Automated Office Blood Pressure Measurement for the Diagnosis of Hypertension

Editoria

Adolescents and Young Adults with Chronic or End-Stage Kidney Disease

Adolescents and young adults face unique and complex physical, psychological, and family challenges. Despite improvements in care for chronic kidney disease (CKD) and end-stage kidney disease (ESKD), long-term mortality for children, adolescents, and young adults with CKD remains substantially higher than their healthy counterparts. In this article, we discuss the complex challenges that adolescent and young adult CKD/ESKD patients face. Adolescents have different CKD etiologies and progress along a course dissimilar to the adult population, but have similar multifarious comorbidities. In the setting of puberty and learning to become self-sufficient, adolescence is a critical time for growth and psychosocial development. Physiological complications of CKD underlie many of the long-term outcomes. CKD-mineral and bone disorder and anemia are particularly challenging given that they are exacerbated by the rapid growth of adolescents. Endocrine imbalances and malnutrition can delay and limit growth. All of these factors, together with family dynamics and socioeconomic status, contribute to the poor long-term outcomes and decreased quality of life (QoL) for these patients and their families. Care for the adolescent CKD/ESKD population is uniquely challenging, but research has identified ways in which we can continue to improve long-term outcomes and QoL for adolescents with CKD/ESKD

Cognitive improvement in children with CKD after transplant

Icard P, Hooper SR, Gipson DS, Ferris ME. Cognitive improvement in children with CKD after transplant. Pediatr Transplantation 2010: 14:887–890. © 2010 John Wiley & Sons A/S.The primary purpose of this paper was to examine the cognitive functioning of children with CKD receiving transplantation to children with CKD not receiving transplantation, and a healthy control group. The sample included six children with CKD receiving transplant, 28 children with CKD being treated conservatively, and 23 healthy controls. All participants were administered intellectual (IQ) or developmental assessments at baseline and at a one-yr follow-up. Results revealed that children with CKD who had received transplant showed a significant increase in their intellectual/developmental functioning post transplant compared to children with CKD not receiving transplant. Although their overall intellectual/developmental level was not fully normalized, when compared with the healthy control group, the change scores for the transplant group reflected over a 12 point increase, moving the group from the borderline range to the low average range of functioning. In this regard, pediatric transplantation appears to have a positive impact on the intellectual and developmental functioning of children with CKD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79239/1/j.1399-3046.2010.01359.x.pd

Transition from pediatric to adult renal services: a consensus statement by the International Society of Nephrology (ISN) and the International Pediatric Nephrology Association (IPNA)

The transfer of young patients from pediatric to adult renal care takes place after a transition process which involves both sides. It is important that it is individualized for each young person, focusing on self-management skills as well as assessing support structures. The consensus statement has been developed by the panel of adult and pediatric nephrologists and endorsed by the councils of both ISN and IPNA. It is hoped that the statement will provide a basis for the development of locally appropriate recommendations for clinical practice

Low agreement between modified-Schwartz and CKD-EPI eGFR in young adults: a retrospective longitudinal cohort study.

Background While there is a great deal of research updating methods for estimating renal function, many of these methods are being developed in either adults with CKD or younger children. Currently, there is limited understanding of the agreement between the modified new bedside Schwartz estimated glomerular filtration rate (eGFR) formula and the adult CKD-EPI formula in adolescents and young adults (AYAs) with chronic kidney disease (CKD) measured longitudinally. Methods Longitudinal cohort study of 242 patients (10-30 years) with CKD, followed retrospectively in a single tertiary centre as they transitioned from the paediatric- to adult-focused settings. The study population came from a longitudinal cohort of AYAs undergoing healthcare transition at the STARx Program at the University of North Carolina, in the South-Eastern USA, from 2006 to 2015. We calculated and compared the eGFR using the new bedside Schwartz formula and the CKD-EPI eGFR. Measurements were repeated for each age in years. Agreement was tested using Bland & Altman analysis. Subgroup analysis was performed using the following age groups 10-15, 15-20, 20-25 and 25-30 years, glomerular and non-glomerular causes of CKD and height z-score. Results Using repeated measures, concordance between the new Schwartz and CKD-EPI eGFR was low at 0.74 (95% C.I. 0.67, 0.79) at the lowest age range of 10-15, 0.78 (95% C.I. 0.71, 0.84) at age 15-20, 0.80 (0.70, 0.87) at ages 20-25, and 0.82 (95% C.I. 0.70, 0.90) at age 25-30. Discordance was worse in males and largest in the 10-15 year-old age group, and in patients with stunted growth. Conclusions The Schwartz and CKD-EPI equations exhibit poor agreement in patients before and during the transition period with CKD-EPI consistently yielding higher eGFRs, especially in males. Further studies are required to determine the appropriate age for switching to the CKD-EPI equation after age 18

