[Physiopathology, diagnosis and treatment of acute renal insufficiency]. / Fisiopatología, diagnóstico y tratamiento de la insuficiencia renal aguda.

Fifty-two clinical charts of children who had been discharged from this hospital, after being treated for acute renal failure, were analyzed to determine the incidence, presentation and results of the treatment used. We found that 0.7% of the total number of children admitted developed this complication and that 4/5 of them were under two years old. The initial illnesses were gastroenteritis, bronchial pneumonia, cyanogenic cardiopathies and sepsis. Some of the patients had hypoxic episodes or went into hypovolemic shock or a combination of both. In half of the patients diagnosis was reached from anamnesis, from of oliguria, acidosis and nitrogen retention. In the rest from whom a urine sample was obtained, the diagnosis was confirmed when the FeNa was higher than 2 and because the U/P osmolarity and urea were under 1.3 and 5 respectively. The oliguric type of acute renal failure was seen in 65% of the cases; the non-oliguric type in 35%. In the first group the mortality rate reached 6.5% even though a third of them were placed under dialysis. Yet, in another 7 cases, dialysis could not be used because the child was in shock. Of the 18 cases of non-oliguric acute renal failure, 12 recovered; only 3 required dialysis. We conclude that the high mortality rate in cases of acute renal failure depends on the severity of the underlying illness, the age of the patient and the delay in the diagnosis of the disease. The use of dopamine and furosemide, as well as the application of hemoperfusion instead place of peritoneal dialysis in neonates with sepsis, could improve results.

[DMF index in patients with end-stage kidney disease]. / Indice CPO en pacientes con enfermedad renal terminal.

In order to demonstrate the role of saliva with high concentration of urea and alkalinity, preventing dental caries in the uremic patients, 4 groups of children were studied: I healthy controls, II children with successful renal transplantation, III uremic children in dialysis and IV uremic children with conservative treatment. The results show a direct correlation between increase of saliva urea concentrations and decrease in saliva hydrogen ion concentration. Higher values of urea and more alkaline pH were found in children with uremia, with or without dialysis. Despite that there was not a statistically significant difference in the caries-lost-obturation index: 0.252 was found in the group of healthy controls and the lowest was 0.119, in the patients with uremia and dialysis. The results suggest that a protector role of saliva in uremic children is possible.

[Advances in the management of severe arterial hypertension]. / Avances en el manejo de la hipertensión arterial grave.

This article deals with current concepts about severe hypertension. This is defined by recorded values of more than 20 mmHg above the 97th percentile for weight and height. Exceptionally it is asymptomatic, abut most of the time presents with signs of hypertensive encephalopathy and/or hypertensive cardiopathy, cardiac failure and/or acute pulmonary edema. The most frequent causes in the Hospital Infantil de México Federico Gómez were: diffuse acute glomerulonephritis, segmental renal hypoplasia, renovascular hypertension and end-stage renal disease. First of all, on admission in the emergency room, the hypertensive child must be treated with rapid-acting drugs such as calcium channel blockers, sodium nitroprusside or diazoxide. Secondly, quick laboratory examinations as urinalysis, serum electrolytes and BUN must be performed to elaborate a presumptive diagnosis, in order to choice a therapy upon the pathophysiology. According to this thought, furosemide administration is mandatory in acute glomerulonephritis and could be supported by nifedipine. In renal hypoplasia and in renovascular hypertension the use of convertase enzyme inhibitors is indicated in the first place and may be supported by propranolol and/or diuretics. Finally, in hypertension due to end-stage renal disease, peritoneal dialysis with hypertonic solutions or ultrafiltration in chronic hemodialysis program are usually needed.

[Bone disorders in children with chronic renal insufficiency exposed to high ingestion of aluminum]. / Alteraciones óseas en niños con insuficiencia renal crónica expuestos a ingestión elevada de aluminio.

