Open Urology and Nephrology Journal最新文献

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Editorial Pediatric Nephrology: an Update 儿科肾脏病学:最新进展

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2015-01-01 DOI: 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.

我很荣幸能够担任本期《开放泌尿学与肾脏病学杂志》儿科肾病特刊的客座编辑。我也很感谢杰出的作者小组，感谢他们的贡献，感谢他们介绍了该专业各个方面的最新临床进展。儿科肾脏病学正在迅速发展。在过去的几十年里，我们目睹了肾脏疾病在分类学、病因学、发病机制和治疗方面的快速变化。我们已经看到肾脏和尿路成像的进步，以及更精确地使用新的尿液生物标志物来定义肾损伤的类型和程度，无论是急性还是慢性。我们现在对导致肾脏正常和异常发育的因素有了更好的了解，特别是肾脏发育和再生的祖细胞，祖细胞治疗的传递，以及表观遗传学的作用。多中心、泛国家和国际临床研究有助于制定诊断和管理肾脏疾病的临床指南。在这一期中，我们将讨论儿科肾脏病学中一些重要的近期临床进展。虽然进行肾脏超声和排尿膀胱输尿管造影(VCUG)曾经是一种常规，但美国儿科学会(AAP)和国家卫生与临床卓越研究所(NICE)现在建议显著减少2-3岁以下发热性尿路感染(UTI)患儿的影像学检查。AAP和NICE也一致认为，这些儿童即使有严重膀胱输尿管反流(VUR)，也不应常规使用预防性抗生素治疗。目前，美国儿科学会建议患有发热性尿路感染的婴儿(2-24个月)进行肾脏和膀胱超声检查作为常规筛查，对于复发性尿路感染或超声显示解剖异常的患者保留VCUG检查。2014年，也就是在这一建议的三年后，膀胱输尿管反流儿童随机干预(RIVUR)研究的结果发表于bbb。根据这项研究，抗生素预防确实可以预防幼儿VUR尿路感染复发，但代价是抗生素耐药性增加，并且在预防潜在肾损害方面的益处尚不清楚。遗传因素可能与尿路感染的风险有关，未来可能会有遗传标记来帮助更精确地选择有疤痕风险的儿童，从而帮助确定需要抗生素治疗的患者。尽管进行了广泛的研究，关于如何筛查和治疗患者的争论……

引用次数: 156

Progress in Pediatric Kidney Transplantation 儿童肾移植研究进展

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2014-12-31 DOI: 10.2174/1874303X014070100115

Jodi M. Smith, V. Dharnidharka

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引用次数: 5

Efficacy of Extended Valganciclovir Prophylaxis in Preventing Cytomegalovirus Infection in Pediatric Kidney Transplantation. 延长缬更昔洛韦预防儿童肾移植巨细胞病毒感染的疗效观察。

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2014-12-31 eCollection Date: 2014-01-01 DOI: 10.2174/1874303X01407010152

Faris Hashim, Jon A Gregg, Vikas R Dharnidharka

Cytomegalovirus (CMV) is one of the most frequent opportunistic infection in renal transplant (RTx) recipients. Valganciclovir (VGC) has been showed to be safe and highly effective in prophylaxis of CMV infection in RTx recipients. Recently, an increase in delayed onset CMV disease has been noted with some arguing that longer prophylaxis may decrease the late-onset disease. We retrospectively tested the hypothesis that extended term prophylaxis (ETP) of VGC for 12 months is more effective than short term prophylaxis (STP) of 6 months in preventing CMV infection and disease in pediatric RTx performed at the University of Florida from July 2003 to December 2010. In this period, all recipients underwent prospective CMV PCR (Polymerase Chain Reaction) monitoring and were maintained on similar immunosuppression. Eighty six patients received RTx during that period. All eligible subjects had to have at least 12 months of graft survival and 18 months of follow up, leaving 73 eligible subjects in final study group. CMV infection or disease occurred in 6/29 (20%) in the STP group vs 6/44 (14%) in the ETP group with no statistical significant difference (P= 0.42). Donor positive/recipients negative CMV serology status (D+/R-) were associated with a higher risk of CMV infection in both univariate and multivariate analysis (P=0.01). Anemia and Leucopenia directly associated with VGC were similar in both groups (P=0.58 and P=0.2 respectively). Biopsy-proven acute rejection was also non-significant in both groups (P=0.39). Although ETP for CMV from 6 months to 12 months is safe and has minimal adverse effect, it did not reduce CMV infection or disease. Further controlled studies in pediatrics age group are considered to compare longer versus shorter periods of prophylaxis and their impact on prevention of CMV infection, resistance, cost, and toxicity.

