Height and weight growth in children with vesicoureteral reflux diagnosed before one year old.

OBJECTIVES: To evaluate the different treatment strategies on height and weight growth in children with vesicoureteral reflux (VUR) diagnosed before age 1 year. METHODS: Height and weight growth were retrospectively studied in 108 children, with 79 boys and 29 girls, having urinary tract infection and then VUR diagnosed before the age 1 year (5.06 +/- 3.34 months). During follow-up for 14-152 months (44.69 +/- 27.28), 45 patients were recovered spontaneously; 24 were corrected by surgery; and 39 were not completely recovered up to the final assessment at the age of 44.69 +/- 27.28 months. We assessed height as height Z score (HZ); and weight as weight for height index (WHI). RESULTS: Patients had normal initial HZ and WHI values. In analyzing relative risk of final HZ decrease, complete recovery revealed protective effect (P <.01). There was negative correlation between age of recovery and annual HZ change (r = -0.302, P = .001). Patients received surgical correction had higher percentage of moderate or severe VUR (P <.0001), higher recovery rate (P <.001), and younger age of recovery (P = .008). They had significant higher final HZ (P = .016) than those under regular antibiotic prophylaxis without recovery. Both recovered groups had better annual HZ change than those nonrecovered (P = .02). The antibiotic prophylaxis, nonrecovered group had higher final WHI than their initial WHI (P = .011). CONCLUSIONS: From our data, considering height growth, we suggest that patients with VUR should start treatment early and consider surgical correction if no complete recovery occurs from prolonged antibiotic prophylaxis.

Fanconi's syndrome, interstitial fibrosis and renal failure by aristolochic acid in Chinese herbs.

Aristolochic acid-associated nephropathy (AAN) has been identified as a separate entity of progressive tubulo-interstitial nephropathy. Its characteristic pathological findings, including hypocellular interstitial fibrosis, intimal thickening of interlobular and afferent arterioles with glomeruli sparing or mild sclerosis, have been identified. Many cases of AAN in adults have been reported in Taiwan as well as throughout the world, but it has seldom been described in children. We report on a 10-year-old boy who presented with severe anemia, Fanconi's syndrome, and progressive renal failure. Renal biopsy revealed typical findings of AAN. Aristolochic acids I and II were identified from a Chinese herb mixture ingested by the boy. AAN was diagnosed after other etiologies had been excluded. The case demonstrates the hazards of Chinese herbs with regard to children's health in Taiwan and suggests that more attention should be paid to this issue.

Vascular ring due to double aortic arch with atretic left arch and left ligamentum arteriosum: report of one case.

A 1-day-old female infant presented with vomiting immediately after feeding and shortness of breath after birth. Esophagography revealed external compression of the esophagus. Echocardiography showed a right aortic arch with mirror image branching of brachiocephalic vessels without intracardiac anomalies. Left ventriculography confirmed the echocardiography findings and revealed a tenting of the proximal part of the left subclavian artery and a blind pouch of Kommerell diverticulum at the descending aorta. The patient underwent surgery, which revealed a complete vascular ring compressing the trachea and the esophagus. The ring was formed by a right aortic arch, atretic left arch and left ligamentum arteriosum. Following surgical division of the ligamentum arteriosum and the atretic left arch, the symptoms subsequently improved.