Ted Groshong

Serum IgE in patients with minimal-change nephrotic syndrome

Serum levels of IgE were studied in 53 children; 17 children had minimal-change nephrotic syndrome, 9 had probable MCNS, and 27 had other renal diseases. These studies showed higher levels of IgE in patients with MCNS and probable MCNS than in the renal control subjects or in the general population. Patients with MCNS who received therapy with cyclophosphamide had lower levels of IgE than those who did not.

Propranolol in human plasma and breast milk

To assess the problem of continuing propranolol therapy in a breast-feeding mother, studies were performed to determine simultaneously plasma and breast milk concentrations of propranolol after single dose (40 mg) and continuous dose (40 mg 4 times daily) treatment with this drug. Breast milk and plasma concentrations of propranolol peaked between 2 and 3 hours after dosing. Propranolol concentrations in breast milk were less than 40 and 64 percent, respectively, of peak plasma propranolol concentrations after single dose and continuous dose administration. It was estimated that the maximal cumulative propranolol load to this breast-feeding infant, consuming 500 ml of whole milk, when the mother received 40 mg of propranolol 4 times daily would be 21 microgram/24 hours. This dose is considerably less than the usual therapeutic dose of propranolol for infants.

Nicardipine for hypertensive emergencies in children with renal disease.

Abstract. Hypertensive emergencies secondary to renal diseases were treated with nicardipine in three children. Nicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its physiological actions include vasodilation, with limited effects on the chronotropic and inotropic function of the myocardium. Nicardipine, starting at 5 μg/kg per min and then continued at a maintenance infusion of 1 – 3 μg/kg per min, effectively controlled the mean arterial pressure in the three patients. Apart from occasional superficial thrombophlebitis in a fourth patient, no adverse effects were noted.

Renal Failure in the Newborn

From the Departments of Child Health and Pathology, University of Missouri-Columbia School of Medicine, Columbia, Missouri 65212. Post-dactoral Neonatal Fellow, Department of Child Health. t Director of Perinatal Medicine, and Associate Professor, Departments of Child Health and Obstetrics/ Gynecology. ‡ Assistant Professor, Department of Child Health. § Assistant Professor, Departments of Child Health and Pathology, and Associate Director, Clinical Research Center (correspondence). Received for publication August, 1978; revised January, 1979 and accepted February 9, 1979. RENAL FAILURE is a serious, potentially ~~~~ serious, fatal illness in newborn infants. The diagnosis is frequently difficult, as diagnostic maneuvers appropriate to older children and adults are technically difficult, and adult values of renal function may not apply to the infant who has immature kidneys. 1-4 Treatment, including dialysis, is frequently uneffectual.5,6 To help determine the most common clinical presentation of newborn infants with renal failure,

Presenting Signs and Symptoms of Pheochromocytoma in Pediatric-aged Patients

To describe the varied presenting signs and symptoms in pediatric patients with pheochromocytoma, a retrospective chart review of the presenting signs and symptoms and subsequent clinical course of patients who presented to the Pediatric ICU following surgical excision of a pheochromocytoma was undertaken. The cohort of 7 patients (5 boys, 2 girls) ranged in age from 4 to 16 years. Two patients were hypertensive at initial presentation, and the other 5 developed hypertension after their initial presentation. The initial presenting signs and symptoms were related to the central nervous system (CNS) in 6 of the patients (5 with an acute alteration in mental status and 1 with visual disturbances). Two patients presented with congestive heart failure. Other signs and symptoms at the time of initial presentation included sweating, headache, weight loss, heat intolerance, increased thirst and urination, a decline in school activity, and red/puffy hands and feet. The time from the initial presentation until the diagnosis was confirmed was 5 months or more in 4 of the 7 patients. The diagnosis was confirmed by demonstration of elevated urinary catecholamines in all 7 patients, although 2 patients had initial negative urinary levels.

