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El desarrollo de un síndrome nefrótico en concomitancia con una tiroiditis de Hashimoto es una asociación infrecuente en la edad pediátrica. Objetivo: Reportar una complicación infrecuente de la tiroiditis autoinmune, como es la aparición de un síndrome nefrótico. Caso Clínico: Paciente de 10 años que se presenta con síndrome nefrótico y bocio. Se pesquisa antecedente de tiroiditis autoinmune e hipotiroidismo no tratado. Se inicia terapia corticoidal y hormonal de sustitución (levotiroxina), logrando buena respuesta clínica y de laboratorio. Conclusión: La tiroiditis autoinmune impacta en la fisiología renal a través de mecanismos inmunológicos y no inmunológicos. Paralelamente, la repercusión renal puede afectar la función tiroidea. La importancia de la presente comunicación radica en reportar una complicación infrecuente de la tiroiditis autoinmune, como lo es la aparición de síndrome nefrótico.

Resumen: La infección del tracto urinario (ITU) es una de las infecciones bacterianas más frecuentes en la edad pediátrica, pero su diagnóstico y manejo se pueden ver complicados por lo inespecífico de sus sín tomas y signos de presentación, la dificultad en la interpretación de los exámenes, especialmente en niños más pequeños, y por un pronóstico respecto a daño renal muchas veces incierto. En los últimos años, y como contribución de la Medicina basada en evidencia, se ha producido a nivel mundial una modificación significativa en la conducta e intervenciones que a la fecha se venían realizando, surgiendo la necesidad de actualizar las recomendaciones sobre manejo de la ITU que la Rama de Nefrología de la Sociedad Chilena de Pediatría había publicado en años anteriores. El propósito de estas recomendaciones es contribuir a reducir la variabilidad de la práctica clínica en el manejo de ITU en la población pediátrica, favoreciendo que las intervenciones diagnósticas y terapéuticas se realicen de la forma más adecuada posible, mejorando la detección y manejo de la patología estructural y otros factores de riesgo de daño renal, pero evitando acciones innecesarias en aquellos niños con bajo ries go. Las recomendaciones sobre el diagnóstico y manejo de la ITU fueron publicadas previamente, y en esta segunda parte, se presentan las recomendaciones de estudio, prevención y seguimiento de la infección urinaria en pediatría.

Urinary tract infection (UTI) is one of the most frequent bacterial infection in pediatrics. However, its diagnosis and management can be complicated due to the nonspecific clinical presentation, the difficulty of exams interpretation, especially in younger children, and an uncertain prognosis regar ding renal damage. In recent years, significant worldwide change has come in treatment, diagnosis, and images studies, we have decided to update the current recommendations on UTI management published by the Pediatric Nephrology branch of Chilean Pediatrics Society in previous years. The purpose of these recommendations is to reduce the variability of clinical practice in management of UTI in our pediatric population, favoring diagnostic and therapeutic interventions in the most ap propriate way, improving detection and management of structural pathology and other risk factors of renal damage, avoiding unnecessary actions in children with low risk. This first part includes diag nosis and treatment recommendations of urinary tract infection in pediatric age. In the second part the study, prevention and monitoring of urinary tract in pediatric age is detailed.

Urinary tract infection (UTI) is one of the most frequent bacterial infections in pediatrics, however, its diagnosis and management can be complicated due to the nonspecific clinical presentation, the difficulty of exams interpretation, especially in the younger group, and due to an uncertain progno sis regarding kidney damage. In recent years, due to evidence-based medicine contribution, there has been a significant worldwide change in treatment, diagnosis and imaging studies that have been performed to date, arising the need for update the current recommendations on UTI management published by the Pediatric Nephrology branch of the Chilean Society of Pediatrics in previous years. The purpose of these recommendations is to reduce the variability of clinical practice in management of UTI in our pediatric population, favoring diagnostic and therapeutic interventions are carried out in the most appropriate way, improving detection and management of structural pathology and others risk factors for kidney damage, avoiding unnecessary actions in children at low risk. Diagnosis and treatment recommendations were published as a first part. This second part includes study re commendations, prevention and follow-up of urinary tract infection in pediatric age.

