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Marlies Ostermann, Michael Joannidis
Acute kidney injury (AKI) is common and is associated with serious short- and long-term complications. Early diagnosis and identification of the underlying aetiology are essential to guide management. In this review, we outline the current definition of AKI and the potential pitfalls, and summarise the existing and future tools to investigate AKI in critically ill patients.
September 27, 2016: Critical Care: the Official Journal of the Critical Care Forum
Kazumoto Iijima, Mayumi Sako, Kandai Nozu
Idiopathic nephrotic syndrome is the most common chronic glomerular disease in children. At least 20 % of children with this syndrome show frequent relapses and/or steroid dependence during or after immunosuppressive therapies, a condition defined as complicated frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS). Approximately 1-3 % of children with idiopathic nephrotic syndrome are resistant to steroids and all immunosuppressive agents, a condition defined as refractory steroid-resistant nephrotic syndrome (SRNS); these SRNS children have a high risk of end-stage renal failure...
July 15, 2016: Clinical and Experimental Nephrology
Kristel De Keyzer, Steven Van Laecke, Patrick Peeters, Raymond Vanholder
Infection with human cytomegalovirus (CMV) is an important cause of morbidity and mortality in kidney transplant recipients. CMV disease is diagnosed based on the detection of viral replication by phosphoprotein 65 antigenemia or CMV DNA polymerase chain reaction in combination with typical signs and symptoms. Risk factors include CMV-seronegative recipients receiving a CMV-seropositive transplant, older donor age, exposure to cyclosporine and/or antilymphocyte antibody, rejection episodes, and impaired transplant function...
July 2011: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Robert F Tamburro, Neal J Thomas, Gary D Ceneviva, Michael D Dettorre, Gretchen L Brummel, Steven E Lucking
BACKGROUND: Aminophylline, an established bronchodilator, is also purported to be an effective diuretic and anti-inflammatory agent. However, the data to support these contentions are scant. We conducted a prospective, open-label, single arm, single center study to assess the hypothesis that aminophylline increases urine output and decreases inflammation in critically ill children. METHODS: Children less than 18 years of age admitted to the pediatric intensive care unit who were prescribed aminophylline over a 24-h period were eligible for study...
2014: Frontiers in Pediatrics
James McCaffrey, Ajaya Kumar Dhakal, David V Milford, Nicholas J A Webb, Rachel Lennon
Acute kidney injury (AKI) is a common condition in children admitted to hospital and existing serum and urine biomarkers are insensitive. There have been significant developments in stratifying the risk of AKI in children and also in the identification of new AKI biomarkers. Risk stratification coupled with a panel of AKI biomarkers will improve future detection of AKI, however, paediatric validation studies in mixed patient cohorts are required. The principles of effective management rely on treating the underlying cause and preventing secondary AKI by the appropriate use of fluids and medication...
August 5, 2016: Archives of Disease in Childhood
Jayanthi Chandar, Gastón Zilleruelo
Hypertensive crisis is rare in children and is usually secondary to an underlying disease. There is strong evidence that the renin-angiotensin system plays an important role in the genesis of hypertensive crisis. An important principle in the management of children with hypertensive crisis is to determine if severe hypertension is chronic, acute, or acute-on-chronic. When it is associated with signs of end-organ damage such as encephalopathy, congestive cardiac failure or renal failure, there is an emergent need to lower blood pressures to 25-30% of the original value and then accomplish a gradual reduction in blood pressure...
May 2012: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Matthew R Weir, Ellen D Burgess, James E Cooper, Andrew Z Fenves, David Goldsmith, Dianne McKay, Anita Mehrotra, Mark M Mitsnefes, Domenic A Sica, Sandra J Taler
Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension...
June 2015: Journal of the American Society of Nephrology: JASN
(no author information available yet)
A. In the rare case of recurrent lupus nephritis, no particular treatment is recommended. Only in the few patients with clinically evident flare up is a reinforcement of immunosuppression recommended. B. Recurrence of Henoch-Schönlein purpura may occur even in the absence of clinical signs and symptoms. The prognosis for the graft may be severe, particularly in adults. C. In the case of recurrent ANCA-associated renal or systemic vasculitis, it is recommended to reinforce the immunosuppression with appropriate agents...
2002: Nephrology, Dialysis, Transplantation
(no author information available yet)
A. In order to reduce or avoid long-term serious adverse effects of corticosteroids, such as bone fractures, diabetes mellitus, arterial hypertension, osteoporosis and eye complications, steroid withdrawal should be considered. B. Steroid withdrawal is safe only in a proportion of graft recipients and is recommended only in low-risk patients. The efficacy of the remaining immunosuppression should be considered. C. After steroid withdrawal, graft function has to be monitored very carefully because of the risk of a delayed but continuous loss of function due to chronic graft dysfunction...
2002: Nephrology, Dialysis, Transplantation
(no author information available yet)
A. In the case of recurrent focal and segmental glomerulosclerosis (FSGS), aggressive treatment with high-dose cyclosporine in children, ACE inhibitors and/or Angiotensin II antagonists, plasma exchange or immunoadsorption may result in remission in some patients. B. In the case of recurrent membranous nephropathy (MN), there is no specific treatment. However, control of risk factors, such as hypertension, heavy proteinuria and hyperlipidaemia, and prevention of thrombotic complications are recommended. C. In the case of recurrent membranoproliferative glomerulonephritis (MPGN), there is no specific treatment...
