Subject(s)
Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , Adolescent , Child , Female , Humans , MaleABSTRACT
A case is reported of a female preschool, age child with nephrotic syndrome, probably secondary to focal and segmentary hyalinosis with progressive decrease of the renal function. The patient was given increasing doses of furosemide to control the important retention of fluids she showed until a daily dose of 120 mg/kg. of body weight was reached. Adequate control of edema was managed and it was possible to decrease sodium restriction from the diet when urinary excretion of sodium increased. Such effect was useful for four months during which, the patient's diet turned more adequate and there was improvement of the nutritional state which was seriously impaired because of the restrictive diet given. However, control was lost because the patient died at home from bronchopneumonia. Thus, it is considered furosemide may be used in chronic renal failure at higher than usual doses in selected patients.
Subject(s)
Furosemide/administration & dosage , Kidney Failure, Chronic/drug therapy , Body Weight , Child , Drug Evaluation , Female , Furosemide/adverse effects , Furosemide/therapeutic use , HumansABSTRACT
Nine infants without evidence of nephropathy were studied. After a control period, furosemide, 1.0 mg/kg. of body weight, was administered intravenously and urine was collected. In all patients, urinary volume increased from a mean of 0.15 ml/min. during the control period, to 0.69 ml/min. after furosemide and urinary sodium excretion rose from 1.77 micro Eq/min. in the first period, to 50.13 micro Eq/min. in the second. There was no significant change in urinary osmolarity and in serum electrolytes. Three hours after furosemide, all children showed dehydration from light to moderate and saline infusion was necessary. No correlation was found between age and weight of the infants with the response to furosemide. Because this diuretic has an energetic action in infants as in children and adults, it must be used carefully and it is proposed that the initial dose of furosemide in infants be 0.5 mg/kg.
Subject(s)
Diuresis/drug effects , Furosemide/administration & dosage , Natriuresis/drug effects , Age Factors , Birth Weight , Drug Evaluation , Female , Furosemide/pharmacology , Humans , Infant , Infant, Newborn , Injections, Intravenous , Kidney/drug effects , Male , Osmolar Concentration , Sodium/urineABSTRACT
Five uremic (7.0 - 15.2 years), non-dialyzed children treated medically (group 1) had an intravenous glucose tolerance test (0.5 g/kg). Blood samples were obtained at frequent intervals and duplicate determinations of plasma glucose (glucose-oxidase method on Somogyi-Nelson protein-free filtrates), insulin and free fatty acids were performed. The same study was performed in eleven children (12.3 - 18.0 years) with chronic renal failure undergoing long-term hemodialysis (group 2), before and two hours after dialysis. Results were compared to a group (group 3) of eight healthy children (7.5 -- 17.5 years). In group 1 a "normal" insulin response was observed in the presence of hyperglycemia and the plasma glucose clearance was in the diabetic range. Twice weekly hemodialysis produced no beneficial acute effects on group 2, based on absolute glucose values or plasma glucose clearance rates, on groups as well as on individual basis; however, a clear hyperinsulinemia was present which was of even higher magnitude three and six months after the initial study. These results demonstrated that chronic hemodialysis had no beneficial acute effects on plasma glucose concentration or plasma glucose clearance rate. However, it may have obvious long term beneficial effects on glucose tolerance by enhancing pancreatic insulin release (to overcome peripheral insulin resistance) to such an extent as to maintain a normal carbohydrate tolerance.
Subject(s)
Kidney Failure, Chronic/therapy , Adolescent , Child , Female , Glucose Tolerance Test , Humans , Insulin/metabolism , Insulin Secretion , Kidney Failure, Chronic/blood , Male , Renal Dialysis , Secretory RateABSTRACT
Seventy-eight A-V fistulas were constructed in 45 children whoses age were between 4 to 16 years, in order to use it for chronic hemodialysis. Twenty-four of them were external A-V shunts which were occluded by thrombosis in 13 instances and deinserted in 3 patients. Thirty-six A-V fistulas were performed with saphenous wein autograft between an artery and vein at the forearm. The main complication in this group was thormbosis in 10 instances and dilations of the graft in 5. In 9 patients, latero-lateral arteriovenous anasthomosis was performed. In these, adequate blood flow developed slowly or was poor in most patients. Six patients with saphenous-femoral anasthomosis developed thrombosis in 3 instances and venous puncture was frequently difficult. In three other patients, bovine carotid artery graft was very efficient to give a good access to circulation for hemodialysis. There was no evidence of local or cardiovascular complications associated with fistulas.
Subject(s)
Acute Kidney Injury/therapy , Arteriovenous Shunt, Surgical/methods , Renal Dialysis , Adolescent , Animals , Carotid Arteries/transplantation , Cattle , Child , Child, Preschool , Female , Femoral Vein/transplantation , Humans , Male , Saphenous Vein/transplantation , Transplantation, Autologous , Transplantation, HeterologousABSTRACT
In three hypertensive uremic children in whom hypertension was not controlled by sodium-free diet, ultrafiltration and hypotensive drugs, a total of twenty low sodium concentration hemodialyses were carried out. In all patients there was insignificant sodium excretion in urine and diastolic blood pressure diminished 10 to 20 mm Hg; two patients showed also reduction of systolic blood pressure. No important changes were seen in the serum concentrations of sodium, calcium and glucose. In one patient improvement of his retin lesions, as well as radiological reduction of heart size were observed. In other two cases, cardio-respiratory symptoms associated with hypertension disappeared. In all but two of them hypotensive drugs were withdrawn; in the other one dose was reduced. With low sodium concentration hemodialysis, sodium extraction was higher than that obtained when using the conventional dialysis solution. Interchangeable sodium decreased in all patients.
Subject(s)
Acute Kidney Injury/complications , Hypertension/complications , Renal Dialysis/methods , Acute Kidney Injury/therapy , Adolescent , Child , Female , Humans , Hypertension/therapy , Hypotonic Solutions , Male , Sodium Chloride/therapeutic useABSTRACT
Six uremic dhildren in periodic hemodialysis with protein-calorie malnutrition were studied. Three of them were given diet supplementation with a compound constituted by carbohydrates and essential amino acids. Evaluation at ,3 and 6 months with somatometry, rutine laboratory analysis, intravenous glucose tolerance test and plasma amino acid determinations, showed that patients with diet supplementation had a slight increase in height and body weight, improved glucose in tolerance, that was initialy detected, and an abnormal pattern of plasma amino acids not modified during the study. Patients without diet supplementation showed no changes in height, body weight, glucose tolerance and plasma amino acids. These results suggest that diet supplementation with carbohydrates and amino acids is useful to improve nutrition in uremic children on hemodialysis, but it is neccesary to study more patients.