Table Of ContentPERSISTENT RENAL
GENITOURINARY DISORDERS
DEVELOPMENTS IN NEPHROLOGY
Gruskin, A.B. and Norman, M.E., eds.: Pediatric Nephrology. 1981.
ISBN 90-247-2514-3.
Schuck, 0., ed.: Examination of the Kidney Function. 1981.
ISBN 0-89838-565-2.
Strauss, 1., ed.: Hypertension, Fluid-Electrolytes and Tubulopathies in
Pediatric Nephrology. 1981. ISBN 90-247-2633-6.
Strauss, 1., ed.: Neonatal Kidney and Fluid-Electrolytes. 1983.
ISBN 0-89838-575-X.
Strauss, 1., ed.: Acute Renal Disorders and Renal Emergencies. 1984.
ISBN 0-89838-663-2.
Didio, L.LA. and Motta, P.M., eds.: Basic, Clinical and Surgical
Nephrology. 1985. ISBN 0-89838-698-5.
Friedman, E.A. and Peterson, C.M., eds.: Diabetic Nephropathy:
Strategy for Therapy. 1985. ISBN 0-89838-735-3.
Dzurik, R., Lichardus, B. and Guder, W., eds.: Kidney Metabolism and
Function. 1985. ISBN 0-89838-749-3.
Strauss, 1., ed: Homeostasis, Nephrotoxicity, and Renal Anomalies in the
Newborn. 1986. ISBN 0-89838-766-3.
Oreopoulos, D.G., ed: Geriatric Nephrology. 1986. ISBN 0-89838-781-7.
Paganini, E.P., ed: Acute Continuous Renal Replacement Therapy. 1986.
ISBN 0-89838-793-0.
Cheigh, 1.S., Stenzel, K.H. and Rubin, A.L., eds.: Hypertension in Kidney
Disease. 1986. ISBN 0-89838-797-3.
Deane, N., Wineman, R.l. and Bemis, 1.A., eds.: Guide to Reprocessing of
Hemodialyzers. 1987. ISBN 0-89838-798-1.
Ponticelli, C., Minetti, L. and D'Amico, G., eds.: Antiglobulins,
Cryoglobulins and Glomerulonephritis. 1987. ISBN 0-89838-810-4.
Persistent
Renal-Genitourinary
Disorders
Current Concepts in Dialysis and Management
Proceedings of Pediatric Nephrology Seminar XII
held at Bal Harbour, Florida
February 25-28, 1985
edited by
Jose Strauss, MD
Division of Pediatric Nephrology
University of Miami
School of Medicine
Miami, Florida, USA
with the assistance of
Louise Strauss, MS, MA
.,
~
Martinus Nijhoff Publishing
a member of the Kluwer Academic Publishers Group
Boston/Dordrecht/Lancaster
Distributors for North America:
Kluwer Academic Publishers
101 Philip Drive
Assinippi Park
Norwell, MA 02601, USA
Distributors for the UK and Ireland:
Kluwer Academic Publishers
MTP Press Limited
Falcon House, Queen Square
Lancaster LAI IRN, UNITED KINGDOM
Distributors for all other countries:
Kluwer Academic Publishers Group
Distribution Centre
Post Office Box 322
3300 AH Dordrecht, THE NETHERLANDS
Library of Congress Cataloging-In-Publication Data
Pediatric Nephrology Seminar (12th: 1985 : Bal Harbour,
Fla.)
Persistent renal-genitourinary disorders.
(Developments in nephrology; DIN 17)
Includes indexes.
I. Kidneys-Diseases-Congresses. 2. Genito-
urinary organs-Diseases-Congresses. 3. Pediatric
nephrology-Congresses. 4. Pediatric urology-Congres
ses. I. Strauss, Jose. II. Strauss, Louise.
III. Series: Developments in nephrology; 17.
[DNLM: 1. Kidney DIseases-in infancy & childhood
congresses. 2. Urologic Diseases-infancy & childhood
congresses. WI DE998EB v. 17/ WS 320 P373 1985p]
RF466.P3675 1985 618.92'6 86-28465
ISBN-13: 978-0-89838-845-9 e-ISBN-13: 978-1-4613-2339-6
001: 10. 1007/978-1-4613-2339-6
Copyright © 1987 by Martinus Nijhoff Publishing, Boston
Reprint of the original edition 1987
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise,
without the prior written permission of the publisher, Martinus Nijhoff Publishing, 101 Philip
Drive, Assinippi Park, Norwell, MA 02061.
