RESUMO
BACKGROUND: The prevalence of pediatric arterial hypertension (AHT) is approximately 1% to 2%. In the last tenyears, mean blood pressure levels (BP) have raised due to obesity and changes in lifestyles. Family history (FH) of AHT is a risk factor to develop AHT in children. AIM: To assess blood pressure, cardiovascular risk factors and family history in healthy children of Santiago. MATERIAL AND METHODS: Blood pressure, family history of AHT, birth weight (BW), gestational age, puberal stage, blood glucose, serum lipids and ultrasensitive Reactive C Protein (usCRP) were analyzed, using data from a study of early markers of atherosclerosis in children. RESULTS: Data of 112 children aged between 6-12 years was analyzed. Hypertension (BP >percentile 95) was detected in 2.7% and pre hypertension (BP in percentiles 90-95) in 3.6% of the sample. Children with abnormal BP had higher levels of usCRP (p <0.05) and a non significant tendency towards a higher body mass index. All hypertensive and one pre hypertensive children had FH of AHT. Eleven percent of parents, had high blood pressure. In no children, both parents were hypertensive. Children with a family history of hypertension had higher concentrations of total serum cholesterol (p <0.05). CONCLUSIONS: The abnormal prevalence of AHT found in this study is comparable to other studies. FH associated to higher levels of BP in children. Children with abnormal BP had a higher subclinical level of inflammation .
Assuntos
Pressão Sanguínea/genética , Hipertensão/genética , Adolescente , Glicemia/genética , Índice de Massa Corporal , Proteína C-Reativa/análise , Criança , Chile/epidemiologia , HDL-Colesterol/sangue , Estudos de Coortes , Feminino , Marcadores Genéticos , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Fatores de RiscoRESUMO
Background: The prevalence of pediatric arterial hypertension (AHT) is approximately 1% to 2%. In the last ten years, mean blood pressure levels (BP) have raised due to obesity and changes in lifestyles. Family history (FH) of AHT is a risk factor to develop AHT inchildren. Aim: To assess blood pressure, cardiovascular risk factors and family history in healthy children of Santiago. Material and methods: Blood pressure, family history of AHT, birth weight(BW), gestational age, puberal stage, blood glucose, serum lipids and ultrasensitive Reactive C Protein (usCRP) were analyzed, using data from a study of early markers of atherosclerosis in children. Results: Data of 112 children aged between 6-12 years was analyzed. Hypertension (BP >percentile 95) was detected in 2.7% and pre hypertension (BP in percentiles 90-95) in 3.6% of thesample. Children with abnormal BP had higher levels of usCRP (p <0.05) and a non significant tendency towards a higher body mass index. All hypertensive and one pre hypertensive children had FH of AHT. Eleven percent of parents, had high blood pressure. In no children, both parents werehypertensive. Children with a family history of hypertension had higher concentrations of total serum cholesterol (p <0.05). Conclusions: The abnormal prevalence of AHT found in this study is comparable to other studies. FH associated to higher levels of BP in children. Children withabnormal BP had a higher subclinical level of inflammation.
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Pressão Sanguínea/genética , Hipertensão/genética , Glicemia/genética , Índice de Massa Corporal , Proteína C-Reativa/análise , Chile/epidemiologia , HDL-Colesterol/sangue , Estudos de Coortes , Marcadores Genéticos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Fatores de RiscoRESUMO
Background: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. Aim: To describe the characteñstics ofpatients with the diagnosis ofHUS in Chile, and to identify the most reliable early predictors oímorbidity and moñality. Material and methods: The clinical records ofpatients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. Results: A cohort of 587 patients aged 2 to 8 years, 48 percent males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39 percent of the patients, hypertension in 45 percent and seizures in 17 percent. Forty two percent required renal replacement therapy (RRT) and perítoneal dialysis was used in the majoríty of cases (78 percent). The most frequently isolated etiological agentwas Escherichia coli. Mortality rate was 2.9 percent in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC) >20.000/mm³ and requirements of renal replacement therapy (p <0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC >20.000/mm³, seizures and hypertension. Conclusions: The present study emphasizes important clinical and epidemiological aspeets ofHUSin a Chilean pediatricpopulation.
