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Introduction: Unilateral renal agenesis is a frequent renal malformation with incidence of 1 per 1000 live born children. There are no statistics nor protocols to manage and follow-up these patients. Usually asymptomatic, it can be early detected by prenatal ultrasound, allowing opportune detection and adequate follow up. The goal is to describe main features found in children with renal agenesis at four ambulatory pediatric nephrology clinics in Cali, Colombia: Hospital Universitario del Valle (HUV), Club Noel Children's hospital and the private practice of two pediatric nephrologists. Methods: This is a retrospective descriptive study in a series of cases with congenital renal agenesis diagnosed between January, 1995 and December 2007, of patients under 18 years of age and based on a review of clinical records. Results: 43 patients were found, 51.2% males, 88% from the department of Valle del Cauca. Prenatal diagnoses were conducted in only 21% of these patients; agenesis was right in 48.8% and left in 51.2%. In 46.5%, association with other pathologies was found: occult spinal bifida, congenital scoliosis, and Klippel-Feil sequence. Compensatory renal hypertrophy was reported in 39.5% of the patients, 42% had episodes of urinary tract infection, 31% vesicoureteral reflux and 10% proteinuria. Four male patients (9.3%) developed renal failure. The average follow-up was 6.6 years. Conclusions: Prenatal diagnose was not very frequent in our set of cases. Urinary tract infection and vesicoureteral reflux were common, increasing the risk of renal deterioration. Prolonged follow up is suggested, with unified protocols to prevent renal failure. [ABSTRACT FROM AUTHOR]

Introduction: The Hospital Universitario del Valle (HUV) at the Pediatrics Intensive Care Unit (PICU) admits intoxicated patients, erroneously medicated by «teguas» or family members with serious aggravation of basic diseases or generating severe intoxications. Absent reports of these practices in Colombia motivated the publication of this case series. Objective: To report a series of pediatric intoxication cases secondary to oral or dermatological application of varied substances by healers («teguas») or family members, leading to admission at the PICU, and to describe complications and hospital costs of these events. Methodology: Clinical charts of patients admitted to the PICU with diagnosis of exogenous intoxication during May 2001 to September 2004, were reviewed. Of 28 registered cases during that time, only 14 clinical charts were recovered. Variables evaluated included: age, gender, proceeding, administered substance, person responsible for the administration, complications, days of mechanical ventilation, total days at the intensive care unit and average costs. Of the 14 medical records with exogenous intoxications only 5 cases were involuntary and 9 were related to the administration of substances by quacks or family members; these are the ones reported in this series. Results: We report a total of 9 intoxicated patients, 5 girls and 4 boys, with an age range from 1 to 24 months, all from Cali. Topical administered substances: alcohol 6/9, vinegar 1/9; oral: aspirin 2/9, paico 1/9, and unidentified herbs 1/9. Administered substances by teguas: 6 patients; 3 by family members. All patients had metabolic acidosis with an increased anion gap: 27 in average (range from 21 to 32). All required mechanical ventilation (2 to 32 day range). Average hospital day costs were $6'657,800 pesos (around U$3,000.oo). Three patients died and 4 presented acute renal failure, 2 convulsions, 2 nosocomial infections, 1 subglotic stenosis. Conclusions and recommendations: Those practices are a high risk for children and have high health costs. Mortality and severe complications are high. Educational campaigns should be started in the community to prevent these cases. [ABSTRACT FROM AUTHOR]

Introduction: Chronic renal disease (CRD) can compromise nutritional status in children. Nutritional assessment should be performed in early stages of CRD in order to maintain growth, as well as to prevent malnutrition and to diminish progression of renal diseases and metabolic consequences of uremia. Objective: Evaluation of nutritional status of children with moderate CRD stages 2- 4 by means of anthropometry, biochemical profile and dietary survey by records of last three days. Methods: A descriptive observational study was performed to a total of 17 patients that attended to pediatric nephrology service at the Hospital Universitario del Valle, from December 2007 to March 2008. Results: Of the children 65% were males, mean age was 6.2 for males and 10.3 for females. Causes of CRD were reflux nephropathy in 41%. Malnutrition under-2 Standard Deviation for height and weight for the age was found in 30% of patients. The measurement of triceps fold, showed moderate undernourishment in 75% of the children. According to the biochemical data 5 patients (29%) had serum albumin <3.5 mg/ dl. Dietary records evidence diminution in the consumption of calories, calcium, iron, zinc. Sodium ingestion was over the recommended values. Conclusions: These results support that an early nutritional intervention, is essential in children with of CRD in early stages; nutritional deficiencies were found in early stages of disease. It is essential to consume 100% of calories and other nutrients to avoid growth deficit and other important alterations. [ABSTRACT FROM AUTHOR]

