Among 140 children with vesicorenal reflux 14 patients were found to be suffering from renal insufficiency. Seven of these patients had histologically proven bilateral segmental renal hypoplasia. Thanks to early commencement and sustainment of antihypertensive therapy, the prognosis of the condition was decisively improved. It does not appear to be worse than in other forms of reflux nephropathy at the renal insufficiency stage. Clinical courses in which there is no deterioration in renal function for more than 10 years are not uncommon. It is also possible to perform an anti-reflux plasty at the renal insufficiency stage. It is thus possible to permanently eliminate feverish infections of the urinary tract.

Adolescent↗

PubMedDate not supplied

The use of recombinant human growth hormone in short children with chronic renal failure.

Regulation of the somatotropic axis is altered in chronic renal failure (CRF) resulting in a secondary syndrome of growth hormone (GH) insensitivity. Secretion of growth hormone estimated by deconvolution analysis is low normal in prepubertal patients and reduced in late pubertal children with CRF. Basal and integrated GH serum concentration measured by RIA is increased due to reduced renal metabolic clearance, whereas the fractional urinary excretion is increased due to damage of renal tubular cells. GH receptor mRNA is decreased (rat) and the serum concentration of GH binding protein (BP) activity is low (man). Insulin-like growth factor (IGF)-1 production rate is reduced, whereas serum concentrations of IGFBPs are increased secondary to reduced renal metabolic clearance. This results in a reduction of free, active IGF-1. Treatment with GH induces a rise in serum IGF-1 concentration and normalizes IGF bioactivity. Clinical studies in prepubertal children demonstrated a dramatic rise in height velocity during the first treatment year and to a lesser extent during the following years. In children on conservative treatment prior to dialysis, mean height SDS improved by 1.5 within two years and by 2.0 within four years. Patients with renal allografts responded in a similar way. Age and pretreatment height velocity SDS are confounding variables for the response to GH. Renal function seems not be altered by recombinant human (rh) GH in patients with CRF, and the number of renal allograft rejection crises seems not to be substantially increased under rhGH treatment in allograft recipients.

Child↗

PubMedDate not supplied

Peritoneal loss of growth hormone in children on automated peritoneal dialysis.

OBJECTIVE: To provide quantitative data regarding the daily dialytic loss of growth hormone (GH) in children on peritoneal dialysis (PD). DESIGN: Prospective study involving 24-hour dialysate collections on 3 consecutive days in patients with and without recombinant human GH (rhGH) treatment. SETTING: Single-center outpatient PD program. PATIENTS: Twenty-six children undergoing automated PD (APD): 6 with and 20 without daily rhGH. MAIN OUTCOME MEASURES: Daily peritoneal losses of GH, alpha1-, beta2-microglobulin, transferrin, and albumin. RESULTS: The mean (+/-SEM) daily dialytic GH loss was 2.18+/-0.62 microg/1.73 m2 per day in rhGH-treated patients and 0.42+/-0.28 microg/1.73 m2 per day in untreated patients, (p < 0.05). The intraindividual coefficient of variation of daily GH loss was 65%. The peritoneal loss of GH was positively correlated with that of beta2-microglobulin (r = 0.77, p < 0.001) and alpha1-microglobulin (r = 0.51, p < 0.01). The variability in beta2-microglobulin and alpha1-microglobulin elimination, together with the use of rhGH, explained 66% of the total variability of daily GH excretion. In patients without rhGH therapy, the daily peritoneal GH loss was approximately 0.05% of the estimated daily endogenous production rate based on previous estimates in children with end-stage renal failure. In patients on rhGH therapy, less than 0.1% of the injected rhGH dose was eliminated by dialysis. CONCLUSION: Peritoneal losses of GH in children on APD account only for a minute fraction of endogenous metabolic clearance, and do not explain the variability of the rhGH treatment response. The assessment of dialytic GH elimination may be used to estimate time-integrated mean plasma GH concentrations, and to monitor rhGH treatment compliance.

Albumins↗

PubMedDate not supplied

Recent advances in the treatment of non-obstructive urinary tract infection in infants and children.

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Anti-Infective Agents, Urinary↗