ABSTRACT
Objectives. Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated kidney disease with genetic predisposition and represents up to 10% of pediatric hemolytic uremic syndrome (HUS) cases. Few studies have evaluated aHUS in Latin American population. We studied a Colombian pediatric cohort to delineate disease presentation and outcomes. Methods. A multicenter cohort of 27 Colombian children with aHUS were included. Patients were grouped by age at onset. Clinical features were compared using analysis of variance (ANOVA) and Fisher exact tests. Renal biopsy was performed on 6 patients who were suspected of having other renal diseases before aHUS diagnosis. Results. Most patients were male (70%). The onset of aHUS occurred frequently before age 4 years (60%) and followed gastroenteritis as the main triggering event (52%). Age groups showed comparable clinical presentation, disease severity, treatment, and outcomes. Pulmonary involvement (67%) was the main extrarenal manifestation, particularly in the 1 to 7 age group (P = .01). Renal biopsies were as follows: 3 had membranoproliferative glomerulonephritis (MPGN) type I, one MPGN type III, one C3-glomerulonephritis, and one rapidly progressive GN. Genetic screening was available in 6 patients and identified 2xCFHR5, 2xMCP, 1xADAMTS13/THBD, and 1xDGKE mutations. A total of 15 relapses were seen, of which 8 (72%) occurred in the 1 to 7 age group. The renal outcome was not significantly different regardless of age group. Conclusion. In our cohort, we observed a relatively high frequency of extrarenal involvement at first presentation represented by pulmonary manifestations. The renal prognosis at initial presentation was worse than in previous reports.
ABSTRACT
BACKGROUND: Anticoagulation of the continuous renal replacement therapy (CRRT) circuit is an important technical aspect of this medical procedure. Most studies evaluating the efficacy and safety of citrate use have been carried out in adults, and little evidence is available for the pediatric patient population. The aim of this study was to compare regional citrate anticoagulation versus systemic heparin anticoagulation in terms of the lifetime of hemofilters in a pediatric population receiving CRRT at a pediatric center in Bogota, Colombia. METHODS: This was an analytical, observational, retrospective cohort study in which we assessed the survival of 150 hemofilters (citrate group 80 hemofilters, heparin group 70 hemofilters) used in a total of 3442 hours of CCRT (citrate group 2248 h, heparin group 1194 h). Hemofilter survival was estimated beginning at placement and continuing until filter replacement due to clotting or high trans-membrane pressures. RESULTS: Hemofilter survival was higher in the citrate group than in the heparin group (72 vs. 18 h; p <0.0001). Bivariate analysis showed that the hemofilter coagulation risk was significantly increased when heparin was used, regardless of hemofilter size and pump flow (hazard ratio 3.70, standard error 0.82, 95% confidence interval 2.39-5.72; p <0.00001). CONCLUSIONS: Regional citrate anticoagulation could be more effective than heparin systemic anticoagulation in terms of prolonging the hemofilter lifetime in patients with acute renal injury who require CRRT.
Subject(s)
Acute Kidney Injury/therapy , Anticoagulants/therapeutic use , Citric Acid/therapeutic use , Hemofiltration/methods , Renal Replacement Therapy/methods , Adolescent , Anticoagulants/adverse effects , Blood Coagulation/drug effects , Child , Child, Preschool , Citric Acid/adverse effects , Cohort Studies , Critical Care , Female , Hemofiltration/instrumentation , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Heparin/adverse effects , Heparin/therapeutic use , Humans , Infant , Male , Retrospective StudiesABSTRACT
Introducción: El diagnóstico de intolerancia a la vía oral en los recién nacidos atérmino no se basa en la definición operativa. No hay estudios sobre factores de riesgo.Objetivo: Caracterizar a recién nacidos a término hospitalizados con diagnóstico deintolerancia a la vía oral. Analizar la calidad sobre este diagnóstico y establecer suincidencia real. Diseño y metodología: Cohorte retrospectiva entre 2011 y 2013. Seanalizaron variables prenatales, intraparto y postparto y si el diagnóstico cumplía conlos criterios de la definición. Resultados: El 11,3 % de los pacientes tenía intoleranciaa la vía oral, y solo el 33 % cumplía con la definición operativa. La incidencia anualestimada estuvo entre el 3,5 % y el 4,4 %. En la caracterización de la población, lasvariables más frecuentes fueron: consumo de fórmula láctea (88 %), antecedentematerno de anestesia regional (69 %), ictericia (61 %), sexo masculino (58 %), partopor cesárea (57 %) e hipoglucemia (53 %). Conclusiones: La incidencia real es similara otros países; el 66 % de los pacientes no cumplía con la definición operativa. Serequieren estudios analíticos que exploren la relación causal con las variables másfrecuentes.
Introduction : The diagnosis of feeding intolerance in at term newborns is not based on the operational definition. There are not studies on risk factors. Objective: To characterize term newborns hospitalized with a diagnosis of feeding intolerance. To develop a quality analysis about diagnostic and to establish real incidence. Design and Methods: Retrospective cohort between 2011 and 2013. Prenatal, intrapartum, and postpartum variables were analyzed as well as if the diagnosis met the criteria for the operational definition. Results: 11.3% of patients showed feeding intolerant, only 33% met the operational definition. The annual incidence was between 3.5% and 4.4%. In the characterization of the population, the most common variables were: consumption of artificial feeding (88%), maternal history of regional anesthesia (69%), jaundice (61%), male sex (58%), cesarean delivery (57 %), and hypoglycemia (53%). Conclusions: The incidence was similar to the one in other countries. 66% of patients did not meet the operational definition. Analytical depth studies exploring causal relationship are required.
