THE DIAGNOSTIC VALUE OF BONE SCAN IN PATIENTS WITH RENAL CELL CARCINOMA

PURPOSE: Bone scan is performed as part of the evaluation of bone metastasis. We assessed the diagnostic value of bone scan in patients with renal cell carcinoma. MATERIALS AND METHODS: Bone scan was performed at presentation in 205 patients with confirmed renal cell carcinoma. Abnormal hot areas were further evaluated by x-ray, computerized tomography or surgery. RESULTS: Of the 56 patients (27%) with an abnormal bone scan 32 (57%) had osseous metastatic lesions. Overall bone metastasis was present in 34 of the 205 patients (17%). Bone scan had 94% sensitivity and 86% specificity. Of the 124 patients with clinically localized, stages T1-2N0M0 disease exclusive of bone metastasis 6 (5%) had bone metastasis only, whereas 28 of 81 (35%) with locally advanced or metastatic disease had bone metastasis, including 12 (35%) who complained of bone pain and 19 (56%) who presented with other symptoms due to local tumor growth or metastasis at other sites. Three patients (9%) were asymptomatic. There was osseous metastasis without other metastasis, enlarged regional lymph nodes or bone pain in 7 patients, including 1 with stage T1b (2% of all with that stage), 2 with stage T2 (5%), 1 with stage T3a (4%), 1 with stage T3b (6%), 1 with stage T3c (14%) and 1 with stage T4 (6%) disease. CONCLUSIONS: Bone scan may be omitted in patients with stages T1-3aN0M0 tumors and no bone pain because of the low proportion of missed cases with bone metastasis.     

RENAL ANGIOMYOLIPOMA: PREOPERATIVE DIAGNOSIS AND CONSERVATIVE SURGERY

A case of renal angiomyolipoma diagnosed before operation and treated by conservative surgery is presented.     

CLOSED RENAL TRAUMA IN CHILDREN

Closed renal trauma in children often results in serious Injury. In a series of 100 consecutive patients with closed renal trauma treated at the Royal Children's Hospital from 1967 to 1978, 32 children required surgery. Of these, eight children came to nephrectomy, whereas in 19 children viable renal tissue was conserved by the use of techniques such as renal suture or partial nephrectomy. The remaining five children had surgery, not for trauma, but rather for preexisting hydronephrosis discovered during investigation. There was a close relationship between the classification of renal injuries and the need for surgery. In this series there were two deaths and two late complications.     

SACROCOCCYGEAL TERATOMA IN CHILDREN: A DIAGNOSTIC CHALLENGE

Sacrococcygeal teratoma is relatively rare. Its characteristic appearance, location and size usually leave little doubt as to the diagnosis, but the less obvious ones may occasionally give rise to diagnostic difficulty. Four cases of sacrococcygeal teratoma in children are reported. One neonate presented with a large protuberant swelling at the sacrococcygeal area, with no diagnostic difficulty. The second neonate presented with a small paraxial sacral swelling with an overlying haemangioma. The third patient presented with a small tail-like appendage at the natal cleft. A properly performed rectal examination in both the second and third patients disclosed the diagnosis. The fourth patient presented with an anocutaneous fistula and partial sacral agenesis with no external sacrococcygeal swelling. The diagnosis was confirmed with computerized tomography. While the diagnosis of the protuberant sacrococcygeal teratoma presents no difficulty, that of the less obvious cases requires a high index of clinical suspicion. A properly performed rectal examination supplemented with appropriate imaging allows the diagnosis to be made.     

