[Blood group P1 and its relation to renal cicatrix in patients with urinary infection]. / Grupo sanguíneo P1 y su reláción con cicatriz renal en pacientes con infección urinaria.

Possible relationships between renal scars and P blood group have been recently emphasized. Urinary tract infections, an important factor in the production of renal scar, are mainly caused by specific types of E. coli, which has the ability to adhere through fimbriae, to receptors of the urinary tract epithelium that are structurally related to antigens detected in people with blood group P1. We looked for P1 sub-group in 30 children with vesicoureteral reflux and renal scar and 30 patients with equivalent degrees of reflux but without evidence of renal scar. Sex and age were unmatched. The frequency of P1 blood sub-group was similar in both kinds of patients (56.7% vs. 66.7, n.s.) so we could not demonstrate that P1 sub-group can be a useful indirect risk marker for renal scar formation.

[New concepts about hemolytic-uremic syndrome]. / Nuevos conceptos acerca del síndrome hemolítico urémico.

According to the heterogenous nature of hemolytic uremic syndrome in relation to the etiology, pathophysiology, treatment and diagnosis, we wish to draw attention to the main characteristics about its epidemiological clinical and immunopathological aspects. The HUS's distributes through all the world, but in Argentina, North of Europe, South Africa and west of USA the incidence is higher than the rest of the countries. The immunopathological studies shows thrombotic angiopathic lesion, consisting in generalized alteration of the capillary and arteriolar epithelium. Decreased levels of PGI2, Von Willebrand's factor and bacterial toxins are apparently involved among mechanism that are able to produce HUS. Dialysis is one of the main helps in the treatment of HUS, and in spite of our continued advances in knowledge about this disease, still further developments are needed in pathophysiology and therapeutics to enlight its intimate mechanisms.

Surgical treatment of complete renal artery occlusion in pediatric patients.

Two children, 8 and 11 years old, presented with severe hypertension secondary to unilateral and bilateral total occlusion of the renal arteries, respectively. The 11-year-old developed sudden anuria requiring hemodialysis. Successful surgical reconstruction allowed recovery of renal function and normal blood pressure in both patients. Routine blood pressure control in the pediatric patient population, high clinical awareness, and judicious use of arteriography, provide the best chance for early diagnosis of renovascular disease. Surgical revascularization or transluminal angioplasty are the treatment modalities of choice in appropriately selected cases of renal artery stenosis. When total occlusion occurs, retrieval or preservation of renal function can be successfully achieved by direct surgical intervention.

[Hemolytic-uremic syndrome. Experience with 154 cases]. / Síndrome hemolítico urémico. Experiencia en 154 casos.

One hundred and fifty four patients with hemolytic uremic syndrome (HUS) were admitted from year 1968 throughout 1989 to a public children's hospital (n = 139) and to a private general clinic (n = 15) at Metropolitan Santiago, Chile. Their mean age at admission was 16 months, 64% of them were 6 to 18 month old. One third of patients were admitted at spring season. The prodromal phase lasted between 1 and 19 days. In 92% of cases there was antecedent diarrhea and 31% showed neurological involvement. Anuria was present in 44 patients (21%) lasting an average of 7 days; sixty one affected children (40%) became hypertensive. Sixty patients (39%) underwent peritoneal dialysis, remaining cases were given maintenance treatment for acute renal failure (ARF). No specific treatment was used except heparin in 5 children along the first years of these series. Ten patients (6%) died during the acute phase of their disease, but death occurred in only 2 of the 76 most recent cases, probably because of more accurate diagnosis and greater experience of the professional team in the management of ARF, even though very heterogeneous clinical presentations were observed along the whole observation period. Three patients developed chronic renal failure.

[Genitourinary anomalies in children with congenital scoliosis]. / Anomalías genitourinarias en niños con escoliosis congénita.

Congenital scoliosis has been associated with malformations of several systems but little attention has been paid to those of the urinary tract. Thirty five patients among 100 children with congenital scoliosis were included in this review because they had been further explored by abdominal ultrasonography or excretory urography. There were 19 female patients (54%). Age ranged from 3 months to 11 years when images were taken. Twelve patients (34%) had 15 urological abnormalities, the most frequent of these was unilateral renal agenesis (36%). In 9 of 12 affected children there were additional defects in a third system (central nervous, cardiovascular or gastrointestinal). On this basis routine abdominal ultrasonography for children with congenital scoliosis seems justified.