Wednesday, June 22, 2016

Lung ultrasound in Pediatric Fluid Overload

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.

An excellent study published in Pediatric Nephrology on the same 

Tuesday, June 14, 2016

Importance of NINJA in Pediatric Nephrology

Current issue of Kidney International shows an excellent study from Dr Goldstein's group, Cincinatti. It talks on development and validation of a systematic screening program called Nephrotoxic Injury Negated by Just-in-time Action (NINJA), 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.

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).

This figure shows improvement in exposure rates following NINJA. 

Behavioural abnormalities and Mutations in children with CKD

We very commonly see children with CKD and ESRD with behavioural problems and autistic features and CAKUT. Current issue of Kidney International nicely shows the 17q12 deletions but not HNF1B intragenic mutations are associated with neurodevelopmental disorders.

Otherwise, Heterozygous mutations of the HNF1B gene are the commonest known monogenic cause of developmental kidney disease.