RENAL TRANSPLANTATION IN VERY YOUNG CHILDREN

Results of renal transplantation in very young children with end-stage chronic renal failure have been poor compared with those in older children and adults. Consequently small children either may not be treated or may be placed on chronic dialysis programmes. Between 1988 and 1992, six children under the age of 5 years received seven renal transplants at the Royal Children's Hospital, Parkville, Victoria, Australia; five from live donors and two from cadaver donors. All children were treated with peritoneal dialysis before transplantation, and immunosuppressed with a standardized regimen of cyclosporine, azathioprine and prednisolone. An extraperitoneal incision was used, and the donor renal vessels were anastomosed to the lower abdominal aorta and inferior vena cava or the common iliac vein. All children received intensive monitoring and fluid replacement during the peri-operative period. Patient survival was 100%. One cadaver graft failed 1 week after transplantation because of irreversible acute rejection. This child subsequently received a successful second transplant. Two children developed postoperative urinary fistulae which were treated successfully by further operation. Current renal function in all children is excellent. The success of this programme has led us to review our attitude towards renal transplantation in this age group and to advocate live donor renal transplantation as the treatment of choice in very young children with end-stage chronic renal failure whenever possible.     

PHARMACOKINETICS OF ATRACURIUM AND ITS METABOLITES IN PATIENTS WITH NORMAL RENAL FUNCTION, AND IN PATIENTS IN RENAL FAILURE

The plasma pharmacokinetic profiles of atracurium and its derivatives,lafdanosine and monoquaternary alcohol, were studied in sixpatients with renal failure after a bolus dose of atracurium0.3–0.4 mg kg^–1. The pharmacokinetics of the derivativesonly were studied in a group of four normal patients receivingatracurium 0.3 mg kg^–1. Measurements of plasma and urineconcentrations were performed by high pressure liquid chromatography.Pharmacokinetics of atracurium were not significantly differentin the renal failure group when compared with those obtainedin a previous study on six normal patients. Although 2–10%of the dose was recovered in the urine of normal patients asunchanged atracurium, and 3–4% as lafdanosine, renal failureproduced no significant differences in plasma pharmacokinetics,with mean plasma elimination half-lives of 20 min for atracurium,234 min for lafdanosine and 39 min for quaternary alcohol. ^*Southend Hospital, Prittlewell Chase, Westcliff-on-Sea, EssexSSO ORY. Upjohn Limited, Fleming Way, Crawley, West Sussex RH10 2NJ.     

URINARY EPIDERMAL GROWTH FACTOR IN DIFFERENT RENAL CONDITIONS IN CHILDREN

Several studies have demonstrated the important role of growth factors, particularly epidermal growth factor (EGF) and transforming growth factor α (TGFα), in cellular growth after renal damage. EGF is mainly synthesized by the kidney. Many studies indicate that urinary EGF concentration significantly decreases in patients with acute and chronic renal failure. In this study we determined urinary EGF concentrations in children with renal and/or urological pathologies. We investigated 38 patients, 17 males and 21 females, of 3.34 ± 2.96 years (mean ± standard deviation), who were followed in the Nephrologic Unit of the Pediatric Department of the University of Verona for recurrent urinary tract infections: seven of these had vesicoureteric reflux and 4 had hypodysplasia. The results were compared with those from a healthy age-matched group of 44 children. In all patients, we assessed renal function including an examination of the urine with a microbiological evaluation. Moreover, a renal ultrasound and a voiding cystourethrogram were performed. Urinary EGF was measured by a radioimmunoassay, using polyclonal goat antibodies. In all patients, laboratory parameters were within the normal range. In 34 patients the renal ultrasound was negative and in 4 cases structural alterations of the renal parenchyma were found. Voiding cystourethrography detected 7 instances of vesicoureteric reflux. In controls 10°, 50°, 90° percentile uEGF values were 7.3, 19 and 40.4μg/L, respectively. Mean urinary EGF values were 22.22 ± 16 μg/L. Urinary EGF values were 54 ± 35.2 μg/L in patients with recurrent urinary tract infections and without urinary malformations, 81 ± 29.37 μg/L in patients with vesicoureteric reflux and 22.30 ± 22.90μg/L in patients with hypodysplasia, respectively. There was a statistical significant difference between controls and groups A (p < 0.001) and B (p < 0.001) respectively, while the difference between group C and controls wasn't significant (p = 0.044). Results are reported in Figure . We believe that our results could be helpful for further studies on pathophysiology of growth factors in different renal conditions of children.

