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Biomedical subjects

C Chantler

Publications and source records attributed to C Chantler.

At least 127 records · Page 7Linked to original sources
PubMed1981

Endarterial urokinase in childhood hemolytic uremic syndrome.

Urokinase was given by unilateral infusion for 48-168 hours into the renal arteries of 8 children (0.2 to 13.0 years) with acute renal failure and impaired renal perfusion due to hemolytic uremic syndrome (HUS). Two children subsequently received a bilateral infusion. Immediate changes in renal perfusion were assessed by serial dynamic renal scanning in all patients and by repeat renal arteriography in 5. No improvement clearly attributable to urokinase was observed. In 4 surviving children assessment of divided renal function by static renal scanning 1 to 5 years after presentation showed no evidence of benefit from urokinase. Examination of the kidneys of 2 of the 3 children who died, and one who underwent bilateral nephrectomy prior to renal transplantation, showed no evidence of benefit from urokinase. Examination of the kidneys of 2 of the 3 children who died, and one who underwent bilateral nephrectomy prior to renal transplantation, showed no preservation of renal mass attributable to urokinase; in one of these children the infused kidney was considerably smaller than the untreated kidney. It is concluded that local infusion of urokinase had no beneficial effect on the course of HUS in these children.

Adolescent↗
PubMed1981

Systemic lupus erythematosus with nephritis.

Thirty-six patients with the onset of symptoms of systemic lupus erythematosus before age 20 years (23 aged less than 15 years at onset) were studied during a 15-year period. All had clinical evidence of nephritis. They were followed for a mean of 5 years (range 6 months to 13 years) or until death. Survival was calculated to be 77% at 10 years for those aged less than 15, and 74% for those aged less than 20, from the onset of clinical nephritis. At referral, renal function was already impaired in two-thirds of patients. Renal biopsies showed mild focal or proliferative changes in 19% of patients, membranous lesions in 11%, and diffuse proliferative lesions in 70%. Three (8%) patients died during follow-up, all from sepsis, and 3 (8%) others required chronic haemodialysis for terminal renal failure. The prognosis even of severe lupus nephritis in childhood and adolescence has improved in recent years. Side effects of treatment remain an important cause of death and morbidity.

Adolescent↗
PubMed1981

Diagnostic puncture in renal cystic dysplasia (multicystic kidney). Evidence on the aetiology of the cysts.

Five cases of cystic dysplastic (multicystic) kidney occurring in infancy are described, in whom diagnostic puncture was used to confirm the suspected diagnosis. The characteristic finding on contrast injection was that the cystic spaces communicated via tubular structures, presumably nephronic, so ruling out the possibility of hydronephrosis. This finding also supports the view that cysts in multicystic kidney derive from nephrons and are not due to dilated calices. Although urography and ultrasonography both give appearances highly suggestive of multicystic kidney, the appearances on renal puncture are pathognomonic. When such appearances are demonstrated there is no urgent need for operative removal, except when necessitated by the size of the mass.

Contrast Media↗
PubMed1981

Nutritional management of chronic renal failure in childhood.

Protein malnutrition is common in children with chronic renal failure (CRF) and is especially severe in young infants. Growth is usually rapid in infants and CRF causes a reduction in cell mass associated with extreme growth retardation in this age group. Poor energy intake and altered energy metabolism are common in CRF and are associated with protein malnutrition and poor growth. Uraemic toxicity may reduce protein synthesis by altering energy metabolism or by a direct effect, low protein high energy diets improve growth and extremely low nitrogen intakes supplemented with essential amino acids and keto acids may be useful in selected children.

Amino Acids↗
PubMed1981

Body composition in children on regular hemodialysis.

Body composition was estimated in 12 pubertal and 7 pre-pubertal children (age range 7-17 years) on regular hemodialysis for chronic renal failure (CRF). The results were expressed as a ratio of observed/predicted. Total body water (TBW) was normal and extracellular water (ECW) was significantly increased in both groups. Intracellular water (ICW), which reflects body cell mass, was significantly decreased in the pre-pubertal children but not in the pubertal children. The deviation in ICW from predicted normal was significantly more marked in the prepubertal children compared with pubertal children. Similarly, fat-free solids (FFS) were significantly decreased in the pre-pubertal, but normal in the pubertal children. Total body fat, estimated from body water, correlated significantly with skinfold thickness measurements and was normal in both groups, with the pre-pubertal children having significantly higher body fat ratio than pubertal children. Body fat was increased in some of the patients whose body cell mass was decreased. It is suggested that these changes are the result of a failure of normal energy metabolism with consequent body protein depletion, and that energy supplements as carbohydrate, particularly in the pre-pubertal patients, will increase body fat without affecting cell mass.

Adolescent↗
PubMed1980

The effects of anabolic steroids on growth, body composition, and metabolism in boys with chronic renal failure on regular hemodialysis.

Eight boys aged 9.5 to 17 years, on regular hemodialysis for chronic renal failure, were treated for 0.4 to 1.3 years with the anabolic steroid oxandrolone. The effects on linear growth, skeletal maturation, cell mass, and the fasting levels and response to intravenous glucose of BG, IRI, NEFA, BCAA, and IRG were measured. Following treatment there was a significant increase in mean growth velocity, growth velocity standard deviation score related to bone age, and cell mass. Overall skeletal maturation was not accelerated, and only a small advance in pubertal status was seen. There was a decrease in fasting levels of BG and NEFA; fasting BCAA and IRG were increased. The response to intravenous glucose was altered; there was a decrease in peak BG response, an increase in peak IRI response, and a more marked fall in plasma NEFA and BCAA levels. Fasting IRG levels correlated with fasting BG levels, and fell significantly following intravenous glucose both before and after treatment. Hepatotoxicity, which was reversible, was seen in a ninth boy who did not complete the study. The only other side effect, salt and water retention, was controlled by a reduction in oxandrolone dosage. These preliminary results suggest that anabolic steroids may be useful to stimulate anabolism and growth in uremic children, and that their effect is mediated by an increase in insulin secretion and/or an improvement in tissue sensitivity to insulin. Further studies with careful monitoring are required to substantiate the effect on final height and the risks involved.

