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Russell W Chesney

Publications and source records attributed to Russell W Chesney.

At least 19 recordsLinked to original sources
PubMed2005

The future of pediatric nephrology.

The delineation of renal disease in children dates to the 1880s with descriptions of Henoch's purpura, bladder exstrophy, renal rickets and nephritis. The discipline of pediatric nephrology mainly emerged during the 20th century in response to problems in fluid and electrolyte balance, characterization of the nephrotic syndrome, use of renal biopsy, antibiotic therapy of urinary tract infections, dialysis and transplantation in children, growth problems associated with chronic renal failure, detection and therapy of hypertension, and the creation of both national and international pediatric nephrology societies and a journal now in its 18th year. The development of molecular and cell biology, genetic and genomic techniques and bioinformatics methods underlie many future directions. We should anticipate further elucidation of single gene disorders, of complex trait analysis of disorders, such as diabetic nephropathy and hypertension, the interplay of developmental genes and gene products and interactions within the podocyte. Specific therapies directed against inflammation, vascular damage, cyst development, the ravages of proteinuria and graft rejection (or induction leading to tolerance) will be developed. Stem cell therapies may replace lost renal mass, even of specific nephron sites. Novel therapies will also modulate the cell cycle, tyrosine kinase signaling and apoptosis. In addition, drugs will be specifically tested in children for many renal conditions. Larger and more specialized registries will be developed; epidemiologic studies and exploration of large data sets will lead to clinical guidelines that are evidenced-based. There is a need for more careful measurement of glomerular filtration rate (GFR), proteinuria and cytokines, and a fuller appreciation of the nutritional and hormonal role of the kidney. Finally, the antecedents of adult renal disease and the need to intervene in a proactive fashion will be realized. Despite these impressive advances in care, the greatest challenges will be in providing children with renal disease access to well-trained pediatric nephrologists, especially in Asia (1 billion children), Africa, Central and South America, and in immigrant and refugee populations. Included in this challenge is the capacity to have affordable access to use of contemporary techniques, and effective medications and prevention strategies. The International Pediatric Nephrology Association (IPNA), its journal, and pediatric advocates will need to use their energies to take on these challenges.

Child↗
PubMed2005

Increased parathyroid hormone and decreased calcitriol during neonatal extracorporeal membrane oxygenation.

OBJECTIVE: We noted that age-related normal calcium doses in neonates on venoarterial extracorporeal membrane oxygenation result in hypercalcemia. To avoid hypercalcemia and its potential consequences these infants are given one-half the normal calcium dose. We studied the pathogenesis of hypercalcemia and hypomagnesemia by evaluating calcitriol, intact parathyroid hormone, and calcitonin status during extracorporeal membrane oxygenation. DESIGN AND SETTING: Prospective, observational study in the intensive care unit of a 225-bed tertiary care pediatric hospital. PATIENTS AND PARTICIPANTS: Twelve neonates under 7 days old with severe pulmonary disease requiring extracorporeal membrane oxygenation. MEASUREMENTS AND RESULTS: Blood was obtained for intact parathyroid hormone and calcitriol concentrations before cannulation, during (extracorporeal membrane oxygenation days 2, 4, and predecannulation in those on >6 days), and after decannulation on days 1 and 3. Calcitonin concentrations were measured before cannulation, during, and after decannulation in the last seven patients. Prior to cannulation parathyroid hormone was normal (1.4-5.7 pmol/l) and on day 2 increased to 7.8+/-8.4 pmol/l. Before cannulation calcitriol was 14.5+/-8.21 pmol/l (normal 41-143 pmol/l), and concentrations remained low until after decannulation. In three of the seven infants calcitonin concentrations (normal <73 ng/l) were above the upper limit of the assay (>1150 ng/l) prior to cannulation and during extracorporeal membrane oxygenation. CONCLUSIONS: Regulation of the vitamin D-endocrine system during neonatal venoarterial extracorporeal membrane oxygenation appears to be aberrant compared to normal vitamin D-endocrine system regulation. The pathogenesis of this abnormality remains unclear and requires further study.