Bone disorders in 28 children with chronic renal failure exposed to aluminum intoxication were studied. All of the children were in the dialysis program. Aluminum blood levels were higher than normal in all of the children and without any correlation to the magnitude of hypocalcemia or with the increase of the parathormone, which were found in different amounts in all of the children. All of the children had various degrees of skeletal retardation and only one had pathological fractures. The bone biopsy showed hypocellular marrow, decreased osteoclastic activity in the majority of the cases same as trabecular mineralization, although the amount of osteoid was lacking in the trabeculae in the majority of the cases. The deposit of aluminum was detected in a great number of them. It is concluded that osteodystrophy recognizes a number of factors as may be hypocalcemia due to a decrease in the production of 1,25-cholecalciferol, an increase in the parathyroid hormone and the deposit of aluminum, coming mainly from water, in the trabeculae which interfere with the incorporation of calcium in the formation of new bone.

[Neurologic disorders in children with chronic terminal renal insufficiency]. / Alteraciones neurológicas en niños con insuficiencia renal crónica terminal.

Neurological alterations are very frequent in children with end stage renal disease (ESRD). In order to assess the type of these complications, a neurological study was undertaken in 30 children with ESRD. Three of the patients had convulsions and hyperreflexia was the only clinical sign found in all the patients. Low serum levels of hemoglobin and calcium and high concentrations of phosphates, aluminum and parathyroid hormone were found in all cases, but correlations with any neurological alteration were not made. Abnormal EEG with slow waves in the occipital region were obtained in 23 patients. Sensorial hypoacusia was registered in 6 children who were previously treated with aminoglucosides. The cerebral tomography showed calcifications in three instances, but only in one patient were of clinical significance. In five, out of the 30 patients, cerebral atrophy was detected. In conclusion, assessment of the neurological condition is mandatory in children with ESRD before renal transplantation is performed, since the complication itself or the therapy may interfere with rehabilitation.

[Psychosocial problems of children with chronic disease]. / Problemática psicosocial del niño con enfermedad crónica.

This presentation comprises: a) the study of psychosocial problems in children with chronic disease (1980-83); b) application and results of a "pluridimensional approach" model, designed to solve these conflicts (1982-88). Thirty-five children with end stage renal disease (ESRD) and 34 families were studied, as well as the members of the professional team. The methods of study were: conducted observations, projective tests, recording and analysis of psychotherapy (individual and familiar) and Balint sessions. The data were analized in the framework of psychoanalysis, theory of the systems and groups, etc. The results showed: depression, anguish and regression, interfering with rehabilitation, in the group of children. The problems worsening with greater length of the dialysis periods and with younger age of the patients. Poverty increases losses and guilty feelings decreasing the defensive and adaptive mechanisms. In the families, ESRD provoked migration, fragmentation, dynamic and structural dysfunctions and several inter and intrapersonal conflicts. In the professional team, tension, anxiety, compulsive and indiscriminate conducts were detected, as well as a great difficulty to communicate with the patients and their families. In an attempt to decrease these conflicts a pluridimensional approach was designed and applied in the patients, families and members of the professional team, with the aim of interrupt the pathologic interaction patterns and change them in therapeutic. This model included the practice of several independent and simultaneous psychological interventions, ergotherapy, recreative and occupational activities with the patients; group sessions for information, diagnostic interviews and psychotherapy with the families and Balint sessions with the professional team.(ABSTRACT TRUNCATED AT 250 WORDS)

Unusual complication in a patient with renal transplantation: cerebral cysticercosis.

A patient with cadaveric renal transplantation was diagnosed by brain-computed tomography and ELISA as having neurocysticercosis in the CSF. Complete cure was achieved after praziquantel therapy. Function of the allograft was not affected.

Adequacy of chronic peritoneal dialysis in low socioeconomic class uremic children.

The ability to provide successful rehabilitation in 57 uremic children from a low socioeconomic background was prospectively evaluated by means of assessment of growth and development, incidence of complications, compliance, mortality rate and final outcome. Forty-three patients were on intermittent peritoneal dialysis (PD) and 14 on continuous ambulatory peritoneal dialysis (CAPD). The overall incidence of peritonitis was 5.6 episodes per patient-year; 41 patients are alive; 12 continue on intermittent dialysis; 16 received a renal allograft and 13 shifted to hemodialysis. Hypervolemia, sepsis due to peritonitis and abandonment of treatment were the main causes of death in 16 children. Malnutrition and non-compliance were the main factors leading to unsatisfactory rehabilitation.