Clinical characteristics and outcomes of children with stage 3-5 chronic kidney disease.

The aim of this study was to report on the clinical characteristics and outcomes of Belgian children with chronic kidney disease (CKD). Between 2001 and 2005, we followed 143 new successive patients younger than 20 years of age with a glomerular filtration rate of <60 ml/min/1.73 m(2) prospectively in a Belgian department of pediatric nephrology. The incidence of diagnosed CKD was 11.9 per million child population (pmcp), and the incidence of renal replacement therapy was 6.2 pmcp. There were 67% patients in CKD stage 3, 19% in CKD stage 4 and 14% in CKD stage 5. Patients with congenital anomalies of the kidney and urinary tract (CAKUTs), hereditary diseases and glomerular diseases were diagnosed at a median age of 1, 2 and 10 years, respectively. CAKUTs were the main causes of CKD, accounting for 59% of all cases. After 3, 4 and 5 years of follow-up, 27, 31 and 38% of patients treated conservatively, respectively, reached end-stage renal failure (ESRF). The progression rate to ESRF was eightfold higher in patients with CKD stage 4 than in those with CKD stage 3. Among our patient group, hereditary diseases progressed more rapidly to ESRF than CAKUTs. Transplantation was performed preemptively in 22% of these children. Infections and cardiovascular diseases were the main causes of death.

[Type 1 primary hyperoxaluria: From childhood to adult, how to manage adequately medical therapy compliance?] / Hyperoxalurie primaire de type 1 : de l'enfance à l'âge adulte, comment gérer adéquatement l'adhésion au traitement médical ?

We report the cases of three young patients suffering from type 1 primary hyperoxaluria, a metabolic genetic disorder characterized by intracellular accumulation of oxalate and which may result in end-stage renal disease with systemic impairment. A number of effective conservative therapeutic means are available for early management of affected children particularly when he is growing older. Despite the demonstrated efficacy of conservative therapy, compliance represents a major and daily challenge. Monitoring therapeutic compliance is thus an important task for physicians in charge of this disease. A better understanding of non-compliance causes is required to improve the follow-up of patients for whom treatment education must be a priority.

Ultrasound Diagnosis and Follow-Up of Neonate Renal Candidiasis.

Urinary tract infection by Candida Albicans is a severe condition that can occur in infants during the course of a preterm or intensive care hospitalization. Candidiasis can affect the kidney and dramatically impair renal function through involvement of the renal cortex, typically associated with potentially obstructive pelvi-caliceal fungus balls. This case report describes the case of a 4.5-month girl who developed renal candidiasis one week after her admission for upper respiratory tract infection. To manage the risk of urinary tract obstruction by fungus balls, several options were discussed and a conservative approach preferred to surgery that has a potential long-term impact on renal growth, proved effective.