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The recommendations of the Consensus Conference "Diagnostic and Therapeutic Management of Urinary Tract Infection in Childhood" are presented. Selection of the most appropriate urine collection technique depends on the child's ability to control urination and the urgency of the diagnosis. Directives for the interpretation of the various parameters of urinalysis are offered with the recommendation that diagnosis of urinary tract infection be based on urine culture. The indication of hospitalization does not depend on the location of the urinary tract infection but on the severity of repercussions and the risk of complications. Guidelines for first choice and alternative antibiotic therapy for parenteral or oral administration are established, as well as recommendations for the choice of route, type of regimen and the duration of the treatment, based on the patient's level of risk. Routine antibiotic prophylaxis is not recommended in children with a normal urinary tract after a first episode of urinary tract infection or in those with low-grade vesicoureteral reflux; the indication of prophylaxis in patients with recurrent infections or with high-grade reflux must be individualized. The current strategy of routine use of diagnostic imaging tests should be substituted by another strategy in which the use of these tests is individualized, taking into account each patient's level of risk.

Introduction: Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in children. The results of several epidemiologic studies have shown surprisingly wide variety in the incidence (0.8 to 22.6 per 100,000 children) and prevalence (7 to 400 per 100,000) of this disease., Material and Methods: We performed a retrospective epidemiological study to identify all patients born after 1989 and resident in Asturias who were diagnosed with JIA using the criteria of the International League of Associations for Rheumatology (ILAR) criteria., Results: Data were obtained from 60 patients (23 boys and 37 girls). The mean age of symptom onset was 5.6 years, with onset of spondyloarthropathies occurring most frequently in the oldest group. An incidence rate of 2.5/10(5) (3.5 at the present time) and a prevalence rate of 51.4/10(5) children and adolescents aged less than 16 years old were calculated. In 50% of patients, JIA started with inflammation in one of the knees. The most frequent form of onset was persistent oligoarticular arthritis (41.7%), followed by spondyloarthropathies (11.7%), conditions that did not meet the criteria for any category (11.7%), polyarticular arthritis (11.7%), systemic disease (10%), psoriatic arthritis (6.7%), and extended oligoarticular arthritis (6.7%). Chronic anterior uveitis was found in 5 patients (pauciarticular group in all 5 patients). Methotrexate was used in 25 children with good response and no relevant adverse events were observed. Only 10% of our patients are currently in the active phase of arthritis., Conclusion: An incidence rate of 3.5/10(5) and a prevalence rate of 51.4/10(5) children and adolescents aged less than 16 years old in Asturias were calculated (taking into account the possible bias of our study). The most frequent form of onset was persistent oligoarticular arthritis and the most commonly involved joints were the knees.

Background and Objective: Several formulae for the diagnosis of hypertension in children and adolescents have recently been published. We analyzed the usefulness of the formulae as a tool for the diagnosis of hypertension., Material and Method: Concordance analysis between formula's predicted values for 95 percentile values in Spanish reference charts (RICARDIN study) for each age and sex and its diagnostic efficiency in the diagnosis of hypertension., Results: Concordance values between pairs were: systolic blood pressure (SBP) 6 to 17 years 0.87 (95% CI, 0.73-0.94; p < 0.0001), diastolic blood pressure (DBP) 6-10 years 0.89 (95% CI, 0.63-0.97; p < 0.0001), and DBP 11-17 years 0.54 (95% CI, 0.03-0.82; p < 0.05). Taking the formula's predicted value as a cut point, area under ROC values were: SBP 0.929 (95% CI, 0.895-0.962), DBP 6-10 years 0.8 (95% CI, 0.663-0.937) and DBP 11-17 years 0.518 (95% CI, 0.394-0.642)., Conclusions: An adecuate concordance was obtained. However, the application of the formulae to Spanish children and adolescents leads to several false positive results for SBP and false negative results for DBP, mainly in children over 11-years-old. Alternative formulae based on data obtained in Spanish children and adolescents are proposed.

