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Ménétrey A, Landolt MA, Buettcher M, Neuhaus TJ, Simma L. Vaccine Hesitancy in Central Switzerland: Identifying and Characterizing Undervaccinated Children in a Pediatric Emergency Department. Pediatr Rep 2023; 15:710-721. [PMID: 38133432 PMCID: PMC10747840 DOI: 10.3390/pediatric15040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Vaccinations play an important role in the prevention of potentially fatal diseases. Vaccine hesitancy has become an important problem both in the public discourse and for public health. We aimed to identify and characterize this potentially unvaccinated or incompletely vaccinated group of children presenting to the pediatric emergency department (PED) of the tertiary children's hospital in central Switzerland, a region that has anecdotally been claimed as a hotspot for vaccine hesitancy. All patients presenting to the PED (N = 20,247) between September 2018 and September 2019 were screened for their vaccination status and categorized as incomplete, unvaccinated, or fully vaccinated in a retrospective cohort study. Some 2.6% (n = 526) visits to the PED were not or incompletely vaccinated according to age, or their vaccination status was unknown. Most of the children in the cohort were not critically ill, and the minority had to be hospitalized. Undervaccinated patients were overrepresented in rural areas. Of all cohort visits, 18 (3.4%) patients received opportunistic vaccination in the PED. No cases of vaccine-preventable diseases were observed. In summary, incompletely vaccinated and unvaccinated status was less frequent than initially expected. The PED may play a role in increasing vaccination coverage by providing opportunistic vaccinations.
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Affiliation(s)
- Anika Ménétrey
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
- Department of Neurology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Markus A. Landolt
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Michael Buettcher
- Pediatric Infectious Diseases Unit, Children’s Hospital Lucerne, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland;
- Department of Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Thomas J. Neuhaus
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Leopold Simma
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland
- Emergency Department, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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Metry EL, Garrelfs SF, Deesker LJ, Acquaviva C, D’Ambrosio V, Bacchetta J, Beck BB, Cochat P, Collard L, Hogan J, Ferraro PM, Franssen CF, Harambat J, Hulton SA, Lipkin GW, Mandrile G, Martin-Higueras C, Mohebbi N, Moochhala SH, Neuhaus TJ, Prikhodina L, Salido E, Topaloglu R, Oosterveld MJ, Groothoff JW, Peters-Sengers H. Determinants of Kidney Failure in Primary Hyperoxaluria Type 1: Findings of the European Hyperoxaluria Consortium. Kidney Int Rep 2023; 8:2029-2042. [PMID: 37849991 PMCID: PMC10577369 DOI: 10.1016/j.ekir.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Primary hyperoxaluria type 1 (PH1) has a highly heterogeneous disease course. Apart from the c.508G>A (p.Gly170Arg) AGXT variant, which imparts a relatively favorable outcome, little is known about determinants of kidney failure. Identifying these is crucial for disease management, especially in this era of new therapies. Methods In this retrospective study of 932 patients with PH1 included in the OxalEurope registry, we analyzed genotype-phenotype correlations as well as the impact of nephrocalcinosis, urolithiasis, and urinary oxalate and glycolate excretion on the development of kidney failure, using survival and mixed model analyses. Results The risk of developing kidney failure was the highest for 175 vitamin-B6 unresponsive ("null") homozygotes and lowest for 155 patients with c.508G>A and c.454T>A (p.Phe152Ile) variants, with a median age of onset of kidney failure of 7.8 and 31.8 years, respectively. Fifty patients with c.731T>C (p.Ile244Thr) homozygote variants had better kidney survival than null homozygotes (P = 0.003). Poor outcomes were found in patients with other potentially vitamin B6-responsive variants. Nephrocalcinosis increased the risk of kidney failure significantly (hazard ratio [HR] 3.17 [2.03-4.94], P < 0.001). Urinary oxalate and glycolate measurements were available in 620 and 579 twenty-four-hour urine collections from 117 and 87 patients, respectively. Urinary oxalate excretion, unlike glycolate, was higher in patients who subsequently developed kidney failure (P = 0.034). However, the 41% intraindividual variation of urinary oxalate resulted in wide confidence intervals. Conclusion In conclusion, homozygosity for AGXT null variants and nephrocalcinosis were the strongest determinants for kidney failure in PH1.
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Affiliation(s)
- Elisabeth L. Metry
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander F. Garrelfs
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisa J. Deesker
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cecile Acquaviva
- Service de Biochimie et Biologie Moléculaire, UM Pathologies Héréditaires du Métabolisme et du Globule Rouge, Hospices Civils de Lyon, France
| | - Viola D’Ambrosio
- Department of Nephrology, Catholic University of the Sacred Heart, Rome, Italy
| | - Justine Bacchetta
- Centre de Référence des Maladies Rares Néphrogones, Hospices Civils de Lyon et Université Claude-Bernard Lyon 1, Lyon, France
| | - Bodo B. Beck
- Institute of Human Genetics, Center for Molecular Medicine Cologne, University Hospital of Cologne, Cologne, Germany
- Center for Rare and Hereditary Kidney Disease Cologne, University Hospital of Cologne, Cologne, Germany
| | - Pierre Cochat
- Centre de Référence des Maladies Rares Néphrogones, Hospices Civils de Lyon et Université Claude-Bernard Lyon 1, Lyon, France
| | - Laure Collard
- Department of Pediatric Nephrology, Center Hospitalier Universitaire Liège, Liège, Belgium
| | - Julien Hogan
- Department of Pediatric Nephrology, Assistance Publique–Hôpitaux de Paris Robert-Debré, University of Paris, Paris, France
| | | | - Casper F.M. Franssen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jérôme Harambat
- Department of Pediatrics, Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France
| | - Sally-Anne Hulton
- Department of Nephrology, Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Graham W. Lipkin
- Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Giorgia Mandrile
- Genetic Unit and Thalassemia Center, San Luigi University Hospital, Orbassano, Italy
| | - Cristina Martin-Higueras
- Institute of Biomedical Technology, CIBERER, University of Laguna, San Cristóbal de La Laguna, Spain
| | - Nilufar Mohebbi
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | | | - Thomas J. Neuhaus
- Department of Pediatrics, Children’s Hospital Lucerne, Lucerne, Switzerland
| | - Larisa Prikhodina
- Department of Inherited and Acquired Kidney Diseases, Veltishev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University, Moscow, Russia
| | - Eduardo Salido
- Department of Pathology, Center for Biomedical Research on Rare Diseases, Hospital Universitario Canarias, Universidad La Laguna, Tenerife, Spain
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Michiel J.S. Oosterveld
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap W. Groothoff
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hessel Peters-Sengers
- Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Herren A, Palmer CS, Landolt MA, Lehner M, Neuhaus TJ, Simma L. Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study. Children (Basel) 2023; 10:1377. [PMID: 37628376 PMCID: PMC10453385 DOI: 10.3390/children10081377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies. METHODS A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis. RESULTS A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12-15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. Conclusions: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention.
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Affiliation(s)
- Anouk Herren
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Department of Pediatrics, University’s Children Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
| | - Cameron S. Palmer
- Trauma Service, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Markus A. Landolt
- Department of Psychosomatics and Psychiatry and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, CH-8050 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, CH-8032 Zurich, Switzerland
| | - Markus Lehner
- Department of Pediatric Surgery, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Thomas J. Neuhaus
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Leopold Simma
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, CH-8032 Zurich, Switzerland
- Emergency Department, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Emergency Department, University’s Children Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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4
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Verploegen MFA, Vargas-Poussou R, Walsh SB, Alpay H, Amouzegar A, Ariceta G, Atmis B, Bacchetta J, Bárány P, Baron S, Bayrakci US, Belge H, Besouw M, Blanchard A, Bökenkamp A, Boyer O, Burgmaier K, Calò LA, Decramer S, Devuyst O, van Dyck M, Ferraro PM, Fila M, Francisco T, Ghiggeri GM, Gondra L, Guarino S, Hooman N, Hoorn EJ, Houillier P, Kamperis K, Kari JA, Konrad M, Levtchenko E, Lucchetti L, Lugani F, Marzuillo P, Mohidin B, Neuhaus TJ, Osman A, Papizh S, Perelló M, Rookmaaker MB, Conti VS, Santos F, Sawaf G, Serdaroglu E, Szczepanska M, Taroni F, Topaloglu R, Trepiccione F, Vidal E, Wan ER, Weber L, Yildirim ZY, Yüksel S, Zlatanova G, Bockenhauer D, Emma F, Nijenhuis T. Parathyroid hormone and phosphate homeostasis in patients with Bartter and Gitelman syndrome: an international cross-sectional study. Nephrol Dial Transplant 2022; 37:2474-2486. [PMID: 35137195 PMCID: PMC9681919 DOI: 10.1093/ndt/gfac029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Small cohort studies have reported high parathyroid hormone (PTH) levels in patients with Bartter syndrome and lower serum phosphate levels have anecdotally been reported in patients with Gitelman syndrome. In this cross-sectional study, we assessed PTH and phosphate homeostasis in a large cohort of patients with salt-losing tubulopathies. METHODS Clinical and laboratory data of 589 patients with Bartter and Gitelman syndrome were provided by members of the European Rare Kidney Diseases Reference Network (ERKNet) and the European Society for Paediatric Nephrology (ESPN). RESULTS A total of 285 patients with Bartter syndrome and 304 patients with Gitelman syndrome were included for analysis. Patients with Bartter syndrome type I and II had the highest median PTH level (7.5 pmol/L) and 56% had hyperparathyroidism (PTH >7.0 pmol/L). Serum calcium was slightly lower in Bartter syndrome type I and II patients with hyperparathyroidism (2.42 versus 2.49 mmol/L; P = .038) compared to those with normal PTH levels and correlated inversely with PTH (rs -0.253; P = .009). Serum phosphate and urinary phosphate excretion did not correlate with PTH. Overall, 22% of patients had low serum phosphate levels (phosphate-standard deviation score < -2), with the highest prevalence in patients with Bartter syndrome type III (32%). Serum phosphate correlated with tubular maximum reabsorption of phosphate/glomerular filtration rate (TmP/GFR) (rs 0.699; P < .001), suggesting renal phosphate wasting. CONCLUSIONS Hyperparathyroidism is frequent in patients with Bartter syndrome type I and II. Low serum phosphate is observed in a significant number of patients with Bartter and Gitelman syndrome and appears associated with renal phosphate wasting.
