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Biomedical subjects

F B Stapleton

Publications and source records attributed to F B Stapleton.

At least 37 records · Page 2Linked to original sources
PubMed1994

Hematuria associated with hypercalciuria and hyperuricosuria: a practical approach.

Hematuria is one of the most common urinary abnormalities found in children. When hypercalciuria was identified as a potential etiology of painless hematuria, many questions arose concerning the general importance of this observation. Subsequently, increased uric acid excretion also has been purported to cause hematuria in children. This review traces the history of these observations and describes the clinical characteristics of the clinical syndrome of hematuria associated with hypercalciuria and hyperuricosuria. Diagnostic criteria of excessive urinary excretion of calcium and uric acid are reviewed; differences in urinary calcium and uric acid excretion between infants and older children are emphasized. Aside from urolithiasis, few long-term consequences from hypercalciuria or hyperuricosuria have been identified, although some debate exists concerning the effect of chronic hypercalciuria upon bone mineralization.

Calcium↗
PubMed1994

Changing pattern of glomerular disease at Beijing Children's Hospital.

Current clinical experience with glomerular disease at a pediatric referral center in Beijing, China, was reviewed. In 1992, renal disorders accounted for 505 of a total 6,885 (7.3%) pediatric medical discharges. Acute glomerulonephritis accounted for 30% of renal diagnoses, while nephrotic syndrome accounted for 28% and Henoch-Schönlein purpura nephritis accounted for 16% of renal disease. Mortality in children with renal disease was 0.4% (two of 505). All children with acute glomerulonephritis recovered or improved at last follow-up, regardless of the relationship to a streptococcal infection. In children with uncomplicated nephrotic syndrome, 91% had a complete or partial response to corticosteroids. Nephritis developed in 81 of 278 patients with Henoch-Schönlein purpura (29%). Since 1956, a dramatic decrease in the diagnosis of acute glomerulonephritis has occurred at this pediatric hospital. Nephrotic syndrome, in contrast, has increased from 45.3 cases per year in the 1956-to-1965 decade to 146 cases annually in the period from 1986 to 1992. Similarly, Henoch-Schönlein purpura has increased from 45.3 cases annually in the 1956-to-1965 period to 238 cases per year in the past 6 years. The incidence of nephritis in patients with Henoch-Schönlein purpura has remained constant at 29% in the past 36 years. These data should be helpful for individuals and institutions who are planning educational or clinical collaborations with pediatric nephrologists in China.

Acute Disease↗
PubMed1993

Renal biopsy in children with asymptomatic hematuria or proteinuria: survey of pediatric nephrologists.

The decision to perform a renal biopsy on children with asymptomatic hematuria or proteinuria remains a problem for clinicians. To assess the current opinion of 349 pediatric nephrologists on this issue, case summaries of a 9-year-old boy with 20 urinary red blood cells per high power field without proteinuria and a 9-year-old boy with 2+ proteinuria (600 mg/day) without hematuria were distributed to each specialist. Seventy-three percent (n = 256; 3:1, male:female) responded. Five percent would biopsy the child with asymptomatic hematuria. The main reasons were academic interest, parental pressure for a diagnosis/prognosis and concern for future economic impact on the child (i.e., life insurance). The determinations to biopsy for hematuria were not related to age or sex of the nephrologist. In contrast, 38% (n = 96) of the pediatric nephrologists would perform a biopsy on the child with proteinuria. The major reasons for biopsy were academic interest and potential for drug therapy. With a normal history, physical examination and laboratory/radiographic evaluation, the vast majority of pediatric nephrologists in North America support a conservative approach to the child with asymptomatic hematuria or proteinuria.

Adult↗
PubMed1993

Insurability for asymptomatic hematuria or proteinuria during childhood.

The objective of this survey was to describe life insurance underwriting practices concerning children with asymptomatic hematuria and proteinuria. A questionnaire was sent to 200 companies licensed to issue life insurance policies in the state of New York. The medical director of each company was asked to respond to the insurability of children with asymptomatic hematuria and proteinuria. Two case summaries were provided with the questionnaire. Of 97 companies, 66 would offer insurance to the patient with hematuria, although 38 (58%) would charge additional premiums. In response to the problem of proteinuria, 61 companies would offer life insurance, although 50 (82%) would require higher premium charges (P < 0.002 compared with hematuria). We conclude that children with asymptomatic hematuria and proteinuria can usually obtain life insurance, although often at higher cost. Invasive diagnostic tests are not necessary for insurers to offer insurance.

Child↗
PubMed1993

Hypercalciuria and nephrocalcinosis in children.

