Niilo Hallman

Microscopic hematuria in schoolchildren: Epidemiology and clinicopathologic evaluation

An unselected population of 8,954 children, age 8 to 15 years, was screened for hematuria. Four urine specimens from each were examined; microscopic hematuria was found in one or more specimens in 4.1%, and in two or more specimens in 1.1% of the children. The prevalence was not age or sex dependent. Those with two or more positive samples were re-examined twice during a half-year period: 33 had hematuria of 6 or more RBC/0.9 mm3, or more than 100,000 RBC/hour, on both occasions; renal biopsy performed on 28 of them revealed two cases of IgA-IgG nephropathy, one of focal segmental sclerosis, one of extracapillary glomerulonephritis, and one of possible hereditary nephritis. In 12 patients the biopsy was entirely normal; the rest showed equivocal changes. Co-existing proteinuria and the degree of hematuria correlated well with the severity of the morphologic alterations. Pathologic findings in microscopic hematuria seem to be less frequent than in hematuria in general; in most such patients, renal biopsy is probably not indicated. In some children the low-grade hematuria may merely represent the upper end of physiologic variation.

Congenital Nephrotic Syndrome

Congentital nephrotic syndrome (CNS) is an uncommon disorder. Several different diseases may cause the syndrome. These may be inherited, sporadic, acquired or part of a general malformation syndrome. The problems associated with nephrotic syndrome in early infancy are divided into three parts: diagnosis, treatment and prenatal diagnosis. Accurate diagnosis is essential for the treatment, genetic counselling and prenatal diagnosis. The ultimate curative treatment of CNS is renal transplantation. The supportive treatment before the transplantation is of utmost importance in order to maintain a reasonable clinical condition and prepare the child for the dialysis and renal transplantation. Prenatal diagnosis is possible in some types of CNS by determination of the maternal serum and amniotic fluid alpha-fetoprotein (AFP). Increased AFP indicates fetal proteinuria, and thereby nephrotic syndrome before birth. In some cases with the onset of proteinuria after birth prenatal AFP measurement does not detect the disease.

Main Features of the Congenital Nephrotic Syndrome

Until now 85 patients with an evident congenital nephrotic syndrome have been recorded in Finland. The main features, incidence and etiology of CN are dealt with in this report.

On the ability of enuretic children to hold urine.

The functional bladder capacity has been tested in 63 enuretics (45 boys and 18 girls) by endeavouring to get the children to hold their urine as long as possible. Among the eases there were no organic diseases, infections of the urinary passages, cases of debility or patients suffering from endocrine diseases. Compared with the control material (81 boys and 48 girls) the capacity of the bladder was generally lower in the enuretics, apart from a few exceptions.

Glomerular Basement Membrane Antigens in Congenital and Acquired Nephrotic Syndrome in Childhood

Urinary and serum glomerular basement membrane (GBM) antigens were detected by immunodiffusion in patients with nephrotic syndrome and in healthy subjects. The excretion of urinary GBM antigens was greatest in patients with congenital nephrotic syndrome of Finnish type (CNF) and in patients with acquired, therapy-resistant nephrotic syndrome who had a variety of histologically identified glomerular lesions. One GBM antigen, indistinguishable from the urinary one, was also detected in the serum of four of these patients. Excretion of urinary GBM antigens was within normal limits, in patients with steroid-sensitive nephrotic syndrome with minimal changes in renal histology and in the parents (heterozygotes) of CNF patients.

NEONATAL HYPOGLYCEMIA I. Occurrence of Hypoglycemia in Patients with Various Neonatal Disorders

Two or more serial blood glucose determinations were performed before the age of five days in 964 neonates treated in the Childrens Hospital. Two or more values of 20 mg/100 ml or less, considered to indicate significant hypoglycemia, were observed in 55 infants, or 5.7% of those studied. The incidence of significant hypoglycemia was 20% in dysmature infants, 16% in infants of diabetic mothers and 15% in critically ill infants dying within ten days of birth. No other important predisposing factors were detected. A screening procedure for the early diagnosis of neonatal hypoglycemia is described.

Das kongenitale nephrotische Syndrom

Im Laufe des letzten Vierteljahrhunderts hat man von der klinisch klar umrissenen, aber hinsichtlich ihrer Atiologie noch immer ratselhaften Krankheitseinheit des nephrotischen Syndroms eine bei Neugeborenen und Sauglingen auftretende Nephrose eigenen Geprages zu unterscheiden begonnen: das kongenitale nephrotische Syndrom. Diese Krankheit kommt in Finnland weit haufiger als anderswo vor, weshalb sie dort besonders reges Interesse erweckt hat. In der Kinderklinik der Universitat Helsinki ist versucht worden, die Krankheit von den verschiedensten Seiten her zu erforschen. Die vorliegende Arbeit hat den Zweck, einerseits die vorhandene Literatur zusammenzufassen und andererseits die besonders in Finnland gewonnenen Erfahrungen zu veroffentlichen, was in dieser umfassenden Weise bisher noch nicht geschehen ist. So monoton das Krankheitsbild des kongenitalen nephrotischen Syndroms in Finnland auftritt, so sind in anderen Landern zwar ahnliche, aber doch auch betrachtlich abweichende Falle beschrieben worden, deren atiologische Ubereinstimmung mit der finnischen Krankheit nicht ohne weiteres klar ist. Sofern nicht anders angegeben, sprechen wir im vorliegenden Text vom kongenitalen nephrotischen Syndrom auf Grund der in Finnland gemachten Erfahrungen.

THE LOW‐WEIGHT GROUPS AND HAEMODIALYSIS

In pediatrics haemodialysis is an accepted treatment in states of renal and prerenal fluid imbalance due to either organic or toxic causes (1, 5) . But the low-weight groups-babies and infants-are rarely included in published series (2-4). One disincentive has been that the instrumentation is designed primarily for adults, another that the tiny vessels make it exceedingly difficult to carry out the procedure on the smallest infants. Fine et al. have reviewed 25 haemodialyses performed on children, smallest of whom weighed only 8 kg (1). In this infant cannulation was done via the femoral artery and saphenous vein for Quinton arteriovenous fistula. Vein-to-vein cannulation has been recommended earlier as the method of choice in the lowest weight groups (5) . The main indications have been acute renal failure and intoxications. This report presents experiences gained when using the low-flow system and cannulation of the main veins.

Thiocyanate Space of Body and Mineral Concentration of Erythrocytes in Severe Infantile Gastroenteritis

1. A study is made of the extracellular (thiocyanate) space and blood chemistry in 14 cases of severe infantile gastroenteritis.

Aetiological Studies on Infantile Diarrhoea in Finland

Results have been given of the occurrence of Salmonellas, Shigellas and Escherichia coli types 0–111, 0–55, 0–44, and 0–26 in the excrements of infants belonging to a series from a Finnish hospital for children. The under‐groups of E. coli are not studied.