URINARY EPIDERMAL GROWTH FACTOR IN DIFFERENT RENAL CONDITIONS IN CHILDREN

All authors

V. Fanos, C. Pizzini, M. Mussap, D. Benini & M. Plebani

https://doi.org/10.1081/JDI-100104742

Published online:

07 July 2009

Figure 1. Urinary epidermal growth factor concentrations (uEGF) in the three groups considered (data are expressed as mean values ± standard deviation) compared with the line of the 90° percentile value calculated in the control group. Unpaired t-test: Group A vs. controls, p < 0.001. Group B vs. controls, p < 0.001. Group C vs. controls, n.s. (p = 0.487). Group A vs. Group B, p = 0.044.     

9.

RENAL DETERIORATION IN MYELODYSPLASTIC CHILDREN: URODYNAMIC EVALUATION AND CLINICAL CORRELATES     

ERIC A. KURZROCK  SANFORD POLSE 《The Journal of urology》1998,159(5):1657-1661

Purpose

We determined which factors portend a higher risk of renal deterioration in the myelodysplastic child, and evaluated the sensitivity and predictive value.

Materials and Methods

We retrospectively reviewed the medical history, imaging studies and urodynamics of 90 children with spinal dysraphism. Median patient age at initial evaluation was 3 months and average followup ranged between 2 and 25 years (average 11). We evaluated the relation of urodynamic parameters and sex to upper tract changes and the resolution of these changes.

Results

Statistically significant relationships were identified between the urodynamic parameters of leak point pressure, compliance and detrusor-sphincter dyssynergia, and renal deterioration but not with resolution of deterioration. Boys and girls did not demonstrate a significant difference among urodynamic parameters. Female patients had a higher incidence of reflux and parenchymal loss.

Conclusions

With knowledge of the inherent sensitivity, specificity and predictive value of urodynamic parameters, selective use of urodynamics will assist in identifying patients at risk of renal deterioration. Female patients with reflux are at greatest risk of parenchymal loss. We advocate early institution of intermittent catheterization in patients identified as high risk for deterioration by urodynamics.     

10.

CYCLOSPORIN DOSING IN CHILDREN FOLLOWING RENAL TRANSPLANTATION: POPULATION PHARMACOKINETIC MODELLING     

McTaggart Sj  Cranswick Ne  Powell Hr  Walker R  Jones CL. 《Nephrology (Carlton, Vic.)》2000,5(3):A93-A93

     

11.

RENAL CELL CARCINOMA IN CHILDREN: EXPERIENCE AT A SINGLE INSTITUTION IN JAPAN   总被引：4，自引：0，他引：4  

HIROSHI ASANUMA  HIDEO NAKAI  MASASHI TAKEDA  SEIICHIRO SHISHIDO  EIJI TAJIMA  TAKESHI KAWAMURA  HIROKO HARA  YUKIHIKO MORIKAWA  TAKESHI KAWAMURA 《The Journal of urology》1999,162(4):1402-1405

PURPOSE: We analyzed the presentation, treatment and survival of 4 children with renal cell carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the pathological and hospital records of 4 Japanese children diagnosed with renal cell carcinoma at our hospital from 1970 to 1998. RESULTS: In the 1 boy and 3 girls with an average age of 8 years 7 months at diagnosis the most common presenting complaints were gross hematuria in 75% and a palpable abdominal mass in 50%. Computerized tomography revealed characteristic calcification within the tumor in 3 of the 4 patients (75%). In the remaining case the lesion had high density areas with microcalcification, as confirmed by histopathological study. In 2 patients with regional lymph node metastasis calcification was also observed in the metastatic lesions. Disease was stages I to III in 1, 1 and 2 patients, respectively. All patients underwent transabdominal nephrectomy with regional lymphadenectomy. One patient with stage I disease had multiple metastases 15 months later and died of disease 55 months postoperatively. However, the remaining 3 patients received adjuvant interferon therapy and they are without evidence of recurrence a mean of 51.3 months postoperatively. CONCLUSIONS: Calcification within the tumor and/or metastatic lesions or high density areas in the tumor on screening computerized tomography are characteristic findings suggestive of pediatric renal cell carcinoma. Adjuvant therapy with interferon may provide some benefit in select pediatric patients. Further studies of a larger number of pediatric renal cell carcinoma cases may be necessary to establish the optimal diagnostic and therapeutic regimen.     

