Tratamiento con hierro en la enfermedad renal crónica moderada-grave no terminal / Treatment with iron in non-endstage moderate-chronic kidney disease

No disponible

Unidad de Nefrología Pediátrica del Hospital Universitario 12 de Octubre / Pediatric Nephrology Unit of the University Hospital 12 de Octubre

La Nefrología Pediátrica es una subespecialidad pediátrica reconocida internacionalmente desde el año 1967 y es una de las áreas de capacitación en vías de acreditación oficial (en el momento actual la acreditación se obtiene a través de la Asociación Española de Nefrología Pediátrica creada en el año 1973). La Unidad de Nefrología Pediátrica del 12 de Octubre está catalogada como nivel II (atiende toda la patología renal pediátrica y la insuficiencia renal terminal mediante diálisis). Cumple todos los requisitos exigidos por la Sociedad de Nefrología Pediátrica para la formación de los especialistas en Pediatría y sus áreas específicas, tanto para la formación general de Pediatría como para la capacitación en Nefrología Pediátrica (subespecialidad pediátrica) contemplando una rotación externa. LaUnidad dispone de consultas externas, planta de hospitalización, hospital de día y sala de intervencionismo compartidas estas dos últimas con otras especialidades pediátricas. En el momento actual hay dos facultativos especialistas de área con capacitación específica en nefrología pediátrica. La cartera de servicios incluye toda la patología renal desde el momento de la concepción hasta los 16 años con excepción del manejo de la enfermedad renal crónica que requiere terapia sustitutiva. Se imparte docencia pregrado a los estudiantes de la Universidad Complutense de Madrid y se colabora activamente en las sesiones y formación de los residentes de la especialidad de Pediatría. La Unidad de Nefrología Pediátrica se mantiene activa con líneas de investigación propias (algunas financiadas) y con colaboración en trabajos, registros y ensayos multicéntricos que producen una actividad cientifica nada despreciable (AU)

Pediatric Nephrology is a pediatric subspecialty that has been internationally known since 1967 and is one of the training areas undergoing official accreditation (at present, accreditation is obtained through the Spanish Association of Pediatric Nephrology created in the year 1973). The Pediatric Nephrology Unit of the 12 de Octubre is listed as level II (it attends to all the pediatric renal conditions and end-stage kidney failure by dialysis). It complies with all the requirements of the Pediatric Nephrology Society for the training of specialists in Pediatrics and their specific areas, both for general Pediatrics training as for training in Pediatric Nephrology (Pediatric subspecialty) contemplating an external rotation. The Unit has external consultations, hospitalization ward, day hospital, and interventionism ward, sharing the latter two with other pediatric specialties. At present, there are two area medical specialists with specific training in pediatric nephrology. The services portfolio includes all the renal conditions from the moment of the conception up to 16 years except for management of chronic kidney disease that requires replacement therapy. Pre-graduate teaching for Complutense University of Madrid students is given and they collaborate actively in the sessions and training of the Pediatric specialty residents. The Pediatric Nephrology Unit remains active with their own research lines (some financed) and with collaboration in multicenter trials, registries, works and that produce a significant scientific activity (AU)

Utilidad de los parámetros analíticos en el manejo de los pacientes pediátricos con sospecha de pielonefritis aguda. ¿Es fiable la procalcitonina? / Usefulness of analytical parameters in the management of paediatric patients with suspicion of acute pyelonephritis. Is procalcitonin reliable?

