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Reinders JJ, Krijnen W. Interprofessional identity and motivation towards interprofessional collaboration. Med Educ 2023; 57:1068-1078. [PMID: 37073763 DOI: 10.1111/medu.15096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION It is unknown whether interprofessional identity is able to explain interprofessional behaviours. Extended professional identity theory provides clues by combining two psychological identity approaches. The aim of this study is to investigate whether interprofessional identity is a source for intrinsic motivation towards interprofessional collaboration related to wider group membership. METHODS Participants of this double-blinded study were 47 dentistry and 41 dental hygiene students (86.3% response) without interprofessional education (IPE) experience. Group productivity was used as indicator of group effort and equal communication as indication for interprofessional direction. The extended professional identity scale (EPIS) was used to measure interprofessional identity eight weeks prior to a mandatory IPE course. Based on EPIS levels, students were assigned to a low or high interprofessional identity group condition. Subsequently, 12 interprofessional teams (four to five members) were randomly composed per condition. Each group received eight problems (regarding roles, responsibilities and collaborative practice) for which they were expected to provide up to 10 solutions. Six trained psychologists rated the validity of solutions after which the percentage of solutions per group was calculated. Additionally, the psychologists rated interprofessional direction by observing team communication (asking questions, topic control, prosocial formulations, and speech frequency) during the second group meeting. RESULTS No interprofessional identity differences were found with regard to gender and profession. The mean difference between groups with low versus high interprofessional identity was 0.5 (M = 3.4; SD = 0.5 and M = 3.9, SD = 0.4, respectively), t = -5.880, p < 0.001. Groups with high identity generated more solutions compared to low identity groups (91.5% vs. 86.4%), t = -2938, p = 0.004. The correlation between individual interprofessional identity and group effort was significant, r = 0.22, p = 0.036. Groups with high identity showed more interprofessional direction, t = -2.160, p = 0.034. DISCUSSION Interprofessional identity has a positive effect on congruent interprofessional behaviours after 10 weeks. More research is required to understand interprofessional identity in relation to performance in education and work.
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Affiliation(s)
- Jan-Jaap Reinders
- Research Group IPE, LEARN, Research Institute SHARE, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Research Group on Interprofessional Identity and Collaboration, Kaunas University of Applied Sciences, Kaunas, Lithuania
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Wim Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
- Undergraduate School of Science and Engineering, Faculty of Science and Engineering, University of Groningen, Groningen, Netherlands
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2
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Resta E, Mula S, Baldner C, Di Santo D, Agostini M, Bélanger JJ, Gützkow B, Kreienkamp J, Abakoumkin G, Khaiyom JHA, Ahmedi V, Akkas H, Almenara CA, Atta M, Bagci SC, Basel S, Kida EB, Bernardo ABI, Buttrick NR, Chobthamkit P, Choi HS, Cristea M, Csaba S, Damnjanović K, Danyliuk I, Dash A, Douglas KM, Enea V, Faller DG, Fitzsimons GJ, Gheorghiu A, Gómez Á, Hamaidia A, Han Q, Helmy M, Hudiyana J, Jeronimus BF, Jiang DY, Jovanović V, Kamenov Z, Kende A, Keng SL, Kieu TTT, Koc Y, Kovyazina K, Kozytska I, Krause J, Kruglanski AW, Kurapov A, Kutlaca M, Lantos NA, Lemay EP, Lesmana CBJ, Louis WR, Lueders A, Malik NI, Martinez AP, McCabe KO, Mehulić J, Milla MN, Mohammed I, Molinario E, Moyano M, Muhammad H, Muluk H, Myroniuk S, Najafi R, Nisa CF, Nyúl B, O'Keefe PA, Osuna JJO, Osin EN, Park J, Pica G, Pierro A, Rees JH, Reitsema AM, Rullo M, Ryan MK, Samekin A, Santtila P, Sasin E, Schumpe BM, Selim HA, Stanton MV, Stroebe W, Sultana S, Sutton RM, Tseliou E, Utsugi A, van Breen JA, van Lissa CJ, van Veen K, van Dellen MR, Vázquez A, Wollast R, Yeung VWL, Zand S, Žeželj IL, Zheng B, Zick A, Zúñiga C, Leander NP. 