Late referrals of pediatric patients with elevated blood pressure

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Urinary KIM-1 is not correlated with gestational age among 5-year-old children born prematurely

BackgroundPreterm birth is associated with decreased nephron endowment. Currently, there is no reliable non-invasive biomarker to identify or monitor decreased nephron number in at-risk patients. Urinary Kidney Injury Molecule-1 (KIM-1) is a biomarker of acute and chronic renal injury. We measured urinary KIM-1 among a wide array of other potential biomarkers.MethodsWe conducted an ambispective cohort study of 5-years-old children born prematurely and healthy controls identified from city schools. Detailed anthropometrics, renal ultrasound dimensions, and biochemical parameters were measured. Urinary KIM-1 was measured using Luminex® technology. Age independent z-scores were calculated and compared. Spearman correlations were used for estimating the association between measures and KIM-1.ResultsWe enrolled 129 children, 97 (75.2%) born pre-term and 32 (24.8%) healthy controls born at full-term. Pre-term patients had significantly lower weight and body surface area than controls. Pre-term patients and controls did not differ in current age, sex, race, height, blood pressure, urinary sodium, fractional sodium excretion, serum creatinine and estimated GFR. All spearman correlation between KIM-1 and gestational age, renal and serum measurements were weak without statistical significanceConclusionIn 5-year-old children born prematurely, KIM-1 was not correlated with gestational age. Further prospective studies need to confirm this finding

Renal volume of five-year-old preterm children are not different than full-term controls

Objective: In previous studies, smaller renal volumes were reported in prematurely born infants, however, these renal volumes were not corrected for body surface area, the main determinant of renal size. Given the rapid growth of the renal cortex after premature birth, the authors hypothesized that corrected volumes would not differ from healthy controls. Methods: Ambispective cohort study with prospective follow-up of prematurely born babies in a large specialized center and retrospectively recruited healthy control group. Children were assessed for renal length and renal volumes at age 5 by three independent ultrasonographers. Detailed anthropometry, blood pressure and renal function were also obtained. Age independent z-scores were calculated for all parameters and compared using descriptive statistics. Results: Eighty-nine premature study participants (median 32 weeks gestational age) and 33 healthy controls (median 38 weeks gestational age) were studied. Study participants did not differ in age, sex, Afro-Colombian descent, height, blood pressure, serum creatinine, or new Schwartz eGFR. Premature study participants had a significantly lower weight (17.65 ± 2.93 kg) than controls (19.05 ± 2.81 kg, p = 0.0072) and lower body surface area. The right renal volumes were significantly smaller (39.4 vs 43.4 mL), but after correction for body surface area, the renal volume and renal length z-scores were identical for both kidneys (mean right kidney -0.707 vs -0.507; mean left kidney -0.498 vs -0.524, respectively). Conclusion: Renal volumes need to be corrected to body surface area. After correction for body surface area, 5-year-old healthy and prematurely born children have comparable renal volumes

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Lower prevalence of aortic dilatation among preemptive pediatric renal transplant recipients - A cross-sectional cohort study.

BACKGROUND: Aortic dilatation is a cardiovascular complication in pediatric renal transplant recipients and may have an increased risk of aortic dissection, aortic rupture, and death. Studies failed to show an association between blood pressure and aortic dilatation; however, 24-hours ambulatory blood pressure monitoring (ABPM) was not performed. There was also no comparison between preemptive transplantation and dialysis. METHODS: After ethics approval, a retrospective cross-sectional study was performed on all prevalent pediatric renal transplant recipients from a single tertiary care center. The presence of aortic dilatation was determined using standard echocardiographic measurements, and those with other risk factors for aortic dilatation were excluded. Associations between 24-hours ABPM, renal function, dialysis history, and aortic dimensions were determined. RESULTS: We enrolled 37 participants with the following characteristics: 46% female, mean age 14.5 ± 3.7 years, 16% preemptive transplantation, and median end-stage renal disease (ESRD) combined vintage (time from ESRD onset to echocardiogram) 597 days (range 289-1290 days). We found 16/37 patients (43%) with aortic dilatation at any level, mostly mild. There was no association between 24-hours ABPM measurements and aortic dilatation. None of the preemptively transplanted children had aortic dilatation. CONCLUSION: This study confirms a high prevalence of aortic dilatation among pediatric renal transplant recipients, which appears to be independent of hypertension on 24-hour ABPM. Patients with preemptive renal transplantation did not have aortic dilatation, suggesting that the effects of dialysis may contribute to the high prevalence of this complication. Pediatric cardiologists need to carefully assess aortic dimensions in these at-risk patients

Renal length z-score for the detection of dysfunction in children with solitary functioning kidney.

