Nephrology News

Paediatric renal transplantation: moving forward in the field

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AbstractMLVI has been used to assess adherence. To determine the MLVI in children  60 IU/L, ACR, death, and graft loss. We analyzed demographic and socioeconomic characteristics, indication for transplantation, and type of donor. Student's t test and the chi‐square test were used. Statistical significance was set at P ≤ .05. Seventy‐two percent were infants or preschoolers, 62% biliary atresia. Seventy‐four percent of the mothers had middle‐school education, and 54% of the families had an income ≤3632.4 US$/y. Twenty‐two (44%) patients had a MLVI ≥ 2 SD; this was more ...

Source: Pediatric Transplantation - October 16, 2017Category: Transplant Surgery Authors: Janete Teresinha Pires Oliveira, Carlos Oscar Kieling, Ana ís Back Silva, Joel Stefani, Maria Carolina Witkowski, Camila Ribas Smidt, Carolina R Mariano da Rocha, Vania Naomi Hirakata, Maria da Graça Grossini, Maria Lúcia Zanotelli, Sandra Maria Gonça Tags: ORIGINAL ARTICLE Source Type: research

Authors: Saner FH, Abeysundara L, Hartmann M, Mallett SV Abstract For over 50 years patients with liver cirrhosis were considered to be at markedly increased risk of bleeding. This dogma was seemingly supported by abnormalities in standard laboratory tests (SLTs), such as the prothrombin time, that were interpreted as indicating a bleeding diathesis. However, publications from the last decade have revealed SLTs to be poor predictors of bleeding and it is now understood that stable patients with cirrhosis have a rebalanced haemostatic system and preserved thrombin generation. Viscoelastic tests (VETs), such as ROTEM...

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Potassium regulation in the neonate

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AbstractPotassium, the major cation in intracelluar fluids, is essential for vital biological functions. Neonates maintain a net positive potassium balance, which is fundamental to ensure somatic growth but places these infants, especially those born prematurely, at risk for life-threatening disturbances in potassium concentration [K+] in the extracellular fluid compartment. Potassium conservation is achieved by maximizing gastrointestinal absorption and minimizing renal losses. A markedly low glomerular filtration rate, plus adaptations in tubular transport along the nephron, result in low potassium excretion in the urine of neonates. Careful evaluation of clinical data using reference values that are normal for the neonate ’s postmenstrual age is critical to avoid over-treating infants with laboratory results that represent physiologic values for their developmental stage. The treatment should be aimed at correcting the primary cause when possible. Alterations in the levels or sensitivity to aldosterone are common i n neonates. In symptomatic patients, the disturbances in [K+] should be corrected promptly, with close electrocardiographic monitoring. Plasma [K+] should be monitored during the first 72 h of life in all premature infants born before 30 weeks of postmenstrual age as these infants are prone to develop non-oliguric hyperkalemia with potential serious complications.

Conclusion Our results suggest that MSCs and CM have a recovery effect on cardiac disturbances due to obesity and corroborate to the paracrine action of MSCs in heart disease models.

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Erratum to: Evaluation of the safety and efficacy of metoprolol infusion for children and adolescents with hypertensive crises: a retrospective case series

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CONCLUSION: These results confirm the therapeutic versatility of our approach. However, to the extent that its synergistic efficacy is dependent on the ability to achieve both a lethal photothermal effect and the thermally-controlled release of a sufficient amount of antibiotic, they also demonstrate the importance of carefully designing appropriate antibody and antibiotic combinations to achieve the desired therapeutic synergy. PMID: 29025325 [PubMed - as supplied by publisher]

CONCLUSIONS: Head-cooling could substantially reduce the negative effect of hyperthermia on human brain activity as well as thermal sensation. PMID: 29025324 [PubMed - as supplied by publisher]

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A child presenting with severe hypertension and circulatory failure, a diagnostic conundrum: Questions

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CONCLUSION: In light of recent studies, lasting bilateral mydriasis may not always be considered a decisive factor for non-escalation of treatment, as variability among TBI patients and outcomes has been demonstrated. Wide decompressive craniectomy is viable for controlling refractory intracranial hypertension in hemodynamically stable patients. PMID: 29026665 [PubMed]

Authors: Saner FH, Abeysundara L, Hartmann M, Mallett SV Abstract For over 50 years patients with liver cirrhosis were considered to be at markedly increased risk of bleeding. This dogma was seemingly supported by abnormalities in standard laboratory tests (SLTs), such as the prothrombin time, that were interpreted as indicating a bleeding diathesis. However, publications from the last decade have revealed SLTs to be poor predictors of bleeding and it is now understood that stable patients with cirrhosis have a rebalanced haemostatic system and preserved thrombin generation. Viscoelastic tests (VETs), such as ROTEM...