Analysis of Variance↗
PubMed2004

Changing requirements for evaluation of pharmacologic agents.

Children sadly have been excluded from some of the therapeutic advances that have marked pharmaceutical drug development during the past 100 years. Most drugs in use today lack Food and Drug Administration approval for use in children or are restricted to certain pediatric age groups, predominantly older than 12 years. Only a few of the new drugs approved each year have pediatric indications and dosing guidelines described in the drug labeling information. However, many of these drugs are used in children. The lack of suitable information places children at risk for over- or underdosing, and there is a lack of suitable dosage forms, which can result in improper drug administration. This lack of information on the safe and effective use of drugs in the most vulnerable patients--infants and neonates--is of greatest concern. Recent changes in the regulations that govern drug development has dramatically increased the number of drugs that undergo testing in children. This article reviews new laws that govern drug testing in children and the use of children in therapeutic research.

Child↗
PubMed2004

Bone mineral density in chronic renal insufficiency and end-stage renal disease: how to interpret the scans.

Bone disorders are common in renal disease and stem largely from deregulation of serum levels of calcium and phosphorus. Accurate methods of assessment are required to monitor bone mineral content and density changes in patients with renal disease, but current methods are complicated. Interpretation of dual-energy X-ray absorptiometry (DXA) measurements in children is difficult, because the areal component that is measured does not adequately reflect bone that is constantly growing. In adults with renal disease, the inability of DXA measurements to distinguish between cortical and cancellous bone is problematic. The recent advent of quantitative computerized tomography (QCT), however, does permit resolution of cancellous and cortical bone. In children with renal osteodystrophy, QCT could show reduced cortical bone density and distinguish differences in total bone density between patients with high-turnover bone disease and those with adynamic bone disease. The strengths and limitations of these imaging techniques are discussed extensively.

Absorptiometry, Photon↗
PubMed2003

Pamidronate in a girl with chronic renal insufficiency dependent on parenteral nutrition.

A 10-year-old 40-kg African-American female with megacystis microcolon hypoperistalsis syndrome maintained on total parenteral nutrition (TPN), with a history of metabolic bone disease and renal insufficiency, was admitted with a Candida parapsilosis central venous line infection. During her 280-day hospital stay, she had multiple episodes of bacteremia and recurrent candidemia. Furthermore, she developed pathological fractures and hip displacement with osteomyelitis due to Enterobacter. Hypercalcemia and a history of nephrocalcinosis had prevented appropriate dosing of calcium prior to and during the first months of her hospital stay. Pamidronate and chlorothiazide were added to her regimen. The urinary calcium to creatinine ratio and ionized calcium decreased. The pamidronate dose was increased to 60 mg once a week and was well tolerated. Daily calcium was added to her TPN solution and was increased to 10 mEq/day by the time of discharge. We conclude that relatively large doses of pamidronate may be required in certain cases of refractory hypercalcemia and are well tolerated in children.

Anti-Inflammatory Agents↗
PubMed2003

Regulation of taurine transporter gene (TauT) by WT1.

In the present study we have demonstrated that WT1 (Wilms tumor suppressor gene) enhances the expression of TauT (taurine transporter gene) in human embryonic kidney 293 cells in a dose-dependent manner. TauT promoter activity was increased five-fold by cotransfection of a full-length TauT promoter-reporter construct with WT1. Electrophoretic mobility shift assays (EMSAs) using nuclear extracts from WT1-overexpressing 293 cells showed a putative WT1-binding site in the basal promoter region of TauT, which bound to WT1 in EMSAs. Mutation of this WT1 consensus sequence abolished binding of WT1. These results demonstrate that TauT may represent a downstream target gene of WT1 during renal development.

Base Sequence↗