[Renal scintigraphy using technetium dimercaptosuccinic acid in the diagnosis of pyelonephritis in children: study of 17 cases] / Cintilografia renal com ácido dimercaptossuccínico marcado com tecnécio no diagnóstico da pielonefrite na infância: estudo de 17 casos.

OBJECTIVE: To determine whether the presence of abnormal results in DMSA renal scintigraphy indicates pyelonephritis. METHODS: We performed the washout test in 17 children with urinary tract infection, as a criterion standard, to locate the infection site. All the children underwent DMSA renal scintigraphy in the acute phase of the disease. The results were analyzed by the chi-square test or Fisher test. RESULTS: DMSA renal scintigraphy revealed changes in all five cases of pyelonephritis, suggesting acute kidney involvement. On the other hand, only one child with cystitis (total = 12 cases) had abnormal results in renal scintigraphy. Sensitivity and specificity were 100% and 92%, respectively. CONCLUSION: DMSA renal scintigraphy is a sensitive method for the diagnosis of pyelonephritis in children.

[Urinary infection in adolescents] / Infecção urinária na adolescência.

OBJECTIVE: Urinary tract infections are caused by various gram-negative bacteria. Escherichia coli is the most common causative agent in all groups of patients. Staphylococcus saprophyticus is now recognized as a common cause of urinary tract infection in adolescents and young adult women. METHODS: Review of literature and clinical experience with urinary tract infections in adolescents at the Pediatric Nephrology Department of Hospital Santa Casa de São Paulo. RESULTS: Lower urinary tract infection, hematuria and dysuria were the most frequent symptoms observed in infections caused by Staphylococcus saprophyticus. Some asymptomatic cases were observed. The infection may be associated with adverse effects of maternal and fetal health during pregnancy. CONCLUSIONS: This article reviews the diagnosis, etiology, treatment, and complications associated with urinary tract infections in adolescents.

[Aplastic crisis in sickle cell anemia induced by parvovírus B19] / Crise aplástica da anemia falciforme condicionada pelo parvovírus B19.

PURPOSE: Transient aplastic crisis is reported in an eight-month old child with sickle cell anemia and acute B19 parvovirus infection. This fact is uncommon in this age. PATIENT AND METHODS: The authors review the literature and describe a clinical case of an eight-month old child with sickle cell anemia presented with profound anemia and reticulocytopenia. His peripheral blood was analyzed for parvovirus B19 using the polymerase chain reaction (PCR), and for anti B19 immunoglobulin Ig M, and Ig G by enzyme-linked immunosorbent assay (ELISA). RESULTS: An eight-month old child with sickle cell anemia was admitted to the hospital with fever and profound anemia (HB = 3.8g/ dl) and reticulocytopenia (2%). A diagnosis of aplastic crisis was established. The results indicate that Ig M and PCR were positive and Ig G negative. The patient needed erytrocyte transfusion, and was discharged on hospital day 4. CONCLUSIONS: The clinical and laboratory features indicate that human parvovirus B19 was the etiologic agent of an aplastic crisis in an eight-month old child. According to the international literature this event is uncommon for this age; in addition, this is the first time it appears in the Brazilian literature.

Hematuria due to hyperuricosuria in children: 36-month follow-up.

Hyperuricosuria (HU), defined as a urinary acid excretion higher than 95 percent of normal values, is an important lithogenic factor, accounting for about 5-20% of recurrent hematuria in childhood. We prospectively studied 30 children (15 male, 15 female; aged 3 to 13 years old) with previously undiagnosed isolated hematuria and HU for 6 to 36 months. The family history of nephrolithiasis was positive in 40%. Idiopathic hypercalciuria (IH), UCa > 4 mg/kg/day, was not found initially, but was diagnosed after 6 to 24 months in 20% of the patients. The following treatments were utilized: restricted purine diet (13%), allopurinol (4%) and potassium citrate (1%). No specific treatment was given to 82% of the patients. Therapy normalized uricosuria with resolution of hematuria over 6-12 months. Thirteen percent and 6% of untreated patients developed urolithiasis after 6 and 12 months respectively. The data suggest that HU, like IH, is associated with hematuria. Furthermore, recognition of this association may prevent unnecessary, and in some cases, invasive diagnostic manoeuvres.

Relationship between acute diarrhoea and low plasma levels of vitamin A and retinol binding protein.

