RESUMO
CVD is a major cause of morbidity and mortality in pediatric patients with CKD. It is unclear whether vascular abnormalities in these patients are reversible, and if transplantation portends salutary effects on arterial function. We compared FMD, PWV, AI75, and CIMT in 15 dialysis (D), 14 transplant patients (T), and 15 controls (C), and their associations with cardiovascular risk factors. There was stepwise lower FMD (p < 0.001), higher AI75 (p < 0.001), higher PWV (p = 0.01), and higher CIMT SDS for age (p = 0.03) and height (p = 0.006) in the D group than T and C groups. FMD, PWV, and CIMT were unrelated to dialysis duration or time from transplantation. On multivariate analysis, group status was independently associated with FMD (ß = 3.15, p = 0.002), AI75 (ß = -5.95, p = 0.01), PWV (ß = -0.57, p = 0.07) and CIMT (ß = -0.02, p = 0.04) and CIMT SDS for height (ß = -0.541, p = 0.009). FMD is lower and AI75, PWV and CIMT are higher in pediatric patients maintained on D than T/C. T patients have similar AI75, PWV and CIMT to C although FMD remains reduced. These findings suggest that transplantation stabilizes or improves CKD associated arteriopathy.
Assuntos
Artéria Braquial/fisiopatologia , Artérias Carótidas/fisiopatologia , Falência Renal Crônica/terapia , Transplante de Rim , Artéria Radial/fisiopatologia , Diálise Renal , Adolescente , Velocidade do Fluxo Sanguíneo , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/patologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Espessura Intima-Media Carotídea , Criança , Estudos Transversais , Técnicas de Diagnóstico Cardiovascular , Feminino , Humanos , Falência Renal Crônica/patologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/cirurgia , Masculino , Análise Multivariada , Artéria Radial/diagnóstico por imagem , Artéria Radial/patologia , Resultado do Tratamento , Rigidez Vascular , VasodilataçãoAssuntos
Carcinoma de Células Renais/complicações , Hematúria/etiologia , Neoplasias Renais/complicações , Traço Falciforme/complicações , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/fisiopatologia , Criança , Diagnóstico Diferencial , Humanos , Nefropatias/patologia , Neoplasias Renais/patologia , Neoplasias Renais/fisiopatologia , Masculino , Nefrectomia , Tomografia Computadorizada por Raios XRESUMO
A 4-week-old boy with previous urinary tract infection and documented vesicoureteral reflux presented with urosepsis and septic arthritis of the right hip. Compliance with prophylactic antibiotic therapy had been poor at home. Complications such as bone and joint infection are known to occur after urinary tract infection in children with urologic abnormalities. However, previous similar reports describe discovery of the urinary tract anomalies only as part of an evaluation performed after the systemic complications have occurred. The purpose of this report is to stress the importance of defining urinary tract abnormalities in a case of antenatal hydronephrosis or at the time of the first urinary tract infection in infants so that appropriate investigations, management, and support of parental compliance can be undertaken to avoid systemic complications.