[Multicenter studies and clinical trials in special populations].
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Journal Article↗
Biomedical subjects
J A Camacho Díaz
Publications and source records attributed to J A Camacho Díaz.
[Long-term effect of angiotensin-converting inhibitors in children with proteinuria].
BACKGROUND: Prolonged proteinuria is a risk factor for renal damage. Angiotensin-converting enzyme (ACE) inhibitors can reduce proteinuria in adults with different types of nephropathy. PATIENTS AND METHODS: We evaluated treatment with low doses of ACE inhibitors (captopril and enalapril) in nine children with proteinuria due to chronic glomerular nephropathy. The patients' diagnoses were Henoch-Schönlein nephropathy, Berger's disease, Alport's disease, and chronic glomerulonephritis (GN) (membranous GN, focal and segmental GN, and membranoproliferative GN). None of the patients were receiving concomitant treatment. Those who had received corticoids, immunosuppressive or hypotensive drugs during the previous 3 months were excluded. The medication was administered over a prolonged period (mean 26.6 6.36 months). RESULTS: Proteinuria was initially in the nephrotic range (M = 55.34 10.44 mg/m2/h). In all patients concentrations fell significantly after 6 months and at the end of the treatment(p = 0.01 and p = 0.05). No adverse reactions to the medication were observed. The decrease in glomerular filtration rate was not significant. No significant changes in arterial pressure were found during treatment. CONCLUSIONS: ACE inhibitors could be an effective alternative for reducing proteinuria in children with prolonged nephropathy. These inhibitors do not produce the adverse effects associated with other drugs and can therefore be used for long periods.
Adolescent↗
[Indications for renal biopsy in idiopathic nephrotic syndrome in children. Results of a national survey].
BACKGROUND: The role of the renal biopsy in children with nephrotic syndrome is controversial, especially in patients with frequent relapses or corticosteroid-dependent nephrotic syndrome. METHODS: We have sent a survey about the nephrotic syndrome to all the Spanish pediatric nephrologists who are members of the Spanish Association of Pediatric Nephrology. The survey is based in 7 questions about biopsy utility in the different circumstances of the illness. RESULTS: The survey reveals a scarce participation, 50%. The 85% of the inquired people uses the same diagnostical criterion. Referring the indication of renal biopsy in this disease, the 85% considers that it would be necessary to do it in case of corticosteroid resistance. The 57.7% of pediatric nephrologists would recommend a biopsy in children with frequently relapsing or corticosteroid-dependent nephrotic syndrome prior to cytotoxic therapy. The 33% doesn't practice biopsy before cytostatic administration, only when alterations in the renal function appear during the treatment. The 50% of the inquired considers that less than a year of age is an indication of biopsy in the nephrotic syndrome, and the 24.4% thinks that the age should never be an indication. CONCLUSIONS: The surveys aren't much used in our country as a resource of information. We think that the participation of expert people in the surveys gives validity to the obtained results. There are different opinions among pediatric nephrologists concerning the biopsy in children with frequently relapsing and corticosteroid-dependent nephrotic syndrome.
Biopsy↗
[Nephrolithiasis in children].
We reevaluated the medical records of 112 children with urolithiasis. The prevalence of this condition was 1/4.500 children admitted to our hospital. The mean age was 8.2 years and 54.4% of the afflicted patients were males. Fifty percent of the patients studied had a family history of urolithiasis. The two most frequent etiologies were urinary tract infections and metabolic disorders (hypercalciuria states, distal renal tubular acidosis and cystinuria). The etiology of the urolithiasis was unknown in 15% of our patients. The levels of magnesium and citrate, inhibitors of crystallization, were moderately low in some of the cases in which it was determined. Fifty percent of the children with urolithiasis showed urinary or renal complications. The extracorporeal lithotripsy was an effective treatment of urolithiasis in the patients in which it was performed. The recurrence rate was 8%. In one third of the urolithiasis associated with urinary infections and/or urinary tract malformations we found chronic pyelonephritis.
Child↗
[Schoenlein-Henoch nephropathy in childhood. Clinical and histologic study of 31 cases].
