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Biomedical subjects

C Chantler

Publications and source records attributed to C Chantler.

At least 91 records · Page 5Linked to original sources
PubMed1986

Renal function following surgical correction of vesico-ureteric reflux in childhood.

To assess the effectiveness of the surgical correction of vesico-ureteric reflux, current renal function was determined in 56 children with scarred kidneys who had undergone ureteric reimplantation between 1978 and 1983. The children were aged between 2 and 15 years, had no coexisting urological disease and a glomerular filtration rate (GFR) of less than 90 ml/min/1.73 m2. In the 32 patients who had bilateral reimplantation of ureters draining bilaterally scarred kidneys the improvement in GFR following surgery was highly significant (P less than 0.001), with improvement occurring in 75%. The greatest improvement was in patients where the GFR was less than 50 ml/min/1.73 m2 (29%). Individual kidney GFR was estimated in 42 kidneys and 81% improved after surgery. This improvement was highly significant (P less than 0.001).

Adolescent↗
PubMed1986

The effect of a low protein diet with amino acid/keto acid supplements on glucose metabolism in children with uremia.

Six children with chronic renal failure were treated with dietary protein restriction and essential amino acid and keto acid supplements for 6 months. Dietary protein and phosphate intake decreased, dietary calcium increased, and dietary carbohydrate and energy did not change. Plasma urea and urea to creatinine ratio decreased significantly during treatment. Glucose metabolism was studied before and after 6 months of treatment using the hyperglycemic clamp technique. Fasting hyperglycemia, glucose intolerance, and insulin resistance improved during treatment, while fasting insulin and insulin levels during hyperglycemia did not change. These metabolic changes were not related to hyperparathyroidism and were probably due to reduction in nitrogen toxicity.

Adolescent↗
PubMed1986

Hyperlipidemia after renal transplantation in children on alternate day corticosteroid therapy.

We studied the serum lipid profiles of 29 children, 3.9-17.9 years of age who were 0.6-7.6 years after renal transplantation (Tx). Twenty normoglycemic and non-proteinuric children had a well functioning allograft and 5 children had reduced renal function. Both groups were at least 7 months on alternate day corticosteroid (ADCS) therapy. Four additional patients had good renal function but were only 2.3 +/- 0.5 months on an ADCS regimen. Fifteen normal children served as controls. The levels of serum triglycerides (STG) and total cholesterol (CHOL) were elevated and high-density lipoprotein CHOL (HDL-CHOL) were low in all patients compared to control subjects (p less than 0.01). Their cardiovascular risk factor (CHOL/HDL-CHOL) was increased. The lipid abnormalities were most prominent in Tx patients with reduced graft function. These data show that treatment with ADCS does not prevent post-Tx hyperlipidemia. More insight is needed into the mechanisms responsible for the hyperlipidemia after Tx in order to reduce possible future morbidity (and mortality) from premature cardiovascular disease in this group of young, high-risk patients.

Adolescent↗
PubMed1985

Suppression of secondary hyperparathyroidism in children with chronic renal failure by high dose phosphate binders: calcium carbonate versus aluminium hydroxide.

Secondary hyperparathyroidism was suppressed over a period of one year in 12 children with chronic renal failure by using a regimen of mild dietary phosphate restriction and high dose phosphate binders. The patients were randomised to receive either aluminium hydroxide or calcium carbonate by mouth for six months and then crossed over to the other medication. Vitamin D (dihydrotachysterol) dosage was unchanged. Serum parathyroid hormone concentrations were reduced to within the normal range, urinary cyclic adenosine monophosphate values fell, plasma phosphate concentrations decreased, and the theoretical renal phosphate threshold increased significantly. Transiliac bone biopsy findings improved in four patients with adequate suppression of parathyroid hormone concentrations, deteriorated in two patients who were not compliant, and did not change in five patients in whom initial bone disease was mild. Growth velocity improved significantly. There was no difference in the clinical response, biochemical changes, or incidence of complications during treatment with the two agents. In view of the risk of aluminium toxicity the use of high dose calcium carbonate with dietary phosphate restriction and vitamin D supplementation is recommended in the control of secondary hyperparathyroidism in children with chronic renal failure.

Adolescent↗
PubMed1985

Why do patients with lupus nephritis die?