'We are all in the same boat': How societal discontent affects intention to help during the COVID-19 pandemic. J Community Appl Soc Psychol 2021; 32:332-347. [PMID: 34898961 PMCID: PMC8653108 DOI: 10.1002/casp.2572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/27/2021] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID‐19) pandemic has caused a global health crisis. Consequently, many countries have adopted restrictive measures that caused a substantial change in society. Within this framework, it is reasonable to suppose that a sentiment of societal discontent, defined as generalized concern about the precarious state of society, has arisen. Literature shows that collectively experienced situations can motivate people to help each other. Since societal discontent is conceptualized as a collective phenomenon, we argue that it could influence intention to help others, particularly those who suffer from coronavirus. Thus, in the present study, we aimed (a) to explore the relationship between societal discontent and intention to help at the individual level and (b) to investigate a possible moderating effect of societal discontent at the country level on this relationship. To fulfil our purposes, we used data collected in 42 countries (N = 61,734) from the PsyCorona Survey, a cross‐national longitudinal study. Results of multilevel analysis showed that, when societal discontent is experienced by the entire community, individuals dissatisfied with society are more prone to help others. Testing the model with longitudinal data (N = 3,817) confirmed our results. Implications for those findings are discussed in relation to crisis management. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.
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Affiliation(s)
- Elena Resta
- Department of Developmental and Social Psychology Sapienza University of Rome Rome Italy
| | - Silvana Mula
- Department of Developmental and Social Psychology Sapienza University of Rome Rome Italy
| | - Conrad Baldner
- Department of Developmental and Social Psychology Sapienza University of Rome Rome Italy
| | - Daniela Di Santo
- Department of Developmental and Social Psychology Sapienza University of Rome Rome Italy
| | | | | | - Ben Gützkow
- Department of Psychology University of Groningen Groningen Netherlands
| | - Jannis Kreienkamp
- Department of Psychology University of Groningen Groningen Netherlands
| | - Georgios Abakoumkin
- Laboratory of Psychology, Department of Early Childhood Education University of Thessaly Volos Greece
| | | | | | - Handan Akkas
- Business Administration Department Ankara Science University Ankara Turkey
| | - Carlos A Almenara
- Faculty of Health Science Universidad Peruana de Ciencias Aplicadas Santiago de Surco Peru
| | - Mohsin Atta
- Department of Psychology University of Sargodha Sargodha Pakistan
| | | | - Sima Basel
- Department of Social Sciences New York University Abu Dhabi Abu Dhabi UAE
| | | | | | - Nicholas R Buttrick
- Department of Psychology University of Virginia Charlottesville Virginia USA
| | | | - Hoon-Seok Choi
- Department of Psychology Sungkyunkwan University Seoul South Korea
| | - Mioara Cristea
- Department of Psychology Heriot Watt University Edinburgh Scotland
| | - Sara Csaba
- Doctoral School of Psychology ELTE Eötvös Loránd University Budapest Hungary
| | | | - Ivan Danyliuk
- Department of Psychology Taras Shevchenko National University of Kyiv Kyiv Ukraine
| | - Arobindu Dash
- Department of Social Sciences International University of Business Agriculture and Technology Dhaka Bangladesh
| | | | - Violeta Enea
- Department of Psychology Alexandru Ioan Cuza University Iași Romania
| | | | | | - Alexandra Gheorghiu
- Center for European Studies, Faculty of Law Alexandru Ioan Cuza University Iași Romania
