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Adrenal and Renal Physiology, and Medical Renal Disease
ADRENAL AND RENAL PHYSIOLOGY, AND MEDICAL RENAL DISEASE nonmonosymptomatic bedwettings in children without NUC was 14%. Arousal difficulty and a positive family history were found in 67% and 11% of children with nocturnal wetting, respectively. The severity of bedwetting and arousal difficulty was significantly greater in infants than in preschool and school-age children. Conclusions: The results from the cross-sectional and retrospective surveys showed that the most important period of attaining NUC is 2 to 3 years of age. Nearly 90% of children attained NUC by the age of 5. Editorial Comment: This is a fascinating study that suggests a large number of Chinese children obtain nighttime dryness before age 2 years. In the United States 20% of children are still wet at age 5 years and 5% are still wet at 10 years. Since many infants in China sleep in bed with their parents, a sudden movement of the arm, leg or body during sleep triggers the mother or father to awaken and help the child to void. Although I do not believe a similar study has been done in young children from Western countries, it appears that the approach to nocturnal enuresis practiced in China as described here may be effective. It may be that sleeping in the same bed with the parent is as effective as a wetting alarm, even in young children. Douglas A. Canning, M.D.
ADRENAL AND RENAL PHYSIOLOGY, AND MEDICAL RENAL DISEASE Risk of Hypertension in Primary Vesicoureteral Reflux A. C. Simoes e Silva, J. M. Silva, J. S. Diniz, S. V. Pinheiro, E. M. Lima, M. A. Vasconcelos, M. R. Pimenta and E. A. Oliveira, Pediatric Nephrourology Unit, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Brazil Pediatr Nephrol 2007; 22: 459 – 462. The aim of this report was to estimate the risk of hypertension in children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR at a single tertiary renal unit. Of 735 patients, 664 (90%) were systematically followed and had multiple measurements of blood pressure. Hypertension was defined as values persistently above 95th for age, sex, and height in three consecutive visits. Risk of hypertension was analyzed by the Kaplan-Meier method. Of 664 patients followed, 20 (3%) developed hypertension. The estimated probability of hypertension was 2% (95%CI, 0.5%–3%), 6% (95%CI, 2%–10%), 15% (95%CI, 11%–20%) at 10, 15, and 21 years of age, respectively. The prevalence of hypertension has increased with age: it was 1.7% for patients with 1 yr–9.9 yr, 1.8% for adolescents with 10 yr–14.9 yr, 4.7% for patients with 15–19.9 yr, and 35% for patients⬎20 years at the end of the follow-up (P⬍0.001). It was estimated by survival analysis that 50% of patients with unilateral and bilateral renal damage would have sustained hypertension at about 30 and 22 years of age, respectively. Hypertension increased with age and was strongly associated with renal damage at entry in an unselected population of primary VUR. Editorial Comment: This is a large study in which the development of hypertension was quantitated in children with reflux. The take home message is that the risk of hypertension is related to the presence of previous renal damage and the severity of renal damage (determined by dimercapto-succinic acid scan), and depends on whether the reflux is unilateral or bilateral. Patients at greatest risk are those with bilateral reflux and significant scarring, approximately 50% of whom will have hypertension as they reach young adulthood. W. Scott McDougal, M.D.
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ADRENAL AND RENAL PHYSIOLOGY, AND MEDICAL RENAL DISEASE Risk of Hypertension in Primary Vesicoureteral Reflux A. C. Simoes e Silva, J. M. Silva, J. S. Diniz, S. V. Pinheiro, E. M. Lima, M. A. Vasconcelos, M. R. Pimenta and E. A. Oliveira, Pediatric Nephrourology Unit, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Brazil Pediatr Nephrol 2007; 22: 459 – 462. The aim of this report was to estimate the risk of hypertension in children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR at a single tertiary renal unit. Of 735 patients, 664 (90%) were systematically followed and had multiple measurements of blood pressure. Hypertension was defined as values persistently above 95th for age, sex, and height in three consecutive visits. Risk of hypertension was analyzed by the Kaplan-Meier method. Of 664 patients followed, 20 (3%) developed hypertension. The estimated probability of hypertension was 2% (95%CI, 0.5%–3%), 6% (95%CI, 2%–10%), 15% (95%CI, 11%–20%) at 10, 15, and 21 years of age, respectively. The prevalence of hypertension has increased with age: it was 1.7% for patients with 1 yr–9.9 yr, 1.8% for adolescents with 10 yr–14.9 yr, 4.7% for patients with 15–19.9 yr, and 35% for patients⬎20 years at the end of the follow-up (P⬍0.001). It was estimated by survival analysis that 50% of patients with unilateral and bilateral renal damage would have sustained hypertension at about 30 and 22 years of age, respectively. Hypertension increased with age and was strongly associated with renal damage at entry in an unselected population of primary VUR. Editorial Comment: This is a large study in which the development of hypertension was quantitated in children with reflux. The take home message is that the risk of hypertension is related to the presence of previous renal damage and the severity of renal damage (determined by dimercapto-succinic acid scan), and depends on whether the reflux is unilateral or bilateral. Patients at greatest risk are those with bilateral reflux and significant scarring, approximately 50% of whom will have hypertension as they reach young adulthood. W. Scott McDougal, M.D.
1505