Follow-up studies of multicystic dysplastic kidneys

Thirty cases of multicystic dysplastic kidney (MCDK) were diagnosed over 11 years. Nine patients underwent nephrectomy: three for increasing kidney size (classic MCDK) and six because of an inconclusive diagnosis (hydronephrotic MCDK). Of the remaining 21 patients, 19 were followed up for a mean of 33.5 months (range, 2-101 months). Follow-up ultrasound examinations revealed that 16 kidneys did not change in size, one decreased in size after cyst puncture, and two disappeared (one after cyst puncture). This series included one case of non-renin-producing hypertension that was controlled medically, one case of nephroblastomatosis found in the removed dysplastic kidney, and one case of pyelonephritis in the contralateral kidney. When the diagnosis of classic MCDK is made with imaging modalities, the lesion may not have to be removed unless there is growth of the mass during the 1st year of life. Nine percent of these lesions will disappear within the first 3 years of follow-up, and the authors recommend an even longer period of follow-up.     

Renal allograft rejection: evaluation by Doppler US and MR imaging

A prospective study compared the efficacy of Doppler ultrasonography (US) and magnetic resonance (MR) imaging in evaluating 38 renal allografts, with specific attention to transplant rejection. Forty-three Doppler US and 42 MR examinations were performed and interpreted. Histologic correlation was obtained from 22 biopsy or nephrectomy specimens. Clinical correlation or a response to instituted therapy was used as confirmation in the remaining allografts. Accuracy in identifying cyclosporine toxicity or acute tubular necrosis could not be evaluated because there were few such cases, with concomitant rejection in most. The ability to predict and identify presence or absence of rejection was not affected by different serum creatinine values. Doppler US was significantly superior to MR imaging in identifying allograft rejection, demonstrating a higher sensitivity (95% vs. 70%), specificity (95% vs. 73%), and accuracy (95% vs. 71%). Because of its low cost and accessibility, Doppler US should become the primary modality for renal transplant screening.     

The effect of income inequality on the health of selected US demographic groups

OBJECTIVES: This study assessed whether documented effects of income inequality on health are consistent across demographic subgroups of the US population. METHODS: Data from the National Health Interview Survey on White and Black non-Hispanics were used. Logistic regression models were estimated with SUDAAN software. Perceived health was the outcome variable. RESULTS: The results of the multivariate analysis, in which individual family income and county-level poverty rates were included, were not consistent with existing research. In the presence of covariates, the conditional effects of inequality were restricted to Whites aged 18-44 years in the 2 highest income inequality quartiles and middle-aged Whites in counties with the highest level of income inequality. The health of Blacks of all ages, elderly Whites, and middle-aged Whites outside of the areas of highest inequality was unaffected when controls for individual characteristics and county-level poverty were in place. CONCLUSIONS: For the United States, the independent and direct contribution of income inequality to the determination of self-perceived health net of individual income and county income levels is restricted to certain demographic groups.     

Body changes in adolescent patients with growth hormone receptor deficiency receiving recombinant human insulin-like growth factor I and luteinizing hormone-releasing hormone analogue: preliminary results

Auxological and body composition changes were studied in three adolescent patients (2 female, 1 male) with growth hormone receptor deficiency (GHRD) given insulin-like growth factor I (IGF-I), 120 μg/kg s.c. twice daily, plus a monthly intramuscular injection of 7.5 mg of a luteinizing hormone-releasing hormone (LHRH) analogue. Preliminary results from the first 12 months of the study show that height velocity was increased compared with the pretreatment values. This increase was probably due to the IGF-I therapy, as the LHRH analogue would have suppressed gonadotrophins and gonadal steroid production. There was a reduction in percentage body fat, and increases in lean mass and the leamfat ratio, whole body mineral content and body calcium content, even when expressed per kg body weight. There was also a trend towards increased bone mineral density of the whole skeleton, lumbar spine and femoral structures, as well as a maturation of facial features. These preliminary results indicate that concomitant therapy with IGF-I and an LHRH analogue is safe and efficacious in inducing growth without advancing bone age in patients with GHRD.