Adolescents with renal disease in an adult world: meeting the challenge of transition of care.
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Adolescent↗
Biomedical subjects
Lorraine Bell
Publications and source records attributed to Lorraine Bell.
Validation of child serum creatinine-based prediction equations for glomerular filtration rate.
Equations for estimating glomerular filtration rate (GFR) are vital in caring for patients with renal disease and the current standard, the Schwartz formula, lacks precision. We evaluated several child serum creatinine-based GFR prediction equations. Subjects aged 2-21 years who underwent iothalamate GFR (IoGFR) testing between 1999 and 2004 were studied retrospectively. GFR was estimated using: (1) Schwartz formula (SchwartzGFR), using a local k value; (2) Schwartz model (SchwartzMod) using regression-derived coefficients; (3) Leger GFR (LegerGFR) using original coefficients; and (4) Leger model (LegerMod) using regression-derived coefficients. Bias, precision, and diagnostic characteristics were evaluated. There were 195 subjects [61% male; mean (SD) age 12.4 (4.5) years; mean (SD) IoGFR 78.9 (33.4) ml/min per 1.73 m(2)]. Only the LegerGFR overestimated IoGFR (5.5 ml/min per 1.73 m(2)). Precision for all formulae was poor (95% limits of agreement approximately -40 to 40 ml/min per 1.73 m(2)), but >or=72% of estimates were within 30% of IoGFR. Sensitivities for detecting IoGFR <30 and 90 ml/min per 1.73 m(2) were highest using the SchwartzGFR (80%) and SchwartzMod (90%), respectively. The LegerGFR was most specific. Using local coefficients, the Schwartz and Leger models were imprecise estimates of GFR, but the Schwartz model was most unbiased and sensitive. Future research should derive more precise equations for GFR in children.
Adolescent↗
Derivation and validation of cystatin C-based prediction equations for GFR in children.
BACKGROUND: Cystatin C (CysC) may be a better marker of glomerular filtration rate (GFR) than serum creatinine (SCr) level. Few studies derived CysC-based GFR prediction equations for children. Objectives of this study are to: (1) derive CysC-based GFR prediction equations for children, and (2) compare these equations with published formulae. METHODS: Patients younger than 18 years undergoing iothalamate GFR (IoGFR) testing were studied prospectively. Data collected were age, sex, CysC level, SCr level, IoGFR, height, weight, and diagnosis. By using linear regression, 2 equations were derived and compared with 3 previously published formulae by using Bland-Altman analysis and diagnostic characteristics. Local coefficients were derived for comparison formulae. RESULTS: There were 111 GFR tests from 103 patients (age, 12.7 +/- 4.7 years; IoGFR, 73.6 +/- 35.7 mL/min/1.73 m(2) [1.23 +/- 0.60 mL/s/1.73 m(2)]; 60% male; and 25% post-renal transplantation). The 2 equations derived were the CysEq (including CysC level) and the CysCrEq (including CysC and SCr levels). Overall, the 2 new equations had bias and precision similar to previously published formulae when local coefficients were used. However, in patients with a renal transplant or spina bifida, the 2 new equations were less biased and more precise. All CysC-based equations performed better than the Schwartz formula. CONCLUSION: This study provides 2 CysC-based GFR prediction equations that are accurate, precise, and sensitive for detecting abnormal GFRs. Three previously published CysC GFR prediction equations have been validated for the first time. Prediction equations based on CysC level are likely to provide more accurate estimates of GFR than SCr-based equations.
Adolescent↗
Prednisone withdrawal in pediatric kidney transplant recipients on tacrolimus-based immunosuppression: four-year data.
Corticosteroids have been used in renal transplant immunosuppression for over 40 yr. Despite their adverse effects, steroid therapy continues to be part of early as well as maintenance immunosuppression in most pediatric renal transplant centers. The association of steroids with growth retardation, weight gain, and acne may be particularly distressing during the critical years of adolescence and young adulthood, increasing the risk of medication non-adherence. This study reviews the outcomes of pediatric renal transplant patients treated with low-dose tacrolimus, mycophenolate mofetil, or azathioprine, and planned prednisone withdrawal. Thirty-seven pediatric renal transplant recipients were withdrawn from steroids. The mean follow-up after steroid withdrawal was 42+/-19 months. Graft and patient survival were 100%. The mean serum creatinine levels and calculated creatinine clearances remained stable throughout the period of observation. The mean creatinine clearance was 96+/-24 mL/min/1.73 m2 at steroid withdrawal and 93+/-20 mL/min/1.73 m2 at the latest follow-up. Five patients restarted prednisone; in four (11%) it was for suspected or confirmed acute rejection. Improvements were observed in serum lipid profiles, blood pressure, and body mass index. Most patients experienced catchup or stable growth after prednisone withdrawal. Four patients developed viral infections; all were successfully treated. The potential benefits of steroid withdrawal in pediatric renal transplantation are supported by our results.
Adolescent↗
Recurrence of membranoproliferative glomerulonephritis type II in renal allografts: The North American Pediatric Renal Transplant Cooperative Study experience.
Membranoproliferative glomerulonephritis type II (MPGN II) is an uncommon form of complement-dependent acquired renal disease. Although it has been recognized since the 1970s that MPGN II recurs almost universally in renal transplants, data regarding the long-term consequences of disease recurrence are limited. Therefore, a retrospective comparative analysis of 75 patients with MPGN II contained in the North American Pediatric Renal Transplant Cooperative Study transplantation database was performed. Five-year graft survival for patients with MPGN II was significantly worse (50.0 +/- 7.5%) compared with the database as a whole (74.3 +/- 0.6%; P < 0.001). Living related donor organs had a significantly better 5-yr survival (65.9 +/- 10.7%) compared with cadaveric donor organs (34.1 +/- 9.8%; P = 0.004). The primary cause of graft failure in 11 (14.7%) patients was recurrent disease. Supplemental surveys were obtained on 29 (38%) of 75 patients. Analysis of these data indicated that recurrent disease occurred in 12 (67%) of the 18 patients with posttransplantation biopsies. Although there was no correlation between pretransplantation presentation, pre- or posttransplantation C3 levels, and either disease recurrence or graft failure, there was a strong association between heavy proteinuria and disease recurrence. The presence of glomerular crescents in allograft biopsies had a significant negative correlation with graft survival. At last follow-up, patients with recurrent disease had significantly higher serum creatinine and qualitatively more proteinuria than patients without biopsy-proven disease. These data indicate that recurrent MPGN II has a significant negative impact on renal allograft function and survival.
Child↗
Towards a cognitive model and measure of dissociation.
Dissociation comprises a range of psychological processes, which have largely been the subject of psychodynamic discussion. Dissociative phenomena are for the most part unaddressed by cognitive theorists. Current measures are atheoretical and our understanding of dissociation has been hampered by the absence of clear psychological models. This paper describes a new cognitive model of dissociation and the development and validation of a theoretically based measure-the Wessex Dissociation Scale (WDS). The WDS has adequate internal consistency, shows convergent validity with the Dissociative Experiences Scale (DES-II), and is equivalent to the DES-II in its associations with severe psychopathology. However, the WDS has some advantages over the DES-II, in that it is sensitive to milder manifestations of dissociation, demonstrating links to less severe pathologies. The findings described here provide preliminary support for the usefulness of the cognitive model, and the varied consequences of dissociative processes. The clinical and research utility of the model and the scale are discussed.
Adolescent↗
Concerns about mouse housing system.
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Animals↗