Felipe Cavagnaro Sm

Litiasis urinaria en pediatría

Existe escasa informacion sobre litiasis urinaria pediatrica en Chile. Objetivo: Conocer las caracteristicas epidemiologicas, clinicas y de laboratorio de esta patologia. Pacientes y Metodos: Se diseno un estudio prospectivo que incluyo ingresos hospitalarios y consultas externas por litiasis en el Hospital de la Pontificia Universidad Catolica. Se elaboro una ficha que consigno identificacion, antecedentes familiares, caracterizacion clinica, laboratorio y tratamiento. Resultados: Entre enero de 1997 y diciembre del 2000, 52 ninos ingresaron al protocolo, (26 mujeres), con edad promedio de 8 anos (rango 2 meses a 16 anos 5 meses). El 50% tenia antecedentes familiares de urolitiasis. Los sintomas y signos al momento de la consulta fueron: dolor abdominal en 23 (44%), hematuria en 21 (40%), fiebre en 13 (25%), eliminacion de calculo en 11(21%), vomito en 11 (21%) e infeccion urinaria en 9(17%). En 9 (17%) fue un hallazgo. Se hospitalizaron 26 ninos, correspondiendo a 1,6 ninos con litiasis por cada 1 000 ingresos en dicho periodo. En el estudio, 12 (23%) pacientes, tenian malformaciones urinarias, siendo las mas frecuentes: doble sistema pielocalicilar (4), estenosis pieloureteral (2) y reflujo vesicoureteral (2). Catorce (37%) pacientes presentaban alteraciones metabolicas al estudio, de los cuales 11 (79%) resultaron ser hipercalciuria idiopatica. En cuatro (8%) la litiasis ocurrio durante periodos de inmovilizacion prolongada. Trece pacientes (25%) tuvieron estudio bioquimico del calculo: todos incluian oxalato de calcio puro o en su forma mixta. Diez (20%) pacientes requirieron tratamiento urologico. Conclusiones: Los sintomas de consulta mas frecuente fueron dolor abdominal, hematuria y fiebre. La mitad tenian antecedentes familiares de litiasis urinaria. El 23% tenian malformaciones urinarias y el 37% presentaban alteraciones metabolicas. El estudio bioquimico del calculo indico en todos la presencia de oxalato de calcio puro o mixto.

Factores de riesgo de daño renal permanente en niños con infección del tracto urinario

Background: In children, urinary tract infection (UTI) is a very common disease, and can cause permanent kidney damage. Aim: To determine risk factors for permanent kidney damage, in children with UTI. Patients and methods: In 337 children with UTI (237 female, mean age 4,2 years) a static renal scintigraphy was performed to assess the presence of permanent kidney damage. The history of vesicoureteral reflux and number of episodes of UTI was obtained. Results: One hundred three children had a history of one episode of infection and the rest had recurrent infections. Permanent kidney damage was observed in 161 children (48%). This damage was observed in 39% of children of less than one year of age, in 43% of children aged 1 to 5 years of age and in 58% of children older than 5 years (p=0.02). Sixty three percent of 122 children with vesicoureteral reflux had permanent kidney damage, compared with 27% of children without this condition (p <0.001). Likewise, damage was observed in 36% of children with one episode of infection and 47% of children with recurrent infections (p <0.01). No gender differences were observed. Conclusions: Vesicoureteral reflux, recurrence of UTI and age are associated with permanent renal damage in children with UTI (Rev Med Chile 2002; 130: 1147-53)

Síndrome hemolítico urémico: Experiencia de un centro pediátrico

During the period, 58 patients were admitted with thediagnosis of HUS but only 43 (age range 1 month to 6 years, 22 females) had complete medicalrecords for review. Ninety five percent presented with prodromic diarrhea, mainly dysenteric.Antibiotics were administered to 70%, in the previous days. Acute renal replacement, mainlyperitoneal dialysis, was required in 40%. The clinical signs and laboratory parameters thatcorrelated better with the indication for dialysis were anuria, hypertension, initial andpermanently high serum creatinine and blood urea nitrogen. Four patients with blood ureanitrogen over 100 mg/dl but without anuria or hyperkalemia, were treated conservatively, andexperienced an uneventful course (permissive azotemia). Hospital stay was almost 3 timesgreater in dialyzed than in non dialyzed children. No deaths related to HUS were reported inthe study period. In an average follow up of 54 months, 11.6% of the patients developed chronicrenal failure of diverse magnitude.

