No abstract

Fourteen children, 2 to 16 years of age, were dialyzed three times weekly for periods of 1 to 27 months on the modified Kiil or Dow Hollow Fiber Kidney. There was one death—from recurrence of Wilms' tumor—and seven children received renal transplants. The superficial femoral, brachial, posterior tibial, or radial artery was cannulated and blood flow during dialysis was > 150 ml/minute without a pump. Mean pre-dialysis serum urea nitrogen levels of 70 to 86 mg/100 ml were maintained in children from 10 to 52 kg by varying the efficiency of the dialyzer and the number of dialysis hours with the size of the child. The children were active and symptoms of uremia were uncommon. Complications found included hemodynamic effects of the shunt, shunt clotting and infection, anemia, hypertension, heart failure, and renal osteodystrophy. Growth was related to calorie intake and was normal in four of eight children. Chronic dialysis was considered successful therapy for uremic children.

Abstracts 449 skin (wrist, ankle, back) and lesions and weekly urinalyses were done on 38 children in 6 families. One month later a 43-year-old mother, her 5-year-old twins, and an unrelated child, not in the study, had onset of acute nephritis (AGN) within a 14-day period. Findings included hematuria (4/4), proteinuria (3/4), hypertension (3/4), low serum complement and C'3 (4/4), and elevated streptococcal antibodies (4/4). All exhibited impetigo, and lesions in 3 of 3 patients cultured before treatment yielded type 57 streptococci. Throat cultures were negative and no pharyngitis preceded onset. Latent periods for the twins were 19 and 22 days. Type 57 streptococci reappeared on the normal skin of both twins after penicillin therapy, resulting in recurrence of lesions in one. Over a 10-week period 704 cultures from the twins and 4 siblings yielded 297 (42%) positive for group A streptococcus, of which 294 were M-57. Lesions accounted for 42%, normal skin sites for 47 % and nose and throat for 11%. Normal skin sites were positive for the M-57 strain in 4 of 6 children before development of lesions (mean 8 days). This strain was found in the respiratory tract (5 of 6) only after its recovery from normal skin and/or lesions. Impetigo with type 57 but no AGN occurred in 16 other children. This is the first report of the occurrence of type 57 nephritis in this country. Prospective studies document the skin as the initial site of infection in these patients with AGN. The nephritogenic strain was found on normal skin prior to the development of impetigo and reappeared after treatment. 54Kinetics of Peritoneal Dialysis in Children. A. B.