Pub Date : 2015-01-01DOI: 10.2174/1874303x01508010090
A. Barakat
Pediatric nephrology is rapidly evolving. Over the last few decades we have witnessed a rapid change in nosology, etiology, pathogenesis and treatment of renal disease. We have seen advances in renal and urinary tract imaging as well as more precise use of novel urinary biomarkers to define the type and degree of renal injury, both acute and chronic. We now have better understanding of factors contributing to normal and abnormal renal development, particularly the progenitors of renal development and regeneration, delivery of progenitor cell therapeutics, and the role of epigenetics [1]. Multi center pan-national and international clinical studies have helped to put together clinical guidelines to diagnose and manage renal disease. In this issue, we will discuss few, but important recent clinical developments in pediatric nephrology.
{"title":"Editorial Pediatric Nephrology: an Update","authors":"A. Barakat","doi":"10.2174/1874303x01508010090","DOIUrl":"https://doi.org/10.2174/1874303x01508010090","url":null,"abstract":"Pediatric nephrology is rapidly evolving. Over the last few decades we have witnessed a rapid change in nosology, etiology, pathogenesis and treatment of renal disease. We have seen advances in renal and urinary tract imaging as well as more precise use of novel urinary biomarkers to define the type and degree of renal injury, both acute and chronic. We now have better understanding of factors contributing to normal and abnormal renal development, particularly the progenitors of renal development and regeneration, delivery of progenitor cell therapeutics, and the role of epigenetics [1]. Multi center pan-national and international clinical studies have helped to put together clinical guidelines to diagnose and manage renal disease. In this issue, we will discuss few, but important recent clinical developments in pediatric nephrology.","PeriodicalId":38952,"journal":{"name":"Open Urology and Nephrology Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68066877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-31DOI: 10.2174/1874303X014070100129
E. Anyaegbu, S. Hmiel
The incidence of post transplant viral infections has increased with the use of more potent immunosuppressive regimens. Consequently, BK virus nephropathy (BKVN) has arisen as a significant cause of graft dysfunction and loss. Reduction of immunosuppression is the first line management of post-transplant viral infections. Other therapies such as intravenous immunoglobulin (IVIg), cidofovir, leflunomide and fluoroquinolones have been tried with varying degrees of success. We report our experience with IVIg in three pediatric renal transplant recipients who presented with allograft dysfunction. First, we describe two cases of biopsy proven BKVN, one diagnosed with undetectable viral titers in plasma, demonstrating that BKVN can occur even at low viral loads. We also present a pediatric renal transplant recipient with persistent BK viremia and allograft dysfunction who responded to therapy with recovery of renal function and clearance of viremia. Therefore we conclude that IVIg is efficacious in the treatment of persistent BK viremia and BKVN. The appropriate dose, frequency and duration of therapy require further study.
{"title":"Intravenous Immunoglobulin in BK Virus Nephropathy","authors":"E. Anyaegbu, S. Hmiel","doi":"10.2174/1874303X014070100129","DOIUrl":"https://doi.org/10.2174/1874303X014070100129","url":null,"abstract":"The incidence of post transplant viral infections has increased with the use of more potent immunosuppressive regimens. Consequently, BK virus nephropathy (BKVN) has arisen as a significant cause of graft dysfunction and loss. Reduction of immunosuppression is the first line management of post-transplant viral infections. Other therapies such as intravenous immunoglobulin (IVIg), cidofovir, leflunomide and fluoroquinolones have been tried with varying degrees of success. We report our experience with IVIg in three pediatric renal transplant recipients who presented with allograft dysfunction. First, we describe two cases of biopsy proven BKVN, one diagnosed with undetectable viral titers in plasma, demonstrating that BKVN can occur even at low viral loads. We also present a pediatric renal transplant recipient with persistent BK viremia and allograft dysfunction who responded to therapy with recovery of renal function and clearance of viremia. Therefore we conclude that IVIg is efficacious in the treatment of persistent BK viremia and BKVN. The appropriate dose, frequency and duration of therapy require further study.","PeriodicalId":38952,"journal":{"name":"Open Urology and Nephrology Journal","volume":"7 1","pages":"129-132"},"PeriodicalIF":0.0,"publicationDate":"2014-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68065544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-31DOI: 10.2174/1874303X014070100133
J. Bethany, L. H. P. Ahna
Poor adherence to immunosuppressive medications may be the most important barrier to long term graft survival. An understanding of medication adherence and its determinants is critical to addressing this important problem. In this paper, we will review the different ways in which adherence may be compromised, summarize the evidence that young people constitute a particularly high risk group, and consider the consequences and impact of poor adherence. We will also review the determinants of adherence, including characteristics of the patient and family, the treatment regimen, the healthcare team and its organization, and the healthcare system. We will highlight the most common barriers to adherence identified by young people, and consider different methods of measuring adherence, along with the advantages and limitations of each. Finally, we will consider possible intervention strategies to improve adherence in young people.