| | - Ángel Gómez
- Social and Organizational Psychology Universidad Nacional de Educación a Distancia Madrid Spain
| | - Ali Hamaidia
- Psychology/ Research Unit Human Resources Development Setif 2 University Sétif Algeria
| | - Qing Han
- The School of Psychological Science University of Bristol Bristol UK
| | - Mai Helmy
- Psychology Department, College of Education Sultan Qaboos University Muscat Oman.,Psychology Department Faculty of Arts, Menoufia University Shebin El-Kom Egypt
| | | | | | - Ding-Yu Jiang
- Department of Psychology National Chung-Cheng University Chiayi Taiwan
| | | | - Zeljka Kamenov
- Faculty of Humanities and Social Sciences University of Zagreb Zagreb Croatia
| | - Anna Kende
- Department of Social Psychology ELTE Eötvös Loránd University Budapest Hungary
| | - Shian-Ling Keng
- Division of Social Science Yale-NUS College Singapore Singapore
| | - Tra Thi Thanh Kieu
- Department of Psychology HCMC University of Education Ho Chi Minh City Vietnam
| | - Yasin Koc
- Department of Psychology University of Groningen Groningen Netherlands
| | | | - Inna Kozytska
- Department of Psychology Taras Shevchenko National University of Kyiv Kyiv Ukraine
| | - Joshua Krause
- Department of Psychology University of Groningen Groningen Netherlands
| | - Arie W Kruglanski
- Department of Psychology University of Maryland College Park Maryland USA
| | - Anton Kurapov
- Department of Psychology Taras Shevchenko National University of Kyiv Kyiv Ukraine
| | - Maja Kutlaca
- Department of Psychology Durham University Durham UK
| | - Nóra Anna Lantos
- Department of Social Psychology ELTE Eötvös Loránd University Budapest Hungary
| | - Edward P Lemay
- Department of Psychology University of Maryland College Park Maryland USA
| | | | | | - Adrian Lueders
- Department of Psychology University of Limerick Limerick Ireland
| | | | | | - Kira O McCabe
- Department of Psychology Carleton University Ottawa Ontario Canada
| | - Jasmina Mehulić
- Faculty of Humanities and Social Sciences University of Zagreb Zagreb Croatia
| | - Mirra Noor Milla
- Department of Psychology Universitas Indonesia Kota Depok Indonesia
| | - Idris Mohammed
- Mass Communication Usmanu Danfodiyo University Sokoto Sokoto Nigeria
| | - Erica Molinario
- Department of Psychology Florida Gulf Coast University Fort Myers Florida USA
| | - Manuel Moyano
- Department of Psychology University of Cordoba Córdoba Spain
| | - Hayat Muhammad
- Department of Psychology University of Peshawar Peshawar Pakistan
| | - Hamdi Muluk
- Department of Psychology Universitas Indonesia Kota Depok Indonesia
| | - Solomiia Myroniuk
- Department of Psychology University of Groningen Groningen Netherlands
| | - Reza Najafi
- Department of Psychology Islamic Azad University, Rasht Branch Rasht Iran
| | - Claudia F Nisa
- Department of Psychology New York University Abu Dhabi Abu Dhabi UAE
| | - Boglárka Nyúl
- Department of Social Psychology ELTE Eötvös Loránd University Budapest Hungary
| | - Paul A O'Keefe
- Division of Social Science Yale-NUS College Singapore Singapore.,Department of Management and Organisation National University of Singapore Business School Singapore Singapore
| | - Jose Javier Olivas Osuna
- Department of Political Science and Administration National Distance Education University (UNED) Madrid Spain
| | - Evgeny N Osin
- Department of Psychology HSE University Moscow Russia
| | - Joonha Park
- Graduate School of Management NUCB Business School Nagoya Japan
| | - Gennaro Pica
- School of Law University of Camerino Camerino Italy
| | - Antonio Pierro
- Department of Developmental and Social Psychology Sapienza University of Rome Rome Italy
| | - Jonas H Rees
- Research Institute Social Cohesion, Institute for Interdisciplinary Research on Conflict and Violence, Department of Social Psychology University of Bielefeld Bielefeld Germany
| | - Anne Margit Reitsema
- Department of Developmental Psychology University of Groningen Groningen Netherlands
| | - Marika Rullo
- Department of Educational, Humanities and Intercultural Communication University of Siena Siena Italy