2002: Nephrology, Dialysis, Transplantation
(no author information available yet)
A. Post-transplant cardiovascular disease is very common, an important cause of morbidity and the first cause of mortality in renal transplant recipients. Therefore, detection and early treatment of post-transplant cardiovascular disease are mandatory. B. Specific risk factors for developing post-transplant cardiovascular disease include pre-transplant cardiovascular disease, arterial hypertension, uraemia (graft dysfunction), hyperlipidaemia, diabetes mellitus, smoking and immunosuppressive treatment. These factors should be targeted for intervention...
2002: Nephrology, Dialysis, Transplantation
(no author information available yet)
A. Kidney transplantation should be the treatment of choice for end-stage renal disease (ESRD) in children (up to 16 years of age). Because the incidence rate of ESRD is very low, approximately 1-2 children per million general population or 4-6 children per million childhood population, kidney transplantation in children should be performed in specialized paediatric centres with multidisciplinary experts, i.e. transplant surgeons, anaesthetists and paediatric nephrologists, and optimally should be supported by psychologists, paediatric nurses and social workers...
2002: Nephrology, Dialysis, Transplantation
(no author information available yet)
A. Renal transplantation restores fertility, and successful pregnancies have been reported in renal transplant women. In women with normal graft function, pregnancy usually has no adverse effect on graft function and survival. Therefore, women of childbearing age who consider pregnancy should receive complete information and support from the transplant team. B. Pregnancy could be considered safe about 2 years after transplantation in women with good renal function, without proteinuria, without arterial hypertension, with no evidence of ongoing rejection and with normal allograft ultrasound...
2002: Nephrology, Dialysis, Transplantation
Daan H H M Viering, Jeroen H F de Baaij, Stephen B Walsh, Robert Kleta, Detlef Bockenhauer
Magnesium is essential to the proper functioning of numerous cellular processes. Magnesium ion (Mg(2+)) deficits, as reflected in hypomagnesemia, can cause neuromuscular irritability, seizures and cardiac arrhythmias. With normal Mg(2+) intake, homeostasis is maintained primarily through the regulated reabsorption of Mg(2+) by the thick ascending limb of Henle's loop and distal convoluted tubule of the kidney. Inadequate reabsorption results in renal Mg(2+) wasting, as evidenced by an inappropriately high fractional Mg(2+) excretion...
May 27, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Goutham Rao
National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor. Prevalence estimates are highly variable because of differing standards, populations, and blood pressure (BP) measurement techniques. Estimates in the United States range from 0.3% to 4.5%. Risk factors for primary hypertension include overweight and obesity, male sex, older age, high sodium intake, and African American or Latino ancestry...
August 2016: Pediatrics
David S Hains, Carlton M Bates, Susan Ingraham, Andrew L Schwaderer
In children, unilateral multicystic dysplastic kidney (MCDK) is one of the most frequently identified urinary tract abnormalities. A variety of proposed etiologies has been associated with the underlying pathogenesis of MCDK. These include genetic disturbances, teratogens, in utero infections, and urinary outflow tract obstruction. From 5-43% of the time, MCDK has associated genito-urinary anomalies, both structural and functional in nature. A review of the literature reveals that involution rates are reported to be 19-73%, compensatory hypertrophy of the contralateral kidney occurs from 24-81% of the time, and estimated glomerular filtration rates (GFRs) (by the Schwartz formula) range from 86-122 ml/min per 1...
February 2009: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Katherine MacRae Dell
Autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD) are important inherited kidney diseases with distinct clinical features and genetics. Although these diseases have classically been considered "adult" (ADPKD) or "infantile/pediatric" (ARPKD), it is now clear that both diseases can present in children and adults. ADPKD and ARPKD also share important pathophysiologic features, including cilia dysfunction. ADPKD is a systemic disease involving cysts in the kidneys and abdominal organs as well as abnormalities in the heart and vasculature...
September 2011: Advances in Chronic Kidney Disease
Olga Baraldi, Chiara Valentini, Gabriele Donati, Giorgia Comai, Vania Cuna, Irene Capelli, Maria Laura Angelini, Maria Ilaria Moretti, Andrea Angeletti, Fabio Piscaglia, Gaetano La Manna
Acute kidney injury (AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome (HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice...
November 6, 2015: World Journal of Nephrology
G Graziani, C Fedeli, L Moroni, L Cosmai, S Badalamenti, C Ponticelli
Giltelman syndrome (GS) is a recessive salt-losing tubulopathy of children or young adults caused by a mutation of genes encoding the human sodium chloride cotransporters and magnesium channels in the thiazide-sensitive segments of the distal convoluted tubule. The plasma biochemical picture is characterized by hypokalemia, hypomagnesemia, hypocalciuria, metabolic alkalosis and hypereninemic hyperaldosteronism. However, patients with GS present some clinical and biochemical alterations resembling that observed in thiazide diuretics abuse...
October 2010: QJM: Monthly Journal of the Association of Physicians
David T Selewski, Jennifer R Charlton, Jennifer G Jetton, Ronnie Guillet, Maroun J Mhanna, David J Askenazi, Alison L Kent
In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described...
August 2015: Pediatrics
2016-07-08 05:57:05
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