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Adult Learning. IN: Elements of Excellence: A Team Approach to Chronic Kidney Disease Care. New York, NY: National Kidney Foundation. 2008. pp 27-38.
This chapter about adult learning is from a manual that was developed to support the distinctive specialty practice for chronic kidney disease (CKD) stages 4 and 5 from a multidisciplinary perspective. Clinicians on the CKD team—including nurses, dietitians, dialysis technicians, and social workers—can use this resource as a foundation for education, orientation, and specialty training. The authors stress that part of the definition of patient-centered care is that patients be informed, communicated with, and educated. Patient education always ranks high on the priority list for interventions because the benefits of a knowledgeable patient and family are numerous. This chapter covers learning styles, assessing learning style, readiness to learn, facilitating learning, evaluating adult learning, nonadherent behavior and Readiness to Change theory, the role of humor in learning and wellness, and peer support and mentoring. The authors note that adult learners differ from children in their motivation levels, history of previous learning experience, involvement in the learning process, and application of the newly learned concepts. Many adult patients are only ready to learn when they feel that what they need to know is important to achieve or maintain their quality of life. Clinicians are encouraged to help patients understand that learning is important, not just to develop skills necessary for self-management, but also to make vital health care decisions. Most of the information in the chapter is presented in bulleted lists for ease of access. 1 figure. 13 references.
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Childhood Nephrotic Syndrome. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 6 p.
The nephrotic syndrome is a group of symptoms that can be the first sign of a disease that damages the tiny blood-filtering units called glomeruli in the kidneys, where urine is made. Written in nontechnical language, this fact sheet presents an overview of childhood nephrotic syndrome. Topics include the symptoms of the nephrotic syndrome; diagnostic tests that may be done to confirm the condition; other conditions that are associated with childhood nephrotic syndrome, such as minimal change disease, focal segmental glomerulosclerosis, and membranoproliferative glomerulonephritis; and treatment strategies for these conditions. Childhood nephrotic syndrome is most common between the ages of 18 months and 5 years. Nephrotic syndrome causes proteinuria, low levels of protein in the blood, less frequent urination, and swelling and weight gain from the buildup of fluid. Diagnosis of nephrotic syndrome requires urine and blood samples and may include a kidney biopsy. The fact sheet concludes with a brief summary of relevant research studies, a list of resource organizations for readers wanting additional information, and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NIKUDIC). 1 figure. 3 references.
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Constipation in Children. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 4 p.
This fact sheet describes constipation in children. Constipation is a condition in which bowel movements occur less frequently than usual or stools tend to be hard, dry, and difficult or painful to pass. Constipation is common in children and is usually without long-term consequences. However, constipation can diminish a child’s quality of life, cause emotional problems, and create family stress. The fact sheet answers common questions about constipation in children, including its causes, symptoms, how to know when to see a doctor, and treatment strategies. Children often develop constipation as a result of withholding stool. A child with constipation should see a doctor if symptoms last for more than 2 weeks. A child should also see a doctor if constipation is accompanied by symptoms that may indicate a more serious health problem. Constipation is treated by changing diet, taking laxatives, and adopting healthy bowel habits. The fact sheet includes a brief description of current research in this area. Readers are referred to online publications and two resource organizations: the American Academy of Pediatrics at 847–434–4000 or www.aap.org and the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1 figure.
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Crohn Disease. JAMA: Journal of the American Medical Association. 299(14): 1738. April 2008.
This single-page fact sheet helps readers understand Crohn’s disease, a type of inflammatory bowel disease (IBD) that can involve the entire gastrointestinal (GI) tract. The inflammation seen in Crohn’s disease has similarities to the disease process of other immune diseases such as rheumatoid arthritis. The fact sheet briefly lists the signs and symptoms of Crohn’s disease, which can include diarrhea, rectal bleeding, abdominal pain, weight loss, arthritis, fever, anemia, and poor growth in children. The fact sheet briefly reviews the diagnostic tests that may be used to confirm the presence and severity of Crohn’s disease and summarizes the treatment options available. Most people with Crohn’s disease are treated by a gastroenterologist. Treatment options include drug therapy with anti-inflammatory and immunosuppressive agents, surgery, and nutritional supplements. Readers are referred to the websites of three resource organizations: the National Institute of Diabetes and Digestive and Kidney Diseases at www.digestive.nikkd.nih.gov, the Crohn’s and Colitis Foundation of America at www.ccfa.org, and the American Gastroenterological Association at www.gastro.org. Readers are also encouraged to go to the JAMA Patient Pages at www.jama.com for more information. 1 figure.
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Deceased Pediatric Donor Kidneys: An Underused Resource. Nephrology News & Issues. 22(7): 47-49, 57. June 2008.
This article considers the use of kidneys donated from pediatric cadavers. The author notes that the number of patients wait-listed for transplantation continues to grow as the availability of transplantable organs remains relatively stable. This disparity makes the use of all potentially transplantable organs imperative. Historically, outcomes with kidneys from young pediatric donors have been compromised by complication rates that are higher than those for adult kidneys, as well as by hyperfiltration injury related to inadequate nephron dosing. The author discusses the history of deceased donor pediatric kidney transplantation, current experience and outcomes, patient evaluation for transplant, and the anticipated postoperative course. The author concludes that, with meticulous attention to technical details, outstanding results can be achieved with kidneys from even very young donors. Maximizing the use of this scarce resource is critically important for patients with renal failure who are often facing a long and uncertain wait for a transplant. 3 figures. 20 references.
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Irritable Bowel Syndrome (IBS) in Children. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 6 p.
This fact sheet describes irritable bowel syndrome (IBS) in children. IBS is a functional gastrointestinal disorder marked by abdominal pain or discomfort, bloating, and irregular bowel habits, such as diarrhea or constipation. Functional gastrointestinal disorders are defined by their symptoms. IBS can cause a great deal of discomfort and distress, but it is not life threatening, does not damage the bowel, and does not progress to other diseases. The fact sheet answers common questions about IBS in children, including the anatomy and function of the bowel, the causes of IBS, who gets IBS, the symptoms, diagnostic strategies, treatment options, and the outlook for a child with IBS. Treatment for IBS includes dietary changes, medication, and stress management. The fact sheet includes a brief description of current research in this area. Readers are referred to two resource organizations: the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.org and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition at 215–233–0808 or www.naspghan.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1 figure.
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Kidney Dysplasia. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 6 p.
This fact sheet describes kidney dysplasia, a condition in which the internal structures of one or both of a baby’s kidneys do not develop normally. Fluid-filled sacs called cysts replace normal kidney tissue. Kidney dysplasia usually happens in only one kidney. A baby with one working kidney can grow normally and has few, if any, health problems. Babies with kidney dysplasia affecting both kidneys generally do not survive pregnancy. Those who do survive need dialysis and a kidney transplant very early in life. Written in a question-and-answer format, the fact sheet explains how kidney dysplasia happens, the causes of kidney dysplasia, the signs or complications of kidney dysplasia, how kidney dysplasia is diagnosed, treatment strategies, and the long-term outlook for a child with kidney dysplasia. The fact sheet includes a list of questions for parents to ask their health care provider about the child’s kidney dysplasia and related problems. The author notes that kidney dysplasia may have genetic causes and is often part of several genetic syndromes that affect other body systems. Children and adults with only one working kidney should have regular checkups for high blood pressure and kidney damage. A final section of the fact sheet briefly notes the importance of ongoing research studies. The fact sheet includes contact information for four resource organizations and concludes with a brief description of the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse. 3 figures.
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Managing High Blood Pressure. PKD Progress. 24(3): 10-11. Fall 2008.
This article describes the interplay of autosomal dominant polycystic kidney disease (ADPKD) and high blood pressure, also called hypertension. ADPKD is the most common genetic cause of kidney failure in both children and adults. Hypertension is very common in adults with ADPKD and can even be the first sign of the disease. The authors discuss appropriate blood pressure targets, why hypertension develops in this patient population, the benefits of good blood pressure control beyond slowing kidney disease, drug therapy for hypertension in ADPKD, and current research studies seeking better treatment for these patients. The authors conclude by reminding readers of the importance of adequate treatment of high blood pressure, to maintain the health of the kidneys, the heart, and the overall well-being of patients with ADPKD. 1 figure.
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Pancreatitis. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 8 p.
This fact sheet describes pancreatitis, defined as inflammation of the pancreas. The pancreas is a large gland behind the stomach that secretes digestive juices, or enzymes, into the duodenum through a tube called the pancreatic duct. Pancreatic enzymes join with bile—a liquid produced in the liver and stored in the gallbladder—to digest food. In addition, the pancreas releases the hormones insulin and glucagon into the bloodstream. These hormones help the body regulate the glucose it takes from food for energy. When the pancreas is inflamed, the enzymes inside it attack and damage the tissues that produce them. Pancreatitis can be acute or chronic. Either form is serious and can lead to complications. In severe cases, bleeding, infection, and permanent tissue damage may occur. The fact sheet answers common questions about the anatomy and function of the pancreas and discusses the symptoms of acute and chronic pancreatitis, the diagnostic tests that may be used to confirm the presence of pancreatitis, treatment strategies, complications, and pancreatitis in children. Common causes of pancreatitis include gallstones and heavy alcohol use, but sometimes the cause of pancreatitis cannot be found. Symptoms of acute pancreatitis include abdominal pain, nausea, vomiting, fever, and a rapid pulse. Treatment for acute pancreatitis includes intravenous (IV) fluids, antibiotics, and pain medications. Surgery is sometimes needed to treat complications. Acute pancreatitis can become chronic if pancreatic tissue is permanently destroyed and scarring develops. Symptoms of chronic pancreatitis include abdominal pain, nausea, vomiting, weight loss, diarrhea, and oily stools. Treatment for chronic pancreatitis may involve IV fluids; pain medication; a low-fat, nutritious diet; and enzyme supplements. Surgery may be necessary to remove part of the pancreas. The fact sheet includes a brief description of current research in this area. Readers are referred to three resource organizations: the American Gastroenterological Association at 301–654–2055 or www.gastro.org, the American Dietetic Association at www.eatright.org, and the American Pancreatic Association at 612–626–9797 or www.american-pancreatic-association.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1 figure.
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Renal Tubular Acidosis. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 6 p.
Renal tubular acidosis (RTA) is a disease that occurs when the kidneys fail to excrete acids into the urine, which causes a person’s blood to remain too acidic. Without proper treatment, chronic acidity of the blood leads to growth retardation, kidney stones, bone disease, and progressive renal failure. This fact sheet reviews the diagnosis, the subtypes of RTA, therapy, and current research activities in RTA. To diagnose RTA, the doctor will check the acid-base balance in samples of the patient’s blood and urine. Physicians use a three-category classification system to describe the different types of RTA. Type 1, also called classic distal RTA, is an inherited disorder associated with diseases that affect many organ systems such as the autoimmune disorders Sjögren’s syndrome and lupus erythematosus. Type 2 is called proximal RTA and occurs most frequently in children as part of a disorder called Fanconi’s syndrome; it can also occur as a side effect of treatment with ifosfamide, a drug used in chemotherapy. Type 4 is caused by another defect in the kidney tubule but is different from classic or proximal RTA because it results in high levels of potassium in the blood instead of low levels. If treated early, most people with RTA will not develop permanent kidney failure. Therefore, the goal is early recognition and adequate therapy, which will need to be maintained and monitored throughout the patient’s lifetime. The fact sheet concludes with a summary of research programs in Renal tubular acidosis (RTA) area and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. Readers are referred to the National Kidney Foundation at www.kidney.org or 1–800–622–9010, the American Association of Kidney Patients at www.aakp.org or 1–800–749–2257, and the American Kidney Fund at www.kidneyfund.org or 1–800–638–8299 for more information.
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Therapeutic Interventions for Autosomal Dominant Polycystic Kidney Disease. Nephrology News & Issues. 22(3): 25-26. March 2008.
This article reviews the treatment interventions that can be used for patients with autosomal dominant polycystic kidney disease (ADPKD), the most common life-threatening hereditary disease in the United States. ADPKD causes end-stage renal disease (ESRD) requiring dialysis and/or kidney transplantation. The author reviews the numerous clinical trials now testing a variety of drugs in children and adults with ADPKD. The major treatments being tested are Tolvaptan, a vasopressin V2receptor antagonist; octreotide, a drug that inhibits growth hormone; sirolimus (Rapamycin); statins, a group of drugs that are used to lower cholesterol; and angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), drugs used to treat hypertension. The author briefly describes how each pharmaceutical may be helpful for patients with ADPKD. A chart lists the drugs; their mechanism of action; current, ongoing human studies; and the studies’ endpoints. 1 table. 9 references.
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What I Need to Know About My Child’s Urinary Tract Infection. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 16 p.
This booklet helps parents understand the problem of urinary tract infections (UTIs) in children and how it can be managed. Written in nontechnical language, the booklet describes the anatomy and function of the urinary tract, the definition of a UTI, symptoms, how to know when to contact a health care provider for UTI symptoms, diagnostic strategies used to confirm the presence of a UTI, treatment options, prevention tips, recurrent UTIs, and questions to ask the pediatrician or urologist about the child’s UTI. Symptoms of a UTI include fever, fussiness and irritability, refusal to eat, diarrhea, vomiting, cloudy or foul-smelling urine, burning urination, back or stomach pain, nighttime or daytime wetting in older children, and blood in the urine. Diagnosis is usually based on a urine sample. Generally, a UTI will be treated successfully with an antibiotic. Most UTIs can be prevented with good bathroom habits, especially for girls. The booklet includes a list of organizations through which readers can get additional information about urinary tract infections. A final section briefly describes the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse (NIKUDIC). The booklet is illustrated with black-and-white line drawings. 7 figures.
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“New Normal”: Life on Dialysis - The First 90 Days: Helpful Advice From People on Dialysis. New York, NY: National Kidney Foundation. 2007. 64 p.
This booklet is designed to help new dialysis patients get through the transition time of their first 90 days on dialysis therapy. Topics covered include adjusting to dialysis, the different types of dialysis available, hemodialysis, peritoneal dialysis, in-center hemodialysis, home dialysis, what to expect in the first few months, emotional and physical health while on dialysis, support systems, managing cardiovascular disease and other comorbid conditions, understanding laboratory test values, employment, travel, and daily living activities. A final section focuses on children who are on dialysis. The booklet is written in nontechnical language, with many supportive quotations from other patients sprinkled throughout the text. Detailed line drawings illustrate some of the sections, including the equipment and techniques used in the different types of dialysis. The booklet concludes with a section of suggested resources for more information, including the National Kidney Foundation (NKF), employment resources, financial and insurance resources, and general readings of encouragement. The booklet includes black-and-white photographs of a variety of kidney patients, as well as blank space for readers to make notes. 9 figures. 18 references.
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2007 Regulatory and Legislative Changes in Review. Dialysis and Transplantation. 36(11): 618-623. November 2007.
This article summarizes some of the recent legislative and regulatory issues that affect renal care. The author reports on several regulations that will have a dramatic impact on the dialysis industry and on hospital-based kidney transplant programs. Topics include anemia drug reimbursement; kidney transplant developments; extended immunosuppressive drug coverage; Stark III regulations, which provide regulatory guidance to the prohibitions against physician self-referrals; and proposed legislation. Tables summarize some of the changes, including to the single payment system, quality incentive payments, and miscellaneous State Children’s Health Insurance Program (SCHIP) provisions. The author concludes that, regardless of the ultimate fate of SCHIP, it is likely that the end-stage renal disease (ESRD) provisions described, or ones similar, will be reintroduced in future legislation. 3 tables.
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Anemia Management in Chronic Kidney Disease: National Clinical Guideline for Management in Adults And Children. Andrews Place, London: Royal College of Physicians of London. 2007. 172 p.
This document provides recommendations for many aspects of anemia management in patients with chronic kidney disease (CKD). Anemia is defined as the state in which the quality or quantity of circulating red blood cells is below normal. Anemia is measured directly as blood hemoglobin (Hb) concentrations. The document offers seven chapters[m1]: development of the guidelines, covering methodology, scope, and key messages of the guideline; the diagnostic evaluation and assessment of anemia; the management of anemia; the assessment and optimization of erythropoiesis; and monitoring treatment of anemia in patients with CKD. The document includes five appendices: evidence-based clinical questions and literature searches, the scope, target Hb levels in patients on hemodialysis, the route of administration of erythropoiesis stimulating agents (ESAs), and a glossary of terms. The aim of the producing organization is to provide a user-friendly, evidence-based clinical guideline that offers the best clinical advice for anemia management in CKD, is based on best published evidence and expert consensus, takes into account patient choice and informed decision-making, defines the major components of care provision for CKD-related anemia, indicates areas suitable for clinical audit, details areas of uncertainty or controversy requiring further research, and provides a choice of guideline versions for differing audiences. 9 figures. 56 tables. 295 references.