12.

RENAL LESION GROWTH IN CHILDREN WITH TUBEROUS SCLEROSIS COMPLEX     

DAVID H. EWALT  EUGENE SHEFFIELD  STEVEN P. SPARAGANA  MAURICIO R. DELGADO  E. STEVE ROACH 《The Journal of urology》1998,160(1):141-145

Purpose

Renal lesions, including angiomyolipoma, renal cysts (simple and polycystic kidney disease) and renal cell carcinoma, develop in patients with tuberous sclerosis complex. While there is limited information that these lesions may grow in adults with tuberous sclerosis complex, the incidence, characterization and growth rate in children have not been reported. Also, the age at which these lesions first appear, thus providing insight into their natural history, is unknown. We present our data from a longitudinal renal surveillance study of children with tuberous sclerosis complex.

Materials and Methods

Since 1985 children with tuberous sclerosis complex at our hospital have undergone periodic renal imaging by ultrasonography or computerized tomography to monitor renal lesions. A total of 35 girls and 25 boys 1 to 18 years old have undergone at least 2 or more annual renal ultrasounds.

Results

On initial evaluation 33 of 60 children (55%) (mean age 6.9 years) had an identifiable renal lesion, which increased to 48 of 60 (80%) at followup (mean age 10.5 years). Angiomyolipoma was the most frequent lesion (75%) followed by simple renal cysts (17%). Angiomyolipomas increased in size and/or number in 10 of 18 boys (56%) and 18 of 27 girls (66%). The largest growth rate in 1 year was from 0 to 4 cm. and from 5 to 9 cm. in diameter. The youngest patient demonstrated lesions at age 2 years. The average age at which a normal ultrasound became abnormal was 7.2 years. While a total of 27 patients had a normal ultrasound on entering the study, lesions had developed in 15 at followup (11 with angiomyolipomas, 4 with cysts). Five patients had cysts that had disappeared at followup. A 7-year-old boy had a 9 cm. renal cell carcinoma removed. One patient has renal lesions characteristic of autosomal dominant polycystic kidney disease.

Conclusions

Renal involvement in patients with tuberous sclerosis complex begins in infancy, and angiomyolipoma is the most common lesion (75%). Angiomyolipomas are more likely to grow than remain stable, although the rate of growth varies. Simple renal cysts may appear or disappear with time but angiomyolipomas do not disappear. An initially normal renal ultrasound does not rule out future development of lesions. Periodic surveillance is indicated in children with tuberous sclerosis complex.     

13.

USE OF ALCURONIUM IN PATIENTS UNDERGOING RENAL TRANSPLANTATION     

KAUSHIK  S.; GROVER  V. K.; SINGH  H.; YADAV  R. V. S. 《British journal of anaesthesia》1984,56(11):1229-1234

Alcuronium 0.16 mg kg^–1 was used to provide neuromuscularblockade in patients with chronic renal failure undergoing renaltransplantation. Relaxation was found to be adequate for intubationand surgery. There were minimal alterations to cardiovascularvariables. The dose required was small, and complete reversaloccurred with neostigmine. Although the number of patients issmall, the drug may be of value as an alternative to tubocurarineor pancuronium in such patients     

14.

RENAL ANGIOMYOLIPOMA ASSOCIATED WITH INFERIOR VENA CAVAL AND RIGHT ATRIAL THROMBUS   总被引：2，自引：0，他引：2  

HIDEAKI ITO  SHINICHI NAKASHIMA  HIROSHI TOMA  TOSHIMITSU MISAKI 《The Journal of urology》1999,162(4):1371-1372

     

15.

CARDIOPULMONARY BYPASS IN PATIENTS WITH MALIGNANT RENAL NEOPLASMS   总被引：1，自引：0，他引：1  

WILKINSON  C. J.; KIMOVEC  M. A.; UEJIMA  T. 《British journal of anaesthesia》1986,58(4):461-465

A case report of a patient with malignant renal neoplasm whounderwent emergency pulmonary embolectomy during operation ispresented. Knowledge of degree of venous extension, appropriateoperative positioning of the patient and consideration of electivecardiopulmonary bypass are suggested ways to reduce morbidityand mortality from massive pulmonary emboli in these patients.     

