Presión arterial en preescolares de la localidad de Usaquén en Bogotá

Introducción: La hipertensión arterial es un problema de salud pública tanto en países industrializados como en vía de desarrollo. Su prevalencia en la infancia viene en aumento por lo que es relevante determinarla en niños preescolares a nivel local. Objetivo: Determinar la prevalencia de hipertensión arterial en niños de tres a cinco años de una cohorte de 14 hogares infantiles del ICBF de la localidad de Usaquén en Bogotá. Materiales y métodos: Se realizó un estudio de corte transversal analítico, utilizando la base de datos de un ensayo aleatorizado y controlado del año 200913, y se evaluaron las cifras de tensión arterial de acuerdo a sexo, edad, talla y su correlación con el IMC con un nivel de confianza del 95% y precisión del 1%. Se calcularon las medias, desviaciones estándar, percentiles y prevalencia. Resultados: Se obtuvo una muestra de 1035 casos, encontrándose una prevalencia de 4,5% de HTA sistólica, 10,4% de diastólica, ambas en estadio I; teniendo en cuenta tanto sistólica como diastólica, fue de 11,6% en estadio I. Se determinaron los valores de presión arterial sistólica y diastólica en cuartiles de acuerdo a edad, sexo y talla. El coeficiente de correlación entre el IMC y los niveles de presión arterial sistólica y diastólica fueron de 0.0992 y 0.0362 respectivamente. Conclusión: La prevalencia de HTA general fue de 11,6%, predominando la diastólica en estadio I en niños preescolares. No se encontró correlación entre el IMC y las cifras de tensión arterial sistólica y diastólica.Background: Hypertension is a public health problem in both industrialized and developing. Its prevalence in children is increasing so it is important to determine it in preschool children locally. Objective: Determine the prevalence of hypertension in children three to five years in a cohort of 14 children's homes ICBF in the town of Usaquén in Bogota. Material and Methods: We performed a cross-sectional analytical study, using the database of a randomized controlled trial in 200913, we evaluated the blood pressure levels according to sex, age, height and BMI correlated with a confidence level of 95% and accuracy of 1%. We calculated the mean, standard deviation, percentiles and prevalence. Result: We obtained a sample of 1035 cases found a prevalence of 4.5% of systolic BP, diastolic 10.4%, both in stage I; taking into account both systolic and diastolic was 11.6% in stage I. We determined the values of systolic and diastolic blood pressure into quartiles according to age, sex and height. The correlation coefficient between BMI and levels of systolic and diastolic blood pressure were 0.0992 and 0.0362 respectively. Conclusion: The overall prevalence of hypertension was 11.6%, predominantly stage I diastolic preschoolers. No correlation was found between BMI and figures for systolic and diastolic blood pressure.Mount Sinai Medical Center de Nueva YorkPlaza SésamoHogares Infantiles del Instituto Colombiano de Bienestar Familia

Renal involvement at diagnosis of pediatric acute lymphoblastic leukemia

Acute leukemia is the most common type of cancer in pediatric patients. This type of cancer accounts for a third of all childhood cancer cases. More than half of pediatric acute leukemia patients show signs and symptoms such as hepatomegaly, splenomegaly, pallor, fever and bruising at the time of diagnosis. In early stages of acute lymphoblastic leukemia (ALL), nephromegaly and other renal manifestations such as high blood pressure (HBP) and renal failure are uncommon, although renal infiltration and nephromegaly are common in advanced-stage pediatric patients. This is a retrospective case review with a critical appraisal of the existing evidence from the literature. We present a clinical case of a child with HBP associated with bilateral nephromegaly which resolved after chemotherapy treatment. This patient presented with HBP that required pharmacological treatment, likely owing to nephromegaly. All HBP secondary causes were rejected. Nephromegaly was resolved after chemotherapy treatment, and antihypertensive medication was discontinued. Nephromegaly and HBP are rare manifestations of ALL debut in pediatrics. The present case report illustrates this unusual combination and Suggests clinicians to consider malignancy as its causal factor, especially if the symptoms are accompanied by other suggestive extrarenal manifestations

