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Introducción. El RVU constituye un motivo de consulta frecuente. Existen grandes controversias y amplia variabilidad en diversos aspectos del tratamiento y seguimiento. Este problema puede mejorar mediante el desarrollo de GPCs basadas en las mejores pruebas. Su objetivo es ayudar a profesionales y pacientes a la toma de decisiones. Objetivo. Revisión de recomendaciones de las últimas GPC sobre: indicación del estudio del tipo de tratamiento del RVU, papel y manejo de las disfunción del tracto urinario inferior (DTUI) y daño renal asociado a RVU y seguimiento del mismo. Material. Revisión del GPC recientes: GPC-ITU de NICE, GPC-RVU y GPC-ITU de la AENP y GPC-RVU de la AUA. Conclusiones. La mayoría de las recomendaciones están sustentadas en un bajo nivel de evidencia. Hay pocos ensayos clínicos y trabajos de investigación de calidad. Esto conlleva a que gran parte de las recomendaciones están basadas en el consenso de las participantes de las GPC. No obstante a día de hoy tenemos conocimientos y criterios más razonables para seleccionar a los pacientes con riesgos, podemos hacer una medicina más personalizada y con ello reducir el número de exploraciones, restringir tratamientos fútiles y disminuir el grado de ansiedad al conocer mejor el pronóstico del RVU (AU)

Introduction. Vesicoureteral reflux (VUR) is a reason for frequent consultation. There are great debates and wide variability in different aspects of the treatment and follow-up. This problem may be improved through the development of the clinical practice guidelines (CPG) guidelines based on the best test. Its objective is to help professionals and patients to make decisions. Objective. Review of the last CPG recommendations on: indication of the study for the diagnosis of VUR, antibiotic prophylaxis, choice of type of VUR treatment, role and management of the lower urinary tract dysfunction (LUTC) and kidney damage associated to VUR and its follow-up. Material. Review of recent CPGs: CPG-UTD of NICE, CPG-VUR and CPG-UTD of the Spanish Association of Pediatric Nephrology (AENP) and CPG VUR of the American Urological Association (AUA). Conclusions. Most of the recommendations are based on a low level of evidence. There are few quality clinical trials and research works. This means that a large part of the recommendations are based on the consensus of the participants of the CPG. However, at present, we have more reasonable knowledge and criteria to select the patients with risks, to perform a more personalized medicine and thus to reduce the number of studies, restrict futile treatments and decrease the degree of anxiety when knowing the prognosis of VUR better (AU)

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There are few data describing the current practices of treatment selection for children with end-stage renal disease (ESRD). In an effort to establish a consensus among Spanish pediatric nephrologists for inclusion and exclusion criteria for renal replacement therapy in children with ESRD, in 1995 we surveyed members of the Spanish Pediatric Nephrology Association. Although only 43% of members responded, pediatric nephrologists and bioethicists studied the results and compiled a list of ten guidelines for treatment of children with ESRD. The proposed guidelines are meant to be a starting point for further discussion. An emphasis on flexibility, individual case assessment, and consideration of the best interests of the patient must remain central to any treatment plan. Decision making should ideally be shared by parents, professionals, the child, when appropriate, and ethics committees, as necessary.

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AIM: Assessment of final adult height and its predictive factors in children transplanted (RTx) and followed up in a single center. METHODS: A cohort of 32 patients (17 boys, 15 girls) who received RTx before the age of 15 years and had reached a final adult height was selected. Twenty patients received a single RTx, 9 patients received two RTx, and 3 patients received three RTx. Seven children were transplanted preemptively, while the remaining 25 children received peritoneal dialysis for relatively short periods of time. In 11 patients, recombinant human growth hormone (rhGH) was administered either before (n = 8) or after (n = 3) RTx. RESULTS: In 13 patiens (41%), the final height standard deviation score for chronological age (hSDS) was -2.3+/-0.5, below the 95% confidence limits for target height (group A), while in 19 patients (59%), it was -0.7+/-0.8, within the 95% confidence limits for target height (group B). The hSDS values at the start of dialysis and at the time of first RTx were significantly lower in group A than in group B. A higher hSDS at the start of dialysis and at the time of first RTx had a significant positive influence on the final height (FH), whereas a longer duration of dialysis had a significant negative effect on the FH. Administration of rhGH after RTx played an important role in the achievement of a normal FH in 3 girls. No differences were observed between group A and B with respect to age at start of dialysis, chronological or bone age at first RTx, number of rejection episodes, duration of the study period from last RTx to FH, glomerular filtration rate during this study period, or percentage of time on prednisone therapy. CONCLUSIONS: The FH is almost exclusively predetermined by the height achieved at the start of dialysis and at the time of first RTx. Therefore, to reach target adult height after RTx, the best strategy is to shorten the time of dialysis and to start rhGH administration at a young age and as early as possible during the course of chronic renal failure. Administration of rhGH after RTx is also highly effective, but, given its potential danger, still remains a matter of investigation.

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We review our experience on IgA nephropathy (Berger's disease), defined as the IgA mesangial deposit in the absence of systemic disease. Following these criteria ten patients have been diagnosed which amount to 10% of all biopsied glomerulonephritis in our centre during 1977-1985. These ten patients have been controlled for periods of time ranging from 4 months to 7 years (means = 3 years). After that time, 2 patients have chronic renal failure, in contrast with other pediatric series in which the prognosis is less severe.

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13 male patients, with type-I Young urethral valves are reported. We analyze the most significant clinical, analytical and radiological findings of them all, at the diagnosis and during the evolution. The clinical course has been from 6 month up to 5 years, the average time being of 3 years, 3 of them have evolved towards a renal insufficiency. The patients diagnosed at the neonatal period (5 in our series) have a higher degree of obstruction producing a greater clinical and radiological alteration at the moment of the diagnosis and a worse prognosis in spite of early disobstructive measures.

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