Over 20 years 42 of 138 patients with systemic lupus erythematosus "died"--that is, suffered actual death or went into terminal renal failure, or both; data from 41 were available for analysis. In most patients the causes of death were multiple. Twenty seven patients went into terminal renal failure, of whom 25 were offered dialysis treatment. Three regained renal function later, 12 survived on dialysis or with functioning kidney allografts--almost all with inactive lupus--but 13 died after starting dialysis, most within a few weeks or months. The principal causes were active lupus or infection. In those patients with renal failure after rapid deterioration in renal function (n = 14) there were nine deaths, while of 10 patients with a slow evolution into renal failure, only four died. Four patients with impaired and 10 with normal renal function died, again most often from complications of lupus or from infection. Vascular disease was a major cause of death in seven patients, all but two of whom were young; of 15 postmortem examinations, eight showed severe coronary artery atheroma, and three surviving patients required coronary bypass operations. Analysis of the timing of death or entry into renal failure showed that in 12 out of 13 patients who died within two years of onset the lupus was judged to be active, while this was true in only eight out of 19 patients who died later. Six of the seven vascular deaths occurred later than two years from onset, while only nine of 26 renal "deaths" occurred before two years; deaths from infections (n = 13) were distributed equally. Despite this and aggressive treatment of active disease, the principal cause of actual death was uncontrolled lupus.

Adolescent↗
PubMed1985

Familial juvenile nephronophthisis, Jeune's syndrome, and associated disorders.

Fourteen patients with familial juvenile nephronophthisis are described, eight of whom displayed one or more additional disorders. One boy with short limbed dwarfism and an abnormal chest was considered to have Jeune's syndrome; review of the published reports supports the view that nephronophthisis is the principal cause of renal failure in this disorder. Another patient with renal failure and retinitis pigmentosa at presentation developed progressive neurological and neuromuscular impairment leading to the discovery of ragged red fibre disease (mitochondrial cytopathy). Cardiomyopathy was present in this and one other patient. Tapeto-retinal degeneration, hepatic fibrosis, cerebellar ataxia, and oculomotor apraxia were among the other disorders encountered. Three patients presented in extremis with acute heart failure and irreversible oligo-anuria and this complication developed in another child who was already known to have nephronophthisis. Awareness of this disease and its associations is important for early diagnosis and appropriate management.

Adolescent↗
PubMed1985

The influence of hyperparathyroidism on glucose metabolism in uremia.

We studied glucose metabolism in a group of adolescents and young adults with uremia using the hyperglycemic clamp technique. In eight adolescent patients, the glucose metabolic rate correlated negatively with PTH levels and positively with the glomerular filtration rate. Six patients, one adolescent and five adults on regular hemodialysis with severe hyperparathyroidism, had low glucose metabolic rates and reduced insulin sensitivity compared to normal subjects. After parathyroidectomy, the glucose metabolic rate improved by 47%; plasma insulin concentrations during hyperglycemia increased by 37%, and insulin sensitivity did not change significantly. Thus, correction of hyperparathyroidism was associated with normalization of glucose metabolic rates and increased insulin secretion, but insulin resistance did not change.

Adolescent↗
PubMed1984

Sodium homeostasis in term and preterm neonates. III. Effect of salt supplementation.

Clinical and biochemical effects of supplementing dietary sodium intake to 4 to 5 mmol(mEq)/kg/day from days 4 to 14 of life were studied in 22 infants of gestational age 27 to 34 weeks. These infants were compared with a group of 24 unsupplemented babies. Supplemented infants lost less weight postnatally and regained birthweight more quickly: their improved weight gain continued after supplementation was stopped. Sodium balance was positive at age 5 to 11 days in supplemented babies but slightly negative in controls. Potassium balance was more strongly positive in the supplemented group. Plasma sodium concentration was higher in supplemented infants during weeks 3 and 4. Hyponatraemia was significantly more common in unsupplemented (37.5%) than supplemented (13.6%) infants. No infant became oedematous, hypernatraemic, or showed evidence of circulatory overload. The incidence of patent ductus arteriosus and necrotising enterocolitis was not increased; no intracranial haemorrhages occurred. Urinary potassium:sodium ratio was lower in supplemented babies than controls suggesting responsiveness of the distal tubule to mineralocorticoids. Providing 4 to 5 mmol(mEq)/kg/day of sodium to infants born before 34 weeks' gestation for the first two postnatal weeks improves growth and biochemical status and causes no undesirable side effects.