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Bacteria and Foodborne Illness. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2007. 8 p.
Foodborne illness results from eating food contaminated with bacteria—or their toxins—or other pathogens such as parasites or viruses. The resulting illnesses range from upset stomach to more serious symptoms, including diarrhea, fever, vomiting, abdominal cramps, and dehydration. This fact sheet reviews the causes, symptoms, risk factors, complications, diagnosis, treatment, and prevention of foodborne illness. People at greater risk for foodborne illness include young children, pregnant women and their fetuses, older adults, and people with lowered immunity. Symptoms usually resemble intestinal flu. Treatment may range from replacement of lost fluids and electrolytes for mild cases of foodborne illness, to hospitalization for severe conditions such as hemolytic uremic syndrome (HUS). Prevention strategies include adequate hand washing; keeping raw meat, poultry and seafood separate from other foods; cooking foods properly; using adequate refrigeration; and cleaning surfaces well before and after using them to prepare foods. One section describes the use of food irradiation as a means of cold pasteurization, which destroys living bacteria, to control foodborne disease A final section considers recent evidence that foodborne pathogens are linked to chronic disorders, including arthritis, inflammatory bowel disease, kidney failure, Guillain-Barre syndrome, and autoimmune disorders. One sidebar reviews common sources of foodborne illness, including the bacteria that are usually responsible. The fact sheet concludes with contact information for nine resource organizations, including government agencies and a brief description of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC). 1 table.
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Can People with CKD Still Have Children?. Kidney Beginnings. 7(1): 11, 21. June-July 2007.
This patient education article is from a series that answers common questions that people coping with chronic kidney disease (CKD) may have. In this entry, the author addresses the question of whether people with CKD can still have children. The author notes that, as a rule, fertility tends to decline as kidney function is lost, due to low levels of the hormones that control sperm and egg production. Libido, or sex drive, tends to decline in the setting of kidney disease due to multiple factors, including low sex hormone levels, anemia, and depression. Approximately 1 to 2 percent of women on dialysis in childbearing years will become pregnant; of those who become pregnant and progress through the first trimester, about 50 percent will deliver viable infants. The author cautions that women on dialysis tend to deliver 8 weeks prematurely with an average birth weight of 3 pounds, so many of these babies will need neonatal intensive care before they can go home. Pregnant women with CKD may need additional dialysis and erythropoietin during their pregnancy. In patients who have received kidney transplants and whose kidney function subsequently returns to close to normal typically enjoy normal fertility and produce healthy babies. The author notes that most kidney diseases in the United States are not hereditary.
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Children and ADPKD: It's Not Just an Adult Disease. PKD Progress. 23(2): 18. Summer 2007.
This brief article presents an excerpt from the recently updated Polycystic Kidney Disease (PKD) Patient's Manual: Understanding and Living with Autosomal Dominant Polycystic Kidney Disease (ADPKD), a publication available free of charge from the PKD Foundation at www.pkdcure.org. This article reminds readers that children can have autosomal dominant PKD, and that these children tend to fall into two groups: those who are diagnosed before birth or in the first year of life with large kidneys or cysts, and those who are diagnosed after the age of 1 year. The number of cysts a child has affects his or her signs and symptoms. Almost all children who are diagnosed after the first year of life have perfectly normal kidney function that seems to stay normal throughout childhood. Most of these children will maintain normal kidney function until they are into their mid-20s. The article also considers whether or not children should be told they are at risk of ADPKD, whether children of parents with ADPKD should be tested for the disease, and recommendations for routine screening. Sidebars review the characteristics of ADPKD in children.
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Clinical Practice Recommendation 3: Diabetes and Chronic Kidney Disease in Special Populations [KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease]. American Journal of Kidney Diseases. 49 (2 Suppl 2): s120-s130. February 2007.
The increasing incidence of diabetes in children, young adults, the elderly, and members of disadvantaged and transitional populations is responsible for a concurrently increasing incidence of diabetic kidney disease (DKD) in these groups. In pregnant women, the presence of diabetes and chronic kidney disease (CKD) may adversely affect the health of both the mother and her baby. This article is from a special supplement to the American Journal of Kidney Diseases that presents the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. This is the first set of guidelines that considers the unique aspects of the evaluation, diagnosis, and management of the complex patient with both diabetes mellitus and CKD. The guidelines emphasize these patients’ high risk of cardiovascular disease. This article presents and discusses the third clinical practice recommendation: management of diabetes and CKD in special populations. The article focuses on six clinical practice recommendations: screening and interventions for diabetes and CKD should focus on populations at greatest risk; treatment of children, adolescents, and older adults warrants special considerations; population-based interventions may be the most cost-effective means for addressing the burden of CKD in special populations; specialists in high-risk pregnancy and kidney disease should co-manage pregnancy in women with diabetes and CKD; treatment of DKD with RAS inhibitors before pregnancy may improve fetal and maternal outcomes, but these medicines should be discontinued during pregnancy; and insulin should be used to control hyperglycemia if drug therapy is necessary in pregnant women with diabetes and CKD. A final section discusses implementation issues. The article features tables that summarize the research studies used to establish the guidelines. 2 figures. 6 tables.
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Diabetes And Chronic Kidney Disease: Clinical Handbook. New York, NY: National Kidney Foundation. 2007. 32 p.
This booklet summarizes the 2007 Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines and clinical practice recommendations for the management of patients with diabetes and chronic kidney disease (CKD). The booklet provides a list of abbreviations, the names and affiliations of the Diabetes in Chronic Kidney Disease Work Group Membership, and a list of the KDOQI Advisory Board Members, as well as a brief explanation of the KDOQI and the differences between clinical guidelines and practice recommendations. The booklet describes the diagnosis, impact, and management of diabetes and CKD in children, adults, the elderly, pregnant women, and different racial and ethnic groups. Included are patients with CKD stages 1 to 5, including dialysis and transplant patients. Detailed guidelines are provided for the screening and diagnosis of diabetic kidney disease, the management of hyperglycemia and general diabetes care in CKD, the management of hypertension in this population, the management of dyslipidemia in diabetes and CKD, nutritional management issues, the management of albuminuria in normotensive patients with diabetes and albuminuria as a surrogate marker, the need for a multifaceted approach to intervention in diabetes and CKD, diabetes and CKD in special populations, and behavioral self-management in diabetes and CKD. The booklet concludes with a section on the role of patient education and a selected bibliography. Much of the information is summarized in charts and illustrations. 22 figures. 57 tables. 3 references.
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Diabetes And Chronic Kidney Disease: Clinical Handbook. New York, NY: National Kidney Foundation. 2007. 32 p.
This booklet summarizes the 2007 Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines and clinical practice recommendations for the management of patients with diabetes and chronic kidney disease. The booklet offers a list of abbreviations, the names and affiliations of the Diabetes in Chronic Kidney Disease Work Group Membership, a list of the KDOQI Advisory Board Members, and a brief explanation of the KDOQI and the differences between clinical guidelines and practice recommendations. The booklet focuses on the diagnosis, impact, and management of diabetes and chronic kidney disease (CKD) in children, adults, the elderly, pregnant women, and different racial and ethnic groups. Included are patients with CKD stages 1 to 5, including dialysis and transplant patients. Detailed guidelines are provided for the screening and diagnosis of diabetic kidney disease, the management of hyperglycemia and general diabetes care in CKD, the management of hypertension in this population, the management of dyslipidemia in diabetes and CKD, nutritional management issues, the management of albuminuria in normotensive patients with diabetes and albuminuria as a surrogate marker, the need for a multifaceted approach to intervention in diabetes and chronic kidney disease, diabetes and CKD in special populations, and behavioral self-management in diabetes and CKD. The booklet concludes with a section about the role of patient education and a selected bibliography. Much of the information is summarized in charts and illustrations. 22 figures. 57 tables. 3 references.
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Eating Healthy From the Start: Kid and Kidney-Friendly Nutrition Tips. PKD Progress. 23(2): 10-11. Summer 2007.
It is likely that eating well in childhood may offer some protection to the kidneys and influence the early progression of polycystic kidney disease (PKD) in children at risk for the condition. This article offers kid-friendly and kidney-friendly nutrition tips for parents of children who have healthy kidney function whether or not they have been diagnosed with PKD. Specific food and nutrition items discussed include flaxseeds, sodium, fruits and vegetables, protein intake, and soy-based foods. Suggestions for increasing a child's sense of adventure and willingness to try new foods are also provided and focus on families eating meals together, the need to offer new foods on at least 10 different occasions, letting children serve themselves, and including children in shopping and cooking activities. One sidebar reviews how much protein is recommended for children in different age groups—the recommended Dietary Reference Intake for children.
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Financial Help for Treatment of Kidney Failure. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2007. 4 p.
This fact sheet helps readers with permanent kidney failure understand some of the options they have to obtain financial assistance to pay for their treatments. In 1972, Congress passed legislation making people of any age with permanent kidney failure eligible for Medicare, a program that helps people older than 65 and people with disabilities pay for medical care, usually up to 80 percent. Other public and private resources can help with the remaining 20 percent. The fact sheet first reviews the role of Medicare, how to apply for Medicare, and where to get help or information about Medicare. Other sections discuss private insurance, Medicaid, State Children’s Health Insurance Programs (SCHIP), benefits available through the Department of Veterans Affairs (VA), benefits from Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), patient assistance programs from prescription drug companies, and additional patient assistance programs. Readers are referred to additional organizations that can help: the National Kidney Foundation at www.kidney.org or 1–800–622–9010, the American Association of Kidney Patients at www.aakp.org or 1–800–749–2257, Life Options Rehabilitation Resource Center at www.lifeoptions.org or 1–800–468–7777, and the American Kidney Fund at www.kidneyfund.org or 1–800–638–8299. The fact sheet concludes with a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
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Getting Ready for a “New Normal”: A Helpful Guide for Starting Dialysis. New York, NY: National Kidney Foundation. 2007. 64 p.
This booklet is designed to help patients with chronic kidney disease (CKD) who are about to begin dialysis. The booklet was designed to answer common questions about what to expect while preparing for dialysis, with a special focus on the emotional issues involved. The booklet includes information and stories from other patients who have gone through the same experience. The introductory section covers the anatomy and function of the kidneys, what happens in kidney failure, treatment options, and choosing no treatment. The booklet offers six sections: dialysis, including hemodialysis, vascular access, self-care hemodialysis, home dialysis, and peritoneal dialysis; emotional health while preparing for dialysis, notably issues of loss and coping; typical issues of physical health in CKD stage 4, including high blood pressure or hypertension, anemia, bone disease, cardiovascular diseases, diabetes, and diagnostic tests; the dialysis care team; support systems, including spouses, family and friends, children, and spiritual and social support; and travel and employment considerations. A final section presents suggested resources, including those related to education and support, employment resources, financial and insurance resources, and general readings for encouragement. The booklet concludes with a group of questions for patients to ask when visiting the dialysis center, with space available for the patient to record the information they receive. The booklet is illustrated with black-and-white line drawings and photographs. 10 figures. 1 table.
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Introduction: Urologic Diseases in America. IN: Litwin, M.S.; Saigal, C.S., eds. Urologic Diseases in America. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. pp. 1-8.
Urologic diseases encompass a wide scope of illnesses of the genitourinary tract, including conditions that are congenital and acquired, malignant and benign, male and female, and medical and surgical. They may be acute and self-limited or chronic and debilitating, may primarily affect quality or quantity of life, and may be financially insignificant or catastrophic. This introductory chapter is from a lengthy text that offers a comprehensive portrait of the illness burden and resource use associated with the major urologic diseases in the United States. The authors have compiled a set of data analyses that synthesize data available from myriad national and regional sources across the public and private sectors. The authors briefly describe the method used to compile the book and explain why their analyses are limited to the topics covered in the 21 chapters: prostatitis, benign prostatic hyperplasia (BPH), prostate cancer, interstitial cystitis (IC) and painful bladder syndrome, urinary incontinence in women, urinary incontinence in men, bladder cancer, urolithiasis (urinary tract stones), ureteropelvic junction obstruction, kidney cancer, pediatric urologic disorders, urinary incontinence in children, urinary tract infection (UTI) in children, male infertility, erectile dysfunction (ED) and Peyronie’s disease, male urethral stricture disease, testicular cancer, UTI in women, UTI in men, and sexually transmitted diseases. The authors encourage readers to explore the tables and figures and use the data for their own analyses.
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Kidney Punch. Today’s Dietitian. 9(12): 52-54. December 2007.
This article familiarizes readers with kidney stones, focusing on dietary strategies that reduce the chances of developing kidney stones. The author defines kidney stones as deposits of minerals in the kidney. Kidney stones can block the ureter, the long narrow duct that takes urine from the kidney to the bladder. This blockage can cause blood in the urine and intense pain. Smaller stones can pass through the urinary tract on their own; larger stones need medical interventions, including medications, extracorporeal shock wave lithotripsy, and ureteroscopy. The author outlines some prevention strategies: drink plenty of water, be aware of beverages with caffeine, drink lemonade, reduce meat intake, and reduce salt intake, particularly in fast food. Other topics include the role of obesity in the development of kidney stones, the increasing incidence of kidney stones, and gender differences in risks for kidney stones. The article includes quotations from patients who have experienced kidney stones and who have changed their dietary habits in an effort to avoid a recurrence. One side bar outlines the problem of kidney stones in children.
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Management Issues in Acid-Related Disorders in the Elderly. Alimentary Pharmacology and Therapeutics. 3(2): 21-26. March 2007.
This article is from an issue of Alimentary Pharmacology and Therapeutics that reports on the proceedings of an Asian workshop—in Kyoto, Japan, in July 2006—on acid-related disorders in pediatric and geriatric populations. The workshop was held to raise awareness that these particular age groups require special consideration in their disease management, to clarify what issues need to be addressed in these populations, and to reach a consensus on recommendations for the management of gastroesophageal reflux disease (GERD) and other acid-related disorders in children and the elderly. This article reviews the management issues that may be encountered in diagnosing and treating acid-related disorders in the elderly. The author stresses that issues that call for attention by Asian gastroenterologists in the management of GERD in the geriatric population include functional changes associated with aging, such as a lower sensitivity to acid stimulation or pain leading to more atypical presenting symptoms versus greater severity of disease, common swallowing problems, polypharmacy, and the slower metabolism of the drugs by the kidney. The author cautions that drug therapy in this population may be complex and recommends proton pump inhibitors (PPIs) as the drug of choice for acid-related disorders in the elderly. 2 figures. 3 tables. 23 references.
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Nutrition and the Pediatric Patient with CKD. Nephrology Nursing Journal. 34(1): 89-92. January-February, 2007.
This article discusses the complicated challenges of caring for pediatric or adolescent patients with chronic kidney disease (CKD), including those with chronic renal insufficiency (CRI) and those on dialysis, focusing on nutritional care. The author notes that a major challenge is to balance the nutritional requirements of these patients to both promote appropriate growth and development while still controlling the biochemical and metabolic consequences associated with the disease state. The author first outlines barriers to achieving nutrition goals in this population, which can include anorexia, changes in taste due to renal failure, metabolic abnormalities, the use of corticosteroids, and psychosocial factors. The author then discusses the nutritional assessment of the pediatric patient with CKD, nutrition for infants with pediatric renal disease, and nutritional concerns for school-aged children and adolescents with CKD. The author concludes by calling for a multidisciplinary team approach, including the patient and his or her family, in the development and delivery of strategies to optimize nutritional status and growth while still maintaining good biochemical control. 11 references.
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Pediatric ESRD. American Journal of Kidney Diseases. 49(1): s159-s172. January 2007.
Pediatric end-stage renal disease (ESRD) patients pose special challenges to providers and to the health care system, which must address not only the disease itself in these patients, but the many extra-renal manifestations that affect their lives and their families. This chapter on pediatric ESRD is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System on the ESRD program in the United States; data through 2004 is included. The Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. This chapter examines patient characteristics, preventive health care, vascular access, and modality in the first 3 to 5 years after initiation of ESRD. The chapter also includes data on differences in hemoglobin levels and anemia treatment by age, gender, and race or ethnicity, trends in infectious complications, and present trend data on overall and cause-specific hospitalization and mortality. 42 figures.
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Peritonitis Caused by Neisseria Sicca in a Child on Chronic Peritoneal Dialysis. Dialysis and Transplantation. 36(8): 457, 463. August 2007.
