[Acute renal failure in critically-ill children. A preliminary study]. / Insuficiencia renal aguda en niños críticamente enfermos. Estudio preliminar.

OBJECTIVE: To analyze the characteristics of acute renal failure (ARF) in critically-ill children and develop a protocol for a multicenter study. METHODS: A prospective, descriptive study was performed in four pediatric intensive care units (PICU) over 5 months. Epidemiological, clinical and laboratory data from children aged between 7 days and 16 years with ARF were analyzed. Premature neonates were excluded. RESULTS: There were 16 episodes of ARF in 14 patients and 62.5 % were male (mean 6 SD age: 50 +/- 49 months). The incidence of ARF was 2.5 % of PICU patients. The most frequent primary diseases were nephro-urological (50 %) and heart disease (31 %). The main risk factors for ARF were hypovolemia (44 %) and hypotension (37 %). Six patients (37.5 %) developed ARF following surgery (cardiac surgery in four, kidney transplantation in one and urological surgery in one). Furosemide was used in 13 patients (as continuous perfusion in nine), inotropes in nine and renal replacement therapy in 12. Medical complications were found in 94 % and some organic dysfunction was found in 81 %. The length of stay in the PICU was 21 +/- 21 days. The probability of death according to the Pediatric Risk of Mortality was 14 +/- 8 %. Five patients died (36 % of the patients and 31.2 % of ARF episodes). CONCLUSIONS: The incidence of ARF in critically-ill children is low but remains a cause of high mortality and prolonged stay in the PICU. Mortality was caused not by renal failure but by multiple organ failure.

[Ambulatory blood pressure monitoring in multicystic dysplastic kidney disease]. / Monitorización ambulatoria de la presión arterial en pacientes con displasia renal multiquística.

OBJECTIVE: To evaluate blood pressure in a group of patients with multicystic dysplastic kidney (MDK) disease through ambulatory blood pressure (ABP) monitoring. PATIENTS AND METHODS: ABP monitoring was performed in 16 patients with MDK disease using a Spacelabs 90207 monitor and an appropriately sized armband. The patients performed their normal daily activities except physical exercise. The activity period was 8:00 am to 8:00 pm and the resting period was midnight to 6:00 am. Patients with a percentage of correct readings of less than 70 % were excluded. The mean systolic and diastolic blood pressures for each period were calculated. Circadian variability was determined by the ratio between mean systolic and diastolic values in the active and resting periods, respectively. The results were compared with ABP values in healthy children. RESULTS: Fourteen patients (mean age 16 3.1 years, range: 6-27.6) were included. No patients with hypertension were found through casual measurement. One patient had daytime systolic hypertension. Five patients presented an abnormal drop in blood pressure during sleep. CONCLUSION: Blood pressure should be monitored in patients with MDK disease. ABP monitoring may detect alterations that can go unnoticed in casual determinations. Further studies with large samples are needed to establish the real prevalence of hypertension in these patients.

[Nephrotic syndrome in infancy: clinical, therapeutic and follow up characteristics in 100 cases]. / Síndrome nefrótico de la infancia: características clínicas, terapéuticas y evolutivas en 100 casos.

In order to understand the natural history, clinical features, anatomopathological findings and response to the initial treatment with steroids of the nephrotic syndrome (NS) during childhood, a group of 100 children under 14 years (46 with renal biopsy) observed for an average period of 4 years and 8 months, was reviewed retrospectively. The patients were divided into 3 groups: idopathic NC (89), secondary NS (9) and NS in the first six months of life (2). In the group of idiopathic NS, in which the significant predominance of males (2.8/1) was confirmed, in 69% of the patients the diagnosis was made between the ages of 2 and 5 years. Edemas were found, sometimes accompanied by oliguria and weigh gain, in 77% of the cases. The periods of hypertension and hematuria were infrequent and brief. Thirty eight kidney biopsies were carried out and showed: 25 minimal changes NS, 7 diffuse mesangial proliferative glomerulonephritis (DMPGN), 3 membranoproliferative glomerulonephritis (MPGN), 2 membranous glomerulonephritis (MGN) and 1 segmental and focal glomerulosclerosis. Of the 83 patients treated in first instance with corticosteroids, a positive response was obtained in 72 (87%), although 44% of them have shown to be cortico-dependent. After an average follow up period of 4 years and 8 months, only 2 children, one with MPGN and the other with MGN, are now in chronic renal failure (CRF). In 5 ot the 9 patients included in the second group, the NS was secondary to a Henoch Schönlein purpura. The kidney biopsies showed DMPGN in three of them.(ABSTRACT TRUNCATED AT 250 WORDS)