tag:blogger.com,1999:blog-118689785614936092024-03-20T12:43:17.208-07:00Pediatric Nephrology India BlogAnonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.comBlogger41125tag:blogger.com,1999:blog-11868978561493609.post-21049000594432867892016-07-29T21:25:00.001-07:002016-07-29T21:25:58.032-07:00Cystinosis: Really an Orphan for Developing world<p dir="ltr">I completely agree with Dr Ravi R paper on difficulties we face in treating children with rare disorders like Cystinosis and aHUS where noone seems to help these children with drugs and treatment and we struggle for it. Appreciate Dr Ravi's foundation on Cystinosis.<br>
CYSTINOSIS a truly orphan disease - Report of the Cystinosis Foundation India | Rajan | Rare Diseases and Orphan Drugs http://rarejournal.org/rarejournal/article/view/81</p>
Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com5tag:blogger.com,1999:blog-11868978561493609.post-47239663234983957332016-06-22T02:51:00.003-07:002016-06-22T02:51:56.017-07:00Lung ultrasound in Pediatric Fluid Overload<div dir="ltr" style="text-align: left;" trbidi="on">
Lung ultrasound imaging may be superior to both echocardiographic methods and BIS in detecting volume overload in children with ESRD. Given the practicality and sensitivity of lung ultrasound imaging, this technique can be adopted alongside clinical examination and blood pressure in the routine assessment of fluid overload in children with ESRD.<br />
<a href="http://link.springer.com/article/10.1007/s00467-016-3431-4/fulltext.html" target="_blank"><br /></a>
<a href="http://link.springer.com/article/10.1007/s00467-016-3431-4/fulltext.html" target="_blank">An excellent study published in Pediatric Nephrology on the same </a><br />
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-13893629019601826362016-06-21T04:09:00.000-07:002016-06-21T04:09:28.632-07:00Our review article published in "Pediatric Nephrology" journal ! <div dir="ltr" style="text-align: left;" trbidi="on">
Today we publish a much awaited review on <a href="http://link.springer.com/article/10.1007/s00467-016-3402-9" target="_blank"><b>"Nutritional Management of a Critically Ill child with Acute Kidney Injury"</b> in the journal </a><b><i><a href="http://link.springer.com/article/10.1007/s00467-016-3402-9" target="_blank">"Pediatric Nephrology"</a>.</i></b> Thanks to Drs Rupesh Raina, Timothy Bunchman, Vijay Kher, Norma Maxvold and Pranaw Jha for all the help and support.<br />
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<a href="http://link.springer.com/article/10.1007/s00467-016-3402-9" target="_blank">Link to the article here</a><br />
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com1tag:blogger.com,1999:blog-11868978561493609.post-77045000777882141502016-06-14T02:58:00.003-07:002016-06-14T02:58:48.699-07:00Importance of NINJA in Pediatric Nephrology<div dir="ltr" style="text-align: left;" trbidi="on">
<a href="http://www.kidney-international.org/article/S0085-2538(16)30123-5/fulltext" target="_blank">Current issue of Kidney International shows an excellent study from Dr Goldstein's group, Cincinatti.</a> It talks on development and validation of a systematic screening program called <b>Nephrotoxic Injury Negated by Just-in-time Action (NINJA)</b>, whereby children admitted to a noncritical care unit in our hospital deemed to be at high-risk of NTMx-AKI were recommended to have a daily serum creatinine (SCr) ordered to assess for AKI development.<br />
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By intensive monitoring, the exposure rate decreased by 38% (11.63–7.24 exposures/1000 patient days), and the AKI rate decreased by 64% (2.96–1.06 episodes/1000 patient days).<br />
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<u>This figure shows improvement in exposure rates following NINJA. </u><br />
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-43228913614120215462016-06-14T02:42:00.000-07:002016-06-14T02:42:01.381-07:00Behavioural abnormalities and Mutations in children with CKD<div dir="ltr" style="text-align: left;" trbidi="on">
We very commonly see children with CKD and ESRD with behavioural problems and autistic features and CAKUT. <i><a href="http://www.kidney-international.org/article/S0085-2538(16)30115-6/fulltext" target="_blank">Current issue of Kidney International</a></i> nicely shows the 17q12 deletions but not HNF1B intragenic mutations are associated with neurodevelopmental disorders.<br />
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Otherwise, Heterozygous mutations of the HNF1B gene are the commonest known monogenic cause of developmental kidney disease.<br />
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-61104548738631498912016-05-13T23:08:00.002-07:002016-05-13T23:08:40.964-07:00Maternal NSAIDs and Renal Tubular Dysgenesis in neonates<div dir="ltr" style="text-align: left;" trbidi="on">
Just saw a neonate whose mother took Nimesulide whole of her pregnancy for pain abdomen, and now the child is in renal failure. It is a difficult task counselling these parents with a neonate with renal failure.<br />
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Renal tubular dysgenesis (RTD) is characterized by absent or poorly developed proximal convoluted tubules.<br />
The glomeruli appear numerous because of the absent proximal tubules in the cortex. Tubules are dilated, and the interstitium is expanded. RTD has been reported to occur as an inherited genetic defect. It has been recognized as a characteristic feature of angiotensin-converting enzyme (ACE) inhibitor foetopathy. It has also been reported sporadically in association with exposure to other drugs, notably the non-selective, non-steroidal, antiinflammatory drugs<br />
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com1tag:blogger.com,1999:blog-11868978561493609.post-4594438540556276572016-05-13T03:34:00.000-07:002016-05-13T03:34:01.651-07:00Managing FSGS: New targets<div dir="ltr" style="text-align: left;" trbidi="on">
<i><a href="http://www.kidney-international.org/article/S0085-2538(16)30005-9/fulltext" target="_blank">Current Issue of Kidney International </a></i>has an excellent review on potential targets for treating FSGS in future years. It is a must read for all researchers and scholars!<br />
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-52581196882641202522016-05-13T03:30:00.000-07:002016-05-13T03:30:23.433-07:00Controversies and Management of Cystinosis<div dir="ltr" style="text-align: left;" trbidi="on">