Presión arterial en preescolares de la localidad de Usaquén en Bogotá

Introducción: La hipertensión arterial es un problema de salud pública tanto en países industrializados como en vía de desarrollo. Su prevalencia en la infancia viene en aumento por lo que es relevante determinarla en niños preescolares a nivel local. Objetivo: Determinar la prevalencia de hipertensión arterial en niños de tres a cinco años de una cohorte de 14 hogares infantiles del ICBF de la localidad de Usaquén en Bogotá. Materiales y métodos: Se realizó un estudio de corte transversal analítico, utilizando la base de datos de un ensayo aleatorizado y controlado del año 200913, y se evaluaron las cifras de tensión arterial de acuerdo a sexo, edad, talla y su correlación con el IMC con un nivel de confianza del 95% y precisión del 1%. Se calcularon las medias, desviaciones estándar, percentiles y prevalencia. Resultados: Se obtuvo una muestra de 1035 casos, encontrándose una prevalencia de 4,5% de HTA sistólica, 10,4% de diastólica, ambas en estadio I; teniendo en cuenta tanto sistólica como diastólica, fue de 11,6% en estadio I. Se determinaron los valores de presión arterial sistólica y diastólica en cuartiles de acuerdo a edad, sexo y talla. El coeficiente de correlación entre el IMC y los niveles de presión arterial sistólica y diastólica fueron de 0.0992 y 0.0362 respectivamente. Conclusión: La prevalencia de HTA general fue de 11,6%, predominando la diastólica en estadio I en niños preescolares. No se encontró correlación entre el IMC y las cifras de tensión arterial sistólica y diastólica.Background: Hypertension is a public health problem in both industrialized and developing. Its prevalence in children is increasing so it is important to determine it in preschool children locally. Objective: Determine the prevalence of hypertension in children three to five years in a cohort of 14 children's homes ICBF in the town of Usaquén in Bogota. Material and Methods: We performed a cross-sectional analytical study, using the database of a randomized controlled trial in 200913, we evaluated the blood pressure levels according to sex, age, height and BMI correlated with a confidence level of 95% and accuracy of 1%. We calculated the mean, standard deviation, percentiles and prevalence. Result: We obtained a sample of 1035 cases found a prevalence of 4.5% of systolic BP, diastolic 10.4%, both in stage I; taking into account both systolic and diastolic was 11.6% in stage I. We determined the values of systolic and diastolic blood pressure into quartiles according to age, sex and height. The correlation coefficient between BMI and levels of systolic and diastolic blood pressure were 0.0992 and 0.0362 respectively. Conclusion: The overall prevalence of hypertension was 11.6%, predominantly stage I diastolic preschoolers. No correlation was found between BMI and figures for systolic and diastolic blood pressure.Mount Sinai Medical Center de Nueva YorkPlaza SésamoHogares Infantiles del Instituto Colombiano de Bienestar Familia

Characterization and Etiopathogenic Approach of Pediatric Renal Biopsy Patients in a Colombian Medical Center from 2007-2017

Introduction. Renal biopsy is the principal instrument to evaluate the diagnosis and prognosis of children with kidney disease. There are relatively few studies establishing epidemiology of its findings in the pediatric population. Methods. A descriptive study was conducted to describe characteristics of pediatric patients who had undergone a renal biopsy over the last 10 years in a national reference center, trying to accomplish an etiopathogenic approach of biopsy findings. Results. 241 patients were included. Most frequent indications were nephrotic syndrome (34.1%) and systemic disease with renal involvement (30.2%). The most prevalent biopsy diagnosis was glomerulonephritis (44%) and among these patients, glomerulonephritis mediated by immune complexes was the most frequent pathogenic type (90.5%). When the biopsy was indicated for proteinuria plus hematuria and systemic disease with renal involvement, the most frequent biopsy diagnosis was glomerulonephritis (60 and 85%, respectively). For isolated hematuria, the predominant biopsy diagnosis was inherited diseases of the glomerular basement membrane (70%) and for nephrotic syndrome, podocytopathy (82%). Glomerulonephritis was more frequent in patients older than 10 yrs (65%) and the rate of postbiopsy major complications was low (1.2%). Conclusion. Immune complex glomerulonephritis was the most frequent histological finding, differing from previous reports. To our knowledge this is the first description that classifies biopsy findings according to the probable pathogenic mechanism

Cystatin C could be a replacement to serum creatinine for diagnosing and monitoring kidney function in children

Background: Chronic kidney disease (CKD) is a worldwide public health problem. Glomerular filtration rate (GFR) is accepted as the best way to diagnose and monitor kidney function. Plasma Cystatin C (CysC) has been proposed as a better marker of GFR than serum creatinine (SCr), but it is not widely used because of some drawbacks with CysC assays. Our purpose is to determine the diagnostic accuracy of CysC and SCr for GFR estimation in children, using 99Tc-DTPA clearance (ClTc) as the reference standard. We also discuss some of the economic implications of these tests, in order to guide clinicians when to use CysC or SCr for the diagnosis or monitoring of CKD. Methods: Data were collected from 109 Colombian outpatients aged less than 18 years referred for determination of GFR because of suspected or definite renal insufficiency. The cost of each test was determined in Bogotá, Colombia, and in Madrid, Spain. Results: Using a GFR of 90 mL/min as a cut-off value, we found: CysC sensitivity 75%, specificity 84%, and area under ROC curve (AUC) 0.84. SCr sensitivity 46%, specificity 100%, and AUC 0.72. Using a GFR of 70 mL/min as a cut-off value, we found: CysC sensitivity 100%, specificity 48%, and AUC 0.94. SCr sensitivity 77%, specificity 91%, and AUC 0.81. In all calculations predictive values behave correspondingly and ranges were narrow at CI 95%. In AUC, p = 0.0001. Cost per enzymatic test in Bogotá: CysC U$27; SCr U$ 2. Cost per enzymatic test in Madrid: CysC U$3; SCr U$ 0.08. Conclusion: CysC is a very interesting option, and could be a replacement to serum creatinine for diagnosing and possibly for monitoring kidney function in children

