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Nephrotic syndrome is a condition that results from various diseases that injure the glomeruli, tiny coils of blood vessels in the kidneys. Characteristic features of nephrotic syndrome include spillage of protein into the urine, low levels of the blood protein albumin, and water retention (edema). For over 30 years, nephrotic syndrome has been treated with steroid drugs such as prednisone. About forty percent of the children who have this condition must take high doses of steroids for long periods of time to prevent illness relapse. Steroids can have some serious side effects, such as growth failure, cataracts, and high blood pressure. Little research has been done on the growth of children with nephrotic syndrome who are being treated with steroids. Because growth failure has been linked to steroids, another class of drugs has been recommended for treating children with nephrotic syndrome; these are the alkylating agents, such as cyclophosphamide and chlorambucil. The growth of twelve children was assessed before and after a period of treatment with cyclophosphamide or chlorambucil, supplemented by prednisone on alternate days. The combination of drugs constituted a break from continuous high-dose steroids, and it was expected that growth might improve during this time. The average age of the group was six years. Growth in height was about 4.3 centimeters (cm) per year before the combined drug regimen, and 8.7 cm per year after treatment. Thus, reduction of steroid use and substitution of alkylating agents improved growth significantly in children with nephrotic syndrome. The side effects of the short-term use of alkylating agents were minimal, but long-term adverse effects may be a concern. Children with nephrotic syndrome who show signs of reduced growth rate should be considered for this regimen. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract. Treatment of end-stage renal failure in children is invasive and prolonged. Although kidney transplantation is often the desired therapy, children usually require some form of life-sustaining dialysis until a suitable donor is found. Home continuous-cycling peritoneal dialysis (CCPD) is a useful alternative to in-center hemodialysis for these children. Adequate biochemical control of the uremic state can be achieved with continuous-cycling peritoneal dialysis. Peritonitis remains the major complication of this form of dialysis, averaging approximately one episode per 12 patient-months. Growth rates of children maintained on continuous-cycling peritoneal dialysis appear to be equivalent to growth rates of children treated with hemodialysis. The advantage of continuous-cycling peritoneal dialysis lies in the fact that exchanges occur during the evening hours and parental intervention is minimized. [ABSTRACT FROM AUTHOR]

Abstract. Clean intermittent catheterization (CIC) has replaced urinary diversion as the treatment of choice for patients with neurogenic bladder. Yet, no well controlled studies are available assessing the efficacy of CIC over ileal loop diversion (ILD). Consequently, a one-year pospective study was carried out comparing short-term patient morbidity, infection rates, and bacterial organisms in 33 children with meningomyelocele. Twenty-four of the children were treated with CIC whereas nine children had an ILD. A minimum of four cultures per year were obtained on each patient. Patients maintained on CIC had 36.8% of their cultures positive for bacteriuria whereas children with ILD had 61.8% of their cultures positive (P < .001). The incidence of bacteriuria associated with clinical signs and symptoms was similar in both groups. Four of 24 children treated with CIC had sterile urine whereas none of the children with ILD were persistently free from bacteriuria. Only five of 24 children receiving CIC had 50% or more of their cultures positive as contrasted with seven of nine children with an ILD (P < .01). Escherichia coli accounted for approximately one third of organisms recovered from infected urine in both groups. Although the short-term morbidity associated with both treatment modalities is similar, the incidence of asymptomatic bacteriuria in children maintained on CIC is significantly less than in children with ILD. Whether this factor plays a role in determining long-term morbidity is a subject for further study. Pediatrics 70:665-669, 1982; meningomyelocele, urinary tract infection, catheterization, urinary diversion. [ABSTRACT FROM AUTHOR]