<i><a href="http://www.kidney-international.org/article/S0085-2538(16)30046-1/fulltext" target="_blank">Current Issue of Kidney International </a></i>has an excellent paper on Cystinosis- from diagnosis to management, a must read for all pediatricians and pediatric nephrologists.<br />
Nephropathic cystinosis is an autosomal recessive metabolic, lifelong disease characterized by lysosomal cystine accumulation throughout the body that commonly presents in infancy with a renal Fanconi syndrome and, if untreated, leads to end-stage kidney disease (ESKD) in the later childhood years.<br />
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com1tag:blogger.com,1999:blog-11868978561493609.post-90860532774527371542016-05-08T02:10:00.004-07:002016-05-08T02:10:51.654-07:00CME Live: Session four<div dir="ltr" style="text-align: left;" trbidi="on">
Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. <span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;">This post was first published on the Curofy app. </span><br />
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Neonatal Renal Physiology <br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Dr Saroj patnaik</div>
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<br style="box-sizing: border-box;" />Glomerular function:<br style="box-sizing: border-box;" />Kidney receives 15% of CO <br style="box-sizing: border-box;" />Low systemic blood pressure<br style="box-sizing: border-box;" />Increased vascular resistance<br style="box-sizing: border-box;" />Renal blood flow more to inner cortex and medulla<br style="box-sizing: border-box;" />GFR is 10-30 ml/min/1.73m2<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Limited adaptive features to stress, sepsis, anorexia and exposure to nephrotoxic drugs are challenges in assessing renal function<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Autoregulation: <br style="box-sizing: border-box;" />Range of autoregulation set to lower perfusion pressure<br style="box-sizing: border-box;" />Susceptible to Hypovolemic insult<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Tubular function:<br style="box-sizing: border-box;" />Total body water 75% of the weight<br style="box-sizing: border-box;" />Shift of ECF into cells<br style="box-sizing: border-box;" />Physiologic weight loss 10-15%<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Low urine concentrating capacity<br style="box-sizing: border-box;" />Dilution mechanism better than conc. capacity<br style="box-sizing: border-box;" />Prone to dehydration<br style="box-sizing: border-box;" />It maybe non oligouric despite poor renal function<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Sodium balance: <br style="box-sizing: border-box;" />Hyponatremia in preterms and rapidly growing LBW babies<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Potassium levels of 6-6.5 is considered acceptable in term and preterm neonates<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Acid base balance:<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Suboptimal acid excretion<br style="box-sizing: border-box;" />Lower serum bicarbonate levels are acceptable in preterm and term neonates<br style="box-sizing: border-box;" />Disease states and drugs can accentuates metabolic acidisis.</div>
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Neonatal AKI<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Dr Malcolm Coulthard</div>
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<br style="box-sizing: border-box;" />Why did AK failure become AK injury, it should be AK dysfunction<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Deficiency of AK*<br style="box-sizing: border-box;" />Reduced GFR<br style="box-sizing: border-box;" />Reduced urine output<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Pre-renal causes:<br style="box-sizing: border-box;" />Hypovolaemia<br style="box-sizing: border-box;" />Non osmotic release of ADH<br style="box-sizing: border-box;" />Renin/endocrine<br style="box-sizing: border-box;" />Renin/paracrine<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />-Furosemide<br style="box-sizing: border-box;" />does not lead to damage if reverses<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Management:<br style="box-sizing: border-box;" />Deal with reversible components<br style="box-sizing: border-box;" />Improve renal perfusion<br style="box-sizing: border-box;" />Sepsis<br style="box-sizing: border-box;" />Surgery<br style="box-sizing: border-box;" />Multiple organ failure<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Furosemide if indicated<br style="box-sizing: border-box;" />Obsessional fluid care<br style="box-sizing: border-box;" />Blood results for fine tuning<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />When to dialyze?<br style="box-sizing: border-box;" />Fluid is the key. If oligouric keep using conservative management until biochemistry is life threatening</div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-22666713969545104232016-05-08T01:28:00.002-07:002016-05-08T01:28:26.797-07:00CME Live: Session Two<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8px;"><b><i><span style="color: blue;">Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. This post was first published on the Curofy app. </span></i></b></span><br />
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Basics of RRT<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Speaker: Dr. Pranaw Jha</div>
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<br style="box-sizing: border-box;" />Dialysis process whereby soluble composition of a solution A is altered by exposing to solution B across a semipermeable membrane<br style="box-sizing: border-box;" />-Need 2 solution- blood & dialysate <br style="box-sizing: border-box;" />-Semi permeable membrane<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Transport mechanisms: <br style="box-sizing: border-box;" />Diffusion<br style="box-sizing: border-box;" />Convection<br style="box-sizing: border-box;" />Adsorption<br style="box-sizing: border-box;" />Osmosis<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Diffusion: <br style="box-sizing: border-box;" />results in random molecular motion<br style="box-sizing: border-box;" />inversly proportional to solute ssite<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Convection:<br style="box-sizing: border-box;" />Ultrafilteration<br style="box-sizing: border-box;" />water driven across semipermeable membrane by hydrostatic/ osmotic force<br style="box-sizing: border-box;" />solvent swept along with it, close to concentrated gradient- solvent drag<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Convective methods:<br style="box-sizing: border-box;" />Hemofilterationlarge amount of ultrafilteration coupled with replacement fluid infusion.<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Hemodiafilteration: combined HD & HF</div>
