Update on Pediatric Hemodialysis Adequacy.

The use of high reflux dialyzers to achieve a Kt/V above 1.2 did not improve patient survival in most literature reports. After an electronic search in many sites, guidelines, systematic reviews, and review articles (cited references): We recommend (1) using the equilibrated double-pool, weekly rather than per session, Kt/V, (2) Use of UF-dry weight to avoid V changes, (3) consider protein catabolic Rate (4) Use of double pool to avoid urea generation rebound effect.

Journey of a patient with scleroderma from renal failure up to kidney transplantation.

The increased awareness of systemic sclerosis (SS) and its pathogenetic background made the management of this disease more amenable than previously thought. However, scleroderma renal crisis (SRC) is a rarely seen as an associated disorder that may involve 2%-15% of SS patients. Patients presented with earlier, rapidly progressing, diffuse cutaneous SS disease, mostly in the first 3-5 years after non-Raynaud clinical manifestations, are more vulnerable to develop SRC.

Drug-Induced Myelosuppression in Kidney Transplant Patients.

Renal transplant is considered the best therapeutic option for suitable patients with end-stage kidney failure. Hematological complications that occur after kidney transplant include posttransplant anemia, leukopenia, neutropenia, and thrombocytopenia. Severely persistent leukopenia and neutropenia events predispose patients to infection, including opportunistic infections.

Post-transplantation lymphoproliferative disorders: Current concepts and future therapeutic approaches.

Transplant recipients are vulnerable to a higher risk of malignancy after solid organ transplantation and allogeneic hematopoietic stem-cell transplant. Post-transplant lymphoproliferative disorders (PTLD) include a wide spectrum of diseases ranging from benign proliferation of lymphoid tissues to frank malignancy with aggressive behavior. Two main risk factors of PTLD are: Firstly, the cumulative immunosuppressive burden, and secondly, the oncogenic impact of the Epstein-Barr virus.

Complement-mediated renal diseases after kidney transplantation - current diagnostic and therapeutic options in and recurrent diseases.

For decades, kidney diseases related to inappropriate complement activity, such as atypical hemolytic uremic syndrome and C3 glomerulopathy (a subtype of membranoproliferative glomerulonephritis), have mostly been complicated by worsened prognoses and rapid progression to end-stage renal failure. Alternative complement pathway dysregulation, whether congenital or acquired, is well-recognized as the main driver of the disease process in these patients. The list of triggers include: surgery, infection, immunologic factors, pregnancy and medications.

Bilateral progressive cystic nephroma in a 9-month-old male infant requiring renal replacement therapy.

We report the case of a 3-year-old boy who presented at 9 months of age with abdominal distension and was found to have a triad of bilateral cystic nephroma, pleuropulmonary blastoma (PPB) and juvenile intestinal polyps. There have been three previous reported cases of patients with the same associated diagnoses. Our patient is the first reported patient with PPB who received renal replacement therapy and progressed to successful renal transplantation.

Continuous venovenous hemofiltration with or without extracorporeal membrane oxygenation in children.

Objectives: We report the frequency of usage, patient demographics, and outcomes in children treated with continuous venovenous hemofiltration (CVVH) in three pediatric intensive care units (PICUs), with one unit providing combined extracorporeal membrane oxygenation (ECMO) and CVVH.

Design: Prospective database analysis.

Setting: Three regional PICUs in the Trent Haemofiltration Network with two general PICUs admitting 450-500 patients annually and the other providing regional cardiac support and a supraregional service for ECMO (600-650 admissions annually with 50 ECMO patients).

Acute renal failure in children: etiology, treatment and outcome.

Children with acute renal failure (ARF) may be treated in pediatric renal or intensive care (PICU) units where there is an increasing use of continuous renal replacement therapies such as hemofiltration (HF). Over three years, we prospectively recorded details of all patients with ARF treated both within our regional pediatric renal unit, in two local neonatal intensive care units (NICUs), and one PICU, which are all supported by our institution. Our study included eighty-three ARF patients (43% male) with a median age of 5.

Multicystic dysplastic kidney and pelviureteric junction obstruction.

Two infants with nonfunctioning antenatally detected multicystic dysplastic kidneys developed acute renal failure in conjunction with pelviureteric obstruction of the contralateral kidney at 9 and 14 months of age, respectively. The initial postnatal ultrasounds had shown mild pelvic dilatation in both cases. Clinicians need to be aware of the possibility of late obstruction.