Autoimmune phenomena in children with Human Immunodeficiency Virus infection and Acquired Immunodeficiency Syndrome

We have studied sera from 44 children with Human Immunodeficiency Virus infection and Acquired Immunodeficiency Syndrome using immunoblotting, radioimmunoassay, enzymoimmunoassay and indirect immunofluorescence. We have detected a low incidence of antinuclear (2.9%), anti-reticulin (2.9%) and anti-smooth muscle (14.7%) antibodies by indirect immunofluorescence. By enzymoimmunoassay we have detected anti-dsDNA (20.5%) and anti-ENA [anti-nRNP (61.3%), anti-Sm (29.5%), anti-Ro (47.7%) and anti-La (18.1%)] antibodies. Tests for anti-dsDNA by radioimmunoassay were negative, suggesting the presence of low-avidity anti-DNA antibodies. By immunoblotting we have detected anti-C (nRNP) (33.3%), anti-BB' (Sm) (33.3%), anti-Ro (60 KD) (4.5%) and anti-La (11.3%) antibodies. The presence of anti-Ro antibodies was associated with progressive neurological disease. Long-term follow-up studies with larger numbers of patients are necessary to evaluate the clinical significance of the presence of anti-dsDNA and anti-ENA antibodies in children infected with Human Immunodeficiency Virus.     

End-stage renal failure in children younger than 6 years: renal transplantation is the therapy of choice

Between 1975 and 1994, 46 children under 6 years of age received a total of 52 renal transplants. Obstructive uropathy and dysplasia accounted for most causes of terminal renal failure (17 and 12 cases respectively). Four patients required a second, 1 patient a third transplantation. Cadaveric organs were used on 33 occasions; 19 patients received a living-related donor kidney. Immunosuppression was performed with azathioprine in 5, with cyclosporine A in 21 and combined azathioprine/cyclosporine therapy in 20 cases. After 1 year, graft survival was 81%, and after 5 years 78%. Creatinine clearance declined slightly between 1 and 5 years from 69 to 56 ml/min per 1.73 m². Main causes of graft failure were thrombotic complications in 6 cases and death with functioning graft in 5 cases. Graft thrombosis occurred only in grafts from young donors under the age of 7 years and after vascular anastomosis to the iliac vessels. Only two transplants were lost in rejection episodes. Patient survival was 94% after 1 and 90% after 5 years. Two patients died due to septiacemia, 1 died of a ruptured aortic aneurysm, 1 of cerebral ischaemia and 1 suddenly of unknown cause. Patient and graft survival was not different compared with 204 patients aged 6–16 years who received a renal transplantation during the same time period at our institution. After transplantation the patients receiving cyclosporine A showed a marked catch-up growth in the 1st year. The median standard deviation score (SDS) of body length improved from −2.63 to −1.39 standard deviations. Conclusion Renal transplantation is the treatment of choice in end-stage renal failure in children under 6 years. Received: 4 February 1997 / Accepted in revised form: 31 July 1997     

小儿肾发育不良手术方法探讨

目的评价后腹腔镜、腹腔镜以及开腹手术3种方法治疗发育不良肾的临床利弊。方法2005年12月至2010年12月,作者共收治31例发育不良肾患儿,采用后腹腔镜、腹腔镜以及开腹手术3种方式治疗,比较3种术式在手术时间、出血量、术后住院时间以及并发症的发生率方面的差别。结果3组手术均获成功,经后腹腔镜组手术时间平均为（149±14）min,腹腔镜组手术时间平均为（145±13）min,开放手术组手术时间平均为（103±10）min。术中出血量分别为（14．7±1．1）mL、（16．2±1．6）mL、（21．1±1．4）mL。术后住院时间分别为（6±0．8）d、（6±0．9）d、（10±1．2）d。3组术后均无并发症。结论小儿肾发育不良在腹腔镜和后腹腔镜下手术,其术后恢复时间、术中出血量比较,均明显优于开腹手术,但手术时间较开腹手术长。     

Age dependence of the renal apparent diffusion coefficient in children

Background Diffusion imaging has proved to be a powerful tool for diagnosing ischemic lesions in the brain, and the technique is now being applied to other organs, including the kidneys. For quantitative studies it is important to define the normal values of the apparent diffusion coefficient (ADC), given the important physiological changes that occur in the kidney during early childhood it is likely that the ADC changes markedly during this period.Objective To evaluate the age dependent changes in the ADC of normal kidneys in the pediatric population.Materals and methods The whole kidney ADC was calculated for 62 pediatric patients on a 1.5-T system using a respiratory-triggered, single-shot diffusion tensor imaging sequence with b values of 50, 200, and 350 mm²/s.Results The ADC was found to increase with age with the largest increase being in the first year of life, the rate of change being described by a constant plus a power function, specifically 1349+{358.5*{age^0.34}}, (P<0.001).Conclusion The renal ADC changes significantly during childhood.     

Growth in the first 5 years of life is unaffected in children with perinatally-acquired hepatitis C infection

OBJECTIVES: To identify the effect of vertical hepatitis C virus (HCV) infection or exposure on growth in childhood. STUDY DESIGN: Children (n=1203) born to HCV-infected mothers were followed up from birth prospectively in centers of the European Paediatric Hepatitis C virus Network. Z-scores compared height- and weight-for-age in HCV-infected and -uninfected children, adjusting for other factors using linear regression. We also quantified the effect of maternal chronic infection with HCV on childhood growth. RESULTS: There was no significant effect of vertical HCV infection on growth (height P=.223, weight P=.095) nor a significant effect of maternal chronic infection with HCV (height P=.733, weight P=.274). Prematurity and maternal injecting drug use were associated with a significant reduction in height (P < .001) and weight (P < .001) in all HCV-exposed children. CONCLUSIONS: This population of HCV exposed infants has higher rates of maternal injecting drug use and prematurity than standard populations and so there are implications for growth of these children, but this is not a direct result of HCV infection or exposure to chronic maternal HCV infection.