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Biomedical subjects

B Fivush

Publications and source records attributed to B Fivush.

At least 19 recordsLinked to original sources
PubMed1999

Longitudinal evaluation of transport kinetics in children receiving peritoneal dialysis.

Functional stability of the peritoneal membrane is necessary for maintenance of peritoneal dialysis (PD) as a therapeutic option. Few studies have investigated this issue in children. We evaluated the peritoneal membrane solute transport capacity longitudinally in 26 children (mean age 11.0+/-5.5 years) receiving long-term PD. Each patient underwent a standardized peritoneal equilibration test on two occasions (mean interval between studies 19.8+/-5.9 months) to determine solute dialysate to plasma (D/P) ratios, dialysate glucose to initial dialysate glucose (D/D(0)) ratios, and mass transfer area coefficients (MTAC). The correlation of transport capacity with peritonitis history was also assessed. No significant change in MTAC, D/P, or D/D(0) values were found when comparing original and follow-up data of the group overall. However, transport of creatinine and glucose was significantly (P<0.05) greater in the peritonitis group compared with the group without peritonitis, and differences in the change over time between the peritonitis groups was significant for MTAC creatinine (P=0.035) and D/D(0) glucose (P=0.020). In summary, this experience demonstrates functional stability of the peritoneal membrane in pediatric patients receiving PD. However, follow-up assessments of peritoneal solute kinetics may be necessary in patients with a history of peritonitis in order to permit early identification of those who may be at risk for ultrafiltration failure and sclerosing peritonitis.

Adolescent↗
PubMed1998

Report of the American Society of Nephrology meetings.

PURPOSE: We summarize presentations on topics of interest to the pediatric urologist from the annual meeting of the American Society of Nephrology, November 1996. MATERIALS AND METHODS: We reviewed all abstracts submitted for presentation and subsequently published in abstract form. Only those abstracts containing information pertinent to the field of pediatric urology were summarized for this report. RESULTS: A total of 24 abstracts addressing a variety of topics were summarized. Obstructive uropathy was represented by the greatest number of papers and reflects the multiple investigative efforts currently evaluating the cellular aspects of this disorder. The genetic basis of hypercalciuria and the impact of water metabolism on nephroliathisis were also discussed. CONCLUSIONS: Clinical and basic research activities that are of mutual interest to pediatric urologists and nephrologists are being conducted. The topic of obstructive uropathy has received the greatest attention during the last year. However, additional research, potentially collaborative in nature, on topics such as nephroliathisis and reflux nephropathy should be encouraged.

Child↗
PubMed1997

Initial experience with FK506 (tacrolimus) in pediatric renal transplant recipients.

PURPOSE: The efficacy and safety of the new immunosuppressant agent, FK506 (tacrolimus), was assessed in pediatric renal transplant recipients over a mean 12-month follow-up period. METHODS: Twenty pediatric renal transplant recipients received oral FK506 therapy (0.3 mg/kg/d) in combination with azathioprine (1 to 2 mg/kg/d) and low-dose prednisone as primary therapy (n = 11) or were converted from cyclosporine-based therapy (n = 9) for complications including cyclosporine toxicity (n = 2), acute refractory rejection (n = 4), and chronic rejection (n = 3). Patients were then followed-up prospectively to evaluate effectiveness of therapy and complications. RESULTS: In the primary treatment group, 45% of patients had one or more rejection episodes. Two required OKT3 therapy (18%) for persistent rejection, with one (9%) graft loss at 3 months. All other episodes were treated effectively with FK506 dose adjustment and steroid pulses. Patient and graft survival was 100% and 91%, respectively, at 12 months mean follow-up. In the FK506 conversion group, two teenage girls with intractable acne and hirsutism were converted with complete resolution and no change in renal function. Four patients were converted for acute rejection: two who did not respond to steroid pulse and two who did not respond to both steroids and OKT3. All four grafts were salvaged (mean follow-up, 12 months; mean Creatinine [Cr], 1.1). Three patients were converted for biopsy-proven chronic rejection at 3, 10, and 12 years after transplant (mean Cr, 2.4) with two of three of patients stable with functioning grafts at 1 year after conversion. Complications of FK506 therapy included temporary insulin-dependent diabetes mellitus (10%), neurological complications (25%), renal toxicity (15%), and hypertension (85%). There were no cases of gastrointestinal toxicity, hepatic dysfunction, lymphoproliferative disorders, or life threatening viral infection. All symptoms of toxicity responded to dose adjustment. No patient required conversion from FK506 to other agents. CONCLUSION: This early experience indicates that FK506 in combination with low-dose steroids and azathioprine appears to provide safe and effective immunosuppression in the pediatric age group as a primary agent and may salvage grafts in patients with refractory steroid and OKT3 resistant rejection. Graft and patient survival is comparable to that seen with conventional cyclosporine-based immunosuppression.