The objective of this study was to assess vitamin A status and association between acute diarrhoea and plasma levels of vitamin A through cross-sectional comparison in children. Plasma vitamin A was measured by colorimetric method of Neeld & Pearson and RBP by radial immunodiffusion technique. Seventy eight children (aged 18-119 months), 26 with current history of diarrhoea and 52 children as controls (outpatient from the Santa Casa de Misericórdia Hospital in metropolitan area of São Paulo City, Brazil) were studied. Children with history of diarrhoea showed significant low levels (mean +/- s.e.) as compared to controls, vitamin A (15.87 +/- 1.4 micrograms/dl vs. 21.14 +/- 1.15 micrograms/dl, p < 0.007) and RBP (1.70 +/- 0.2 mg/dl vs. 2.52 +/- 0.11 mg/dl). Multivariate logistic regression adjusted by sex, age, nutritional status and mother education revealed association between diarrhoea and inadequate levels of vitamin A and RBP.

Urinary inhibitors of crystallization in hypercalciuric children with hematuria and nephrolithiasis.

Urinary inhibitors are suggested to play a significant role in reducing crystallization in calcium (Ca) stone former and idiopathic hypercalciuria (IH). Urinary inhibitors such as magnesium (Mg), citrate, and glycosaminoglycans (GAGs) were evaluated, as well as urinary Ca and creatinine (Cr), in IH children with nephrolithiasis (LIT) or with hematuria plus IH (HEM) and were compared with a control group. The mean 24-h urinary excretion of Mg was similar in all groups. However, the urine Ca/Mg ratio was significantly increased (P < 0.005) in LIT and HEM groups. A higher mean value for GAGs and citrate was found in the HEM group, but a very low level of GAGs (less than 60% of the normal value) and citrate (less than 30% of the normal value) was found in the LIT group. These data suggest that, despite a high urinary Ca excretion (3.6 +/- 0.1 mg/kg per day) in the HEM group, elevated urinary GAGs (32.0 +/- 1.0 mg/g Cr) and a normal urinary citrate (428.7 +/- 62.3 mg/24 h) excretion may prevent Ca crystallization and thus renal stones. In contrast, in the LIT group low urinary GAG (10.3 +/- 0.9 mg/g Cr) and citrate (235.2 +/- 52.3 mg/24 h) excretion may precipitate stone formation in the presence of a high urinary Ca excretion. Thus, it is reasonable to suggest that patients with hematuria and IH may not develop overt renal stone due to the presence of normal levels of renal stone inhibitors.

Estudo metabolico da nefrolitiase na infancia: avaliacao em cinquenta criancas litiasicas / Metabolic study of the nephrolitiasis in the childhood: evaluation in fifty lithyasic children

Para avaliar os fatores litogenicos, estudamos retrospectivamente, com relacao a idade, ao sexo, a manifestacao clinicas e antecedentes, cinquenta criancas com nefrolitiase. Todas elas foram submetidas a protocolo prospectivo que constou dos seguintes exames: urina I, urocultura, urinas de 24 horas para dosagem de calcio, acido urico e creatinina, urografia excretora, uretrocistografia miccional, ultra-som renal e prova de sobrecarga oral de calcio. As criancas foram classificadas quanto ao disturbio metabolico conforme criteiros ja estabelecidos. Das cinquenta criancas estudadas apenas 7 (14//) nao apresentaram anormalidade metabolica. Encontramos hipercalciuria renal (HCaR) em 17 (34//); absorvida (HAInt) em 16 (32//); hiperuricosuria (HEAcUr) em 7 (14//) e infeccao dotrato urinario (ITU) em 4 (8//). Observamos um caso de cistinuria. Atraves deste estudo pudemos verificar a importancia da avaliacao metabolica para proposicao de terapeutica especifica para cada caso, principalmente se considerarmos que em 86// das criancas estudadas houve deteccao de alguma, alteracao metabolica

Effectiveness of cefetamet pivoxil in the treatment of pyelonephritis in children.

Cefetamet pivoxil was investigated in an open, randomized comparative study involving a total of 37 children with acute pyelonephritis, whose ages ranged from 2 to 14 years. The patients received either 10 mg/kg (n = 18) or 20 mg/kg (n = 8) cefetamet pivoxil twice daily, or 30-50 mg/kg amoxycillin/clavulanic acid three times daily (n = 11) for a period of 7-10 days. Escherichia coli was the main causative agent isolated in 28 (75.7%) of the patients; other pathogens included Proteus mirabilis (three patients). Proteus species (one patient), Klebsiella pneumoniae (two patients), Pseudomonas diminuta (one patient) and mixed infections (three patients). No differences in the overall treatment outcome could be observed between the treatment regimens used and, at the end of treatment, all pathogens were eradicated with neither relapse, nor persistence of the isolated pathogen, nor reinfection occurring. The clinical signs and symptoms had subsided in all patients at treatment end and the tolerability of the trial drugs was found to be satisfactory with no premature treatment withdrawal required. It is concluded that cefetamet pivoxil in the standard twice-daily dose of 10 mg/kg was equally effective and as well tolerated as 20 mg/kg cefetamet pivoxil given twice daily or 30-50 mg/kg amoxycillin/clavulanic acid given three times daily.