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Dialysis Modality<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Dr. Siddhartha Sethi</div>
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<br style="box-sizing: border-box;" />Choice of modality<br style="box-sizing: border-box;" />Peritoneal dialysis<br style="box-sizing: border-box;" />intermittent hemodialysis<br style="box-sizing: border-box;" />CRRT<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />PD is declining in the west, since expertise is increasing. CRRT is used<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Modality of choice in India<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />less expertise in India<br style="box-sizing: border-box;" />not insured in India<br style="box-sizing: border-box;" />expensive<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />indication of CRRT<br style="box-sizing: border-box;" />prevention of fluid overload<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Acute peritoneal dialysis:<br style="box-sizing: border-box;" />indication: Refractory volume overload<br style="box-sizing: border-box;" />refract hyperkalemia<br style="box-sizing: border-box;" />refract metabolic disease<br style="box-sizing: border-box;" />uremia complication<br style="box-sizing: border-box;" />dysnatemias in AKI<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Apparatus: <br style="box-sizing: border-box;" />PD catheter<br style="box-sizing: border-box;" />three way connector<br style="box-sizing: border-box;" />IV sets<br style="box-sizing: border-box;" />PD fluid bags<br style="box-sizing: border-box;" />Drain bag<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Catheter: <br style="box-sizing: border-box;" />Stiff catheter<br style="box-sizing: border-box;" />two cuff tenckhoff's catheter<br style="box-sizing: border-box;" />Cook's catheter<br style="box-sizing: border-box;" />tenckhofs single cuff<br style="box-sizing: border-box;" />soft thermal <br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Bicarbonate dialysis<br style="box-sizing: border-box;" />Severe lactic acidosis or hepatic failure<br style="box-sizing: border-box;" />asepsis required<br style="box-sizing: border-box;" />1 hr exchange time<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Ultra filtration<br style="box-sizing: border-box;" />Not more than 5-10% weight loss should be targeted<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Session length: Stiff catheter are 48-72 hr affair<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />anuria, hypercatabolism, nutritional support<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Additives: <br style="box-sizing: border-box;" />heparin, potassium, insulin<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Disadvantage: <br style="box-sizing: border-box;" />Slower concentration<br style="box-sizing: border-box;" />lower URA clearance<br style="box-sizing: border-box;" />lower ultra filtration<br style="box-sizing: border-box;" />risks of peritonitis<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Automated PD:<br style="box-sizing: border-box;" />warm fluids, keeps track, less infection</div>
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Prescribing HD & Mathematics<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Dr. Rupesh Raina</div>
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<br style="box-sizing: border-box;" />Dialysis cannot clear solutes not present in intravascular space.<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Diffusion: <br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Factors:<br style="box-sizing: border-box;" />Conc. gradient(dC)<br style="box-sizing: border-box;" />surface area(A)<br style="box-sizing: border-box;" />diffusivity(KO)<br style="box-sizing: border-box;" />sum of resistance(dx/KO)<br style="box-sizing: border-box;" />concurrent flow<br style="box-sizing: border-box;" />time<br style="box-sizing: border-box;" />J=KOA x dC/dx<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Solutes:<br style="box-sizing: border-box;" />Low molecular weight- uo to 300 daltons<br style="box-sizing: border-box;" />middle molecular weight- 300- 2000 daltons<br style="box-sizing: border-box;" />large molecular weight- 5000- 1200 daltons<br style="box-sizing: border-box;" />serum albumin-69 366 D<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Hollow fiber dialyser;<br style="box-sizing: border-box;" />Thousands of hollow capillary sizes fibers fixed in a polyurethane capsules.<br style="box-sizing: border-box;" />blood flows through fibers, dialysate flows around fibers<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Clearance: volume of blood cleared of solute per unit time. <br style="box-sizing: border-box;" />( Refer pic) <br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />KoA <br style="box-sizing: border-box;" />Product of the overall mass transfer co efficient for a given solute x dialyser surface area<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Ultrafilteration co efficient: ( KUf)<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Volume of fluid transferred across the membrane per mmHg of pressure gradient<br style="box-sizing: border-box;" />Low KUf denotes low permeability and low flux<br style="box-sizing: border-box;" />high KUf denotes near complete permeability<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />High flux of dialyzers: KUf> 14ml/min/mmhg<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Urea kinetic modeling:<br style="box-sizing: border-box;" />Process to determine the amount of dialysis actually given<br style="box-sizing: border-box;" />uses mathematical equation<br style="box-sizing: border-box;" />( refer urea soup pic)<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />KT/V( Urea)<br style="box-sizing: border-box;" />represnts fractional ura clearance<br style="box-sizing: border-box;" />K= dialyzer clearance<br style="box-sizing: border-box;" />T= time<br style="box-sizing: border-box;" />V= volume of urea distribution<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />-0.5= uremic, death<br style="box-sizing: border-box;" />-0.7= EEg abnormal<br style="box-sizing: border-box;" />-1.0= short trm <br style="box-sizing: border-box;" />-1.2-1.4= long term<br style="box-sizing: border-box;" />->1.4= better outcome<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Initial hemodynamic prescription concepts; Aim to prescribe a dose of dialysis to effect a desired result<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Tubing: < 10 kg- neonatal tubing <br style="box-sizing: border-box;" />10-20 kg- pediatric tubing<br style="box-sizing: border-box;" />>20 kg adult tubing</div>
