Schwartz Formula Research Articles

Knowledge, attitudes, and practices related to augmented renal clearance among pediatricians in China: A cross-sectional study.

Our purpose was to assess pediatricians’ knowledge of augmented renal clearance (ARC).We conducted cross-sectional analyses of 500 pediatricians from 16 tertiary hospitals in Anhui Province, China. Pediatricians provided demographic information and were asked questions about their knowledge of ARC, including risk factors, evaluation tools, and the impact on patient prognosis, with a focus on the attitude and practice of pediatricians related to adjusting vancomycin regimens when ARC occurs.A total of 491 valid questionnaires were finally included, only 276 pediatricians stated that they “know about ARC.” Compared with the “do not know about ARC” group, the “know about ARC” group was younger (43.7 ± 8.0 vs 48.0 ± 7.9, P < .001), and their main source of ARC knowledge was from social networking platforms. A total of 193 (70%) chose at least 4 of the following factors as risk factors for children with ARC: severe trauma, sepsis, burns, major surgery, lower disease severity, and hematological malignancies. A total of 110 (40%) and 105 (38%) pediatricians chose the Schwartz formula and cystatin C, respectively, as the indicators to evaluate the renal function of ARC children. Concerning the estimated glomerular filtration rate threshold to identify ARC children, 201 (73%) pediatricians chose 130 mL/min/1.73 m2, while 55 (20%) chose “age-dependent ARC thresholds.” Overall, 220 (80%) respondents indicated that ARC would impact the treatment effect of vancomycin, but 149/220 (68%) were willing to adjust the vancomycin regimen; only 22/149 (8%) considered that the dose should be increased, but no one knew how to increase. Regarding the prognosis of ARC children, all respondents chose “unclear.”ARC is relatively common in critically ill children, but pediatricians do not know much about it, as most of the current knowledge is based on adult studies. Furthermore, ARC is often confused with acute kidney injury, which would lead to very serious treatment errors. Therefore, more pediatric studies about ARC are needed, and ARC should be written into official pediatric guidelines as soon as possible to provide reference for pediatricians.

Fixed-dose combination bictegravir, emtricitabine, and tenofovir alafenamide in adolescents and children with HIV: week 48 results of a single-arm, open-label, multicentre, phase 2/3 trial

Bictegravir is a potent integrase strand-transfer inhibitor (INSTI) with a high genetic barrier to resistance. Bictegravir, coformulated with emtricitabine and tenofovir alafenamide, is recommended by key European and US HIV treatment guidelines as the preferred single-tablet regimen for adults and adolescents. The aim of this study was to assess the pharmacokinetics, safety, and efficacy of switching to this regimen in virologically suppressed children and adolescents with HIV. In this single-arm, open-label trial, we enrolled virologically suppressed children and adolescents (aged 6 to <18 years) with HIV at 22 hospital clinics in South Africa, Thailand, Uganda, and the USA. Eligible participants had a bodyweight of at least 25 kg, were virologically suppressed (HIV-1 RNA <50 copies per mL) on a stable ART regimen for at least 6 months before screening, had a CD4 count of at least 200 cells per μL, and an estimated glomerular filtration rate of at least 90 mL/min per 1·73 m2 by the Schwartz formula at screening. All participants received the fixed-dose regimen of coformulated bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafenamide 25 mg once daily. Pharmacokinetic analysis was used for dosing confirmation, and results compared with adult values. The primary outcomes were area under the curve at the end of the dosing interval (AUCtau) and concentration at the end of the dosing interval (Ctau) of bictegravir, and incidence of treatment-emergent adverse events and laboratory abnormalities at week 24. Efficacy and safety analyses included all participants who received at least one dose of study drug. We report the 48-week results. This study is registered with ClinicalTrials.gov, NCT02881320. Between Sept 29, 2016 and Feb 16, 2018, we enrolled 102 participants. 100 participants received bictegravir, emtricitabine, and tenofovir alafenamide (cohort 1 [adolescents aged 12 to <18 years], n=50; cohort 2 [children aged 6 to <12 years], n=50). The mean bictegravir AUCtau was 89 100 ng × h/mL (coefficient of variation 31·0%) in adolescents (cohort 1) and 128 000 ng × h/mL (27·8%) in children (cohort 2). Compared with adults, bictegravir Ctau was 35% lower in adolescents and 11% lower in children. The 90% CIs of both parameters were within the predefined pharmacokinetic equivalence boundary and within overall range of exposures observed in adults and deemed to be safe and efficacious (geometric least-squares mean ratio [GLSM] 86·3% [90% CI 80·0-93·0] for AUCtau and 65·4% [58·3-73·3] for Ctau in adolescents; GLSM 125% [90% CI 117-134] for AUCtau and 88·9% [80·6-98·0] for Ctau for children). Bictegravir, emtricitabine, and tenofovir alafenamide was well tolerated; most adverse events were grade 2 or less in severity and no study drug-related serious adverse events were reported. One participant discontinued study drug due to adverse events (grade 2 insomnia and anxiety). Virological suppression (HIV-1 RNA <50 copies per mL) was maintained by all 100 participants at week 24 and by 98 (98%) of 100 at week 48; no participants had treatment-emergent resistance. In adolescents and children with HIV, the bictegravir, emtricitabine, and tenofovir alafenamide single-tablet regimen was well tolerated and maintained virological suppression. Our data support the treatment of HIV in adolescents and children with this single-tablet regimen. At present, the single-tablet regimen is recommended as first-line treatment in the USA for adolescents and as an alternative regimen in children and has the potential to represent an important regimen in the paediatric population. Gilead Sciences.