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Affiliation(s)
| | - Rosa Vargas-Poussou
- Department of Genetics, Centre de Références MARHEA, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London, UK
| | - Harika Alpay
- Division of Paediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Atefeh Amouzegar
- Division of Nephrology, Department of Medicine, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gema Ariceta
- Paediatric Nephrology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Bahriye Atmis
- Department of Paediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Justine Bacchetta
- Department of Paediatric Nephrology, Rheumatology and Dermatology, Reference Centre for Rare Renal Diseases, Reference Centre for Rare Diseases of Calcium and Phosphate Metabolism. University Children's Hospital, Lyon, France
| | - Peter Bárány
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Stéphanie Baron
- Department of Physiology, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Umut Selda Bayrakci
- Department of Paediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, Çankaya/Ankara, Turkey
| | - Hendrica Belge
- Center for Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Martine Besouw
- Department of Paediatric Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anne Blanchard
- Clinical Research Centre 1418, Centre de Références MARHEA, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Arend Bökenkamp
- Department of Paediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Olivia Boyer
- Department of Paediatric Nephrology, Necker Hospital, APHP, MARHEA, Imagine Institute, Paris University, Paris, France
| | - Kathrin Burgmaier
- Faculty of Medicine, University Hospital of Cologne, Children's and Adolescents' Hospital, Paediatric Nephrology, University of Cologne, Cologne, Germany
| | - Lorenzo A Calò
- Department of Medicine (DIMED), Nephrology, Dialysis, Transplantation, University of Padova, Padova, Italy
| | - Stéphane Decramer
- Department of Paediatric Nephrology. Centre de Références SORARE, Toulouse University Hospital, Toulouse, France
| | - Olivier Devuyst
- Division of Nephrology, UCLouvain Medical School, Brussels, Belgium; Institute of Physiology, Mechanism of Inherited Kidney Disorders Group, University of Zurich, Zurich, Switzerland
| | - Maria van Dyck
- Department of Paediatric Nephrology, University Hospital Leuven, Leuven, Belgium
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marc Fila
- Pediatric Nephrology, CHU Arnaud de Villeneuve, Montpellier University Hospital, Montpellier, France
| | - Telma Francisco
- Department of Paediatric Nephrology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Leire Gondra
- Pediatric Nephrology Department, Cruces University Hospital, Barakaldo, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; Paediatric Department, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Nakysa Hooman
- Ali-Asghar Clinical Research Development Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pascal Houillier
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France,Department of Physiology, Centre de Références MARHEA, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Konstantinos Kamperis
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jameela A Kari
- Pediatric Nephrology Centre of Excellence and Paediatric Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Martin Konrad
- Department of General Paediatrics, Paediatric Nephrology, University Hospital Münster, Munster, Germany
| | - Elena Levtchenko
- Department of Paediatric Nephrology & Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Laura Lucchetti
- Department of Paediatric Subspecialties, Division of Nephrology, Bambino Gesù Children's Hospital – IRCCS, Rome, Italy
| | - Francesca Lugani
- Division of Nephrology, Dialysis and Transplantation, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Barian Mohidin
- Department of Renal Medicine, University College London, London, UK
| | - Thomas J Neuhaus
- Department of Paediatrics, Children's Hospital of Lucerne, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Abdaldafae Osman
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London, UK
| | - Svetlana Papizh
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Manel Perelló
- Nephrology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maarten B Rookmaaker
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Fernando Santos
- Department of Paediatrics, Asturias Central University Hospital, University of Oviedo, Oviedo, Spain
| | - Ghalia Sawaf
- Department of Paediatric Nephrology, Damascus Hospital, Damascus, Syria
| | - Erkin Serdaroglu
- Department of Paediatric Nephrology, Dr Behçet Uz Children's Hospital, Izmir, Turkey
| | - Maria Szczepanska
- Department of Paediatrics, Faculty of Medical Sciences in Zabrze, SUM in Katowice, Katowice, Poland
| | - Francesca Taroni
- Paediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Rezan Topaloglu
- Department of Paediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Enrico Vidal
- Division of Paediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Elizabeth R Wan
- Department of Renal Medicine, University College London, London, UK
| | - Lutz Weber
- Faculty of Medicine, University Hospital of Cologne, Children's and Adolescents' Hospital, Paediatric Nephrology, University of Cologne, Cologne, Germany
| | - Zeynep Yuruk Yildirim
- Department of Paediatrics, Division of Paediatric Nephrology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selçuk Yüksel
- Department of Paediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Galia Zlatanova
- University Children's Hospital Medical University, Sofia, Bulgaria
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, London, UK,Paediatric Nephrology Unit, Great Ormond Street Hospital, London, UK
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5
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Jaboyedoff M, Rakic M, Bachmann S, Berger C, Diezi M, Fuchs O, Frey U, Gervaix A, Glücksberg AS, Grotzer M, Heininger U, Kahlert CR, Kaiser D, Kopp MV, Lauener R, Neuhaus TJ, Paioni P, Posfay-Barbe K, Ramelli GP, Simeoni U, Simonetti G, Sokollik C, Spycher BD, Kuehni CE. SwissPedData: Standardising hospital records for the benefit of paediatric research. Swiss Med Wkly 2021; 151:w30069. [PMID: 34964587 DOI: 10.4414/smw.2021.w30069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Improvement of paediatric healthcare is hampered by inefficient processes for generating new evidence. Clinical research often requires extra encounters with patients, is costly, takes place in an artificial situation with a biased selection of patients, and entails long delays until new evidence is implemented into health care. Electronic health records (EHR) contain detailed information on real patients and cover the entirety of patients. However, the use of EHR for research is limited because they are not standardised between hospitals. This leads to disproportionate amounts of work for extracting data of interest and frequently data are incomplete and of poor quality. AIMS SwissPedData aims to lay the foundation for a paediatric learning health system in Switzerland by facilitating EHR-based research. In this project, we aimed to assess the way routine clinical data are currently recorded in large paediatric clinics in Switzerland and to develop a national EHR-based set of common data elements (CDEs) that covers all processes of routine paediatric care in hospitals. METHODS A taskforce of paediatricians from large Swiss children's hospitals reviewed the current status of routine data documentation in paediatric clinical care and the extent of digitalisation. We then used a modified Delphi method to reach a broad consensus on a national EHR-based set of CDEs. RESULTS All Swiss children's hospitals use EHR to document some or all aspects of care. One hundred and nineteen paediatricians, representing eight hospitals and all paediatric subspecialties, participated in an extended Delphi process to create SwissPedData. The group agreed on a national set of CDEs that comprises a main module with general paediatric data and sub-modules relevant to paediatric subspecialties. The data dictionary includes 336 CDEs: 76 in the main module on general paediatrics and between 11 and 59 CDEs per subspecialty module. Among these, 266 were classified as mandatory, 52 as recommended and 18 as optional. CONCLUSION SwissPedData is a set of CDEs for information to be collected in EHR of Swiss children's hospitals. It covers all care processes including clinical and paraclinical assessment, diagnosis, treatment, disposition and care site. All participating hospitals agreed to implement SwissPedData in their clinical routine and clinic information systems. This will pave the way for a national paediatric learning health system in Switzerland that enables fast and efficient answers to urgent clinical questions by facilitating high-quality nationwide retrospective and prospective observational studies and recruitment of patients for nested prospective studies and clinical trials.
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Affiliation(s)
- Manon Jaboyedoff
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Milenko Rakic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sara Bachmann
- University of Basel Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Christoph Berger
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Manuel Diezi
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oliver Fuchs
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Frey
- University of Basel Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Alain Gervaix
- Department of Woman, Child and Adolescent, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Amalia Stefani Glücksberg
- Pediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Michael Grotzer
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Heininger
- University of Basel Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | | | - Daniela Kaiser
- Children's Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Matthias V Kopp
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger Lauener
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas J Neuhaus
- Children's Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Paolo Paioni
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Klara Posfay-Barbe
- Department of Woman, Child and Adolescent, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gian Paolo Ramelli
- Pediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Umberto Simeoni
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giacomo Simonetti
- Pediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Christiane Sokollik
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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6
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Rakic M, Jaboyedoff M, Bachmann S, Berger C, Diezi M, do Canto P, Forrest CB, Frey U, Fuchs O, Gervaix A, Gluecksberg AS, Grotzer M, Heininger U, Kahlert CR, Kaiser D, Kopp MV, Lauener R, Neuhaus TJ, Paioni P, Posfay-Barbe K, Ramelli GP, Simeoni U, Simonetti G, Sokollik C, Spycher BD, Kuehni CE. Clinical data for paediatric research: the Swiss approach : Proceedings of the National Symposium in Bern, Switzerland, Dec 5-6, 2019. BMC Proc 2021; 15:19. [PMID: 34538238 PMCID: PMC8450032 DOI: 10.1186/s12919-021-00226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Continuous improvement of health and healthcare system is hampered by inefficient processes of generating new evidence, particularly in the case of rare diseases and paediatrics. Currently, most evidence is generated through specific research projects, which typically require extra encounters with patients, are costly and entail long delays between the recognition of specific needs in healthcare and the generation of necessary evidence to address those needs. The Swiss Personalised Health Network (SPHN) aims to improve the use of data obtained during routine healthcare encounters by harmonizing data across Switzerland and facilitating accessibility for research. The project "Harmonising the collection of health-related data and biospecimens in paediatric hospitals throughout Switzerland (SwissPedData)" was an infrastructure development project funded by the SPHN, which aimed to identify and describe available data on child health in Switzerland and to agree on a standardised core dataset for electronic health records across all paediatric teaching hospitals. Here, we describe the results of a two-day symposium that aimed to summarise what had been achieved in the SwissPedData project, to put it in an international context, and to discuss the next steps for a sustainable future. The target audience included clinicians and researchers who produce and use health-related data on children in Switzerland. KEY HIGHLIGHTS The symposium consisted of state-of-the-art lectures from national and international keynote speakers, workshops and plenary discussions. This manuscript summarises the talks and discussions in four sections: (I) a description of the Swiss Personalized Health Network and the results of the SwissPedData project; (II) examples of similar initiatives from other countries; (III) an overview of existing health-related datasets and projects in Switzerland; and (IV) a summary of the lessons learned and future prospective from workshops and plenary discussions. IMPLICATIONS Streamlined processes linking initial collection of information during routine healthcare encounters, standardised recording of this information in electronic health records and fast accessibility for research are essential to accelerate research in child health and make it affordable. Ongoing projects prove that this is feasible in Switzerland and elsewhere. International collaboration is vital to success. The next steps include the implementation of the SwissPedData core dataset in the clinical information systems of Swiss hospitals, the use of this data to address priority research questions, and the acquisition of sustainable funding to support a slim central infrastructure and local support in each hospital. This will lay the foundation for a national paediatric learning health system in Switzerland.
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Affiliation(s)
- Milenko Rakic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Manon Jaboyedoff
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sara Bachmann
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Christoph Berger
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Manuel Diezi
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | - Urs Frey
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Oliver Fuchs
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alain Gervaix
- Department of Woman, Child and Adolescent, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Amalia Stefani Gluecksberg
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Michael Grotzer
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Heininger
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | | | - Daniela Kaiser
- Children’s Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Matthias V. Kopp
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger Lauener
- Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas J. Neuhaus
- Children’s Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Paolo Paioni
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Klara Posfay-Barbe
- Department of Woman, Child and Adolescent, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gian Paolo Ramelli
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Umberto Simeoni
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giacomo Simonetti
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Christiane Sokollik
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ben D. Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
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7
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Stocker M, Szavay P, Wernz B, Neuhaus TJ, Lehnick D, Zundel S. What are the participants' perspective and the system-based impact of a standardized, inter-professional morbidity/mortality-conferences in a children's hospital? Transl Gastroenterol Hepatol 2021; 6:48. [PMID: 34423169 DOI: 10.21037/tgh-20-42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/20/2020] [Indexed: 11/06/2022] Open
Abstract
Background Morbidity and mortality conferences (MMC) are well established but little data exists on inter-professional aspects, system-based outcomes and characteristics in pediatric departments. Our study aim was to analyze the system-based impact and to assess participant's perspectives on standardized, inter-professional MMCs in a children's hospital. Methods In a prospective observational analysis the inter-professional MMCs held at a tertiary teaching children's hospital in Switzerland were analyzed for (I) resulting clinical consequences and (II) participants perception on format, usefulness and no-blame atmosphere. Results Eighteen MMC, discussing 29 cases were analyzed. Twenty-seven clinical errors/problems were identified and 17 clinical recommendations were developed: ten new or changed clinical guidelines, two new therapeutic alternatives, three new teaching activities, and two guidelines on specific diagnostics. Altogether, the 466 participants evaluated the conferences favorably. Little differences were seen in the evaluations of physicians of different disciplines or seniority but non-physicians scored all questions lower than physicians. Overall, three quarters of the participants felt that there was a no-blame culture during the conferences but results varied depending on the cases discussed. Conclusions An inter-professional MMC can have relevant impact on clinical practice and affect system-based changes. Inter-professional conferences are profitable for all participants but evaluated differently according to profession. A standardized format and the presence of a moderator are helpful, but not a guarantee for a no-blame culture. Highly emotional cases are a risk factor to relapse to "blame and shame". A time gap between the event and the MMC may have a beneficial effect. Keywords Inter-professional communication; inter-professional health care; learning from failure; morbidity and mortality conference (MMC); patient safety; psychological safety.
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Affiliation(s)
- Martin Stocker
- Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Luzern, Switzerland.,Department of Pediatrics, Children's Hospital Lucerne, Luzern, Switzerland
| | - Philipp Szavay
- Department of Pediatric Surgery, Children's Hospital Lucerne, Luzern, Switzerland
| | - Birgit Wernz
- Department of Nursing, Children's Hospital Lucerne, Luzern, Switzerland
| | - Thomas J Neuhaus
- Department of Pediatrics, Children's Hospital Lucerne, Luzern, Switzerland
| | - Dirk Lehnick
- Biostatistics and Methodology, University of Lucerne, Luzern, Switzerland
| | - Sabine Zundel
- Department of Pediatric Surgery, Children's Hospital Lucerne, Luzern, Switzerland
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8
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Kollbrunner L, Hirt-Minkowski P, Sanz J, Bresin E, Neuhaus TJ, Hopfer H, Jehle AW. Case Report: Lipoprotein Glomerulopathy Complicated by Atypical Hemolytic Uremic Syndrome. Front Med (Lausanne) 2021; 8:679048. [PMID: 34150810 PMCID: PMC8206272 DOI: 10.3389/fmed.2021.679048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/10/2021] [Accepted: 05/07/2021] [Indexed: 11/14/2022] Open
Abstract
Lipoprotein glomerulopathy (LPG) is a rare inherited disease caused by mutations in the APOE gene, encoding apolipoprotein E (apoE). Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy (TMA) characterized by overactivation of the alternative complement pathway. Here we report the case of a 21-year-old man with LPG who developed aHUS. A functional complement assay demonstrated an overactivation of the complement system. Complementary genetic analysis revealed a homozygous aHUS risk allele for complement factor-H related 1 (CFHR1), CFHR1*B. To the best of our knowledge, this is the first report of an aHUS in a patient with LPG.