16.

SILDENAFIL AND ERECTILE DYSFUNCTION IN MALE RENAL PATIENTS     

De Zoysa Jr  Lawrence IG 《Nephrology (Carlton, Vic.)》2002,7(1):A101-A101

     

17.

PHARMACOKINETICS OF FAZADINIUM IN PATIENTS WITH RENAL FAILURE     

DUVALDESTIN  P.; BERTRAND  J. C.; CONCINA  D.; HENZEL  D.; LARENG  L.; DESOMNTS  J. M. 《British journal of anaesthesia》1979,51(10):943-947

The serum concentrations of fazadinium and its metabolites weremeasured in 14 surgical patients with end-stage renal failureand in 11 patients free from kidney disease undergoing abdominalsurgery. A two-compartment open model was used in the pharmacokineticanalysis of the data. The elimination half-life (Tß)was prolonged by 60% in patients with renal failure (from 85to 140 min) and corresponded to a 30% decrease of the plasmaclearance. The plasma concentration of the metabolites neverexceeded 7% of the unchanged fazadinium. These results suggestthat the duration of action will be less prolonged for fazadiniumthan for other non-depolarizing neuromuscular blocking drugsin patients with renal failure. A supplementary biliary pathwayappears to be a possible explanation for the rapid eliminationof fazadinium, even in patients with renal failure.     

18.

PLASMA POTASSIUM CHANGES FOLLOWING SUXAMETHONIUM AND SUXETHONIUM IN NORMAL PATIENTS AND IN PATIENTS IN RENAL FAILURE     

DAY  S. 《British journal of anaesthesia》1976,48(10):1011-1015

Fifty-four healthy patients and 21 patients with chronic renaldisease received either suxamethonium 100 mg or suxethonium150 mg for neuromuscular blockade during endotracheal intubation.A significant increase in plasma potassium concentration wasobserved following the administration of suxamethonium. No increaseoccurred in patients who received suxethonium. It is concludedthat suxethonium may be preferable to suxamethonium in patientswho are at risk from an increase in the plasma potassium concentration.     

19.

小儿急性肾功能衰竭100例临床分析   总被引：6，自引：0，他引：6  

于力  杨霁云 《中华肾脏病杂志》1995,11(3):137-139

介绍１００例小儿急性肾功能衰竭（ＡＲＦ）的病因、临床表现、实验室检查、病理及预后。肾前性１３例（１３％），肾性８６例（８６％），其中肾小球疾病６６例（６６％），肾后性１例（１％）。３１例肾活检，病理为９种类型，毛细血管内增生性肾小球肾炎（ＥｎＰＧＮ）８例（２５．８１％），系膜增殖性肾小球肾炎（ＭｓＰＧＮ）４例（１２．９０％），膜增殖性肾小球肾炎（ＭＰＧＮ）Ｉ型５例（１６．１３％），局灶节段性肾小球     

20.