Background: The RICARDIN Study multicenter study of cardiovascular risk factors in children and adolescents has described the standards of normality of blood cholesterol levels in the Spanish school population. The objective of the present study was to compare mean values of cholesterol between different regions of Spain, and to compare the global mean with a pool international study. Also, the pattern of total cholesterol and cHDL by age and sex using mathematical model is described, and comparison with two international studies carried out in USA and Japan is performed., Subjects and Methods: 10,683 children aged 6 to 18 were selected from 7 different Spanish provinces (Madrid, Vizcaya, Lugo, Badajoz, Murcia, Asturias and Barcelona). Blood samples were obtained by capilar puncture (Reflotron)., Results: Mean values of total cholesterol was different among provinces, and globally, were lower than the international pooled population, although the pattern observed in each population was very similar. Total cholesterol curve for Spanish boys showed a curvilinear trend that can be estimated through a cubic function that explains 89% of observed data, while for girls the best estimate was obtained through an inverse function (R2 = 0.40). cHDL for boys showed a cubic function as the best estimate (R2 = 0.90), while for girls the best estimate was obtained through a quadratic function (R2 = 0.59)., Conclusions: There are important physiological variations of total cholesterol level by age and sex in children and adolescents. The pattern of cholesterol does not follow a linear model but a curvilinear one, that need to be considered in clinically assessing individual determinations of cholesterol, since highest percentiles can vary by age and sex.

Aim: To analyze the relationship between blood pressure in childhood and adolescence and different variables including gender, age, weight, height, body mass index and sexual maturation., Methods: Cross-sectional study conducted in 1278 boys and girls aged 6 to 18 years old. Two blood pressure measurements were obtained. Mean value in the two measurements was obtained for each of the pressures: systolic (SBP), diastolic IV (DBPIV) and diastolic V (DBPV). Simple and multiple regression analysis were done to evaluate association between variables., Results: 14 years 0.33; SBP boys > 14 years 0.34; DBPIV 0.25; DBPV 0.24) and height (SBP 6-13 years 0.33; SBP girls > 14 years 0.23; SBP boys > 14 years 0.29; DBPIV 0.25; DBPV 0.24) than for age (SBP 6-13 years 0.27; SBP girls > 14 years 0.17; SBP boys > 14 years 0.15; DBPIV 0.23; DBPV 0.22) for each of the blood pressures. Multiple regression analysis demonstrated a significant association between body mass index, height and SBP in the group of boys and girls aged 6-13 years old. No other significant associations were obtained., Conclusions: Blood pressure values in childhood and adolescence show a positive association with growth and maturation variables. It's of capital importance to considerate not only age, but also height, weight and body mass index when evaluating the blood pressure value of a child.

Objective: Our objective was t evaluate the current knowledge and attitudes of pediatricians regarding the issue of pediatric sedation., Patients and Methods: In October 1996 we conducted a mail survey of all 686 members of the Asturias, Cantabria and Castilla y Leon Pediatric Society. Physicians were asked to complete and return a confidential 18-item questionnaire., Results: One hundred fifty-seven (23%) of the eligible physicians responded. Of the responding physicians, 90% agreed that they had insufficient training in pain and sedation management. Seventeen percent thought childhood sedation to be very effective, 76% effective and 7% little effective. Fifty-nine percent thought infant sedation was easy and 36% considered it to be difficult. Thirty-six percent of the pediatricians who work in hospitals considered the cooperation of children under 8 to be good versus only 17% of the primary attention pediatricians (p < 0.05). Thirty-nine percent thought that it was only necessary on some occasions that the parents are present when the child is sedated before surgery. Forty-eight percent of the male pediatricians considered that sedation was always or almost always indicated versus 67% of the female pediatricians (p < 0.05). The most used sedative drugs are midazolam (24%), diazepam (23%) and chloral hydrate (14%). Eleven percent indicated that it was necessary to monitor cardiorespiratory function and oxygen saturation during sedation., Conclusions: Pediatricians in this Society seem to have a lack of knowledge concerning sedation of their patients. Training in childhood sedation is needed.

Objective: The aim of this study was to evaluate glomerular filtration rate (GFR) and renal functional reserve (RR) in young patients after diagnosis of minimal change nephrotic syndrome (MCNS) during childhood., Patients and Methods: GFR and RR were evaluated in 15 young patients (10 female) diagnosis of childhood MCNS 18.5 +/- 4 years before. Creatinine clearance (CC) was measured before and after an acute protein load to determine GFR and RR. Based on the tendency towards relapses, the study subjects were divided into two groups: Group A had less than five relapses and group B five or more relapses. Study subjects (groups A and B) and control subjects (group C) were matched for sex and age., Results: Group B showed a higher GFR than groups A and C (group B = 133.9 +/- 16.26 ml/min/1.73 m2, group A = 107.91 +/- 18.19 ml/min/1.73m2; p = 0.014, group C = 113.89 +/- 13.17 ml/min/1.73m2, p = 0.015). RR was significantly lower (absolute and relative) in group B than in group C (group B = 10.9 +/- 15.46 ml/min/1.73m2, group C = 38.58 +/- 21.47 ml/min/1.73m2, p = 0.016 and group B = 8.56 +/- 11.75%, group C = 34.35 +/- 21.43%, p = 0.016, respectively)., Conclusions: After childhood MCNS, young patients who presented more than five relapses showed an increase in GFR and a decrease in RR.

