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  • Chronic renal failure  (3)
  • Children  (2)
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  • 1
    Electronic Resource
    Electronic Resource
    Organ transplantation in children (1989)
    Springer
    Intensive care medicine 15 (1989), S. S76 
    Details
    ISSN: 1432-1238
    Keywords: Organ transplantation ; Kidney transplantation ; Heart transplantation ; Heart and lung transplantation ; Liver transplantation ; Small intestine transplantation ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Organ transplantations have opened a new field in medicine and particularly in pediatrics. The kidney was the first organ to be regularly transplanted and there are now more than 2000 children who have received a kidney graft. Cadaver kidneys or living-related donor (LRD) kidneys can be used since an adult kidney may be grafted in a young child. Cadaver graft survival exceeds 85% at 1 year in recent single centre reports and patient survival is above 95%, the results being even better with LRD. Some complications may be observed in the long term, such as bone osteonecrosis, hypertension or infections. Rehabilitation is generally remarkable and growth which remained abnormal in 1/3 of cases under conventional treatment seems to improve markedly with cyclosporin. In the future, the development of kidney transplantation could lead hopefully to a drastic decrease in the number of children on dialysis. Liver transplantation is now performed in children with biliary atresia and metabolic diseases. There is no age limit for grafting a liver, the only problem being to find a pediatric cadaver donor of similar size. It is also possible to use an adult liver after hepatectomy. There were 170 liver grafts recorded in children in Europe in December 1986, and the long-term survival thanks to cyclosporin is exceeding 80% in some units. Thanks to cyclosporin, programs of cardiac transplantation for children are rapidly developing. The main indications are gross-congenital cardiac malformations or severe functional abnormality not compatible with life. Newborns have been grafted with success. The only problem is also to find a suitable pediatric donor. At the end of 1984, there were 88 cadaver transplantations reported in children, and this number is growing rapidly. Survival is estimated above 70% at 1 year. Indications for heart and lung transplantation are more numerous than for the heart alone, including severe cardiac malformations with abnormality of pulmonary circulation and a number of pulmonary diseases. A close similarity in the size of donor and recipient is mandatory. The immediate results are generally good, but the final outcome remains under evaluation. First investigated in animals, small intestine transplantation has been added recently to the list of possible organ transplantations in children. Indications are extensive intestinal resections, or malformations. The initial results are encouraging, but the long-term outcome remains under evaluation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00260895
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    A study of recombinant human erythropoietin in the treatment of anaemia of chronic renal failure in children on haemodialysis (1994)
    Springer
    Pediatric nephrology 8 (1994), S. 338-342 
    Details
    ISSN: 1432-198X
    Keywords: Anaemia ; Chronic renal failure ; Haemodialysis ; Haemoglobin ; Recombinant human erythropoietin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This was an open-label multicentre study of recombinant human erythropoietin (r-HuEPO) in 116 children aged 6 months to 20 years with anaemia of chronic renal failure undergoing haemodialysis. Haemoglobin concentration at entry ranged from 3.4 to 9.5 g/dl. r-HuEPO was given intravenously two or three times per week, the starting dose being 75 U/kg per week. This was subsequently titrated in steps of 75 U/kg per week with the goal of increasing haemoglobin concentration at the rate of 1 g/dl per 4 weeks into the range 9.6–11.2 g/dl (6–7 mmol/l), with treatment then continued for up to 1 year with the aim of maintaining the haemoglobin concentration within the target range. Of the 115 children in whom efficacy could be evaluated, 93 (81%) achieved the target haemoglobin and a further 6 had a rise in haemoglobin concentration of at least 2 g/dl. At 52 weeks, the median maintenance dose for children〈30 kg was 225 U/kg per week, compared with 107 U/kg per week for children ≥30 kg. Analysis suggested that 150 U/kg per week would have been a more appropriate starting dose. The mean transfusion requirement fell from 8.9 to 0.7 units/patient per year. Of the 22 patients who failed to reach the target, 15 went on to transplantation and left the study prematurely. Sub-group analysis showed that similar doses lead to similar rates of rise in haemoglobin regardless of the severity of the original anaemia. Assessment of quality of life suggested that this may have improved with r-HuEPO. Twenty-four children needed initiation or increase of anti-hypertensive medication, suggesting that successful r-HuEPO therapy was associated with a tendency towards increased blood pressure. However, there were no significant mean changes in blood pressure, suggesting that the problem was successfully addressed by the changes in treatment. No child developed anti-r-HuEPO antibodies. The overall safety profile was excellent and no new r-HuEPO toxicities were identified in children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00866354
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Acute pancreatitis in six non-transplanted uraemic children (1988)
    Springer
    Pediatric nephrology 2 (1988), S. 431-435 
    Details
    ISSN: 1432-198X
    Keywords: Chronic renal failure ; End-stage kidney disease ; Children ; Pancreatitis ; Haemodialysis ; Peritoneal dialysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ten clinical episodes of acute pancreatitis (AP) occurred in six patients (mean age 10 years, range 3–15 years) with chronic renal failure (CRF) during a 9-year period (1977–1986). The underlying cause of CRF was vesicoureteral reflux (2); urethral valves (1); ureterohydronephrosis (1); nephronopthisis (1) and a haemolytic uraemic syndrome which occurred 12 years before (1). In all patients a diagnosis of AP was established both on clinical grounds and with a serum amylase level of 〉600 IU/1. In 3 patients laparotomy was performed because of suspected appendicitis. All patients required exclusive parentenral feeding (mean duration 25 days) and 2 patients had a partial pancreatectomy. No patient developed pancreatic pseudocysts, 2 patients experienced one relapse (3 and 21 months later) and 1 patient had two relapses and died. Mean duration of follow up was 3 years (range 1–10 years). Possible aetiological factors were: choledochal cyst (1); parotitis without a rise in mumps antibodies (1); familial dyslipidaemia but without AP in other family members (1), and aluminium intoxication with hypercalcaemia and convulsive encephalopathy treated with valproic acid in 1 patient. Severe hyperparathyroidism with radiological signs was absent in all patients. Transplantation had been performed either before AP in 2 patients (1 and 3 years before AP) or had followed AP in 1 patient (7 years after) without occurrence or relapse of AP.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00853437
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Plasma growth hormone-binding activity is low in uraemic children (1991)
    Springer
    Pediatric nephrology 5 (1991), S. 545-547 
    Details
    ISSN: 1432-198X
    Keywords: Growth hormone ; Growth hormone-binding protein ; Chronic renal failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Plasma growth hormone-binding protein (GH-BP) activity was evaluated in two groups of prepubertal children with chronic renal failure (CRF) who had been treated with recombinant human GH (rhGH). Group 1 consisted of eight children (mean chronological age 10.8 years) with advanced renal failure; group 2 consisted of nine children (mean chronological age 6 years) presenting with end-stage renal disease, who were on dialysis. Before treatment the specific binding of (125I)hGH to highaffinity GH-BP was low in the two groups (group 1, 17.3±1.6% of radioactivity; group 2, 14.2±1.4%) compared with the mean value obtained in normal prepubertal children (24.8±1.7%). No significant changes in GH-BP activity were found during the 1st year of GH therapy, although growth velocity and plasma levels of insulin-like growth factor-I increased significantly in both groups. The low GH-binding activity found in children with CRF supports the state of GH resistance. The reason for the absence of a GH-BP response to GH therapy has to be clarified.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01453698
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    Paper (German National Licenses)
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