RESUMO
BACKGROUND: End-stage kidney disease may develop in 1% to 3% of cyclosporine-treated heart transplant recipients, and most patients show a decreased glomerular filtration rate. There are little data on kidney function in pediatric recipients, although good function is needed for their optimal development. METHODS: Kidney function was prospectively investigated in 10 children receiving triple immunosuppression (cyclosporine, azathioprine, methylprednisolone) during the first 18 months after heart transplantation. The early cyclosporine trough level target was 300 to 500 micrograms/L and 100 to 200 micrograms/L after the first year. 51Chromium-ethylenediamine tetraacetic acid, para-amino hippuric acid, lithium, and sodium clearances, measurements of serum and urinary electrolytes, and urinary concentration tests were performed. Renal biopsy specimens were obtained from four patients after 18 months. RESULTS: Heart function was good in all patients. Six patients (60%) remained rejection-free at 18 months. The mean glomerular filtration rate was 92.4 ml/min/1.73 m2 before transplantation, increased to 115 by 6 months (p < 0.05), and thereafter remained stable. The mean renal plasma flow was 487 ml/min/1.73 m2 after 18 months. Hypertension was seen in all patients at discharge but in only one at 18 months. Mild hyperuricemia was the most common sign of tubular dysfunction occurring in five patients at discharge but in only two patients at 18 months. The result of kidney histopathologic study was normal in three of four patients, and cyclosporine nephrotoxicity was not diagnosed. CONCLUSIONS: Triple immunosuppression with cyclosporine adequately protects the graft against acute rejection. It is compatible with normal glomerular function and leads to only minor tubular disturbances.
Assuntos
Ciclosporina/uso terapêutico , Transplante de Coração , Imunossupressores/uso terapêutico , Rim/fisiologia , Adolescente , Azatioprina/uso terapêutico , Biópsia , Quelantes , Criança , Pré-Escolar , Radioisótopos de Cromo , Ciclosporina/efeitos adversos , Ciclosporina/sangue , Ácido Edético , Eletrólitos/sangue , Eletrólitos/urina , Taxa de Filtração Glomerular/efeitos dos fármacos , Glucocorticoides/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Transplante de Coração/fisiologia , Humanos , Hipertensão/etiologia , Imunossupressores/efeitos adversos , Imunossupressores/sangue , Rim/efeitos dos fármacos , Rim/patologia , Falência Renal Crônica/induzido quimicamente , Túbulos Renais/efeitos dos fármacos , Túbulos Renais/fisiopatologia , Lítio/urina , Metilprednisolona/uso terapêutico , Estudos Prospectivos , Compostos Radiofarmacêuticos , Fluxo Plasmático Renal/efeitos dos fármacos , Fluxo Plasmático Renal/fisiologia , Sódio/urina , Ácido Úrico/sangue , Ácido p-Aminoipúrico/urinaRESUMO
Between May 1955 and July 1987, 33 children with a vascular ring compression syndrome were treated at this institution. There were 4 iatrogenic, 2 unexpectedly found and 27 symptomatic congenital vascular rings. Accurate diagnosis is based on a water soluble iodine contrast dye oesophagogram, bronchoscopy and angiography which are complementary examinations. All symptomatic congenital vascular rings were treated successfully without mortality, but the mortality was 50% if the lesion was iatrogenic in origin or unexpectedly found during palliative or corrective cardiac surgery.