Adolescent↗
PubMed1997

Metabolic complications secondary to obstruction of a Kock pouch afferent limb.

Metabolic complications are frequently seen following urinary diversion with an intestinal segment. Afferent limb complications are noted in 10% of patients undergoing continent Kock urinary diversion. We present a patient with cloacal exstrophy with developed significant hypocalcemic tetany and metabolic acidosis related to a nondraining afferent limb of a Kock pouch created to achieve continence.

Adolescent↗
PubMed1997

Acute hypertensive crises in children: emergencies and urgencies.

Hypertensive crises result from acute elevations in blood pressure. Although uncommon in children, they can be life-threatening and require immediate recognition and treatment to decrease morbidity. The diagnosis is made following complete history and physical assessment, with confirmation of blood pressure elevation using an appropriate-size blood pressure cuff. There are various options for treatment. Some of the more commonly used agents include nitroprusside, diazoxide, hydralazine, labetalol, esmolol, nicardipine, nifedipine, enalaprilat, and minoxidil. Close monitoring of blood pressure during treatment is mandatory to ensure a good outcome.

Acute Disease↗
PubMed1997

Renal transplantation in children from 1987-1996: the 1996 Annual Report of the North American Pediatric Renal Transplant Cooperative Study.

The 1996 Annual Report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) summarizes data voluntarily collected from 130 centers on 4329 children and adolescent patients who received renal transplants on or after January 1, 1987. This report updates information on transplants; data on dialysis and chronic renal insufficiency have, for the first time, been reported separately (in submission). The NAPRTCS registry shows that the majority of pediatric renal transplants are performed in children above 6 years of age (73%). The most frequent diagnoses include obstructive uropathy (16%), aplastic/hypoplastic/dysplastic kidneys (16%), and focal segmental glomerulosclerosis (12%). Pre-emptive transplantation was performed in 24% of patients. Triple drug maintenance therapy with prednisone, cyclosporine and azathioprine was used by >70% of all transplant recipients throughout 7 years of follow-up. Fifty-six per cent of transplant recipients were rehospitalized during months 1-5 (51% live donor (LD), 62% cadaver donor (CD)), with rejection and infection as the main causes. In the period 30-35 months post-transplant, 19-22% of patients (163 LD, 185 CD) were rehospitalized. The median time to the first rejection was 46 days for CD transplants and 377 days for LD grafts (p<.001). Six-year graft survival rates were 73% and 56% for LD grafts and CD grafts, respectively (p<.001). The overall growth deficit was constant over a period of 60 months. However, children transplanted under 5 years of age reduce their height deficit by about one-third compared to an increase in height deficit of up to 22% for older children. The NAPRTCS data analysis also demonstrates a delay in first rejection episodes in LD compared to CD transplants, and a steady improvement in CD graft survival over the past 5 years in pediatric transplant recipients.

Adolescent↗
PubMed1997

Report of the American Society of Nephrology meeting.

PURPOSE: We summarize presentations on topics of interest to the pediatric urologist from the annual meeting of the American Society of Nephrology in November 1995. MATERIALS AND METHODS: We reviewed all abstracts submitted for presentation and subsequently published in abstract form in the Journal of the American Society of Nephrology, September 1995. Only abstracts containing information pertinent to the field of pediatric urology were summarized for this report. RESULTS: A total of 22 abstracts addressing the subjects of nephrolithiasis, obstructive uropathy, renal transplantation, vesicoureteral reflux and genetics/development was summarized. CONCLUSIONS: Research activities in various subject areas are applicable to the pediatric nephrology and urology communities. Sharing the results of these investigative efforts in forums such as this report is mutually beneficial and should be encouraged.