Objective: The objective of this study was to evaluate the current sensibility and knowledge of pediatricians regarding the issue of pediatric pain assessment and management., Patients and Methods: In October 1996 we conducted a mail survey of all 686 members of the Asturias, Cantabria and Castilla y León Pediatric Society. Physicians were asked to complete and return a confidential 95-item questionnaire., Results: One hundred fifty-seven (23%) of eligible physicians responded. Ninety percent of the respondents agreed they had insufficient training in pain management. Sixty-nine percent though their knowledge to deal with acute pain was adequate. Only 12% admitted to having enough background to treat chronic pain. Sixty-five percent of the respondents admitted to know no method at all for pain evaluation, while 82% had never applied any in their clinical practice. About half the respondents (42%) did not know any guidelines for the management of pediatric pain, although 75% considered they would be very useful. A high percentage of pediatricians answered that analgesia was required before performing certain diagnostic or therapeutic procedures (lumbar puncture, venous canalization, arterial puncture and others), but differences in relation to age, sex and clinical setting of the physicians were detected in these responses. The most used drug for the treatment of moderate acute pain is acetaminophen (88%), for severe acute pain metamizol (58%) and for severe chronic pain acetaminophen-codeine (37%). Only 48% admitted to having used opioids., Conclusions: Pediatricians in this society seem to be too confident about the topic of acute pain management in their patients, even though they report a lack of training which could influence the quality of the care they are offering to their patients. Opioid use is very low. Training in childhood pain management is needed.

Objective: Different studies conclude that apoprotein E (Apo E) is a genetic determinant of lipid levels and cardiovascular risk, although these studies have been carried out principally in adults, with scarce and variable results available in children. The aim of our study was to analyze the association between lipid profile and the different Apo E isoforms (E2, E3 and E4) in a group of Spanish children., Patients and Methods: In a transversal study, apo E genotypes and the lipid profile [total cholesterol (TC), LDL-c, HDL-c, triglycerides (TG), Apo A1, apo B and Lp(a)] were determined in 191 children (110 boys and 81 girls) between 8 and 15 years of age. Apo E genotyping was performed by means of polymerase chain reaction and subsequent digestion with the restriction enzyme HhaI., Results: The relative frequency for the E3, E4 and E2 alleles were 0.87, 0.09 and 0.04, respectively. Total cholesterol, LDL-c and Apo B serum levels were highest in the group of individual with the genotypes E3/E4 and lowest in the group E2/E3, while E3/E3 individuals had intermediate levels. When analyzed according to gender, we only found statistical significance in the group of girls (p < 0.004)., Conclusions: The apo E genotype was significantly associated with lipid differences observed in the childhood population and this is modulated by gender.

Objective: The purpose of this study was to know the current practices of Spanish pediatric nephrologists concerning the inclusion or not of children with end-stage renal disease (ESRD) in programs of dialysis and transplantation in order to open a discussion on the topic that would allow a consensus to be reached., Patients and Methods: A descriptive and prospective study using an anonymously mailed survey to 90 members of the Spanish Pediatric Nephrology Association was carried out., Results: The index of response was 43%. In 90% of the physicians polled they believe that some situations exist where it is advisable not to include a child with ERF in dialysis and, although all assure that there are no written procedures, a large majority (85%) think that they should exist, at least in the most representative cases. Serious physical and/or intellectual handicap and poor prognosis constitute the most important factors for making a decision. The expressed desire of the parents is considered the third most important factor by 56%. Of the answers, 82% placed economic cost of the substituting treatments as least important. Ninety-two percent think that not always and not in all cases is it necessary to turn to all possible technical means to extend the life. More than half (54%) think that the last decision must be taken by the physician and the family, although 44% confer this power to the Ethical Committee., Conclusions: It would be useful to develop guidelines to help pediatric nephrologists and/or ethical committees to decide, with the family of the patient, about the inclusion of the child in ESRD in programs of dialysis and transplantation.

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)