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Biomedical subjects

S Hellerstein

Publications and source records attributed to S Hellerstein.

At least 73 records · Page 4Linked to original sources
PubMed1988

Creatinine excretion rates for evaluation of kidney function in children.

A protein load protocol for evaluation of kidney function was tested in normal children and pediatric renal patients. An overnight, timed urine collection was used for calculation of the baseline creatinine clearance and creatinine excretion rate. One hour following ingestion of a standardized protein meal (baked chicken), a 2-3 h urine collection was begun. The post-protein meal changes in creatinine clearance showed considerable variation in both the normal children and those with renal disorders. In contrast, the rate of excretion of creatinine was consistently increased in the normal children following the protein meal (73.4 +/- 18%; range 48.2%-122.4%). Of 33 renal patients, 14 showed less than a 48% increase in creatinine excretion rate, even though 9 of these children had baseline creatinine clearances within the normal range. These 9 patients have evidence of less than normal quantities of functioning renal tissue. Serial studies over a year on 2 children who presented with acute renal failure showed a progressive increase in creatinine clearance with scant increases in creatinine excretion rate. These studies provide indirect evidence that a less than normal enhancement of the rate of creatinine excretion following a protein load reflects the presence of adaptive glomerular hyperfiltration and hyperperfusion.

Adolescent↗
PubMed1988

Growth and development of infants with end-stage renal disease receiving long-term peritoneal dialysis.

The growth and development of four infants with end-stage renal disease receiving long-term peritoneal dialysis was studied during the first year of life. In each patient, dialysis was begun before 4 weeks of age. A nutritional regimen was designed to attain a daily weight gain appropriate for height age while minimizing the blood urea nitrogen level. A neurodevelopmental evaluation of gross and fine motor, cognitive, language, and psychosocial skills was performed at least every 3 months. At age 1 year, the mean height standard deviation score (SDS) was -1.33 +/- 0.2. Weight for height was greater than 95th percentile in one patient and normal in three. Mean caloric and protein intake were 105 +/- 20 kcal/kg/d (11.4 +/- 2.7 kcal/cm/d) and 2.7 g/kg/d (0.30 +/- 0.11 g/cm/d), respectively. Mean blood urea nitrogen was 53.6 +/- 17.8 mg/dL. Developmentally, three of the patients were functioning in the normal range and one was mildly retarded. However, gross motor skills were delayed in all patients. Although infants with end-stage renal disease are usually severely growth retarded and developmentally delayed, our observations suggest that early nutritional intervention and dialysis can yield improved results.

Blood Urea Nitrogen↗
PubMed1988

Urinary lactic acid dehydrogenase activity and the site of urinary tract infections.

A report that elevated urinary lactic acid dehydrogenase (LDH) isoenzyme 5 activity is a reliable tool for separating patients with upper from those with lower urinary tract infections (UTIs) led us to study urinary LDH enzyme activity in girls having bladder washout studies to localize the site of infection. Urinary LDH isoenzyme 5 activity in 64 instances of lower UTI was 16.1 +/- 3.3%, a value not significantly different than that of 18.2 +/- 12.6% found in 26 instances of upper tract infection (t = 0.8726, P = 0.1928). The data show that LDH isoenzyme 5 activity is of no value for localization of the site of a UTI. The data of these studies also showed that urinary LDH enzyme activity clearly separates girls with UTIs from those without infections, but it is unlikely that this finding will be of value in diagnosis or management.

Adolescent↗
PubMed1987

Nutritional management of children with chronic renal failure. Summary of the task force on nutritional management of children with chronic renal failure.

Current information on the adaptations to progressive loss of renal function is presented. The assessment of renal function in infants and children using serum creatinine concentration and its derivatives is considered as are various methods for assessment of growth. Children with creatinine clearances less than 50% of normal, who do not have uremic symptoms (and who are not on dialysis), should be ingesting diets providing close to 100% of the RDA for calories with 8% of the calories as protein. Recommendations for nutritional management of children on chronic peritoneal dialysis are also presented.

Child↗
PubMed1986

Elevated serum creatinine levels in three patients treated with phenacemide.

Three adolescent patients with severe seizure disorders were treated with phenacemide. All three patients showed elevated serum creatinine and normal blood urea nitrogen values while on phenacemide. Simultaneous urea and creatinine clearance studies performed on each patient demonstrated normal urea clearances and decreased creatinine clearances. Inulin clearance performed in one patient was normal. The medication was discontinued in two of the patients because of co-existing neutropenia. Serum creatinine values returned to normal after phenacemide treatment was terminated. The elevation in serum creatinine values with phenacemide appears to be dose related, reversible, and unrelated to impairment of glomerular filtration.

Adolescent↗
PubMed1985

Wegener granulomatosis in pediatric patients.

Wegener granulomatosis is more easily recognized as a distinct clinical entity than other vasculitides because the initial clinical features frequently include granulomatous vasculitis of the upper and lower respiratory tract and glomerulonephritis. Although the disease has been lethal in the past, prolonged survival and avoidance of end-stage kidney disease can now be expected when cyclophosphamide therapy is introduced early in the course. We report four children with Wegener granulomatosis in whom the initial clinical findings suggested Henoch-Schönlein purpura. In two of the patients Wegener granulomatosis was not recognized until after end-stage kidney disease had developed. The course in these patients emphasizes the need for attention to even scant evidence of inflammation of the upper or lower respiratory tract in patients with glomerulonephritis. Appropriate diagnostic studies may then lead to recognition of Wegener granulomatosis and the prompt institution of appropriate treatment.