Reliability of different estimated glomerular filtration rate as measures of renal function in children with sickle cell disease

BackgroundThere is no reliable marker for detecting early renal disease in early children with sickle cell disease (SCD). Estimation of glomerular filtration rate (eGFR) as derived from the height/plasma creatinine formula is dependent on the accuracy of the creatinine analytical method used. The aim of this study was to evaluate different equations for eGFR. MethodsChildren aged 5–16 years recruited. mGFR was obtained using plasma disappearance of Inutest/Iohexol, serum creatinine (SCr) was measured either by standard laboratory method or by tandem mass spectrometry (MSMS). Estimated GFR was then calculated either by “Bedside Schwartz method” or by the full-age spectrum (FAS) equation. FindingsA total of 79 patients (mean age 9.8 ± 4.0 years). A revised eGFR constant was calculated for Schwartz equation from the slope of the plot of height/plasma creatinine versus mGFR. Mean values for mGFR (132.7 ± 32.1 ml/min/1.73m2) and eGFR methods compared: eGFR from standard SCr was significantly higher (144.2 ± 37.3 ml/min/1.73m2, p = 0.008). The MSMS eGFR showed the lowest SD (SD = 27.5), while both FAS eGFR and FAS-height eGFR showed the highest correlation coefficient (r = 0.67). InterpretationeGFR calculation based on height and SCr determined with MSMS traceable creatinine is more reliable than Schwartz formula using jaffe/enzymatic methods in SCD children.

Evaluation of Glomerular functions in Patients with SCA in Maiduguri North-eastern Nigeria: a recommendation for early assessment and detection of dysfunction in a resource-poor setting

Background: Sickle cell anaemia (SCA) is a disorder of Mendelian autosomal recessive inheritance, characterised by abnormal haemoglobin synthesis resulting in multi-systemic manifestations. The kidneys are largely affected by this disorder, but overt features of kidney disease mostly manifest after the second decade, even though insult and sub-clinical features may occur during childhood. Unfortunately, investigating these sub-clinical features is not routinely done in resource-scarce settings, partly due to the low socioeconomic status of most of our patients and the overwhelmed health care workers. Objectives: To investigate glomerular dysfunction in children with SCA in the context of the resource-poor setting. Methodology: This cross-sectional study was conducted at the University of Maiduguri Teaching Hospital (UMTH), over 6 months. One hundred and ten SCA (Hb SS) children aged 3 – 14 years in steady-state constituted the cases, while 110 non-SCA (Hb AA) age and sex-matched, apparently healthy children formed the control. Anthropometry, blood pressure, urinalysis and serum creatinine of the subjects was done. Glomerular filtration rate (GFR) was estimated using the Schwartz formula. Results: The mean systolic blood pressure (SBP) ± SD of the cases and controls were 96.8±9.34mmHg and 99.14±13.44mmHg respectively, (p = 0.13). The mean diastolic BP ± SD of the cases and controls were 60.18±6.85mmHg and 64.35±8.23mmHg respectively, (p = 0.0001). Glomerular filtration rate was significantly higher among the cases than the controls, 126±32ml/min/1.73m2 and 93±16ml/min/1.73m2 respectively (p &lt;0.001). Proteinuria was higher among the cases (8.2%), with one (0.9%) having nephrotic range proteinuria. Conclusions: The proteinuria and hyperfiltration found in some of the children with SCA in this study suggest that renal function abnormalities can be detected early in this group of children when appropriately and timely investigated.

EVALUATION OF GLOMERULAR FUNCTIONS IN PATIENTS WITH SCA IN MAIDUGURI NORTH-EASTERN NIGERIA: A RECOMMENDATION FOR EARLY ASSESSMENT AND DETECTION OF DYSFUNCTION IN A RESOURCE-POOR SETTING.

