Biomedical subjects
Publications and source records attributed to P R Lewy.
Varicella-zoster infections developed in ten of 76 children receiving a renal transplant during 1973 to 1978. Two children had varicella and one died during this infection. Eight children had herpes zoster and one experienced encephalitis. In the latter group, reduction of prednisone and azathioprine therapy resulted in rejection and loss of the graft in two of three patients in whom this drug therapy was altered.
Nineteen children with the hemolytic-uremic syndrome were treated in our hospital from 1968 to 1976. Seven were over 5 years of age. The disease occurred most often in the spring of the year. Lethargy was a prominent symptom in all patients, and seizures occurred in seven. Transfusion and dialysis were the most important treatment modalities. Heparin was used in four children and did not appear to affect the course of disease although three recovered. Thirteen of 15 children who did not receive heparin recovered. Irreversible renal failure occurred in three children, all of whom were in the older age group. Serious sequelae were rare in those who survived.
Plasma prednisolone levels have been measured hourly in children receiving a single dose of oral prednisone. Peak prednisolone levels occurred one to two hours after ingestion; half-life studies gave a mean value of 132 minutes in most children. Some children had marked variability in absorption and metabolism of prednisone. Somatomedin activity and cell-mediated immunity were inhibited by plasma prednisolone values which were achieved by single doses of prednisone of 0.5 mg/kg or higher. Monitoring prednisolone levels may be of value in identifying those children who accumulate excessively high levels on moderate dosage regimens.
One hundred thirty-seven courses of furosemide therapy were given to 106 hospitalized pediatric patients with salt and water retention associated with cardiac or renal disease. The diuretic was effective and safe in the pediatric age group when administered acutely as a parenteral medication and over a long-term course by the oral route in the doses and at the time intervals used in this study. On the basis of each kilogram of body weight, the infants with edema as a result of cardiac failure and the children with edema secondary to renal disease responded equally well to furosemide therapy.
Oliguric renal failure, bilateral renal enlargement, and hyperuricemia were noted in three term infants. The findings on intravenous pyelography and radionuclide renography were consistent with intratubular obstruction to urinary outflow in two of the infants. The onset of diuresis appeared to follow intravenous pyelography in these infants. Urinary urate crystalluria was prominent in each infant in the first few days after the onset of diuresis, during which normal serum urate concentrations and normal renal function were established.
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Renal biopsies obtained from four adolescent girls who developed symptomatic thrombocytopenia with serologic evidence of systemic lupus erythematosus, without clinical signs of renal involvement, showed glomerular disease by electron and immunofluorescent microscopy with light microscopic changes in two cases. Subsequently, three of the patients developed proteinuria, and repeat biopsies from all four showed appearances ranging from resolution to significant glomerulitis. The findings illustrate the variable patterns of occult glomerulitis in lupus, and highlight the value of correlating light, electron and immunofluorescent studies in renal pathology.
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A family is described in which gross vesicoureteral reflux and renal scarring are present in the father and three sons, none with a history of urinary tract infection. Vesicoureteral reflux alone is present in an infant daughter. Father-to-son transmission of vesicoureteral reflux has not been previously reported. Autosomal dominant inheritance of the trait is suggested. The renal scarring noted in these patients may reflect generalized maldevelopment of affected renal units. The increasing recognition of vesicoureteral reflux as a familial trait suggests the need for evaluation of families in which vesicoureteral reflux is found in more than one member.
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