Effect of vesicoureteral reflux on renal function in children with recurrent urinary tract infections

Effect of vesicoureteral reflux on renal function in children with recurrent urinary tract infections. The functional damage caused by vesicoureteral reflux (VUR) has been examined by unilateral clearance studies in 22 children with recurrent urinary tract infection (UTI) and representing 23 kidneys with large VUR, 7 kidneys with small to moderate VUR and 14 kidneys without VUR. Inulin clearance, Na+ excretion and glucose reabsorption were determined. In kidneys without or with small and moderate VUR, UTI had no effect on renal function if treated. In kidneys with large VUR extending into the pelvis and dilating the ureter, there was a gradual deterioration of glomerular filtration rate (GFR) that was accelerated after the age of 6yr. Before puberty more than 50% of renal function was lost despite strict medical care of the UTI. If this functional loss was unilateral, hyperfunction of the contralateral kidney was generally observed. Maximal glucose reabsorption was depressed in proportion to GFR. In kidneys with unilaterally low GFR, the fractional Na+ excretion was consistently increased as compared to the contralateral kidney with normal GFR. This adaptive increase in Na+ excretion must therefore be of intrarenal origin.Effet du reflux vésico-urétéral sur la fonction chez l'enfant atteint d'infection urinaire récidivante. L'altération de la fonction rénale déterminée par le reflux vésico-urétéral (VUR) a été étudiée par clearance unilatérale chez 22 enfants atteints d'infection urinaire récidivante (UTI). L'étude a porté sur 23 reins avec reflux importants, 7 reins avec reflux minime ou moyen et 14 reins sans reflux. La clearance de l'inuline, l'excrétion de Na et la réabsorption de glucose ont été déterminés. L'infection urinaire récidivante n'a pas d'effets sur la fonction des reins sans reflux ou avec reflux minime ou moyen. Dans les reins avec reflux important atteignant le bassinet et dilatant l'uretère on observe une détérioration progressive de la filtration glomérulaire, détérioration qui est plus rapide après l'âge de 6 ans. Avant la puberté, plus de 50% de la fonction rénale sont perdus malgré un traitement strict de l'infection urinaire récidivante. Quand cette diminution de la fonction est unilatérale, une augmentation de la fonction controlatérale est habituellement observée. La réabsorption maximale de gluclose est diminuée en proportion du débit de filtration glomérulaire. L'excrétion fractionnelle de sodium par les reins dont la filtration glomérulaire est diminuée est nettement plus grande que celle du rein controlatéral dont la filtration glomérulaire est normale. Il semble donc que cette adaptation dans l'excrétion du sodium doive être d'origine intrarénale

Discordant findings on dimercaptosuccinic acid scintigraphy in children with multi-detector row computed tomography-proven acute pyelonephritis

PurposeThe diagnosis of acute pyelonephritis (APN) is often difficult, as its clinical and biological manifestations are non-specific in children. If not treated quickly and adequately, however, APN may cause irreversible renal damage, possibly leading to hypertension and chronic renal failure. We were suspecting the diagnostic value of 99mTc-dimercaptosuccinic acid (DMSA) scan by experiences and so compared the results of DMSA scan to those of multi-detector row computed tomography (MDCT).MethodsWe retrospectively selected and analyzed 81 patients who were diagnosed as APN by MDCT during evaluation of their acute abdomen in emergency room and then received DMSA scan also for the diagnostic work-up of APN after admission. We evaluated the results of imaging studies and compared the diagnostic value of each method by age groups, <2 years (n=45) and ≥2 years (n=36).ResultsAmong total 81 patients with MDCT-proven APN. DMSA scan was diagnostic only in 55 children (68%), while the remaining 26 children (32%) showed false negative normal findings. These 26 patients were predominantly male with average age of 21 months and most of them, 19 (73.1%) were <2 years of age.ConclusionDMSA scan has obvious limitation compared to MDCT in depicting acute inflammatory lesions of kidney in children with APN, especially in early childhood less than 2 years of age. MDCT showed hidden lesions of APN, those were undetectable through DMSA scan in children