This article reports a case of peritonitis caused by Neisseria sicca in a child on chronic peritoneal dialysis (PD). Peritonitis is an serious complication of PD and has an incidence of about one episode per year in children on PD. The case report is a 6-year-old African American boy, diagnosed in utero with hydronephrosis, who received a Tenckhoff catheter for chronic outpatient PD at home just after his 6th birthday. Two months after beginning PD, the boy was admitted to the hospital for Pseudomonas aeruginosa urinary tract infection (UTI); 2 weeks later, after a mishap, the catheter connector was replaced in the outpatient nephrology clinic under sterile conditions. One week after this episode, the boy was admitted to the hospital with a diagnosis of peritonitis. On the third day, the boy’s cultures showed N. sicca, which is sensitive to penicillin. Although the patient recovered uneventfully, an elective kidney transplant from a living related donor had to be postponed several months because of this infection. The authors discuss this case and conclude by reiterating the importance of physicians to continually reinforce the understanding of parents and patients of the vital necessity of proper PD catheter care and must stress extremely close supervision of a child on chronic PD. 9 references.
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Questions And Answers About Paget’s Disease of Bone. New York, NY: Paget Foundation. 2007. 14 p.
This lengthy fact sheet provides an overview of Paget’s disease of bone, also called osteitis deformans. Paget’s disease is a disorder of bone resorption followed by excessive bone formation, resulting in bone that is architecturally unsound. Symptoms can include bone pain, bone deformity, and skeletal fragility. The fact sheet is written in question and answer format and addresses common concerns, including the causes of Paget’s disease; the groups of people usually affected by Paget’s disease; diagnostic tests used to confirm the disease; screening siblings or children of patients diagnosed with Paget’s disease; the symptoms of this condition; mild cases of Paget’s disease that go undiagnosed; disease prognosis; the incidence of bone cancer in Paget’s disease patients; juvenile Paget’s disease; the relationship between Paget’s disease and other medical conditions, including osteoarthritis, osteoporosis, heart disease, kidney problems, hearing loss, oral health, and hyperparathyroidism; the relationship between diet and Paget’s disease; locating a physician who specializes in Paget’s disease; complications including osteonecrosis of the jaw (ONJ); and treatment options, including physical therapy for improving muscle strength and mobility, drug therapy with bisphosphonates or calcitonins, pain management, and surgery. Bisphosphonates are the most widely used drugs for the management of this disease; they reduce the bone turnover to normal levels in many patients with moderate to severe Paget’s disease. One chart summarizes the drug therapies often used for Paget’s disease. The fact sheet concludes with a brief description of the Paget Foundation, including the contact information for this support organization. 2 tables.
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Surviving Change: Can the ESRD Provisions in the SCHIP Create A Level Playing Field? Nephrology News & Issues. 21(10): 52-54, 56. September 2007.
This article reviews the key provisions that are incorporated into the Children’s Health and Medicare Protection Act of 2007, including the creation of an end-stage renal disease (ESRD) bundled payment system, elimination of the hospital differential for treatment payments, creation of quality outcome incentive payments and performance standards, and extension of the Medicare Secondary Payer (MSP) provision. The proposed bill includes two provisions from the Kidney Care Quality and Education Act: establishing a demonstration project on education for chronic kidney disease (CKD) patients and requiring technical certification. However, the bill fails to include an inflationary update. The author encourages readers, regardless of which dialysis provider they work for, to work for the passage of this legislation. The author stresses that any rearrangement of payments called for by legislation should be budget neutral so as not to take any dollars from the ESRD program as a whole.
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Urologic Diseases in America Compendium. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2007. (CD-ROM).
Urologic diseases encompass a wide scope of illnesses of the genitourinary tract, including conditions that are congenital and acquired, malignant and benign, male and female, and medical and surgical. They may be acute and self-limited or chronic and debilitating, may primarily affect quality or quantity of life, and may be financially insignificant or catastrophic. This CD-ROM includes the complete contents of a lengthy text that offers a comprehensive portrait of the illness burden and resource use associated with the major urologic diseases in the United States. The authors have compiled a set of data analyses that synthesize data available from myriad national and regional sources across the public and private sectors. The CD-ROM includes 21 chapters covering prostatitis, benign prostatic hyperplasia (BPH), prostate cancer, interstitial cystitis (IC) and painful bladder syndrome, urinary incontinence in women, urinary incontinence in men, bladder cancer, urolithiasis (urinary tract stones), ureteropelvic junction obstruction, kidney cancer, pediatric urologic disorders, urinary incontinence in children, urinary tract infection (UTI) in children, male infertility, erectile dysfunction (ED) and Peyronie’s disease, male urethral stricture disease, testicular cancer, UTI in women, UTI in men, and sexually transmitted diseases. In each chapter, the authors identify and summarize principal findings for the topic at hand, but the bulk of the data is presented in tabular format; readers are encouraged to explore the tables and figures to glean information about their own particular areas of interest. A final chapter outlines the methodology used to compile the information. Each chapter offers a detailed table of contents and a list of relevant references; no subject index is provided.
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Urologic Diseases in America. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2007. 745 p.
Urologic diseases encompass a wide scope of illnesses of the genitourinary tract, including conditions that are congenital and acquired, malignant and benign, male and female, and medical and surgical. They may be acute and self-limited or chronic and debilitating, may primarily affect quality or quantity of life, and may be financially insignificant or catastrophic. This lengthy text offers a comprehensive portrait of the illness burden and resource use associated with the major urologic diseases in the United States. The authors have compiled a set of data analyses that synthesize data available from myriad national and regional sources across the public and private sectors. The book includes 21 chapters covering prostatitis, benign prostatic hyperplasia (BPH), prostate cancer, interstitial cystitis (IC) and painful bladder syndrome, urinary incontinence in women, urinary incontinence in men, bladder cancer, urolithiasis (urinary tract stones), ureteropelvic junction obstruction, kidney cancer, pediatric urologic disorders, urinary incontinence in children, urinary tract infection (UTI) in children, male infertility, erectile dysfunction (ED) and Peyronie’s disease, male urethral stricture disease, testicular cancer, UTI in women, UTI in men, and sexually transmitted diseases. In each chapter, the authors identify and summarize principal findings for the topic at hand, but the bulk of the data is presented in tabular format; readers are encouraged to explore the tables and figures to glean information about their own particular areas of interest. A final chapter outlines the methodology used to compile the information. Each chapter offers a detailed table of contents and a list of relevant references; no subject index is provided.
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Acute Nephritis. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 95-102.
This chapter about acute nephritis is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors define acute nephritis as inflammation of the nephrons of the kidney, which develops over a short period of time such as a few days. This inflammation is generally concentrated in the glomerulus and is referred to as acute glomerulonephritis (AGN)—the most common type in children. Clinical manifestations of AGN include reduced urine volume (oliguria), hematuria, edema, and hypertension. The authors discuss the pathology and pathophysiology of AGN, epidemiology and triggering factors, clinical features, differential diagnosis, natural history, management options, and the long-term course and outcomes of postinfectious AGN. The authors caution that the persistence of proteinuria and trace hematuria may be a sign that the initial process was not postinfectious AGN but rather the beginning of a chronic glomerular disease, which requires careful follow up. The chapter concludes with a list of Internet sources for information, as well as a list of print references. 6 tables. 17 references.
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Acute Renal Failure and Hemolytic Uremic Syndrome. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 181-192.
This chapter about acute renal failure and hemolytic uremic syndrome is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors define acute renal failure (ARF) as the sudden loss of the kidneys’ ability to excrete wastes, concentrate urine, and reabsorb electrolytes. The first section of the chapter describes the classification and etiology of ARF; diagnosis; the stages of ARF; urine diagnostic indices; pathogenesis; and specific disorders associated with intra-renal ARF, including acute tubular necrosis, aminoglycoside nephrotoxicity, amphotericin B nephrotoxicity, pigment-induced ARF, postoperative ARF, radiocontrast nephropathy, acute interstitial nephritis, and hepatorenal syndrome. The next section focuses on hemolytic uremic syndrome (HUS), including epidemiology, etiology, pathogenesis, clinical findings, and outcome. The final section describes management strategies, complications, and the recovery phase of ARF. The management of patients with ARF can include pharmacologic strategies such as diuretics and dopamine, nutritional support, and dialysis. 7 tables. 39 references.
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Assessment of GFR in Children: The Point of View of the Paediatric Nephrologist. IN: Prigent, A.; Piepsz, A., eds. Functional Imaging in Nephro-Urology. New York, NY: Informa Healthcare USA. 2006. pp 41-48.
This chapter about measurements of glomerular filtration rate (GFR) in children by means of radionuclide techniques is from a textbook that presents a comprehensive look at the use of functional imaging in nephrourology. The text focuses on management strategies based on the patient, the choice of modality, and cost implications for various imaging modalities commonly used in nephrourology. The author presents the perspective of the pediatric nephrologist on the use of GFR in children. Topics include the physiology of glomerular filtration, the concept of clearance, methods available for assessing GFR in children, the standard urinary clearance, the constant infusion technique without urine collection, plasma disappearance curve using the single injection technique, plasma concentration, the estimation of GFR in clinical practice with different markers such as inulin or creatinine, the use of cystatin C, and the assessment of GFR in neonates. 5 figures. 3 tables. 59 references.
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Cardiovascular Disease in Patients with Kidney Disorders in Childhood and Adolescence. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 117-130.
This chapter about cardiovascular disease in patients with chronic kidney disease (CKD) is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors note that children with CKD are at risk for accelerated rates of cardiovascular disease due to the high burden of cardiovascular risk factors in CKD. Topics covered include epidemiology, cardiovascular risk factors in childhood CKD, nontraditional risk factors, and strategies to modify pediatric cardiovascular disease. The authors conclude by emphasizing that prevention of cardiovascular disease should be a top clinical priority in the management of children with CKD. 4 figures. 45 references.
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Childhood Kidney Disease Gene Identified. Nephrology News & Issues. 20(3): 16. March 2006.
This brief article reports on the recent identification of a new gene linked to the inherited kidney disorder called Meckel-Gruber syndrome (MKS). Children with MKS have central nervous system deformities as well as abnormal cysts in their kidneys, and usually die shortly after birth. The news of the gene identification is important to MKS families who might have their blood screened for the defect and seek genetic counseling. The finding also is important for better understanding of common birth defects, such as neural tube abnormalities, and for related disorders, such as more common forms of polycystic kidney disease (PKD). The author notes that the current work is an extension of Mayo Clinic researchers' work for more than a decade that has helped to reveal the genetic basis of PKD and to develop therapies. The author briefly reports on the research study methodology and the investigators from different institutions who were part of the research team.
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Chronic Nephritis in Children: With Emphasis on IGA Nephropathy. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 103-116.
This chapter about chronic nephritis is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors define chronic nephritis as a slow but persistent form of renal disease that is often accompanied by proteinuria, hematuria, and/or hypertension. The most common form of chronic nephritis that results in end-stage renal disease (ESRD) in both children and adult patients around the world is IgA nephropathy, which is the primary focus of this chapter. The authors discuss epidemiology, pathology, etiology, pathogenesis, predisposing genetic factors, the mechanism of progression of disease in the kidneys, light microscopy findings, clinical features, laboratory studies for chronic nephritis, differential diagnosis, and treatment of IgA nephropathy. The authors conclude that there are multiple factors to consider when deciding whether to treat a child with IgA nephropathy or some other form of chronic nephritis; thus, primary care physicians should seek pediatric nephrology consultation. Because of this complexity, specific treatment options are not discussed in this text. The chapter includes black-and-white illustrations and photographs and concludes with an extensive list of references. 9 figures. 2 tables. 61 references.
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Chronic Renal Failure and Dialysis Options. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 193-202.
This chapter about chronic renal failure and dialysis options is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors cover incidence, etiology, pathophysiology, and the role of nutrition in chronic renal failure (CRF); pathophysiology and treatment of renal osteodystrophy; renal anemia; hypertension; the impact of CRF in childhood on growth and development; the prognosis for children with CRF; and dialysis and renal transplantation as treatment options. The authors conclude by recommending a comprehensive, multidisciplinary approach to patient treatment plans for children with CRF. 1 table. 7 references.
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Congenital Abnormalities of the Kidney and Urinary Tract. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 35-52.
This chapter about congenital abnormalities of the kidney and urinary tract is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author stresses that congenital abnormalities of the urinary tract are an important cause of morbidity and, occasionally, mortality in children. Topics covered include development of the renal tract, antenatally detected urinary tract abnormalities (AUTAs), antenatal intervention, investigations, renal agenesis, renal fusion and ectopia, duplex systems, renal dysplasia and hypoplasia, multicystic dysplastic kidney, pelviureteric junction (PUJ) obstruction, vesicoureteric junction (VUJ) obstruction, vesicoureteral reflux (VUR), posterior urethral valves (PUV), neuropathic bladder, renal cystic disease, familial nephronophthisis and medullary cystic disease complex, autosomal dominant medullary cystic kidney disease, medullary sponge kidney, and tuberous sclerosis complex (TSC). The author concludes that the use of antenatal ultrasound has resulted in increasing numbers of asymptomatic infants being referred for postnatal investigations and has changed perceptions of the natural history of many conditions. Pediatricians and nephrologists will have an increasing role to play in the ongoing monitoring process of children with these congenital conditions. The chapter includes black-and-white illustrations and photographs and concludes with an extensive list of references. 16 figures. 2 tables. 26 references.
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Effects of Kidney Disorders on the Endocrine System. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 203-214.
This chapter about the effects of kidney disorders on the endocrine system is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors note that chronic renal failure (CRF) interferes with the metabolism and regulation of many hormones by various mechanisms. Topics include increased plasma hormone concentrations, decreased plasma hormone concentrations, disorders of hormone action, the gonadotropic hormone axis, the somatotropic hormone axis, the thyroid hormone axis, and the adrenal hormone axis. In each section, the authors review clinical findings, specific relevant hormones, and diagnostic and patient management approaches. 5 figures. 27 references.
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Effects of Kidney Disorders on the Endocrine System. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 203-214.
This chapter about the effects of kidney disorders on the endocrine system is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors note that chronic renal failure (CRF) interferes with the metabolism and regulation of many hormones by various mechanisms. Topics include increased plasma hormone concentrations, decreased plasma hormone concentrations, disorders of hormone action, the gonadotropic hormone axis, the somatotropic hormone axis, the thyroid hormone axis, and the adrenal hormone axis. In each section, the authors review clinical findings, specific relevant hormones, and diagnostic and patient management approaches. 5 figures. 27 references.
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Family and ADPKD: A Guide for Children and Parents. Kansas City, MO: Polycystic Kidney Disease Foundation. 2006. 18 p.
This document provides basic information for the parents of a child that has just been diagnosed with autosomal dominant polycystic kidney disease (ADPKD), a genetic disease that affects the kidneys and other parts of the body. In ADPKD, cysts can form in the kidney, anywhere along the nephron. This fact sheet answers common questions in the areas of general information, inheritance, diagnosis, health promotion, prognosis, extra-renal manifestations, psychosocial factors, and current research on PKD. Specific topics include the anatomy and function of the kidneys, how PKD can damage the good parts of the kidney, diagnosis in people who have no symptoms, dietary approaches to preventing disease progression, limiting protein intake, avoiding dehydration, sodium, sports and recreation, medications, high blood pressure, mortality due to ADPKD, dialysis and kidney transplantation, organ donation, disclosing health information to a child, screening in siblings, complications in ADPKD, cerebral aneurysms, coping with pain, and finding information resources. The information is presented in a kid-friendly fashion, so an adolescent would be comfortable reading the fact sheet by him or herself.
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Functional Imaging in Nephro-Urology. New York, NY: Informa Healthcare USA. 246 p.
This textbook presents a comprehensive look at functional imaging in nephrourology. The text focuses on management strategies based on the patient, the choice of modality, and cost implications for various imaging modalities commonly used in nephrourology. The text offers 23 chapters in six sections: measurement of renal function in health and disease, obstruction in adults, antenatally detected hydronephrosis, renovascular disease, functional and molecular imaging, and urinary tract infection (UTI) in children. Specific topics include the assessment of glomerular filtration rate (GFR), measurements of renal function with radionuclide techniques in adults, the role of nuclear medicine, the contribution of radiology in managing obstruction, present and future developments of functional and molecular imaging, radiological modalities in renovascular disease, angiotensin-converting enzyme (ACE) inhibition renography in the evaluation of suspected renovascular hypertension, functional imaging of the kidney with electron beam computerized tomography (CT), functional and cellular imaging of the kidney by magnetic resonance imaging (MRI), positron emission tomography (PET) imaging of the kidneys, and pediatric nephrology. Each chapter includes full-color and black-and-white illustrations and a list of references. A detailed subject index concludes the volume.
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Hematuria and Proteinuria. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 75-84.