Objetivo. Valorar la utilidad de la procalcitonina (PCT) y de otros parámetros analíticos (leucocitos en sangre, proteína C reactiva [PCR]) como indicadores de daño renal agudo en niños tras su primer episodio de infección del tracto urinario febril o afebril (ITU). Material y métodos. Se ha realizado un estudio retrospectivo, con obtención de medidas séricas de PCT, PCR y leucocitos en pacientes pediátricos admitidos entre enero de 2009 y diciembre de 2011, con un primer episodio de ITU, objetivando el daño renal agudo mediante gammagrafía renal con 99mTc-DMSA (DMSA) en las primeras 72h después de la admisión. Se ha llevado a cabo un estudio descriptivo de la muestra y un trazado de curvas ROC con cálculo de puntos de corte óptimos para cada parámetro. Resultados. Se han incluido 101 pacientes divididos en 2 grupos en función del resultado del DMSA, 64 fueron diagnosticados de pielonefritis aguda (PNA) y 37 de ITU. Las medias de leucocitos en sangre, PCR y PCT fueron significativamente mayores en pacientes con PNA respecto a aquellos con DMSA normal. El área bajo la curva ROC fue de 0,862 para la PCR, 0,774 para leucocitos en sangre y 0,731 para la PCT. El punto de corte óptimo para la PCT fue 0,285ng/ml (sensibilidad 71,4% y especificidad 75%). Conclusión. Si bien los niveles medios de fiebre, leucocitos, PCR y PCT estuvieron significativamente más elevados en pacientes con PNA que en los que tenían ITU, la sensibilidad y especificidad de estos parámetros analíticos no permiten predecir la existencia de afectación renal aguda, haciendo imprescindible la realización de una gammagrafía renal con DMSA (AU)

Objective. To investigate the usefulness of procalcitonin (PCT) and other analytical parameters (white blood cell count [WBC], C-reactive protein [CRP]) as markers of acute renal damage in children after a first febrile or afebrile urinary tract infection (UTI). Methods. A retrospective study was conducted on children with a first episode of UTI admitted between January 2009 to December 2011, and in whom serum PCT, CRP and white blood cell count were measured, as well as assessing the acute renal damage with renal scintigraphy with 99mTc-DMSA (DMSA) within the first 72h after referral. A descriptive study was performed and ROC curves were plotted, with optimal cut-off points calculated for each parameter. Results. The 101 enrolled patients were divided into two groups according to DMSA scintigraphy results, with 64 patients being classified with acute pyelonephritis (APN), and 37 with UTI. The mean WBC, CRP and PCT values were significantly higher in patients with APN with respect to normal acute DMSA. The area under the ROC curve was 0.862 for PCR, 0.774 for WBC, and 0.731 for PCT. The optimum statistical cut-off value for PCT was 0.285ng/ml (sensitivity 71.4% and specificity 75%). Conclusion. Although the mean levels of fever, WBC, CRP, and PCT were significantly increased in patients with APN than in those who had UTI, the sensitivity and specificity of these analytical parameters are unable to predict the existence of acute renal damage, making the contribution by renal DMSA scintigraphy essential (AU)

Usefulness of analytical parameters in the management of paediatric patients with suspicion of acute pyelonephritis. Is procalcitonin reliable? / Utilidad de los parámetros analíticos en el manejo de los pacientes pediátricos con sospecha de pielonefritis aguda. ¿Es fiable la procalcitonina?

OBJECTIVE: To investigate the usefulness of procalcitonin (PCT) and other analytical parameters (white blood cell count [WBC], C-reactive protein [CRP]) as markers of acute renal damage in children after a first febrile or afebrile urinary tract infection (UTI). METHODS: A retrospective study was conducted on children with a first episode of UTI admitted between January 2009 to December 2011, and in whom serum PCT, CRP and white blood cell count were measured, as well as assessing the acute renal damage with renal scintigraphy with 99mTc-DMSA (DMSA) within the first 72h after referral. A descriptive study was performed and ROC curves were plotted, with optimal cut-off points calculated for each parameter. RESULTS: The 101 enrolled patients were divided into two groups according to DMSA scintigraphy results, with 64 patients being classified with acute pyelonephritis (APN), and 37 with UTI. The mean WBC, CRP and PCT values were significantly higher in patients with APN with respect to normal acute DMSA. The area under the ROC curve was 0.862 for PCR, 0.774 for WBC, and 0.731 for PCT. The optimum statistical cut-off value for PCT was 0.285ng/ml (sensitivity 71.4% and specificity 75%). CONCLUSION: Although the mean levels of fever, WBC, CRP, and PCT were significantly increased in patients with APN than in those who had UTI, the sensitivity and specificity of these analytical parameters are unable to predict the existence of acute renal damage, making the contribution by renal DMSA scintigraphy essential.

