Persistent Renal-Genitourinary Disorders: Current Concepts in Dialysis and Management Proceedings of Pediatric Nephrology Seminar XII held at Bal Harbour, Florida February 24–28, 1985 PDF
Preview Persistent Renal-Genitourinary Disorders: Current Concepts in Dialysis and Management Proceedings of Pediatric Nephrology Seminar XII held at Bal Harbour, Florida February 24–28, 1985
PERSISTENT RENAL GENITOURINARY DISORDERS DEVELOPMENTS IN NEPHROLOGY Gruskin, A.B. and Norman, M.E., eds.: Pediatric Nephrology. 1981. ISBN 90-247-2514-3. Schuck, 0., ed.: Examination of the Kidney Function. 1981. ISBN 0-89838-565-2. Strauss, 1., ed.: Hypertension, Fluid-Electrolytes and Tubulopathies in Pediatric Nephrology. 1981. ISBN 90-247-2633-6. Strauss, 1., ed.: Neonatal Kidney and Fluid-Electrolytes. 1983. ISBN 0-89838-575-X. Strauss, 1., ed.: Acute Renal Disorders and Renal Emergencies. 1984. ISBN 0-89838-663-2. Didio, L.LA. and Motta, P.M., eds.: Basic, Clinical and Surgical Nephrology. 1985. ISBN 0-89838-698-5. Friedman, E.A. and Peterson, C.M., eds.: Diabetic Nephropathy: Strategy for Therapy. 1985. ISBN 0-89838-735-3. Dzurik, R., Lichardus, B. and Guder, W., eds.: Kidney Metabolism and Function. 1985. ISBN 0-89838-749-3. Strauss, 1., ed: Homeostasis, Nephrotoxicity, and Renal Anomalies in the Newborn. 1986. ISBN 0-89838-766-3. Oreopoulos, D.G., ed: Geriatric Nephrology. 1986. ISBN 0-89838-781-7. Paganini, E.P., ed: Acute Continuous Renal Replacement Therapy. 1986. ISBN 0-89838-793-0. Cheigh, 1.S., Stenzel, K.H. and Rubin, A.L., eds.: Hypertension in Kidney Disease. 1986. ISBN 0-89838-797-3. Deane, N., Wineman, R.l. and Bemis, 1.A., eds.: Guide to Reprocessing of Hemodialyzers. 1987. ISBN 0-89838-798-1. Ponticelli, C., Minetti, L. and D'Amico, G., eds.: Antiglobulins, Cryoglobulins and Glomerulonephritis. 1987. ISBN 0-89838-810-4. Persistent Renal-Genitourinary Disorders Current Concepts in Dialysis and Management Proceedings of Pediatric Nephrology Seminar XII held at Bal Harbour, Florida February 25-28, 1985 edited by Jose Strauss, MD Division of Pediatric Nephrology University of Miami School of Medicine Miami, Florida, USA with the assistance of Louise Strauss, MS, MA ., ~ Martinus Nijhoff Publishing a member of the Kluwer Academic Publishers Group Boston/Dordrecht/Lancaster Distributors for North America: Kluwer Academic Publishers 101 Philip Drive Assinippi Park Norwell, MA 02601, USA Distributors for the UK and Ireland: Kluwer Academic Publishers MTP Press Limited Falcon House, Queen Square Lancaster LAI IRN, UNITED KINGDOM Distributors for all other countries: Kluwer Academic Publishers Group Distribution Centre Post Office Box 322 3300 AH Dordrecht, THE NETHERLANDS Library of Congress Cataloging-In-Publication Data Pediatric Nephrology Seminar (12th: 1985 : Bal Harbour, Fla.) Persistent renal-genitourinary disorders. (Developments in nephrology; DIN 17) Includes indexes. I. Kidneys-Diseases-Congresses. 2. Genito- urinary organs-Diseases-Congresses. 3. Pediatric nephrology-Congresses. 4. Pediatric urology-Congres ses. I. Strauss, Jose. II. Strauss, Louise. III. Series: Developments in nephrology; 17. [DNLM: 1. Kidney DIseases-in infancy & childhood congresses. 2. Urologic Diseases-infancy & childhood congresses. WI DE998EB v. 17/ WS 320 P373 1985p] RF466.P3675 1985 618.92'6 86-28465 ISBN-13: 978-0-89838-845-9 e-ISBN-13: 978-1-4613-2339-6 001: 10. 1007/978-1-4613-2339-6 Copyright © 1987 by Martinus Nijhoff Publishing, Boston Reprint of the original edition 1987 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher, Martinus Nijhoff Publishing, 101 Philip Drive, Assinippi Park, Norwell, MA 02061. ERNESTO STRAUSS my big brother found his own way to glory * living for giving caring and sharing 1928-1985 CONTENTS Foreword ••••••••...••••••••.••••••••••••••••••••••.••••••••••••..•... xi Acknowledgements ••.•.•••••.•••••••••••••..•••••••••.•.••••••••••.