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Zandi R, Huang R, Sternfeld A, Rahmani S, Kurup SP. Bilateral nonarteritic ischemic optic neuropathy and retinal ischemia in a pediatric dialysis patient. J AAPOS 2024; 28:103948. [PMID: 38825070 DOI: 10.1016/j.jaapos.2024.103948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 06/04/2024]
Abstract
A nearly 3-year-old boy on nightly dialysis presented emergently with sudden loss of vision. On examination, his visual acuity was light perception in the right eye and no light perception in the left eye. There was bilateral optic disk edema, diffuse pallor of posterior poles, and a cherry red spot in the left fundus. The patient was subsequently found to be hemodynamically unstable and admitted to the pediatric intensive care unit with presumed septic shock. Optical coherence tomography revealed paracentral acute middle maculopathy lesions in the right eye and diffusely thick retina in the left eye. Magnetic resonance imaging and magnetic resonance angiography of the brain and vessels did not reveal any acute findings. The patient's presentation was most consistent with bilateral nonarteritic ischemic optic neuropathy and unilateral central retinal artery occlusion. On repeat evaluation 9 months later, vision was largely unchanged.
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Affiliation(s)
- Roya Zandi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Russell Huang
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amir Sternfeld
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Ophthalmology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Safa Rahmani
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Ophthalmology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sudhi P Kurup
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Ophthalmology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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Mai K, Su R, Basalely A, Castellanos LJ, Singer P, Pomeranz HD, Verma R, Sethna CB. Anterior and posterior ischemic optic neuropathy in a child with focal segmental glomerulosclerosis on hemodialysis. Pediatr Nephrol 2024; 39:1771-1774. [PMID: 38197957 DOI: 10.1007/s00467-023-06252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Ischemic optic neuropathy (ION) is exceedingly rare in children on dialysis, resulting from poor perfusion of the optic nerve, and presents as sudden acute painless vision loss. CASE-DIAGNOSIS/TREATMENT We report the case of a 3-year-old male with stage 5 chronic kidney disease (CKD 5) due to focal segmental glomerulosclerosis (FSGS) status post-bilateral nephrectomy on chronic hemodialysis who had acute loss of vision several hours after a hemodialysis session. Earlier that day, he had a drop in blood pressure intra-dialysis to 89/67 mmHg, with at home blood pressures ranging 90/60 to 150/100 mmHg. The patient was treated with tight blood pressure control to maintain blood flow and prevent blood pressure lability, received high-dose corticosteroids with a corticosteroid taper, and placed on high-dose erythropoietin for neuroprotective effect. He regained partial vision beginning approximately 1 month after presentation. CONCLUSIONS The exact cause of our patient's simultaneous bilateral anterior and posterior ION, confirmed via MRI and fundoscopic examination, is unclear; however, is likely secondary to a combination of fluctuating blood pressure, anemia, anephric status, and hemodialysis. This highlights the need for close blood pressure monitoring, management of anemia, and more diligent ophthalmologic screening in pediatric patients on chronic hemodialysis.
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Affiliation(s)
- Katherine Mai
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA.
| | - Rina Su
- Division of Ophthalmology, Northwell Eye Institute, Northwell Health, Great Neck, NY, USA
| | - Abby Basalely
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Laura J Castellanos
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Pamela Singer
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Howard D Pomeranz
- Division of Ophthalmology, Northwell Eye Institute, Northwell Health, Great Neck, NY, USA
| | - Rashmi Verma
- Division of Ophthalmology, Northwell Eye Institute, Northwell Health, Great Neck, NY, USA
| | - Christine B Sethna
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA
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Harvey E. Bioimpedance analysis in children on peritoneal dialysis: to fill or not to fill? Pediatr Nephrol 2024; 39:1319-1321. [PMID: 38206433 DOI: 10.1007/s00467-023-06274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Elizabeth Harvey
- Hospital for Sick Children, Toronto, Canada.
- University of Toronto, Toronto, Canada.