Parada cardíaca: presentación mortal de una miocarditis viral / Cardiac arrest: Fatal presentation of viral myocarditis

La miocarditis es un trastorno inflamatorio del miocardio que cursa con la necrosis de los miocitos. La principal causa son las infecciones virales. La presentación clínica es muy variada: desde formas leves hasta formas fulminantes que cursan con la muerte y que se inician frecuentemente con síntomas banales. Presentamos el caso de un niño de 18 meses que acude a urgencias por astenia y anorexia de 24h de evolución, con antecedente de fiebre en el contexto de infección respiratoria de vías altas la semana anterior. A su llegada a urgencias y durante las primeras horas de observación la exploración física fue rigurosamente normal. Posteriormente presentó empeoramiento progresivo del estado general (palidez y mala perfusión periférica) con alteraciones analíticas (acidosis metabólica, insuficiencia renal e hiperglucemia) y de forma brusca parada cardiorrespiratoria sin respuesta a maniobras de reanimación cardiopulmonar (AU)

Myocarditis is an inflammatory disease of the myocardium accompanied by necrosis of myocytes. The main causes are viral infections. The clinical presentation varies from mild forms to devastating ones which usually begin with trivial symptoms with progression, in some cases, to death. We report the case of an 18 month-old male toddler consulting for asthenia and anorexia for the last 24h and a previous history of respiratory tract infection with high fever in the last week. Upon arrival at the emergency room and during the first hours of admission, physical examination was perfectly normal. Later, his general state gradually deteriorated, with biochemical disturbances (metabolic acidosis, renal failure and hyperglycaemia) and, eventually, a sudden cardiac arrest, with no response to cardiopulmonary resuscitation manoeuvres (AU)

[Cardiac arrest: fatal presentation of viral myocarditis]. / Parada cardíaca: presentación mortal de una miocarditis viral.

Myocarditis is an inflammatory disease of the myocardium accompanied by necrosis of myocytes. The main causes are viral infections. The clinical presentation varies from mild forms to devastating ones which usually begin with trivial symptoms with progression, in some cases, to death. We report the case of an 18 month-old male toddler consulting for asthenia and anorexia for the last 24h and a previous history of respiratory tract infection with high fever in the last week. Upon arrival at the emergency room and during the first hours of admission, physical examination was perfectly normal. Later, his general state gradually deteriorated,with biochemical disturbances (metabolic acidosis, renal failure and hyperglycaemia) and, eventually, a sudden cardiac arrest, with no response to cardiopulmonary resuscitation manoeuvres.

¿Se puede predecir el reflujo vesicoureteral en lactantes con infección urinaria? / Can vesicoureteral reflux be predicted in infants with urinary infection?

No disponible

No disponible

[Acute lobar nephronia: Diagnosis, treatment and prognosis]. / Nefronía focal aguda bacteriana: diagnóstico, tratamiento y evolución.

Acute lobar nephronia is a focal form of acute bacterial renal infection. The prevalence of this disease is low. We report four cases of acute lobar nephronia. Three patients were diagnosed among 77 patients admitted to hospital for acute pyelonephritis. The fourth case was atypical and associated with epidermolysis bullosa. All cases were diagnosed by renal ultrasonography and the diagnosis was confirmed by computed tomographic examination in two patients with poor clinical course. A small abscess was detected in one patient. Urine cultures were positive in three of the four patients. Acute lobar nephronia is a radiological diagnosis and requires aggressive treatment and strict follow-up due to the risk of renal abscesses. Because the clinical manifestations are insidious and laboratory findings can be contradictory, this entity should be suspected in patients with poor clinical course or alterations on renal ultrasonography. Medical treatment is usually sufficient and prognosis is generally good.

Nefronía focal aguda bacteriana: diagnóstico, tratamiento y evolución / Acute lobar nephronia: diagnosis, treatment and prognosis

La nefronía focal aguda (NA) es una infección bacteriana aguda localizada en el riñón. La prevalencia de esta enfermedad es escasa. Presentamos 4 casos de nefronía bacteriana aguda. De ellos, 3 pacientes fueron diagnosticados entre 77 pacientes ingresados por pielonefritis aguda y hubo un caso atípico, asociado con una epidermólisis bullosa. El diagnóstico se realizó por ecografía renal y se confirmó con tomografía computarizada ante la mala evolución de dos de los casos, detectando un pequeño absceso en uno de ellos. El urocultivo fue positivo en 3 de los 4 pacientes. La NA es un diagnóstico radiológico que precisa tratamiento más agresivo y seguimiento más estrecho por el riesgo de evolucionar a absceso renal. Dado que la clínica es insidiosa y las pruebas de laboratorio dispares, es preciso sospecharla ante una evolución tórpida de una pielonefritis o alteraciones en la ecoestructura renal. El tratamiento médico es suficiente y el pronóstico, en general, bueno

