[Uropathogen pattern and antimicrobial susceptibility in positive urinary cultures isolates from paediatric patients]. / Patrón de aislamiento bacteriano y sensibilidad antimicrobiana en urocultivos positivos obtenidos de una población pediátrica.

OBJECTIVE: Knowledge of urophatogens and antibiotic susceptibility should be used to assist with empirical urinary tract infection treatment. METHODS: We retrospectively analysed local bacterial pattern and antimicrobial susceptibility in positive urinary isolates from paediatric patients collected in the period 2009-2013. Results were compared with a previous study carried out in the same sanitary area between 1995 and 1999. RESULTS: We identified 2,762 urinary isolates. Escherichia coli was the most common uropathogen (58.9%), followed by Enterococcus sp. (11.6%) and Proteus mirabilis (10.9%). More than 95% of non extended-spectrum beta-lactamase (ESBL)-producing E. coli were susceptible to nitrofurantoin, fosfomycin, cefotaxime and aminoglycosides. However, 56%, 49%, and 22% of the E. coli isolates were resistant to ampicillin, oral first-generation cephalosporins, and trimethoprim-sulfamethoxazole, respectively. Ampicillin and amoxicillin-clavulanate were the most effective antibiotics to treat Enterococcus sp. and P. mirabilis, respectively. Not significant modifications were found compared to results published at the same area in the 90´s. CONCLUSIONS: E. coli was the mostly isolated uropathogen, with a high percentage of resistance to ampicillin, oral first-generation cephalosporins, and trimethoprim-sulfamethoxazole. These urinary isolates and antimicrobial susceptibility patterns were similar to those reported in other paediatric studies and did not show significant changes compared to local previously published results. Thus, it can be considered that the current recommendations about empiric antibiotic therapy in paediatric urinary tract infections remain applicable nowadays.

[Congenital anomalies of the kidney and urinary tract. A vision for the paediatrician]. / Anomalías nefrourológicas congénitas. Una visión para el pediatra.

The congenital abnormalities of kidney and urinary tract (CAKUT) are disorders with a high prevalence in the general population, with urinary tract dilations being the most frequent. CAKUT also account for the most important cause of chronic kidney disease in childhood. This paper focuses on the role of the primary care paediatrician in the diagnosis, assessment, and follow-up of children with CAKUT, with special emphasis on the associated urinary tract infections, the progression toward chronic renal failure, and the genetic basis.

[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.

Anomalías nefrourológicas congénitas. Una visión para el pediatra / Congenital nephro-urological abnormalities. A view for the pediatrician

No disponible

Anomalías nefrourológicas congénitas. Una visión para el pediatra / Congenital anomalies of the kidney and urinary tract. A vision for the paediatrician

Las anomalías nefrourológicas congénitas (CAKUT) son alteraciones con una alta prevalencia en la población general; de ellas, las más frecuentes son las dilataciones de la vía urinaria. Suponen además la causa más importante de enfermedad renal crónica en la edad infantil. En este artículo se hace especial énfasis en el papel del pediatra de Atención Primaria en la valoración y el seguimiento de los niños con CAKUT, fundamentalmente en lo que hace referencia a las infecciones urinarias asociadas, a la progresión hacia la insuficiencia renal y a su base genética

The congenital abnormalities of kidney and urinary tract (CAKUT) are disorders with a high prevalence in the general population, with urinary tract dilations being the most frequent. CAKUT also account for the most important cause of chronic kidney disease in childhood. This paper focuses on the role of the primary care paediatrician in the diagnosis, assessment, and follow-up of children with CAKUT, with special emphasis on the associated urinary tract infections, the progression toward chronic renal failure, and the genetic basis

[Urinary concentration capacity in neonatal hydronephrosis]. / Capacidad de concentración urinaria en la hidronefrosis neonatal.

In order to determine the renal concentration capacity in neonatal hydronephrosis, 10 micrograms of DDAVP were administered intranasally to 18 infants with hydronephrosis. Fluid intake was restricted to 50% of normal for 3 hours before and 6 hours after the administration of DDAVP. Maximal urine osmolality (mean +/- SD) was 348 +/- 180 mOsm/kg in 7 newborns younger than 21 days and 420 +/- mOsm/kg in 11 neonates between 22-50 days of age. Both osmolarities were inferior to the standard response to DDAVP reported in normal neonates. After 24 hours of clinical observation, we did not notice any secondary effects caused by this test.