| | - Michelle K Ryan
- Psychology University of Exeter Exeter UK.,Faculty of Economics and Business University of Groningen Groningen Netherlands
| | - Adil Samekin
- School of Liberal Arts M. Narikbayev KAZGUU University Nur-Sultan Kazakhstan
| | - Pekka Santtila
- Department of Psychology New York University Shanghai Shanghai China
| | - Edyta Sasin
- Department of Psychology New York University Abu Dhabi Abu Dhabi UAE
| | - Birga M Schumpe
- Faculty of Social and Behavioural Sciences University of Amsterdam Amsterdam Netherlands
| | - Heyla A Selim
- Department of Psychology King Saud University Riyadh Saudi Arabia
| | | | - Wolfgang Stroebe
- Department of Psychology University of Groningen Groningen Netherlands
| | - Samiah Sultana
- Department of Psychology University of Groningen Groningen Netherlands
| | | | - Eleftheria Tseliou
- Laboratory of Psychology, Department of Early Childhood Education University of Thessaly Volos Greece
| | - Akira Utsugi
- Graduate School of Humanities Nagoya University Nagoya Japan
| | - Jolien A van Breen
- Institute of Governance and Global Affairs Leiden University Leiden Netherlands
| | - Caspar J van Lissa
- Department of Methodology & Statistics Utrecht University Utrecht Netherlands
| | - Kees van Veen
- Sustainable Society University of Groningen Groningen Netherlands
| | | | - Alexandra Vázquez
- Social and Organizational Psychology Universidad Nacional de Educación a Distancia Madrid Spain
| | - Robin Wollast
- Laboratoire de Psychologie Sociale et Cognitive Université Clermont-Auvergne Clermont-Ferrand France
| | | | - Somayeh Zand
- Department of Psychology Islamic Azad University, Rasht Branch Rasht Iran
| | - Iris Lav Žeželj
- Department of Psychology University of Belgrade Belgrade Serbia
| | - Bang Zheng
- Ageing Epidemiology Research Unit, School of Public Health, Faculty of Medicine Imperial College London London UK
| | - Andreas Zick
- Institute for Interdisciplinary Research on Conflict and Violence (IKG) Bielefeld University Bielefeld Germany
| | - Claudia Zúñiga
- Department of Psychology Universidad de Chile Santiago Chile
| | - N Pontus Leander
- Department of Psychology University of Groningen Groningen Netherlands
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Bagci SC, Turnuklu A, Tercan M. Positive intergroup contact decreases the likelihood that prejudicial attitudes become avoidant behavioral tendencies. Eur J Soc Psychol 2020. [DOI: 10.1002/ejsp.2646] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cárdenas D, de la Sablonnière R. Participating in a new group and the identification processes: The quest for a positive social identity. Br J Soc Psychol 2020; 59:189-208. [PMID: 31603256 PMCID: PMC6972616 DOI: 10.1111/bjso.12340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 08/31/2019] [Indexed: 11/30/2022]
Abstract
Immigrants experience identity shifts; they can identify with the new cultural group and, sometimes, identify less with their group of origin. Previous research suggests that participation in the new cultural group predicts these two identity shifts. However, these studies have exclusively used correlational methodologies. Furthermore, previous research ignored that when a group is negatively valued, individuals may not identify with it, even after participating in it, to preserve a positive social identity. This article tests with an experimental methodology whether participation recreated the identity shifts previously identified (greater identification with the new group and lower identification with the group of origin when perceiving dissimilarity). Furthermore, it tested how a group's value impacted these identity shifts following participation. Immigrants in Quebec (N = 184) either participated in Quebec's culture (watched hockey) or did not (watched basketball). Quebec's value was manipulated by changing whether Quebec won, tied, or lost the game. Compared to watching basketball, watching Quebec's team win or tie showed the hypothesized identity shifts, illustrating the importance of the new group's value when participating.