AIM: To evaluate whether renal length z-scores predict renal dysfunction in children with a solitary functioning kidney (SFK). METHODS: In a single-centre retrospective cohort of children with SFK, we correlated body mass index z-scores, extracellular volume and lean body mass to renal length z-scores. We grouped these z-scores to other markers of renal dysfunction (proteinuria, hypertension, extracellular volume and abnormal estimated glomerular function rate [eGFR]) and analysed renal length z-score with multivariate analysis, receiver-operated characteristics (ROC) plots and Youden\u27s index to determine an appropriate cut-off. RESULTS: 111 children had a median follow-up 5.08 years, eGFR 80.8 mL/min/1.73 m CONCLUSION: In this cohort of children with SKF, using the renal length z-score as a biomarker of renal dysfunction at 7 years of age is not recommended

Systemic Bevacizumab for Recurrent Respiratory Papillomatosis: A Scoping Review from 2009 to 2022

Background: Respiratory recurrent papillomatosis (RRP) is a fatal disease with no known cure. In severe RRP cases, systemic bevacizumab (SB) could be used as adjuvant therapy. Objective: This study aims to determine the extent and type of evidence in relation to the clinical outcomes of RRP after SB treatment. Methods: Participants with RRP of all genders are included in this scoping review. There were no exclusion criteria (country, language, or document type). The information sources included experimental, quasi-experimental, and analytical observational studies. Unpublished data will not be covered, but gray literature was covered. Screening, paper selection, and data extraction were all done by two independent reviewers. This procedure was performed blindly. Results: Of the 175 unique records found, 15 were eligible for inclusion. Fourteen studies were included after applying inclusion and exclusion criteria. Thirty-four patients in these studies came from the United States, India, Germany, Colombia, Argentina, Chile, and Spain. In total, 17 and 34 patients were below 18 years old and were adults respectively. The most commonly reported dose was 10 mg/kg, which was received by 25 (73.5%) patients. According to reports, 58.8% of patients completed the questionnaire. Twelve (35%) patients did not require a repeat surgery. The time interval between surgical procedures has increased for patients who require them. Conclusion: SB may be a promissory treatment and control option for RRP. More research is needed to evaluate the efficiency and adverse effects in various populations

Nefropatía por Ig A en pediatría, desenlaces clínicos con diferentes esquemas de manejo.

Introduction: IgA nephropathy (IgAN) is the most common glomerular disease in the world, in Colombia belongs to 11-22% of primary glomerulonephritis in pediatric patients. Of these, 30% progress to chronic kidney disease. &nbsp; Materials and methods: It is a retrospective descriptive study. We used median and IRQ for continuous variables, and proportions for categorical variables, Fisher test to compare clinical outcomes. &nbsp; Results: Between 1996 to 2013 58 patients were diagnosed. The mean age at symptoms onset was 7.5 years (SD±4.2) and at the time of renal biopsy was 10 years (SD±3.8). At diagnosis, 77.6% of the patients showed microscopic hematuria, 27.6% gross hematuria and 81% proteinuria, classified as severe in 29%. Three patients required dialysis and two needed kidney transplant. Three groups with different therapeutic regimens were evaluated: first group only prednisone 34.5% (n = 20), second group prednisone and mycophenolate mofetil (MMF) 22.4% (n = 13) and third group without prednisone neither MMF 43.1% (n = 25). The difference in the presence of hematuria among the groups was significant (p&gt; 0.001), being more frequent in the group without prednisone neither MMF (68%). There were no significant differences in proteinuria, hypertension or creatinine among the groups. The median of years between the renal biopsy and the last control was 4 years RI 1-7. At five years, the renal fuction survival probability (GFR &gt;90 ml/min/1.73m2) was 89.1%. &nbsp; Conclusion: IgAN needs early recognition and strict follow-up, since it may have ominous outcomes. The results of the present work constitute up to now the most extensive experience described in the Colombian pediatric population.Introducción: La nefropatía IgA (NIgA) es la enfermedad glomerular más común del mundo, en Colombia corresponde 11- 22% de las glomerulonefritis primarias en niños. De ellos, 30% progresa a enfermedad renal terminal. Objetivo: Describir características paraclínicas e histopatológicas y resultados clínicos de acuerdo con tres tipos de tratamiento de pacientes pediátricos con NIgA en un hospital de alta complejidad en el suroccidente Colombiano. Materiales y métodos: Estudio descriptivo retrospectivo con alcance comparativo. Resultados: Se incluyeron 58 pacientes desde 1996&nbsp; hasta 2013. La media de edad al inicio de síntomas fue 7.5 años (DE ±4.2) y al momento de la biopsia renal 10 años (DE ±3.8). Al diagnóstico, el 77.6% presentó hematuria microscópica y 27.6% macroscópica. El 81% proteinuria, severa en el 29%. Histológicamente (OMS), 10% se clasificaron como grado I, 62% grado II, 21% grado III y 7% grado IV. Tres pacientes requirieron diálisis y dos trasplante renal. Se evaluaron diferentes esquemas terapéuticos: solo prednisona 34.5 % (n=20), prednisona y MMF 22.4 % (n=13) y sin prednisona ni MMF 43.1% (n=25). La diferencia en la presencia de hematuria entre los grupos fue significativa (p&gt;0.001), siendo más frecuente en el grupo sin prednisona ni MMF (68%). No hubo diferencia entre los grupos de proteinuria, hipertensión arterial y valor de creatinina. A 5 años la supervivencia de la función renal fue 89.1%. Conclusión: La NIgA amerita reconocimiento temprano y seguimiento estricto, ya que puede tener desenlaces ominosos. Los resultados del presente trabajo constituyen hasta hoy la más amplia experiencia descrita en la población pediátrica colombiana