Consumption of a high-salt diet by ewes during pregnancy alters nephrogenesis in 5-month-old offspring

Maternal nutrition during pregnancy can affect kidney development in the foetus, which may lead to adverse consequences in the mature kidney. It was expected that high-salt intake by pregnant ewes would lead to a reduction in foetal glomerular number but that the ovine kidney would adapt to maintain homoeostasis, in part by increasing the size of each glomerulus. Merino ewes that were fed either a control (1.5% NaCl) or high-salt (10.5% NaCl) diet during pregnancy, as well as their 5-month-old offspring, were subjected to a dietary salt challenge, and glomerular number and size and sodium excretion were measured. The high-salt offspring had 20% fewer glomeruli compared with the control offspring ( P,0.001), but they also had larger glomerular radii compared with the control offspring ( P,0.001). Consequently, the cross-sectional area of glomeruli was 18% larger in the high-salt offspring than in the control offspring ( P,0.05). There was no difference in the daily urinary sodium excretion between the two offspring groups ( P.0.05), although the high-salt offspring produced urine with a higher concentration of sodium. Our results demonstrated that maternal high-salt intake during pregnancy affected foetal nephrogenesis, altering glomerular number at birth. However, the ability to concentrate and excrete salt was not compromised, which indicates that the kidney was able to adapt to the reduction in the number of glomeruli

Ambulatory blood pressure monitoring and renal functions in children with a solitary kidney

The aim of this study is to investigate the blood pressure (BP) profile, microalbuminuria, renal functions, and relations with remaining normal kidney size in children with unilateral functioning solitary kidney (UFSK). Sixty-six children with UFSK were equally divided into three groups: unilateral renal agenesis (URA), unilateral atrophic kidney (UAK), and unilateral nephrectomy (UNP). Twenty-two age-, weight-, and height-matched healthy children were considered as a control group. The serum creatinine level and first-morning urine microalbumin and creatinine concentrations were determined by the standard methods. Also, the BP profile was determined by ambulatory blood pressure monitoring (ABPM). We found that the serum creatinine level was higher and creatinine clearance was lower in each patient groups compared to those of the control group (p < 0.05). Compared with the controls, each group of patients had mean office, 24-h, daytime, and night-time systolic and diastolic BP values similar to those of the controls (p > 0.05). An inverse correlation was found between the renal size standard deviation scores (SDS) of normal kidneys and 24-h systolic and diastolic BP load SDS in all of the patients (p < 0.05; r = −0.372, r = −0.295, respectively). The observed relationship between renal size SDS and 24-h mean arterial pressure (MAP), systolic and diastolic BP load SDS suggests that children with UFSK should be evaluated by using ABPM for the risk of hypertension

Nephrotoxicity in survivors of Wilms' tumours in the North of England

One aspect of concern for survivors of Wilms' tumour has been the late outcome in terms of renal function. Previous studies have documented low glomerular filtration rate and high blood pressure in some patients. Furthermore, disorders in tubular function (especially urinary concentration defects) have been suggested but not confirmed in small studies. The aim of this study was to determine the prevalence and nature of subclinical and overt glomerular, proximal and distal renal tubular toxicity in a population based cohort of survivors of Wilms' tumour. Forty patients (24 female) with a median age of 4.3 years (3 months–11.8 years) at diagnosis were studied. Median follow-up was 8.8 (range 0.06–27.5) years. Glomerular filtration rate was measured by 51Cr-EDTA plasma clearance, proximal tubular function by electrolyte fractional excretions, urine excretion of low molecular weight proteins (retinol-binding protein) and renal tubular enzymes (alanine aminopeptidase; N-acetylglucosaminidase) and distal tubular function by the osmolality of the first two urines of the day on 3 consecutive days. Renal size (ultrasound) and blood pressure were also measured. Mean (range) glomerular filtration rate was 100 (61–150) ml min−1 1.73 m−2. Nine were below the reference range for healthy individuals with two kidneys. Most serum electrolyte concentrations (sodium, potassium, chloride, calcium, magnesium and phosphate) fell within the normal range for age, as did the fractional excretions. The values that fell outside the normal range were only marginally abnormal. Subclinical measures of tubular toxicity (retinal-binding protein, alanine aminopeptidase, N-acetylglucosaminidase) were abnormal in only four patients. Thirty-seven patients achieved maximal urine osmolalities ⩾800 mOsm kg−1, but three failed to achieve this value even after DDAVP administration. Two patients had evidence of increased urinary albumin excretion. Compensatory renal hypertrophy was seen in all but two patients, but blood pressure was within normal limits in all patients. Current and past treatment for Wilms' tumour does not have any clinically important nephrotoxic effect in the majority of patients. This finding will enable paediatric oncologists to reassure patients and parents that treatment for Wilms' tumour rarely causes long-term renal impairment