Body Weight↗
PubMed1983

Peritoneal dialysis in infants.

A commercially available closed dialysis system and a new peritoneal cannula with potential advantages for infants have been developed. The dialysis set includes three dialysate bags that may be connected to the filling burette; the warming coil of the set is placed in a thermostatically controlled water bath. The peritoneal catheter comprises a flexible tube with side holes and a sharp short bevelled needle with obturator. Advantages of the new equipment over previously available equipment are that the cannula is easier to insert; there is less risk of contaminating the dialysate since the tubing set is unbroken from supply to cannula; the mix of the dialysate may be changed easily without interrupting dialysis; and the equipment may be assembled easily by unskilled staff.

Catheters, Indwelling↗
PubMed1983

Renal transplantation in very young children.

Thirteen cadaver and three live-donor renal transplants were undertaken in fifteen children aged less than 5 years, of whom seven were younger than 3 years. Mean weight of the recipients was 11.5 kg; six weighted less than 10 kg at operation. Mean age of the cadaver donors was 13.5 years. Bilateral nephrectomy was undertaken before or at the time of transplantation in eight recipients; ten required dialysis before transplantation. Five grafts were lost in four patients, three owing to long-segment renal-artery stenosis possibly due to chronic rejection. After mean follow-up of 1.2 years the mean plasma creatinine of the ten functioning grafts was 64 mumol/l with a mean estimated glomerular filtration rate of 70 ml/min/1.73 m2. Careful circulatory control to avoid hypovolaemia or hypervolaemia and the maintenance of a high urine flow rate immediately post-transplant have prevented the graft loss due to thromboses or primary non-function previously reported with cadaver grafts in young children. Postoperative growth has been encouraging.

Adolescent↗
PubMed1983

Idiopathic mesangiocapillary glomerulonephritis. Comparison of types I and II in children and adults and long-term prognosis.

Of 104 patients with idiopathic mesangiocapillary glomerulonephritis studied for at least two years, 69 patients had type I disease and 35 had type II. Forty-five patients were children, and 59 were adults. Type II mesangiocapillary glomerulonephritis was more common in children than in adults, but no other clinical feature distinguished the two types at onset. Complement studies revealed that patients with type II had lower serum C3 concentrations and more frequently showed C3-splitting activity (C3 nephritic factor) in the serum. Children had hypertension or a lowered glomerular filtration rate less frequently at onset than did adults, but children had a higher incidence of a hematuric onset; C3 nephritic factor was also more frequent in the children. During a follow-up period of two to 21 years (mean eight years), only seven patients (five with type I and two with type II) showed clinical remission, whereas 38 percent of patients with type I and 49 percent of patients with type II died or required dialysis; a further 23 percent of patients with type I and 16 percent of patients with type II had continuing disease and reduced glomerular filtration rate. Only the presence and persistence of a nephrotic syndrome in type I predicted renal failure. In both types, the presence of sclerosis or crescents in the initial renal biopsy specimen was associated with a poorer prognosis, but no other feature was of major prognostic value.

Adolescent↗
PubMed1983

Oral essential aminoacid and ketoacid supplements in children with chronic renal failure.

The effects on growth, body composition, and metabolism of a protein-restricted diet supplemented with essential aminoacids, the calcium-ketoacids of valine, leucine, isoleucine, and phenylalanine, and the calcium-hydroxyacid of methionine, were investigated in seven growth-retarded children with chronic renal failure. During 0.4 to 1.0 years of treatment there were significant increases in growth velocity and upper arm circumference SD scores, body cell mass (intracellular water calculated as tritium space minus corrected sodium bromide space) and serum transferrin. Blood urea and urea:creatinine ratio fell in all children. Renal function assessed from plasma creatinine and 51Cr EDTA clearance did not change significantly. During treatment there was an increase in plasma calcium, high levels necessitating brief interruption of therapy in two children, and a decrease in plasma phosphate. Levels of serum parathormone fell in all children, and were correlated inversely with plasma calcium and positively with plasma phosphate. Abnormalities compared to control children in blood aminoacid and branched-chain ketoacid levels were unaffected by treatment. These results suggest that a protein-restricted diet supplemented with essential aminoacids and calcium-keto and hydroxyacids may be useful to improve linear growth and nutritional status in children with chronic renal failure, and that a reduction in hyperparathyroidism may be partly responsible for some of the beneficial effects observed.

