Paleonephrology and reflux nephropathy: from the 'big bang' to end-stage renal disease

Article Abstract:

Reflux nephropathy is kidney disease resulting from the combined effects of urinary tract infections and ureteral reflux, or the backflow of urine into the ureters (which normally convey urine from the kidneys to the bladder). Dysperistalsis, or impaired movement and elimination of urine from the ureter, may also contribute to the development of reflux nephropathy. Reflux nephropathy may progress to hypertension, or high blood pressure; proteinuria, or the elimination of protein in the urine; and end- stage renal disease (ESRD), or kidney failure. A possible mechanism underlying the progression of reflux nephropathy to ESRD is described. The combined effects of urinary tract infection and reflux nephropathy may reduce the number of functioning glomeruli, the filtering units of the kidney. The kidney may adapt by increasing blood flow and pressure within the remaining functional glomeruli, subsequently causing hyperfiltration, or excessive filtering activity, of the remaining glomeruli. The degree of hyperfiltration may be influenced by the amount of protein that must be filtered. Hence, greater protein intake would result in higher rates of filtration. The combined effects of hyperfiltration and glomerular damage may alter the ability of the kidney to selectively retain protein and, thus, lead to proteinuria. Proteinuria is an indicator of developing glomerular sclerosis, the thickening of glomerular tissue, which occurs in response to hyperfiltration. Progressive glomerular sclerosis may result in kidney failure. Hyperfiltration may be an adaptive mechanism, which developed in response to occasional high protein intake during sporadic meat consumption among the paleolithic hunter-gatherers more than 10,000 years ago. Since the degree of hyperfiltration is influenced by the amount of protein intake, protein intake should be restricted in children with reflux nephropathy to prevent the progression to kidney failure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Causes of, Complications and side effects, Physiological aspects, Development and progression, Adaptation (Physiology), Physiological adaptation, Urinary tract infections, Chronic kidney failure, Bladder diseases, Paleolithic period

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Epidemic nephropathy in children

Article Abstract:

This report describes the authors' experience with 13 patients younger than 16 who developed epidemic nephropathy (EN), a hemorrhagic fever and kidney disorder that results from viral infection. Caused by the Puumala virus and transmitted through the feces of small rodents, EN peaks every third or fourth year in rural surroundings. It is considered rare among children. These patients were treated between 1977 and 1989 in Finland. Abdominal pain was the first and most common symptom, and the patients also developed oliguria (reduced urination), followed by polyuria (increased urination). Kidney pain was present in 12 cases. A fever ranging from 38.3 to 40.5 degrees Centigrade was present for, on average, slightly fewer than nine days. Inflammation of the conjunctiva and sore throat were also common. Five patients developed neurologic symptoms, such as visual disturbances. Excess protein was found in the urine of all patients, and microscopic hematuria (small amounts of blood in the urine) was also common. The majority of cases of EN occurred in early winter. All the patients recovered without complications, with normal test values six months after their infections. EN is a hantavirus disease, one of a group of disorders whose causative agent has not been reported in North America. Variations in the incidence of EN coincide with the population cycles of the rodents that carry the Puumala virus. Although the prognosis of the disorder was good in this group of patients, EN is a serious condition and requires active treatment, particularly in the early phases. Fatalities in adults have been reported. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Prolonged pH monitoring is of limited usefulness for gastroesophageal reflux

Article Abstract:

Monitoring the pH level of the esophagus does not provide accurate information on the severity of gastroesophageal reflux (GER) in children. GER is a potentially life-threatening condition that in its most severe forms can lead to severe weight loss, anemia, gastrointestinal tract bleeding and death. Though pH monitoring is widely used, its diagnostic accuracy may be limited. Of 38 infants aged one to 12 months, 89% were found to have abnormal pH readings. In a group of 26 older children aged 13 months to 18 years, only 42% had abnormal pH readings. Esophageal biopsies done on the same children yielded different results. However, pH monitoring may be helpful in diagnosing the presence of GER in children without a history of vomiting when they have evidence of some of the associated symptoms of the condition.

Diagnosis, Gastroesophageal reflux in children, Pediatric gastroesophageal reflux

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