Follow-Up of Infants With Bilateral Renal Disease Detected In Utero. Growth and Renal Function

Follow-Up of Infants With Bilateral Renal Disease Detected In Utero. Growth and Renal Function

PEDIATRIC UROLOGY to reveal any other lesion. She was treated uu,'°"'"'u,uy with chemotherapy and was well 19 months after the initial nosis. 2 figur...

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PEDIATRIC UROLOGY

to reveal any other lesion. She was treated uu,'°"'"'u,uy with chemotherapy and was well 19 months after the initial nosis. 2 figures, 15 references. Terry D. M.D. Dallas, Texas

Editorial comment. We have been involved in the management of an 8-year-old girl with an extrarenal tumor during the last 2 years in whom the outcome has not been so happy. The tumor was widely spread in the abdomen and pelvic organs at diagnosis. The largest tumor was in the right adrenal. The tumor was poorly differentiated and although it responded well to chemotherapy and radiation initially, tumor regrowth presently is indicating that treatment is unlikely to have a favorable outcome. Many of the extrarenal Wilms tumors that have been reported have unfavorable histological findings and would have a poor prognosis even if localized to the kidney. Lowell R. King, M.D. Durham, North Carolina

Follow-Up of Infant§ With Bilateral Renal Disease Detected In. Utero, Growth and Renal Function V. M. REZNIK, G. W. KAPLAN, J. L. MURPHY, M. G. PACKER, D. BOYCHUCK, W. R. GRISWOLD, G. R. LEOPOLD AND S. A. MENDOZA, Departments of Pediatrics, Surgery and Radiology, University of California, San Diego, School of Medicine, and Children's Hospital and Health Center, San Diego, California

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Growth ar!d Devefopme:nt of Infari.te: With Renal Di§ease Receiving Peritoneal Dialy§is

M. KRILEY, H. LOVELL, s. K FARRELL ANDS. Department of ""nn,,w,,v The Children's Mercy Hospital, Kansas City, Missouri

B. A.

HELLERSTEIN,

J. Ped., 112: 714-719 (May) 1988 The growth and development of 4 infants with end stage renal disease undergoing long-term peritoneal dialysis was studied during the first year of life. In each patient dialysis was begun before they were 4 weeks old. A nutritional regimen was designed to attain a daily weight gain appropriate for height age, while minimizing the blood urea nitrogen level. A neurodevelopmental evaluation of gross and fine motor, cognitive, language and psychosocial skills was performed at least every 3 months. At a patient age of 1 year the mean height standard deviation score was -1.33 ± 0.2. Weight for height was 95th percentile in 1 patient and normal in 3. Mean caloric and protein intake was 105 ± 20 kcal./kg. daily (11.4 ± 2.7 kcal./ cm. daily) and 2.7 gm./kg. daily (0.30 ± 0.11 gm.fem. daily), respectively. Mean blood urea nitrogen was 53.6 ± 17.8 mg./dl. Developmentally, 3 of the patients were functioning in the no:rmal range and 1 was mildly retarded. However, gross motor skills were delayed in all patients. Although infants with end stage renal disease are usually severely growth retarded and developmentally delayed, our observations suggest that early nutritional intervention and can improved results, Authors' abstract 1 figure, 3 tables, 28 references

Amer. J. Dis. Child., 142: 453-456 (Apr.) 1988 We studied 69 neonates with urinary tract abnormalities detected by antenatal ultrasound examination. There were 21 intrauterine or immediate neonatal deaths; in all 21 cases severe bilateral renal disease incompatible with life was found at autopsy. Of the live-born neonates with abnormal results of antenatal ultrasound examinations 6 had a normal urinary tract after birth. Of the remaining 42 infants the prenatal diagnosis was confirmed with renal ultrasound and other studies during week 1 of life. Of 42 neonates 21 had bilateral renal disease. We obtained followup data on 19 of these 21 neonates and 12 had an obstructive "'°'"""u"" condition that was treated surgically. After 1 to 51 months (mean 18 months) of followup renal function varied. Of 19 patients 10 had a calculated glomerular filtration rate greater than or to 79 mL per minute per 1.73 m. 2 • One infant required long-term ambulatory peritoneal dialysis. Renal function ::re,:-:-::,!';;.,~, filtration rate 74 ± 5 ml. per minute per 1.73 m. 2 ) and growth (height percentile 41 ± 8) were unexpectedly good considering the severity of the urinary tract abnormalities. Prenatal detection of bilateral renal disease followed by careful medical and surgical management results in a favorable outcome with growth and renal function. Authors' abstract 3 tables, 21 references

Editorial comment. The authors confirm the excellent results that can be achieved after urinary tract reconstruction in early infancy to relieve obstruction. Return of renal function often is greater than expected and individual kidneys may recover almost completely when decompressed within 1 or 2 months after birth. Lowell R. King, M.D. Durham, North Carolina

Renal Function Correlates of Postnatal Diu..resi§ in Plteteirm Infants

K. S, BmIWALA, J.M. LORENZ AND L. L KLEINMAN, Depart"'"''~'°"-' " of Cincinments of Pediatrics, Newborn Brook, nati, Ohio and State University of New York at School of Medicine, Brook, New York

u111u,ct1,,v that pre·-term infants with the distress nd0·m~ may have spontaneous diuresis in the immediate µv,~'""'"'cu The authors have demonstrated n~,nmrn,w the characteristic pattern of fluid homeostasis in week l of life in pre-term infants that was u11-'-t1-'ta,u,a, of fluid intake. Initially, urine output is low but diuresis occurs on days 2 and 3 of life. By days 4 and 5 of life urine output begins to vary with fluid intake. The purpose of this study was to understand further the factors involved in the initial phase of minimal urine output and the subsequent spontaneous diuresis. A total of 22 pre-term neonates varying from 750 to 1,900 gm. was studied within 1 week of life. Of the patients 1 7 had at least 1 period of diuresis. Among these neonates urine output, glomerular filtration rate and fractional sodium excretion were lowest at 12 to 24 hours. During the diuresis urine output tripled. This was associated with a significant, abrupt increase in glomerular filtration rate and fractional sodium excretion. By 108 to 120 hours urine output decreased as did glomerular filtration rate, and water and electrolyte output began to vary with fluid intake so that water and electrolyte balance stabi0 "'