{"title":"Adherence in Adolescent and Young Adult Kidney Transplant Recipients","authors":"J. Bethany, L. H. P. Ahna","doi":"10.2174/1874303X014070100133","DOIUrl":"https://doi.org/10.2174/1874303X014070100133","url":null,"abstract":"Poor adherence to immunosuppressive medications may be the most important barrier to long term graft survival. An understanding of medication adherence and its determinants is critical to addressing this important problem. In this paper, we will review the different ways in which adherence may be compromised, summarize the evidence that young people constitute a particularly high risk group, and consider the consequences and impact of poor adherence. We will also review the determinants of adherence, including characteristics of the patient and family, the treatment regimen, the healthcare team and its organization, and the healthcare system. We will highlight the most common barriers to adherence identified by young people, and consider different methods of measuring adherence, along with the advantages and limitations of each. Finally, we will consider possible intervention strategies to improve adherence in young people.","PeriodicalId":38952,"journal":{"name":"Open Urology and Nephrology Journal","volume":"7 1","pages":"133-143"},"PeriodicalIF":0.0,"publicationDate":"2014-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68065594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-31DOI: 10.2174/1874303X014070100113
R. Vikas
The science of kidney transplantation in children has advanced remarkably in the last 40 years [1, 2]. As kidney transplants in adult recipients were becoming more common with improving shortand long-term outcomes, results in children were lagging behind. This lag was attributed to multiple factors: greater surgical and technical problems in small children, different metabolism for needed drugs, lack of actionable scientific data, and studies with inadequate sample sizes to make definitive research conclusions, among others.
{"title":"Advances in Pediatric Renal Transplantation","authors":"R. Vikas","doi":"10.2174/1874303X014070100113","DOIUrl":"https://doi.org/10.2174/1874303X014070100113","url":null,"abstract":"The science of kidney transplantation in children has advanced remarkably in the last 40 years [1, 2]. As kidney transplants in adult recipients were becoming more common with improving shortand long-term outcomes, results in children were lagging behind. This lag was attributed to multiple factors: greater surgical and technical problems in small children, different metabolism for needed drugs, lack of actionable scientific data, and studies with inadequate sample sizes to make definitive research conclusions, among others.","PeriodicalId":38952,"journal":{"name":"Open Urology and Nephrology Journal","volume":"7 1","pages":"113-114"},"PeriodicalIF":0.0,"publicationDate":"2014-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68065459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-31DOI: 10.2174/1874303X014070100123
A. Moudgil, K. Martz, Therese Moore, W. Harmon, V. Dharnidharka
Background: Many pediatric transplant (TX) centers routinely monitor Epstein-Barr (EB) viral load (VL) by real time quantitative PCR and intervene to prevent post-transplant lymphoproliferative disorder (PTLD). Some children develop asymptomatic persistent VL (PVL). Outcome of different interventions in preventing PTLD and other undesired effects on acute rejection (AR), graft failure (GF) and function amongst children with asymptomatic PVL is not known. Methods: NAPRTCS centers invited to enter data on children with asymptomatic PVL (≥ 6 months) into the EB VL registry. Comparison group included children into the NAPRTCS TX arm during the same period without PVL or VL monitoring. EB VL were arbitrarily divided into low (1-10), medium (>10-100) and high (>100times detection limit for the center) ratio. Results: Of 645 children (18 centers), 85 (13.2%) developed onset of PVL at a mean of 6.4 ± 6.3 months post-TX. PVL children were more likely to be younger (< 5 years) at TX and less likely to be African-American and majority (75.3%) was mismatched for EBV (donor EBV IgG positive and recipient negative). Thymoglobulin induction was used in 29.4% children with PVL versus 37% in controls (p=ns). PTLD developed in 7/85 (8.2%) children with PVL versus 5/560 (0.9%) controls (p < 0.0001). EB VL ratios were not different in those with and without PTLD. EB PVL as time varying covariate did not affect patient survival, GF and AR (HR, 0.85, 0.53 and 0.99). The change in GFR overtime in children with PVL was comparable to controls. Conclusion: Children with PVL (actual load not predictive) are at increased risk for PTLD, but not for AR, death, GF or loss of graft function.
