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Objective: The aim of this study was to analyze the postoperative progress and medical management in the Pediatric Intensive Care Unit (PICU) of patients that underwent bilateral lung transplant., Patients and Methods: From April 1997 to June 1998, 10 pediatric lung transplants were performed at the Hospital Reina Sofía (Córdoba, Spain). There were 4 males and 6 females (mean age 11.5 years, range 5 to 15 years). Indications for transplantation were cystic fibrosis (n = 9) and one pulmonary fibrosis secondary to viral infection. Before the transplant, two patients required mechanical ventilation for acute respiratory decompensation and one patient was ventilator-dependent. Immunosuppression consisted of corticosteroids, azathioprine and cyclosporine or tacrolimus. Post-transplantation management included early extubation, when possible, optimal fluid balance to prevent lung edema, low aggressive mechanical ventilation and adequate treatment of complications, such as rejection and infection., Results: There were no peri-operative mortalities. The mean stay in the PICU was 28 days (median: 17 days) and the mean time on mechanical ventilation was 19 days (median: 5.5 days). The most frequent complications were rejection (n = 8), hyperglycemia (n = 6), renal failure (n = 4), arterial hypertension (n = 4) and respiratory infections (n = 3). There were no airway complications., Conclusions: Even if the post-operative period in pediatric lung transplant patients is difficult, the results have been good with an important improvement in the quality of life of these patients has been achieved.

Objectives: To find out if differences in diet may justify the presence of idiopathic hypercalciuria (IH) and to verify if the calcium-restricted diet, often recommended for treatment of IH, is nutritionally appropriate., Patients and Methods: Dietary intake and mineral and electrolyte urinary excretion were studied twice in 10 children diagnosed of IH and in 9 controls. First, while being on a free diet. Second, after a week of suppression of milk and dairy products., Results: Intakes of calories, proteins, carbohydrates, fats, and minerals were similar in IH patients and controls. Withdrawal of dairy products of diet resulted in an important reduction in the intakes of calcium (71.1%), phosphorus (63.5%) and fats (30.1%), although only calcium intake was remarkably below international recommendations (33.6 +/- 10.4%)., Conclusions: Spontaneous diet of this group of hypercalciuric children was no different from that of control children. Suppression of milk and dairy products causes a nutritionally inappropriate diet.

In order to determine the renal concentration capacity in neonatal hydronephrosis, 10 micrograms of DDAVP were administered intranasally to 18 infants with hydronephrosis. Fluid intake was restricted to 50% of normal for 3 hours before and 6 hours after the administration of DDAVP. Maximal urine osmolality (mean +/- SD) was 348 +/- 180 mOsm/kg in 7 newborns younger than 21 days and 420 +/- mOsm/kg in 11 neonates between 22-50 days of age. Both osmolarities were inferior to the standard response to DDAVP reported in normal neonates. After 24 hours of clinical observation, we did not notice any secondary effects caused by this test.

Objective: To find the existence of early relationships between alterations in the glucidic metabolism and the glomerular and tubular basal function in diabetic insulin-dependent children without clinical evidence of diabetic nephropathy (DN)., Methods: We determined blood pressure, basal plasma concentrations of glucose, glycosilated hemoglobin and total proteins, glomerular filtration rate (GFR), and the glucose, proteins, calcium, phosphorus, uric acid, sodium, potassium and chloride excretions in diurnal, nocturnal and 24-hour urine samples in 43 diabetic children and 13 healthy controls., Results: The microproteinuria mean value in all urine samples (always less than 15 micrograms/min/1.73 m.2), the GFR and blood pressure were similar in both groups. In the diabetic children, we found an inverse correlation between age and 24-hour urine microproteinuria (r-0.33; p less than 0.05) and between age and nocturnal urine microproteinuria (r-0.35; p less than 0.05). There was also a highly significant correlation between microproteinuria and the albumin/creatinine ratio in urine samples (r = 0.94, p less than 0.0001). Diabetic children showed a greater nocturnal excretion of calcium (p less than 0.05) and phosphorus (p less than 0.05)., Conclusions: Our results suggest that microproteinuria, GFR and blood pressure have not served as predictors of DN in pediatric patients.

In order to understand the natural history, clinical features, anatomopathological findings and response to the initial treatment with steroids of the nephrotic syndrome (NS) during childhood, a group of 100 children under 14 years (46 with renal biopsy) observed for an average period of 4 years and 8 months, was reviewed retrospectively. The patients were divided into 3 groups: idopathic NC (89), secondary NS (9) and NS in the first six months of life (2). In the group of idiopathic NS, in which the significant predominance of males (2.8/1) was confirmed, in 69% of the patients the diagnosis was made between the ages of 2 and 5 years. Edemas were found, sometimes accompanied by oliguria and weigh gain, in 77% of the cases. The periods of hypertension and hematuria were infrequent and brief. Thirty eight kidney biopsies were carried out and showed: 25 minimal changes NS, 7 diffuse mesangial proliferative glomerulonephritis (DMPGN), 3 membranoproliferative glomerulonephritis (MPGN), 2 membranous glomerulonephritis (MGN) and 1 segmental and focal glomerulosclerosis. Of the 83 patients treated in first instance with corticosteroids, a positive response was obtained in 72 (87%), although 44% of them have shown to be cortico-dependent. After an average follow up period of 4 years and 8 months, only 2 children, one with MPGN and the other with MGN, are now in chronic renal failure (CRF). In 5 ot the 9 patients included in the second group, the NS was secondary to a Henoch Schönlein purpura. The kidney biopsies showed DMPGN in three of them.(ABSTRACT TRUNCATED AT 250 WORDS)

