We evaluated the policy changes of 10 pediatric departments in the Friuli Venezia Giulia region following the implementation of a new protocol for the diagnosis and treatment of urinary tract infection. Clinical data concerning 1,059 infants and children with a first episode of urinary tract infection were recorded in three periods, before (A), during (B), and after (C) implementation of the protocol application. We observed a significant increase in the total number of urinary tract infections (288 in period A, 464 in C) from period A to C, with particular regard to pyelonephritis (36.8 % in period A, 64.3 % in C). As radiological investigations were carried out more frequently, there was a significant increase in the number of cases of vesicoureteral reflux recorded (from 23 in period A to 76 in period C). Finally, a better therapeutic approach was progressively achieved: errors in the choice of antibiotics and the duration of treatment have been almost completely avoided in period C. In our opinion, these results demonstrate a long-term improvement of pediatricians' awareness of this frequent pediatric pathology and their policies to control it.
The long-term effect of hydrochlorothiazide (HCT) was studied in 30 children (17 boys and 13 girls), aged 4-13 years (mean 7.6 +/- 3.4), with renal hypercalciuria (HCU) for a period of 2.5 +/- 0.95 years. The purpose of the study was to evaluate the effect of HCT mainly on renal calcium excretion, but also on serum K+, Ca, P, Mg, cPTH, nephrogenic cAMP (ncAMP) and bone mineral content (BMC). In addition to the above-mentioned parameters, oxalate, uric acid, citrate and cystine levels in 24-hour urine collections were also measured, and UCa/UCr, UP/UCr, UMg/UCr in 3-hour urine collections were assayed. The results of the study showed that 1 mg/kg/day of HCT caused a rapid and long-lasting correction of HCU, a decrease in serum cPTH and ncAMP, a significant increase in BMC and prevention of the formation of new urinary stones or of the increase in size of stones already present. No side effects were observed.
The optimal treatment, surgical or conservative, for multicystic dysplastic kidney (MDK) is still undetermined. We analyzed prospectively the evolution of 12 children with MDK who were managed conservatively. After a mean follow-up of 32 months, the only complication found was an episode of urinary tract infection in 3 patients. Complete involution of MDK was observed in 9 patients (75%), the mean period for sonographical disappearance being 16 months. Infants with MDK should be closely monitored and nephrectomy performed when MDK compresses neighbor organs or hypertension develops. There is no agreement on the best therapeutic approach in patients in whom MDK involution has not occurred after a prudential waiting time still not determined.
Renal involvement in desquamative interstitial pneumonitis (DIP) manifesting as chronic renal failure has been reported only once. An uncommon disorder in children, DIP has been associated with a variety of systemic disorders and has an immune-mediated pathogenesis. A 16-year-old Black male was diagnosed to have DIP on lung biopsy at the age of 10 months. He was first noted to have proteinuria at age 5 which progressed to nephrotic syndrome by age 13 when the laboratory tests showed elevated IgG, normal serum complement, increased circulating immune complexes and absent anti-GBM antibodies. A percutaneous renal biopsy specimen performed at age 13 revealed focal segmental glomerulosclerosis. Despite prednisone treatment of 2 mg/kg/day for 12 weeks, renal failure progressed requiring hemodialysis. Pulmonary functions, although reduced, remained stable.
Through the benefit of a large body of normative data on blood pressure throughout childhood, along with the clinical practice of regular blood pressure measurement in the young, mild elevation of blood pressure can be detected in the young. Unlike secondary hypertension in the young which is more severe, slight to mild elevations in blood pressure during childhood may be an early expression of essential hypertension. Mildly elevated blood pressure in the young is usually associated with other risk factors including obesity, family history of cardiovascular disease, and metabolic alterations in lipids and insulin. Environmental factors, which include health related behaviors can modulate the expression of the risk factors including elevated blood pressure. The extent to which the health behaviors of diet and exercise can be modified in the young may be important for risk factor intervention during the early phases of hypertension.
We report 9 female patients with labial fusion and concomitant urinary tract infection. The mean age at presentation was 47 months. All except 1 patient had labial fusion extending at least 50% of the length of the labia minora. All had symptoms of urinary tract infection and a positive urine culture. We recommend that a urine culture be performed in children with labial fusion and that all girls with urinary tract infection should be checked for labial fusion.
The effect on growth of long-term treatment with prednisolone was studied in 12 patients with steroid-sensitive nephrotic syndrome. Our patient's heights were found between the 10th and 25th percentile both at the first and last height measurement. There was no statistical difference between the first and last height standard deviation score (Ht SDS) (p greater than 0.05). When compared with chronological age, growth velocity (GV), GV SDS and bone age were found low but within the normal range for this age group. There was not any correlation between the last Ht SDS and relapse number, total doses and duration of daily and alternate-day steroid therapy (p greater than 0.05). Growth hormone (GH) responses to pharmacological stimuli were obtained as severe deficiency in 10 patients, partial deficiency in 1 patient and normal level in 1. There was statistical difference between the pulse number of the overnight GH profile of the patients and control group (p less than 0.05). But no statistical difference was found between GH pulse amplitude and GH concentration in patients and control group (p greater than 0.05).