Riñón y deportes

La actividad deportiva ha ido ganando adeptos en nuestro pais, sin hacer diferencias entre grupos socio-economicos ni por edades. Los beneficios que aporta esta actividad fisica son ampliamente reconocidos y tienden a mejorar la calidad de vida de quienes la realizan, pero la practica de estos mismos deportes puede tener efectos adversos, mas alla de las clasicas lesiones ortopedicas y/o traumatologicas. Ya sea por la agresividad del deporte en si, la demanda fisica excesiva que requiere, o por condiciones de salud personales, esta actividad puede alterar la funcion o lesionar otros sistemas u organos. En este articulo se revisan los efectos adversos que pueden tener algunos deportes o actividad fisica sobre el rinon -sano y enfermo-, y sobre algunos parametros de regulacion homeostatica renal, con especial enfasis en la edad pediatrica

Hemofiltración continua en pacientes con complicaciones abdominales del síndrome hemolítico urémico: Report of ten cases

Background: Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dialytic therapy, mainly peritoneal dialysis (PD). In some cases, PD may have relative or absolute contraindications, usually when HUS is associated to severe intra-abdominal complications. Aim: To report the results of continuous hemofiltration use, in children with abdominal complications of HUS. Material and methods: Retrospective review of the files of 40 patients that were admitted to our pediatric unit with HUS, since 1995. Six children had relevant intra-abdominal complications and were treated with continuous hemofiltration (CHF). Four additional children, with similar HUS related complications and treated with CHF before 1995, were included in the analysis. Results: The age of the patients ranged from 5 to 66 months old. An arterio-venous CHF was performed in four and veno-venous CHF in six children. The duration of CHF was 93.2 hours in average. Adequate control of volemia was achieved in every patient; diafiltration with peritoneal dialysis solution was added in five patients, to improve azotemia. Four patients had complications related to the vascular access or the anticoagulation procedure. The procedure was terminated due to improvement of diuresis in five cases, transfer to PD in four and a cardiorespiratory arrest in one. Only one patient developed a chronic renal failure during the follow up. Conclusions: CHF is an effective and safe alternative of acute renal replacement therapy in the management of renal failure in pediatric cases with HUS, aggravated with abdominal complications (Rev Med Chile 2002; 130: 768-72).

Mortalidad por insuficiencia renal crónica en niños y adolescentes chilenos: Evolución de 20 años

Antecedentes: Durante los anos 80 y 90 se crearon en Chile diversos programas para reducir la morbimortalidad por insuficiencia renal cronica (IRC) en ninos y adolescentes. Objetivo: Describir la evolucion de la mortalidad y proporcion de muertes por IRC en un periodo de 20 anos. Material y Metodos: Se calculo la tasa de mortalidad y proporcion de muertes por IRC para cada ano del periodo 1984-2003 en pacientes menores de 19 anos. Se analizo su evolucion temporal mediante la comparacion del riesgo de fallecer por IRC en los trienios extremos (1984-1986 y 2001-2003); similar metodologia se empleo para caracterizar la evolucion temporal de la proporcion de muertes por IRC. Resultados: El riesgo de fallecer por IRC en el trienio 1984-1986 fue 3,7 veces mayor al riesgo del trienio 2001-2003 (p = 0,01). La comparacion de la proporcion de muertes por IRC no presento diferencias entre los trienios extremos (p = 0,68). Conclusion: La tasa de mortalidad por IRC en ninos y adolescentes disminuyo entre 1984 y 2003, a diferencia de la proporcion de muertes por IRC, la cual permanecio invariable. Este comportamiento estaria explicado tanto por una disminucion de la mortalidad por IRC de manera proporcional a la mortalidad por otras causas de mayor incidencia (ej. enfermedades infecciosas) como por un desplazamiento de su ocurrencia a edades mayores

Fibrosis Hepática congénita: un espectro clínico variable: Casos clínicos

: Three children presented autosomic recessivepolycystic kidney disease, which was diagnosed before the appearance of liver disease manifes-tations. They presented a more severe liver damage, with a more aggressive clinical course re-quiring use of transjugular intrahepatic porto-systemic shunts (TIPS) or surgical porto-systemicshunts to control portal hypertension. The other two children, in whom the diagnosed was basedon asymptomatic hepatomegaly, had normal renal function and structure with a more benignclinical course.

