RESUMO
The incidence of acute renal failure in children is higher due to the prevalence of diarrheal dehydration, use of nephrotoxic substances and sepsis. The occurrence in the newborn has increased, probably due to the large number of seriously sick infants maintained in neonatal intensive care units. Various laboratory examinations have been proposed as diagnostic indices of acute renal failure in children. Among these are the urine-to-plasma concentrations of urea and creatinine and the urine-to-plasma osmolality ratio. The fractional excretion of sodium and the so-called renal failure index are the most reliable of the diagnostic tests. The functional abnormalities and complications of acute renal failure include reduced glomerular filtration rate, retention of nitrogenous wastes, hyponatremia, hyperkalemia, metabolic acidosis, hypocalcemia, hyperphosphatemia and hypermagnesemia. The principles of management and treatment of complications are discussed.
Assuntos
Injúria Renal Aguda , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/metabolismo , Injúria Renal Aguda/terapia , Criança , HumanosRESUMO
IgA nephropathy, also called Berger's disease, is characterized by recurrent gross hematuria or persistent microscopic hematuria, together with mesangial glomerular deposits of IgA found in the renal biopsy. Seven children with IgA nephropathy were studied. Most of them presented initially with recurrent macroscopic hematuria and low or moderate-grade proteinuria, without hypertension or renal function impairment. Only one patient presented with a rapidly progressive glomerulonephritis. Four patients did not receive any treatment; one of them is in remission, one has improved and two remain with moderate proteinuria and hematuria. One patient with significant proteinuria improved after prednisone and azathioprine treatment. The patient with rapidly progressive glomerulonephritis improved his renal function after oral prednisone and intravenous boluses of methylprednisolone and cyclophosphamide.
Assuntos
Glomerulonefrite por IGA/diagnóstico , Adolescente , Biópsia , Criança , Pré-Escolar , Feminino , Hematúria/diagnóstico , Humanos , Rim/patologia , Masculino , Microscopia Eletrônica , Proteinúria/diagnóstico , RecidivaRESUMO
Several renal and renal-related disturbances have been described in patients with AIDS (acquired immune deficiency syndrome), in adults and children as well. These are mainly electrolyte and acid-base imbalance, acute renal failure and nephrotic syndrome. The latter is usually steroid non-responder. The renal histopathological lesions described more commonly are minimal change, mesangial hyperplasia and focal segmental glomerulosclerosis. Herein, we describe a 5 year-old with AIDS, that developed nephrotic syndrome, characterized by edema, ascites, hypoalbuminemia and massive proteinuria. A percutaneous renal biopsy showed mesangial proliferation. She did not respond to a 6 week treatment with prednisone. She died with sepsis after several viral and bacterial infections.
Assuntos
Nefropatia Associada a AIDS , Síndrome Nefrótica , Pré-Escolar , Feminino , HumanosRESUMO
Africanized bees are unique in their aggressive behavior, characterized by massive attacks during which the victims are injected an important amount of venom. For this reason, Africanized bees are extremely dangerous. Their venom contains biological toxic substances, mainly mellitin, phospholipases, histamine, hyaluronidase and apamin. Non-sensitized persons that survive a massive attack may develop acute renal failure, as a consequence of the severe hemolysis, rhabdomyolysis and shock. These complications may lead to acute renal tubular necrosis. Also, the clinical pattern and treatment of the acute renal failure secondary to bee stings are discussed.
Assuntos
Injúria Renal Aguda/etiologia , Abelhas , Mordeduras e Picadas de Insetos/complicações , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Animais , Venenos de Abelha/toxicidade , Humanos , Mordeduras e Picadas de Insetos/diagnóstico , Mordeduras e Picadas de Insetos/fisiopatologia , Mordeduras e Picadas de Insetos/terapiaRESUMO
The ability to provide successful rehabilitation in 57 uremic children from a low socioeconomic background was prospectively evaluated by means of assessment of growth and development, incidence of complications, compliance, mortality rate and final outcome. Forty-three patients were on intermittent peritoneal dialysis (PD) and 14 on continuous ambulatory peritoneal dialysis (CAPD). The overall incidence of peritonitis was 5.6 episodes per patient-year; 41 patients are alive; 12 continue on intermittent dialysis; 16 received a renal allograft and 13 shifted to hemodialysis. Hypervolemia, sepsis due to peritonitis and abandonment of treatment were the main causes of death in 16 children. Malnutrition and non-compliance were the main factors leading to unsatisfactory rehabilitation.
Assuntos
Diálise Peritoneal Ambulatorial Contínua , Diálise Peritoneal , Fatores Socioeconômicos , Uremia/terapia , Adolescente , Líquidos Corporais/fisiologia , Criança , Feminino , Humanos , Masculino , México , Cooperação do Paciente , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/etiologia , Estudos Prospectivos , Classe Social , Uremia/mortalidadeRESUMO
Hematuria is the most common complication of renal biopsy. Other complications are less frequent, but some of them may be life threatening. Herein, we present a case or recurrent hematuria. Within one year, two renal biopsies were surgically performed in this patient. The histological diagnosis reported minimal change glomerular lesions. Complications arose after the second biopsy, with development of an abdominal mass in the left side with severe pain. IVP showed absence of dye excretion from the left kidney. Renal arteriogram showed an arteriovenous fistula in the lower pole and absence of venous circulation in the same side. This data was consistent with renal vein thrombosis. The fistula was a complication of the renal biopsy, and most likely, the renal vein thrombosis developed from the fistula. Both complications disappeared spontaneously, the patient is asymptomatic and the IVP is normal. We conclude that the renal biopsy is not a harmless surgical procedure and it is necessary to carry out a through evaluation in order to justify the necessity to perform it.