Acute Renal Disorders and Renal Emergencies: Proceedings of Pediatric Nephrology Seminar X held at Bal Harbour, Florida, January 30 – February 3, 1983 (Developments in Nephrology, 7)

My thoughts about the Hemolytic Uremic Syndrome (HUS) got started in 1961 along with my attempt to return to Argentina. As I sought my way in Buenos Aires, I visited Carlos Gianantonio whom I had met in Caracas the year before during the Pan American pediatric meetings. At that time he was actively working on HUS which had become an epidemic in Buenos Aires and other parts of Argentina. I was impressed by the team effort and devotion of his group to such heavy demands. They obviously were meeting the challenge at an amazingly high level under a very crippling physical situation with shortages of space, laboratories and equipment. His group together with Dr. Becu, at the time the pathologist at the Children's Hospital of Buenos Aires (we had met through his mother who was instrumental in arranging my return to Buenos Aires), wrote some of the classic papers on HUS. Through the years as Dr. Gianantonio became more involved in general pediatrics, the administrative aspects and its orientation in Latin America, he became known for his deep philosophical questions as to what we are doing and where we are going. His questions have obvious implications regarding an agressive approach to our pediatric nephrology patients. Front Matter....Pages i-xvi Front Matter....Pages 1-1 The Hemolytic-Uremic Syndromes: The Most Important Cause of Acute Renal Failure in Infants and Children....Pages 3-12 Past and Present of the Hemolytic Uremic Syndrome in Argentina....Pages 13-19 Thrombocytopenia in Hemolytic-Uremic Syndrome....Pages 21-31 Uric Acid Perturbations in the Hemolytic Uremic Syndrome....Pages 33-42 Extrarenal Manifestations of the Hemolytic Uremic Syndrome....Pages 43-50 Similarities and Differences between the Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura....Pages 51-68 Current Approaches to the Management of Hemolytic Uremic Syndrome....Pages 69-86 Panel Discussion: Hemolytic Uremic Syndrome....Pages 87-99 Front Matter....Pages 101-101 Perinatal Asphyxia: Pathophysiology and an Approach Towards Therapy....Pages 103-110 Seizures in Renal Diseases....Pages 111-114 Abdominal Mass in the Newborn....Pages 115-118 Near-Drowning and The Kidney....Pages 119-130 Intoxications in Children: A Nephrological Approach....Pages 131-142 Treatment of Severe Hypertension in Children with Renal Disease....Pages 143-185 Panel Discussion: Renal Emergencies....Pages 187-197 Front Matter....Pages 199-199 A Therapeutic Update of Superficial Skin Infections....Pages 201-207 Glomerulonephropathies Causing the Acute Nephritic Syndrome: Similarities and Differences....Pages 209-230 Circulating Immune-Complexes in Glomerular Disease....Pages 231-238 Acute Manifestations of Systemic Lupus Erythematosus....Pages 239-255 Renal Imaging in Acute Renal Disorders — Renal Emergencies....Pages 257-265 Front Matter....Pages 199-199 Antimicrobial Agents in Urinary Tract Infections....Pages 267-275 Panel Discussion: Acute Renal Diseases....Pages 277-282 Front Matter....Pages 285-285 Etiopathogenesis and Differential Diagnosis of Acute Renal Failure....Pages 287-296 Mineral Metabolism in Acute Renal Failure....Pages 297-302 Antimicrobial Therapy in Renal Failure....Pages 303-310 Therapeutic Approach to the Child with Acute Renal Failure....Pages 311-338 Some Aspects of Treatment of Septic Shock....Pages 339-353 Panel Discussion: Acute Renal Failure....Pages 355-368 Front Matter....Pages 371-371 Workshop: Clinico-Pathologic Correlations....Pages 373-395 Peritoneal Dialysis in Children....Pages 397-407 The Proceedings of the Fifth International Pediatric Nephrology Symposia are dedicated to those who make the writing possible: the delegates; those who wanted to attend, but could not, and to our colleagues, families and friends who helped organize the meeting. with the advent of certification of pediatric nephrologists in the USA and the increasing numbers of pediatric nephrologists contributing to and practic­ ing this specialty throughout the world, it is appropriate that we begin to record our international symposia in order to periodically document the State of the Art of pediatric nephrology and to share new information in a timely fashion with colleagues who care for children. Four previous international pediatric nephrology symposia have been spon­ sored by the International Pediatric Nephrology Association. These meetings were held in Guadalajara, Mexico, 1968, Paris, France, 1971, Washington, DC, USA, 1974 and Helsinki, Finalnd, 1977. This is the first time that it has been possible to organize the publication of the proceedings of a symposium. The enclosed manuscripts represent