Interest for preventive therapies and nutritional supplementation has increased over the last years. Probiotics are live organisms that once ingested, improve the intestinal balance. The organisms with best experience and information are acid lactic bacteria, mainly Lactobacillus spp y Bifidobacterium spp., which are considered safe for humans. Probiotics beneficial effects have been demonstrated in the fallowing situations: prevention of rotavirus diarrhea in children, diarrhea related to antibiotics use, traveler's diarrhea, vaginosis, urinary tract infections, food allergies, lactose intolerance and atopic dermatitis. Promising results using proibiotics have been reported in bowel inflammatory disease, necrotizing enterocolitis and irritable bowel syndrome. Recently some evidence suggests that probióticos can improved treatment for Helicobacter pylori and prevent the carcinogenesis process, but more studies are needed in this area. The use of lactic bacteria in the elaboration of vaccines to improve protective effect is under investigation. Although probiotics represent an important therapeutic option more studies are necessary in some areas to elucidate their utility, mechanism of action and determine why and when they fail in different clinical situations. [ABSTRACT FROM AUTHOR]

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Objective: To know the epidemiology of Acute Kidney Injury (AKI) in the pediatric population at Hospital Universitario del Valle (HUV), a tertiary University Hospital in Cali, Colombia., Methods: We obtained a series of cases through daily surveillance for a seven-month period (June 1 to December 31, 2009) in patients older than 30 days and under 18 years at HUV. We excluded patients with previous diagnosis of chronic renal failure. The new pRIFLE scale was used to define AKI., Results: 27 patients were detected, with mean age of 36 months. Incidence of AKI was 0.38% from pediatric admissions and 6.2% from the pediatric intensive care unit (pICU) admissions. The pRIFLE scale at study entrance was: Risk: 2 patients, Injury: 8, Failure: 17. Etiology of AKI was: pre-renal in 89%, primary renal disease in 3.7%, and post-renal in 7.4%. There was an association of AKI with sepsis in 66.7% and 48.2% progressed to septic shock. Six patients required renal replacement therapy, all required peritoneal dialysis. The AKI was multi-factorial in 59.3% and associated with systemic multi-organ failure in 59.3%. At study entry, 63% patients were in pICU. The average hospital stay was 21.3 ± 9.2 days. Six children died, 16 resolved AKI, and nine were left with renal sequelae., Conclusions: We recommended pRIFLE scale for early diagnosis of AKI in all pediatric services. Education in pRIFLE scale, prevention of AKI, and early management of sepsis and hypovolemia is recommended.

Hypercalciuria in the absence of urolithiasis has been considered to be a cause of asymptomatic hematuria. No mechanism for this association has been demonstrated. In an effort to establish the specificity of this association, we induced hypercalciuria in 10 healthy subjects by oral administration of 1,25(OH)2 vitamin D for 10 days. This protocol reproducibly produced markedly increased urinary calcium excretion (mean calcium:creatinine ratio 0.5). Despite this, no subject developed hematuria as seen by dipstick urinalysis or by alteration in erythrocyte Addis counts (mean counts 1.02 x 10(6)/12 h before vitamin D and 0.84 x 10(6)/12 h after 10 days of therapy). This study provides no evidence that short-term hypercalciuria alone produces hematuria in otherwise healthy individuals.

Some children with Bartter syndrome have hypercalciuria. To determine the mechanism for this phenomenon, we studied tubular function and calcium metabolism in six such children. All patients had hypokalemic alkalosis, normotension, hyperreninemia, growth retardation, low fractional distal chloride reabsorption (4/5), and elevated urinary prostaglandin E2 excretion (5/6). In addition, all had hypercalciuria (urinary calcium 6.5 to 25.0 mg/kg/day), with evidence of nephrocalcinosis in five. None, however, had evidence of rickets or hyperparathyroidism. There was a marked elevation in the serum concentration of 1,25-dihydroxyvitamin D in all, and four patients had a response to oral calcium loading suggestive of absorptive hypercalciuria. Five children have had long-term therapy with indomethacin. They have had improvement in hypokalemia and reduced urinary prostaglandin E2 excretion as well as reductions in the serum concentration of 1,25-dihydroxyvitamin D and in urinary calcium excretion. These data suggest that hypercalciuria in some children with Bartter syndrome is associated with an excess of 1,25-dihydroxyvitamin D. The improvement in hypercalciuria with prostaglandin synthesis inhibition may result in part from correction of this vitamin D abnormality.