{"title":"Significance of Asymptomatic Persistent Epstein-Barr Viral Load in Pediatric Renal Transplant Recipients: North American Pediatric Renal Trials and Collaborative Studies Report","authors":"A. Moudgil, K. Martz, Therese Moore, W. Harmon, V. Dharnidharka","doi":"10.2174/1874303X014070100123","DOIUrl":"https://doi.org/10.2174/1874303X014070100123","url":null,"abstract":"Background: Many pediatric transplant (TX) centers routinely monitor Epstein-Barr (EB) viral load (VL) by real time quantitative PCR and intervene to prevent post-transplant lymphoproliferative disorder (PTLD). Some children develop asymptomatic persistent VL (PVL). Outcome of different interventions in preventing PTLD and other undesired effects on acute rejection (AR), graft failure (GF) and function amongst children with asymptomatic PVL is not known. Methods: NAPRTCS centers invited to enter data on children with asymptomatic PVL (≥ 6 months) into the EB VL registry. Comparison group included children into the NAPRTCS TX arm during the same period without PVL or VL monitoring. EB VL were arbitrarily divided into low (1-10), medium (>10-100) and high (>100times detection limit for the center) ratio. Results: Of 645 children (18 centers), 85 (13.2%) developed onset of PVL at a mean of 6.4 ± 6.3 months post-TX. PVL children were more likely to be younger (< 5 years) at TX and less likely to be African-American and majority (75.3%) was mismatched for EBV (donor EBV IgG positive and recipient negative). Thymoglobulin induction was used in 29.4% children with PVL versus 37% in controls (p=ns). PTLD developed in 7/85 (8.2%) children with PVL versus 5/560 (0.9%) controls (p < 0.0001). EB VL ratios were not different in those with and without PTLD. EB PVL as time varying covariate did not affect patient survival, GF and AR (HR, 0.85, 0.53 and 0.99). The change in GFR overtime in children with PVL was comparable to controls. Conclusion: Children with PVL (actual load not predictive) are at increased risk for PTLD, but not for AR, death, GF or loss of graft function.","PeriodicalId":38952,"journal":{"name":"Open Urology and Nephrology Journal","volume":"7 1","pages":"123-128"},"PeriodicalIF":0.0,"publicationDate":"2014-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68065535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-31DOI: 10.2174/1874303X014070100144
I. Ashoor, Ryan H. Pasternak
Normal adolescence marks a period of significant physical, cognitive and psychosocial change. It is characterized by transition from concrete to abstract thought processes and concern for risk taking behaviors. Adolescents and young adults with chronic conditions are at a particular disadvantage and tend to be more vulnerable to risky behavior than their healthy peers. While there currently exists no information on the burden of sexually transmitted infections (STIs) in adolescent renal transplant recipients, they present a particularly worrisome population as they are likely to engage in risk taking behavior when they feel "normal" following transplantation to compensate for poor quality of life endured on dialysis. This is further compounded by adolescents' false perception that they are unlikely to acquire such infections, and the likely improvement in libido and sexual functioning after transplantation. The potential for acquiring a sexually transmitted infection is concerning given their immunocompromised status, and complex treatment regimens which might have unfavorable interactions with STI treatments. Also, unintentional pregnancy is likely to have a significant impact on their overall medical condition and social functioning thereby impacting their long term allograft outcomes. As the pediatric nephrologist assumes a primary care provider role for these patients following their renal transplant, it becomes increasingly important to be familiar with basic reproductive health counseling techniques and available contraceptive methods on the market. Until consensus guidelines and specific recommendations for reproductive health counseling are developed for adolescent renal transplant recipients, this review provides a brief summary of available knowledge in those areas.