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5
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Thijs J, Keim AC, Geerlings J. Classroom identification in ethnic minority and majority students: Effects of relationships and ethnic composition. Br J Educ Psychol 2018; 89:707-725. [PMID: 30367456 PMCID: PMC6899858 DOI: 10.1111/bjep.12253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 10/02/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many studies have shown that school belonging is crucial for students' school adjustment, but the construct has been operationalized in different ways. Moreover, most research has focused on adolescents and not compared its antecedents for ethnic minority versus majority students. AIMS Based on Goodenow and Grady's (1993) seminal paper, we examined classroom identification as a central aspect of school belonging in minority and majority preadolescents, and predicted it from relationships with peers and teachers, taking into account classroom ethnic composition and perceived multicultural teaching. SAMPLE Participants were 485 grade 4-6 students from 39 classrooms in Dutch primary schools. Of these children, 68 had a Turkish background, 72 had a Moroccan background, and 345 had a native Dutch background. METHODS Participants completed questionnaires at two waves (4.5 months apart). We used self-reports to measure classroom identification at both waves, and student-teacher relationship closeness and conflict, multicultural teaching, and peer friendship and rejection at Wave 1. We conducted multilevel analyses to predict classroom identification at Wave 2, while controlling for classroom identification at Wave 1. RESULTS Children of all ethnicities reported more classroom identification over time if they were less rejected by their peers and had more co-ethnic classmates. For minority children, both closeness and conflict with the teacher predicted less identification, but the effect of conflict appeared to result from their ethnic underrepresentation in the classroom. CONCLUSIONS Negative peer relationships can undermine classroom identification, and the student-teacher relationship has special significance for ethnic minority students.
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Affiliation(s)
| | - Abigail C Keim
- The Pennsylvania State University, State College, Pennsylvania, USA
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Connor A, Highton J, Hung NA, Dunbar J, MacGinley R, Walker R. Multicentric carpal-tarsal osteolysis with nephropathy treated successfully with cyclosporine A: a case report and literature review. Am J Kidney Dis 2007; 50:649-54. [PMID: 17900466 DOI: 10.1053/j.ajkd.2007.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2006] [Accepted: 06/01/2007] [Indexed: 11/11/2022]
Abstract
Multicentric carpal-tarsal osteolysis is a rare skeletal disorder characterized by osteolysis of the metacarpal, carpal, and tarsal bones and leading to crippling joint deformities. Progressive nephropathy occurs in more than half the cases. All previously reported series with renal biopsies showed only end-stage renal disease on histological examination because of the late presentation to nephrologists. Accurate diagnosis of the underlying renal pathological state therefore has not been possible. We report the first case in which early and sequential renal biopsies were performed. These show the renal lesion to be focal and segmental glomerulosclerosis, which was treated successfully with cyclosporine A.
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Affiliation(s)
- Andrew Connor
- Department of Medical and Surgical Sciences, University of Otago School of Medicine, Dunedin, New Zealand.
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Faber MR, Verlaak R, Fiselier TJW, Hamel BCJ, Franssen MJAM, Gerrits GPJM. Inherited multicentric osteolysis with carpal-tarsal localisation mimicking juvenile idiopathic arthritis. Eur J Pediatr 2004; 163:612-8. [PMID: 15290262 DOI: 10.1007/s00431-004-1502-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED Five patients with multicentric carpal-tarsal osteolysis are presented: a mother and her three children with an autosomal dominant mode of inheritance and one of the children with nephropathy, the fifth a sporadic case also with renal involvement. The main findings common to these five patients are symptoms and signs simulating arthritis of the wrists and/or ankles starting at a young age and mimicking juvenile idiopathic arthritis. Early signs of osteolysis and shortening of the carpus or tarsus are radiological characteristic. The disease may be associated with a peculiar face, but most importantly with nephropathy. The pathogenesis is still unknown. CONCLUSION Recognition of this disease and differentiation from juvenile idiopathic arthritis is important to avoid unnecessary investigations and treatment. Follow-up of renal function is indicated.
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Affiliation(s)
- Marianne R Faber
- Department of Paediatrics, University Medical Centre Nijmegen, Nijmegen, The Netherlands
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8
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Abstract
The primary cause of nephropathy in idiopathic multicentric osteolysis is as yet unknown. We report a young girl with idiopathic multicentric osteolysis and nephropathy. An abnormal glomerular basement membrane was the only abnormality found in a renal biopsy taken 2 years before the development of end-stage renal failure. We believe that this biopsy finding represents or is related to the unknown primary lesion causing nephropathy in idiopathic multicentric osteolysis.