C4d como factor pronóstico en una cohorte de pacientes pediátricos con nefropatía IgA en una institución en Cali, Colombia

Background: IgA nephropathy (IgAN) is the most common glomerular disease in the world. In pediatrics, the frequency of this disease is not well established, and it can lead to end-stage renal failure at 20 years in between 20-30% of cases. A relationship among positive histological C4d staining, and clinical and histological variables of worse renal prognosis has been described. Purpose: The aim of the present study is to correlate the diagnostic presence of C4d in renal biopsies with clinical and histological variables in patients with IgAN. Methods: Observational and retrospective study. Between 2011 and 2018, all pediatric patients with a histopathological diagnosis of IgAN, who had adequate renal biopsy material for C4d staining, were included. The main outcome variable was the glomerular filtration rate (GFR) at the time of diagnosis and at the last follow-up. Results: Fourteen patients were included in the study. Two (14.2%) had positive staining for C4d in the diagnostic biopsy, of which none presented impaired renal function by GFR or moderate-severe proteinuria during the study. No relationship was found between positive C4d staining and histopathological variables of worse prognosis (including mesangial hypercellularity and interstitial fibrosis-tubular atrophy), according to the Oxford classification. Conclusion: Given the small sample size, our findings were not consistent with the literature regarding the relationship between positive staining for C4d and clinical and histopathological variables of worse renal prognosis.Introducción: la nefropatía por IgA (NIgA) es la enfermedad glomerular más común del mundo. En pediatría, la frecuencia de la enfermedad no está bien establecida y puede llevar a falla renal terminal a los 20 años entre el 20-30 % de los casos. Se ha descrito relación entre una tinción histológica C4d positiva y variables clínicas e histológicas de peor pronóstico renal. Objetivo: el objetivo del presente estudio es correlacionar la presencia diagnóstica de C4d en biopsias renales con variables clínicas e histológicas en pacientes con NIgA. Métodos: estudio observacional y retrospectivo. Se incluyeron entre los años 2011-2018 todos los pacientes pediátricos con diagnóstico histopatológico de NIgA que contaran con material de biopsia renal adecuado para la tinción de C4d. La variable resultado principal fue la tasa de filtración glomerular (TFG) al momento del diagnóstico y al último seguimiento. Resultados: catorce pacientes fueron incluidos en el estudio. Dos (14.2 %) tuvieron tinción positiva para C4d en la biopsia de diagnóstico, de los cuales, ninguno presentó deterioro de la función renal por TFG ni proteinuria moderada-severa durante el estudio. No se encontró relación entre una tinción para C4d positiva y variables histopatológicas de peor pronóstico (incluyendo hipercelularidad mesangial y fibrosis intersticial-atrofia tubular), de la clasificación de Oxford. Conclusión: dado el escaso tamaño de la muestra, nuestros hallazgos no fueron concordantes con la literatura en cuanto a la relación entre una tinción positiva para C4d y variables clínicas e histopatológicas de peor pronóstico renal

Clinical characteristics of patients with NS at the last follow-up.

Clinical characteristics of patients with NS at the last follow-up.</p