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Affiliation(s)
- Lara Kollbrunner
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | | | - Javier Sanz
- Division of Human Genetics, University Hospital of Bern, Bern, Switzerland
| | - Elena Bresin
- Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bergamo, Italy
| | - Thomas J Neuhaus
- Department of Pediatrics, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Helmut Hopfer
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
| | - Andreas W Jehle
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland.,Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
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9
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Buettcher M, Trueck J, Niederer-Loher A, Heininger U, Agyeman P, Asner S, Berger C, Bielicki J, Kahlert C, Kottanattu L, Meyer Sauteur PM, Paioni P, Posfay-Barbe K, Relly C, Ritz N, Zimmermann P, Zucol F, Gobet R, Shavit S, Rudin C, Laube G, von Vigier R, Neuhaus TJ. Correction to: Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr 2021; 180:675-677. [PMID: 33001233 PMCID: PMC7886751 DOI: 10.1007/s00431-020-03820-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The article “Swiss consensus recommendations on urinary tract infections in children”
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Affiliation(s)
- Michael Buettcher
- Paediatric Infectious Diseases, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Luzern 16, Switzerland.
| | - Johannes Trueck
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Anita Niederer-Loher
- Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Ulrich Heininger
- Paediatric Infectious Diseases, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Philipp Agyeman
- Department of Pediatric Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Sandra Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Julia Bielicki
- Paediatric Infectious Diseases, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Christian Kahlert
- Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Lisa Kottanattu
- Pediatric Infectious Diseases, Pediatric Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500 Bellinzona, Switzerland
| | - Patrick M. Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Klara Posfay-Barbe
- General Pediatrics & Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva & Medical School of Geneva, 6, rue Willy-Donzé, 1211, Geneva 14, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Nicole Ritz
- Paediatric Infectious Diseases, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Rita Gobet
- Paediatric Urology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Sandra Shavit
- Paediatric Surgery, Lucerne Children’s Hospital, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Luzern 16, Switzerland
| | - Christoph Rudin
- Pediatric Nephrology, University Children’s Hospital Basel, Spitalstrasse 33, CH-4031 Basel, Switzerland
| | - Guido Laube
- Pediatric Nephrology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Rodo von Vigier
- Pediatric Clinic, Wildermeth Children’s Hospital, Kloosweg 84, 2502 Biel-Bienne, Switzerland
| | - Thomas J. Neuhaus
- Paediatrics, Lucerne Children’s Hospital, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Luzern 16, Switzerland
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10
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Maurer E, Neuhaus TJ, Weitz M, Kuehni CE, Laube GF. Paediatric end-stage renal disease and renal replacement therapy in Switzerland: survival and treatment trends over four decades. Swiss Med Wkly 2020; 150:w20300. [PMID: 32920790 DOI: 10.4414/smw.2020.20300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Renal replacement therapy for paediatric end-stage renal disease (ESRD) has developed steadily since its introduction five decades ago. Continuous and long-term analysis of patient outcomes is essential for quality control. METHODS The Swiss Paediatric Renal Registry, founded in 1970, includes patients diagnosed with ESRD, defined as dialysis for more than three months or renal transplantation, at age <20 years. Here we describe the incidence, primary renal disease, treatment modalities and long-term outcomes over 45 years. RESULTS This paper reports on 367 children and adolescents treated with chronic renal replacement therapy in Switzerland. Incidence was 5.4 per million children per year, with a tendency to increase over time. The primary renal disease was congenital anomalies of the kidney and the urinary tract in 133 (36%), monogenetic hereditary diseases in 122 (33%) and acquired diseases in 112 (31%) patients. The first renal replacement therapy was haemodialysis in 194 (53%), peritoneal dialysis in 116 (32%) and pre-emptive renal transplantation in 57 (15%) patients. Over the years, pre-emptive renal transplantation became more frequent (34% of all first renal replacement therapies in 2006–2015), reducing the duration of dialysis. Median time on dialysis until transplantation decreased from 1.60 years in 1981–90 to 0.34 years in 2010–15. Over the four decades 1970–80, 1981–90,1991–2000 and 2001–10, the one-year graft survival rate improved from 0.76 to 0.80, 0.89 and then 0.96; and the five-year graft survival rate improved from 0.44 to 0.64, 0.84 and 0.89, respectively. The five-year patient survival rates for the four decades were 0.83, 0.99, 0.93 and 0.94; and the 10-year patient survival rates were 0.75, 0.96, 0.88 and 0.94, respectively. In the four cohorts starting renal replacement therapy in the 70s, 80s, 90s and 00s, the number of children alive after five years of renal replacement therapy increased from 15 to 24, 47 and then 45 respectively. In total, 29 patients (8%) died during chronic renal replacement therapy with ESRD before the age of 20 years. CONCLUSION Over time, a higher number of children on renal replacement therapy survived, graft survival improved, and the duration of dialysis before renal transplantation decreased.
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Affiliation(s)
- Elisabeth Maurer
- Swiss Paediatric Renal Registry, Institute of Social and Preventive Medicine, Research Group on Child and Adolescent Health, University of Bern, Switzerland / Inselspital, Bern University Hospital, University of Bern, Switzerland +41 31 918 44 75
| | | | - Marcus Weitz
- Nephrology Unit, University Children's Hospital, University of Zurich, Switzerland
| | - Claudia E Kuehni
- Swiss Paediatric Renal Registry, Institute of Social and Preventive Medicine, Research Group on Child and Adolescent Health, University of Bern, Switzerland / Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Guido F Laube
- Swiss Paediatric Renal Registry, Institute of Social and Preventive Medicine, Research Group on Child and Adolescent Health, University of Bern, Switzerland / Nephrology Unit, University Children's Hospital, University of Zurich, Switzerland
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11
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Affiliation(s)
- Leopold Simma
- Emergency Department, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Thomas J Neuhaus
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
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12
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Kemper MJ, Neuhaus TJ. Levamisole in relapsing steroid-sensitive nephrotic syndrome: where do we stand? Kidney Int 2018; 93:310-313. [PMID: 29389398 DOI: 10.1016/j.kint.2017.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 11/30/2022]
Abstract
Many patients with steroid-sensitive nephrotic syndrome develop a relapsing course; therefore, alternative treatment may be necessary to avoid steroid toxicity. In this issue, a multicenter controlled study in relapsing steroid-sensitive nephrotic syndrome shows the effectiveness of levamisole. Time to first relapse was significantly increased compared with placebo. In addition, possible differential treatment effects were suggested for subgroups: patients with frequent relapses might have a superior response to those with steroid dependency.
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13
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Spartà G, Gaspert A, Neuhaus TJ, Weitz M, Mohebbi N, Odermatt U, Zipfel PF, Bergmann C, Laube GF. Membranoproliferative glomerulonephritis and C3 glomerulopathy in children: change in treatment modality? A report of a case series. Clin Kidney J 2018; 11:479-490. [PMID: 30094012 PMCID: PMC6070093 DOI: 10.1093/ckj/sfy006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/31/2017] [Accepted: 12/27/2017] [Indexed: 12/11/2022] Open
Abstract
Background Membranoproliferative glomerulonephritis (MPGN) with immune complexes and C3 glomerulopathy (C3G) in children are rare and have a variable outcome, with some patients progressing to end-stage renal disease (ESRD). Mutations in genes encoding regulatory proteins of the alternative complement pathway and of complement C3 (C3) have been identified as concausative factors. Methods Three children with MPGN type I, four with C3G, i.e. three with C3 glomerulonephritis (C3GN) and one with dense deposit disease (DDD), were followed. Clinical, autoimmune data, histological characteristics, estimated glomerular filtration rate (eGFR), proteinuria, serum C3, genetic and biochemical analysis were assessed. Results The median age at onset was 7.3 years and the median eGFR was 72 mL/min/1.73 m2. Six children had marked proteinuria. All were treated with renin-angiotensin-aldosterone system (RAAS) blockers. Three were given one or more immunosuppressive drugs and two eculizumab. At the last median follow-up of 9 years after diagnosis, three children had normal eGFR and no or mild proteinuria on RAAS blockers only. Among four patients without remission of proteinuria, genetic analysis revealed mutations in complement regulator proteins of the alternative pathway. None of the three patients with immunosuppressive treatment achieved partial or complete remission of proteinuria and two progressed to ESRD and renal transplantation. Two patients treated with eculizumab revealed relevant decreases in proteinuria. Conclusions In children with MPGN type I and C3G, the outcomes of renal function and response to treatment modality show great variability independent from histological diagnosis at disease onset. In case of severe clinical presentation at disease onset, early genetic and biochemical analysis of the alternative pathway dysregulation is recommended. Treatment with eculizumab appears to be an option to slow disease progression in single cases.
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Affiliation(s)
- Giuseppina Spartà
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ariana Gaspert
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas J Neuhaus
- Children's Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Marcus Weitz
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nilufar Mohebbi
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Urs Odermatt
- Nephrology Unit, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Peter F Zipfel
- Leibniz Institute for Natural Product Research and Infection Biology e. V. Hans-Knöll-Institute, Jena, Germany.,Friedrich Schiller University, Jena, Germany
| | - Carsten Bergmann
- Bioscientia Center of Human Genetics, Ingelheim am Rhein, Germany
| | - Guido F Laube
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Zurich, Switzerland
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14
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Goerens A, Lehnick D, Büttcher M, Daetwyler K, Fontana M, Genet P, Lurà M, Morgillo D, Pilgrim S, Schwendener-Scholl K, Regamey N, Neuhaus TJ, Stocker M. Neonatal Ventilator Associated Pneumonia: A Quality Improvement Initiative Focusing on Antimicrobial Stewardship. Front Pediatr 2018; 6:262. [PMID: 30320046 PMCID: PMC6165906 DOI: 10.3389/fped.2018.00262] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/03/2018] [Indexed: 12/24/2022] Open
Abstract
Background and Aims: Neonatal ventilator associated pneumonia (VAP) is a common nosocomial infection and a frequent reason for empirical antibiotic therapy in NICUs. Nonetheless, there is no international consensus regarding diagnostic criteria and management. In a first step, we analyzed the used diagnostic criteria, risk factors and therapeutic management of neonatal VAP by a literature review. In a second step, we aimed to compare suspected vs. confirmed neonatal VAP episodes in our unit according to different published criteria and to analyze interrater-reliability of chest x-rays. Additionally, we aimed to evaluate the development of VAP incidence and antibiotic use after implementation of multifaceted quality improvement changes regarding antimicrobial stewardship and infection control (VAP-prevention-bundle, early-extubation policy, antimicrobial stewardship rounds). Methods: Neonates until 44 weeks of gestation with suspected VAP, hospitalized at our level-III NICU in Lucerne from September 2014 to December 2017 were enrolled. VAP episodes were analyzed according to 4 diagnostic frameworks. Agreement regarding chest x-ray interpretation done by 10 senior physicians was assessed. Annual incidence of suspected and confirmed neonatal VAP episodes and antibiotic days were calculated and compared for the years 2015, 2016, and 2017. Results: 17 studies were identified in our literature review. Overall, CDC-guidelines or similar criteria, requesting radiographic changes as main criteria, are mostly used. Comparison of suspected vs. confirmed neonatal VAP episodes showed a great variance (20.4 vs. 4.5/1,000 ventilator-days). The interrater-reliability of x-ray interpretation was poor (intra-class correlation 0.25). Implemented changes resulted in a gradual decline in annual VAP incidence and antibiotic days from 2015 compared with 2017 (28.8 vs. 7.4 suspected episodes/1,000 ventilator-days, 5.5 vs. 0 confirmed episodes/1,000 ventilator-days and 211 vs. 34.7 antibiotic days/1,000 ventilation-days, respectively). Conclusion: The incidence of suspected VAP and concomitant antibiotic use is much higher than for confirmed VAP, therefore inclusion of suspected episodes should be considered for accurate evaluation. There is a high diagnostic inconsistency and a low reliability of interpretation of chest x-rays regarding VAP. Implementation of combined antimicrobial stewardship and infection control measures may lead to an effective decrease in VAP incidence and antibiotic use.
