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Paediatric renal transplant

Agnieszka Prytuła, Teun van Gelder
The calcineurin inhibitor tacrolimus, cornerstone of most immunosuppressive regimens, is a drug with a narrow therapeutic window: underexposure can lead to allograft rejection and overexposure can result in an increased incidence of infections, toxicity and malignancies. Tacrolimus is metabolised in the liver and intestine by the cytochrome P450 3A (CYP3A) isoforms CYP3A4 and CYP3A5. This review focusses on the clinical aspects of tacrolimus pharmacodynamics, such as efficacy and toxicity. Factors affecting tacrolimus pharmacokinetics, including pharmacogenetics and the rationale for routine CYP3A5*1/*3 genotyping in prospective paediatric renal transplant recipients, are also reviewed...
February 26, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Alexander Fichtner, Caner Süsal, Claudia Schröder, Britta Höcker, Susanne Rieger, Rüdiger Waldherr, Jens H Westhoff, Anja Sander, Duska Dragun, Burkhard Tönshoff
Background: We analysed in a carefully phenotyped cohort of paediatric patients the association of serum angiotensin II type 1 receptor antibodies (AT1R-Ab) with specific histological lesions and with graft function and survival in conjunction with overall and complement-binding donor-specific human leucocyte antigen donor-specific antibodies (HLA-DSA). Methods: Sera of 62 patients at the time of renal graft biopsy for clinical indication >1 year post-transplant were assessed for AT1R-Ab by enzyme-linked immunosorbent assay (ELISA) and for DSA and C1q-fixing DSA by single-antigen bead technology...
February 12, 2018: Nephrology, Dialysis, Transplantation
Victoria Birlutiu, Rares Mircea Birlutiu
RATIONALE: Haemolytic-uremic syndrome is a rare but serious complication of bacterial and viral infections, which is characterized by the triad of: acute renal failure, microangiopathic haemolytic anemia and thrombocytopenia, sometimes severe, requiring peritoneal dialysis. In Europe, hemolytic-uremic syndrome (HUS) in paediatric pathology is primarily caused by Shiga toxin-producing Escherichia coli (STEC) O157, followed by O26. Beside these etiologies, there are other bacterial and viral infections, and also noninfectious ones that have been associated to lead to HUS as well: in the progression of neoplasia, medication-related, post-transplantation, during pregnancy or associated with the antiphospholipid syndrome, systemic lupus erythematosus or family causes with autosomal dominant or recessive inheritance...
February 2018: Medicine (Baltimore)
Rubens Caliento, Dmitry José de Santana Sarmento, Érika Mont'alverne Pereira Silva, Tânia Regina Tozetto-Mendoza, Priscila Lie Tobouti, Vanda Benini, Paulo Henrique Braz-Silva, Marina Gallottini
OBJECTIVE: Previous research demonstrated that salivary shedding of HSV-1 and EBV occurs often in adult renal transplant recipients, but there is a lack of studies on the presence of them in the saliva of paediatric population. Therefore, the objective of this study is to describe oral characteristics and to compare the shedding profile of HSV-1 and EBV in the saliva of children with renal transplant to that of chronic kidney disease patients and controls. METHODS: This is a cross-sectional study involving 100 children, being 25 renal transplant recipients, 25 chronic kidney disease patients and 50 healthy children...
February 6, 2018: Acta Odontologica Scandinavica
Neil K Fennelly, Claire Kennedy, Allan C Jenkinson, Dervla M Connaughton, Caragh Stapleton, Anthony M Dorman, Brendan Doyle, Peter J Conlon
BACKGROUND: IgA nephropathy is the most common primary glomerulonephritis worldwide and a significant cause of end-stage renal disease (ESRD). While most cases of IgA nephropathy are considered sporadic, familial cases have been reported. METHODS: We performed a national audit of 1,809 patients attending renal clinics and dialysis units to identify a family history among patients with kidney disease. We reviewed all renal biopsies performed at our institution spanning a 30-year period...
January 19, 2018: Nephron
S R Ali, I Shaheen, D Young, I Ramage, H Maxwell, D A Hughes, D Athavale, M G Shaikh
Calcineurin inhibitors post-renal transplantation are recognized to cause tubulopathies in the form of hyponatremia, hyperkalemia, and acidosis. Sodium supplementation may be required, increasing medication burden and potentially resulting in poor compliance. Fludrocortisone has been beneficial in addressing tubulopathies in adult studies, with limited paediatric data available. A retrospective review of data from an electronic renal database from December 2014 to January 2016 was carried out. Forty-seven post-transplant patients were reviewed with 23 (49%) patients on sodium chloride or bicarbonate...
