Against the background of the increasing incidence of many immune mediated childhood conditions, this study aimed to identify recent time trends and ethnic patterns of childhood nephrotic syndrome. A population-based cohort of children (0-15 years) diagnosed according to strict criteria with nephrotic syndrome (NS) was ascertained within the northern UK region of Yorkshire between 1987 and 1998. South Asian ethnicity was assigned based on the child's full name using a dedicated computer algorithm and expert individual checks. NS was diagnosed in 194 children, 170 (88%) of whom were steroid sensitive. The incidence of steroid sensitive NS was 2.0/100,000 pyrs (95% CI 1.7-2.3), peaking in 1-4 year olds (4.1/100,000 pyrs). Over the 12-year study period incidence rates of steroid sensitive NS were fairly stable although south Asian children displayed significantly higher rates than non-south Asians (P<0.01). The size of our population-based series reflects the relative rarity of paediatric nephrotic syndrome but is nonetheless recent and includes larger numbers than previous reports. The absence of any increase in incidence over the last decade contrasts with other paediatric immune mediated conditions such as asthma and diabetes.

ABSTRACT.Objective. Published data show that plasma creatinine falls steadily during the first 28 days of life and that creatinine levels in the neonatal period are higher in more premature infants. However, the best reference data commence on day 2 of life. The objective of this study was to document how plasma creatinine changes in the first 48 hours of life and to examine the reason for the apparently high levels of creatinine in preterm infants, compared with maternal levels.Design. A prospective observational study on a regional neonatal intensive care unit.Patients. A total of 42 preterm infants, mean gestational age of 29.4 weeks (range: 23-35), mean birth weight of 1.42 kg (.55-2.77), divided into 4 gestation groups: 23 to 26 weeks (n ‫؍‬ 9), 27 to 29 weeks (n ‫؍‬ 13), 30 to 32 weeks (n ‫؍‬ 12), and 33 to 35 weeks (n ‫؍‬ 8).Interventions. Measurement of plasma creatinine and urea concentration in cord blood and in serial samples taken for routine arterial blood gas analysis.Outcome Measurements. Changes in creatinine concentration with time and relationship to gestational age, birth weight, and illness severity. Conclusions. Rather than falling steadily from birth, creatinine rises dramatically in the first 48 hours of life, especially in infants of <30 weeks' gestation. Even large rises in creatinine in the first 48 hours may be expected and should not be used in isolation to diagnose renal failure. Pediatrics 1999;104(6). URL: http://www. pediatrics.org/cgi/content/full/104/6/e76; creatinine, preterm infant, renal failure.

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The 2-pool urea kinetic model has been developed analytically and applied to the description of the observed increase in blood levels of urea following dialysis (urea rebound), assuming that the dialyser urea clearance K less than 0.4X where X is the urea mass transfer coefficient between the intracellular and extracellular pools (volumes V1, V2 respectively). Urea generation was also neglected. Measurements were made in a group of six children suffering from chronic renal failure. From the model X, the efficiency of dialysis, and the equilibrium urea concentration C infinity were estimated in the presence of urea rebound using a blood urea measurement taken 90 min following start of dialysis, in addition to the conventional samples taken immediately pre- and post-dialysis. In three of the patients agreement between the experimental value of X derived from a multi-blood-sample technique post-dialysis, and the model value, was within 10%, for the range V1 = 0.4 W - 0.38 W, V2 = 0.2 W - 0.238 W, (W = patient's weight). Experimental values of X were in the range 93 - 300 ml min-1. Model estimates of C infinity were accurate to within 10%. An approximate technique was also developed which permitted an estimate of C infinity which was independent of V1, V2, K. The results indicated that C infinity was estimated to within 10% of the true equilibrium urea concentration. The error in the estimate of dialysis efficiency based on a single pool model was reduced by at least 50% using the model. The model may be applied clinically to the estimation of dialysis efficiency in the presence of significant urea rebound.

In 11 children (aged 5-18 years) with end stage chronic renal failure, the effect on plasma potassium of two doses of salbutamol (separated by two hours) given intravenously (4 ,ug/kg) and on a separate date, of salbutamol administered by nebuliser (2 5 mg ifthe child weighed below 25 kg, 5 mg if above) was observed. Within 30 minutes of the first dose, the mean plasma potassium concentration fell significantly by 0-87 and 0-61 mmol/l after intravenous and nebulised administration respectively. Sixty minutes after the second dose the plasma potassium was significantly reduced by a further 0-28 and 0 53 mmol/l respectively. There was a significant difference between the two methods of administration at 300 minutes after the first dose favouring nebulisation. No major side effects were observed. Nebulised salbutamol should be the first choice emergency treatment ofhyperkalaemia.

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SummaryIn a survey of virus cross-infection in paediatric wards there were 15 cross-infections due to respiratory syncytial (R.S.) virus and 16 due to influenza A, both during a fourmonth period, and 19 due to parainfluenza viruses over two years. The illnesses produced by these infections acquired in hospital ranged from a slight cold to severe pneumonia: in 17 of the 50 cases the illness involved the lower respiratory tract. A measure of cross-infection frequency in the form of a "cross-infection rate" has been devised, and It is suggested that this can be used to assess theinfluenceof factors such as ward design and admission policy on the frequency of cross-infection.