, to examine 101 urine specimens from 90 pediatric patients with hematuria. 28 cases were subsequently excluded because the clinical diagnosis was uncertain. In the remaining 62 patients the laboratory diagnosis based on the erythrocyte morphology was compared with the primary clinical diagnosis. Observer 1 documented dysmorphic red cells in 40 of 42 patients with glomerulonephritis, and isomorphic red cells in 19 of the 20 cases of non-glomerular bleeding. Observer 2 documented dysmorphic red cells in 39 of the 42 glomerular lesions, and isomorphic red cells in all of the non-glomerular lesions. This represents a sensitivity for predicting glomerular hematuria of 95% for observer 1 and 93% for observer 2, and a specificity of 95% and 100% respectively. There was no definite advantage in the use of Nomarski compared to phase-contrast microscopy. These results confirm the accuracy of this technique in predicting the source of hematuria in pediatric patients.

Altered in vitro lymphocyte response in childhood nephrotic syndrome.

The immune system, and disturbed T lymphocyte function in particular, has previously been implicated in the pathogenesis of childhood idiopathic nephrotic syndrome. As this disorder is commonly responsive to steroid therapy, we set out to determine whether in vitro suppression of lymphocyte blastogenic response to the mitogen phytohaemagglutinin (PHA) could predict the clinical situation. Comparing nine nephrotic children with nine healthy controls we were able to show the inhibitory prednisolone dose that suppressed lymphocyte blastogenesis by 50% (ID50) at a known concentration of PHA was significantly greater (P < 0.005) for nephrotic individuals. However, the in vitro assay did not reliably predict the clinical response to prednisolone. This study further implicates altered lymphocyte function in the mechanisms underlying idiopathic nephrotic syndrome.

Congenital renal salt-losing syndrome and failure to thrive in infancy.

An infant with congenital renal salt-losing syndrome is reported. The importance of recognizing this rare disorder is emphasized because early detection, and treatment with sodium supplementation, results in marked growth improvement and may prevent volume depletion, electrolyte disturbance, and cardiovascular collapse. The clinical features and biochemical abnormalities seen in the congenital renal salt-losing syndrome are described. In this condition, natriuresis occurs in the face of normal renal and adrenal function and, as the child gets older, spontaneous resolution occurs. Other causes of hyponatraemia in infancy are discussed.

Renal osteodystrophy in children undergoing continuous ambulatory peritoneal dialysis.

Fifteen children undergoing continuous ambulatory peritoneal dialysis for 0.3 to 2.4 years were evaluated longitudinally for renal osteodystrophy. Immunoreactive parathyroid hormone, 25-OHD, total and ionized calcium, inorganic phosphate, and alkaline phosphatase levels were measured regularly. Skeletal radiographic studies were performed at the onset and conclusion of CAPD and at six-month intervals during therapy. All children received 1,25(OH)2D3 and aluminum hydroxide, and nine received supplemental calcium. Plasma 25-OHD concentrations were normal to elevated, and calcium increased steadily to high normal levels despite a trend to persistent hyperphosphatemia. The increased calcium levels suppressed parathyroid hormone overactivity in only one patient. At the onset of CAPD, nine patients had hyperparathyroid bone disease seen radiographically, three of whom also had rachitic lesions. At the end of CAPD, the hyperparathyroid lesions had improved in four patients, completely resolved in three, and deteriorated in two. Rachitic lesions had completely healed in two patients and improved in the third. However, among the six children without radiographically evident lesions at onset of CAPD, hyperparathyroid bone lesions developed in two and rachitic lesions in two others during CAPD. Although CAPD and appropriate therapy benefited most patients with renal osteodystrophy, the benefits were not uniform, and bone lesions deteriorated in some.

Growth in children receiving continuous ambulatory peritoneal dialysis.

Linear growth of 17 children receiving CAPD was compared with growth in 18 patients receiving hemodialysis and 20 who had undergone transplantation, as well as with the previous growth in 11 of the 17 patients. Growth was normal in 10 receiving CAPD, fair in six others, and poor in only one. Growth velocity indexes in those receiving CAPD were significantly better than those of the group receiving hemodialysis (P less than 0.01) but did not differ significantly from those of children who had undergone kidney transplant. All patients grew significantly better after beginning CAPD than before (P less than 0.01). Appropriate management of renal osteodystrophy combined with adequate energy and protein intake were important factors in the growth of patients receiving CAPD.