Background
Our aim was to determine the prevalence of sub-target hemoglobin (Hb) levels in children with a renal allograft and to identify potential determinants associated with these Hb levels.
...Methods
Data from 3669 children with a functioning renal allograft, aged <18 years between 1 January 2000 and 31 December 2012, from 20 European countries were retrieved from the ESPN/ERA-EDTA Registry, providing 16,170 Hb measurements.
Results
According to the NKF/KDOQI classification and the UK-NICE guidelines, 49.8 and 7.8 % of the patients, respectively, were anemic. Hb levels were strongly associated with graft function, with Hb levels of 12.6 g/dl in children with chronic kidney disease (CKD) stage 1, declining to 10.7 g/dl in children with CKD stage 5 (
P
< 0.001). Higher Hb levels were associated with the use of tacrolimus compared to ciclosporin (0.14 g/dl; 95 % confidence interval 0.02–0.27;
P
= 0.002). Low Hb levels were associated with an increased risk of graft failure (
P
= 0.01) or combined graft failure and death (
P
< 0.01), but not with death alone (not significant).
Conclusions
Anemia is present in a significant proportion of European pediatric kidney transplant recipients and is associated with renal allograft dysfunction and type of immunosuppressants used. In our patient cohort, higher Hb levels were associated with better graft and patient survival and less hypertension.
Background. Few studies have investigated the determinants of glomerular filtration rate (GFR) in paediatric patients starting on dialysis or with a transplant. Methods. Data were collected as part ...of the European Society of Paediatric Nephrology/European Renal Association–European Dialysis and Transplant Association registry from 14 European countries and referred to incident paediatric patients starting on renal replacement therapy (RRT) between 2002 and 2007 under the age of 18 years. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz formula. Data were adjusted for age, gender, treatment modality at start, primary cause of renal failure (PRD) and regions in Europe (eGFRadj). Results. Median eGFR in the 938 patients starting RRT was 10.4 mL/min/1.73 m2 (5th and 95th percentile: 4.0–26.9). Twenty-six patients (2.8%), mainly infants with Finnish-type nephropathy, started with eGFR levels >50 mL/min/1.73 m2. Younger age, female gender, starting on dialysis and having a short time between the first visit to a paediatric nephrologist (PN) and start of RRT were associated with lower eGFR at start of RRT. Gender differences were only present during adolescent age and disappeared when using the same K value for both genders. The various PRDs showed large differences in the rate of decline in eGFR between the first visit to a PN and start of RRT; however, this did not result in differences in eGFRadj at start of RRT. Conclusions. The main determinants of eGFR at start of RRT were age, gender, treatment modality at start, and the time between the first visit to a PN and start of RRT. Research is needed to determine the consequences of these differences.
Purpose We present different ultrasound techniques to detect vesicoureteral reflux in children with special emphasis on voiding urosonography. Materials and Methods Urinary tract infection is a ...common problem in children that may be related to vesicoureteral reflux. Currently there is no consensus on investigations in children after the first urinary tract infection. The least invasive imaging with the smallest radiation burden should be used in children. Ultrasound to detect reflux meets several of these criteria. The development of echo enhancing agents has markedly improved reflux visualization by ultrasound. Results We discuss the clinical relevance of voiding urosonography. We reviewed the currently available literature and the results of our studies of this issue. We also describe our endeavors to avoid catheterization and detect vesicoureteral reflux based on various sonomorphological features, ie indirect voiding urosonography and ureteral jet Doppler waveform analysis, to avoid applying any substance into the bladder. Conclusions Voiding urosonography is safe and reliable to detect vesicoureteral reflux. When indicated, considerably decreased radiation exposure can be achieved by voiding urosonography instead of established cystography methods. Indirect voiding urosonography and ureteral jet Doppler waveform analysis could be an alternative to invasive voiding cystography, at least in children older than 3 years.
