Treatment of BK virus with a stepwise immunosuppression reduction and intravenous immunoglobulin in pediatric kidney transplant.

Background: BKV and BKVN are common in pediatric kidney transplant, but there is limited data on treatment approaches. Our objective was to study the prevalence of BKV and BKVN utilizing only plasma qPCR and report treatment outcomes with stepwise IR and IVIG.

Methods: A retrospective study of all pediatric kidney transplants from 2013 to 2020.

Clinical profile of children incidentally found to have advanced kidney failure.

Introduction: No data exist on the epidemiology of children incidentally diagnosed with advanced kidney failure (KF) during evaluation for non-specific symptoms. This is likely related to unrecognized symptoms and signs of CKD. The objective of our study was to evaluate incidentally diagnosed patients with advanced KF requiring long-term kidney replacement therapy (KRT).

Postinfectious Glomerulonephritis.

Postinfectious glomerulonephritis continues to be the most common cause of acute glomerulonephritis in children. Although in the past it was considered to be mainly a complication of streptococcal infections, today it is well known that infection with many other pathogens may trigger an immune response that results in glomerular injury. Most children with postinfectious glomerulonephritis have an excellent prognosis with complete recovery of renal function and no recurrence.

A Practical Guide to the Management of Severe Hypertension in Children.

Severe hypertension in children may result in life-threatening complications. Although there has not been extensive research in this area in children, and recommendations are mostly derived from adult data, in the last few years, there have been more pediatric studies on the safety and effectiveness of antihypertensives. The clinical presentation of a child with severe hypertension varies and may be completely asymptomatic or include signs and symptoms of end-organ damage.

APOL1-Associated Collapsing Focal Segmental Glomerulosclerosis in a Patient With Stimulator of Interferon Genes (STING)-Associated Vasculopathy With Onset in Infancy (SAVI).

Apolipoprotein L1 (APOL1) risk variants G1 and G2 are known to result in risk for kidney disease in patients of African ancestry. APOL1-associated nephropathy typically occurs in association with certain environmental factors or systemic diseases. As such, there has been increasing evidence of the role of interferon (IFN) pathways in the pathogenesis of APOL1-associated collapsing glomerulopathy in patients with human immunodeficiency virus (HIV) infection and systemic lupus erythematosus, 2 conditions that are associated with high IFN levels.

Pheochromocytoma and paraganglioma-an update on diagnosis, evaluation, and management.

Pheochromocytomas and paragangliomas (PPGLs) generally grouped together are rare catecholamine-secreting endocrine tumors. Symptoms of catecholamine excess are non-specific and therefore a high index of suspicion in children with sustained hypertension, family history of endocrine tumors, or features of syndromes associated with PPGLs leads to a timely diagnosis and treatment. Free metanephrines in the plasma or 24-h urine are the preferred tests to establish catecholamine excess.

Atypical hemolytic uremic syndrome: a clinical conundrum.

Background: Patients negative for Shiga toxin-producing E. coli (STEC) are categorized as having atypical hemolytic uremic syndrome (HUS) and are associated with an increased risk for complement mutations and poorer prognosis compared with typical HUS. However, STEC identification is limited by the natural history of HUS.

Pharmacologic Treatment of Pediatric Hypertension.

Prevalence of hypertension is increasing in children and adolescents. Uncontrolled hypertension in children not only causes end organ damage but also increases the risk of adult hypertension and cardiovascular disease. Clinical trials have proven efficacy of antihypertensive medications in children.

Treatment of Hypertension in Children With Catecholamine-Secreting Tumors: A Systematic Approach.

Management of blood pressure in children with pheochromocytoma and other catecholamine-secreting tumors (CSTs) is unique and challenging. The authors report a single-center experience using sequential α-adrenergic blockade (phenoxybenzamine), increased fluid intake, and β-blockade for presurgical management of 10 CSTs in children. In this retrospective review, mean duration for blood pressure control in preparation for surgery was 4.

