Dialysis and pediatric acute kidney injury: choice of renal support modality

Dialytic intervention for infants and children with acute kidney injury (AKI) can take many forms. Whether patients are treated by intermittent hemodialysis, peritoneal dialysis or continuous renal replacement therapy depends on specific patient characteristics. Modality choice is also determined by a variety of factors, including provider preference, available institutional resources, dialytic goals and the specific advantages or disadvantages of each modality. Our approach to AKI has benefited from the derivation and generally accepted defining criteria put forth by the Acute Dialysis Quality Initiative (ADQI) group. These are known as the risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria. A modified pediatrics RIFLE (pRIFLE) criteria has recently been validated. Common defining criteria will allow comparative investigation into therapeutic benefits of different dialytic interventions. While this is an extremely important development in our approach to AKI, several fundamental questions remain. Of these, arguably, the most important are “When and what type of dialytic modality should be used in the treatment of pediatric AKI?” This review will provide an overview of the limited data with the aim of providing objective guidelines regarding modality choice for pediatric AKI. Comparisons in terms of cost, availability, safety and target group will be reviewed

Social capital and institutional performance: methodological and theoretical discussion on the water casin committees in metropolitan São Paulo - Brazil Capital social e desempenho institucional: discussão teórica e metodológica sobre comitês debacias hidrográficas na região metropolitana de São Paulo - Brasil

The paper analyses the institutional transformations that have taken place in the environmental management process in Brazil since the 90´s, emphasizing the enlargement of democratic spaces and popular participation, specially in the field of water management. The focus is on the water basin committees, an institutional engineering that has become one of the references of institutional innovation in the water management process in Brazil since 1997. The new watershed law presents a new framing of the issue of watershed protection, by recognizing the prime importance of a management system, by extending the protection instruments proposed and by opening the possibility of developing widespread agreement among stakeholders for the actions that are needed. The article presents an overview of the theoretical debate and the main outcomes of a survey with all members of the five subcommittees that compose the water basin. The research was developed in 2004 in the water basin of Alto Tietê that covers the Metropolitan Region of São Paulo, and is based in the framework of social capital, as a tool to evaluate the institutional development of these democratic spaces. The analysis based on the conceptual framework allows to evaluate the level of associativism, trust, reciprocity and cooperation that enables the consolidation of an effective performance. Water basin committees are the appropriate arenas to develop a comparative study of institutional performance and its relations with cooperative practices linked to preservation and spatial and environmental management.<br>Este texto analisa as transformações institucionais ocorridas na gestão ambiental no Brasil a partir da década de 1990, com ênfase na ampliação dos espaços democráticos e de participação popular, especialmente no campo do gerenciamento de recursos hídricos, com destaque para a experiência dos Comitês de Bacias, e seu caráter inovador. O artigo apresenta uma revisão do debate teórico e dos principais resultados de pesquisa realizada em 2004 com os membros dos cinco subcomitês que compõem a bacia do Alto Tietê, na Região Metropolitana de São Paulo. A base analítica do trabalho se apóia no referencial conceitual do capital social, como instrumento para avaliar o desenvolvimento institucional destes espaços de gestão compartilhada de recursos hídricos. A análise possibilita a avaliação do nível de associativismo, confiança, reciprocidade e cooperação para a consolidação de uma performance mais efetiva. Os resultados apresentados mostram que os comitês de bacias hidrográficas são arenas apropriadas para desenvolver um estudo comparativo sobre desempenho institucional e sua relação com práticas cooperativas vinculadas com a preservação e a gestão territorial e ambiental