1
|
Krishnasamy S, Deepthi B, Kamath N, Iyengar A, Thomas CC, Uthup S, Saha A, Mathew G, Agarwal I, Tiewsoh K, Bhat NK, Mandal K, Krishnamurthy S. Clinical characteristics, genetic profile and short-term outcomes of children with primary hyperoxaluria type 2: a nationwide experience. Pediatr Nephrol 2024; 39:1093-1104. [PMID: 37914965 DOI: 10.1007/s00467-023-06200-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Three types of primary hyperoxaluria (PH) are recognized. However, data on PH type 2 (PH2), caused by defects in the GRHPR gene, are limited. METHODS We reviewed the medical records of patients < 18 years of age with genetically-proven PH2 from seven centres across India to identify the age of onset, patterns of clinical presentation, short-term outcomes and genetic profile, and to determine if genotype-phenotype correlation exists. RESULTS We report 20 patients (all with nephrolithiasis or nephrocalcinosis) diagnosed to have PH2 at a median (IQR) age of 21.5 (7, 60) months. Consanguinity and family history of kidney stones were elicited in nine (45%) and eight (40%) patients, respectively. The median (IQR) serum creatinine at PH2 diagnosis was 0.45 (0.29, 0.56) mg/dL with the corresponding estimated glomerular filtration rate being 83 (60, 96) mL/1.73 m2/min. A mutational hotspot (c.494 G > A), rare in Caucasians, was identified in 12 (60%) patients. An intronic splice site variant (c.735-1G > A) was noted in five (25%) patients. Four (20%) patients required surgical intervention for stone removal. Major adverse kidney events (mortality or chronic kidney disease (CKD) stages 3-5) were noted in six (30%) patients at a median (IQR) follow-up of 12 (6, 27) months. Risk factors for CKD progression and genotype-phenotype correlation could not be established. CONCLUSIONS PH2 should no longer be considered an innocuous disease, but rather a potentially aggressive disease with early age of presentation, and possible rapid progression to CKD stages 3-5 in childhood in some patients. A mutational hotspot (c.494 G > A variant) was identified in 60% of cases, but needs further exploration to decipher the genotype-phenotype correlation.
Collapse
Affiliation(s)
- Sudarsan Krishnasamy
- Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Bobbity Deepthi
- Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Nivedita Kamath
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | | | - Susan Uthup
- Department of Pediatric Nephrology, Government Medical College, Thiruvananthapuram, India
| | - Anshuman Saha
- Department of Pediatric Nephrology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
| | - Georgie Mathew
- Division of Pediatric Nephrology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Indira Agarwal
- Division of Pediatric Nephrology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Karalanglin Tiewsoh
- Division of Pediatric Nephrology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Kausik Mandal
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sriram Krishnamurthy
- Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
| |
Collapse
|
2
|
Kamath N, Iyengar A, Reddy HV, Sharma J, Singhal J, Ekambaram S, Uthup S, Selvam S, Wan M, Rahn A, Christiane-Fischer D, Shroff R. Changes in bone biomarkers in response to different dosing regimens of cholecalciferol supplementation in children with chronic kidney disease. Pediatr Nephrol 2023; 38:1907-1913. [PMID: 36322258 DOI: 10.1007/s00467-022-05790-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND The effect of different dosing regimens of cholecalciferol supplementation on bone biomarkers has not been studied in children with chronic kidney disease (CKD). METHODS This is a post hoc analysis of a multi-center randomized controlled trial which included children with CKD stages 2-4 with vitamin D deficiency (25-hydroxy vitamin D (25OHD) < 30 ng/ml) randomized 1:1:1 to receive an equivalent dose of oral cholecalciferol as daily, weekly or monthly treatment. Markers of bone formation (bone alkaline phosphatase (BAP), procollagen I N terminal peptide (PINP)), bone resorption (tartarate-resistant acid phosphatase 5b (TRAP), C terminal telopeptide (CTX)), and osteocyte markers (intact fibroblast growth factor 23 (iFGF23), sclerostin) and soluble klotho were measured at baseline and after 3 months of intensive replacement therapy. The change in biomarkers and ratio of markers of bone formation to resorption were compared between treatment arms. BAP and TRAP were expressed as age- and sex-specific z-scores. RESULTS 25OHD levels increased with cholecalciferol supplementation, with 85% achieving normal levels. There was a significant increase in the BAP/TRAP ratio (p = 0.04), iFGF23 (p = 0.004), and klotho (p = 0.002) with cholecalciferol therapy, but this was comparable across all three therapy arms. The BAPz was significantly higher in the weekly arm (p = 0.01). The change in 25OHD (Δ25OHD) inversely correlated with ΔPTH (r = - 0.4, p < 0.001). CONCLUSIONS Although cholecalciferol supplementation was associated with a significant increase in bone formation, the three dosing regimens of cholecalciferol supplementation have a comparable effect on the bone biomarker profile, suggesting that they can be used interchangeably to suit the patient's needs and optimize adherence to therapy. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Nivedita Kamath
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India.