Urolithiasis in childhood: metabolic evaluation.

In order to determine metabolic disorders in children with urolithiasis, 50 patients with urinary calculi were studied. Abdominal pain and/or haematuria were the most predominant symptoms. Surgical procedures were required in 22% of these children and urinary tract infection was observed in 34% of this group. Only 2 children had anatomical malformations of the urinary tract. Absorptive hypercalciuria (32%), renal hypercalciuria (34%) and uric acid hyperexcretion (24%) were the most common metabolic abnormalities in these children. We were unable to find an underlying metabolic abnormality in only 14% of the patients. These data suggest that appropriate metabolic study will allow rational management of children with urinary stones.

Metabolic disturbance as a cause of recurrent hematuria in children.

Metabolic disturbance as a cause of recurrent hematuria in children. To evaluate metabolic disturbance as a cause of hematuria, 250 children, aged eight months to fourteen years, with recurrent hematuria were studied. In the present series, metabolic disturbance was mainly due to idiopathic hypercalciuria (IH), the most common etiology of hematuria without proteinuria in childhood. Sixty-seven (27%) of the children had IH, ten children (4%) had hyperuricosuria, and 27 (11%) had nephrolithiasis. To better characterize the IH into renal (RH) or absorptive hypercalciuria (AH) subtypes, 45 of the 67 children (ranging age from six to twelve years) were further submitted to an oral calcium load test. Eighteen patients (40%) had AH, 7 (15.5%) RH and 20 (44.4%) could not be classified as having AH or RH [indeterminant (ID) idiopathic hypercalciuria group]. Intravenous pyelography or ultrasound were normal in all children. The oral calcium load test may be useful in characterizing the subtype of IH in some children; however, a great number of the IH children were characterized as indeterminant. Also hyperuricosuria, recently described as another metabolic disturbance associated with hematuria, may be an important cause of recurrent hematuria in children.

[Recurrent hematuria in children: study of 250 cases]. / Hematúria recorrente na infância: estudo de 250 casos.

In order to analyse the etiology of recurrent hematuria in childhood, we studied 250 children, referred to our Service (age: 6 mo-17 ys; 102 female and 148 male). They were submitted to the following protocol: urine analyses, uroculture, serum total and fraction complement, electrophoresis of hemoglobin, serum creatinine, BUN, 24h urinary calcium, uric acid and protein, oral calcium load test in children with hypercalciuria (UCa greater than 4mg/kg/day). Radiological evaluation and renal percutaneous biopsy was performed when necessary. The following diagnostic distribution was obtained: Alport syndrome, 19; Berger disease, 15; other glomerulopathies, 45; hypercalciuria, 67; uric acid hyperexcretion, 10; nephrolithiasis, 27; urinary tract infection, 14; renal malformation, 8; no diagnosis, 43. Based in these results, we conclude that appropriate investigation on recurrent hematuria, leads to determination of etiology in over 80% of cases.

Cistinose na infancia. Apresentacao de tres casos. / Cystinosis in childhood. Report of 3 cases

A cistinose, alteracao metabolica rara (f=1/40.000), e a principal causa de sindrome de De Toni-Debre-Fanconi na infancia. Os autores apresentam o estudo de tres criancas, todas brancas, do sexo feminino, portadoras de cistinose nefropatica que se manifestou clinicamente como sindrome de Fanconi. O material para estudo histologico foi obtido por necropsia, no primeiro caso; por biopsia renal, no segundo; e puncao de medula ossea, na terceira crianca. Em todos os tecidos houve deposicao de cristais de cistina, em grande quantidade

Concentracoes plasmaticas apos a inoculacao de penicilina benzatina. / Plasma concentrations after inoculation of benzathine penicillin

Os autores estudaram os niveis sanguineos de penicilina benzatina em 16 criancas e 18 adultos, nos quais se ministrou este antibiotico nas doses usualmente recomendadas. Foram determinados os niveis plasmaticos de penicilina no primeiro, segundo, terceiro, setimo e decimo dia apos a inoculacao da droga. Estes niveis foram adequados quando comparados com as concentracoes inibitorias minimas (CIM) dos estreptococos beta-hemoliticos do grupo A em 5 dos 16 casos no primeiro dia, em 6 de l2 no segundo dia, em 12 de 15 no terceiro dia, em 4 de 16 casos no setimo dia e 1 de 15 casos no decimo dia. Os autores concluem que os niveis plasmaticos de penicilina nestes experimentos sao inferiores a CIM do estreptococo beta-hemolitico do grupo A em numerosos casos principalmente a partir do quinto dia, podendo determinar, desta maneira, novos surtos de febre reumatica na vigencia do tratamento profilatico habitual