[Effect of treatment with 1,25-dihydroxyvitamin D3 in children with chronic renal insufficiency]. / Efecto del tratamiento con 1,25 dihidroxivitamina D3 en niños con insuficiencia renal crónica.

The effect of 1,25-dihydroxyvitamin-D3 administration on growth rate, renal failure progression and calcium-phosphorus metabolism was evaluated in 8 children younger than 13 years, mean age 6.3 +/- 3.3 (mean +/- SD), with chronic renal failure (glomerular filtration rate: 44.1 +/- 16.5 ml/min/1.73 m2) receiving conservative treatment in whom at least two periods, with a minimal duration of six months each, without and with rocaltrol treatment, could be compared 1.25-dihydroxyvitamin-D3 at dosage of 16.3 +/- 6.3 ng/kg/day resulted in a significant increase (p less than 0.05) of growth index velocity (81.4 +/- 37.8 versus 122.4 +/- 60.3) without altering renal failure progression rate which was assessed by means of 1 to serum creatinine concentration ratio. One hypercalcemic episode (serum calcium equal or greater than 11 mg/dl) every 28.4 months was observed. Our results confirm the beneficial effect of 1.25-dihydroxyvitamin-D3 administration in the management of children with chronic real failure.

[Chronic renal insufficiency in 22 children: diagnosis and evolution]. / Insuficiencia renal crónica en 22 niños: diagnóstico y evolución.

Clinical characteristics, evolution of growth, and glomerular rate were analysed in 22 patients, younger than 14 years, with chronic renal failure (glomerular filtration rate: 32.6 +/- 24.8 ml/min/1.73 m2, x +/- DS) with a minimal follow-up of 6 months (3.5 +/- 3.3 years). Recurrent urinary tract infections were the most common initial clinical features (27%) and obstructive uropathies constituted the most frequent etiology (41%). Renal failure progression rate, which was assessed by means of 1 to serum creatinine concentration ratio, was faster in the group of children with glomerulonephropaties. At the diagnosis, one out of 3 children had short stature. At the end of the follow-up time, the delay of growth did not significatively modified (-1.6 +/- 2.2 DS versus -2.1 +/- 1.2 DS, p greater than 0.05).

[Influence of diet in idiopathic hypercalciuria]. / Influencia de la dieta en la hipercalciuria idiopática.

OBJECTIVES: To find out if differences in diet may justify the presence of idiopathic hypercalciuria (IH) and to verify if the calcium-restricted diet, often recommended for treatment of IH, is nutritionally appropriate. PATIENTS AND METHODS: Dietary intake and mineral and electrolyte urinary excretion were studied twice in 10 children diagnosed of IH and in 9 controls. First, while being on a free diet. Second, after a week of suppression of milk and dairy products. RESULTS: Intakes of calories, proteins, carbohydrates, fats, and minerals were similar in IH patients and controls. Withdrawal of dairy products of diet resulted in an important reduction in the intakes of calcium (71.1%), phosphorus (63.5%) and fats (30.1%), although only calcium intake was remarkably below international recommendations (33.6 +/- 10.4%). CONCLUSIONS: Spontaneous diet of this group of hypercalciuric children was no different from that of control children. Suppression of milk and dairy products causes a nutritionally inappropriate diet.

[Management of chronic non-terminal renal failure in childhood. Estimation of mean annual cost]. / Manejo del niño en insuficiencia renal crónica no terminal. Una aproximación al coste medio anual.

We have calculated the mean annual cost (MAC) referred to 1,988 pesetas derived from the treatment and surveillance of 15 patients diagnosed of non terminal chronic renal failure (NT-CRF). The patients were aged between 1 month and 12 years at the moment of diagnosis and they were followed-up for five years at least. We have differentiated among costs from hospitalization, pharmacological treatment and outpatient control which were respectively 455,400, 47,798 and 57,917 pesetas/patient year. The costs from hospitalization decreased progressively every year after diagnosis being of 21,211 pesetas/patient year at the 5th year from diagnosis. The 30.1% of pharmacological treatment costs were due to the use of alkalines, 23.4% to phosphorus quelants (calcic carbonate mainly) and 27.3% to the active forms of vitamin D3. The outpatient surveillance costs corresponded 24,000 pesetas/year to staff expenses, 27,492 pesetas/year to laboratory work-up and 6,424 pesetas/year to radiological examination. We conclude that the total MAC for children with NT-CRF eas 561,115 pesetas/patient being the hospitalizations costs the most important concept (81.2%), followed by ambulatory care (10.3% and drug treatment (8.5%).