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Affiliation(s)
- Anouk Goerens
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Dirk Lehnick
- Clinical Trial Unit, University of Lucerne, Lucerne, Switzerland
| | - Michael Büttcher
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Infectious Diseases Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Karin Daetwyler
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Matteo Fontana
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Petra Genet
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Marco Lurà
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric Pulmonology Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Davide Morgillo
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Sina Pilgrim
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Katharina Schwendener-Scholl
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Nicolas Regamey
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric Pulmonology Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Thomas J Neuhaus
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
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15
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Weitz M, Sazpinar O, Schmidt M, Neuhaus TJ, Maurer E, Kuehni C, Parvex P, Chehade H, Tschumi S, Immer F, Laube GF. Balancing competing needs in kidney transplantation: does an allocation system prioritizing children affect the renal transplant function? Transpl Int 2016; 30:68-75. [PMID: 27732754 DOI: 10.1111/tri.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/28/2016] [Accepted: 10/07/2016] [Indexed: 12/01/2022]
Abstract
Children often merit priority in access to deceased donor kidneys by organ-sharing organizations. We report the impact of the new Swiss Organ Allocation System (SOAS) introduced in 2007, offering all kidney allografts from deceased donors <60 years preferentially to children. The retrospective cohort study included all paediatric transplant patients (<20 years of age) before (n = 19) and after (n = 32) the new SOAS (from 2001 to 2014). Estimated glomerular filtration rate (eGFR), urine protein-to-creatinine ratio (UPC), need for antihypertensive medication, waiting times to kidney transplantation (KTX), number of pre-emptive transplantations and rejections, and the proportion of living donor transplants were considered as outcome parameters. Patients after the new SOAS had significantly better eGFRs 2 years after KTX (Mean Difference, MD = 25.7 ml/min/1.73 m2 , P = 0.025), lower UPC ratios (Median Difference, MeD = -14.5 g/mol, P = 0.004), decreased waiting times to KTX (MeD = -97 days, P = 0.021) and a higher proportion of pre-emptive transplantations (Odds Ratio = 9.4, 95% CI = 1.1-80.3, P = 0.018), while the need for antihypertensive medication, number of rejections and living donor transplantations remained stable. The new SOAS is associated with improved short-term clinical outcomes and more rapid access to KTX. Despite lacking long-term research, the study results should encourage other policy makers to adopt the SOAS approach.
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Affiliation(s)
- Marcus Weitz
- University Children's Hospital Zurich, Zurich, Switzerland
| | - Onur Sazpinar
- University Children's Hospital Zurich, Zurich, Switzerland
| | - Maria Schmidt
- University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Elisabeth Maurer
- Institute for Social and Preventive Medicine, Berne, Switzerland
| | - Claudia Kuehni
- Institute for Social and Preventive Medicine, Berne, Switzerland
| | | | | | | | | | - Guido F Laube
- University Children's Hospital Zurich, Zurich, Switzerland
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16
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Buder K, Werner H, Landolt MA, Neuhaus TJ, Laube GF, Spartà G. Health-related quality of life and mental health in parents of children with hemolytic uremic syndrome. Pediatr Nephrol 2016; 31:923-32. [PMID: 26701835 DOI: 10.1007/s00467-015-3294-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about health-related quality of life (HRQoL) and mental health of parents having children with a history of hemolytic uremic syndrome (HUS). METHODS This study included 63 mothers and 58 fathers of a cohort of 63 HUS-affected children. At assessment, the mean time since a child experienced an acute episode of HUS was 6.4 years. Parental HRQoL, mental health and posttraumatic stress disorder (PTSD) were assessed with standardized self-report questionnaires. Medical data were extracted from patients' hospital records. RESULTS The HRQoL and mental health of both the mothers and fathers were not impaired compared to normative data. However, a shorter time since a child's acute HUS episode was a significant predictor of lower HRQoL among the mothers, while no such effect was found among the fathers. Two fathers (3%), but no mothers, met the criteria for a diagnosis of HUS-related full PTSD; one father (2%) and four mothers (6%) met the criteria for a diagnosis of HUS-related partial PTSD. CONCLUSIONS Our study shows that most parents of our study sample were doing well in terms of HRQoL and mental health, although a small number met the criteria for full or partial PTSD diagnosis due to their child's HUS. We therefore recommend that healthcare providers pay special attention to parents regarding PTSD symptoms during the clinical follow-up of a HUS-affected child since some parents may benefit from psychological support.
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Affiliation(s)
- Kathrin Buder
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Helene Werner
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Department of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich, Binzmuehlestrasse 14, 8051, Zurich, Switzerland
| | - Thomas J Neuhaus
- Children's Hospital of Lucerne, Cantonal Hospital of Lucerne, 6000, Lucerne 16, Switzerland
| | - Guido F Laube
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Giuseppina Spartà
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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17
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Buder K, Werner H, Landolt MA, Neuhaus TJ, Laube GF, Spartà G. Erratum to: Health-related quality of life and mental health in parents of children with hemolytic uremic syndrome. Pediatr Nephrol 2016; 31:1035-7. [PMID: 27048229 DOI: 10.1007/s00467-016-3377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Kathrin Buder
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Helene Werner
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Department of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich, Binzmuehlestrasse 14, 8051, Zurich, Switzerland
| | - Thomas J Neuhaus
- Children's Hospital of Lucerne, Cantonal Hospital of Lucerne, 6000, Lucerne 16, Switzerland
| | - Guido F Laube
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Giuseppina Spartà
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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18
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Weitz M, Heeringa S, Neuhaus TJ, Fehr T, Laube GF. Standardized multilevel transition program: Does it affect renal transplant outcome? Pediatr Transplant 2015; 19:691-7. [PMID: 26260514 DOI: 10.1111/petr.12570] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/28/2022]
Abstract
The transfer of renal transplant patients from pediatric to adult care is a crucial step with a high risk of subsequent graft loss. Therefore, the transition should be a thoroughly planned, well-designed and multidisciplinary process focused on the individual patient. Our pediatric nephrology department introduced a structured step-by-step transition program supported by a multidisciplinary team of health professionals. The purpose of our study was to determine the effects of the transition program on eGFR and number of ARs in comparison to a group without a transition program at one and three yr after transfer. We conducted a single-center retrospective cohort study of renal transplant patients prior to and after the introduction of the transition program. Multiple regression analysis revealed a significantly lower decline of eGFR in the group with transition program (-11.3 ± 44 mL/min/1.73 m(2) ) compared to the group without transition program (-28.4 ± 33 mL/min/1.73 m(2) ) at three yr after transfer. The number of AR episodes significantly decreased from 34.6% in the group without transition program to 9.1% in the group with transition program. The standardized multilevel transition program seems to have significant positive effects on eGFR and number of AR episodes in renal transplant patients.
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Affiliation(s)
- Marcus Weitz
- Nephrology Unit, University Children's Hospital Zurich, Zurich, Switzerland
| | - Saskia Heeringa
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | | | - Thomas Fehr
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland.,Department of Internal Medicine, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Guido F Laube
- Nephrology Unit, University Children's Hospital Zurich, Zurich, Switzerland
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19
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Lehnhardt A, Karnatz C, Ahlenstiel-Grunow T, Benz K, Benz MR, Budde K, Büscher AK, Fehr T, Feldkötter M, Graf N, Höcker B, Jungraithmayr T, Klaus G, Koehler B, Konrad M, Kranz B, Montoya CR, Müller D, Neuhaus TJ, Oh J, Pape L, Pohl M, Royer-Pokora B, Querfeld U, Schneppenheim R, Staude H, Spartà G, Timmermann K, Wilkening F, Wygoda S, Bergmann C, Kemper MJ. Clinical and molecular characterization of patients with heterozygous mutations in wilms tumor suppressor gene 1. Clin J Am Soc Nephrol 2015; 10:825-31. [PMID: 25818337 DOI: 10.2215/cjn.10141014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/20/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES The Wilms tumor suppressor gene 1 (WT1) plays an essential role in urogenital and kidney development. Genotype/phenotype correlations of WT1 mutations with renal function and proteinuria have been observed in world-wide cohorts with nephrotic syndrome or Wilms tumor (WT). This study analyzed mid-European patients with known constitutional heterozygous mutations in WT1, including patients without proteinuria or WT. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS Retrospective analysis of genotype, phenotype, and treatment of 53 patients with WT1 mutation from all pediatric nephrology centers in Germany, Austria, and Switzerland performed from 2010 to 2012. RESULTS Median age was 12.4 (interquartile range [IQR], 6-19) years. Forty-four of 53 (83%) patients had an exon mutation (36 missense, eight truncating), and nine of 53 (17%) had an intronic lysine-threonine-serine (KTS) splice site mutation. Fifty of 53 patients (94%) had proteinuria, which occurred at an earlier age in patients with missense mutations (0.6 [IQR, 0.1-1.5] years) than in those with truncating (9.7 [IQR, 5.7-11.9]; P<0.001) and splice site (4.0 [IQR, 2.6-6.6]; P=0.004) mutations. Thirteen of 50 (26%) were treated with steroids and remained irresponsive, while three of five partially responded to cyclosporine A. Seventy-three percent of all patients required RRT, those with missense mutations significantly earlier (at 1.1 [IQR, 0.01-9.3] years) than those with truncating mutations (16.5 [IQR, 16.5-16.8]; P<0.001) and splice site mutations (12.3 [IQR, 7.9-18.2]; P=0.002). Diffuse mesangial sclerosis was restricted to patients with missense mutations, while focal segmental sclerosis occurred in all groups. WT occurred only in patients with exon mutations (n=19). Fifty of 53 (94%) patients were karyotyped: Thirty-one (62%) had XY and 19 (38%) had XX chromosomes, and 96% of male karyotypes had urogenital malformations. CONCLUSIONS Type and location of WT1 mutations have predictive value for the development of proteinuria, renal insufficiency, and WT. XY karyotype was more frequent and associated with urogenital malformations in most cases.
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Affiliation(s)
- Anja Lehnhardt
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material.
| | - Claartje Karnatz
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Thurid Ahlenstiel-Grunow
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Kerstin Benz
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Marcus R Benz
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Klemens Budde
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Anja K Büscher
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Thomas Fehr
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Markus Feldkötter
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Norbert Graf
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Britta Höcker
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Therese Jungraithmayr
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Günter Klaus
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Birgit Koehler
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Martin Konrad
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Birgitta Kranz
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Carmen R Montoya
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Dominik Müller
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Thomas J Neuhaus
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Jun Oh
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Lars Pape
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Martin Pohl
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Brigitte Royer-Pokora
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Uwe Querfeld
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Reinhard Schneppenheim
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Hagen Staude
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Giuseppina Spartà
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Kirsten Timmermann
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Frauke Wilkening
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Simone Wygoda
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Carsten Bergmann
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Markus J Kemper
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
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20
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Buder K, Latal B, Nef S, Neuhaus TJ, Laube GF, Spartà G. Neurodevelopmental long-term outcome in children after hemolytic uremic syndrome. Pediatr Nephrol 2015; 30:503-13. [PMID: 25234636 DOI: 10.1007/s00467-014-2950-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND To investigate the long-term neurodevelopmental outcome in children after hemolytic uremic syndrome (HUS) and to compare outcome dependent on central nervous system (CNS) involvement during HUS. METHODS A single-center retrospective cohort of 47 children was examined at a median age of 10.6 (range 6-16.9) years and a median follow-up of 7.8 (range 0.4-15.3) years after having had HUS. Intellectual performance was assessed with the German version of the Wechsler Intelligence Scale 4th version and neuromotor performance with the Zurich Neuromotor Assessment (ZNA). The occurrence of neurological symptoms during the acute phase of HUS was evaluated retrospectively. RESULTS Mean IQ of the whole study population fell within the normal range (median full scale IQ 104, range 54-127). Neuromotor performance was significantly poorer in the domains "adaptive fine," "gross motor," "static balance" (all p < 0.05) and "associated movements" (p < 0.001); only the "pure motor" domain was within the normal reference range. Neurological findings occurred in 16/47 patients (34 %) during acute HUS. Neurodevelopmental outcome was not significantly different between children with or without CNS involvement. CONCLUSIONS Our follow-up of children after HUS showed a favorable cognitive outcome. However, neuromotor outcome was impaired in all study participants. Neurological impairment during acute HUS was not predictive of outcome.
