Eduardo Wolff P

Hemodiálisis crónica en niños

: The clinical features of eight patients, four females, aged 4 to 15 years under chronic hemodialysis for terminal renal failure (creatinine clearance 10 ml.min.1,73 m2 or less) are reported. Initial diseases were Alport syndrome, systemic lupus erythematosus, chronic glomerulonephritis (n = 2), bilateral polycystic kidney, prune belly syndrome and reflux nephropathy (n = 2). Distal vascular approach by means of arteriovenous fistulas was preferred for these patients and the kinetic urea model was used to evaluate the performance of the procedure. Patients required nine to twelve hours of hemodialysis per week for optimal results. Mean weight decreases of 1 to 3 kg and reductions in blood urea nitrogen and serum potassium of 40 mg.dl and 2,5 mEq.1, respectively, were observed. The main complications of hemodialysis were the disequilibrium syndrome, infections at the site of insertion of the arteriovenous fistulae and congestive heart failure. Three patients were submitted to renal transplantation with live donors homografts: one died and the other two remain alive but under chronic hemodialysis. Five children are attending school regularly, and two of them are waiting a kidney donor for transplantation. Despite encouraging results chronic hemodialysis in children constitutes only primary supportive therapy prior to renal transplantation.

Trasplante renal en pediatría: Experiencia en el Servicio de Nefrología Pediátrica del Hospital Necker des Enfants Malades, París, Francia

Successful kidney transplantation Is considered to be the optimal theraphy for end stage renal disease in children.Forty four renal transplants, five from leve-reiated donor and Ihirty nine from cadaver donor were performed along oneyear (november 1990 throughout november 1991) at fhe Pediolric Nephology Division, Necker-Enfants MaladesHospital, Paris, France. Patient caracteristics, donor-feceptor histocompatibility, inmunosuppresive regimen, early andlate complications, graft rejection and corresponding theraphy are described, together with graft function, clinicalevolution, general health conditions and complications of the transplanted patients at the time. Patients survival rate was] 00% and graft survival rate was 89%,[K«y words: kidney transplantation.)

Hipercalciuria idiopática. Diagnostico diferencial

: In 50 children with hematuria or urolithiasis and idiopathic hypercalciuria, and in 15 control children, urinary calcium/creatinine concentration rates were measured after fasting and after calcium loading. Patients were classified into two groups depending on the results of an orally administered calcium loading test. Children were considered to have absorptive hypercalciuria (42%) when they had low fasting urinary calcium/creatinine concentration ratio (less than 0.21), and a large increase of this index after calcium administration (greater than 0.28). Patients were labeled as renal hypercalciuria (32%) if they had high fasting urinary calcium/creatinine concentration ratio (greater than 0.21), and variable increases of it after calcium overload. A third group of children (26%), were not classifiable by means of this test. Our data support the contention that this simple ambulatory test is very useful in the diagnostic workup of idiopathic hypercalciuria.