Invited to "Narayan Health" for "Symposium on Pediatric Liver Transplantation"

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".

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.

It shall also be an honor to talk after well renowned Pediatric transplant physicians of the country!

What should be the dose of CRRT in patients with sepsis?

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.

Randomised Controlled Trial published in American Journal of Kidney Diseases 2016

Intervention: Conventional (40 mL/kg/h) and high (80 mL/kg/h) doses of CVVHDF for the duration of CRRT
Results: High-dose CVVHDF, but not the conventional dose, significantly reduced interleukin 6 (IL-6), IL-8, IL-1b, and IL-10 levels.
Conclusions
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.
Personal view: These patients are so sick, that these studies usually fail to find a change in the hard clinical end points. 

Monitoring children for upper tract damage in Myelodysplasia

An interesting abstract from Turkey published in Journal of Urology 2009 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.
Detrusor leak point pressure evolved from the research of McGuire in the early 1980s (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).

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Lichen Planus and Nephrotic syndrom

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.

Coincidence of lichen planus in nephrotic syndrome may reflect common immunological abnormalities, based on altered cell mediated immunity. It has already been reported from our friend Dr Sriram from JIPMER.  Lichen planus is a chronic inflammatory dermatological condition usually affecting adults, but rare in children. The diagnosis is essentially clinical.

Immunogenicity of HPV vaccine in CKD children

Vaccination is must in all children especially with kidney disorders. CJASN today publishes an excellent study from Baltimore on HPV vaccination.
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.

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Eculizumab for aHUS: The first use in India

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.
We publish our experience today in Indian Journal of Nephrology to raise the awareness about the treatment, and the difficulties faced in doing the right thing in the right way!