To identify factors that contribute to a decreased Z score of volumetric spine bone mineral densi... more To identify factors that contribute to a decreased Z score of volumetric spine bone mineral density (ZvSBMD) and the development of vertebral fractures (VF) in children receiving chronic systemic corticosteroid therapy (SCT); to describe their outcome after 2 years, and to define predictive threshold values for ZvSBMD for VF. Fifty-five children on SCT for >or= 6 months were prospectively followed for 2 years. In children with a ZvSBMD > -1.5, we prescribed preventive measures for osteoporosis and densitometry annually. In children with ZvSBMD <or= -1.5, we prescribed spine x-rays and those with VF received alendronate. The association between clinical and biochemical variables and the presence of VF or ZvSBMD were analyzed by logistic regression or multiple regression analysis. The threshold value of ZvSBMD for predicting VF was determined by ROC curve and the probability of having a VF was modeled by multiple logistic regressions. Children who do not develop osteoporosis ...
... 3 , Paulina Salas del C. 4. 1. Nefrólogo Pediatra. Instructor Asociado. Pontificia Universida... more ... 3 , Paulina Salas del C. 4. 1. Nefrólogo Pediatra. Instructor Asociado. Pontificia Universidad Católica de Chile. 2. Nefrólogo Pediatra. Profesor Asistente. Facultad de Medicina, Universidad de Chile, Hospital Luis Calvo Mackenna. 3. Nefrólogo Pediatra. Hospital Roberto del Río. ...
Pulmonary embolism is a very infrequent event in previously healthy children, particularly in the... more Pulmonary embolism is a very infrequent event in previously healthy children, particularly in the outpatient scenario. This report involves a 7-year-old girl who presented to the emergency room after syncope. A prompt diagnostic workup showed a massive pulmonary embolism. A timely treatment initiation permitted a good and rapid response. She represented a diagnostic and treatment challenge, mainly because of the atypical presentation and the absence of known risk factors. Finally, a thorough study uncovered a nephrotic-range urine protein loss. At the beginning, the patient did not meet the whole nephrotic syndrome diagnostic requirements. The complete thombophilic study was normal. The clinical presentation, epidemiology, diagnostic tools and the treatment of pulmonary embolism are reviewed. We also discuss a recently described risk factor, present in our patient, as a potential role in the development of pulmonary embolism.
Background: Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dia... more Background: Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dialytic therapy, mainly peritoneal dialysis (PD). In some cases, PD may have relative or absolute contraindications, usually when HUS is associated to severe intra-abdominal complications. Aim: To report the results of continuous hemofiltration use, in children with abdominal complications of HUS. Material and methods: Retrospective review of the files of 40 patients that were admitted to our pediatric unit with HUS, since 1995. Six children had relevant intra-abdominal complications and were treated with continuous hemofiltration (CHF). Four additional children, with similar HUS related complications and treated with CHF before 1995, were included in the analysis. Results: The age of the patients ranged from 5 to 66 months old. An arterio-venous CHF was performed in four and veno-venous CHF in six children. The duration of CHF was 93.2 hours in average. Adequate control of volemia was achieved in every patient; diafiltration with peritoneal dialysis solution was added in five patients, to improve azotemia. Four patients had complications related to the vascular access or the anticoagulation procedure. The procedure was terminated due to improvement of diuresis in five cases, transfer to PD in four and a cardiorespiratory arrest in one. Only one patient developed a chronic renal failure during the follow up. Conclusions: CHF is an effective and safe alternative of acute renal replacement therapy in the management of renal failure in pediatric cases with HUS, aggravated with abdominal complications (Rev Med Chile 2002; 130: 768-72).
Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dialytic therap... more Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dialytic therapy, mainly peritoneal dialysis (PD). In some cases, PD may have relative or absolute contraindications, usually when HUS is associated to severe intraabdominal complications. To report the results of continuous hemofiltration use, in children with abdominal complications of HUS. Retrospective review of the files of 40 patients that were admitted to our pediatric unit with HUS, since 1995. Six children had relevant intra-abdominal complications and were treated with continuous hemofiltration (CHF). Four additional children, with similar HUS related complications and treated with CHF before 1995, were included in the analysis. The age of the patients ranged from 5 to 66 months old. An arterio-venous CHF was performed in four and veno-venous CHF in six children. The duration of CHF was 93.2 hours in average. Adequate control of volemia was achieved in every patient; diafiltration with perito...
ZusammenfassungStreptokokken-Infektionen können in Abhängigkeit von den verschiedenen Bakterienst... more ZusammenfassungStreptokokken-Infektionen können in Abhängigkeit von den verschiedenen Bakterienstämmen zu unterschiedlicher Nierenbeteiligung führen, deren klinisches Spektrum vom asymptomatischen Verlauf bis zum akuten Nierenversagen reicht. Erkrankungen mit β-hämolysierenden Streptokokken der Gruppe A sind Ursache der Poststreptokokken-Glomerulonephritis (PSGN), die im Kindesalter typischerweise als ein akutes nephritisches Syndrom bei histologisch diffus endokapillär proliferativer Glomerulonephritis verläuft. Selten kommt es bei der PSGN zu einer rapid-progressiven Glomerulonephritis mit Voranschreiten der Niereninsuffizienz. Spätfolgen der unkomplizierten PSGN sind selten und treten in milder Form mit isolierter Hämaturie, Proteinurie oder arterieller Hypertension bei weniger als 15% der Kinder auf. Rezidivierende Verläufe der PSGN sind sehr selten, und eine Assoziation der PSGN mit einem akuten rheumatischen Fieber ist die Ausnahme. Streptokokken (S.) der Stämme B bis O sowie ...
