Renovascular hypertension in children.

Renal arteriography remains the only study to identify and define correctly both location and extent of renal artery stenosis. Because other studies do not adequately identify all children who have renal artery disease, it is reasonable to perform renal arteriography in those children with severe hypertension who do not have another readily identifiable cause for their hypertension. On the other hand, in children with less profound elevation of blood pressure in whom there is no other definable cause, it is possible to defer renal angiography. In these children with mild or moderate hypertension, studies such as the captopril 99mTc-DTPA scan or intravenous digital subtraction angiography may identify those for whom arteriography is more likely to have abnormal results.

Psychogenic intractable sneezing in children.

Four preadolescent children had paroxysms of intractable sneezing. After days of hospitalization and numerous local and systemic drug treatments had failed, a psychogenic cause of their problem was entertained. This uncommon form of conversion reaction most often occurs between the ages of 9 and 15 years, and prognosis is good if the appropriate interventions are undertaken.

Blood pressure of infants of hypertensive mothers: a two-year follow-up.

This study was designed to determine if the blood pressure (BP) of infants in the first two years of life relates to the presence of maternal hypertension during pregnancy. The BP of infants was measured at birth, and at 9, 18, and 24 months after delivery. Women with elevated BP in pregnancy or labor (n = 190) were enrolled as cases. Two-hundred-and-one normotensive women served as controls. The cases were divided according to the time BP became elevated, i.e., before or after 24 weeks of pregnancy, and intrapartum only. The largest of the case groups was hypertensive intrapartum only. A minority of the case mothers had proteinuria in association with elevated BP. There were no differences in BP between case and control infants at bith or at 9 and 18 months of age. However, by 24 months of age, the systolic BP of the infants of case mothers was higher (p less than .05) than that of the infants of control mothers. No differences in systolic BP could be attributed to the time of onset of maternal hypertension.

Cefazolin in children with renal insufficiency.

Cefazolin (7 mg/kg) were administered to 11 children with renal insufficiency and to ten children on hemodialysis. The serum half-life of the drug was progressively prolonged as glomerular filtration rate fell. The serum half-life of cefazolin was variably prolonged in those children on hemodialysis, but their serum levels of cefaxolin had dropped by 35 to 65% during dialysis. Most had no measurable level prior to the next dialysis. Dosage recommendations are made for both groups of patients.

Encephalopathy in children with chronic renal failure.

The progressive encephalopathy observed in 5 children with chronic renal failure was clinically similar to the so-called dialysis encephalopathy of adults, except that it was not related to dialysis therapy. Renal osteodystrophy is more prevalent in children than in adults and often more severe. The attempt to control the crippling deformities of renal osteodystrophy in growing children with renal insufficiency has led to the use of large quantities of aluminum containing antacids. The encephalopathy observed in children with chronic renal failure may be related to the oral ingestion of aluminum containing compounds in the presence of persistent secondary hyperparathyroidism. We suggest that alternative methods for the adequate control of serum phosphorus levels should be sought and indications for parathyroidectomy in children reevaluated. During the past 18 mos we have lowered the dose of aluminum containing compounds to 50 to 100 mg/Kg/day in our patients with progressive renal failure and recommend parathyroidectomy. No new cases of the encephalopathy have occurred.