January 18, 2018: Pediatric Transplantation
Ankit Sharma, Anne M Durkan
BACKGROUND: Transplantation is the preferred modality for renal replacement therapy in children. With increasing rates of re-transplantation within the paediatric population, there are more sensitised children on waiting lists. One issue with developing strategies to treat these children is the number of different definitions of sensitisation. and we would therefore recommend an immunological risk stratification approach. METHODS: We discuss methods of sensitisation prevention, assessment and management, including paired exchange programmes and desensitisation protocols...
January 13, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Britta Höcker, Martin Aguilar, Paul Schnitzler, Lars Pape, Martin Bald, Jens König, Stephen D Marks, Gurkan Genc, Anja Büscher, Markus J Kemper, Heiko Billing, Martin Pohl, Luca Dello Strologo, Nicholas J A Webb, Susanne Rieger, Annette Mankertz, Kai Krupka, Thomas Bruckner, Alexander Fichtner, Burkhard Tönshoff
BACKGROUND: Avoidance of vaccine-preventable infections in paediatric renal allograft recipients is of utmost importance. However, the development and maintenance of protective vaccination titres may be impaired in this patient population owing to their need for immunosuppressive medication. METHODS: In the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN), we therefore performed a multi-centre, multi-national study and analysed vaccination titres pre- and post-transplant in 155 patients with serial titre measurements in comparison with published data in healthy children...
January 10, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Pauline Lancia, Beate Aurich, Phuong Ha, Anne Maisin, Véronique Baudouin, Evelyne Jacqz-Aigrain
BACKGROUND: Progress in immunosuppression has reduced acute rejection, graft loss and mortality after renal transplantation. Adverse drug reactions are well described in adults but few data are available in children. Our objectives were to analyse the adverse events reported in the first 3 years post-transplantation in children receiving tacrolimus or cyclosporine-based immunosuppression and compare them with the information of the Summary of Product Characteristics. METHODS: This retrospective study included all children who underwent a renal transplant at Hospital Robert Debré between 2002 and 2015...
February 2018: Clinical Drug Investigation
J R F Wilson, F Saeed, A K Tyagi, J R Goodden, G Sivakumar, D Crimmins, M Elliott, S Picton, P D Chumas
INTRODUCTION: The neutrophil-lymphocyte count ratio (NLCR) is an established prognostic marker for renal, lung and colorectal carcinomas and has been suggested to be predictive of histological grade and outcome in adult intracranial tumours. The purpose of this study was to determine whether a correlation of the pre-operative neutrophil count (NC) and NLCR with the final histological grade exists in paediatric intracranial tumours. METHODS: A retrospective analysis was undertaken at a single centre...
November 29, 2017: Acta Neurochirurgica
Jaythoon Hassan, Jonathan Dean, Cillian F De Gascun, Michael Riordan, Clodagh Sweeney, Jeff Connell, Atif Awan
BACKGROUND: Epstein-Barr virus (EBV) was the first human virus identified to express microRNA (miRNA). To date, 44 mature miRNAs are encoded for within the EBV genome. EBV miRNAs have not been profiled in paediatric renal transplant recipients. In this study, we investigated circulating EBV miRNA profiles as novel biomarkers in paediatric renal transplant patients. METHODS: Forty-two microRNAs encoded within 2 EBV open reading frames (BART and BHRF) were examined in renal transplant recipients who resolved EBV infection (REI) or maintained chronic high viral loads (CHL), and in non-transplant patients with acute infectious mononucleosis (IM)...
November 28, 2017: Journal of Nephrology
Charlotte Gimpel, Fred E Avni, Carsten Bergmann, Metin Cetiner, Sandra Habbig, Dieter Haffner, Jens König, Martin Konrad, Max C Liebau, Lars Pape, Georg Rellensmann, Andrea Titieni, Constantin von Kaisenberg, Stefanie Weber, Paul J D Winyard, Franz Schaefer
Importance: Prenatal and neonatal cystic kidney diseases are a group of rare disorders manifesting as single, multiple unilateral, or bilateral cysts or with increased echogenicity of the renal cortex without macroscopic cysts. They may be accompanied by grossly enlarged kidneys, renal oligohydramnios, pulmonary hypoplasia, extrarenal abnormalities, and neonatal kidney failure. The prognosis is extremely variable from trivial to very severe or even uniformly fatal, which poses significant challenges to prenatal counseling and management...
January 1, 2018: JAMA Pediatrics
Nicholas C Chesnaye, Karlijn J van Stralen, Marjolein Bonthuis, Jaap W Groothoff, Jérôme Harambat, Franz Schaefer, Nur Canpolat, Arnaud Garnier, James Heaf, Huib de Jong, Søren Schwartz Sørensen, Burkhard Tönshoff, Kitty J Jager
Background: The impact of donor age in paediatric kidney transplantation is unclear. We therefore examined the association of donor-recipient age combinations with graft survival in children. Methods: Data for 4686 first kidney transplantations performed in 13 countries in 1990-2013 were extracted from the ESPN/ERA-EDTA Registry. The effect of donor and recipient age combinations on 5-year graft-failure risk, stratified by donor source, was estimated using Kaplan-Meier survival curves and Cox regression, while adjusting for sex, primary renal diseases with a high risk of recurrence, pre-emptive transplantation, year of transplantation and country...