ERNESTO STRAUSS
my big brother
found his own way to glory
*
living for giving
caring and sharing
1928-1985
CONTENTS
Foreword ••••••••...••••••••.••••••••••••••••••••••.••••••••••••..•... xi
Acknowledgements ••.•.•••••.•••••••••••••..•••••••••.•.••••••••••.•. xiii
PERSISTENT RENAL-GENITOURINARY DISORDERS
I PRIMARY NEPHROTIC SYNDROME
Idiopathic Nephrotic Syndrome:
Proliferative and Membranous Nephropathy ••••••••••••••••••••••••• 3
Russell W. Chesney and Antonia C. Novello
Focal and Segmental Glomerulosclerosis •••••••••••••••••••••••••• 23
Karen M. Gaudio and Norman J. Siegel
Abnormal Lipid Metabolism in Primary Nephrotic Syndrome ••••••••• 33
Gaston Zilleruelo, S.L. Hsia, Michael Freundlich,
Carolyn Abitbol, Milan Novak, Marianne Fordyce and
Jose Strauss
Mineral Metabolism in Nephrotic Syndrome •••••••••••••••••••••••• 45
Michael Freundlich, Gaston Zilleruelo, Carolyn
Abitbol and Jose Strauss
DISCUSSION: Primary Nephrotic Syndrome ••••••••••••••••••••••••• 51
Panelists: Russell Chesney, Michael Freundlich, Warren
Grupe, Norman Siegel and Gaston Zilleruelo
Moderator: Jose Strauss
II THE KIDNEY IN SYSTEMIC DISEASES
Renal Involvement in Vasculitic Syndromes in Children ••••••••••• 69
Norman J. Siegel and Karen M. Gaudio
The Kidney in Sickle Cell Disease ••••••••••••••••••••••••••••••• 77
Jose Strauss, Carolyn Abitbol, Gaston Zilleruelo
and Michael Freundlich
Renal Changes in Children with Congenital Heart Disease ••••••••• 87
Alan B. Gruskin
Renal Injury from Chemotherapeutic Agents ••••••••••••••••••••••• 95
Julie R. Ingelfinger
DISCUSSION: Systemic Diseases ••••••••••••••••••••••••••••••••• lll
Panelists: Alan B. Gruskin, Julie R. Ingelfinger,
Gwendolyn Scott, Norman J. Siegel and Carlos Vaamonde
Moderator: Jose Strauss
III NUTRITIONAL ASPECTS OF HYPERTENSION AND ATHEROSCLEROSIS
The Role of Sodium in Childhood Hypertension ••••••••••••••••••• 127
Alan B. Gruskin, Gary Lerner and Larry E. Fleischmann
Hormonal Factors in Juvenile Hypertension •••••••••••••••••••••• 137
Julie R. Ingelfinger
Nutritional Aspects of Hypertension and Atherosclerosis
Calcium: Does It Have a Role? •••••••••••••••••••••••••••••••• 145
Russell w. Chesney
Nutrition, Lipoproteins and Atherosclerosis in Childhood ••••••• 155
Peter O. Kwiterovich, Jr.
DISCUSSION: Hypertension and Atherosclerosis •••••••••••••••••• 171
Panelists: Sidney Blumenthal, Russell W. Chesney,
Jule R. Ingelfinger and Peter O. Kwiterovich
Jose Strauss, Moderator
IV CONGENITAL RENAL ANO~~LIES
Dilemmas Created by Prenatal Detection of Urinary Tract
Anomalies •••••••••••••••••••••••••••••••••••••••••••••••••••••• 181
Warren E. Grupe
Nutritional Aspects of Growth in Children with
Congenital Renal Anomalies ••••••••••••••••••••••••••••••••••••• 187
Carolyn Abitbol, Michael Freundlich, Gaston Zilleruelo
and Jose Strauss
DISCUSSION: Congenital Renal Anomalies •••••••••••••••••••••••• 193
Panelists: Carolyn Abitbol, Joan Chesney, Warren
E. Grupe, Abdollah Iravani, Catherine Poole, George
Sfakianakis, Norman J. Siegel
Moderator: Jose Strauss
V RENAL REPLACEMENT THERAPY
DIALYSIS
Four Years Experience - CAPD and CCPD in Children •••••••••••••• 207
Heinz E. Leichter, Isidro B. Salusky and
Richard Fine
Lipid Changes in Children on Dialysis •••••••••••••••••••••••••• 217
Gaston Zilleruelo, Milan Novak, Michael Freundlich,
Carolyn Abitbol and Jose Strauss
viii
Mineral Metabolism in Patients on Continuous
Ambulatory Peritoneal Dialysis ••••••••••••••••••••••••••••••••• 227
Michael Freundlich, Gaston Zilleruelo, Carolyn
Abitbol and Jose Strauss
DISCUSSION: Renal Replacement Therapy
Dialysis •••••••.••••••••.••••.••••••.•••••••••••..•.•....•...•. 235
Panelists: Richard Fine, Michael Freundlich, Gaston
Zilleruelo
Moderator: Jose Strauss
VI RENAL REPLACEMENT THERAPY
PROGRESSION OF RENAL DISEASES AND TRANSPLANTATION
Effects of Protein on Renal Funtion and Disease •••••••••••••••• 243
J. J. Bourgoignie
Protein and Energy Requirements in Renal Insufficiency ••••••••• 255
Warren Grupe, N. Spinozzi and W. Harmon
Progression of Chronic Renal Disease in Children:
The University of Miami Experience ••••••••••••••••••••••••••••• 265
Gaston Zilleruelo, Nuria Dominguez, Michael
Freundlich, Carolyn Abitbol and Jose Strauss
Mineral Metabolism in Children with End Stage
Renal Failure ..••••.•••.•••••.•••••..•••••.••••••.••..•••••••.• 271
Russell W. Chesney.