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Affiliation(s)
- S J Bakker
- Department of Nephrology, University Hospital Maastricht, The Netherlands
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9
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Costa MM, Santos H, Santos MJ, Medeira A, Da Costa T, De Queiroz V. Idiopathic multicentric osteolysis: a rare disease mimicking juvenile chronic arthritis. Clin Rheumatol 1996; 15:97-8. [PMID: 8929789 DOI: 10.1007/bf02231698] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M M Costa
- Department of Rheumatology and Genetics, Hospital Santa Maria, Lisboa, Portugal
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Abstract
We describe a type III carpotarsal osteolysis patient with nephropathy who has been maintained on chronic hemodialysis for 12 years. The diagnosis of osteolysis was based on x-ray findings and bone biopsy. At the age of 12 years, she developed renal disease that progressed; she was placed on chronic dialysis at the age of 18 years. Blood pressure was controlled by a medical regimen, and her anemia has benefitted from erythropoietin up to a level of 28% to 30%. Her osteolysis has stabilized since the age of 20 years; she is presently 30 years old. The major problem affecting the patient's clinical outcome is hyperphosphatemia.
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Affiliation(s)
- S I Borra
- Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY 11203, USA
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Tirelli AS, Paterlini G, Ghio L, Edefonti A, Assael BM, Bettinelli A, Cavanna G, Sereni F. Renal effects of cyclosporin A in children treated for idiopathic nephrotic syndrome. Acta Paediatr 1993; 82:463-8. [PMID: 8518523 DOI: 10.1111/j.1651-2227.1993.tb12723.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Little data have been published on tubular renal function during cyclosporin A treatment in children without transplants. We studied 12 young subjects (mean age 10 years) with steroid-responsive idiopathic nephrotic syndrome and with signs of steroid toxicity. After achieving remission with prednisone 60 mg/m2, 8 children started cyclosporin A therapy (6 mg/kg/day) (group A) and 4 children were given cyclophosphamide 2.5 mg/kg/day (group B). The latter were considered as controls together with 10 other children with idiopathic nephrotic syndrome in complete remission and off therapy (group C). We monitored creatinine clearance and tubular handling of beta 2-microglobulin, sodium, phosphorus and uric acid for one year. Cyclosporin A induced a decrease in creatinine clearance with a decrease in fractional excretion of beta 2-microglobulin; sodium excretion was similar in the two treated groups and a transient decrease in fractional excretion of uric acid was seen only in patients receiving cyclosporin A. Both groups showed an increased renal threshold phosphate concentration. Our results suggest that in children, cyclosporin A therapy induces a decrease in glomerular filtration rate associated with increased reabsorption activity of proximal tubular cells.
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Affiliation(s)
- A S Tirelli
- Department of Pediatrics, University of Milan, Italy
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Abstract
Eight patients with Alport's syndrome and massive proteinuria (129 +/- 60.57 mg/m2 per hour) were treated with cyclosporin A (CyA) for 8 months. The average dose of CyA administered to all patients was 4.21 +/- 0.26 mg/kg per day and blood CyA levels of 63.4 +/- 4.1 ng/ml were attained. In five patients, proteinuria abated during the 3rd week of treatment. In the remaining three, all of whom had low creatinine clearance (82.0, 46.0 and 43.2 ml/min per 1.73 m2 respectively), proteinuria persisted but at levels lower than before treatment: 32.5 +/- 15.9 mg/m2 per hour versus 183.3 +/- 29.7 mg/m2 per hour. No permanent decrease in creatinine clearance was observed in any of these patients throughout treatment. In those patients in whom proteinuria abated, it reappeared 2 weeks after discontinuation of CyA treatment. We observed no significant increases in angiotensin II plasma levels in our patients during CyA administration. Although we have shown that CyA will reduce massive proteinuria in patients with Alport's syndrome, we cannot yet recommend its use as a therapeutic measure.