[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)

[Type 1 diabetes mellitus and nephropathy. Predicting factors in pediatric age]. / Diabetes mellitus tipo I y nefropatía. Factores predictores en la edad pediátrica.

OBJECTIVE: To find the existence of early relationships between alterations in the glucidic metabolism and the glomerular and tubular basal function in diabetic insulin-dependent children without clinical evidence of diabetic nephropathy (DN). METHODS: We determined blood pressure, basal plasma concentrations of glucose, glycosilated hemoglobin and total proteins, glomerular filtration rate (GFR), and the glucose, proteins, calcium, phosphorus, uric acid, sodium, potassium and chloride excretions in diurnal, nocturnal and 24-hour urine samples in 43 diabetic children and 13 healthy controls. RESULTS: The microproteinuria mean value in all urine samples (always less than 15 micrograms/min/1.73 m.2), the GFR and blood pressure were similar in both groups. In the diabetic children, we found an inverse correlation between age and 24-hour urine microproteinuria (r-0.33; p less than 0.05) and between age and nocturnal urine microproteinuria (r-0.35; p less than 0.05). There was also a highly significant correlation between microproteinuria and the albumin/creatinine ratio in urine samples (r = 0.94, p less than 0.0001). Diabetic children showed a greater nocturnal excretion of calcium (p less than 0.05) and phosphorus (p less than 0.05). CONCLUSIONS: Our results suggest that microproteinuria, GFR and blood pressure have not served as predictors of DN in pediatric patients.

Homeostasis del magnesio. Etiopatogenia, clínica y tratamiento de la hipomagnesemia. A propósito de un caso / No disponible

El magnesio es el catión extracelular más abundante en el cuerpo humano y el segundo más abundante intracelular después del potasio. Es esencial para la transferencia, almacenamiento y utilización de la energía como regulador y catalizador de más de 300 sistemas enzimáticos. La hipomagnesemia puede producir una variedad de anormalidades metabólicas y consecuencias clínicas. Puede resultar del desequilibrio entre la absorción intestinal y la excreción renal. La principal consecuencia relacionada directamente con la hipomagnesemia son las arritmias cardiovasculares por hipopotasemia secundaria, y si no se reconoce y trata puede ser fatal. En este artículo revisamos las hipomagnesemias haciendo hincapié en los mecanismos moleculares responsables de la homeostasis del magnesio, diagnóstico diferencial y tratamiento, a propósito de la descripción de las manifestaciones clínicas y bioquímicas y el defecto genético en una familia afectada de síndrome de Gitelman (AU)

Magnesium is the fourth-most abundantion in the human body and the second-most abundant intracellular cation after potassium. Magnesium is pivotal in the transfer, storage, and utilization of energy as it regulates and catalyzes more than300 enzyme systems. Hypomagnesemia may thus result in avariety of metabolic abnormalities and clinical consequences. It results from an imbalance between gastrointestinal absorption and renal excretion of magnesium. The main consequence related directly to hypomagnesemia is cardiovascular arrhythmias secondary to hipokaliemia and if this is not recognized and treated it may be fatal. In this article we review the hypomagnesemic disorders in children with emphasis on the molecular mechanisms responsible for abnormalities in magnesium homeostasis, differential diagnosis and appropriate therapy, and we describe the clinical and biochemical manifestations as well as the genetic defect in a family with Gitelman syndrome (AU)

Cólico nefrítico / Nephritic colic

Aun tratándose de una forma de presentación infrecuente de la urolitiasis en la edad infantil, el cólico renal supone una verdadera urgencia que es preciso identificar y tratar precozmente. El diagnóstico es eminentemente clínico, pero debe ser confirmado mediante técnicas de imagen encaminadas a detectar la presencia de un cálculo en la vía urinaria o de signos obstructivos agudos en ésta. Su manejo pasa, inicialmente, por el tratamiento efectivo del dolor y la identificación de las situaciones que precisan de una valoración urgente por parte del cirujano pediátrico y, a largo plazo, por programar un seguimiento clínico adecuado hasta la objetiva y completa eliminación del cálculo (AU)

Even though this is an uncommon presentation form of urolithiasis in infant and early childhood age, renal colic supposes a true emergency which must be identified and treated early. The diagnosis is largely clinical, but it should be confirmed with imaging techniques aimed at detecting the presence of a urinary tract stone or acute obstructive signs in it. Its treatment is initially performed by the effective treatment of the pain and the identification of the situations that require urgent evaluation by the pediatric surgeon and, in the long run, by scheduling an adequate clinical follow-up until the objective and complete elimination of the stone (AU)