A series of 31 cases of children affected by nephropathy, out of a total of 120 presenting with Schönlein-Henoch syndrome, observed in a period of seven years is reviewed. 87% of the patients evidenced renal involvement in the first month of disease. The manifestations of nephropathy were: Isolated hematuria. Hematuria-proteinuria less than 40 mg/m2/h. Nephrotic syndrome. Hematuria-nephrotic syndrome. Hematuria-nephrotic syndrome renal insufficiency. Biopsy was performed in 13 cases (41.9%). With regard to the ISKDC rules, the histological classification was: type I, one patient; type II, three patients; type III, seven patients; type V, one patient; type VI, one patient. Evolution was favorable in 30 cases, independently of treatment applied, and a complete remission was obtained in all of them.
Acute Kidney Injury↗
[Review of pseudohypoaldosteronism. Apropos of a clinical case in a 2-month-old girl].
The case of a two month-old child admitted because of dystrophy is presented. At physical examination she presented a growth retardation (-2DS) as well as cutaneous and mucosal pallor. Metabolic acidosis, hyponatremia, hyperkaliemia and salt loss were demonstrated. Aldosterone, both plasmatic and urinary, was increased. Plasma renin activity, was also increased. In respect to renal function, hypercalciuria was found but not other abnormalities neither in the renal nor suprarrenal function were noticed. The electrolytic levels in sweat, saliva and feces were also normal. The clinical and laboratory findings were not modified with the DOCA test. Spirolactone caused an increase in salt loss. Treatment with indometacine improved both the clinical and analytical findings. On the other hand, treatment with chloride sodium (4 gr p.o. per day) also improved dramatically the disturbances. In the last 12 months she has growth up normally. At the same time, the renal loss of sodium has decreased and aldosterone, both plasmatic and urinary, is not so increased as it was at diagnosis. Finally, electrolytic parameters are fully normal.
Age Factors↗
[Hemolytic-uremic syndrome in children. Review of nine cases].
Nine cases of hemolytic uraemic syndrome diagnosed in a single institution during the last eight years are reviewed. In two cases the prodromic phase was rather dramatic and, the disease itself was apparently triggered by streptococcal infections (S. haemolyticus of group C in one case and S. "Agalactiae" in another one). Interestingly enough, one patient with familiar haemolytic uraemic syndrome showed hypocomplementaemia. Complement levels were also low in another patient. In seven out of nine cases, a histopathologic study of the kidney was carried out showing micro angiopathy predominantly glomerular (five cases), microangiopathy predominantly arterial (one case) and cortical necrosis (one case). A fairly good correlation between the histopathological changes and the clinical outcome has been observed in the only case with long-term sequelae who has predominantly vascular microangiopathy. With respect to the therapy, efficacy of the inhibitor of the angiotensin converting enzyme in a case in which severe arterial hypertension appeared, is emphasized.
Child, Preschool↗
[Xanthogranulomatous pyelonephritis in children. 2 new cases].
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Appendicitis↗
[Berger's disease. Study of eleven cases (author's transl)].
Among 39 patients with recurrent hematuria, 11 accomplished criteria of Berger's disease. The frequent association between recurrent hematuria and upper respiratory tract infections as well as constant elevation of serum IgA are emphasized. Their finding as well as the deposition of IgA on the mesangium and C'3 without C1q and C'4 suggest an alternative activation of the complement system which could explain the role of the IgA in the pathogenesis of Berger's disease. The disease can begin as acute glomerulonephritis and occasionally as a nephrotic syndrome, and its' prognosis is generally good in most instances.
Child↗
[Arterial hypertension in acute post-infection glomerulonephritis based on case reports].
Sixty-six cases of acute post-infectious glomerulonephritis, 31,4% of all glomerulopathies diagnosed in our Service were studied. Patients were classified according to the presence (33,3%), or not (66,7%) of arterial hypertension during the acute phase of disease. As far as clinical and analytical data are concerned, the more symptomatic forms were observed among cases with arterial hypertension. However, after the acute phase of disease clinical evolution was similar in both groups.
Acute Disease↗
[Nephrotic syndrome and hereditary spherocytosis (author's transl)].
A case of nephrotic syndrome associated with hereditary spherocytosis in a 22 month old girl is reported. In an attempt to explain the relationships between these two entities and alteration of lipidic metabolism, red cells count and serum cholesterol during relapses of nephrotic syndrome were compared. Until now only two cases involving this association have been published.
Female↗