Diagnosis and management of urinary tract infection and vesicoureteral reflux in the neonate.

Urinary tract infection (UTI) is the most common bacterial infection in febrile newborns, particularly those born prematurely and with a low birth weight. Vesicoureteral reflux (VUR) predisposes to UTI and renal scarring. Half of neonates with UTI may have only low-grade fever or no fever.

Pediatric hypertensive emergencies.

Hypertensive emergency is a life-threatening condition that requires immediate evaluation and treatment. In children, severe hypertension can be caused by a variety of different underlying conditions. It usually presents with neurological involvement; however, signs and symptoms of injury to the kidneys, myocardium and eyes can also be present.

Reducing central venous catheters in chronic hemodialysis--a commitment to arteriovenous fistula creation in children.

Background: An internal permanent vascular access [arteriovenous fistula (AVF) or arteriovenous graft (AVG)] is preferred over central venous catheters (CVC) for chronic hemodialysis. However, CVC remain the most commonly used access in children. The objective of this study was to evaluate our experience with AVF.

Evaluation of hypertension in children.

Hypertension is an important public health problem, and increasingly children are being diagnosed with primary hypertension. As the list of secondary causes of hypertension is extensive, pediatric practitioners increasingly need to decide on investigations needed for evaluating children presenting with high blood pressure. The differentiation between primary and secondary hypertension is paramount to understanding this important health issue, since many forms of secondary hypertension require specific treatment.

Prediction of primary vs secondary hypertension in children.

Despite current guidelines, variability exists in the workup of hypertensive children due to physician preferences. The study evaluates primary vs secondary hypertension diagnosis from investigations routinely performed in hypertensive children. This retrospective study included children 5 to 19 years with primary and secondary hypertension.

Weight or body surface area dosing of steroids in nephrotic syndrome: is there an outcome difference?

Although prednisone is the treatment of choice for nephrotic syndrome (NS) in childhood, the dosing regimen varies between 60 mg/m(2)/day, as recommended in early studies, to the often prescribed 2 mg/kg/day dose, which is used in common practice. Mathematical models have demonstrated that weight-based dosing can be less than body surface area (BSA)-based dosing in smaller children. To test our hypothesis that weight-based dosing would result in altered treatment outcomes in children with NS, we analyzed a cohort of 56 children (mean age 5.

Iron deficiency in children with early chronic kidney disease.

Iron deficiency (ID) contributes to the development of anemia in patients with chronic kidney disease (CKD). The frequency of ID in children with early CKD has not previously been reported. This was a retrospective chart review of children with CKD stages 2 and 3 followed at the CKD clinic of Children's Hospital of Michigan.

Clinical utility of valsartan in the treatment of hypertension in children and adolescents.

Valsartan is a potent antagonist of the type 1 angiotensin receptor (AT(1)). By blocking the actions of angiotensin II on the AT(1), it inhibits vasoconstriction and synthesis of aldosterone thus lowering systemic blood pressure. Valsartan has been approved by the FDA for the treatment of hypertension in children aged 6 years and older.

A comparison of the prevalence of metabolic syndrome and its components in high and low altitude populations in peru.

Background: Prevalence of the metabolic syndrome has been described in populations with ethnic and cultural differences. The aim of this study was to determine the prevalence of the metabolic syndrome on a population from the Andes Mountains of Peru and compare it to a sea-level population.

Methods: A cross-sectional study of subjects aged 30 years old or more from the high-altitude population of San Pedro de Cajas (SPC) (13,450 feet) and the sea-level population of Rimac (331 feet) was done.

Lipid profile, waist circumference, and body mass index in a high altitude population.

Some studies have found different distribution patterns for the lipid profile of high altitude populations, having found the majority of them a more favorable one in these subjects. The objective of this study is to describe the lipid profile of a high altitude population and relate it to the waist circumference, body mass index, gender, and age. A descriptive study was done in an adult population, 30 yr old and above, of the town of San Pedro de Cajas (SPC), Peru, located at 4100 m (13,450 ft) above sea level.