This chapter about hematuria and proteinuria is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author recommends that children presenting with hematuria or proteinuria should be considered in different clinical categories: children with hematuria without or with minimal proteinuria, children with hematuria associated with significant proteinuria, and children with proteinuria without accompanying hematuria. The first section of the chapter considers hematuria, covering definition, hemoglobinuria and myoglobinuria, colorants in urine, red blood cell morphology, urinary sediment, differential diagnosis, and recommended workup of hematuria. The section about proteinuria covers definition, differential diagnosis, and workup. Pediatricians are encouraged to orient the clinical investigations of children with these signs in an orderly way to make a correct differential diagnosis and thus identify children who need referral to a pediatric nephrologist. 4 figures. 2 tables. 15 references.
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Hemolytic Uremic Syndrome. American Family Physician. 74(6): 998. September 15, 2006.
This patient education fact sheet reviews hemolytic uremic syndrome (HUS), a problem usually caused by Escherichia coli bacteria. An uncommon problem in the United States, the illness is usually one of bloody diarrhea following ingestion of contaminated hamburger meat. Children with HUS usually present with gastroenteritis complaints such as abdominal pain or tenderness, nausea or vomiting, fever, and anemia; adults may be asymptomatic. The fact sheet reviews how people can get HUS, the symptoms of the syndrome, the diagnostic tests that may be done to confirm the condition, treatment strategies, and how to prevent getting HUS. The fact sheet concludes with the contact information for the National Kidney Foundation and the National Kidney and Urologic Diseases Information Clearinghouse.
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Hemolytic Uremic Syndrome: An Emerging Health Risk. American Family Physician. 74(6): 991-996. September 15, 2006.
This article discusses hemolytic uremic syndrome (HUS), a problem caused primarily by Shiga toxin-producing Escherichia coli bacteria O157:H7. HUS is the most common cause of acute kidney failure in children but can also occur in adults. The author reviews the etiology, pathophysiology, epidemiology, clinical characteristics, differential diagnosis, laboratory evaluation, patient management, complications, and prognosis of HUS. The syndrome is characterized by microangiopathic anemia, thrombotic thrombocytopenia, and renal failure. The illness is usually one of bloody diarrhea following ingestion of hamburger meat contaminated with E. coli O157:H7. Children with HUS usually present with gastroenteritis complains such as abdominal pain or tenderness, nausea or vomiting, fever, and anemia; adults may be asymptomatic. Complications from HUS can include intussusception, chronic kidney failure, and, in severe cases, seizures. There is an incubation period of approximately 1 week between the start of diarrhea and the onset of HUS; physicians should maintain a high index of suspicion. Early laboratory testing, including a complete blood count, stool culture, and Shiga toxin testing, is important to diagnose and manage the syndrome. 5 tables. 30 references.
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Henoch-Schonlein Purpura. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 4 p.
This fact sheet describes Henoch-Schönlein purpura (HSP), a disease that causes small blood vessels in the skin to leak because of inflammation. The primary symptom is a rash that looks like many small, raised bruises on the legs. Other symptoms can include abdominal pain, arthritis, and kidney involvement. The fact sheet reviews the causes of HSP, the four main symptoms, diagnostic tests that may be used to confirm HSP, treatment approaches, and the long-term outlook for people with HSP. HSP can occur at any time in life but usually happens in children between the ages of 2 and 11. In most cases, HSP lasts 4 to 6 weeks, with no long-term consequences. In some cases, HSP can lead to kidney damage and permanent kidney failure. Another rare complication can be intestinal blockages. Tests used to confirm a diagnosis of HSP can include blood tests, a urine sample, skin biopsy, and kidney biopsy. The main goals of treatment are to relieve symptoms such as joint pain, abdominal pain, or swelling. One final section briefly describes some of the current research in this area. Readers are referred to four resource organizations for more information: American Academy of Pediatrics at www.aap.org, American Academy of Family Physicians at www.familydoctor.org, American Society of Pediatric Nephrology at www.asphneph.com, and National Institute of Arthritis and Musculoskeletal and Skin Diseases at www.niams.nih.gov. The fact sheet also provides a brief summary of the work of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. 1 figure.
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Hypertension: Evaluation, Monitoring, and Therapy. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 117-130.
This chapter about hypertension is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors note that blood pressure levels in childhood have been found to be the strongest predictor of adult blood pressure levels. The chapter discusses blood pressure evaluation in children; clinical diagnosis and monitoring of hypertensive pediatric patients; patient selection for therapy; and drug therapy, including therapy with calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and diuretics. The authors note that antihypertensive therapy is usually instituted in children who have persistent elevation of blood pressure above the 99th percentile. However, in children with chronic renal failure or diabetes mellitus, the decision to include drug therapy may be appropriate at lower levels of blood pressure. 2 figures. 7 tables. 55 references.
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Immunization and Anti-Microbial Therapy for Children with Chronic Kidney Disease. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 2225-234.
This chapter about immunization and antimicrobial therapy for children with chronic kidney disease (CKD) is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors review current approaches to immunization and antimicrobial therapy in healthy children and discuss recommendations in these areas for children with CKD. All children with CKD who are not on immunosuppressive drugs should receive age-appropriate recommended standard and special vaccines. Evaluation of vaccine responses in patients on dialysis is complicated because they might receive their initial immunizations before starting dialysis therapy and receive a booster dose while on dialysis. Live viral vaccines should be avoided in transplant patients. The authors consider the use of antibiotics in children who have varying stages of CKD. When these patients are diagnosed with an acute bacterial infection, the physician must choose an antibiotic and dosing schedule for not only the type and severity of the infection but also the type and severity of the kidney disorder. The author provides basic guidelines for patients in different age groups and levels of kidney disease. 1 figure. 4 tables. 23 references.
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Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. 266 p.
This textbook presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The book emphasizes diagnosis and treatment, rather than etiology, pathology, and pathogenesis, which are covered in other textbooks. The text includes 22 chapters: normal kidney function and development and the choice of laboratory studies in children; radiographic studies in children with kidney disorders; congenital abnormalities of the kidney and urinary tract; neonatal kidney problems; mass screening for kidney disease in children; hematuria and proteinuria; the nephrotic syndrome; acute nephritis; chronic nephritis in children, particularly IgA nephropathy; the evaluation, monitoring, and therapy of hypertension; cardiovascular disease in patients with kidney disorders in childhood and adolescence; urinary tract infections and vesicoureteral reflux in children; nocturnal enuresis and voiding disorders; renal tubular disorders; acute renal failure and hemolytic uremic syndrome; chronic renal failure and dialysis options; the effects of kidney disorders on the endocrine system; nutritional and growth aspects of the care of children with kidney disease; immunization and anti-microbial therapy for children with chronic kidney disease (CKD); the social and developmental consequences of chronic kidney disease in children; renal transplantation in childhood; and the transition of children with renal diseases into adulthood. Each chapter includes black-and-white illustrations and photographs and concludes with an extensive list of references. The textbook begins with a section of full-color plates and concludes with a detailed subject index.
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Kidney Health for Kids. Diabetes Self-Management. 23(3): 82-87. May-June 2006.
Kidney disease (diabetic nephropathy) is one of the most common and serious complications of type 1 diabetes. This article helps parents of children with type 1 diabetes learn about kidney health and how to prevent diabetic nephropathy. The symptoms of diabetes-related kidney disease can include high blood pressure (hypertension), loss of protein in the urine, or lower-than-normal kidney function (calculated by glomerular filtration rate, or GFR). The author emphasizes that sustained control of blood glucose levels over many years is among the most important steps that can be taken to avoid diabetes complications, including nephropathy. The author explains various terms that parents should be familiar with, including microalbuminuria, albumin excretion rate, and GFR. The article reviews the development of diabetic nephropathy, the markers and predictors of kidney disease, the need for better screening and diagnostic tests, and treatment strategies, including the use of ACE inhibitors and angiotensin receptor blockers (ARBs). The author concludes that regular urine screening and careful control of blood glucose and blood pressure levels can go a long way toward preventing or slowing the development of diabetic kidney disease in children. 2 figures. 1 table.
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Mass Screening for Kidney Disease in Children: Should It Be Done? If So, When?. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 67-73.
This chapter about mass screening for kidney disease in children is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors note that many forms of chronic kidney disease (CKD) are believed to start in childhood. However, children and adolescents are frequently asymptomatic for many years, resulting in their diagnosis and treatment being delayed and possibly a poor prognosis. The authors consider whether mass screening of children detects sufficient treatable pathology to justify the tangible and intangible costs. They discuss international attitudes, experience in the field with mass screening and the resulting clinical picture, and arguments in favor of screening. The authors conclude that the use of screening urinalysis can be recommended. Dipstick urinalysis could be obtained at preschool entry age—between 5 and 6 years of age—and annual dipstick urinalysis conducted between school entry age and adolescence. These tests would provide epidemiologic information and the opportunity for setting up clinical trials in the early stages of disease. 4 tables. 15 references.
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Measurement of GFR in Children by Means of Radionuclide Techniques. IN: Prigent, A.; Piepsz, A., eds. Functional Imaging in Nephro-Urology. New York, NY: Informa Healthcare USA. 2006. pp 31-36.
This chapter about measurements of glomerular filtration rate (GFR) in children by means of radionuclide techniques is from a textbook that presents a comprehensive look at the use of functional imaging in nephrourology. The text focuses on management strategies based on the patient, the choice of modality, and cost implications for various imaging modalities commonly used in nephrourology. The authors discuss how radionuclide plasma clearances, specifically tailored to the pediatric patient, can offer an interesting tool in the practice of nephrourology. Topics include gamma camera or plasma samples, glomerular or tubular tracers, Tc-99n DTPA or CR-51 EDTA, radiation burden, multiple blood sample technique, slope-intercept method, single blood sample clearance, slope method, quality control, the reproducibility of renal clearance, normal values, and the clinical advantages of radionuclide techniques compared with traditional nonradioactive methods. The authors conclude that radionuclide methods allow an accurate estimation of GFR for all levels of clearance, provide reproducible results, and are noninvasive and easy to perform for both the young patient and the physician in charge of the test. 1 figure. 22 references.
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Neonatal Kidney Problems. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 53-66.
This chapter about neonatal kidney problems is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author reviews maturation during fetal life, postnatal maturation, symptoms and signs of renal disease in the neonate, gross hematuria, malformation syndromes, diagnostic tests used to confirm kidney and urologic disorders in the neonate, blood pressure and hypertension, renal function during neonatal respiratory disorders, acute renal failure (ARF), acquired diseases, and drugs and the neonatal kidney, including drugs administered to the mother during pregnancy. Acquired diseases discussed include urinary tract infection; renal venous thrombosis; cortical, medullary, and papillary necrosis; Bartter’s syndrome; nephrogenic diabetes insipidus; and oligonephropathy. The chapter includes black-and-white illustrations and photographs and concludes with an extensive list of references. 6 figures. 16 tables. 24 references.
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Nephrotic Syndrome. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 85-94.
This chapter about the nephrotic syndrome is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors define the nephrotic syndrome as a clinical entity characterized by massive urinary protein losses, resulting in hypoalbuminemia and usually associated with edema formation. They review the clinical features; laboratory findings; pathogenesis of edema formation; definitions; classification; idiopathic nephrotic syndrome (INS); initial treatment; treatment of relapse; treatment of steroid-resistant nephrotic syndrome; alternative forms of therapy for INS; and complications of the nephrotic syndrome, including abnormalities in lipid metabolism, bacterial infections, viral infections, thromboembolic complications, loss of vitamins and hormones in the urine, and acute renal failure (ARF). 2 tables. 27 references.
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Nocturnal Enuresis and Voiding Disorders. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 153-164.
This chapter about nocturnal enuresis and voiding disorders is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author notes that failure to obtain urinary continence during the day and/or night is one of the most common disorders of childhood. Over the last 2 decades, a better understanding has developed of the heterogeneity of this disorder and resulted in a more active treatment attitude. Children are now more carefully differentiated in respect to both evaluation and treatment. The author discusses the different syndromes, their prevalence, diagnosis, and treatment options. Syndromes described include nocturnal enuresis, voiding dysfunction, urinary tract infection (UTI), vesicoureteral reflux, non-neuropathic bladder sphincter dysfunction, giggle incontinence, and vaginal voiding. The author concludes that, although the large majority of patients have a nonorganic cause for their symptoms, a few cases may be caused by an underlying structural or neurogenic anomaly. Only a minority of patients will need invasive urodynamic investigation and imaging studies. The chapter includes patient care algorithms. 6 figures. 26 references.
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Normal Kidney Function and Development and Choice of Laboratory Studies in Children. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 1-14.
This chapter about normal kidney function and development is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors also focus on the measurement of kidney function in children outside the newborn period. The definition of kidney damage and staging of chronic kidney disease (CKD) is covered. The authors present algorithms for the choice of laboratory studies for common kidney problems presenting in children. They stress that early markers of kidney damage should be identified and treated to protect the long-term health of the child and the adult he or she will become. Common kidney problems included are asymptomatic proteinuria, hematuria, gross hematuria, and urinary tract infection (UTI). The authors conclude by calling for definition, early evaluation, common terminology, and a simple staging system for clinicians to better identify evidence of kidney damage earlier in children and adolescents. This early evaluation and recognition of kidney disease, and subsequent intervention, will lead clinicians to screen for risk factors of progressive kidney disease and to institute therapies in a timely manner. The chapter includes black-and-white illustrations and photographs and concludes with an extensive list of references. 6 figures. 3 tables. 52 references.
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Nuclear Medicine Techniques. IN: Prigent, A.; Piepsz, A., eds. Functional Imaging in Nephro-Urology. New York, NY: Informa Healthcare USA. 2006. pp 103-116.
This chapter about the use of nuclear medicine to diagnose hydronephrosis is from a textbook that presents a comprehensive look at the use of functional imaging in nephrourology. The text focuses on management strategies based on the patient, the choice of modality, and cost implications for various imaging modalities commonly used in nephrourology. The authors present the value of state-of-the-art renography as an important tool for diagnosing kidney function changes in cases with congenital unilateral dilatation of the renal pelvis. They focus on the development of renography during the past decade and the role of renography in relation to short-term and long-term validation of renal function outcome after surgical and nonsurgical treatment of prenatally detected hydronephrosis. Gamma camera renography incorporates dynamic renoscintigraphy as a noninvasive method in both children and adults for evaluating hydronephrosis by the quantification of differential renal function (DRF) and drainage. The authors review pitfalls in the interpretation of renography and the differences between adults and children in terms of procedures and results. Patient care algorithms are included. 10 figures. 1 table. 67 references.
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Nutrition in Children with Chronic Kidney Disease. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 8 p.
This fact sheet reviews nutritional needs and approaches for children with chronic kidney disease (CKD), which is the permanent loss of kidney function. The fact sheet emphasizes that patients can prevent or delay health problems from CKD by eating the right foods and avoiding foods high in phosphorus, potassium, and sodium. The fact sheet reviews how kidney disease can affect a child’s growth and development, caloric intake, the role of protein, portion control, sodium, potassium, phosphorus, fluids, special problems in the first year of life, and recordkeeping. In each section, the fact sheet explains why foods might need to be restricted and offers specific suggestions for incorporating changes into the diet. The fact sheet concludes with a brief list of suggested readings, a list of resource organizations for readers wanting additional information, and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse. 6 tables.
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Nutritional and Growth Aspects of the Care of Children with Kidney Disease. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 215-224.
This chapter about the nutritional and growth aspects of the care of children with kidney disease is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author reminds readers that chronic kidney disease (CKD) can cause a progressive decline in glomerular filtration rate (GFR), which in turn results in metabolic abnormalities. These abnormalities have a negative impact on the child’s nutritional status and growth. Malnutrition, renal osteodystrophy, anemia, salt wasting, metabolic acidosis, and resistance to hormones mediating growth are all factors that contribute to poor linear growth in children with CKD. The author discusses each of these conditions, after an introduction that considers the assessment and interpretation of growth and nutritional status and the effect of the child’s developmental stage of growth—i.e., infancy, childhood, and puberty—when progressive CKD manifests. The author concludes by applauding recent improvements in early diagnosis, modern dialysis, aggressive nutritional management, early referral to nephrologists, use of recombinant human erythropoietin, and use of recombinant human growth hormone. 4 figures. 54 references.
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PKD Patient's Manual: Understanding and Living with Autosomal Dominant Polycystic Kidney Disease. Kansas City, MO: Polycystic Kidney Disease Foundation. 2006. 33 p.
