Pediatric nephrology : journal of the International Pediatric Nephrology Association
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Recently, an international consensus paper was published for standardization of home self-blood pressure (BP) measurement in adults. However, few data exist regarding home BP measurement in children, although it is recommended for all pediatric patients on renal replacement therapy in Germany. Therefore, a survey was performed among German-speaking pediatric nephrologists (members of the Arbeitsgemeinschaft Pädiatrische Nephrologie) in order to study their opinions about home blood pressure measurements. ⋯ The results of the survey showed wide discrepancies for standards of home BP measurement in children and adolescents, especially for the recommendations for upper diastolic BP. Before home blood pressure measurements can be recommended unrestrictedly in children and adolescents, we stress the need for standardization of blood pressure devices and measurement. Prospective studies in children are needed to demonstrate that these standards facilitate better prediction of cardiovascular outcome using home BP measurements compared to office BP recordings in children.
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We describe four adolescents with the nutcracker syndrome. In three patients, the nutcracker syndrome was detected through mass urinary screening; the other patient was diagnosed after a sudden onset of dark urine. All patients underwent magnetic resonance angiography (MRA) for diagnosis of the nutcracker syndrome, which revealed dilatation of the left renal vein ranging between 7.4 and 13 mm at the hilar portion. ⋯ This report indicates that the nutcracker syndrome may cause serious physical ailments that clinically mimic an orthostatic disturbance. It may be important to identify the nutcracker syndrome among children who manifest non-specific physical complaints. MRA could be a safe and reliable method for diagnosing the nutcracker syndrome.
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The effect of intrauterine growth restriction (IUGR) on renal hemodynamics and excretory functions was studied in 76 newborn piglets 12-27 h old. The experiments were performed on anesthetized animals divided into normal-weight piglets and IUGR piglets according to their birth weight. The "normal-weight" category included animals with a birth weight >40th percentile (piglets heavier than 1,220 g); the IUGR category included animals with a birth weight >5th and <10th percentiles (piglets with a birth weight between 733 g and 853 g). ⋯ However, in IUGR animals, glomerular filtration rate was significantly less than in the controls (P<0.05). Normal-weight and IUGR newborn piglets reabsorbed sodium very efficiently, the fractional sodium excretion was less than 1% in both groups. We conclude that renal blood flow is maintained in relation to kidney and body weight in IUGR newborns, but that important renal excretory functions are compromised due to IUGR.
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A 16-month-old female experienced a massive carbamazepine ingestion resulting in a peak serum carbamazepine concentration of 55 microg/ml. Clinical manifestations included generalized seizures, coma, shock, and gastrointestinal hypomotility. Gut decontamination was attempted using multiple-dose activated charcoal and cathartics. ⋯ There were no complications. The patient recovered completely and was discharged on the 4th hospital day. Charcoal hemoperfusion should be considered for life-threatening carbamazepine intoxication, especially when drug-induced gastrointestinal hypomotility prevents elimination via the gut.