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | - Hamsa V Reddy
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | - Jyoti Sharma
- Department of Pediatric Nephrology, KEM Hospital, Pune, India
| | - Jyoti Singhal
- Department of Pediatric Nephrology, KEM Hospital, Pune, India
| | - Sudha Ekambaram
- Department of Pediatric Nephrology, Mehta Multispecialty Hospital, Chennai, India
| | - Susan Uthup
- Department of Pediatric Nephrology, SAT Hospital, Government Medical College, Thiruvanathapuram, India
| | - Sumithra Selvam
- Department of Biostatistics, St Johns Medical College Hospital, Bangalore, India
| | - Mandy Wan
- Pharmacy Department, Evelina London Childrens Hospital, Guys and St. Thomas NHS Foundation Trust, and Institute of Pharmaceutical Science, King's College London, London, UK
| | - Anja Rahn
- Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
| | | | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| |
Collapse
|
3
|
Pradeepchandran G, Joseph S, Uthup S, Saradakutty G. Urine Neutrophil Gelatinase-associated Lipocalin as a Prognostic Biomarker in the First Episode of Idiopathic Nephrotic Syndrome in Children. jpr 2022. [DOI: 10.4274/jpr.galenos.2022.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
4
|
Wan M, Green B, Iyengar AA, Kamath N, Reddy HV, Sharma J, Singhal J, Uthup S, Ekambaram S, Selvam S, Rait G, Shroff R, Patel JP. Population pharmacokinetics and dose optimisation of colecalciferol in paediatric patients with chronic kidney disease. Br J Clin Pharmacol 2021; 88:1223-1234. [PMID: 34449087 PMCID: PMC9291800 DOI: 10.1111/bcp.15064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
Aims The prevalence of vitamin D deficiency is high in children with chronic kidney disease (CKD). However, current dosing recommendations are based on limited pharmacokinetic (PK) data. This study aimed to develop a population PK model of colecalciferol that can be used to optimise colecalciferol dosing in this population. Methods Data from 83 children with CKD were used to develop a population PK model using a nonlinear mixed effects modelling approach. Serum creatinine and type of kidney disease (glomerular vs. nonglomerular disease) were investigated as covariates, and optimal dosing was determined based on achieving and maintaining 25‐hydroxyvitamin D (25(OH)D) concentration of 30–48 ng/mL. Results The time course of 25(OH)D concentrations was best described by a 1‐compartment model with the addition of a basal concentration parameter to reflect endogenous 25(OH)D production from diet and sun exposure. Colecalciferol showed wide between‐subject variability in its PK, with total body weight scaled allometrically the only covariate included in the model. Model‐based simulations showed that current dosing recommendations for colecalciferol can be optimised using a weight‐based dosing strategy. Conclusion This is the first study to describe the population PK of colecalciferol in children with CKD. PK model informed dosing is expected to improve the attainment of target 25(OH)D concentrations, while minimising the risk of overdosing.
