Calcium carbonate as a phosphate binder in children on continuous ambulatory peritoneal dialysis and hemodialysis.

The aim of the study was the evaluation of the efficacy of calcium carbonate (CaCO3) in the control of serum phosphorus level in children with ESRD. Sixteen patients (group I) were evaluated retrospectively, 25 pts (group II) were observed prospectively. The pts from group I were treated with CaCO3 (100-800 mg/kg/day) with or without Al(OH)3 and with different doses of DHT. The pts from group II were treated with CaCO3 and DHT without Al(OH)3 but some of them had obtained Al(OH)3 in the past. The doses of CaCO3 were individually adjusted to maintain the serum calcium level 5.0-5.5 mEq/l. In the pts on CAPD evaluated retrospectively the control of serum phosphorus level was better and episodes of hypercalcemia were more frequent than in the pts on HD. Neither the concomitant use of Al(OH)3 with CaCO3 nor varying the dosage of DHT within assumed range influenced serum phosphorus level. The differences in serum phosphorus level and in the frequency of episodes of hypercalcemia in pts in group II were less obvious then in group I. It may depend on more precise adjustment of CaCO3 doses to the individual needs of these pts. The episodes of hypercalcemia in the group II were more frequent in pts who received Al(OH)3 in the past.

Acquired cystic kidney disease in renal insufficiency.

The frequency of acquired cystic kidney disease (ACKD) in adult patients with end-stage renal failure (ESRF) varies from 8 to 95%. Systematic data are available neither on children with chronic renal insufficiency (CRI) nor on the frequency of ACKD in children below 15 years undergoing dialysis. Twenty-one children with CRI and 28 patients with ESRF were investigated. The age of the children ranged from 1 month to 15.8 years. Ultrasonographic examination determined the incidence of ACKD; in some children computerized tomography was performed. ACKD was diagnosed in 2 children (9.8%) with CRI and in 6 (21.6%) with ESRF. Diagnostic criteria and evolution of ACKD within the observation period of 3-48 months (mean 23.4 +/- 12.6 months) are discussed.

Prognostic significance of certain factors in the haemolytic-uraemic syndrome.

The prognostic significance of certain factors in the outcome of the haemolytic-uraemic syndrome (HUS) was evaluated. Seventy-three children with HUS were observed; 35 recovered without residual abnormalities, 6 had normal renal function with hypertension (HT) and/or urinary abnormalities, 5 had chronic renal failure, 1 child required chronic dialysis treatment, 4 children died of end-stage renal failure, and 22 died of acute renal failure (ARF). To identify the risk factors which influence prognosis, a logistic discrimination method was used to analyse the clinical and laboratory data. The logistic discrimination method established the role of independent factors which were linked together. The grouping of the patients in three different categories of favourable and unfavourable prognosis yielded conclusions concerning: (1) outcome of ARF survivors (2) recovery without sequelae or all other outcomes including death; (3) survival or death. The most important unfavourable factors for recovery of ARF survivors were HT and to a lesser degree cardiovascular (CV) disturbances; for recovery of the entire group, and for survival, the presence of CV disturbances was the worst prognostic factor. Among other factors were seasonal incidence, central nervous system disturbances, prodromal symptoms and age, which varied in their prognostic significance in the various groups.

[Acquired cysts of the kidneys in children with chronic renal failure]. / Nabyta torbielowatosc nerek u dzieci z przewlekla niewydolnoscia nerek.

The study aimed at evaluating an incidence of the acquired cysts of the kidneys in children with chronic renal failure. The study involved 33 children with renal failure treated conservatively with continuous peritoneal dialysis under ambulatory conditions and hemodialyses. CT tomography and sonography were carried out in all patients. The acquired cysts of the kidney were diagnosed in one out of 33 examined patients (3.03%) by ultrasound. This result was confirmed by CT-scanning. It is worth following the development of the cyst in his child waiting for kidney transplantation and further following all dialysed patients with ultrasound performed once per three months and CT-scans in some patients.