Background: Sickle cell anaemia (SCA) is a disorder of Mendelian autosomal recessive inheritance, characterised by abnormal haemoglobin synthesis resulting in multi-systemic manifestations. The kidneys are largely affected by this disorder, but overt features of kidney disease mostly manifest after the second decade, even though insult and sub-clinical features may occur during childhood. Unfortunately, investigating these sub-clinical features is not routinely done in resource-scarce settings, partly due to the low socioeconomic status of most of our patients and the overwhelmed health care workers. Objectives: To investigate glomerular dysfunction in children with SCA in the context of the resource-poor setting. Methodology: This cross-sectional study was conducted at the University of Maiduguri Teaching Hospital (UMTH), over 6 months. One hundred and ten SCA (Hb SS) children aged 3 – 14 years in steady-state constituted the cases, while 110 non-SCA (Hb AA) age and sex-matched, apparently healthy children formed the control. Anthropometry, blood pressure, urinalysis and serum creatinine of the subjects was done. Glomerular filtration rate (GFR) was estimated using the Schwartz formula. Results: The mean systolic blood pressure (SBP) ± SD of the cases and controls were 96.8±9.34mmHg and 99.14±13.44mmHg respectively, (p = 0.13). The mean diastolic BP ± SD of the cases and controls were 60.18±6.85mmHg and 64.35±8.23mmHg respectively, (p = 0.0001). Glomerular filtration rate was significantly higher among the cases than the controls, 126±32ml/min/1.73m2 and 93±16ml/min/1.73m2 respectively (p &lt;0.001). Proteinuria was higher among the cases (8.2%), with one (0.9%) having nephrotic range proteinuria. Conclusions: The proteinuria and hyperfiltration found in some of the children with SCA in this study suggest that renal function abnormalities can be detected early in this group of children when appropriately and timely investigated.

Comparison of cystatin C, creatinine, and iohexol clearance in pediatric liver transplantation-a retrospective cohort study.

Impaired renal function after pediatric (LT) is a recognized problem. Accurate monitoring of (GFR) is imperative to detect declining renal function. GFR can be estimated via s-creatinine and/or p-cystatin C or measured by inulin and or/iohexol clearances. We retrospectively compared eGFRcrea and eGFRcyst, to mGFRiohex after LT. Data from 91 children with 312 concomitant measurements of s-creatinine, p-cystatin C, and iohexol clearance, obtained between 2007 and 2015, were analyzed. eGFR was calculated by using the p-cystatin C-based CAPA and CKD-EPI formulas, and the s-creatinine-based Schwartz-LYON, FAS, revised Schwartz and MDRD formulas. Also, the arithmetic means of cystatin C-based and creatinine-based equations were used. Every calculated eGFR was compared to mGFRiohex in statistical correlation, accuracy, precision, bias, and misclassifications. Among the different equations, p-cystatin C-based formulas (CAPA and CKD-EPI) as well as the s-creatinine-based Schwartz-LYON formula showed the most correct estimates regarding accuracy (84-87.5%), bias (0.19-4.0ml/min/1.73m2 ), and misclassification rate (24.7-25%). In patients with renal function <75ml/min/1.73m2 , cystatin C-based formulas were significantly more accurate and less biased than creatinine-based formulas. In conclusion, S-creatinine could be used in a clinical setting on a regular basis in liver transplanted pediatric patients, with reliable results, if eGFR is calculated by the Schwartz-LYON formula. When suspected renal dysfunction, cystatin C-based eGFR should be calculated, since it gives more accurate and less biased estimates than creatinine-based eGFR, and should be confirmed by mGFR (iohexol).

Population Pharmacokinetic Analysis of Rivipansel in Healthy Subjects and Subjects with Sickle Cell Disease.

BackgroundSickle cell disease is an inherited blood disorder with reduced blood-carrying capacity. It is associated with a tendency to form microclots in blood vessels, leading to painful episodes known as a vaso-occlusive crisis. Rivipansel is a pan-selectin inhibitor being studied for the treatment of a vaso-occlusive crisis in patients with sickle cell disease.MethodsA population pharmacokinetic model of rivipansel plasma and urine concentrations was constructed using a two-compartment model and data from nine different clinical studies. Creatinine clearance was calculated using the Schwartz formula for children and the Chronic Kidney Disease Epidemiology Collaboration formula for adults. Urine volume and concentration of the study drug in urine from subjects in five clinical studies were used to estimate renal and nonrenal clearance.ResultsRivipansel drug concentrations were well described by the model. The post hoc estimates of average steady-state concentrations were predicted to be similar for the adult and pediatric cohorts of the pivotal phase III study. Parameter estimates showed almost exclusively renal excretion of rivipansel, which is consistent with the known properties of the drug.ConclusionsThe pharmacokinetics of rivipansel was well characterized by a two-compartment population pharmacokinetic model. Our results illustrate the important role of simulations in optimizing a potential drug dosing regimen for patients with sickle cell disease and progressive renal impairment.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40268-021-00346-3.

