S R MEADOW, FRCP, DCH, senior lecturer and consultant paediatrician a nephrotic syndrome and a high proportion of crescents in renal biopsy specimens was associated with a poor outcome. Neither the clinical presentation nor the renal morphology were, however, precise determinants of outcome. Outcome was not related to age, associated streptococcal infection, or recurrences of the rash. The clinical state two years after presentation was compared with the state six and a half years or more after presentation in 76 patients. The clinical state had changed in 32 patients, in 17 of whom it had deteriorated. It was not possible to identify with any certainty the patients who would deteriorate (or improve). Patients who have had Henoch-Schonlein nephritis should be followed up for at least five years.
SummaryDuring 72 episodes of acute renal failure were treated in 70 children aged up to 16 years. The commonest causes were renal hypoperfusion (31 cases), haemolyticuraemic syndrome (12), glomerulonephritis (9), septicaemia (5), and congenital abnormalities (6). Though referral from other hospitals was generally prompt, 10 out of 51 patients had been observed for up to seven days before transfer. Dialysis was used in 44 cases, the most common complications of which were peritonitis in those treated with peritoneal dialysis and acute changes in fluid balance in those treated with haemodialysis.Altogether 37 patients fully recovered, 10 were discharged with chronically impaired renal function, 17 died, and six entered the dialysis and transplantation programme. The mortality fell from 33% in 1972 to 20% in later years, which was due solely to maintenance dialysis being available. Though all patients with irrevocable kidney failure who were suitable entered the dialysis and transplantation programme, with current financial restrictions we doubt whether we shall be able to find places for all such patients in the future.
sumARY 75 children aged under 15 years have entered the regular haemodialysis/renal transplant programme at Guy's Hospital in the 10 years since its inception; 13 children have subsequently died.A combination of hospital and home haemodialysis and renal transplantation was used. 64 children received 80 renal allografts; 37 1st grafts were from live, related donors and 27 were from cadaver donors. The 5-year acturial patient survival for the whole group and for those who had transplants was 76%. Live donor graft survival was 65% at 3 years, and 55% at 5 years; 1st cadaver graft survival was 42% at 3 years. Results obtained during the last 6 years of the 10-year period showed an improvement with a live related donor graft survival rate of 71%, and a 1st cadaver graft survival rate of 47% at 3 years. Particular experience was gained with home haemodialysis and live, related donor transplantation. Despite growth, and psychosocial and rehabilitation problems, the overall results were encouraging, particularly for the 46 children who had successful transplants. These children grew better, had fewer psychosocial difficulties, and were rehabilitated more successfully into normal life than those on long-term dialysis. We conclude that dialysis and transplantation should be offered to all suitable children with terminal renal failure.The most recent data from the Paediatric Registry of the European Dialysis and Transplantation Association suggests that each year about 1 5 children per million population under age 15 years require dialysis and transplantation in order to survive.' Just over a decade ago the outlook for such children was bleak, with many people suggesting that dialysis and transplantation should not be offered in view of the poor results and the heavy strain on family and child.2 Despite this, many centres undertook longterm dialysis and transplantation for children.
Counahan, R., and Mearns, M. B. (1975). Archives Abnormal exercise-induced bronchial lability and skin atopy have been shown in patients with cystic fibrosis (CF). Day and Mearns (1973) reported that only 27% of 52 children with CF had normal bronchial lability in response to exercise, and McCarthy, Pepys, and Batten (1969) found that 43 % of 57 CF patients had positive skin reactions to common allergens. A higher than normal prevalence of increased bronchial lability and skin atopy has been shown in the relatives of children with asthma and of infants with wheezy bronchitis (Konig and Godfrey, 1973a, b). The present study was done to determine the prevalence of abnormal bronchial lability and skin atopy in children with CF and their first-degree relatives.Subjects and methods Thirty-five children with CF and 59 first-degree relatives (37 parents and 22 sibs) were studied. The children attended this hospital between July 1973 and January 1974 and at the times of testing they were free of acute infection. The relatives were all volunteers and the purpose of the study was explained to them. Some ofthe relatives of patients were too young to be exercised, and some of the younger patients and relatives refused skin testing. The mean age of the patients tested was 10 2 years (4-18), sibs 11 5 years (6-18), and parents 37-3 years (27-54). Clinical histories were taken from the relatives and they were classiffied as being atopic (past or present asthma, hayfever, allergic rhinitis, infantile or flexural eczema) or healthy. Smoking habits were recorded. Skin testing was carried out on patients and relatives by prick test with a control and the following allergens: Dermatophagoides pteronyssinus, milk, cat fur, dog hair, early summer flower pollens, Aspergillus fwnigatus and mixed aspergilli (Bencard M5 combining Asperigillus amsteldami, niger, and terreus).Exercise tests were performed by the subjects running on a treadmill for 6 minutes at a slope of 10 degrees and at a speed of 3-4 mph, the speed being adjusted to give a pulse rate of approximately 170/min (Connolly and Godfrey, 1970). Before testing the patients were given routine percussion physiotherapy. The peak expiratory flow rate (PEFR)
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