Common renal problems in pediatric medicine

Management of Hematuria in Children

Purpose of Review

This paper provides a review of the diagnostic evaluation of both microscopic and gross hematuria, as well as an update on the pathogenesis, clinical features, and treatment strategies for several diseases of the kidneys and urinary tract in which hematuria is a prominent finding. The goal is to provide pediatric providers with a framework through which appropriate and expeditious referral to subspecialty care may be made for definitive treatment.

Recent Findings

Although there has been great heterogeneity in published treatment strategies for many causes of hematuria, the Kidney Diseases Improving Global Outcomes (KDIGO) initiative has recently set forth guidelines for glomerular diseases in particular to provide evidence-based strategies for treatment. In addition, recent advances in the understanding of molecular pathogenesis and long-term clinical outcomes for other non-glomerular diseases has led to updates in treatment strategies summarized in this review.

Summary

As the pediatric primary care provider is often the first point of contact for children with microscopic or gross hematuria, updated knowledge as to the epidemiology and management of several of the various causes of hematuria will improve the care of children by both avoiding extraneous testing and interventions and implementing definitive care (either by expectant management and reassurance or by subspecialty referral) in a timely manner.

Predictive factors of acute renal failure in colon and rectal surgery

Postoperative acute renal failure (ARF) is a major factor of morbidity and mortality in colon and rectal surgery. The objectives of this study were: 1) to determine the frequency of ARF in colorectal surgery; and 2) to evaluate the impact of patient characteristics, comorbidities, resection type, pathology, surgical technique, and admission type on ARF. Using the National Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2006 to 2008. A total of 975,825 patients underwent colorectal resection during this period. Overall, the rate of ARF was 7.41 per cent (elective surgery: 3.38% vs emergent surgery: 12.99% ; P<0.01). Using multivariate regression analysis, chronic renal failure (adjusted odds ratio [AOR], 5.37), emergent operation (AOR, 2.64), total colectomy (AOR, 2.61), age 65 years or older (AOR, 2.02), liver disease (AOR, 1.82), congestive heart failure (AOR, 1.81), alcohol abuse (AOR, 1.67), peripheral vascular disease (AOR, 1.50), obesity (AOR, 1.45), malignant tumor (AOR, 1.44), open operation (AOR, 1.37), male sex (AOR, 1.37), left colectomy (AOR, 1.32), black race (AOR, 1.22), and teaching hospital (AOR, 1.05) were associated with higher risk of ARF. There was no association between hypertension, diabetes, chronic lung disease, smoking, transverse colectomy, proctectomy, diverticulitis, ulcerative colitis, or Crohn's disease and ARF. Chronic renal failure, emergent operation, total colectomy and age 65 years or older are potent independent predictors of ARF. In high-risk circumstances, specific care should be taken to prevent renal insults.