Pediatric renal biopsy: ambulatory versus overnight hospitalization.

Renal biopsy may be safely performed on selected pediatric patients in an ambulatory care setting. In order to verify the safety of this new procedure, we performed 51 renal biopsies on an ambulatory care basis over a five-year period (from December 1993 to December 1998): twenty-eight biopsies on transplanted kidneys and twenty-three of native kidneys. During the same period, 56 renal biopsies were performed during a regular hospitalization of a minimum of 24 hours. We compared the two groups: Ambulatory procedure group and overnight hospitalization group. There were no significant differences between the two groups in mean age, adequacy of renal samples and complications such as post-biopsy pain or hematuria. After this encouraging experience, we are proposing the ambulatory procedure to all pediatric patients in our unit. Parents will be informed that if macroscopic hematuria is noted in the immediate post-biopsy period, hospitalization might be necessary.

Bartter syndrome in a neonate: early treatment with indomethacin.

The neonatal form of Bartter syndrome is characterized by intrauterine onset of polyuria leading to severe polyhydramnios. We report a patient with the early onset of the syndrome and a similar history in a previous sibling who died in early neonatal life. The patient is a female product of 33 weeks of gestation complicated by severe polyhydramnios. Her birth weight was 2,100 g. Polyuria led to severe dehydration on the 3rd day of life. Laboratory studies showed hypokalemia, hyponatremia, and elevated plasma levels of renin and aldosterone. Hypercalciuria was associated with echographic evidence of nephrocalcinosis. Indomethacin therapy resulted in a significant reduction in urine volume and correction of biochemical abnormalities. Growth and development are satisfactory after 4 years of indomethacin therapy, but nephrocalcinosis remains unchanged.

Kidney transplantation after a severe form of pseudotumor cerebri.

Pseudotumor cerebri is a syndrome characterized by intracranial hypertension (intracranial pressure >200 mmH2O) and a normal ventricular system. The diagnosis should be made as early as possible to prevent impairment of vision. Several diseases have been reported in association with pseudotumor cerebri in pediatric patients, and have been occasionally also noted with chronic renal failure, heart and renal transplantation. We report a 7-year-old boy who complained of severe headaches and visual impairment 2 years after hemodialysis for renal hypoplasia. Pseudotumor cerebri was suspected and, despite treatment with corticosteroids, acetazolamide, and lumboperitoneal diversion, visual impairment worsened. Bilateral optic nerve sheath decompression (ONSD) was performed without success and the child completely lost his vision within 2 weeks. He was successfully transplanted 2 months later. Two years post transplantation, the blind child has a normal renal function and school performance. Pseudotumor cerebri must be rapidly suspected in a child with renal failure suffering from headaches and papilledema. Visual loss may progress rapidly and ONSD seems to be the best surgical treatment when medical treatment fails. In this patient renal transplantation was well tolerated, with no deterioration in the neurological status over 2 years of follow-up.