Acute lobar nephronia is a focal form of acute bacterial renal infection. The prevalence of this disease is low. We report four cases of acute lobar nephronia. Three patients were diagnosed among 77 patients admitted to hospital for acute pyelonephritis. The fourth case was atypical and associated with epidermolysis bullosa. All cases were diagnosed by renal ultrasonography and the diagnosis was confirmed by computed tomographic examination in two patients with poor clinical course. A small abscess was detected in one patient. Urine cultures were positive in three of the four patients. Acute lobar nephronia is a radiological diagnosis and requires aggressive treatment and strict follow-up due to the risk of renal abscesses. Because the clinical manifestations are insidious and laboratory findings can be contradictory, this entity should be suspected in patients with poor clinical course or alterations on renal ultrasonography. Medical treatment is usually sufficient and prognosis is generally good

[Growth charts for the Spanish population with neurofibromatosis type 1]. / Gráficos de crecimiento de la población española con neurofibromatosis tipo 1.

OBJECTIVE: To make the charts of stature and head circumference of Spanish pediatric patients affected with neurofibromatosis type 1 (NF1), to compare them with the ones from a healthy population and to review the possible causes of its alterations. PATIENTS AND METHODS: We obtained the data from 251 Spanish patients (122 women and 129 men) with NF1 seen in seven hospitals between the years 2000 and 2002, with ages between 1 month and 18 years old. The calculation of the 50th centile or median was done using the method of mobile variables, and the 3rd and 97th centiles where calculated from this median. RESULTS: Girls with NF1 have a shorter stature than the healthy ones, which becomes evident after 10 years of age. We have not found differences in the stature between boys with the disease and those without it. In regards to head circumference, in boys and girls we have observed that it is bigger throughout life in patients affected with NF1, and that the 50th centile of healthy people correlates with the 3rd centile of those affected, the 97th centile of the healthy ones with the 50th centile of those affected, being the 3rd centile of the healthy people well below the 3rd centile of the affected ones, and the 97th centile of the affected ones well above the 97th of the healthy people. CONCLUSIONS: The short stature in postpuberal girls and the macrocephaly in both sexes at all ages, are primary characteristics in the NF1 and they are not usually related with other alterations, although they are not specific for this illness.

Gráficos de crecimiento de la población española con neurofibromatosis tipo 1 / Growth charts for the Spanish population with neurofibromatosis type 1

Objetivo. Realizar los gráficos de crecimiento para la talla y el perímetro cefálico de los pacientes pediátricos españoles afectados de neurofibromatosis tipo 1 (NF1), compararlos con los de la población sana y revisar las posibles causas de sus alteraciones. Pacientes y métodos. Se obtuvieron los datos de 251 pacientes españoles (122 mujeres y 129 hombres) con NF1 vistos en siete hospitales españoles, entre los años 2000 y 2002, con edades comprendidas entre 1 mes y 18 años. El cálculo del percentil 50 o mediana se realizó por el método de variables móviles, y, a partir del mismo, se calcularon los percentiles 3 y 97. Los gráficos de la población afectada con NF1 se compararon con los de la población española sana. Resultados. Las mujeres con NF1 presentan una talla más baja que las mujeres sanas, lo que se evidencia fundamentalmente a partir de los 10 años de edad. No hemos observado diferencias en la talla entre los varones sanos y los afectados. En ambos sexos, el perímetro cefálico es mayor en los pacientes afectados con NF1 durante toda su vida, de modo que el percentil 50 de los niños sanos se corresponde aproximadamente con el percentil 3 de los afectados, el 97 de los sanos, con el 50 de las afectados, el percentil 3 de los sanos se encuentra muy por debajo del 3 de los afectados, y el percentil 97 de los afectados, muy por encima del de los sanos. Conclusiones. La baja talla observada en las mujeres pospúberes de nuestra serie y la macrocefalia, presente en ambos sexos a todas las edades, constituyen características primarias en la NF1 y no suelen relacionarse con otras alteraciones, aunque no son específicas de esta enfermedad (AU)

