1071 Cefazolin in Children With Renal Insufficiency

Abstract

. Although the dose and duration of therapy with cyclophosphamide (cy) are known to influence the incidence of subsequent relapses in children with nephrotic syndrome, other factors which predispose to relapses after cy have not been extensively evaluated. The clinical course of 30 children with steroidsensitive, frequently-relapsing nephrotic syndrome was analyzed. Each of the pts had a renal biopsy at the time of initiation of cy, and all of the children had a complete remission while on cy (2 mg/Kg/d for 12 wks). After cy, one or more relapses occurred in 14 pts, while 16 pts had a sustained remission. There were no significant differences between the two groups of pts concerning: 1) age at onset (4.5 vs 4.9 yrs), 2) interval between onset and cy (6.35 vs 6.52 yrs), and 3) duration of follow-up after cy (4.0 vs 4.4 yrs).The most important factor associated with relapses after cy was the histopathologic lesion. Of the 14 pts with relapses, 9 (64%) had focal and segmental glomerulosclerosis (FGS), whereas only 5 (36%) had minimal change lesions (MCL) (P<0.05).In contrast, only 3 (19%) of the 16 pts in remission had FGS, while 13 (81%) had a MCL (P<0.05).These data indicate: 1) the histopathologic lesion at the time of cy is an important determinant of subsequent relapses and 2) late onset FGS predisposes to relapses after cy. The antihypertensive agent clonidine (C) appears to lower blood pressure (BP) via central alpha-adrenergic stimulation. In order to determine safety and efficacy of this drug, an openlabel study was done in 16 hypertensive children and adolescents (ages 7-18). C (.15 to l.lmg/day) was used when other agents hac failed or were medically undesirable; informed consent was obtained. 8 patients (P) had post-transplant hypertension; 6, chronic nephritides, 1, polycystic-hamartomatous kidneys; and 1, essential hypertension. 10 of 16 P had BP controlled on C plus diuretic; in another 5, all with severe hypertension, C clearly improved BP control, but other agents were still required. No control was obtained in only one P (allograft renal artery disease in whom surgical repair failed). No P had hematologic or chemical abnormalities induced by the drug. Except for somnolence in 8 P, no problems occurred while regularly taking C. However, 1 of the 10 P on C plus diuretic had 2 episodes of hypertension with encephalopathy within 16 hours of drug discontinuation due to vomiting. In 2 additional patients rebound hypertension was suspected but not proven. 2 P on C plus additional agents had episodes of symptomatic hypotension when C was added to their regimen. Thus C appears to be a useful and generally safe agent in children; however, rebound hypertension makes it important to determine patient compliance and awareness of the effect of vomiting episodes before the drug is prescribed. T/2 for children on hemdialysis varies with the efficiency of dialysis. Supported in part by NIH grants RR-75 and RR-5624. U M NOR ME HUS .COMPARISON OF SUPPORT- NEWBORN INFANT RENIN-ANGIOTENSIN-ALD STER NE SYS

Pharmacokinetics of β-Lactam Antibiotics

“…No accumulation of cefazolin in serum was observed after 8 days of therapy. HINER et al (1980) administered sodium cefazolin (7 mg/kg) intravenously to children with varying degrees of renal insufficiency. Generally the apparent serum half-life of cefazolin increased as creatinine clearance declined.…”