In recent years, the exact role of vesicoureteric reflux (VUR) in general has become controversial, though in some groups of children the knowledge of the existence or non-existence of VUR is still a ...very important issue. The number of techniques available for the assessment of VUR is increasing, and a new classification taking into account their real characteristics (direct/indirect, catheter-using/catheter-free, radiation-giving/radiation-free) has been proposed. The purpose of the following review is to evaluate the currently available evidence supporting the use of various catheter-free methods for VUR detection. We believe that as the clinical role of VUR has been questioned, it is even more important for the method of its detection to be user-friendly as regards catheterisation, radiation and availability. There is still no evidence supporting the assertion that any of the catheter-free methods of VUR detection might be the optimal one for any child. However, there are some groups of children who would benefit from using them. New studies using new, catheter-free methods of VUR detection or a combination of two or more of the methods described may prove useful in improving sensitivity and providing additional data on this important issue.
The development of echo-enhancing agents has significantly improved the detection of the movement of fluid within the urinary tract by ultrasonography (US). The purpose of our study was to compare ...ultrasound voiding cystography (USVC) for the detection of vesicoureteric reflux (VUR) in children with direct radionuclide voiding cystography (DRVC). Ninety-nine children, aged 1.1-12.3 years, with 198 potentially refluxing units, were investigated simultaneously by DRVC and USVC. The indications for cystography were urinary tract infection, follow-up of a previously detected VUR, and screening of siblings of children with VUR. During the investigation an echo-enhancing agent (Levovist) was administered intravesically through a catheter already in place for the DRVC. The movement of both agents, radiotracer and Levovist, was registered simultaneously by a computerized gamma camera and US, respectively. The results were analyzed with DRVC representing the reference diagnostic test. The overall sensitivity and specificity of USVC for the detection of VUR were 79% and 92%, respectively. USVC may represent a reliable diagnostic tool for the detection and follow-up of VUR in children.
Abstract
This report provides a summary of the 2011
S
lovenian renal replacement therapy (
RRT
) data. Data were obtained from 24 renal centers: 23 dialysis and one transplant center, referred as of ...31
D
ecember 2011, with 100% response rate to individual patient questionnaires.
S
lovenia has a population of approximately 2 million (2 052 496 in 2011). The total number of patients treated by
RRT
was 2011,that is, 980 per million of population (pmp); 0.4% decrease compared to 2010. 1347 (67.0%) were treated by hemodialysis, 60 (3.0%) by peritoneal dialysis, and 604 (30.0%) had a functioning kidney graft. A total of 236 incident patients, 115 pmp (at day one), started
RRT
, their median age was 68 years, 64.8% were men, 36.4% were diabetics. Regarding hemodialysis patients, 59.3% were treated with on‐line hemodiafiltration, 86% with ultrapure dialysis fluid. Median weekly duration of hemodialysis was 12.5 h, median dry body weight 70 kg, mean blood flow 275 ± 46 mL/min, 7.1% were dialyzed in a single‐needle mode. Vascular accesses were native arteriovenous fistula in 79%, polytetrafluoroethylene graft in 6%, and catheter in 15%. The crude death rate was 15.9% in dialysis patients, 1.9% in transplant recipients, and 12.0% in all
RRT
patients (both dialysis and transplant, incident patients at day 1 included).
S
lovenia has been a member of
E
urotransplant since 2000. Forty‐six kidney transplantations were performed in 2011, all from deceased donors. A slight decrease in prevalent number of
RRT
patients was observed in 2011, for the first time in 40 years. The number and proportion of patients with functioning kidney grafts is increasing, reaching 30% in 2011.
Three methods are currently used to identify vesicoureteral reflux (VUR) in children, namely X-ray voiding cystourethrography (VCUG), radionuclide voiding cystography (RVC), and, recently, ...echo-enhanced voiding urosonography (VUS). It is known that the sensitivity of VCUG and RVC for detecting VUR can be improved by using cyclic procedures, such as repeated bladder filling and voiding. The purpose of our prospective study was to evaluate whether the cyclic procedure is superior to the conventional (one cycle only) procedure in VUS also. VUS was performed in 49 patients, aged 1.4-15.8 years (mean 4.1 years). After the first micturition, the catheter was left in place and the whole procedure was repeated under the same conditions. The results of the first and second cycles and the combined procedure were compared. In the initial cycle, 7 of 35 (20%) refluxing renal units that were detected in the second cycle and 4 of 26 (15%) children with at least unilateral VUR were missed. Cyclic VUS detected 25% more VURs than the conventional (one cycle only) VUS ( P=0.049) and revealed 50% more VUR III than the first cycle. Our results suggest that cyclic VUS is superior to conventional VUS.
