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Systematic exclusion of all previously described causes of hypertension in children established idiopathic essential hypertension associated with suppressed plasma renin activity as an apparently distinct entity here reported for the first time in a child. Additional features of this condition include normal rates of excretion of aldosterone, normal levels of plasma aldosterone which were not suppressed in response to mineralocorticoid administration, and an abnormally low salivary sodium-potassium ratio.

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.

The efficacy of ATG (ATGAMR-Upjohn Co.) in prolonging patient + cadaver renal allograft survival was studied in 21 patients,age 5 to 19 yrs receiving transplants from May 1977 to Oct.1979. Of the 9 patients randomly selected to receive ATG, 3 were given a fixed dose for the 28 day period of therapy; the daily doses of 3 were altered in relation to the percentage of rosette forming cells. Six of the selected patients received the full course of therapy; 1 patient had a positive skin test to ATG; 2 had untoward reactions to the first (and only) administered dose. Of those receiving ATG 1 had irreversible rejection 1 mo after transplantation, and 1 kidney was rejected after 3 mo. Three control patients experienced irreversible rejection within 1 mo, + 2 kidneys were rejected after 3 mos. All patients except 1 experienced threatened rejection episodes during the first mo. One patient died at 2 wks and 2 died within 1 yr after transplantation. All 3 were controls. The 5 treated patients with functioning allografts 4 mos to 2 yrs after surgery had creatinine clearances from 42 to 91 m1/min/1.73M2; 7 controls had clearances from 22 to 120 m1/min/1.73M2. Conclusions: Although the number of patients was very small, there appeared to be no correlation between patient and graft survival and ATG therapy. There was a correlation between graft survival and HLA matching.

Peritoneal dialysis was performed in 7 uremic children (4 months to 18 years). Rates of diffusion of Na, K, Cl, PO4, urea, creatinine, and uric acid were similar to adult diffusion curves. With the exception of uric acid diffusion, no age related differences were found. Peritoneal urea and creatinine clearnces paralleled the rate of exchage of dialysis fluid. Actual urea clearance values were within the range of clearance values obtained in adults dialysed at similar rates. Data to compare creatinine clearances in adults to children is not avialble over the range of dialysis volumes utilized in their studies. Estimation of urea production based on the average daily rise in BUN revealed similar production rates per kg body weight in all ages. These studies demonstrate no intrinsic age-related differences in the kinetics of peritoneal dialysis. Thus, there is no necessity to correct peritoneal clearances to cither 70 kg body weight or 1.73 M2, in order to compare children to adults. The greater ‘efficiency’ of peritoneal dialysis in children can be ascribed to a smaller body pool size in children relative to adults. Therefore, at a give clearance rate, the amount of material in the pool diminishes at a faster rate in children than in adults. Moreover, since peritoneal clearance increases as the rate of dialysis increases, no single clearance value for a given individual exists but rather a family of values related to the rate of dialysis. (Supported in part by NIH grants RR-5624. HD-2870 and FR-75.)