Guest Artist Recital: J. Taylor Hightower, baritone and Michael Buchman, piano

The Kennesaw State University School of Music presents guest artist Taylor Hightower, baritone, Associate Professor of Music at The University of Southern Mississippi along with Michael Bunchman, pianist, Assistant Professor of Collaborative Piano, University of Southern Mississippi.https://digitalcommons.kennesaw.edu/musicprograms/2037/thumbnail.jp

A syndrome of acute interstitial nephritis and anterior uveitis

A syndrome of acute interstitial nephritis (AIN) and anterior uveitis is described in two children and the literature is reviewed. These disorders appear to improve, in uncontrolled studies, with systemic and topical ophthalmic corticosteroid treatment. Although the renal and ocular prognoses appear good, it is important to recotnize that patients with AIN are at risk for uveitis and if present, consultation with an ophthalmologist is recommended.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47832/1/467_2004_Article_BF00852531.pd

Dialysis therapy for children with acute renal failure: survey results

We surveyed 123 pediatric nephrologists to investigate the current dialytic management of acute renal failure (ARF) in children. Data collected from 92 responding physicians revealed that hemodialysis (HD), peritoneal dialysis (PD), and continuous renal replacement therapy (CRRT) are currently used as the primary means of acute renal replacement therapy in a nearly equal percentage of centers. The preferential use of CRRT appears to be increasing, while PD usage is decreasing except for the youngest infants and those patients likely to develop end-stage renal disease (ESRD). Additional data correlating patient outcome to dialytic modality should be collected to compare the efficacy of the three techniques.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42302/1/467-15-1-2-11_00150011.pd

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

Invited Review Recognition and management of angiotensin converting enzyme inhibitor fetopathy

Angiotensin converting enzyme (ACE) inhibitors are extensively used for the treatment of hypertension, to decrease proteinuria, and to mitigate hyperfiltration. These drugs now have been shown to be fetotoxic causing profound fetal hypotension, renal tubular dysplasia, anuria-oligohydramnios, growth restriction, hypocalvaria, and death when used in the second and third trimesters of pregnancy. We recommend that ACE inhibitors not be used in pregnancy. However, if a child is born with ACE inhibitor fetopathy, aggressive therapy with dialysis to remove the inhibitor may mitigate the profound hypotensive effects. Therapy will depend on the specific ACE inhibitor, and care recommendations cannot be generalized for the entire class of drugs as their protein binding and volume of distribution differ substantially.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47835/1/467_2005_Article_BF02254221.pd

Efectos de la circulación extracorpórea sobre el filtrado glomerular en la cirugía cardiovascular pediátrica

Objetivoconocer como afecta la circulación extracorpórea la función renal tomando como marcador la alteración del filtrado glomerular.Material y métodose realizó un estudio prospectivo, analítico y observacional en 63 pacientes pediátricos sometidos a cirugía cardiaca electiva con circulación extracorpórea en el Cardiocentro Pediátrico «William Soler» entre octubre de 2009 y abril de 2010. Se calcularon las variaciones del filtrado glomerular durante la circulación extracorpórea por el método de Schwartz y se extrajeron muestras de sangre antes y después de la circulación extracorpórea para determinar las cifras de creatinina en el plasma. Los datos se procesaron con el paquete estadístico SPSS versión 11.5.1. Los resultados se expresaron en forma de media, desviación estándar y por cientos. Se consideró que existió diferencia o asociación significativa si la probabilidad asociada al test aplicado era menor que 0,05 (p<0,05). El análisis se realizó por medio de pruebas no paramétricas dado n < 30 y a través de muestras relacionadas.Resultadosla disminución del filtrado glomerular pos-circulación extracorpórea, no se asoció con el tipo de cardiopatía (p<0,056) y sí con el estado previo de éste (p<0,000). El tiempo de duración de la circulación extracorpórea contribuyó significativamente al deterioro del filtrado glomerular (p<0,021); no así el tiempo de pinzamiento aórtico (p<0,06). El volumen de orina obtenido durante el tiempo de la circulación extracorpórea (p<0,051) y en el período trans-operatorio (p<0.056) no fue un índice de buen funcionamiento renal medido a través del filtrado glomerular.Conclusionesla circulación extracorpórea afecta de manera significativa la función renal tomando como marcador la alteración del filtrado glomerular.Objectiveknow how extracorporeal circulation affects renal function taking as marker the impairment of the glomerular filtration rate.Material and methodwe performed a prospective analytical observational study in 63 pediatric patients that underwent elective cardiac surgery with extracorporeal circulation in the Pediatric Cardiac Center ¨William Soler¨ between october 2009 and april 2010. Variations of glomerular filtration rate during extracorporeal circulation were calculated by the Schwartz method and blood samples were taken to determine plasma creatinine values before and after extracorporeal circulation. Data were processed with the SPSS statistical package version 11.5.1. Results were expressed as mean, standard deviation and percentage. We considered that difference or significant association existed if the probability associated to the applied test was less than 0,05 (p<0,05). Analysis was performed by nonparametric testing given n < 30 and through related samples.Resultsthe decline in glomerular filtration rate post extracorporeal circulation was not associated to the type of cardiopathy (p<0,056) but it was associated to its previous state (p<0,000). The duration of extracorporeal circulation contributes significantly to the deterioration of the glomerular filtration rate (p<0,021); this did not happen with the aortic clamping time (p<0,06). The volume of urine obtained during the duration of extracorporeal circulation (p<0,051) and during the trans-operative period (p<0,056) was not an index of appropriate renal function measured by glomerular filtration rate.Conclusionsextracorporeal circulation affects significantly the renal function taking as a marker the impairment of glomerular filtration rate