Collapse
Affiliation(s)
- Mandy Wan
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, Evelina London Children's Hospital, London, UK.,Institute of Pharmaceutical Science, King's College London, London, UK
| | | | | | - Nivedita Kamath
- Department of Paediatric Nephrology, St John's Medical College Hospital, Bengaluru, India
| | - Hamsa V Reddy
- Department of Paediatric Nephrology, St John's Medical College Hospital, Bengaluru, India
| | - Jyoti Sharma
- Paediatric renal service unit, King Edward Memorial Hospital, Pune, India
| | - Jyoti Singhal
- Paediatric renal service unit, King Edward Memorial Hospital, Pune, India
| | - Susan Uthup
- Department of Paediatric Nephrology, Government Medical College, Trivandrum, India
| | - Sudha Ekambaram
- Department of Paediatric, Mehta Multispecialty Hospital, Chennai, India
| | - Sumithra Selvam
- Department of Paediatric Nephrology, St John's Medical College Hospital, Bengaluru, India
| | - Greta Rait
- Research Department of Primary Care and Population Health, University of College London, London, UK
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Jignesh P Patel
- Institute of Pharmaceutical Science, King's College London, London, UK.,Department of Haematological Medicine, King's College Hospital Foundation NHS Trust, London, UK
| |
Collapse
|
5
|
Radhakrishnan RC, Uthup S, Rajesh L, Pulinilkunnathil RG. Lentiform Fork Sign in a Child on Hemodialysis. Indian J Nephrol 2021; 31:329-330. [PMID: 34376958 PMCID: PMC8330653 DOI: 10.4103/ijn.ijn_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/25/2020] [Accepted: 07/17/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Susan Uthup
- Department of Pediatric Nephrology, SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Liji Rajesh
- Department of Pediatric Nephrology, Government Medical College, Thiruvananthapuram, Kerala, India
| | | |
Collapse
|
6
|
Abstract
Justification Steroid sensitive nephrotic syndrome (SSNS) is one of the most common chronic kidney diseases in children. These guidelines update the existing Indian Society of Pediatric Nephrology recommendations on its management. Objective To frame revised guidelines on diagnosis, evaluation, management and supportive care of patients with the illness. Process The guidelines combine evidence-based recommendations and expert opinion. Formulation of key questions was followed by review of literature and evaluation of evidence by experts in two face-to-face meetings. Recommendations The initial statements provide advice for evaluation at onset and follow up and indications for kidney biopsy. Subsequent statements provide recommendations for management of the first episode of illness and of disease relapses. Recommendations on the use of immunosuppressive strategies in patients with frequent relapses and steroid dependence are accompanied by suggestions for step-wise approach and plan of monitoring. Guidance is also provided regarding the management of common complications including edema, hypovolemia and serious infections. Advice on immunization and transition of care is given. The revised guideline is intended to improve the management and outcomes of patients with SSNS, and provide directions for future research.
Collapse
Affiliation(s)
- Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr. Arvind Bagga, Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | | | - Kirtisudha Mishra
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Amarjeet Mehta
- Department of Pediatrics, Sawai Man Singh Medical College, Jaipur, India
| | - Indira Agarwal
- Department of Pediatrics, Christian Medical College, Vellore, India
| | - Susan Uthup
- Department of Pediatrics, Trivandrum Medical College, Thiruvananthapuram, India
| | - Abhijeet Saha
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Om Prakash Mishra
- Department of Pediatrics, Institute of Medical Sciences, Benaras Hindu University, Varanasi, India
| |
Collapse
|
7
|
Iyengar A, Kamath N, Reddy HV, Sharma J, Singhal J, Uthup S, Ekambaram S, Selvam S, Rahn A, Fischer DC, Wan M, Shroff R. Determining the optimal cholecalciferol dosing regimen in children with CKD: a randomized controlled trial. Nephrol Dial Transplant 2020; 37:326-334. [DOI: 10.1093/ndt/gfaa369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
The optimal treatment regimen for correcting 25-hydroxyvitamin D (25OHD) deficiency in children with chronic kidney disease (CKD) is not known. We compared cholecalciferol dosing regimens for achieving and maintaining 25OHD concentrations ≥30 ng/mL in children with CKD stages 2–4.
