ABSTRACT
Glomerular function of all long-term survivors who underwent hemopoietic stem cell transplantation (HSCT) from 1991 to 1998 (study I, n=121) was studied retrospectively. In addition, we prospectively analyzed glomerular and tubular function of all long-term surviving children who received an HSCT between 1998 and 2000 (study II, n=41). We found a lower prevalence of children with chronic renal failure (CRF) post-HSCT in our more recent cohort (study II: 10%) as compared to the older cohort (study I: 24%) 5.0 (0.7 s.d.) and 7.6 (2.4 s.d.) year's post-HSCT, respectively. Furthermore, it seems that renal function may stabilize after 1-year post-HSCT. None of the patients required dialysis or antihypertensive medication at long-term follow-up. The sole predictor of CRF in our study was high serum creatinine pre-HSCT (P=0.007), while acute renal failure within 3 months after HSCT (P=0.08) only showed a trend towards predicting CRF. We could not confirm a relation of conditioning with irradiation with CRF post-HSCT, as was shown in several other pediatric and adult studies. Proximal and distal tubular dysfunction only occurred in a minority of long-time survivors of HSCT (3-12 and 9-13%, respectively) and had no clinical consequences.
Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Kidney/pathology , Child , Cohort Studies , Creatinine/blood , Female , Follow-Up Studies , Glomerular Filtration Rate , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Kidney Failure, Chronic/etiology , Kidney Tubules/pathology , Male , Prevalence , Prospective Studies , Regression Analysis , Retrospective Studies , Time Factors , Transplantation ConditioningABSTRACT
A neonate was born prematurely with polyhydramnios and yellow amniotic fluid. He developed gastric retention and bilious vomiting. Abdominal röntgenography showed jejunum atresia.
Subject(s)
Infant, Premature, Diseases/diagnosis , Intestinal Atresia/diagnosis , Jejunum/abnormalities , Amniotic Fluid/chemistry , Female , Fetal Diseases/diagnosis , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/surgery , Intestinal Atresia/complications , Intestinal Atresia/surgery , Jejunum/surgery , Male , Polyhydramnios/diagnosis , Polyhydramnios/etiology , Pregnancy , Pregnancy Complications , Pregnancy Outcome , Treatment OutcomeABSTRACT
AIM: To determine the incidence of immune complex associated complications (IAC) after severe meningococcal disease (SMD) in a group of Dutch children admitted to a paediatric intensive care unit (PICU). METHODS: Retrospective chart analysis and follow up of 130 survivors of SMD admitted to PICU. Signs of IAC, inflammatory parameters, and temperature profile were reviewed. RESULTS: Of 130 children with SMD, 20 (15.3%) showed one or more of the three manifestations of IAC: 18 (13.8%) developed arthritis (effusion, with or without erythema/arthralgia), 11 (8.4%) vasculitis, and five (3.8%) pleuritis. Eighteen of 20 (90%) patients with IAC had a secondary rise in temperature; in patients with no IAC this was 48 of 110 (43.6%). IAC was associated with leucocytosis in 82.3% versus 47.7% in patients without IAC, and with increased CRP in 86.6% versus 47.2% in patients without IAC. Leucocytes on admission were significantly lower in patients who would later develop IAC (mean 8.6 versus 13.8x10(9)/l). CONCLUSION: IAC is a common complication of SMD, mainly occurring 4-10 days after systemic disease. IAC presents clinically as arthritis or vasculitis, mostly accompanied by secondary fever and raised inflammatory parameters.
Subject(s)
Immune Complex Diseases/complications , Meningococcal Infections/complications , Adolescent , Arthritis, Reactive/immunology , Child , Child, Preschool , Female , Fever/complications , Humans , Immune Complex Diseases/epidemiology , Immune Complex Diseases/microbiology , Incidence , Infant , Length of Stay , Leukocytosis/complications , Male , Meningococcal Infections/immunology , Netherlands/epidemiology , Pleurisy/immunology , Retrospective Studies , Vasculitis/immunologyABSTRACT
The aim of the study was to investigate renal function and renal replacement therapy after cardiopulmonary bypass surgery in children. Patient characteristics (sex, age, diagnosis), operation type, and death were listed. The study was performed retrospectively using serum creatinine level before, and peak values after, cardiopulmonary bypass surgery for assessment of renal function. Of the children on renal replacement therapy, indication, efficacy, and complications were recorded. In a 5-year period, 1075 children had cardiopulmonary bypass surgery at the Department of Cardiothoracic Surgery at Leiden University Medical Center and Academic Medical Center of Amsterdam. One-hundred eighty (17%) patients developed acute renal insufficiency. Twenty-five (2.3%) patients required renal replacement therapy. Peritoneal dialysis is a safe and effective treatment for children after cardiopulmonary bypass surgery. However, 15 (60%) of 25 children on renal replacement therapy died of nonrenal causes. In 9 out of 10 surviving children, renal function was normal at time of discharge from hospital. Acute renal insufficiency is a frequent complication after open-heart surgery, although renal replacement therapy was infrequently necessary. Peritoneal dialysis is a safe and effective therapeutic measure for children after cardiac bypass surgery.