Regulation of magnesium balance is achieved by a steady‐state mechanism in which intake and output are maintained at an equal level. Dietary magnesium intake, total and ionized plasma magnesium ...levels, and urinary magnesium were assessed in 46 renal transplant recipients treated with cyclosporine, nine transplant recipients who had never been on cyclosporine, and 31 healthy volunteers. Dietary magnesium intake 13.5 (11.0–15.1) mmol/day vs 13.0 (11.1–16.0) mmol/day and 13.7 (11.4–16.7) mmol/day, respectively; median and interquartile range and urinary magnesium excretion 4.31 (3.57–5.89) vs 4.39 (3.56–6.02) and 5.01 (3.73–6.01) mmol/day, respectively were similar in renal transplant recipients treated with cyclosporine, transplant recipients who had never been on cyclosporine, and control subjects. Total 0.74 (0.70–0.78) vs 0.80 (0.74–0.84) and 0.81 (0.79–0.87) mmol/l, respectively and ionized 0.49 (0.46–0.52) vs 0.53 (0.50–0.58) and 0.54 (0.52–0.59) mmol/l, respectively plasma magnesium were significantly lower in renal transplant recipients on cyclosporine than in transplant recipients without cyclosporine, and healthy controls. These observations indicate a modified magnesium steady state in renal transplant recipients treated with cyclosporine.
BACKGROUNDSince good control of arterial hypertension is of paramount importance, the present study was carried out to evaluate blood pressure control in pediatric patients with hypertension ...receiving regular medical care.
STUDY DESIGNThe charts of 80 hypertensive children receiving medical care were reviewed. Their antihypertensive medication had been stable during three or more separate clinic visits and during 3 or more months. Patients with office hypertension were excluded.
RESULTSBlood pressure values higher than the corresponding 95th centiles were noted in 20 of the 80 patients. Hypertension was systolic in seven, diastolic in four and both systolic and diastolic in nine patients. The number of prescribed antihypertensive drugs and the number of doses/day of prescribed antihypertensive drugs was similar in patients with good and in those with poor blood pressure control. Plasma creatinine was higher in patients with poor than in those with good blood pressure control.
CONCLUSIONSThe present survey indicates that the goal of antihypertensive medication is not achieved in a noticeable number of pediatric patients with treated hypertension.
Circulating magnesium exists in the bound and in the free ionized form, that is biologically active. In kidney disease the relationship between ionized and total circulating magnesium is often ...altered. Little information is available on the influence of hemodialysis on the relationship between ionized and total circulating magnesium in end-stage kidney disease.
Plasma total and ionized magnesium and the plasma ionized magnesium fraction were assessed before and after hemodialysis (dialysate magnesium content 0.75 mmol/l) in 46 patients with end-stage kidney disease and in a control group of 25 healthy subjects.
In patients plasma total (from 1.19 1.05-1.33 to 1.10 1.02-1.16 mmol/l; median and interquartile range) and ionized (from 0.71 0.66-0.78 to 0.65 0.63-0.69 mmol/l) magnesium significantly decreased during dialysis (control subjects: 0.82 0.80-0.92, respectively, 0.57 0.54-0.59 mmol/l). The plasma ionized magnesium fraction was significantly lower in patients both before (0.61 0.58-0.64) and after (0.60 0.56-0.62) hemodialysis than in controls (0.68 0.65-0.70).
The study demonstrates a tendency towards a reduced circulating ionized magnesium fraction in end-stage kidney disease that is not corrected by hemodialysis.
Blocking the formation of angiotensin II with converting enzyme inhibitors is an established intervention for kidney disease. The advent of antagonists of the angiotensin II receptor has increased ...the options for inhibiting the renin-angiotensin-aldosterone system. In adults, angiotensin II antagonists have antihypertensive and antiproteinuric effects similar to those of converting enzyme inhibitors and an adverse effect profile similar to that of placebo. In children, no information is available on angiotensin II antagonists. A total of 20 children (aged 4 to 17 years) with chronic kidney disease received the angiotensin II antagonist irbesartan given once daily. They had hypertension (n = 11), overt proteinuria (n = 3), or both (n = 6). At last follow-up, 2 to 17 months after starting irbesartan (median dosage: 3.3 mg/kg body weight daily), arterial pressure was significantly reduced: the systolic value by 16 6-22 and the diastolic value by 11 4-22 mmHg (median and interquartile range). In nine patients with proteinuria, the urinary albumin/creatinine ratio significantly decreased by 145 105-209 mg/mmol. The frequency of reported adverse events was similar before and with irbesartan.