Methods
An open-label, multicentre randomized controlled trial randomized children with 25OHD concentrations <30 ng/mL in 1:1:1 to oral cholecalciferol 3000 IU daily, 25 000 IU weekly or 100 000 IU monthly for 3 months (maximum three intensive courses). In those with 25OHD ≥30 ng/mL, 1000 IU cholecalciferol daily (maintenance course) was given for up to 9 months. Primary outcome was achieving 25OHD ≥30 ng/mL at the end of intensive phase treatment.
Results
Ninety children were randomized to daily (n = 30), weekly (n = 29) or monthly (n = 31) treatment groups. At the end of intensive phase, 70/90 (77.8%) achieved 25OHD ≥30 ng/mL; 25OHD concentrations were comparable between groups (median 44.3, 39.4 and 39.3 ng/mL for daily, weekly and monthly groups, respectively; P = 0.24) with no difference between groups for time to achieve 25OHD ≥30 ng/mL (P = 0.28). There was no change in calcium, phosphorus and parathyroid hormone, but fibroblast growth factor 23 (P = 0.002) and klotho (P = 0.001) concentrations significantly increased and were comparable in all treatment groups. Irrespective of dosing regimen, children with glomerular disease had 25OHD concentrations lower than non-glomerular disease (25.8 versus 41.8 ng/mL; P = 0.007). One child had a 25OHD concentration of 134 ng/mL, and 5.5% had hypercalcemia without symptoms of toxicity.
Conclusion
Intensive treatment with oral cholecalciferol as daily, weekly or monthly regimens achieved similar 25OHD concentrations between treatment groups, without toxicity. Children with glomerular disease required higher doses of cholecalciferol compared with those with non-glomerular disease.
Collapse
Affiliation(s)
- Arpana Iyengar
- Department of Pediatric Nephrology, St John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Nivedita Kamath
- Department of Pediatric Nephrology, St John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Hamsa V Reddy
- Department of Pediatric Nephrology, St John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Jyoti Sharma
- Pediatric Renal Service, Renal Unit, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Jyoti Singhal
- Pediatric Renal Service, Renal Unit, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Susan Uthup
- Department of Pediatric Nephrology, Government Medical College, Trivandrum, Kerala, India
| | - Sudha Ekambaram
- Department of Pediatrics, Mehta Children’s Hospital, Chennai, Tamil Nadu, India
| | - Sumithra Selvam
- Department of Pediatric Nephrology, St John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Anja Rahn
- Department of Pediatrics, University of Rostock, Rostock, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, University of Rostock, Rostock, Germany
| | - Mandy Wan
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rukshana Shroff
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
8
|
Uthup S, Radhakrishnan R, T.s A, Remeshan S. SUN-196 MANAGEMENT OF PEDIATRIC END STAGE KIDNEY DISEASE IN A DEVELOPING COUNTRY - CHANGE IN THE TREND OVER 12 YEARS. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.729] [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: 10/24/2022] Open
|
9
|
Kamath N, Iyengar A, V Reddy H, Uthup S, Sharma J, Singhal J, Ekambaram S, Shroff R. SAT-271 DETERMINING THE OPTIMAL DOSE OF CHOLECALCIFEROL SUPPLEMENTATION IN CHILDREN WITH CHRONIC KIDNEY DISEASE (C3 TRIAL) - AN OPEN LABEL MULTICENTRE RANDOMIZED CONTROLLED TRIAL. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
10
|
Abstract