This booklet provides information about autosomal dominant polycystic kidney disease (ADPKD) to those who have the disease, those who are at risk due to an affected family member, and people who care about someone who has been diagnosed with ADPKD. The primary manifestation of ADPKD is cysts in the kidney, cysts as well as other abnormalities can occur in other areas of the body. Written in a question-and-answer format, this booklet covers the epidemiology of ADPKD, symptoms, genetics and inheritance, the ADPKD genes, screening tests for ADPKD, kidney anatomy and function, cysts and their impact on the kidney, high blood pressure (hypertension), weight loss, exercise, sodium, potassium, tobacco use, acute and chronic pain in ADPKD, blood in the urine, urinary tract infection (UTI), kidney stones, liver cysts, dialysis and transplantation, mitral valve prolapse, intracranial aneurysms, hernias, diverticula, pregnancy, diet therapy, fluids, caffeine, children with ADPKD, symptoms of kidney failure, and common tests that are done to diagnose and monitor cystic disease. The booklet concludes with a list of resource organizations through which readers can get more information. 12 figures. 1 table. 2 references.
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Radiographic Studies in Children With Kidney Disorders: What to Do and When. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 15-34.
This chapter about radiographic studies is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors provide a description of standard imaging methods that are used to evaluate children with nephro-urologic disorders, and provide some practical imaging algorithms to assist readers in typical pediatric clinical presentations. They focus on the impact of imaging on patient management and prognosis. Specific imaging modalities discussed include ultrasound studies, plain film of the kidney, ureters, and bladder (KUB), intravenous urography, and voiding cystourography (VCUG); other studies covered are isotope studies of the urinary tract, computerized tomography (CT scan), magnetic resonance imaging (MRI), and angiography and interventional procedures. The latter half of the chapter offers suggestions for diagnostic algorithms in pediatric nephro-urologic disorders, including congenital hydronephrosis or uropathy, other congenital urinary tract malformations, screening, urinary tract infection, functional disorders such as bladder-sphincter dysfunction, hematuria, proteinuria, nephrotic syndrome, renal parenchymal disease, renal failure, renal hypertension, palpable or suspected tumor, complicated renal cysts, renal transplant, and neonatal imaging. The chapter includes black-and-white illustrations and photographs and concludes with an extensive list of references. 7 figures. 48 references.
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Renal Transplantation in Childhood. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 243-252.
This chapter about renal transplantation in childhood is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author notes that in recent years, graft and patient survival have increased due to improvements in the care of young patients and advances in pharmacologic immunosuppression. The author focuses on providing information for primary care physicians on the care of a child who has received a kidney transplant for end-stage renal disease (ESRD). Topics include the results of transplantation with a living related donor versus a cadaveric donor; graft survival; antirejection medications, including corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus, rapamycin, and antilymphocyte antibodies; complications of renal transplantation, including delayed graft function, vascular thrombosis, rejection, hypertension, infections, recurrence of primary disease, malignancy, and noncompliance with treatment; growth after renal transplantation; and preparation for renal transplantation. 33 references.
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Renal Tubular Disorders. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 165-180.
This chapter about renal tubular disorders is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author notes that hereditary renal tubular transport disorders can lead to profound problems in the homeostasis of electrolytes, minerals, or organic solutes in the body and thus can be associated with significant morbidity. However, not all tubular disorders are associated with significant clinical abnormalities. Most patients with renal tubular disorders present in the neonatal period or the 1st year of life. The author summarizes the general characteristics of hereditary tubular transport disorders, reviews some aspects of the pathophysiology and genetic aspects of a few of the diseases, describes the clinical features of the tubulopathies, and briefly summarizes the therapy of some of the disorders that are seen in children. Specific disorders considered include classic cystinuria, hereditary isolated glycosuria, Dent’s disease, proximal renal tubular acidosis, Bartter’s and Gitelman’s syndromes, Liddle syndrome, pseudohypoaldosteronism type 1, distal renal tubular acidosis, and nephrogenic diabetes insipidus. The author concludes that molecular genetics and molecular biology studies have led to the identification of numerous renal tubular disease-causing mutations, have provided important insight into the defective molecular mechanisms underlying various tubulopathies, and have greatly increased the understanding of the physiology of renal tubular transport. 9 figures. 2 tables. 55 references.
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School and Family Problems of Children With Kidney Failure. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 6 p.
Serious and long-lasting medical conditions such as kidney failure affect many parts of a child’s life. Having kidney failure influences a child’s self-image and relationships with peers and family. It can also lead to behavior problems and make achieving goals more difficult. This fact sheet presents an overview of the potential school and family problems of children with kidney failure. Topics covered include learning problems, the role of adequate dialysis, school situations, the Individuals with Disabilities Education Act (IDEA, Public Law 94–142), dealing with low self-esteem, following medical instructions, issues for adolescents, engaging in sports or physical activities, making friends, preparing to enter the workforce, and the availability of professional help, including counselors and social workers. The fact sheet concludes with a list of resource organizations, websites, and publications for readers wanting additional information. The fact sheet includes the contact information for the National Kidney Foundation at www.kidney.org or 1–800–622–9010, the American Association of Kidney Patients at www.aakp.org or 1–800–749–2257, Life Options Rehabilitation Resource Center at www.lifeoptions.org or 1–800–468–7777, and the American Kidney Fund at www.kidneyfund.org or 1–800–638–8299, as well as a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
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Social and Developmental Consequences of Chronic Kidney Disease in Children. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 235-242.
This chapter about the social and developmental consequences of chronic kidney disease (CKD) in children is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors note that physical development is affected to varying degrees in children with renal disease. Reduced growth, compounded by the nausea and other signs of toxicity, results in decreased energy and reduced physical ability to participate in the normal activities of childhood. Other factors that can contribute to problems with mental and social development in these children include financial consequences for the family, the time and energy requirements for dialysis or transplantation, and delayed diagnosis and treatment. The authors outline recommended psychosocial care and support for children with CKD in different age groups, including infants and preschool children, primary school age children, and adolescents. The authors consider the impact of different types of treatment on the psychosocial development of children with CKD. They conclude that the best approach to these children requires a cohesive team attitude and good communication between the pediatric nephrologist and primary care physician. 20 references.
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Transition of Children With Renal Diseases into Adulthood. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 253-260.
This chapter about the transition of children with renal diseases into adulthood is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author reminds readers that the adolescent patient meets the difficulties of transfer of care, from pediatric to adult care, just when he or she is already struggling with the usual problems of identity, independence, self-image, burgeoning sexuality, and the need to define life goals, along with the additional burdens of chronic illness. The author stresses that pediatric nephrologists have the responsibility to initiate a plan of treatment in childhood that will support the patient throughout his or her lifetime. Management decisions with long-term consequences, particularly those that are irreversible, must be taken with extreme care, including the use of drugs capable of inducing sterilization, the removal of remaining renal tissue, the care of vascular access, and any procedure likely to lead to alloimmunization. The chapter considers some specific clinical problems, including the dilemma of renal disease apparently in remission, children with idiopathic hypertension, and coping with diseases that have manifestations outside the kidney. A final section details some of the issues that need to be considered in managing the transition from the pediatric clinic to adult health care. 1 table. 49 references.
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Treatment Methods for Kidney Failure in Children. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 12 p.
The kidneys play an important role in a child’s growth and health, including removing wastes and extra water from the blood, regulating blood pressure, balancing chemicals like sodium and potassium, making a hormone that signals bone marrow to make red blood cells, and making a hormone to help bones grow and keep them strong. This fact sheet reviews treatment methods for kidney failure in children. A successful kidney transplant can give a child with chronic kidney disease (CKD) the best chance to grow normally and lead a full, active life. Dialysis can help a child survive an acute episode of kidney failure or stay healthy until a donated kidney becomes available. Families are encouraged to work closely with their team of health care providers. Topics include problems specific to children with kidney failure, treatment details, deceased donor kidneys, living donor kidneys, preemptive transplantation, keeping a transplanted kidney healthy, peritoneal dialysis, continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), hemodialysis, the various members of the health care team and the duties of each one, anemia, bone problems, growth failure, and financial help for treatment of kidney failure. The fact sheet concludes with a list of resource organizations, websites, and publications for readers wanting additional information. Also included is a brief summary of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. 4 figures.
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Treatment Methods for Kidney Failure in Children. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 12 p.
This booklet provides information about treatment methods for kidney failure in children. The authors briefly review the physiology of the kidneys, describing how they remove wastes and extra water from the blood, regulate blood pressure, balance chemicals like sodium and potassium, make a hormone that signals bone marrow to make red blood cells, and make a hormone to help bones grow and keep them strong. The booklet outlines problems specific to children with kidney disease, notably medical complications that have an impact on their growth and development. Treatment choices are discussed, including transplantation with deceased or living donor kidneys; preemptive transplantation; appropriate post-transplant care and the issue of compliance or nonadherence; peritoneal dialysis, including continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD); and hemodialysis, including the creation of a vascular access site. The booklet describes the role of members of the child’s health care team, including the pediatrician, nephrologist, dialysis nurse, transplant coordinator, social worker, psychologist or counselor, and dietitian. Final sections cover vaccinations and immunosuppression, anemia, bone problems and growth failure, and financial help for treatment of kidney failure. The booklet concludes with a list of resources and organizations. Each organization is described briefly. Website addresses, when available, are noted. The back cover describes the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC).
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Urinary Incontinence in Children. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 6 p.
This fact sheet reviews the problem of urinary incontinence in children. The authors stress that many children experience occasional incontinence and that treatment is available for most children who have difficulty controlling their bladders. Written in a question-and-answer format, the booklet covers how the urinary system works to keep the chemicals and water in the body in balance, the causes of nighttime incontinence, the causes of daytime incontinence, and treatment options, including the child outgrowing the problem, medications, bladder training and related strategies, and moisture alarms. The causes of nighttime incontinence are described as slower physical development, excessive output of urine during sleep, anxiety, genetics, obstructive sleep apnea, and structural or anatomical problems. The booklet lists resource organizations for readers seeking additional information and briefly describes the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse. 1 figure.
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Urinary Tract Infections and Vesico-Ureteral Reflux in Children. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 139-152.
This chapter about urinary tract infections (UTI) and vesicoureteral reflux (VUR) is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author notes that UTI is one of the most common bacterial infections during childhood. UTI can involve the kidneys and result in acute pyelonephritis, with subsequent risk for permanent renal injury, notably scarring, and possible deterioration of renal function and hypertension in later life. Renal scarring may be avoided, or reduced in many patients, by early treatment and investigation of predisposing factors such as obstruction and VUR. The author discusses pathophysiology, predisposing factors for UTI, risk factors for renal scarring, malformations, bacterial virulence factors, signs and symptoms in different age groups, lower versus upper UTI, asymptomatic bacteriuria, urine testing, blood tests, ultrasonography, scintigraphy, antibacterial treatment, prophylaxis, evaluation for residual urine and bladder dysfunction, surgical treatment of VUR, circumcision, and the long-term course and outcome of UTI. Readers are encouraged to individualize patient care and to be particularly vigilant for early diagnosis of pyelonephritis in infants. The chapter includes black-and-white illustrations and photographs and concludes with an extensive list of references. 7 figures. 10 tables. 22 references.
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Urinary Tract Infections. New York, NY: National Kidney Foundation. 2006. 10 p.
This booklet provides information about urinary tract infections (UTIs), which occur when bacteria get into the urinary tract and multiply. Written in nontechnical language, the booklet answers common questions about the incidence of UTIs; the causes of UTIs; typical symptoms of these infections; diagnostic tests that may be used to confirm the presence of a UTI; treatment strategies, notably antibiotics; risk factors for getting a UTI; the problem of recurrent UTIs; steps that may help the development of a UTI; UTI in men and children; problems that can occur with untreated UTIs; and how to find out more about these infections. About 80 percent of UTIs are caused by a type of Escherichia coli bacteria that colonize the intestines but sometimes get into the urinary tract. Symptoms can include an urgent need to urinate, a burning feeling when urinating, cloudy or blood-tinged urine, and fever. Diagnosis is usually made through a urine test. UTIs often clear up with a few days of treatment with antibiotics. Patients who have recurrent UTIs should work closely with their health care providers to help prevent repeated infection. The booklet is illustrated with simple line drawings and black-and-white photographs. The booklet includes a brief description of the National Kidney Foundation (NKF). 6 figures. 3 tables.
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What I Need to Know About My Child’s Bedwetting. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 14 p.
This booklet helps readers understand the problem of bedwetting and how it can be managed. Written in nontechnical language, the booklet describes the reasons why a child may wet the bed, how parents can help the child stay dry through the night, how to know when to consult a doctor about the problem, and the types of treatments available for bedwetting. The booklet emphasizes that bedwetting is a medical problem, not a behavior problem. Treatments discussed include bladder training, a moisture alarm, and medications. Readers are reassured that most children outgrow bedwetting naturally. The booklet concludes with a list of organizations through which readers can get additional information about bedwetting. A final section briefly describes the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse. The booklet is illustrated with black-and-white line drawings. 10 figures.
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Assessing Health Status and Health Care Utilization in Adolescents With Chronic Kidney Disease. Journal of the American Society of Nephrology. 16(5): 1427-1432. May 2005.
Few validated health status measures have been assessed in children with chronic kidney disease (CKD). This article reports on a study undertaken to assess the validity of a generic health status measure, the Child Health and Illness Profile-Adolescent Edition (CHIP-AE), in adolescents with CKD. The case-control study was performed to assess scores on the CHIP-AE in adolescents with CKD compared with two control groups of age-, socioeconomic-, and gender-matched peers and to compare health of patients who had chronic renal insufficiency (CRI), were on dialysis, and were posttransplantation. Seven pediatric nephrology centers recruited the 113 patients (mean age, 14 years; 39 CRI, 21 dialysis, 53 posttransplantation). Compared with 226 control subjects, patients with CKD had lower overall satisfaction with health and more restriction in activity. Positively, patients with CKD had more family involvement, better home safety and health practices, and better social problem-solving skills and were less likely to participate in risky social behaviors or to socialize with peers who engaged in risky behavior. Patients who received dialysis were less physically active and experienced more physical discomfort and limitations in activities than did transplant or CRI patients. The authors conclude that patients with CKD have poorer functional health status than age-matched peers. Among CKD patients, dialysis patients have the poorest functional health status. The medical and surgical status of adolescents with CKD clearly has an impact on their level of social role functioning and the resources that they have available to meet the challenges of living with CKD and becoming well-functioning adults. 5 tables. 23 references.
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Chronic Dialysis and Access-Related Morbidities in Children. Dialysis and Transplantation. 34(5): 278-282. May 2005.
This article reports on a study of the scope of morbidity facing children with end stage renal disease (ESRD). Morbidity data were collected prospectively during three separate periods from October 2001 through April 2003 from all children (aged 1 to 18 years) maintained on either chronic hemodialysis (HD) or peritoneal dialysis (PD) within the ESRD Network of New England. Data were obtained on 26 HD patients and 33 PD patients. The results showed that despite the use of recombinant human erythropoietin (EPO), anemia was often noted (48.9 percent of PD patients; 33.3 percent of HD patients). A low serum albumin was seen commonly in PD patients (53.2 percent) versus that in HD patients (11.9 percent). Growth failure occurred in 36 percent of the patients and correlated directly with years of renal failure. Dialysis access malfunction, dialysis access-related infection, and hypertension accounted for most of the patient morbidity and nearly all of the hospitalizations. HD access failures were twice as common with central venous catheters and arteriovenous grafts as they were with arteriovenous fistulas. Approximately one-third of HD and PD patients experienced an access-related infection. Hospitalization was necessary in 75 percent of the cases of access failures, 85 percent of the cases of dialysis access-related infections, and 40 percent of the cases of hypertension. 3 figures. 32 references.
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Chronic Kidney Disease and Inflammation in Pediatric Patients: From Bench to Playground. Pediatric Nephrology. 20(6): 714-720. June 2005.
This review article addresses the mechanisms involved in the inflammatory process in pediatric patients with chronic kidney disease (CKD). The authors focus on the main causes and consequences of the inflammatory state observed in the CKD patient. Markers of a chronically activated immune system are closely linked to several complications of CKD, such as accelerated atherosclerosis, vascular calcification, insulin resistance, increased muscle catabolism, loss of appetite, bone remodeling, and increased peritoneal permeability. The authors note that all of these pathological states resemble a state of accelerated aging and are strongly associated with increased morbidity and mortality in CKD patients. Although preliminary findings suggest that inflammation is highly prevalent in the pediatric population with CKD, information on related pathogenic links and clinical outcomes is lacking. The authors conclude that inflammation is exaggerated in both adults and children with CKD, and it is closely related to malnutrition, which may contribute to a poor prognosis by aggravating pre-existing inflammatory status, heart failure, accelerating atherosclerosis, and increasing the susceptibility to infections. 1 figure. 1 table. 71 references.
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Clinical Dialysis. 4th ed. New York: McGraw-Hill. 2005. 1167 p.
