Atypical hemolytic uremic syndrome (aHUS) is associated with significant mortality and morbidity, including acute renal injury, anemia and thrombocytopenia. Rare cases of aHUS in a child with acute ...leukemia before diagnosis or during chemotherapy have been reported. We report a pediatric case of B-cell acute lymphoblastic leukemia complicated by pancreatitis with concomitant aHUS following induction chemotherapy.
Background
Medullary sponge kidney (MSK) disease predisposes patients to recurrent nephrolithiasis, which affects one in every 5000 people in the United States.
Methods
We report a rare case of a ...pediatric recipient of a living donor MSK transplant and discuss considerations when discussing risks and benefits of accepting MSK allografts for this population.
Results
The recipient was admitted due to concerns for nephrolithiasis, hydronephrosis, and urinary tract infection at 1‐month post‐transplant. The hydronephrosis was resolved by surgical removal of an encrusted ureteral stent; this was followed by supplementation with oral medications to prevent future episodes of nephrolithiasis. The recipient did not have any further episodes after this as seen at a 1‐year follow‐up. The donor has remained well through this period.
Conclusions
With increasing organ shortages, the use of variety of donors may need to be considered to enlarge the organ pool.
BACKGROUNDMedullary sponge kidney (MSK) disease predisposes patients to recurrent nephrolithiasis, which affects one in every 5000 people in the United States. METHODSWe report a rare case of a ...pediatric recipient of a living donor MSK transplant and discuss considerations when discussing risks and benefits of accepting MSK allografts for this population. RESULTSThe recipient was admitted due to concerns for nephrolithiasis, hydronephrosis, and urinary tract infection at 1-month post-transplant. The hydronephrosis was resolved by surgical removal of an encrusted ureteral stent; this was followed by supplementation with oral medications to prevent future episodes of nephrolithiasis. The recipient did not have any further episodes after this as seen at a 1-year follow-up. The donor has remained well through this period. CONCLUSIONSWith increasing organ shortages, the use of variety of donors may need to be considered to enlarge the organ pool.
Background
Focal segmental glomerulosclerosis (FSGS) predisposes patients for risk of recurrent disease in allografts.
Methods
We report a case of a recipient of an unrelated living donor renal ...transplant and discuss considerations for utilization of ofatumumab and eplerenone in treatment for recurrent FSGS.
Results
The recipient was initially managed with scheduled plasmapheresis, intravenous immunoglobulin (IVIG), and rituximab post‐transplant during index hospitalization. With notable recurrence of FSGS noted on kidney transplant biopsy, she was initially treated with additional plasmapheresis sessions leading to downtrend in proteinuria. The patient was then transitioned to LDL‐A pheresis, which resulted again in uptrend in proteinuria. This prompted return to scheduled plasmapheresis sessions weekly, leading again to a downtrend in proteinuria. Albumin levels remained within normal range throughout her course. Following initiation of eplerenone and ofatumumab, the patient demonstrated normalization of urine protein:creatinine ratio and remission of FSGS recurrence without need for additional apheresis.
Conclusions
With notable risk of recurrence of FSGS in kidney transplants leading to allograft failure, the use of ofatumumab and eplerenone in conjunction should be considered for management to induce remission.
Fission-fragment mass distributions were measured for 225,227Pa nuclei formed in fusion reactions of 19F+206,208Pb around fusion barrier energies. Mass-angle correlations do not indicate any ...quasi-fission like events in this bombarding energy range. Mass distributions were fitted by Gaussian distribution and mass variance extracted. At below-barrier energies, the mass variance was found to increase with decrease in energy for both nuclei. Results from present work were compared with existing data for induced fission of 224,226Th and 228U around barrier energies. Enhancement in mass variance of 225,227Pa nuclei at below-barrier energies shows evidence for presence of asymmetric fission events mixed with symmetric fission events. This is in agreement with the results of mass distributions of nearby nuclei 224,226Th and 228U where two-mode fission process was observed. Two-mode feature of fission arises due to the shell effects changing the landscape of the potential-energy surfaces at low excitation energies. The excitation-energy dependence of the mass variance gives strong evidence for survival of microscopic shell effects in fission of light actinide nuclei 225,227Pa with initial excitation energy ∼30–50 MeV.
Multisystem inflammatory syndrome in children (MIS-C) is a recently identified entity in association with COVID-19. AKI has been widely reported in patients with primary COVID-19 infection. However, ...there is a paucity of literature regarding renal injury in MIS-C. We aim to characterize AKI in MIS-C in this cohort identified at a major children's hospital in New York City during the COVID-19 pandemic.
We conducted a retrospective cohort study of children 0-20 years old admitted to Morgan Stanley Children's Hospital (MSCH) between April 18th and September 23rd, 2020. Patients were included if they met criteria for MIS-C on the basis of CDC guidelines. All patients were evaluated for the presence of AKI, and AKI was staged according to KDIGO criteria.
Of the 57 children who met inclusion criteria, 46% (26 of 57) were found to have AKI. The majority of patients (58%; 15 of 26) were classified as KDIGO stage 1. AKI was present upon admission in 70% of those identified. All patients had resolution of AKI at discharge, with 61% achieving recovery by day 2. One patient required dialysis. When compared with those without renal injury, the AKI cohort was older (
<0.001) and had higher median peak values of CRP (
<0.001), IL-6 (
=0.02), ferritin (
<0.001), and procalcitonin (
=0.02). More patients with AKI had left ventricular systolic dysfunction (
<0.001) and lymphopenia (
=0.01) when compared with those without AKI. No differences in body mass index or sex were found.
Although children with MIS-C may develop AKI, our study suggests that most experience mild disease, swift resolution, and promising outcome. Older age, increased inflammation, and left ventricular systolic dysfunction may be risk factors. Our study highlights the substantial differences in epidemiology and outcomes between AKI associated with pediatric MIS-C versus primary COVID-19 infection.
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