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SLED & CRRT<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Dr. Timothy Buchman</div>
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<br style="box-sizing: border-box;" />Continuous form of renal replacement therapy that allows for hemodynamic stability<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />SLED: Slow Low Efficiency Dialysis<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Pediatric data for CRRT: optimal use in situation of hemodynamic compromise, Hypermetabolic state, sepsis<br style="box-sizing: border-box;" />45% survival<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Pediatric data SLED: <br style="box-sizing: border-box;" />Heparin Anticoagulation<br style="box-sizing: border-box;" />14 children in 16 sessions. less than 8 hours.<br style="box-sizing: border-box;" />cheaper than CRRT<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Advantages of CRRT:<br style="box-sizing: border-box;" />Continuous in nature making decision making of medication, dosage and nutrition delivery easier. <br style="box-sizing: border-box;" />Hemodynamically stable<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Disadvantages, of CRRT:<br style="box-sizing: border-box;" />greater need of utilization of resources<br style="box-sizing: border-box;" />High pharmacy costs<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Adv. of SLED<br style="box-sizing: border-box;" />less resource utilization<br style="box-sizing: border-box;" />less expensive<br style="box-sizing: border-box;" />hemodialysis in morning and nocturnal SLED at night<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Disadvantages of SLED<br style="box-sizing: border-box;" />may cause hemodynamic compromise<br style="box-sizing: border-box;" />intermittent<br style="box-sizing: border-box;" />risk of over dialysis due to minimal dialysate flow of 6 ltrs per hour</div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-78995137849672402812016-05-08T01:23:00.001-07:002016-05-08T01:23:24.285-07:00CME Live: Anticoagulation<div dir="ltr" style="text-align: left;" trbidi="on">
CME Live: Anticoagulation<br />
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Dr. Rupesh Raina<br />
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<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8px;"><b><i><span style="color: blue;">Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. This post was first published on the Curofy app. </span></i></b></span><br />
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<span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Heparin:</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Commonly used</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Easy to use and monitor</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">No evidence on dose</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Systemic side effect</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Contraindicated in bleeding patient</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Citrate</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Calcium dependent mechanism </span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Binds to free calcium and inhibits binding</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Has zero effect upon the patient </span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Easy to monitor</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Less clotted circuits</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Less work of machinery</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Problems:</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Metabolic alkalosis</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Electrolyte disorders</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Cardiac toxicity</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Complications: </span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Seen with rising total calcium with dropping patient ionized calcium.</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Citrate gap.</span><br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-29527429771906321772016-05-08T01:21:00.003-07:002016-05-08T01:21:35.258-07:00CME Live: Session One<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8px;"><span style="color: blue;"><b>Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. This post was first published on the Curofy app. </b></span></span><br />
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Non Dialytic Management of AKI: <br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Dr. Rupesh Raina</div>
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<br style="box-sizing: border-box;" />Modified RIFLE criteria doesn't help on bedside<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Creatinins is not the only marker neither is it good.<br style="box-sizing: border-box;" />Solute clearance<br style="box-sizing: border-box;" />Risk assessment<br style="box-sizing: border-box;" />Early intervention is critical in golden hour<br style="box-sizing: border-box;" />Normal saline is the best for fluid replacement - gives them proteins, hypercatabolic state<br style="box-sizing: border-box;" />Contrast induced neprotoxicity should be avoided. No contrast MRI<br style="box-sizing: border-box;" /></div>
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<br style="box-sizing: border-box;" />Nutrition in AKI <br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Dr. Timothy buchman</div>
