Here is your researchbulletin for June 2024! I realise it is now July but such is life. I have scoured the farthest recesses of the internet to curate this strange mix of publications. ⭐🌛
From around the web
CKD
- This interesting review highlights paediatric CKD as a risk factor for school absenteeism and low educational attainment. Paediatric CKD is linked to lower employment rates. European cohorts have reported unemployment rates of 44-57% in the CKD population. Lower socio-economic and educational status predicts CKD progression and adverse CKD-associated outcomes.
- What novel approaches can we find to bridge this gap?
Haemodialysis
- This slightly mad paper describes a randomised control trial of 68 children on haemodialysis subjected to either 40 minutes of exercise three times a week for 2 months or routine hospital care. They have reported (wildly) that 66.7% of study group patients and just 3.3% of control group patients had a “good QoL” assessed via a questionnaire and the PedsQL scale.
- These crazy results have me wondering if we can persuade someone to run dialysis friendly exercise sessions?
Assessment of volume status of pediatric hemodialysis patients. Fadel et al. Pediatric Nephrology
- This study explored the utility of lung and IVC ultrasound in assessing volume status by comparing findings to clinical evaluation and bioimpedance pre and post dialysis sessions. Lung B-lines outperformed IVC measurements and bioimpedance in subclinical overload detection.
- Could ultrasound help us determine fluid status when our BCM is not in keeping with the clinical picture?
AKI
- No surprises here as our old friend aciclovir appears to cause more AKI than other antivirals used for herpes zoster in Chinese hospitalised adults. Rates of AKI by drug type – aciclovir 5%, ganciclovir 3%, famciclovir 3%, foscarnet 1%.
Hypertension
- Hypertension is a common complication of adolescents with T1DM. This study evaluated 46 such patients and found hypertension was mainly elevated nocturnal diastolic BP. The finding of albuminuria correlated with diastolic hypertension – particularly nocturnal diastolic hypertension and impaired nocturnal dipping.
Nephrotic syndrome
- In this Japanese cohort of 45 patients with SRNS receiving rituximab 69, 24, and 7% of the patients achieved complete remission, partial remission, and no remission respectively at one year after treatment.
- Combination treatment with rituximab and immunosuppressives resulted in favourable outcomes. Risk factors for poor response were FSGS on biopsy and late rituximab administration.
- The complete remission rate if rituximab was given within 6 months of diagnosis was 90% vs 21% when given beyond 6 months making a compelling argument for early administration.
Stones
- Two cases of pure xanthine stone formation in patients with TLS-induced AKI. Both developed within 1-2 weeks of initiating therapy and in one case burden was significant with a 1.8cm stone among many other smaller stones.
- Allopurinol prevents conversion of xanthine to uric acid. Xanthine is less soluble than uric acid and relatively unaffected by urinary alkalinisation. The new-ish medication Rasburicase converts uric acid to allantoin which is five times more soluble than uric acid.
Oddities 🧐
- Take one small step – Astronauts suffer from stones, damage and dysfunction… but why?
- This exasperated author was funded by AstraZeneca to write about the slow progress with SGLT2i’s in paediatrics.
- This case series describes PHA secondary to urinary tract infection and obstruction in paediatric patients at a tertiary paediatric unit in Zaragoza, Spain. The most interesting part of this series is that one patient in this cohort actually did develop iatrogenic extrapontine myelinolysis secondary to rapid correction of severe hyponatraemia with hypertonic saline!