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1/8. Percutaneous antegrade pyelography in small infants and neonates.

    Percutaneous antegrade pyelography is a safe and useful alternative to retrograde pyelography in the investigation of urinary-tract malformations in the neonate or very young infant. It is preferred to arteriography in the infant with a loin mass. Satisfactory delineation of hydronephrosis or cysts is simply and directly accomplished by this method, so that more complex and less definitive investigations can often be avoided. In addition, a variety of ureteric abnormalities may be displayed.
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2/8. Preimplantation genetic diagnosis for polycystic kidney disease.

    OBJECTIVE: To use preimplantation genetic diagnosis for achieving a polycystic kidney disease (PKD)-free pregnancy for a couple in which the female partner was affected by PKD but whose PKD1 or PKD2 carrier status was not established. DESIGN: Case report. SETTING: The IVF program of Reproductive genetics Institute, chicago, illinois. PATIENT(S): An at-risk couple with the female partner affected by PKD, whose PKD1 or PKD2 carrier status was not established. INTERVENTION(S): Removal of PB1 and PB2 and testing for three closely linked markers to PKD1 (Kg8, D16S664, and SM7) and four closely linked markers to PKD2 (D4S2922, D4S2458, D4S423, and D4S1557) after standard IVF. MAIN OUTCOME MEASURE(S): Deoxyribonucleic acid analysis of PB1 and PB2 indicating whether corresponding oocytes were PKD1 or PKD2 allele free, for the purpose of transferring only embryos resulting from mutation-free oocytes. RESULT(S): Of 11 oocytes tested by PB1 and PB2 dna analysis, 7 were predicted to contain PKD1 or PKD2, with the remaining 4 free of both mutations. Three embryos resulting from these oocytes were transferred, yielding a twin pregnancy and the birth of two unaffected children. CONCLUSION(S): This is the first preimplantation genetic diagnosis for PKD, which resulted in the birth of healthy twins confirmed to be free of PKD1 and PKD2. Preimplantation genetic diagnosis based on linked marker analysis provides an alternative for avoiding the pregnancy and birth of children with PKD, even in at-risk couples without exact PKD1 or PKD2 carrier information.
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3/8. Gabapentin in the treatment of uremic itch: an index case and a pilot evaluation.

    BACKGROUND: The prevalence of renal itch in patients on dialysis is approximately 30%, but its treatment is often ineffective. We describe an index case of a hemodialysis (HD) patient suffering from painful diabetic neuropathy (PDN) treated with gabapentin; the first administration of the drug led to the complete remission of the concomitant uremic pruritus. Subsequently, we report the results of a pilot evaluation aimed at testing the effectiveness and safety of low gabapentin doses in HD patients with uremic pruritus. methods: Five consecutive HD patients unresponsive to antihistamines received 4-week gabapentin treatment at a starting dose of 100 mg after every thrice-weekly HD, which was subsequently adjusted based on clinical response. Puritus severity was evaluated by means of a visual analogue scale (VAS) before each HD session on days 0, 2, 4, 7, 14, 21, 28 and 35. safety was assessed using adverse event data. RESULTS: All patients experienced a rapid subjective improvement in pruritus, with the mean VAS score decreasing from 8.4-1.6 after the first drug administration. Three patients required a dose increase to 100 mg four times a week to obtain better itch control. Two patients experienced complete itch remission. CONCLUSION: Although a double-blind placebo-controlled clinical trial should be conducted to better elucidate the efficacy and toxicity of gabapentin in patients with uremic itch, our data suggest that gabapentin could be considered an effective and safe alternative treatment for uremic pruritus.
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4/8. Continuous arteriovenous hemofiltration: an alternative dialysis therapy in neonates.

    Modifications have made it possible to perform CAVH in the neonate. One of these is decreasing the extravascular volume in the tubing and filter to a minimal amount to allow for adequate intravascular blood volume in the infant. Another is utilizing predilutional fluid to decrease the need for heparinization. A third modification is utilizing the suction-assist pumps to help control the amount of fluid removed from the infant. With modifications of this system to fit the special needs of neonates and intensive nursing and medical management, CAVH can be a successful alternative to traditional dialysis therapies in neonates.
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5/8. hypertension and multicystic kidney.

    The optimal management of the asymptomatic patient with a multicystic kidney remains a dilemma. The risk of nephrectomy in a neonate or infant with this lesion is small and the morbidity is minimal. The alternative to elective nephrectomy is life-long follow-up with blood pressure determinations, beginning in infancy. We report herein two infants with multicystic kidney (MCK) in whom hypertension was cured by its removal. Since accurate blood pressure measurements are relatively difficult to obtain in infants and since periodic long-term follow-up is difficult in the best of circumstances, we are concerned that hypertension caused by a retained MCK goes undiagnosed perhaps more frequently than a review of the current literature suggests. Such hypertension may result in contralateral renal damage and arteriosclerosis, so that later removal of the MCK may not have a beneficial effect on the elevated blood pressure.
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6/8. Percutaneous puncture of abdominal cystic masses in children.

    A technique of percutaneous puncture and opacification of cystic abdominal masses is outlined, and its diagnostic and therapeutic potential demonstrated in a series of 16 masses in 15 children. It is suggested as an alternative to ultrasound and computed tomography in certain situations.
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7/8. Continuous percutaneous cyst drainage for multicystic kidney.

    We report a patient with a multicystic kidney treated successfully by continuous percutaneous drainage. This method may be an alternative to surgical resection of a multicystic kidney that has not involved after one year of follow-up.
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8/8. mycobacterium tuberculosis infection of a native polycystic kidney following renal transplantation.

    BACKGROUND: Tuberculosis is a recognized complication following renal transplantation. patients with autosomal dominant polycystic kidney disease are increasingly being offered renal transplantation as an alternative to chronic hemodialysis. These patients are uniquely susceptible to serious upper urinary tract infections that are associated with significant morbidity and mortality. While involvement with gram-negative organisms is well described, mycobacterial infection of native polycystic kidneys after transplantation has not been addressed. methods: A case report of a renal transplant recipient who suffered an isolated mycobacterium tuberculosis infection of a native polycystic kidney and a literature review. RESULTS: Despite appropriate drug therapy, the infection proved refractory, and the patient required nephrectomy. CONCLUSIONS: Mycobacterial tuberculosis, though not common, must be recognized as a potential source of infection of native polycystic kidneys in immunocompromised transplant recipients. Similar to the pattern observed with more common pathogens, these infections may be difficult to eradicate with standard antimicrobial drug regimens.
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