Paulina Baquedano D

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)

Enfrentamiento médico quirúrgico de la invaginación intestinal: Experiencia de una institución universitaria

Background: Management of intestinal intussusception in children has evolved from exclusively surgical treatments to nonoperative reduction under fluoroscopic monitoring. Aim: To report a 10 year experience in a University Hospital in the management of intestinal intussusception. Patients and methods: Seventy two patients, aged 2 to 72 months of age, with an uncomplicated intussusception, that were treated by barium or air enema, were studied. Results: The success rate was 73% with barium reductions, and 100% with air reductions. In 17 patients (24%), enema reduction was unsuccessful and were subjected to a surgical reduction. Conclusions: Nonsurgical reduction is safe and effective as the initial treatment of uncomplicated intussusception in children

Quistes renales, manifestación de diversas patologías

Many diseases can be associated with kidney cysts and they may be classified as hereditary and non-hereditary renal cystic disease. The first group can be sub-classified as autosomal recessive cystic disease, such as autosomal recessive polycystic kidney disease and nephronophthisis, as autosomal dominant kidney disease such as autosomal dominant polycystic kidney disease, glomerulocystic disease and tuberous sclerosis, and as cysts associated with syndromes. Cystic dysplasia, multicystic dysplastic kidney, simple cyst, multilocular cysts, Wilms tumor and acquired cystic kidney disease are classified in the second group. The genetic study of renal cysts is becoming increasingly important, due to the possible therapeutic interventions that could be devised in the future. The aim of this review is to provide a fast and easy clinical approach to renal cysts.

Hidronefrosis perinatal: enfoque diagnostico

Prenotally diagnosed hydronephrosis is rather frequent. An adequate prenatal evaluation should consider fetalviability and available resources [technical and medical] to approach the patient and his [her) problem. Amultidisciplinary team should workup each cose individually, to deliver a rational and flexible therapeuticalrecommendation to parents. Current indications for intrauterine surgery are limited., and they will probably changewith the development of new surgical procedures. Perinatal diagnostic evaluation needs may be quite different thanthose at a later postnatal period. A diagnostic alaorithm based mainly on image studies (X ray films,ultrasonography and scintigraphy) is hereby suggested for these patients, Supported on experience gathered fromprevious studies, we describe therapeutic options and further follow-up,(Key words: hydronephrosis, perinatal, ultrasonography, scintigraphy, pyelography].

Síndrome de mala eliminación

El Sindrome de Mala Eliminacion (SME) comprende la alteracion en la evacuacion a nivel intestinal y urinario, en distintos grados y formas de presentacion clinica. Diversos estudios muestran el origen de esta patologia en una alteracion a nivel de la musculatura del piso pelviano. El objetivo de esta revision es entregarle al pediatra una vision general de este concepto, usa cada vez mas utilizado en la literatura internacional, destacando la importancia de la sospecha clinica, diagnostico y manejo precoz. Los resultados de estudios internacionales avalan la necesidad del tratamiento conjunto de la afeccion urinaria y gastrointestinal, para lograr mayor porcentaje de mejoria. El enfoque conjunto de la incontinencia y la constipacion, mas la amplia gama de situaciones clinicas que cada uno de ellos conlleva, es el objetivo que persigue introducir este nuevo sindrome

Diagnóstico y manejo de la pielectasia fetal

RESUMENPielectasia es la dilatacion leve de la pelvis renal, con o sin dilatacion de los calices, alteracion quepude ser detectada mediante ultrasonografia prenatal. La pielectasia se detecta en 2,9% de los fetosevaluados (rango: 2-7%). El criterio mas utilizado para el diagnostico es la medicion del diametro antero-posterior de la pelvis renal mayor a 4 mm antes de las 33 semanas y mayor a 7 mm despues de las 33semanas. Se recomienda clasificar a las pielectasias de acuerdo al grado de dilatacion en leve ( 15 mm). El manejo antenatal es conservador. Laevaluacion postnatal se basa en confirmar la dilatacion, determinar la etiologia y descartar obstruccion.PALABRAS CLAVES: Pielectasia fetal, dilatacion de la pelvis renalSUMMARYFetal pyelectasis is a mild dilatation of the renal pelvis, with or without dilatation of the renal chalices.Pyelectasis is detected in 2.9% of evaluated fetus (range: 2-7%). A measurement of more than 4 mmbefore 33 weeks gestation or more than 7 mm after 33 weeks in the anterior-posterior diameter of thefetal renal pelvis is used as the threshold diagnostic value. Pyelectasis are classified according to thedegree of dilatation in minimal ( 15 mm). Prenatal managementis expectant. Postnatal evaluation is aimed to demonstrate the dilatation, to precise the etiology and todiscard obstruction.KEY WORDS: Fetal pyelectasis, renal pelvis dilatation

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).

Causa infrecuente de hipertensión arterial en lactantes: neuroblastoma congénito quístico suprarrenal. Caso clínico

La frecuencia de hipertension arterial (HTA) en ninos ha aumentado significativamente en la ultima decada. A menor edad del paciente mayor es la probabilidad de que la HTA sea secundaria. Asi, las principales causas de HTA en recien nacidos son de origen renovascular o parenquimatoso. objetivo: Presentar el caso de un lactante hipertenso por neuroblastoma (NB) congenito quistico. Caso Clinico: Recien nacido con diagnostico prenatal de quiste suprarrenal, quien evoluciono con HTA por sobre el percentil 99 para edad, sexo y talla, sin respuesta a terapia farmacologica. La resonancia magnetica permitio realizar el diagnostico presuntivo de neuroblastoma congenito y la reseccion de la lesion permitio resolver la HTA y confirmar el diagnostico. Conclusion: La HTA en recien nacidos generalmente se debe a causas secundarias. El NB es el tumor maligno neonatal mas frecuente que se puede presentar como una masa abdominal de diagnostico antenatal, siendo la HTA una forma infrecuente de presentacion.