La infección del tracto urinario (ITU) es una de las infecciones bacterianas más frecuentes en la edad pediátrica, pero su diagnóstico y manejo se pueden ver complicados por lo inespecífico de sus síntomas y signos de presentación, la dificultad en la interpretación de los exámenes, especialmente en niños más pequeños, y por un pronóstico respecto a daño renal muchas veces incierto. En los últimos años, y como contribución de la Medicina basada en evidencia, se ha producido a nivel mundial una modificación significativa en la conducta e intervenciones que a la fecha se venían realizando, surgiendo la necesidad de actualizar las recomendaciones sobre manejo de la ITU que la Rama de Nefrología de la Sociedad Chilena de Pediatría había publicado en años anteriores. El propósito de estas recomendaciones es contribuir a reducir la variabilidad de la práctica clínica en el manejo de ITU en la población pediátrica, favoreciendo que las intervenciones diagnósticas y terapéuticas se realicen de la forma más adecuada posible, mejorando la detección y manejo de la patología estructural y otros factores de riesgo de daño renal, pero evitando acciones innecesarias en aquellos niños con bajo riesgo. Las recomendaciones sobre el diagnóstico y manejo de la ITU fueron publicadas previamente, y en esta segunda parte, se presentan las recomendaciones de estudio, prevención y seguimiento de la infección urinaria en pediatría.

Urinary tract infection (UTI) is one of the most frequent bacterial infection in pediatrics. However, its diagnosis and management can be complicated due to the nonspecific clinical presentation, the difficulty of exams interpretation, especially in younger children, and an uncertain prognosis regarding renal damage. In recent years, significant worldwide change has come in treatment, diagnosis, and images studies, we have decided to update the current recommendations on UTI management published by the Pediatric Nephrology branch of Chilean Pediatrics Society in previous years. The purpose of these recommendations is to reduce the variability of clinical practice in management of UTI in our pediatric population, favoring diagnostic and therapeutic interventions in the most appropriate way, improving detection and management of structural pathology and other risk factors of renal damage, avoiding unnecessary actions in children with low risk. This first part includes diagnosis and treatment recommendations of urinary tract infection in pediatric age. In the second part the study, prevention and monitoring of urinary tract in pediatric age is detailed.

In this paper, taking the model of Arrazola and Hevia (Applied Economics Letters, 11 – 145-8, 2004) as a starting point, we propose a homogeneous measure of human capital of individuals, which permits interpersonal comparisons. This indicator has been set up for a sample of Spanish men and women and compared to the results obtained when using Portela's proposal to construct a human capital indicator (Economics Letters, 72, 27-32, 2001). It was concluded that both from a theoretical and empirical point of view, the properties of the index proposed in this article are better than those of Portela''s suggested measure.

High mountain lakes and lagoons are not a typical feature of the landscape of the Iberian Peninsula, but rather an exception in the natural environment, therefore its study and conservation presents great interest. This study arises in order to inventory and characterize a set of seventeen lagoon complex located over the provinces of Palencia and León, without any kind of size restriction. Likewise their basins are described, since they are related with them and they will determine their future evolution. Among other results, it should be noted that, despite they are situated at high altitude, they have a complex and varied hydrological network, denoting the high diversity of these systems. The lithology factor seems to affect significantly to the depth of the studied units, however depth and dimensions of the lakes are strongly related with the specific characteristics of their morphogenesis. In general, studied lakes and lagoons appear to be more fragile to possible alterations in their catchments if they are compared with bigger systems studied in the specialized literature., Los lagos y lagunas de alta montaña no son un rasgo típico del paisaje de la Península Ibérica, sino más bien una excepción en el medio natural, por ello su estudio y conservación presenta gran interés. Este trabajo surge con objeto de inventariar y caracterizar un conjunto de diecisiete complejos lagunares ubicados en las provincias de Palencia y León (Cordillera Cantábrica y Sierra de la Cabrera), sin ningún tipo de restricción por tamaño. Así mismo se describen sus cuencas, ligadas con las masas de agua y que determinarán su futura evolución. Entre otros resultados, cabe señalar que, a pesar de su carácter de cabecera, presentan una red hidrológica compleja y variada, denotando la diversidad de estos sistemas. La composición litológica parece incidir significativamente en la profundidad de las unidades, sin embargo la profundidad y dimensiones de las lagunas dependen en gran medida de las características concretas de su morfogénesis. En general, los lagos y lagunas estudiados parecen ser más frágiles ante posibles alteraciones en sus cuencas al compararlas con otros sistemas de mayor tamaño recogidos en diferentes estudios.

