Changes in body composition assessed by bioimpedance analysis in the first 6 months of chronic peritoneal dialysis.

Dietary protein restriction, progressive loss of renal adaptive capacity, and uremic toxicity may contribute to the development of malnutrition and water retention in severe chronic renal failure (CRF). Malnutrition is also common in children treated with chronic peritoneal dialysis (CPD). It is not clear how the start of CPD influences body composition of children with CRF. We used a bioimpedance analysis device (BIA 101S Akern) to measure resistance and reactance in 7 children, with residual creatinine clearance of about 5 mL/min/1.73 m2 at the start of CPD (t0) and repeated the test 6 months later (t1). Distance (D), which is considered a reliable index of hydration and nutrition, was obtained from resistance (R) and reactance (Xc) by calculating phase angle (PA). BIA values of our patients were compared with those of healthy children of the same statural age from a series of 551 controls. There was an overall improvement of Xc, PA, and D after 6 months of CPD. In some cases D did not normalize, which indicates that some children with CRF on a restricted protein diet may present changes of body composition that are only partially reversed by short-term CPD. The present indications for the start of CPD should probably be reassessed, at least in some cases, to prevent malnutrition.

[Indications for recombinant growth hormone (rhGH) treatment in kidney diseases]. / Indicazioni al trattamento con ormone della crescita ricombinante (rhGH) nelle malattie renali.

Growth retardation is one of the major problem in children with chronic and terminal renal failure. The growth hormone-insulin-like growth factor axis is altered in uraemia, resulting in peripheral resistance. This insensitivity seems to be overcome in an experimental study by supraphysiological doses of recombinant human growth hormone (rhGH). Several clinical studies have confirmed that rhGH increases growth velocity in children with chronic renal failure with and without dialysis and after renal transplant, without significant side-effects. The improvement of growth is more marked in prepubertal patients and during the first year of rhGH treatment. Also in our experience prepubertal children showed an increase of height standard deviation score and growth velocity during rhGH treatment; the pubertal patients failed to improve their statural growth. GH, as the prototype of an anabolic hormone, has also great potential in improving catabolic conditions of various origin, particularly those due to renal failure. RhGH can improve nitrogen balance and the nutritional parameters with an increase of muscle mass and a decrease of fat mass. Prospectively, rhGH could be utilized to improve the hypercatabolic condition of acute renal failure. The following analysis will discuss the recent studies employing rhGH in renal diseases and will attempt to give some guide lines to rhGH treatment in these illnesses.

[Treatment of corticoid-resistant nephrotic syndrome: a still unresolved problem]. / Il trattamento della sindrome nefrosica corticoresistente: un problema tuttora aperto.

The nephrotic syndrome persists unchanged after the initial course of steroid therapy in 15 to 20% of patients. In such cases, the severity of the condition lies essentially in the risk of developing end-stage renal failure. This occurs in one third to one half of the cases. Furthermore, some of these children are at risk for recurrence of their original disease in the transplanted kidney. The course of steroid resistant nephrotic syndrome (SRNS) is usually punctuated by the need for numerous hospitalizations for mobilization of edema and treatment of infection. The treatment of patients with SRNS presents a major problem in the field of pediatric nephrology. Immunosuppressive agents may be efficient in some of steroid-resistant patients, inducing remission of proteinuria and protecting renal function. Unfortunately, all these agents have a low therapeutic index. Thus, in deciding whether, how, and when to use immunomodulating drugs, the nephrologist should be aware of their potential side effects, of the results that may be obtained and of the possible strategies for maximizing their therapeutic index.

A new device for the care of Congenital Central Hypoventilation Syndrome patients during sleep.

Congenital Central Hypoventilation Syndrome (CCHS) is a genetic disease that causes an autonomous nervous system dysregulation. Patients are unable to have a correct ventilation, especially during sleep, facing risk of death. Therefore, most of them are mechanically ventilated during night and their blood oxygenation is monitored, while a supervisor keeps watch over them. If low oxygen levels are detected by the pulse-oximeter, an alarm fires; the supervisor deals with the situation and, if there is neither a technical problem nor a false alarm, wakes the subject, as CCHS patients usually recover from hypoxia when roused from sleep. During a single night multiple alarms may occur, causing fractioned sleep for the subject and a lasting state of anxiety for supervisors.