The Experts below are selected from a list of 264 Experts worldwide ranked by ideXlab platform
Alex H.c. Wong - One of the best experts on this subject based on the ideXlab platform.
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Proteinuria in children.
American Family Physician, 2010Co-Authors: Alexander K. C. Leung, Alex H.c. WongAbstract:Proteinuria is common in children and may represent a benign condition or a serious underlying renal disease or systemic disorder. Proteinuria may occur secondary to glomerular or tubular dysfunction. Although a 24-hour urine protein excretion test is usually recommended, it may be impractical in children. A spot, first-morning urine test for protein/creatinine ratio can be useful in this situation. Proteinuria is usually benign, in the form of transient or orthostatic proteinuria. Persistent proteinuria may be associated with more serious renal diseases. Clinical features from the history, physical examination, and laboratory tests help determine the cause of proteinuria. Treatment should be directed at the underlying cause. Patients with active urinary sediments, persistent and gross hematuria, hypertension, hypocomplementemia, renal insufficiency with depressed glomerular filtration rate, or signs and symptoms suggestive of vasculitic disease may require a renal biopsy and referral to a Pediatric Nephrologist.
Arvind Bagga - One of the best experts on this subject based on the ideXlab platform.
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Management of steroid sensitive nephrotic syndrome: revised guidelines.
Indian pediatrics, 2008Co-Authors: Arvind Bagga, Uma Ali, Sushmita Banerjee, Madhuri Kanitkar, Kishore D. Phadke, Prabha Senguttuvan, Sidharth Kumar Sethi, Mehul ShahAbstract:Justification In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with steroid sensitive nephrotic syndrome. In view of emerging scientific evidence, it was felt necessary to review the existing recommendations. Process Following a preliminary meeting in March 2007, a draft statement was prepared and circulated among Pediatric Nephrologists in the country to arrive at a consensus on the evaluation and management of these patients. Objectives To revise and formulate recommendations for management of steroid sensitive nephrotic syndrome. Recommendations The need for adequate cortico-steroid therapy at the initial episode is emphasized. Guidelines regarding the initial evaluation, indications for renal biopsy and referral to a Pediatric Nephrologist are updated. It is proposed that patients with frequently relapsing nephrotic syndrome should, at the first instance, be treated with long-term, alternate-day prednisolone. The indications for use of alternative immunosuppressive agents, including levamisole, cyclophosphamide, mycophenolate mofetil and cyclosporin are outlined. The principles of dietary therapy, management of edema, and prevention and management of complications related to nephrotic syndrome are described. These guidelines, formulated on basis of current best practice, are aimed to familiarize physicians regarding management of children with steroid sensitive nephrotic syndrome.
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Revised guidelines for management of steroid-sensitive nephrotic syndrome.
Indian journal of nephrology, 2008Co-Authors: Arvind BaggaAbstract:Justification: In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with steroid-sensitive nephrotic syndrome. In view of emerging scientific evidence, it was felt necessary to review the existing recommendations. Process: Following a preliminary meeting in March 2007, a draft statement was prepared and circulated among Pediatric Nephrologists in the country to arrive at a consensus on the evaluation and management of these patients. Objectives: To revise and formulate recommendations for management of steroid-sensitive nephrotic syndrome. Recommendations: The need for adequate corticosteroid therapy at the initial episode is emphasized. Guidelines regarding the initial evaluation, indications for renal biopsy and referral to a Pediatric Nephrologist are updated. It is proposed that patients with frequently relapsing nephrotic syndrome should, at the first instance, be treated with longterm, alternate-day prednisolone. The indications for use of alternative immunosuppressive agents, including levamisole, cyclophosphamide, mycophenolate mofetil, and cyclosporin are outlined. The principles of dietary therapy, management of edema, and prevention and management of complications related to nephrotic syndrome are described. These guidelines, formulated on the basis of current best practice, are aimed to familiarize physicians regarding principles of management of children with steroid-sensitive nephrotic syndrome.
Guido Filler - One of the best experts on this subject based on the ideXlab platform.
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Educational review: role of the Pediatric Nephrologists in the work-up and management of kidney stones
Pediatric Nephrology, 2020Co-Authors: Carmen Inés Rodriguez Cuellar, Michael Freundlich, Peter Zhan Tao Wang, Guido FillerAbstract:Background The incidence of nephrolithiasis in children and adolescents is increasing and appears to double every 10 years. The most important role of the Pediatric Nephrologist is to diagnose and modify various metabolic and non-metabolic risk factors, as well as prevent long-term complications especially in the case of recurrent nephrolithiasis. Objective The purpose of this review is to summarize the existing literature on the etiology and management of Pediatric nephrolithiasis. Results The incidence of kidney stones is increasing; dietary and environmental factors are probably the main causes for this increased incidence. In most Pediatric patients, the etiology for the kidney stones can be identified. Metabolic factors, such as hypercalciuria and hypocitraturia, urinary tract infection, and urinary stasis, constitute leading causes. Herein, we review the etiologies, diagnostic work-up, and treatment options for the most prevalent causes of kidney stones. The detrimental effects of excessive dietary sodium, reduced fluid intake, and the benefits of plant-based over animal-based protein consumption on urinary crystal formation are discussed. We also review the long-term complications. Conclusions Pediatric Nephrologists have an important role in the diagnostic work-up and prevention of recurring nephrolithiasis.