Cystatin C could be a replacement to serum creatinine for diagnosing and monitoring kidney function in children

Background: Chronic kidney disease (CKD) is a worldwide public health problem. Glomerular filtration rate (GFR) is accepted as the best way to diagnose and monitor kidney function. Plasma Cystatin C (CysC) has been proposed as a better marker of GFR than serum creatinine (SCr), but it is not widely used because of some drawbacks with CysC assays. Our purpose is to determine the diagnostic accuracy of CysC and SCr for GFR estimation in children, using 99Tc-DTPA clearance (ClTc) as the reference standard. We also discuss some of the economic implications of these tests, in order to guide clinicians when to use CysC or SCr for the diagnosis or monitoring of CKD. Methods: Data were collected from 109 Colombian outpatients aged less than 18 years referred for determination of GFR because of suspected or definite renal insufficiency. The cost of each test was determined in Bogotá, Colombia, and in Madrid, Spain. Results: Using a GFR of 90 mL/min as a cut-off value, we found: CysC sensitivity 75%, specificity 84%, and area under ROC curve (AUC) 0.84. SCr sensitivity 46%, specificity 100%, and AUC 0.72. Using a GFR of 70 mL/min as a cut-off value, we found: CysC sensitivity 100%, specificity 48%, and AUC 0.94. SCr sensitivity 77%, specificity 91%, and AUC 0.81. In all calculations predictive values behave correspondingly and ranges were narrow at CI 95%. In AUC, p = 0.0001. Cost per enzymatic test in Bogotá: CysC U$27; SCr U$ 2. Cost per enzymatic test in Madrid: CysC U$3; SCr U$ 0.08. Conclusion: CysC is a very interesting option, and could be a replacement to serum creatinine for diagnosing and possibly for monitoring kidney function in children

Regional citrate anticoagulation for continuous renal replacement therapy in children

9 páginasBackground Anticoagulation of the continuous renal replacement therapy (CRRT) circuit is an important technical aspect of this medical procedure. Most studies evaluating the efficacy and safety of citrate use have been carried out in adults, and little evidence is available for the pediatric patient population. The aim of this study was to compare regional citrate anticoagulation versus systemic heparin anticoagulation in terms of the lifetime of hemofilters in a pediatric population receiving CRRT at a pediatric center in Bogota, Colombia. Methods This was an analytical, observational, retrospective cohort study in which we assessed the survival of 150 hemofilters (citrate group 80 hemofilters, heparin group 70 hemofilters) used in a total of 3442 hours of CCRT (citrate group 2248 h, heparin group 1194 h). Hemofilter survival was estimated beginning at placement and continuing until filter replacement due to clotting or high trans-membrane pressures. Results Hemofilter survival was higher in the citrate group than in the heparin group (72 vs. 18 h; p <0.0001). Bivariate analysis showed that the hemofilter coagulation risk was significantly increased when heparin was used, regardless of hemofilter size and pump flow (hazard ratio 3.70, standard error 0.82, 95% confidence interval 2.39–5.72; p <0.00001). Conclusions Regional citrate anticoagulation could be more effective than heparin systemic anticoagulation in terms of prolonging the hemofilter lifetime in patients with acute renal injury who require CRRT

Renal involvement at diagnosis of pediatric acute lymphoblastic leukemia

Acute leukemia is the most common type of cancer in pediatric patients. This type of cancer accounts for a third of all childhood cancer cases. More than half of pediatric acute leukemia patients show signs and symptoms such as hepatomegaly, splenomegaly, pallor, fever and bruising at the time of diagnosis. In early stages of acute lymphoblastic leukemia (ALL), nephromegaly and other renal manifestations such as high blood pressure (HBP) and renal failure are uncommon, although renal infiltration and nephromegaly are common in advanced-stage pediatric patients. This is a retrospective case review with a critical appraisal of the existing evidence from the literature. We present a clinical case of a child with HBP associated with bilateral nephromegaly which resolved after chemotherapy treatment. This patient presented with HBP that required pharmacological treatment, likely owing to nephromegaly. All HBP secondary causes were rejected. Nephromegaly was resolved after chemotherapy treatment, and antihypertensive medication was discontinued. Nephromegaly and HBP are rare manifestations of ALL debut in pediatrics. The present case report illustrates this unusual combination and Suggests clinicians to consider malignancy as its causal factor, especially if the symptoms are accompanied by other suggestive extrarenal manifestations