Hypercalciuria has become a significant clinical focus both for pediatricians and for pediatric nephrologists after it was found that increased urinary calcium excretion is the most common abnormality in children with nonglomerular hematuria and with nephrolithiasis. The question of long-term implications of hypercalciuria in growing children, regardless of the underlying cause, remains unanswered. Whether dietary or pharmacologic therapy is warranted in children with hypercalciuria is controversial. One of the proposed consequences of hypercalciuria is nephrocalcinosis. With the availability of increasingly sensitive, noninvasive imaging techniques, nephrocalcinosis is being recognized more frequently. In some instances, concern about the risk and progression of nephrocalcinosis is provoking reevaluation of well-established metabolic therapies. New urinary inhibitors of crystal formation and aggregation have recently been identified. As the basic pathogenesis of nephrocalcinosis becomes clearer, clinical therapies will become more specific and effective.

Alkalosis↗
PubMed1992

Renal tubular disorders in the neonate.

Renal tubular disorders are uncommon in the newborn period, but, when present, they may produce complex life-threatening alterations in the composition of the intracellular and extracellular fluid compartments. Because of the infrequency with which these disorders are encountered; clinicians are often uncertain of the appropriate diagnostic evaluation. The authors believe that localizing major neonatal renal tubular disorders to the proximal and distal nephron will assist physicians in developing a pathophysiologic understanding of these conditions.

Bartter Syndrome↗
PubMed1991

Natural history of hematuria associated with hypercalciuria in children.

Hypercalciuria (HCU) is frequently found during the evaluation of children with hematuria; the long-term implications of untreated HCU in children are uncertain. Since 1981, we have identified HCU (urinary calcium, greater than 0.1 mmol.kg-1.d-1) in 58 patients (41 male) with hematuria; 64% had gross hematuria and 74% had a relative with urolithiasis. Renal HCU was diagnosed in 19 patients and absorptive HCU in 24 patients. In 15 children, the calcium loading test was nondiagnostic. In nine patients (16%), urolithiasis developed, and in one patient, a renal calcification developed. These 10 patients (seven male) were older (10.1 vs 7.5 years) than the other 48 patients and initially presented with gross hematuria (nine of 10). All 10 patients had a family history of urolithiasis. The initial urinary calcium value was similar between the 10 patients with stones (0.15 mmol.kg-1.d-1) and the patients without stones (0.14 mmol.kg-1.d-1); five had absorptive HCU and four had renal HCU. At least one follow-up urinary calcium measurement was available for 23 patients who were not receiving thiazide therapy during 1 to 6 years after diagnosis (mean, 3.1 years). At 1-year follow-up, 12 of 17 patients had HCU and five had hematuria. Twenty-one patients were studied 2 to 3 years from diagnosis; 11 had HCU and eight had hematuria. After 4 years, six of seven patients had HCU and three had hematuria. We concluded that children with HCU and hematuria are at significant risk for urolithiasis, especially if they have gross hematuria and a family history of urolithiasis. Hypercalciuria may be episodic in children with hematuria, and factors other than urinary calcium concentration may be responsible for urinary bleeding.

Calcium Metabolism Disorders↗
PubMed1991

Ambulatory blood pressure patterns in children and adolescents: influence of renin-sodium profiles.

A renin-sodium nomogram for normotensive children and adolescents was developed at our institution. The ambulatory blood pressure patterns of subjects classified by the nomogram were then compared. A biracial sample of 159 children and adolescents were classified as having a low, intermediate, or high renin-sodium profile based on the relationship between their plasma renin activity and 24-hour urinary sodium excretion. Casual (106/58 vs 107/61 vs 106/62 mm Hg) and awake (116/69 vs 117/69 vs 116/70 mm Hg) blood pressure values were comparable among subjects with low, intermediate, and high renin-sodium profiles. Subjects with high renin-sodium profiles, however, had a smaller decline in systolic blood pressure with sleep than did subjects with low renin-sodium profiles (7 vs 11 mm Hg; P less than .04), and higher diastolic blood pressure readings during sleep than subjects with intermediate renin-sodium profiles (65 vs 62 mm Hg; P less than .05). Subjects with high renin-sodium profiles also had greater variance of diastolic blood pressure readings during sleep than either subjects with low renin-sodium profiles (P less than .01) or those with intermediate renin-sodium profiles (P less than .02). The blunted nocturnal decline and increased nocturnal variance of blood pressure among subjects with high renin-sodium profiles may be a marker or mechanism for the future development of essential hypertension.

Adolescent↗