Given that childhood obesity is an epidemic, the frequency of critically-ill patients who are overweight or obese seen at intensive care units has increased rapidly. Adipose tissue is an endocrine organ that secretes a number of protein hormones, including leptin, which stands out because it regulates adipose tissue mass. The presence of arterial hypertension, metabolic syndrome, diabetes mellitus, respiratory disease and chronic kidney disease may become apparent and complicate the course of obese pediatric patients in the Intensive Care Unit. Obesity management is complex and should involve patients, their families and the medical community. It should be coordinated with comprehensive government health policies and implemented in conjunction with a change in cultural context.Actualmente, la obesidad infantil constituye una epidemia. La frecuencia de pacientes críticos con sobrepeso u obesidad ha aumentado rápidamente en las unidades de cuidados intensivos. El tejido adiposo es un órgano endocrino que secreta varias hormonas proteicas, entre las que se destaca la leptina, la cual es reguladora de su masa. La presencia de hipertensión arterial, síndrome metabólico, diabetes mellitus, enfermedades respiratorias y enfermedad renal crónica se puede manifestar en el paciente pediátrico obeso durante su estadía en la Unidad de Cuidados Intensivos y complicar su evolución. El tratamiento de la obesidad es complejo y debe involucrar al paciente, a su familia y a la comunidad médica. Debe realizarse en coordinación con políticas sanitarias gubernamentales integrales y en conjunto con un cambio de marco cultural.

El objetivo principal de este trabajo fue montar y probar un modelo experimental para medir la conductancia hidráulica de la dentina ex vivo. Diecisiete terceros molares sanos, con indicación de exodoncia, de donantes sanos de edades entre 15 y 30 años fueron obtenidos mediante consentimiento informado. Luego de limpiarlos, desinfectarlos, incluirlos en resina epóxica y cortarlos se obtuvieron 17 muestras de dentina, correspondiente a un disco de resina con un corte coronal de diente que presenta dentina expuesta en ambas caras de éste. Tres equipos para medir la conductancia hidráulica de la dentina fueron armados siguiendo la descripción del modelo de Pashley. Las muestras fueron instaladas en una cámara de difusión, conectada mediante tubos de silicona a una pipeta graduada y una columna de agua de 20cm. Mediante el desplazamiento de una burbuja de agua al interior de la pipeta, se midió la conductancia hidráulica de cada muestra, 3 veces los días 14, 21, 28 y 35 postextracción. Los datos fueron tabulados y analizados estadísticamente. No existe diferencia en la tasa de flujo de una muestra medida en los tres equipos (p=0.5937). No existe diferencia en las mediciones de la conductancia hidráulica de 13 muestras de dentina humana medida en los días 14, 21, 28 y 35 postextracción (p=0.0704). Es posible montar un modelo experimental para estudiar la conductancia hidráulica de la dentina ex vivo, basado en el modelo de Pashley y col. El modelo pareciera ser confiable, pero es necesaria más investigación para poder validar su confiabilidad. The main objective of this work was to mount and test an experimental model to measure the hydraulic conductance of ex vivo dentin. Seventeen healthy third molars, with indication of extraction of healthy donors aged between 15 and 30 years were obtained by informed consent. After cleaning them, disinfecting them, including them in resin epoxy and cutting them, there were 17 samples of dentin, corresponding to a disk of resin with a coronal section of tooth showing the dentin exposed on both sides of it. Three machines to measure the hydraulic conductance of the dentin were assembled according to the description of the model of Pashley. Samples were installed in a Chamber of diffusion, connected by using silicone tubes to a graduated transfer pipette and a 20cm water column. Through the displacement of a bubble of water in the inside of the pipette, the hydraulic conductance of each sample was measured 3 times on the 14th, 21st, 28th and 35th day post extraction. The data were tabulated and analyzed statistically. There is no SS difference in the rate of flow of a measured sample in the three machines (p=0.5937). There is no SS difference in measurements of the hydraulic conductance of 13 samples of human dentin measured in days 14, 21, 28 and 35 postextraction (p=0.0704). It is possible to mount an experimental model to study the hydraulic conductance of dentin ex vivo, based on the model of Pashley. The model seems to be reliable, but more research is needed in order to validate its reliability

