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Walker EYX, Winyard P, Marlais M. Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families. Pediatr Nephrol 2024; 39:1065-1075. [PMID: 37656310 PMCID: PMC10899401 DOI: 10.1007/s00467-023-06137-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
Congenital anomalies of the kidney and urinary tract are collectively one of the most commonly diagnosed antenatal conditions. Clinicians have several tools available to diagnose anomalies, including imaging, biomarkers, family history and genetic studies. In certain cases, antenatal interventions such as vesico-amniotic shunting may be considered to improve postnatal outcomes.Congenital kidney anomalies detected antenatally can vary in clinical significance from almost no impact postnatally to significant morbidity and perinatal mortality. Prognosis broadly depends on kidney size, structure and amount of amniotic fluid, alongside genetics and family history, and progression on subsequent scans. It is important to counsel parents appropriately using a parent-focused and personalised approach. The use of a multidisciplinary team should always be considered.
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Affiliation(s)
- Emma Y X Walker
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Paul Winyard
- UCL Great Ormond Street Institute for Child Health, London, UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute for Child Health, London, UK.
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2
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Mekahli D, Müller RU, Marlais M, Wlodkowski T, Haeberle S, de Argumedo ML, Bergmann C, Breysem L, Fladrowski C, Henske EP, Janssens P, Jouret F, Kingswood JC, Lattouf JB, Lilien M, Maleux G, Rozenberg M, Siemer S, Devuyst O, Schaefer F, Kwiatkowski DJ, Rouvière O, Bissler J. Clinical practice recommendations for kidney involvement in tuberous sclerosis complex: a consensus statement by the ERKNet Working Group for Autosomal Dominant Structural Kidney Disorders and the ERA Genes & Kidney Working Group. Nat Rev Nephrol 2024:10.1038/s41581-024-00818-0. [PMID: 38443710 DOI: 10.1038/s41581-024-00818-0] [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] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the presence of proliferative lesions throughout the body. Management of TSC is challenging because patients have a multifaceted systemic illness with prominent neurological and developmental impact as well as potentially severe kidney, heart and lung phenotypes; however, every organ system can be involved. Adequate care for patients with TSC requires a coordinated effort involving a multidisciplinary team of clinicians and support staff. This clinical practice recommendation was developed by nephrologists, urologists, paediatric radiologists, interventional radiologists, geneticists, pathologists, and patient and family group representatives, with a focus on TSC-associated kidney manifestations. Careful monitoring of kidney function and assessment of kidney structural lesions by imaging enable early interventions that can preserve kidney function through targeted approaches. Here, we summarize the current evidence and present recommendations for the multidisciplinary management of kidney involvement in TSC.
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Affiliation(s)
- Djalila Mekahli
- PKD Research Group, Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
- Department of Paediatric Nephrology, University Hospitals Leuven, Leuven, Belgium.
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tanja Wlodkowski
- Division of Paediatric Nephrology, Center for Paediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - Stefanie Haeberle
- Division of Paediatric Nephrology, Center for Paediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - Marta López de Argumedo
- Basque Office for Health Technology Assessment, (OSTEBA), Basque Government, Vitoria-Gasteiz, Spain
| | - Carsten Bergmann
- Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany
| | - Luc Breysem
- Department of Radiology, University Hospital of Leuven, Leuven, Belgium
| | - Carla Fladrowski
- Associazione Sclerosi Tuberosa ASP, Rome, Italy
- European Tuberous Sclerosis Complex Association (ETSC), Oestrich-Winkel, Germany
| | - Elizabeth P Henske
- Center for LAM Research and Clinical Care, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Janssens
- Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
| | - François Jouret
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium
- Interdisciplinary Group of Applied Genoproteomics, Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - John Christopher Kingswood
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Centre, St Georges University of London, London, UK
| | - Jean-Baptiste Lattouf
- Department of Surgery-Urology, CHUM-Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marc Lilien
- Department of Paediatric Nephrology, Wilhelmina Children´s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Micaela Rozenberg
- European Tuberous Sclerosis Complex Association (ETSC), Oestrich-Winkel, Germany
- Associação de Esclerose Tuberosa em Portugal, Lisbon, Portugal
| | - Stefan Siemer
- Department of Urology and Paediatric Urology, Saarland University, Homburg, Germany
| | - Olivier Devuyst
- Department of Physiology, Mechanisms of Inherited Kidney Disorders, University of Zurich, Zurich, Switzerland
- Institute for Rare Diseases, Saint-Luc Academic Hospital, UC Louvain, Brussels, Belgium
| | - Franz Schaefer
- Division of Paediatric Nephrology, Center for Paediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - David J Kwiatkowski
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivier Rouvière
- Department of Radiology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France, Faculté de médecine Lyon Est, Lyon, France
| | - John Bissler
- Department of Paediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA.
- Children's Foundation Research Institute (CFRI), Le Bonheur Children's Hospital, Memphis, TN, USA.
- Paediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, TN, USA.
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3
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Rohner K, Marlais M, Ahn YH, Ali A, Alsharief A, Novak AB, Brambilla M, Cakici EK, Candan C, Canpolat N, Yu-Hin Chan E, Decramer S, Didsbury M, Durao F, Durkan AM, Düzova A, Forbes T, Gracchi V, Güngör T, Horinouchi T, Demir BK, Kobayashi Y, Koskela M, Kurt-Sukur ED, La Scola C, Langan D, Li X, Malgieri G, Mastrangelo A, Min J, Mizerska-Wasiak M, Moussaoui N, Noyan A, Nuutinen M, O'Gormon J, Okamoto T, Oni L, Oosterveld M, Pańczyk-Tomaszewska M, Parmaksiz G, Pasini A, Rianthavorn P, Roelofs J, Shen Y, Sinha R, Topaloglu R, Torres DD, Udagawa T, Wennerström M, Yap YC, Tullus K. Outcome of immunosuppression in children with IgA vasculitis-related nephritis. Nephrol Dial Transplant 2024:gfae009. [PMID: 38211969 DOI: 10.1093/ndt/gfae009] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS IgA vasculitis with nephritis (IgAVN) is the most common vasculitis in children. Treatment recommendations are, due to a lack of evidence, based on expert opinion resulting in variation. The aim of this study was to describe clinical presentation, treatment and outcome of an extremely large cohort of children with biopsy proven IgAVN to identify prognostic risk factors and signals of treatment efficacy. METHODS Retrospective data were collected on 1148 children with biopsy proven IgAVN between 2005 and 2019 from 41 international paediatric nephrology centres across 25 countries and analyzed using multivariate analysis. The primary outcome was estimated glomerular filtration rate (eGFR) and persistent proteinuria at last follow up. RESULTS The median follow up was 3.7 years (IQR 2-6.2). At last follow up, 29% of patients had an eGFR < 90 ml/min/1.73m2, 36% had proteinuria and 3% had chronic kidney disease stage 4-5. Older age, lower eGFR at onset, hypertension and histological features of tubular atrophy and segmental sclerosis were predictors of poor outcome. There was no evidence to support any specific second line immunosuppressive regimen to be superior to others, even when further analysing subgroups of children with reduced kidney function, nephrotic syndrome or hypoalbuminemia at onset. Delayed start of immunosuppressive treatment was associated with a lower eGFR at last follow up. CONCLUSION In this large retrospective cohort, key features associated with disease outcome are highlighted. Importantly there was no evidence to support that any specific immunosuppressive treatments were superior to others. Further discovery science and well-conducted clinical trials are needed to define accurate treatment and improve outcomes of IgAVN.