Amino Acids, Essential↗
PubMed1983

Haemolytic-uraemic syndrome: an analysis of prognostic features.

Seventy-two children with the haemolytic-uraemic syndrome were seen between 1969 and 1980 at The Hospital for Sick Children and Guy's Hospital, London. They probably constitute the majority of such cases in south-east England during that period. Boys and girls were affected equally, the mean age at presentation was 3.5 years, and a peak incidence of the disorder in summer months was observed. In 52 (72%) there was a history of diarrhoea at onset. Fifty-seven (78%) were managed by dialysis. Fifty (70%) of the 72 children had a favourable outcome with complete recovery, 3 (4%) died in the acute phase of the illness, 8 (11%) had residual hypertension or chronic renal failure, and 11 (16%) never recovered renal function. The probability of complete recovery of renal function was analysed by logistic regression which indicated that younger age, presentation in the summer months, diarrhoea at onset and, in those patients who were dialysed, a short prodromal illness were associated with a good outcome. Further analysis of the interaction among these variables in the patient group as a whole indicated that diarrhoea favoured a good outcome among boys but not girls.

Acute Kidney Injury↗
PubMed1983

Growth after renal transplants.

The growth of every child with a bone age less than 15 years who received a first renal transplant between 1975 and 1980 was analysed to determine the growth expectation of children with renal transplants substantially maintained on alternate-day prednisolone. Growth was expressed as a standard deviation score defined as the difference between the standard deviation for height at the time of the transplant and at the end of 1981. Average growth achieved by the 46 children. 41 with functioning transplants, was normal with a mean standard deviation score of +0.7 +/- 0.3 (SEM) for boys and -0.3 +/- 0.3 (SEM) for girls; 25 of the children had accelerated growth. Mean standard deviation scores per year of advance of bone age in 29 children was +0.003, which suggested no overall loss of growth potential. No difference in growth per year of advance in bone age was detected in children with a bone age less than 12 years at transplant compared with more mature children, but boys with a bone age less than 12 years grew better per year of advance in chronological age; this appeared to be related at least in part to their greater growth deficit at transplant. Glomerular filtration rate, alternate-day prednisolone dose, and level of plasma phosphate did not appear to affect growth in the 11 prepubertal children with functioning first grafts.

Adolescent↗
PubMed1983

Sodium homeostasis in term and preterm neonates. I. Renal aspects.

Eighty five 24 hour sodium balance studies and creatinine clearance measurements were performed in 70 infants of gestational age 27-40 weeks and postnatal age 3-68 days. The kidney's capacity to regulate sodium excretion was a function of conceptional age (the sum of gestational age and postnatal age) and an independent effect of postnatal age was also observed--extrauterine existence increased the maturation of this function. The sodium balance was negative in 100% of infants of less than 30 weeks' gestation, in 70% at 30-32 weeks, in 46% at 33-35 weeks, and in 0% of greater than 36 weeks, and the incidence of hyponatraemia closely paralleled that of negative sodium balance. Despite a low glomerular filtration rate (GFR) urinary sodium losses were highest in the most immature babies but fractional sodium excretion (FENa) was exponentially related to gestational age. An independent effect of postnatal age could be identified on FENa but not in GFR. These findings indicate that in infants of greater than 33 weeks' gestation sodium conservation is possible because of a favourable balance between the GFR and tubular sodium reabsorption, but that below this age GFR exceeds the limited tubular sodium reabsorption capacity. The rapid increase in sodium reabsorption in the first few postnatal days seems to be due to maturation of distal tubular function, probably mediated by aldosterone. We suggest that the glomerulotubular imbalance for sodium is a consequence of the immaturity of the tubuloglomerular feedback mechanism, and we estimate that the minimum sodium requirement during the first 2 weeks of extrauterine life is 5 mmol (mEq)/kg/day for infants of less than 30 weeks' gestation and 4 mmol (mEq)/kg/day for those born between 30 and 35 weeks.

Aging↗