Long-term renal outcome in methylmalonic acidemia in adolescents and adults

BackgroundChronic kidney disease (CKD) is one of the main long-term prognosis factors in methylmalonic acidemia (MMA), a rare disease of propionate catabolism. Our objective was to precisely address the clinical and biological characteristics of long-term CKD in MMA adolescent and adult patients.Patients and methodsIn this retrospective study, we included MMA patients older than 13 years who had not received kidney and/or liver transplantation. We explored tubular functions, with special attention to proximal tubular function. We measured glomerular filtration rate (mGFR) by iohexol clearance and compared it to estimated glomerular filtration rate (eGFR) by Schwartz formula and CKD-EPI.ResultsThirteen patients were included (M/F = 5/8). Median age was 24 years (13 to 32). Median mGFR was 57 mL/min/1.73 m2 (23.3 to 105 mL/min/1.73 m2). Ten out of 13 patients had mGFR below 90 mL/min/1.73 m2. No patient had significant glomerular proteinuria. No patient had complete Fanconi syndrome. Only one patient had biological signs suggestive of incomplete proximal tubulopathy. Four out of 13 patients had isolated potassium loss, related to a non-reabsorbable anion effect of urinary methylmalonate. Both Schwartz formula and CKD-EPI significantly overestimated GFR. Bias were respectively 16 ± 15 mL/min/1.73 m2 and 37 ± 22 mL/min/1.73 m2.ConclusionCKD is a common complication of the MMA. Usual equations overestimate GFR. Therefore, mGFR should be performed to inform therapeutic decisions such as dialysis and/or transplantation. Mild evidence of proximal tubular dysfunction was found in only one patient, suggesting that other mechanisms are involved.

Chronic Kidney Disease Prevalence and Glomerular Filtration Rate Trends in Children With Type 1 Diabetes

Background and Objectives: Children with type 1 diabetes (T1D) are at risk for acute kidney injury (AKI) secondary to diabetic ketoacidosis, as well as chronic kidney disease (CKD) from diabetic nephropathy. The primary objective of this study was to assess the prevalence of abnormalities in estimated glomerular filtration rate (eGFR) in children with T1D. As a secondary objective, we sought to explore the relationship between clinical characteristics and trends in eGFR. Design, Setting, Participants, and Measurements: This ambispective cohort study involved children aged 18 years or younger with T1D (n = 420), followed in the diabetes clinic at British Columbia Children’s Hospital (BCCH), the tertiary pediatric hospital in Vancouver, British Columbia, Canada. Data was collected from the BCCH paper and electronic health records. CKD was defined as eGFR less than 60 mL/min/1.73 m2. Being at risk of CKD was defined as having a mildly decreased eGFR (60-<90 mL/min/1.73 m2) and/or hyperfiltration (eGFR ≥140 mL/min/1.73 m2). eGFR was calculated using the modified Schwartz formula (36.5 x height in cm / serum creatinine in μmol/L). Linear regression analysis was used to describe the relationship between eGFR and duration of T1D. Covariates included in the analysis included sex, history of DKA, A1c, and BMI. Results: Of the 420 participants, 225 (54%) were male, with a median age at T1D diagnosis of 6.1 years and T1D duration of 4.8 years (range <1.0–15.0 years). One-hundred and eighty-six (44%) children were hospitalized for DKA, of which 89 (48%) developed AKI. No participants had an eGFR < 60 ml/min/1.73m2, and 317 (76%) had normal renal function. Fifty-one participants (12%) had an eGFR < 90 ml/min/1.73 m2, and 52 (12%) demonstrated hyperfiltration. When analyzed as a cohort cross-sectionally based on duration of T1D, there was a significant linear decline in eGFR of 1.4 ml/min/1.73 m2 per year (95% CI -1.95, -0.87 ml/min/1.73 m2). Conclusion: In a large group of pediatric patients with type 1 diabetes, 24% were at risk for chronic kidney disease based on a mildly decreased GFR and/or hyperfiltration. The pattern of eGFR decline over time is concerning and relevant, as this cohort is at risk for CKD secondary to diabetic kidney disease. Strategies are needed to improve the follow-up and management of early CKD in children with type 1 diabetes to maintain their renal function into adulthood, and more studies are needed to quantify further change in eGFR in the young adult population.

Glomerular Filtration Rate Estimation Based on Cystatin C Formulas among Neonates

Background: Glomerular filtration rate (GFR) is the best indicator to assess renal function; however, it is difficult to perform it, especially in neonates. Serum creatinine is the most commonly used marker of GFR; nevertheless, it has some limitations since it can be affected by factors other than renal function. Cystatin C, another endogenous marker used to estimate GFR, is not affected by non-renal factors. The results of some studies suggest that serum cystatin C levels are more accurate tests of kidney function than serum creatinine levels. This study aimed to estimate GFR with cystatin C-based formulas among neonates and determine the correlations between these methods and the Schwartz formula. Methods: The population of this research consisted of 99 neonates whose serum creatinine and cystatin C levels were measured concurrently. Moreover, the glomerular filtration rate was estimated using the Schwartz formula and 14 cystatin C-based formulas separately. Results: Based on the findings, all GFR values based on cystatin C formulas correlated significantly with each other (p 0.05). The only cystatin C formula that yielded values correlating with the Schwartz formula was CysCrEq, which used serum cystatin C and creatinine concomitantly. Conclusion: It can be concluded that since all GFR values based on cystatin C correlated significantly and cystatin Cwasindependent of non-renal factors, cystatin C reflected the real GFR more accurately than serum creatinine. Nonetheless, further studies with gold standard techniques are required to verify the usefulness of cystatin C-based formulas.