巨细胞病毒(CMV)是肾移植(RTx)受者最常见的机会性感染之一。缬更昔洛韦(VGC)已被证明在预防RTx受体巨细胞病毒感染方面是安全和高效的。最近，迟发性巨细胞病毒疾病的增加已被注意到，一些人认为更长时间的预防可能会减少迟发性疾病。我们回顾性检验了2003年7月至2010年12月在佛罗里达大学进行的儿科RTx患者中，VGC延长期预防(ETP) 12个月比短期预防(STP) 6个月在预防巨细胞病毒感染和疾病方面更有效的假设。在此期间，所有接受者都进行了前瞻性CMV PCR(聚合酶链反应)监测，并维持类似的免疫抑制。在此期间，86名患者接受了RTx治疗。所有符合条件的受试者必须至少有12个月的移植物存活和18个月的随访，最终研究组有73名符合条件的受试者。STP组6/29(20%)发生CMV感染或疾病，而ETP组6/44(14%)发生CMV感染或疾病，差异无统计学意义(P= 0.42)。在单因素和多因素分析中，供体CMV阳性/受体CMV阴性血清学状态(D+/R-)与CMV感染的高风险相关(P=0.01)。两组直接与VGC相关的贫血和白细胞减少相似(P=0.58和P=0.2)。两组活检证实的急性排斥反应也无统计学意义(P=0.39)。虽然从6个月到12个月的CMV ETP是安全的，副作用最小，但它并没有减少CMV感染或疾病。在儿科年龄组进行进一步的对照研究，比较较长和较短的预防期及其对预防巨细胞病毒感染、耐药性、成本和毒性的影响。

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引用次数: 12

Intravenous Immunoglobulin in BK Virus Nephropathy 静脉注射免疫球蛋白治疗BK病毒肾病

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2014-12-31 DOI: 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.

移植后病毒感染的发生率随着更有效的免疫抑制方案的使用而增加。因此，BK病毒肾病(BKVN)已成为移植物功能障碍和丧失的重要原因。减少免疫抑制是移植后病毒感染的一线治疗。其他治疗方法，如静脉注射免疫球蛋白、西多福韦、来氟米特和氟喹诺酮类药物，已尝试取得不同程度的成功。我们报告了我们在三例表现出同种异体移植物功能障碍的儿童肾移植受者中应用IVIg的经验。首先，我们描述了两例活检证实的BKVN病例，其中一例诊断为血浆中检测不到病毒滴度，这表明即使在低病毒载量下也可能发生BKVN。我们也报道了一名患有持续性BK病毒血症和同种异体移植物功能障碍的儿童肾移植受者，他对治疗有反应，肾功能恢复和病毒血症清除。因此，我们认为IVIg治疗持续性BK病毒血症和BKVN是有效的。适当的剂量、频率和治疗时间需要进一步研究。

引用次数: 1

Adherence in Adolescent and Young Adult Kidney Transplant Recipients 青少年和青年肾移植受者的依从性

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2014-12-31 DOI: 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.

免疫抑制药物依从性差可能是移植物长期存活的最重要障碍。了解药物依从性及其决定因素对于解决这一重要问题至关重要。在本文中，我们将回顾可能损害依从性的不同方式，总结年轻人构成特别高风险群体的证据，并考虑不良依从性的后果和影响。我们还将回顾依从性的决定因素，包括患者和家庭的特征，治疗方案，医疗团队及其组织，以及医疗保健系统。我们将强调年轻人确定的最常见的坚持障碍，并考虑衡量坚持的不同方法，以及每种方法的优点和局限性。最后，我们将考虑可能的干预策略，以提高年轻人的依从性。

引用次数: 17

Advances in Pediatric Renal Transplantation 儿童肾移植研究进展

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2014-12-31 DOI: 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.

在过去的40年里，儿童肾移植科学取得了显著的进步[1,2]。随着肾脏移植在成人接受者中变得越来越普遍，短期和长期的结果都有所改善，儿童的结果却落后了。这种滞后是由多种因素造成的:幼儿的手术和技术问题更大，所需药物的代谢不同，缺乏可操作的科学数据，以及样本量不足，无法得出明确的研究结论等。

引用次数: 0

Significance of Asymptomatic Persistent Epstein-Barr Viral Load in Pediatric Renal Transplant Recipients: North American Pediatric Renal Trials and Collaborative Studies Report 儿童肾移植受者无症状持续性Epstein-Barr病毒载量的意义:北美儿童肾脏试验和合作研究报告

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2014-12-31 DOI: 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.

