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.

Kidney transplantation in children with congenital anamolies: improved outcomes

Congenital uropathy included chronic pyelonephritis/reflux, prune belly syndrome and congenital obstructive uropathy. Congenital pediatric kidney disease included polycystic kidney disease, hypoplasia, dysplasia, dysgenesis, agenesis and familial nephropathy.

Analysis of trends in the last 14 years in SRTR (Scientific Registry of Transplant Recipients)demonstrates that patients with both lower and upper tract congenital anomalies experienced delayed time to the first renal transplant. Furthermore, patients had similar age matched graft and patient survival whether the primary source of renal demise was the congenital lower or upper tract. These findings may indicate that improved urological and nephrological care are promoting renal preservation in both groups.

Encouraging indeed! 

Take home message: 
Important to screen CAKUT and manage them well early to prevent renal deterioration. 

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) .

Need for more studies on drug monitoring of MMF

As Pediatric Nephrologists, we do not do routing therapeutic drug monitoring of MMF, and neither it is available as a part of routine lab test. Current edition of Pediatric Nephrology reviews this topic, and makes us feel that maybe we should be doing more studies on this aspect, and do this in addition to Tacrolimus in Pediatric renal transplantation in the world.

The paper says- ' In terms of short-term efficacy, there is strong evidence that a MPA area under the time-concentration curve of >30 mg × h/L reduces acute rejection episodes early after renal transplantation, and there is evolving evidence that aiming for the same exposure over the long term may be a viable strategy to reduce the formation of donor-specific antibodies.'
Link to the Original Review
Image Source