[Study of renal function and compensatory changes in children with single kidney]. / Determinación de función renal y cambios compensadores en niños con riñón único.

INTRODUCTION: It has always been thought that a reduction of renal tissue in childhood sometimes causes some irreversible injury in the remnant kidney as the years go by. The aim of this paper is to look over the presence of these changes and identify the risk of nephropaty throughout several parameters. MATERIAL AND METHODS: We reviewed 38 children, 23 males and 15 females, aged between 1 and 15 years, who had lost unilateral renal mass because of congenital or adquired diseases. We made two groups of patients on the basis of having born without any unilateral renal function -group I- or having lost unilateral renal function after the second year of life. We measured: Somatometry, arterial pressure, glomerular filtration, microalbuminuria, renal volume and gammagraphic studies were also made. We also considered the presence of contralateral anomalies. RESULTS: Body weight and height were within normal percentiles. Arterial pressure increased in 5 patients. Seric creatinine was normal, creatinine clearance (Ccr) was higher than normal in all patients of both groups, and urinary excretion of protein was normal. Renal volume of remnant kidney was similar in both groups, and no relation with renal function level was found, but it increased through the years. Isotopic studies showed ectatic drainage in all urinary systems. Contralateral anomalies were seen in 7 patients, and they consisted in hydronephrosis and vesico-ureteral reflux. CONCLUSIONS: Hypertension was not related to the cause of renal absence nor the pathology of remnant kidney. Ccr was higher than normal, showing an hyperfiltration status, not confirmed by the values of isotopic filtrate. Renal volume reached by the single kidney was affected by the time after the renal loss, and apparently has been slowed down in cases with contralateral anomalies.

Determinación de función renal y cambios compensadores en niños con riñón único / Study of renal function and compensatory changes in children with single kidney

Introducción. Se ha considerado siempre que la reducción de la masa renal durante la infancia, causa una serie de cambios funcionales que eventualmente pueden conducir a un daño irreversible en el riñón remanente con el paso de los años. Objetivos. La evidencia de estas lesiones en múltiples publicaciones nos movió a revisar a un grupo de 38 pacientes monorrenos en la edad infantil y a intentar determinar el riesgo de aparición de las mismas a través de parámetros como la función renal, la tensión arterial, la presencia de proteinuria y el volumen renal. Material y métodos. Se estudiaron 38 pacientes, 23 de ellos varones y 15 mujeres, de edades entre 1 y 13 años, que habían sufrido pérdida de masa renal por causas congénitas o adquiridas. Se separaron en dos grupos de enfermos: Grupo I: Ausencia congénita unilateral de riñón funcionante (25 casos). Grupo II: Nefrectomizados por pérdida de un riñón(con función previa normal) después del segundo año de vida (13 casos). Se midió la somatometría, la tensión arterial (TA), el filtrado glomerular (FG), la proteinuria, el volumen renal (VR) y se consideró la presencia de anomalías contralaterales (AC). Resultados. El peso y la talla se encontró en percentiles normales. La TA se encontró elevada en 5 pacientes. La creatinina sérica sólo estaba elevada en 1 paciente con severa afectación del riñón remanente, el aclaramiento de creatinina (Ccr) resultó elevado de forma generalizada y se observó microalbuminuria en 2 pacientes. El volumen renal fue similar en ambos grupos. El estudio isotópico evidenció ectasia sin obstrucción en el 80% de todos los casos y el FG según el método de Inoue (corregido para niños) resultó en ambos grupos dentro de valores normales. Conclusiones. No encontramos diferencias significativas en la función renal entre los dos grupos de pacientes ni tampoco indicios de nefropatía por hiperfiltración. El Ccr evidenció una situación de hiperfiltrado en todos los casos. El filtrado glomerular calculado por estudio isotópico no confirmó estasituación. El volumen renal no se observó relacionado con la edad a la que se produjo la pérdida renal, y sí con el tiempo transcurrido postpérdida. La existencia de anomalías en el riñón contralateral influye en el grado de hipertrofia que desarrolla (AU)