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<br style="box-sizing: border-box;" />Protein energy waste= increased morbidity & mortality<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Hypoglycemis:<br style="box-sizing: border-box;" />Altered substrate utilization in acute illness:<br style="box-sizing: border-box;" />Inefficient oxidation, impaired glycogenesis, lipogenesis<br style="box-sizing: border-box;" />Insulin resistance<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Protein metablism:<br style="box-sizing: border-box;" />Muscle efflux of amino acid to fuel gluconeogenesis<br style="box-sizing: border-box;" />Liver protein synthesis shifts from anabolic to acute phase proteins. <br style="box-sizing: border-box;" />Net negetive nitrogen protein balance<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Lipid metabolism:<br style="box-sizing: border-box;" />Increased triglyceride<br style="box-sizing: border-box;" />Decreased cholestrol<br style="box-sizing: border-box;" />Impaired lipolysis<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Water soluble vitamins:<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Vit B1 def. altered energy metabolism<br style="box-sizing: border-box;" />Vit B6 def: altered amino acid and lipid metabolism<br style="box-sizing: border-box;" />Folate deficiency: anemia<br style="box-sizing: border-box;" />Vit c def: potential for losses during CRRT</div>
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Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-11868978561493609.post-59462640148663920392016-05-08T01:14:00.004-07:002016-05-08T01:14:44.710-07:00CME Live: Hyperammonaemia and CRRT in acute liver failure<div dir="ltr" style="text-align: left;" trbidi="on">
<b><i>CME Live: Hyperammonaemia and CRRT in acute liver failure</i></b><br />
<b><i><br /></i></b>
<b><i>Dr. Timothy Buchman</i></b><br />
<b><i><br /></i></b>
<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8px;"><b><i><span style="color: blue;">Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. This post was first published on the Curofy app. </span></i></b></span><br />
<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;"><br /></span>
<span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Indication of RRT in ALF</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Hepatic encephalopathy grade 3-4</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Renal dysfunction</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Metabolic abnormalities</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">No one indication is an absolute one in for initiation of RRT</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">RRT in CLD</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Supportive therapy for kids who deteriorate</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Volume overload, intractable metabolic acidosis, and hyperkalemia</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Delay in RRT decreases mortality by 90% </span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Serves as a bridge to transplant</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Modalities:</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">CRRT-CVVH, CVVHD CVVHDF- no evidence which was bettter </span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">TPE- therapeutic plasma exchange </span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">MARS</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">SPAD: single pass albumin dialysis</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">No evidence for RRT in liver patients</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Should we undertake CRRT in ALF?</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Yes and review </span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">For neuroprotection, metabolic disarray, bridge for recovery or transplant</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">CRRT- unstable</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">TPE- the way to go</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Dose: No evidence in pediatrics, High is gaining popularity</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Anticoagulation: PGI2 and low dose heparin</span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-33896685203265127262016-05-08T01:12:00.000-07:002016-05-08T01:12:04.557-07:00CME Live: Hemolytic Uremic Syndrome<div dir="ltr" style="text-align: left;" trbidi="on">
CME Live: Hemolytic Uremic Syndrome<br />
<br />
Dr Siddhartha Sethi<br />
<br />
<b><i><span style="color: blue;">Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. <span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8px;">This post was first published on the Curofy app. </span></span></i></b><br />
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<span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Etiology</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Infection: Shiga and verocytotoxin</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Steptococcus Pneumoniae disorders: </span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">a) genetic disorders of complement regulation</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">b) Acquired disorders of complement regulation</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">VonWillebrand proteinase:</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">a) Genetic disorder</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">b) Acquired</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">HIV</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Malignancy</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Lupus</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Complement studies should be a part of every HUS evaluation</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Diarrhea+ HUS in young, severe, recurrent, family history</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Early: plasma infusions, plasma exchange</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Recurrence post renal transplant</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Immunosuppression </span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Eculizumab</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Renal transplant in HUS</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">High rate of recurrence</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Factor H & I mutation</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Patients ideally not living related to non-Stx-HUS</span><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><br style="background-color: white; box-sizing: border-box; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;" /><span style="background-color: white; color: #5f5f5f; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">Eculizumab: most expensive drug trial</span></div>
