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Indian Pediatr 2019;56: 256 |
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Clippings
Theme: Pediatric Nephrology
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Sidharth Kumar Sethi
Email:
[email protected]
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Utility of different blood pressure measurement
components in childhood to predict adult carotid intima-media thickness
(Hypertension. 2019;73:335-41)
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Childhood blood pressure (BP) levels predict adult subclinical
atherosclerosis. It is well known, among adults, that elevated carotid
artery intima-media thicknessis associated with cardiovascular disease
and stroke. The best childhood BP component for prediction has not been
determined. This study comprised 5925 children aged 3 to 18 years who
were followed into adulthood (mean (SD) follow-up 25.8 (6.2) years).
Childhood BP was measured by using a standard mercury sphygmomanometer.
Carotid intima-media thickness
³90th
percentile was used to define subclinical atherosclerosis. In age- and
sex-adjusted analyses, area under the receiver operating characteristic
curves for systolic BP (SBP) showed significantly improved prediction
compared with diastolic BP or mean arterial pressure. Combining
different BP components did not improve prediction over SBP measurement
alone. Based on the associations with adult carotid intima-media
thickness, cut points for elevated SBP were 105 mmHg for 3- to
6-year-old boys, 108 mmHg for 3- to 6-year-old girls, 108 mmHg for 7- to
12-year-old boys, 106 mm Hg for 7- to 12-year-old girls, 123 mm Hg for
13- to 18-year-old boys, and 115 mm Hg for 13- to 18-year-old girls.
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Mycophenolate mofetil versus levamisole
in frequently relapsing nephrotic syndrome (Kidney Int.
2019;95:210-8)
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This single-center, randomized, open-label trial from India enrolled 149
children ages 6-18 years with frequently relapsing or steroid-dependent
nephrotic syndrome, to either receive therapy with MMF (750-1000 mg/m2
daily) or levamisole (2-2.5 mg/kg on alternate days) for 1 year;
prednisolone was discontinued by 2-3 months. The frequency of relapses
was similar in MMF and levamisole treatment groups. Relapse rates
declined to almost one-third of baseline for both treatment groups.
Therapy with MMF was not superior to levamisole in terms of the
proportions of participants with sustained remission (40.8% vs.
34.2%), frequent relapses (14.5% vs. 16.4%), or treatment
failure.
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Optimizing AKI definitions during first postnatal week (Pediatr
Res. 2019;85:329-38)
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AWAKEN (Assessment of Worldwide Acute Kidney injury Epidemiology in
Neonates) is the largest neonatal Acute kidney injury (AKI) study to
date. It is the first multi-center, multi-national project and the first
to include infants hospitalized in the neonatal intensive care unit
across the gestation age spectrum. All neonates admitted to 24
participating neonatal intensive care units from four countries
(Australia, Canada, India, United States) between January 1 and March
31, 2014, were screened. Of 4273 neonates screened, 2022 (47.3%) met
study criteria. Neonates with
³1
serum creatinine (SCr) on postnatal days 1-8 were assessed. They
compared the mortality predictability of SCr absolute (³0.3
mg/dL) vs percent (³50%)
rise. They also determined the optimal absolute, percent, and maximum
SCr thresholds that provide the highest mortality area under curve (AUC)
and specificity for different GA groups. The
³0.3 mg/dL rise
outperformed ³50%
SCr rise. The optimal SCr thresholds to predict AUC and specificity were
³0.3 and
³0.6 mg/dL for
£29 weeks GA,
and ³0.1 and
³0.3 mg/dL for
>29 week GA. The maximum SCr value provides great specificity.
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Three-monthly bolus vitamin D supplements (1000 vs 400
IU/day) for prevention of bone loss in children with
difficult-to-treat nephrotic syndrome (Paediatr Int Child
Health. 2018;38:251-60).
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There are no uniform consensus guidelines regarding the optimum dose of
calcium and vitamin D dosage in children for osteoprotection. This
parallel-group, open-label, randomized clinical trial was done to
compare the efficacy of three-monthly bolus vitamin D supplementation
(1000 vs 400 IU/day) to prevent bone loss in children with
difficult-to-treat nephrotic syndrome (DTNS). Sixty children aged 1-18
years with DTNS [37 with frequently relapsing NS (FRNS), 13
steroid-dependent NS (SDNS) and 10 steroid-resistant NS (SRNS)] were
enrolled and block randomized. In Group A, oral vitamin D was
administered at a bolus dose of 90,000 IU every three months (calculated
for a period of three months at 1000 IU/day). In Group B, vitamin D (cholecalciferol)
was administered as a bolus dose of 36,000 IU every three months
(calculated for a period of three months at 400 IU/day). The
proportionate change in bone mineral content (BMC) was studied by dual
energy X-ray absorptiometry (DEXA) scan (baseline vs.
after 12 months). The proportionate change in BMC was not significantly
different between the two groups (median proportionate change in BMC in
Group A 13.4% vs 11.6% in Group B, P=0.22). Overall, BMC
increased in both groups (96.7% in each). None of the patients had
hypercalciuria at the end of the study. Authors concluded that
three-monthly bolus vitamin D dosing regimens administered either as
1000 or 400 IU/day prevent bone loss in children with DTNS who require
long-term steroids. Further studies are required to demonstrate the
superiority of the former regimen over the latter.
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