Current opinion in pediatrics
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To present the latest data that demonstrate how climate change affects children's health and to identify the principal ways in which climate change puts children's health at risk. ⋯ Through many pathways, and in particular via placing additional stress upon the availability of food, clean air, and clean water and by potentially expanding the burden of disease from certain vector-borne diseases, climate change represents a major threat to child health. Pediatricians have already seen and will increasingly see the adverse health effects of climate change in their practices. Because of this, and many other reasons, pediatricians have a unique capacity to help resolve the climate change problem.
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Curr. Opin. Pediatr. · Apr 2011
ReviewContinuous renal replacement therapy: mechanism of clearance, fluid removal, indications and outcomes.
Continuous renal replacement therapy (CRRT) is the most common dialysis modality provided to critically ill children with acute kidney injury (AKI). However, confusion still exists with respect to CRRT terminology and the optimal use of this modality across the entire pediatric disease and age spectrum. ⋯ CRRT represents an essential dialytic modality for the pediatric nephrologist caring for critically ill children. Current data suggest that earlier initiation of CRRT to prevent excessive fluid accumulation may lead to improved survival in critically ill children, but prospective trials are required to test this hypothesis directly.
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Ingestions and iatrogenic administration of drugs are all too common causes of acute kidney injury. This review will discuss these preventable causes of acute kidney injury. ⋯ Knowledge of the drugs that cause acute kidney injury and how this injury is manifested can lead to improved diagnosis and treatment with the ultimate goal of prevention.
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Acute kidney injury (AKI) is a common and serious condition, the diagnosis of which depends on serum creatinine, which is a delayed and unreliable indicator of AKI. Fortunately, understanding the early stress response of the kidney to acute injuries has revealed a number of potential biomarkers. The current status of the most promising of these novel AKI biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), and interleukin (IL)-18, is reviewed. ⋯ It is vital that additional large future studies demonstrate the association between biomarkers and hard clinical outcomes independent of serum creatinine concentrations and that randomization to a treatment for AKI based on high biomarker levels results in an improvement in clinical outcomes.