Child↗
PubMed1996

Diabetes as a complication of tacrolimus (FK506) in pediatric renal transplant patients.

Three cases of insulin-requiring diabetes mellitus associated with tacrolimus (FK506) therapy in pediatric renal transplant patients are presented. New-onset diabetes mellitus has been reported with tacrolimus therapy post liver and kidney transplants in up to 12% of adult patients, but is thought to be rare in pediatrics. Although insulin requirement with tacrolimus therapy has been occasionally reported in adolescent patients post liver transplant, only a single case in a pediatric kidney transplant recipient has been previously documented. These cases illustrate the significant diabetogenic effect of tacrolimus in pediatric renal transplant patients. As the use of tacrolimus becomes more prevalent in pediatric kidney transplantation, pediatric nephrologists should be aware of this potential complication.

Adolescent↗
PubMed1996

Pneumococcal polysaccharide vaccine in children with chronic renal disease: a prospective study of antibody response and duration.

We studied the antibody response to pneumococcal serotypes 3 and 14 after pneumococcal polysaccharide vaccine was administered to 41 children with renal disease. One month after vaccination, 76% and 61% of patients achieved at least a twofold titer rise to serotypes 3 and 14, respectively; this finding was comparable to historic control values. One year after vaccination, the majority of patients retained protective antibody levels. Achieving a titer > or = 1.0 microgram/ml IgG at 1 month was highly predictive of retaining a protective antibody level > or = 0.15 microgram/ml at 1 year.

Adolescent↗
PubMed1995

Immune response to influenza vaccination in children with renal disease.

Although immunization with influenza vaccine is recommended for children with chronic renal disease and after organ transplantation, the antibody response in these children has not been well described. We studied the response to the 1993-1994 trivalent influenza vaccine in children, aged 1-21 years, with chronic renal failure (n = 15), end-stage renal disease requiring dialysis (n = 10), and post renal transplantation (n = 17). Each group's antibody response was compared with that of a control group (n = 7). No significant differences were found in seroconversion rates, percentage of patients achieving protective hemagglutination-inhibition titers post vaccination or change in geometric mean titers from pre to post vaccination between study groups and controls. These results suggest that pediatric patients with renal disease will respond and therefore will benefit from currently recommended influenza immunization.

Adolescent↗
PubMed1995

Proximal renal tubular acidosis secondary to FK506 in pediatric liver transplant patients.

We hereby report our experience with an index case of a pediatric liver transplant patient in whom FK506 administration was associated with the development of proximal renal tubular acidosis (RTA), as well the prevalence of acidosis and renal dysfunction in all pediatric liver transplant patients in our institution followed long term during a 6-year period. Data were grouped according to immunosuppressant regime: cyclosporine (CsA) only, FK506 only, or CsA with conversion to FK506. A 23-month-old female treated with FK506 after orthotopic liver transplantation (OLT) performed 15 months earlier presented with a 1-wk history of fever, watery diarrhea and metabolic acidosis. Although the acidosis did not improve following correction of her hydration status, administration of oral bicarbonate was effective. Discontinuation of this therapy resulted in acidosis. Since other indirect measurements of renal tubular function were normal, the patient was judged to have an isolated proximal RTA. In our group of pediatric liver transplant patients converted from CsA to FK506, FK506 administration was associated with a decline in serum bicarbonate (19 +/- 1 vs. 16 +/- 1 mEq/l, p < 0.02); neither blood urea nitrogen nor serum creatinine differed between the two groups. The number of rejection episodes/patient/month was comparable, allowing clinically relevant comparison of relative drug nephrotoxicities. We conclude that proximal RTA may be a relatively common treatable complication of FK506 administration in children.

Acidosis, Renal Tubular↗
PubMed1992

Safety of intraperitoneal calcium therapy in a rodent model.