AutoMon. Automatic monitoring and problem detection for distributed systems

When working with distributed systems, detecting faults can be a difficult task, as abnormalities isn't necessarily immediately evident by warnings or system crashes. This is especially true with subtle faults, such as variations in performance of a running program, it is not necessarily its own fault, but could rather be from a different source, somewhere in the cluster, using a lot of resources (CPU, IO, etc.), thereby causing other programs to perform sub-par compared to earlier executions. These types of problems won't necessarily be detected by regular cluster monitoring tools, as these only look at cluster metrics, or by distributed debuggers, as these only monitor specific programs, and thus won't find the cause for the degraded performance if it comes from a different source. As the usage of distributed systems is becoming more common amongst those without an intimate knowledge about these systems, being able to quickly inform the user about any faults or abnormalities, would be a great improvement on their efficient use of the system. It would additionally be a great help to developers, as they could easily get their programs performance data without implementing specific procedures for the task, thus simplifying the development of new distributed software. This thesis is looking to discover if the system, and process, information attainable from each nodes operating system, is enough to detect abnormal operation. This is approached by creating a prototype system that collects this information from the cluster, and doing analysis on the data during runtime to check for faults. The achieved system is capable of collecting large amounts of data from the cluster, storing it, and doing some rudimentary analysis on the data. While leaving most of the clusters resources free for its computations. This shows that it is possible to create a low resource cluster monitoring tool, that collects large amounts of system data, with high frequency, from each of the nodes, and analyze the data

Ordforråd hos utenlandsadopterte ungdommer En komparativ studie av reseptivt og ekspressivt ordforråd hos adopterte og norskfødte ungdommer