The Use of Cyclosporine in Pediatric Recipients
of Renal Transplants ••••••••••••••••••••••••••••••••••••••••••• 283
B.D. Kahan, C.T. Van Buren, S.B. Conley, M.T. Lorber
and S.M. Flechner
DISCUSSION: Renal Replacement Therapy
Progression of Renal Disease and Transplanta.tion ••••••••••••••• 293
Panelists: Jacques J. Bourgoignie, Russel W. Chesney,
Richard Fine, Warren E. Grupe, Barry Kahan, George
Kyriakides and Gaston Zilleruelo
Moderator: Jose Strauss
VII WORKSHOP: FOUR CASES •••••••••••••••••••••••••••••••••••••••••• 317
Moderator: Jose Strauss
PAATICIPANTS •••••••••••••••••••••••••••••••••••••••••••••••••••••••• 337
INDEXE s ............................................................. 341
ix
FOREWORD
This Pediatric Nephrology series is a focus on salient points which
at the time of each annual seminar are of importance to the practicing
pediatrician and nephrologist, the clinical researcher, and basic
researcher interested in clinical problems. Hence the format of
selected papers and panel discussions to capture the tenor of the times.
More thorough coverage of many of the subjects can be found in current
journals and textbooks listed in the authors' references. Those
searching for the conventional should look there rather than here since
our aim is not to cover each subject in its entirety but to secure
attention to the controversial aspects of the subjects, dispel the
notion that there is one answer to a question, and raise the level of
inclination toward dynamic problem solving.
The basic subject chosen this year reflects dominant concerns this
year and the participants chosen--speakers and discussants--represent
certain views relevant to the subject at this time. To reflect the
tempo and flavor produced by this unique blend, the discussions are
included almost verbatim. For some this means readability; for others,
excess verbiage. The careful reader will notice that I have been the
chairman of all sessions and have moderated all discussions. This is in
keeping with our aim to ferret out interrelated basic questions and
varying answers to the subjects--seen as related in problems and
solutions. In the discussions, all names have been deleted. This is in
agreement with participants who thus are encouraged to speak with less
inhibition and more candor. My point is, this volume must be evaluated
on the basis of its aim, not by standard textbook criteria.
I consider most valuable (30 M.D.) my realization that what is
considered known--"the facts"-is temporal, still a question in search
of a new answer--even what we think of as basic facts. I would consider
myself to have made a significant contribution to the field of medicine
if I could stimulate preference for a dynamic approach to any problem-
no matter how "standard". We too often see what we look for rather than
whatever else there might be, and in the very process of educating, dull
the inclination to question, consider alternatives. What seems to be
"old stuff"/"routine procedures" may not be/should not be. Of course,
we cannot face the volume of our responsibility without using routine
procedures; we do not have time or energy to question our every step
every day, but absolutely essential to the practice of "good medicine"
is an attitude of questioning--removal of the film of familiarity
covering truly unresolved questions.
Thus, my hope in this volume (as in the eleven preceding it) is to
gently disturb the status quo, to challenge the physician/researcher to
think as he acts, to see when he looks. Those who have conspired with
me in this effort this year include guest faculty Sidney Blumenthal,
Joan Chesney, Russell Chesney, Richard Fine, Warren Grupe, Alan Gruskin,
Julie Ingelfinger, Abdollah Iravani, Barry Kahan, Peter Kwiterovich,
Norman Siegel, Kirsti Thodenius, and local faculty Carolyn Abitbol,
Jacques Bourgoignie, Michael Freundlich, George Kyriakides, Jorge
Lockhart, Joshua Miller, Victoriano Pardo, Charles Lynne, Catherine
Poole, Gwendolyn Scott, George Sfakianakis, Carlos Vaamonde, and Gaston
Zilleruelo.
xii
