G Filler

..To determine the sequential therapy of childhood nephrotic syndrome (NS) with presumed minimal change nephropathy using the evidence from clinical trials...

..Prednisolone was left unaltered at 2-4 mg/m2 per day. We conclude that MMF allows safe reduction of CyA with markedly better graft function, suggesting that chronical CyA-toxicity partially accounts for deteriorating allograft function...

..08 g of EC-MPS was 218.2 mgxh/L. EC-MPS once daily may be a well-tolerated therapeutic option for nonadherent adolescent lupus patients, but may be associated with a significantly higher exposure than the equivalent MMF BID dose...

..It is important that these provisional target levels are validated in prospective studies. The above points clearly indicate that there is a role for TDM of MPA in pediatric transplant recipients...

..A special formula must be used for children. The AUC of MPA can be predicted by limited sampling including C0, C0.5, and C2, while an approach using C0, C1, C2, and C4 is preferable...

..i.d. dosing. Our results indicate t.i.d. dosing of CyA-ME results in significantly lower exposure when the same total dose is administered in two divided doses. This reduced exposure may potentially increase the risk for rejection...

..The AUC can be estimated with great precision by using an identical approach for all three drugs. Target AUCs for a given time-point after transplantation remain to be established...

..A true increase in FSGS possibly could alter the current practice of withholding renal biopsy in childhood nephrotic syndrome (NS) unless the patient fails to respond to a 28-day course of corticosteroid therapy...

..Analysis of the pharmacokinetic data suggests that haemodialysis or haemofiltration would be more efficacious for removal of the drug, and these treatments should be performed if available...

..There were few side effects: one episode each of diarrhea and leukocytopenia and two viral infections. We conclude that MMF at 900 mg/m(2) per day appears to be effective in these patients...

..In conclusion, the data suggest that this novel cystatin C-based GFR estimate shows significantly less bias and serves as a better estimate for GFR in children...

..93). Adding SIR to TAC-based immunosuppression in young pediatric renal transplant recipients results in a significant decrease of TAC exposure. TAC trough levels should be monitored frequently...

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..Renal function and graft survival were also superior with Tac. Glomerular filtration rate appears to be an useful surrogate marker for long-term outcome...

..Although designed for adults, the Cockcroft-Gault formula was recently proposed for use in children > or =13 years of age...

..To summarize recent knowledge on the small molecular weight protein cystatin C (cys-C) and its use as a marker of the glomerular filtration rate (GFR)...

..In this review, we summarize important articles on pediatric renal transplantation over the past 2 yr. The review is intended to be comprehensive but not exhaustive...

..The significantly higher peak in the group with a lower CyA profile supports the concept of a dose-dependent cyclosporine-induced inhibition of MPA glucuronidation...

..Dialysis remains the most important tool to bridge the time needed for recovery of renal function. There is increasing evidence that more intense use of dialysis may improve the overall prognosis...

..More work is required to establish specific target ranges with the various drug combinations--especially for the pediatric population...

..i.d., in combination with tacrolimus at a dose of 300 mg/m(2) b.i.d., and without a calcineurin inhibitor at a dose of 500 mg/m(2) b.i.d., and adjusting doses using therapeutic drug monitoring of MPA...

..In children, there is added complexity because of the age dependency of drug metabolism. This review addresses the age dependency of drug metabolism in childhood on the basis of routine PK monitoring...

..In conclusion, both Sir and MMF drug disposition vary in children and adolescents from adult patients, most likely because of developmental changes of biliary transporters and metabolic enzymes...

..Cystatin C proved to be a superior marker in patients with spina bifida. In the control group the Schwartz formula was comparable to cystatin C and beta-trace protein, although cystatin C remained superior...

..Unfortunately, clearance of most radiolabeled markers of GFR including 125I-iothalamate remain costly and time consuming...

..Further prospective studies with repetitive measurement of cystatin C are needed to determine whether cystatin C-based estimates of GFR will be sufficiently accurate to monitor long-term allograft function...

..All pediatric solid organ transplant recipients receiving CNI should be screened regularly for high blood pressure and early evidence of renal damage using either GFR scans or cystatin C-based GFR estimations...

..From our data, we recommend a target C3 at approximately 800 ng/ml early after transplantation and 450-550 ng/ml beyond 100 days...

..The shift in focus on long-term complications allows for improved graft outcome. Side effects of immunosuppressive medications require continued attention to further improve long-term outcomes...

..We therefore conclude that measurement of CysC can be used for longitudinal intra-individual follow-up of renal function post-Tx...

..In conclusion, Tac was significantly more effective than CyA microemulsion in preventing acute rejection after renal transplantation in a pediatric population. The overall safety profiles of the two regimens were comparable...

..We recommend that cyclosporine should be chosen when patients experience tacrolimus-related adverse events...

..Their production appears more susceptible to MMF therapy. A thorough work-up of new-onset proteinuria after conversion to Sirolimus should be performed, including an immunological work-up and a renal biopsy...

..However, creatinine-based equations are inaccurate in RTRs leading to frequent CKD stage misclassification. It is not known whether the classification of CKD stage would be improved using a cystatin C-based estimate of GFR...

..This was associated with a significantly higher Banff score for ci and ct; while renal function was not affected. Further controlled studies are required...

..We recommend modification of the KDOQI guidelines for children to reflect the differences described in this paper...

..We conclude that for the detection of mildly impaired GFR, a full clearance study cannot be replaced by measurement of serum Cys-C or beta2-MG concentrations...

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..The utility of BTP has been limited by the lack of an equation to translate BTP into an estimate of GFR. The objectives of this study were to develop a BTP-based GFR estimation equation...