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Affiliation(s)
- L Callís
- Department of Paediatric Nephrology, Hospital Materno-Infantil Vall d'Hebrón, Barcelona, Spain
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13
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Abstract
Therapeutic guidelines are not available for children with minimal change nephrotic syndrome (MCNS) who experience frequent relapses or develop steroid resistance after a course of cytotoxic therapy. The records of nine children with biopsy-proven MCNS who received two courses of cytotoxic therapy with either chlorambucil or cyclophosphamide were reviewed to evaluate the length of remission, associated side-effects and long-term outcome. Initial cytotoxic therapy was given to five frequent-relapsing patients and four steroid-resistant patients 2-48 months (mean 16 months) following diagnosis of nephrotic syndrome. The second drug was given 4-85 months (mean 27 months) after the first. Steroid-resistant patients attained remissions of 0-81 months (mean 23 months) following the first agent and 13-67 months (mean 32 months) following the second. Frequent-relapsing patients experienced remissions of 0.5-24 months (mean 7.4 months) following the first cytotoxic drug and 3-72 months (mean 22 months) after the second. Remissions following the second agent were equal to or longer than those following the first in the seven patients who received both chlorambucil and cyclophosphamide. In the 19- to 128-month follow-up (mean 66 months), all four steroid-resistant patients experienced infrequent relapses which responded to prednisone. One frequent-relapsing patient remains in remission, three have chronic proteinuria and one still has a frequent-relapsing course. For the select group of patients who become frequent relapsing or steroid resistant after one course of cytotoxic therapy, a second course of cytotoxic therapy may allow time for catch-up growth, as well as improve steroid responsiveness once relapses occur.
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Affiliation(s)
- D P Jones
- LeBonheur Children's Medical Center, Department of Pediatrics, Memphis, TN
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14
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Abstract
Idiopathic multicentric osteolysis is a rare skeletal disorder, usually presenting in early childhood with a clinical picture mimicking juvenile rheumatoid arthritis. Progressive destruction of the carpal and tarsal bones usually occurs and other bones may also be involved. Chronic renal failure is a frequent component of this syndrome. Mental retardation and minor facial abnormalities have been noted in some patients. We report on 2 unrelated, sporadic cases, one with facial anomalies and the other with nephropathy. Our second patient is the first black child to be diagnosed with this disease. The mode of presentation, differential diagnosis, and natural history of this disorder are briefly reviewed.
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Affiliation(s)
- G S Pai
- Department of Pediatrics, Medical University of South Carolina, Charleston 29425
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Abstract
Thirty-five children (12 girls, 23 boys), aged from 1 year and 5 months to 14 years at the onset of idiopathic nephrotic syndrome, received cyclosporin A (CyA) because of steroid toxicity or failure to respond to steroids. The initial oral dose was 6 mg/kg per day and this was adjusted to obtain trough plasma levels of 50-150 ng/ml. The duration of treatment was between 2 and 8 months. In patients who responded to CyA treatment, the dosage was tapered off; treatment was stopped if found to be ineffective. Of the 35 children, 20 were frequent-relapsing steroid responders who suffered serious side-effects from steroid therapy. Seventeen of them either went into remission or did not relapse despite the withdrawal of prednisone. Prednisone doses could be lowered but not stopped in 1 patient and the remaining 2 patients relapsed when prednisone was tapered off. At the final examination, 10 of the 12 children in whom CyA was tapered off and who had initially responded to CyA had relapsed. A second course was given to these 10 patients and 3 failed to respond. Five children were partial steroid responders and CyA induced a remission in 1 and a partial remission in another. Among the 10 children who were steroid resistant, only 1 responded to CyA, 2 had a partial response and 7 failed to respond to CyA. A reduction of glomerular filtration rate occurred in 8 patients, 7 of whom had either persistent nephrotic syndrome or were in relapse, which suggests that factors other than CyA nephrotoxicity may have been operative. Complete reversal occurred in only 4 patients. Significant histological changes, likely to be related to CyA, were seen in 2 repeat renal biopsies out of the 11 performed.
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Affiliation(s)
- P Niaudet
- Service de Néphrologie Pédiatrique, Hôpital Necker Enfants-Malades, Paris, France
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