C REACTIVE PROTEIN IN PATIENTS WITH CHRONIC RENAL DISEASES     

《Renal failure》2013,35(3-4):551-562

Base-line serum levels of plasma C-reactive protein (CRP) are predictive of future myocardial infarction and sudden cardiac death in apparently healthy subjects, suggesting the hypothesis that chronic inflammation might be important in the pathogenesis of atherothrombosis. CRP production is mediated by several inflammatory mediators: interleukin 6 (IL-6) is currently felt to be the major cytokine influencing the acute phase response. CRP and other acute phase proteins are elevated in dialysis patients and cardiovascular diseases represent the single largest cause of mortality in chronic renal failure patients. Little information is available, however regarding CRP and IL-6 plasma levels in pre-dialysis renal failure. Plasma CRP was determined by a modification of the laser nephelometry technique; IL-6 by immunoassay (RD System); and fibrinogen, serum albumin, cholesterol, triglycerides, hematocrit, white blood cell count, erythrocytic sedimentation rate (ESR) and urinary protein levels by standard laboratory techniques. Results were obtained in 102 chronic pre-dialysis patients whose mean age was 53 ± 5.8 years with a mean creatinine clearance (C_Cr) of 52 ± 37 mL/min). CRP was greater than 5 mg/L in 25% of the global population. CRP and IL-6 were 4.0 ± 4.6 mg/L and 5.8 ± 5.6 pg/mL, respectively and were not significantly correlated (r = 0.11, p = n.s.). CRP and IL-6 were however related with renal function (CRP versus C_Cr r = ?0.40 p < 0.001; IL-6 versus C_Cr r = ?0.45; p < 0.001). When patients were divided in two groups according to renal function, CRP resulted 7.4 ± 6.3 mg/L in the group of patients with a C_Cr lower than 20 mL/min (n = 32) and 2.76 ± 4.35 in the group of patients with a C_Cr higher than 20mL/min (n = 70) (p < 0.0001). CRP and IL-6 were positively related with ESR (r = 0.32 and 0.46 respectively). Serum albumin levels were not significantly different in the two groups of patients (3.2 ± 0.4 versus 3.0 ± 0.5 g/dL). CRP and serum albumin were not significantly related (r = 0.17). CRP and IL-6 correlated positively with ESR (r = 0.32 and 0.46 respectively). In pre-dialysis patients we have demonstrated an increase in both CRP and IL-6 that occurs as renal function decreases. These data provided evidence of the activation – even in the predialysis phase of renal failure – of mechanisms known to contribute to the enhanced cardiovascular morbidity and mortality of the uremic syndrome.     

RENAL DETERIORATION IN MYELODYSPLASTIC CHILDREN: URODYNAMIC EVALUATION AND CLINICAL CORRELATES

Purpose

We determined which factors portend a higher risk of renal deterioration in the myelodysplastic child, and evaluated the sensitivity and predictive value.

Materials and Methods

We retrospectively reviewed the medical history, imaging studies and urodynamics of 90 children with spinal dysraphism. Median patient age at initial evaluation was 3 months and average followup ranged between 2 and 25 years (average 11). We evaluated the relation of urodynamic parameters and sex to upper tract changes and the resolution of these changes.

Results

Statistically significant relationships were identified between the urodynamic parameters of leak point pressure, compliance and detrusor-sphincter dyssynergia, and renal deterioration but not with resolution of deterioration. Boys and girls did not demonstrate a significant difference among urodynamic parameters. Female patients had a higher incidence of reflux and parenchymal loss.

Conclusions

With knowledge of the inherent sensitivity, specificity and predictive value of urodynamic parameters, selective use of urodynamics will assist in identifying patients at risk of renal deterioration. Female patients with reflux are at greatest risk of parenchymal loss. We advocate early institution of intermittent catheterization in patients identified as high risk for deterioration by urodynamics.     

RENAL CELL CARCINOMA IN CHILDREN: EXPERIENCE AT A SINGLE INSTITUTION IN JAPAN

PURPOSE: We analyzed the presentation, treatment and survival of 4 children with renal cell carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the pathological and hospital records of 4 Japanese children diagnosed with renal cell carcinoma at our hospital from 1970 to 1998. RESULTS: In the 1 boy and 3 girls with an average age of 8 years 7 months at diagnosis the most common presenting complaints were gross hematuria in 75% and a palpable abdominal mass in 50%. Computerized tomography revealed characteristic calcification within the tumor in 3 of the 4 patients (75%). In the remaining case the lesion had high density areas with microcalcification, as confirmed by histopathological study. In 2 patients with regional lymph node metastasis calcification was also observed in the metastatic lesions. Disease was stages I to III in 1, 1 and 2 patients, respectively. All patients underwent transabdominal nephrectomy with regional lymphadenectomy. One patient with stage I disease had multiple metastases 15 months later and died of disease 55 months postoperatively. However, the remaining 3 patients received adjuvant interferon therapy and they are without evidence of recurrence a mean of 51.3 months postoperatively. CONCLUSIONS: Calcification within the tumor and/or metastatic lesions or high density areas in the tumor on screening computerized tomography are characteristic findings suggestive of pediatric renal cell carcinoma. Adjuvant therapy with interferon may provide some benefit in select pediatric patients. Further studies of a larger number of pediatric renal cell carcinoma cases may be necessary to establish the optimal diagnostic and therapeutic regimen.     