There are not many studies on long term follow up of children following surgery for posterior urethral valve in India. This study was done to assess the growth and renal function of children who had completed five years after surgery for posterior urethral valve at our hospital. Thirty children were included in this study. They were assessed retrospectively for the age and pattern of presentation, time of surgery and outcome. Outcomes measured were stunting, renal failure (GFR, tubular functions) and bladder functions. Fifty per cent of children were symptomatic five years after surgery with enuresis, dribbling, polyuria and recurrent urinary tract infection (UTI). GFR was <60 ml/m/1.73 m2 in 33%. Growth failure, according to the World Health Organization (WHO) definition, was present in one-third of children. A low GFR was associated with growth failure. Poor bladder function evidenced by history of dribbling and significant residual urine was seen in one-third of patients. Residual hydronephrosis was seen in 74%. The most common presenting symptoms of PUV were poor urinary stream followed by recurrent UTI, poor weight gain, renal failure and abdominal mass. Eighty per cent of the study population had undergone surgery in infancy. Five years after surgery, 50% children were symptomatic; 30% had stunting. 33% had a GFR <60 ml/m/1.73 m2 and a significantly greater degree of stunting than those with GFR >60 ml/m/1.73 m2. Sonologically normal kidneys on follow-up were associated with a GFR above 60 ml/m/1.73 m2. Poor bladder function was present in 30% of the children. Univariate analysis showed that statistically significant risk factors for decline in GFR in this study are oligohydramnios and surgery beyond the neonatal period.
Collapse
Affiliation(s)
- S Uthup
- SAT Hospital, Government Medical College, Thiruvananthapuram, India
| | | | | | | | | |
Collapse
|
11
|
Uthup S, Balachandran K, Ammal VA, Abdul Salam R, George J, Nair GM, Leela M. Renal involvement in multicentric Castleman disease with glomeruloid hemangioma of skin and plasmacytoma. Am J Kidney Dis 2006; 48:e17-24. [PMID: 16860182 DOI: 10.1053/j.ajkd.2006.04.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 04/17/2006] [Indexed: 12/17/2022]
Abstract
A 47-year-old man presented with fever of unknown origin, generalized weakness, edema, and renal failure. He had left-sided pleural effusion, generalized lymphadenopathy, multiple nontender cutaneous nodules, hepatomegaly, renal failure, and hypergammaglobulinemia. Axillary lymph node biopsy showed findings consistent with Castleman disease of the hyaline vascular type associated with interfollicular plasmacytosis. A renal biopsy performed in view of proteinuria and acute renal failure showed hypercellular glomeruli with capillary loop thickening and double contours consistent with membranoproliferative glomerulonephritis. Skin nodule biopsy showed a glomeruloid hemangioma characterized by dermal proliferation of capillary loops in a nodular manner resembling a glomerulus. He experienced clinical and biochemical remission with steroids. Discontinuation of steroid therapy was associated with recurrence of renal failure, reappearance of nodules, lymphadenopathy, and appearance of bony lytic lesions. Biopsy of bony lytic lesions showed plasmacytoma. The patient achieved complete remission on treatment with steroids and cyclophosphamide and is free of symptoms at the end of 40 months of follow-up. To our knowledge, this is the first case report of the occurrence of membranoproliferative glomerulonephritis, glomeruloid hemangioma of the skin, and plasmacytoma in a patient with multicentric Castleman disease without human immunodeficiency virus infection.
Collapse
Affiliation(s)
- Susan Uthup
- Department of Nephrology, Medical College Thiruvananthapuram, Kerala, India.
| | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
The clinical presentation of pseudohypoaldosteronism (PHA) mimics congenital adrenal hyperplasia (CAH). Poor response of the dehydration and electrolyte abnormalities to steroid therapy should make one suspect PHA. The treatment is supportive in the form of salt replacement and sodium resonium. We report a case of PHA that presented as salt wasting on the second day of life, initially appearing like CAH. The baby responded well to sodium resonium and salt replacement.
Collapse
Affiliation(s)
- G Ranjith
- Kerala Institute of Medical Sciences,Trivandrum, Kerala, India
| | | | | | | |
Collapse
|