Introduction. It has always been thought that a reduction of renal tissue in childhood sometimes causes some irreversible injury in the remnant kidney as the years go by. The aim of this paper is to look over the presence of these changes and identify the risk of nephropaty throughout several parameters. Material and methods. We reviewed 38 children, 23 males and 15 females, aged between 1 and 15 years, who had lost unilateral renal mass because of congenital or adquired diseases. We made two groups of patients on the basis of having born without any unilateral renal function –group I– or having lost unilateral renal function after the second year of life. We measured: Somatometry, arterial pressure, glomerular filtration, microalbuminuria, renal volume and gammagraphic studies were also made. We also considered the presence of contralateral anomalies. Results. Body weight and height were within normal percentiles. Arterial pressure increased in 5 patients. Seric creatinine was normal, creatinine clearance (Ccr) was higher than normal in all patients of both groups, and urinary excretion of protein was normal. Renal volume of remnant kidney was similar in both groups, and no relation with renal function level was found, but it increased through the years. Isotopic studies showed ectatic drainage in all urinary systems. Contralateral anomalies were seen in 7 patients, and they consisted in hydronephrosis and vesico-ureteral reflux. Conclusions. Hypertension was not related to the cause of renal absence nor the pathology of remnant kidney. Ccr was higher than normal, showing an hyperfiltration status, not confirmed by the values of isotopic filtrate. Renal volume reached by the single kidney was affected by the time after the renal loss, and apparently has been slowed down in cases with contralateral anomalies Introduction. It has always been thought that a reduction of renal tissue in childhood sometimes causes some irreversible injury in the remnant kidney as the years go by. The aim of this paper is to look over the presence of these changes and identify the risk of nephropaty throughout several parameters. Material and methods. We reviewed 38 children, 23 males and 15 females, aged between 1 and 15 years, who had lost unilateral renal mass because of congenital or adquired diseases. We made two groups of patients on the basis of having born without any unilateral renal function –group I– or having lost unilateral renal function after the second year of life. We measured: Somatometry, arterial pressure, glomerular filtration, microalbuminuria, renal volume and gammagraphic studies were also made. We also considered the presence of contralateral anomalies. Results. Body weight and height were within normal percentiles. Arterial pressure increased in 5 patients. Seric creatinine was normal, creatinine clearance (Ccr) was higher than normal in all patients of both groups, and urinary excretion of protein was normal. Renal volume of remnant kidney was similar in both groups, and no relation with renal function level was found, but it increased through the years. Isotopic studies showed ectatic drainage in all urinary systems. Contralateral anomalies were seen in 7 patients, and they consisted in hydronephrosis and vesico-ureteral reflux. Conclusions. Hypertension was not related to the cause of renal absence nor the pathology of remnant kidney. Ccr was higher than normal, showing an hyperfiltration status, not confirmed by the values of isotopic filtrate. Renal volume reached by the single kidney was affected by the time after the renal loss, and apparently has been slowed down in cases with contralateral anomalies (AU)

Neuroblastoma and bronchogenic cyst: a rare association.

A few of the known associations between paediatric cancer and congenital anomalies are attributable to contiguous-gene syndromes. Neuroblastoma (NB) has been linked with an excess of gastrointestinal malformations, but there is a significant scarcity of associated respiratory anomalies. We report on two children having an abdominal NB and a bronchogenic cyst diagnosed simultaneously and in different order of appearance. Both masses were removed in separated procedures, taking into account the priority and the time sequence of chemotherapy. Literature is reviewed, checking that the genetic basis for this association is supported by speculations about the oncogene RON.

[Congenital hydronephrosis. An evolutionary study of renal function]. / Hidronefrosis congénitas. Estudio evolutivo de la función renal.

