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A distinct neurologic syndrome characterized by varying degrees of myoclonus, dysarthria, seizures, dementia, coma, and abnormal EEG occurred in 6 children with chronic renal failure. EEG findings were similar to those described in adults with dialysis dementia and consisted of diffuse slowing with bursts of 2-4 hz polyspike wave discharges. The children (4 male and 2 female) had congenital renal disorders. The encephalopathy could not be attributed to hypertension or known metabolic disturbances due to uremia. Encephalopathy occurred between the ages ot 26 months and 10 years, when renal failure was advanced (GFR 5-10 ml/min/ 1.73 m2). All had received high doses (340-800 mg/kg/day) of aluminum containing phosphate binding gels for periods of 9 months to 5 years prior to the onset of their encephalopathy. Dialysis and successful renal transplantation did not significantly alter the clinical course. The encephalopathy may be related to aluminum intoxication. However, these children differ from previously described adults with dialysis related encephalopathy attributed to aluminum toxicity in that they had not been dialyzed prior to the onset of neurologic signs. Perhaps the nervous system of growing children is more susceptible to trace metal intoxication. These observations suggest that the use of large quantities of aluminum containing gels needs reevaluation in children with renal failure. Supported by NIH grants KR-75 and RR 5624.

Cefazolin has not been studied before in children with renal insufficiency. A single dose of 7 mg/kg was administered to 10 children (1½-16 yr) with varying degrees of renal impairment (Grp I), and to 10 children (7-14 yr) undergoing hemodialysis (Grp II). Serum half-life (T/2) in hours was calculated from disappearance curves and creatinine clearance was obtained (ml/min/1.73 m2). In Grp I one child had a ClCr of 57 ml/min and a T/2 of 4.8 hr. Three children with ClCr of 15-25 ml/min had a T/2 of 19-23 hr. Four children had a ClCr of 8-10 ml/min and had a T/2 of 29-40 hr. Two children with ClCr less than 5 ml/min had T/2 values greater than 58 hr. Normal adults have T/2 of 1.8-1.9 hr. Studies have shown adults with ClCr of 40-60 ml/min to have T/2 of about 5 hrs. Adults with lower ClCr had less prolongation of T/2 than did the children. The drug did not alter the tubular reabsorption of phosphate or the clearance of uric acid. In Grp II the T/2 was 8.25-29.5 hrs. A value of 6.5 hrs. has been reported for adults. The T/2 increased as the efficiency of dialysis, estimated by per cent reduction of BUN and creatinine, fell. T/2 of cefazolin is prolonged in children with renal insufficiency and the degree of prolongation is comparable to adults when the ClCr is only moderately reduced. As the ClCr falls further, the T/2 increases more among the children. T/2 for children on hemodialysis varies with the efficiency of dialysis. Supported in part by NIH grants RR-75 and RR-5624.

Renal blood flow has been measured in children of age 1½ to 16 years, by injecting 133Xe into the renal artery at the time of aortography or surgery. The rate of washout of radioactivity was monitored on magnetic tape and the resultant data analyzed by graphic analysis using a semi-automatic method of plotting and computing the rates and fraction of blood flow perfusing the outer and inner cortical regions of the kidney. The number, type, and results of the studies follows: 1) In 8 normal kidneys, RBF's were similar to adult values. 2) In 53 studies of RBF in children with congenital heart disease, RBF's were reduced in both cyanotic and acyanotic heart disease, were further reduced when heart failure was present (8 patients) and fell after angiography (19 patients). 3) Following renal biopsy drops in RBF may occur in intact kidneys, but not in the transplanted kidney (4 patients). 4)In chronic renal disease outer cortical blood flow is diminished. 5) 31 measurements of RBF in donor kidneys upon insertion and/or following transplantation suggest that this technique may have some value in predicting both the immediate and subsequent function of the graft. 6)In 5 patients with renal vascular hypertension, 133Xe measurements of RBF were helpful in determining secretory rates of renin in both kidneys. Supported NIH grants RR-75, RR-5624 and HE-12651.