POS-060 CHRONIC KIDNEY DISEASE IN PEDIATRIC ACUTE KIDNEY INJURY SURVIVORS FROM INTENSIVE CARE UNIT: PROSPECTIVE STUDY FROM A DEVELOPING COUNTRY

Acute kidney injury (AKI) is an independent risk factor for mortality in critically il. Incidence of AKI in PICU ranges from 8-30%. Despite advances in therapy, mortality is still high and survivors are at risk of CKD. A hospital based prospective cohort study was conducted on critically ill children and neonates with AKI admitted to SAT Hospital, a tertiary care teaching hospital in South India over a period of 1 year with the objective to assess the immediate and long term outcome and risk factor involved in adverse outcome. Adverse outcome is defined as mortality or development of CKD in survivors. AKI was defined by pRIFLE and nRIFLE criteria respectively in children and neonates. Those with pre-existing CKD or CAKUT were excluded. The demographic profile, etiology, organ dysfunction, inotrope support, mechanical ventilation, AKI severity, need for dialysis and condition at discharge were assessed. Survivors were followed up with assessment of blood pressure, proteinuria and e GFR by Schwartz formula at 3 months, 6 months and 1 year. GFR below 90 mL/min/1.73 m2 or a normal GFR with proteinuria and/or hypertension were used to identify CKD. Statistical analysis was done with SPSS 20.0 .Chi square test was used for discrete variables, t test and ANOVA for quantitative variables. Univariate analysis and binary logistic regression were done for assessment of factors affecting the outcome. 155 critically ill babies- 87 neonates and 68 children were diagnosed with AKI during the study period. Male to Female ratio was 4.1:1 for new-born and 1.8:1 for children. Out of the 87 neonates 25.3% (22) were at risk, 43.7 % (38) in injury and 31 % (27) had failure. Dehydration due to faulty feeding and lactation failure formed the major cause of neonatal AKI (50.6%) followed by septicaemia (28.7%). Of the 68 children 17.7% (12), 23.5 % (16) and 58.8% (40) were in risk, injury and failure respectively. Acute Glomerulonephritis was the major etiology (23.5%) followed by sepsis with MODS (19.1%). Significant association was found between mortality and severity of AKI in both neonates and children. (P 0.002, P 0.00). Significant risk factors of mortality are given in Table 1.View Large Image Figure ViewerDownload Hi-res image Download (PPT) 13 out of 87 neonates expired (14.9%). 83.7% had normal GFR at discharge. 8.6% (3/35) with Injury and 53% (9/17) with Failure had partial recovery. 74 survivors were followed up for 1 year. 12 were lost to follow up and 1 died at 3 months. 4/61 babies (6.5%) developed CKD - 11% with injury and 14.2% with failure. Of the 68 children, 15 expired (22%). Among 53 survivors, 27 (51%) – {33.3 % (5/15) with injury and 80.8 % (21/26)} had abnormal GFR at discharge. 48 children were followed up till 1 year. 22.9% (11) had CKD . Of this 20% (3/15) were with injury and 36% (8/22) with failure. Severity of AKI correlated with adverse outcome. Risk factors for CKD were anuric AKI, MODS, need for dialysis, component therapy, inotrope support, abnormal GFR and hypertension at discharge. Anuric AKI and need for dialysis were the independent risk factors by multivariate analysis for development of CKD (Table 2). 22.9% children and 6.5% neonates surviving an AKI episode had CKD at 1 year follow up. Regardless of the severity, all AKI survivors after critical illness should be monitored regularly for long-term kidney damage so that early intervention becomes possible to retard the progression.

Serum NGAL, BNP, PTH, and albumin do not improve glomerular filtration rate estimating formulas in children

Glomerular filtration rate (GFR) is difficult to measure, and estimating formulas are notorious for lacking precision. This study aims to assess if the inclusion of additional biomarkers improves the performance of eGFR formulas. A hundred and sixteen children with renal diseases were enrolled. Data for age, weight, height, inulin clearance (iGFR), serum creatinine, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), parathyroid hormone (PTH), albumin, and brain natriuretic peptide (BNP) were collected. These variables were added to the revised and combined (serum creatinine and cystatin C) Schwartz formulas, and the quadratic and combined quadratic formulas. We calculated the adjusted r-square (r2) in relation to iGFR and tested the improvement in variance explained by means of the likelihood ratio test. The combined Schwartz and the combined quadratic formulas yielded best results with an r2 of 0.676 and 0.730, respectively. The addition of BNP and PTH to the combined Schwartz and quadratic formulas improved the variance slightly. NGAL and albumin failed to improve the prediction of GFR further. These study results also confirm that the addition of cystatin C improves the performance of estimating GFR formulas, in particular the Schwartz formula.Conclusion: The addition of serum NGAL, BNP, PTH, and albumin to the combined Schwartz and quadratic formulas for estimating GFR did not improve GFR prediction in our population.What is Known:• Estimating glomerular filtration rate (GFR) formulas include serum creatinine and/or cystatin C but lack precision when compared to measured GFR.• The serum concentrations of some biological parameters such as neutrophil gelatinase-associated lipocalin (NGAL), parathyroid hormone (PTH), albumin, and brain natriuretic peptide (BNP) vary with the level of renal function.What is New:• The addition of BNP and PTH to the combined quadratic formula improved its performance only slightly. NGAL and albumin failed to improve the prediction of GFR further.