Between 1986 and 1995, 24 newborn and young infants underwent to surgical repair of 32 renal units affected by congenital hydronephrosis in spite of their levels of renal function and dilation. 22 renal units were pelviureteral junction obstruction and 10 were vesico-ureteral obstruction. Isotopic studies were made pre- and post-operatively, resulting in a high percentage of kidneys with the highest values of relative renal function showing a downward after surgery, and a general improvement among the renal units with previously moderate function. Drainage slope curves showed an improvement of its partial obstruction, and no change when dilation without obstruction. The clearance half-time showed a reduction in the slower renal units. We conclude that the natural evolution of these age-group kidneys is a counterbalance with the healthy contralateral renal unit.

Poliposis pieloureteral: a propósito de un caso / Pyeloureteral polyposis: a case report

Se presenta el caso de un varón de 8 años de edad con hematuria y dolor abdominal izquierdo esporádico de varios años de evolución. Se detectó hidronefrosis por obstrucción pieloureteral izquierda y se exploró quirúrgicamente, observándose formaciones polipoides en el tercio superior de la luz del uréter. Se precticó desmembrada pieloureteral, con buena evolución posterior. Se hace notar la posibilidad de pólipos ureterales sean causa de dolor abdominal y/o lumbar y la conveniencia en estos casos, de realizar una resección ureteral limitada por la naturaleza benigna de esta lesión

Poliposis pieloureteral: a propósito de un caso / Pyeloureteral polyposis: a case report

Se presenta el caso de un varón de 8 años de edad con hematuria y dolor abdominal izquierdo esporádico de varios años de evolución. Se detectó hidronefrosis por obstrucción pieloureteral izquierda y se exploró quirúrgicamente, observándose formaciones polipoides en el tercio superior de la luz del uréter. Se precticó desmembrada pieloureteral, con buena evolución posterior. Se hace notar la posibilidad de pólipos ureterales sean causa de dolor abdominal y/o lumbar y la conveniencia en estos casos, de realizar una resección ureteral limitada por la naturaleza benigna de esta lesión

Long-term follow-up of Nissen fundoplication.

A study of 68 children under 7 years of age, who had had an abdominal approach Nissen operation, with a postoperative follow-up of between 4 and 14 years, is presented. The patients were classified into three groups, according to radiological appearance and cuff site. In the first group (40 patients) the cuff was intraabdominal and competent; in the second group (22 patients) the cuff was partially displaced into the thorax and was competent. 92% of the patients of these groups are currently asymptomatic and none required reoperation. In the third group (6 patients), there was disorganization of the cuff, together with its displacement into the chest, recurrence of symptoms and the authors recommended reoperation. Nissen's operation is an effective treatment for gastrooesophageal reflux in children unresponsive to medical treatment. Although displacement occurs frequently, valve competence is unaffected except in those where the cuff has disappeared and there is herniation into the thorax in which case reoperation is necessary.

[Gastroschisis: a review of five cases (author's transl)]. / Gastrosquisis. A propósito de cinco casos.

Five cases of gastroschisis operated between September 1975 and May 1980 are described. The first two of these died but the other three maintain normal health at eleven, ten and four months of life. The embryological theory relevant to our cases and features of differential diagnosis with omphalocele are described. Authors stress prognosis importance of reintroduction of eviscerated intestine with minimal manipulation, careful attention to parenteral feeding, antibiotherapy and re-establishment of body temperature.

[Necrotizing enterocolitis and its surgical management. Study of 35 cases]. / Enterocolitis necrotizante. Consideraciones sobre su tratamiento quirúrgico. Estudio de 35 casos.

Thirty five cases of necrotizing enterocolitis, seen in the past five years in this clinic, are reviewed. Twenty four cases were seen up to December 1977 and eleven cases from January to March 1978 due to a neonatal I.C.U. epidemy. The relationship between some of the accepted perinatal pathogenic factors and the development of necrotizing enterocolitis is analyzed. The temporal relationship of the time of diagnosis to the onset of treatment is an important consideration for the prognosis. We propose surgical treatment if after eighteen hours of treatment there is no improvement. A guideline for the early treatment and surgical indications of acute necrotizing enterocolitis, is suggested.