Hidronefrosis del recién nacido: Cintigrafía renal dinámica con Tc99m MAG3 durante el primer mes de vida

Background: The early and accurate diagnosis of obstructive uropathy in the newborn, prevents secondary complications and kidney damage. Aim: To study the usefulness of Tc99M MAG3 diuretic renogram in newborns with hydronephrosis. Material and methods: Forty newborns, aged 1 to 30 days, with hydronephrosis, were studied. A Tc99M MAG3 diuretic renogram (DR) was done and its results were compared with clinical features and other imaging studies. Each kidney and its ureter, were considered a renal unit. Results: Seventy six renal units were evaluated. Twenty six were normal on prenatal ultrasound examination and DR. In 11 of the 50 renal units with hydronephrosis, renal function was impaired. Thus, it was impossible to obtain an excretory curve. In 17 of the 39 remaining renal units, the absence of obstructive uropathy was demonstrated clinically. In 16 of these, the DR showed absence of obstruction. In 20 of 21 renal units with confirmed obstructive uropathy, DR showed an obstructive pattern. Conclusions: In newborns, there is an adequate Tc99M MAG3 uptake and diuretic response. Thus, DR becomes a good functional assessment method in newborns with hydronephrosis (Rev Med Chile 2003; 131: 251-8).

Síndrome nefrótico y complicaciones tromboembólicas, 4 casos clínicos y revisión de la literatura

Los fenomenos tromboembolicos en pacientes con sindrome nefrotico constituyen una de las complicaciones mas temidas debido al riesgo vital asociado. Objetivo: Describir los principales mecanismos fisiopatologicos responsables del desarrollo de este tipo de complicacion a proposito de cuatro casos clinicos, en tres de los cuales se describen fenomenos tromboembolicos cerebrales y en uno trombosis extensa de extremidad inferior asociado a dificultad respiratoria. Las interacciones entre cuatro condiciones: actividad desbalanceada entre moleculas procoagulantes y anticoagulantes, trombocitosis, hiperagregacion plaquetaria e hiperviscosidad sanguinea, promueven un estado de hipercoagulabilidad que conduce al desarrollo de complicaciones tromboembolicas, sin embargo, los mecanismos fisiopatologicos subyacentes no han sido completamente aclarados. La presencia de otros factores tales como infecciones, complejos inmunes circulantes, hipovolemia, hipertension, terapia esteroidal, punciones venosas e inmovilizacion pueden jugar un rol en la trombogenesis asociada al sindrome nefrotico. Conclusion: El sindrome Nefrotico representa una condicion de alto riesgo de tromboembolismo, y requiere consideraciones terapeuticas tales como el uso criterioso de diureticos, prevencion de infecciones, mantenimiento de niveles adecuados de albumina y el uso de farmacos antiplaquetarios y/o anticoagulantes

Glomerulonefritis crescéntica con anticuerpos anticitoplasma de neutrofilos (+) en niños.: Casos clínicos

Anti neutrophil cytoplasmic antibodies are associated to vasculitis and crescentic glomerulonephritis in adults. However, this association has been seldom reported in children. We report two girls aged 12 and 15 years old with ANCA + glomerulonephritis. Both were subjected to a percutaneous kidney biopsy. One girl had to enter a chronic hemodialysis program. The other patient recovered her renal function and after 12 months of treatment with steroids and cyclophosphamide microscopic hematuria and proteinuria persist but with normal kidney function. ANCA should be measured in children with vasculitis and glomerulonephritis