Data about aldosterone production and excretion in the neonatal period are still few and controversial. Our objectives are to assess urinary aldosterone excretion (UAE) in very low birth weight (VLBW) infants and to identify clinical and biochemical variables that may influence this excretion. Thirty VLBW infants (14 males and 16 females), their gestational age <32 weeks and body weight <1500 g, were included in the study. Demographic and clinical data were recorded, within the first 72 h of life and urine and blood samples were collected for the measurement of urinary aldosterone and serum potassium, sodium, and chloride. The mean UAE value was 0.176 ± 0.05 μg/24 h and the mean absolute UAE was 1906 ± 271 pg/mL. There was a statistically significant positive correlation between UAE and gestational age and birth weight; also, infants with respiratory distress syndrome had higher urinary aldosterone levels than infants without respiratory distress. Only plasma sodium was a significant independent factor that negatively influenced UAE on linear regression analysis. The renin-angiotensin-aldosterone system of VLBW infants seems to be able, even immediately after birth, to respond to variations of plasma sodium concentrations; measurement of UAE constitutes an interesting method to determine aldosterone production in VLBW infants.
INTRODUCTION: 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy is accepted as the gold standard in the diagnosis of acute pyelonephritis. OBJECTIVE: In an attempt to reduce the number of investigations after urinary tract infections (UTIs), with this prospective study we aimed to evaluate the diagnostic value of acute-phase reactants in identifying renal involvement in infants with febrile UTI. METHODS: Fifty-four infants (36 male, 18 female) aged 1 to 12 months were studied. For all infants, clinical findings such as duration and height of fever before antibiotic administration and laboratory parameters such as leukocytosis (white blood cell count of Ͼ15.000/ L), elevated erythrocyte sedimentation rate (ESR) (Ͼ20 mm/hour), and high levels of C-reactive protein (Ͼ10 mg/mL) were compared with the results of the DMSA scan obtained within 72 hours after referral. RESULTS: Regarding microbial agents, Escherichia coli was identified in 42 (78%) of the 54 infants, and 16 (29.5%) of the 54 of infants were febrile for Ͼ2 days before diagnosis of UTI. Leukocytosis, elevated ESR, and high levels of C-reactive protein were present in 14 (26%), 41 (76%), and 38 (70%) infants, respectively. Acute-phase DMSA showed renal involvement in 10 (18.5%) infants. Vesicoureteral reflux was found in 16 (29.5%) infants. Gender, duration of fever before antibiotic administration, leukocytosis, elevated ESR, and high levels of C-reactive protein were not related to the severity of renal damage, as shown by DMSA. Only fever of Ͼ39°C was slightly correlated with an abnormal DMSA scan result (r ϭ 0.3; P ϭ .032). CONCLUSIONS: Acute-phase DMSA scintigraphy remains superior to clinical and laboratory data for predicting renal involvement in infants with febrile UTIs. IMMUNE FINDINGS IN CHILDREN OBJECTIVE:The aim of our study was to investigate prospectively the immune disturbances in steroid-sensitive (SS) and steroid-resistant (SR) NS and identify whether these immune disturbances may predict the response to steroid therapy. METHODS: Thirty children with SS NS and 7 children with SR NS (aged 2 to 14 years) were studied. To evaluate the possible relationship between immune disturbances and response to treatment, patients were evaluated during different disease stages. Data were compared with those obtained from 25 age-matched controls. The following parameters were assessed: basic B-and T-cell populations, percentages of CD23 ϩ , CD3 ϩ /CD69 ϩ /interferon ␥ ϩ (IFN-␥ ϩ ) cells, and CD3 ϩ /CD69 ϩ /interleukin 4 ϩ (IL-4 ϩ ) T cells, and serum levels of IL-13 and IL-18. RESULTS: In patients with SS NS percentages of CD23 ϩ and CD19 ϩ B cells, CD3 ϩ /CD69 ϩ /IL-4 ϩ T cells and serum levels of IL-13, IL-18 were significantly higher in the active stage compared with the remission stage on steroids, remission off steroids, and controls (P Ͻ .05). On the contrary, percentages of CD3 ϩ /CD69 ϩ /IFN-␥ ϩ T cells were significantly decreased (P Ͻ .05). In patients with SR NS, percentages of CD23 ϩ B cells, CD3 ϩ /CD69 ϩ / IL-4 ϩ T cells, and serum levels...
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