ABSTRACT
CVD is a major cause of morbidity and mortality in pediatric patients with CKD. It is unclear whether vascular abnormalities in these patients are reversible, and if transplantation portends salutary effects on arterial function. We compared FMD, PWV, AI75, and CIMT in 15 dialysis (D), 14 transplant patients (T), and 15 controls (C), and their associations with cardiovascular risk factors. There was stepwise lower FMD (p < 0.001), higher AI75 (p < 0.001), higher PWV (p = 0.01), and higher CIMT SDS for age (p = 0.03) and height (p = 0.006) in the D group than T and C groups. FMD, PWV, and CIMT were unrelated to dialysis duration or time from transplantation. On multivariate analysis, group status was independently associated with FMD (ß = 3.15, p = 0.002), AI75 (ß = -5.95, p = 0.01), PWV (ß = -0.57, p = 0.07) and CIMT (ß = -0.02, p = 0.04) and CIMT SDS for height (ß = -0.541, p = 0.009). FMD is lower and AI75, PWV and CIMT are higher in pediatric patients maintained on D than T/C. T patients have similar AI75, PWV and CIMT to C although FMD remains reduced. These findings suggest that transplantation stabilizes or improves CKD associated arteriopathy.
Subject(s)
Brachial Artery/physiopathology , Carotid Arteries/physiopathology , Kidney Failure, Chronic/therapy , Kidney Transplantation , Radial Artery/physiopathology , Renal Dialysis , Adolescent , Blood Flow Velocity , Brachial Artery/diagnostic imaging , Brachial Artery/pathology , Carotid Arteries/diagnostic imaging , Carotid Arteries/pathology , Carotid Intima-Media Thickness , Child , Cross-Sectional Studies , Diagnostic Techniques, Cardiovascular , Female , Humans , Kidney Failure, Chronic/pathology , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/surgery , Male , Multivariate Analysis , Radial Artery/diagnostic imaging , Radial Artery/pathology , Treatment Outcome , Vascular Stiffness , VasodilationSubject(s)
Carcinoma, Renal Cell/complications , Hematuria/etiology , Kidney Neoplasms/complications , Sickle Cell Trait/complications , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/physiopathology , Child , Diagnosis, Differential , Humans , Kidney Diseases/pathology , Kidney Neoplasms/pathology , Kidney Neoplasms/physiopathology , Male , Nephrectomy , Tomography, X-Ray ComputedABSTRACT
A 4-week-old boy with previous urinary tract infection and documented vesicoureteral reflux presented with urosepsis and septic arthritis of the right hip. Compliance with prophylactic antibiotic therapy had been poor at home. Complications such as bone and joint infection are known to occur after urinary tract infection in children with urologic abnormalities. However, previous similar reports describe discovery of the urinary tract anomalies only as part of an evaluation performed after the systemic complications have occurred. The purpose of this report is to stress the importance of defining urinary tract abnormalities in a case of antenatal hydronephrosis or at the time of the first urinary tract infection in infants so that appropriate investigations, management, and support of parental compliance can be undertaken to avoid systemic complications.