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Affiliation(s)
- Kathrin Buder
- Pediatric Nephrology Unit, University Children's Hospital, Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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21
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Donas A, Marty-Nussbaumer A, Roost HP, Neuhaus TJ. [Measles epidemic in a highly developed country: low mortality, high morbidity and extensive costs]. Klin Padiatr 2014; 226:13-8. [PMID: 24435790 DOI: 10.1055/s-0033-1363254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Vaccination with 2 doses of > 95% of the population is necessary to eliminate measles. In Switzerland and especially in the central part, vaccine coverage is low (2006: 65%). This led 2006-2009 to a measles epidemic with thousands of cases and high costs. One death was noted in a formerly healthy 12 year old girl. PATIENTS AND METHODS All measles cases, either hospitalized or reported to the authority, in the canton Lucerne between 2006 and 2009 were included. Course, complications, immunization rates and costs of the hospitalized children were analyzed. RESULTS A total of 1 041 cases of measles were recorded; 758 (73%) were children < 16 years of age. 56 (6%) of the patients were admitted to hospital; half of them were children (n=26, admission rate 3.4%). Main complications were pneumonia with oxygen requirement (n=19), bacterial infections of the base of the skull (n=2) and acute measles encephalitis (n=3). One child each developed acute appendicitis and diabetes mellitus type 1. No death was noted. Median hospitalisation costs were 18 780 CHF. The surveillance system was incomplete: Every third admitted child was not reported to the authority. CONCLUSION Due to low vaccine coverage measles still account for epidemics with high morbidity and extensive costs. Instant reporting of all cases is crucial for disease control. Early identification of persons at risk allows timely immunization. Switzerland will remain of central importance to eliminate measles in Europe by 2015.
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Affiliation(s)
- A Donas
- Pädiatrie, Kinderspital Luzern, Schweiz
| | | | - H-P Roost
- Gesundheits- und Sozialdepartement, Dienststelle Gesundheit, Kanton Luzern, Schweiz
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22
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Pabst WL, Neuhaus TJ, Nef S, Bresin E, Zingg-Schenk A, Spartà G. Successful long-term outcome after renal transplantation in a patient with atypical haemolytic uremic syndrome with combined membrane cofactor protein CD46 and complement factor I mutations. Pediatr Nephrol 2013; 28:1141-4. [PMID: 23519521 DOI: 10.1007/s00467-013-2450-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/18/2013] [Accepted: 02/22/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Atypical haemolytic uremic syndrome (aHUS) is often associated with a high risk of disease recurrence and subsequent graft loss after isolated renal transplantation. Evidence-based recommendations for a mutation-based management after renal transplantation in aHUS caused by a combined mutation with complement factor I (CFI) and membrane cofactor protein CD46 (MCP) are limited. CASE-DIAGNOSIS/TREATMENT We describe a 9-year-old boy with a first manifestation of aHUS at the age of 9 months carrying combined heterozygous mutations in the CFI and MCP genes. At the age of 5 years, he underwent isolated cadaveric renal transplantation. Fresh frozen plasma was administered during and after transplantation, tapered and finally stopped after 3 years. CONCLUSIONS During the 5-year follow-up after transplantation there have been no signs of aHUS recurrence and graft function has remained good. The combination of heterozygous MCP and CFI mutations with aHUS might have a positive impact on the post-transplant course, possibly predicting a lower risk of aHUS recurrence after an isolated cadaveric renal transplantation.
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Affiliation(s)
- Werner Lukas Pabst
- Pediatric Nephrology Unit, University Children's Hospital of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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23
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Hoff S, Halbritter J, Epting D, Frank V, Nguyen TMT, van Reeuwijk J, Boehlke C, Schell C, Yasunaga T, Helmstädter M, Mergen M, Filhol E, Boldt K, Horn N, Ueffing M, Otto EA, Eisenberger T, Elting MW, van Wijk JAE, Bockenhauer D, Sebire NJ, Rittig S, Vyberg M, Ring T, Pohl M, Pape L, Neuhaus TJ, Elshakhs NAS, Koon SJ, Harris PC, Grahammer F, Huber TB, Kuehn EW, Kramer-Zucker A, Bolz HJ, Roepman R, Saunier S, Walz G, Hildebrandt F, Bergmann C, Lienkamp SS. ANKS6 is a central component of a nephronophthisis module linking NEK8 to INVS and NPHP3. Nat Genet 2013; 45:951-6. [PMID: 23793029 PMCID: PMC3786259 DOI: 10.1038/ng.2681] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/03/2013] [Indexed: 11/09/2022]
Abstract
Nephronophthisis (NPH) is an autosomal recessive cystic kidney disease that leads to renal failure in childhood or adolescence. Most NPHP gene products form molecular networks. We have identified ANKS6 as a new NPHP family member that connects NEK8 (NPHP9) to INVERSIN (INVS, NPHP2) and NPHP3 to form a distinct NPHP module. ANKS6 localizes to the proximal cilium and knockdown experiments in zebrafish and Xenopus confirmed a role in renal development. Genetic screening identified six families with ANKS6 mutations and NPH, including severe cardiovascular abnormalities, liver fibrosis and situs inversus. The oxygen sensor HIF1AN (FIH) hydroxylates ANKS6 and INVS, while knockdown of Hif1an in Xenopus resembled the loss of other NPHP proteins. HIF1AN altered the composition of the ANKS6/INVS/NPHP3 module. Network analyses, uncovering additional putative NPHP-associated genes, placed ANKS6 at the center of the NPHP module, explaining the overlapping disease manifestation caused by mutations of either ANKS6, NEK8, INVS or NPHP3.
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Affiliation(s)
- Sylvia Hoff
- Department of Medicine, Renal Division, University of Freiburg Medical Center, Freiburg, Germany
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24
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Zingg-Schenk A, Caduff J, Azzarello-Burri S, Bergmann C, Drenth JPH, Neuhaus TJ. Boy with autosomal recessive polycystic kidney and autosomal dominant polycystic liver disease. Pediatr Nephrol 2012; 27:1197-200. [PMID: 22415584 DOI: 10.1007/s00467-012-2137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 10/23/2011] [Revised: 02/08/2012] [Accepted: 02/10/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Autosomal recessive polycystic kidney disease (ARPKD) shows a great phenotypic variability between patients, ranging from perinatal demise to mildly affected adults. Autosomal dominant polycystic liver disease (PCLD) does not manifest in childhood. CASE-DIAGNOSIS/TREATMENT A boy was reported with the co-occurrence of ARPKD and PCLD. He presented at the age of 16 days with pyelonephritis and urosepsis. Subsequent investigations showed enlarged kidneys and hyperechogenic renal medulla and liver parenchyma. Genetic analysis revealed compound heterozygous mutations in the PKHD1 gene (p.Arg496X and p.Ser1862Leu). After his mother was diagnosed with PCLD, the finding of a liver cyst on ultrasound prompted analysis of the PRKCSH gene, revealing a missense mutation (p.Arg139His). At the most recent follow-up at 13 years of age, the patient's course and clinical examination was uneventful with normal renal and liver function without evidence of portal hypertension. CONCLUSIONS The patient with ARPKD and PCLD has so far demonstrated a benign clinical outcome, consistent with the great phenotypic variability of ARPKD and, apart from the liver cyst, asymptomatic manifestation of PCLD in childhood. However, close long-term follow-up is mandatory.
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25
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Davis EE, Zhang Q, Liu Q, Diplas BH, Davey LM, Hartley J, Stoetzel C, Szymanska K, Ramaswami G, Logan CV, Muzny DM, Young AC, Wheeler DA, Cruz P, Morgan M, Lewis LR, Cherukuri P, Maskeri B, Hansen NF, Mullikin JC, Blakesley RW, Bouffard GG, Gyapay G, Rieger S, Tönshoff B, Kern I, Soliman NA, Neuhaus TJ, Swoboda KJ, Kayserili H, Gallagher TE, Lewis RA, Bergmann C, Otto EA, Saunier S, Scambler PJ, Beales PL, Gleeson JG, Maher ER, Attié-Bitach T, Dollfus H, Johnson CA, Green ED, Gibbs RA, Hildebrandt F, Pierce EA, Katsanis N. Erratum: Corrigendum: TTC21B contributes both causal and modifying alleles across the ciliopathy spectrum. Nat Genet 2011. [DOI: 10.1038/ng0511-499b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Spartà G, Neuhaus TJ, Laube GF. Erfolgreicher Langzeitverlauf nach Nierentransplantation bei atypischem HUS(aHUS) mit kombinierter MCP und Complement-Faktor I(CFI) Mutation. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Neuhaus TJ, Arnold W, Gaspert A, Hopfer H, Fischer A. Recurrence of membranoproliferative glomerulonephritis after renal transplantation in Denys-Drash. Pediatr Nephrol 2011; 26:317-22. [PMID: 21046168 DOI: 10.1007/s00467-010-1669-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 08/30/2010] [Accepted: 09/10/2010] [Indexed: 11/29/2022]
Abstract
Denys-Drash syndrome (DDS) consists of the triad of nephropathy, male pseudohermaphroditism, and Wilms tumor caused by mutations within exons 8 or 9 of the Wilms tumor suppressor gene 1. Early onset nephrotic syndrome progresses to end-stage renal failure. The characteristic histological lesion is diffuse mesangial sclerosis. Here, we report on a boy with DDS who presented early with diffuse mesangial sclerosis, but subsequently also developed immune complex glomerulonephritis with a membranoproliferative pattern (MPGN-pattern GN) in his native kidneys. Four years after renal transplantation, immune complex glomerulonephritis with an MPGN pattern recurred in the renal graft resulting in proteinuria and progressive renal insufficiency.
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Affiliation(s)
- Thomas J Neuhaus
- Department of Pediatrics, Children's Hospital Lucerne, Spitalstrasse, 6000, Lucerne 16, Switzerland.
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Otto EA, Ramaswami G, Janssen S, Chaki M, Allen SJ, Zhou W, Airik R, Hurd TW, Ghosh AK, Wolf MT, Hoppe B, Neuhaus TJ, Bockenhauer D, Milford DV, Soliman NA, Saunier S, Johnson CA, Hildebrandt F. Mutation analysis of 18 nephronophthisis associated ciliopathy disease genes using a DNA pooling and next generation sequencing strategy. J Med Genet 2011; 48:105-16. [PMID: 21068128 PMCID: PMC3913043 DOI: 10.1136/jmg.2010.082552] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nephronophthisis associated ciliopathies (NPHP-AC) comprise a group of autosomal recessive cystic kidney diseases that includes nephronophthisis (NPHP), Senior-Loken syndrome (SLS), Joubert syndrome (JBTS), and Meckel-Gruber syndrome (MKS). To date, causative mutations in NPHP-AC have been described for 18 different genes, rendering mutation analysis tedious and expensive. To overcome the broad genetic locus heterogeneity, a strategy of DNA pooling with consecutive massively parallel resequencing (MPR) was devised. METHODS In 120 patients with severe NPHP-AC phenotypes, five pools of genomic DNA with 24 patients each were prepared which were used as templates in order to PCR amplify all 376 exons of 18 NPHP-AC genes (NPHP1, INVS, NPHP3, NPHP4, IQCB1, CEP290, GLIS2, RPGRIP1L, NEK8, TMEM67, INPP5E, TMEM216, AHI1, ARL13B, CC2D2A, TTC21B, MKS1, and XPNPEP3). PCR products were then subjected to MPR on an Illumina Genome-Analyser and mutations were subsequently assigned to their respective mutation carrier via CEL I endonuclease based heteroduplex screening and confirmed by Sanger sequencing. RESULTS For proof of principle, DNA from patients with known mutations was used and detection of 22 out of 24 different alleles (92% sensitivity) was demonstrated. MPR led to the molecular diagnosis in 30/120 patients (25%) and 54 pathogenic mutations (27 novel) were identified in seven different NPHP-AC genes. Additionally, in 24 patients only single heterozygous variants of unknown significance were found. CONCLUSIONS The combined approach of DNA pooling followed by MPR strongly facilitates mutation analysis in broadly heterogeneous single gene disorders. The lack of mutations in 75% of patients in this cohort indicates further extensive heterogeneity in NPHP-AC.