La infección urinaria (ITU) es una de las patologías infecciosas más frecuentes en pediatría. Tradicionalmente se ha considerado como marcador de probables anormalidades anatómicas y funcionales de la vía urinaria, por lo cual, en las últimas décadas todos los niños que presentaban una ITU eran sometidos a estudio por imágenes en busca de cicatrices renales o anormalidades de la vía urinaria. El objetivo de este artículo es actualizar los conceptos sobre el estudio y tratamiento de pacientes pediátricos que presentan una ITU febril. El estudio por imágenes es incómodo para los pacientes, estresante para los padres y las evidencias actuales para continuar realizándolo son limitadas por lo cual debe ser selectivo en orden de focalizar en los pacientes que puedan beneficiarse con cirugías urológicas correctoras o tratamientos médicos adecuados. Estas pautas están basadas en las guías NICE de ITU e intentan demostrar que uno de los pilares más importantes para evitar secuelas renales es el diagnóstico y tratamiento oportuno de las ITU febriles.

The effect of ammonia on the leaching of copper smelter dust and copper precipitation from these solutions as sulphide using sulfur and sulfur dioxide was studied. The precipitation was done in ammoniacal media because this solution produced more satisfactory results at room temperature that a sulphuric media. A solid was precipitated containing 60 % of copper of the dust smelter. The other waste generated contained around 80 % of the arsenic of the original copper smelter dust. Based on the preliminary results obtained in this work it will propose a procedure for the recovery of copper as sulphide from copper smelter dust with parallel confinement of arsenic. Se estudió el efecto del amoniaco en la lixiviación de polvos de fundición de cobre y en la precipitación de sulfuro de cobre, usando azufre y dióxido de azufre desde estas disoluciones. La precipitación se realizó en un medio amoniacal para tener rendimientos satisfactorios a temperatura ambiente. Se precipitó un sólido que recupera alrededor del 60 % del cobre contenido en los polvos de fundición. El otro residuo generado contenía del orden del 80 % del arsénico de los polvos originales. Sobre la base de estos resultados preliminares, se planteó un procedimiento para la recuperación de cobre desde los polvos de fundición y para el confinamiento del arsénico.

Background: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. Aim: To describe the characteñstics ofpatients with the diagnosis ofHUS in Chile, and to identify the most reliable early predictors oímorbidity and moñality. Material and methods: The clinical records ofpatients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. Results: A cohort of 587 patients aged 2 to 8 years, 48% males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39% of the patients, hypertension in 45% and seizures in 17%. Forty two percent required renal replacement therapy (RRT) and perítoneal dialysis was used in the majoríty of cases (78%). The most frequently isolated etiological agentwas Escherichia coli. Mortality rate was 2.9% in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC) >20.000/mm³ and requirements of renal replacement therapy (p 20.000/mm³, seizures and hypertension. Conclusions: The present study emphasizes important clinical and epidemiological aspeets ofHUSin a Chilean pediatricpopulation.

