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Indian Pediatr 2017;54: 336 |
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Clippings
Theme: Pediatric Nephrology
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Sriram Krishnamurthy
Email: [email protected]
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Clinical outcomes in children with Henoch-Schönlein
purpura nephritis without crescents. (Pediatr Nephrol. 2017 Feb
15. doi: 10.1007/s00467-017-3604-9. [Epub ahead of print])
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Henoch-Schönlein purpura (HSP) is the most common vasculitis in
children. Its long-term prognosis depends on renal involvement. The
management of HSP nephritis (HSPN) remains controversial. This study
reports the prognosis of children with HSP presenting with class-2 ISKDC
(International Study of Kidney Disease in Children) nephritis. All such
children diagnosed between 1995 and 2015 in four pediatric nephrology
centers were included, and clinical and biological data were collected
from the medical files. The primary endpoint was remission of
proteinuria defined as <200 mg/L. Ninety-two children were included in
the study with a median (range) follow-up of 36 (6-120) months; 28% had
nephrotic syndrome, 31% had proteinuria >3 g/L, 52% had proteinuria
1-3 g/L, and 18% proteinuria <1 g/L. Forty-seven percent of patients
received treatment with oral steroids alone, and 37% received
methylprednisolone pulses followed by oral steroids, and 18% did not
receive steroids. Although 85% reached remission during follow-up, 12%
did not maintain complete remission over time so that only 75% remained
in complete remission by the end of the follow-up. Univariate analysis
found a higher likelihood of remission in patients with higher
proteinuria at disease onset (P=0.009). This trend was not found
in the multivariate analysis after adjusting for treatments, as patients
with higher proteinuria were most often treated with steroids. This
study concludes that one-fourth of patients with HSPN class-2 remain
proteinuric, and thus carry the risk of developing chronic kidney
disease over the long term. This finding, together with the better
outcome of patients treated with steroids, is in favor of using
high-dose oral or intravenous steroids in these patients.
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Incidence and outcome of acute cardiorenal syndrome in
hospitalized children. (Indian J Pediatr. 2017 Feb 27.
doi: 10.1007/s12098-017-2307-3. [Epub ahead of print])
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The objective of this prospective cohort study was to determine
the incidence, etiology and outcome of Cardiorenal syndrome (CRS) in 242
children (age 6 mo-18 y) hospitalized with primary cardiac, renal or any
systemic disorder at a tertiary care center in India. Sixty-seven
(27.7%) children developed CRS; 40.3%, 20.9%, and 38.8% had CRS-1, 3 and
5, respectively. Cardiac diseases leading to CRS were myocarditis
(40.7%) followed by congenital heart disease (25.9%), rheumatic heart
disease (18.5%), and dilated cardiomyopathy (7.4%); renal disease
associated with CRS was acute glomerulonephritis (100%), and major
systemic disorders leading to CRS were septicemia (53.8%), malaria
(23.1%), scrub typhus (7.7%) and acute gastroenteritis (3.8%). The
occurrence of CRS was associated with an increased risk of mortality (OR
6.3, 95% CI 2.8, 14.1; P< 0.001). A subgroup analysis revealed
that children with CRS having acute kidney injury stage 2 and 3 also had
a higher risk of mortality. The study concludes that the incidence of
CRS is quite high in children with cardiac, renal or systemic diseases,
and is associated with a significant risk of mortality. Children
presenting with these illnesses should be monitored for the occurrence
of CRS so that early intervention may reduce mortality.
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Outcome of extremely low birth weight infants
with a history of neonatal acute kidney injury. (Pediatr
Nephrol. 2017 Feb 14. doi: 10.1007/s00467-017-3582-y. [Epub
ahead of print])
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The objective of this study was to evaluate the outcome of extremely low
birth weight (ELBW) infants with a history of acute kidney injury (AKI).
Medical records of all ELBW infants admitted to the neonatal intensive
care unit (NICU) between Jan 2002 and Dec 2011 were reviewed for
infants’ demographics, blood pressure (BP) at NICU discharge and at
³3 years, and
estimated glomerular filtration rate (eGFR) at
³2 years. Out of 222
included patients, 10% had AKI stage 2 and 3, 39% had AKI stage 1, and
the rest did not have AKI. At NICU discharge, there was a difference in
diastolic BP (DBP) among infants who had AKI stages 2 and 3, those who
had stage 1, and those who did not have AKI, and 11% had hypertension
(HTN). Although there was a significant correlation between the rise in
SCr and DBP at NICU discharge in infants with AKI (R=0.304; P=0.004),
there was no difference in HTN between infants with and those without
AKI. At ³2
years of age, five children across all groups had an eGFR <90
ml/min/1.73m2 or chronic kidney disease (CKD). At
³3 years of age, 5%
(11 out of 222) had HTN. The study concluded that at NICU discharge,
infants with AKI stages 2 and 3 have a higher DBP than infants with
stage 1 AKI and those who did not have AKI. However, there is no
difference in the rate of HTN between the two groups. At
³2 years ELBW infants
are at risk for CKD independently of whether or not they develop
neonatal AKI.
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Association between vancomycin trough concentrations and
acute kidney injury in neonates. (BMC Pediatr. 2017 Feb
11;17(1):50. doi: 10.1186/s12887-017-0777-0)
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The objective of this study was to compare the incidence of acute kidney
injury (AKI) in neonates with serum vancomycin trough concentrations <10
mg/L, 10-15 mg/L, or >15 mg/L. A retrospective chart review of patients
in the neonatal intensive care unit (NICU) was conducted to determine
the incidence of AKI in neonates receiving vancomycin. The overall
incidence of AKI was 2.7%. Comparison of the incidence of AKI in the
three groups showed a statistically significant association between
increasing vancomycin trough concentration and incidence of AKI. The
study concluded that there is low incidence of AKI in neonates receiving
vancomycin. However, there is a positive correlation between increasing
vancomycin trough concentrations and an increasing serum creatinine.
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