Adolescent↗
PubMed1980

Nutritional therapy in children with chronic renal failure.

Children grow most during the first 2 years of life; growth retardation at this time has a major effect on the height of a child. Dietary therapy to maximize growth during the first few years before dialysis and transplantation are generally recommended as important. Energy and protein requirements for children in relation to their body weights are greater than for adults. In addition, the metabolic rate may be increased in uremia. Malnutrition and the metabolic disturbances of uremia appear to be more severe in prepubertal children than in adults and growth in such children is generally poor. This may be related to the lower anabolic drive of the prepuberal child; anabolic steroids may improve growth. Severely limited protein diets are difficult to achieve in children without reducing energy intake. It may be easier to give babies diets high in energy and low in protein with essential amino acid supplements to ensure an adequate essential amino acid intake. Fat intake should be increased to provide sufficient energy without causing hypertriglyceridemia. It is hoped that ketoacids may allow sufficient protein to be consumed as that an adequate energy intake is ensured while reducing nitrogen toxicity.

Amino Acids↗
PubMed1980

Oral essential amino acid supplements in children with advanced chronic renal failure.

The effects on growth, nitrogen balance, and body composition of a protein-restricted diet supplemented with oral essential amino acids (EAA) were studied in seven children with advanced chronic renal failure. The diet was designed to provide minimum protein requirements for height-age, half in unselected form and half as an EAA supplement. Energy from carbohydrate and fat were increased to give a protein/energy ratio of 1.25 G:100 kcal. Nitrogen balance, studied in five children before and after 6 to 8 months of EAA treatment, was improved in each case. intracellular water (total body water minus bromide space) increased in four children but fell in three children during treatment. No significant improvement in growth, expressed as height or height velocity standard deviation scores in relation to bone age, was observed. Serum urea and urea/creatinine ratio fell after institution of EAA treatment, but the fall was not sustained. Although the EAA preparation proved acceptable to the children, dietary assessments indicated that the desired dietary aims were rarely achieved. It is concluded that, in this pediatric age group, the long-term application of a protein restricted diet with EAA supplements is of limited value.

Adolescent↗
PubMed1980

10 years' experience with regular haemodialysis and renal transplantation.

75 children aged under 15 years have entered the regular haemodialysis/renal transplant programme at Guy's Hospital in the 10 years since its inception; 13 children have subsequently died. A combination of hospital and home haemodialysis and renal transplantation was used. 64 children received 80 renal allografts; 37 1st grafts were from live, related donors and 27 were from cadaver donors. The 5-year acturial patient survival for the whole group and for those who had transplants was 76%. Live donor graft survival was 65% at 3 years, and 55% at 5 years; 1st cadaver graft survival was 42% at 3 years. Results obtained during the last 6 years of the 10-year period showed an improvement with a live related donor graft survival rate of 71%, and a 1st cadaver graft survival rate of 47% at 3 years. Particular experience was gained with home haemodialysis and live, related donor transplantation. Despite growth, and psychosocial and rehabilitation problems, the overall results were encouraging, particularly for the 46 children who had successful transplants. These children grew better, had fewer psychosocial difficulties, and were rehabilitated more successfully into normal life than those on long-term dialysis. We conclude that dialysis and transplantation should be offered to all suitable children with terminal renal failure.

Adolescent↗
PubMed1980

Treatment of mesangiocapillary glomerulonephritis in children with combined immunosuppression and anticoagulation.

10 children with mesangiocapillary (membranoproliferative) glomerulonephritis with features associated with a poor prognosis (either crescentic nephritis or a decline in renal function occurring after the initial presentation) were treated with a combination of immunosuppression and anticoagulation using corticosteroids, azathioprine, and heparin followed by warfarin and dipyridamole. Children were followed up for between 2 and 5 years, and at the end of this period 2 had died and 2 had entered the dialysis/transplant programme, but 6 were well (5 with glomerular filtration rates greater than 65 ml/min per 1 x 73 m2). We suggest that these results are sufficiently promising to encourage further trials of this form of treatment.

Adolescent↗
PubMed1980

Hypertension in a four-year-old child: gas chromatographic and mass spectrometric evidence for deficient hepatic metabolism of steroids.

A 4-yr-old boy with hypertension and hypokalaemic alkalosis had low plasma aldosterone levels and renin activity. The hypertension and hypokalemia responded to spironolactone and triamterene therapy. A partial response to dexamethasone was observed. Analysis of urinary steroid metabolites by gas chromatography-mass spectrometry showed that the excretion of metabolites of deoxycorticosterone and aldosterone was subnormal, and there was no evidence for sizeable excretion of unusual steroids with potential mineralocorticoid activity. The cortisol excretion rate, however, was subnormal, and the relative excretions of individual metabolites of this hormone were not typical. In particular, the excretion of tetrahydrocortisone was markedly reduced, and the excretions of allotetrahydrocortisol and free cortisol and metabolites were elevated. These findings suggest that modified or deficient metabolism of adrenal steroids could give rise to elevated blood pressure. It is not known whether the inappropriate production of unusual cortisol metabolites were responsbile for the high blood pressure or whether the altered metabolism is indicative of similar abnormality in the metabolism of other adrenal steroids, resulting in hyperproduction or extended half-life of minor but highly active mineralocorticoids of unknown structures.

Aldosterone↗