In children with chronic kidney disease the effects of the angiotensin II antagonist irbesartan on arterial pressure and proteinuria mimic those observed with the converting enzyme inhibitors. The effectiveness of a single daily dose and the paucity of side-effects suggest that angiotensin II antagonists expand therapeutic options for inhibiting the renin-angiotensin-aldosterone system in children.
Background. The use of aminoglycosides has been linked with hypomagnesaemia in scattered reports. The objective of the study was to measure prospectively the effect of treatment with the ...aminoglycoside amikacin on renal magnesium homeostasis. Methods. Twenty‐four cystic fibrosis patients (aged 9–19 years) admitted because of exacerbation of pulmonary symptoms caused by Pseudomonas aeruginosa were treated with the aminoglycoside amikacin and the cephalosporin ceftazidime for 14 days. Renal values and plasma and urinary electrolytes were measured before and at the end of the systemic anti‐pseudomonal therapy. Results. In the patients with cystic fibrosis, treatment with amikacin and ceftazidime did not modify plasma creatinine or urea and plasma or urinary sodium, potassium and calcium. Treatment with amikacin and ceftazidime significantly decreased both plasma total magnesium (from 0.77 (0.74–0.81) to 0.73 (0.71–75) mmol/l; median and interquartile range) and ionized magnesium (from 0.53 (0.50–0.55) to 0.50 (0.47–0.52) mmol/l) concentration and increased fractional urinary magnesium excretion (from 0.0568 (0.0494–0.0716) to 0.0721 (0.0630–0.111)) and total urinary magnesium excretion (from 30.7 (26.5–38.0) to 38.5 (31.5–49.0) μmol/l glomerular filtration rate). Conclusions. The present study demonstrates that systemic therapy with amikacin plus ceftazidime causes mild hypomagnesaemia secondary to renal magnesium wasting even in the absence of a significant rise in circulating creatinine and urea.
A total of 42 children with erythema multiforme (aged 0.1 to 15.8 years, median 6.1 years) were treated between 1978 and 1997 at the Department of Paediatrics, University of Bern, Switzerland. ...Antecedent infections were noted in 30 cases: Mycoplasma pneumoniae infection (n = 14), acute upper respiratory tract disease (n = 10) and herpes simplex infection (n = 6). Four cases were associated with antecedent medication (n = 3) or immunization (n = 1). In 12 of the 30 patients in whom erythema multiforme followed an infectious disease, drugs described in the literature as inducers of erythema multiforme had been given for symptoms not suggestive of the condition. In the remaining eight children no precipitating agent could be detected.
In this survey infections were found as a definite or at least presumptive trigger of erythema multiforme in 71% of cases. Drugs (including immunization) implicated as triggers of erythema multiforme played a definite causative role in 10% and a presumptive role in a further 29% of patients. In 19% of patients an associated condition was not diagnosed.
Circulating sodium in acute meningitis von Vigier, R O; Colombo, S M; Stoffel, P B ...
American journal of nephrology,
03/2001, Letnik:
21, Številka:
2
Journal Article
Recenzirano
In acute meningitis hyponatremia is common and traditionally attributed exclusively to inappropriate water retention. However, the exact mechanisms underlying hyponatremia are unknown.
The files of ...300 pediatric patients with acute bacterial (n = 190) or aseptic (n = 110) meningitides were retrospectively analyzed.
The plasma sodium level ranged from 122 to 148 mmol/l and was low (<133 mmol/l) in 97 patients. Fluid volume contraction was significantly more pronounced in hyponatremia (median 6.0. 10(-2)) than in normonatremia (median 2.0. 10(-2)). The fractional sodium excretion was less than 1.00. 10(-2) in the 26 hyponatremic children with this measurement.
In acute meningitis hyponatremia is not exclusively brought about by inappropriate water retention.
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