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Affiliation(s)
- Katharina Rohner
- Department of Pediatric Nephrology, University Children's Hospital Zurich, Switzerland
| | - Matko Marlais
- Paediatric Nephrology Department, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute for Child Health, University College London, UK
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Alaa Ali
- Great North Children's Hospital Newcastle, UK
| | - Abrar Alsharief
- Department of Pediatric Nephrology, The Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anja Blejc Novak
- Pediatric Nephrology Department, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marta Brambilla
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Evrim Kargin Cakici
- Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Cengiz Candan
- Instanbul Medeniyet University, Department of Pediatric Nephrology, Istanbul, Türkiye
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, The University of Hong Kong
| | - Stéphane Decramer
- Paediatric Nephrology Centre, Hôpital des Enfants, CHU Purpan, Centre de Référence du Sud-Ouest des Maladies Rénales Rares SORARE, Filière ORKiD Toulouse, France
| | - Madeleine Didsbury
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
| | - Filipa Durao
- Pediatric Nephrology and Kidney Transplantation Unit, Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Anne M Durkan
- Department of Nephrology, The Children's Hospital at Westmead, Sydney, Australia
| | - Ali Düzova
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Thomas Forbes
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Valentina Gracchi
- Department of pediatric nephrology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tulin Güngör
- Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Belde Kasap Demir
- İzmir Katip Çelebi University, Department of Pediatrics, Division of Pediatric Nephrology and Rheumatology, Türkiye
- Health Sciences University Tepecik Training and Research Hospital, Divisions of Pediatric Nephrology and Rheumatology, Türkiye
| | - Yasuko Kobayashi
- Gunma University Graduate School of Medicine, Department of Pediatric, Gunma, Japan
| | - Mikael Koskela
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eda Didem Kurt-Sukur
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Dean Langan
- UCL Great Ormond Street Institute for Child Health, University College London, UK
| | - Xiaozhong Li
- Pediatric Nephrologic and Immunologic Department, Children's hospital of Soochow University, China
| | - Gabriele Malgieri
- Division of Nephrology, Dialysis and Transplant, AORN Santobono Pausilipon, Napoli, Italy
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Jeesu Min
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea
| | | | - Nabila Moussaoui
- Paediatric Nephrology Centre, Hôpital des Enfants, CHU Purpan, Centre de Référence du Sud-Ouest des Maladies Rénales Rares SORARE, Filière ORKiD Toulouse, France
| | - Aytul Noyan
- Baskent University, Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Matti Nuutinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu)
| | | | - Takayuki Okamoto
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Louise Oni
- Department of Women's and Children's health, Alder Hey Children's NHS Foundation Trust Hospital and University of Liverpool, UK
| | - Michiel Oosterveld
- Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Gonul Parmaksiz
- Baskent University, Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Pornpimol Rianthavorn
- Department of Pediatrics, Faculty of Medecine, Chulalongkorn University, Bangkok, Thailand
| | - Joris Roelofs
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Yunyan Shen
- Pediatric Nephrologic and Immunologic Department, Children's hospital of Soochow University, China
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | | | - Tomohiro Udagawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Martin Wennerström
- Department of Pediatric Nephrology, The Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Yok Chin Yap
- Department of Paediatric, Hospital Tunku Azizah, Women and Children Hospital Kuala Lumpur, Malaysia
| | - Kjell Tullus
- Paediatric Nephrology Department, Great Ormond Street Hospital for Children, London, UK
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4
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Walker EYX, Lindsay TAJ, Allgrove J, Marlais M, Bockenhauer D, Hayes W. Burosumab in management of X-linked hypophosphataemia: a retrospective cohort study of growth and serum phosphate levels. Arch Dis Child 2023; 108:379-384. [PMID: 36717209 DOI: 10.1136/archdischild-2022-324962] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/09/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Burosumab, an antifibroblast growth factor 23 monoclonal antibody, improves rickets severity, symptoms and growth in children with X-linked hypophosphataemia (XLH) followed up to 64 weeks in clinical trials. International dosing guidance recommends targeting normal serum phosphate concentration; however, some children may not achieve this despite maximal dosing. This study compares clinical outcomes in children with XLH on long-term burosumab treatment who achieved normal phosphate versus those who did not. METHODS Single-centre retrospective review of a large paediatric cohort with XLH treated with burosumab. We evaluated growth and biochemical markers of bone health in those who did compared with those who did not achieve normal plasma phosphate concentration. RESULTS Fifty-five children with XLH with median age of 11.7 (IQR 6.8-15.5) years were included. 27 (49%) had low plasma phosphate concentration, and 27 (49%) had normal phosphate after a median burosumab treatment duration of 3.3 (IQR 2.6-3.7) years. 1 (2%) did not have a recent phosphate level recorded. No difference in growth was found between normal and abnormal phosphate groups (p=0.9). CONCLUSIONS Young children with XLH experience sustained growth on long-term burosumab treatment, although without normal plasma phosphate concentration in many. Consideration should be made to changing burosumab dosing recommendations to target normalisation of alkaline phosphatase, as opposed to plasma phosphate concentration.
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Affiliation(s)
- Emma Yi Xiu Walker
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Jeremy Allgrove
- Department of Endocrinology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Institute of Child Health, University College London, London, UK
| | - Detlef Bockenhauer
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Renal Medicine, University College London, London, UK
| | - Wesley Hayes
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK .,Institute of Child Health, University College London, London, UK
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Marlais M, Wlodkowski T, Printza N, Kronsteiner D, Krisam R, Sauer L, Aksenova M, Ashoor I, Awan A, Bacchetta J, Balasubramanian R, Basu B, Bekassy Z, Boyer O, Chan EYH, Csaicsich D, Decramer S, Dorresteijn E, Drozynska-Duklas M, Eid LA, Espinosa L, Ferraris V, Flögelová H, Forero-Delgadillo J, Gianviti A, Gracchi V, González ML, Hansen M, Hattori M, Hong X, Hooman N, Ivanov D, Kang HG, Karava V, Kazyra I, Lungu A, Marks S, Maxted A, Moczulska A, Müller R, Nastausheva T, Parolin M, Pecoraro C, Principi I, Sanchez-Kazi C, Saygili S, Schild R, Shenoy M, Sinha R, Spizzirri AP, Stack M, Szczepanska M, Tsygin A, Tzeng J, Urbonas V, Zapata C, Zieg J, Schaefer F, Vivarelli M, Tullus K. Clinical Factors and Adverse Kidney Outcomes in Children With Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis. Am J Kidney Dis 2023; 81:119-122. [PMID: 35810826 DOI: 10.1053/j.ajkd.2022.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/18/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
| | - Tanja Wlodkowski
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nikoleta Printza
- Paediatric Nephrology, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Regina Krisam
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Lukas Sauer
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Marina Aksenova
- Y. Veltischev Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Isa Ashoor
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Atif Awan
- Children's Hospital Ireland at Temple Street, Dublin, Ireland
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Biswanath Basu
- Department of Pediatrics, N. R. S. Medical College & Hospital, Kolkata, India
| | | | - Olivia Boyer
- Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Paris University, Necker Hospital, APHP, Paris, France
| | | | - Dagmar Csaicsich
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Vienna, Austria
| | - Stéphane Decramer
- Pediatric Nephrology and Internal Medicine, CHU Purpan, Toulouse, France
| | | | | | - Loai Akram Eid
- Pediatric Nephrology, Dubai Medical College & Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Laura Espinosa
- Paediatric Nephrology Department, University Hospital La Paz, Madrid, Spain
| | | | - Hana Flögelová
- Department of Paediatrics, Faculty of Medicine, Palacky University, Faculty Hospital Olomouc, Olomouc, Czech Republic
| | | | | | - Valentina Gracchi
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Beatrix Children's Hospital, Groningen, The Netherlands
| | | | - Matthias Hansen
- KfH Kidney Center for Children and Adolescents, Frankfurt, Germany
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Xu Hong
- Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Nakysa Hooman
- Aliasghar Children's Hospital, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Dmytro Ivanov
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Vasiliki Karava
- Paediatric Nephrology, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ina Kazyra
- Belarus State Medical University, Minsk, Belarus
| | - Adrian Lungu
- Pediatric Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Stephen Marks
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Andrew Maxted
- Nottingham Children's Hospital Renal and Urology Unit, Nottingham, United Kingdom
| | - Anna Moczulska
- Jagiellonian University Medical College of Krakow, Krakow, Poland
| | - Rebekka Müller
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mattia Parolin
- Pediatric Nephrology, Dialysis and Transplantation Unit, Woman's and Child's Health Department, University Hospital of Padova, Padova, Italy
| | | | - Iliana Principi
- Department of Nephrology, Hospital Pediátrico Humberto J Notti, Mendoza, Argentina
| | | | - Seha Saygili
- Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Raphael Schild
- Division of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Ana Paula Spizzirri
- Nephrology Department, Hospital de Niños "Superiora Sor Maria Ludovica," La Plata, Argentina
| | - Maria Stack
- Children's Hospital Ireland at Temple Street, Dublin, Ireland
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Alexey Tsygin
- Department of Pediatrics, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland; National Medical Research Center for Children's Health, Moscow, Russia
| | - Julia Tzeng
- Valley Children's Healthcare, Madera, California
| | - Vaidotas Urbonas
- Vilnius University Clinic for Children's Diseases, Vilnius, Lithuania
| | - Carlos Zapata
- Hospital Infantil Universitario "Rafael Henao Toro," Manizales, Colombia
| | - Jakub Zieg
- Department of Paediatrics, Second Medical Faculty, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Kjell Tullus
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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6
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Walker EYX, Marlais M. Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease? Pediatr Nephrol 2023; 38:77-85. [PMID: 35106642 PMCID: PMC8807382 DOI: 10.1007/s00467-022-05432-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 01/10/2023]
Abstract
This is an overview of the challenges associated with screening for asymptomatic intracranial aneurysms (ICA) in children with autosomal dominant polycystic kidney disease (ADPKD). ADPKD is the most common inherited kidney disease affecting 1 in 1,000 people. ICAs are an extra-kidney manifestation of ADPKD, and while the exact pathophysiology of how they develop is unknown, we know that they more commonly occur in the adult rather than paediatric population. ICAs can be found in up to 9-11.5% of adults with ADPKD, but ICA rupture remains a rare event in adults with an incidence of 0.04 per 100 patient years. ICA size is an important factor in determining the risk of aneurysm rupture and therefore affects the decision on intervention in asymptomatic adults. For some, unruptured aneurysms cause no clinical significance, but those that rupture can be associated with devastating morbidity and mortality. Therefore, if detected, the treatment for unruptured ICAs is usually endovascular coiling, alongside recognising the importance of preventative interventions such as hypertension management. There are, however, no current guidelines for either adult or paediatric patients with ADPKD supporting regular screening for asymptomatic ICAs, although there is a suggestion for individualised practice, for example, with those with a positive family history. The UK clinical guidelines for ADPKD in children make research recommendations due to a lack of published literature, which in itself indicates that ICA rupture is an extremely rare phenomenon in children.