To identify factors that contribute to a decreased Z score of volumetric spine bone mineral densi... more To identify factors that contribute to a decreased Z score of volumetric spine bone mineral density (ZvSBMD) and the development of vertebral fractures (VF) in children receiving chronic systemic corticosteroid therapy (SCT); to describe their outcome after 2 years, and to define predictive threshold values for ZvSBMD for VF. Fifty-five children on SCT for >or= 6 months were prospectively followed for 2 years. In children with a ZvSBMD > -1.5, we prescribed preventive measures for osteoporosis and densitometry annually. In children with ZvSBMD <or= -1.5, we prescribed spine x-rays and those with VF received alendronate. The association between clinical and biochemical variables and the presence of VF or ZvSBMD were analyzed by logistic regression or multiple regression analysis. The threshold value of ZvSBMD for predicting VF was determined by ROC curve and the probability of having a VF was modeled by multiple logistic regressions. Children who do not develop osteoporosis ...
... 3 , Paulina Salas del C. 4. 1. Nefrólogo Pediatra. Instructor Asociado. Pontificia Universida... more ... 3 , Paulina Salas del C. 4. 1. Nefrólogo Pediatra. Instructor Asociado. Pontificia Universidad Católica de Chile. 2. Nefrólogo Pediatra. Profesor Asistente. Facultad de Medicina, Universidad de Chile, Hospital Luis Calvo Mackenna. 3. Nefrólogo Pediatra. Hospital Roberto del Río. ...
Pulmonary embolism is a very infrequent event in previously healthy children, particularly in the... more Pulmonary embolism is a very infrequent event in previously healthy children, particularly in the outpatient scenario. This report involves a 7-year-old girl who presented to the emergency room after syncope. A prompt diagnostic workup showed a massive pulmonary embolism. A timely treatment initiation permitted a good and rapid response. She represented a diagnostic and treatment challenge, mainly because of the atypical presentation and the absence of known risk factors. Finally, a thorough study uncovered a nephrotic-range urine protein loss. At the beginning, the patient did not meet the whole nephrotic syndrome diagnostic requirements. The complete thombophilic study was normal. The clinical presentation, epidemiology, diagnostic tools and the treatment of pulmonary embolism are reviewed. We also discuss a recently described risk factor, present in our patient, as a potential role in the development of pulmonary embolism.
Background: Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dia... more Background: Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dialytic therapy, mainly peritoneal dialysis (PD). In some cases, PD may have relative or absolute contraindications, usually when HUS is associated to severe intra-abdominal complications. Aim: To report the results of continuous hemofiltration use, in children with abdominal complications of HUS. Material and methods: Retrospective review of the files of 40 patients that were admitted to our pediatric unit with HUS, since 1995. Six children had relevant intra-abdominal complications and were treated with continuous hemofiltration (CHF). Four additional children, with similar HUS related complications and treated with CHF before 1995, were included in the analysis. Results: The age of the patients ranged from 5 to 66 months old. An arterio-venous CHF was performed in four and veno-venous CHF in six children. The duration of CHF was 93.2 hours in average. Adequate control of volemia was achieved in every patient; diafiltration with peritoneal dialysis solution was added in five patients, to improve azotemia. Four patients had complications related to the vascular access or the anticoagulation procedure. The procedure was terminated due to improvement of diuresis in five cases, transfer to PD in four and a cardiorespiratory arrest in one. Only one patient developed a chronic renal failure during the follow up. Conclusions: CHF is an effective and safe alternative of acute renal replacement therapy in the management of renal failure in pediatric cases with HUS, aggravated with abdominal complications (Rev Med Chile 2002; 130: 768-72).
Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dialytic therap... more Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dialytic therapy, mainly peritoneal dialysis (PD). In some cases, PD may have relative or absolute contraindications, usually when HUS is associated to severe intraabdominal complications. To report the results of continuous hemofiltration use, in children with abdominal complications of HUS. Retrospective review of the files of 40 patients that were admitted to our pediatric unit with HUS, since 1995. Six children had relevant intra-abdominal complications and were treated with continuous hemofiltration (CHF). Four additional children, with similar HUS related complications and treated with CHF before 1995, were included in the analysis. The age of the patients ranged from 5 to 66 months old. An arterio-venous CHF was performed in four and veno-venous CHF in six children. The duration of CHF was 93.2 hours in average. Adequate control of volemia was achieved in every patient; diafiltration with perito...
ZusammenfassungStreptokokken-Infektionen können in Abhängigkeit von den verschiedenen Bakterienst... more ZusammenfassungStreptokokken-Infektionen können in Abhängigkeit von den verschiedenen Bakterienstämmen zu unterschiedlicher Nierenbeteiligung führen, deren klinisches Spektrum vom asymptomatischen Verlauf bis zum akuten Nierenversagen reicht. Erkrankungen mit β-hämolysierenden Streptokokken der Gruppe A sind Ursache der Poststreptokokken-Glomerulonephritis (PSGN), die im Kindesalter typischerweise als ein akutes nephritisches Syndrom bei histologisch diffus endokapillär proliferativer Glomerulonephritis verläuft. Selten kommt es bei der PSGN zu einer rapid-progressiven Glomerulonephritis mit Voranschreiten der Niereninsuffizienz. Spätfolgen der unkomplizierten PSGN sind selten und treten in milder Form mit isolierter Hämaturie, Proteinurie oder arterieller Hypertension bei weniger als 15% der Kinder auf. Rezidivierende Verläufe der PSGN sind sehr selten, und eine Assoziation der PSGN mit einem akuten rheumatischen Fieber ist die Ausnahme. Streptokokken (S.) der Stämme B bis O sowie ...
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