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4
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Gong HX, Xie SY. Non-arteritic anterior ischemic optic neuropathy combined with branch retinal vein obstruction: A case report. World J Clin Cases 2023; 11:6189-6193. [PMID: 37731577 PMCID: PMC10507569 DOI: 10.12998/wjcc.v11.i26.6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/16/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Non-arteritic anterior ischemic optic neuropathy (NAION) is an independent disease characterized by edematous optic discs. In eyes with branch retinal vein occlusion (BRVO), the arteries and veins in the ethmoid plate of the optic disc are relatively crowded; however, a combination of the two is clinically uncommon. Herein, we reported a patient with NAION and concealed BRVO, for which the treatment and prognosis were not similar to those for NAION alone. CASE SUMMARY Herein, we report a case of NAION with concealed BRVO that did not improve with oral medication. A week later, we switched to intravenous drug administration to improve circulation, and the patient's visual acuity and visual field recovered. Hormonal therapy was not administered throughout the study. This case suggested that: (1) Fundus fluorescein angiography (FFA) can help detect hidden BRVO along with the NAION diagnosis; (2) intravenous infusion of drugs to improve circulation has positive effects in treating such patients; and (3) NAION with concealed BRVO may not require systemic hormonal therapy, in contrast with the known treatment for simple NAION. CONCLUSION NAION may be associated with hidden BRVO, which can only be observed on FFA; intravenous therapy has proven effectiveness.
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Affiliation(s)
- Hong-Xia Gong
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020, China
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
- Neuroophthalmology, Nankai University Affiliated Eye Hospital, Tianjin 300020, China
| | - Shi-Yong Xie
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020, China
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
- Neuroophthalmology, Nankai University Affiliated Eye Hospital, Tianjin 300020, China
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Kim HS, Ruebner RL, Brady TM. Acute bilateral vision loss in a toddler with stage 5 chronic kidney disease: Answers. Pediatr Nephrol 2021; 36:4125-4127. [PMID: 34499253 DOI: 10.1007/s00467-021-05229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Hannah S Kim
- Division of Pediatric Nephrology and Hypertension, Penn State College of Medicine, Hershey, PA, USA.
| | - Rebecca L Ruebner
- Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, MD, USA
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Vidal E, Parolin M, Gamba P. Unilateral or bilateral early nephrectomy in infants with autosomal recessive polycystic kidney disease? Weighing risks and benefits. J Pediatr Surg 2021; 56:435-436. [PMID: 32862996 DOI: 10.1016/j.jpedsurg.2020.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Enrico Vidal
- Pediatric Nephrology Program, Division of Pediatrics, Department of Medicine (DAME), University-Hospital of Udine, Udine, Italy..
| | - Mattia Parolin
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University-Hospital of Padova, Padova, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Department of Women's and Children's Health, University-Hospital of Padova, Padova, Italy
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Teitelbaum I, Glickman J, Neu A, Neumann J, Rivara MB, Shen J, Wallace E, Watnick S, Mehrotra R. KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis. Am J Kidney Dis 2020; 77:157-171. [PMID: 33341315 DOI: 10.1053/j.ajkd.2020.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/29/2022]
Abstract
The recently published 2020 International Society for Peritoneal Dialysis (ISPD) practice recommendations regarding prescription of high-quality goal-directed peritoneal dialysis differ fundamentally from previous guidelines that focused on "adequacy" of dialysis. The new ISPD publication emphasizes the need for a person-centered approach with shared decision making between the individual performing peritoneal dialysis and the clinical care team while taking a broader view of the various issues faced by that individual. Cognizant of the lack of strong evidence for the recommendations made, they are labeled as "practice points" rather than being graded numerically. This commentary presents the views of a work group convened by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) to assess these recommendations and assist clinical providers in the United States in interpreting and implementing them. This will require changes to the current clinical paradigm, including greater resource allocation to allow for enhanced services that provide a more holistic and person-centered assessment of the quality of dialysis delivered.