•. xiii PERSISTENT RENAL-GENITOURINARY DISORDERS I PRIMARY NEPHROTIC SYNDROME Idiopathic Nephrotic Syndrome: Proliferative and Membranous Nephropathy ••••••••••••••••••••••••• 3 Russell W. Chesney and Antonia C. Novello Focal and Segmental Glomerulosclerosis •••••••••••••••••••••••••• 23 Karen M. Gaudio and Norman J. Siegel Abnormal Lipid Metabolism in Primary Nephrotic Syndrome ••••••••• 33 Gaston Zilleruelo, S.L. Hsia, Michael Freundlich, Carolyn Abitbol, Milan Novak, Marianne Fordyce and Jose Strauss Mineral Metabolism in Nephrotic Syndrome •••••••••••••••••••••••• 45 Michael Freundlich, Gaston Zilleruelo, Carolyn Abitbol and Jose Strauss DISCUSSION: Primary Nephrotic Syndrome ••••••••••••••••••••••••• 51 Panelists: Russell Chesney, Michael Freundlich, Warren Grupe, Norman Siegel and Gaston Zilleruelo Moderator: Jose Strauss II THE KIDNEY IN SYSTEMIC DISEASES Renal Involvement in Vasculitic Syndromes in Children ••••••••••• 69 Norman J. Siegel and Karen M. Gaudio The Kidney in Sickle Cell Disease ••••••••••••••••••••••••••••••• 77 Jose Strauss, Carolyn Abitbol, Gaston Zilleruelo and Michael Freundlich Renal Changes in Children with Congenital Heart Disease ••••••••• 87 Alan B. Gruskin Renal Injury from Chemotherapeutic Agents ••••••••••••••••••••••• 95 Julie R. Ingelfinger DISCUSSION: Systemic Diseases ••••••••••••••••••••••••••••••••• lll Panelists: Alan B. Gruskin, Julie R. Ingelfinger, Gwendolyn Scott, Norman J. Siegel and Carlos Vaamonde Moderator: Jose Strauss III NUTRITIONAL ASPECTS OF HYPERTENSION AND ATHEROSCLEROSIS The Role of Sodium in Childhood Hypertension ••••••••••••••••••• 127 Alan B. Gruskin, Gary Lerner and Larry E. Fleischmann Hormonal Factors in Juvenile Hypertension •••••••••••••••••••••• 137 Julie R. Ingelfinger Nutritional Aspects of Hypertension and Atherosclerosis Calcium: Does It Have a Role? •••••••••••••••••••••••••••••••• 145 Russell w. Chesney Nutrition, Lipoproteins and Atherosclerosis in Childhood ••••••• 155 Peter O. Kwiterovich, Jr. DISCUSSION: Hypertension and Atherosclerosis •••••••••••••••••• 171 Panelists: Sidney Blumenthal, Russell W. Chesney, Jule R. Ingelfinger and Peter O. Kwiterovich Jose Strauss, Moderator IV CONGENITAL RENAL ANO~~LIES Dilemmas Created by Prenatal Detection of Urinary Tract Anomalies •••••••••••••••••••••••••••••••••••••••••••••••••••••• 181 Warren E. Grupe Nutritional Aspects of Growth in Children with Congenital Renal Anomalies ••••••••••••••••••••••••••••••••••••• 187 Carolyn Abitbol, Michael Freundlich, Gaston Zilleruelo and Jose Strauss DISCUSSION: Congenital Renal Anomalies •••••••••••••••••••••••• 193 Panelists: Carolyn Abitbol, Joan Chesney, Warren E. Grupe, Abdollah Iravani, Catherine Poole, George Sfakianakis, Norman J. Siegel Moderator: Jose Strauss V RENAL REPLACEMENT THERAPY DIALYSIS Four Years Experience - CAPD and CCPD in Children •••••••••••••• 207 Heinz E. Leichter, Isidro B. Salusky and Richard Fine Lipid Changes in Children on Dialysis •••••••••••••••••••••••••• 217 Gaston Zilleruelo, Milan Novak, Michael Freundlich, Carolyn Abitbol and Jose Strauss viii Mineral Metabolism in Patients on Continuous Ambulatory Peritoneal Dialysis ••••••••••••••••••••••••••••••••• 227 Michael Freundlich, Gaston Zilleruelo, Carolyn Abitbol and Jose Strauss DISCUSSION: Renal Replacement Therapy Dialysis •••••••.••••••••.••••.••••••.•••••••••••..•.•....•...•. 235 Panelists: Richard Fine, Michael Freundlich, Gaston Zilleruelo Moderator: Jose Strauss VI RENAL REPLACEMENT THERAPY PROGRESSION OF RENAL DISEASES AND TRANSPLANTATION Effects of Protein on Renal Funtion and Disease •••••••••••••••• 243 J. J. Bourgoignie Protein and Energy Requirements in Renal Insufficiency ••••••••• 255 Warren Grupe, N. Spinozzi and W. Harmon Progression of Chronic Renal Disease in Children: The University of Miami Experience ••••••••••••••••••••••••••••• 265 Gaston Zilleruelo, Nuria Dominguez, Michael Freundlich, Carolyn Abitbol and Jose Strauss Mineral Metabolism in Children with End Stage Renal Failure ..••••.•••.•••••.•••••..•••••.••••••.••..•••••••.