[Persistence of antibodies three years after vaccination with the 23-valent pneumococcal vaccine]. / Persistencia de anticuerpos a los 3 años de la inmunización antineumocócica 23-valente en pacientes con síndrome nefrótico.

OBJECTIVE: To study the persistence of antibodies after primary immunization with the 23-valent pneumococcal vaccine in children with nephrotic syndrome. METHODS: Sera from 14 of 26 children with nephrotic syndrome were obtained 3 years after vaccination. We used an ELISA method to measure IgG antibody levels to pneumococcal serotypes 14, 23F, 3 and 6B. Antibody levels before vaccination, 1 month and 3 years after vaccination were compared. RESULTS: Significant increases in specific antibody concentrations were observed 30 days after vaccination for all serotypes except serotype 3. Differences in response according to serotype were found. The highest serological response was observed for serotype 14 (78.5 % of the patients showed a good-to-moderate response). Three years after vaccination antibody levels were significantly decreased (27.3 % of children for serotype 14, 46.2 % for serotype 23F and 50 % for serotype 6B). CONCLUSIONS: The 23-valent pneumococcal vaccine is immunogenic in children aged more than 2 years with nephrotic syndrome. Response varied according to serotype. Persistence of vaccine-induced antibodies is short-term, with low antibody levels 3 years after immunization. The results of this study suggest that these patients require revaccination 3 years after the first dose.

Persistencia de anticuerpos a los 3 años de la inmunización antineumocócica 23-valente en pacientes con síndrome nefrótico / Persistence of antibodies three years after vaccination with the 23-valent pneumococcal vaccine

Objetivo: Estudiar la persistencia en el tiempo de las concentraciones de anticuerpos inducidos por la vacuna antineumocócica 23-valente en niños con síndrome nefrótico. Métodos Mediante método de enzimoinmunoanálisis (ELISA), se han determinado las concentraciones séricas de anticuerpos IgG frente a los polisacáridos capsulares de los serotipos 14, 23F, 3 y 6B de neumococo en 14 de 26 niños con síndrome nefrótico que habían sido inmunizados 3 años antes con vacuna antineumocócica 23-valente. Se han comparado las concentraciones de anticuerpos previas a la vacunación con las alcanzadas a los 30 días y a los 3 años de la misma. Resultados Los incrementos de los títulos de anticuerpos a los 30 días de la vacunación fueron estadísticamente significativos para todos los serotipos estudiados, excepto para el 3. Se observaron variaciones en la respuesta según serotipo, con una mayor inmunogenicidad para el serotipo 14 (78,5 per cent de pacientes con respuesta buena-moderada).A los 3 años de la vacunación, las concentraciones de anticuerpos habían disminuido de forma marcada (27,3 per cent de los niños para el serotipo 14; 46,2 per cent para el 23F, y 50 per cent para el 6B).Conclusiones La vacuna antineumocócica 23-valente es inmunógena en niños mayores de 2 años con síndrome nefrótico, con variaciones en la respuesta según serotipo. La persistencia de anticuerpos vacunales es limitada en el tiempo, con pérdidas importantes a los 3 años de la inmunización. Los resultados obtenidos apoyan la necesidad de revacunación a los 3 años de la primovacunación (AU)

[Immunogenicity of the 23-valent pneumococcal vaccine in children with chronic renal disease]. / Inmunogenicidad de la vacuna antineumocócica de 23 polisacáridos en niños con enfermedad renal crónica.

OBJECTIVE: To study the immunogenicity of the 23-valent pneumoccal vaccine in children with chronic renal disease and in those with nephrotic syndrome, and to compare it with the response in healthy children. METHODS: The vaccine was administered to 150 children aged 2-18 years: 113 with renal diseases (26 with nephrotic syndrome, 23 with severe grades of vesicoureteral reflux, 16 with chronic renal insufficiency, 6 renal transplant recipients, 6 requiring dialysis and 36 with other renal diseases) (group 1) and 37 healthy (group 2). Specific IgG antibodies concentrations were measured by ELISA before and 30 days after vaccination. The results obtained in both groups were compared. We compared too the response observed between the subgroup of children with renal diseases in which pneumococcal vaccine is indicated (nephrotic syndrome, chronic renal insufficiency, renal transplant and those requiring dialysis (group 3) and healthy children. RESULTS: 87.3% of children showed a 2-fold increase in antibody concentrations after vaccination. No significant differences were observed between the three groups. We considered that the vaccine was immunogenic in 78.4% of healthy children, in 77.9% of group 1 children and in 72.5% of those in the group 3 (p = 0,533). A lower response was observed in children with a kidney transplant and in those requiring dialysis. CONCLUSIONS: These results suggest that 23-valent pneumococcal vaccine is immunogenic in children with chronic renal diseases or nephrotic syndrome and may protect these patients from invasive pneumococcal disease. The importance of improved vaccine coverage is emphasized.