P0110 / #800: MEASURED GLOMERULAR FILTRATION RATE USING DTPA PLASMA CLEARANCE VERSUS ESTIMATED GLOMERULAR FILTRATION RATE USING MODIFIED SCHWARTZ FORMULA IN CRITICALLY ILL CHILDREN: A OBSERVATIONAL STUDY

Aims & Objectives: To study the strength of agreement between the Measured (m-GFR) by 99mTc-DTPA renal clearance and Estimated GFR (e-GFR) by modified Schwartz formula in critically ill children in PICU. Methods: Children aged 1 month to 12 years admitted in PICU, were included in the study within 24 hours of admission to PICU with stable hemodynamic parameters. One mCi (mile Curie) of freshly prepared 99mTc-DTPA dispensed in pre-weighed syringes was injected intravenously followed by 2 ml of normal saline flush.Two blood samples for GFR estimation and simultaneous SCr were taken at two hour and four-hour following injection in a heparinized vial. The counting of samples was done within by Russell’s two-sample slope-intercept method was performed. GFR was calculated as follows by using the modified Schwartz formula, e-GFR = k x L / Sr Results: Bland–Altman plot for GFR by 99mTc-DTPA plasma clearance and bedside Schwartz method showed a mean difference of 4.538 (95% confidence interval [CI] = -0.388–8.895). The limit of agreement ranged from -61.32to 69.87. ICC coefficient in our study showed moderate correlation in the whole study group, in subjects more than 24 months of age and in patients suffering from AKI.One thirty-one (64.8%) patients were diagnosed with AKI as per p-RIFLE classification.One hundred twenty-seven patients (62.87%) diagnosed AKI within 24 hours of PICU stay by using bedside Schwartz formula and 117 of them also matching AKI criteria if GFR was considered as per m-GFR value. Conclusions: We found good agreement between measured and estimated GFR in pediatric patients.

Glomerular hyperfiltration in Yemeni children with sickle cell disease

Background: Glomerular hyperfiltration (GH) is a common feature of sickle cell nephropathy (SCN) starting at infancy and represents an early marker of incipient glomerular injury and renal dysfunction. Methods: This study aimed to determine the prevalence and correlates of GH among children (≤ 16 years) with sickle cell disease (SCD) at their steady state, recruited over 6 months at the Pediatric Outpatient Clinic in Al-Sadaqa General Teaching Hospital, Aden, Yemen. Glomerular filtration rate (eGFR) was estimated using the Schwartz formula. Data on clinical history, anthropometry, blood pressure (BP) and laboratory investigations were collected. Results: Of 101 children (mean age 7.2 ± 3.9 years), 65 (64.4%) were males. The prevalence of GH was observed in 36 (35.6%) children, who were significantly older (10.7 ± 3.2 vs. 5.2 ± 2.7 years, p &lt; 0.001) and had a lower fetal Hb level (5 ± 3.3 vs. 9 ± 7.1, p = 0.02). All children were normotensive, but hyperfiltrating children showed significantly higher systolic (97.2 ± 7.3 vs. 89.7 ± 5.2 mmHg) and diastolic pressure (55.1 ± 5.0 vs. 49 ± 4.3 mmHg) (all p &lt; 0.001). Among evaluated children, 25.7% had hyperfiltration alone, whereas 9.9% had an associated microalbuminuria (MA), and no significant difference in eGFR between those with and without MA (158.4 ± 33.7 vs. 160.7 ± 29.8 ml/min/173m2, p = 0.84). Conclusion: This study demonstrated a relatively high prevalence of GH in Yemeni children with SCD that increased with age. Recognition of hyperfiltration and other early markers of nephropathy in this population could help to develop renal protective strategies to prevent progressive loss of kidney function.

Çocukluk Çağı Kanser Yaşayanlarında Nefrotoksisitenin İncelenmesi ve Glomerüler Filtrasyon Hızı Yöntemlerinin Karşılaştırılması

Objective: Increased survival rates in childhood cancers have led the researchers to focus on long-term side effects and possible risk factors for late nephrotoxicity related to the treatment regimens applied. Our aim is to evaluate drug-induced nephrotoxicity in survivors of childhood cancer and to investigate the compatibility of creatinine clearance with the estimated glomerular filtration rate. Methods: The presence of glomerular and tubular dysfunction has been screened among 59 childhood cancer survivors who had completed their treatment regimens with cisplatin, carboplatin, ifosfamide, and /or high dose methotrexate. Results: The mean age of patients was 10.7±5.5 years (2.5-23), and mean follow-up time was 2.6±2.1 years (0.5-8). Renal dysfunction was detected in 65% of the patients. The most prevalent manifestation of renal dysfunction was decreased glomerular filtration rate (n: 19, 32.2%), and increased urinary β2-microglobulin excretion (n: 12, 20.4%), followed by microalbuminuria (n: 6, 10.1%). Survivors treated with combined chemotherapy regimens (cisplatin, carboplatin, ifosfamide) had significantly lower tubular reabsorption of phosphate than those treated with high dose of methotrexate. The glomerular filtration rate analysis was performed using different methods, and a moderate correlation (r=0.563, p=0.00) was found between estimated glomerular filtration rates calculated according to cystatin-C-based equations and Schwartz formula. Conclusion: Childhood cancer survivors demonstrated a high frequency of renal complications in the current study. We have shown that the calculation of the estimated glomerular filtration rate using the Schwartz formula or cystatin-C-based equations is compatible with the creatinine clearance in this specific patient group. In survivors of childhood cancer who cannot perform 24-hour urine collection, determination of estimated glomerular filtration rate is a more practical approach.