Adolescent↗
PubMed1985

Follow-up studies on children with severe dietary chloride deficiency during infancy.

Ten children who had severe dietary chloride deficiency during early infancy have grown normally during their first 4 to 5 years. With the exception of one child who did not get into the sitting position alone until he was 9 1/2 months of age, the patients reached the usual developmental milestones of the first 2 years during the expected age intervals. Developmental and psychological testing indicates that all of the children have at least average ability. However, three children have shown behavior patterns that may interfere with successful school performance. Serum creatinine and urea nitrogen concentrations appear to be normal as does renal concentrating capacity. During a 4-year follow-up, one child has shown persistent and a second intermittent microscopic hematuria.

Alkalosis↗
PubMed1982

Serum C-reactive protein and the site of urinary tract infections.

Elevated surum levels of C-reactive protein have been found regularly in girls with acute clinical pyelonephritis but only infrequently in those with clinical cystitis. Based on these data, the suggestion has been made that elevated serum CRP concentrations may be useful in identifying patients with upper urinary tract infections. In a study in which the bladder washout test was used to localize the site of urinary tract infections, we identified nine girls with renal bacteriuria who did not have clinical findings suggesting acute pyelonephritis; four of these girls had serum CRP concentrations less than 10 micrograms/ml. Twenty-eight girls had bladder washout-proven lower urinary tract infections; three of these had serum CRP values greater than 30 micrograms/ml. These studies show that an elevated serum CRP concentration is not accurate in localizing the site of a urinary tract infection in girls who do not have clinical signs of acute pyelonephritis.

Adolescent↗
PubMed1981

Localization of the site of urinary tract infections with the bladder washout test.

The data from 100 bladder washout studies on pediatric patients have been analyzed to derive criteria for interpretation of this test and to define the limitations of this procedure in localization of the site of urinary tract infections. Using the bladder washout test, infection of the upper urinary tract is characterized by an abrupt increase in the concentration of bacteria in urinary specimens collected following urinary bladder sterilization. Infection limited to the lower urinary tract is characterized by scant if any bacterial growth in the specimens of urine collected following bladder sterilization. The site of infection may be incorrectly localized to the lower urinary tract or classified as not determined in patients with scant or intermittent renal bacteriuria.

Adolescent↗
PubMed1980

The dietary chloride deficiency syndrome.

Chronic depletion of body chloride developed in a group of infants ingesting a diet consisting almost exclusively of chloride deficient Neo-Mull-Soy. Ten of the 12 infants were on this diet three to five months before loss of appetite, failure to thrive, muscle weakness, and lethargy led to a diagnostic evaluation. The outstanding laboratory features were severe hypokalemic metabolic alkalosis, low urinary chloride concentrations (< 10 mEq/liter), and erythrocyturia. There was marked decrease in weight for age in all 12 infants. Head circumference for age had decreased in five of six and length for age in five of ten infants for whom earlier measurements were available. The biochemical abnormalities reverted to normal following dietary supplementation with either sodium or potassium chloride. Appetite, affect, and muscle strength improved, and weight gain resumed. Head circumference for age has moved toward the percentile level present prior to starting Neo-Mull-Soy in all instances. With one exception, length measurements show a similar pattern. The erythrocyturia has decreased or vanished. Chloride deficiency led to contraction of the extracellular volume and the substitution of poorly reabsorbable anions for readily reabsorbable chloride. These alterations caused development of the negative hydrogen ion and potassium balances which led to the hypokalemic metabolic alkalosis.

Alkalosis↗
PubMed1979

Segregation of human peripheral blood lymphocytes according to their affinity for insolubilized histamine. Principal differences between males and females.

An attempt was made to investigate the possible existence of differences in the composition of peripheral blood lymphocytes between males and females. Using affinity chromatography of human peripheral mononuclear cells on insolubilized histamine together with staining by fluoresceinated histamine-rabbit serum albumin (HRSA) we revealed that males possess a significantly higher proportion of mononuclear cells which bind to HRSA. These results are also reflected in sex-related differences in proliferative responses of the HRSA-non-adherent mononuclear cell population to T cell-dependent mitogens antigens and allogeneic mononuclear cells.

Animals↗
PubMed1978

Localization of the site of urinary tract infections by means of antibody-coated bacteria in the urinary sediments.

A prospective study was conducted in children with urinary tract infections to examine the relationship between the presence of antibody-coated bacteria in the urinary sediments and the presence of pyelonephritis. The site of the urinary tract infection was localized as upper or lower urinary tract by the bladder washout technique. Antibody-coated bacteria in the urinary sediments were identified by an immunofluorescent method. In 4 of 12 children with upper urinary tract infections, less than 1% of the bacteria in the urinary sediments were antibody coated. In 10 of 35 children with lower urinary tract infections more than 50% of the bacteria in the urinary sediments were antibody coated. These studies show no significant correlation between the presence of antibody-coated bacteria in urinary sediments and infection of the upper urinary tract.

Adolescent↗