In adults the calcium antagonist amlodipine given once a day has proved to be an attractive addition to the antihypertensive armamentarium. The present report describes our experience in 43 ...paediatric outpatients (26 boys and 17 girls, aged between 1.1 and 19, median 9.8 years) with chronic kidney diseases. The patients were given amlodipine for 16 weeks as part of their antihypertensive treatment. Before amlodipine arterial pressure was 150 (142-163)/90 (84-95) mm Hg (median and interquartile range). Six patients withdrew from amlodipine because of oedema, flushing or headache. In the remaining patients amlodipine 7.7 (6.9-9.4) mg/m(2) body surface area once a day significantly decreased arterial pressure by 17 (13-22)/10 (7-13) mm Hg. The efficacy of amlodipine was more pronounced in girls than in boys. No changes in heart rate, body weight and circulating haemoglobin, sodium, potassium and creatinine were noted. In none of the patients circulating potassium, sodium or creatinine changed by more than 0.5 mmol/l, 5 mmol/l respectively 20%. In 11 patients concomitantly treated with cyclosporine the dosage and the trough-level of this agent were stable throughout the trial. In conclusion the present experience in paediatric outpatients with chronic kidney diseases supports the view that amlodipine is an effective and rather well tolerated antihypertensive drug when given once a day.
The purpose of this analysis was to investigate biochemical disturbances at presentation and initial fluid resuscitation before surgery in infantile pyloric stenosis. The charts of 139 consecutive ...infants (113 boys and 26 girls) between 7d and 20 wk of age with hypertrophic pyloric stenosis were reviewed. The infants were treated at the Department of Pediatric Surgery, University of Bern, Switzerland, in the period between 1987 and 1997. A trend towards hypokalemia (13 of the 139 patients), hypochloraemia (39 patients) and especially metabolic alkalosis (98 patients) was frequently noted on admission. In 84 patients, data on fluid management and on circulating sodium, potassium, chloride and the acid‐base balance immediately before surgery were also available. In these patients a significant correlation was found between the parenteral chloride dose given for fluid repair (y= 0.310 x; rs= 0.54; p > 0.001) and the changes in plasma bicarbonate. The equation indicates that a chloride dose of 10mmol/kg body weight is required to reduce plasma bicarbonate on average by 3 mmol/l.
Conclusion: Since assessment of the fluid volume stated by physical examination and history is inaccurate in infants with vomiting, the severity of metabolic alkalosis helps to define the amount of fluid required for repair.
Many diseases are linked with uveitis, but few studies have specifically looked at the noninfectious triggers of childhood uveitis in Central Europe. The charts of 70 paediatric patients with ...non‐infectious uveitis admitted to the Department of Pediatrics, University of Bern, Switzerland, between 1983 and 1998 were therefore reviewed. In the patients the age at presentation with uveitis ranged between 0.3 and 16 y, median 8.5 y. Based on the localization, uveitis anterior was diagnosed in most cases (n= 40; 57%), followed by panuveitis (n= 20; 29%) and uveitis posterior (n= 10; 14%). Uveitis was chronic in 54 (77%) and acute in 16 (23%), bilateral in 38 (54%) and unilateral in 32 (46%) cases. An associated condition was noted in 32 (46%) cases: juvenile idiopathic arthritis in 24 cases, sarcoidosis and juvenile spondyloarthropathy in 3 cases, and Sjögren's syndrome and Behçet's disease in 1 case each. In the remaining 38 (54%) patients, no associated condition was diagnosed.
It is concluded that in Swiss children, uveitis can be due to a wide spectrum of non‐infectious diseases, juvenile idiopathic arthritis being the leading cause. In the majority of the children, no associated condition was recognized.
Better renoprotective effect of angiotensin II antagonist compared to dihydropyridine calcium channel blocker in childhood.
The dihydropyridine calcium channel blocker amlodipine and the angiotensin ...II antagonist irbesartan effectively reduce blood pressure in hypertensive children.
Eligible for the open-label, randomized study were nephropathic children between 6.0 and 18 years of age with plasma creatinine <177 μmol/L, overt proteinuria, untreated arterial hypertension (systolic, 5 to 30mm Hg; and diastolic, 1 to 15mm Hg;>95th centile) and stable immunosuppressive treatment. The initial dose of amlodipine was 5mg (body weight, 20 to 40 kg) and 10mg (body weight,>40 kg), respectively, that of irbesartan, which was 75mg (body weight, 20 to 40 kg) and 150mg (body weight,>40 kg), respectively. The dosage was doubled if necessary.
A total of 26 children aged 6.1 to 17 years were allocated to receive either amlodipine (N = 13) or irbesartan (N = 13) for 16 weeks. Severe edema and headache occurred in two patients on amlodipine who withdrew from the study. No adverse experiences were noted in patients given irbesartan. Amlodipine by 12 (10 to 14)/7 (5 to 10) mm Hg; median and interquartile range, respectively and irbesartan by 13 (9 to 16)/9 (7 to 11) mm Hg, respectively reduced blood pressure (P < 0.01) in a similar fashion. Heart rate, plasma sodium, and creatinine did not change. Irbesartan slightly increased plasma potassium by 0.1 (0.0 to 0.2) mmol/L; P < 0.05. Plasma albumin and the urinary albumin/creatinine ratio were similar before and with amlodipine. On the contrary, irbesartan increased plasma albumin by 4 (3 to 5) g/L; P < 0.03 and decreased the urinary albumin/creatinine ratio by 242 (68 to 312) mg/mmol; P < 0.03.
