RESUMENNormalmente, la ingesta de carga proteica aumenta el filtrado glomerular, lo que implica reserva funcional renal. Cuando disminuye el número de nefronas pueden observarse filtrados glomerulares normales por hiperfiltración, lo que implica pérdida de reserva funcional, temprano indicador de daño renal y, probablemente, factor contribuyente a su progresión. Determinamos el filtrado glomerular mediante la curva de desaparición plasmática del ácido dietilen-triamino-pentaacé-tico marcado con tecnecio-99m, en pacientes con proteinuria y depuración de creatinina normal, que padecieron síndrome urémico-hemolítico con antelación mayor de 1 año. En 33 niños, de 2-16 años de edad, se determinó la reserva funcional renal mediante filtrado glomerular basal y tras carga proteica. Considerando normal un aumento superior al 20%, 16 pacientes mostraron no tener reserva funcional renal. Esta prueba, por su seguridad y fácil realización, resulta particularmente útil en pacientes que necesitan especial control y tratamiento. Palabras clave: síndrome urémico-hemolítico, reserva funcional renal, depuración 99mTc-DTPA. SUMMARYProtein loads in normal subjects increase glomerular filtration rate (GFR), which implies a renal functional reserve (RFR). Patients who have suffered a loss in the number of nephrons may show normal values of GFR due to hyperfiltration of remnant nephrons, with subsequent loss of RFR. This could be an early sign of renal damage, and probably a contributory factor to renal damage progress. The objective of this study is to determine the RFR through technetium-99m diethylene-triamine-penta-acetic acid (99m Tc-DTPA) clearance in patients who have recovered from hemolytic uremic syndrome.Renal functional reserve was determined in 33 children from 2 to 16 years old, with normal values of proteinuria, serum creatinine and creatinine clearance after over a year of having suffered hemolitic uremic syndrome. For that purpose 99m Tc-DTPA clearance was determined in basal condition and following protein load. In 17 patients DTPA clearance increased 20% or more after protein load compared to basal condition, and they were considered to have normal RFR, a probably index of totally recovered renal function; in the remaining 16 patients the increases were lower than 20%, and were considered to have no RFR, condition that was postulated as a contributing factor to renal damage progress. There was not significant diferences either in age or basal GFR between both groups. Being the test easier than inuline clearance and more accurate than creatinine clearance, it proves particularly useful for early diagnosis of patients that need special follow-up and treatment. INTRODUCCIÓNEn sujetos normales, luego de la ingesta de una carga proteica existe un incremento del filtrado glomerular (FG), lo que implica la existencia de una reserva funcional renal (RFR), definida como la diferencia entre el FG estimulado y el FG basal.En pacientes que por su enfermedad renal tienen disminución del número de nefronas, el FG puede ser normal...
nos w -w , B m s Aires, Argentina. w2desz33 patients (11 des,with ages less than 13 years) h a w BD which were fmdciuring radiologic examhation of urinary tract infection(UI), vesim u z teral refl&(VUR), enuresis, hmturia and mictional pain. None had obstructive pathology of urethra nor neurogenic bladder disease. 26/33 were studied with a m p l w urcdynamics( intravesical pressure, intraabdoninal pressure perineal E X , flow rate and simltaneous radioscopy) . 20 only decreased by 7%. Cerebral Q rmahed stable as in suvivors £ran Ckap I. All 6 lambs sunrived. In 5 l a b , atmpine was only amninistered thuring HEM, when bradycardia and hypotension had already developed. Brady wuld not be rwertd by repeating atropine or by increasing doses (0.4mgfig). 'lW limhs survived.We conclude that unanesthetized newbm lambs develop bradycardia ciuring HEM. Bradycardia can be prevented by administering atropine before and during HEM. This treatment IIcdifies physiolg gic responses especially W. Haever, atropine cannot rarert bra dycardia once it has developed. This suggests that there are p s bably other issues involved in HEM imiuced bradycardia, other than vagal sthulation. Very IBW infants (<1500g) are nursed in incubators (I) or radiant wamers. Usually parents are allwed to visit and twch their infant establishing a limited mntact. We hipthesized that it is m t of risk to remare the Wants £ran the I and to let their parents hold than between arms. We studied 15 neonates birthweights 900 to 14009, (1124574g) clinically stable and not on mchanical ventilation bebeen ages 7 and 44 days (17.4+12). Infants were dressed in the I and 4 were receiving intrav-&us fluids(IVLHeart rate, transcutvlgvls pD2, 02 Saturation (Pulse Qqwtry) ; skin(S), rectal and enviranental m a t u r e were mntinlvxlsly reoorded. Axillary T was nt2asured every 5 minutes. We studied three 20 min.periods: 1) Control in the I; 2) InIrother's arms mveredby a regular sheet and blanket and with no additional heat; 3)Control in the I. Results: There were m omplications in any patient. None of the infants had a decrease in T during period 2. On the contrary T increased by 0.4'~, axillary 2, R2ctal3, and cutaneous 12 patients. (btigenation was stable (Basal + 20%) in 12 infants.3 had a d m p in Tq02 > 20% which was briefS recovered spontaneously and had no effect on other clinical variables. In all cases parents s h x d a favorable attitude tcwards repeating the experienoe. We conclude that stable very I B J infants can be ten prally rcmved £ran the I to be held by their parents,pmidG mnitoring available at any NICU with no evident risks.This early contact may enhance parent-infant relationships. The data showed that failure to catch up growth was related to the poor caloric intake received by this gmup seconda~~ to mr bidity. Better m a~g e n m t of nutrition may i n p m e catch up growth. This analysis a l h s earlier identification of M a n t s with delayed catch up growth and the respmsible variables. The three above variables may be used to predict the risk o...
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