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Affiliation(s)
- Edgar A. Otto
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Gokul Ramaswami
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Sabine Janssen
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Moumita Chaki
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan J. Allen
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Weibin Zhou
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Rannar Airik
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Toby W. Hurd
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Amiya K. Ghosh
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthias T. Wolf
- Pediatric Nephrology, Children’s Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bernd Hoppe
- Department of Pediatrics, Division of Pediatric Nephrology, University Hospital Cologne, Germany
| | - Thomas J. Neuhaus
- Department of Pediatrics, Children’s Hospital Lucerne, Lucerne, Switzerland
| | - Detlef Bockenhauer
- Department of Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - David V. Milford
- Department of Pediatric Nephrology, Birmingham Children’s Hospital, Birmingham, UK
| | - Neveen A. Soliman
- Center of Pediatric Nephrology & Transplantation, Cairo University, Cairo, Egypt
- Egyptian Group for Orphan Renal Diseases (EGORD), Cairo, Egypt
| | - the GPN Study Group, Corinne Antignac
- Department of Genetics, Hopital Necker-Enfants Malades, Assistance Publique–Hopitaux de Paris, Paris, France
- INSERM U-983, Hopital Necker-Enfants Malades, Universite Paris Descartes, Paris, France
| | - Sophie Saunier
- Department of Genetics, Hopital Necker-Enfants Malades, Assistance Publique–Hopitaux de Paris, Paris, France
| | - Colin A. Johnson
- Division of Molecular & Translational Medicine, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom
| | - Friedhelm Hildebrandt
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
- Howard Hughes Medical Institute
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Davis EE, Zhang Q, Liu Q, Diplas BH, Davey LM, Hartley J, Stoetzel C, Szymanska K, Ramaswami G, Logan CV, Muzny DM, Young AC, Wheeler DA, Cruz P, Morgan M, Lewis LR, Cherukuri P, Maskeri B, Hansen NF, Mullikin JC, Blakesley RW, Bouffard GG, Gyapay G, Rieger S, Tönshoff B, Kern I, Soliman NA, Neuhaus TJ, Swoboda KJ, Kayserili H, Gallagher TE, Lewis RA, Bergmann C, Otto EA, Saunier S, Scambler PJ, Beales PL, Gleeson JG, Maher ER, Attié-Bitach T, Dollfus H, Johnson CA, Green ED, Gibbs RA, Hildebrandt F, Pierce EA, Katsanis N. TTC21B contributes both causal and modifying alleles across the ciliopathy spectrum. Nat Genet 2011; 43:189-96. [PMID: 21258341 PMCID: PMC3071301 DOI: 10.1038/ng.756] [Citation(s) in RCA: 260] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/22/2010] [Indexed: 12/17/2022]
Abstract
Ciliary dysfunction leads to a broad range of overlapping phenotypes, termed collectively as ciliopathies. This grouping is underscored by genetic overlap, where causal genes can also contribute modifying alleles to clinically distinct disorders. Here we show that mutations in TTC21B/IFT139, encoding a retrograde intraflagellar transport (IFT) protein, cause both isolated nephronophthisis (NPHP) and syndromic Jeune Asphyxiating Thoracic Dystrophy (JATD). Moreover, although systematic medical resequencing of a large, clinically diverse ciliopathy cohort and matched controls showed a similar frequency of rare changes, in vivo and in vitro evaluations unmasked a significant enrichment of pathogenic alleles in cases, suggesting that TTC21B contributes pathogenic alleles to ∼5% of ciliopathy patients. Our data illustrate how genetic lesions can be both causally associated with diverse ciliopathies, as well as interact in trans with other disease-causing genes, and highlight how saturated resequencing followed by functional analysis of all variants informs the genetic architecture of disorders.
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Affiliation(s)
- Erica E Davis
- Center for Human Disease Modeling, Department of Cell Biology, Duke University Medical Center, Durham, North Carolina, USA
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Abstract
PURPOSE The aim of this study was to estimate the frequency and severity of ocular involvement in paediatric patients with haemolytic uraemic syndrome (HUS). METHODS The study was designed as an institutional, retrospective, observational case series. Charts for all 87 paediatric patients with HUS treated at the University Children's Hospital Zurich between 1995 and 2007 were reviewed. Patients with ocular involvement were identified and clinical findings presented. RESULTS Three of 69 examined patients with HUS showed ocular involvement. Ophthalmic findings in two children were consistent with bilateral Purtscher retinopathy, showing multiple haemorrhages, exudations and superficial retinal whitening. The third child presented with bilateral isolated central intraretinal haemorrhages as a milder form of ocular involvement. In one of the children with Purtscher retinopathy, laser photocoagulation was required for bilateral rubeosis irides and development of disc neovascularization. Longterm outcomes in the two severely affected children showed decreased visual acuity caused by partial atrophy of the optic nerves. In the milder case visual acuity was not impaired at any time. CONCLUSIONS A minority of paediatric patients with HUS developed ocular involvement. Acute ocular findings varied in severity from isolated intraretinal haemorrhages to Purtscher-like retinopathy with retinal ischaemia. Longterm complications included the development of neovascularizations and consecutive optic nerve atrophy. Although ocular involvement in HUS seems to be rare, physicians should be aware of this complication because of its possible vision-endangering consequences.
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Affiliation(s)
- Veit Sturm
- Department of Ophthalmology, University Hospital of Zurich, Switzerland.
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Neuhaus TJ, Langlois V, Licht C. Behavioural abnormalities in children with nephrotic syndrome--an underappreciated complication of a standard treatment? Nephrol Dial Transplant 2010; 25:2397-9. [PMID: 20573807 DOI: 10.1093/ndt/gfq358] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Behaviour and psychosocial adjustment are impaired in children with steroid-sensitive idiopathic nephrotic syndrome (SSNS). Both illness-related variables and family climate play a role. Steroid treatment-both short- and long-term-is an important contributor among other determinants. The exact mechanisms by which steroids lead to behavioural alterations in humans is unclear. Optimizing the benefit/risk ratio of steroid treatment in children with SSNS is a constant goal.
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Schoeb DS, Chernin G, Heeringa SF, Matejas V, Held S, Vega-Warner V, Bockenhauer D, Vlangos CN, Moorani KN, Neuhaus TJ, Kari JA, MacDonald J, Saisawat P, Ashraf S, Ovunc B, Zenker M, Hildebrandt F. Nineteen novel NPHS1 mutations in a worldwide cohort of patients with congenital nephrotic syndrome (CNS). Nephrol Dial Transplant 2010; 25:2970-6. [PMID: 20172850 DOI: 10.1093/ndt/gfq088] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Recessive mutations in the NPHS1 gene encoding nephrin account for approximately 40% of infants with congenital nephrotic syndrome (CNS). CNS is defined as steroid-resistant nephrotic syndrome (SRNS) within the first 90 days of life. Currently, more than 119 different mutations of NPHS1 have been published affecting most exons. METHODS We here performed mutational analysis of NPHS1 in a worldwide cohort of 67 children from 62 different families with CNS. RESULTS We found bi-allelic mutations in 36 of the 62 families (58%) confirming in a worldwide cohort that about one-half of CNS is caused by NPHS1 mutations. In 26 families, mutations were homozygous, and in 10, they were compound heterozygous. In an additional nine patients from eight families, only one heterozygous mutation was detected. We detected 37 different mutations. Nineteen of the 37 were novel mutations (approximately 51.4%), including 11 missense mutations, 4 splice-site mutations, 3 nonsense mutations and 1 small deletion. In an additional patient with later manifestation, we discovered two further novel mutations, including the first one affecting a glycosylation site of nephrin. CONCLUSIONS Our data hereby expand the spectrum of known mutations by 17.6%. Surprisingly, out of the two siblings with the homozygous novel mutation L587R in NPHS1, only one developed nephrotic syndrome before the age of 90 days, while the other one did not manifest until the age of 2 years. Both siblings also unexpectedly experienced an episode of partial remission upon steroid treatment.
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Affiliation(s)
- Dominik S Schoeb
- Department of Pediatrics, University of Michigan, 1150 W. Medical Center Drive Drive, Ann Arbor, MI, USA
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Kleinknecht M, Neuhaus TJ, Gehring TM, Landolt MA. [Renal transplanted adolescents' perception of the relationship to the interdisciplinary health care team]. Pflege 2009; 22:287-96. [PMID: 19650034 DOI: 10.1024/1012-5302.22.4.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Various studies have demonstrated that the experience of a supportive relationship improves adherence of chronically ill adolescents. Their experience of the professional relationship in the context of the interdisciplinary treatment setting is still rarely investigated. The aim of this descriptive cross-sectional study in adolescents with renal transplant was to explore how they experience the relationship to the exponents of the different professionals of the health care team. Twenty-seven adolescents, aged 12 to 18, years were investigated by the Family System Test (FAST). The analysis showed that to them, both the pediatric-nephrological specialized nurses and the doctors are attachment figures in a comparable manner. The emotional relationship to the nurses was stronger, whereas in their behavior decisions the influence of the doctors was more pronounced. The adolescents' wish is an equally friendly-professional, yet low hierarchical relationship. These results demonstrated that the patient group specialized primary nursing concept established at the Zurich University Children's Hospital is approved and that interdisciplinarity is important for the care of chronically ill adolescents.
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Ulmer FF, Landolt MA, Vinh RH, Huisman TAGM, Neuhaus TJ, Latal B, Laube GF. Intellectual and motor performance, quality of life and psychosocial adjustment in children with cystinosis. Pediatr Nephrol 2009; 24:1371-8. [PMID: 19294426 DOI: 10.1007/s00467-009-1149-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 02/05/2009] [Accepted: 02/06/2009] [Indexed: 12/18/2022]
Abstract
Cystinosis is a rare multisystemic progressive disorder mandating lifelong medical treatment. Knowledge on the intellectual and motor functioning, health-related quality of life and psychosocial adjustment in children with cystinosis is limited. We have investigated nine patients (four after renal transplantation) at a median age of 9.7 years (range 5.3-19.9 years). Intellectual performance (IP) was analysed with the Wechsler Intelligence Scale for Children-III (seven children) and the Kaufman Assessment Battery for Children (two children). Motor performance (MP) was evaluated using the Zurich Neuromotor Assessment Test, and quality of life (QOL) was studied by means of the Netherlands Organization for Applied Scientific Research Academical Medical Center Child Quality of Life Questionnaire. Psychosocial adjustment was assessed by the Child Behavior Checklist. The overall intelligence quotient (IQ) of our patient cohort (median 92, range 71-105) was significantly lower than that of the healthy controls (p = 0.04), with two patients having an IQ < 85. Verbal IQ (93, range 76-118) was significantly higher than performance IQ (90, range 68-97; p = 0.03). The MP was significantly below the norm for pure motor, pegboard and static balance, as well as for movement quality. The patients' QOL was normal for six of seven dimensions (exception being positive emotions), whereas parents reported significant impairment in positive emotions, autonomy, social and cognitive functions. Significant disturbance was noted in terms of psychosocial adjustment. Based on the results from our small patient cohort, we conclude that intellectual and motor performance, health-related QOL and psychosocial adjustment are significantly impaired in children and adolescents with cystinosis.
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Affiliation(s)
- Francis F Ulmer
- Nephrology Unit, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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Kleinknecht M, Neuhaus TJ, Landolt MA. [Nursing needs of renal transplanted adolescents, a descriptive cross sectional study in a Swiss hospital]. Pflege 2009; 22:172-82. [PMID: 19496030 DOI: 10.1024/1012-5302.22.3.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Various studies have demonstrated that the five-year graft survival of adolescents after renal transplantation is significantly lower than in children. This may be due to poor adherence to the post-transplant regime in adolescents. It has been shown that nurses can provide support to renal transplanted adolescents with positive effects on their adherence. The aim of this descriptive cross-sectional study was to gain knowledge about important topics of nurses' support to adolescent renal transplant patients. Twenty-seven adolescents between the ages of 12 and 18 years were interviewed and given a questionnaire based on a focus group discussion. Each of the provided 43 topics was rated on its importance. Results showed that responses corresponding to the judgment "very important" ranged from 20 % to 100 %. Information about illness and therapy was given highest priority, followed by the provision of support services as well as information and the support of planning and managing the personal way of living. These topics can be seen as a set of relevant variables that may be used for focused assessment, and for planning of nursing interventions. With regard to clinical practice it is necessary to develop nursing strategies and patient and family education programs based on the results of this study.
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Affiliation(s)
- Michael Kleinknecht
- Universitäts-Kinderspital Zürich, Schweiz und Stiftung Mercator Schweiz, Zürich, Schweiz.