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Affiliation(s)
- Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado, Aurora, CO
| | - Joel Glickman
- Division of Nephrology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alicia Neu
- Division of Pediatric Nephrology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | | | - Matthew B Rivara
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Jenny Shen
- Division of Nephrology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Eric Wallace
- Division of Nephrology, Department of Medicine, University of Alabama, Birmingham, AL
| | - Suzanne Watnick
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA; Northwest Kidney Centers, Seattle, WA
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
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Burgmaier K, Ariceta G, Bald M, Buescher AK, Burgmaier M, Erger F, Gessner M, Gokce I, König J, Kowalewska C, Massella L, Mastrangelo A, Mekahli D, Pape L, Patzer L, Potemkina A, Schalk G, Schild R, Shroff R, Szczepanska M, Taranta-Janusz K, Tkaczyk M, Weber LT, Wühl E, Wurm D, Wygoda S, Zagozdzon I, Dötsch J, Oh J, Schaefer F, Liebau MC. Severe neurological outcomes after very early bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD). Sci Rep 2020; 10:16025. [PMID: 32994492 PMCID: PMC7525474 DOI: 10.1038/s41598-020-71956-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
To test the association between bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD) and long-term clinical outcome and to identify risk factors for severe outcomes, a dataset comprising 504 patients from the international registry study ARegPKD was analyzed for characteristics and complications of patients with very early (≤ 3 months; VEBNE) and early (4–15 months; EBNE) bilateral nephrectomies. Patients with very early dialysis (VED, onset ≤ 3 months) without bilateral nephrectomies and patients with total kidney volumes (TKV) comparable to VEBNE infants served as additional control groups. We identified 19 children with VEBNE, 9 with EBNE, 12 with VED and 11 in the TKV control group. VEBNE patients suffered more frequently from severe neurological complications in comparison to all control patients. Very early bilateral nephrectomies and documentation of severe hypotensive episodes were independent risk factors for severe neurological complications. Bilateral nephrectomies within the first 3 months of life are associated with a risk of severe neurological complications later in life. Our data support a very cautious indication of very early bilateral nephrectomies in ARPKD, especially in patients with residual kidney function, and emphasize the importance of avoiding severe hypotensive episodes in this at-risk cohort.
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Affiliation(s)
- Kathrin Burgmaier
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Gema Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Martin Bald
- Department of Pediatric Nephrology, Klinikum Stuttgart, Olga Children's Hospital, Stuttgart, Germany
| | | | - Mathias Burgmaier
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Florian Erger
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michaela Gessner
- Department of General Pediatrics and Hematology/Oncology, Children's University Hospital Tuebingen, Tuebingen, Germany
| | - Ibrahim Gokce
- Division of Pediatric Nephrology, Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Jens König
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | | | - Laura Massella
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Djalila Mekahli
- Department of Development and Regeneration, PKD Research Group, KU Leuven, Leuven, Belgium.,Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Lars Pape
- Department of Pediatrics II, University Hospital Essen, Essen, Germany.,Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Ludwig Patzer
- Children's Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | - Alexandra Potemkina
- Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Gesa Schalk
- Department of Pediatrics, University Hospital Bonn, Bonn, Germany
| | - Raphael Schild
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Rukshana Shroff
- UCL Great Ormond Street Hospital for Children Institute of Child Health, UCL, London, UK
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, SUM in Katowice, Katowice, Poland
| | | | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Lutz Thorsten Weber
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Donald Wurm
- Department of Pediatrics, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Simone Wygoda
- Clinic for Children and Adolescents, Hospital St. Georg, Leipzig, Germany
| | - Ilona Zagozdzon
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Jörg Dötsch
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jun Oh
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Max Christoph Liebau
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne and University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. .,Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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Miro Quesada JJ, Carvajal Rico W, Toncel Churio O, Montoya Llano L, Duran Rubio J. Neuropatía óptica asociada con lesión de Dieulafoy. REPERTORIO DE MEDICINA Y CIRUGÍA 2020. [DOI: 10.31260/repertmedcir.01217372.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: describir el caso de un paciente del Hospital de San José de Bogotá con hemorragia del tracto digestivo superior secundaria a lesión de Dieulafoy, que presentó cuadro compatible con neuropatía óptica anterior isquémica no arterítica (NOIANA). Se hace una revisión narrativa y búsqueda sistemática de la literatura para determinar las características clínicas, demográficas, tratamiento y pronóstico visual de los pacientes con NOIANA. Materiales y métodos: reporte de caso, revisión narrativa y búsqueda sistemática de la literatura en las bases de datos Medline (vía Ovid) y Embase de NOIANA secundaria a hipovolemia. Se analizaron las variables sociodemográficas, clínicas, diagnóstico, condiciones asociadas, tratamiento y pronóstico visual. El análisis estadístico se realizó mediante frecuencias absolutas y relativas. Resultados: la mejoría de agudeza visual final en los pacientes que presentaron un episodio de NOIANA es incierta. En 42% hubo algún tipo de mejoría de la agudeza visual, independiente del tratamiento recibido. Menos del 50% de los casos clínicos reportados incluidos en este estudio que recibieron tratamiento con corticoides intravenosos mejoraron la visión. Discusión: la NOIANA por choque hipovolémico es una entidad infrecuente y poco reportada que puede generar cambios irreversibles en la agudeza visual, por lo que es importante sospecharla y detectarla para dar un manejo oportuno. Este caso de NOIANA es uno de los pocos descritos como secundarios a hemorragia digestiva y el primero asociado con lesión de Dieulafoy.