Bakgrunn og formål:Denne masteroppgaven er en del av det longitudinelle forskningsprosjektet «Internasjonalt adopterte barns språkutvikling fra 4-13 år». Prosjektet er ledet av Anne-Lise Rygvold, førsteamanuensis ved Institutt for Spesialpedagogikk, Universitetet i Oslo. I prosjektet er det også en jevnaldret kontrollgruppe med norskfødte ungdommer. Ungdommene går i 8. klasse og er henholdsvis 13 eller 14 år gamle. En internasjonal adopsjon innebærer nye omgivelser, nye omsorgspersoner, ny kultur og nytt språk for barnet som er adoptert. Det er mange forandringer på kort tid. Språkutviklingen legger grunnlaget for den læring og utvikling som skal skje i barnets nye hjemland. Flere studier viser til at utenlandsadopterte barn er språklig forsinket kort tid etter adopsjonstidspunktet (Dalen & Theie, 2012; L. C. Miller & Hendrie, 2000). Noen mener forsinkelsene forsvinner noen år etter adopsjonen (Glennen & Masters, 2002; Roberts et al., 2005). Andre mener forsinkelsene er synlig også i skolealder (Behen, Helder, Rothermel, Solomon, & Chugani, 2008; Croft et al., 2007; Eigsti, Weitzman, Schuh, de Marchena, & Casey, 2011). Barn som er adoptert kan derfor sies å være i risiko for å tilegne seg språklige vansker. Dette er noe omsorgspersoner og skole- og barnehagepersonell bør være oppmerksom på. Spesielt viktig er oppmerksomhet på barnets reseptive språk. Vansker med det reseptive språket blir betegnet som skjulte vansker, da barn som er adoptert tilsynelatende har hurtig innlæring av ord (Dalen & Rygvold, 2012; Geren, Snedeker, & Ax, 2005). Reseptive vansker viser seg blant annet som problemer med å forstå hva hverdagslige ord betyr (Hene, 1993). Videre kan enkelte barn som er adoptert ha ekspressive vansker, ved de har et bredt ordforråd med mange ord, men begrensninger på dybden i ordene (Hough & Kaczmarek, 2011). Slike hull i språktilegnelsen kan føre til utfordringer med språklige krav når barna blir eldre. Når de kommer på skolen møter barna et mer akademisk språk (Cummins, 2008). Skriftspråket skal også mestres. Ordforrådet blir derfor et viktig grunnlag når barna skal beherske et stadig mer kognitivt avansert språk, samt skriftspråklige ferdigheter som lesing og skriving (Hennings, 2000; Lervag & Aukrust, 2010; Perfetti, 2007). Formål: Formålet med masteroppgaven er å undersøke ordforrådet hos to grupper ungdommer. Problemstillingen for oppgaven er; Hvordan er ordforrådet til utenlandsadopterte ungdommer sammenlignet med norskfødte jevnaldrende? Ordforråd er et begrep som defineres ulikt. Ordforråd har en forståelsesside og en produksjonsside (Leonard, 2014). Dette kalles av noen for bredde- og dybdeordforråd (Ouellette, 2006). Det finnes ulike måter å kartlegge ordforråd på, i form av reseptive og ekspressive oppgaver. Denne undersøkelsen kartlegges det reseptive og ekspressive ordforrådet til de to gruppene, i tillegg til setningsrepetisjon. Metode: Masteroppgaven bruker kvantitativ metode med et deskriptivt design. Deltakerne i undersøkelsen er 34 utenlandsadopterte og 45 norskfødte ungdommer. De er alle kartlagt med ulike språktester fra flere kartleggingsbatteri. Resultatene som blir presentert og drøftet i masteroppgaven er fra testene BPVS-II, CELF-4: Likheter 2 reseptivt, Språk 6-16: Begreper, WISC-III: Ordforståelse og Språk 6-16: Setningsminne. Statistical Program for Social Sciences (SPSS) er brukt for å analysere resultatene fra testene. Ved hjelp av SPSS og drøfting rundt egne funn beskriver oppgaven de to gruppenes resultater på de ulike testene. Resultater og drøfting: Resultatene fra undersøkelsen viser at de to gruppene har tilnærmet jevne resultater på de ulike språktestene. Undersøkelsen er en del av en større longitudinell studie. Det gir rom for å se på utviklingen i resultater hos begge grupper fra en tidligere testalder, og sammenligne disse med resultater samlet inn til denne undersøkelsen. De adopterte ungdommene har nådd igjen, og skårer nå noe høyere enn sine jevnaldrende norskfødte på tester for ekspressivt ordforråd (WISC-III: Ordforståelse og Språk 6-16: Begreper). Tester for reseptivt ordforråd viser varierende resultater. De adopterte ungdommene skårer svakt bedre enn kontrollgruppen på BPVS-II, mens kontrollgruppen skårer noe bedre på CELF-4: Likheter 2 reseptivt. Mellom gruppene er forskjellen på de ekspressive testene noe større enn på de reseptive, og det kan tenkes at adoptivgruppen gjør det bedre ekspressivt enn reseptivt. Det som imidlertid skiller seg ut er resultater fra screeningen Språk 6-16: Setningsminne. Her er det en signifikant forskjell mellom gruppene. På de fleste testene viser adoptivgruppen større spredning enn kontrollgruppen, noe som samsvarer med andre studier med adopterte barn og unge (Dalen & Rygvold, 2006; Scott, Roberts, & Glennen, 2011)