RENAL LESION GROWTH IN CHILDREN WITH TUBEROUS SCLEROSIS COMPLEX

Purpose

Renal lesions, including angiomyolipoma, renal cysts (simple and polycystic kidney disease) and renal cell carcinoma, develop in patients with tuberous sclerosis complex. While there is limited information that these lesions may grow in adults with tuberous sclerosis complex, the incidence, characterization and growth rate in children have not been reported. Also, the age at which these lesions first appear, thus providing insight into their natural history, is unknown. We present our data from a longitudinal renal surveillance study of children with tuberous sclerosis complex.

Materials and Methods

Since 1985 children with tuberous sclerosis complex at our hospital have undergone periodic renal imaging by ultrasonography or computerized tomography to monitor renal lesions. A total of 35 girls and 25 boys 1 to 18 years old have undergone at least 2 or more annual renal ultrasounds.

Results

On initial evaluation 33 of 60 children (55%) (mean age 6.9 years) had an identifiable renal lesion, which increased to 48 of 60 (80%) at followup (mean age 10.5 years). Angiomyolipoma was the most frequent lesion (75%) followed by simple renal cysts (17%). Angiomyolipomas increased in size and/or number in 10 of 18 boys (56%) and 18 of 27 girls (66%). The largest growth rate in 1 year was from 0 to 4 cm. and from 5 to 9 cm. in diameter. The youngest patient demonstrated lesions at age 2 years. The average age at which a normal ultrasound became abnormal was 7.2 years. While a total of 27 patients had a normal ultrasound on entering the study, lesions had developed in 15 at followup (11 with angiomyolipomas, 4 with cysts). Five patients had cysts that had disappeared at followup. A 7-year-old boy had a 9 cm. renal cell carcinoma removed. One patient has renal lesions characteristic of autosomal dominant polycystic kidney disease.

Conclusions

Renal involvement in patients with tuberous sclerosis complex begins in infancy, and angiomyolipoma is the most common lesion (75%). Angiomyolipomas are more likely to grow than remain stable, although the rate of growth varies. Simple renal cysts may appear or disappear with time but angiomyolipomas do not disappear. An initially normal renal ultrasound does not rule out future development of lesions. Periodic surveillance is indicated in children with tuberous sclerosis complex.     

USE OF ALCURONIUM IN PATIENTS UNDERGOING RENAL TRANSPLANTATION

Alcuronium 0.16 mg kg^–1 was used to provide neuromuscularblockade in patients with chronic renal failure undergoing renaltransplantation. Relaxation was found to be adequate for intubationand surgery. There were minimal alterations to cardiovascularvariables. The dose required was small, and complete reversaloccurred with neostigmine. Although the number of patients issmall, the drug may be of value as an alternative to tubocurarineor pancuronium in such patients     

CARDIOPULMONARY BYPASS IN PATIENTS WITH MALIGNANT RENAL NEOPLASMS

A case report of a patient with malignant renal neoplasm whounderwent emergency pulmonary embolectomy during operation ispresented. Knowledge of degree of venous extension, appropriateoperative positioning of the patient and consideration of electivecardiopulmonary bypass are suggested ways to reduce morbidityand mortality from massive pulmonary emboli in these patients.     

PHARMACOKINETICS OF FAZADINIUM IN PATIENTS WITH RENAL FAILURE

The serum concentrations of fazadinium and its metabolites weremeasured in 14 surgical patients with end-stage renal failureand in 11 patients free from kidney disease undergoing abdominalsurgery. A two-compartment open model was used in the pharmacokineticanalysis of the data. The elimination half-life (Tß)was prolonged by 60% in patients with renal failure (from 85to 140 min) and corresponded to a 30% decrease of the plasmaclearance. The plasma concentration of the metabolites neverexceeded 7% of the unchanged fazadinium. These results suggestthat the duration of action will be less prolonged for fazadiniumthan for other non-depolarizing neuromuscular blocking drugsin patients with renal failure. A supplementary biliary pathwayappears to be a possible explanation for the rapid eliminationof fazadinium, even in patients with renal failure.     