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36
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Neuhaus TJ, Berger C, Buechner K, Parvex P, Bischoff G, Goetschel P, Husarik D, Willi U, Molinari L, Rudin C, Gervaix A, Hunziker U, Stocker S, Girardin E, Nadal D. Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis. Eur J Pediatr 2008; 167:1037-47. [PMID: 18074149 DOI: 10.1007/s00431-007-0638-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 11/06/2007] [Indexed: 11/30/2022]
Abstract
The hypothesis was tested that oral antibiotic treatment in children with acute pyelonephritis and scintigraphy-documented lesions is equally as efficacious as sequential intravenous/oral therapy with respect to the incidence of renal scarring. A randomised multi-centre trial was conducted in 365 children aged 6 months to 16 years with bacterial growth in cultures from urine collected by catheter. The children were assigned to receive either oral ceftibuten (9 mg/kg once daily) for 14 days or intravenous ceftriaxone (50 mg/kg once daily) for 3 days followed by oral ceftibuten for 11 days. Only patients with lesions detected on acute-phase dimercaptosuccinic acid (DMSA) scintigraphy underwent follow-up scintigraphy. Efficacy was evaluated by the rate of renal scarring after 6 months on follow-up scintigraphy. Of 219 children with lesions on acute-phase scintigraphy, 152 completed the study; 80 (72 females, median age 2.2 years) were given ceftibuten and 72 (62 females, median age 1.6 years) were given ceftriaxone/ceftibuten. Patients in the intravenous/oral group had significantly higher C-reactive protein (CRP) concentrations at baseline and larger lesion(s) on acute-phase scintigraphy. Follow-up scintigraphy showed renal scarring in 21/80 children treated with ceftibuten and 33/72 with ceftriaxone/ceftibuten (p = 0.01). However, after adjustment for the confounding variables (CRP and size of acute-phase lesion), no significant difference was observed for renal scarring between the two groups (p = 0.2). Renal scarring correlated with the extent of the acute-phase lesion (r = 0.60, p < 0.0001) and the grade of vesico-ureteric reflux (r = 0.31, p = 0.03), and was more frequent in refluxing renal units (p = 0.04). The majority of patients, i.e. 44 in the oral group and 47 in the intravenous/oral group, were managed as out-patients. Side effects were not observed. From this study, we can conclude that once-daily oral ceftibuten for 14 days yielded comparable results to sequential ceftriaxone/ceftibuten treatment in children aged 6 months to 16 years with DMSA-documented acute pyelonephritis and it allowed out-patient management in the majority of these children.
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Affiliation(s)
- Thomas J Neuhaus
- Department of Nephrology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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Neuhaus TJ, Stallmach T, Genewein A. A boy with congenital analbuminemia and steroid-sensitive idiopathic nephrotic syndrome: an experiment of nature. Eur J Pediatr 2008; 167:1073-7. [PMID: 17952464 DOI: 10.1007/s00431-007-0620-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 09/25/2007] [Indexed: 11/24/2022]
Abstract
In this paper, a boy is reported with the association of congenital analbuminemia (CAA) and steroid-sensitive idiopathic nephrotic syndrome (INS), two conditions resulting independently in reduced colloid oncotic pressure. The unique occurrence helps confirm earlier reports that albumin is not the exclusive factor responsible for maintaining colloid oncotic pressure.
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Affiliation(s)
- Thomas J Neuhaus
- Nephrology Unit, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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Falger J, Latal B, Landolt MA, Lehmann P, Neuhaus TJ, Laube GF. Outcome after renal transplantation. Part I: intellectual and motor performance. Pediatr Nephrol 2008; 23:1339-45. [PMID: 18389283 DOI: 10.1007/s00467-008-0795-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 02/08/2008] [Accepted: 02/08/2008] [Indexed: 02/04/2023]
Abstract
Comprehensive information on neurodevelopmental outcome in children and adolescents with chronic kidney disease is still limited. Intellectual performance (IP) and motor performance (MP) were systematically assessed in 27 patients at a median age of 14.1 years (range 6.5-17) and 6 years (range 0.5-12.7) after renal transplantation (RTPL). IP was analyzed with the Wechsler Intelligence Scale for Children-III (WISC-III) in 25 patients and by the Kaufman Assessment Battery for Children in two patients. MP was evaluated by the Zurich Neuromotor Assessment. Median full- scale intelligent quotient (FSIQ) was 97 (range 49-133). Twenty-one patients had an FSIQ >or= 85 (i.e. >or= mean-1 standard deviation). The five patients with neurological comorbidity had a median FSIQ of 81 (range 49-101). Verbal IQ (VIQ) (median 104; range 50-146) was significantly (p < 0.01) higher than performance IQ (PIQ) (median 88; range 48-117). The PIQ was significantly lower compared with controls (p < 0.007), and patients scored significantly lower compared with controls in five of 11 subtests of the Wechsler Scale. All MP tasks were significantly (p < 0.01) lower than in controls, and also in children without neurological comorbidity. Socioeconomic status was significantly correlated with FSIQ (p = 0.03). IP after RTPL was within the normal range for the majority of children. PIQ was lower compared with VIQ, and MP was significantly affected in all children after RTPL.
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Affiliation(s)
- Jutta Falger
- Nephrology Unit, University Children's Hospital, Steinwiesstrasse 75, Zurich, Switzerland
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Bergmann C, Fliegauf M, Brüchle NO, Frank V, Olbrich H, Kirschner J, Schermer B, Schmedding I, Kispert A, Kränzlin B, Nürnberg G, Becker C, Grimm T, Girschick G, Lynch SA, Kelehan P, Senderek J, Neuhaus TJ, Stallmach T, Zentgraf H, Nürnberg P, Gretz N, Lo C, Lienkamp S, Schäfer T, Walz G, Benzing T, Zerres K, Omran H. Loss of nephrocystin-3 function can cause embryonic lethality, Meckel-Gruber-like syndrome, situs inversus, and renal-hepatic-pancreatic dysplasia. Am J Hum Genet 2008; 82:959-70. [PMID: 18371931 PMCID: PMC2427297 DOI: 10.1016/j.ajhg.2008.02.017] [Citation(s) in RCA: 208] [Impact Index Per Article: 13.0] [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: 10/22/2007] [Revised: 01/17/2008] [Accepted: 02/22/2008] [Indexed: 10/22/2022] Open
Abstract
Many genetic diseases have been linked to the dysfunction of primary cilia, which occur nearly ubiquitously in the body and act as solitary cellular mechanosensory organelles. The list of clinical manifestations and affected tissues in cilia-related disorders (ciliopathies) such as nephronophthisis is broad and has been attributed to the wide expression pattern of ciliary proteins. However, little is known about the molecular mechanisms leading to this dramatic diversity of phenotypes. We recently reported hypomorphic NPHP3 mutations in children and young adults with isolated nephronophthisis and associated hepatic fibrosis or tapetoretinal degeneration. Here, we chose a combinatorial approach in mice and humans to define the phenotypic spectrum of NPHP3/Nphp3 mutations and the role of the nephrocystin-3 protein. We demonstrate that the pcy mutation generates a hypomorphic Nphp3 allele that is responsible for the cystic kidney disease phenotype, whereas complete loss of Nphp3 function results in situs inversus, congenital heart defects, and embryonic lethality in mice. In humans, we show that NPHP3 mutations can cause a broad clinical spectrum of early embryonic patterning defects comprising situs inversus, polydactyly, central nervous system malformations, structural heart defects, preauricular fistulas, and a wide range of congenital anomalies of the kidney and urinary tract (CAKUT). On the functional level, we show that nephrocystin-3 directly interacts with inversin and can inhibit like inversin canonical Wnt signaling, whereas nephrocystin-3 deficiency leads in Xenopus laevis to typical planar cell polarity defects, suggesting a role in the control of canonical and noncanonical (planar cell polarity) Wnt signaling.
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Affiliation(s)
- Carsten Bergmann
- Department of Human Genetics, RWTH Aachen University, 52074 Aachen, Germany.
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Zingg-Schenk A, Bacchetta J, Corvol P, Michaud A, Stallmach T, Cochat P, Gribouval O, Gubler MC, Neuhaus TJ. Inherited renal tubular dysgenesis: the first patients surviving the neonatal period. Eur J Pediatr 2008; 167:311-6. [PMID: 17443344 DOI: 10.1007/s00431-007-0492-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [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] [Received: 02/05/2007] [Accepted: 03/28/2007] [Indexed: 11/27/2022]
Abstract
Renal tubular dysgenesis (RTD) is a clinical disorder either acquired during fetal development or inherited as an autosomal recessive condition. Inherited RTD is caused by mutations in the genes encoding the components of the renin-angiotensin system angiotensinogen, renin, angiotensin-converting enzyme and angiotensin II receptor type 1. Inherited RTD is characterized by early onset oligohydramnios, skull ossification defects, preterm birth and neonatal pulmonary and renal failure. The histological hallmark is the absence or poor development of proximal tubules. So far, all patients died either in utero or shortly after birth. We report the first patients with inherited RTD surviving the neonatal period and still being alive. Genetic and functional analysis of the renin-angiotensin system contributes to the diagnosis of RTD. In conclusion, the clinical diagnosis of inherited RTD is easily missed after birth without renal biopsy or information on affected family members. Genetic and functional analysis of the renin-angiotensin system contributes to correct diagnosis.
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Affiliation(s)
- Andrea Zingg-Schenk
- Nephrology Unit, University Children's Hospital, Steinwiesstrasse 75, 8032, Zürich, Switzerland
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Laube GF, Falger J, Kemper MJ, Zingg-Schenk A, Neuhaus TJ. Selective late steroid withdrawal after renal transplantation. Pediatr Nephrol 2007; 22:1947-52. [PMID: 17874140 DOI: 10.1007/s00467-007-0576-1] [Citation(s) in RCA: 6] [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] [Received: 04/13/2007] [Revised: 06/26/2007] [Accepted: 07/10/2007] [Indexed: 11/29/2022]
Abstract
Steroid withdrawal (SW) after paediatric renal transplantation (RTPL) is controversial. Selective late SW has been performed in our unit since 1995. The safety and effects of SW were analysed retrospectively in 47 patients undergoing RTPL between 1995 and 2004. Initial immunosuppression consisted of cyclosporine A, azathioprine or mycophenolate mofetil and steroids. Criteria for SW were: (1) stable renal function, (2) time interval after RTPL > or = 1 year, (3) no rejection or time interval after last rejection > or = 1 year and (4) good compliance. SW was performed in 30 patients at an age of 13.5 years (range 4.5-18.5) and 2.2 years (range 1-6.6) after RTPL. After SW, one patient experienced a steroid-sensitive rejection. Follow-up after SW (1.3 year; range 0.25-7.5) showed maintained renal function: glomerular filtration rate at SW and currently was 82 (65-128) and 82 (42-115) ml/min per 1.73 m(2), respectively. The number of patients on antihypertensive treatment did not significantly change (at SW: n = 15; currently: n = 11). Height and body mass index (BMI) remained stable: Median standard deviation score (SDS) for height/BMI at SW and currently was -1.1/0.2 and -0.8/0.1, respectively. Selective late SW was safe regarding renal function and had no significant effect on blood pressure and growth.
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Affiliation(s)
- Guido F Laube
- Nephrology Unit, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
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Klein A, Fasnacht M, Huisman TAGM, Neuhaus TJ, Martin E, Boltshauser E. Siblings with infantile cerebral stroke and delayed multivessel involvement--a new hereditary vasculopathy? Eur J Paediatr Neurol 2007; 11:292-6. [PMID: 17428710 DOI: 10.1016/j.ejpn.2007.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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] [Received: 08/30/2006] [Revised: 02/02/2007] [Accepted: 02/05/2007] [Indexed: 11/30/2022]
Abstract
We describe an unusual vasculopathy in two sisters of non-consanguineous parents. The first child developed an acute hemiparesis and focal seizures at the age of 6 months during a febrile illness. Magnetic resonance imaging (MRI) of the brain showed bilateral cortical-subcortical infarction not confined to a vascular territory. Subsequently, the child had a persistent stable neurological deficit. Her younger sister had a similar encephalitis-like episode at the age of 4 months, with left-sided cortical-subcortical ischaemic lesions. Two months later she had left-sided focal seizures. MRI showed a right-sided cortical enhancement, magnetic resonance angiography (MRA) was normal. The neurological deficit was stable and she was seizure free. These episodes were initially interpreted as metabolic strokes, but work-up was normal and mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) was excluded. In their teens both sisters were diagnosed with pulmonary and systemic hypertension and, due to the arterial hypertension, myocardial hypertrophy. Renal artery stenosis, pathological pulmonary arteries, and stenosis and rarefication of coronary arteries were found; the aorta and retinal vessels were normal. Repeat cranial MRI and MRA showed multiple collaterals, while the carotid and basilar arteries were extremely narrowed (moyamoya appearance). We suggest the diagnosis is a hereditary systemic vasculopathy of unknown origin.
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Affiliation(s)
- Andrea Klein
- Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland.
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Abstract
Fetal exposure to angiotensin-converting enzyme inhibitors (ACEIs) is associated with increased neonatal morbidity and mortality. Long-term follow-up of three patients with fetal ACEI exposure revealed impaired renal function in two, severe hypertension and proteinuria in one and isolated polycythaemia in all three. Careful long-term follow-up of children with ACEI fetopathy is recommended.