This textbook offers a comprehensive overview of the care of patients who are undergoing dialysis therapy. Forty-seven chapters cover a wealth of topics, including the history of the development of hemodialysis (HD) and peritoneal dialysis (PD), vascular access, technological aspects, hollow-fiber dialyzers, biocompatibility, anticoagulation, kinetic modeling, optimizing dialysis in pediatric patients, complications during HD, dialyzer reuse, HD in children, peritoneal access devices, the physiology of PD, the clinical use of PD, infections in PD, infection and host defense, PD in pediatric patients, acid-base homeostasis, nutrition, growth and growth hormone treatment, liver disease in dialysis patients, gastrointestinal diseases in dialysis patients, hematologic aspects of chronic kidney disease, cardiac disease in dialysis patients, hypertension in HD, lipoprotein metabolism and dyslipidemia, endocrine dysfunction in chronic kidney disease, neurologic aspects of dialysis, diabetes and dialysis, drug usage in dialysis patients, the psychosocial adaptation of dialysis patients, psychosocial care of children on dialysis, high-flux renal replacement therapies, quality and accountability in dialysis, sorbent dialysis, continuous renal replacement therapy, pediatric hemofiltration, preemptive kidney transplantation in infancy, quotidian dialysis, HD access in children, surgical issues in pediatric PD, renal osteodystrophy, and the management of anemia. Each chapter concludes with a lengthy list of references; a detailed subject index concludes the volume.
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Growth and Growth Hormone Treatment in Children with Chronic Renal Insufficiency. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 611-652.
As the treatment of children with end stage renal disease (ESRD) has advanced and many children’s lives have consequently been prolonged by dialysis and kidney transplantation, the impact of growth retardation on those with renal insufficiency has emerged. This chapter on growth and growth hormone treatment in children with chronic renal insufficiency (CRI) is from a comprehensive textbook on the clinical management of dialysis patients. The authors note that optimizing nutritional support and medical care with vitamin D and mineral supplements does not uniformly improve growth in children with chronic renal failure (CRF). The authors discuss the pathomechanism of growth failure, growth patterns in children with CRF, and treatment strategies. They conclude that growth hormone therapy has been shown to stimulate growth significantly in prepubertal children with renal failure and ESRD, and does not appear to exhaust growth potential. Therapy should be instituted when the patient falls below the third percentile for height and does not show spontaneous catch-up growth after other factors contributing to uremic growth failure have been adequately stabilized. Therapy is continued until final height is reached or a well-functioning renal transplant is achieved. 29 figures. 286 references.
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Growth Failure in Children with Kidney Disease. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2005. 4 p.
This fact sheet describes growth failure in children with kidney disease. The fact sheet first reviews the role of the kidneys in child growth and development. In addition to removing wastes and extra fluid from the blood, the kidneys produce hormones that promote red blood cell production. The kidneys also help regulate the amounts and interactions of nutrients from food, including minerals like calcium, phosphorus, and vitamin D, which are necessary for growth. Finally, the kidneys may also play a role in the metabolism of growth hormone, also called somatotropin. The fact sheet describes how chronic kidney failure can have a negative impact on the child’s growth and development, as well as the dietary and other treatment strategies that can be used to counter this effect. A final section briefly considers the use of human growth hormone in children who are very short as a result of kidney disease. Readers are referred to the American Kidney Fund at www.akfinc.org or 1–800–638–8299, the American Society of Pediatric Nephrology at www.aspneph.com, and the National Kidney Foundation at www.kidney.org or 1–800–622–9010 for more information. The fact sheet also provides a brief summary of the work of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. 2 figures.
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Growth Hormone Therapy in Chronic Kidney Disease. Growth, Genetics, and Hormones. 21(1): 1-8. March 2005.
This article reviews the use of growth hormone therapy in children with chronic kidney disease (CKD). The authors note that in the last few years, there has been a shift in emphasis on the medical management of this population from attempts to preserve kidney survival to optimizing global biological potential, thereby maximizing quality of life. Early diagnosis and prompt treatment have become the cornerstones of modern care. The authors review the growth failure common to CKD, the growth hormone (GH) and insulin-like growth factor (IGF) interplay, metabolic changes and recombinant human growth hormone (rhGH) therapy, glucose metabolism, protein metabolism, lipid metabolism, food intake and energy homeostasis, sleep defects and rhGH, immune function, bone mineral content and rhGH, and quality-of-life issues. The authors conclude that, in the absence of kidney transplantation, it is important to restore the profound metabolic and physiologic defects arising from renal insufficiency. 4 figures. 77 references.
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Hemodialysis Access in Children. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1073-1080.
Although peritoneal dialysis tends to be the preferred dialysis modality for children, many young patients with end stage renal disease (ESRD) are managed with hemodialysis. This chapter on hemodialysis access in children is from a comprehensive textbook on the clinical management of patients on dialysis. The author describes three predominant types of vascular access that are utilized in children: the hemodialysis vascular access catheter, the autogenous arteriovenous (AV) fistula, and the AV graft, which can be constructed from a variety of different materials. The author discusses the associated benefits and potential complications of these types of vascular access. A final section considers the importance of hemodialysis access monitoring. The author concludes by reminding readers of the latest recommendations to transplant young children early if hemodialysis access is necessary. However, a percutaneously placed dialysis catheter with aggressive management of any complications should be an adequate access for a period of 1 year. 3 figures. 59 references.
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Hemodialysis in Children. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 293-308.
While most children with chronic kidney failure will eventually be treated with renal transplantation, nearly half of these children will be placed on hemodialysis while awaiting their transplants. In addition to the children with chronic dialysis needs, there is a population of children with acute renal insufficiency who may require a period of hemodialysis during acute illness and recuperation. This chapter on hemodialysis (HD) in children is from a textbook on the clinical management of dialysis patients. The authors caution that, with children, the whole task of providing care becomes even more daunting as the physical and psychosocial effects of HD and especially chronic HD therapy may adversely affect important aspects of normal childhood growth and development. The authors discuss epidemiology, the physiology of HD in children, the dialysis prescription, vascular access, the acute HD setting, HD in chronic renal failure, anemia, osteodystrophy, growth, the cognitive effects of HD, complications of HD, and the adequacy of HD. The authors note that there is preliminary evidence that optimizing caloric intake and diet and intensifying dialysis to achieve higher-than-normal measures of dialysis adequacy improves growth and pubertal development in children. 3 figures. 1 table. 66 references.
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Hemodialysis in Children: General and Practical Guidelines. Pediatric Nephrology. 20(8): 1054-1066. August 2005.
Over the past 20 years children have benefited from major improvements in both the technology and clinical management of dialysis. This article offers general practical guidelines for hemodialysis (HD) in children. The authors note that morbidity during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have both been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. The authors offer specific guidelines in the areas of the dialysis unit, water quality, the dialysis machine, blood lines; principles of blood purification, extracorpeal blood access and circulation, dialyzer membranes, the dialysate, post-dialytic dry weight assessment and adjustment, assessments (of urea dialytic kinetic, dialysis dose, and protein intake), dialysis dose and outcome, and dialysis adequacy and monitoring. Although the optimum dialysis dose requirement for children remains uncertain, reports of longer duration or daily dialysis show they are more effective for phosphate control than conventional HD. In children, HD has to be individualized and viewed as an integrated therapy considering their long-term exposure to chronic renal failure treatment. The authors stress that dialysis is usually seen only as a temporary measure for children compared with renal transplantation because the latter enables the best chance of rehabilitation in terms of education and psychosocial functioning. 1 figure. 6 tables. 83 references.
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Hemolytic Uremic Syndrome. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2005. 4 p.
This fact sheet describes hemolytic uremic syndrome (HUS), one of the most common causes of sudden, short-term kidney failure in children. Most cases of HUS occur after an infection of the digestive system by a certain type of Escherichia coli (E. coli) bacteria, which can contaminate foods and beverages. The fact sheet reviews the typical course of the disease, how it can be contracted, signs and symptoms, treatment strategies, and research efforts in this area. HUS develops when the bacteria lodged in the digestive system make toxins that enter the bloodstream and start to destroy red blood cells. Symptoms of HUS may not become apparent until a week after the digestive problems begin. Treatments, which consist of maintaining normal salt and water levels in the body, are aimed at easing the immediate symptoms and preventing further problems. Only the most severe cases require dialysis. Most children recover completely with no long-term consequences. Readers are referred to the American Society of Pediatric Nephrology at www.aspneph.com and the National Kidney Foundation at www.kidney.org or 1–800–622–9010 for more information. The fact sheet also provides a brief summary of the work of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. 2 figures.
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Henoch Schonlein Nephritis: Clinical Findings Related to Renal Function and Morphology. Pediatric Nephrology. 20(1): 46-51. January 2005.
Henoch-Schonlein Purpura (HSP) is the most common systemic vasculitis in childhood. This article reports on a study that evaluated the kidney hemodynamics and the urine protein excretion rate of 73 children with Henoch-Schonlein nephritis (HSN). Forty of the children also underwent a renal biopsy. The study was designed to evaluate the relationship between the clinical findings at onset and the renal function and histological findings in HSN patients biopsied within 5 years of disease onset. Results showed that the mean glomerular filtration rate (GFR, a measure of kidney function) at the first examination was reduced in the HSN patients and most reduced in those with nephrotic proteinuria (protein in the urine). There was an inverse correlation between the GFR at the first examination and the amount of albuminuria (albumin, a type of protein, in the urine) and urinary IgG excretion. Among the 40 patients with some degree of proteinuria who underwent a renal biopsy, 9 of 13 patients with mild to moderate proteinuria had severe morphological changes. The authors conclude that GFR is moderately reduced early in HSN and more reduced in patients with more proteinuria and in those with more advanced morphological changes. The authors caution that even mild to moderate proteinuria may indicate severe morphological changes, which increase the indications for early renal biopsy in these patients. 3 figures. 3 tables. 24 references.
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Kidney Transplantation in Children. IN: Danovitch, G.M. Handbook of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 414-450.
Successful kidney transplantation in children and adolescents not only treats uremic symptoms but also allows for significant improvement of delayed skeletal growth, sexual maturation, cognitive performance, and psychosocial functioning. This chapter on kidney transplantation in children is from a handbook that offers a practical guide for health care providers who manage kidney transplant patients. Current success in pediatric renal transplantation is attributed to improvements in transplantation technology, immunosuppressive therapy, and the provision of age-appropriate clinical care. The authors discuss epidemiology of end-stage renal disease (ESRD) in children, including etiology, incidence, access to transplantation, the timing of transplantation, and patient and graft survival; prognostic factors influencing graft survival, including donor source, recipient age, donor age, ethnicity, HLA matching, presensitization, immunologic factors, technical factors and delayed graft function, antibody induction, transplantation center volume, and cohort year; recurrent renal disease in pediatric transplantation, including glomerular diseases and metabolic diseases; pretransplant evaluation, including evaluation of living donors, neuropsychiatric development, psychoemotional status, infection, immunization status, preemptive transplantation (performed before the child has been on dialysis), and nutrition; perioperative management of the pediatric renal transplant recipient; pediatric immunosuppressive protocols; acute rejection; noncompliance in pediatric transplantation; growth and development in transplant recipients; and rehabilitation of transplanted children. The authors conclude that the child with a well-functioning kidney transplant can enjoy a quality of life that cannot be achieved by any form of dialysis therapy. 4 tables. 23 references.
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Kidney Transplantation in Children. In: Medical Management of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 198-230.
Successful kidney transplantation in children and adolescents not only resolves uremic symptoms but also allows for significant improvement of delayed skeletal growth, sexual maturation, cognitive performance, and psychosocial function. The child with a well-functioning kidney can lead a quality of life that cannot be achieved by any dialysis therapy. This chapter on kidney transplantation in children is from a textbook that provides a compendium of the latest advances and understandings regarding the complex medical problems seen in kidney transplant patients. The authors discuss the epidemiology of end stage renal disease (ESRD) in children, access to transplantation, timing of transplantation, patient and graft survival, prognostic factors influencing graft survival, contraindications to transplantation, recurrence of original disease, pretransplantation evaluation, perioperative management of the pediatric kidney transplant recipient, postoperative management, immunosuppressive protocols and drugs, acute rejection, nonadherence, growth after transplantation, sexual maturation after transplantation, infections after transplantation, posttransplantation hypertension and cardiovascular disease, and rehabilitation considerations. The authors remind readers that success in pediatric kidney transplantation is still a challenging proposition. Children and adolescents are constantly growing, developing, and changing. Each developmental stage produces a series of medical, biologic, and psychological challenges that must be appropriately addressed if truly successful graft outcome and rehabilitation are to be realized. 1 figure. 9 tables. 119 references.
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Management of Anemia in Pediatric Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1111-1134.
Anemia is a common problem in children with chronic kidney disease (CKD) and is nearly universal in children with end stage renal disease (ESRD). Even with erythropoietin treatment, many children are still anemic due to iron deficiency, inadequate erythropoietin dosing, blood loss, acute or chronic inflammation, secondary hyperparathyroidism, and nutritional deficiencies. This chapter on the management of anemia in pediatric patients is from a comprehensive textbook on the clinical care of patients on dialysis. The author first briefly reviews the pathophysiology of anemia in CKD (readers are referred to another chapter for a more detailed explanation), then focuses on the epidemiology, clinical evaluation, and treatment of anemia in children with CKD. The potential contributing factors are discussed, including erythropoietin deficiency, blood loss, decreased red blood cell survival, bone-marrow suppression, iron deficiency, inadequate dialysis, malnutrition, inflammation and infection, hyperparathyroidism, vitamin B12 or folate deficiency, aluminum toxicity, carnitine deficiency, and the role of medications. The author discusses treatment strategies, including determining a target hemoglobin level, monitoring hemoglobin levels, the use of recombinant human erythropoietin (rHuEPO), the pharmacokinetics of rHuEPO, dosing considerations, complications, and the use of darbepoetin alpha (Aranesp). A final section focuses on diagnosing and treating iron deficiency. 1 figure. 13 tables. 232 references.
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Multicystic Dysplastic Kidney: Conservative Management and Follow-Up. Renal Failure. 27(2): 189-192. 2005.
This article reports on the authors’ experience in the conservative management of patients with multicystic dysplastic kidney (MCDK) disease. The authors describe the care of 35 children, 18 male and 17 female, who were diagnosed with MCDK between 1992 and 2003 and followed at the Riyadh Armed Forces Hospital. The authors performed static scintigraphy with dimercaptosuccinic acid and micturating cystourethrogram in all patients; ultrasound was performed every 3 months, then annually. Mean age at diagnosis during the postnatal period was 2.4 days. Follow-up ultrasound examinations showed partial involution in 17 patients (48.6 percent) and complete involution in 13 (37.1 percent); 5 (14.3 percent) showed an unchanged size without any pathological manifestations. The mean age at complete or partial involution of the lesion was 43.7 months. No child developed complications such as hypertension or tumors, and all maintained normal growth and development. The authors conclude that MCDK lesions are often benign, and the affected kidneys tend to show involution with time. 2 figures. 2 tables. 26 references.
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NAPRTCS Dialysis Registry Status Report. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1021-1030.
The North American Pediatric Renal Transplant Cooperative Study Group (NAPRTCS) was founded in 1987 with the purpose of studying kidney transplantation in children and adolescents in North America. This chapter, which provides a status report on the NAPRTCS Dialysis Registry, is from a comprehensive textbook on the clinical management of patients on dialysis. The authors first outline the history of the NAPRTCS, then provide information on patient demographics and nephrologic history, modality initiation and termination, peritoneal dialysis, hemodialysis, dialysis dose, and temporal trends. In the sections on peritoneal dialysis and hemodialysis, the authors report on means of access, the first year of dialysis, complications (notably peritonitis, in the case of peritoneal dialysis), and differences between the two modalities. 2 figures. 14 tables. 1 reference.
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Nephrotic Syndrome in Children. Indian Journal of Medical Research. 122(1): 13-28. July 2005.
Nephrotic syndrome is a common chronic disorder in children, characterized by changes of permselectivity at the glomerular capillary wall in the kidneys, resulting in the inability to restrict the urinary loss of protein. This article reviews nephrotic syndrome in children, including pathogenesis, complications, drug therapy, steroid-resistant nephrotic syndrome (SRNS), and outcome. Patients with nephrotic syndrome are at risk for life threatening infections and thromboembolic episodes. Long term effects of persistent hyperlipidemia (high levels of fats in the blood) and prolonged steroid therapy are increasingly recognized. Remission of proteinuria (protein in the urine) following corticosteroid therapy has greater prognostic value, in relation to long term outcome, than does the precise renal history. Prolonged duration of therapy for the child's initial episode results in sustained remission and reduced frequency of relapses. Treatment with levamisole, cyclophosphamide, cyclosporine, and mycophenolate mofetil is beneficial in a variable proportion of patients with frequent relapses or steroid dependence. The management of SRNS is difficult; most patients who fail to achieve remission show progressive kidney damage. Reduction of proteinuria is also possible, in children, using ACE inhibitors or angiotensin receptor blockers. 2 figures. 5 tables. 90 references.