The study demonstrates that in children the effect of angiotensin II antagonists on proteinuria is better than that of dihydropyridine calcium channel blockers.
Background. The cardinal characteristics of primary hypomagnesaemia–hypercalciuria–nephrocalcinosis include renal magnesium wasting, marked hypercalciuria, renal stones, nephrocalcinosis, a tendency ...towards chronic renal insufficiency and sometimes even ocular abnormalities or hearing impairment. Methods. As very few patients with this syndrome have been described, we provide information on nine patients on follow‐up at our institutions and review the 42 cases reported in the literature (33 females and 18 males). Results. Urinary tract infections, polyuria–polydipsia, renal stones and tetanic convulsions were the main clinical findings at diagnosis. The clinical course was highly variable; renal failure was often reported. The concomitant occurrence of ocular involvement or hearing impairment was reported in a large subset of patients. Parental consanguinity was noted in some families. Conclusions. The results indicate an autosomal recessive inheritance. The diagnosis of primary hypomagnesaemia–hypercalciuria–nephrocalcinosis deserves consideration in any patient with nephrocalcinosis and hypercalciuria.
In order to ascertain the prevalence of agents that cause childhood diarrheal illness, stool specimens of 312 consecutive children with community-acquired diarrhea requiring admission were evaluated. ...Pathogens were detected in 166 (53%) of the 312 children (≥2 pathogens in 28 children): Rotavirus (n=75), Salmonella spp. (n=37), Campylobacter spp. (n=24), Shigella spp. (n=5), Giardia spp. (n=4), Yersinia spp. (n=2), Aeromonas spp. (n=15), Cryptosporidium (n=15), enteropathogenic Escherichia coli (n=13), enterotoxigenic E. coli (n=7), and enterohemorrhagic E. coli (n=5). In conclusion, acute childhood diarrheal illness pathogens, such as Aeromonas, Cryptosporidium, and diarrheagenic E. coli, account for a large proportion of patients with a microbiologically positive stool specimen.
Studies in adults with chronic kidney diseases demonstrate that the orally available angiotensin II antagonist irbesartan reduces arterial pressure and pathological proteinuria, mostly with an ...excellent tolerability profile. Little information is available on irbesartan in childhood.
A total of 44 pediatric outpatients with chronic kidney disease (27 male and 17, aged 3.7 to 18 years, median 10 years) were given irbesartan once a day during 18 weeks for arterial hypertension (
N = 23), proteinuria (
N = 8), or both (
N = 13).
In patients with hypertension, the use of irbesartan 4.1 (3.1–5.3) mg/kg body weight daily (median and interquartile range) was associated with a decrease (
P < .005) in arterial pressure by 17 (13–22)/10 (7–12) mm Hg. In patients with overt proteinuria the urinary protein excretion decreased (
P < .01) during treatment with irbesartan (2.9 2.0–4.8 mg/kg body weight) by 52 (0–75) mg/m
2 × h), whereas plasma albumin increased (
P < .05) by 4 (1–5) g/L. The frequency of abdominal pain, constipation, cough, diarrhea, dizziness, edema, fatigue, headache, insomnia, myalgia, orthostasis, and rash was similar before and with irbesartan. Plasma sodium slightly decreased, whereas plasma potassium increased, with irbesartan (
P < .01).
In pediatric patients with chronic kidney diseases, irbesartan given once a day for 18 weeks significantly reduces arterial pressure and proteinuria, with an excellent tolerability and side effect profile.
Most girls with recurrent urinary tract infections do not have major urinary tract abnormalities. Recent studies focus on predisposing behavioral and functional abnormalities: infrequent voiding, ...inadequate fluid intake, stool retention, poor genital hygiene and voiding dysfunction.
Complete history, bladder and bowel questionnaire, physical examination, voiding-drinking diary, sonography and uroflowmetry were used to assess infrequent voiding, functional stool retention, poor fluid intake, inadequate hygiene, or voiding dysfunction in girls referred for evaluation of three or more symptomatic urinary tract infections (with a first infection at the age of more than 36 months).
A total of 141 girls aged 3.9 to 18 years were evaluated between 1996 and 1999; 212 abnormalities were noted in 120 patients: infrequent voiding (isolated, 16; combined with other abnormalities, 47), poor fluid intake (isolated, 10; combined, 50), functional stool retention (isolated, 5; combined, 25), inadequate hygiene or toilet habits (isolated, 3; combined, 24), dysfunctional voiding (isolated, 15; combined, 10), bladder overactivity (isolated, 5; combined, 2).
Most girls referred for evaluation of three or more urinary tract infections have host-mediated predisposing abnormalities: infrequent voiding, poor fluid intake, functional stool retention or voiding dysfunction. Poor genital hygiene and toilet habits were almost always combined with other abnormalities, suggesting that infections are not necessarily related to poor genital hygiene or toilet habits. Two or more indications of predisposing behavior often concur in the same patient.
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