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Affiliation(s)
- Emma Y. X. Walker
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute for Child Health, London, UK.
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Jacob H, Marlais M. Safeguarding children and young people requiring kidney replacement therapy: challenges and potential opportunities. Pediatr Nephrol 2022; 37:1007-1015. [PMID: 34247294 DOI: 10.1007/s00467-021-05133-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 10/20/2022]
Abstract
Kidney replacement therapy (KRT) makes considerable physical and psychological demands on children, young people and their families. The impact can be wide-ranging, affecting education, employment, mental health, finances and relationships for both child and caregiver. It is vitally important for those working with these families to recognise the psychosocial challenges they face and to know the range of interventions available. This article explores the psychosocial impact of KRT, considering opportunities to minimise risk and optimise outcomes for children, young people and their families.
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Affiliation(s)
- Hannah Jacob
- Department of Nephrology, Great Ormond Street Hospital, London, UK.
| | - Matko Marlais
- Department of Nephrology, Great Ormond Street Hospital, London, UK
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8
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ROHNER K, Marlais M, Tullus K, International Study group for IgAVN/HSPN I. POS-145 CLINICAL PRESENTATION, TREATMENT AND OUTCOME OF IgA VASCULITIS WITH BIOPSY PROVEN NEPHRITIS - A MULTICENTRE STUDY WITH 1102 CHILDREN. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Marlais M, Martin K, Marks SD. Improved renal allograft survival for pre-emptive paediatric renal transplant recipients in the UK. Arch Dis Child 2021; 106:1191-1194. [PMID: 34016592 PMCID: PMC8666698 DOI: 10.1136/archdischild-2020-321277] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether being on dialysis at the time of renal transplantation affected renal allograft survival in paediatric renal transplant recipients (pRTRs). METHODS Retrospective study of UK Transplant Registry (National Health Service Blood and Transplant) data on all children (aged <18 years) receiving a kidney-only transplant from 1 January 2000 to 31 December 2015. Kaplan-Meier estimates of patient and renal allograft survival calculated and Cox regression modelling accounting for donor type. The relationship between time on dialysis and renal allograft survival was examined. RESULTS 2038 pRTRs were analysed: 607 (30%) were pre-emptively transplanted, 789 (39%) and 642 (32%) on peritoneal dialysis and haemodialysis, respectively, at the time of transplantation. Five-year renal allograft survival was significantly better in the pre-emptively transplanted group (90.6%) compared with those on peritoneal dialysis and haemodialysis (86.4% and 85.7%, respectively; p=0.02). After accounting for donor type, there was a significantly lower hazard of 5-year renal allograft failure in pre-emptively transplanted children (HR 0.742, p=0.05). Time spent on dialysis pre-transplant negatively correlated with renal allograft survival (p=0.002). There was no significant difference in 5-year renal allograft survival between children who were on dialysis for less than 6 months and children transplanted pre-emptively (87.5% vs 90.5%, p=0.25). CONCLUSIONS Pre-emptively transplanted children have improved 5-year renal allograft survival, compared with children on dialysis at the time of transplantation. Although increased time spent on dialysis correlated with poorer renal allograft survival, there was no evidence that short periods of dialysis pre-transplant affected renal allograft survival.
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Affiliation(s)
- Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate Martin
- Statistics, NHS Blood and Transplant, Bristol, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK .,NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, UK
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10
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Kharbanda K, Iyasere O, Caskey F, Marlais M, Mitra S. Commentary on the NICE guideline on renal replacement therapy and conservative management. BMC Nephrol 2021; 22:282. [PMID: 34416872 PMCID: PMC8379858 DOI: 10.1186/s12882-021-02461-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
NICE Guideline NG107, “Renal replacement therapy and conservative management” (Renal replacement therapy and conservative management (NG107); 2018:1–33) was published in October 2018 and replaced the existing NICE guideline CG125, “Chronic Kidney Disease (Stage 5): peritoneal dialysis” (Chronic kidney disease (stage 5): peritoneal dialysis | Guidance | NICE; 2011) and NICE Technology Appraisal TA48, “Guidance on home compared with hospital haemodialysis for patients with end-stage renal failure”(Guidance on home compared with hospital haemodialysis for patients with end-stage renal failure (Technology appraisal guideline TA48); 2002) The aim of the NICE guideline (NG107) was to provide guidance on renal replacement therapy (RRT), including dialysis, transplant and conservative care, for adults and children with CKD Stages 4 and 5. The guideline is extremely welcomed by the Renal Association and it offers huge value to patients, clinicians, commissioners and key stakeholders. It overlaps and enhances current guidance published by the Renal Association including “Haemodialysis” (Clinical practice guideline: Haemodialysis; 2019) which was updated in 2019 after the publication of the NICE guideline, “Peritoneal Dialysis in Adults and Children” (Clinical practice guideline: peritoneal Dialysis in adults and children; 2017) and “Planning, Initiation & withdrawal of Renal Replacement Therapy” (Clinical practice guideline: planning, initiation and withdrawal of renal replacement therapy; 2014) (at present there are no plans to update this guideline). There are several strengths to NICE guideline NG107 and we agree with and support the vast majority of recommendation statements in the guideline. This summary from the Renal Association discusses some of the key highlights, controversies, gaps in knowledge and challenges in implementation. Where there is disagreement with a NICE guideline statement, we have highlighted this and a new suggested statement has been written.