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Anterior Ischemic Optic Neuropathy in a Child Receiving Chronic Hemodialysis. Case Rep Nephrol 2020; 2020:7012586. [PMID: 32257471 PMCID: PMC7102483 DOI: 10.1155/2020/7012586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/18/2022] Open
Abstract
Anterior ischemic optic neuropathy (AION) occurs due to hypoperfusion of the optic nerve and is a rare complication in patients receiving maintenance dialysis. To date, AION has only been reported in 22 children, all of whom were receiving peritoneal dialysis. We report the first case of AION in a 2-year 11-month-old child receiving chronic hemodialysis secondary to polycystic kidney disease from a phosphomannomutase 2 gene mutation. This case highlights the consideration for frequent blood pressure monitoring and ophthalmic screening in a certain cohort of children receiving chronic dialysis.
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11
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Warady BA, Schaefer F, Bagga A, Cano F, McCulloch M, Yap HK, Shroff R. Prescribing peritoneal dialysis for high-quality care in children. Perit Dial Int 2020; 40:333-340. [DOI: 10.1177/0896860819893805] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Peritoneal dialysis (PD) remains the most widely used modality for chronic dialysis in children, particularly in younger children and in lower and middle income countries (LMICs). We present guidelines for dialysis initiation, modality selection, small solute clearance, and fluid removal in children on PD. A review of the literature and key studies that support these statements are presented. Methods: An extensive Medline search for all publications on PD in children was performed using predefined search criteria. Results: High-quality randomized trials in children are scarce and current clinical practice largely relies on data extrapolated from adult studies or drawn from observational cohort studies in children. The evidence and strength of the recommendation is GRADE-ed, but in the absence of high-quality evidence, the opinion of the authors is provided and must be carefully considered by the treating physician, and adapted to local expertise and individual patient needs as appropriate. We discuss the timing of dialysis initiation, factors to be considered when selecting a dialysis modality, the assessment and management of volume status on PD, achieving optimal small solute clearance, and the importance of preserving residual kidney function. While optimal dialysis must remain the goal for every patient, a careful discussion with fully informed patients and caregivers is important to understand the patient and family’s expectations of dialysis and reasonable adjustments to the dialysis program may be considered in accordance with a philosophy of shared decision-making. Conclusions: There continues to be very poor evidence in the field of chronic PD in children and these recommendations can at best serve to guide clinical decision-making. In LMICs, every effort should be made to conform to the framework of these statements, taking into account resource limitations.
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Affiliation(s)
- Bradley A Warady
- Division of Pediatric Nephrology, Children’s Mercy, Kansas City, MO, USA
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Arvind Bagga
- Division of Pediatric Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Francisco Cano
- Division of Pediatric Nephrology, Luis Calvo Mackenna Children’s Hospital, University of Chile, Santiago, Chile
| | - Mignon McCulloch
- School of Child and Adolescent Health, Red Cross Children’s Hospital, Cape Town, South Africa
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London, Institute of Child Health, London, UK
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13
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Maio T, Lemos J, Moreira J, Sampaio F, Pereira S. Visual Impairment After Haemodialysis. Neuroophthalmology 2018; 43:43-48. [PMID: 30723524 DOI: 10.1080/01658107.2018.1471093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 10/28/2022] Open
Abstract
Hypotension is the most frequent complication of haemodialysis. We report a case of acute visual impairment after one session of haemodialysis in a context of an acute optic neuropathy. The immunological and serological studies were negative. The records of hypotension greater than usual after the dialysis session that coincided with the visual complaints strongly suggest the dialysis-induced hypotension is the underlying mechanism of this non-arteritic anterior ischemic optic neuropathy.