Estimation of Glomerular Filtration Rate: Which Formula to Apply in G-Spot Subjects Aged 1 - 17 Years?

Introduction: Morbidity and mortality in paediatric practice is dominated in Africa by malaria, diarrhoeal diseases and acute respiratory infections. Aim: In order to evaluate the Glomerular Filtration Rate (GFR) with the formulas commonly used by medical laboratories, we proposed to undertake this study. Patients and Method: This was a descriptive, prospective and cross-sectional study conducted at the PA and KA medical biology laboratory in Bamako Hamdalaye ACI 2000 in collaboration with the medical biology and hospital hygiene laboratory service at the Point G University Hospital. Results: During the study period, we recruited 360 subjects, 189 of whom were male (52.5%) and 171 female (47.5%). The mean age was 8.75 ± 4.8 years with extremes of 1 and 17 years. Subjects aged 15 to 17 years were the most numerous. The reference means GFR of the subjects according to age was with the SCHWARTZ formula 179.16 ± 50.47 with extremes of 173.93 and 184.39; with CKD-Epi 37.63 ± 11.25 with extremes of 36.46 and 38.79; with MAYO 107.87 ± 18.11 with extremes of 105.99 and 109.75 and MDRD 350.83 ± 251.15 with extremes of 324.79 and 376.86. Conclusion: The Mayo formula showed a better distribution around the mean than other formulas for estimating the glomerular filtration rate.

Early functional and metabolic disorders in children with type I diabetes mellitus and diabetic nephropathy.

Type 1 diabetes (T1D) is mainly adisease of children and young adults. The onset of disease is associated with 3 classical symptoms: polydipsia, polyphagia, and polyuria. Hyperglycaemia is the main and primary metabolic disorder in T1D. One of the complications developing as aresult of microangiopathy is diabetic nephropathy (DN). Additionally, diabetes remains the most common reason for progressing to end-stage renal disease (ESRD). The aim of the study was to evaluate the most initial metabolic and functional disorders in diabetic children and children with DN. The study involved 76 children with T1D and diabetic nephropathy (aged 3 to 17 years). The levels of ET-1 measured using ELISA assay and ratio of lipid oxidation measured spectrophotometrically. Main clinical parameters (blood pressure, glycaemia, albuminuria, creatininaemia, HbA1C, cholesterol levels) were measured using conventional methods available in Clinical Paediatric Hospital No. 6 (Kyiv, Ukraine). The glomerular filtration rate (GFR) was calculated using the Schwartz formula. Patterns of the BP changes, kidney function impairment, ET-level, and metabolic and functional disorders in children with T1D and DN were found.

Assessment of hepatitis B and hepatitis C status in children with chronic kidney disease

Background: Children with chronic kidney disease (CKD) are immunocompromised and they are more prone to develop hepatitis B and hepatitis C virus infections. Objective: The aim of this study was to evaluate the status of hepatitis B and hepatitis C in children with CKD. Study Design: This was a cross-sectional study. Study Setting and Period: This study was conducted at the Department of Pediatrics Nephrology, Dhaka Shishu (Children) Hospital, from February 2019 to July 2019. Study Population: Children aged 6 months–18 years with the diagnosis of CKD participated in the study. Materials and Methods: A total of 35 purposively selected patients with CKD were enrolled. Thorough history, physical examination, and necessary investigations were done. CKD staging was done by using the revised Schwartz formula. All 35 patients were in CKD stages 3–5. They were divided into three groups: CKD stage 3–4; CKD stage 5 pre-hemodialysis (pre-HD); and CKD stage 5 maintenance HD. Then hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (anti-HCV), and hepatitis B surface antibody (anti-HBs) titer were assessed in all patients and compared between the groups. Analysis was done by the analysis of variance (ANOVA) and t test. A value of P < 0.05 was considered statistically significant. Results: The study revealed that all 35 patients were negative for HBsAg and anti-HCV. Anti-HBs antibody titer in 25.7% patients were 00 mIU/mL, in 40% patients <10 mIU/mL, in 20% patients 10–100 mIU/mL, and in 14.3% patients >100 mIU/mL. Majority (65.7%) of the patients had no protection (titer 0–<10 mIU/mL) against hepatitis B virus (HBV) infection and seen declining of anti-HBs antibody titer with increase of age in the study population. No significant difference of antibody titer was found in between gender, cause of CKD, different stages of CKD, and duration of the disease. Conclusion: In this study, all patients with CKD were negative for HBsAg and anti-HCV. Patients were negative for HBsAg. However, majority (65.7%) of patients show no protection against HBV infection.