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Affiliation(s)
- Kunaal Kharbanda
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. .,Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Osasuyi Iyasere
- John Walls Renal Unit, Leicester General Hospital, Leicester, UK
| | - Fergus Caskey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK.,Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
| | - Matko Marlais
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sandip Mitra
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Devices for Dignity Healthcare Technology Co-Operative, Royal Hallamshire Hospital, Sheffield, UK
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11
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Kim JS, Marlais M, Balasubramanian R, Muorah M, Inward C, Smith GC, Reynolds BC, Yadav P, Morgan H, Shenoy M, Tse Y, Hussain F, Grylls S, Kessaris N, Sinha MD, Marks SD. UK national study of barriers to renal transplantation in children. Arch Dis Child 2021; 106:384-386. [PMID: 32241783 DOI: 10.1136/archdischild-2019-318272] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/19/2020] [Indexed: 11/04/2022]
Abstract
AIMS To investigate access to paediatric renal transplantation and examine potential barriers within the process. METHODS Cross-sectional, multicentre, observational study where paediatric nephrology centres in the UK were requested to provide data on transplantation plans for all children (<18 years) with end-stage kidney disease (ESKD). RESULTS 308 children with ESKD were included in this study from 12 out of 13 UK paediatric nephrology centres. 139 (45%) were being prepared for living donor transplantation and 82 (27%) were listed for deceased donor transplantation. The most common cited factors delaying transplantation from occurring in children were disease factors (36%), donor availability (27%) and size of the child (20%). Psychosocial factors were listed as a barrier in 19% of children. CONCLUSIONS In this study we have documented the main barriers to renal transplantation in children. Some identified factors may be modifiable through local or national intervention, including donor availability and patient psychosocial factors.
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Affiliation(s)
- Ji Soo Kim
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK .,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Matko Marlais
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Mordi Muorah
- Paediatric Nephrology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Carol Inward
- Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
| | - Graham C Smith
- Paediatric Nephrology, Children's Hospital for Wales, Cardiff, UK
| | - Ben C Reynolds
- Paediatric Renal Unit, Royal Hospital for Children Glasgow, Glasgow, UK
| | - Pallavi Yadav
- Paediatric Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Henry Morgan
- Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Mohan Shenoy
- Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Yincent Tse
- Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Farida Hussain
- Paediatric Nephrology, Nottingham Children's Hospital, Nottingham, UK
| | - Sarah Grylls
- Paediatric Nephrology, Southampton Children's Hospital, Southampton, UK
| | - Nicos Kessaris
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Transplantation, Evelina London Children's Hospital, London, UK
| | - Manish D Sinha
- Paediatric Nephrology, Evelina London Children's Hospital, London, UK.,Child Health Clinical Academic Group, King's College London, London, UK
| | - Stephen D Marks
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Great Ormond Street Institute of Child Health, University College London, London, UK
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12
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Marlais M, Wlodkowski T, Al-Akash S, Ananin P, Bandi VK, Baudouin V, Boyer O, Vásquez L, Govindan S, Hooman N, Ijaz I, Loza R, Melgosa M, Pande N, Pape L, Saha A, Samsonov D, Schreuder MF, Sharma J, Siddiqui S, Sinha R, Stewart H, Tasic V, Tönshoff B, Twombley K, Upadhyay K, Vivarelli M, Weaver DJ, Woroniecki R, Schaefer F, Tullus K. COVID-19 in children treated with immunosuppressive medication for kidney diseases. Arch Dis Child 2020; 106:archdischild-2020-320616. [PMID: 33355203 PMCID: PMC7754669 DOI: 10.1136/archdischild-2020-320616] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Children are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity. METHODS Cross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19. RESULTS 113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications. CONCLUSIONS This global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.
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Affiliation(s)
- Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tanja Wlodkowski
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Samhar Al-Akash
- Driscoll Children's Kidney Center, Driscoll Children's Hospital, Corpus Christi, Texas, USA
| | - Petr Ananin
- Pediatric Nephrology, National Medical Research Center for Children's Health, Moscow, Russian Federation
| | - Varun Kumar Bandi
- Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and RF, Vijayawada, India
| | | | - Olivia Boyer
- Service de Néphrologie pédiatrique, Centres de référence MARHEA et SNI, Université de Paris, Inserm U1163, Hôpital Necker-Enfants malades, AP-HP, Paris, France
| | - Luciola Vásquez
- Pediatric Nephrology Transplant Department, G.Almenara Hospital, Lima, Peru
| | - Sukanya Govindan
- Department of Paediatric Nephrology, Mehta Multispecialty Hospitals, Chennai, India
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center, Aliasghar Children hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran (the Islamic Republic of)
| | - Iftikhar Ijaz
- Children's Kidney Centre, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Reyner Loza
- Nephrology Paediatric Unit, Department of Pediatrícs, Cayetano Heredia National Hospital, Lima, Peru
| | - Marta Melgosa
- Pediatric Nephrology Department, La Paz University Hospital, Madrid, Spain
| | - Nivedita Pande
- Department of Pediatrics, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, India
| | - Lars Pape
- Department of Paediatrics II, University Hospital Essen, Essen, Germany
| | - Anshuman Saha
- Pediatric Nephrology, Institute Of Kidney Diseases And Research Center And Institute Of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | | | | | | | - Sahar Siddiqui
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Rajiv Sinha
- ICH, Institute of Child Health, Kolkata, India
| | - Heather Stewart
- Dwaine & Cynthia Willet Children's Hospital, Savannah, Georgia, USA
| | - Velibor Tasic
- Paediatric Nephrology, University Children's Hospital, Skopje, North Macedonia
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | | | - Kiran Upadhyay
- Division of Pediatric Nephrology, University of Florida, Gainesville, Florida, USA
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Donald J Weaver
- Division of Pediatric Nephrology and Hypertension, Atrium Health Levine Children's, Charlotte, North Carolina, USA
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kjell Tullus
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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13
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Cinar OK, Marlais M, Al Obaidi M, Cheng IL, Tullus K, Brogan P, Moraitis E. Ofatumumab use in juvenile systemic lupus erythematosus: A single centre experience. Lupus 2020; 30:527-530. [PMID: 33327846 DOI: 10.1177/0961203320981137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Ovgu Kul Cinar
- Paediatric Rheumatology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Matko Marlais
- Paediatric Nephrology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Muthana Al Obaidi
- Paediatric Rheumatology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Iek Leng Cheng
- Pharmacy, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Kjell Tullus
- Paediatric Nephrology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Paul Brogan
- Paediatric Rheumatology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Infection, Immunity and Rheumatology Section, Great Ormond Street Institute of Child Health, London, UK
| | - Elena Moraitis
- Paediatric Rheumatology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
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14
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Marlais M, Wlodkowski T, Vivarelli M, Pape L, Tönshoff B, Schaefer F, Tullus K. The severity of COVID-19 in children on immunosuppressive medication. Lancet Child Adolesc Health 2020; 4:e17-e18. [PMID: 32411815 PMCID: PMC7220160 DOI: 10.1016/s2352-4642(20)30145-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Matko Marlais
- Department of Nephrology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
| | - Tanja Wlodkowski
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Lars Pape
- Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Burkhard Tönshoff
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kjell Tullus
- Department of Nephrology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
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15
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Gimpel C, Bergmann C, Bockenhauer D, Breysem L, Cadnapaphornchai MA, Cetiner M, Dudley J, Emma F, Konrad M, Harris T, Harris PC, König J, Liebau MC, Marlais M, Mekahli D, Metcalfe AM, Oh J, Perrone RD, Sinha MD, Titieni A, Torra R, Weber S, Winyard PJD, Schaefer F. International consensus statement on the diagnosis and management of autosomal dominant polycystic kidney disease in children and young people. Nat Rev Nephrol 2019; 15:713-726. [PMID: 31118499 PMCID: PMC7136168 DOI: 10.1038/s41581-019-0155-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
These recommendations were systematically developed on behalf of the Network for Early Onset Cystic Kidney Disease (NEOCYST) by an international group of experts in autosomal dominant polycystic kidney disease (ADPKD) from paediatric and adult nephrology, human genetics, paediatric radiology and ethics specialties together with patient representatives. They have been endorsed by the International Pediatric Nephrology Association (IPNA) and the European Society of Paediatric Nephrology (ESPN). For asymptomatic minors at risk of ADPKD, ongoing surveillance (repeated screening for treatable disease manifestations without diagnostic testing) or immediate diagnostic screening are equally valid clinical approaches. Ultrasonography is the current radiological method of choice for screening. Sonographic detection of one or more cysts in an at-risk child is highly suggestive of ADPKD, but a negative scan cannot rule out ADPKD in childhood. Genetic testing is recommended for infants with very-early-onset symptomatic disease and for children with a negative family history and progressive disease. Children with a positive family history and either confirmed or unknown disease status should be monitored for hypertension (preferably by ambulatory blood pressure monitoring) and albuminuria. Currently, vasopressin antagonists should not be offered routinely but off-label use can be considered in selected children. No consensus was reached on the use of statins, but mTOR inhibitors and somatostatin analogues are not recommended. Children with ADPKD should be strongly encouraged to achieve the low dietary salt intake that is recommended for all children.