背景:许多儿科移植(TX)中心通过实时定量PCR监测EB病毒载量(VL)，并干预预防移植后淋巴细胞增生性疾病(PTLD)。一些儿童发展为无症状的持续性VL (PVL)。在无症状PVL儿童中，预防PTLD和其他对急性排斥反应(AR)、移植物衰竭(GF)和功能的不良影响的不同干预措施的结果尚不清楚。方法:邀请NAPRTCS中心将无症状PVL(≥6个月)儿童的数据输入EB VL登记处。对照组在同一时期将儿童纳入NAPRTCS TX组，无PVL或VL监测。将ebvl随机分为低(1-10)、中(>10-100)和高(>100倍检测限为中心)比率。结果:645名儿童(18个中心)中，85名(13.2%)在tx后平均6.4±6.3个月发生PVL。PVL儿童在TX时更可能年龄更小(< 5岁)，非裔美国人的可能性更小，大多数(75.3%)EBV不匹配(供体EBV IgG阳性，受体EBV IgG阴性)。29.4%的PVL患儿使用胸腺球蛋白诱导治疗，而对照组为37% (p=ns)。PVL患儿中有7/85(8.2%)发生PTLD，对照组为5/560 (0.9%)(p < 0.0001)。有无PTLD的EB - VL比值无显著差异。ebpvl作为时变协变量对患者生存、GF和AR无影响(HR分别为0.85、0.53和0.99)。PVL患儿GFR随时间的变化与对照组相当。结论:PVL患儿(实际负荷不可预测)发生PTLD的风险增加，但发生AR、死亡、GF或移植物功能丧失的风险没有增加。

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引用次数: 7

Sexuality and Reproductive Health Counseling in Adolescent Renal Transplant Recipients 青少年肾移植受者的性与生殖健康咨询

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2014-12-31 DOI: 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.

正常的青春期标志着身体、认知和心理社会发生重大变化的时期。它的特点是从具体的思维过程向抽象的思维过程过渡，关注冒险行为。患有慢性病的青少年和青壮年处于特别不利的地位，往往比健康的同龄人更容易受到危险行为的伤害。虽然目前还没有关于青少年肾移植受者的性传播感染负担的信息，但他们是一个特别令人担忧的人群，因为他们在移植后感觉“正常”，以补偿透析期间忍受的低质量生活时，可能会从事冒险行为。青少年错误地认为他们不太可能获得这种感染，并且移植后性欲和性功能可能得到改善，这进一步加剧了这种情况。考虑到他们的免疫功能低下，以及复杂的治疗方案可能与性传播感染治疗产生不利的相互作用，获得性传播感染的可能性令人担忧。此外，意外怀孕可能对其整体医疗状况和社会功能产生重大影响，从而影响其长期同种异体移植结果。由于儿科肾病专家承担了这些患者肾移植后的初级保健提供者的角色，熟悉基本的生殖健康咨询技术和市场上可用的避孕方法变得越来越重要。在为青少年肾移植受者制定生殖健康咨询的共识指南和具体建议之前，本综述简要总结了这些领域的现有知识。

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引用次数: 1

Editorial Advances in Pediatric Renal Transplantation 儿科肾移植的编辑进展

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2014-12-16 DOI: 10.2174/1874303X01407010113

V. Dharnidharka

引用次数: 0

Management of End Stage Renal Disease-Bangladesh Perspective 终末期肾病的管理——孟加拉国观点

Q4 Medicine

Open Urology and Nephrology Journal

Pub Date : 2014-10-31 DOI: 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.

终末期肾病(ESRD)是全世界发病率和死亡率的重要原因。肾替代疗法(RRT)对ESRD患者的治疗是昂贵的。人均收入与终末期肾病的治疗有直接关系。85%的世界人口生活在低收入或中等收入国家，这些国家的慢性肾病患者死亡率最高。孟加拉国的未来前景并不令人满意，因为对大多数人来说，终末期肾病的治疗遥不可及。应努力预防和治疗慢性肾病在疾病的初期阶段。

引用次数: 21

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