[Solitary kidney. Study of renal morphology and function in 95 children]. / Valoración de la morfología y función renal en una serie de 95 pacientes pediátricos con riñón unico.

UNLABELLED: The aim of the study was to evaluate renal growth and function of solitary kidney in paediatric patients. MATERIALS AND METHODS: A prospective study was performed in a fifteen years period between 1988 and 2003 in paediatric patients with a solitary kidney, in a Children's Hospital. All the following parameters were evaluated every year: age, sex, ethiology, elapsed time since the concept of solitary kidney was assessed (ET), blood pressure, renal function measured by GFR, urinary excretion of solutes, concentration ability and microalbuminuria (MA). DMSA was made at the beginning and every five years and renal ultrasonography was carried out every two years. Two groups were made depending of nephrourologic malformations in the remanent kidney and/or antecedents of pyelonephritis: Group I with antecedents of pyelonephritis and/or malformations; Group II, nor antecedents of pyelonephritis neither malformations. RESULTS: Ninety five patients were evaluated, 69% (n = 66) were males and 31% (n = 29) were females, with an age at diagnosis of 3.5 yr (ranged 0.1-17 yrs). ET was 9.2 yrs (range 1-20 yrs). The ethiology was: Nephrectomy of the contralateral kidney 39 patients (pts) (41%), renal agenesis (RA) 47 pts (49%) and nonfunctioning multicystic displastic kidney (MCDK) 9 pts (9.4%). Functional alterations were found in 18 pts (19%), such as MA in 12 pts (12.6%), decreased GRF in 5 pts (5.5%) and hypertension in 3 pts (3.2%). It was observed more significant functional alterations in the patients of the Group I (58%) versus Group II (9%) (p < 0.001). There was in Group II a significant correlation between kidney size and GFR (p < 0.01, r = 0.3), and between kidney size and ET (P < 0.05; r = 0.3). CONCLUSIONS: Any alteration in the renal function was observed in the 12.6% of the children. The most frequent affected parameter of renal damage was MA, followed by GFR reduction. Arterial hypertension was not a prominent finding. Alterations have been less frequently found in RA and MCDK of the Group II, so clinical reviews should be made with a lesser frequency.

Reflujo vesicoureteral. Aspectos viejos y nuevos / Vesico-ureteral reflux. Old and new aspects

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Influence of calcium intake on calcitriol levels in idiopathic hypercalciuria in children.

Twenty-four children with idiopathic absorptive hypercalciuria (IAH) and a control group (CG) of 11 healthy children were studied. Plasma 1,25-hydroxyvitamin D3 (calcitriol), parathyroid hormone (PTH), calcium (Ca) and phosphate (P) levels were measured during dietary manipulation. The three diets analyzed were: (A) calcium-restrictive diet (400 mg/1.73 m2/day) for 7 days; (B) supplemented diet (1,000 mg/1.73 m2/day) for 3 days; (C) supplemented diet continued for 15 days. The IAH group had higher levels of serum calcitriol than the control group for all three diets. Serum calcitriol levels in the IAH group decreased in diet B compared to diet A, and returned to levels observed with diet A during diet C. Serum Ca, P and plasma PTH levels did not vary throughout the study in either group. In IAH, two subgroups were observed. In one, serum calcitriol levels were elevated and in the other, serum calcitriol levels were not different from the controls. This second group had a lower P and maximum rate of tubular reabsorption of phosphate per 100 ml of glomerular filtrate than the IAH group with elevated serum calcitriol levels and the control group. These results suggest that IAH in children may be related both to increased serum calcitriol levels and to an altered Tmp/GFR.

[Partial lipodystrophy and membranoproliferative glomerulonephritis. Apropos of a case]. / Lipodistrofia parcial y glomerulonefritis membranoproliferativa. A propósito de un caso.

We have studied a girl seven and a half years old with a renal disease manifested by proteinuria and nephrotic syndrome combined with initial macroscopic hematuria normal blood pressure and persistent depression of the complement C3 levels with the complement activating gamma globulin (C3 Nef) present in serum. The anatomopathological study showed findings of membranoproliferative glomerulonephritis type II with intramembranous deposit (dense deposit disease). An unusual association with partial lipodystrophy was present in this case. A follow-up of five years, and a few considerations about etiopathogenic theories were presented.