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Affiliation(s)
- Charlotte Gimpel
- Division of Pediatric Nephrology, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
| | - Carsten Bergmann
- Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
| | - Detlef Bockenhauer
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Luc Breysem
- Department of Pediatric Radiology, University Hospital of Leuven, Leuven, Belgium
| | - Melissa A Cadnapaphornchai
- Rocky Mountain Pediatric Kidney Center, Rocky Mountain Hospital for Children at Presbyterian St Luke's Medical Center, Denver, CO, USA
| | - Metin Cetiner
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | - Jan Dudley
- Renal Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Francesco Emma
- Division of Nephrology and Dialysis, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - Martin Konrad
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Tess Harris
- PKD International, Geneva, Switzerland
- PKD Charity, London, UK
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Jens König
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Max C Liebau
- Department of Pediatrics and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matko Marlais
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Djalila Mekahli
- Department of Pediatric Nephrology, University Hospital of Leuven, Leuven, Belgium
- PKD Research Group, Laboratory of Pediatrics, Department of Development and Regeneration, GPURE, KU Leuven, Leuven, Belgium
| | - Alison M Metcalfe
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Jun Oh
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald D Perrone
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Manish D Sinha
- Kings College London, Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Andrea Titieni
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Roser Torra
- Department of Nephrology, University of Barcelona, Barcelona, Spain
| | - Stefanie Weber
- Department of Pediatrics, University of Marburg, Marburg, Germany
| | - Paul J D Winyard
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
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16
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Dudley J, Winyard P, Marlais M, Cuthell O, Harris T, Chong J, Sayer J, Gale DP, Moore L, Turner K, Burrows S, Sandford R. Clinical practice guideline monitoring children and young people with, or at risk of developing autosomal dominant polycystic kidney disease (ADPKD). BMC Nephrol 2019; 20:148. [PMID: 31039757 PMCID: PMC6489289 DOI: 10.1186/s12882-019-1285-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/07/2019] [Indexed: 11/30/2022] Open
Abstract
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is thought to affect about 1 in 1000 people in the UK. ADPKD causes a progressive decline in kidney function, with kidney failure tending to occur in middle age. Children and young people with ADPKD may not have any symptoms. However they may have high blood pressure, which may accelerate progression to later stages of chronic kidney disease.There is uncertainty and variation in how health professionals manage children and young people with confirmed or a family history of ADPKD, because of a lack of evidence. For example, health professionals may be unsure about when to test children's blood pressure and how often to monitor it in the hospital clinic or at the GP. They may have different approaches in recommending scanning or genetic testing for ADPKD in childhood, with some recommending waiting until the young person is mature enough to make this decision his or herself.This guideline is intended to help families affected by ADPKD by making sure that: health professionals with specialist knowledge in ADPKD offer you information on inheritance and potential benefits and harms of testing for ADPKD. the decision to test and the method of testing for ADPKD in children and young people is shared between you or your family and the health professionals blood pressure assessment is undertaken regularly in children and young people at risk of developing ADPKD.
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Affiliation(s)
- Jan Dudley
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Paul Winyard
- 0000000121901201grid.83440.3bUniversity College London Medical School, London, UK
| | - Matko Marlais
- 0000000121901201grid.83440.3bUniversity College London Medical School, London, UK
| | - Oliver Cuthell
- 0000 0001 0575 1952grid.418670.cPlymouth Hospitals NHS Trust, Plymouth, UK
| | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | - Jiehan Chong
- 0000 0004 1936 9262grid.11835.3eUniversity of Sheffield, Sheffield, UK
| | - John Sayer
- 0000 0001 0462 7212grid.1006.7Newcastle University, Newcastle, UK
| | - Daniel P. Gale
- 0000000121901201grid.83440.3bUniversity College London Medical School, London, UK
| | - Lucy Moore
- Patient Representative, c/o The Renal Association, Bristol, UK
| | - Kay Turner
- Patient Representative, c/o The Renal Association, Bristol, UK
| | - Sarah Burrows
- 0000 0001 2177 007Xgrid.415490.dQueen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Richard Sandford
- 0000 0004 0622 5016grid.120073.7Addenbrooke’s Hospital, Cambridge, UK
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Marlais M, Pankhurst L, Martin K, Mumford L, Tizard EJ, Marks SD. Renal allograft survival rates in kidneys initially declined for paediatric transplantation. Pediatr Nephrol 2018; 33:1609-1616. [PMID: 29808263 PMCID: PMC6061660 DOI: 10.1007/s00467-018-3969-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/19/2018] [Accepted: 04/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The outcome of organs which have been declined for paediatric recipients is not known. This study aimed to determine the outcome of kidneys initially declined for paediatric recipients and establish renal allograft survival in kidneys that were eventually transplanted. METHODS Data were obtained from the UK Transplant Registry for all donation after brain death (DBD) kidneys offered and declined to paediatric recipients (< 18 years) in the UK from 2009 to 2014. RESULTS Eighty-two percent (503/615) of kidneys initially declined for paediatric transplantation were eventually transplanted, 7% (46/615) of kidneys went to paediatric recipients and 62% (384/615) of kidneys went to adult (kidney only) recipients. The remainder were used for multiple organ transplants. In the 46 kidneys that went to paediatric recipients, 1 and 3-year renal allograft survivals were 89% (95% CI 75.8-95.3%) and 82% (95% CI 67.1-90.6%), respectively. In the 384 kidneys given to adult kidney-only recipients, 1 and 3-year renal allograft survivals were 96% (95% CI 93.5-97.6%) and 94% (95% CI 90.7-96.1%), respectively. Eighty-four percent of the 204 children who initially had an offer declined on their behalf were eventually transplanted and have a functioning graft at a median 3-year follow-up. CONCLUSIONS This study reports acceptable short-term renal allograft survival in kidneys that were initially declined for paediatric recipients and subsequently transplanted. Evidence-based guidelines are required to ensure that the most appropriate kidneys are selected for paediatric recipients.
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Affiliation(s)
- Matko Marlais
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | | | | | - E Jane Tizard
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stephen D Marks
- University College London Great Ormond Street Institute of Child Health, London, UK.
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
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Tripković M, Bakija I, Sindik J, Marlais M, Zečević I. Family Financial Situation, Parental Marital Status and Self-Harm amongst Adolescents in Croatia. Acta Clin Croat 2017; 56:469-477. [PMID: 29479913 DOI: 10.20471/acc.2017.56.03.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to determine the level of self-harm behaviors among adolescents in the general population (students of secondary schools in Zagreb, Croatia), as well as to determine if the level of self-harm behaviors differed according to financial circumstances of the family and marital status of the parents. The study was conducted in 701 adolescents (male and female, age range 14 to 19 years). A specially designed questionnaire that included family and demographic data was used to determine the family financial circumstances. The Scale of Auto-Destructiveness measuring instrument was used to assess the level self-harm. Study results revealed that 87.3% of adolescents indicated average levels of self-harm, whereas above-average and high above-average self-harm was indicated in 12.7% of the adolescents. Results also showed that single-parent families significantly differentiated the level of self-harm among adolescents of both genders, whereas financial deprivation (perception of financial stress) partially differentiated these levels. Practical implications of this study emphasize the importance of social support to parents of adolescents grown up in single-parent and/or financially challenged families.