Cognitive improvement in children with CKD after transplant: Cognitive improvement in children with CKD

Icard P, Hooper SR, Gipson DS, Ferris ME. Cognitive improvement in children with CKD after transplant. Pediatr Transplantation 2010: 14:887–890. © 2010 John Wiley & Sons A/S. The primary purpose of this paper was to examine the cognitive functioning of children with CKD receiving transplantation to children with CKD not receiving transplantation, and a healthy control group. The sample included six children with CKD receiving transplant, 28 children with CKD being treated conservatively, and 23 healthy controls. All participants were administered intellectual (IQ) or developmental assessments at baseline and at a one-yr follow-up. Results revealed that children with CKD who had received transplant showed a significant increase in their intellectual/developmental functioning post transplant compared to children with CKD not receiving transplant. Although their overall intellectual/developmental level was not fully normalized, when compared with the healthy control group, the change scores for the transplant group reflected over a 12 point increase, moving the group from the borderline range to the low average range of functioning. In this regard, pediatric transplantation appears to have a positive impact on the intellectual and developmental functioning of children with CKD

Disordered aldosterone-volume relationship in end-stage kidney disease

Sodium loading, and subsequent volume expansion, suppresses aldosterone levels in individuals with normal renal function. We hypothesised that loss of renal function impairs this volume-aldosterone relationship

Vitamin D in incident nephrotic syndrome: a Midwest Pediatric Nephrology Consortium study

Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20–100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation

Why Not Nephrology? A Survey of US Internal Medicine Subspecialty Fellows

There is a decreased interest in nephrology such that the number of trainees likely will not meet the upcoming workforce demands posed by the projected number of patients with kidney disease. We conducted a survey of US internal medicine subspecialty fellows in fields other than nephrology to determine why they did not choose nephrology

Mechanisms of Severe Acute Respiratory Syndrome Coronavirus-Induced Acute Lung Injury

ABSTRACT Systems biology offers considerable promise in uncovering novel pathways by which viruses and other microbial pathogens interact with host signaling and expression networks to mediate disease severity. In this study, we have developed an unbiased modeling approach to identify new pathways and network connections mediating acute lung injury, using severe acute respiratory syndrome coronavirus (SARS-CoV) as a model pathogen. We utilized a time course of matched virologic, pathological, and transcriptomic data within a novel methodological framework that can detect pathway enrichment among key highly connected network genes. This unbiased approach produced a high-priority list of 4 genes in one pathway out of over 3,500 genes that were differentially expressed following SARS-CoV infection. With these data, we predicted that the urokinase and other wound repair pathways would regulate lethal versus sublethal disease following SARS-CoV infection in mice. We validated the importance of the urokinase pathway for SARS-CoV disease severity using genetically defined knockout mice, proteomic correlates of pathway activation, and pathological disease severity. The results of these studies demonstrate that a fine balance exists between host coagulation and fibrinolysin pathways regulating pathological disease outcomes, including diffuse alveolar damage and acute lung injury, following infection with highly pathogenic respiratory viruses, such as SARS-CoV.IMPORTANCESevere acute respiratory syndrome coronavirus (SARS-CoV) emerged in 2002 and 2003, and infected patients developed an atypical pneumonia, acute lung injury (ALI), and acute respiratory distress syndrome (ARDS) leading to pulmonary fibrosis and death. We identified sets of differentially expressed genes that contribute to ALI and ARDS using lethal and sublethal SARS-CoV infection models. Mathematical prioritization of our gene sets identified the urokinase and extracellular matrix remodeling pathways as the most enriched pathways. By infecting Serpine1-knockout mice, we showed that the urokinase pathway had a significant effect on both lung pathology and overall SARS-CoV pathogenesis. These results demonstrate the effective use of unbiased modeling techniques for identification of high-priority host targets that regulate disease outcomes. Similar transcriptional signatures were noted in 1918 and 2009 H1N1 influenza virus-infected mice, suggesting a common, potentially treatable mechanism in development of virus-induced ALI