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Affiliation(s)
- Guido F Laube
- University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
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Neuhaus TJ, Rüth EM, Kemper M. Obesity and other clinical endpoints in steroid-sensitive nephrotic syndrome. Pediatr Nephrol 2007; 22:471; author reply 472-3. [PMID: 17151875 DOI: 10.1007/s00467-006-0362-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 09/02/2006] [Indexed: 10/23/2022]
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Chinali M, de Simone G, Matteucci MC, Picca S, Mastrostefano A, Anarat A, Caliskan S, Jeck N, Neuhaus TJ, Peco-Antic A, Peruzzi L, Testa S, Mehls O, Wühl E, Schaefer F. Reduced systolic myocardial function in children with chronic renal insufficiency. J Am Soc Nephrol 2007; 18:593-8. [PMID: 17215443 DOI: 10.1681/asn.2006070691] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Increased left ventricular (LV) mass in children with chronic renal insufficiency (CRI) might be adaptive to sustain myocardial performance in the presence of increased loading conditions. It was hypothesized that in children with CRI, LV systolic function is impaired despite increased LV mass (LVM). Standard echocardiograms were obtained in 130 predialysis children who were aged 3 to 18 yr (59% boys) and had stages II through IV chronic kidney disease and in 130 healthy children of similar age, gender distribution, and body build. Systolic function was assessed by measurement of fractional shortening at the endocardial (eS) and midwall (mS) levels and computation of end-systolic stress (myocardial afterload). The patients with CRI exhibited a 6% lower eS (33.1 +/- 5.5 versus 35.3 +/- 6.1%; P < 0.05) and 10% lower mS (17.8 +/- 3.1 versus 19.7 +/- 2.7%; P < 0.001) than control subjects in the presence of significantly elevated BP, increased LVM, and more concentric LV geometry. Whereas the decreased eS was explained entirely by augmented end-systolic stress, mS remained reduced after correction for myocardial afterload. The prevalence of subclinical systolic dysfunction as defined by impaired mS was more than five-fold higher in patients with CRI compared with control subjects (24.6 versus 4.5%; P < 0.001). Systolic dysfunction was most common (48%) in patients with concentric hypertrophy and associated with lower hemoglobin levels. CRI in children is associated with impaired intrinsic LV contractility, which parallels increased LVM.
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Affiliation(s)
- Marcello Chinali
- Echocardiography Laboratory, Department of Clinical and Experimental Medicine, "Federico II" University Hospital School of Medicine, Ed.1, Via Sergio Pansini 5, 80131, Napoli, Italy
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Kemper MJ, Güngör T, Halter J, Schanz U, Neuhaus TJ. Favorable long-term outcome of nephrotic syndrome after allogeneic hematopoietic stem cell transplantation. Clin Nephrol 2007; 67:5-11. [PMID: 17269593 DOI: 10.5414/cnp67005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The development of nephrotic syndrome (NS) after allogeneic hematopoietic stem cell transplantation (HS-CT) is a rare complication with few long-term outcome data. PATIENTS Clinical course and long-term outcome of three adult patients and one child with NS after HSCT (total number of transplants n = 533) are presented. RESULTS The median age at onset of NS was 35 years (range 15 - 56), occurring at a median of 17 months (range 11 - 21) after HSCT. Discontinuation of cyclosporine A (CSA) prior to onset of NS was a consistent feature and occurred a median of 6 months (range 2 - 10 months) prior to the development of NS. The histopathological lesion was membranous nephropathy (n = 3) and membranoproliferative glomerulonephritis Type 1 (n = 1). History of acute or concomitant clinically apparent chronic graft versus host disease (GVHD) was present in all cases except the pediatric patient who had abundant DR-activated cytotoxic T cells without evidence of viral reactivation. Long-term immunosuppression for 11 - 36 months with steroids (n = 1), combined steroids and CSA (n = 2) or CSA alone in steroid-refractory NS (n = 1) resulted in sustained remission of the NS in all patients (12 months - 8 years off immunosuppression). CONCLUSION NS after HSCT seems to be etiologically related to subclinical or overt chronic GVHD, which flares up after discontinuation of CSA. However, resumption of immunosuppression can reverse NS as well as GVHD and induce favorable sustained long-term remission.
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Affiliation(s)
- M J Kemper
- Department of Pediatric Nephrology, University Children's Hospital Eppendorf, Hamburg, Germany
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Sasse B, Hailemariam S, Wüthrich RP, Kemper MJ, Neuhaus TJ. Angiotensin converting enzyme gene polymorphisms do not predict the course of idiopathic nephrotic syndrome in Swiss children. Nephrology (Carlton) 2006; 11:538-41. [PMID: 17199794 DOI: 10.1111/j.1440-1797.2006.00669.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Contradictory reports exist about a correlation of angiotensin I converting enzyme (ACE) gene polymorphisms to the outcome of idiopathic nephrotic syndrome (INS) in children. We investigated the frequency of ACE polymorphisms and their impact on the clinical course of INS in children in a Swiss hospital. METHODS The ACE gene polymorphism (I, insertion; D, deletion) was assessed in 32 children - 22 with steroid-sensitive INS and 10 with steroid-resistant INS - with a median age at onset of INS of 2.9 years (range 1.1-15.0). Polymerase chain reaction amplification was performed on genomic DNA isolated from blood leucocytes. Results were correlated to clinical course and renal morphology. RESULTS The ACE genotype was I/I, I/D and D/D in two, 12 and eight patients, respectively, with steroid-sensitive INS, and in one, eight and one patient, respectively, with steroid resistance. Renal morphology, available in 25 patients showed minimal change glomerulopathy in 17 patients (14 steroid-sensitive; three steroid-resistant) and focal segmental glomerulosclerosis in eight (one steroid-sensitive; seven steroid-resistant). There was no significant correlation between ACE genotype and steroid responsiveness, histology or outcome. ACE genotype was I/I, I/D and D/D in none, 12 and five patients, respectively, with minimal change glomerulopathy, and in one, five and two patients, respectively, with focal segmental glomerulosclerosis. Six patients with steroid-resistant nephrotic syndrome went into end stage renal disease; ACE genotype was I/I in one and I/D in five, but none were D/D. CONCLUSION In contrast to previous reports, ACE gene polymorphism is irrelevant for clinical outcome, steroid responsiveness or morphology in Swiss children with INS.
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MESH Headings
- Age of Onset
- Child
- Child, Preschool
- Disease Progression
- Drug Resistance/genetics
- Female
- Genotype
- Glomerulosclerosis, Focal Segmental/drug therapy
- Glomerulosclerosis, Focal Segmental/genetics
- Glomerulosclerosis, Focal Segmental/physiopathology
- Humans
- Kidney Failure, Chronic/drug therapy
- Kidney Failure, Chronic/genetics
- Kidney Failure, Chronic/physiopathology
- Male
- Nephrosis, Lipoid/drug therapy
- Nephrosis, Lipoid/genetics
- Nephrosis, Lipoid/physiopathology
- Peptidyl-Dipeptidase A/genetics
- Polymorphism, Genetic
- Predictive Value of Tests
- Steroids/therapeutic use
- Switzerland
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Affiliation(s)
- Bernd Sasse
- Institute for Clinical Pathology, Department of Pathology, University Hospital, Zurich, Switzerland.
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Spartà G, Kemper MJ, Neuhaus TJ. Hyperuricemia and gout following pediatric renal transplantation. Pediatr Nephrol 2006; 21:1884-8. [PMID: 16947031 DOI: 10.1007/s00467-006-0257-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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] [Received: 03/09/2006] [Revised: 05/31/2006] [Accepted: 06/15/2006] [Indexed: 10/24/2022]
Abstract
Hyperuricemia and gout are common complications in adult renal transplant recipients. In pediatric recipients, however, hyperuricemia seems to be rare, but data are scarce. Thirty-two children (21 males, 11 females) were investigated for a median time of 4.8 years (range: 0.4-11.2 years) following renal transplantation. The median age of this pediatric study group was 13.9 years (range: 5.7-20.3 years), and the calculated glomerular filtration rate (GFR) was 61 ml/min per 1.73 m(2) (range:12-88 ml/min per 1.73 m(2)). All patients were given calcineurin inhibitors, with 22 and ten children receiving cyclosporine A (CSA) and tacrolimus (TAC), respectively. The median plasma uric acid was 385 micromol/l (range: 62-929 micromol/l); 15 children (47%) were above the age-related normal range. Only one patient experienced gouty arthritis. There was a significant correlation between plasma uric acid concentration and both time span after transplantation and plasma creatinine, and an inverse correlation to GFR (p<0.05). No significant correlation was found between plasma uric acid and body mass index (BMI). Plasma uric acid concentrations were neither different among CSA- and TAC-treated children, nor did they correlate with drug exposure or blood trough levels of CSA or TAC. Plasma uric acid concentration was not different when compared to children with chronic renal failure (CRF) of a similar degree in native kidneys. We conclude that hyperuricemia is common among pediatric renal transplant recipients and rather a consequence of chronic renal transplant dysfunction than the use of calcineurin inhibitors. Gout, however, is rare.
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Affiliation(s)
- Giuseppina Spartà
- Nephrology Unit, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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Abstract
BACKGROUND Prognosis of fetuses with renal oligohydramnios (ROH) is often still regarded as poor. Neonatal complications and the long-term follow-up of fetuses with ROH in two pediatric centres are described. Method. 23 fetuses (16 males, 7 females) were included as patients. Primary diseases included congenital anomalies of the kidney and urinary tract (n = 16), autosomal recessive polycystic kidney disease (n = 4) and renal tubular dysgenesis (n = 3). The analysis includes retrospective chart review. RESULTS Seven children died (30%), the majority (n = 4, 17%) within the neonatal period due to pulmonary hypoplasia and renal insufficiency. Fourteen patients (61%) required postnatal mechanical ventilation for a median of 4 (range 1-60) days; 11 infants had an associated pneumothorax. All 16 surviving children have chronic kidney disease (CKD) at a current median age of 5.7 years (range 0.5-14.5), managed conservatively in eight patients [median glomerular filtration rate 51 (range 20-78) ml/min/1.73 m(2)]. Eight patients reached end-stage renal disease at a median age of 0.3 years (range 2 days to 8.3 years), including one patient with pre-emptive kidney transplantation. Five of the patients requiring dialysis underwent successful renal transplantation at a median age of 3.5 years (range 2.5-4). Growth was impaired in seven children requiring growth hormone treatment. Cognitive and motor development was normal in 12 (75%) of the 16 patients and showed a delay in four children, including two with associated syndromal features. CONCLUSION ROH is not always associated with a poor prognosis and long-term outcome in survivors is encouraging. The high incidence of neonatal complications and long-term morbidity due to CKD requires a multidisciplinary management of these children.
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Affiliation(s)
- Ilka Klaassen
- Pediatric Nephrology, University Medical Center, Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
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Bergmann C, Küpper F, Schmitt CP, Vester U, Neuhaus TJ, Senderek J, Zerres K. Multi-exon deletions of the PKHD1 gene cause autosomal recessive polycystic kidney disease (ARPKD). J Med Genet 2006; 42:e63. [PMID: 16199545 PMCID: PMC1735935 DOI: 10.1136/jmg.2005.032318] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Autosomal recessive polycystic kidney disease (ARPKD) is caused by mutations in the PKHD1 (polycystic kidney and hepatic disease 1) gene on chromosome 6p12, a large gene spanning 470 kb of genomic DNA. So far, only micromutations in the 66 exons encoding the longest open reading frame (ORF) have been described, and account for about 80% of mutations. OBJECTIVE To test the hypothesis that gross genomic rearrangements and mutations in alternatively spliced exons contribute to a subset of the remaining disease alleles. METHODS Using DHPLC for alternatively spliced exons and quantitative real time polymerase chain reaction to detect genomic imbalances, 58 ARPKD patients were screened, of whom 55 were known to harbour one PKHD1 point mutation in the longest ORF. RESULTS Three different heterozygous PKHD1 deletions and several single nucleotide changes in alternatively spliced exons were identified. The detected partial gene deletions are most likely pathogenic, while a potential biological function of the alterations identified in alternatively spliced exons must await the definition of transcripts containing alternative exons and their predicted reading frames. CONCLUSIONS Gross PKHD1 deletions account for a detectable proportion of ARPKD cases. Screening for major genomic PKHD1 rearrangements will further improve mutation analysis in ARPKD.
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Affiliation(s)
- C Bergmann
- Department of Human Genetics, Aachen University, Germany.
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