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Affiliation(s)
| | - Ivana Bakija
- Sveti Ivan Psychiatric Hospital, Zagreb, Croatia
| | - Joško Sindik
- Institute of Anthropological Research, Zagreb, Croatia
| | - Matko Marlais
- Institute of Child Health, University College London, London, United Kingdom
| | - Iva Zečević
- Psychiatric Hospital for Children and Youth, Zagreb, Croatia
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Marlais M, Lyttle MD, Inwald D. Erratum to: Ten concerns about blood pressure measurement and targets in paediatric sepsis. Intensive Care Med 2017; 43:472. [DOI: 10.1007/s00134-017-4692-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marlais M, Lyttle MD, Inwald D. Ten concerns about blood pressure measurement and targets in paediatric sepsis. Intensive Care Med 2016; 43:433-435. [DOI: 10.1007/s00134-016-4642-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022]
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Marlais M, Cuthell O, Langan D, Dudley J, Sinha MD, Winyard PJD. Hypertension in autosomal dominant polycystic kidney disease: a meta-analysis. Arch Dis Child 2016; 101:1142-1147. [PMID: 27288429 DOI: 10.1136/archdischild-2015-310221] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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] [Received: 11/25/2015] [Revised: 05/05/2016] [Accepted: 05/20/2016] [Indexed: 11/04/2022]
Abstract
CONTEXT Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder that can cause hypertension during childhood, but the true prevalence of hypertension during childhood is not known. OBJECTIVE We undertook a systematic review and meta-analysis to determine the prevalence of hypertension in children with ADPKD. DATA SOURCES Systematic review of articles published between 1980 and 2015 in MEDLINE and EMBASE. STUDY SELECTION Studies selected by two authors independently if reporting data on prevalence of hypertension in children and young persons aged <21 years with a diagnosis of ADPKD. Observational series were included with study populations of >15 children. Articles were excluded if inadequate diagnostic criteria for hypertension were used. Studies with selection bias were included but analysed separately. DATA EXTRACTION Data extracted on prevalence of hypertension, proteinuria and reduced renal function using standardised form. Meta-analysis was performed to calculate weighted mean prevalence. RESULTS 903 articles were retrieved from our search; 14 studies met the inclusion criteria: 1 prospective randomised controlled trial; 8 prospective observational studies; and 5 retrospective cross-sectional studies. From 928 children with clinically confirmed ADPKD, 20% (95% CI 15% to 27%) were hypertensive. The estimated prevalence of proteinuria in children with ADPKD is 20% (8 studies; 95% CI 9% to 40%) while reduced renal function occurred in 8% (5 studies; 95% CI 2% to 26%). LIMITATIONS Studies showed a high degree of methodological heterogeneity (I2=73.4%, τ2=0.3408, p<0.0001). Most studies did not use ambulatory blood pressure (BP) monitoring to diagnose hypertension. CONCLUSIONS In this meta-analysis we estimate 20% of children with ADPKD have hypertension. In the population, many children with ADPKD are not under regular follow-up and remain undiagnosed. We recommend that all children at risk of ADPKD have regular BP measurement.
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Affiliation(s)
- Matko Marlais
- Institute of Child Health, University College London, London, UK
| | - Oliver Cuthell
- Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Dean Langan
- Institute of Child Health, University College London, London, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Paul J D Winyard
- Institute of Child Health, University College London, London, UK
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Marlais M, Callaghan C, Marks SD. Kidney donation after circulatory death: current evidence and opportunities for pediatric recipients. Pediatr Nephrol 2016; 31:1039-45. [PMID: 26384332 DOI: 10.1007/s00467-015-3175-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/06/2015] [Accepted: 07/15/2015] [Indexed: 11/26/2022]
Abstract
Organ donation after circulatory death (DCD) has experienced a revival worldwide over the past 20 years, and is now widely practiced for kidney transplantation. Some previous concerns about these organs such as the high incidence of delayed graft function have been alleviated through evidence from adult studies. There are now a number of large adult cohorts reporting favorable 5-year outcomes for DCD kidney transplants, comparable to kidneys donated after brain death (DBD). This has resulted in a marked increase in the use of DCD kidneys for adult recipients in some countries and an increase in the overall number of kidney transplants. In contrast, the uptake of DCD kidneys for pediatric recipients is still low and concerns still exist over the longer-term outcomes of DCD organs. In view of the data from adult practice and the poor outcomes for children who stay on dialysis, DCD kidney transplantation should be offered as an option for children on the kidney transplant waiting list.
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Affiliation(s)
- Matko Marlais
- Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Stephen D Marks
- Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
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MESH Headings
- Clinical Competence
- Cross-Sectional Studies
- Education, Medical, Continuing/organization & administration
- Education, Medical, Continuing/standards
- Education, Medical, Continuing/trends
- Education, Medical, Graduate/organization & administration
- Education, Medical, Graduate/standards
- Education, Medical, Graduate/trends
- Health Personnel
- Humans
- Personnel Staffing and Scheduling
- Physicians/statistics & numerical data
- Surveys and Questionnaires
- United Kingdom
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Affiliation(s)
- Matko Marlais
- The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - John Abraham Mathews
- The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - Ian Eardley
- The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK.
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Abstract
Systemic insulin resistance is becoming more prevalent in the young due to modern lifestyles predisposing to the metabolic syndrome and obesity. There is also evidence that there are critical insulin-resistant phases for the developing child, including puberty, and that renal disease per se causes systemic insulin resistance. This review considers the factors that render children insulin resistant, as well as the accumulating evidence that the kidney is an insulin-responsive organ and could be affected by insulin resistance.
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Affiliation(s)
- Matko Marlais
- Institute of Child Health, University College London, London, United Kingdom
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Plumb LA, Marlais M, Bierzynska A, Martin H, Brugger K, Abbs S, Saleem MA. Unilateral hypoplastic kidney - a novel highly penetrant feature of familial juvenile hyperuricaemic nephropathy. BMC Nephrol 2014; 15:76. [PMID: 24886545 PMCID: PMC4036736 DOI: 10.1186/1471-2369-15-76] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 04/16/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Familial juvenile hyperuricaemic nephropathy is a rare inherited nephropathy with genetic heterogeneity. Categorised by genetic defect, mutations in uromodulin (UMOD), renin (REN) and hepatocyte nuclear factor-1β (HNF-1β) genes as well as linkage to chromosome 2p22.1-21 have previously been identified. Knowledge of the genetics of this phenotype has provided important clues to developmental pathways in the kidney. CASE PRESENTATION We report a novel phenotype, with the typical features of hyperuricemia and renal deterioration, but with the additional unexpected feature of unilateral renal hypoplasia. Mutation analyses of the existing known genes and genetic loci were negative indicating a new monogenic cause. Interestingly two cousins of the index case did not share the latter feature, suggesting a modifier gene effect. CONCLUSION Unilateral renal hypo/aplasia is usually sporadic and relatively common, with no genetic cause to date identified. This reported pedigree reveals the possibility that a new, unknown renal developmental gene may be implicated in the FJHN phenotype.
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Affiliation(s)
- Lucy A Plumb
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - Agnieszka Bierzynska
- Academic Renal Unit, University of Bristol, Dorothy Hodgkin building level 1, Whitson Street, Bristol BS1 3NY, UK
| | - Howard Martin
- Department of Molecular Genetics, Regional Molecular Genetics Laboratories, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Kim Brugger
- Department of Molecular Genetics, Regional Molecular Genetics Laboratories, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Stephen Abbs
- Department of Molecular Genetics, Regional Molecular Genetics Laboratories, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Moin A Saleem
- Department of Paediatric Nephrology, University of Bristol, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
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Abstract
There have been phenomenal advances in our understanding of renal biology over the last 20 years through our ability to define the genetic mutations causing kidney disease in children. This review will take you through a trip down the nephron and highlight how these conditions may present to the paediatrician and the molecular basis for their biological effects.
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Affiliation(s)
- M Marlais
- Department of Paediatric Nephrology, Bristol Children's Hospital, , Bristol, UK
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Abstract
BACKGROUND Previous studies have shown peer-assisted learning (PAL) to be an effective method of teaching, with benefits to students and tutors; however, the effect of PAL in paediatrics has not been evaluated in the literature. This study aimed to evaluate a student-led paediatrics revision course for students preparing for examinations in medical specialties. METHODS Students in their specialties year were invited to undergo a 1-day revision course consisting of a lecture and small group teaching, with a supplemental revision booklet. Tutors were recruited from the final-year cohort to facilitate the teaching. Questionnaires containing Likert-scale questions (1, strongly disagree; 5, strongly agree) were distributed before and after the course to assess its effectiveness. RESULTS In all, 62 per cent (87/140) of students who attended the course responded to the study. Students felt significantly more prepared for their exam after the course (mean 3.47 post-course versus 2.16 pre-course), and significantly more prepared to manage children in clinical practice (mean 3.49 post-course versus 2.53 pre-course). Students rated the course as good (4.35/5), with the small group sessions deemed to be the most useful aspect. Tutors agreed that participating had improved their teaching in general (4.0/5), their confidence (4.1/5), their clinical knowledge (3.6/5) and their oral presentation skills (3.8/5). DISCUSSION The results demonstrate an effective model for students and tutors in building vital skills in paediatrics and exam preparation. This reinforces the holistic positive attributes attainable from peer-assisted learning, and such schemes should be incorporated into undergraduate medical curricula for paediatrics to increase student confidence and potentially increase recruitment to paediatrics.