Hypocalcemia can be a significant problem for the patient with end stage renal disease (ESRD). Although oral calcium supplementation and activated vitamin D therapy may be successful in normalizing serum calcium levels, occasional peritoneal dialysis patients have persistent and clinically significant hypocalcemia. Several researchers have successfully utilized intraperitoneal calcium therapy (ICT) for the treatment of this abnormality. In order to evaluate whether high calcium dialysate is well tolerated, we developed a model system of ICT in Sprague Dawley rats. These rats received intraperitoneal infusion with either normal or high calcium peritoneal dialysate. Studies in this experimental rodent model showed no evidence of adverse effects of high calcium dialysate when used for up to 71 days, except for unexplained weight loss in the high calcium group. ICT can be an important adjunct in the treatment of hypocalcemia seen in patients on peritoneal dialysis. This preliminary animal study supports its clinical use. However further long term studies in animal models will be necessary to establish the long term safety of this therapy.

Animals↗
PubMed1990

Irritability and dysuria in infants with idiopathic hypercalciuria.

Idiopathic hypercalciuria (IH) is being diagnosed with increasing frequency in the pediatric population and occurs in approximately 2.9-6.2% of normal children. The majority of children with IH are asymptomatic; however, the most common clinical presentation is that of isolated hematuria (gross or microscopic). The prevalence, presentation and clinical course of IH is less well established in infants. We have recently seen two young infants with IH who had dysuria on presentation. Their hypercalciuria was difficult to manage and required frequent manipulations of drug therapy and diet restrictions. These cases emphasize the importance of evaluating infants with dysuria and irritability for IH, even in the absence of hematuria. Further studies are needed to establish the prevalence and classical presentation of IH in this population, and to determine the necessary duration of therapy.

Affect↗
PubMed1990

Heptavax-B in pediatric dialysis patients: effect of systemic lupus erythematosus. Chesapeake Pediatric Nephrology Study Group.

Twenty-three pediatric dialysis patients [6 hemodialysis (HD) and 17 peritoneal dialysis (PD)], with a mean age of 13.9 years, were vaccinated against hepatitis B virus and their seroconversion rates were analyzed. There was no significant difference in the mean duration of dialysis between the HD and PD groups, or between responders and nonresponders to the vaccine. In the HD group, there was a response rate of 83.3% while the PD patients had a response rate of 88.2%. The only patients failing to seroconvert after the three vaccine series all had systemic lupus erythematosus and were taking oral corticosteroids.

Adolescent↗
PubMed1990

Cyclosporine lowers seizure threshold in an experimental model of electroshock-induced seizures in Munich-Wistar rats.

We have developed a model of cyclosporin A (CsA) central nervous system toxicity in the Munich-Wistar rat in which CsA, 20 mg/kg/day i.p., produces significant EEG abnormalities and mortality. In the present study we used cohorts of Munich-Wistar rats to assess effects of CsA on the threshold for tonic-clonic electroshock-induced seizures. Rat cohorts were begun on cremephore, CsA-10 mg/kg/day, or CsA-20 mg/kg/day. On day 7 and day 14 of the dosing protocol, cohorts of animals were exposed to maximal electroshock (MES) using a minimal staircase method within each cohort. Multiple logistic regression models were used to determine differences between groups on the relative odds of producing a MES-induced seizure while controlling for other variables. Seizure threshold was significantly affected by shock amperage and body weight, but not by SUN, creatinine, bilirubin, sodium, potassium, weight loss or day the shock was delivered. The odds ratios of seizure induction in the CsA-treated groups versus placebo group were 1.91 for CsA-10 mg/kg/day and 3.63 for CsA 20-mg/kg/d, both statistically significant. These results suggest that cyclosporine lowers seizure threshold and probably increases susceptibility to seizures, the etiology of which may be multifactorial clinically.

Animals↗
PubMed1990

Thrombocytopenia absent radius syndrome associated with renal insufficiency.

Thrombocytopenia absent radius (TAR) syndrome, associated with small, echogenic kidneys and subsequent end-stage renal disease, was seen in a full-term newborn. In this infant, renal insufficiency may have increased the known risk of bleeding that is associated with TAR syndrome. Renal abnormalities and dysfunction are unusual in TAR syndrome. When they are present, however, treatment with frequent transfusions and early dialysis may be necessary to prevent serious and life-threatening hemorrhagic episodes.

Abnormalities, Multiple↗