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Affiliation(s)
- Tiago Maio
- Hospital Pedro Hispano, Matosinhos, Portugal
| | - José Lemos
- Hospital Pedro Hispano, Matosinhos, Portugal
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Carlström M, Cananau C, Checa A, Wide K, Sartz L, Svensson A, Wheelock CE, Westphal S, Békássy Z, Bárány P, Lundberg JO, Hansson S, Weitzberg E, Krmar RT. Peritoneal dialysis impairs nitric oxide homeostasis and may predispose infants with low systolic blood pressure to cerebral ischemia. Nitric Oxide 2016; 58:1-9. [PMID: 27234508 DOI: 10.1016/j.niox.2016.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/05/2016] [Accepted: 05/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND & PURPOSE Infants on chronic peritoneal dialysis (PD) have an increased risk of developing neurological morbidities; however, the underlying biological mechanisms are poorly understood. In this clinical study, we investigated whether PD-mediated impairment of nitric oxide (NO) bioavailability and signaling, in patients with persistently low systolic blood pressure (SBP), can explain the occurrence of cerebral ischemia. METHODS & RESULTS Repeated blood pressure measurements, serial neuroimaging studies, and investigations of systemic nitrate and nitrite levels, as well as NO signaling, were performed in ten pediatric patients on PD. We consistently observed the loss of both inorganic nitrate (-17 ± 3%, P < 0.05) and nitrite (-34 ± 4%, P < 0.05) during PD, which may result in impairment of the nitrate-nitrite-NO pathway. Indeed, PD was associated with significant reduction of cyclic guanosine monophosphate levels (-59.4 ± 15%, P < 0.05). This reduction in NO signaling was partly prevented by using a commercially available PD solution supplemented with l-arginine. Although PD compromised nitrate-nitrite-NO signaling in all cases, only infants with persistently low SBP developed ischemic cerebral complications. CONCLUSIONS Our data suggests that PD impairs NO homeostasis and predisposes infants with persistently low SBP to cerebral ischemia. These findings improve current understanding of the pathogenesis of infantile cerebral ischemia induced by PD and may lead to the new treatment strategies to reduce neurological morbidities.
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Affiliation(s)
- Mattias Carlström
- Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Carmen Cananau
- Dept. Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Antonio Checa
- Dept. of Medical Biochemistry and Biophysics, Div. of Physiological Chemistry 2, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Wide
- Dept. of Clinical Science, Intervention and Technology, Div. of Pediatrics, Karolinska University Hospital, Huddinge, Sweden
| | - Lisa Sartz
- Dept. of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anders Svensson
- Dept. Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Craig E Wheelock
- Dept. of Medical Biochemistry and Biophysics, Div. of Physiological Chemistry 2, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Westphal
- Dept. of Pediatrics, The Queen Silvia Children's Hospital, Göteborg, Sweden
| | - Zivile Békássy
- Dept. of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peter Bárány
- Dept. of Renal Medicine, Karolinska University Hospital, Stockholm, Huddinge, Sweden
| | - Jon O Lundberg
- Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Sverker Hansson
- Dept. of Pediatrics, The Queen Silvia Children's Hospital, Göteborg, Sweden
| | - Eddie Weitzberg
- Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Rafael T Krmar
- Dept. of Clinical Science, Intervention and Technology, Div. of Pediatrics, Karolinska University Hospital, Huddinge, Sweden.
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Schaefer F. Peritoneal dialysis in infants: never lose sight of-and from-arterial hypotension! Perit Dial Int 2015; 35:123-4. [PMID: 25904770 DOI: 10.3747/pdi.2015.00044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Franz Schaefer
- Division of Pediatric Nephrology Center for Pediatrics and Adolescent Medicine Heidelberg, Germany
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