Objective. To make the charts of stature and head circumference of Spanish pediatric patients affected with neurofibromatosis type 1 (NF1), to compare them with the ones from a healthy population and to review the possible causes of its alterations. Patients and methods. We obtained the data from 251 Spanish patients (122 women and 129 men) with NF1 seen in seven hospitals between the years 2000 and 2002, with ages between 1 month and 18 years old. The calculation of the 50th centile or median was done using the method of mobile variables, and the 3rd and 97th centiles where calculated from this median. Results. Girls with NF1 have a shorter stature than the healthy ones, which becomes evident after 10 years of age. We have not found differences in the stature between boys with the disease and those without it. In regards to head circumference, in boys and girls we have observed that it is bigger throughout life in patients affected with NF1, and that the 50th centile of healthy people correlates with the 3rd centile of those affected, the 97th centile of the healthy ones with the 50th centile of those affected, being the 3rd centile of the healthy people well below the 3rd centile of the affected ones, and the 97th centile of the affected ones well above the 97th of the healthy people. Conclusions. The short stature in postpuberal girls and the macrocephaly in both sexes at all ages, are primary characteristics in the NF1 and they are not usually related with other alterations, although they are not specific for this illness (AU)

[Metabolic alterations related to syndrome X and low vitamin E levels in obese children with acanthosis nigricans]. / Alteraciones relacionadas con el síndrome X y bajos niveles de vitamina E en niños con obesidad y acantosis nigricans.

BACKGROUND: In adults, both metabolic alterations related to syndrome X and lower plasma vitamin E levels have been associated with an increased risk of developing cardiovascular disease. OBJECTIVES: To study the presence of metabolic alterations related to syndrome X and to determine the plasma levels of vitamin E in obese children with acanthosis nigricans. METHODS: We performed a prospective study in 42 obese children [15 with acanthosis nigricans (AN) and 27 without]. Thirteen healthy non-obese children were also studied. After a 12-hour fast, plasma levels of glucose, insulin, triglycerides, cholesterol, high-density lipoprotein (HDL)-cholesterol, and vitamin E were determined. The insulin resistance index was also calculated. Differences between groups were determined using ANOVA. RESULTS: Obese children with AN showed higher plasma levels of insulin and triglycerides and lower plasma levels of HDL-cholesterol and vitamin E, as well as a higher insulin resistance index than non-obese children and obese children without AN. CONCLUSIONS: In obese children, the presence of acanthosis nigricans is linked to a group of metabolic alterations associated with a higher risk of developing cardiovascular disease and type 2 diabetes.

Alteraciones relacionadas con el síndrome X y bajos niveles de vitamina E en niños con obesidad y acantosis nigricans / Metabolic alterations related to syndrome X and low vitamin E levels in obese children with acanthosis nigricans

Antecedentes: En adultos, tanto las alteraciones metabólicas asociadas al síndrome X, como la disminución en las concentraciones plasmáticas de vitamina E, se han asociado a un mayor riesgo de desarrollar enfermedades cardiovasculares. Objetivos: Estudiar en niños obesos con acantosis nigricans la presencia de alteraciones metabólicas relacionadas con el síndrome X y determinar las concentraciones plasmáticas de vitamina E. Métodos: Se llevó a cabo un estudio prospectivo en 42 niños obesos, 15 con acantosis nigricans (OB+AN) y 27 sin ella (OB-AN), y 13 niños sanos sin obesidad. En todos ellos, y tras 12 h de ayuno, se determinaron las concentraciones plasmáticas de glucosa, insulina, vitamina E, triglicéridos, colesterol y colesterol HDL. Se calculó el índice de resistencia a la insulina. Las diferencias entre grupos se determinaron mediante el análisis de la varianza. Resultados: Los niños obesos con acantosis nigricans presentaron mayores concentraciones de insulina plasmática y de triglicéridos, menores niveles de colesterol HDL (lipoproteínas de alta densidad) y de vitamina E en plasma, así como un índice de resistencia a la insulina más elevado que los niños obesos sin acantosis nigricans o que los valores observados en un grupo de niños sin obesidad. Conclusiones: La presencia de acantosis nigricans en niños obesos define a un grupo de niños con alteraciones metabólicas asociadas a un mayor riesgo de desarrollar enfermedades cardiovasculares y diabetes de tipo 2 (AU)

[Presence of genu valgum in obese children: cause or effect?]. / Presencia de genu valgum en obesos: causa o efecto.