{"title":"Sexuality and Reproductive Health Counseling in Adolescent Renal Transplant Recipients","authors":"I. Ashoor, Ryan H. Pasternak","doi":"10.2174/1874303X014070100144","DOIUrl":"https://doi.org/10.2174/1874303X014070100144","url":null,"abstract":"Normal adolescence marks a period of significant physical, cognitive and psychosocial change. It is characterized by transition from concrete to abstract thought processes and concern for risk taking behaviors. Adolescents and young adults with chronic conditions are at a particular disadvantage and tend to be more vulnerable to risky behavior than their healthy peers. While there currently exists no information on the burden of sexually transmitted infections (STIs) in adolescent renal transplant recipients, they present a particularly worrisome population as they are likely to engage in risk taking behavior when they feel \"normal\" following transplantation to compensate for poor quality of life endured on dialysis. This is further compounded by adolescents' false perception that they are unlikely to acquire such infections, and the likely improvement in libido and sexual functioning after transplantation. The potential for acquiring a sexually transmitted infection is concerning given their immunocompromised status, and complex treatment regimens which might have unfavorable interactions with STI treatments. Also, unintentional pregnancy is likely to have a significant impact on their overall medical condition and social functioning thereby impacting their long term allograft outcomes. As the pediatric nephrologist assumes a primary care provider role for these patients following their renal transplant, it becomes increasingly important to be familiar with basic reproductive health counseling techniques and available contraceptive methods on the market. Until consensus guidelines and specific recommendations for reproductive health counseling are developed for adolescent renal transplant recipients, this review provides a brief summary of available knowledge in those areas.","PeriodicalId":38952,"journal":{"name":"Open Urology and Nephrology Journal","volume":"7 1","pages":"144-151"},"PeriodicalIF":0.0,"publicationDate":"2014-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68065621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-31DOI: 10.2174/1874303X01407010108
H. Rashid
End stage renal disease (ESRD) is an important cause of morbidity and mortality throughout the world. The treatment of renal replacement therapy (RRT) for patients with ESRD is expensive. There is a direct relationship between per capita income and treatment of ESRD. Eighty five per cent of the world's population lives in low income or middle- income countries, where the mortality is highest in patients with chronic kidney disease. The future perspective is not satisfactory for Bangladesh where treatment of ESRD is out of reach for majority of people. Effort should made for prevention and treatment of CKD at an initial stage of disease.