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Evaluation of the safety and efficacy of metoprolol infusion for children and adolescents with hypertensive crises: a retrospective case series

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ConclusionAn infusion of metoprolol for a hypertensive emergency is a safe and effective treatment for pediatric patients.

CONCLUSION: In light of recent studies, lasting bilateral mydriasis may not always be considered a decisive factor for non-escalation of treatment, as variability among TBI patients and outcomes has been demonstrated. Wide decompressive craniectomy is viable for controlling refractory intracranial hypertension in hemodynamically stable patients. PMID: 29026665 [PubMed]

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2017 Nobel Prize in Physiology or Medicine: Molecular mechanisms controlling the circadian rhythm

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High Blood Pressure During Pregnancy Tied to Obesity in Children


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High blood pressure during pregnancy poses serious risks to mothers and babies. It may also increase the risk for childhood obesity, a new study reports.

Chinese researchers studied 88,406 mother-child pairs, with complete data on maternal blood pressure during pregnancy and multiple follow-ups between ages 4 and 7 for the children. About 10 percent of the children were overweight or obese.

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Stopping aspirin treatment raises cardiovascular risk by over a third

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Discontinuing aspirin treatment may pose a serious threat to health, a new study shows.
New research published in the journal Circulation suggests that interrupting long-term, low-dose aspirin treatment may increase the likelihood of a second stroke or heart attack.

Researchers led by Johan Sundström, a professor of epidemiology at Uppsala University in Sweden, set out to examine the effect of stopping low-dose aspirin treatment on the odds of having a second heart attack or stroke.

The American Heart Association (AHA) recommend that people at risk of having a heart attack take low-dose aspirin preventively. Aspirin is also recommended by the AHA to heart attack and stroke survivors, in order to avoid recurrence.

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Distinct Phosphate Targets Feasible, Pilot Study Shows

A randomized controlled pilot study demonstrated the feasibility and safety of performing a large clinical trial that is powered to establish whether phosphate lowering reduces fatal and nonfatal cardiovascular events.
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Lupus risk almost three times higher after trauma

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Researchers have linked psychosocial trauma with a higher risk of lupus.
A new study expands on the physical health risks associated with post-traumatic stress disorder, after finding that the condition may raise the risk of lupus by almost threefold.

What is more, researchers found that exposure to any traumatic event - even in the absence of post-traumatic stress disorder (PTSD) - may increase lupus risk.

Study leader Dr. Andrea Roberts, of the Harvard T.H. Chan School of Public Health in Boston, MA, and colleagues recently reported their results in the journal Arthritis & Rheumatology.

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Daily Vitamin D Does Not Improve or Prevent Anemia

In a randomized study of patients with heart failure, including some with concurrent chronic kidney disease, patients who received vitamin D supplements or placebo had similar changes in hemoglobin levels over 36 months.
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Pruritus in Hemodialysis Patients Underestimated, Undertreated

Among hemodialysis patients always or nearly always bothered by itchy skin, 17% did not report their symptoms to a health care provider and 18% used no treatment for the condition.
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Pruritus in Hemodialysis Patients Underestimated, Undertreated

Among hemodialysis patients always or nearly always bothered by itchy skin, 17% did not report their symptoms to a health care provider and 18% used no treatment for the condition.
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High Phosphorus Ups Risk of Kidney Transplant Failure, Death

Each 1-mg/dL increase in serum phosphorus among kidney transplant recipients is associated with 36% and 21% increased risk in graft failure and death, respectively.
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Immunotherapy Superior to Sunitinib for Front-Line mRCC Treatment

Checkpoint inhibitor combination of nivolumab plus ipilimumab improved progression-free and overall survival compared with sunitinib.
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Chronic Kidney Disease Raises Tinnitus Risk

Tinnitus is 3-fold more likely to develop in patients with versus without chronic kidney disease, new study shows.
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Intensive BP Control May Reduce Death Risk in CKD Patients

Targeting and treating systolic blood pressure to a lower range was associated with a 14% decreased risk of death, meta-analysis shows.
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Upfront Cabozantinib for Advanced RCC Improves Outcomes

Cabozantinib reduced the risk of disease progression or death compared with sunitinib among patients with previously untreated advanced renal cell carcinoma.
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Chronic Kidney Disease Risk Higher With Intensive BP Control

Targeting a systolic blood pressure below 120 mm Hg versus 135 to 139 mm Hg increased the absolute risk of incident CKD by 2.6% over 3 years, but decreased the risk of cardiovascular events or death.
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Early NLR Changes Predict mRCC Immunotherapy Outcomes

Rises and decreases in neutrophil-to-lymphocyte ratio at 6 weeks after treatment with anti-PD-1/PD-L1 immune checkpoint blockade is associated with progression-free and overall survival.
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