Background: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. Aim: To describe the characteñstics ofpatients with the diagnosis ofHUS in Chile, and to identify the most reliable early predictors oímorbidity and moñality. Material and methods: The clinical records ofpatients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. Results: A cohort of 587 patients aged 2 to 8 years, 48% males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39% of the patients, hypertension in 45% and seizures in 17%. Forty two percent required renal replacement therapy (RRT) and perítoneal dialysis was used in the majoríty of cases (78%). The most frequently isolated etiological agentwas Escherichia coli. Mortality rate was 2.9% in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC) >20.000/mm³ and requirements of renal replacement therapy (p 20.000/mm³, seizures and hypertension. Conclusions: The present study emphasizes important clinical and epidemiological aspeets ofHUSin a Chilean pediatricpopulation.

Acute pyelonephritis in children can leave a kidney scar that eventually can lead to hypertension or renal failure. 99mTc-dimercaptosuccinic acid renal scintigraphy (RC DMSA) is a widely accepted technique to assess children with acute pyelonephritis.To evaluate the presence of residual kidney scars detected through RC DMSA, in children with a first episode of acute pyelonephritis.Clinical records of children with a first episode of acute pyelonephritis that were assessed within seven days of the episode with RC DMSA were reviewed. Children were considered eligible if they did not have a new episode of acute pyelonephritis and a second RC DMSA, one year after the first episode, was performed. The presence or absence of a renal scar after one year was associated to demographic, scintigraphy and laboratory variables.Fifty nine children, aged 1 month to 10 years, 35 females, were studied. Thirty nine percent had a renal scar in the scintigraphy perfomed after one year of follow up. The presence of a scar was correlated with a C reactive protein over 130 mg/dl and an altered relative renal function (below 44%), during the acute phase.A high C reactive protein and alterations of relative renal function during the acute phase of acute pyelonephritis in children, may be risk factors for the development of renal scars in the long term follow up.

Background: Acute pyelonephritis in children can leave a kidney scar that eventually can lead to hypertension or renal failure. 99mTc-dimercaptosuccinic acid renal scintigraphy (RC DMSA) is a widely accepted technique to assess children with acute pyelonephritis. Aim: To evaluate the presence of residual kidney scars detected through RC DMSA, in children with a first episode of acute pyelonephritis. Patients and methods: Clinical records of children with a first episode of acute pyelonephritis that were assessed within seven days of the episode with RC DMSA were reviewed. Children were considered eligible if they did not have a new episode of acute pyelonephritis and a second RC DMSA, one year after the first episode, was performed. The presence or absence of a renal scar after one year was associated to demographic, scintigraphy and laboratory variables. Results: Fifty nine children, aged 1 month to 10 years, 35 females, were studied. Thirty nine percent had a renal scar in the scintigraphy perfomed after one year of follow up. The presence of a scar was correlated with a C reactive protein over 130 mg/dl and an altered relative renal function (below 44%), during the acute phase. Conclusions: A high C reactive protein and alterations of relative renal function during the acute phase of acute pyelonephritis in children, may be risk factors for the development of renal scars in the long term follow up

Background: Acute pyelonephritis in children can leave a kidney scar that eventually can lead to hypertension or renal failure. 99mTc-dimercaptosuccinic acid renal scintigraphy (RC DMSA) is a widely accepted technique to assess children with acute pyelonephritis. Aim: To evaluate the presence of residual kidney scars detected through RC DMSA, in children with a first episode of acute pyelonephritis. Patients and methods: Clinical records of children with a first episode of acute pyelonephritis that were assessed within seven days of the episode with RC DMSA were reviewed. Children were considered eligible if they did not have a new episode of acute pyelonephritis and a second RC DMSA, one year after the first episode, was performed. The presence or absence of a renal scar after one year was associated to demographic, scintigraphy and laboratory variables. Results: Fifty nine children, aged 1 month to 10 years, 35 females, were studied. Thirty nine percent had a renal scar in the scintigraphy perfomed after one year of follow up. The presence of a scar was correlated with a C reactive protein over 130 mg/dl and an altered relative renal function (below 44%), during the acute phase. Conclusions: A high C reactive protein and alterations of relative renal function during the acute phase of acute pyelonephritis in children, may be risk factors for the development of renal scars in the long term follow up