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Nutritional Management of Pediatric Patients on Chronic Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 595-610.
Nutritional factors play an important role in the management of patients with end stage renal disease (ESRD) as well as those with chronic kidney disease (CKD) not yet on dialysis; in pediatric patients, nutrition is an even more crucial factor. Protein and calorie malnutrition is a common complication of ESRD in children and has been linked to a wide range of complications, including growth retardation and death. This chapter on the nutritional management of pediatric patients is from a comprehensive textbook on the clinical management of dialysis patients. The authors discuss the assessment of nutritional status, the prevention and treatment of malnutrition, and the role of the optimization of dialysis. The authors stress that the treatment of malnutrition in children must be multidisciplinary and based on a series of steps: accurate and periodic monitoring of nutritional status, the provision of adequate calorie and protein intake, the optimization of dialysis treatment, drug prescriptions that are specific for each patient, and continuous psychosocial support for the patient and family. 3 figures. 1 table. 115 references.
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Optimizing Dialysis in Pediatric Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 203-222.
This chapter on optimizing dialysis in pediatric patients is from a textbook on the clinical management of patients on dialysis. The author reviews the current information available on the optimal approach to the prescription and quantification of peritoneal dialysis (PD), the predominant mode of dialysis therapy for children through early adolescence. The author presents data on the kinetics of PD, the basis for the peritoneal equilibration test (PET), and the role of this information in the dialysis prescription. A final section covers the prescription of hemodialysis (HD), with specific emphasis on issues of importance to the pediatric population. Specific topics include peritoneal membrane function in children, scaling factor for kinetic studies, the peritoneum as a dialyzing membrane, mass transfer area coefficient, ultrafiltration and convection, peritoneal fluid and lymphatic absorption, principles of the peritoneal equilibration test, pediatric PET procedure, solute equilibration in children, and the adequacy of peritoneal dialysis. The author concludes that in both HD and PD, optimization in children can be achieved only if the dialysis prescription is individualized and based on the patient’s clinical status and some measure of dialysis delivery. 7 figures. 2 tables. 138 references.
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Oro-dental Health in Children with Chronic Renal Failure and After Renal Transplantation: A Clinical Review. Pediatric Nephrology. 20(10): 1388-1394. October 2005.
This article reviews oro-dental health in children with chronic renal failure (CRF), including after renal transplantation. An early effect of kidney disease is undergrowth (hypoplasia) of the dental enamel, due to a defect of enamel development and mineralization. This is usually reparable using dental composite filling material. Children with CRF have significantly less dental caries than healthy children due to the inhibitory effect of increased salivary urea levels. After transplantation, patients frequently develop gingival (gum) enlargement as a result of immunosuppression with cyclosporine A, which is further exacerbated by the additional use of antihypertensive calcium-blocking agents. Surgical reduction of gingival hyperplasia is effective and is required in approximately one-third of adolescents with CRF. A very high standard of home care should be encouraged for all children with CRF, in the form of thorough mechanical tooth cleaning and plaque inhibition through the use of an antibacterial mouthwash. In children with transplants, antibiotic prophylaxis may be recommended for dental treatment procedures. 7 figures. 58 references.
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Pediatric ESRD Chronic Kidney Disease Fact Sheet. Pitman, NJ: American Nephrology Nurses Association. 2005. 4 p.
This fact sheet from the American Nephrology Nurses' Association (ANNA) provides information for classroom teachers, school nurses, and other caregivers about children who have chronic kidney disease (CKD). The fact sheet describes the different types of kidney disease, exhorting readers to focus on wellness rather than illness; the child should be viewed as having a chronic illness, as opposed to being chronically ill. The fact sheet outlines the signs and symptoms of CKD, common medications used in treatment, and the possibly changing nutritional considerations for children with CKD. The fact sheet includes space to individualize the information about a specific child who may be in the classroom. Readers are referred to the ANNA website at www.annanurse.org for more information.
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Pediatric ESRD Hemodialysis Fact Sheet. Pitman, NJ: American Nephrology Nurses Association. 2005. 4 p.
This fact sheet from the American Nephrology Nurses' Association (ANNA) provides information for classroom teachers, school nurses, and other caregivers about children who are undergoing hemodialysis (HD) as treatment for end-stage renal disease (ESRD). The fact sheet introduces ESRD and its treatments and describes HD. Specific topics include the arteriovenous fistula and arteriovenous graft, the use of central venous catheters, hypertension in children, and common medications used in children on dialysis. The fact sheet includes space to individualize the information about a specific child who may be in the classroom. Readers are referred to the ANNA website at www.annanurse.org for more information.
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Pediatric ESRD Peritoneal Dialysis Fact Sheet. Pitman, NJ: American Nephrology Nurses Association. 2005. 4 p.
This fact sheet from the American Nephrology Nurses' Association (ANNA) provides information for classroom teachers, school nurses, and other caregivers about children who are undergoing peritoneal dialysis (PD) as treatment for end-stage renal disease (ESRD). The fact sheet introduces ESRD and its treatments and outlines the different types of PD and their indications. Specific topics include continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), care of the peritoneal dialysis catheter, blood pressure control, and common medications used in children on dialysis. The fact sheet includes space to individualize the information about a specific child who may be in the classroom. Readers are referred to the ANNA website at www.annanurse.org for more information.
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Pediatric ESRD Renal Transplant Fact Sheet. Pitman, NJ: American Nephrology Nurses Association. 2005. 4 p.
This fact sheet from the American Nephrology Nurses' Association (ANNA) provides information for classroom teachers, school nurses, and other caregivers about childhood kidney transplant recipients. The fact sheet briefly introduces end-stage renal disease (ESRD) and its treatments and outlines the complications that may be encountered after a kidney transplantation. A two-page chart lists common medications prescribed for transplant patients, along with their brand name, use, and practical suggestions. The fact sheet includes space to individualize the information about a specific child who may be in the classroom. Readers are referred to the ANNA website at www.annanurse.org for more information. 1 table.
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Pediatric Hemofiltration. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1013-1020.
This chapter on pediatric hemofiltration (HF) is from a comprehensive textbook on the clinical management of patients on dialysis. The authors begin with a discussion of the three modes of dialysis (hemodialysis, peritoneal dialysis, and hemofiltration) and the choices to be made for pediatric patients in the acute care setting. The authors then discuss continuous renal replacement therapy (CRRT), continuous venovenous hemofiltration (CVVH), continuous venovenous hemofiltration with dialysis (CVVHD), ultrafiltration, equipment, membranes for HF, tubing, access, dialysate solutions, anticoagulation therapy, nutrition in CRRT, drug clearance, the complications of HF, and expected outcomes in acute renal failure (ARF). The authors conclude that CRRT is effective for the treatment of fluid and solute management in ARF and multi-organ system failure (MOSF). Early intervention with CRRT characterized by aggressive replacement and dialysis fluid parameters as well as the use of citrate anticoagulation results in superior patient outcomes. 2 tables. 26 references.
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Peritoneal Dialysis in Pediatric Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 514-552.
This chapter on peritoneal dialysis (PD) in pediatric patients is from a comprehensive textbook on the clinical management of patients on dialysis. The author notes that patient selection plays an important part in determining whether a child is placed on PD. If PD is an option for the treatment of chronic renal failure, the psychosocial determinants of the child and his or her family are important. Age, maturation, distance from the dialysis center, and other family characteristics influence the balance of choice between PD and HD. The author explains the components of a typical PD system and the dialysate used, then discusses the different types of PD, the PD prescription, and complications of this therapy. The ultimate goal of dialysis in pediatric patients is renal transplantation, and children on PD are as good candidates for transplantation as those on HD. New dialysis fluids are being developed, and bicarbonate-buffered solutions as well as solutions containing isodextrin are of benefit to patients. Attention to the adequacy of dialysis has led to intensification of the dialysis prescription schedules. 1 figure. 1 table. 151 references.
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Polycystic Kidney Disease (PKD). American Family Physician. 71(1): 135-136. January 1, 2005.
This patient education fact sheet reviews the problem of polycystic kidney disease (PKD), a condition in which sacs of fluid grow in the kidneys. If too many cysts grow or if they become too big, the kidneys are damaged. The cysts may also be painful or get infected. The fact sheet reviews the symptoms of PKD, the impact of PKD on lifestyle and lifespan, diagnostic tests that may be used to confirm the presence of PKD, who should be tested for PKD, and the diagnosis of PKD in unborn babies. PKD tends to run in families and children of people with PKD have a 50 percent chance of getting the disease. Blank space for notes is also included.
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Preemptive Kidney Transplantation in Infancy. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1031-1054.
Kidney transplantation is the preferred mode of renal replacement therapy (RRT) for children with end stage renal disease (ESRD). Transplanted children resume a more normal growth and development pattern than their counterparts on dialysis, thus making transplant the most attractive opportunity for infants who are at the period of most rapid height and brain growth. This chapter on preemptive kidney transplantation in infancy is from a comprehensive textbook on the clinical management of patients on dialysis. The authors outline indications for RRT in infancy, review the available modalities, and compare the advantages and disadvantages of each. Specific topics include growth in infants with renal failure, neurologic development in this population, peritoneal dialysis in infancy, the complications and immunologic effects of peritoneal dialysis in infants, hemodialysis in infancy, preparation for infant transplantation, factors affecting infant transplantation (donor source, immunosuppression effect, donor age, immunologic responsiveness, rejection incidence, technical factors, hemodynamic considerations), posttransplant complications, immunosuppression protocols, the identification and treatment of allograft rejection, and posttransplantation growth in the infant. The authors conclude that the mode that allows the patient and family to function most normally is that of kidney transplantation. 1 figure. 12 tables. 132 references.
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Psychosocial Care of Children on Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 937-948.
This chapter on the psychosocial care of children on dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. After reviewing what is known about the epidemiology of psychosocial problems in children and adolescents with kidney disease and those on dialysis in particular, the authors discuss general issues of concern in the psychosocial domain with respect to child nephrology and dialysis patients. Topics include psychosomatic relationships, renal failure as a risk factor for psychiatric disorder in children, coping behaviors and psychological defenses in children, care of the dying child, the burden of dialysis treatment and care, the complexity of syndromes associated with chronic renal failure (CRF), nonadherence and patient compliance issues, the early detection of mental health problems, and specific disorders, including adjustment disorders, depression, eating disorders, posttraumatic stress disorders, confusional states, fear of procedures, separation anxiety, and short stature. The authors also introduce and describe a proposed model of psychosocial care. The authors stress that all members of the nephrology clinical team have a role in psychosocial care of these children and their families. A functional psychosocial team should be able to recognize when children have significant mental health problems, seek appropriate advice, and make appropriate referrals for specialist mental health assessment and intervention. 22 references.
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Renal Manifestations in Henoch-Scholein Purpura: A Ten-Year Clinical Study. Pediatric Nephrology. 20 (09): 1269-1272. September 2005.
Henoch-Schonlein purpura (HSP) is an IgA-mediated systemic small vessel vasculitis of childhood. HSP is characterized by symptoms including nonthrombocytopenic purpura, abdominal pain, hematuria (blood in the urine) or proteinuria (protein in the urine), and arthritis or arthralgia (painful joints). This article reports on a retrospective study of 261 patients diagnosed with HSP from December 1991 to December 2001. Of the 261 patients, 53 (20.3 percent) developed renal (kidney) manifestations after onset of the disease. During the study period, the renal survival rate after disease onset was 100 percent. The prognosis of kidney involvement was better than reports from other series. The authors also found factors associated with HSP nephritis: older age at onset, gastrointestinal bleeding, and central nervous system involvement. The long-term morbidity (associated illness) of HSP is predominantly attributed to kidney involvement. The authors conclude by recommending that patients with HSP nephritis are followed for longer periods of time after diagnosis and initial therapy. 3 figures. 3 tables. 20 references.
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Renal Osteodystrophy in Pediatric Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1091-1110.
Despite improvements in the management of children with chronic kidney disease (CKD), linear growth impairment and bone deformities are still prevalent. This chapter on renal osteodystrophy in children with CKD is from a comprehensive textbook on the clinical management of patients on dialysis. The author notes that renal osteodystrophy encompasses the spectrum of high-turnover to low-turnover bone lesions, all of which can change in response to various treatment modalities. The author summarizes the major factors that contribute to the development of renal bone disease, the typical clinical presentation in pediatric patients, diagnostic tests available, and the treatment strategies currently used in this patient population. The author concludes that in the clinical management of children with chronic renal failure, hypocalcemia should be corrected early, age-appropriate serum phosphorus levels must be achieved, metabolic acidosis must be treated, and serum intact PTH levels must be maintained within the recommended target ranges. The primary aim in the early treatment of secondary hyperparathyroidism in children with CKD is to protect the young skeleton against the effects of progressive renal failure and to prevent the development of parathyroid gland hyperplasia. 13 figures. 166 references.
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Sailing on a Wave of New Research: Part 2. Diabetes Forecast. 58(11): 45-48. November 2005.
This article, the second in a two-part series, summarizes recent research findings that were reported at the American Diabetes Association's 65th Scientific Sessions, held in San Diego (2005). This article covers undiagnosed kidney disease in people with type 2 diabetes, diet soda and weight gain in both type 1 and type 2 diabetes, poor diabetes control and depression in children and adolescents with type 1 diabetes, the use of exercise to prevent gestational diabetes, and eye disease (retinopathy) that may develop before clinical diabetes develops. Some of the information reported is from the Diabetes Prevention Program (DPP), a study that showed that weight loss, exercise, or treatment with the diabetes drug metformin can cut the risk of developing diabetes in people with pre-diabetes.
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Surgical Issues in Pediatric Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1081-1090.
Although peritoneal dialysis is the predominant modality for children with end stage renal disease (ESRD), there must be adequate peritoneal access for this method to be successful. This chapter on surgical issues in pediatric peritoneal dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. The author reviews different catheter and surgical insertion techniques as well as lessons to be learned from the literature of this field. Topics covered include access types, preoperative evaluation and preparation, omentectomy, fibrin sealant, the choice of surgical technique, open technique, laparascopic technique, postimplantation care, the timing of catheter use, mechanical complications, exit-site infection, tunnel infection, peritonitis, the timing of catheter removal after kidney transplantation, and complications associated with peritoneal dialysis catheter removal. In each area, the author briefly summarizes the related research literature. 9 figures. 39 references.
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Transplant Operation and Its Surgical Complications. IN: Danovitch, G.M. Handbook of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 193-211.
Kidney transplantation is an elective or semi-elective surgical procedure performed in patients who have undergone careful preoperative assessment and preparation. Chronic dialysis enables patients to be maintained in optimal condition and provides time to address potentially complicating medical and surgical issues. The authors of this chapter discuss these preparations. The chapter, on the transplant operation and its surgical complications, is from a handbook that offers a practical guide for health care providers who manage kidney transplant patients. Specific topics include immediate preoperative preparations, operative techniques, surgical considerations in young children, intraoperative fluid management, dual-kidney transplantation, and the surgical complications of kidney transplantation, including wound infection, lymphocele, bleeding, graft thrombosis, the need for perioperative anticoagulation, renal artery stenosis, urine leaks, and ureteral obstruction. An additional section discusses allograft nephrectomy (removal of prior kidney transplants that have failed). 6 figures. 2 tables. 14 references.
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Urinary Tract Infections in Children. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2005. 6 p.
This fact sheet reviews the problem of urinary tract infections (UTIs) in children. The authors caution that untreated UTIs can lead to serious kidney problems. Written in a question-and-answer format, the booklet reviews the anatomy and physiology of the urinary system and considers how the urinary tract becomes infected, the signs and symptoms of a UTI, diagnostic tests that may be used to confirm a diagnosis and monitor subsequent abnormalities in the urinary tract, treatment options for urinary tract infections, and abnormalities that may contribute to a child getting a UTI, including vesicoureteral reflux, urinary obstruction, and dysfunctional voiding. The authors discuss the prevention of UTIs. The booklet provides contact information for the American Urological Association Foundation, Inc., and briefly describes the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse. 3 figures.
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Waiting for a Transplant. Revised ed. New York, NY: National Kidney Foundation. 2005. 70 p.
