Pediatric nephrology : journal of the International Pediatric Nephrology Association
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Comment Letter Case Reports
Really sterile pyuria with Kawasaki disease?
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In a systematic review and meta-analysis of randomized controlled trials (RCT), we aimed to evaluate the benefits and harms of all interventions for children with steroid-resistant nephrotic syndrome (SRNS). Nine RCTs involving 225 children were included. ⋯ No RCTs were identified comparing combination regimens comprising high-dose steroids, alkylating agents or cyclosporin with single agents, placebo, or no treatment. Further adequately powered and well-designed RCTs are needed to confirm the efficacy of cyclosporin and to evaluate regimens of high-dose steroids with alkylating agents or cyclosporin for SRNS.
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Case Reports
Continuous venovenous hemodiafiltration in hypernatremic hyperglycemic nonketotic coma.
Rapid changes in serum sodium concentration can result in adverse neurological outcome. The gradual correction of hypernatremia in the setting of acute renal failure can be difficult to achieve. ⋯ She had a full recovery of her renal function. She does not have clinical neurological sequelae from hypernatremia during a 1-year follow-up period.
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Clinical Trial
Citrate clearance in children receiving continuous venovenous renal replacement therapy.
Anticoagulation is usually indicated in patients receiving continuous renal replacement therapy (CRRT) to prevent clotting of the extra-corporeal circuit. While heparin is the most frequently used anticoagulant, regional citrate anticoagulation is becoming the preferred choice in those patients at high risk for bleeding. However, it has been widely claimed that to avoid citrate toxicity, CRRT with citrate anticoagulation should utilize diffusive clearance (e.g., continuous venovenous hemodialysis). ⋯ Renal function recovered in all patients. We conclude that citrate anticoagulation in children is feasible, effective, and safe. Sufficient citrate clearance to prevent its toxic accumulation is achieved by convective clearance (CVVH) alone and diffusive clearance (CVVHDF) does not appear to be mandatory when utilizing citrate anticoagulation during CRRT.