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Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-11868978561493609.post-54116036707247487872016-05-08T01:08:00.001-07:002016-05-08T01:08:05.738-07:00CME Live: Pediatric Palliative Care: Chronic kidney disease<div dir="ltr" style="text-align: left;" trbidi="on">
<i><b>CME Live: Pediatric Palliative Care: Chronic kidney disease</b></i><br />
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<i><b>Dr Mona Gupta</b></i><br />
<i><b><br /></b></i>
<i><b>Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. <span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;">This post was first published on the Curofy app. </span></b></i><br />
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>In life threatening conditions Goals would be to:</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Enhance quality of life</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Minimize suffering</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Optimize function</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Interdisciplinary roles:</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Pediatricians:</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Initiate treatment</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Decision making and future care</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Care co-ordination</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Nephrologist: </b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>- Replacing electrolytes</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Psycologist:</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>-Family</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b><br /></b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Palliative care works towards </b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Family bereavement</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Support</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Maximize quality of life</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Minimize time</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b><br /></b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Benefits:</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Attention to symptoms and quality of life</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>End of life preparation</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Pain and symptom management</b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b>Early involvement beneficial to family, child, caregiver. </b></i></span></span></div>
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<span style="color: #222222; font-family: arial, sans-serif;"><span style="font-size: 12.8px;"><i><b><br /></b></i></span></span></div>
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Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-11868978561493609.post-43935382190861345732016-05-07T00:28:00.001-07:002016-05-07T00:28:22.145-07:00<div dir="ltr" style="text-align: left;" trbidi="on">
CME LIVE: <span style="background-color: white; color: #a800a8; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;">International Neonatal and Pediatric Nephrology Training Workshop</span><br />
<span style="background-color: white; color: #a800a8; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-style: italic; font-weight: bold; line-height: 20px;"><br /></span>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;">
<b><i>Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. This post was first published on the Curofy app. </i></b></div>
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<a href="https://bnc.it/z53c/KW9zY4k0at">https://bnc.it/z53c/KW9zY4k0at</a></div>
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ACUTE KIDNEY INJURY</div>
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<br style="box-sizing: border-box;" />Most common cause: Post cardiac surgery<br style="box-sizing: border-box;" />62% of neonates undergoing cardiac surgery develop AKI<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />1 in every 3 child in hospital contracts acute kidney injury<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Children on ventilators: 36% of children on ventilators develop AKI<br style="box-sizing: border-box;" />Inotrope score: increased postsurgery Inotrope, increased risks<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />AKI in non critically ill children:<br style="box-sizing: border-box;" />Risk factors : longer treatment, AG treatment in previous months<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />How to prevent damage?<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Decreased nephrotoxic drugs<br style="box-sizing: border-box;" />Regulate hypotension<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Fluid overload calculation <br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Increased fluid overload means increased fatality<br style="box-sizing: border-box;" />Fluid accumulation and fatality is independent of the critical condition of the patient, <br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Survival rates fall down with increased fluid accumulation<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Oxygenation is directly proportional to fluid overload<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />Renal Angina Index= risk of AKI*signs of injury<br style="box-sizing: border-box;" /><br style="box-sizing: border-box;" />RAI predicts the survival and fluid overload. decreased RAI decreased risk of AKI</div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-51303494818557068692016-04-26T00:10:00.002-07:002016-04-26T04:13:56.761-07:00Invited to "Narayan Health" for "Symposium on Pediatric Liver Transplantation"<div dir="ltr" style="text-align: left;" trbidi="on">
This weekend, I shall be at Narayan Health- Mazumdar Shah Medical Center, for taking a lecture on "Long term Kidney Issues in Pediatric Liver Transplantation".<br />
