Wenzl, James E.

A survey of the case records of children seen at the Mayo Clinic from 1935 to 1965 revealed that 77 had nephro-ureterolithiasis and 6 had nephrocalcinosis. Calculous disease occurred twice as frequently in boys as in girls; the incidence did not change with age between the ages of 1 and 15 years. Urologic lesions, urinary infections, or both were present in 49 children and cystinuria was present in 5. In 8 children, renal stones were considered causally related to hypercalciuria, whereas in 14 children no etiologic associations could be found. Chemical analysis of calculi, which was performed in 36 cases, revealed that most stones consisted of calcium oxalate or phosphate; no uric acid stones were found.

Radioisotope renograms with orthoiodohippurate-I131 were obtained for 41 children who had known renal or renovascular disorders. (Two patients had hypertension but no evidence of renal disease.) Values determined for various components of the renogram curves were considered abnormal when they exceeded two standard deviations from the mean values for normal children of similar body surface area or when time B (from injection to the point of maximal radioactivity) exceeded 6.5 minutes or differed from the contralateral kidney by more than 1 minute. The renogram was clearly abnormal in all 17 patients who had unilateral or predominantly unilateral renal disorders. Abnormalities associated with bilateral renal disorders varied with the disease and its severity. The clinical severity of impairment of renal function could be estimated from the renogram. The isotope renogram proved to be a simple, reproducible technique for determination of function of the separate kidneys.

Isotope renograms (ortho-iodohippurate-I were obtained from 30 children who had no evidence of renal disease. Determinations were made by a standardized technique with the subjects in a state of relative dehydration; in 15 children the renogram was repeated under conditions of hydration (14 children) or further dehydration (1 child). Values for the point of initial peak (point A), point of maximal radioactivity (point B), and the differences between these points (B-A) were calculated. These values were plotted arithmetically against surface area to obtain regression lines and estimates of the variability of the observations about the line. The time from appearance of radioactivity to peak radioactivity was calculated and found to fall into a relatively narrow range. Similar attempts to correlate mathematically the height of timed segments of the decreasing slope of the renogram with surface area were successful in children with a body surface area of 1.15 m2 or greater. The state of hydration appeared to influence the excretory slope of the renogram; this effect was most pronounced in children whose total body surface area was less than 1.15 m2.

At the Mayo Clinic 711 children, ranging in age from birth to 15 years, were examined for the presence of spider nevi. The children were divided into three groups: normal controls, patients with chronic illness and patients with disease of the central nervous system. In the normal children, the incidence of spider nevi increased rapidly after 2 years of age to reach a plateau at about the time of puberty for both sexes. In children more than 13 years of age the incidence appeared to be decreasing, presumably toward the stated incidence of 12 to 15% in so-called normal adults. In normal children, spider nevi appeared to occur more frequently in pubertal females than in pubertal males. The incidence was increased in both sexes in patients more than 4 years of age with disease of the central nervous system. In patients with chronic illnesses, there was no significant increase in spider nevi, but the ratio of pubertal females to pubertal males was reversed. The anatomic distribution in all groups differed from that of adults, the dorsum of the hands and forearms being the sites of predilection in children. In view of the frequency of these lesions in childhood, it appears that the presence of spider nevi in otherwise healthy children is an insignificant stigma.