• 271 Russell W. Chesney. The Use of Cyclosporine in Pediatric Recipients of Renal Transplants ••••••••••••••••••••••••••••••••••••••••••• 283 B.D. Kahan, C.T. Van Buren, S.B. Conley, M.T. Lorber and S.M. Flechner DISCUSSION: Renal Replacement Therapy Progression of Renal Disease and Transplanta.tion ••••••••••••••• 293 Panelists: Jacques J. Bourgoignie, Russel W. Chesney, Richard Fine, Warren E. Grupe, Barry Kahan, George Kyriakides and Gaston Zilleruelo Moderator: Jose Strauss VII WORKSHOP: FOUR CASES •••••••••••••••••••••••••••••••••••••••••• 317 Moderator: Jose Strauss PAATICIPANTS •••••••••••••••••••••••••••••••••••••••••••••••••••••••• 337 INDEXE s ............................................................. 341 ix FOREWORD This Pediatric Nephrology series is a focus on salient points which at the time of each annual seminar are of importance to the practicing pediatrician and nephrologist, the clinical researcher, and basic researcher interested in clinical problems. Hence the format of selected papers and panel discussions to capture the tenor of the times. More thorough coverage of many of the subjects can be found in current journals and textbooks listed in the authors' references. Those searching for the conventional should look there rather than here since our aim is not to cover each subject in its entirety but to secure attention to the controversial aspects of the subjects, dispel the notion that there is one answer to a question, and raise the level of inclination toward dynamic problem solving. The basic subject chosen this year reflects dominant concerns this year and the participants chosen--speakers and discussants--represent certain views relevant to the subject at this time. To reflect the tempo and flavor produced by this unique blend, the discussions are included almost verbatim. For some this means readability; for others, excess verbiage. The careful reader will notice that I have been the chairman of all sessions and have moderated all discussions. This is in keeping with our aim to ferret out interrelated basic questions and varying answers to the subjects--seen as related in problems and solutions. In the discussions, all names have been deleted. This is in agreement with participants who thus are encouraged to speak with less inhibition and more candor. My point is, this volume must be evaluated on the basis of its aim, not by standard textbook criteria. I consider most valuable (30 M.D.) my realization that what is considered known--"the facts"-is temporal, still a question in search of a new answer--even what we think of as basic facts. I would consider myself to have made a significant contribution to the field of medicine if I could stimulate preference for a dynamic approach to any problem- no matter how "standard". We too often see what we look for rather than whatever else there might be, and in the very process of educating, dull the inclination to question, consider alternatives. What seems to be "old stuff"/"routine procedures" may not be/should not be. Of course, we cannot face the volume of our responsibility without using routine procedures; we do not have time or energy to question our every step every day, but absolutely essential to the practice of "good medicine" is an attitude of questioning--removal of the film of familiarity covering truly unresolved questions. Thus, my hope in this volume (as in the eleven preceding it) is to gently disturb the status quo, to challenge the physician/researcher to think as he acts, to see when he looks. Those who have conspired with me in this effort this year include guest faculty Sidney Blumenthal, Joan Chesney, Russell Chesney, Richard Fine, Warren Grupe, Alan Gruskin, Julie Ingelfinger, Abdollah Iravani, Barry Kahan, Peter Kwiterovich, Norman Siegel, Kirsti Thodenius, and local faculty Carolyn Abitbol, Jacques Bourgoignie, Michael Freundlich, George Kyriakides, Jorge Lockhart, Joshua Miller, Victoriano Pardo, Charles Lynne, Catherine Poole, Gwendolyn Scott, George Sfakianakis, Carlos Vaamonde, and Gaston Zilleruelo. xii
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