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It shall be interesting to have audience as Pediatric Liver transplant physicians and Pediatric Liver transplant surgeons, and trying to create awareness about renal issues in all kinds of Pediatric Transplantation.<br />
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It shall also be an honor to talk after well renowned Pediatric transplant physicians of the country!<br />
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-42792964327867420052016-04-19T23:15:00.000-07:002016-04-19T23:15:01.450-07:00What should be the dose of CRRT in patients with sepsis? <div dir="ltr" style="text-align: left;" trbidi="on">
Continuous renal replacement therapy (CRRT) has been suggested to play a part in immunomodulation by cytokine removal. However, the effect of continuous venovenous hemodiafiltration (CVVHDF) dose on inflammatory cytokine removal and its influence on patient outcomes are not yet clear.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvLhmiOcJfQSknJADWQ0o-NffMT8x6IBQAYlzVxZHjeGTZm6yRim_cLyWzHiKnfQdWxLQTj4Rkf8CSCaXRR4AUhQyEGMgToawaP7s-iiFWXKUycHTwi9kogNUFfS5f8lbRH4ggstV9zw/s1600/cover.tif.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvLhmiOcJfQSknJADWQ0o-NffMT8x6IBQAYlzVxZHjeGTZm6yRim_cLyWzHiKnfQdWxLQTj4Rkf8CSCaXRR4AUhQyEGMgToawaP7s-iiFWXKUycHTwi9kogNUFfS5f8lbRH4ggstV9zw/s200/cover.tif.jpg" width="151" /></a></div>
<b><a href="http://www.ajkd.org/article/S0272-6386(16)00696-X/abstract" target="_blank"><br /></a></b>
<b><a href="http://www.ajkd.org/article/S0272-6386(16)00696-X/abstract" target="_blank">Randomised Controlled Trial published in American Journal of Kidney Diseases 2016</a></b><br />
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<b>Intervention: </b>Conventional (40 mL/kg/h) and high (80 mL/kg/h) doses of CVVHDF for the duration of CRRT<br />
<b>Results:</b> High-dose CVVHDF, but not the conventional dose, significantly reduced interleukin 6 (IL-6), IL-8, IL-1b, and IL-10 levels.<br />
<b>Conclusions</b><br />
High CVVHDF dose did not improve patient outcomes despite its significant influence on inflammatory cytokine removal. CRRT-induced immunomodulation may not be sufficient to influence clinical end points.<br />
<b>Personal view: </b>These patients are so sick, that these studies usually fail to find a change in the hard clinical end points. </div>
Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-39027576902833303582016-04-19T23:09:00.002-07:002016-04-19T23:09:37.629-07:00Monitoring children for upper tract damage in Myelodysplasia<div dir="ltr" style="text-align: left;" trbidi="on">
<a href="http://www.jurology.com/article/S0022-5347(09)60888-0/abstract" target="_blank">An interesting abstract from Turkey published in Journal of Urology 2009</a> on looking at the peak detrusor pressures and the risk of upper tract damage in these children. It challenges the McGuire study on leak point pressures published in 1981.<br />
Detrusor leak point pressure evolved from <a href="http://www.medscape.com/viewarticle/556480_2" target="_blank">the research of McGuire in the early 1980s</a> (McGuire, Woodside, Borden, & Weiss, 1981). McGuire, Woodside, and Borden (1983) studied a population of myelodysplastic children and noted a correlation between the DLPP and the likelihood of upper-tract deterioration. Of the 42 patients studied, 22 had DLPP > 40 cm H2O. In that group, vesicoureteral reflux occurred in 68% and ureteral dilatation in 81%. In long-term followup, patients with the DLPP > 40 cm H2O developed upper-tract deterioration at a rate of 100% (McGuire et al., 1983).<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEik9B0rupyHfBGIIWKjjGRl1TBKypW8ASM6x50iS9rhyphenhyphenjFFMmkc_W2KsNUiBtV0P5TEZJYxAu5rMl3HOs3kzVk0w4vht9xAD9OhOXEjWiCg40KakJgDXhASnG6y06Z72Mhkw5HrEJQccQ/s1600/urodinamica-abc-82-728.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEik9B0rupyHfBGIIWKjjGRl1TBKypW8ASM6x50iS9rhyphenhyphenjFFMmkc_W2KsNUiBtV0P5TEZJYxAu5rMl3HOs3kzVk0w4vht9xAD9OhOXEjWiCg40KakJgDXhASnG6y06Z72Mhkw5HrEJQccQ/s400/urodinamica-abc-82-728.jpg" width="400" /></a></div>
<a href="http://image.slidesharecdn.com/urodinamica-abc-101013100517-phpapp02/95/urodinamica-abc-82-728.jpg?cb=1286964540" target="_blank">Image Source</a></div>
Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-19371465572843573562016-04-07T23:15:00.004-07:002016-04-07T23:15:45.989-07:00Lichen Planus and Nephrotic syndrom<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMw7BKllKz32i1OHDiaV1j2ZalV5so2vsZHXAJoLa9NgGNAbo8o8-criap0-qmTueBbQz26eoH_BH0HhJsFFF53C4c8GdtZ6GQcZBqFtgsWdXHHJJB2o_FQlGb2xriH4d0pmflzCt_JQ/s1600/20160407_154610.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMw7BKllKz32i1OHDiaV1j2ZalV5so2vsZHXAJoLa9NgGNAbo8o8-criap0-qmTueBbQz26eoH_BH0HhJsFFF53C4c8GdtZ6GQcZBqFtgsWdXHHJJB2o_FQlGb2xriH4d0pmflzCt_JQ/s400/20160407_154610.jpg" width="400" /></a></div>
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<span style="color: #660000;">Today one of my old nephrotic syndrome child presented with skin lesions bilaterally symmetrical violaceous polygonal pruritic papules present over both upper limbs, diagnostic of lichen planus.</span><br />
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Coincidence of lichen planus in nephrotic syndrome may reflect common immunological abnormalities, based on altered cell mediated immunity. <a href="http://www.indianpediatrics.net/may2012/may-421.htm" target="_blank">It has already been reported from our friend Dr Sriram from JIPMER. </a> Lichen planus is a chronic inflammatory dermatological condition usually affecting adults, but rare in children. The diagnosis is essentially clinical.<br />
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-28836460118498388362016-04-07T22:31:00.001-07:002016-04-07T22:31:55.714-07:00Immunogenicity of HPV vaccine in CKD children<div dir="ltr" style="text-align: left;" trbidi="on">
Vaccination is must in all children especially with kidney disorders. <a href="http://cjasn.asnjournals.org/content/early/2016/04/06/CJN.09690915.abstract?papetoc" target="_blank"><i>CJASN today publishes an excellent study from Baltimore on HPV vaccination.</i></a><br />