Прогнозування ранньої діагностики гострого пошкодження нирок у недоношених дітей з гемодинамічно значущою відкритою артеріальною протокою

The development of acute kidney injury (AKI) in preterm infants with hemodynamically significant patent ductus arteriosus (HSPDA) is an additional burden on homeostatic mechanisms, leading to loss of fluid, electrolyte balance, and acid-base disturbance and increasing the risk of mortality by 50%. Therefore, early detection of AKI in preterm infants with HSPDA is extremely important in terms of improving treatment outcomes. Purpose — to create, evaluate and further analyze the binary logistic regression model of AKI on the background of HSPDA in premature infants. Materials and methods. The group of study participants consisted of 40 premature babies with HSPDA, who were admitted for treatment on the first day of life to the Department of Anesthesiology and Neonatal Intensive Care at MI «Dnepropetrovsk Regional Children's Clinical Hospital» Dnepropetrovsk Regional Council». On the third to fifth day of life, 23 (57.5%) patients were diagnosed with AKI. Clinical and laboratory examination included obstetric history, gestational age, weight, physical examination, clinical analysis of blood and urine, arterial blood oxygen saturation, biochemical methods — examination of urea, serum and urine creatinine, serum and urine sodium, serum potassium. The concentration index of creatinine, fractional excretion of sodium, glomerular filtration rate (GFR) according to the Schwartz formula were calculated. Instrumental methods of examination included echocardiography with Doppler, ultrasound Doppler of renal vessels, renal spectroscopy in the near infrared region. In order to preliminarily determine the diagnostic potential of some clinical'anamnestic and laboratory data, the parameters of the sample with AKI and the sample without this pathology were compared: in the case of interval scale the Mann–Whitney U-test was used, in the case of categorical scale — χ2-test or Fisher's exact test. Spearman's rank correlation was used to form the optimal set of input variables for regression modeling. The method of binary logistic regression was used to develop a diagnostic model of AKI development on the background of HSPDA in premature infants. Results. At the stage of exploratory data analysis (several dozen parameters of clinical and biochemical analysis of blood and urine, renal hemodynamics, renal oxygenation and therapeutic measures on the first day), as well as clinical and anamnestic data, it was found that AKI has a significant relationship with 14 interval ( maximum blood flow velocity in the interlobar renal artery, minimum blood flow velocity in the interlobar renal artery, resistance index in the interlobar renal artery, maximum blood flow velocity in the main renal artery, diameter of the open arterial duct, renal oxygenation, fractional renal tissue extraction of oxygen, serum creatinine, GFR, creatinine concentration index, urinary sodium, fractional sodium excretion, urine protein, diastolic blood pressure) and 9 nominal values (the size of the patent ductus arteriosus on the first day of more than 2 mm, ibuprofen therapy at a dose of 20 mg/kg on the first day, ibuprofen therapy on the first day of life, furosemide treatment, history of renal disease in the mother, chronic foci of infection in the mother, hypertension of pregnancy, threat of abortion, necrotizing enterocolitis in the patient on the first day of life). Conclusions. The most significant predictors of AKI development in premature infants with HSPDA are the parameter of maximum blood flow velocity in the interlobar renal artery, HSPDA diameter greater than 2 mm and serum creatinine level on the first day of life. The sensitivity of the AKI logistic regression model, in which HSPDA diameter and serum creatinine level are used as explanatory variables, is 91%, specificity — 88%, overall accuracy — 90%. Replacement of serum creatinine in the logit function for the maximum blood flow velocity in the interlobar renal artery allows to increase the sensitivity of the model up to 96%, and the overall accuracy up to 93%. The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents of children was obtained for the research. The authors were declare no conflict of interest. Key words: hemodynamically significant patent ductus arteriosus, premature infants, acute kidney injury, prediction of early diagnosis.

ФУНКЦИЯ ПОЧЕК У НОВОРОЖДЕННЫХ ДЕТЕЙ

Objective. The article discusses the problem of assessing renal function of the kidneys in premature babies born as a result of prematurely premature births with extremely low birth weight. Materials and methods. The functional state of the kidneys was evaluated in 148 children with ELBW and VLBW in the period from 1 to 90 days of postnatal age. The urine output rate, serum creatinine level, GFR calculation according to the Schwartz formula. Results. The results of the study showed that premature babies with ELBW are characterized by elevated serum creatinine levels and a low glomerular filtration rate, starting from the 4th day of life. An increase in GFR from the 3rd week of postnatal life significantly increases the likelihood of survival of premature babies with ELBW. The decrease in glomerular filtration rate in this contingent of children is associated not so much with kidney damage, but rather due to a more pronounced immaturity of nephrons Conclusion: Kidney function in preterm infants with ENMT is much lower than even in more mature children with ONHT. This is confirmed by high persistent levels of creatinine in serum and low SCF values throughout the neonatal period of life.