Preterm Birth: Long Term Cardiovascular and Renal Consequences.

Cardiovascular and chronic kidney diseases are a part of noncommunicable chronic diseases, the leading causes of premature death worldwide. They are recognized as having early origins through altered developmental programming, due to adverse environmental conditions during development. Preterm birth is such an adverse factor. Rates of preterm birth increased in the last decades, however, with the improvement in perinatal and neonatal care, a growing number of preterm born subjects has now entered adulthood. Clinical and experimental evidence suggests that preterm birth is associated with impaired or arrested structural or functional development of key organs/systems making preterm infants vulnerable to cardiovascular and chronic renal diseases at adulthood. This review analyzes the evidence of such cardiovascular and renal changes, the role of perinatal and neonatal factors such as antenatal steroids and potential pathogenic mechanisms, including developmental programming and epigenetic alterations. Preterm born subjects are exposed to a significantly increased risk for altered cardiovascular and renal functions at young adulthood. Adequate, specific follow-up measures remain to be determined. While antenatal steroids have considerably improved preterm birth outcomes, repeated therapy should be considered with caution, as antenatal steroids induce long-term cardiovascular and metabolic alterations in animals' models and their involvement in the accelerated cellular senescence observed in human studies cannot be excluded

La théorie endocrinienne de l'énurésie nocturne idiopathique [Endocrine theory of idiopathic nocturnal enuresis]

Body fluid homeostasis is maintained by the kidney. Such an accurate control in achieved via the secretion of antidiuretic hormone (ADH), the secretion of which is regulated by hypothalamic osmoreceptors. Both urine flow rate and the excretion of most electrolytes have a diurnal rhythm; they increase during daytime and decrease during nighttime. Such a rhythm seems to be absent in some subjects who suffer from bedwetting because of relative polyuria. In these cases, the polyuria is associated with a decreased nocturnal secretion of ADH and the subsequent excretion of dilated urine. A deficit in the nocturnal secretion of ADH thus appears to explain the response to desmopressin of children with a polyuric form of enuresis

L'hématurie chez l'enfant. Plan d'investigation en pratique pédiatrique [Hematuria in the child. Investigation plan in pediatric practice].

The discovery of hematuria in a child should lead the pediatrician to a methodical evaluation of the patient based on an extensive history and comprehensive physical examination. The microscopic examination of the urine is the cornerstone in the evaluation process and may suggest the origin of the hematuria. For instance, red blood cell casts indicate glomerular lesions and rule out the need for further urological examinations. According to the type of hematuria and the associated symptoms, a complete and immediate evaluation is sometimes necessary. This article presents a decisional tree to help the pediatrician to investigate an hematuria and to refer the child to a specialist, when needed

Polyurie, pollakiurie et nycturie chez l'enfant: approche diagnostique et thérapeutique [Polyuria, pollakiuria, and nocturia in children: diagnostic and therapeutic approach]

Polyuria is defined as the passage of large volumes of diluted urine secondary to an abnormality of urine concentration. This disorder can result either from deficient secretion of vasopressin (cranial diabetes insipidus), or from renal resistance to vasopressin (nephrogenic diabetes insipidus), primary polydipsia, osmotic diuresis, electrolytic disorders or drugs. Suspicion of impaired renal concentration ability can be confirmed by a fluid deprivation test. The administration of exogenous vasopressin allows to clarify the pathogenetic mechanism. Once the mechanism responsible for polyuria has been clarified it is mandatory to search for underlying causes. Treatment of polyuria should be causal, if its origin is known, and/or symptomatic in order to prevent severe dehydration. Symptomatic treatment of cranial diabetes insipidus consists of administering exogenous vasopressin. Salt restriction associated to a combined administration of hydrochlorothiazide/amiloride or hydrochlorothiazide/indomethacin can reduce urine output by 20 to 50% in case of nephrogenic diabetes insipidus. Pollakiuria is defined as a daytime urinary frequency. It can be isolated or may be a manifestation of lower urinary tract infections, bladder instability, nephrolithiasis or concentrated acidic urines. Detailed history and physical examination represent major clues to diagnostic. Therapy of pollakiuria can be causal or symptomatic using anticholinergic drugs or reeducation in case of bladder instability. Nocturia is characterized by voluntary nocturnal micturitions secondary to conditions inducing impaired renal concentration ability, or to heart failure

Le rein de l'enfant face à la chimiothérapie [The kidney in children under chemotherapy].

Nowadays more and more children survive after an intensive anti-tumoral therapy. The price to pay consists of numerous and relatively frequent long-term sequelae (secondary tumors, neuropsychological deficits, endocrine or cardiac damage). After chemotherapy, we sometimes observe renal side-effects, either tubular (metabolic acidosis, hypokalemia, hypomagnesemia, proteinuria, Fanconi syndrome, rickets) or glomerular (acute or chronic decreased GFR). These renal toxic side-effects are encountered especially after cisplatinum and ifosfamide, less frequently after carboplatin and cyclophosphamide. The pediatrician has to be aware of these toxic nephrologic side-effects, to look out for them and monitor carefully the renal function of all paediatric patients receiving these potentially nephrotoxic chemotherapies

Section XVI - The Kidney: concentration and dilution of urine

International audienc

Reflux vésico-urétéral chez l'enfant: connaissances actuelles et prise en charge [Vesico-ureteral reflux in children: current knowledge and management]

Reflux nephropathy is an important cause of chronic renal failure and arterial hypertension in children. While its prognosis is favourably influenced by the early recognition and management of vesicoureteric reflux, there is a real risk of missing the diagnosis of this insidious condition. This article describes the main features of vesicoureteric reflux and associated nephropathy and presents practical recommendations, through a nonexhaustive literature review. As several aspects of this disease remain to be established, any recommendation concerning its management should be constantly reevaluated according to new data