Clevidipine Controls Intraoperative Blood Pressure In an Adolescent with Renal Failure

In pediatric-aged patients, various factors may result in perioperative hypertension including renal failure or insufficiency, volume overload, or other factors that activate the sympathetic nervous system including pain and agitation. Perioperative blood pressure control may be even more difficult to achieve and maintain in patients with pre-existing hypertension. We present a 16-year-old adolescent with renal failure and hypertension who presented for anesthetic care during placement of a peritoneal dialysis catheter. Perioperative blood pressure control was achieved with the administration of clevidipine, an ultra-short acting calcium channel antagonist of the dihydropyridine class. Its role in the perioperative control of blood pressure is discussed.

Preliminary experience with amlodipine in the pediatric population.

The authors retrospectively examined their experience with amlodipine in the treatment of hypertension in 32 pediatric-aged patients, ranging in age from 4 to 26 years, with blood pressure (BP) readings greater than the 90th percentile for age. Amlodipine was used as the sole therapy in 9 patients and with other antihypertensive therapy in 23 patients. Additional antihypertensive drugs used in combination with amlodipine included β-adrenergic antagonists, ACE inhibitors, and diuretics. The starting dose of amlodipine was 0.13±0.09 mg/kg/d. The dose was increased in 20 of 32 patients to 0.23±0.13 mg/kg/d. Amlodipine was administered once daily to 26 patients and twice daily to 6 patients. After therapy with amlodipine was initiated, the systolic BP decreased from 141±15 to 132±9 mm Hg (P=0.01) and the diastolic BP decreased from 84±16 to 77±8 mmHg (P=0,03). There were a total of 2145 follow-up BP readings. The follow-up systolic BP was lower than the initial BP prior to starting amlodipine 59% of the time and the diastolic BP was lower than the initial BP 61% of the time. The follow-up systolic BP was lower than the 90th percentile predicted for age 33% of the time after starting amlodipine and the diastolic BF was lower than the 90th percentile for age 52% of the time. Adverse effects were noted in 4 of the 32 patients (12.5%). These included fatigue (n=2), dizziness (n=1), and ankle edema (n=1). Amlodipine therapy was discontinued in only 1 patient (the patient with ankle edema). Given its efficacy, the low incidence of adverse effects, and availability as a suspension, amlodipine is an effective agent for the treatment of hypertension in the pediatric-aged patient.

Renal function following cortical necrosis in childhood

Renal disease rarely spares juxtamedullary nephrons. To identify unique characteristicsof these nephrons, renal function was assessed over 19 months in a 17-month-old child following cortical necrosis and 25 days of anuria. Open renal biopsies (ages 17 and 23 months) showed cortical destruction with selective sparing of juxtamedullary nephrons. C inulin (7.2±1.0) and renal plasma flow (C PAH ) (34±6.6/0.6 M. 2 ) were very low. Plasma renin and erythropoietin values were normal. High TmPAH/GFR, maximum Uosm, C H 2 O /GFR, and NH 4+ excretion, low minimum Uosm, C PO 4 /GFR, C urea /GFR, and the range of Uosm and C Na /GFR are consistent with preservation of relatively more tubular function per glomerular filtration rate than usual in severe renal failure.

Lithium carbonate decreases ultrafiltration rates in an experimental model of PD.

Animal studies have shown increased fluid absorption from the peritoneal cavity following intraperitoneal (ip) vasopressin. Lithium is known to antagonize vasopressin effects on fluid absorption in kidney distal nephrons. The aim of the present study was to see whether lithium-containing exchanges increase the ultrafiltration rates (UF) during peritoneal dialysis (PD) in rats. PD was carried out in 6 Sprague-Dawley rats with 1.5% dextrose-containing PD solution using 15-ml volumes. Each exchange (ex) took 1 min for inflow, 4 mins for outflow and 25 mins for dwell. All rats underwent 9 consecutive half-hourly exs. During exs 4-6 lithium carbonate 2.5 mM was added to the PD solution. During lithium-containing exs significant increases in the glucose absorption rates (3.9 ± 7.8 vs 37.5 ± 8.1 mg/ex; p=0.025) were associated with significnat reductions in the UF (3.03 ± 0.25 vs 1.78 ± 0.12 ml/ex; p=0.005). In conclusion, the isolated increase in glucose absorption without increases in the dialysate protein concentration with ip lithium, may suggest either a selective increase in size of the pores with a mean dimater near that of the glucose molecule or enhanced lymphatic absorption. ip lithium did not increase the UF in a rat model of PD.