Diagnosis of Renal Failure in the Newborn

Abstract

Ontario. T~p o n . by Donald Fraser). To d i f f e r e n t i a t e medically t r e a t a b l e causes of hypertension from those requiring s u r g i c a l intervention. 9 renal transplant recipients (aged 15-19 y r s ) f u l f i l l i n p t h e following c r i t e r i a were inveatip.ated: a) a t l e a s t 3 months a f t e r transplantation. b) o r i g i n a l diseased kidneys removed, c) no evidence of r e j e c t i o n d) e t e r o i d dosage a t low l e v e l s . According t o s i t t i n g d i a s t o l i c BP and response t o antihypertensive drups t h e patients were divided i n t o 3 groups ( I ) severe, (11) moderate and (111) no HT (3 p a t i e n t s i n each). A l l patients i n proups I and I1 demonstrated a l l o g r a f t r e n a l a r t e r y s t e n o s i s (RAS) by arteriography. the X lumlnal occlusion being more pronounced i n t h e group I ( 250% The incidence, course and time of onset of s k e l e t a l abnormali t i e a cawed by chronic r e n a l f a i l u r e (CRF) a r e not c l e a r i n rapidly growing young children. To study these featurea we investigated t h e a k e l a t a l s t a t u s of 12 children under 5 years of aRe (mean age 2.5 yrs) who had mild t o moderate degrees of CRP (serum c r u t i n i n e (S.Cr) 0.9 -5.5 &dl). Seven p a t i e n t s had low growth velocity; 4 had obvious s k e l e t a l deformities. Major ossaous derangements were detected on radiographs i n 7 p a t i e n t a , and were present i n the i l i a c c r e s t bone biopay apecimena i n a l l 12 patients. Radiographic evidence of r i c k e t s appeared e a r l y (within 1.9 y r s a f t e r detection of CRF, m u n S.Cr 2.4 mgldl). Normal placrma 25-OH vitamin D l e v e l s ruled out vitamin D deficiency. I n contrast. X-ray signs of secondary hyperparathyroidism appeared l a t e r (mean duration of CRF 3.2 yrs. mean S.Cr 3.5 mgldl). Rickets responded readily t o vitamin D therapy (1600-5000 IU/day) but secondary hyperparathyroid lesions were refractory t o conventional d i e t a r y and medical management, including l a r g e doses of vitamin D (up t o 20,000 IU1d.y). Progressive bone disease constituted t h e reason f o r a h i t t i n g 3 of our p a t i e n t s t o t h e transplant program. We conclude t h a t renal osteodyatrophy i a an unexpectedly common occurrence i n very young children and may represent a major complication even before CRP becomes advanced.GLQMERULhR PEPMEABILITY I N AVMLOCOUS IMMUNE COMPLeX 1083 (AIC) NEPHRITIS. Ingelfinger, J u l i e R., Schneeberger Eveline E. and Grupe, Warren E., Dept of Pods, Children's Hompital Medical Center, Boston, Massachusetts.Glomeryier permaability t o neutral polydisperse polyvinylpyrrolidone I (PW) was studied i n Foreman r a t s with and without autologous i m u n e complex glomarulonephritis (AIC). The Foreman r a t generally develops milder disease than other s t r a i n s . However, a l l AIC r a t s studied were nephrotic with proteinuria i n excess of 50mg/24 hra. PW clearance (MW 8000-85000) was determined by column chromatography and compared t...