Background. The clinical significance of vesicoureteric reflux (VUR) in renal transplant recipients remains controversial. Voiding urosonography (VUS), a new modality for detecting VUR, can be used ...in these patients. The sensitivity of X‐ray and radionuclide cystography for detecting VUR may be improved with cyclic procedures. The aim of our study was to evaluate whether cyclic VUS is superior to the single‐cycle procedure. Methods. Cyclic VUS was performed in 27 renal transplant recipients. Eight were children or adolescents and the remaining 19 recipients were adults. VUS was performed according to accepted guidelines. After the first micturition, the catheter was left in place and the entire procedure was repeated under the same conditions. Results. Both initial cycle and cyclic VUS detected 17 out of 27 (63%) VURs in the same patients. The sensitivity was not improved by cyclic VUS. However, there were differences between the initial cycle and cyclic VUS (P=0.028) when comparing the number of negative results and the grades of VURs detected. This difference was even more pronounced when analysing only positive results. In the initial cycle, five out of 17 (29%) VURs were grade III, compared with 10 out of 17 (59%) grade III VURs in the same patients using the cyclic procedure (P=0.008). Conclusions. Cyclic VUS did not improve the detection sensitivity for VUR in our study. However, given that VUR grade may be important for the management of renal transplant recipients, the use of cyclic VUS may provide a useful diagnostic tool for these patients.
Renal parenchymal defects (RPD) -- scars, hypoplasia/dysplasia -- in children are a major risk factor for chronic renal failure. Most authors would agree that RPD should be detected and followed by a ...99mTc-dimercaptosuccinic acid renal scan (DMSA), as ultrasonography (US) does not seem to be sensitive enough for this purpose. However, it might well be that DMSA is too sensitive and detects RPD that are too small to be clinically significant. The purpose of this study was to evaluate the sensitivity of US in identifying patients with clinically significant RPD and in detecting RPD of various grades as seen by DMSA. In 89 children with abnormal DMSA, a second DMSA, US, and other tests for evaluating renal function were performed at least 1 year after the first DMSA. The extent of RPD detected by DMSA and US was correlated with renal function parameters. In all 5 patients with diminished renal function, RPD were detected by both DMSA scan and US. In addition, US detected clinically insignificant RPD in 48 of 67 cases (71.6%). The present study has shown that, compared with DMSA, US is sensitive enough to detect clinically significant RPD in children. The substitution of DMSA with US would be beneficial, as this would eliminate radiation exposure, reduce costs, and increase availability.
The total number of end-stage renal failure patients treated by renal replacement therapy increased, from 1435 at 31 December 2000 to 1542 at 31 December 2001 (7.5% increase). At the end of 2001, 771 ...p.m.p. end-stage renal failure patients were treated by renal replacement therapy in Slovenia, 73% of them with haemodialysis, 7.4% with peritoneal dialysis and 19.7% had a functioning graft. Incident (new) patients in 2001 were 144 p.m.p. The number of haemodialysis patients increased by 7% compared with the year before, the number of patients on peritoneal dialysis decreased by 3.4% and the number of patients with a functioning graft increased by 13.9%. The gross mortality rate of dialysis patients was stable between the years and was 10.4% in 2001. Erythropoietin therapy was prescribed to 87.3% of dialysis patients (88.9% of haemodialysis patients and 71.7% of patients on peritoneal dialysis). The number of dialysis patients positive for hepatitis B or hepatitis C virus is relatively low, 3.2% of all dialysis patients; an increased number of MRSA-positive dialysis patients is observed in 2001 (2.9% of all dialysis patients). The epidemiology of renal replacement therapy in Slovenia is in general comparable with that of the countries of the European Union.
PDF