September 15, 2017: Nephrology, Dialysis, Transplantation
Jaap W Groothoff, Martin Offringa, Martha Grootenhuis, Kitty J Jager
Few data exist on the prospects in adulthood for children on chronic renal replacement therapy (RRT). This article summarizes the results of a comprehensive Dutch long-term follow-up study performed in 2000 and 2010 of patients with RRT onset at age <15 years between 1972 and 1992. After a median of 25.5 RRT years, patients had stayed 23% of RRT time on dialysis. We observed a 30 times greater mortality risk compared with age-matched peers with cardiovascular disease (CVD) as the main cause of death during 1972-2000 and infections during 2000-10...
July 7, 2017: Nephrology, Dialysis, Transplantation
Britta Höcker, Martin Aguilar, Paul Schnitzler, Lars Pape, Luca Dello Strologo, Nicholas J A Webb, Martin Bald, Gurkan Genc, Heiko Billing, Jens König, Anja Büscher, Markus J Kemper, Stephen D Marks, Martin Pohl, Marianne Wigger, Rezan Topaloglu, Susanne Rieger, Kai Krupka, Thomas Bruckner, Alexander Fichtner, Burkhard Tönshoff
BACKGROUND: Because infections constitute a major cause of morbidity and mortality in paediatric renal allograft recipients, avoidance of preventable systemic infections by vaccination before transplantation is of utmost importance. However, data on the completeness of vaccinations and factors associated with incomplete vaccination coverage are scarce. METHODS: Within the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN), we therefore performed a multi-centre, multi-national, retrospective study investigating the vaccination coverage before transplantation of 254 European children with end-stage renal disease (mean age 10...
October 5, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Jon Jin Kim, Olivia Shaw, Chloe Martin, George Michaelides, Ramnath Balasubramaniam, Neil J Sebire, Nizam Mamode, Anthony Dorling, Robert Vaughan, Stephen D Marks
INTRODUCTION: We have previously shown that children who developed de novo donor-specific human leukocyte antigen (HLA) antibodies (DSA) had greater decline in allograft function. We hypothesised that patients with complement-activating DSA would have poorer renal allograft outcomes. METHODS: A total of 75 children developed DSA in the original study. The first positive DSA sample was subsequently tested for C1q and C3d fixing. The primary event was defined as 50% reduction from baseline estimated glomerular filtration rate and was analysed using the Kaplan-Meier estimator...
January 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Guido Filler, Maria Ferris
Renal transplantation is the therapy of choice for end-stage kidney disease (ESKD) in children and adolescents.[1] Patients, caregivers and physicians deem a successful transplantation as a highly rewarding and definitive treatment. With current cost-effective immunosuppression regimes [2] rejection rates are low, and the recipient can look forward to long-term graft survival. This article is protected by copyright. All rights reserved.
September 2, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
Nizam Mamode, Stephen D Marks
No abstract text is available yet for this article.
July 28, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Jamsheer Jehangir Talati, Sally-Anne Hulton, Sander F Garrelfs, Wajahat Aziz, Shoaib Rao, Amanullah Memon, Zafar Nazir, Raziuddin Biyabani, Saqib Qazi, Iqbal Azam, Aysha Habib Khan, Jamil Ahmed, Lena Jafri, Mohammad Zeeshan
Primary hyperoxalurias (PH) are devastating, autosomal recessive diseases causing renal stones. Undifferentiated hyperoxaluria is seen in up to 43% of Pakistani paediatric stone patients. High rates of consanguinity in Pakistan suggest significant local prevalence. There is no detailed information regarding number of cases, clinical features, and genetics in Pakistan-origin (P-o) patients. We reviewed available information on P-o PH patients recorded in the literature as well as from two major PH registries (the Rare Kidney Stone Consortium PH Registry (RKSCPHR) and the OxalEurope PH Registry (OxER); and the Aga Khan University Hospital in Pakistan...
June 28, 2017: Urolithiasis
W W Geense, B G I van Gaal, J L Knoll, E A M Cornelissen, T van Achterberg
BACKGROUND: Parents of children with a chronic kidney disease (CKD) have a crucial role in the management of their child's disease. The burden on parents is high: they are often exhausted, depressed and experience high levels of stress and a low quality of life, which could have a negative impact on their child's health outcomes. Support aiming at preventing and reducing parental stress is essential. Therefore, it is necessary to have insight in the problems and support needs among these parents...
May 25, 2017: Child: Care, Health and Development
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