ABSTRACT
Plasma and urine concentrations of protein S were measured in five children with steroid-resistant nephrotic syndrome. It was found that plasma free protein S was reduced in three out of the five patients studied. Thus, acquired free protein S deficiency does occur in children with nephrotic syndrome and is one of many factors which may place them at risk for a thromboembolic event.
Subject(s)
Nephrotic Syndrome/complications , Protein S Deficiency/etiology , Protein S/analysis , Steroids/pharmacology , Child , Child, Preschool , Creatinine/urine , Enzyme-Linked Immunosorbent Assay , Female , Humans , Kidney Transplantation , Male , Nephrotic Syndrome/metabolism , Protein S/urine , Protein S Deficiency/metabolism , Proteinuria/etiology , Risk Factors , Thromboembolism/etiologyABSTRACT
Acute peritoneal dialysis in unstable infants is at times plagued by early catheter malfunction secondary to omental plugging in both rigid acute catheters and conventional Tenckhoff catheters. This problem is inherent to the design of catheters using sideports for outflow and is enhanced by the tenacity of the omentum in this population in walling off foreign bodies. We have modified and utilized a non-luminal, channeled surgical drain for acute peritoneal dialysis in infants to avoid this problem. Five infants ranging in age from 2 days to 7 months were dialyzed acutely in a Pediatric Intensive Care Unit setting for periods ranging from 5 to 34 days utilizing this modified catheter. The infants ranged in weights from 1.96 to 8 Kg. Catheters were placed by a surgeon and peritoneal dialysis was initiated using a Y-setup. In none of the patients was there loss of catheter function secondary to omental plugging. Three patients subsequently died of their underlying illness and two recovered renal function. Two acute catheters were subsequently changed to conventional Tenckhoff catheters when it became apparent that dialysis would need to be performed for a prolonged time. The acute catheter which was used has a four channel cloverleaf appearance when cut in cross section with no central lumen. There is a transition to a luminal catheter outside the peritoneal cavity. The advantage of the cloverleaf configuration is the ability to exchange fluid along its entire intraperitoneal length, thereby excluding a defined area of catheter sideports where omentum can occlude the system causing a ball valve phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Catheterization/instrumentation , Peritoneal Dialysis/instrumentation , Acute Kidney Injury/therapy , Age Factors , Equipment Design , Female , Humans , Infant , Infant, Newborn , Kidney/abnormalities , Male , Peritoneal Dialysis/methodsABSTRACT
We have conducted a controlled trial on the efficacy of cyclosporine in eight patients with steroid-resistant nephrotic syndrome (four with idiopathic minimal lesion nephrotic syndrome and four with focal segmental glomerulosclerosis). Patients were randomly allocated to a cyclosporine (5 mg/kg/d) or a control group. After eight weeks of therapy and one month without cyclosporine therapy, patients in the control group were given cyclosporine for eight weeks and those in the cyclosporine group became controls. Before the initiation of treatment, there was no difference between the groups with regard to proteinuria and serum albumin levels. Proteinuria remained unchanged in the cyclosporine group, while there was a significant increase in proteinuria in the control group. There were no significant changes in serum albumin levels in either group during the trial. This study does not support the use of cyclosporine at the dose of 5 mg/kg/d in patients with steroid-resistant minimal lesion nephrotic syndrome or focal segmental glomerulosclerosis.