Inmunogenicidad de la vacuna antineumocócica de 23 polisacáridos en niños con enfermedad renal crónica / Immunogenicity of the 23-valent pneumococcal vaccine in children with chronic renal disease

Objetivos: Estudiar la inmunogenicidad de la vacuna antineumocócica de 23 polisacáridos en niños con diversos tipos de enfermedad renal crónica y en los afectados de síndrome nefrótico, y compararla con la obtenida en niños sanos. Métodos: Se han incluido en el estudio 150 niños mayores de 2 años: 113 con enfermedad renal (26 con síndrome nefrótico, 23 con reflujo vesicoureteral grado III-IV, 16 con insuficiencia renal crónica, 6 con trasplante renal, 6 en hemodiálisis y 36 con otras enfermedades renales) (grupo 1) y 37 sanos (grupo 2), a los que se administró una dosis de vacuna. Se ha determinado la concentración de IgG total específica frente a neumococo antes de la vacunación y a los 30 días de la misma por el método ELISA. Se comparan los resultados obtenidos entre los dos grupos de niños, así como la respuesta observada entre el subgrupo de niños con enfermedades renales en las que la vacuna está indicada (síndrome nefrótico, insuficiencia renal crónica, trasplante renal y terapia con hemodiálisis) (grupo 3) y los niños sanos. Resultados El 87,3 por ciento de los niños duplicaron las concentraciones de anticuerpos al mes de la vacunación, no observándose diferencias significativas entre los tres grupos. Se consideró que la vacuna fue inmunógena en el 78,4 por ciento de los niños sanos, en el 77,9 por ciento de los del grupo 1 y en el 72,5 por ciento de los del grupo 3 (p = 0,533). Los niños con trasplante renal y los sometidos a hemodiálisis presentaron una respuesta menor. Conclusiones La vacuna antineumocócica de 23 polisacáridos es inmunógena en niños mayores de 2 años con insuficiencia renal crónica, síndrome nefrótico, sometidos a trasplante renal o a hemodiálisis. Hay que destacar la importancia de aumentar la cobertura vacunal en este grupo de enfermos de alto riesgo de enfermedad neumocócica invasiva (AU)

[Lupus nephropathy in children. Based on the authors' caseload]. / Nefropatía lúpica en niños. A propósito de nuestra casuística.

We studied retrospectively 12 children with lupus nephritis divided in two groups according to the treatment made. The patients in the first group received oral 6-methyl-prednisolone alone, until children in the second received too oral cyclophosphamide. At the moment of the admission, no statistical differences were seen between both groups in terms of age, sex, clinical features, renal function, laboratory values and renal pathology based on the classification of the World Health Organisation. Patients in the second group showed a significantly better evolution in mortality (p less than 0.05), improvement of proteinuria and glomerular filtration rate (p less than 0.01 and p less than 0.05 respectively) and laboratory values, without important adverse effects. It seems that the addition of cyclophosphamide in the treatment of patients with lupus nephritis is useful to improve the prognosis of the illness in our patients.

[Pilot study of arterial blood pressure in the school children of Girona and its province]. / Estudio piloto de la tensión arterial escolar de Girona y provincia.

UNLABELLED: The arterial blood pressure was measured in 1,494 school children (810 boys and 684 girls) 5 to 14 years old who attended 46 schools in the province of Girona. OBJECTIVE OF THE STUDY: to establish the distribution of arterial blood pressure in school children in our community in empirical percentiles according to chronologic and anthropometric variables (age, height, weight and body surface). In our study the systolic arterial blood pressure increased significantly (p less than 0.001) in both sexes in all the variables studied. The simple correlations in decreasing order were, in boys: body surface, weight, height and age, and in girls: weight, body surface, height and age. However, there was no correlation between the diastolic arterial blood pressure in either sex with the variables studied.

[Tubular handling of potassium in cystinosis]. / Manejo tubular del potasio en la cistinosis.

Seven patients with cystinosis (Ccr between 30 and 90 ml/m/1.73 m2), were studied attempting to delineate renal tubular handling of potassium. Ks, Ck/Ccr X 100, Aldou and UAldo V/Ks were determined in basal conditions; tubular handling of water and sodium, and clearance of potassium were studied during hypotonic saline diuresis. Results obtained in cystinosis were compared with normal values and with values found in renal insufficiencies in the same range of GFR. Studies performed indicate that in cystinosis Ks is lower and Ck/Ccr X 100 and UAldo V/Ks higher than in normal children. During hypotonic saline diuresis, patients with cystinosis presented higher fractional water, sodium and potassium clearances than control children with the same range of GFR.

[Vesicoureteral reflux in the first year of the life (author's transl)]. / Reflujo vesicoureteral del primer año de vida.

A group of 50 children in the first year of life with vesicoureteric reflux (VUR) has been followed-up for a period of two-eleven years. VUR has been classified in four grades according to Hertz's criteria. Clinical evolution and renal scarring have been related to the degree of VUR. The absence of urinary tract infection (UTI) influences disappearance of the VUR grade 3 but does not influence the disappearance of VUR grade 2. There is a statistically significant correlation between renal scarring, the degree of VUR and renal growth. UTI influences renal growth in scarred kidneys with VUR grade 3. No scars have been seen in previously normal kidneys in the first radiological examination.