Tc99m DMSA (dimercaptosuccinic acid) scintigraphy has a high sensitivity for the detection of cortical kidney damage. Aim: To evaluate the Tc99m DMSA renal scintigraphy in children with a first episode of acute pyelonephritis and its association with laboratory parameters, kidney ultrasound and vesicoureteral reflux. Patients and methods: We studied 143 children (age range 8 days, 12 years, 66% female) hospitalized with the clinical diagnosis of acute pyelonephritis (first episode) with a positive urine culture and a renal scintigraphy performed within seven days of diagnosis. DMSA was considered the gold standard for the detection of cortical lesions. Its results were related to the presence of fever, C-reactive protein (CRP), erythrocyte sedimentation rate (VHS), white blood count (WBC), ultrasound examination and vesicoureteral reflux. Results: Seventy nine percent of the population had an abnormal DMSA scan. There were no differences between sex, age and laboratory parameters in children with normal or abnormal DMSA scans, except for CRP (p

Tc99m DMSA (dimercaptosuccinic acid) scintigraphy has a high sensitivity for the detection of cortical kidney damage. Aim: To evaluate the Tc99m DMSA renal scintigraphy in children with a first episode of acute pyelonephritis and its association with laboratory parameters, kidney ultrasound and vesicoureteral reflux. Patients and methods: We studied 143 children (age range 8 days, 12 years, 66% female) hospitalized with the clinical diagnosis of acute pyelonephritis (first episode) with a positive urine culture and a renal scintigraphy performed within seven days of diagnosis. DMSA was considered the gold standard for the detection of cortical lesions. Its results were related to the presence of fever, C-reactive protein (CRP), erythrocyte sedimentation rate (VHS), white blood count (WBC), ultrasound examination and vesicoureteral reflux. Results: Seventy nine percent of the population had an abnormal DMSA scan. There were no differences between sex, age and laboratory parameters in children with normal or abnormal DMSA scans, except for CRP (p

El riñón multicístico (RMC) se asocia a malformación del riñón contralateral en porcentajes variables. Con el propósito de determinar la prevalencia y tipo de malformaciones asociadas, y la evolución de la función renal, se estudiaron de manera retrospectiva 34 niños con diagnóstico de RMC entre 1 día y 13 meses de edad con ecotomografía renal, cintigrama renal Tc99 DMSA y uretrocistografía miccional. Se encontró malformación del riñón contralateral en 11/34 pacientes (32%) siendo las más frecuentes la estenosis pieloureteral y el reflujo vesicoureteral. En 5 pacientes el seguimiento demostró signos de displasia renal y en 1 hipertensión arterial. No hubo malignización. Se concluye que la malformación del riñón contralateral es de alta frecuencia, por lo que siempre debe realizarse el estudio completo con ecotomografía renal, cintigrama renal Tc99 DMSA y uretrocistografía. Debe además efectuarse control seriado del crecimiento y función renal, para la detección y manejo precoz de la insuficiencia renal A multicystic dysplastic kidney (MCDK) is often associated with contralateral kidney abnormalities. Medical records of 34 children with a diagnosis of MCDK were retrospectively analized for contralateral kidney abnormalities and global renal function. They were examined using ultrasound, isotope scan with Tc-99m dimercaptosuccinic acid (Tc-99 DMSA) and voiding cystouretrogrphy (VUG). Abnormalities of the contralateral kidney were found in 11/34 (32%). The most common being ureteropelvic junction obstruction and vesicoureteral reflux. In five patients follow-up revealed renal dysplasia, of these one developed hypertension. No malignancy was found. Based on the results of this study we recommend a complete evaluation of the contralateral kidney using ultrasound, Tc-99 DMSA and VUG. Regular follow-up must be performed, evaluating serum creatinine levels and kidney growth for the early detection and treatment of chronic renal failure