{"title":"Management of End Stage Renal Disease-Bangladesh Perspective","authors":"H. Rashid","doi":"10.2174/1874303X01407010108","DOIUrl":"https://doi.org/10.2174/1874303X01407010108","url":null,"abstract":"End stage renal disease (ESRD) is an important cause of morbidity and mortality throughout the world. The treatment of renal replacement therapy (RRT) for patients with ESRD is expensive. There is a direct relationship between per capita income and treatment of ESRD. Eighty five per cent of the world's population lives in low income or middle- income countries, where the mortality is highest in patients with chronic kidney disease. The future perspective is not satisfactory for Bangladesh where treatment of ESRD is out of reach for majority of people. Effort should made for prevention and treatment of CKD at an initial stage of disease.","PeriodicalId":38952,"journal":{"name":"Open Urology and Nephrology Journal","volume":"7 1","pages":"108-112"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68065558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-09DOI: 10.2174/1874303X01407010105
P. Senguttuvan, S. Gowtham, P. Soundararajan
Human immunodeficiency virus-associated nephropathy (HIVAN) in children has not been reported in India. In a single centre study, we analyzed 8 children diagnosed with HIVAN from 2007 to 2010. There were 6 boys and 2 girls with a male to female ratio of 3:1. Their ages ranged between 5 yrs to 11 yrs with a peak age of 8 years. The routes of HIV transmission were vertical in 5, blood transfusion in 2 and unknown in one. The presentation included generalized edema 100%, hypertension 2/8 (25%) and macroscopic hematuria 1/8 (12.5%). On evaluation by urine dipstick, all children had proteinuria and urine PCR showed nephrotic proteinuria (>3). 5/8 (62.5%) had extra renal involvement: 2 children had hepatosplenomegaly and 3/8 (37.5%) children had pulmonary tuberculosis and were on highly active antiretroviral therapy (HAART) and antituberculous treatment (ATT). Renal disease was the presenting problem in 4/8 (50%) and the remaining 4 (50%) were referred from the HIV clinic. The duration of HIV infection to the development of HIVAN was unknown in 4/8 (50%) nephrotic patients but in those referred from HIV clinic, it ranged between 5 months to 2 yrs. CD4 count ranged from 700 to 2465/mm 3 . All the children had enlarged kidneys bilaterally, except for one child who had normal sized kidneys with increased echogenicity and loss of corticomedullary distinction. He was not biopsied and he progressed to renal failure. Renal biopsy in other 7 children showed FSGS in 4 (57%) and collapsing FSGS in 2 (28.5%), and early segmental sclerosis with IgA deposits in one child (14.2%). 7/8 who had nephrotic proteinuria were initiated on steroids.
{"title":"Human Immunodeficiency Virus-Associated Nephropathy (HIVAN) in Indian Children","authors":"P. Senguttuvan, S. Gowtham, P. Soundararajan","doi":"10.2174/1874303X01407010105","DOIUrl":"https://doi.org/10.2174/1874303X01407010105","url":null,"abstract":"Human immunodeficiency virus-associated nephropathy (HIVAN) in children has not been reported in India. In a single centre study, we analyzed 8 children diagnosed with HIVAN from 2007 to 2010. There were 6 boys and 2 girls with a male to female ratio of 3:1. Their ages ranged between 5 yrs to 11 yrs with a peak age of 8 years. The routes of HIV transmission were vertical in 5, blood transfusion in 2 and unknown in one. The presentation included generalized edema 100%, hypertension 2/8 (25%) and macroscopic hematuria 1/8 (12.5%). On evaluation by urine dipstick, all children had proteinuria and urine PCR showed nephrotic proteinuria (>3). 5/8 (62.5%) had extra renal involvement: 2 children had hepatosplenomegaly and 3/8 (37.5%) children had pulmonary tuberculosis and were on highly active antiretroviral therapy (HAART) and antituberculous treatment (ATT). Renal disease was the presenting problem in 4/8 (50%) and the remaining 4 (50%) were referred from the HIV clinic. The duration of HIV infection to the development of HIVAN was unknown in 4/8 (50%) nephrotic patients but in those referred from HIV clinic, it ranged between 5 months to 2 yrs. CD4 count ranged from 700 to 2465/mm 3 . All the children had enlarged kidneys bilaterally, except for one child who had normal sized kidneys with increased echogenicity and loss of corticomedullary distinction. He was not biopsied and he progressed to renal failure. Renal biopsy in other 7 children showed FSGS in 4 (57%) and collapsing FSGS in 2 (28.5%), and early segmental sclerosis with IgA deposits in one child (14.2%). 7/8 who had nephrotic proteinuria were initiated on steroids.","PeriodicalId":38952,"journal":{"name":"Open Urology and Nephrology Journal","volume":"7 1","pages":"105-107"},"PeriodicalIF":0.0,"publicationDate":"2014-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68065514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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