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Affiliation(s)
- Ajay Gandhi
- Imperial College School of Medicine, Imperial College London, UK
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Khavandi A, Bentham J, Marlais M, Martin RP, Morgan GJ, Parry AJ, Brooks MJ, Manghat NE, Hamilton MCK, Baumbach A, McPherson S, Thomson JD, Turner MS. Transcatheter and endovascular stent graft management of coarctation-related pseudoaneurysms. Heart 2013; 99:1275-81. [DOI: 10.1136/heartjnl-2012-303488] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Evans J, Marlais M, Abrahamson E. Reply: To PMID 21901857. Pediatr Pulmonol 2013; 48:416. [PMID: 22821821 DOI: 10.1002/ppul.22605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 11/06/2022]
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Evans J, Marlais M, Abrahamson E. Clinical predictors of nasal continuous positive airway pressure requirement in acute bronchiolitis. Pediatr Pulmonol 2012; 47:381-5. [PMID: 21901857 DOI: 10.1002/ppul.21549] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 01/11/2011] [Accepted: 07/23/2011] [Indexed: 11/10/2022]
Abstract
INTRODUCTION There is growing use of nasal continuous positive airway pressure ventilation (nCPAP) for infants with bronchiolitis, based on clinical assessment of severity. Despite this there have been no studies which identify clinical predictors for the requirement of nCPAP. OBJECTIVE To identify clinical factors in infants with acute bronchiolitis in the emergency department (ED), which might predict a requirement for nCPAP following admission. MATERIALS AND METHODS Retrospective review of pediatric ED case notes was conducted on bronchiolitis admissions to one dedicated Paediatric ED over a 12-month period. Potential predictors were identified through literature review. Data extraction of predictors was carried out and recorded for each case. Logistic regression was conducted for each variable to identify statistically significant predictors of nCPAP requirement. RESULTS Twenty-eight (17%) of the 163 admitted infants received nCPAP. The strongest predictors of nCPAP requirement in were as follows: oxygen requirement within the ED (P < 0.001), lower oxygen saturation (P < 0.001), younger age at presentation (P = 0.002), higher respiratory rate (P = 0.002), higher heart rate (P = 0.003), lower Glasgow Coma Scale score (0.006), and younger gestational age (P = 0.024). CONCLUSION We have identified clinical variables that were predictive of nCPAP requirement in infants admitted to our unit with bronchiolitis, oxygen requirement in the ED being the strongest single predictor. This is the first such study in the UK, and we hope it may be a starting point for further work that may provide an evidence base to aid clinicians in predicting the use of nCPAP in infants with bronchiolitis.
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Affiliation(s)
- Jordan Evans
- Department of Paediatric Emergency Medicine, Chelsea and Westminster Hospital, London, UK
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Bakija-Konsuo A, Marlais M. A brief history of dermatovenereology in Dubrovnik. Acta Dermatovenerol Croat 2012; 20:141-147. [PMID: 23069298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Since its inception, Dubrovnik has been associated with medicine. The citizens of Dubrovnik have felt the need for the development and improvement of public health conditions in their city as the basic conditions of their existence. In this context, we focused our attention on the development of dermatology and venereology to date; from the first hospital Domus Christi to the modern hospital Medarevo; from the first doctors to specialist doctors, who have marked dermatovenereology in Dubrovnik and Croatia. Domus Christi started accepting patients in 1540 as a public sector hospital and operated for more than 350 years. In 1847, doctors Pinelli and Lopišić operated on breast cancer in this hospital with the use of ether narcosis (one year after ether narcosis had been discovered). A doctor is first mentioned in Dubrovnik in 1280, until this time it could be said that there were no doctors. Medical operations were performed by barbers. The first written records of a doctor in Dubrovnik practicing in dermatovenereology are those of military doctor Marko Bibica. In the context of Dubrovnik dermatovenereology, we must mention doctor Luko Stulli, who was the first to describe Mal de Meleda.
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Abstract
AIM To determine the relationship between blood tests and oesophageal histology in Eosinophilic oesophagitis (EoE). METHODS All children diagnosed with EoE at one hospital from 2000 to 2009 were considered for inclusion in this study. Three blood test results were analysed, blood eosinophil count, serum total immunoglobulin E (IgE) and radioallergosorbent tests (RAST) to common food allergens. Oesophageal histology was prospectively re-reviewed, and mean eosinophil counts were enumerated. Blood test results were correlated with oesophageal eosinophil counts using Spearman's rank test. RESULTS Forty children (70% boys) were included in this study, median age at diagnosis 6.5 years (range 0-15). At the time of diagnosis, 78% of children had a raised blood eosinophil count, 90% had a raised serum total IgE and 83% had one or more positive RAST tests. The mean oesophageal eosinophil count was significantly correlated with both blood eosinophil count (p=0.008) and serum total IgE level (p=0.008). CONCLUSION This study shows that blood tests are often abnormal in children with EoE at the time of diagnosis. Our data demonstrate an association between histological abnormalities and blood test results in children with EoE.
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Affiliation(s)
- M Marlais
- Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, and Department of Histopathology, Imperial College Healthcare NHS Trust, London, UK.
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Bakija-Konsuo A, Mulić R, Boraska V, Pehlic M, Huffman JE, Hayward C, Marlais M, Zemunik T, Rudan I. Leprosy epidemics during history increased protective allele frequency of PARK2/PACRG genes in the population of the Mljet Island, Croatia. Eur J Med Genet 2011; 54:e548-52. [PMID: 21816242 DOI: 10.1016/j.ejmg.2011.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Two regulatory polymorphisms (rs1040079 and rs9356058) shared by PARK2 and PACRG genes were identified as major risk variants for leprosy susceptibility. The aim of this study was to investigate if allele frequencies of these polymorphisms in the isolated population of the island of Mljet, which served as a quarantine for leprosy patients during past centuries, were different to allele frequencies in two control populations with no history of leprosy. SUBJECTS AND METHODS This study included 88 unrelated Caucasian individuals from the island of Mljet while two control groups included 93 individuals from the island of Rab and 160 individuals from the region of Split. Genotyping for rs1040079 and rs9356058 was performed by "real-time" PCR analysis. We also compared the allele frequency of the rs9356058 polymorphism from the population of Mljet with allele frequencies derived from the existing genome wide association scans in two additional island populations, Vis (924 subjects) and Korcula (909 subjects). RESULTS We found a significant increase in the frequency of rs9356058 allele C in the population of Mljet when compared to both control groups. We also observed a significant increase in the frequency of rs1040079 allele A in the population of Mljet when compared with the population of Rab, however this increase was not significant when compared with the population of Split. Allele frequencies of both examined polymorphisms did not differ between the two control populations. Protective haplotype rs9356058-rs1040079 CA was also more frequent in the population of Mljet compared with the Rab and Split populations. In addition, an increase of frequency of rs9356058 allele C was also observed in the population of Mljet when compared with the frequency in the Korcula population. CONCLUSION The results of our study show the association of polymorphisms rs9356058 and rs1040079 in gene PARK2/PACRG with leprosy. The results of our study indicate that exposure to leprosy and mortality in the population caused by leprosy on Mljet resulted in the selection of rs9356058 "protective" C allele in the PARK2 gene, while this was not observed in the two control groups. This is the first study to assess the genetic susceptibility to leprosy in a European population.
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Affiliation(s)
- A Bakija-Konsuo
- Clinic for Dermatovenerology Cutis, Vukovarska 22, Dubrovnik, Croatia.