The study shows that- Antibody response to the quadrivalent recombinant HPV vaccine was robust and sustained in girls and young women with CKD and on dialysis. A less robust response to the vaccine was observed among those with a kidney transplant.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZCmY7LJ_CDnsYLqLRKwml7w93VFuDj2CSqZbDSA0tgKrRgSMq_XFdAWj2vzgtxl3lLEoryZ7Zxo6wcgmT4HGWeW1EX9JEFunQhGxh-_vjbBe1Vc9fZkvmsmcN2vVrRHPCF9u5DcwbJg/s1600/Vaccination-Schedule-For-Children.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZCmY7LJ_CDnsYLqLRKwml7w93VFuDj2CSqZbDSA0tgKrRgSMq_XFdAWj2vzgtxl3lLEoryZ7Zxo6wcgmT4HGWeW1EX9JEFunQhGxh-_vjbBe1Vc9fZkvmsmcN2vVrRHPCF9u5DcwbJg/s200/Vaccination-Schedule-For-Children.jpg" width="200" /></a></div>
<a href="http://www.lifemartini.com/wp-content/uploads/2013/06/Vaccination-Schedule-For-Children.jpg" target="_blank">Image Source</a></div>
Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-80418995500222492912016-04-05T04:30:00.002-07:002016-04-05T22:17:58.115-07:00Eculizumab for aHUS: The first use in India<div dir="ltr" style="text-align: left;" trbidi="on">
We used Eculizumab in an American boy with aHUS, and kept him in remission, till his genetic results came back normal. This was the first time in the country, that someone used this drug, since it is very costly and not available in the country.<br />
<a href="http://www.indianjnephrol.org/temp/IndianJNephrol000-4680438_011800.pdf" target="_blank">We publish our experience today in Indian Journal of Nephrology </a>to raise the awareness about the treatment, and the difficulties faced in doing the right thing in the right way!<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3McvbI1P2UHUIV7WMTKqtBIEaOCjx1gB8tE-9L22bUgRqyhCN590zZs71N6Dl-tdRPfTFwYGqMskElnuRccol7r_VIxgf__Ew_Zp2hfwM7PoW-9SSvDf6muTgn_fd1Td1QJDef6yPKg/s1600/Figure-2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3McvbI1P2UHUIV7WMTKqtBIEaOCjx1gB8tE-9L22bUgRqyhCN590zZs71N6Dl-tdRPfTFwYGqMskElnuRccol7r_VIxgf__Ew_Zp2hfwM7PoW-9SSvDf6muTgn_fd1Td1QJDef6yPKg/s400/Figure-2.jpg" width="400" /></a></div>
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com0tag:blogger.com,1999:blog-11868978561493609.post-25156103671593825452016-03-28T23:30:00.000-07:002016-03-28T23:30:11.569-07:00Think together; kidney-liver-lung-spleen-heart-gut interactions<div dir="ltr" style="text-align: left;" trbidi="on">
Recent data from basic and clinical research have begun to elucidate complex organ interactions in AKI between kidney and distant organs, including heart, lung, spleen, brain, liver, and gut.<a href="http://www.kidney-international.org/article/S0085-2538(15)00128-3/fulltext" target="_blank"> This review</a> serves to update the topic of organ cross talk in AKI and focuses on potential therapeutic targets to improve patient outcomes during AKI-associated multiple organ failure.<br />
<i><a href="http://www.kidney-international.org/article/S0085-2538(15)00128-3/fulltext" target="_blank">Link to the Kidney International Article</a></i><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwdrEw5B6_n-LmDagYLnhfNIJ0FrNBQ0Q14p6-P-PJuedKsyUG-DM_jt3L1jy-a7GnY4tj6VdFW3_OWVdfzsbieIg6-7YgrhLjkE9qQ1FCD2PigKE5FBOWxgI3IxC1Q5nMjnajG1iXMg/s1600/gr1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="312" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwdrEw5B6_n-LmDagYLnhfNIJ0FrNBQ0Q14p6-P-PJuedKsyUG-DM_jt3L1jy-a7GnY4tj6VdFW3_OWVdfzsbieIg6-7YgrhLjkE9qQ1FCD2PigKE5FBOWxgI3IxC1Q5nMjnajG1iXMg/s400/gr1.jpg" width="400" /></a></div>
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com1tag:blogger.com,1999:blog-11868978561493609.post-15985462440098642002016-03-25T23:50:00.000-07:002016-03-25T23:50:26.784-07:00Fluid overload as an adverse marker for neonatal mortality<div dir="ltr" style="text-align: left;" trbidi="on">
<a href="http://www.ncbi.nlm.nih.gov/pubmed/26975386" target="_blank">Another study from Seoul</a>, shows that neonates with a higher percentage fluid overload and higher levels of serum creatinine at CRRT initiation showed poor outcomes. Early initiation of CRRT before the development of severe FO or azotemia might improve the outcomes of neonates requiring CRRT.<br />
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The survival rates of patients with an FO of ≥30 % at the time of CRRT initiation were lower than those of patients with an FO of <30 % at the same time-point.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwnk6nmJx02aZToB9YciwqDt_OY5_mtRLezBmVZWgGGOSRinkjqQZEsScZeSaL3i36qGeOmp2aB3YboSgaS97hpOGszqU8deU9c_VmuLMXVafwgOa_xT58CAMqyeW-XexDqjflijM_9A/s1600/12-goldstein-pediatric-crrt-dialysis-outcome-11-728.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwnk6nmJx02aZToB9YciwqDt_OY5_mtRLezBmVZWgGGOSRinkjqQZEsScZeSaL3i36qGeOmp2aB3YboSgaS97hpOGszqU8deU9c_VmuLMXVafwgOa_xT58CAMqyeW-XexDqjflijM_9A/s400/12-goldstein-pediatric-crrt-dialysis-outcome-11-728.jpg" width="400" /></a></div>
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<b><span style="color: #660000;">Early RRT may help in these sick children! </span></b></div>
Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com1tag:blogger.com,1999:blog-11868978561493609.post-49257881770875941812016-03-25T00:17:00.000-07:002016-03-25T00:17:13.528-07:00Ultilising FE-urea for differentiating types of AKI<div dir="ltr" style="text-align: left;" trbidi="on">
The fractional excretion of urea nitrogen (FEUN) is less influenced by furosemide, which inhibits sodium and chloride reabsorption at the thick ascending loop of Henle. In adults, FEUN has been shown to be a useful biomarker in the differential diagnosis of prerenal AKI and ATN, especially in patients receiving diuretic therapy.<br />
<i><a href="http://download.springer.com/static/pdf/363/art%253A10.1007%252Fs00467-016-3366-9.pdf?originUrl=http%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%2Fs00467-016-3366-9&token2=exp=1458891053~acl=%2Fstatic%2Fpdf%2F363%2Fart%25253A10.1007%25252Fs00467-016-3366-9.pdf%3ForiginUrl%3Dhttp%253A%252F%252Flink.springer.com%252Farticle%252F10.1007%252Fs00467-016-3366-9*~hmac=36c3e297f65b5c837a8db133286a90693b0ba9fb719ed93edbd42b3a9d6f716a" target="_blank">Current issue of Pediatric Nephrology</a></i> has an excellent paper on FE-urea vs FENa in children with AKI, and finding the etiology.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTTWcoIG7HajIdvajtSVwY0VzR0bjL-IvYZUNctPltMpihormhu7DN-7ofQF57glGha4m2rTPepK_35Koz2Y9P-bn0epN8931ogQytZdFGvpLujm0fzTzWPttAge1eUxG7hmdmgTyGCQ/s1600/feu.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTTWcoIG7HajIdvajtSVwY0VzR0bjL-IvYZUNctPltMpihormhu7DN-7ofQF57glGha4m2rTPepK_35Koz2Y9P-bn0epN8931ogQytZdFGvpLujm0fzTzWPttAge1eUxG7hmdmgTyGCQ/s320/feu.jpg" width="320" /></a></div>
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Anonymoushttp://www.blogger.com/profile/03806207678777937163noreply@blogger.com2