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Educational review: role of the Pediatric Nephrologists in the work-up and management of kidney stones.
Pediatric nephrology (Berlin Germany), 2019Co-Authors: Carmen Inés Rodriguez Cuellar, Michael Freundlich, Peter Zhan Tao Wang, Guido FillerAbstract:The incidence of nephrolithiasis in children and adolescents is increasing and appears to double every 10 years. The most important role of the Pediatric Nephrologist is to diagnose and modify various metabolic and non-metabolic risk factors, as well as prevent long-term complications especially in the case of recurrent nephrolithiasis. The purpose of this review is to summarize the existing literature on the etiology and management of Pediatric nephrolithiasis. The incidence of kidney stones is increasing; dietary and environmental factors are probably the main causes for this increased incidence. In most Pediatric patients, the etiology for the kidney stones can be identified. Metabolic factors, such as hypercalciuria and hypocitraturia, urinary tract infection, and urinary stasis, constitute leading causes. Herein, we review the etiologies, diagnostic work-up, and treatment options for the most prevalent causes of kidney stones. The detrimental effects of excessive dietary sodium, reduced fluid intake, and the benefits of plant-based over animal-based protein consumption on urinary crystal formation are discussed. We also review the long-term complications. Pediatric Nephrologists have an important role in the diagnostic work-up and prevention of recurring nephrolithiasis.
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Practice recommendations for the monitoring of renal function in Pediatric non-renal organ transplant recipients.
Pediatric transplantation, 2016Co-Authors: Guido Filler, Anette Melk, Stephen D. MarksAbstract:The management of non-renal Pediatric solid organ transplant recipients has become complex over the last decade with innovations in immunosuppression and surgical techniques. Post-transplantation follow-up is essential to ensure that children have functioning allografts for as long as possible. CKD is highly prevalent in these patients, often under recognized, and has a profound impact on patient survival. These practice recommendations focus on the early detection and management of hypertension, proteinuria, and renal dysfunction in non-renal Pediatric solid organ transplant recipients. We present seven practice recommendations. Renal function should be monitored regularly in organ transplant recipients, utilizing assessment of serum creatinine and cystatin C. GFR should be calculated using the new Schwartz formula. Transplant physicians should also monitor blood pressure using automated oscillometric devices and confirm repeated abnormal measures with manual blood pressure readings and ambulatory 24-h blood pressure monitoring. Proteinuria and microalbuminuria should also be assessed regularly. Referrals to a Pediatric Nephrologist should be made for non-renal organ transplant recipients with repeated blood pressures >95th percentile using the Fourth Task Force reference intervals, microalbumin/creatinine ratio >32.5 mg/g (3.7 mg/mmol) creatinine on repeated testing and/or GFR
Robert H Squires - One of the best experts on this subject based on the ideXlab platform.
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munchausen syndrome by proxy ongoing clinical challenges
Journal of Pediatric Gastroenterology and Nutrition, 2010Co-Authors: Janet Squires, Robert H SquiresAbstract:In 1977, Roy Meadow, a Pediatric Nephrologist, first described a condition he subsequently coined Munchausen syndrome by proxy. The classic form involves a parent or other caregiver who inflicts injury or induces illness in a child, deceives the treating physician with fictitious or exaggerated information, and perpetrates the trickery for months or years. A related form of pathology is more insidious and more common but also damaging. It involves parents who fabricate or exaggerate symptoms of illness in children, causing overly aggressive medical evaluations and interventions. The common thread is that the treating physician plays a role in inflicting the abuse upon the child. Failure to recognize the problem is common because the condition is often not included in the differential diagnosis of challenging or confusing clinical problems. We believe that a heightened "self-awareness" of the physician's role in Munchausen syndrome by proxy will prevent or reduce the morbidity and mortality associated with this diagnosis. In addition, we believe contemporary developments within the modern health care system likely facilitate this condition. Language: en
Ayse Akcan-arikan - One of the best experts on this subject based on the ideXlab platform.
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Kidney replacement therapy in Pediatric patients on mechanical circulatory support: challenges for the Pediatric Nephrologist
Pediatric Nephrology, 2020Co-Authors: Alexandra Idrovo, Natasha Afonso, Jack Price, Sebastian Tume, Ayse Akcan-arikanAbstract:The use of mechanical circulatory support (MCS) therapies in children with medically refractory cardiac failure has increased over the past two decades. With the growing experience and expertise, MCS is currently offered as a bridge to recovery or heart transplantation and in some cases even as destination therapy. Acute kidney injury (AKI) is common in patients with end-stage heart failure (ESHF). When severe AKI develops requiring kidney replacement therapy (KRT), these patients present unique challenges for the Pediatric nephrology team. The use of KRT has not been adequately described in children with ESHF on the newer MCS. We also present original case series data from our center experience. The purpose of this review is to familiarize the reader with the current MCS technologies, approach to their selection, how they interact when combined with current KRT circuits, and distinguish similarities and differences. We will attempt to highlight the distinctive features of each technology, specifically focusing on growing trends in use of continuous-flow ventricular assist devices (CF-VAD) as it poses additional challenges to the Pediatric Nephrologist.