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Injúria Renal Aguda , Anuria/etiologia , Síndrome Hemolítico-Urêmica/complicações , Injúria Renal Aguda , Anuria/epidemiologia , Anuria/terapia , Serviços de Saúde da Criança/estatística & dados numéricos , Chile/epidemiologia , Seguimentos , Síndrome Hemolítico-Urêmica/mortalidade , Síndrome Hemolítico-Urêmica/terapia , Hospitalização , Modelos Logísticos , Prognóstico , Diálise Renal , Estudos Retrospectivos , Fatores de RiscoRESUMO
Blood pressure (BP) is a vital sign routinely obtained in adult physical examination. This is not the case in children; therefore, high blood pressure in children is frequently not diagnosed. It should be measured with adequate equipment according to age and height of the child, considering that BP values increase under physiological conditions. Arterial hypertension is defined in percentiles for age, gender and height. Three categories can be established: normal BP, pre-hypertension and hypertension. Clinical studies have determined that the younger the child, the probability of secondary hypertension increases, usually of renal origin. Genetic and metabolic risk factors have been identified intrauterine; this "fetal programming" is related later in life with the onset of high blood pressure. Arterial hypertension evolves without symptoms for long periods of time, making more relevant a complete physical examination that includes BP. The hypertensive patient must be approached by age, clinical history, physical examination and BP values, followed by a laboratory work-up. Complementary studies including BP ambulatory monitoring are being used with increasing frequency in the pediatric population, allowing a big number of BP readings during diary activities of the child. Arterial hypertension treatment in pediatrics begins with the prevention of known risk factors, encouraging a change of lifestyle for the child and his/her family. Drug treatment must be reserved after secondary causes have been corrected and lifestyle modifications did not work out. Pharmacological treatment must be indicated individually, its efficacy monitored and potential adverse effects assessed. Still at an experimental stage, antihypertensive vaccination modifying the renin-angiotensin system is being studied.
La presión arterial (PA), a pesar de ser un signo vital, no se registra habitualmente en pediatría lo que hace que la hipertensión arterial esté sub diagnosticada. El registro de la presión arterial debe hacerse cumpliendo criterios consensuados, con los aparatos adecuados para la edad y talla del niño, ya que los valores de presión arterial aumentan progresivamente en condiciones fisiológicas. La definición de Hipertensión arterial se basa en percentiles para edad, sexo y talla y se distinguen tres etapas: presión normal, pre hipertensión e hipertensión. Mientras menor es el niño es más probable que su hipertensión sea secundaria y tenga origen renal. Se han identificado factores de riesgo genético que aún no podemos prevenir y metabólicos especialmente en la vida intrauterina o "programación fetal" que se relaciona con la presencia de hipertensión arterial posterior. La hipertensión arterial evoluciona asintomática por largos períodos, lo que hace más importante su búsqueda sistemática. El estudio del paciente hipertenso debe orientarse de acuerdo a la edad, los antecedentes anamnésticos, los hallazgos del examen físico y las cifras de presión encontradas para lo que hay estudios de laboratorio sistematizados en fases. El estudio complementario con la monitorización ambulatoria de presión arterial está siendo utilizado frecuentemente en la población pediátrica porque permite tener un gran número de mediciones durante las actividades regulares del niño. El tratamiento de la hipertensión arterial en pediatría comienza con la prevención de los factores de riesgo conocidos propiciando cambios de estilos de vida en él y su familia. El tratamiento farmacológico debe indicarse cuando se han corregido las causas secundarias y/o la modificación de los estilos de vida no han logrado un resultado satisfactorio. El tratamiento farmacológico debe ser individualizado, monitorizando su eficacia y los potenciales efectos secundarios. En etapa experimental está el uso de va...
Assuntos
Humanos , Masculino , Feminino , Criança , Hipertensão/diagnóstico , Hipertensão/terapia , Determinação da Pressão Arterial/normas , Hipertensão/etiologia , Hipertensão/prevenção & controle , Estilo de Vida , Monitorização Ambulatorial , Guias de Prática Clínica como Assunto , Peptidil Dipeptidase A/farmacologia , Pressão Sanguínea/fisiologia , Valores de Referência , Fatores de Risco , Programas de Rastreamento/normasRESUMO
BACKGROUND: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. AIM: To describe the characteristics of patients with the diagnosis of HUS in Chile, and to identify the most reliable early predictors of morbidity and mortality. MATERIAL AND METHODS: The clinical records of patients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. RESULTS: A cohort of 587 patients aged 2 to 8 years, 48% males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39% of the patients, hypertension in 45% and seizures in 17%. Forty two percent required renal replacement therapy (RRT) and peritoneal dialysis was used in the majority of cases (78%). The most frequently isolated etiological agent was Escherichia coli. Mortality rate was 2.9% in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC)>20.000/mm3 and requirements of renal replacement therapy (p<0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC>20.000/mm3, seizures and hypertension. CONCLUSIONS: The present study emphasizes important clinical and epidemiological aspects of HUS in a Chilean pediatric population.
Assuntos
Injúria Renal Aguda/etiologia , Anuria/etiologia , Síndrome Hemolítico-Urêmica/complicações , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Anuria/epidemiologia , Anuria/terapia , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Chile/epidemiologia , Feminino , Seguimentos , Síndrome Hemolítico-Urêmica/mortalidade , Síndrome Hemolítico-Urêmica/terapia , Hospitalização , Humanos , Lactente , Modelos Logísticos , Masculino , Prognóstico , Diálise Renal , Estudos Retrospectivos , Fatores de RiscoRESUMO
Many diseases can be associated with kidney cysts and they may be classified as hereditary and non-hereditary renal cystic disease. The first group can be sub-classified as autosomal recessive cystic disease, such as autosomal recessive polycystic kidney disease and nephronophthisis, as autosomal dominant kidney disease such as autosomal dominant polycystic kidney disease, glomerulocystic disease and tuberous sclerosis, and as cysts associated with syndromes. Cystic dysplasia, multicystic dysplastic kidney, simple cyst, multilocular cysts, Wilm's tumor and acquired cystic kidney disease are classified in the second group. The genetic study of renal cysts is becoming increasingly important, due to the possible therapeutic interventions that could be devised in the future. The aim of this review is to provide a fast and easy clinical approach to renal cysts.