PLASMA POTASSIUM CHANGES FOLLOWING SUXAMETHONIUM AND SUXETHONIUM IN NORMAL PATIENTS AND IN PATIENTS IN RENAL FAILURE

Fifty-four healthy patients and 21 patients with chronic renaldisease received either suxamethonium 100 mg or suxethonium150 mg for neuromuscular blockade during endotracheal intubation.A significant increase in plasma potassium concentration wasobserved following the administration of suxamethonium. No increaseoccurred in patients who received suxethonium. It is concludedthat suxethonium may be preferable to suxamethonium in patientswho are at risk from an increase in the plasma potassium concentration.     

小儿急性肾功能衰竭100例临床分析

介绍１００例小儿急性肾功能衰竭（ＡＲＦ）的病因、临床表现、实验室检查、病理及预后。肾前性１３例（１３％），肾性８６例（８６％），其中肾小球疾病６６例（６６％），肾后性１例（１％）。３１例肾活检，病理为９种类型，毛细血管内增生性肾小球肾炎（ＥｎＰＧＮ）８例（２５．８１％），系膜增殖性肾小球肾炎（ＭｓＰＧＮ）４例（１２．９０％），膜增殖性肾小球肾炎（ＭＰＧＮ）Ｉ型５例（１６．１３％），局灶节段性肾小球     

C REACTIVE PROTEIN IN PATIENTS WITH CHRONIC RENAL DISEASES

Base-line serum levels of plasma C-reactive protein (CRP) are predictive of future myocardial infarction and sudden cardiac death in apparently healthy subjects, suggesting the hypothesis that chronic inflammation might be important in the pathogenesis of atherothrombosis. CRP production is mediated by several inflammatory mediators: interleukin 6 (IL-6) is currently felt to be the major cytokine influencing the acute phase response. CRP and other acute phase proteins are elevated in dialysis patients and cardiovascular diseases represent the single largest cause of mortality in chronic renal failure patients. Little information is available, however regarding CRP and IL-6 plasma levels in pre-dialysis renal failure. Plasma CRP was determined by a modification of the laser nephelometry technique; IL-6 by immunoassay (RD System); and fibrinogen, serum albumin, cholesterol, triglycerides, hematocrit, white blood cell count, erythrocytic sedimentation rate (ESR) and urinary protein levels by standard laboratory techniques. Results were obtained in 102 chronic pre-dialysis patients whose mean age was 53 ± 5.8 years with a mean creatinine clearance (C_Cr) of 52 ± 37 mL/min). CRP was greater than 5 mg/L in 25% of the global population. CRP and IL-6 were 4.0 ± 4.6 mg/L and 5.8 ± 5.6 pg/mL, respectively and were not significantly correlated (r = 0.11, p = n.s.). CRP and IL-6 were however related with renal function (CRP versus C_Cr r = ?0.40 p < 0.001; IL-6 versus C_Cr r = ?0.45; p < 0.001). When patients were divided in two groups according to renal function, CRP resulted 7.4 ± 6.3 mg/L in the group of patients with a C_Cr lower than 20 mL/min (n = 32) and 2.76 ± 4.35 in the group of patients with a C_Cr higher than 20mL/min (n = 70) (p < 0.0001). CRP and IL-6 were positively related with ESR (r = 0.32 and 0.46 respectively). Serum albumin levels were not significantly different in the two groups of patients (3.2 ± 0.4 versus 3.0 ± 0.5 g/dL). CRP and serum albumin were not significantly related (r = 0.17). CRP and IL-6 correlated positively with ESR (r = 0.32 and 0.46 respectively). In pre-dialysis patients we have demonstrated an increase in both CRP and IL-6 that occurs as renal function decreases. These data provided evidence of the activation – even in the predialysis phase of renal failure – of mechanisms known to contribute to the enhanced cardiovascular morbidity and mortality of the uremic syndrome.