Free Online articles on Pediatric Nephrology

This month ERA-EDTA provides free online articles for all for childhood renal disorders.

Following are my favourites:

• Editorial on "World Kidney Day"
• Excellent prospective study on biomarkers and renal angina index in critically ill children by Dr Goldstein's group
• A chapter on Pediatric AKI by Dr Rees
• A chapter on Pediatric transplantation by Dr Minnie Sarwal
• Plasmapheresis experience from CMC Vellore, India
• A chapter on Pediatric Hypertension

CMV prophylaxis in Pediatric Renal Transplantation

This week's Transplantation journal has an excellent study on CMV prophylaxis in pediatric renal transplantation.
It shows:

• chemoprophylaxis was associated with a better preservation of transplant function at 3 years posttransplant
• CMV replication was associated with a more pronounced decline of graft function 

Conclusions: Antiviral chemoprophylaxis with VGCV or GCV in recipients with a high or moderate CMV risk is associated with a better preservation of transplant function. Hence, the prevention of CMV replication in this patient population has the potential to improve transplant outcome.

Seven steps for physicians taking care of children undergoing any transplant

A recent paper published in Pediatric Transplantation from UK elegantly discusses 7 steps for every physician taking care of a child post transplantation,whether it is liver/ bone marrow/ stem cell.

1. Renal function should be monitored regularly in organ transplant recipients, utilizing assessment of serum creatinine
   
2. Also by cystatin C
3. GFR should be calculated using the new Schwartz formula. 
4. Transplant physicians should also monitor blood pressure using automated oscillometric devices and 
5. Confirm repeated abnormal measures with manual blood pressure readings and ambulatory 24-h blood pressure monitoring. 
6. Proteinuria and microalbuminuria should also be assessed regularly. 
7. Referrals to a pediatric nephrologist should be made for non-renal organ transplant recipients with repeated blood pressures >95th percentile using the Fourth Task Force reference intervals, microalbumin/creatinine ratio >32.5 mg/g (3.7 mg/mmol) creatinine on repeated testing and/or GFR <90 mL/min/1.73 m(2) .

Diagnosing CKD early: supAR

It's interesting to read todays's correspondence in NEJM and thoughts that suPAR might be an early marker of CKD in patients in the long run. Though we are still waiting for evidence, and also suPAR in multiple type of renal disorders.