more than seventy percent of the symposia presentations delivered at the Fifth International Pediatric Symposia (October 6-10, 1980, Phila., PAl which was - hosted by St. Christopher's Hospital for Children and The Children's Hospital of Philadelphia representing the Departments of Pediatrics of Temple University School of Medicine and The University of Pennsylvania School of Medicine. The purpose of this volume and Pediatric Nephrology Seminar IX from which it was created is to provide easy access to current concepts in the diagnosis and management of kidney diseases in the newborn. Complimentary to this purpose is the opportunity the Seminar structure gives me to invite those particularly interested in the subject chosen to come together, share experiences and ideas in an unhurried, unpressured atmosphere for four con­ tinuous days - an oasis for me and, I am told, also for the faculty and registrants. This year's subject choice is an expression of my perennial interest in the kidney of the newborn. A step back to view the steps forward reveals unwittingly intertwined associations and actions which now fall into focus. When I was just beginning my pediatric nephrology training with Sol Kaplan at Downstate in Brooklyn, we discussed Bob Usher's pioneering thought that there was something wrong with the kidneys of babies with RDS. Without really knowing what needed to be done, I started looking at the kidneys of those babies. Subsequently, Dick Day who was Chairman of the Department of Pedia­ trics there, stopped me in the hall, and asked me to come into his office. Glowing in quiet introspection, he extolled the joy of working with one's hands, then hurried away to his laboratory. He had been the Director of the Newborn Nursery at Babies Hospital before coming to Downstate, and (as I later found out) was trying to do something with oxygen electrodes. A year or so after Dr. Robert Popovieh arrived in Seattle in 1965 to begin working on his doctoral thesis under Dr. A.L. Babb, we had just begun work to try to prove the prediction that the peritoneum had a higher permeability to'middle molecules'than hemodialysis membranes [I]. Several years later, when Dr. Popovieh accepted a position at the University of Texas in Austin, he decided to concentrate his research efforts in the area of peritoneal dialysis and everyone knows how successful that effort has become [2]. Indeed, because of continuous ambulatory peritoneal dialysis (CAPD), long-term per­ itoneal dialysis after a two-decade incubation period is finally becoming an equal option to hemodialysis and transplantation in the management of chronic renal failure. For me this development represents final vindication of a twenty-year effort to help promote peritoneal dialysis, often in the face of enormaus opposition. I particularly remember a policy meeting at the NIH a few years back in which it was decided by my colleagues on the committee that long term peritoneal dialysis had no future and therefore no funds for projects in this area would be forthcoming. Based on the excellent results that Boen and later Tenckhoff had been getting in our Seattle program, I knew the committee was wrong and tried to convince them otherwise. Naturally, being the only favorable vote, I failed. I often wonder how many years this decision and others like it set back peritoneal dialysis. The thrust here is for those who want to know more than the answer to an exam question - an approach to disease diagnosis and treatment which emphasizes thoughtful consideration of alternatives, finding ones way through uncertainties and lack of knowledge. The annual seminar on which this volume is based has evolved into a forum for open discussion of puzzling questions - actually old questions in the light of new data. To me, the adventure of life is in recognizing the openendedness of all things. So you thought that a certain disease was a settled question? In medicine a'settled'question is a transient conclusion. Even the solutions to the so-called simplest problems have another side. Our aim this year was to air out concepts and conclusions about hypertension, fluid-electrolytes, and tubulopathies. The stars were Drs. Juan Rodriguez-Soriano, Alan Gruskin, and Donald Potter, along with Drs. Gustavo Gordillo, Ronald Kallen, and Antonia Novello as guest faculty. Local stars included Drs. Mary Jane Jesse, Jacques Bourgoignie, and Carlos Vaamonde. Their contributions added to those of the other faculty and registrants, coalesced into vibrant exchanges which are reproduced here for the reader's perusal. Edited By José Strauss ; With The Assistance Of Louise Strauss. Includes Bibliographical References And Indexes. Proceedings of Pediatric Nephrology Seminar X, Held at Bal Harbour, Florida, January 30 - February 3, 1983