[Recurrent infection of the urinary tract in girls]. / Infección recurrente del tracto urinario en niñas.

A group of 18 girls, studied in a period between 1979 and 1985 with recurrent urinary tract infections (RUTI), with at least three culture documented episodes of bacteriuria in the previous year and without radiologic evidence of urinary tract abnormality is described. Incidence was 6.1% amount a selected group of 295 girls with urinary tract infection. The period of follow-up was between 2 and 6 years (X 3.33). Symptomatology was light. No predominance of urinary symptoms were found. E. coli was the most frequent germ isolated. The number of recurrences/year/girl were significantly lower with prophylactic treatment and with years of evolution. Renal damage was not found. Vesicoureteral reflux appeared in two girls only. They had a benign course and a good prognosis. Reduction of aggressive investigation in this group of patients is proposed.

Renal handling of uric acid in normal children by means of the pyrazinamide and sulfinpyrazone tests.

Thirteen normal children have been studied with the Sulfinpyrazone and Pyrazinamide tests, in order to evaluate the mechanisms of urate tubular management. A decrease in presecretory reabsorption, and an increase in tubular secretion have been identified, with regard to what has already been reported in adults. These facts could explain the higher fractional excretion of uric acid found in childhood.

[Xanthogranulomatous pyelonephritis in childhood: analysis of 4 cases]. / Pielonefritis xantogranulomatosa en la infancia: análisis de cuatro casos.

A critical retrospective evaluation of four cases of xanthogranulomatous pyelonephritis (XPG) treated between 1966 and 1980. Incidence was 1.93%. Age range was from 1.5 and 24 months. Interval since first symptoms to diagnosis was between one and 14 months. Clinical presentation was nonspecific in two and urinary symptoms in the rest, abdominal mass present in all, the fourth had an onset similar to an acute leucosis. There were was a grossly dilated pelvis and calices in two patients and nonfunctioning kidney in the others, one with multiple calculi. Ureteral stenosis was present in two and three showed a vesiureteral reflux grade IV. Urinculture yielded E. coli and Proteus mirabilis. In all cases diagnosis was confirmed by macro and microscopic examination. Nephrectomy was effectively cure in all four children. All patients are well at the end of follow-up, between one and four years.

[Idiopathic hematuria in childhood (author's transl)]. / Hematuria idiopática en la infancia. A propósito de seis casos.

Idiopathic hematuria is a clinical condition of unknown etiology; it is defined as persistent or recurrent, macro or microscopic hematuria in the absence of systemic or local disease and with normal renal function. Six patients who had these criterions were studied. There were all girls. The age of the first episode was between one and four years. There was no other family or personal history of renal disease or deafness. Only two patients had their episodes of macroscopic hematuria within flu-like illness or exercise. All had normal renal function and no proteinuria was found. Serum C'3 and C'4 were normal. Microscopic and immunofluorescence studies were negative. We remark the convenience of a triple criteria clinical, histopathologic and evolutive to select a patient into the "idiopathic hematuria" group. We comment the usefullness of renal biopsy in the investigation of unexplained hematuria.

[Natural history of urinary tract infection in children]. / Historia natural de las infecciones del tracto urinario en niños

Urinary tract infection was studied in 61 children whose ages ranged between 6 months and 9 years. History, symptoms, urine cultures and renal function are compared between those with normal radiology and those with pyelonephritis and/or reflux and obstructive lesions. Prognosis was analized in these two groups.

[Urinary tract infection in early infancy, study of 15 cases]. / Infección urinaria sintomática en el lactante pequeño. Anánisis de 15 casos

Urinary tract infection in the newborn shows peculiar characteristics not found in older children. 15 cases of urinary tract infection in infants aged 7 days to 2 months are presented. There is higher incidence in males (11 m./4 f.). Severe clinical picture diverse and undefined clinical course, incidence of jaundice radiological findings and posterior evolution are specially noted. Early diagnosis and effective management lined in base to evolution and prognosis. Hospital stay varied between 2 and 12 weeks. No deaths were registered.