BACKGROUND: Changes in body configuration that may affect the physical activity may play a role in the caloric consumption and led to the development of obesity. OBJECTIVES: To determine the presence of genu valgum, an alteration that may decrease physical activity and caloric expenditure, in overweight children. METHODS: Thirty-five overweight children without any endocrinological alterations that could lead to obesity were studied. Twenty-nine non-overweight children of a similar age were studied as a control group. In all children weight, height, and body mass index (BMI) were studied, and intermalleolar distance was used to measure the degree of genu valgum. The differences between groups were studied using ANOVA and the correlation between variables was determined using Pearson's correlation. RESULTS: BMI was higher in overweight children than in the control group. Intermalleolar distance was greater in overweight children than in the non-overweight group (11.0 0.6 vs 2.90 0.43; p < 0.001). A positive correlation between the intermalleolar distance and the BMI was observed in the overweight group (p < 0.009). Fifty percent of the overweight children showed an intermalleolar distance of more than 10 cm, a value considered abnormal. CONCLUSIONS: The incidence of genu valgum is much higher in overweight children than in non-overweight children of the same age. This alteration may lead to decreased physical activity and lead to obesity.

Presencia de genu valgum en obesos: causa o efecto / Presence of genuvalgum in obese children: cause or effect?

Antecedentes. Las alteraciones corporales que puedan afectar la actividad física podrían desempeñar un papel relevante en el consumo de calorías y, por tanto, en el desarrollo de obesidad. Objetivos. Determinar, en niños con sobrepeso, la presencia de genu valgum, alteración que puede afectar la realización de ejercicio físico y disminuir el gasto calórico. Métodos. Se estudiaron 35 niños con sobrepeso, en los que se descartaron enfermedades endocrinológicas como causa de la obesidad. Como controles, se estudiaron 29 niños sin sobrepeso de similar edad. En todos los niños se determinó la talla, el peso, el índice de masa corporal (IMC) y la distancia intermaleolar (DIM) como índice del grado de genu valgum. Las diferencias entre grupos se realizaron utilizando el test de análisis de la varianza (ANOVA) y la asociación entre diferentes variables se analizó mediante la correlación lineal de Pearson. Resultados. Los niños con sobrepeso mostraron un IMC superior al grupo control. Este grupo también presento una DIM superior a la observada en el grupo de niños sin sobrepeso (11,0+/-0,6 frente a 2,90+/-0,43; p < 0,001). En los niños con sobrepeso se observó una correlación positiva entre el IMC y la DIM (p < 0,009). El 50 por ciento de los niños con sobrepeso presenta una DIM superior a los 10 cm, valor considerado patológico. Conclusiones. En los niños obesos, la incidencia de genu valgum es muy superior a la observada en la población sin sobrepeso de la misma edad. Dicha alteración podría limitar la actividad física y originar el desarrollo de obesidad (AU)

[Patterns of drug resistance in Staphylococcus aureus from human clinical isolates]. / Patrones de drogorresistencia de cepas de Staphylococcus aureus de origen clínico humano.

Fifty circulating strains of Staphylococcus aureus of clinical origin were characterized by their drug susceptibility to 15 antimicrobials through the method of radial diffusion in Mueller Hinton medium. Also, beta-lactam production was determined by acidimetric and chromogenic methods as well as the presence of methicillin-resistant strains. It was confirmed that 32% of strain was susceptible to tested antimicrobials, the most effective of which were imipenem, norfloxacyn, and amikacyn for 98, 96 and 92% susceptibility respectively. Twenty-seven different drug resistance patterns were found in the studied strains. 22% of the total strains was beta-lactam producers whereas 27% of the latter turned out to be methicilline-resistant.