We have calculated the mean annual cost (MAC) referred to 1,988 pesetas derived from the treatment and surveillance of 15 patients diagnosed of non terminal chronic renal failure (NT-CRF). The patients were aged between 1 month and 12 years at the moment of diagnosis and they were followed-up for five years at least. We have differentiated among costs from hospitalization, pharmacological treatment and outpatient control which were respectively 455,400, 47,798 and 57,917 pesetas/patient year. The costs from hospitalization decreased progressively every year after diagnosis being of 21,211 pesetas/patient year at the 5th year from diagnosis. The 30.1% of pharmacological treatment costs were due to the use of alkalines, 23.4% to phosphorus quelants (calcic carbonate mainly) and 27.3% to the active forms of vitamin D3. The outpatient surveillance costs corresponded 24,000 pesetas/year to staff expenses, 27,492 pesetas/year to laboratory work-up and 6,424 pesetas/year to radiological examination. We conclude that the total MAC for children with NT-CRF eas 561,115 pesetas/patient being the hospitalizations costs the most important concept (81.2%), followed by ambulatory care (10.3% and drug treatment (8.5%).

C reactive protein (CRP) levels are sequencially settled in 58 children, divided in three groups in dependence of their illness: acute bacterial pneumopathy, acute pyelonephritis or neonatal sepsis, all of them receiving antibiotic treatment. CRP values are compared with clinical, radiologic and bacteriologic findings, showing in patients of the first two groups a normalization between fourth and ninth day of treatment, together with clinical and radiologic improvement. In contrast, it was shown that normalization of CRP in neonatal sepsis group was quite slow related to the torpid evolution. The sequentially measure of CRP was prove useful as antibiotic treatment control in children affected with different infectious pictures.

Sixteen members of three families, eight of which had vesicoureteral reflux, are studied. Authors report a high incidence in females (7 cases) and atrophic chronic pyelonephritis (75% of the serie). Only one girl presented disminution of renal function. The types of inheritance was dominant autosomal in the A family and autosomal recessive in the B and C families. Finally the norms of investigation of the familial vesicoureteral reflux are appointed.

Clinical and laboratory findings in 142 children with Schönlein-Henoch syndrome are studied. The children were diagnosed during a ten-year period (1974-1984). Purpura, as more significant clinical finding, was observed in all patients, followed by articular signs (61.2%), abdominal complaints (57.7%), renal signs (30.2%) and testicular (4.2%). IgA, IgG, IgM, complement and cryoglobulin alterations, are remarkable factors to assume an immunologic origin for the syndrome.

Nephritis plays a major role in long-term prognosis of Schönlein-Henoch syndrome. We have studied a group of 142 children with this syndrome; 43 (30.2%) showed clinical evidence of renal disease. Renal biopsy was obtained in 12 cases. A subgroup of 36 patients have been controlled during a much greater two years period. Thirty-five are asymptomatic and one with minor urinary anomalies. Thereafter in our experience the long-term prognosis (means = five years) of Schönlein-Henoch syndrome is excellent in unselected patients.

Clinical characteristics, evolution of growth, and glomerular rate were analysed in 22 patients, younger than 14 years, with chronic renal failure (glomerular filtration rate: 32.6 +/- 24.8 ml/min/1.73 m2, x +/- DS) with a minimal follow-up of 6 months (3.5 +/- 3.3 years). Recurrent urinary tract infections were the most common initial clinical features (27%) and obstructive uropathies constituted the most frequent etiology (41%). Renal failure progression rate, which was assessed by means of 1 to serum creatinine concentration ratio, was faster in the group of children with glomerulonephropaties. At the diagnosis, one out of 3 children had short stature. At the end of the follow-up time, the delay of growth did not significatively modified (-1.6 +/- 2.2 DS versus -2.1 +/- 1.2 DS, p greater than 0.05).

Seric levels of C reactive protein (C.R.P.) were determined in a series of 125 children under one month old. Of them, 75 were clinically healthy and 50 showed signs that suggested infection. In all this infants, in addition to C.R.P., different components of white blood cell differential count were determined, and a bacteriological study was undergone. Authors found high concentration of C.R.P. in 100% of children in which diagnosis of sepsis was bacteriologically confirmed. On the other hand, concentrations of this biological parameter were not substantially modified in newborns used in the control, nor in those other ones in which sepsis was not confirmed. Sensibility of C.R.P. showed itself significantly higher than other hematological indexes in study.

The effect of 1,25-dihydroxyvitamin-D3 administration on growth rate, renal failure progression and calcium-phosphorus metabolism was evaluated in 8 children younger than 13 years, mean age 6.3 +/- 3.3 (mean +/- SD), with chronic renal failure (glomerular filtration rate: 44.1 +/- 16.5 ml/min/1.73 m2) receiving conservative treatment in whom at least two periods, with a minimal duration of six months each, without and with rocaltrol treatment, could be compared 1.25-dihydroxyvitamin-D3 at dosage of 16.3 +/- 6.3 ng/kg/day resulted in a significant increase (p less than 0.05) of growth index velocity (81.4 +/- 37.8 versus 122.4 +/- 60.3) without altering renal failure progression rate which was assessed by means of 1 to serum creatinine concentration ratio. One hypercalcemic episode (serum calcium equal or greater than 11 mg/dl) every 28.4 months was observed. Our results confirm the beneficial effect of 1.25-dihydroxyvitamin-D3 administration in the management of children with chronic real failure.