Assuntos
Doenças Renais Císticas/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Doenças Renais Císticas/classificação , Doenças Renais Císticas/genética , Rim Displásico Multicístico/classificação , Rim Displásico Multicístico/diagnóstico por imagem , Doenças Renais Policísticas/classificação , Doenças Renais Policísticas/diagnóstico por imagem , Doenças Renais Policísticas/genética , Prognóstico , UltrassonografiaRESUMO
Many diseases can be associated with kidney cysts and they may be classified as hereditary and non-hereditary renal cystic disease. The first group can be sub-classified as autosomal recessive cystic disease, such as autosomal recessive polycystic kidney disease and nephronophthisis, as autosomal dominant kidney disease such as autosomal dominant polycystic kidney disease, glomerulocystic disease and tuberous sclerosis, and as cysts associated with syndromes. Cystic dysplasia, multicystic dysplastic kidney, simple cyst, multilocular cysts, Wilm's tumor and acquired cystic kidney disease are classified in the second group. The genetic study of renal cysts is becoming increasingly important, due to the possible therapeutic interventions that could be devised in the future. The aim of this review is to provide a fast and easy clinical approach to renal cystc.
Assuntos
Humanos , Doenças Renais Císticas , Diagnóstico Diferencial , Doenças Renais Císticas/classificação , Doenças Renais Císticas/genética , Rim Displásico Multicístico/classificação , Rim Displásico Multicístico , Doenças Renais Policísticas/classificação , Doenças Renais Policísticas/genética , Doenças Renais Policísticas , PrognósticoRESUMO
Los fenómenos tromboembólicos en pacientes con síndrome nefrótico constituyen una de las complicaciones más temidas debido al riesgo vital asociado. Objetivo: Describir los principales mecanismos fisiopatológicos responsables del desarrollo de este tipo de complicación a propósito de cuatro casos clínicos, en tres de los cuales se describen fenómenos tromboembólicos cerebrales y en uno trombosis extensa de extremidad inferior asociado a dificultad respiratoria. Las interacciones entre cuatro condiciones: actividad desbalanceada entre moléculas procoagulantes y anticoagulantes, trombocitosis, hiperagregación plaquetaria e hiperviscosidad sanguínea, promueven un estado de hipercoagulabilidad que conduce al desarrollo de complicaciones tromboembólicas, sin embargo, los mecanismos fisiopatólogicos subyacentes no han sido completamente aclarados. La presencia de otros factores tales como infecciones, complejos inmunes circulantes, hipovolemia, hipertensión, terapia esteroidal, punciones venosas e inmovilización pueden jugar un rol en la trombogénesis asociada al síndrome nefrótico. Conclusión: El síndrome Nefrótico representa una condición de alto riesgo de tromboembólismo, y requiere consideraciones terapéuticas tales como el uso criterioso de diuréticos, prevención de infecciones, mantenimiento de niveles adecuados de albúmina y el uso de fármacos antiplaquetarios y/o anticoagulantes.
Assuntos
Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Humanos , Síndrome Nefrótica/complicações , Tromboembolia/diagnóstico , Tromboembolia/etiologia , Tromboembolia/tratamento farmacológico , Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Resultado do TratamentoRESUMO
Se sospecha Síndrome Poliúrico (SP) cuando el volumen urinario excede en 2 a 3 veces lo esperado para la edad o cuando a raíz de una deshidratación o restricción hídrica no se produce concentración urinaria adecuada. El volumen y la osmolaridad de los líquidos orgánicos se regulan con gran precisión gracias a la actividad de la hormona antidiurética (HAD), producida en el eje hipotálamo hipofisiario, que maneja la permeabilidad del agua de los túbulos distales y colectores renales. El SP se clasifica en dos grandes grupos: 1) con niveles plasmáticos bajos de HAD (diabetes insípida central DIC o neurogénica y polidipsia primaria) y 2) con niveles plasmáticos normales de HAD (diuresis osmótica y diabetes insípida nefrogénica DIN). El diagnóstico diferencial se hace con la prueba de deprivación acuosa y el tratamiento consiste en reemplazo hormonal con HAD en DIC y en la DIN reducción del aporte calórico proteico con la ingesta libre de agua, más diuréticos tiazídicos y antiinflamatorios. En el presente artículo se hace una revisión actualizada del SP.