..Recent findings in adults, suggesting an improved performance of CysC-based estimated glomerular filtration rate (CysC eGFR) by accounting for body mass, necessitated a careful re-evaluation of this issue in children...

..0 +/- 1.2 (T1) and -1.0 +/- 1.59 (T2, NS), with 21% at T1 and 30% at T2 below two SDS. We observed suboptimal growth, hypertension, hypercholesterolemia, bone disease, and anemia in a significant proportion of transplanted children...

..Obesity is an independent risk factor for chronic kidney disease (CKD). We compared the body composition of pediatric nephrology patients with that of the general child population over 2 decades...

..Follow-up after more than 4 years continued to show hyper-echogenic kidneys with almost normal renal glomerular function. There continues to be no neurobehavioural abnormalities...

..No side effects occurred. This approach may reduce the risk of sensitization in future potential organ donor recipients in similar situations...

..This was addressed by intermittent plasma exchange through an arterio-venous fistula. The prognosis and therapeutic dilemmas are discussed...

..Pediatric renal patients became progressively overweight and showed an increase in the incidence of CRI. This is the first time that this phenomenon, well known in adults, has been observed in the pediatric age group...

..CONCLUSIONS: BTP is superior to serum creatinine and an alternative for Cys-C to detect mildly reduced GFR in children, but it is not better than the Schwartz GFR estimate...

..CONCLUSION: Therefore, the high GFR measurements represent early hyperfiltration in children and adolescents with ADPKD, which may give a rationale to start ACE inhibitor therapy...

..Although others have reported on overall results of transplantation for PH1 covering a wide age spectrum, none has specifically addressed the high-risk infantile form of the disease...

..We found an inverse relationship between glucocorticoid exposure and spine areal bone mineral density (BMD) Z-score and a low rate of vertebral deformities (8%)...

..We conclude that growth hormone therapy aggravates alteration of glucose metabolism in patients with KTx and not in children with CRF and UTS. Progressive hyperinsulinemia occurred only in patients with UTS...

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..Office handling was a component for patients with access target <1 week, whereas availability of clinic space was the main reason for nonadherence to access targets...

..Estimates in the literature are highly variable, and previous studies did not use a healthy control group to establish outcomes attributable to HUS...

..The mechanism is tubulotoxicity. Caution should be exercised when using this potentially nephrotoxic cocktail, with clear criteria established for the initiation of combination therapy and close monitoring of serum creatinine...

..In addition, kidney graft function and survival was also found not to be associated with a recipient GNB3 C825T polymorphism...

..The metabolism of sirolimus in the children included in our study differed from that reported in adults, which should be considered when monitoring sirolimus exposure immunologically...

..27 for 1/Cys-C vs CrCl). CONCLUSION: These data demonstrate that despite claims to the contrary, Cys-C is a poor marker of GFR during pregnancy. Similarly, BTP shows little promise...

..Twelve of the 28 patients (43%) examined had prothrombotic abnormalities. CONCLUSION: Neonatal RVT is associated with significant renal morbidity and a high prevalence of prothrombotic abnormalities...

..This may explain the high prevalence of HHV6 in transplanted kidneys. Further studies on HHV6 and 7 using molecular techniques should be supported...

..This study evaluated the extent of thyroid abnormalities in a remote iodine-deficient area of the Ivory Coast...

..Unlike previous reports in which rituximab was used in conjunction with a calcineurin inhibitor, we present the first case where rituximab was used as the sole therapeutic agent...

..In addition, we review the current literature on the use of cidofovir in pediatric renal transplant patients with BKVN and the potential of IVIg use in this condition...

..Prospective studies with appropriate controls are needed to completely resolve this issue...

..Since elevated BMI and blood pressure clearly are known risk factors of future CKD, targeting healthier weights prior to conception is likely to reduce the CKD burden in children...

..Separate formulas according to gender did not perform better than that for the pediatric population. This BTP-based formula was found to estimate GFR with reasonable precision and provided improved accuracy over the Schwartz GFR formula...

..CysC provides accurate data for calculating GFR independent of the drug doses studied and avoids the use of methods of direct GFR measurement...

..Icodextrin fluid removal correlated significantly with age (Spearman rank r=0.8571, P=0.0107). The data suggest that Icodextrin behaves differently in young children...

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..Thus, screening for CFHR3/1 deficiency should be considered in patients with severe AMR associated with TMA...

..Therefore, we postulate that the loss of rhoGAP C1 function is most likely compensated by other members of the GAP family...

..These results were an improvement compared to the MDRD and Schwartz equations, both of which had high median bias and reduced accuracy. The updated Schwartz equation also performed well...

..The aim of this study is to examine the independent effect of various clinical parameters on serum concentrations of creatinine, cystatin C, and BTP in kidney transplant recipients...

..This growth pattern should be considered in the evaluation of individual growth and the assessment of treatment efficacy such as rhGH therapy...

..22, p=0.0435). There was a significant correlation between the GFR and both the Hgb Z-score (p=0.0068) and the Hct Z-score (p=0.0128). There was poor agreement between conventional and KDOQI definitions of anemia in children with CKD...

..EC-MPS is a safe and effective immunosuppressive agent approved for use in the prevention of acute rejection after renal transplantation. However, the anticipated improvement of GI side effects has not been forthcoming...

..We report a HUS-induced significant pericardial effusion that resulted in a cardiac tamponade. We also discuss the diagnostic and therapeutic implications of this complication...

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..These results were attributed to tight catheter securing during the insertions. Objective: To compare catheter-related outcomes after different break-in periods in the tightly secured PD catheters...