This booklet was written for patients who are waiting for a kidney transplant by patients who have already undergone this waiting period. Readers are encouraged to read the booklet if they are able, or to put it aside until a more appropriate time. Readers are also encouraged to work closely with the health professionals at the treatment or transplant center. The booklet is written in question-and-answer format and organizes topics into six sections: considering transplantation, living donation, the experience of waiting, strategies that can help, end-of-life decisions, and other sources of help. Specific topics include candidacy for organ transplant, potential donors, the advantages of living donation, recovery time for kidney donors, risks associated with kidney donor surgery, live liver donation, live lung donation, donor advocates, costs and insurance coverage, what to expect after a transplantation, retransplantation, employment considerations, coping with chronic illness, family and parenting dynamics, stress and other emotions, planning ahead, the role of exercise, treating anxiety and depression, learning about addictions, support groups, taking care of caretakers, and talking about death within the family. The booklet concludes with a list of resources organized into five categories: general readings of encouragement, financial and insurance resources, websites, materials for children and their families, and National Kidney Foundation resources from www.kidney.org. The brochure includes motivational quotes from kidney patients. The brochure concludes with a tear-off evaluation survey form for readers to fill out and return to the transAction Council.
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20-Year History of Childhood HIV-Associated Nephropathy. Pediatric Nephrology. 19(10): 1075-1092. October 2004.
In 1984, physicians in New York and Miami reported HIV-infected adult patients with heavy proteinuria and rapid progression to end-stage renal disease. These patients showed large edematous kidneys with a combination of focal segmental glomerulosclerosis (FSGS) and tubulointerstitial lesions. This renal syndrome, named HIV-associated nephropathy (HIVAN), was found predominantly in African Americans. This article reviews 20 years of research into the pathogenesis of HIVAN and discusses how these concepts could be applied to the treatment of children with HIVAN. The authors stress that HIV-1 infection plays a direct role in the pathogenesis of childhood HIVAN, at least partially by affecting the growth and differentiation of glomerular and tubular epithelial cells and enhancing the kidney recruitment of infiltrating mononuclear cells and cytokines. These changes enhance the infectivity of HIV-1 in the kidney and induce injury and proliferation of intrinsic renal cells. The authors conclude that highly active anti-retroviral therapy (HAART) appears to be the most promising treatment to prevent the progression of childhood HIVAN. 7 figures. 182 references.
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About Chronic Kidney Disease. El Segundo, CA: DaVita Inc. 2004. 4 p.
Healthy kidneys function to remove extra water and wastes from the body, to help control blood pressure, to keep body chemicals in balance, to keep bones strong, to tell the body to make red blood cells, and to help children grow normally. This patient education fact sheet offers a basic description of chronic kidney disease (CKD), a condition that occurs when the kidneys are no longer able to clean toxins and waste products from the blood or perform their functions to full capacity. Written in a question-and-answer format, the fact sheet discusses acute renal failure and how it differs from CKD, the main causes of kidney disease, diabetes-related kidney disease, kidney stones, parathyroid hormone (PTH) and calcium, polycystic kidney disease (PKD), the symptoms of CKD, and diagnostic tests used to confirm CKD. The fact sheet concludes with information about a patient education program sponsored by DaVita (the producer of the fact sheet and a provider of in-center hemodialysis nationally).
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Enalapril in Children with Alport Syndrome. Pediatric Nephrology. 19(3): 271-275. March 2004.
This article reports on a study of ten pediatric patients (9 boys, 1 girl) with Alport syndrome who received enalapril for 5 years. Eight patients have the X-linked form of the disease and 2 have the autosomal recessive form. The median age at the start of treatment was 10.25 years. All patients had hematuria (blood in the urine) and proteinuria (protein in the urine); seven of them had bilateral hearing loss. Only one patient had hypertension (high blood pressure). Three patients did not reach the target dose of enalapril because of orthostatic hypotension (low blood pressure). One of the those three was the only patient to develop chronic renal failure (CRF) within 5 years. The results indicate that enalapril reduces urinary protein excretion and preserves glomerular filtration in Alport patients as a group. However, there was individual variation, as in most studies of patients with proteinuric nephropathies given ACE inhibitors. 2 figures. 4 tables. 22 references.
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Glomerular Permeability Activity: Prevalence and Prognostic Value in Pediatric Patients with Idiopathic Nephrotic Syndrome. American Journal of Kidney Diseases. 44(4): 604-610. October 2004.
This article reports on a study of kidney glomerular permeability activity and how it can be used in the care of pediatric patients with idiopathic nephrotic syndrome (INS), a condition characterized by fluid accumulation (edema), proteinuria (protein in the urine), hypoalbuminemia (reduced protein levels in the blood), and susceptibility to infections. A circulating factor that increases in vitro glomerular permeability to albumin (P-alb) has been isolated from patients with recurrence of focal segmental glomerulosclerosis in their renal allografts (kidney transplant). The authors determined the P-alb activity level in sera from 26 children with new-onset INS before the initiation of therapy. The authors also collected demographic information, serum albumin and cholesterol concentrations, calculated glomerular filtration rate (GFR, a measure of kidney function), age at disease onset, response to corticosteroid treatment, and long-term outcome. Patients ranged in age from 2 to 18 years and 19 patients (73 percent) were male. P-alb in patients with a steroid-responsive course (n=17) did not differ from that of patients with steroid-resistant disease (n=9). The authors conclude that permeability activity, defined as P-alb greater than 0.5, is present in pretreatment serum samples from nearly half the children with INS. However, the presence of permeability activity does not predict clinical response to steroid treatment, renal histopathologic characteristics, or clinical outcome at up to 5 years of follow-up. 1 figure. 1 table. 45 references.
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Hematuria in Children. New York, NY: National Kidney Foundation, Inc. 2004. 2 p.
This fact sheet discusses hematuria (the presence of red blood cells in the urine) in children. Urine does not normally contain red blood cells because the filters in the kidney prevent blood from entering the urine. In hematuria, the filters or other parts of the urinary tract allow blood to leak into the urine. The fact sheet reviews the causes of hematuria including structural, inherited, mineral imbalances, glomerulonephritis, and idiopathic hematuria; and the evaluation of hematuria. Microscopic hematuria can be detected only with a microscope, while gross hematuria features urine discolored by blood. Microscopic hematuria in an otherwise healthy child does not usually need to be investigated unless it is present in at least three urine tests over several months. However, if the child has high blood pressure, chronic kidney disease, or protein in the urine (proteinuria), the hematuria should be investigated promptly.
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Importance of Being Tested for Kidney Disease. Kidney Beginnings. p. 6-7, 26. March-April 2004.
This article, from a journal for kidney patients, reminds newly diagnosed patients of the importance of having their family members tested for kidney disease. While diagnosis and treatment can be beneficial at any stage of kidney disease, the most benefit comes when the disease is identified early. In addition to those persons with diabetes or hypertension (high blood pressure), first-degree relatives (children, siblings, parents) of people with kidney failure should also be tested. The guidelines for this group are still undecided, but it is clear that these relatives are at high risk for kidney disease. They should also be assessed for diabetes and hypertension in addition to the laboratory tests of kidney function. The article describes the two routine tests for kidney disease: measurement of albumin (a type of protein) in the urine and measurement of creatinine in the blood (a measure of kidney function). The author also mentions some special tests and when they would be indicated. 1 figure.
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Medical Management of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. 608 p.
Kidney transplant recipients are a unique group of patients who are being seen more commonly in general medical practices, in addition to the subspecialty practices of nephrologists, transplant physicians, and surgeons. This textbook provides a compendium of the latest advances and understandings regarding the complex medical problems seen in kidney transplant patients. Thirty-five chapters are organized into three sections: pre-transplantation, transplantation, and post-transplantation. Topics covered include graft and patient survival, detection of recipient pretransplant alloreactivity, recipient evaluation, waiting list management, renal allograft preservation, initial hospitalization care, surgical issues in the transplant recipient, extracorporeal blood purification, immunosuppression, evaluation and treatment of graft dysfunction, recurrent and new diseases after kidney transplantation, kidney transplantation in children, psychiatric and psychosocial issues, pregnancy and gender issues, the prevention and treatment of coronary artery disease, dyslipidemia or hyperlipidemia after solid organ transplantation, hypertension, evaluation and management of posttransplant diabetes mellitus, hematologic complications of transplantation, posttransplantation liver disease, management of transplantation renal bone disease, malignancies after transplantation, bacterial infections in the kidney transplant recipient, cytomegalovirus, fungal infections, erectile dysfunction, the pathology of kidney allografts, imaging considerations, kidney and pancreas dual transplantation, drug interactions, and other medical complications in the kidney transplant recipient. Each chapter concludes with a list of references and the textbook concludes with a detailed subject index.
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Natural History of Multicystic Kidney Conservatively Managed: A Prospective Study. Pediatric Nephrology. 19(10): 1102-1107. October 2004.
This article reports on a study of the long-term clinical results of conservative management of children with unilateral multicystic dysplastic kidneys (MCDK). Between 1989 and 2002, 43 children with MCDK detected by prenatal ultrasonography were prospectively followed. Follow-up ultrasound (US) examinations were performed at 6-month intervals during the first 2 years of life and yearly thereafter. The mean follow-up time was 42 months (range 12 to 156 months). Two children developed hypertension (high blood pressure) during follow-up. US scans demonstrated partial involution of the MCDK in 30 cases (70 percent) and complete involution in 8 cases (19 percent). The absolute MCDK length remained almost unchanged in 5 children (11 percent). A total of 33 (76.7 percent) contralateral kidneys underwent compensatory hypertrophy (the uninvolved kidneys grew larger to compensate for the kidney damaged by MCDK), reaching a renal length above the 95th percentile during follow-up. The authors conclude that the natural history of MCDK is usually benign but patients must have long-term follow-up with US scans and blood pressure measurements. 3 figures. 1 table. 35 references.
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Organ Transplants: What Every Kid Needs to Know. Richmond, VA: United Network for Organ Sharing (UNOS). 2004. 10 p.
This booklet helps children with chronic disease understand the process of organ transplantation and what they can expect if they receive a transplant. The booklet covers why an organ may need to be transplanted, the waiting process, what each of the organs does (lungs, heart, pancreas, liver, kidneys, intestine), where the donated organs come from, the transplant team, postoperative care, and coping with the transition back to school. The booklet encourages children to ask questions, follow the doctor's instructions, keep themselves healthy, take their medicine, exercise, eat healthy foods, get plenty of sleep, know that they are important, and set goals for themselves. The booklet is illustrated with colorful drawings of children.
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Relationship Between Acute Pyelonephritis, Renal Scarring, and Vesicoureteral Reflux: Results of a Coordinated Research Project. Pediatric Nephrology. 19(10): 1122-1126. October 2004.
Acute pyelonephritis (APN, inflammation of the kidney and its pelvis, usually due to bacterial infection) may produce permanent renal damage (PRD), which can subsequently lead to diverse complications. This article reports on a study that prospectively evaluated 147 females and 122 males (mean age 3.5 years) with APN in order to analyze the relationship between the presence of PRD, at the time of cortical renal scintigraphy, and age, gender, episodes of urinary tract infection (UTI), and presence of vesicoureteral reflux (VUR, the return of urine from the bladder back through the ureters to the kidneys). There were 152 children studied after the first proven UTI; VUR was present in 150 children; PRD was observed in 170 children. There were no significant differences between boys and girls. PRD was found in 36.4 percent of children younger than 1 year and in 70.1 percent of those older than 1 year. Of children with VUR, 72 percent had PRD compared with 52 percent of children without VUR. Of children with a first episode of UTI, 55.9 percent developed PRD as did 72.6 percent of those with recurrent UTI. The authors conclude that PRD in children with APN is important, especially in the presence of VUR, recurrent UTI, and older age.
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Screening for Vesicoureteral Reflux and Renal Scars in Siblings of Children with Known Reflux. Pediatric Nephrology. 19(10): 1127-1131. October 2004.
The incidence of vesicoureteral reflux (VUR, the return of urine from the bladder back through the ureters to the kidneys) in the general population is less than 1 percent, but it tends to run in families. The reported prevalence of VUR among siblings of index patients with reflux has ranged from 4.7 percent to 51 percent. Reflux carries an increased risk of pyelonephritis (inflammation of the kidney and its pelvis, usually due to bacterial infection) and long-term renal impairment. This article reports on a study undertaken to identify the age-related incidence and severity of reflux, and the frequency of associated renal parenchymal (kidney body) damage in siblings of children with reflux in order to assess the use of screening at different ages. Between October 1994 and February 2003, 40 siblings of 34 index patients were screened. Of 40 siblings, 17 had VUR, representing an incidence of 42.5 percent. The mean age at study entry of the 15 boys and 25 girls was 63 months. Reflux was unilateral (one side only) in 12 siblings and bilateral (both sides) in 5 siblings. Of the 17 refluxing siblings, 7 (41.2 percent) had a history of symptomatic urinary tract infection (UTI). The authors conclude that their data confirms a significant overall incidence of VUR and renal parenchymal damage in the siblings of patients with known reflux. The authors recommend that all siblings over 6 years of age should undergo a screening cystogram, even in the absence of UTI. 1 figure. 59 references.
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Standards of Medical Care in Diabetes. Diabetes Care. 27(Supplement 1): S15-S35. January 2004.
Diabetes care is complex and requires that many issues, beyond glycemic (blood glucose) control, be addressed. This article presents standards of care from the American Diabetes Association that are intended to provide clinicians, patients, researchers, payors, and other interested persons with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. Topics include classification, diagnosis, and screening; initial evaluation; patient care management, including glycemic control, referral for diabetes management, and intercurrent illness; assessment of glycemic control; medical nutrition therapy (MNT); physical activity; prevention and management of diabetes complications, including cardiovascular diseases, high blood pressure (hypertension), smoking cessation, nephropathy (kidney disease) screening and treatment, diabetic retinopathy (eye disease), and foot care (including amputation prevention); preventive care, including preconception care and immunization; and special considerations for the care of older adults with diabetes, children and adolescents, and standards of care. 8 tables. 129 references.
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Tacrolimus Therapy in Pediatric Patients with Treatment-Resistant Nephrotic Syndrome. Pediatric Nephrology. 19(3): 281-287. March 2004.
This article reports on a retrospective analysis of 16 children started on tacrolimus with various types of treatment-resistant nephrotic syndrome. In the group, there are 13 patients with focal glomerulosclerosis, 1 minimal change disease, and 2 IgA nephropathy with nephrosis. The mean age of the children was 11.4 years (range 3.5 to 18.1 years) with a mean age at diagnosis of 5.6 years (range 1.6 to 13.3 years). All patients initially received prednisone 2 milligrams per kilogram per day. Other therapies for 15 of 16 included cyclosporine (n = 15), chlorambucil (n = 5), mycophenolate mofetil (n = 5), levamisole (n = 3), i.v. methylprednisolone (n = 3), and cyclophosphamide (n = 2). The major indication for the initiation of tacrolimus included treatment resistance or dependence (n = 15) and intolerable side effects from other therapies (n = 1). The average time from the diagnosis to initiation of tacrolimus was 5.3 years. Thirteen patients (81 percent) went into a complete remission within an average of 2 months, with 3 patients relapsing while on treatment. Three patients did not respond. Of these, 2 had partial remissions (13 percent) and 1 failed to respond. Adverse events included anemia (n = 1), seizure (n = 1), worsening or new-onset hypertension (n = 5), and sepsis (n = 1). All patients remained on tacrolimus. The authors conclude that tacrolimus is an effective, well-tolerated medication for treatment-resistant forms of nephrotic syndrome in children, with a complete remission rate of 81 percent and a partial remission rate of 13 percent. 1 figure. 3 tables. 37 references.
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Two Different Therapeutic Regimes in Patients with Sequelae of Hemolytic-Uremia Syndrome. Pediatric Nephrology. 19(10): 1148-1152. October 2004.
Renal (kidney) disease is the most important long-term complication of hemolytic-uremic syndrome (HUS). This article reports on a comparative study of renal function that was carried out in two groups of patients. Group 1 included 19 children followed for a median of 11 years, 1960–1980, with a low-sodium diet, antihypertensive drugs, and a restricted protein intake in the end stage of renal disease (ESRD). Group 2 included 26 children treated for a median of 9 years, 1988–2002, on a low-sodium diet, early restriction of protein intake according to recommendations, and angiotensin converting enzyme (ACE) inhibitors. Long-term renal function was assessed by the inverse of the plasma creatinine concentration over time. In Group 1, seven children experienced a significant linear fall in kidney function over time; all the children had negative linear regression lines. In contrast, children in Group 2 had 11 negative slopes (only 1 significant) and 15 positive slopes. The authors conclude that this comparatively better long-term outcome of renal function in children under contemporary treatment was probably associated with early restriction of protein and use of ACE inhibitor therapy. 1 figure. 2 tables. 49 references.
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