Continuous arterial-venous diahemofiltration and continuous veno-venous diahemofiltration in infants and children

Continuous arterial-venous diahemofiltration and continuous veno-venous diahemofiltration [CAVH(D)/CVVH(D)] in the infant and pediatric population is increasingly being utilized in the child needing renal replacement therapy (RRT). Difficulties with infant- and pediatric-specific equipment remains a limitation. The availability of techniques and equipment in this unique population is addressed. Use of this form of RRT as opposed to hemodialysis or peritoneal dialysis is discussed. The decision for CAVH(D) or CVVH(D) remains an individual choice.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47833/1/467_2004_Article_BF00868282.pd

Medication errors and patient complications with continuous renal replacement therapy

Continuous renal replacement therapy (CRRT) is commonly used for renal support in the intensive care unit. While the risk of medication errors in the intensive care unit has been described, errors related specifically to CRRT are unknown. The purpose of this study is to characterize medication errors related to CRRT and compare medication errors that occur with manually compounded solutions versus commercially available solutions. We surveyed three separate internet-based, pediatric list serves that are commonly used for communications for programs utilizing CRRT. Data regarding CRRT practices and medication errors were recorded. Medication errors were graded for degree of severity and compared between programs using manually compounded dialysis solutions versus commercially available dialysis solutions. In a survey with 31 program responses, 18 reported medication errors. Two of the 18 were related to heparin compounding, while 16/18 were due to solution compounding errors. Half of the medication errors were classified as causing harm, two of which were fatal. All medication errors were reported by programs that manually compounded their dialysis solutions. Medication errors related to CRRT are associated with a high degree of severity, including death. Industry-based, commercially available solutions can decrease the occurrence of medication errors due to CRRT.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45869/1/467_2006_Article_49.pd

Reduced endothelin-1– and nitric oxide–mediated arteriolar tone in hypertensive renal transplant recipients

Reduced endothelin-1– and nitric oxide–mediated arteriolar tone in hypertensive renal transplant recipients.BackgroundThe prevalence of hypertension is high in renal transplant recipients. It has been suggested that calcineurin inhibitors (CI) contribute to the development of post-transplant hypertension by stimulating endothelin (ET-1)-mediated and/or reducing nitric oxide (NO)-mediated vascular tone.MethodsWe tested this hypothesis using 2 groups of renal transplant recipients [normotensive patients without a need for antihypertensive medication (Normo-Tx), and hypertensive patients requiring antihypertensives (Hyper-Tx)] in the presence of CI-based immunosuppression. In addition, we studied matched control subjects (C). BQ 123 (ET-A receptor antagonist), BQ123 + BQ788 (ET-A/B-receptor antagonist), ET-1, L-NMMA (NO-synthase inhibitor), acetylcholine (ACH; endothelium-dependent vasodilator), glyceroltrinitrate (GTN, NO donor), and norepinephrine (NE, endothelium-independent vasoconstrictor) were infused into the brachial artery. Forearm blood flow (FBF) was measured by venous occlusion plethysmography.ResultsEndothelium-independent vasomotion in response to GTN and NE was similar in all groups. Vascular responses to selective and combined blockade of ET receptors in both Normo-Tx and Hyper-Tx did not exceed those of C. In fact, we observed a significantly lower increase in FBF after BQ 123 (P = 0.03), as well as after BQ 123/788 (P = 0.03) in Hyper-Tx compared with Normo-Tx. This was associated with an increased vascular sensitivity to exogenous ET-1 in Hyper-Tx compared with Normo-Tx (P = 0.04). Vasoconstriction after L-NMMA was reduced in Hyper-Tx compared with Normo-Tx (P = 0.015), while the response to ACH was reduced in both groups of Tx patients to a similar degree (P = 0.005 vs. C).ConclusionOur results do not support a major role for the vascular endothelin system in the hypertension of renal transplant recipients, whereas deficient baseline NO production may be a contributing factor

Management of toxic ingestions with the use of renal replacement therapy

Although rare, renal replacement therapy (RRT) for the treatment of the metabolic, respiratory and hemodynamic complications of intoxications may be required. Understanding the natural clearance of the medications along with their volume of distribution, protein binding and molecular weight will help in understanding the benefit of commencing RRT. This information will aid in choosing the optimal forms of RRT in an urgent setting. Overdose of common pediatric medications are discussed with suggestions on the type of RRT within this educational review