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ABSTRACT: The aim of our study is to analyze the clinic characteristics and evolution of the primary reflux in infants.
We studied retrospectively 203 infants in our hospital, diagnosed of severe primary renal reflux. Renal ecography and cyclic mictional cystography were practiced in all cases. DMSA was carried out in 181 patients.
Renal reflux was unilateral in the 23% of the patients, and bilateral in the remaining cases; 72% of the renal reflux were grade IV and 28% grade V. The renal injuries affected to male infants and reflux grade V. The renal injury was focal (27%), global (44%) and atrophic (29%). The 79% of the patients had conservative treatment, while 21% had surgical treatment. 100% infants with surgical treatment and 94.2% infants with conservative treatment were recovered (Test of Kaplan-Meier). The 27% of patients developed one or several urinary infections, but progression of old renal injuries or formation of new ones, were exceptional (3 cases): While the time the study lasted none of the patients developed chronic renal failure nor arterial hypertension.
1) The fetal severe primary reflux of the patients was characterized by the following features: to be bilateral reflux, to affect mainly to male infants and to be associated in 33% of cases with a severe renal injury of congenital origin (renal displasia) most of them unilateral. 2) The natural evolution of the reflux goes to spontaneous recovery, so treatment must be conservative. 3) Some patients underwent urinary infections, but progression or formation of new renal injuries were inusual. None of the patients had terminal renal failure nor hypertension and 4) Risk patients would be male infants with bilateral injuries although these are infrequent.
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2004; 24(2):131-41. · 1.00 Impact Factor
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ABSTRACT: The present study demonstrates that renal tubular unresponsiveness to aldosterone, without associated hyperkalaemia, is present in children with acute pyelonephritis. We studied 32 children with a diagnosis of acute pyelonephritis established by high fever, flank pain/tenderness, increased blood levels of C-reactive protein and significant Escherichia coli growth in the urine culture. Renal tubular function tests and determinations of plasma renin activity and aldosterone concentration were performed at diagnosis (study 1), after three days of iv gentamycin (study 2) and after 21 days of antibiotic therapy (study 3). Findings were compared to those present in 32 normal children of similar age. Despite normal plasma potassium concentration, fractional potassium excretion and transtubular potassium concentration gradient were significantly decreased in studies 1 and 2, becoming normal in study 3. Decreased renal potassium excretion coexisted with increased values for plasma renin activity and aldosterone concentration. In study 3 these hormones remained elevated only in patients with scarred kidneys. The functional alteration present in acute pyelonephritis may be directly caused by the interstitial inflammation or be mediated by some E. coli endotoxin.
Acta Paediatrica 06/1992; 81(5):402-6. · 2.07 Impact Factor
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ABSTRACT: Increased luminal calcium decreases potassium secretion in microperfused rat distal tubule. To determine if such an effect is also present in vivo, we evaluated renal potassium excretion in 49 children with idiopathic hypercalciuria (urinary excretion of Ca = 5.5 +/- 1.3 mg/kg/day) and in 214 age-matched control children (urinary excretion of Ca = 1.9 +/- 0.3 mg/kg/day). In comparison to controls, hypercalciuric children had significantly increased levels of sodium excretion (fractional excretion of Na = 0.7 +/- 0.3 vs. 0.6 +/- 0.3%, respectively; p less than 0.001) and decreased levels of fractional potassium excretion (7.2 +/- 2.9 vs. 9.2 +/- 3.4%, respectively; p less than 0.001) and of the transtubular potassium concentration gradient (4.2 +/- 1.5 vs. 5.9 +/- 1.5, respectively; p less than 0.001). All indices of potassium excretion correlated significantly and inversely with urinary calcium excretion (p less than 0.001). After an oral calcium load, performed in 30 hypercalciuric children, the increased rates of urinary calcium excretion were accompanied by increased rates of urinary sodium excretion and by a significant decrease in the transtubular potassium concentration gradient. These results support the hypothesis that increased luminal calcium concentration also inhibits renal potassium secretion in man.
Mineral and Electrolyte Metabolism 02/1991; 17(6):357-61.
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Anales espanoles de pediatria 12/1990; 33 Suppl 43:214-9.
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ABSTRACT: The present investigation was designed to validate the usefulness of transtubular potassium (K) concentration gradient (TTKG) as an indicator of aldosterone bio-activity in infants and children. TTKG was calculated by the formula: [K]urine: (urine/plasma)osmolality/[K]venous blood. We compared this index with fractional K excretion (FEK) and urine K concentration to urine sodium (Na) concentration ratio (UK/UNa) in 473 normal children aged 1 month-15 years. Values of TTKG followed a non-gaussian distribution (median, 6.3; 3rd centile, 4.1; 97th centile, 13.4). TTKG in infants (n = 108; median, 7.8) was significantly higher than in children (n = 365; median, 6.0). TTKG correlated directly with FEK and UK/UNa. Indices of K excretion were also assessed in 13 patients with hypo- and pseudohypoaldosteronism. TTKG values varied between 1.6 and 4.1 and were all below the 3rd percentile established for the age of the subject. We conclude that calculation of TTKG is an easy and sensitive method for the evaluation of mineralocorticoid action in distal and collecting tubules.
Pediatric Nephrology 04/1990; 4(2):105-10. · 2.52 Impact Factor
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Anales españoles de pediatría: Publicación oficial de la Asociación Española de Pediatría (AEP), ISSN 1695-4033, Vol. 69, Nº. 6, 2008, pags. 521-525.
