[Thyroid dysfunction in children with chronic renal failure]. / Alteraciones de la función tiroidea en niños con insuficiencia renal crónica.

OBJECTIVES: To determine the frequency and type of thyroid dysfunction in children with chronic renal failure (CRF) in peritoneal dialysis (PD) or hemodialysis (HD); and to establish the accuracy of the presence of goiter to identify patients with CRF and thyroid dysfunction. PATIENTS AND METHODS: This is a cross-sectional study performed in a tertiary pediatric medical care center. CRF patients younger than 17 years old, with more than three months in PD or HD were included. All patients were assessed regarding their growth and sexual development; thyroid dysfunction was evaluated by serum concentration of thyrotropin (TSH), thyroxine (T4L) and triiodothyronine (T3T). RESULTS: 50 patients were included, 25 were male, and mean age was 12 years old. There were 14 (28%) patients with thyroid dysfunction; nine had subclinical hypothyroidism, three patients had euthyroid sick syndrome and two primary hypothyroidism. Thirteen patients had goiter: seven had thyroid dysfunction and in six patients the thyroid function was normal. The sensitivity of goiter to detect thyroid dysfunction was 50% and the specificity was 83.3%. The two patients with the greatest delay in their growth were hypothyroid. CONCLUSIONS: Given that the high frequency of thyroid dysfunction in children with CRF, these patients need a systematic screening, in order to improve their quality of care.

Alteraciones de la función tiroidea en niños con insuficiencia renal crónica / No disponible

Objetivos: Determinar la frecuencia y tipo de alteraciones de la función tiroidea en niños con insuficiencia renal crónica (IRC) en programa de diálisis peritoneal (DP) o hemodiálisis (HD), así como establecer la utilidad de bocio como marcador clínico para identificar pacientes con IRC que cursan con alteraciones de la función tiroidea. Pacientes y métodos: Estudio transversal y descriptivo, realizado en un hospital pediátrico de tercer nivel de atención. Se incluyeron pacientes menores de 17 años, con IRC y con más de tres meses en DP o HD. En cada paciente se evaluó su crecimiento y desarrollo, así como la presencia de bocio. Las alteraciones tiroideas se detectaron mediante la cuantificación de los niveles séricos de tirotropina (TSH), tiroxina (T4L) y triyodotironina (T3T). Resultados: Se incluyeron 50 pacientes, 25 del sexo masculino, con edad promedio de 3 años. Hubo 14 (28%) pacientes con alteración en la función tiroidea, nueve con hipotiroidismo subclínico, tres con síndrome de enfermo eutiroideo y dos con hipotiroidismo primario. En 13 pacientes se detectó bocio, siete con disfunción tiroidea y seis con función normal. La sensibilidad del bocio para la detección de alteraciones tiroideas fue del 50%, y la especificidad del 83.3%. Dos de los pacientes con hipotiroidismo presentaron la mayor afectación en su crecimiento. Conclusiones: Debido a la alta frecuencia de alteraciones tiroideas en niños con IRC, es necesaria su valoración de manera sistemática, a fin de mejorar la calidad de su atención (AU)

Objectives: To determine the frequency and type of thyroid dysfunction in children with chronic renal failure (CRF) in peritoneal dialysis (PD) or hemodialysis (HD); and to establish the accuracy of the presence of goiter to identify patients with CRF and thyroid dysfunction. Patients and methods: This is a crosssectional study performed in a tertiary pediatric medical care center. CRF patients younger than 17 years old, with more than three months in PD or HD were included. All patients were assessed regarding their growth and sexual development; thyroid dysfunction was evaluated by serum concentration of thyrotropin (TSH), thyroxine (T4L) and triiodothyronine (T3T). Results: 50 patients were included, 25 were male, and mean age was 13 years old. There were 14 (28%) patients with thyroid dysfunction; nine had subclinical hypothyroidism, three patients had euthyroid sick syndrome and two primary hypothyroidism. Thirteen patients had goiter: seven had thyroid dysfunction and in six patients the thyroid function was normal. The sensitivity of goiter to detect thyroid dysfunction was 50% and the specificity was 83.3%. The two patients with the greatest delay in their growth were hypothyroid. Conclusions: Given the high frequency of thyroid dysfunction in children with CRF, these patients need a systematic screening, in order to improve their quality of care (AU)

Amuchina 10% solution, safe antiseptic for preventing infections of exit-site of Tenckhoff catheters, in the pediatric population of a dialysis program.

Although, decreasing in incidence with the disconnection systems, the first complication is still peritonitis in patients with chronic renal failure and the second is infection of Tenckhoff catheter exit-site. All efforts made to diminish the frequency of exit-site infection lower the possibility of peritonitis. The pediatric population is well-known to have a major risk of infectious complications, and making easy and safe the care of the exit-site will prevent the peritonitis that follows. The aim of the study was to evaluate the efficacy of the Amuchina 10% solution vs. pH neutral soap in children with chronic renal failure, on preventing exit-site infection. There were 60 patients who were assigned randomly to one of two groups. One group used Amuchina 10% solution for the daily cleaning of the exit-site, and the other used pH neutral soap, with 14 months of follow-up. Before the study they have to be free of infection for at least 30 days. All were taught by the same nurse how to clean their exit-site. Groups were almost identical in years, sex, and time on dialysis. We had nine infections in the soap group and none in the Amuchina 10% solution group, with an OR: 17 (p = 0.004). From these nine infections, the bacteria isolated were: 4 (13%) were caused by Pseudomona aeruginosa, 1 (3.3%) by Staphylococcus aureus, coagulase-positive staphylococci in 2 (6.6%) and Serratia marcensens in 1 (3.3%). In conclusion, Amuchina 10% solution is effective in preventing infection on the exit-site, without any secondary topical reaction.

"H" reflex as a measure of subclinical uremic polyneuropathy in children with chronic renal failure.

Uremic polyneuropathy (UPNP) is a serious complication of chronic renal failure (CRF) in adults; however, its prevalence is unknown in the pediatric population. An easy-to-perform maneuver for its detection in children is the evaluation of "H" reflex. The objective of this study was to validate the usefulness of the "H" reflex maneuver for the diagnosis of UPNP in pediatric dialysis patients for CRF. Thirty-seven CRF patients were paired with healthy controls by age and sex. The patients were being treated with dialysis or one of its variants. Information was obtained regarding diagnosis, duration, and control of dialysis. Neurological examination was performed, conduction velocities in sensory and motor nerves were measured, and "H" reflex elicited bilaterally. Peripheral polyneuropathy was determined by the presence of at least two nerves with alterations in latency and/or conduction velocities. It was found that 59.4% (22/37) of the children with CRF treated with dialysis developed UPNP, 17 with ambulatory peritoneal dialysis, and 5 with hemodialysis. There was no difference in diagnosis, duration of dialysis, or control of the same in these patients from other CRF patients who did not have UPNP. All patients were clinically asymptomatic. "H" reflex showed a sensibility of 44%, a specificity of 87%, a predictive value positive of 66%, and a predictive value negative of 76%, when measured to 28 msec. With a 30 msec duration specificity rises to 95%. UPNP presents asymptomatically in pediatric patients. "H" reflex is an adequate screening test for the selection of pediatric patients to be tested further.