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Abstract
BACKGROUND Bronchiolitis is a significant cause of acute morbidity in the first 12 months of life and some infants with bronchiolitis are admitted to hospital. No studies have yet devised a scoring system to predict admission for routine use in the emergency department. AIM To identify clinical predictors of hospital admission in infants with acute bronchiolitis and to devise a simple clinical risk scoring system which could be used to aid decision making in the emergency department. METHODS All infants presenting with acute bronchiolitis to a dedicated paediatric emergency department from April 2009 to March 2010 were included in the study. Clinical predictors of admission were determined through case note review and logistic regression analysis. The strongest predictors of admission were assimilated into a simple clinical risk scoring system using widely accepted statistical methods. RESULTS 449 infants presented with acute bronchiolitis during the study period (298 (66%) male, mean age 23±14.5 weeks). 163 (36%) infants were admitted to hospital. The five best predictors of admission (age, respiratory rate, heart rate, oxygen saturations and duration of symptoms) were incorporated into the bronchiolitis risk of admission scoring system. The area under the receiver operator characteristic curve was 0.81 (95% CI 0.77 to 0.85) at the optimal cut-off, demonstrating good diagnostic accuracy. CONCLUSIONS The authors have identified important clinical predictors of admission in acute bronchiolitis. This information has been used to develop a simple clinical risk scoring system to aid decision making in the emergency department.
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Affiliation(s)
- M Marlais
- Department of Paediatric Emergency Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK
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Patel KD, Abeysekera KWM, Marlais M, McPhail MJW, Thomas HC, Fitzpatrick JA, Lim AKP, Taylor-Robinson SD, Thomas EL. Recent advances in imaging hepatic fibrosis and steatosis. Expert Rev Gastroenterol Hepatol 2011; 5:91-104. [PMID: 21309675 DOI: 10.1586/egh.10.85] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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] [Indexed: 01/17/2023]
Abstract
Liver disease is an increasing cause of morbidity and mortality worldwide. Currently, the gold standard for diagnosis and assessment of parenchymal disease is histopathological assessment of a percutaneous or transjugular liver biopsy. The risks and limitations of this technique are well recognized and as a result, significant effort has gone into the development of novel noninvasive methods of diagnosis and longitudinal assessment. Imaging techniques have improved significantly over the past decade and new technologies are beginning to enter clinical practice. Ultrasound, computed tomography and MRI are the main modalities currently used, but novel MRI-based techniques will have an increasing role. While there has been extensive research into the imaging of focal liver disease, the evidence base for imaging in diffuse disease has also undergone recent rapid development, particularly in the assessment of fibrosis and steatosis. Both of these abnormalities of the parenchyma can lead to cirrhosis and/or hepatocellular carcinoma and represent an important opportunity for detection of early liver disease. We discuss the recent advances in liver imaging techniques and their role in the diagnosis and monitoring of diffuse liver disease, with a focus on their current and potential clinical relevance and whether they may replace or augment liver biopsy. We also discuss techniques currently under development and their potential clinical applications in the future.
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Affiliation(s)
- Kayur D Patel
- Liver Unit, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, 10th Floor Queen Elizabeth the Queen Mother Wing, St Mary's Hospital Campus, Imperial College London, South Wharf Street, London W2 1NY, UK
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Abstract
AIM To determine the incidence and examine the epidemiology of achalasia before the age of 16 years in the UK from 1998 to 2008. METHODS 25 regional paediatric surgery referral centres were asked to provide demographic and epidemiological data on cases of childhood achalasia from 1998 to 2008. Incidence rates were calculated from national population estimates. The data collection method was validated in one centre. RESULTS 228 patients from 24 centres were diagnosed with achalasia before 16 years in the UK from 1998 to 2008. The mean incidence from 1998 to 2008 was 0.18/10(5) children/year. Where additional data was provided (69-81% of cases) 56% of children were male and the mean age of diagnosis was 10.9 years. Logistic regression analysis showed a rising incidence, with an OR of 1.12 (95% CI 1.06 to 1.16) for having achalasia in each successive year. The validation of this methodology showed that 95% of true cases and no false cases were identified. CONCLUSIONS The mean incidence of childhood achalasia in the UK from 1998 to 2008 is at least 0.18/10(5) children/year; this has risen over the last 11 years and compared to the only other study published in 1988.
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Affiliation(s)
- M Marlais
- Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK
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Abstract
AIMS To assess self-reported QoL in children with achalasia aged 5-18 and compare this with both disease and healthy control children in a prospective study. METHODS All children diagnosed with achalasia at one hospital were asked to participate in this study by completing the self-report module of the validated PedsQL™ generic QoL assessment. All children attending a tertiary paediatric gastroenterology clinic from February 2009 to May 2009 with chronic constipation or inflammatory bowel disease were asked to participate in this study as disease controls. The PedsQL™ considers physical, emotional, social and school domains and is scored from 0-100. Healthy children were also recruited from the same site. Groups were compared using Analysis of Variance with Tukey's post-hoc test. RESULTS One hundred and sixty one children completed the assessment (90 (56%) male, mean age 11.3 yrs ± 3.4 years) including 17 children with achalasia, 44 with chronic constipation, 59 with inflammatory bowel disease and 41 healthy children. QoL was significantly lower in the achalasia group compared to both children with IBD (73 vs. 82, p = 0.035) and healthy children (73 vs. 84, p = 0.005), and was comparable to that of children with chronic constipation (73 vs. 74, p = 0.99). CONCLUSION Children with achalasia report a significantly lower QoL compared to children with inflammatory bowel disease and healthy children.
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Affiliation(s)
- Matko Marlais
- Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK.
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Evans J, Marlais M, Abrahamson E. P75 Clinical predictors of continuous positive airway pressure requirement in bronchiolitis. Thorax 2010. [DOI: 10.1136/thx.2010.150979.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
AIM To assess self-reported Quality of life (QoL) in children with Gastro-oesophageal reflux disease (GORD) aged 5-18 and compare this with both disease and healthy control children in a prospective consecutive sample. METHODS All children attending a tertiary paediatric gastroenterology clinic from February 2009 to May 2009 with GORD, chronic constipation and inflammatory bowel disease (IBD) were asked to complete the validated PedsQL generic QoL assessment (self-report) at their clinic appointment. The PedsQL considers physical, emotional, social and school domains and is scored from 0 to 100. Healthy children were also recruited from the same site. Groups were compared using the independent samples Student's t-test. RESULTS A total of 184 children completed the assessment [103 (56%) male, mean age 10.7 years +/- 3.3] including 40 children with GORD, 44 with chronic constipation, 59 with IBD and 41 healthy children. QoL was significantly lower in the GORD group compared with both children with IBD (74 vs. 82) and healthy children (74 vs. 84), and was comparable to that of children with chronic constipation (74 vs. 74). CONCLUSIONS Self-reported QoL in children with GORD attending a tertiary paediatric gastroenterology clinic is significantly reduced compared with both healthy children and children with IBD.
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Affiliation(s)
- M Marlais
- Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK.
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Abstract
BACKGROUND Achalasia is an uncommon oesophageal motility disorder occasionally affecting children. Children with achalasia can experience significant morbidity, and quality-of- life (QoL) has never been studied in this population. AIM The aim was to develop a disease-specific quality-of-life (DS-QoL) measure for children with achalasia. METHODS Item response theory methods were used to develop the DS-QoL measure. The construct validity of this measure was assessed by comparing items and domains with the generic PedsQL questionnaire. Reliability was assessed using Cronbach's alpha coefficient for internal consistency. RESULTS 17 children completed the final DS-QoL measure, which consisted of 20 items in three domains. The completion rate for items was 99%. "Floor and ceiling effects" ranged from 0-19%. Construct validity was good with significant correlation between 2 domains and 2 items on the PedsQL. Reliability was excellent, with Cronbach's alpha coefficient ranging from 0.78-0.93. CONCLUSIONS This DS-QoL measure is appropriate for use in children with achalasia and has shown good results in this validation study. Further work in higher numbers is necessary to determine discriminant validity and test-retest reliability.
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Affiliation(s)
- M Marlais
- Chelsea and Westminster Hospital, Department of Paediatric Gastroenterology, London, United Kingdom.
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Movsesyan A, Marlais M. Supersized surgeries. Assoc Med J 2009. [DOI: 10.1136/sbmj.b3612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Civljak M, Koshy E, Marlais M, Car J. Internet-based interventions for smoking cessation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007078.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Marlais M, Car J. Now is the time for ehealth. Assoc Med J 2007. [DOI: 10.1136/sbmj.0712432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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