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SUMMARY The data cited have been intended to show that renal functional abnormalities are commonly associated with reflux. Tubular abnormalities, particularly concentrating defects, probably occur early, and glomerular dysfunction is a late manifestation. Problems with acid-base balance are uncommonly examined but may be more relevant clinically, because such abnormalities could affect bone growth. Fractional excretion studies are less sensitive than concentrating ability in indicating dysfunction. Associated pyelonephritis hastens renal damage and exacerbates any functional abnormality. Renal functional abnormalities are more common in patients with renal scarring and indeed may be predictive of a process that is not yet apparent pathologically.

Purpose: We evaluated our 10-year experience with the surgical treatment of vesicoureteral reflux in uncomplicated duplicated collecting systems.Materials and Methods: Between 1984 and 1994, 54 refluxing renal units (8 bilateral) in 37 female and 9 male patients required surgery. Patient age ranged from 7 months to 17 years (average 4.9 at surgery). Postoperative followup (average 14.2 months) included voiding cystourethrography and renal sonography or excretory urography.Results: Common sheath ureteral reimplantation via an intravesical approach was performed in 48 of the 54 refluxing renal units. Of the remaining 6 renal units detrussorrhaphy was performed in 4, and ureteroureterostomy combined with ureteral reimplantation and partial lower pole nephrectomy were done in 1 each. Two treated renal units had persistent postoperative vesicoureteral reflux, which resolved after subureteral polytetrafluoroethylene (Teflon) injection. No renal unit had postoperative hydronephrosis. Contralateral reflux...

We studied hematologic findings in 617 apparently healthy Georgia elementary, middle, and high school students, aged 10 to 19 years, and examined the influence of several parameters (race, sex, iron status, and genetic hemoglobin [Hb] abnormalities) on hypochromia and microcytosis, with or without anemia. Fourteen students (2%) (6 male, 8 female; 4 white, 10 black) were found to be anemic (Hb < 11.8 g/dL in boys or < 11.3 g/dL in girls). Hypochromia (mean corpuscular Hb < 25 pg) with or without microcytosis (mean corpuscular volume < 78 fL) was found in 26 students (4%). Iron deficiency was the main associated factor in white students, but in blacks genetic Hb abnormalities, especially alpha-thalassemia trait, were other predisposing factors. The overall prevalence of iron deficiency (serum ferritin < or = 12 ng/mL) was 32.4% in the entire sample population, 30.5%, among blacks, and 33.2% among whites.

Growth was assessed in children following 128 separate kidney transplants using a generalized growth curve multivariate analysis. The height standard deviation score was the dependent variable. Time since transplant, prednisone dosage, and creatinine clearance were the independent variables. For the purposes of comparison patients were grouped according to sex, race, age at transplantation, initial allograft function, acute rejection episodes and the use of cyclosporin A. Patient's height standard deviation scores tended to increase negatively after transplantation. However, children who received transplants before their 7th birthday, with initial allograft function greater than 60 ml/min per 1.73 m2, exhibited “catch-up” growth. Height standard deviation scores positively improved in males but not in females, as prednisone dosage was decreased. Height standard deviation scores became more negative as renal function decreased after transplantation. Changes in renal function produced the greatest effect upon height in black children, children less than 7 years, and males.

The complications associated with surgery of duplex collecting systems are difficult to manage, and multiple options for reconstruction are available. Successful correction is based on an assessment of the anatomy and function in the kidney draining the complicated segment and on assessment of the remaining ureteral tissue. Many times successful reconstruction requires an innovative approach.

The current study investigated the role of family resources in successful outcome of alcoholism treatment. Fixty-six patients were administered the Family Environment Scale. The scores of completers and non-completers were compared. The current findings suggest that marital status alone is not predictive of outcome and that self-reports of the family environment should not be accepted without qualification. The need for further research which looks at the role of needs and accommodation within the relationship is discussed.

Eighty-five girls, ages 3-16, with a past history of recurrent urinary tract infections were treated for 10 days with either trimethoprim/sulfamethoxazole, ampicillin or cephalexin. Patients with normal roentgenograms as well as those with reflux and cortical scarring were included. In the 12 weeks following completion of treatment, a significantly lower recurrence rate was noted in children who received trimethoprim/sulfamethoxazole. There was no differ ence in the recurrence rate whether or not radiographic abnormalities were present. No serious side effects were noted with any drug regimen.

Angiographic findings of unilateral angiitis in a case of herpes zoster ophthalmicus with contralateral hemiplegia are described. Herpes zoster is often associated with major CNS involvement and a vascular etiology was previously postulated. Recent pathological reports suggest that cerebral angiitis secondary to herpes virus infection may be more common than heretofore realized. Our findings suggest a means by which suspected cases can be more fully evaluated.

• The growth of children undergoing continuous ambulatory peritoneal dialysis (CAPD) therapy for end-stage renal disease (ESRD) was compared with the growth of children undergoing hemodialysis and that of children after successful kidney transplantation. The bone ages of the children were used to predict expected growth velocities. The actual growth velocities observed were then expressed as percentages of the predicted rates. Children receiving CAPD therapy grew better than those treated by hemodialysis and as well as the children who received a kidney transplant. There was some correlation between growth and allograft function in the transplant recipients. Children receiving CAPD were less acidotic and were more likely to exhibit improvement in renal osteodystrophy than children treated by ongoing hemodialysis. There were no significant differences in reported caloric intake between the two groups. ( AJDC 1984;138:28-31)