ABSTRACT
The effects of bone and mineral metabolism on skeletal formation, as well as vascular and soft tissue calcifications, define chronic kidney disease-metabolic bone disease (CKD-MBD). Treatment recommendations center on establishing adequate vitamin D status, phosphate control through diet restriction and phosphate binders, and the use of vitamin D analogs for specific indications. Several emerging bone-promoting therapies have now been studied in adults with CKD, including bisphosphonates and denosumab. These approaches are associated with improved bone mass and, in some cases, decreased fracture rates in adults with CKD-MBD and are of potential interest for some children with CKD-MBD. In children with CKD and immobilization and/or muscle weakness, bisphosphonates appear to be an effective treatment to increase bone mass; baseline assessment and careful monitoring of bone density and/or bone biopsy findings are important in consideration of any new bone therapies for children with CKD-MBD.
Subject(s)
Bone Diseases, Metabolic , Chronic Kidney Disease-Mineral and Bone Disorder , Renal Insufficiency, Chronic , Bone Diseases, Metabolic/drug therapy , Bone Diseases, Metabolic/etiology , Child , Chronic Kidney Disease-Mineral and Bone Disorder/drug therapy , Chronic Kidney Disease-Mineral and Bone Disorder/etiology , Denosumab , Diphosphonates , Humans , Minerals , Phosphates , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/metabolism , Renal Insufficiency, Chronic/therapy , Vitamin D/therapeutic useABSTRACT
The most common acute glomerulonephritis in children is poststreptococcal glomerulonephritis (PSGN) usually occurring between 3 and 12 years old. Hypertension and gross hematuria are common presenting symptoms. Most PSGN patients do not experience complications, but rapidly progressive glomerulonephritis and hypertensive encephalopathy have been reported. This paper reports 17 patients seen in 1 year for PSGN including 4 with atypical PSGN, at a pediatric tertiary care center. Seventeen children (11 males), mean age of 8 years, were analyzed. Ninety-four percent had elevated serum BUN levels and decreased GFR. Four of the hospitalized patients had complex presentations that included AKI along with positive ANA or ANCAs. Three patients required renal replacement therapy and two were thrombocytopenic. PSGN usually does not occur as a severe nephritis. Over the 12-month study period, 17 cases associated with low serum albumin in 53%, acute kidney injury in 94%, and thrombocytopenia in 18% were treated. The presentation of PSGN may be severe and in a small subset have associations similar to SLE nephritis findings including AKI, positive ANA, and hematological anomalies.
ABSTRACT
AIM: The overall aim of the current study was to analyze trends in hospital charges, length of stay (LOS), and mortality for children hospitalized with nephrotic syndrome (NS) in the US. METHODS: Hospitalization characteristics for children ages 0 - 17 years discharged with the principal diagnosis of NS (ICD-9-CM 581.9) in 2000, 2003, and 2006 were evaluated using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID). RESULTS: The mean number of children hospitalized with a principal diagnosis of NS was 1,869 per year. These discharges accounted for mean total hospital charges that increased from $11,338 to $16,760 and aggregate hospital charges that increased from $21 to $31 million dollars from 2000 to 2006. Compared to non-children's hospitals, children's hospitals had significantly higher mean hospital charges and longer lengths of stay. Importantly, the estimated mortality rate for NS (< 0.5%) was notably lower than prior reports and remained stable throughout the study period. CONCLUSIONS: The national health care expenditures for pediatric NS related hospitalizations are both significant and growing, although mortality is now far lower than previously reported.
